Quackademic medicine in Connecticut

A common topic that I’ve written about since the very beginning of this blog is the infiltration of quackery into what were formerly bastions of science-based medicine. Most recently, I lamented just how far this process has progressed at the Cleveland Clinic, as evidenced by its recent opening of a clinic devoted to the quackery that is functional medicine and, not long before that, its opening a clinic run by a dubious naturopath practicing traditional Chinese medicine. That’s not even counting its long-standing credulous promotion of the faith healing known as reiki and the use of acupuncture on children.

Unfortunately, the Cleveland Clinic is far from the only bastion of what I like to call quackademic medicine. Far from it. I was reminded of this when I saw a story yesterday pop up in my Google Alerts on alternative medicine. It’s entitled Alternative medicine gains steam in Connecticut, an article that’s also on the Connecticut NPR website. Where in Connecticut is it gaining steam? Yale University, that’s where. Well, there and the University of Connecticut. Of course, Yale is the home of David Katz, whom we’ve met several times before, such as when he advocated a “more fluid concept of evidence” and claimed that it is necessary to embrace quackery in order not to “abandon patients.” If this article is any indication, it’s only getting worse there.

Now, one thing I have to be clear about here is that I have no objection to studying natural products like black cohosh and capsaicin. Indeed, the appropriation of such substances by “integrative medicine” is, as I’ve said time and time again, a “rebranding” of natural products pharmacology (also known as pharmacognosy) as somehow being “alternative” or “integrative.” It’s not. On the other hand, as I like to say, black cohosh and other herbal remedies like it are drugs, impure drugs with a high degree of lot-to-lot variability, but drugs nonetheless. They also tend to be oversold drugs in “integrative medicine,” with the claims of efficacy made for them far exceeding their actual promise, but, unlike so much else of alternative medicine, they are drugs and therefore not implausible as modalities like “energy healing” are. For example, there’s John Geible, a surgeon at Yale:

Geibel, vice chairman of the Department of Surgery at Yale, noted that genetic screening has been effective in determining whether some women will get breast cancer. “But even if you come in and perform the mastectomy, it’s difficult to impossible to remove every single (cancer) cell,” he said.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish. What if, he posited, after a surgeon has removed a malignant tumor from a breast, the doctor can “coat the underlying tissue area with a capsaicin-based preparation to prevent any residual cells” from reproducing?

Geibel said he initially tested capsaicin on breast cancer cells in a culture to determine the dose and the best way to deliver it. “The next phase is to now take some tissue from an individual,” he said.

Why capsaicin? Why not any number of other drugs used against breast cancer, like paclitaxel or compounds that are known to slow down or stop brast cancer tumors in a dish? I mean, seriously. Capsaicin can indeed inhibit the growth of breast cancer cells, but it requires a high concentration. For instance, this paper testing its effect on MCF-7 cells (a breast cancer cell line) found that at a concentration of 200 μM, decrease in cell viability is only around 50%. That’s nothing. No wonder Dr. Geibel is talking about topical application in the surgery bed. There’s no way to achieve such high concentrations in the blood by oral ingestion, and even at that high of a level the effects are at best modest. Remember how I discussed IC₅₀? That’s the concentration required for 50% of maximum effect of a drug. Remember how I discussed how an IC₅₀ above 10 μM tends to be problematic for a cancer drug? Well, here we have an estimated IC₅₀ of close to μM for capsaicin for the endpoint of cell survival. For apoptosis (programmed cell death), eyeballing the graph in the paper I estimate the IC₅₀ of around 75-100 μM. All in all, it’s very unimpressive, even in cell culture. Another paper found roughly the same thing for a number of breast cancer cell lines, an IC₅₀ ranging between 50 and 200 μM. Granted, it did a reasonable job inhibiting the growth of breast cancer xenografts.

But I don’t really want to dwell on natural products. As I said before, I have no real objection to studying things like black cohosh and capsaicin. I just doubt that they show much promise and don’t like how “integrative” medicine has co-opted such products as somehow being outside of “conventional medicine” when they aren’t. What I really don’t like is this:

With training in molecular and cellular biology, Dr. Gloria Gronowicz, a professor at the UConn Health Center, has long been looking into the effects of energy healing on tumor growth and metastasis, working most recently with a breast cancer model in mice.

Energy medicine, which includes Reiki, qigong and a practice named Therapeutic Touch, actually involves no direct touching of a patient or an object being studied. Rather, practitioners work with what they say is the energy emitted from their hands, which they call biofields. A paper published in May by Gronowicz and others, in the Journal of Complementary and Alternative Medicine, said that Therapeutic Touch had prevented cancer cells in a breast cancer model from spreading, though it had not shrunk the size of the primary tumor.

“Let us use everything to help patients,” Gronowicz said of the growth in research into alternative treatments.

We’ve met Gronowicz before. It was six years ago. She was doing therapeutic touch on osteoclasts in cell culture and claiming that it could stimulate them to grow. Her results were, as I described, underwhelming. so is this paper, because it’s not a paper at all. It’s an abstract for a poster for the International Research Congress on Integrative Medicine and Health (IRCIMH) in Miami in May. So, what we have here is an abstract for a poster (the lowest form of scientific publication) being misrepresented as an actual scientific paper, but even if it were a paper it would be in a bottom-feeding alternative medicine journal. Anyone wonder why I’m not impressed?

Basically, it looks like an exercise in cherry picking. Breast cancer cells (4T1, a mouse mammary cancer cell line with which I am quite familiar) were injected into the foot pads of mice, which were divided into three groups. One group got therapeutic touch; one got “mock therapeutic touch” (I’d like to see that); and the other got saline injections. At 26 days, tumor volumes were measured and serum collected for 32 different cytokines and chemokines. Metastases were measured, and cells isolated for a number of assays. There’s a big problem, though: Nowhere is it mentioned that the therapeutic touch practitioners were blinded to experimental group or that those collecting the serum, measuring the metastases, or the tumors. and, of course, it’s just an abstract for a poster presentation.

OK, so we know that both Yale and UConn are deep into the woo. Yale has David Katz plus a large integrative medicine program. UConn has Gronowicz and its own integrative medicine program, complete with credulous treatments of homeopathy, Ayurveda, naturopathy, and, of course, traditional Chinese medicine. What’s really irritating about this article is that it is written from the standpoint of pure credulity, full of false balance. Actually, it goes beyond false balance. It’s downright supportive of integrative medicine and goes out of its way to paint critics as close-minded:

But alternative medicine continues to have its critics. They can be found on such websites as Quackwatch.com and The Skeptic’s Dictionary. Dr. Steven Novella, a researcher and assistant professor of neurology at Yale School of Medicine, founded the take-no-prisoners website Science-Based Medicine, of which he is editor. On Sept. 29, the site’s managing editor, Dr. David Gorski, a surgical oncologist, posted his latest attack on alternative medicine: “Quackademia Update: The Cleveland Clinic, George Washington University, and the continued infiltration of quackery into medical academia.”

A growing number of researchers are ignoring that skepticism by using scientific methods to measure and quantify the efficacy of unconventional treatments.

See that? Got the idea? Critics are “unscientific”! So the brave intrepid doctors of “integrative medicine” have just decided to ignore them! They’re “ignoring them” by using scientific methods. Except that they’re not. Not really. They don’t take basic science and prior plausibility into consideration. They study mystical magical faith healing like reiki and its bastard offspring made even more palatable for “Western” consumers, therapeutic touch. All the stuff about diet, exercise, and natural products like black cohosh is the Trojan horse. These modalities seem plausible and follow in the tradition of existing scientific study of natural products. Once the Trojan horse has gained entrance to the fortress of medical academia, the quackery leaps out, in particular traditional Chinese Medicine, the various magical mystical “energy medicine” techniques, and a whole host of other quackery.

Actually, the Trojan Horse has already gained entrance to a number of academic medical centers. Combatting that is why I do what I do.