Loose Ends: Dr. Koh and More
After Dr. Federman’s letter and my reply, posted in Part V of this series,† there seemed little point in pursuing the matter further. Although Dr. Federman never answered my reply, he did send, at my request, a copy of Commissioner of Public Health Howard Koh‘s written “construction of the events in the Massachusetts Special Commission.” As you may recall, those events had occurred at meetings that Dr. Koh never attended:
July 29, 2002
Dear Dr. Federman:
I have had an opportunity to review Dr. Kimball Atwood’s characterizations of the role Dr. David Eisenberg played as an advisor and designee of the Department of Public Health (DPH) and I am writing to clarify several misrepresentations of that role. As you may know, I personally selected Dr. Eisenberg as my designee for the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners based on his high level of scientific and clinical expertise in the field, as well as his international reputation for evidence-based research. I felt at that time, as I do now, that he was the appropriate choice to represent the Department and I am extremely grateful for his advice and his integrity during this most contentious process.
During the course of the Commission, Dr. Eisenberg brought to my attention some of the conflicts that had arisen among the members, despite his attempts to diffuse the hostility and to engage the members in collegial debate. In an effort to overcome these difficulties and deflect unwarranted criticism, Nancy Ridley, Assistant Commissioner for Health Quality Management, attended the meetings over the last six months as the DPH voting designee, with Dr. Eisenberg as an advisor. She also organized a DPH workgroup of the Commission in an attempt to bring consensus and closure to what had become a very polarized and highly personalized process.
I need to state emphatically that the approval of the final Commission report is my responsibility, and is largely a product of the DPH workgroup that Assistant Commissioner Ridley chaired. Dr. Eisenberg had actually not been supportive of either the “majority” or “minority” reports that were originally presented, and neither was Ms. Ridley. She attempted to address as many of Dr. Eisenberg’s concerns as possible but knew he still had issues with the final document. She feels very strongly that there needs to be regulatory oversight of non-physician practitioners of complementary and alternative naturopathic practice. Assistant Commissioner Ridley, on behalf of the Department and with my consent, signed the report that included a significant number of revisions which narrowed the scope of practice, ensured collaborative relationships between physician and non-physician practitioners, and broadened the scope of any proposed regulatory oversight required. Dr. Eisenberg’s advice to DPH was delivered in a fair and balanced manner based his outstanding experience as a clinician and scientist.
I believe that one of the contributing factors for the polarization within the Commission had little to do with Dr. Eisenberg’s participation rather than that of his staffperson, Michael Cohen, who attended Commission meetings in his absence. Mr. Cohen was repeatedly characterized as the alternate DPH designee, which he was not.
In summary, Dr. Eisenberg’s expertise and professionalism throughout this difficult process have been greatly appreciated by the Department. DPH was truly fortunate to be represented and advised by a person of Dr. Eisenberg’s stature and character. I would be more that pleased to speak to you or Dean Martin on his behalf. Please feel free to contact me at xxx.xxx.xxxx if you need any additional information.
Howard K. Koh, MD, MPH
The range of self-serving misrepresentations in that letter is wide, and is worrisome in someone who will be “responsible for the major health agencies, including the CDC, FDA and NIH, and [will be] the leading health advisor to the Secretary of HHS.” I have already discussed some of the facts here and here, and will add more now.
Regarding Dr. Eisenberg’s “high level of scientific and clinical expertise in the field,” Dr. Koh can be excused for having at first assumed this to be the case, but not after being presented with mounting evidence to the contrary. After one of several meetings of the commission in which Dr. Relman and I had enumerated absurd and dangerous naturopathic practices, I asked Dr. Eisenberg why he had not spoken up in agreement with our reservations. He replied that he hadn’t previously known about such particulars. If true, this belied his implicit expertise. It was also an indictment of his previous claim to having been familiar with some of the very sources from which we got our information. Now, moreover, he had been made aware of such particulars; yet still he did not speak. I sent a letter to Dr. Koh making this point and calling attention to Dr. Eisenberg’s conflicts of interest, but never received a reply. In other treatises made available to Dr. Koh, particularly the Minority Report, I called attention to numerous challenges to the Public Health that would be posed by licensed NDs.
The assertion that Dr. Eisenberg had attempted to “diffuse the hostility and to engage the members in collegial debate” is laughable. The “hostility,” such as it was—really more a tone of exasperation coming from Relman and me—was based mainly on two, frustrating facts of the commission’s deliberations, each a result of Eisenberg’s efforts or lack thereof: first, that the commission, as a matter of formal policy, would not entertain scientific or medical critiques of naturopathic practices; second, that Dr. Eisenberg himself refused to engage in debate, collegial or otherwise, even though the naive members of the commission looked to him for expertise. Whatever “concerns” or “issues with the final document” Dr. Eisenberg might have had, he didn’t bother to voice them to the commission as a whole. Dr. Koh knew, because I wrote him, that I’d asked Dr. Eisenberg to meet privately to discuss naturopathic practices but he had declined.
Assistant Commissioner Ridley’s organization of a “DPH workgroup” had not been formally disclosed to those commission members opposed to ND licensure, although we had heard of its existence. The workgroup could not have been conceived to “bring consensus,” since it excluded dissenters, and it was probably illegal.
How fortunate was the DPH to be represented and advised by Dr. Eisenberg? The statement, “there needs to be regulatory oversight of non-physician practitioners of complementary and alternative naturopathic practice” reveals that Dr. Koh’s advisor had failed to inform him of the most important point of all: NDs tell patients that they are physicians.
Readers more savvy than I might recognize Dr. Koh’s scapegoating of Michael Cohen as standard procedure for political functionaries. I find it cynical and distasteful, even if I have no use for Mr. Cohen’s views of modern medicine or of “CAM.” I add that Mr. Cohen was the “alternate DPH designee” whether or not Dr. Koh might have approved. This was established not by my “repeated characterizations,” more accurately described as observations, but by Dr. Eisenberg’s having sent Mr. Cohen in his stead more often than not.
Notably missing from Dr. Koh’s letter was an acknowledgment of Dr. Eisenberg’s undisclosed funding sources and of their embarrassing relation to the commission’s work.
Dr. Relman Speaks Up
I sent Dr. Relman a copy of my last exchange with Dr. Federman. To my happy surprise, he went out of his way to support me:
October 11, 2002
Kim Atwood sent me a copy of your letter of September 26 to him, and his reply.
I do not want to become part of your dialogue with him, nor do I want to be involved in any discussions between the Dean’s office and David Eisenberg’s CAM center. This is not because I do not have opinions about CAM (you surely know I do), but because I am not sufficiently acquainted with all the relevant events and factual details in this case.
However, I do have first-hand knowledge about two of the issues raised in your letter, and felt compelled to tell you what I know about them.
First, Howard Koh’s “construction of the events in the Massachusetts Special Commission.” I personally attended virtually all of the meetings for more than a year, before I felt impelled to resign as the Commission’s work was drawing to a close. Howard Koh attended none of the meetings and must have formed whatever “construction” he put on events that transpired at those meetings from accounts by either David Eisenberg (who was often absent), or his deputy Nancy Ridley (who suddenly showed up for the last two or three meetings). I resigned to protest the grossly biased manner in which the meetings were being conducted. I personally observed David’s behavior during many meetings (when neither Koh nor Ridley were there) and became increasingly disturbed by his actions and comments, which I thought were equivocating, unscholarly, and anti-scientific. I did not at the time know of any financial conflicts of interest with the naturopaths, but if Kim’s assertion is correct that David’s activities received support from a naturopathic school, this information should certainly have been made clear to all members of the Commission—and David’s behavior at the meetings becomes even more reprehensible. At any rate, I cannot believe that if you had attended those meetings, you would be comfortable defending David against most of the charges Kim now makes.
Secondly, with respect to the avowed mission of Eisenberg’s CAM center. The only justification for its existence at Harvard, it seems to me, should be that it serves as an instrument for carrying out rigorous scientific studies of the effectiveness and safety of CAM modalities. I think I know something about this subject because I have carefully studied the CAM literature for a long time and have paid particular attention to what has come from David Eisenberg and his colleagues. The relatively few credible clinical trials of CAM have been negative or at best equivocal. Eisenberg’s contributions to that scientific literature are almost non-existent.
To date there has been virtually no clinical science from the CAM center at HMS—mostly descriptions of the use and theory of CAM. Were this any other field, I cannot imagine HMS continuing to be so supportive. Why do we not hold CAM to the same standards as other areas in Medicine? What will it take for us to finally say that the Emperor has no clothes—however popular and well-funded he may be?
Arnold S. Relman, M.D.
As far as I know, nothing much came of my efforts. An opportunity for the matter to become more widely known seemed to appear a few months later, when science writer Chris Mooney called me to say that he was interested in writing something about “CAM” at Harvard and that Stephen Barrett of Quackwatch had told him, “Atwood knows where the body is buried at Harvard Medical School.” This eventually resulted in an article in Reason Magazine, but I never heard a peep about it from anyone at HMS.
More “CAM” Promotions
Although I grew weary of the topic, I couldn’t help but notice, over the years, more evidence of the main point that I had tried to make to Dr. Federman: that HMS promotes quackery. Some of this had occurred well before I entered the fray, but I’d been unaware of it. The 1992 report “Alternative Medicine: Expanding Medical Horizons,” accurately described as “an uncritical catalog of virtually every dubious and unproven treatment method of the past 100 years,” had included Eisenberg, his deputy Ted Kaptchuk, Harvard homeopath Edward Chapman, and Harvard nutritionists Walter Willett and Lilian Cheung among its contributors. The January, 1999 newsletter The Integrator for the Business of Alternative Medicine included this entry (emphasis in the original):
Eisenberg to headline NMHCC track. David Eisenberg, MD, will deliver the kick-off presentation at the National Managed Health Care Congress track. INTEGRATOR publisher-editor John Weeks, the track chair, who was originally scheduled to give the presentation explains simply: “We want to draw people into the CAM conversation and David Eisenberg has been a giant in this movement.” Weeks remains involved as a moderator throughout the seven session meeting. Funding for the change came available when San Diego-based American Specialty Health Plans came aboard to sponsor the track. ASHP has sponsored numerous CAM events in the past two years, including the Casa Colina WholeHealth Forum, the annual meeting by the publishers of Employee Benefits News, and the Healthcare Forum meeting scheduled for Honolulu in early February. The NMHCC has also scheduled a CAM debate, which pits National Council Against Health Fraud’s John Renner, MD, against James Dillard, MD, medical director for Oxford Health Plans. March 29-April 1: 888-882-2500A two-day event in San Francisco in June on integrative clinic skills training, developed by Cambridge Health Resources (CHR) together with Linda Bedell Logan’s Solutions in Integrative Medicine has been firmed up. However, the broader In Health conference which CHR was paired has been canceled for lack of major sponsorship, according to Marcy Robinson. Robinson heads up planning and sponsor relations for CHR. Robinson recently announced that the five speakers include: Bedell-Logan (sessions on practice management), Lynn Budlong, of Budlong, Glassanos and Company (sessions on business development — Budlong has worked in this arena for the Harvard team assembled by Eisenberg), Russell Greenfield, MD, a resident at the University of Arizona Center for Integrative Medicine (clinical integration), and author-expert on CAM legal issues, Michael Cohen, Esq. (legal issues). John Weeks, INTEGRATOR publisher-editor will provide an overview on the state of CAM integration early on the first day.
Several bullets were spent from that smoking gun. When I first saw it I lamented not having known of it at the time of my correspondence with Dean Federman, but I doubt it would have mattered. The hyperlinked file of Integrator newsletters is chock full of more damning information regarding the HMS “CAM” cabal, most of which I’ll leave to readers to discover for themselves. One passage worth mentioning is from January, 2000:
Minneapolis-based MEDTRONIC FOUNDATION has awarded a $900,000 grant over three years to BETH ISRAEL DEACONESS MEDICAL CENTER to support infrastructure developments on a model integrative facility. DAVID EISENBERG, MD, an assistant professor of medicine at HARVARD MEDICAL SCHOOL, will direct the project. A January 19 release identified the leading infrastructure “components” which Eisenberg views as necessary in a conventional medical establishment as: 1) development of referral mechanisms; 2) credentialing and quality assurance; 3) “communication strategies;” 4) creating standards for a natural products formulary; 5) development of educational materials; and 6) creating secured electronic data collection methods.” Eisenberg states the goal as “to develop a model that serves as a resource for other Harvard affiliated teaching hospitals.”
Dean Federman must have known about that grant well before I approached him. I guess I could have saved myself a lot of effort and frustration if I’d known about it, too. Clearly, there was never to be a real reckoning of the charges that I made. Sometimes I wonder why he gave me as much of a hearing as he did. Perhaps he worried that I knew things that would embarrass HMS. I thought I did, but what I knew apparently wasn’t embarrassing enough.
Not long after the first quoted passage from The Integrator was written, Dr. Renner died and Dr. Eisenberg joined with Andrew Weil protegé Russell Greenfield to pull the wool over the eyes of the Federation of State Medical Boards, making it suddenly easier for quacks to peddle snake oil—an event that I’ve discussed here and here on SBM.
Is it “Quackery” only if it’s Deceptive?
At about the same time that I was corresponding with Dr. Federman, Dr. Carl Bartecchi of the University of Colorado School of Medicine sent a letter to HMS wondering about financial conflicts of interest and other aspects of the HMS “CAM” program. At some point Dr. Bartecchi and I discovered each other and he sent me Harvard’s reply, which had also involved Drs. Federman and Eisenberg. There was an interesting passage in Dr. Eisenberg’s response:
Dr. Bartecchi says in his letter, “I long for the day when they label something ‘quackery’.” It should be mentioned that I served as a consultant to the Federation of Sate Medical Boards ‘Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice.’ This document describes a series of suggestions, derived through consensus, as to the judicious use or avoidance of complementary and alternative medicine. These guidelines avoid the label ‘quackery’ which explicitly implies deception. I share with Dr. Bartecchi a disdain for any practice which intentionally deceives and manipulates a patient in any circumstance. Moreover, in the annual Harvard Medical School course on complementary and alternative medicine I typically deliver a didactic presentation entitled ‘Advising patients who seek complementary and alternative medicine.’ In this lecture I include a summary of the article by Beyerstein from the Academic Medicine 2001 series on CAM which provides sensible advice in terms of avoiding complementary and alternative medicine practitioners who meet certain criteria consistent with definitions of ‘quackery.’
Wow. I can’t explain how something might “explicitly imply,” but to claim that the practitioner’s intent, which will frequently be unknowable, is a necessary basis for identifying quackery can only be a sign of naïveté or of, well, deception. It is also contrary to other, more influential uses of the term, as I and others have previously explained. Is it not obvious that peddling Laetrile or “colon cleansing” is quackery, regardless of whether or not the peddler believes in those methods?
Dr. Eisenberg’s citation of Barry Beyerstein is laughable. I knew Barry quite well and had many discussions with him about the sad state of affairs on campuses, including that of HMS. He sparred quite heatedly, right on the pages of Academic Medicine, with Eisenberg’s cronies Andrew Weil and John Astin. Here is some of the “Sensible Advice” that Dr. Eisenberg reported having borrowed from Dr. Beyerstein:
Avoid CAM Practitioners who:
1) Are hostile to conventional medicine
2) Cannot supply a reasonable rationale
3) Claim to possess secret ingredients or processes
4) Appeal to “other ways of knowing”
Nothing to disagree with there, of course, but Eisenberg himself has violated those tenets repeatedly, e.g.,
Please consult your local telephone yellow pages under these categories:
Massage – Therapeutic
The Elusive Degree of Dr. So and So
Dr. Beyerstein had also warned against practitioners who “claim degrees from unaccredited institutions,” and Eisenberg included that caveat in his response to Dr. Bartecchi. At around the same time the late Bob Imrie observed that it was curious, in this era of the World Wide Web, that if you Google the “Macao Institute of Chinese Medicine” you get, well, nothing—other than it being named as the alma mater of two American “CAM” enthusiasts. One of them is Ted Kaptchuk, ‘OMD,’ who has long been Dr. Eisenberg’s second in command of “CAM” at HMS. When I first heard this I didn’t think much about it. My reply to Imrie was something like, “what difference does it make? It’s bogus whether it’s bogus or not, because the entire field is bogus.”
Shortly thereafter I realized that there is an obvious, additional ethical problem with portraying oneself as having earned a degree from an institution that most people would assume had been endorsed by some appropriate body, if such is not the case. At the time I was the chairman of the Committee for the Quality of Medical Practice at the Massachusetts Medical Society, and using that title I wrote to the Macao government asking about the Macao Institute of Chinese (or “Traditional Chinese”) Medicine. Here was the reply (emphasis in the original):
Sent: Tuesday, October 07, 2003 12:41 AM
Subject: Reply to the inquiry about “Macao Institute of Traditional Chinese Medicine ”
Dear Chairman Kimball C. Atwood,
Thank you very much for your e-mail dated 18th Sept (we received it from Government Information Bureau on 6th Oct.). In reply to your inquiry, we would like to inform you that ¡§Macao Institute of Traditional Chinese Medicine¡¨ HAS NOT BEEN one of the higher education institutions in Macao, and the concerned Institute hence HAS NOT BEEN a degree-conferring academic institution.
If there is anything additional you would like to know, please feel free to contact us:
Address: Calçada de Sto. Agostinho. No 19, Edf. Nam Yue, 13o a 15o Andares, Macau
E-mail: [email protected]
With Best Regards
Higher Education BureauMacao SAR
I realize that this does not settle the matter. It is quite possible that in the 30+ years since Kaptchuk reports having attended the Institute, governmental memory has faded or has become selective. That is all the more possible because Macao, like Hong Kong, was ‘handed over’ from its colonial ruler (Portugal, in Macao’s case) to China on the eve of the 21st century. Nevertheless, there are more reasons to think otherwise. One of my correspondents had traveled to Macau prior to the hand-over and was unable to find any record of the MICM in various libraries and pertinent governmental offices. The Web continues to lack any corroborating evidence of such an institute, although there ought to have been many students there from all over the world: according to the two Americans, the school was a magnet for ‘overseas Chinese.’ Other attempts by Dr. Bartecchi and me to get information—from HMS (see below), from the Massachusetts and California Acupuncture Boards, and from Dan Bensky, the other American who reports having attended the MICM—have been frustrated.
Dr. Bensky’s online CV, however, raises more disturbing questions. He calls his diploma from Macao a “Diploma in Chinese Medicine,” suggesting that the ‘D’ in ‘OMD’ stands for ‘Diploma’, not for ‘Doctor’—as Kaptchuk has represented it (Bensky can call himself ‘doctor’ in any case, because he subsequently completed the osteopathy program at Michigan State University). Bensky reports having attended MICM with Kaptchuk, and that it took two years to complete. Bensky did not have a bachelor’s degree when he began at Macau. Currently, a doctoral candidate at the Chengdu University of Traditional Chinese Medicine must be a college graduate, and the course of study requires three years.
Bensky also reports that at Macao there were “three main teachers…although in the end, one of the teachers refused to allow Westerners to participate in her clinic.” And: “after graduation…as I was identified with the school, no one else in Macau would work with me.” This hardly suggests an ‘Institute’ or a course of study with externally recognized standards.
According to this report, a couple of years ago at the nomenclature conference of the A.A.O.M. (either ‘American Association of Oriental Medicine’ or ‘Association of Acupuncture and Oriental Medicine’—I’m not sure which)
Dr. Benksy dismissed the long-term expert consensus described in Marnae Ergil’s excellent paper on translation principles as simply “wrong.”
An interested observer, suggesting that Bensky’s credentials might be relevant to evaluating his opinion, responded with this:
Both Dan Bensky and Ted Kaptchuk hold degrees from The Macau Institute of Chinese Medicine. According to Dan in that very discussion on CHA to which Bob makes reference, the school came into existence shortly before he and Ted arrived in 1973 and went out of existence shortly after they left in 1975 with their degrees. Or were they diplomas? Or were they doctorates? What is written on those pieces of paper? This was the question I posed in the post that preceded my being banned from CHA. The notion of being “qualified by expertise and training to establish such standards” (of academic freedom) suggests that training standards themselves are of nontrivial importance in the whole matter of academic freedom. Of course they are. And of course it matters whether the word “diploma” or the word “doctorate” is written on the pieces of paper that Dan and Ted took home with them when their respective sojourns in Macau had come to an end. What does the “D” stand for in the “OMD” that appears after the names Bensky and Kaptchuk? Socrates said that to use words wrongly is not only a fault itself, it also corrupts the soul. Certainly it corrupts the use of words to use highly meaningful terms (including their abbreviations) like “diploma” and “doctorate” interchangeably. If one is qualified by expertise and training to establish standards of academic freedom, then we had better at least know with as much certainty as possible what the basis of one’s qualifications actually is…
Are Bensky and Kaptchuk the MICM’s only graduates?
In 2003 I queried some of the faculty at HMS who were affiliated with Eisenberg and Kaptchuk. I sent them the message from the Macao Higher Education Bureau. They agreed that it would be ‘disturbing’ if Kaptchuk’s degree were anything but legitimate. After all, he had parlayed it into his entire academic career, including not only his appointment at HMS (where he now appears to be an Associate Professor), but numerous articles in the Annals of Internal Medicine, the British Medical Journal, JAMA, and other journals. He used it to become a licensed health care practitioner in Massachusetts and probably elsewhere. He also used it to gain public roles that some would consider prestigious, such as his long membership on the NCCAM Advisory Council. He has been referred to as “Doctor” in all of those contexts.
About two weeks after I sent the inquiry to HMS, I got this reply from my old fellow intern, Russell Phillips:
Kim-I researched Ted’s background and am convinced that the credentials he lists on his CV, including his doctorate, are correct. When this came up previously he put together a packet of his diplomas etc that confirm his degree. Additionally, several state licensing boards have given him a license to practice acupuncture after researching his background. The Dean’s office (Dan Federman) has also looked into this and is convinced his credentials are correct. Please let me know if you want to discuss further. Russ
I believe that this reply merely begged the question. The several state licensing boards almost certainly did not research his background, which would have been an impossible task for them. I don’t think that HMS or any of the individuals who looked at the ‘credentials’ had either the will or the competence to investigate them thoroughly and skeptically. It is intriguing that in the past few years Kaptchuk’s ‘OMD’ has disappeared from certain contexts, including at HMS: compare this and this, for example.
I reiterate that I don’t know the answer to this question. There is enough doubt about Kaptchuk’s ‘OMD’ degree, however, to put the onus on him, on HMS, and on the other interested entities to produce the evidence. It should then be evaluated by a disinterested, competent investigator.
Harvard’s Contribution to Unethical Human Studies of Implausible Claims
During the time that I was gathering information for Dr. Federman, I discovered a report of an uncontrolled trial of homeopathic remedies for small children diagnosed with acute otitis media. The trial was a dangerous exploitation of vulnerable subjects for no useful purpose; I have previously mentioned it here and here. Three of the authors were Dr. Eisenberg, Ted Kaptchuk, and Harvard homeopath Edward Chapman, who would soon lose his medical license after having been caught diddling patients.
On SBM I’ve discussed other examples of unethical human trials of “CAM” claims, including NaEDTA ‘chelation therapy’ and the ‘Gonzalez Regimen’ for cancer of the pancreas. As explained here, representatives of the HMS “CAM” project—Eisenberg and Kaptchuk—were guilty of helping to launch at least one of those trials and of misrepresenting both of them.
The Annals of Internal Medicine ‘CAM’ Series
In 2001, the Annals of Internal Medicine launched a ‘CAM’ series, with Eisenberg and Kaptchuk named guest editors. Although it promised “discourse about the effectiveness and safety of commonly used CAM therapies…, critical reviews of the literature…, thought pieces addressing the broader social aspects of CAM therapy…, and the rules of scientific evidence,” most of the articles were puff pieces. They also failed to disclose funding sources, in some cases, or to explain the meaning of funding sources in others. In early 2003 I wrote two letters to new editor-in-chief Harold Sox—one short enough for publication, the other detailed—explaining these points. Here are some excerpts:
Language and Fact Distortions in the Annals “CAM” Series
In summary, Dr. Eisenberg and some others in the academic “CAM” movement have been promoting old-fashioned quackery under the guise of “CAM.” In so doing they have been careful to avoid informing the Annals readership of the abundance of absurd and dangerous practices offered by the “CAM providers” that they endorse. Instead they appear to excuse such practices as “reflect[ing] larger cultural and political collisions concerning evolving definitions of mainstream medical care” and “fundamental philosophic questions as to who determines which providers and therapies will be accepted as safe, effective, appropriate, or reimbursable.”
This is, in a word, nonsense. Does the question of whether a damp compress can abort an evolving stroke depend on “who determines which therapies are effective?” Is the inability of the skin to absorb substantial oxygen a matter of “political collisions?” Chiropractors posing as “primary care providers” are a threat to public health, not a “conundrum.” Homeopaths making therapeutic claims, chiropractors treating infants or recommending spinal “adjustments” for health maintenance, acupuncturists performing “pulse and tongue diagnoses,” massage therapists claiming to contribute to cures by removing “toxins,” and M.D.s prescribing EDTA “chelation therapy” for coronary artery disease are all common examples of health fraud, but readers would have to look outside of the Annals series for competent discussions of such issues.
Undisclosed Sources of Bias in the Annals Series
Dr. Eisenberg’s funding sources are conflicts of interest for his Annals articles, disclaimers notwithstanding. Did he report, to the Annals, the conflicts discussed above? According to the instructions, “when authors submit a manuscript, they must disclose all financial relationships that might bias their work.” Moreover, as you have affirmed, “editors should publish this information if they believe it will be important to readers in judging the manuscript.” That means that merely reporting the funding for the paper in question is not enough. Yet, in the “credentialing” article, there is no mention of the Fetzer Institute, the Osher Foundation, the Southwest College of Naturopathic Medicine, the New York Chiropractic College, the New England School of Acupuncture, or the Cambridge Muscular Therapy Institute, each of which has provided funds for Dr. Eisenberg’s activities in the recent past, and all of which favor the veneer of legitimacy that “credentialing” offers to “CAM providers.”
Nor, when considering conflicts of interest, is disclosure by name alone adequate. The “credentialing” article was funded by the NCCAM, whose CAM advocacy is documented above, but whose identity was veiled by the “NIH” designation; by American Specialty Health, an organization representing chiropractors, acupuncturists, naturopaths, and massage therapists, and also the single biggest contributor to both the American Association of Naturopathic Physicians and the licensing effort for “NDs” in California; and by Medtronics, a company whose founder is also committed to the promotion of implausible methods in the absence of validation. These ideologically biased donors may not have “had editorial input into the paper,” but will they donate in the future if they are displeased by the content of the work that they helped spawn? That is the broader truth of all such arrangements, and always has been.
Dr. Sox never replied, and the Annals did not print the short version of my letter. I guess their expectations of authors and editors are flexible. It’s funny: I’ve since met Dr. Sox more than once in other contexts, and have found him to be a thoughtful and decent man. I haven’t talked to him specifically about that regrettable episode in the journal’s history. There’s a lot that I don’t understand, when I think of Drs. Federman, Sox, and others.
HMS Alumni: Scientists, Shruggies and Pascal’s Wager
In 2004 I gave a talk about naturopathy to the Symposium of the 25th reunion of the HMS class of 1979—my class. Dean Federman didn’t come, which irked me a bit but didn’t surprise me. Later I ran into him and he apologized for not having been there. FWIW. There were a few standard reactions to my talk. A couple of classmates who had become biomedical scientists and a couple of clinicians congratulated me for taking a stand against encroaching pseudomedicine. Two or three others had recently been diagnosed with scary diseases and were dabbling with fanciful methods; they wondered why I did what I did. An alumna of some note (not a member of my class) observed that “CAM” advocates could teach us something about prevention. I tried to deliver her of that notion. Most of the audience seemed to just, well, shrug.
The proof is in the pudding. Et tu, Daniel?
In spite of it all, there is a glimmer of hope. Everything changes, even HMS. A couple of my old friends have recently become relatively big makhers there. It’s unlikely, of course,…(especially without any moolah)…but who knows?
†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)