Nov 30 2009

Announcing the Institute for Science in Medicine

I have stated before that I think one of the most important battle lines for skeptics and science promoters relates to issues of science in medicine. The science-based standard of care is being systemically attacked on every conceivable front – not just public opinion, but legislative, academic, and commercial. Promoters of dubious health treatments and products, what used to comfortably be called “health fraud” have successfully rebranded their products as “natural” and “alternative.”

But at its heart, the complementary and alternative medicine (CAM) movement is about eroding science as an obstacle to selling bogus treatments.

I created the Science-Based Medicine site in order to confront the public opinion and academic angles of this important issue. But educating the public and exposing the flawed arguments and weak evidence of CAM does not directly address what is perhaps the most important front – legislation. Ultimately, it is laws and regulations that establish or weaken the science-based standard of care.

That is why Larry Sarner and Linda Rosa have brought together an international group of 42 physicians (and growing) to form the Institute for Science in Medicine. From the ISM website:

The ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health.  We are a watchdog group of medical professionals who believe the best science available should be used to determine health policy and establish a standard of care that protects and promotes the public health.  We oppose legislation that seeks to erode the science-based standard of care and expose the public to potentially fraudulent, worthless, or harmful medical practices or products.

Already we are faced with many urgent legislative issues. Our first press release deals with the stealth promotion of dubious treatments in the proposed health reform bills in the US House and Senate. These provisions would mandate coverage of non-science-based practitioners, essentially giving them equal status to recognized health professionals. While the provisions are promoted as “fair,” they are fair in the exact same way that teaching Intelligent Design along side evolution would be “fair.” These provisions essentially remove science and evidence as a way of distinguishing between which health care modalities are safe and effective and therefore worthy of use and reimbursement. Essentially these provisions would mandate that state and federal governments pay for worthless or harmful treatments.

These provisions are anti-consumer and anti-health as they would further erode the standard of care.

At the same time, in Canada there is a legislative move to allow Naturopaths to prescribe drugs. This is a good example of the steady expansion of the scope of practice that tends to occur once you license dubious “professions.” Naturopaths promote a wide range of unscientific health philosophies and treatments, such as homeopathy, the “water cure”, and nutritional pseudoscience. But they have been successful in acquiring licensure in some states and countries, usually with the old argument that licensure will provide quality control (but it never does). As Edzard Ernst said, (I’m paraphrasing slightly)  “The most meticulous regulation of nonsense must still result in nonsense.” Often one group of naturopaths uses licensure to remove competition from other naturopaths – but licensure never results in establishing a science-based standard of care, because naturopaths are not science-based.

Then, once licensure is achieved there is the steady lobbying for expanded coverage and scope of practice – beyond their training and expertise.

Other legislative mischief includes so-called health-freedom laws, now passed in about 15 states, that effectively remove the standard of care for so-called “alternative” treatments. What this means is that the state board of health cannot act against a practitioner’s license simply because they are engaged in sub-standard care, if they label what they do as “alternative.” If you cannot discipline sub-standard care – then there is no standard of care.

Sometimes such provisions are issue specific. For example, several months ago in Connecticut a bill was passed that states that the the board of health cannot act against a practitioner for treating “chronic Lyme disease” – again, specifically eliminating any mechanism for maintaining the standard of care with respect to a specific controversial issue.

What such laws represent, in part, is legislative arrogance – putting the political process above the scientific process of determining what treatments are legitimate.

We are still a relatively small group of professionals, with a mountainous and endless task before us, but the ISM gives us a mechanism to take on directly the more important legislative issues that come up. We will need to grow and expand our resources, and we plan on doing so.

And as always we will need the support of the scientific and skeptical communities if we are to succeed.

Share

22 responses so far

22 Responses to “Announcing the Institute for Science in Medicine”

  1. Gabor Hraskoon 30 Nov 2009 at 10:04 am

    This is great news! Is there any intention to cover European issues as well? We badly need a group that is coordinating similar efforts on an EU level. There are several EU directives that clearly promote CAM.

    Gabor Hrasko
    President – Hungarian Skeptic Society
    http://www.szkeptikustarsasag.hu/en/
    Board member – ECSO
    http://www.ecso.org/

  2. [...] Steve Novella has more. [...]

  3. Steven Novellaon 30 Nov 2009 at 10:36 am

    Yes – we have european members. We intend this to be a truly international organization.

  4. Fred Cunninghamon 30 Nov 2009 at 11:43 am

    I’m glad to be among the first to congratulate you and your distinguished cohorts in this endeavor. Any chance of some kind of an Associate grade of membership for interested non medical professionals?

  5. Steven Novellaon 30 Nov 2009 at 12:08 pm

    Yes – we are working on various levels of membership. Stay tuned.

  6. Michael Hopfenspirgeron 30 Nov 2009 at 12:47 pm

    Steven -

    Congratulations on this and a hearty ‘Thank You’ as well! I would be eager (as a physician myself) to be involved in this if possible…

    Michael Hopfenspirger

  7. Willon 30 Nov 2009 at 1:43 pm

    I’m a volunteer at CFI Ontario. I’d love to do something about the Naturopathic legislation. Not sure what though.

    Does the ISM plan to have a Canadian branch as well?

    Also, I suggest that the ISM work closely with CFI’s “Office of Public Policy”. Previously, they have lobbied against the same subversion of the health reform bills that you guys are worried about.

  8. azinykon 30 Nov 2009 at 2:55 pm

    Besides straight-up woo, are you also against anything that mainstream medicine does, like patenting drugs that are nearly identical to existing drugs that are much cheaper? It seems to me that advertising, as a means to deceive people, is also opposed to science and clear thinking.

    I think that Mark Crislip prides himself on having taken “not even a slice of pizza” from a drug company.

    The ISM website doesn’t have anything under it’s “policy papers” section yet.

  9. Jayhoxon 30 Nov 2009 at 3:25 pm

    FWIW, I just attemepted to contact them at execdir@scienceinmedicine.org, but my email bounced. Any info on this?

  10. rasmuron 30 Nov 2009 at 4:30 pm

    I’m really excited about this! I hope it will become as important as NCSE or JREF. I’m looking forward to an opportunity to become an associate member or to click a Paypal button on the ISM Website. Good luck and go for it!

  11. Ribozymeon 30 Nov 2009 at 6:14 pm

    Wow, Dr Novella, you don’t cease to amaze me! I always wonder how you get the time, and specially the energy, to do all the things you do. This institute is great news and I take the occasion to thank you for that and this marvelous blog, as well as the SBM blog and the SGU podcast. When I grow up I want to be like you!

  12. Steven Novellaon 30 Nov 2009 at 7:30 pm

    The correct e-mail address is: execdir@scienceinmedicine.net It is correct on the site now.

  13. skeptologicon 30 Nov 2009 at 8:32 pm

    This is great news. An organization like this is very much needed. Thanks Dr. Novella for everything you do. What Carl Sagan was to the public understanding of science, you are to the public understanding of science in medicine.

  14. CivilUnreston 30 Nov 2009 at 9:26 pm

    This is excellent, but I still think the most important aspect of this fight is swaying public opinion.

    I would love to see science-based advocacy groups that publicize alternative medicine horror stories. There is so much to choose from that supplying anecdotal evidence that “hits home” should be simple.

    I know that, generally, “alternative treatments” are not dangerous unto themselves and that the true danger lies in eroding the public trust in SBM. Still, this sort of argument doesn’t gain much traction because it is just not sensational enough.

    While publicizing the rare, but real, tragedies that result DIRECTLY from alternative medicine, I think we have a chance to avert the true disaster: widespread public acceptance (in both opinion and policy) of alternative treatments as comparable to SBM

    Pneumothorax due to acupuncture

    Hospitalization as a result of a treatable condition that was missed by an “alternative” doctor

    Medical complications resulting from the active ingredients in “Chinese Herbs”

    Multiple deaths and injuries at an alternative healing retreat

  15. Riaynon 30 Nov 2009 at 11:51 pm

    The ISM is a wonderful idea and I am very glad to see an international body such as this come into existence to fight ‘health fraud’ at an international level.

    For those of us who blog and protest against this type of thing, I think at times, we feel like we are preaching to the choir and not really reaching our target audience – those who legislate and in effect allow these types of products and associated nonsense into medical practices.

    I am looking forward to the positive changes that ISM can make worldwide in this area and will also be looking out for ways that I can, in my own small way, help the ISM achieve them.

  16. halincohon 30 Nov 2009 at 11:51 pm

    I too would like to become a physician member.

  17. halincohon 01 Dec 2009 at 12:16 am

    azinyk,

    If you are addressing the differences between brand names and generics , please note that generics do not exactly equal brand names. The most important difference between generic and brand name meds is that brand names have less variability between batches ( some references have suggested the number as 3-5%) as compared to generics ( which can have as much as 15% variability). Though this often is not important, it can be important when precise levels of medications are needed, such as in seizure disorders. Many variables can effect the actual pharmacokinetic effect. There is no need to add another variable when it’s important to know what exactly is being delivered.

    The Pharmaceutical industry does not usually try to invent a more expensive version of a cheaper wheel. The brand names, after the patent expires, evolve to form generic medications. What the industry does to is try to grab a piece of the same pie while the going is good. That’s capitalism. It’s ok. We, the physicians, must simply make a judgement call based on the best available data.

    When a class of drug becomes a major tool for medicine, in general, one company after another often will develop their own version. For example, for hypertension, the first ARB was COZAAR. Now there are four. Closely related to the ARBS are the ACES, which preceded the ARBS. There are TEN of these! However, several ACES are now generic and these are usually used first by most physicians. Are there differences between these meds within a class? Yes. Are these differences clinically relevant? Not often, but sometimes the differences do matter. Sometimes it definitely depends on the class. This is where science based medicine comes in. WHAT IS THE DATA? Then act accordingly IF the insurance company permits. Which is another story.

  18. halincohon 01 Dec 2009 at 12:20 am

    azinyk,

    However, with regards to advertising, how I wish that direct to the consumer advertising was banned. It makes my job MUCH tougher.

  19. Tom Nielsenon 01 Dec 2009 at 4:16 pm

    Fantastic initiative. I know it can seem tacky to have a donation button on a website, but this is a thing I really need to contribute too.

  20. davidlpfon 02 Dec 2009 at 11:37 am

    Congrats, and keep up the great work.

  21. titmouseon 02 Dec 2009 at 1:15 pm

    Steve, I maded u a cookie here.

    WRT policy: keep it simple. Emphasize the non-sectarian method of rating evidence quality and of weighing risks and benefits. That way you won’t have to update the policy page very often.

    Details regarding me-too drugs, HRT, vitamin D, etc., will change while the method of inquiry won’t.

    For fun and to promote your site, create an award to draw attention to examples of anti-science or bad science. Might I suggest, “The Tinfoil Hat.”

    Advertising is cherry-picked info presented in a manner that takes advantage of the neurobiology of branding. It should be secondary to a systematic review published somewhere that patients can access. Adds should point to that review.

  22. titmouseon 02 Dec 2009 at 1:39 pm

    Oh, can I nitpick an awkwardly worded sentence in your first press release?

    “In the current state of confusion that many in the general population find themselves as to what constitutes good medical practices, the last thing we need is the licensure and governmental support of more substandard (CAM) practitioners.”

    Maybe:

    “The public face a cacophony of discordant voices regarding what constitutes good medical practice. The last thing we need is licensure and governmental support of substandard (CAM) practitioners.”

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.