Cancer Clinical trials Complementary and alternative medicine Medicine Quackery

Beth Israel joins the Academic Woo Aggregator!

I feel bad.

I realize that I’ve been completely neglecting my Academic Woo Aggregator. You remember my Academic Woo Aggregator, don’t you? It was my attempt to compile a near-definitive list of academic medical centers that had “integrated” woo into their divisions or departments of “integrative medicine” (i.e., departments of academic-sounding quackery). Perusing it, I now realize that it’s been over five months since I did a significant update to it. You just know that, given the rate of infiltration of unscientific medical practices into medical academia as seemingly respectable treatment modalities that there must be at least several new additions to this role of shame. Alas, even today, having been shamed myself by the realization of my failure to keep the list updated, I’m not going to do the full update and revamping that the Woo Aggregator cries out for. However, that doesn’t mean I can’t do a piecemeal addition here and there. That doesn’t mean I can’t point out new additions to the Woo Aggregator as they pop up, even if it takes me a while to find the time to give it the facelift it needs.

It doesn’t mean I can’t call out hospitals like Beth Israel when they fall into woo, especially when they do it in a big way for cancer patients.

The first thing to know about this degeneration of a once great academic powerhouse is that, as is the case for many centers of “complementary and alternative medicine” (CAM) or of “integrative medicine” (IM), when looking for the reason why physicians ostensibly dedicated to scientific medicine would embrace this woo, look for the financial reason. In this case, the financial incentive comes from Donna Karan, founder of the famous DKNY line of clothing. In search of her dollars, Beth Israel has turned over an entire cancer treatment floor to woo:

Medical advances sometimes happen in strange ways. Someone finds a fungus in dirty lab dishes and — eureka! — penicillin is born. Now a premier Manhattan hospital is turning a cancer-treatment floor over to a world-famous fashion designer in the hope that serendipity, science and intuition will strike again.

A foundation run by Donna Karan, creator of the “seven easy pieces” philosophy of women’s wardrobes and founder of the much-imitated DKNY line of clothing, has donated $850,000 for a yearlong experiment combining Eastern and Western healing methods at Beth Israel Medical Center. Instead of just letting a celebrated donor adopt a hospital wing, renovate it and have her name embossed on a plaque, the Karan-Beth Israel project will have a celebrated donor turn a hospital into a testing ground for a trendy, medically controversial notion: that yoga, meditation and aromatherapy can enhance regimens of chemotherapy and radiation.

Whatever happened to the days when a wealthy donor would be happy just to have her name on a building or on a floor? I guess they never truly existed. However, it’s truly depressing to see a former academic powerhouse accommodate such wishes just because they’re trendy, because a wealthy donor is willing to fund them, and because, no doubt, hospital administrators perceive it as good publicity and a draw for credulous patients. I wish I could view this as merely a cynical ploy to add a spoon full of woo to make the real scientific medicine go down easier, but somehow I don’t think that’s the case. I also really, really hate it when I see the same old false dichotomy of “Eastern” versus “Western” medicine. There is no such thing as “Eastern” or “Western” medicine. As blog bud PalMD put it:

I’ll stipulate that by “Eastern and Western healing methods” they mean credulous Americans’ impression of what is done in “the East” vs. science-based medicine as it is practiced around the world (the Eastern and Western bits).

What is “Eastern” medicine and what Americans think “Eastern” medicine is are often related only by coincidence.

There’s an old saying, though, that’s so famous and overused that it’s become a cliché, and that’s that the road to Hell is paved with good intentions. Donna Karan hopes that her new “Urban Zen” center will help patients deal with the side effects of chemotherapy. There’s no doubt that, depending on the regimen, chemotherapy can cause very unpleasant side effects, and the alleviation of those side effects is an active area of research in scientific medicine. Here’s what the program will involve:

Fifteen yoga teachers will be sent to Beth Israel’s ninth-floor cancer ward starting in January to work with nonterminal patients, and nurses will be trained in relaxation techniques. Their salaries, as well as a cosmetic overhaul of the ward, are being paid for by Ms. Karan’s Urban Zen Foundation, created after her husband and business partner, Stephan Weiss, 62, died of lung cancer in 2001.

While other hospitals in New York and across the country have dabbled in yoga, the new Beth Israel project is broader, better financed and more integrated into the medical protocol, and because of Ms. Karan’s concern that it might be dismissed as touchy-feely nonsense, it includes a research component. Ms. Karan hopes to prove that the Urban Zen regime can reduce classic symptoms of cancer and its treatment, like pain, nausea and anxiety (thereby cutting hospital stays and costs) and serve as a model for replication elsewhere.

As is the case with virtually all such efforts, this is about proselytization. Donna Karan is a believer, and she is looking for evidence to support her belief in order to justify further proselytizing to other hospitals. It’s all very much like a religion, so much so that we’re hearing the usual excuses that that evil reductionistic “Western” medicine can’t adequately study whether yoga can do what is claimed for it:

But Dr. Benjamin Kligler, the research director in integrative family medicine for the Beth Israel-affiliated Continuum Center for Health and Healing and the research project’s principal investigator, acknowledged that the experiment of yoga teachers and their interaction with patients did not lend itself to the random, double-blind placebo trials favored in the medical world.

“The truth is, from a very traditional research perspective, that’s a problem,” Dr. Kligler conceded, adding that it might be time for the medical establishment to consider a new research model for what he called “lifestyle interventions.”

Poppycock. Even though a randomized, double-blind, placebo-controlled trial can’t be done in a classical sense, but that’s a convenient excuse by woo-meisters for not doin gthe most rigorous studies possible. For example, when a study of Tai Chi as an immune booster was done, the study itself was not really a study of Tai Chi but rather a study of mild exercise versus no exercise in the elderly–with predictable results. Of course, the positive results from that trial were attributed to the woo, rather than to mild, low impact exercise, which, when stripped of all its “Eastern” mysticism, is all that Tai Chi really is. The problem was, the Tai Chi study had no control group in which patients underwent another form of mild, low impact exercise without all the “spiritual” trappings to see if that had a similar effect.

I’m expecting to see the same sort of thing here.

You see, it’s not unreasonable to hypothesize that flexibility exercise might make people undergoing chemotherapy feel better through whatever mechanism, be it distraction or a physiological effect of physical activity. However, this particular form of flexibility exercise, yoga, is overlaid with all sorts of “Eastern” mysticism that credulous CAM aficionados love so dearly. In fact, the “problem” that Dr. Kligler laments about testing yoga for this indication are really not that big a problem. True, blinding is impossible, but we surgeons do unblinded randomized experiments in surgery all the time. (It’s not really practical to blind surgeons to the surgical procedure performed, nor is a sham surgery control group usually feasible, after all.) It’s a bit more difficult to get usable scientific data from clinical trials under such circumstances, but by no means anywhere near impossible. Certainly, it’s not so difficult that we should consider jettisoning current clinical trial methodology, as Dr. Kligler seems to imply that we should.

Of course, where there’s one form of woo, there’s other woo. After all, it’s highly doubtful that Donna Karan would try to sell her yoga program to an institution not likely to be receptive to her woo, and, boy, oh, boy is Beth Israel open to woo. Just get a load of its Continuum Center for Health & Healing. Just peruse its webpage, and it’s a veritable cornucopia of woo and unscientific medical modalities. It’s all there. There’s leech therapy for osteoarthritis, reiki, traditional indigenous healing therapies, acupuncture, even that woo of woo, that quackery to rule all quackeries, homeopathy:

As a pediatrician Dr. Stern finds that homeopathic medicines, which are safe and efficacious, are particularly well suited for the care of children’s common ailments. In her practice Dr. Stern uses homeopathy not only to treat acute problems such as upper respiratory infections and acute ear infections but also to treat more chronic conditions. For children suffering from conditions such as asthma, recurring ear infections, eczema and behavioral problems homeopathy has helped reduce or eliminate daily doses of antibiotics and steroids which are often required for symptomatic control.

Such quackery has no place in an academic medical center–or any medical center, for that matter. Worse, this quackery is being administered to children. Homeopathy is water. Period. Diluting a substance does not render it more potent, nor does shaking it. Period. There is no plausible physiological mechanism by which homoepathy could work, and homeopathy goes against well-established science. Period. Barring incredibly compelling evidence for its efficacy in non-self-limited diseases, there is no reason to suspect that whatever effects are attributed to homeopathy are due to anything more than the placebo effect, regression to the mean, the expectation effect, confirmation bias, or a combination thereof. Period. Yet this woo is being offered at Beth Israel as though it’s on par with scientific medicine–to Beth Israel’s shame. Worse, its being promoted by true believers. Don’t believe me? Then get a load of this detailed and credulously positive description of homeopathy. I just about spit up my drink when I saw Samuel Hahnemann’s homeopathic provings as “meticulously executed experiments” and indulged in appeals to ancient knowledge:

Although Hahnemann was the first to clearly formulate the law of similars and first began to use its principals in a systematic way, he clearly states that a number of people before him had very similar ideas. The “Law of Similars” has a very rich historical basis. Hippocrates (VI century, B.C.) wrote: “through the like, disease is produced, and through the application of the like it is cured”. Celsus and Paracelsus are known to have used the Law of Similars in their practice. The Delphic Oracle proclaimed:” That which makes sick shall heal”. In one of the ancient Jewish writings, called Mekilta, we read: “Man does not heal with the same thing with which he wounds, but he wounds with a knife and heals with a plaster. The Holy One, blessed be He, however is not so, but He heals with the very same thing with which he smites.” Modern medicine uses this principle daily. The “father” of immunology , Dr. Emil Adolph von Behring, wrote about the origins of immunology: “By what technical term could we more appropriately speak of this influence than by Hahnemann’s word “homeopathy”? Desensitization techniques used by conventional allergologists utilize very small doses of allergens to stop a pathological response in the patient.

If ancient knowledge is so great, I always ask whether believers in these ancient modalities would like to go back to the medical systems that existed thousands, or even 200 years ago (the time of Samuel Hahnemann) and see how well it worked compared to today’s scientific medicine. Right on cue after appeals to ancient knowledge are also appeals to popularity:

In England, Australia, New Zealand, India, Russia, Brazil and many other countries homeopathy is recognized as a valid mode of treatment. In the United Kingdom, around 42% of physicians refer patients to homeopathic practitioners, and homeopathic training is the most popular post-graduate training program. In France, approximately 36% of the public and 32% of the physicians use homeopathic remedies. Moscow, Russia, has a homeopathic hospital with a large homeopathic outpatient clinic and many homeopathic pharmacies with many people using various homeopathic preparations daily. India has approximately 125 four- and five-year homeopathic medical colleges with over 100,000 homeopathic doctors practicing around the country.

If you really want to throw up (homeopathically, of course), read another homeopathy article entitled Homeopathy — How it works & when to use it. Its deconstruction is left as an exercise for the reader. I know you guys can handle such a task just fine. While you’re at it, feel free to take on the other woo on the Continuum website. Suffice it to say it’s–shall we say?–a “target-rich environment.”

Of course, no true floor of woo would be complete without real “integration” plus feng shui:

“A lot of other hospitals have integrative medicine, but it’s kind of stuck away in the basement,” said Dr. Merrell, who, not coincidentally, is Ms. Karan’s internist. “People like to think it’s not there.” Starting in November, the cancer ward will be renovated by Ms. Karan, the architect David Fratianne and Alex Stark, a feng shui master. The dull beige walls and green linoleum tile floors will be replaced with bamboo wallpaper and cork floors. Nooks and crannies now used for brown-bag lunches and naps and crammed with a desultory selection of dusty books will be turned into yoga, prayer and meditation retreats for patients, their families and nurses.

As I said before, this is more religion–excuse me, “spirituality”–not science. And, true to most “alternative” medicine, it relies on testimonials. In this case, it’s the story of Lynn Kohlman, a photographer, model and DKNY fashion director who inspired Donna Karan when she developed cancer. In fact, a quote by Karan is most revealing as to the true motivation for the Urban Zen center:

She [Kohlman] intensified her yoga. “She asked for it in the hospital,” said Ms. Karan, who practices yoga daily. “She needed it, she wanted it.

“This works,” Ms. Karan insisted. “Now we have to prove it in the clinical setting.”

That’s exactly the problem. Karan believes that yoga works (although one can’t help but note that it failed to save her friend), and she’s looking for evidence to support her belief, not to see if her belief stands up to experimental testing that could falsify it. That’s one key difference between science and pseudoscience. Given Karan’s attitude, think about this: If the results of the “clinical trials’ being carried out at Beth Israel fail to bear out her belief, how long do you think her generosity will continue? CAM boosters frequently criticize trials of “conventional” pharmaceuticals because of perceived conflicts of interest due to the funding source. That cuts both ways. Don’t think that doctors running the “studies” of yoga at Urban Zen don’t know what their wealthy patron hopes that they will find. Of course, they appear to be true believers as well; so they want to find it too.

Don’t get me wrong. I’m not opposed to using yoga because it makes patients feel better. That’s not what this is about, however, no matter how much Donna Karan and the academic woo-meisters at Beth Israel try to argue otherwise. I wish it were, but it’s not. No, in reality it’s about the rejection of science in favor of “spirituality,” the embrace of testimonial evidence over scientific evidence, and the abandonment of science and reason in medicine–or, even worse, their subversion to serve the beliefs of the people promoting these modalities.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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