In which I am compared to Donald Trump by a pro-quackademic medicine activist…again!

John Weeks has long been an activist for alternative medicine—excuse me, “complementary and alternative medicine” (CAM) or, as it’s more commonly referred to these days, “integrative medicine.” Despite his having zero background in scientific research or the design and execution of experiments and clinical trials, for some bizarre reason in May he was appointed editor of the Journal of Alternative and Complementary Medicine (JACM). It didn’t take him long at all to use his new post to launch a nasty broadside against CAM critics in general (such as yours truly) and those who criticized a sloppily done systematic review article by high ranking members of the National Center for Complementary and Integrative Health (NCCIH) in particular (such as Edzard Ernst, Steve Novella, Michael Vagg, and, of course, yours truly), in which he compared critics of the NCCIH review to Donald Trump. This was, of course, before the election.

I hadn’t planned on mentioning Donald Trump again for a while, given that my last two posts were about him and his antivaccine views, but apparently, Mr. Weeks is still nursing a grudge, because he’s still unhappy and still comparing critics of CAM and “integrative medicine” to Donald Trump. So into the fray I leap once more! Only this time it’s not in his journal, but rather in the pages of the left-leaning Huffington Post (or, as I like to refer to it, that wretched hive of scum and quackery) in an article entitled Trumpism and the Bigotry of the Antagonists to Integrative Medicine and Health, where, no doubt, a comparison to Donald Trump is more toxic than just about anywhere else shy of AlterNet. This time around, it’s because of an article in JAMA by Jennifer Abbasi entitled As Opioid Epidemic Rages, Complementary Health Approaches to Pain Gain Traction. The article reported, mostly approvingly and with little input from critics, about the NCCIH systematic review published in September. Worse, as I pointed out in my discussion of the JAMA article a little more than a week ago, Abbasi seemed to buy totally into a favorite CAM trope, namely the idea that somehow CAM can ease the opioid addiction epidemic through “nonpharmacological approaches” to the management of chronic pain.

I wasn’t the only one unhappy about JAMA’s article, either. For instance, Juliana LeMieux of the American Council on Science and Health (ACSH) referred to JAMA as the “journal of medical atrocities” in response to Abbasi’s article. Regular readers know that I’m not generally a big fan of the ACSH. I view it as too sympathetic to industry interests, particularly pesticide manufacturers, as evidenced in part by its buying into right wing smears against Rachel Carson and remarks by its founder and former president Elizabeth Whelan dismissing concerns about potentially toxic chemicals, especially pesticides, as “chemophobia,” which she characterized as an “emotional, psychiatric problem.” That’s why I thought its attack on Dr. Oz last year was a very bad idea. Be that as it may, as much as I tend to distrust ACSH, I do have to admit that it’s gotten somewhat less blatant in supporting corporate interests since Hank Campbell took over, which is perhaps why it irritates me a lot less than before. This time around, Dr. LeMieux and I are pretty much in agreement, for example.

Indeed, it seems to be LeMieux at whom Weeks’ anger and rant are mostly directed. Let’s take a look at Weeks’ framing first. After discussing Donald Trump and his penchant for name calling, the first thing Weeks does is—you guessed it—poison the well by comparing his opponents to Donald Trump and labeling their tactics “Trumpian.” He then describes the reaction to the JAMA article as an example:

An example came across my desk yesterday. It was in response to a news piece at JAMA Network entitled “As Opioid Epidemic Rages, Complementary Health Approaches to Pain Gain Traction highlighted a paper published in Mayo Clinic Proceeding.”

Stage-setter #1: JAMA is of course a well-known, historic advocate for complementary and integrative health approaches. Not.

Stage-setter #2: The focus of JAMA Network was an article published through the Mayo Clinic. Mayo of course has a long history of quickly adopting new approaches without consideration for science. Not.

Stage-setter #3: The subject of the Mayo article considered in JAMA was a review from a team of five authors each of whom are scientists at the USA National Institutes of Health. This of course is another institution with a long-time disregard for science. Not.

Stage-setter #4: The subject of the paper, “Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States,” was based on an examination of 105 USA-based randomized controlled trials (RCTs). RCTs are of course rank near case reports at the bottom of the evidence hierarchy. Not.

So we have aligned JAMA, Mayo Clinic, NIH and RCTs. Now that’s a line-up from which one can expect shoddy science. That is the assertion in the name-calling article in response to the work of this triumvirate+ entitled “JAMA: Journal of Alternative Medicine Atrocities.” Atrocities. The approach of the NIH researchers is denigrated as “ridiculous.” The author asserts, on the basis of her personal experience, that despite positive outcomes in multiple studies, that yoga cannot possibly have real value for chronic pain but only for “mild discomfort.”

Let’s unpack them one by one. Stage-setter #1 is, of course, irrelevant. It’s a straw man. No one claimed JAMA is a “well-known, historic advocate” for CAM. No one. In fact, it was because JAMA has historically been considered a top tier journal that I and others who criticized the JAMA article were so irritated. Indeed, in the past JAMA has published editorials advocating against the NIH funding of CAM research, a study showing that saw palmetto doesn’t work against urinary tract symptoms, and an article criticizing the supplement industry, while JAMA Oncology has published a study showing that CAM use is associated with patients declining chemotherapy. And, no, JAMA didn’t recommend chiropractic care first for low back pain.

Stage-setter #2 is just silly. In actuality, Weeks is wrong. The Mayo Clinic has jumped whole-heartedly on the CAM bandwagon and recommends a number of interventions that are not science-based, such as traditional Chinese medicine and even cupping. Yes, the Mayo Clinic used to be a bastion of science-based medicine, and in many ways it still is. However, it does now have a lengthening history of quickly adopting CAM approaches without consideration for science. That is, unfortunately, just a fact.

Stage-setter #3 is even sillier. Yes, the NIH is a bastion of science-based medicine, but NCCIH is not. Notice how Weeks said “NIH,” not “NCCIH.” This remark is just another example of how CAM advocates co-opt the reputation of the NIH as a mantle to cover the pseudoscience of NCCIH. NCCIH studies are frequently represented as coming from the NIH or funded by the NIH. It’s an intentional tactic. While true, characterizing such a review as coming from the “NIH” doesn’t tell the whole story, which is that there is a center within the NIH that was foisted upon it in the 1990s by a woo-loving Senator and his allies that has a long history of pseudoscience and bad science. That is where this review came from.

Stage-setter #4 is a another straw man and red herring. No one—and I mean no one—who criticized the NCCIH systematic review claimed that it was using anything but RCTs as its basis. Our complaints were, quite clearly, that the RCTs used were either small, of poor quality, or misinterpreted. For example, I pointed out how in reality this systematic review produced a negative result for acupuncture for back pain. To summarize what I said then, the only clearly “positive” results were found in studies that compared acupuncture versus usual care or no treatment and only one study comparing “verum” acupuncture to sham showed a positive result, that result being “slight but significant.” To me, “slight but significant” means small and statistically significant but almost certainly not clinically significant. This sort of result is very common in studies of treatments that are no better than placebo controls, and the proper way to report this would have been that there is no good evidence that acupuncture does better than sham/placebo for low back pain. Worse, nowhere in the review is there any rigorous formal assessment of the quality of the studies that were used to do the review. This is hardly the dismissal of the review because the studies used in it were less than RCTs.

All this leads Mr. Weeks to a truly mind-blowingly stupid statement. (Note to Mr. Weeks: I said the statement was stupid, not you. This is not an ad hominem or “Trumpism.” Sometimes smart people make stupid statements.) Here it is:

So we have aligned JAMA, Mayo Clinic, NIH and RCTs. Now that’s a line-up from which one can expect shoddy science. That is the assertion in the name-calling article in response to the work of this triumvirate+ entitled “JAMA: Journal of Alternative Medicine Atrocities.” Atrocities. The approach of the NIH researchers is denigrated as “ridiculous.” The author asserts, on the basis of her personal experience, that despite positive outcomes in multiple studies, that yoga cannot possibly have real value for chronic pain but only for “mild discomfort.”

No, Mr. Weeks. Just no. Yes, Dr. LeMieux did mention her personal experience, but only after discussing Tables 3 and 4 from the systematic review and pointing out, in essence, what I pointed out: That the studies were actually mostly negative. Oh, and while we’re working on logical fallacies, Mr. Weeks is using a whopper of one, an appeal to authority (authorities, actually), while attacking Dr. LeMieux’s weakest argument and ignoring her strongest. And, again, this is not an ad hominem, Mr. Weeks. It is a description of your argument.

I’ll say one thing about Mr. Weeks. When he picks a logical fallacy to accuse his critics of, he doesn’t let go:

The group, from Australia, USA and Great Britain – the 3 last two named…[Orac] and Ernst – each used Trumpian tactics. One pre-emptively names the report as “one of the most blatant examples of quackacademic confabulation I have seen in ages.” Another’s label is “tooth fairy science.” Like the Florida judge deemed mistrustful to Trump by his heritage, the study is questioned based on the professional background of two members of the team: “If you want to know why NCCIH supports so much pseudoscience, look no further than it having chiropractors and naturopaths in high ranking positions.” Never mind that each of these NIH employees has a separate research doctorate along with a clinical doctorate.

I’ve already dealt with Mr. Weeks’ complaints about these criticisms in detail. So I will spare you the same arguments again; that’s what hyperlinks are for. Instead, I will point out that describing a report as “quackademic confabulation” is not “Trumpian” (for one thing, Trump rarely uses language that complex or flowery) or an ad hominem. It is a description of the science of the review. Second, it is not illegitimate to question the source of a review article. Indeed, when some of the authors belong to “professions” (and I do use the word loosely) based on pseudoscience, it is not only legitimate to point that out, but mandatory. As for their having PhDs in addition to their quack degrees, who cares? They’re still chiropractors and naturopaths, and they still advocate for chiropractic and naturopathy.

Edzard Ernst nailed Mr. Weeks’ methods perfectly:

The principle is adorably simple and effective:

  • you are faced with some criticism,
  • you find it hard to argue against it,
  • therefore you elect to attack your critic personally,
  • you claim that the criticism is insulting,
  • you re-name any criticism ‘TRUMPISM’,
  • and all is forgiven!

Weeks is not even original; others have used this method before him. In fact, advocates of alternative medicine thrive on ad hominem attacks, and without them they would go nowhere.

Exactly. This is the second time Mr. Weeks has done exactly that.

Here’s the funny thing. Whenever a critic of CAM does do what Mr. Weeks claims he wants, and tries to remain respectful, sticking to just the science and facts, does Mr. Weeks respond any differently? Not that I can recall, but it’s possible confirmation bias is clouding my memory. Maybe a prospective experiment is in order. Perhaps I’ll keep an eye out for Mr. Weeks’ next attack on science and then intentionally write a perfectly measured, reasonable response with no snark, sarcasm, or hyperbole whatsoever. Compared to my usual writing it’ll be as boring as hell to read and will probably result in record low traffic for a post, but it would make an interesting experiment. We’ll see.

In the meantime, I have a friendly suggestion for Mr. Weeks. Given his constituency among CAM practitioners and believers, whom he represents in the media frequently, he might not want to use Donald Trump’s name as an insult so freely or frequently. After all, a lot of believers in alt-med love Donald Trump. Love him. I’m serious. For example, Mr. Weeks might want to wander over to Mike Adams’, where Mikey is beside himself with glee at Trump’s victory in the election. Advocates of “autism biomed” are equally elated. Maybe it’s because Donald Trump is just like them, full of conspiracy theories and antivaccine to the core. He even ran a pyramid scheme multi-level marketing scam selling supplements. As Ernst also pointed out, Donald Trump is one of their own.