The Pseudomedical Pseudoprofessional Organization (PPO*)

(*Not to be confused with “Preferred Provider Organization,” which shares the acronym)

This is part of an ongoing series† discussing pitfalls of regulating physicians, but I’ve decided, in the interest of flexibility, to vary the title. A couple of weeks ago I gave some examples of how individual physicians practicing substandard, implausible medicine manage to avoid or delay being disciplined by state medical boards. I observed that the boards themselves seem reluctant or slow to act against such practices, even those that are illegal, and that this stands in contrast to their prompt actions against other types of malfeasance: those of the “low-hanging fruit” variety. In a comment, David Gorski reminded me that he had previously offered a few reasons for that discrepancy, with which I agree. Nevertheless, it seems odd that state boards don’t do better.

In an attempt to find more explanations, this week we’ll look at another tactic of practitioners of pseudomedicine: banding together to create pseudomedical pseudoprofessional organizations (PPOs), complete with pseudo-legitimate names, pseudo-legitimate conferences, pseudo-legitimate appearing websites, pseudo-“board certifications,” protocols for pseudo-therapies, patient brochures hyping pseudo-therapies, pseudo-consent forms for pseudo-therapies, pseudo-Institutional Review Boards to approve pseudo-research, pseudo-journals to publish reports of pseudo-research, very real financial contributions from pseudoscientific corporations to help pay for very real advertising, very real lobbying, very real legal representation, and more.

There are many more PPOs than we’ll be able to examine, but they have common features. We’ll also look at how some Institutions That Should Know Better respond to PPOs, which can be frightening.

We mentioned two representative PPOs in Part 1 of this series: the International Bio-Oxidative Medicine Foundation (IBOMF) and the International Oxidative Medicine Association (IOMA), each founded by the late Charles Farr, the “Father of Oxidative Medicine,” to promote intravenous hydrogen peroxide and other dubious treatments. We saw that the IOMA has recently been absorbed by another PPO of which Charles Farr was a founder: the American College for Advancement in Medicine (ACAM).

The ACAM: the Mother of all PPOs

The ACAM, founded in 1973 (webmaster note: Malware URL removed, sorry!) as the American Association of Medical Preventics “to help educate physicians and to promote the use of EDTA chelation therapy for cardiovascular disease,” stands at the center of what is probably the largest and most insidious family of organizations hyping implausible practices and the “freedom” to peddle them. These include the International College of Integrative Medicine (ICIM; formerly called the Great Lakes College of Clinical Medicine and the Great Lakes Association of Clinical Medicine); the American Board of Clinical Metal Toxicology (ABCMT; formerly the American Board of Chelation Therapy); and the American Association for Health Freedom (AAHF; formerly the American Preventive Medical Association). The roles of each are somewhat different, although there is considerable overlap: the ACAM and ICIM are primarily “educational,” the ABCMT confers “board certification” for “chelation therapy,” and the AAHF lobbies in Washington for the misleading “health freedom” agenda, among other things. (Subsequent to this posting, the AAHF changed its name to the Alliance for Natural Health.–KA)

We have provided a history of those organizations in our article about the NIH Trial to Assess Chelation Therapy (TACT). That history provides abundant documentation for each of the “pseudo-” practices named above, which I’ll not repeat here except to make a few points. First, although I used the term “largest,” these groups are actually quite small. The ACAM has about 1000 members, of which 800 live in the US. This amounts to 1/1000th of the licensed MDs and DOs in the country (there is also a huge overlap in membership among these PPOs, but I haven’t bothered with a formal census).  Next, I meant “mother” in the Saddamian sense, not in the “original” sense. The ACAM and its related organizations, like most entities spawned in recent decades to promote implausible medical claims, are part of the House that Laetrile Built.

Laetrile, you’ll recall, is a quack cancer drug that reached its heyday in the 60s and 70s, when it became the most lucrative health fraud in the history of the United States. Virtually all Laetrile pushers were arch-right wing, anti-government Birchers, who had been learning how to fight for “health freedom” since the early 60s and even before. When the drug became illegal in 1979 they were madder’n hornets in a stuck nest. To their advantage, but to the detriment of rational medicine and public health, they began to learn how to game the system more effectively, through friends in Congress and other means. The results have included the PPOs discussed here, the Office of Alternative Medicine and its successor, the NCCAM, the Office of Cancer Complementary and Alternative Medicine (OCCAM) of the National Cancer Institute, the attenuation of state medical boards’ authority to discipline physicians for practicing quackery, and more.

Can PPOs Really Be That Insidious?

Most honest, hard-working physicians find it hard to believe that innocuous-sounding “professional” organizations would engage in pernicious activities, but the evidence is there for anyone who bothers to look for it. Is it possible, for example, that a medical organization would create an institutional review board (IRB)—the legitimate purpose of which is to protect human subjects in clinical trials—to provide a veneer of “research” in order to shield its members from regulatory scrutiny of their dubious practices? Well, yes:

GLACM also has an Institutional Review Board, or IRB, which reviews member’s research projects. This gives these projects IRB status and protection…

The Institutional Review Board of the Great Lakes Association of Clinical Medicine was formed in 1990. The IRB has met National Institutes of Health guidelines…

With an increase in the number of physicians who are under review from state medical boards for practicing alternative medicine, the IRB may offer protection. The IRB recommends that any GLACM members who want to organize procedures in their offices and get peer-reviewed, officially-sanctioned research contact Karen at Dr. Chappell’s office (419) 358-4627, to get guidelines for preparing a proposal.

The GLACM IRB approved numerous nonsensical, dangerous, and unethical trials until it was finally disbanded in 2001, under pressure from the FDA. One of those trials achieved notoriety in the medical ethics literature and the popular press: “Induced Malaria Therapy for HIV/AIDS,” conducted in China by Henry Heimlich (yes, he of the Maneuvre). In spite of that, ACAM and GLACM kingpin L. Terry Chappell, the secretary of the IRB that had approved the study in 1994, flew under the radar when he appeared as the star witness at Congressman (and former Laetrile champion) Dan Burton’s 1999 Hearing of the House Committee on Government Reform, where Burton bullied NHLBI Director Claude Lenfant into accepting, in principle, a chelation trial; and again when Chappell was named by the original TACT protocol (p. 284) as one of the “prominent experts in chelation therapy” appointed to the “Liaison Committee to the American College for Advancement in Medicine”; yet again when he was made a co-investigator in the trial; and again when he was made a member of the NIH “Special Emphasis Panel” (scientific review committee) that passed judgment on the original protocol, in clear violation of NIH conflict-of-interest policies.

Is it possible that his NIH handlers were so naive? Here are Dr. Chappell’s public views of Heimlich’s malaria-for-AIDS trial, quoted in the Cincinatti Enquirer in March, 2003, only a few months before accrual of the first TACT subjects, but well after it had become clear that Highly Active Anti-Retroviral Therapy (HAART) had revolutionized the treatment of AIDS:

Malariotherapy worth investigating

Dr. Henry Heimlich should be applauded for his research on treating AIDS with malariotherapy. The type of malaria used was easily curable with medications, and indeed there were no serious complications reported in his research project. The research was carried out according to the scientific guidelines.

Medications used to treat AIDS are not highly effective, can be toxic and are prohibitively expensive. Resistance to these medications is developing.

Malariotherapy is much cheaper than conventional drugs for AIDS. Health officials from several African counties have expressed considerable interest in Heimlich’s pilot project. The therapy has the potential to be a major force against one of our greatest disease challenges.

Terry Cappell (sic), M.D., Bluffton, OH

Hmmm. As my colleague Liz Woeckner so aptly put it:

Contrary to Dr. Chappell’s assertion that no serious complications were reported in [Heimlich’s] research project, two research subjects [of 30] died. On any account, death qualifies as a serious complication. (4)

You have to wonder what Dr. Chappell thinks scientific guidelines are. The trial protocol had no bibliography, so he and his fellow IRB members had no way in which to judge the scientific merit of the study they approved. IRB members didn’t know the name of the principal investigator conducting the study in China — it’s difficult to understand how they could evaluate the way in which the study was to be carried out if they didn’t know who carried it out. As part of their obligation to research subjects in the review of proposed research protocols, IRB members would need to evaluate the credentials of the investigators and the resources and policies of the institution.

Little PPO, You’re Really Lookin’ Fine!

Is this the sort of person you’d want passing judgment on, and participating as an investigator in, a dangerous, $30 million, 2000-subject trial funded by your money? I believe that at least part of the reason that this happened is found in the slick packaging of groups like the ACAM and the GLACM (now ICIM). We saw in Part 1 that ACAM conferences, including courses on the intravenous administration of the dangerous and illegal drugs disodium EDTA and hydrogen peroxide, are granted Continuing Medical Education credits by the Accreditation Council for Continuing Medical Education (ACCME). The original TACT protocol calls the ACAM “the world’s largest and most respected organization of physicians who employ chelation therapy,” and repeatedly refers to “board certification in chelation therapy” as if that were equivalent to board certification in cardiology, for example. It is not: real board certification means recognition by the American Board of Medical Specialties (ABMS). “Chelation therapy,” of course, is not so recognized.

Lest you think, reasonably, that the NIH failed to notice such shenanigans only because the fix was in (which it was, thanks to Burton), there are reasons to think that there was more to it. It is a fair assumption that for some of the insiders, such “ignorance” was willful. Many others, however, were likely fooled by the hype discussed above. Several years ago, the consumer health website InteliHealth (The Trusted Source®) posted a misleading article entitled “Finding a Doctor Who Understands Complementary And Alternative Medicine.” Like many other articles on that site, it had been written by a faculty member at the Harvard Medical School (HMS). The article advised readers to

Seek out organizations in your community for people interested in complementary and alternative therapy. Look for yoga classes, women’s health groups, or local chapters of national organizations that support alternative health, such as the American Holistic Medical Association and the American College For the Advancement of Medicine. Take a class or attend a meeting. Ask the people you meet about local doctors who provide the therapies that interest you. [Hyperlinks in the original]

I wrote to a dean at HMS to complain about that article, making the point that the ACAM existed to push “chelation therapy,” a dangerous, implausible, and discredited treatment (I also objected to the author’s recommendation of the AHMA, another PPO, but one that at least telegraphs its agenda with “Holistic”). Unbeknownst to me until a bit later, Steve Barrett of Quackwatch had previously complained directly to InteliHealth, making the more colorful point that “referring readers to ACAM members is like referring people who want to borrow money to Mafia loan sharks.”

Editor Howard LeWine replied to him, admitting that the real agenda of the ACAM had escaped the notice of the Harvard reviewers, including “experts in CAM.” What’s worse, they were still unable to discern it when they perused the ACAM website after being tipped off by Dr. Barrett! The result, by the way, was that InteliHealth dropped those recommendations—but only those recommendations—from the otherwise ditzy, promotional article, which is still featured on the website.

Speaking of Quackwatch, there you can find numerous examples of PPOs, many with dead-giveaway names like American Academy of Quantum Medicine (AAQM), but others with names that belie their true identities, ranging from the quasi-environmental American Academy of Environmental Medicine (AAEM), which is all about “toxins” and promotes the fake disease known as “multiple chemical sensitivity syndrome” (MCS), to the how-nerdy-can-you-get National Academy of Research Biochemists (NARB), which is nothing more than a purveyor of fake diplomas.

Getting back to the ACAM for a moment, it has some pretty fine-lookin’ members too, judging by the picture on the website. How holesome and committed they seem! And how versatile!

Attention, Burnt-Out Physicians: Don’t be Bored, Be “Board-Certified”! It’s Quick and Easy!

As mentioned above, legitimate “board certification” in a medical specialty or sub-specialty means being certified by a board that is recognized by the American Board of Medical Specialties. That typically involves post-graduate training in a legitimate residency for 3-7 years or more, often followed by 1-4 years of fellowship training, and passing rigorous, usually multi-part exams. To become “board-certified” by the American Board of Chelation Therapy (now the ABCMT), the last time I looked, required a weekend course, a score of 65% on an examination in which 60% of the questions were True/False, and administering 1000 unsupervised disodium ethylene diamine tetra-acetic acid (Na2EDTA) infusions.

A few years ago I compared the board membership of the ABCMT to that of the American Board of Preventive Medicine, which is recognized by the ABMS and which offers a subspecialty certification in Medical Toxicology. Unsurprisingly, there were no common members. That’s a relief: if you lift the rotten stump at the ABCMT today, you’ll find a den of vermin that’ll make you shudder. Three members, Rozema, Chappell, and Trowbridge, were members of the GLACM IRB discussed above. To the following roster, I’ve added hyperlinks to additional information that’s easy to find—don’t assume that the lack of a hyperlink implies the lack of a quack:

Chairman

Rashid A. Buttar, DO, FAAPM, FACA

Vice Chairman

James M. Holbert, MD, PhD

Secretary

John P. Trowbridge, MD

Treasurer

James Smith, DO

Directors

Theodore C. Rozema, MD, FAAFP, FACAM, CP

H. Joseph Holliday, MD

Robban Sica, MD

Advisors

Robert Rowen, MD

John L. Wilson Jr., MD

Terry Chappell, MD

Peter J. Van Der Schaar MD, PhD, CMT

William Duncan, PhD

H. Vasken Aposhian, Ph.D.
The University of Arizona

Buttar is also the President, and John Wilson the Vice-President, of another notable PPO: the North Carolina Integrative Medical Society (NCIMS). The NCIMS speaks for itself:

Our Position

Who We Are…

The North Carolina Integrative Medical Society (NCIMS) is comprised of dedicated and professional physicians deeply committed to the profession of healing, regardless of the oppression that we encounter or the consequences to us personally for staying true to our calling.

What We Do…

The NCIMS –

• Is a viable opportunity for doctors to join a group of like-minded physicians who have recognized that the traditional methods of medicine are lacking. We consider ourselves the “natural option”, if you will.
• Offers valuable educational opportunities to our fellow physicians and potential patients.
• Helps standardize the methods of practice among the various types of non-conventional doctors.
• Assists physicians in protecting themselves against being singled out just because they chose to practice and offer an alternative healthcare option to patients.
• Provides a forum for our members to stay connected and share items of mutual interest.
• Is a valuable public resource on issues such as malpractice, heavy metal toxicity, and other pertinent health care topics.

The NCIMS has pitted itself squarely against the “oppression” of the North Carolina Medical Board, which just happens to have caught Dr. Buttar in practices that don’t seem very professional, committed to healing, or natural. I guess they must be what the NCIMS calls “alternative healthcare options.” Funny: some very influential people think that Buttar is a great guy. One of them is Congressman Dan Burton.

Where the Money Is

I’m running out of gas, but before leaving this topic I’d like to direct you to lists of sponsors of some of the PPOs discussed above. For the ACAM, go here. Read the blurbs and help yourselves to the websites. Rosemary, Fifi, and Dr. Val are right: quackery is big business. I’ll give you a head start on the second sponsor on the list, because you won’t find this info on its website: American Biologics is the original Laetrile scamufacturer.

For sponsors of the AAHF, the ACAM’s political wing, look here. No wonder that this PPO is so gung-ho to keep DSHEA on the books:

We believe that the Dietary Supplement Health and Education Act of 1994 to be one the single most important events to happen for health freedom. That is why we believe in protecting and defending this bill.

……………………..

† The State Regulation Series:

1. Pitfalls in Regulating Physicians. Part 1
2. Pitfalls in Regulating Physicians. Part 2: The Games Scoundrels Play
3. The Pseudomedical Pseudoprofessional Organization (PPO*)
4. A New Twist for Autism: A Bogus “Biomedical” Board
5. How State Medical Boards Shoot Themselves (and You) in the Foot
6. “Integrative Medicine Experts”: Another Barrier to Effective Discipline
7. Bogus Diagnostic Tests