Senator Tom Harkin: NCCAM and inviting the Four Horsemen of the Woo-pocalypse into the Senate

Yesterday, I wrote about Senator Tom Harkin’s (D-IA) little woo-fest in the Senate’s Committee on Health, Education, Labor, and Pensions, which he called Integrative Care: A Pathway to a Healthier Nation. I and a lot of the rest of the medical blogosphere (such as PalMD, Val Jones, and Tufted Titmouse) shook our heads in disbelief and disgust at Harkin’s statement (video here) about the National Center for Complementary and Alternative Medicine (NCCAM):

One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.

Although I was actually somewhat happy that he did it for all to see, I couldn’t believe that Harkin actually laid it on the line so bluntly about what the true purpose of NCCAM was from its very founding. Harkin’s admission showed that, for all its promotion of pseudoscience, CAM “fellowships,” and bad science, even that is not enough for promoters of woo like Senator Harkin. Even though NCCAM is incredibly friendly to pseudoscience, it has still failed to “validate” a single alternative medicine. The closest it’s come is for various natural products, but testing plants and herbs for medicinal compounds is nothing that can’t be done in all the other Institutes and Centers that make up the NIH. It does not need a special center. In any case, Harkin’s admission also made clear that NCCAM, even in its current form, is still too “science-y” for woo-philes, who have wanted it from the very beginning to give unscientific quackery a patina of scientific respectability and to “prove” that woo works. When, even under the easiest testing, reality does not conform to their preexisting beliefs, they lash out and try to pressure NCCAM to “validate” more woo.

Senator Harkin, as you may recall, is the legislator who, above all others, is responsible for the creation of the pseudoscientific monstrosity that is NCCAM. He based his championing of “alternative medicine” on an anecdote about a friend of his from the House of Representatives who became ill, tried alternative medicine, and supposedly got better, combined with his own belief that bee pollen cured his allergies. But even a Senator as senior and powerful as Tom Harkin can’t do it alone. Even he needs help. And, to help him, he brought in the Four Horsemen of the Woo-pocalypse into the very chambers of the Senate, as a two-fer from their concurrent engagement at the Institute of Medicine and Bravewell Collaborative woo-fest being held on the same days: Dr. Andy Weil, Director, Arizona Center for Integrative Medicine, University of Arizona, Vail, AZ; Dr. Dean Ornish, Founder and President, Preventive Medicine Research Institute, Sausalito, CA; Dr. Mark Hyman, Founder and Medical Director, The UltraWellness Center, Lenox, MA; Dr. Mehmet C. Oz, Director, Cardiovascular Institute and Complementary Medicine Program, New York-Presbyterian Hospital, New York, NY.

It was the opening shot in the war against science-based medicine, using President Obama’s desire and plan to reform the health care system as the vehicle upon which to piggyback quackery.

First off, the way that Senator Harkins fawns over these luminaries of of faith-based medicine is truly disgusting to behold. At one point, he even says:

I don’t mean to be pandering but you’re all my heroes and we need you involved in our healthcare reform platform.

Gag me with a spoon. (I know, that’s really ancient history.) However, there was enough of that that I really couldn’t stomach listening to the full hour and a half. Instead I surfed and sampled.

Let’s look at the opening statements of these four leaders of the CAM movement. At the risk of echoing too closely my blog bud PalMD, I found Mehmet Oz’s initial statement to be particularly full of weasel words of woo:

We spend roughly twice as much per capita on healthcare than our counterparts in Europe, but do not appear to derive value for this investment. Part of the reason is that Americans are twice as sick as Europeans as a people because of our chronic disease burden.1 Since lifestyle choices drive 70% of the aging process, most experts agree that we should focus on what we put in our mouths (food and addictions), how we tune our engines (exercise and sleep) and how we cope with stress (community and psychological growth). A key solution is support for a Smart Patient movement that integrates complementary and alternative medical (CAM) approaches to conventional medical treatment. We can combine the best of modern American medical practices with alternative approaches to wellness and harvest the natural healing powers of our bodies. CAM is not just about extreme treatments for advanced disease when no other solutions are available. It is about taking a population that has gotten comfortable living with half of the energy and sense of physical well being that they should have at their age and moving them up the spectrum to live at full vitality.

I note that the one reference Oz cites to support this load of CAM-speak is not even from a scientific journal. Rather, it comes from a health policy journal journal. But let’s say for the moment that there are higher rates of chronic diseases in the U.S. and that they are primarily due to poor lifestyle and diet. There is no doubt that obesity rates have increased markedly over the last 25 years. Let’s grant Oz that. Even if everything he says is true (although I have no idea what he means by lifestyle choices driving “70% of the aging process”), that does not mean that the answer to the problem is to embrace pseudoscience. CAM advocates ensconce themselves within the Trojan horses of diet and lifestyle modifications and ride that Trojan horse into the fortresses of medical academia and health policy, where the quackery lying within leaps out to take over. In other words, as I’ve said time and time again, by so closely trying to relabel healthy diet and exercise as being somehow “alternative,” they hope to get their foot in the door to let all the other woo in behind it.

Oz then continues:

As Vice-Chair and Professor of Surgery at Columbia University and Director of the Heart Institute at New York Presbyterian, I’m in the operating room every week and have performed thousands of heart operations utilizing the most state-of-the-art equipment and innovative approaches of science in order to save lives. I spent much of my life past the cutting edge as I operated on the bleeding edge of medicine. My specialty was mechanical heart pumps (See Appendix A – Visual of Mechanical Heart Pump) and transplantation and my patients were barely gripping the ledge of life as they pulled themselves up from the crevice of death. To survive, they needed a pump to replace their failing organ, but this was not enough. They also wanted to return to a fulfilling life, so they introduced me to their “other” healershypnotherapists, massage therapists, spiritual healers, and even energy medicine experts like Reiki masters. Clearly these patients had not read the same books that I got in medical school.

So we began offering massage and meditation, and even audiotapes in the operating room with some internal resistance, but general support from a medical community that recognized that conventional medicine alone could not offer the robust, holistic approach that our patients deserved. We started a center where we paid salaries of complementary and alternative medical (CAM) practitioners to offer free services to all of our heart surgery patients. We had two goals. First introduce patients to new powerful lifestyle approaches that they could do on their own after discharge. Second, evaluate rather than just advocate these unconventional approaches to see what works and spread the word by publishing in mainstream journals. We researched if we could reduce pain medications with hypnosis, if we could improve survival after heart procedures with prayer, and if we could alter memory with what patients hear during their operations. As we merged high tech to low tech approaches, folks around the hospital started to notice, and so did the media as evidenced by this early piece in the New York Times Magazine.

Notice that Oz’s statement is almost completely science-free. “To see if we could improve survival after heart procedures with prayer?” That’s been tested, and intercessory prayer has failed miserably. I also find it funny that, for all Dr. Oz’s grandiose braggadocio about how he’ll study this woo and publish on it, I find his publication record, although impressive in standard cardiovascular surgery, mighty short on scientific publications testing or studying alternative medicine. (Of course, I can’t help but reiterate my belief that, with rare exceptions, “scientific alternative medicine” is an oxymoron.) Later, he tries to sell alternative medicine as the “globalization” of medicine and states baldly, “The globalization of medicine mandates that we incorporate foreign approaches like traditional Chinese and Ayurvedic healing practices into Western medicine.” In other words, we poor advocates of scientific medicine are hopelessly “provincial,” as he puts it, for not being sufficiently open-minded that our brains fall out. Personally, I would argue that it is alternative medicine that is provincial. After all, it’s often based on culture-specific religious beliefs, especially so-called “traditional Chinese medicine” (TCM) I would counter that it is science- and evidence-based medicine that is truly the globalization of medicine. Science knows no cultural boundaries, and even the younger generation of Chinese are rejecting TCM in droves.

Next up is Mark Hyman, who tells us that so-called “functional” medicine is the way:

  • This new paradigm is personalized, preventive, participatory, predictive, and patient centered. It is proactive rather than reactive. It is based on addressing the causes of disease and optimizing biologic function in the body’s core physiologic systems, not only treating the symptoms.
  • It based on systems biology or medicine. That model exists today, and is called Functional Medicine.
  • Functional medicine is a system of personalized care, a new “operating system” that directly addresses how environment and lifestyle influence our genes to create imbalances in our core biologic systems that, over time, manifest as disease. It is this kind of medicine that is needed to create real successes in 21st century medicine.

Functional medicine is highly dubious, based not on science, but seemingly on a grab bag of popular CAM myths and misconceptions. Whenever you hear the term “personalized medicine” used in this manner, as Wally Sampson correctly points out, what is really being said is a codeword for total freedom to deviate from the standard of care based on no science. As for the whole “operating system” analogy, that’s just a glib but meaningless catchphrase. Functional medicine is in fact a woo-filled pseudoscientific version of systems biology applied to health care–without the science and gene profiling. Systems biology may be at the cutting edge of science, but it may end up going nowhere as well. “Functional” medicine is no more than hijacking the term. Indeed, look at how Hyman refers to “core imbalances” that result in disease. Sound familiar? It should. It’s no different than “imbalances of the four humors” (or “imbalances” between yin and yang or a person’s qi) or a more high tech-sounding version of the German New Medicine, which postulates that disease is a manifestation of imbalances caused by emotional trauma. In other words, it’s very old, vinegary wine in a new cask, supported by nothing but anecdotes.

Next up we have Dean Ornish. I’ve written about Dean Ornish before. My overall impression is that he wants to be scientific (or at least to appear scientific) but just doesn’t know how to do it right, which leads him to do studies of his rather radical diet using cDNA microarray technology and then exaggerating the results, which he does again here:

We used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. We showed that integrative medicine approaches may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, obesity, hypercholesterolemia, and other chronic conditions. We also published the first randomized controlled trial showing that these lifestyle changes may slow, stop, or even reverse the progression of prostate cancer, which may affect breast cancer as well.

No, that’s not what he did, as I explained in my usual nauseating detail last summer. At best, what he did is to show that a very severe dietary and exercise regimen may favorably change gene expressoin profiles in a small, very highly select, group of men with early stage, well-differentiated prostate cancer. He then spews this bit of nonsense:

Our research, and the work of others, have shown that our bodies have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. Medicine today focuses primarily on drugs and surgery, genes and germs, microbes and molecules, but we are so much more than that.

Damn those scientific doctors for concentrating on the actual causes of disease! Also note the assumption that we are “more than that.” It almost sounds as though he’s arguing that we humans are more than our biology, which is, after all, what science- and evidence-based medicine uses as the basis for its treatments.

Finally, we have the macher of the CAM movement, the Big Kahuna himself, Andrew Weil. His testimony shows why he’s the big dog, the top gun, the number one woo-meister in the entire U.S. Weil doesn’t disappoint, either, laying it on thick. First, we have the biggest lie about alternative medicine that there is, but, alas, it’s the most effective because it contains at its heart a small grain of truth.

For practitioners of IM, preventing disease is not an afterthought, it is the cornerstone of our practice – the physician and patient form an ongoing partnership to maintain health, rather than fight illness, and IM practitioners are trained to be agents of lifestyle change. We treat illness promptly and aggressively when appropriate, but always seek to maximize the body’s innate capacity to stay healthy and resist disease and injury.

The lie is that preventing disease is an afterthought to science-based practitioners. It’s not, despite all the attempts of CAM advocates like Andrew Weil to coopt prevention for their own sectarian ends. The grain of truth is that, given the constraints of modern medical practices, physicians practicing science- and evidence-based medicine fail more often than they should in emphasizing prevention to patients. It’s difficult; it takes time; and there aren’t enough hours in the day, given the current reimbursement system. Moreover, patients resist it; they like their crappy lifestyle changes. Changing behavior is very, very difficult. Of course, that scientific medicine arguably too often doesn’t do enough to emphasize prevention of does not mean that the solution to this shortcoming is to embrace woo. (I know, I’m repeating that a lot, but these CAM aficionados are so repetitive in their mischaracterization of both scientific medicine and their abilities.) He’s also suffering delusions of grandeur if he thinks that CAM practioners do anything to maximize the body’s innate anything.

And, of course, Weil can’t resist argumentum ad populum:

Consider: Integrative medicine is quickly gaining momentum. I founded the first integrative medicine training program at the University of Arizona in 1992,. Today, 42 academic health centers, including those at Harvard, Duke, Johns Hopkins, and the University of California as well as the Mayo Clinic, have IM initiatives. [source: http://www.imconsortium.org/about/home.html] At the University of Arizona alone, we have trained over 400 physicians, nurse practitioners, and medical residents, many of whom are now leading their own programs at other institutions in this country and around the world. We are expanding our trainings as quickly as we can, because demand for them is increasing rapidly, and are working to make a comprehensive curriculum in IM a required, accredited part of all residency training in all medical specialties. I can assure you, that more and more doctors and allied health professionals want to practice this kind of medicine, because they see it as the medicine of the future: cost-effective medicine that can revitalize American health care and make it truly the best in the world.

Consumers have already embraced integrative medicine, but skeptics still question whether it really works. We need good outcomes studies to convince them, but we already have data showing that patients do indeed achieve better outcomes and are more satisfied with their care when treated by integrative physicians. For example, a 2008 study of patient experiences at the University of Michigan’s Integrative Medicine Clinic showed that over 62 percent of responding patients called the clinic’s care either “excellent” or “best care ever.” An amazing 81.2 percent of respondents reported partial or full effectiveness of their patient plan in achieving their primary objective. [source: http://www.liebertonline.com/doi/pdf/10.1089/acm.2008.0154] That is a success rate most conventional clinics could not match.

Note how he confuses–intentionally, I would argue–popularity with scientific validity. Let’s put it this way. Lots of people (over 50% of people in the U.S., by some surveys) do not believe in evolution. Lots of people believe in ghosts. Heck, lots of people believe that aliens are visiting earth and abducting people to do experiments on them. That does not make any of these things science. Moreover, lots of people who see, for example, psychics believe that they got the best service of their lives. Pay some personal attention to people in a pleasant environment, listen to them, and they will be satisfied. “Conventional” medicine has a hard time matching that. Also note what Weil seems to contradict himself. He says that he has data showing that patients achieve better outcomes with “integrative” medicine, but does he discuss that data? No! Rather, he discusses, in essence, consumer satisfaction surveys that find that people like the woo CAM practitioners are dishing out. Get a load of the abstract’s conclusion:

Using three tools to evaluate patient outcomes and satisfaction, statistically significant outcomes were noted. The SF-12 showed positive change in the physical component score, the Holistic Health Questionnaire showed improvements in all of the subscales of body, mind, and spirit, and a unique Integrative Medicine Patient Satisfaction Tool suggested high satisfaction with an integrative approach to care.

Twisting the knife in my heart, this paper was published by my alma mater, the University of Michigan. Oh, woo is me!

The bottom line is that the strategy of CAM advocates that I warned about early this year is now being implemented. CAM-friendly legislators like Tom Harkin are being used to give CAM supporters a forum in the halls of power to push their agenda. There, they do their best to falsely conflate disease “prevention” with alternative medicine by emphasizing diet and exercise while hiding the bizarre methodologies in CAM, such as reiki, homeopathy, and the like, knowing that if they are successful, after they become the accepted “experts” in diet, exercise, and nutrition that they can bring the woo in later in increasing doses.

Be very, very afraid. The age of scientific endarkenment could well be on its way in medicine, unless the President Obama truly meant what he said in his inaugural address when he stated that he would “restore science to its rightful place.” To do so, he’s going to have to fight a lot of powerful interests who very much don’t want that to happen. Not all of these powerful interests reside in the Republican Party.