DC's Improbable Science

Integrative baloney @ Yale

May 16th, 2008 · 28 Comments

The extent to which irrationality has become established in US Medicine is truly alarming I wrote about Quackademics in the USA and Canada on my last trip to the USA, and on my May trip I visited Yale, where I decided to try a full frontal attack. [download the poster]

Several US blogs have written about this phenomenon. For example the incomparable Orac at the The Academic Woo Aggregator , and Dr RW (R.W. Donnell) , see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave. Excellent US stuff too at Science-based Medicine (try this and this). There is also a good analysis of what’s happening at Yale by Sandy Szwarc at Junkfood Science.

Remember that the terms ‘integrative’ and ‘complementary’ are euphemisms coined by quacks to make their wares sound more respectable, There is no point integrating treatments that don’t work with treatments that do work.

‘Integrative Medicine’ at Yale says, like all the others on the roll of shame, says “we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide”. They all pay lip service to being “evidence based”, but there is just one snag. It is untrue. In almost all cases, the evidence is either negative or absent. But this does not put them off for a moment. The whole process is simply dishonest.

The evidence

The evidence has been summarised in several books recently, The following books are particularly interesting because they are all ‘views from the inside. Edzard Ernst is the UK’s first Professor of Complementary Medicine. Barker Bausell was research director of an NIH funded Complementary and Alternative Medicine Specialized Research Center at the University of Maryland.

The first two books go through the evidence fairly and carefully. They show no bias against alternative treatments (if anything, I’d say they are rather generous in cases of doubt).

For a first class US account try Barker Bausell’s Snake Oil Science

 Bausell’s book gives an excellent account of how to test treatments properly, and of all the ways you can be fooled into thinking something works when it doesn’t. Bausell concludes “There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo”.
 For an excellent account of how to find the truth, try Testing Treatments (Evans. Thornton and Chalmers). One of the authors, Iain Chalmers, is a founder of the Cochrane library and a world authotity on how to separate medical fact from medical myth.

It can now be said with some certainty that the number of alternative treatments that have been shown to work better than placebo is very small, and quite possibly zero,

With that settled, what’s going on at Yale (and many others on the roll of shame)?

David L. Katz, MD, MPH, FACPM, FACP, is founder and director of the Integrative Medicine Center (IMC) at Griffin Hospital in Derby, Connecticut. He is also an associate professor, adjunct, of Public Health and director of the Prevention Research Center (PRC) at the Yale University School of Medicine in New Haven, Connecticut.

That sounds pretty respectable. But he is into not just good nutrition, exercise, relaxation and massage, but also utterly barmy and disproved things like homeopathy and ‘therapeutic touch’.

 Watch the movie It so happens that Yale recently held an “Integrative Medicine Scientific Symposium”. Can we find the much vaunted evidence base there? That is easy to answer because three hours of this symposium have appeared on YouTube. So this is the public face of Yale medical school. There’s some interesting history and a great deal of bunkum and double-speak. To save you time, I’ve cut out about 6 minutes from the movies.

Dean of education Richard Belitsky and Dr David Katz

Pretty remarble 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” .

It’s equally bizarre to hear Richard Belitsky, Dean of Medical Education at Yale saying he is “very proud” of this betrayal of enlightenment values. If this is what Yale now considers to be education, it might be better to go somewhere else.

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. Katz asks, as one must, what should we do if there is no treatment that is known to help a patient. That is only too frequent a problem. The reasonable thing to say is “there is no treatment that is known to help”. But Dr Katz thinks it’s better to guess an answer. There is nothing wrong with placebo effects but there is everything wrong with trying to pretend that you are doing more than give placebos. Perhaps he should consider the dilemmas of alternative medicine. You can read about more about Yale’s activities here and in interviews here. Dr Katz says “The founding approach—and I think Andrew Weil, MD, gets the lion’s share of credit for establishing the concept —is training conventional practitioners in complementary disciplines”. Let’s take a look at this hero. Try, for example, Arnold Relman’s “A trip to Stonesville“. “According to Weil, many of his basic insights about the causes of disease and the nature of healing come from what he calls “stoned thinking,” that is, thoughts experienced while under the influence of psychedelic agents or during other states of “altered consciousness” induced by trances, ritual, magic, hypnosis, meditation, and the like.” “To the best of my knowledge, Weil himself has published nothing in the peer-reviewed medical literature to document objectively his personal experiences with allegedly cured patients or to verify his claims for the effectiveness of any of the unorthodox remedies he uses.” Here is the advertisment for Andrew Weil’s nutrition symposium. Not only does this yet again propagate the great antioxidant myth, but a few moments with Google show that it is riddled with vested interests, as already pointed out on Quackademics in USA and Canada. What has brought medical schools down to this level? That isn’t hard to see, The main thing is simply money. Very few university administrators have the intellectual integrity to turn down money, whatever the level of dishonesty that is required by its acceptance. You can buy a lot of silence for$100m

The US Taxpayer has given almost a billion dollars, via NIH.

Wallace Sampson, MD says of NCCAM

“. . it has not proved effectiveness for any ‘alternative’ method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed”

“Its major accomplishment has been to ensure the positions of medical school faculty who might become otherwise employed in more productive pursuits.”

“Special commercial interests and irrational, wishful thinking created NCCAM. It is the only entity in the NIH devoted to an ideological approach to health.”

NCCAM has given money from some very dubious trials too, Both Orac on Respectful Insolence and Dr RW (R.W. Donnell) have written recently about the NCCAM-funded trial of “chelation therapy”, as first exposed in a devastating article by Kimball C. Atwood IV, MD; Elizabeth Woeckner, AB, MA; Robert S. Baratz, MD, DDS, PhD; Wallace I. Sampson, MD on Medscape Today. This is a $30 million, 5-year, phase 3 Trial to Assess Chelation Therapy (TACT) for coronary artery disease. “But how did such a crappy study ever come to be, much less be funded by the NIH to the tune of$30 million? The answer, not surprisingly, involves one of the foremost promoters of quackery in the federal government, Representative Dan Burton (R-IN).”

We conclude that the TACT is unethical, dangerous, pointless, and wasteful. It should be abandoned.”

“TACT is not the only example of an unethical and scientifically worthless trial being funded not because the science is compelling but because powerful lobbies and legislators who are true believers in woo applied pressure to the NIH to do them”

The Bravewell Collaboration is the other major source of money. Forbes Business says “Bravewell is not some flaky New Age group”. Well dead wrong there, That is precisely what it is.

 This group of ultra-rich people, according to its boss, Christy Mack, has a ” . . common goal —fast-tracking integrative medicine into mainstream medicine” So Bravewell is corrupting the search for real knowledge and real cures with big bucks. You can buy a lot of hokum for $100m. The money comes from Morgan Stanley,  “John Mack earned the nickname “Mack the Knife” during his ascension to the top of the company [Morgan Stanley] ladder, known for his aggressive cost cutting and consolidation, managerial efficiency, yelling matches, and brutal treatment of others.” “From 2002 until July 2004, Mack was Co-CEO of Credit Suisse, where he eliminated about 10,000 jobs, cut costs by about$3 billion, and turned the company around to post a huge profit. Accused by SEC of insider trading in 2001, but escaped despite pressure from Senate Finance Committee Chairman Charles Grassley in 2006. Returned as CEO of Morgan Stanley in 2005.”

Bravewell is run by his wife, Christy Mack (Mack-the-wife?) Vice-President, The C.J. Mack Foundation, Member, Board of Directors, The Bravewell Collaborative.

The Flexner report.

The story of Bravewell stands in chilling contrast to another case of philanthropy. Andrew Carnegie’s foundation financed the report by Abraham Flexner, “Medical Education in the United States and Canada” (1910) [download, 15 Mb] . That report was responsible for dragging medical education out of the dark ages
almost a century ago. It resulted in creation of some of the best medical schools anywhere (including Yale).

“By educational patriotism I mean this: a university has a mission greater than the formation of a large student body or the attainment of institutional completeness, namely, the duty of loyalty to the standards of common honesty, of intellectual sincerity, of scientific accuracy.”

“The tendency to build a system out of a few partially apprehended facts, deductive inference filling in the rest, has not indeed been limited to medicine, but it has nowhere else had more calamitous consequences.”

Flexner (1910).

Now another philanthropist is using big bucks to reverse the process and push medicine back into the 19th century.

Flexner would have thought it quite inconceivable that in 2007 medical schools would be offering Continuing Medical Education in homeopathy.

Perhaps they don’t even know it’s happening. If they say firmly that they don’t want it, it will go,

It’s been done before

Florida State University, allegedly under political pressure, proposed to set up a school of Chiropractic. That would have made it Florida State school of snake-oil salesmanship. What a sad fate. [ Science magazine comment] [comment form Paul Lee] [Comment in St Petersburg Times]

But the academics stopped it. An FSU professor, Albert Stiegman, predicted the future campus map.

According to FSUnews

“The Florida Board of Governors voted 10-3 Thursday to deny Florida State University’s request to build a chiropractic school.”

“However, the passage of the bill for the chiropractic school by the Legislature seemingly bypassed the Board of Governors.”

In the end, reason won. Let’s hope that Yale follows their example.

The problem of Yale has been taken up with great eloquence by some US commentators

Dr RW (R.W, Donnell): “Quackademic Medicine at Yale

“By the way, where’s the AAMC in all this? Aren’t they supposed to be guardians of integrity and professionalism in medical education? Are they asleep at the switch or is money silencing them too?”

Orac (Respectful Insolence): “Integrative” medicine at Yale: A more “fluid” concept of evidence?

“after the Dean of the Yale School Medicine embarrassed himself in the introduction by saying he’s proud of how far this nonsense has come, Dr. Katz takes the stage and demonstrates the sort of hostile attitude towards science that, if allowed to take root will be the death of scientific medicine in any meaningful form at U.S. medical schools”

Junkfood Science. Sandy Szwarc on “Quote of the day: ;We need a more fluid concept of evidence’

“Will healthcare professionals and consumers . . . . speak out against these wellness programs being enacted by government agencies, insurers and employers? Or is the money too good?”

Science-based Medicine. Steven Novella writes on “Changing the rules of evidence“. When alternative medicine people do not like the evidence, they change the rules to get the outcome that they want, as seen so graphically in this post. They have always done this, but it is only recently that this sort of behaviour has been endorsed by places like Yale.

The Macho Response, another US blog, comments bluntly, in “Yale wants a more fluid concept of evidence

This is beyond embarrassing – it’s a fucking crime – and it’s happening at Yale University and many others.

If you’re in the medical profession (and I know many of my readers are) you need to go here – now.

Kiosque Médias writes as follows

Pour ceux qui s’intéressent à la médecine et à la santé, le blog de David Colquhoun vaut probablement le détour. Ce professeur-chercheur au département de neurosciences, de physiologie et de pharmacologie de l’University College London y décrypte les résultats d’études médicales, en mettant l’accent sur les médecines alternatives. Et il est rarement tendre!

James Randi Newsletter. The hit rate soars after a recommendation this piece by the amazing Randi.

Hokum-Balderdash Assay. Edwardson writes

“Yale University is going to the ducks. It now has an Integrative Medicine program and in April held its first annual Integrative Medicine Scientific Symposium. I think there must’ve been a typo there. They must’ve meant “Ist Annual I.M. Pseudoscientific Symposium.” There! Now we’ve done away with the oxymoron.”

Why is Yale so secretive about its quackery department?,

Most universities are only to keen to boast about their grant income. Not in this case though. When I asked how they funded their quackery, all I got was a letter that had very obviously been drafted by a lawyer.

“As a private institution, Yale University is not generally subject to the U.S. Freedom of Information Act. We therefore respectfully decline to compile and provide the information you have requested.”

So pretty clear signs of guiltiness there.

Dr David Katz, yes, he of the “fluid concept of evidence”, has posted an article, Health Hazards of rhe Blogoshere. If it quacks like a duck . . .

It seems that he has been a bit alarmed by the reaction of the bloggers. It starts, rather pompously, thus.

“Being well educated does not guarantee you’ll always be right, and it certainly doesn’t guarantee everyone will agree with you. But it still matters. Or at least it used to “

But the rest if it reads less like a defence than as an admission of guilt, thus prompting the next item.

Paul Hutchinson’s blog

 A quack who admits it picks out a quotation from Dr Katz’s response and turned into a cartoon, released to the public domain, So here it is.

Respectful Insolence.

Orac comments too, in “Fluid evidence” strikes back: Dr. Katz versus the skeptical blogsophere”. He does a terrific job in taking apart the response from the hapless Dr Katz.

“No, Dr. Katz does not like his first encounter with the medical blogosphere at all. Indeed, he is so unhappy that apparently a few weeks ago he tried t answer the bloggers who had raked him over the coals for blatantly advocating “integrating” unscientific woo like homeopathy with scientific medicine. Unfortunately for him, he did not do a particularly good job of it. Indeed, what most stood out as I read his rejoinder was that he does not answer a single substantive criticism leveled at his comments. Not one. Instead, he does what pretty much all woo-meisters do when criticized for shifting goalposts and appealing to other ways of knowing besides science as a means of “proving” that their preferred fairy dust works; he wraps himself in the mantle of the brave iconoclast willing to challenge accepted dogma and whines about the peons who criticized him, heaping contempt on the bloggers who had the temerity to criticize his advocacy for pseudoscience because to him they have not earned the right to criticize his (at least in his opinion, apparently) greatness in comparison to him.”

28 responses so far ↓

• 1 jdc325 // May 16, 2008 at 16:14

Nutritionism: an industry that uses all the same dirty tricks as Big Pharma, but doesn’t have all those tiresome regulatory requirements. In both cases it is all about the money.

I was starting to find this post a bit depressing until I saw the picture of Stiegman’s Campus Map.

• 2 klymkowskky // May 16, 2008 at 22:42

Brilliant and depressing. It remains befuddling how this anti-scientific and really, anti-rational hokum not only survives but flourishes.

I ascribe it to a failure of science education specifically and liberal education in general to cultivate and celebrate critical thinking.

• 3 badly shaved monkey // May 17, 2008 at 08:06

It is really quite extraordinary how much effort these fools are prepared to devote to protecting their belief in the unbelievable.

What Katz seems to be unaware of is that if he depends on “absence of evidence is not evidence of absence” he is getting painted into a progressively tighter corner as studies are done, show that woo therapy X doesn’t work in condition Y. This is, of course, one of the practical limitations of scientific analysis of medicine- too much crap, too little time. Because a good trial needs large numbers of people, a well defined and predefined end-point and an appropriate duration there will always be problems. The numbers issue is a genuine problem, but if something has a clinically meaningful biologically substantial effect then it should show up in reasonably sized trials. The problems come with the second two- the woos will quibble endlessly over the end-points and claim that the duration was never long enough.

I think we must accept that definitive, clear-cut disproof of most woo will never exist, but as we have seen with R. Barker Bausell, and Ernst and Singh’s recent books, although the coverage by good quality evidence is a bit patchy we are now in a position to state firmly that if it walks like a duck and quacks like a duck, then that therapy is quackery. Unfortunately, the arguments they use and the evidence they deploy take hundreds of pages to corral into a coherent mass and the reader has to be willing to go along for the ride. Having said that, people like Katz and Belitsky, who should be opinion leaders have no excuse- they have been given the training and they have spent the time.

• 4 badly shaved monkey // May 17, 2008 at 08:11

Hmm..should have proofed that offline. The point about showing “that woo therapy X doesn’t work in condition Y” is that they will simply bounce back and say, “What about therapy W and condition Y, or therapy X and condition A etc?” ad nauseam ad infinitum

• 5 badly shaved monkey // May 17, 2008 at 19:31

One of those “oh, and another thing moments”…

I’d very much like to engage in debate with these idiots and their cultural relativism. Obviously I am prepared to concede that scientific truth is a subjective construct, and I’d concede it to them face-to-face if they’d meet me at my chosen venue on the shoreline of Beachy Head. I make only one condition- that they start at the top of the cliff facing the sea and take 10 paces forwards to show me the subjective nature of the scientifically alleged fact of gravity.

• 6 urban » Blog Archive » Quackademics at Yale: a “fluid concept of evidence” // May 20, 2008 at 15:03

[…] US readers might be interested in the talk I gave at Yale on 12th May. It is wriiten up as "Integrative Baloney @Yale" […]

• 7 Science-Based Medicine » Changing the Rules of Evidence // May 20, 2008 at 20:49

[…] David Katz from Yale’s “Integrative Medicine” Program wants to allow for “a more fluid concept of evidence.” This way modalities he favors, such as homeopathy, that have failed by the generally […]

• 8 David Colquhoun // May 30, 2008 at 15:14

Thanks to James Randi for the link, Always sends the hit rate soaring.

• 9 Claire // Jun 6, 2008 at 16:05

Breaking news from Holford Watch:
http://holfordwatch.info/2008/06/06/patrick-holford-is-an-ex-professor-he-has-resigned-his-visiting-professorship-at-teesside/

• 10 Dr Aust // Jun 19, 2008 at 15:20

The “Retreat on Spirituality and Medicine” with the Benedictine nuns (sic) sounds particularly enticing (not).

• 11 A very bad report: gamma minus for the vice-chancellor // Jun 21, 2008 at 10:13

[…] The Health Professions Council (HPC) says that one of the criteria for registering new professions is aspirant groups must “Practise based on evidence of efficacy”. If that were actually applied, none of this process would occur anyway. No doubt the HPC will fail to apply its own criteria. On past form, it can be expected to adopt a “fluid concept of evidence“., […]

• 12 Five good books and a bad one // Jul 2, 2008 at 08:47

[…] Belitsky, to Yale’s own division of “fluid concepts of evidence”, as described at Integrative baloney @ Yale, and as featured on YouTube. There are a lot of cryptic allusions to alternative forms of evidence […]

• […] pablum and nonsense, the symposium came in for some well-deserved criticism, especially from here, here , here, and here. It was directed mostly at two participants: Yale’s Dean of Medical […]

• 14 Doctor Who? Deception by chiropractors // Jul 25, 2008 at 15:49

[…] State University famously turned down a large donation to start a chiropractic school because they saw, quite rightly, that to do so would damage their […]

• 15 Plain speaking: Wellington, Russell and Wakley on managers, reform, medicine and quacks // Aug 18, 2008 at 17:03

[…] distraction from a plague of lawyers, in New Zealand, here in the UK, and now in the USA (my movie, Integratative baloney@Yale, has recently been removed for YouTube. More on that coming soon). The duty of an advocate is to […]

• 16 Yale bans video -but then sees sense // Aug 19, 2008 at 21:09

[…] original piece on Integrative Baloney@Yale was posted on May 16th, after I got back from a visit there. The talk I gave there included a short […]

• 17 Science-Based Medicine » Postmodernist attacks on science-based medicine // Sep 15, 2008 at 14:01

[…] of Medicine in New Haven, Connecticut. My co-blogger Dr. Kimball Atwood IV has. Here’s the statement that Dr. Katz has become infamous for: I think we have to look beyond the results of RCTs in order […]

• 18 Better Health » The Oprah-fication Of Medicine // Jun 7, 2009 at 20:03

[…] to suggest that we need to think more “fluidly” about evidence. For this, he has been roundly criticized and even mocked in the blogosphere–and deservedly so. No wonder he’s a regular, along with Dr. […]

• 19 King’s Fund reports on alternative medicine: little consensus and less progress // Sep 9, 2009 at 11:22

[…] (NCCAM) Should Be Defunded;   Should there be more alternative research?;   Integrative baloney @ Yale, and most recently, \$2.5B Spent, No Alternative Med Cures found. […]

• […] medicine, it is also embracing non-evidence-based medicine. It is embracing a “more fluid concept of evidence” in order to allow CAM to obtain […]

• […] the national attention can be reviewed here, here, here, and here; the international attention is here. (Sorry about the flippancy; it was […]

• […] the national attention can be reviewed here, here, here, and here; the international attention is here. (Sorry about the flippancy; it was […]

• 23 Half-baked nonsense in The Atlantic // Jun 25, 2011 at 07:16

[…] main reason, I’d guess, is money. Through NCCAM and the Bravewell Collaborative, large amounts of money have been thrown to the winds and businesses like Yale and Harvard have […]

• 24 Bevis det eller hold opp « Skepsisbloggen // Aug 26, 2012 at 11:23

[…] Han tar for seg en annen person som føler seg misforstått, motarbeidet og misfornøyd etter at å ha blitt tatt alvorlig — professor David Katz ved Yale, som etter å ha måttet innrømme at bevisene for virkning […]

• 25 The Prince of Wales joins the “Detox” fraud // Jul 25, 2013 at 17:32

[…] on testing alternative treatments  So far they have produced no good new remedies (see also Integrative baloney @ Yale).They publish a database of knowledge about herbs. This is what they […]

• 26 Five good books and a bad one // Mar 27, 2015 at 11:27

[…] Belitsky, to Yale’s own division of “fluid concepts of evidence”, as described at Integrative baloney @ Yale, and as featured on YouTube. There are a lot of cryptic allusions to alternative forms of evidence […]

• 27 The road to alternative medicine apostasy | I World New // May 11, 2015 at 13:12

[…] when he advocated a “more fluid concept of evidence” with respect to medicine back in a now infamous 2008 talk. His message has been correctly characterized as, “Don’t abandon patients; abandon science […]

• 28 The road to alternative medicine apostasy [Respectful Insolence] | Gaia Gazette // May 11, 2015 at 15:04

[…] when he advocated a “more fluid concept of evidence” with respect to medicine back in a now infamous 2008 talk. His message has been correctly characterized as, “Don’t abandon patients; abandon science […]