M.D. Anderson enters the blogosphere–and goes woo

Did you know that acupuncture is very much related to astrology?

No, it’s not just because both of woo. Rather, it’s likely true that the whole concept of “meridians,” those invisible “channels” through which our life energy (a.k.a. qi) allegedly flow were indirectly based on astrological signs, which had been used to guide points used by ancient healers for bloodletting. Indeed, far from being “ancient wisdom,” by the middle of the second century, needling had been mostly abandoned and even banned by the Imperial Medical Academy in China and prohibited in Japan, only to be resurrected by Chairman Mao in the “barefoot doctor” campaign in the 1960s as a method of providing care to the masses without actually investing in–you know–modern medicine. In other words, whether it “works” or not (and, make no mistake, the totality of the evidence is most consistent with no effect greater than a placebo), the history and mythology that have grown around acupuncture bear little resemblance to its actual history.

I was thinking of this as I perused a relatively new blog about which I had been unaware until recently, namely Cancerwise, the official blog of the M.D. Anderson Cancer Center in Houston. This blog appears to have been in existence around five months or so, and it was pointed out to me by a reader a couple of days ago. Last night, curiosity led me to take a look. After all, M.D. Anderson is one of the two most renowned cancer centers in the U.S., if not the world. Whenever one thinks cancer, two names come to mind: M.D. Anderson Cancer Center or Memorial Sloan-Kettering Cancer Center. These two cancer centers are without a doubt the Big Kahunas of cancer centers, academic powerhouses towards which all other cancer centers strive. And, no, I’m not just sucking up. Personally, I’d love to work at M.D. Anderson if it weren’t in Houston and I weren’t terminally allergic to hot, hot heat and super high humidity. What that means, I guess, is that I doubt I ever could work there (even if the administration there had any interest in hiring me) and, after this post, it may well be that I will destroy any chance I might ever have had of working there.

The reason?

Quackademic medicine. Lots of it. Worse, as it typical in these cases the dubious “complementary and alternative medicine” CAM (also known as “integrative medicine, or IM) is interspersed with good, solid science-based information (for instance, this story about the acceleration of the start of phase I clinical trials) and personal interest stories relevant to cancer patients. In many ways, I consider the mixing of science-based modalities with pure woo by a source as authoritative as M.D. Anderson to be a profound threat to science-based cancer care, because this blurring of the line between science and the highly implausible leaves it impossible for the typical lay person (and even many physicians) to distinguish between science-based medicine and woo. In any case, I perused the Wellness category, and, well, unfortunately, all I can say is: The woo it is strong there.

For example, the most recent post in this category involves the Feldenkrais Method of Somatic Education, otherwise known as “therapeutic movement.” This is what:

The Feldenkrais Method was conceived by Moshe Feldenkrais (1904-1984), a physicist and martial artist, mainly to recover from his own sports-related knee injury in the 1920s. He learned to decrease pain and improve performance when he paid attention to how his body moved.

Prior to his findings, most people believed it was difficult to retrain the body to do an already-learned activity once a person reached a certain age. But, Feldenkrais concluded the brain continues to develop throughout life and retains the ability to relearn. His findings have been confirmed by research in neuroscience.

Uh, no. No they haven’t. More on that later. In the meantime, here is the woo-ful language straight from the Feldenkrais website itself:

The Feldenkrais Method is named after its originator, Dr. Moshe Feldenkrais, D.Sc. (1904-1984) [about], a Russian born physicist, judo expert, mechanical engineer and educator.

The Feldenkrais Method is a form of somatic education that uses gentle movement and directed attention to improve movement and enhance human functioning. Through this Method, you can increase your ease and range of motion, improve your flexibility and coordination, and rediscover your innate capacity for graceful, efficient movement. These improvements will often generalize to enhance functioning in other aspects of your life.

The Feldenkrais Method is based on principles of physics, biomechanics and an empirical understanding of learning and human development. By expanding the self-image through movement sequences that bring attention to the parts of the self that are out of awareness, the Method enables you to include more of yourself in your functioning movements. Students become more aware of their habitual neuromuscular patterns and rigidities and expand options for new ways of moving. By increasing sensitivity the Feldenkrais Method assists you to live your life more fully, efficiently and comfortably.

“Include more of yourself in your functioning movements”? What the hell does that mean? Maybe the experts at M.D. Anderson can tell me. Or not:

Maybe this will help:

When she works with a student, Smith says, she doesn’t dwell on what hurts or what obstacles are in the way. Instead she discovers what brings pleasure to that person. Through being aware of movement, the student learns to perform everyday actions (for instance, gardening, singing or just being comfortable) using a new pattern that works better with current life circumstances.

Nope. No help there.

Now, I don’t know about those fancy-pants high-powered docs at M.D. Anderson, but I’m just a simple surgeon with a lab from the Midwest working at a strong, but not super-duper top two cancer center like M.D. Anderson. Dumb surgeon or not, though, I recognize woo-speak when I see it, and this is some of the finest vintage. Does M.D. Anderson present any evidence that this Feldenkrais method is anything more than glorified yoga? Nope. It simply tells us that Feldenkrais’ findings have been “confirmed by neuroscience,” whatever that means. So I looked at that bane of woo-meister claims, PubMed. Unfortunately I couldn’t find any evidence that the Feldenkrais method has been “confirmed by by research in neuroscience,” at least not any neuroscience published in the peer-reviewed literature indexed on PubMed. True, I did find 34 references, but a lot of them were in the CAM literature, and none of them were in any neuroscience journals that I could find. I did, however, find this rather more (I suspect) accurate summation of the Feldenkrais method as being much more akin to faith healing than science. I’m left to come to the opinion that the Feldenkrais method borders on quackery.

Quack one!

Next up is reflexology. Yes, you read me right. Reflexology. No, I’m not kidding you. Really, I’m not. I couldn’t believe it myself. There it was, right there on the official blog of the world-renowned M.D. Anderson Cancer Center reflexology:

The eyes have been called the windows to the soul, but the hands and feet are often the first parts of the body to experience something, perhaps the softness of a blanket or hot sand on a beach.

The importance of hands and feet make them the focal point of reflexology, a healing art historians believe was used first in China more than 5,000 years ago. It focuses on pressure points of the hands and feet and can be used by anyone, but it may be especially beneficial to cancer patients…

Reflexology therapists use their hands – usually their thumbs or forefingers – to apply pressure to areas of the hands and feet that they believe are connected to specific zones of the body. Stretching and movement techniques also may be used. They may open or close the session with a gentle hand or foot rub.

I may get in trouble for pointing this out, but I don’t know how else to put my opinion based on having studied the literature and examined the tenets of reflexology. Reflexology is quackery. It just is. Reflexology postulates a connection between regions of the feet and hands and ten zones of the body and that massaging and manipulating specific areas of the hands and feet can manipulate the flow of life energy, blood, nutrients, and nervous impulses to the corresponding zone of the body and thereby can relieve symptoms or ailments in that zone. There is no evidence to support the contention that these pathways exist or that there is any connection between specific areas of the feet and hands and specific “zones” of the body. There is no anatomic structure or physiology that supports such a connection. In other words, it’s bunk, and M.D. Anderson is not only offering it, but promoting it. It would be one thing if MDA were simply offering foot massages as a means of making its patients feel better. Few are those who don’t like a good foot massage. But reflexology is not merely foot and hand massage. It is an entire modality built on pseudoscience and mystical concepts that have no basis in evidence or science–and it’s right there on the official blog of one of the top two cancer centers in the U.S., if not the world, complete with a credulous, evidence-free, glowing review by a practitioner.

Quack two!

Finally we come full circle. Admittedly, this is was the one form of CAM that I used consider to be among the most plausible of the mish-mash of unrelated and often mutually contradictory treatments that have been lumped together under the rubric of CAM, because I imagined that there might actually be a physiological mechanism to explain how it might actually work. As such, I used to consider it nowhere near as quacktastically quackademic as reflexology. Now I consider it placebo medicine. I’m referring, of course, to acupuncture, and the M.D. Anderson Cancerwise Blog has a very credulous and promotional post on acupuncture. (Surprise, surprise!) It’s by Lorenzo Cohen, Ph.D., the director of M. D. Anderson’s Integrative Medicine Program and entitled The 3 Most Common Questions People Ask About Acupuncture. I’m going to address them out of order. For instance, question two is “Is it safe?” Well, yes, acupuncture is pretty safe, but it’s not entirely without risk. There have been cases of pneumothorax after acupuncture, infection, and bleeding. True, such complications are uncommon, but their incidence is not zero.

Let’s move on to the more problematic questions. Question one is “What should I use acupuncture for?” The answer is disturbing:

Acupuncture has been shown to be effective for nausea/vomiting and some types of pain. There also is a growing body of evidence for xerostomia (dry mouth) and hot flashes. Although it may help for other symptoms such as constipation, loss of appetite, fatigue, insomnia, anxiety, depression, peripheral neuropathy and delayed wound healing, not enough rigorous clinical trials have been conducted to draw meaningful conclusions. That being said, as a safe, inexpensive treatment, there’s no reason not to try it if you’re interested.

Uh, no. It hasn’t. As I’ve documented here and friends have documented elsewhere, there is no evidence for an effect of acupuncture above and beyond that of placebo or “noise” from random chance that produces the occasional apparently positive study. It disturbs me mightily to see what should be a bastion of science-based medicine advocating in essence anecdote-based medicine:

As a clinician, I often see a synergistic effect when acupuncture is added to a patient’s treatment plan. For example, adding it to a comprehensive pain management regimen often allows patients to reduce the amount of medications they’re taking and thereby reduce unpleasant or debilitating side effects. Dr. Moshe Frenkel, medical director of our Integrative Medicine Program, always says, “Can’t hurt, might help, why not!”

I was in pain when I read that last sentence. Trepanation. Can’t hurt, might help, why not? OK, that was a bad example. How about this instead: Homeopathy. Can’t hurt, might help, why not? Never mind that homeopathy is based on magical thinking and ideas that would require for them to be true that huge swaths of exceedingly well-established science in physics, chemistry, and biology to be not just wrong, but fantastically wrong.

Why not?

True, acupuncture is not quite as wildly implausible as homeopathy, but it’s still pretty darned implausible from a scientific point of view. For it to “work,” a lot of what we know about physiology would have to be wrong. Again, I’m willing to consider that possibility if evidence supporting the efficacy of acupuncture were presented in a quantity and quality as compelling as the scientific evidence that it can’t possibly work the way it’s claimed, but no such strong evidence exists. This brings us to what’s most depressing about this post, namely the answer given to this question, “Why does acupuncture research often show mixed results?” Of course, I’d question the very premise of this question in that the research testing acupuncture is not really mixed, at least not if you look at it closely. Not to Dr. Cohen:

I think there are many reasons. Sometimes it’s because of poor study design. Sometimes researchers ask the wrong questions, and sometimes it’s because we don’t have a clear understanding of how acupuncture works. Recent data from Germany show that although acupuncture points are indeed areas on the skin with reduced bioelectric resistance, this characteristic varies over time; thus, timing of the treatment may be key to its effectiveness. To date, very little research has evaluated this aspect of acupuncture, even though it’s an important concept in traditional Chinese medicine theory.

I’d be very interested in seeing this research, given that I can’t find it on PubMed. Of course, I only have so much time to devote to literature searches. It is rather convenient, though. If acupuncture doesn’t work better than a placebo, then it must be the timing! Even if that were true, it adds one more layer to the whole edifice of woo that makes acupuncture so much of a logistic pain in the rear that I ask: Why bother? Think about it. If it’s not enough just to stick acupuncture needles in special places (I know, I know, it doesn’t matter where the needles are placed; sham acupuncture with toothpicks is indistinguishable from “real” acupuncture–sometimes even better!) but you have to do it only at certain times, then one starts to wonder what the attraction is. It’s difficult, and, even under the kindest interpretation of current studies, is equal to or perhaps only slightly better than a placebo. So, again, why bother? It’s a long run for a short slide.

What I find more disturbing, though, is this passage:

Putative mechanisms of acupuncture are multiple, and although there’s certainly a large placebo effect, fMRI and animal studies clearly indicate there’s a physiologic response above and beyond placebo. Let’s face it, if it works on lab rats, there’s something more than the “power of suggestion” at work. In terms of pain, for example, animal studies have shown the effects of acupuncture are reversed with Naloxone, a powerful opioid antagonist. For other symptoms such as xerostomia, mechanisms are a little harder to explain, but studies are under way to explore these questions.

Ugh. Dr. Cohen clearly doesn’t understand the placebo effect if he dismisses it as just the “power of suggestion.” In any case, the five animal studies cited are hardly convincing evidence. Two of these studies (1, 2) were of electroacupuncture, which is not acupuncture. It’s a frequent bait-and-switch to study electroacupuncture, which is in reality nothing more than the science-based treatment method of transcutaneous electrical nerve stimulation rebranded. Other articles (3, 4) appeared in Chinese in Chinese journals of traditional Chinese medicine, which make them very difficult to evaluate. Only one study looking at acupuncture without electrical stimulation is cited, and it’s 13 years old; it also only looked a surrogate marker of immune system activation and concluded that acupuncture was associated with better immune function. This is all very thin gruel indeed to feed any scientific interest in acupuncture. Suffice it to say, I’m not impressed. Even worse, I’m profoundly disappointed that M.D. Anderson would lend its hallowed name to this sort of dubious science.

Quack three! You’re outta there!

Sadly, there’s even more than just what I’ve described at Cancerwise. There’s a full-on buy-in to the concept of “integrative” care as being anything more than “integrating” nonsense with science:

I recently watched the Feb. 26, 2009, hearing before the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee: Principles of Integrative Health: A Path to Health Reform. I was pleased to hear Sen. Tom Harkin (D-IA) support the role of integrative medicine in the national health care plan: “It is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative “… “Today, we are not just talking about alternative practices but also the integration between conventional and alternative therapies in order to achieve truly integrative health.”

The Integrative Medicine Program at M. D. Anderson is shifting the focus from sickness to wellness, treating the whole person, and providing a forum for all evidence-based practices. The program’s goal is to integrate the best of complementary and conventional treatments using a multidisciplinary approach.

As regular readers of this blog would guess, integrating pseudoscience with science-based medicine does not impress me. Indeed, I’ve written extensively about Senator Tom Harkin’s promotion of pseudoscience and quackery, the use of his power to create NCCAM, and, most recently, to try to hijack President Obama’s health care reform initiative in order to force the government to pay for “alternative” medicine. To see one of the two premier cancer centers in this country declaring solidarity with Tom Harkin on its official blog is truly depressing.

In closing, I’d like you to think once again about how acupuncture is, in essence, astrology with needles. Then think how an academic cancer center as high-powered and revered as M.D. Anderson has apparently embraced such pre-scientific magical thinking in toto. It’s the ultimate triumph of quackademic medicine, to be mixed in with science-based medical treatments in what would normally be considered one of the most authoritative sources for cancer information out there, with nothing to distinguish science from pseudoscience, the science-based from the woo. Indeed, I can’t help but think: If M.D. Anderson doesn’t have the wherewithal to resist the infiltration of woo and to refuse to sully its name by association with this sort of nonsense, what hope do the rest of us have?