The Yale Journal of Medicine & Law blows it big time on alternative medicine

It’s always frightening when lawyers delve into the realm of medicine. It’s even worse when pre-law students and political science majors do the same.

Such was the thought running through my mind when I came across the most recent issue of the Yale Journal of Medicine & Law. The result is what I would most accurately characterize as–shall we say?–uneven. Even though the authors try to don the mantle of skepticism, for the most part they fail. Perhaps the best example of this failure is this particular article entitled Chiropractic Medicine: “Quackery’s” Struggle for Fair Practice. Rarely have I seen an article as chock full of misinformation about chiropractic written by an apparent non-chiropractor. I’ll show you what I mean. First, the author (Eduard Vangelder) begins with the classic logical fallacy of appealing to popularity:

Chiropractic medicine is a commonplace and popular form of medical treatment in today’s society. Classified as a form of Complementary and Alternative Medicine, chiropractic medicine primarily aims to improve body posture and treat such functional symptoms as neck and back pain. According to the 2007 National Health Interview Survey (NHIS), over 18 million Americans adults (8% of the general population) and more than 2 million children had received chiropractic or osteopathic spinal manipulations in the previous twelve months. Chiropractic medicine has not always been so widely accepted, however, and for nearly a century after its inception in 1895, it was frowned upon and labeled with terms such as “quackery” and “an unscientific cult” by the American Medical Association (AMA). Chiropractic medicine had to come a long way to be as widely accepted and recognized as it is today.

Note the narrative, common to many forms of “complementary and alternative medicine” (CAM). Chiropractic was once viewed as “quackery,” but now it’s become “mainstream.” It’s popular! Therefore there must be something to it! But no good CAM story would be complete without a nice, juicy conspiracy theory. So Vangelder parrots one, namely the conspiracy theory claiming that conventional medicine tried to suppress chiropractic not because it was rank quackery but because it was trying to suppress an effective, rival therapy.

Vangelder starts out by describing the origins of chiropractic, which, as all good skeptics should know, was created in 1895 by Daniel David Palmer. Of course, what Vangelder forgets to mention is that Palmer claimed that he had manipulated the spine of a man who was nearly deaf and thus cured him. He also forgets to point out that chiropractic, as created by Palmer, was based on vitalistic beliefs. In fact, in this chiropractic resembled acupuncture in that it postulated that disease was caused by interruptions in what chiropractors called the “innate intelligence,” which was a “nervous energy” or “life force” that flowed through the spine, blockages of which chiropractic could relieve by relieving subluxations. Not surprisingly, Palmer viewed the “innate intelligence” as representing God’s presence in man. Indeed, Palmer briefly considered branding chiropractic as a religion because he could then claim First Amendment protections for it, but decided against it only because of the confusion that would result between chiropractic and Christian Science.

Vangelder then discusses the efforts of the American Medical Association to limit chiropractic, portraying it as seemingly unreasonable and more for the purpose of protecting doctors’ turf than actually protecting patients from pseudoscience. He finishes by portraying the lawsuit against the AMA that prevented the AMA on antitrust grounds from acting against chiropractors:

Ever since Wilk, the AMA and other federally associated institutions have been obliged to recognize and treat chiropractic medicine as a legitimate practice in alternative medicine. Nevertheless, a subtle disrespect for chiropractic practitioners as “unscientific witch doctors” still, to some extent, pervades the AMA and the medical community today. Doctors should always question the scientific legitimacy of a particular method of treatment and the credentials of any person who calls themselves a healer. Historical development indicates, however, that misconceptions about chiropractic medicine are likely to continue to dissipate as it becomes more respected within the realm of “standard medicine” and as its safety protocol falls more and more under the auspices of federal regulation.

One notes that nowhere in Vangelder’s article does he actually concentrate on the science behind chiropractic (or, more appropriately, the lack thereof). Instead, he frames the story as that of brave maverick chiropractors, underdogs, battling an arrogant AMA and triumphing by achieving popular acceptance. Science doesn’t enter into the story anywhere.

Elsewhere in the issue, Annie Wang produces an article entitled Eastern Medicine and Herbs: Treating the Individual. This is perhaps the worst of the lot, at least in terms of sheer credulity. Wang’s post is basically a paean to traditional Chinese medicine in which she quotes Ted Kaptchuk (one of the prime investigators “credited” with the recent acupuncture/placebo paper published in the New England Journal of Medicine). In the article, Wang falls for the false claim that somehow traditional Chinese medicine (or other forms of alternative medicine) is “individualized” medicine:

So what is the appeal of Eastern medicine? Why do its believers swear by its natural remedies, while others label it as money-wasting, spiritual mumbo-jumbo? Eastern medicine, in particular Chinese medicine, focuses on the individual, with physicians giving each patient unique herbal treatments based on their individual diagnoses. Patients enjoy the personal attention given to them by their doctors, who not only ask about their symptoms but also try to connect their illnesses with their mental states.

The main difference between Eastern and Western medicine lies in how physicians diagnose diseases. A Western physician separates the patient’s symptoms from the patient’s being as he searches for what is typically a commonly-diagnosed underlying disease. An Eastern physician, however, unifies a patient’s symptoms and soul, perceiving illnesses as disharmonies in the body.

This is, of course, utter nonsense, a fetid load of dingo’s kidneys. A better term for the “individualization” of treatment under various alternative medicine regimens is what I like to call, “Making shit up as you go along.” That’s how “Eastern” practitioners diagnose diseases. Wang also falls into the false dichotomy between “Eastern” and “Western” medicine, a false dichotomy that I consider to be profoundly racist. After all, the implication that “Western” medicine is scientific and ” Eastern” medicine is more “intuitive,” as though Asians aren’t capable of rigorous science or “Westerners” aren’t capable of empathy for their patients.

Be that as it may, Wang then spends several paragraphs trying to convince readers that Ginseng is some sort of wonder herb, claiming that it can “improve performance, boost energy levels, reduce fatigue, enhance memory, and stimulate the immune system.” She even claims that Ginseng can melt tumors away, concluding:

More evidence must be collected before integrating herbal remedies into Western medicine. However, Western physicians could benefit by incorporating some of the tenets of Eastern medicine. One of the major complaints about Western medicine is that patients do not feel like they get enough individual attention from their physicians. By following the Eastern traditions of giving patients more personal attention and seeing them as more than just a collection of symptoms, perhaps patients will become more satisfied with Western medicine. Indeed, as Dr. William Osler, one of the founding professors of Johns Hopkins Hospital, once said, “The good physician treats the disease; the great physician treats the patient who has the disease.”

I hate it when apologists for quackery start quoting Osler. It’s almost as bad as when they quote Hippocrates. In any case, this is just more of the same, including the same false dichotomy between “Western medicine” and the woo that Wang likes so much. As far as medicine goes, Wang’s article is a law article. Well, actually, it isn’t. It doesn’t really mention law at all, which makes me wonder why it was even included in this issue.

Unfortunately, Molly Anderson takes up the slack that Annie Wang leaves behind. Penning an article entitled Alternative Cancer Treatments: Can the Food and Drug Administration ever be too cautious?, Anderson pens her very own credulous treatment of quack cancer cures. She even uses the term “allopathic” to describe conventional medicine, which is about as big a warning flag for an apologist for quackery as there is, even in spite of Anderson’s citing insulin potentiation therapy as a dangerous form of cancer quackery. In other words, IPT is dangerous, but that other woo works, or, as I like to rephrase it, the woo I like works and all that other stuff is dangerous quackery.

Anderson’s article starts, as so many quack apologist articles do, with a testimonial. Because this is an article about quack cancer cures–excuse me, “alternative cancer treatments”–Anderson chooses a testimonial from a person with what appears to be advanced cancer, a hemangioendothelioma. So what we get from Molly is the typical “they sent me home to die” narrative–until, of course, the person giving the testimonial finds the woo du jour. However, there is a wide spectrum of behavior in this particular tumor type, from indolent, slow-growing hemangioma-like tumors to very aggressive tumors angiosarcoma-like tumors. That Anoush, the “testimonial” patient used to set up the story, survived two years after choosing quackery says very little about whether the quackery he chose worked or not. Regular readers know that I’ve explained this sort of thing time and time again since the very beginning of this blog; so I’ll try not to belabor the point (much).

The most annoying aspect of this article is that Anderson frames her whole article as the FDA versus alt-med believers:

Overall, these procedures seem to be effective. But until the FDA permits clinical trials of these alternative techniques, experimental findings indicate their success, and the techniques obtain FDA-approval, cancer patients will have to travel internationally to explore alternative treatment options. Still, the effectiveness of these therapies is under intense investigation and evidence at this point neither supports nor deters their implementation.

For now, those seeking alternative cancer treatment will have to take the same unendorsed risk Anoush took two years ago. Perhaps they will be as lucky as Anoush has been, perhaps not. If anything, those brave enough to try can at least find solace in the prospect of the alternative treatments while they wait for conventional methods to improve, or for the FDA to catch up.

Yes, Anderson’s implication is that the FDA is far behind the times, out of the loop, too hidebound, too unwilling to see the light with respect to “alternative therapies.” Her language is full of straw men, misunderstandings of how the FDA works, and spinning FDA regulations in the worst possible light, so much so that I recommend her for a writing gig at NaturalNews.com. In fact, in Anderson’s account, the FDA isn’t trying to prevent these “alternative” therapies out of a desire to protect the public but to suppress “alternatives,” while laying down this howler of a turd:

But alternative cancer treatments should certainly not be considered feeble attempts with low expectations; stunting cancer growth with alternative treatment has the amazing potential to induce cancer remission.

But if certain alternative cancer treatments sometimes lead to better results than mainstream methods, why does the FDA continue to deny attempts at their approval?

The alternative cancer treatment approval process is a cycle almost as vicious as the disease itself. The FDA will not allow testing of these alternative treatments on human subjects, which eliminates the opportunity to conduct research on their effectiveness. Then because there is no scientific evidence supporting the effectiveness of the treatment, endorsement is denied during the FDA approval process.

Wow. Can I see your tinfoil hat, Ms. Anderson? I bet it’s a nice, thick one.

Anderson reveals a shocking ignorance of how clinical trials are conducted and how human subjects protections work. The FDA doesn’t mandate human subjects protections; the Department of Health and Human Services does through the Common Rule. All the FDA does is to require that any clinical trials used in support of an application for FDA approval of a drug or device must conform to the Common Rule and have been approved by a properly constituted Institutional Review Board (IRB). IRB approval is what determines whether a clinical trial is considered legal and ethical with respect to U.S. law, at least as far as whether or not the trial includes adequate protections for the human subjects participating in it. In any case, anyone in academia who wants to can propose a clinical trial, and if it passes ethical muster after review by local IRB of the institution where the investigators work approves the trial, it can be performed if the investigator has the funding to do it. Let’s just put it this way. If you’re going to write an article about the FDA and how it regulates (or fails to regulate) alternative medicine, you should at least take a little time to learn about the FDA.

The reason that some alternative medical treatments “can’t be tested” (in Anderson’s framing) is not because of a conspiracy to suppress “alternative medicine” but rather because testing therapies with virtually no chance of working on patients with cancer is almost always unethical and violates laws and regulations designed to protect human research subjects. Yet Anderson portrays the situation as the evil FDA trying to suppress alternative medicine cancer cures. What’s even more depressing is that this little screed appeared in a law journal, and its author clearly has zero clue about the laws and regulations concerning human subjects research and FDA approval. In fact, it’s obvious that she didn’t even bother to do a bit of research into the relevant law and regulations, which is the sort of thing you’d think–oh, you know–writers for a law journal would do. You’d think that a Yale student publication such as the Yale Journal of Medicine & Law could attract better student authors, capable of less sloppy, ideologically motivated work. You’d think wrong, apparently. Even though the Yale Journal of Medicine & Law is an undergraduate journal, presumably its authors are interested in going into–oh, you know–medicine or law or related fields.

The rest of this issue is chock full of articles ranging from the questionable to the downright credulous. Titles include Tips from the Past: The ancient Oriental medical art of acupuncture and its emergence in modern day alternative medicine, which is almost as credulous as the article on the FDA; “Leaky Gut” or Suspect Science?, which cites Andrew Wakefield and Jenny McCarthy but is at least somewhat skeptical in parts; Ayurveda: Holistic Treatment from the Hindu Scriptures, which is slightly better in that it at least recognizes the problem with adulteration of Ayurvedic medicines; and Naturopathy’s Battle for Licensing, which is a lot like the article about chiropractic in that it buys into the propaganda of naturopaths trying to represent their quackery as scientific as they battle state legislatures for licensure. Sadly, the credulity in these articles far outweighs the skepticism, and in some cases, such as the ones I used for examples, the lack of skepticism and science with respect to alternative medicine is brain-fryingly irresponsible.

If this is what passes for critical analysis of the intersection of law and medicine by students at Yale, I fear for its students. Where were the faculty advisors for the editors of this journal? Asleep at the switch, apparently.