HMS Puts the Messenger in its Crosshairs
When, during the fall and winter of 2001-02 I first approached Dean Daniel Federman of the Harvard Medical School (HMS) with evidence that the HMS “CAM” program was promoting pseudomedicine, I gave him some materials that I thought would be adequate to make the case: ‘CAM’ Director David Eisenberg’s dubious funding sources and his failure to disclose them to the Massachusetts Special Commission; the website of the Caregroup/Harvard Medical School Center for Alternative Medicine Research and Education (CAMRE), which urged anonymous websurfers to “consult your local telephone yellow pages” for ‘naturopathic physicians’ and other quacks; the presence on the ultra-PPO American Association for Health Freedom (AAHF) Advisory Board of attorney Michael H. Cohen, the Harvard CAMRE’s “Director of Legal Programs” (at the time, Dr. Federman agreed with me that the mere existence of such a position was curious, if the CAMRE’s purpose was “research and education”); that Dr. Eisenberg and Atty Cohen had contributed to a report to the Massachusetts State Legislature recommending a formal state imprimatur for the practice of pseudomedicine; and other embarrassing findings. A bit later, in March 2002, I sent him a draft of the essay that I posted in Parts I and II of this series.
That material proved not to be adequate, for on March 20, 2002, Dr. Federman sent me the following letter:
I ready to undertake a formal review of the Harvard Medical School’s Division of Research and Education in Complementary and Alternative Medicine, and of its leadership to investigate the charges outlined in your letter of November 4, 2001, subsequent emails, and our meeting of January 22, 2002 in my office. I have read almost all of the voluminous literature you sent me and am writing to ask you to assist our efforts. Specifically, I am asking you to prepare a one to three page summary of the specific portions of the material you sent me that you consider erroneous, duplicitous, misleading, or fraudulent.* I do not feel I should summarize your views. Please be specific and give sources, where you can, in support of your statements.
I am committed to achieving a careful and balanced review of the issues you raise.
Daniel E. Federman, M.D.
* [These are terms that I had used in my communications with Dr. Federman; the only one from which I backed away, after he reacted with considerable alarm, was “fraudulent.”]
That was the first real suggestion that the fix was in. The pertinent literature that I’d sent Dr. Federman did not consist of “my views” or even my words. It consisted of statements copied from CAMRE publications and other public sources. Why did Dr. Federman now seem to be framing the issue as a matter of (my) opinion? Why weren’t the points that I’d already presented and documented (they were specific and I gave sources) sufficient to trigger an independent, formal review? What about the summary that I’d already written in the form of a letter to Harvard Magazine, which Dr. Federman had also read? No matter: I was still confident that he would do the right thing when he saw the totality of the evidence, abundantly and overwhelmingly supporting my contention that the CAMRE and other HMS affiliates were promoting pseudomedicine—dangerously, unethically, and in contrast to their stated purpose.
It was then that I resolved to write the essays that I posted in Parts I, II and III of this series.‡ I also prepared the summary that Dr. Federman had requested, which is reprinted below. In June, 2002, I sent these together with this letter:
Here is the summary you requested. Along with it are two essays that provide extensive documentation for the assertions made. The first is similar to the one that I sent you in March (I’m not sure you ever saw it), but with some revisions. Please replace that one with this one. Both essays read like magazine articles, because I tried to interest Harvard Magazine in hosting a real debate on the subject of “CAM” at HMS. HM refused.
As illustrated by these essays, in order to grasp some of the realities of “CAM” it is necessary to invest a bit of time and effort. I’ve done most of that for those that might sit in judgment of this issue; I trust that they will do their part by actually reading the material, as you did earlier this year. I also think that you and I should talk about who might be involved in this inquiry.
Kimball Atwood, MD
Harvard Medical School’s “CAM” Program Promotes Absurd and Dangerous Practices: Summary
Harvard Medical School’s “Complementary and Alternative Medicine” program is not what its public image suggests. In addition to dubious “research and education” a major function of the project is the public promotion, both explicit and implicit, of methods that are highly implausible, dangerous, or both. Such promotion is likely to be detrimental to public health, to public perceptions of how science relates to progress in medicine, to the education of medical students, and to Harvard’s reputation as an institution devoted to rational inquiry and to the dissemination of reliable medical information. Most importantly, it is a violation of the ethical principle of veracity.
Some of these promotions are, undoubtedly, well meaning but based on a naïve understanding of the practices themselves. Others are ideologically driven or based on a pseudoscientific view that is unacceptable in a modern medical school. Still others are an inevitable result of the conflict of interest that occurs when a university accepts funds from organizations with ideological biases. In the case of “CAM” at Harvard, some of the funding organizations are the Fetzer Institute, the Osher Foundation, the American Specialty Health Plans, the Templeton Foundation, the Southwest College of Naturopathic Medicine, the New England School of Acupuncture, the New York Chiropractic College, the Cambridge Muscular Therapy Institute, and the National Center for Complementary and Alternative Medicine (NCCAM). A grant from any of these has the same implications for bias in discussion and inquiry as would a grant from the Tobacco Institute—or worse, because the grantor can count on the ignorance, regarding “CAM” claims, of both the public and of the great majority of faculty and students at the recipient institution.
I have summarized several examples of implicit and explicit promotions below. In addition, I’ve provided documents that support most of the assertions made here, and more. They leave no doubt that advocacy is a major part of the HMS “CAM” project. They also explain how I became aware of this matter. They refute, in various ways, any contention that “CAM” claims are mostly harmless and are therefore of little concern when promoted in the context of academic medicine. They also cast doubt on the legitimacy of the “research and education” part of the project.
There are other promotions of dubious health claims that bear the HMS imprimatur, but enough are shown here to make the point. I doubt that many HMS faculty members, including many of those nominally involved with the “CAM” program, are aware of most of the facts described herein.
I. Explicit promotions of dubious and/or dangerous methods.
- The “information resources for consumers” webpage of the Caregroup/Harvard Medical School Center for Alternative Medicine Research and Education (CAMRE) recommends, without further comment, that consumers consult any of several dubious practitioners via the telephone yellow pages. It also recommends a web-based book (Choices in Healing by Michael Lerner) on unproven cancer “remedies,” many of which have no more scientific validity than laetrile.
- Dr. David Eisenberg and Attorney Michael Cohen (“Director of Legal Programs, Division for Research and Education in Complementary & Integrative Medical Therapies, Harvard Medical School”) represented the Massachusetts Department of Public Health at the recently adjourned Mass. Special Commission to Study Complementary and Alternative Health Practitioners. In this role they contributed to a report recommending that the Commonwealth license “naturopathic physicians,” a group of pseudoscientific quacks, as health care providers. Mr. Cohen’s writings and activities demonstrate that he is committed to the promotion of pseudoscientific health claims through legal and political means.
- InteliHealth, a health information website that appears to be a partnership between Harvard Medical School and Aetna, specifically or indirectly advocates several absurd methods in the context of erroneous descriptions of “CAM” practices. Some of the more outrageous therapeutic claims in these treatises have been removed recently, but many of the misleading descriptions remain.
- Homeopathy is explicitly promoted in several contexts within or related to the HMS “CAM” project. Although it is not the only absurd method being promoted, it is useful as an example. Nor is it benign, in spite of what some might imagine. It is also the subject of an unethical study co-authored by the Director and Associate Director of the Harvard Center for Alternative Medicine Research and Education.
II. Implicit promotions of dubious and/or dangerous methods.
- The new Zakim Center for Integrated Therapies at Dana Farber recommends numerous examples of unlikely and unsupported claims. Among these are homeopathy, therapeutic (non) touch, “guided imagery” and other suggestions that cancer can be wished away, and the previously mentioned Choices in Healing by Michael Lerner. Even if some patients are comforted by some of these measures, this does not justify their implicit promotion as disease-altering remedies: it is inevitable that in some cases they will confuse and disappoint desperate cancer patients and their families.
- A recurring Harvard CME course, funded by the Templeton Foundation, is“Spirituality and Healing in Medicine.” A regular speaker in this course is the Chairman of the Board of the Church of Christ, Scientist. How ironic that barely ten years after the last public example of a Massachusetts child being sacrificed to Christian Science “healing,” and at a time when the practice has been successfully marginalized to the brink of extinction, Harvard Medical School may be aiding in its resurrection.
III. Two local examples of the recent widespread promotion of dubious methods.
- Most “CAM” courses in American medical schools are not critical of the claims that they teach.† If the annual Harvard CME “Complementary and Integrative Medicine” course and Dr. Eisenberg’s public proclamations regarding homeopathy and other unlikely claims are any indication, the HMS CAM course is no different. This would be unfortunate for Harvard Medical Students, some of whom are likely, at this stage in their lives, to be susceptible to fanciful medical claims. It would also undermine efforts by other Harvard faculty to impart the critical thinking skills necessary for legitimate scientific inquiry and for the interpretation of the literature of evidence-based medicine.
- The “Marino Center for Progressive Health” is a chain of local medical practices offering “state-of-the-art conventional medicine combined with complementary and alternative therapies.” Among the latter are homeopathy, EDTA chelation “therapy” for coronary artery disease, “craniosacral therapy,” chiropractic for “prevention of disease,” and more. The Marino Center also has its own “health store,” which sells unnecessary vitamins and useless homeopathic “remedies,” apparently for a profit. Several of the physicians on the Center staff are recent graduates of Harvard Medical School or Harvard residencies, and/or hold teaching positions at HMS. The website lists the staff homeopath as a “Teaching Associate in Anaesthesiology, Harvard Medical School.” Perhaps HMS should spend more effort soliciting funds for the teaching of medical ethics, and less for the teaching of “CAM.”
† Sampson, Wallace. The Need for Educational Reform in Teaching about Alternative Therapies. Academic Medicine 76(3): 248-250. (March, 2001)
Kimball C. Atwood
HMS Class of ‘79
On June 27, 2002, Dr. Federman replied:
Thank you for the material you sent. I am beginning an appropriate inquiry.
On one of your points there is no need for investigation. As the representative of Dean Joseph Martin, I can confirm—contrary to your allegation—that Harvard Medical School as such has no advocacy position whatsoever regarding complementary and alternative medicine. The division was undertaken to conduct research and to provide education about, not in, complementary and alternative medicine.
Daniel Federman, M.D.
Oh boy. At this point I was well on my way to losing confidence in the ‘inquiry.’ I responded as follows:
Thank you for acknowledging your receipt of the written material that I sent you.
Apparently one of my points requires clarification. I did not allege, nor did I mean to imply, that the Harvard Medical School per se, or even its “CAM” program, has a formal “advocacy position” regarding implausible health claims. Rather I described numerous examples of such advocacy, and these are simply facts: consider InteliHealth. Thus in my summary a pertinent statement reads as follows: “[These documents] leave no doubt that advocacy is a major part of the HMS ‘CAM’ project” (emphasis added). I continue to stand by that statement. If the distinction between formal and de facto advocacy was not clear throughout the essays, please consider this letter a correction.
I can also assure you that I have never thought that the HMS hierarchy has anything to do with the advocacy of dubious health claims, other than by unwitting association. This inquiry is an opportunity for the HMS leadership to dissociate itself from such advocacy (again, consider InteliHealth). That is one of the reasons that I approached you in the first place.
Advocacy by some in the Harvard “CAM” project has run amok, as demonstrated in the materials that I sent you. I consider those responsible to be ‘loose cannons’ on the ship of HMS, but I can’t know exactly what their motivations are or even if they are consciously aware of such advocacy. Dr. Eisenberg, fresh from advocating state endorsement of naturopathic practices and in receipt of funds from the Southwest College of Naturopathic Medicine, denied it in his answer to my letter to Harvard Magazine. However, as Dr. Holmes might put it, “the question naturally arises: is not this man deceiving himself, or trying to deceive others?” Questions of motivation and deception aside, the insidious promotion of quack practices by those who wrap themselves in the HMS banner is an embarrassment to the Harvard Medical School, to its leadership, and to its alumni. The public doesn’t make the sorts of distinctions that both you and I might wish were apparent.
Kimball Atwood, M.D.
HMS Class of 1979
I was right, and I was pissed. In the American sense, that is.
‡The Harvard Medical School series:
- Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.3: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (concluded)