NOTE: There is a follow up to this post.
The holidays are over. Time to start dishing out fresh Insolence, Respectful and, as appropriate, not-so-Respectful for 2015.
I do, however, feel obligated to deal with one painfully inappropriate action by a major science journal left over from 2014. It happened in an issue that came out just before Christmas, and, with all the festivities, being on call last week, and having houseguests; so, unfortunately, I just didn’t get around to addressing it, either here or on my not-so-super-secret other blog (where I might crosspost this later in the week). The journal is Science, which, as most readers know, is one of the two most prominent general science journals out there, the other being Nature. Actually, it’s appropriate that I mention Nature in this discussion because Nature pulled exactly the same bone-headed move three years ago, almost to the day.
Yes, Nature shilled for traditional Chinese medicine (TCM) by publishing an advertising supplement promoting it sponsored by a Japanese supplement manufacturer. Now it’s Science‘s turn to do the same in the form of—you guessed it!—an advertising supplement entitled The Art and Science of Traditional Medicine Part 1: TCM Today — A Case for Integration. Worse, Science appears to be going Nature one better—two better, in fact. This is the first part of what is promised to be a three part series.
Looks like I have blog material for a while.
The overview of the issue is nausea-inducing:
In this first installment of a three part series, “The Art and Science of Traditional Medicine,” we present a series of articles making a case for the integration of traditional Chinese medicine (TCM) into modern medical practice. From the new WHO Traditional Medicine Strategy to the application of systems biology in studying TCM, we aim to highlight the potential for creating an integrated, network-based health care system. The next two issues will cover herbal genomics and highlight the importance of quality control, standardization, regulation, and safety for traditional therapies. An overview of indigenous medicines in Europe, Africa, the Middle East, India, and the Americas will also be provided.
How about the importance of applying actual science to medical treatment, not “rebranding” herbal medicines as somehow “alternative,” and eliminating prescientific superstitious beliefs about disease, such as the concept of qi and the idea that you can map any organ to an area of the tongue using “tongue diagnosis”? Or maybe we should make a case for “integrating” traditional “Western” medicine into science-based medicine. After all, what are the “five elements” in TCM but a different version of the four humors of the humoral theory of disease that was practiced dating back to the time of Hippocrates until less than a couple hundred years ago? Or what about homeopathy, which was invented by a German? Where’s the love for traditional Western medicine (TWM), here, Science?
One has to wonder about the authors here, too. For instance, Josephine Briggs, the director of the National Center for Complementary and Integrative Health (NCCIH, formerly the National Center for Complementary and Alternative Medicine, or NCCAM) is listed as part of the editorial team. Is that kosher? She’s a government official and she’s contributed to the writing of what is, in essence, an advertorial section. Other editors include known boosters of TCM, such as Jan van der Greef, PhD, of the University of Leiden, who actually contributed a particularly awful article to the Nature debacle three years ago. The overall guest project editor is Tai-Ping Fan, PhD, from the University of Cambridge, who looks like a scientist who started out strong studying angiogenesis (one of my favorite topics) but became enamored with the herbal treatments of TCM and is now wasting sophisticated genomics and next generation sequencing methods to study woo.
The introductory articles are painful to read, full of the obfuscations and justifications for the pseudoscience that makes up most of TCM, all wrapped up in calls for more tooth fairy science and completed with a bow of argumentum ad populum. Disappointingly, Margaret Chan, MD, the Director-General of the World Health Organization, begins this parade in an article entitled Supporting the integration and modernization of traditional medicine:
TM [traditional medicine] is often seen as more accessible, more affordable, and more acceptable to people and can therefore also represent a tool to help achieve universal health coverage. It is commonly used in large parts of Africa, Asia, and Latin America. For many millions of people, often living in rural areas within developing countries, herbal medicines, traditional treatments, and traditional practitioners are the main—and sometimes the only—source of health care. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health care costs and widespread austerity.
Calling Dr. Chan. Calling Dr. Chan. The zombie corpse of Chairman Mao Zedong called. He wants his 1950s-era justification for promoting TCM and “integrating” it with “Western” medicine back, not to mention his “barefoot doctors.” Meanwhile, he’s laughing because he did not believe in or use TCM, nor do most educated Chinese, for that matter. Indeed, more than anything else, in China, TCM practitioners are complaining about the infiltration of “Western medicine” into their bailiwick. Of course, using a medical system based on prescientific religious beliefs (e.g., Taoism) to “achieve universal coverage” doesn’t exactly achieve universal coverage with effective medicine, now, does it?
It goes downhill from there:
In wealthy countries, TM meets an additional set of needs. People increasingly seek natural products and want to have more control over their health. They turn to TM to relieve common symptoms, improve their quality of life, and protect against illness and diseases in a holistic, nonspecialized way.
Hey, it’s not just the poor upon whom we can foist our pseudoscience! The rich worried well in “Western countries” like it too! Better yet, they’ll pay big money for it! You know, Dr. Chan mentions the WHO Traditional Medicine Strategy. I might very well have to take a look, if her rationales here in any way resemble what the WHO published. True, she makes the most massive understatement of the year (2014, given that that’s when this was published) when she opines that “to move into mainstream medicine on an equally trusted footing, TM needs a stronger evidence base.” However, she doesn’t seem to consider the question of: What happens if that stronger evidence base just doesn’t exist, as it doesn’t for practices like tongue diagnosis and acupuncture? Never fear, though. The WHO is all about “integrating” quackery with scientific medicine because…well, because:
The two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in beneficial harmony, taking advantage of the best features of each system and compensating for certain weaknesses in each as well. In an ideal world, TM would be an option, a choice, offered by a well-functioning, people-centred health system that balances curative services with preventive care. The challenge is to give TM its appropriate place in an integrated health system, to help all practitioners understand its unique and valuable contribution, and to educate consumers about what it can and cannot do. In other words, we need to modernize this rich resource and cultural heritage, and put it in its proper place in today’s world.
What if its proper place in today’s world doesn’t exist? Strip TCM of its Taoist roots, its balancing of the five elements and attribution of disease to excess “heat,” “dampness,” or other such aspects, and pretty much all you have left is herbal medicine, which needs no special dispensation to become part of science-based medicine. All it needs is for pharmacologists and physicians to study it, identify what’s useful and discard what is not, and then figure out what active ingredients can be used. Then it could become just “medicine,” as the cliche goes. Dr. Chan prominently brags in her article that “nearly a quarter of all modern medicines are derived from natural products, many of which were first used in a traditional medicine context.” Even if so, that doesn’t mean that all of TCM is of value or even that all of the herbal medicines used in TCM have value.
Next up, the CEO of the American Association for the Advancement of Science and Executive Publisher of Science, Alan Leshner, PhD, proclaims A middle way for traditional medicine. Dr. Leshner’s very first paragraph should result in his immediate firing by the AAAS Board of Directors, so horrible is the misunderstanding of the science of medicine reflected in it:
In discussions surrounding traditional healing techniques, a common perception is that those in the West most often take a reductionist approach to medicine, breaking down the body into ever-smaller parts in order to understand its inner workings. In the East, by contrast, medical practitioners are seen to take a more holistic view, regarding the body as a complex, integrated system and treating it as such.
Utter bollocks, Dr. Leshner. This is a stereotype promulgated by quacks who want to attack “Western medicine.” Good science-based primary care medicine is holistic. It takes care of the whole patient. As for “reductionism,” part of the reason why medicine tended to be reductionistic in the past is because it just didn’t have the tools to analyze more than one—or a handful—of genes and enzymes at a time. This, however, has rapidly changed over the last couple of decades, with the advent of cDNA microarrays that can measure the expression of every known gene in the genome at once; next generation sequencing, which, when done finely enough, can measure the levels of every transcript produced, now even getting down to the single cell level; and proteomics, which has provided much more powerful methods of analyzing many proteins at once.
Medicine has become more “systems-oriented” now because it can be. It has the tools now. That medicine and medical research have evolved this way has nothing to do with the attraction of TCM or other TM. Yet, that’s exactly what Leshner seems to be implying in his article, that “Western medicine” is becoming more like TCM because, again implied, TCM was right to be more “holistic.” It’s such utter drivel that I found it hard to finish his article, as brief as it was. That’s even leaving aside the inherent racism in the whole false dichotomy between “Western” and “Eastern” medicine, which implies that the “West” is more analytical and reductionist, while the “East” is more “holistic” and touchy-feely.
Leshner ends appealing to the “middle way” of Buddhism:
In Buddhism, the Middle Way is described as the route to enlightenment—a path found by balancing opposing views, accepting neither extreme, but rather investigating both sides and finding a middle ground. Perhaps a Middle Way can be found for traditional medicine, one that takes the best of East and West and brings them together for the benefit of all.
Can anyone name the logical fallacy here? It’s known by a few names: the fallacy of the golden mean, the appeal to the middle ground, and the argument to moderation. Just because there are two extreme positions does not automatically mean that the truth lies somewhere between the two positions. Think antivaccine pseudoscience. Think evolution denialism. Advocates of such positions love to try to present themselves as being “reasonable” and urging their opponents to “meet them in the middle,” but for some things there is no middle ground, or the truth is so much closer to one pole than the other that, for all practical purposes, there is no middle ground.
You know what? as I write this, I realize that there’s so much material in this advertising supplement, so many fallacies, and so much…plain wrongness that I think I will require at least one more installment to cover it. Indeed, the papers by Briggs and colleagues and discussions of the WHO Traditional Medicine Strategy will likely take at least one more post, if not more.
In the meantime, however, I can quickly and easily cover the last article in the paper, an article by Geoffrey Burnstock entitled Purinergic signaling in acupuncture. I already covered this rather blatant appropriation of acupuncture as a means of making an interesting, but relatively mundane, discovery about pain signaling as somehow being relevant to acupuncture. It isn’t, at least not in any apparently clinically useful way. Let’s just say that trying to shoehorn adenosine and purinergic signaling into acupuncture is very similar to how, for instance, quacks have appropriated the developing science of epigenetics to justify claims that “we control our genome.” It takes quite a contortion to accomplish this.
In the meantime, I can’t help but say to whoever at Science decided that publishing an advertising supplement like this, plus two additional ones to come: What the hell were you thinking? I mean, seriously. Publishing a blatantly purchased supplement promoting TCM is no different than publishing a blatantly purchased supplement paid for by a drug company promoting drug research and its own products. In fact, if you look at the table of contents of this supplement you will find that none of the material in this supplement was peer-reviewed:
The content contained in this special, sponsored section was commissioned, edited, and published by the Science/AAAS Custom Publishing Office. It was not peer-reviewed or assessed by the Editorial staff of the journal Science; however, all manuscripts have been critically evaluated by an international editorial team consisting of experts in traditional medicine research selected by the project editor. The intent of this section is to provide a means for authors from institutions around the world to showcase their state-of-the-art traditional medicine research through review/perspective-type articles that highlight recent progress in this burgeoning area. The editorial team and authors take full responsibility for the accuracy of the scientific content and the facts stated.
Sadly, I can’t help but conclude, Science, like Nature, has sold its soul. Nature, at least, seems to have learned from its mistake. At least it hasn’t done it again in three years. It remains to be seen how low Science will go. After having skimmed the articles that require further discussion, I shudder to go deeper, and I await with trepidation the next two segments in this ad-fest.
For shame, Science. There is no excuse.