Thursday, May 22, 2008

Quackery at Yale

Post below excerpted from DC's Improbable Science. See the original for links and more

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 also Testing Treatments (Evans. Thornton and Chalmers)
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.

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.

No surprise that it is the Left who are big on food nuttiness

Facts and evidence generally matter little to them. Looking good is all

Fried shrimp on a bed of jasmine rice and a side of mango salad, all served on a styrofoam plate. Bottled water to wash it all down. These trendy catering treats are unlikely to appear on the menu at parties sponsored by the Denver 2008 Host Committee during the Democratic National Convention this summer.

Fried foods are forbidden at the committee's 22 or so events, as is liquid served in individual plastic containers. Plates must be reusable, like china, recyclable or compostable. The food should be local, organic or both.

And caterers must provide foods in "at least three of the following five colors: red, green, yellow, blue/purple, and white," garnishes not included, according to a Request for Proposals, or RFP, distributed last week. The shrimp-and-mango ensemble? All it's got is white, brown and orange, so it may not have the nutritional balance that generally comes from a multihued menu. "Blue could be a challenge," joked Ed Janos, owner of Cook's Fresh Market in Denver. "All I can think of are blueberries."

The national nominating convention Aug. 25-28 will bring about 50,000 people to Denver, and many will scarf loads of chow served at catered parties. The prospect of that business windfall has tantalized caterers since Denver was named host city for the convention more than a year ago. Caterers praise the committee and the city for their green ambitions, but some say they're baffled by parts of the RFP.

"I think it's a great idea for our community and our environment. The question is, how practical is it?" asks Nick Agro, the owner of Whirled Peas Catering in Commerce City. "We all want to source locally, but we're in Colorado. The growing season is short. It's dry here. And I question the feasibility of that." Agro's biggest worry is price. Using organic and local products hikes the costs. "There is going to be sticker shock when those bids start coming in," he says. "I'll cook anything, but I've had clients who have approached me about all-organic menus, and then they see the organic stuff pretty much doubles your price."

The document, which applies only to the host committee's parties, came after months of work that involved discussions with caterers and event planners along the Front Range, says Parry Burnap, Denver's "greening" director. Burnap is attached to the host committee full time for now; the committee works closely with the city but is a separate, nonprofit entity.

Thousands of other parties hosted by corporations, lobbying groups, individuals, nonprofits and more will happen in Denver during the convention, Burnap says. None of them is subject to the committee's green agenda. The committee's effort to host eco-friendly events, she says, hinges on its determination not just to put on a smart convention but to transform Denver into a top-shelf green city. "We are hoping that everything we are doing for greening (the convention) has some legacy value," she says. The RFP, for example, will likely live on after the convention in a brochure the city will distribute widely to help guide local businesses interested in improving their green practices.

Burnap says taking the organic and local route may be more costly, but the committee thinks caterers will find ways to comply and still make a profit. "It takes some creativity because some of these things are more expensive," she says. "But we're at the front end of a market shift."

Joanne Katz, owner of Three Tomatoes Catering in Denver, cheers the committee's environmental aspirations and is eager to get involved with the convention, but she wonders if some of the choices the committee is making are really green. Compostable products, such as forks and knives made from corn starch, are often imported from Asia, delivered to the U.S. in fuel-consuming ships. But some U.S. products are made from recyclable pressed paper. Which decision is more environmentally sound? "Customers are beginning to demand these things, and we don't have all of the information," she says. "And we are doing the best we can, one project at a time."

Burnap acknowledged that figuring out what is most green can be difficult. "Maybe in 20 years, there will be better analysis for us to make better choices," she says. "One we are talking about now is, is it better to compost or to recycle? If you are using a cup for a beverage, is it better to be (plastic) and back in the materials stream, or compostable, biodegradable waste and go into the waste stream or compost? There are no definitive answers."

Composting for the convention hasn't been entirely figured out yet, she says. Colorado has commercial composting companies, such as A1 Organics in Eaton, but the link between the composters and caterers hasn't been made.

The committee is working with other groups to develop a carbon-footprint "calculator" that will measure the environmental impact of each event and suggest an "offset" - a fee - that will go toward a fund helping to match carbon losses with carbon gains. "That's a fun one," Burnap says. "If these event planners will calculate and offset, it will start to get the money flowing into the Colorado Carbon Fund, a fund that will reinvest in renewable energy here in Colorado."


1 comment:

Anonymous said...

Denver is one of the *few* cities in the USA like Berkeley (which I know little about, since, well, though I visited once in my early teens, they didn't accept my doctoral application for attendance)...or the suburb of Boston where Harvard is where the hippies have figured out how to infiltrate local planning and zoning bureaucracies as nobody notices. The rest of the USA just writes them off as goofy college towns. Rich people move out, which explains a bit why Cambridge now wants to tax Harvard's multi-billion dollar endowment (high IQ people *do* tend to donate their excess wealth to the college they went to).

Harvard Square, for instance if full (chock full) of "fake punk rockers", meaning trust fund kids who actually dress in retro (very expensively dog collar studded) jackets, drinking and smoking marijuana in public. In actual fact, unlike the actual STUDENTS of Harvard or Berkeley, who, being in top notch competition with other ivy league students, the students themselves actually don't protest much. They are literally all in the library, studying, all day, every day. The subway shuts down at 1AM in Boston, so nightlife is also nil.

Columbia in NYC is a bit different. Much more laid back, due to being in NYC and thus allowing for REAL nightlife on weekends, and lots of sugar daddies for the nubile coeds, but is still a bit stressed out, because it's not exactly an, uh hum, *easy* school.

But Denver is the worst, because it's a MUCH lower tier school than the ivy league ones and has a warring population of really rich people, such as my brother (who used to live there until the local government declared his bought and paid for, and architect-paid, mountain lot DRIVEWAY a threat to elk migration!) who invented bits and pieces of the Internet and are now rich VERSUS the dreadlocked "fine art" student types who "key" (scratch the paint) the BMW brand SUVs of the entrepreneurs.

So, yeah, Denver is a real piece of work.

My brother now pays no property tax since he sold the huge log cabin he eventually bought in the mountains above Denver, and now lives on a rock-star size tour bus, traveling the USA, teaching professional photographers how to use computers, and making books of his own photographs of old Americana that still exist along highways. Every time he runs into a coast again, by sea or air he arrives in foreign lands to add another series to his photography portfolio.

Denver lost yet another of its millionaire tax payers because they wouldn't approve his driveway. By God he was up for the fight too, and didn't just lose, but realized there was no fighting City Hall in Denver. He stayed a while, anyway, then pulled up stakes for good when he got sick of the nightlife, and the frozen hippie spit on his black BMW four wheel drive (you really do need traction on mountain roads).

The most depressing thing about Denver though is that besides the tiny college for low IQ students, and a *tiny* downtown for actual residents (besides a huge shopping mall main street or two for tourists), is that 90% of the people who live there (or in nearby Nederland) live in HUGE soviet-like single story carbon-copy condominiums, in which literally 50 or more houses are all physically linked into big chains, row behind row, mile after mile in the flat valley and due to pollution laws, although they all have fireplaces, they are all FAKE fireplaces! They literally have a switch on the wall to turn them on, and natural gas is burned under fake (iron) logs that eventually glow slightly orange. There is no chimney, since natural gas just gives off CO2 and water, no smoke of any kind. It's depressing as hell to see a "fire" that never crackles.

I'll let you in on a little secrete. A lot of old NYC apartments have REAL fireplaces, and officially it's only legal to burn those packaged chemical logs, but real wood is what people really burn when they have dinner parties or romantic evenings. They sell bundles of real wood in the local stores, too. What excuse there is for that, I don't know. Building cat forts?

Oh, you also have a post on Yale. Having been the top student of both Columbia and Harvard PhD/postdoc programs, I got flown to lots of other university to give guest lectures. Yale is another college town. But it closes at 10PM, at best, and there's nobody there except students, and again, it's ivy league so they are all studying, all day, and there is almost no nightlife. Actually, none at all, unless a dive bar or two counts.