I realize that I haven't done an installment of Your Friday Dose of Woo for a while--well over a month, in fact. Because of the gap between woo installments, I had been thinking that today was the time. There are at least a couple of really good candidates (and a host of halfway decent ones) in my Folder of Woo. However, sadly, another installment in the unfortunately never-ending story of YFDoW will have to wait at least another week. You see, the Bat Signal went up (or should I call it the Woo Signal?), and duty calls. What is the particular instance of someone being wrong on the Internet that requires a loving application of a heapin' helpin' of not-so-Respectful Insolence. I'll give you a hint.

It's on that repository of quackery, anti-vaccine madness, and woo, The Huffington Post. Where else?

This time around, The Three Musketeers of Woo (Larry Dossey, Deepak Chopra, and Rustum Roy) have decided to launch a full frontal assault on science-based medicine in an outrageously stupid piece, chock full of logical fallacies, whining, false dichotomies, and just plain bad reasoning in a post entitled The Mythology of Science-Based Medicine (conveniently crossposted on Deepak Chopra's Intent Blog). Think of a supernova of burning stupid meeting a black hole of ignorance. Which would win? Would the supernova of burning stupid be able to overcome the ignorance well of the black hole, or would the black hole suck all the burning stupid out of the supernova past its event horizon? Which would win?

I don't know which would win, but I do know that, whatever does win such a monumental struggle, it won't be the reader.

One thing I noticed is that, since the last time the Three Musketters of Woo attacked science-based medicine in the pages of HuffPo, it consisted of Deepak Chopra, Andrew Weil, and Rustum Roy, which makes me wonder; What happened to Andrew Weil? Why did the Musketeers have to bring in a ringer? Maybe Weil, being the "reasonable" face of the complementary and alternative medicine (CAM) movement, realizes that what follows is so blisteringly dumb that he doesn't want to be associated with it. Weil's always been the clever one, and he doesn't usually launch such frontal assaults on the very concept of science-based medicine. Instead, he tries to subvert it by trying to infiltrate it with woo and assimilate it, Borg-like. So they brought in Andrew Weil's dumber brother in the CAM movement to fill in, and he lives down to expectations, given his bio on HuffPo:

Dr. Larry Dossey is a former physician of internal medicine and former Chief of Staff of Medical City Dallas Hospital. He received his M. D. degree from Southwestern Medical School (Dallas), and trained in internal medicine at Parkland and the VA hospitals in Dallas. Dossey has lectured at medical schools and hospitals throughout the United States and abroad. In 1988 he delivered the annual Mahatma Gandhi Memorial Lecture in New Delhi, India, the only physician ever invited to do so. He is the author of ten books dealing with consciousness, spirituality, and healing, including the New York Times bestseller HEALING WORDS: THE POWER OF PRAYER AND THE PRACTICE OF MEDICINE, most recently THE POWER OF PREMONITIONS. Dr. Dossey is the former co-chairman of the Panel on Mind/Body Interventions, National Center for Complementary and Alternative Medicine, National Institutes of Health. He is the executive editor of the peer--reviewed journal EXPLORE: The Journal of Science and Healing. Dr. Dossey lectures around the world. He lives in Santa Fe with his wife Barbara, who is a nurse-consultant and the author of several award-winning books.

So Dossey's the executive editor of EXPLORE? Truly, the woo is strong in this one. Remember, EXPLORE is the "journal" that publishes allegedly scientific papers on topics such as "distant healing" and, even more hilariously, imbuing chocolate with "intent." His editorial standards, suffice it to say, do not impress me. Moreover, the very fact that he ever held any position whatsoever at NCCAM tells you all you need to know about the promotion of pseudoscience and woo by NCCAM, especially given the fetid load of dingo's kidneys that he laid down with Brother Deepak and Brother Rustum. It's based on a massive straw man argument and a whole lot of special pleading. But first, it starts with a false dichotomy:

The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

Not exactly. Well, no, not really, but I'm sure Dossey would like the dichotomy to be this. However, I think that the use of this false dichotomy is intentional. If there's one thing boosters of unscientific and pseudoscientific treatments want, it's to be viewed as on par with science-based medicine, as an "alternative" but equal system. Framing the issue this way from the first paragraph is likely an intentional strategy to implant right from the beginning in the reader's brain that there really is a dichotomy. My response, of course, is to repeat once again my oft-repeated favorite saying: There is no such thing as "alternative medicine." There is medicine that is scientifically validated and there is medicine that is not. Of the latter, there is medicine that doesn't work and medicine that has not been shown to work with science. Nearly all of the modalities falling into the "thousands of treatment modalities not taught in medical school" are in fact not taught in medical school because they fall into one of these latter two categories: The don't work, or there's no good evidence that they should, not to mention that there's no good reason based in science to think that they would work.

Now, on to the whine:

One side, mainstream medicine, promotes the notion that it alone should be considered "real" medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it's dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.

Note the subtle use of the word "procedures." Not "treatments." Not "medicines." Not "therapies." Procedures. Note how that is then juxtaposed against "alternative medicine" or "indigenous medicine." This framing intentionally makes another false dichotomy: Between "procedures" of science-based medicine and the nice, fuzzy, happy "treatments" of alt-med. And, of course, they're "enormously popular," leading to the classic logical fallacy of argumentum ad populum.

More importantly is the nonsense about medicine being unrelentingly hostile to alt-med. In fact, in a case of being so open-minded that its brains are falling out, academic medicine is embracing woo wholesale. How many times have I complained about just that right here on this blog, be it about NCCAM wasting $120 million of taxpayer money every year studying woo or the infiltration of woo into academic medical centers? The problem isn't that "mainstream medicine" is hostile to alt-med. It used to be, but no more. The problem is that, at the same time mainstream medicine is promoting "evidence-based" 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 legitimacy.

The next part of the article consists of a whole lot of special pleading, topped off with some serious cherry picking and deception by omission. First up, The Three Musketeers of Woo make a huge deal out of the BMJ's attempt to evaluate mainstream medical treatments and determine which ones have solid evidence to support them. Unfortunately, I do not have access to the website, and neither does my institution; so I can't evaluate much of it. Be that as it may, the Musketeers make much of the observation that 46% of treatments were "unknown" in their effectiveness or that, if you believe BMJ's analysis, only 36% are likely to help. Even if this were true, I notice one glaring omission. Notice how the Musketeers don't mention comparable numbers for their treatments. Even if scientific medicine performed this poorly, it's virtually certain that alt-med performs far more poorly. Moreover, I'd be willing to bet that the evidence base in favor of the woo that the Musketeers favor is pathetic in comparison to that supporting science-based medicine. In other words, this is a massive case of the pot calling the kettle black, except that the kettle isn't even black in this case.

Then the Musketeers get really sloppy with the facts (surprise, surprise):

We all marvel at the technological advances in materials and techniques that allow doctors to perform quadruple bypass surgeries and angioplasties without marveling that recent studies indicate that coronary bypass surgery will extend life expectancy in only about three percent of cases. For angioplasty that figure sinks to zero percent. Those numbers might be close to what you could expect from a witch doctor, one difference being that witch doctors don't submit bills in the tens of thousands of dollars.

This is deceptive in the extreme, as the Musketeers neglect to mention that these results are in patients with stable angina. In high risk anatomic subsets, both CABG and angioplasty prolong survival versus medical therapy alone. Moreover, they don't discuss relief of angina symptoms. While survival is the most important endpoint, relief of symptoms is also quite important. Another deceptive statement made in the article is that anti-depressants don't work better than placebo. There may be evidence that this is true for patients with mild to moderate depression, for severe depression even the meta-analysis cited supports the efficacy of anti-depressants, so much so that Dr. Scott Mendelson, no enemy of woo he, arrived in the comments to take the Musketeers to task for a huge straw man:

The second point is that while some psychiatrists and many primary care physicians may believe that antidepressants work simply by increasing the levels of serotonin and/or norepinephrine in the brain, no competent psychopharmacologist believes this. To suggest that experts in the field are either misleading people into taking medications they don't need, or that we ourselves have been fooled by the pharmaceutical industry into believing that the underlying problem is a mere lack of neurotransmitter than can be reversed by antidepressants, is incorrect.

Then, of course, there's the claim that "Dr. Barbara Starfield, writing in the Journal of the American Medical Association, estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes, or physician error, making this number three in the leading causes of death for all Americans." This figure has actually always bothered me, as it's clearly the highest of the usual apocalyptic estimates for how many people doctors supposedly kill, and the reason is simple math. Each and every year in the U.S., approximately 2.5 million people die. If Dr. Starfield is to be believed, approximately 10% of all deaths are from iatrogenic causes, which would make iatrogenic death the third leading cause of deaths in the U.S. after heart disease and cancer. Patients in hospitals tend to be sick and more prone to complications. For one thing, Starfield counts 80,000 deaths from nosocomial infections in hospitals. Nosocomial infections (hospital-acquired infections) are a big problem, no doubt, but lumping them in with medical error and iatrogenic causes is rather questionable. Many nosocomial infections can't be prevented easily and are not the fault of the physicians treating the patient. Moreover, nearly all of these numbers were derived from hospital studies. Similar considerations apply to non-error adverse reactions, which are said to claim 100,000 deaths a year. Remember, these were not medicines given in error. To compare this number honestly, you have to look at it in comparison to the number of lives saved every year by these medications. In other words, one has to compare the risks versus the benefits:

But there is a more important fact that should keep you from being scared away from real medicine. Advances in the treatment of coronary artery disease, the number one killer of Americans, reduced the number of deaths by over 340,000 in 2000 alone. And that's just one disease. So, in one year, medical errors may cause a few tens of thousands of deaths (and these are preventable deaths), but real medicine, in one disease alone, saves an order of magnitude more.

Don't get me wrong. We ought to be doing everything we can to decrease complications and death due to medical errors. The Institute of Medicine suggests the number may be from 44,000 to 98,000. By any measure this is far too many, but remember this: it wasn't The Three Musketeers of Woo who did the studies to derive these estimates. It was not Dr. Dossey, and it was most certainly not Deepak Chopra or Rustum Roy. It was science-based physicians trying to improve the practice of medicine, and there is nothing even coming close to a similar dataset maintained by alt-med practitioners.

The Three Musketeers of Woo are really good with special pleading, though. Because they have no convincing evidence that their therapies are any better than placebo medicine, all they can do is to try to attack the efficacy of scientific medicine. They don't dare go head-to-head with scientific medicine becaue they know the don't have the goods. The day I see woo-meisters like The Three Musketeers produce studies similar to the IOM report on medical errors or honest appraisals of the efficacy of, say, homeopathy is the day I might take their whining and special pleading more seriously. Not before.