Quote of the day: “We need a more fluid concept of evidence”

I’ve waited to write more more about the roots of unscience in medical schools and universities, to include what I knew would be a priceless synopsis of his trip to the United States. Professor David Colquhoun of the Dept of Pharmacology at University College in London, recently spoke at the Integrative Medicine at Yale. As covered in-depth here, medical professionals in the UK are actively working to advocate for the safety and welfare of patients and the integrity of science in medicine by exposing quackery.

As readers will remember, Yale joined nearly 40 other top medical schools around the U.S. opening integrative medicine programs and bringing alternative modalities to their medical training and practices. Much of the funding and support for spreading these programs comes from the $250 million a year in federal grants through the NCCAM and National Cancer Institute. (There’s a reason so much flawed research and ideas surround cancer.) Another major source is through private billionaire backers who began the Bravewell Collaborative for Integrative Medicine in 2001, with the goal of integrating alternative modalities into mainstream medicine.

Bravewell was founded by John Mack, the Wall Street tycoon, and is run by his wife. Based in Minneapolis, in just its first 5 years, it had raised $21 million from backers, all of whom had to agree to support Bravewell in every course of action. It has established the Consortium for Academic Health Centers for Integrative Medicine with nearly 40 medical schools now, all readily abandoning science to teach “other ways of knowing” in return for countless millions of dollars. Forbes wrote about one of the those centers, Duke Center for Integrative Medicine, when it opened the fall of 2006 after being financed with a $10 million donation from the C.J. Mack Foundation. As Robert Lenzner reported for Forbes:

The Macks, along with other Bravewell members, also raised money for the PBS special this year, "The New Medicine," which featured the use of hypnosis and guided imagery as techniques to reduce pain and help ill people lead active lives. The special won the Freddie Award for Health and Science Media in the area of health and wellness.

Bravewell is aiming its proselytizing guns at university medical centers, attempting to promote the construction of integrative health facilities. It funded the development of the curricula on the topic for medical schools and trains 30 doctors a year in integrative medicine at a cost of $30,000 per doctor, using the works of Andrew Weil, a best-selling author and guru in the wellness field. And it gives a biannual $100,000 prize to recipients of its Bravewell Leadership Award, given to doctor who have made a big impact within the field.

Bravewell has also recently set up its own BraveNet (Bravewell Integrative Medicine Research Network) with 8 of those university integrative medical centers, to increase knowledge about alternative modalities and their “evidence-base.”

One of the most revealing parts of professor Colquhoun’s talk was his coverage of the recent Integrative Medicine Scientific Symposium at Yale [JFS background here; YouTube video here] where Dr. David Katz, the founder and direct of the integrative program, spoke. Do listen to professor Colquhuon’s tape of Dr. Katz’ talk as he describes randomized clinical trials of vitamins for fibromyalgia, homeopathy for ADHD, coenzyme-Q10 and carbetalol for heart disease, phytoestrogens, yoga, acupuncture, and others that all found no demonstration of clinical efficacy using the most credible clinical evidence. We know the evidence on antioxidants also shows them to be ineffective, said Dr. Katz, but “we need to think more fluidly about evidence.” He repeated this idea several times. As Colquhoun reports today:

Pretty remarkable uh? Dr Katz goes through several different trials, all of which come out negative. And what is his conclusion? You guessed. His conclusion is not that the treatments don’t work but that we need a “more fluid concept of evidence” ...

This is not science. It isn’t even common sense. It is a retreat to the dark ages of medicine when a physician felt free to guess the answer. In fact it’s worse. In the old days there was no evidence to assess. Now there is a fair amount of evidence, but Dr Katz feels free to ignore it and guess anyway. He refers to teaching about evidence as ‘indoctrination’, a pretty graphic illustration of his deeply anti-scientific approach to knowledge. And he makes a joke about having diverted a $1m grant from CDC, for much needed systematic reviews, into something that fits his aims better. [“We knew it was silly, but on the other hand, a million dollars sounded really good,” said Dr. Katz.]

As Colquhoun explains with no holds barred spunk, the foundation of these alternative-integrative programs is nutritional quackery, nutrigenomics, antioxidants and flavonoids, diets and ‘healthy’ eating [beyond basic nutritition to prevent deficiences] for preventive health and optimum wellness. These issues have been heavily covered here at JFS, but the unsoundness of so much of them is still difficult for many readers to grasp because feel-good modalities have become so incorporated into what people believe is legitimate health and medicine. They also include just enough interventions with a degree of efficacy (such as general massage and relaxation techniques to reduce anxiety and pain perception) to make all the mind-body vitalism-based modalities and their claims appear credible. It’s understandable for people to want to believe that by diligently following a certain lifestyle and eating ‘healthy’ they can prevent chronic diseases of aging, cancers, diabetes and heart disease. But disease, just like actual obesity, is not a measure of good behavior or eating some certain way.

In response to dietary quackery in preventive health, optimal wellness and longevity, experts funded by the National Institute on Aging emphatically stated: “Our language on this matter must be unambiguous: there are no lifestyle changes, surgical procedures, vitamins, antioxidants, hormones or techniques of genetic engineering available today that have been demonstrated to influence the processes of aging.”

But fostering these beliefs among consumers is an ingenious way to enact policies to control food and lifestyles and get people to believe it’s in their best interests. It also promotes blame and discrimination against those with health problems, as it being their own fault and costing everyone else. This melding of alternative beliefs into mainstream medicine is seeing rapid success. Some additional background information may be helpful in understanding why. Bravewell has also created powerful “strategic partnerships” to promote “preventive health and wellness” and alternative modalities as part of the national health agenda. Its partners seek to “change the way healthcare is delivered in this country.” You’ll recognize most of these influential organizations, such as the NIH, National Committee for Quality Assurance (NCQA), National Business Group on Health (behind employer and insurer “wellness” programs and insurance mandates) and Robert Wood Johnson Foundation.

As professor Colquhoun reports today, the main thing that’s brought medical schools and universities down to the level of promoting nonscience is “simply money.” But he ends on a positive note, saying that this can be stopped if people and healthcare professionals care enough to speak out. When Florida State University proposed setting up such a program, public pressure on legislators and the governor was able to stop the passage of a funding bill and shut the project down. “In the end, reason won,” he writes. Will healthcare professionals and consumers act to ensure Yale and the 39 other universities on the list follow their example? Will they speak out against these wellness programs being enacted by government agencies, insurers and employers? Or is the money too good?