Bad science and bad arguments for “integrative pediatrics”

There’s a website out there that calls itself Opposing Views. I haven’t visited it in a while, but its very reason for existence and philosophy seems to be built on the “tell both sides” fallacy that so irritates me. In other words, Opposing Views appears to be built from the ground up to provide “balance” in all things. Sometimes, as in areas of politics, balance is not a bad thing. When it comes to science, not so much. The reason is that the “balance” in science shown by Opposing views is the sort that thinks there are two equally valid views in manufactroversies like the “debate” over whether vaccines cause autism (hint: the best available data currently existing does not support this notion); whether animal research is useful in making discoveries that improve our understanding and treatment of human disease (it does, the dubious arguments of Ray Greek notwithstanding), or whether alternative medicine (like Stanislaw Burzynski) is worthy of being “integrated” into science-based medicine (hint: it’s not).

Oddly enough, a while back I was actually invited to join Opposing Views (OV) as one of its “experts.” Even though I am a legitimate expert in some topics and a bit of a self-taught lower tier expert in others, I was highly reluctant to join for the same reasons that I’m reluctant to do public “debates” with creationists, HIV/AIDS deniers, anti-vaccine loons, or other cranks. It elevates the crank’s views by putting them on an equal footing with scientific views. None of this, however, means I can’t call BS when I see it on OV. So it was when I saw an article by someone named Alice Shabecoff entitled Pediatricians Beginning to Embrace Alternative Medicine for Kids, and the article wasn’t a lament that this is true but rather a celebration of the infliction of quackery on children.

One thing you should know is where Shabecoff is coming from; she’s the co-author of a fear mongering book entitled Poisoned for Profit: How Toxins Are Making Our Children Chronically Ill. One thing I can’t help but notice right off the bat is that Shabecoff apparently doesn’t know what the word “toxin” means. As I’ve pointed out before, “toxin” has a specific meaning in science, and she appears to be using it to mean “chemical.” Given this background, I find it utterly unsurprising that Shabecoff would be into alternative medicine for children:

In the 1970s, when visits to his office cost $4 and he would come to your home for $5, pediatrician Warren Levin began to practice alternative medicine, figuring it out a bit at a time. After a few years, his practice grew into New York City’s first full-blown holistic health center. But the mainstream medical world objected. Alternative pediatricians were called quacks back then. For prescribing vitamin supplements and a healthier way of eating for patients with severe allergies, Dr. Warren was hauled before the state’s Office of Professional Medical Conduct. In the end, he was exonerated.

Today, holistic, mind-body pediatrics has come of age. It seems very appropriate for a generation of parents looking for foods without pesticides and cosmetics without solvents.

“Conventional Western medicine is about fixing disease, mainly acute illnesses. It’s oriented around disease labeling and treatment,” says Dr. Lawrence Rosen, a young New Jersey-based pediatrician who is one of today’s leading holistic practitioners.

Ah, yes. Two (at least) of the most popular alt-med canards right there in the introduction. First, there’s the usual annoying and exaggerated claim that “Western” medicine is only about taking care of acute illnesses. Yawn. Second, there’s the bait and switch, wherein the prescribing of healthy diets and/or exercise is co-opted and labeled as being somehow “alternative,” “complementary,” or “integrative,” when diet-based interventions are part of science-based medicine. Then the fact that a healthy diet does lead to better health is used to imply that the rest of the woo that comes along with it as “alternative” is also just as valid. Notice how Shabecoff talks about “healthier eating” in one breath and then in the next breath mentions prescribing vitamins and supplements for patients with severe food allergies. No wonder Dr. Warren was hauled before the state’s Office of Professional Medical Conduct. Fat lot of good it apparently did; Dr. Warren is still in business, and his practice appears to be a veritable cornucopia of woo, leavened with more than a touch of self-aggrandizement:

Dr. Warren M. Levin is recognized as the “East Coast Dean of Alternative Medicine.” He has been a visionary in reporting the interconnections among many intractable syndromes with the Standard American Diet–which he calls SAD, the heavy metals in our environment, and other factors in the modern lifestyle and drug-oriented conventional medicine.

Whenever you see a practitioner rant about “drug-oriented conventional medicine,” the odds are pretty good that you’re dealing with someone for whom science is not a big motivator. Just an observation. In any case, Dr. Warren takes credit for a number of amazing things, including being:

• One of the first to document the connection of Candida (Yeast) infections with Fibromyalgia, Chronic Fatigue Syndrome, Autistic Spectrum Disorders, Multiple Chemical Sensitivities and most recently with refractory Lyme disease
• An early pioneer in treating Autism, Asperger’s, ADD/ADHD, and Learning Disabilities with avoidance of allergenic foods, environments, and toxins, as well as via correcting metabolic imbalances and infections.
• The first to recognize and report Lyme-Induced Autism.
• Among the first to offer IV Chelation Therapy for heart Disease.
• One of the first to warn about the dangers of vaccine, especially Hep B for newborns, cervical cancer vaccine for young girls, and as a contributing factor to Mercury overload in infants
• A pioneer in providing Bio-Identical Hormone Replacement for weight loss and anti-aging.

See what I mean? It truly is a veritable cornucopia of woo. Dr. Warren’s into it all, including blaming yeast for disease for which there’s no good evidence it’s involved, “detoxification” to treat autism, Lyme-induced autism (a nonexistent entity), anti-vaccine nonsense, and even bioidentical hormone therapy.

Given that Dr. Levin is such a pioneer in so many areas, I did a PubMed search for his name. All I could find were two articles, both letters to the editor to medical journals. He also appears to have a publication from 1972 in which he is in the middle of the pack of authors; my guess is that he was probably in medical school then and did a research project as a part of that. Whatever the case, it’s not exactly what one would call an impressive publication record. Whatever “visionary” discoveries Dr. Levin might have made, he apparently never saw fit to publish his discoveries in the peer-reviewed medical literature and thus bestow them upon his scientific peers.

No apologia for alternative medicine would be complete without a broadside against “conventional” science-based medicine, and Shabecoff doesn’t disappoint:

In contrast to the conventional approach, holistic medical care works to keep children well by instilling a long-life pattern of healthy living and by treating simple problems such as earaches without resorting to the overuse of drugs. It particularly lends itself to caring for children with chronic illnesses, including cancer, juvenile arthritis, obesity, asthma and developmental disorders like autism and ADHD, where conventional medicine hasn’t a great track record of cures. In fact, there’s been a major increase in the number of prescription medications used to treat symptoms of childhood chronic illnesses, despite the absence of data that they are effective in curing the underlying problems.

If the incidence of chronic childhood illnesses continues the upward climb it has taken over the past two decades, and as more families understand the link between prevention and treatment, integrative pediatrics may very well become the standard practice of the future.

First off, even if the incidence of chronic childhood illnesses is climbing, it’s a non sequitur to conclude from that increase that “integrative pediatrics” is likely to become the standard practice in the future. Shabecoff also repeats a claim that I hear again and again and again from “integrative” practitioners. Unfortunately, I never see any actual–oh, you know–evidence presented to back up. That claim is that somehow “integrative” medicine or pediatrics is better at encouraging a healthy diet and lifestyle than “conventional” medicine or that health outcomes are better when integrative medicine is used. Seriously, I’ve looked, and I have yet to see any integrative practitioner cite any rigorous research on this issue; rather, they seem to expect us to take their word on faith or based on patient anecdotes. Couple that with an invocation of areas where current medicine might not do as well as we would like, and–voilà!–you have standard CAM or “integrative medicine” boilerplate.

Arguments like Shabecoff’s are an insult to the intelligence of skeptics and critical thinkers.

But that’s not all. Implicit in Shabecoff’s arguments are the standard CAM apologia that we’ve all come to know and not exactly love. For instance, there’s the appeal to popularity, in which Shabecoff paints “integrative pediatrics” as the “wave of the future.” Indeed, her entire article is based on the logical fallacy of argumentum ad populum. How many times does it need to be repeated that just because something is popular doesn’t mean it’s scientific, worthwhile, right, or whatever you want to call it? Apparently ad nauseam. Also implicit in Shabecoff’s argument is the claim that “integrative pediatrics” is already so accepted and popular that it’s already mainstream. Here’s a hint: I am not impressed to learn that Dr. Andrew Weil has edited the “first textbook on integrative medicine,” although I am disappointed to learn that the American Academy of Pediatrics has formed a practitioners’ section. The AAP really should know better.

Also nauseating is the fluffy, New Age vibe that Shabecoff give her article. She refers to the health of children being inextricably linked to the health of the planet, after which she argues for providing the “context–the ecology–in which the whole child’s health and wellness can thrive.” Here’s what this means:

In the first months of a child’s life, the doctor focuses on frequent well-baby care. As part of that conversation, doctor and parents together design individualized schedules for vaccinations and treat problems that may arise, such as colic. These conversations with parents and patient continue as the child grows. What could be more different from the usual harried, cookie-cutter 15-minute consultation!

Once again, I have to ask: How many times does it have to be repeated that the way to fix the systemic problem of physicians not being able to spend as much time as they should with patients due to how they are reimbursed is not to throw out science and let the quacks take care of all the touchy-feely stuff. It’s to find a way to alter the system so that it is possible–nay, encouraged–to spend time with patients. I would argue that a practitioner who spends a lot of time with patients and their parents in order to peddle “individualized” vaccine schedules that leave children vulnerable to infectious disease are doing far more harm than physicians who practice according to science-based guidelines but can’t spend that much time with patients. More is not better when that “more” is crap. When that’s true, all that “more” gets you is deeper in a pile of crap. Yet that’s what “integrative pediatrics” offers. Not surprisingly, Shabecoff herself appears to buy into common anti-vaccine myths wholesale, to the point that she actually recommends the Barbara Loe Fisher’s National Vaccine Information Center as a source of “sensible and reliable information,” even going so far as to recommend its ridiculous Vaccine Ingredients Calculator.

Oh, and Shabecoff recommends the rabidly anti-vaccine group Generation Rescue as a good source for “alternative vaccination schedules,” and Generation Rescue’s propaganda blog Age of Autism loves her back.

Shabecoff ends by quoting Dr. Tieraona Low Dog, director of education at the Arizona Center for Integrative Medicine:

Her prescription for a healthy child: “Unplug. Go for a walk in nature and find your voice again. Never leave the house without telling your children you love them.” When was the last time you heard a “conventional” pediatrician say something so wise?

Uh, last week?

Again, the bait and switch rears its ugly head. Again, pediatricians are perfectly capable of suggesting to the parents of their patients that perhaps they should take their children for nature walks and have the child unplug from technology from time to time. Pediatricians are perfectly capable of advising parents to let their children know how much they love them. Physicians don’t have to abandon science for quackery in order to do this, but Shabecoff and other integrative medicine apologists portray a false dichotomy in which the ony answer to the impersonalized, rushed primary care visit is to embrace woo.

Unfortunately, for some reason this argument is dangerously attractive.