The woo-meister supreme returns, and he’s brought his friends

Here we go again.

You know, now that it’s 2009, I had hoped that one of the most irritating people alive would continue his blissful quiet. I’m referring, of course, to Deepak Chopra, that Indian physician who demonstrates that a medical training is no protection whatsoever against pseudoscientific and anti-scientific thinking. Indeed, Chopra goes far beyond that in that, not only has he become a leader of the so-called “complementary and alternative medicine” (CAM) movement, also sometimes called the “integrative medicine” (IM) movement that seeks to “integrate” treatments that range from the dubious to outright quackery with effective scientific medicine, but he has subjected numerous other field besides medicine to his “quantum” lunacy, including evolution. Indeed, so bad is Chopra’s “science-y” quantumness, that I even coined a term for it: Choprawoo. I even came up with the only response ever needed to Choprawoo. He had been quite quiet of late, and that was a good thing.

Given that I’m still (sort of) on vacation until Monday, I didn’t want to have to do too much heavy lifting, you know, like actually reading some peer-reviewed articles and doing an in depth analysis and critique. Fear not! I will be trying to do that more frequently in 2009. But in the meantime I couldn’t think of a more amusing and at the same time more frustrating way to start the new year than to take a look at Chopra’s latest, which he couldn’t resist posting to that repository of anti-science and antivaccination stylings The Huffington Post and also to his own personal blog. Apparently, Chopra is very unhappy about an article by Steve Salerno that the Wall Street Journal published right after Christmas entitled The Touch That Doesn’t Heal.

The WSJ article was that rarest of things for the mainstream media. It was a direct, skeptical, and science-based attack on CAM/IM. Indeed, it even expressed fear that any comprehensive health care reform undertaken by the incoming Obama administration could provide the opening for CAM advocates and their boosters in Congress like Dan Burton and Tom Harkin to insert language into any reform legislation that would force the government to pay for quackery. It is a fear I share, and I was happy to see a major newspaper like the WSJ publish such an editorial. I was even more happy to see the article’s conclusion:

Is there anecdotal evidence that unconventional therapies sometimes yield positive outcomes? Yes. There’s also anecdotal evidence that athletes who refuse to shave during winning streaks sometimes bring home championships. It was George D. Lundberg, a former editor of the Journal of the American Medical Association, who said: “There’s no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data.” We’d do well to keep that in mind as we plot the future of American health care. It’s not like we’ve got billions to waste.

Speak it, brother Salerno!

This article, predictably enough, has riled Deepak Chopra. He’s not happy about it at all. Oh, no. Nor are his buddies, including the Godfather of Quackademic Medicine and Lover of Anecdotal Evidence above controlled observations, Dr. Andrew Weil, and that king of pseudoscientific arguments for homeopathy, Dr. Rustum Roy. Truly, this is an Unholy Trinity of Woo, and the results are very predictable. They view Salerno’s article as the “opening salvo” against CAM/IM.

I certainly hope it is. I certainly hope it’s the first salvo of a veritable barrage that would put the bombardment of Normandy in preparation for the D-Day invasion to shame. I hope it’s the first salvo of a barrage that flattens any pretensions Chopra and his ilk have to scientific legitimacy, pulverizing it to a cloud of woo-ful dust the way a shell pulverizes its target.

Dr. Chopra seems rather unhappy at how he was characterized in the article, and he starts out with, instead of Choprawoo, a bit of Choprawhine:

Without discernible professional credentials in health reportage, the writer opened his piece by pledging allegiance to “scientifically proven, evidence-based medicine.” He next declared opposition to integrative medicine, and characterized as “gurus” two proponents of integrative medicine, Deepak Chopra and Andrew Weil, choosing to overlook that we both are highly trained MDs with almost 40 years of clinical-experience. Joining us in our response is Rustum Roy, an internationally known scientist, and member of five major National Academies of Science Engineering, who has spent ten years researching a wide range of health technologies, both ancient and modern. We predict that while they may try to dismiss us, the Wall Street Journal writer and editors will find they can’t dismiss a burgeoning field of medicine currently saving and improving millions of lives worldwide.

Ah, yes. The classic “argument from authority.” How dare that unwashed non-M.D. criticize us? whines Chopra. After all, we’re doctors, dammit!

So friggin’ what?

Chopra and Weil long ago gave up their claim to being science-based. This is true of Chopra more than Weil, the latter of whose proclivity for–if you’ll excuse me, I can’t resist–“integrating” the unproven and dubious with some sound medical advice is infuriating, particularly his advocacy of “uncontrolled clinical observations” over sound clinical trials and epidemiology and his proselytization of CAM/IM to the point that he is “integrating” it into family medicine residencies. In this, Weil may well be the greater threat to science-based medicine that Chopra. That’s because Deepak Chopra, with his “quantum” nonsense, is so far off the deep end that very few, even in academia, take him seriously. Andrew Weil, on the other hand, mixes just enough sound medicine with his woo that he goes down a lot easier. You won’t hear him going on and on about “quantum universal consciousness,” as Chopra does, but you will hear him blurring the distinction between medicine that is dubious and that is science-based, which allows him to be the Trojan horse filled with quackery that medical schools are now eagerly letting into their fortresses.

In any case, titles mean nothing here. As I have discussed time and time again, an M.D. after one’s name is no guarantee whatsoever that that person has the slightest understanding of the scientific method or what does and does not constitute good science. Indeed, Deepak Chopra is living proof of that, as is Andrew Weil, David Katz, not to mention the horde of physicians signing petitions expressing “Dissent from Darwin” over evolution on pro-“intelligent design” creationism sites. Come to think of it, Chopra has been known to say some very stupid things about evolution as well. Arguments matter, not titles, and Chopra and his Trio of Woo can’t marshal them. Of course, it’s all a plot by The Man (and Big Pharma, of course) to keep The People down:

We believe that Salerno’s piece is the opening salvo from the right aiming to influence the incoming administration as it strategically allocates resources for improving the U.S. health and wellness system. Fortunately, Tom Daschle, the upcoming Health and Human Services Secretary is better informed than either the WSJ writer or those who dictate WSJ editorial policy. The co-author (along with Jeanne Lambrew) of Critical: What We Can Do About the Health Care Crises, Daschle names the principal challenge to true reform, “[S]pecial interests are especially numerous and influential in the health-care system. Health care comprises one-sixth of our economy… since cutting costs is tantamount to cutting profits for many of these special interests, it is reasonable to expect (an) all-out war to defeat reform.”

As in Mr. Salerno’s article, this war extends to advancing ill-informed pseudo-scientific arguments to discredit effective low-cost health care options precisely because they compete with the current high-cost system.

“Special interests”? My irony meter exploded again into a twisted, smoldering heap of quivering, sparking circuits. It is, in fact, the CAM/IM movement spearheaded by the likes of Chopra and Weil that represent the quintessential “special interest.” It is pretty ballsy of them to try to appropriate the “reform” label, of course, because if any aspect of the health care system needs reform, it’s the Dietary Supplement Health and Education Act of 1994 (DSHEA), which allows supplement makers to sell their supplements with minimal oversight. As long as they don’t make specific claims to be able to treat or cure a disease or condition, they can pretty much say anything they want in their advertising. If I were reforming the health care system, one thing I’d most definitely want to do would be to repeal the DSHEA and give jurisdiction over supplement sales back to the FDA.

I also find it curious that Chopra would politicize this as an attack from the “right.” One other thing I’ve said time and time again about unscientific medicine and quackery: It’s totally a bipartisan affair, although admittedly the reasons for supporting quackery differ tend to differ with politics. On the “left,” for example, the push for CAM/IM is associated with a “wholistic” treatment and a whole lot of suspicion of big pharma, big medicine, and corporate interests. On the “right,” CAM/IM is sold more as an issue of “health freedom,” which in reality means “freedom for quacks to do whatever they want” and the removal of all protections against quackery, as represented by Ron Paul, who is one of the greatest enablers of quackery Congress has ever seen. The idea from the right is that laws protecting the public against quackery and unscientific medical practices represent an unacceptable infringement of individual liberty. Indeed, two of the biggest boosters of CAM/IM there are in Congress are both Republicans: Ron Paul and Dan Burton, the latter of whom is especially known for his antivaccine views and in support of autism quackery.

More importantly, any true “reform” should require evidence of efficacy for therapies for which the government pays. In this, CAM/IM, by and large, has failed miserably. Chopra et al seemingly almost implicitly recognize this, because they only arguments they can come up with are attacks against science-based medicine, not postive arguments based on science for the efficacy of their preferred woo. Indeed, they present not a single positive scientific argument, just vague claims and paranoid attacks:

Nor does it sustain a doctor’s sworn duty to “first do no harm.” Abundant evidence uncovers high-tech medicine, with its powerful drugs, as a major, possibly the leading, cause of death in this country. The National Academy’s data attributes 100,000 deaths per year to physicians’ errors, added to well over 100,000 deaths due to severe drug interactions and another 100,000 fatalities from hospital-based-infections. (For a detailed analysis, see Death By Medicine, by Gary S. Null, et al.)

Why is the allegedly “scientifically proven” health care that the WSJ writer champions so dangerous to health? The blind allegiance to “evidence-based medicine” overlooks how readily this form of research can be manipulated. It was first developed to isolate patentable agents for drug formulations. In scientific arenas outside of mainstream medicine, this “statistics-based medicine” is regarded as dubious science at best. Narrowly confining itself to costly, selectively published, industry-sponsored clinical trials, to promote pharmaceutical products, “evidence based medicine” is the marketing “icon” used by the current system to squelch lower cost competitors.

Science’s only gold standard are facts derived from reproducible results, however unpalatable those facts are to current theory. When theories fail to explain the facts, they lose viability. The spectacular failures of “evidence based” medical theories include the millions spent on ineffective AIDS vaccines, the collapse of interferon as the wonder drug for cancer, and the marginal decrease in cancer deaths despite billions wasted during decades of fruitless research. Many once-standard treatments devised via this theoretical model now stand discredited, like the use of Thalidomide and Thorazine.

Yes, you saw it right. Chopra and his addle-brained trio of woo-meisters are actually citing Gary Null! I hate to point out to Chopra that the article he cites is about as bad as pseudoscience and advocacy of quackery gets, full of cherry picking of data and ignoring any context or benefit. So bad is it that the relentlessly anti-evolution neurosurgeon Dr. Michael Egnor cited it. Moreover, Gary Null is a known über-quack, HIV/AIDS denialist, coffee enema maven, and antivaccinationist. That Chopra et al would think him to be a reliable source for any analysis of science or medicine shows just how off the plantation Chopra and company are. Indeed, Harriet Hall and Peter Lipson (also here) both demolished this article. I’d suggest that Chopra read their analyses if I thought it would do any good, but it won’t. After all, if they think that the failure to develop an HIV vaccine or the only modest improvements in cancer survival for cancers other than childhood cancers is evidence that evidence-based medicine is a failure, rather than a reflection of the difficulty involved in making such a vaccine or the extreme complexity of developing cancer treatments, respectively, they are even more clueless than I had thought before.

Chopra’s other attacks on science-based medicine rely, as do those of most apologists for quackery, on the “science has been wrong before” fallacy. Yes, science has been wrong before. Yes, what we believe about illness and its treatment today is likely to change based on new findings. Here’s the rub. The reason that the treatments listed by Chopra were ultimately abandoned was not because some woo-meister doubted that they worked. It was because physicians applied the scientific method to the study of them and discovered that they did not work as well as thought or even did not work at all. Science is self-correcting. It may not be as quick as we would like; it may be far messier than non-scientists like Chopra and Weil like; but inevitably it does weed out ideas that don’t reflect nature and treatments that don’t work.

This is in marked contrast to CAM/IM, where there is no treatment that has ever been abandoned because science has shown it to be no more effective than placebo. Indeed, even Laetrile, whose lack of efficacy was conclusively demonstrated in the 1980s, is still touted in some sectors. Meanwhile, homeopathy, the 200 year old placebo that won’t die (Rustum Roy’s handwaving about the “memory of water” and the utter failure of homeopaths to be able to distinguish homeopathically “potentized” treatments from water notwithstanding), rears its ugly head in even academic medical centers. If there’s one thing that distinguishes CAM/IM from evidence-based medicine, it’s that it’s faith-based more than anything else. In yet another irony, CAM/IM has been able to co-opt evidence-based medicine by ignoring prior probability far more than big pharma could ever dream of. (See Prior Probability: The Dirty Little Secret of “Evidence-Based Alternative Medicine by Kimball Atwood IV and its two followups for more.) At least big pharma has to justify scientifically its treatments; there is no such requirement of CAM/IM.

The final part of the article boils down to what I like to call the “big bait and switch.” It begins:

Over the last three decades, millions of Americans, and a dedicated group of physicians and practitioners have front-line, hands-on experience with integrative health care. Via concerted research and clinical practice, international scientists and practitioners, have progressively uncovered the root causes and the most effective treatments for health maintenance and restoration. This is science’s cutting edge.

Really? Perhaps Chopra could point me in the direction of this CAM/IM “cutting edge” research that has “uncovered the root causes and the most effective treatments for health maintenance and restoration.” I’ve looked, and I’ve yet to see it. I’ll settle for just a handful of studies representing “cutting edge” research in CAM that have uncovered the root causes and most effective treatments . What I have seen, as I’ve documented time and time again, are badly conceived, poorly designed, and equivocal studies that are oversold by woo-meisters like Chopra as representing far more than they, in fact, do represent.

Now here’s the bait and switch:

One sine qua non for any future sustainable U.S. health system is the necessity to empower, rather than undercut each citizen’s right to choose health care and take responsibility for his/her own wellness. Countless chronic diseases result from the neglect of basic wellness measures. The blame for underutilizing such proactive, cost-saving approaches lies directly with the official policy of blind reliance on drugs and surgery, whatever the cost. The public has been lulled into medical apathy on the false assumption that if something goes wrong, fix-it mechanics will tune up your body the way a garage tunes up your car.

A new integrative medicine system would marry the superb options of high tech emergency care, its brilliant surgical achievements, the tried and least harmful pharmaceuticals, by empowering and educating its citizens to maintain wellness and prevent disease, through improved nutrition, exercise, stress-management, and a wide range of other proven integrative approaches. Sadly, mainstream medicine largely ignores these viable health approaches, because they’re not financially lucrative.

The reason I call this a “bait and switch” is that CAM/IM apologists like Chopra try very hard to appropriate science- and evidence-based modalities like good nutrition and exercise, along with health maintenance measures, as being somehow “alternative” or “integrative” (the bait) when they are in the purview of “conventional medicine.” That they may be underemphasized (which is arguable, although not as clearly so as Chopra would have you believe, given how hard lifestyle changes are to persuade patients to undertake) does not mean that we have to “throw the baby out with the bathwater” and ditch evidence-based medicine in favor of Choprawoo. Indeed, the appropriation of such modalities by the CAM/IM movement is the “foot in the door,” so to speak, that (or so CAM/IM advocates hope) will allow the entrance of the more dubious therapies (the switch). Today, nutrition and excercise, tomorrow homeopathy. To CAM/IM advocates, it would seem, it’s all the same. Far be it from them to worry themselves about doing the actual hard work to do the science that determines what treatments do and don’t work. Far easier to appropriate a possibly underutilized part of science- and evidence-based medicine and then wrap it in woo, which is exactly what Chopra does in this article. He can’t do otherwise, because he doesn’t have the evidence for nearly every other form of CAM/IM other than perhaps herbalism, which is, let’s face it, nothing more than the way medicine was practiced 200 years ago, with the use of crude plant extracts as drugs simply because the technology didn’t exist to isolate the pure, active ingredients.

Basically, the argument being made by the Woo-meisters Three boils down to an attack on evidence-based medicine based on exaggeration and cherry picking, topped off with a huge dollop of conspiracy-mongering and playing the victim. There is not a single positive, science-based argument that Chopra’s woo or Andrew Weil’s “integration” of the dubious with the evidence-based produces better health outcomes than the evidence-based medicine they attack. I’ll concede it’s probably cheaper, but that’s just because, at least in this case, you get what you pay for.

Chopra’s article demonstrates beyond a shadow of a doubt is that advocates of unscientific medicine and quackery apologists are a potent political force, and their new strategy has become clear. With the impending inauguration of Barack Obama as the President of the United States, they see a huge opportunity in his plans to overhaul the government health care system to insert into legislation provisions that will pay for unproven and pseudoscientific CAM/IM modalities. They will sell these provisions as “reform” and as “health maintenance,” when they represent neither. If advocates of science- and evidence-based medicine remain silent, they may well succeed. They may well succeed anyway in spite of the promising start that Obama has had in appointing supporters of science to his team, but we can at least try to limit the damage.