Dr. Mark Hyman: Let’s turn back the clock on science-based medicine in favor of anecdote-based medicine

I sometimes think I ought to send a thank you letter to Dr. Mark Hyman.

True, I don’t owe him quite as much as I owe, for example, Mike Adams of NaturalNews.com, anyone on the blogging crew of the anti-vaccine crank propaganda blog Age of Autism, Dr. Jay Gordon, or several other pseudoscientists, quacks, or other assorted cranks who have provided me with blogging material over the last five years. However, whether he’s mangling autism science, postulating dubious “personalized medicine” for Alzheimer’s disease, championing that form of quackery known as “functional medicine,” trying to persuade our legislators to include coverage for alternative medicine in health insurance reform legislation, or, most recently, misrepresenting research, Dr. Hyman is definitely an up-and-comer as far as providing me with grade-A crankery to blog about. For that, I can’t help but be a little bit grateful to him. Truly, he is not only a connoisseur of woo but a constant source of amazingly nonsensensical statements about health.

And he does a lot of it on that wretched hive of scum, villainy, and quackery, The Huffington Post.

Over the weekend, Dr. Hyman was at it again. He dropped a big drippy, stinky turd on science-based medicine, as if to tell SBM what he thought of it, entitled, Is There a Cure for Autoimmune Disease? Truly, the woo doth flow, beginning with an anecdote:

Isabel, a cute 10-year-old girl from Texas who loved riding horses, walked into my office a year and a half ago with one of the most severe cases of autoimmune disease I had ever seen. Her face was swollen, her skin was inflamed, her joints were swollen, her immune system was attacking her entire body–her muscles, her skin, her joints, her blood vessels, her liver, and her white and red blood cells. Isabel couldn’t squeeze her hand or make a fist. The tips of her fingers and toes were always cold from Raynaud’s disease that inflammed her blood vessels. She was tired and miserable and was losing her hair. Isabel was on elephant doses of intravenous steroids every three weeks just to keep her alive, and she was taking prednisone, aspirin, acid blockers, and methotrexate, a chemotherapy drug used to shut down the immune system daily.

I bet you can know what’s coming next, can’t you? And come next it does, but not quite yet. First, Hyman has to go on a bit more about how clueless those “conventional” doctors were, unable to figure out wht was wrong with Isabel or how to treat it. In fact, they were just at the point of adding another powerful immunosuppressant, a TNF-blocking drug, which, Hyman gleefully points out, increases the risk of cancer and the risk of overwhelming sepsis. Unwilling to accept this drug, the parents brought Isabel to…guess who? Of course, they brought her to Dr. Hyman, who did that voodoo woo that he do so well, with the following results:

Two months after I first saw Isabel and discovered and treated the underlying causes of her inflammation–after, as she says she, “stopped eating gluten, dairy, and sugar and took some supplements” she was symptom free. In less than a year, she was completely healthy, her blood tests were normal, and she was off all her medication.

Of course. The savior, the guru, the Messiah saved her.

I’ve noted before how so many of these testimonials are like religious conversion stories. The ill start out lost, suffering, and in pain. They wander from remedy to remedy. Then, suddenly, they find a charismatic figure, someone who can lead them out of the darkness, a Savior, if you will. And suddenly everything is alright again. Disease is banished, health is restored, and the “evil” scientific doctors vanquished, their knowledge revealed to be false. At least, that’s how these testimonials frequently go.

These testimonials also rarely provide enough information to allow an educated reader or physician to hazard a reasonable guess as to whether the interventions used on the patient were actually responsible for the improvement reported. Indeed, I started this blog out by writing about just how such testimonials can seem convincing even if the treatments being promoted do nothing. The same thing is going on here with Dr. Hyman, who says that Isabel stopped eating gluten and dairy and took some supplements and then in less than a year was symptom-free and off medications. Regular readers can probably guess why Hyman’s testimonial is not particularly convincing. It follows one of the cardinal rules of alt-med testimonials in that it is reasonably clear that Isabel continued to take her medications for a considerable period of time after meeting Hyman. After all, he said it took “the better part of a year” for Hyman to get better. At its heart, Hyman’s testimonial is no different than the testimonial about breast cancer that I described so long ago. Basically, in the case of the breast cancer testimonial, it was quite clear that it was the surgery, not the woo, that effected a cure of the woman’s cancer. In this case, it’s not quite as clear, but it’s certainly not at all clear that Hyman’s woo effected this cure, particularly since it took nearly a year. It’s quite possible that conventional therapy finally worked. It’s also possible that Isabel’s autoimmune disease, whatever it is, went into remission, which is not that uncommon for autoimmune diseases, which can wax and wane in intensity. Basically, this testimonial tells us close to nothing about whether Hyman’s woo works.

Not that that stops Hyman from going on a rant about what he calls the “unfortunate demise of the case study in medicine”:

Historically medical discoveries originated from physicians’ keen observation of their patients’ diseases and responses to treatment. Doctors reported their findings to their colleagues or published them as case studies. Today these “case studies” are often dismissed as “anecdotes” and have become increasingly irrelevant. Instead, we now focus on randomized controlled trials as the only standard of “evidence”. Sadly, this dismisses the experience of thousands of patients and physicians as they apply new scientific findings to treat difficult conditions.

Basic scientific discoveries often take decades to be translated into medical practice. Unfortunately, this prevents millions from accessing therapies that could benefit from them now. The determining factor in deciding whether to try a new approach with a patient is the risk/benefit equation. Is the treatment more likely to help than harm? How risky is the treatment? What are the side effects? How dangerous or risky is the current approach to a problem? How debilitating or life threatening is the disease being treated? These questions can guide exploration toward innovative approaches to chronic disease.

This is, of course, utter poppycock. The difference between modern medicine, whether you want to call it science-based or evidence-based is the evolution from using anecdotes and case reports as the basis for deciding how to provide care. Before the dawn of scientific medicine, how Hyman advocates practicing medicine was the mainstream. That was how new therapies were evaluated. Individual practitioners would do exactly what Hyman advocates. They’d try new treatments on their patients, record the results, and either communicate them to their colleagues in various venues or, later, write them up as case studies.
Indeed, randomized clinical trials are a relatively new development in the history of medicine. For example, one of the earliest clinical trials was that of John Lind, who showed that scurvy could be treated with citrus fruit, and that wasn’t until 1753. then there were studies such as those done by Ingaz Semmelweis in the mid-1800s that showed that handwashing by physicians and practitioners could greatly decrease the death rate from puerperal fever in the maternity ward. It wasn’t until the early 20th century that the methodology of the modern randomized clinical trial (RCT) took form, and RCTs didn’t come to dominate medicine until the latter half of the 20th century. Even then, it’s only been in the last couple of decades that doctors are truly starting to “get it” and not rely as heavily on anecdotes and the received dogma of the physicians who trained them.

I’ve explained before time and time again how anecdotes (i.e., single patient experiences) can be profoundly misleading. Confirmation bias, confusing correlation with causation, regression to the mean, and various forms of selective memory to which physicians are just as prone as anyone else all conspire to make anecdotal observations of the sort that Hyman advocates profoundly unreliable. Even when the treatment effect is fairly dramatic, anecdotal evidence has a hard time showing it convincingly. To boil it all down, what Hyman wants is to move medicine back from the scientific basis that it took hundreds of years to reach and send the practice of medicine back to the way it was done 200 years ago. The acceptance of anecdotal medicine as the standard of care is the sort of atmosphere that allowed homeopathy not only to be invented but to fluorish and become respectable.

Yes, that’s exactly where Hyman wants to take medicine. To illustrate it, Hyman then goes on to promote his particular brand of woo, namely functional medicine:

Functional medicine is a hidden movement sweeping across the globe, and it is based on a different method of diagnosing and treating disease–one that focuses on causes not symptoms, one that is based on an understanding of the dynamic way our genes interact with environment, one that goes beyond simply treating diseases based on their label. The training I lectured at teaches practitioner to understand the body as a system; to seek the causes of illness; to understand the body’s basic functional systems, where they go awry, and how to restore balance; to understand the interconnections between symptoms and organs rather segregate diseases into specialties.

This approach is a fundamentally different way of solving medical problems, one that allows us to decipher the origins of illness and identify the disturbances in biology that lead to symptoms. Let’s see how this approach worked for Isabel.

To be honest, I’ve read about “functional medicine.” In fact, I have yet to figure out exactly what it is. I do know that it involves a lot of things that have no science to support them, modalities such as “detoxification,” various dubious “gut and digestive health” treatments that are based on the same sorts of “logic” that Andrew Wakefield used to try to link the MMR to autism, and various treatments based on “oxidative stress.” He even spouts germ theory denialism à la Bechamps and says that the germ theory of disease has led us astray in that to him modern medicine “ignores” that our health is determined by the interaction of our genes and our environment. Of course, Hyman has no clue how genes influence our health in concert with the environment any more than the crew at AoA does and has proven it time and time again.

Still, Hyman thinks he understands how genes interact with environment, and he then goes on to tell Isabel’s tale in more detail. His tale is most instructive in that Hyman serially tries out a veritable panoply of woo on Isabel, all the while proclaiming that his woo reigns supreme:

For Isabel, the only response physicians had to her life-threatening illness was to shut down her immune system, leaving her at risk for cancer, infection, osteoporosis, muscle wasting, and psychiatric illness. But there was another way. I simply asked the question WHY. I didn’t focus on WHAT the name of her disease was (mixed connective tissue disease, otherwise known as an autoimmune disease that affects the whole body), but WHY she was inflamed, WHERE this inflammation originated from, and HOW we could locate the causes and restore balance to her overactive immune system that was attacking her own body?

I really, really hate it when woomeisters pull this gambit. They make it seem as though they are the only ones who think about these questions and try to apply the answers to the care of their patients. I guess what I really resent is the sense of utter condescension, the arrogance, the contempt for scientific medicine, none of which they’ve earned the right to through, you know, actually being superior. So what Hyman does is to describe how he tried woo after woo on Isabel based on his pseudoscientific “understanding” of how the body works and how genes interact with the environment. Did it work? Who knows? The story is perfectly consistent with a remission due to the patient’s conventional therapy, a spontaneous remission, with Hyman’s woo actually having done some good, or with a combination of any or all of the above. That’s the problem with anecdotal evidence; there’s no way to tell which possibility is most likely to be the best explanation for Isabel’s apparent recovery. That’s the problem when you rely on anecdotal evidence to dictate your care.

That’s why we need science-based medicine.

For that vast majority of its existence, medicine has relied primarily on anecdotal evidence to determine which treatments work and which do not. That’s how treatments such as homeopathy, bleeding, purging, and treating various diseases with toxic metals persisted so long even though they either do nothing or cause harm. It’s only been in the last 100 years or so that we have seen the rise of randomized clinical trials and truly scientific medicine. As a result, the last 100 years have witnessed the most rapid progress in medicine the world has ever seen. Hyman would like to take us back to the time before that progress while pretending to be more scientific than science-based medicine.