meditation, ADHD, and bad reporting

There's an excellent discussion over at Space City Skeptics that I wish I'd written myself. In it, Skepticpedi illustrates both the credulous reporting of the media on science, and a particularly poor study that was just reported. I say "reported" because it wasn't really published - the report was based on an article in an online education journal edited by graduate students.

What did the study (and the article) claim? Just this: that Transcendental Meditation (TM) was beneficial in the treatment of childhood attention-deficit hyperactivity disorder, also called ADHD.  The study did almost everything wrong - in fact, if you wanted to illustrate what *not* to do in a clinical study, this one would provide a wealth of examples:

1. There were only 10 subjects, too few to make any statistically valid conclusions.
   
2. There was no control group - all 10 subjects (children) were told to try TM techniques. By the way, TM basically consists of sitting and chanting a nonsense word to yourself, over and over.
   
3. The results were based purely on self-reporting by the teachers.
   
4. There was no "blinding" - all the teachers knew what the study was trying to show.
   
5. The students were probably coached in what they were supposed to say.
   
6. The headmaster of the school (all the students were at the same school) is a strong proponent of TM, and is on the board of the foundation that funded the study!
   
7. The "scientist" (sorry, have to put that in quotes) who did the study is also on the board of the foundation that funded it. Yikes!
   

So basically, we have a small, terribly-designed, self-funded study by a proponent of TM who claims that she's produced evidence that TM helps treat children with ADHD. What's surprising here is that Reuters Health news service wrote a report on this (as did other news organizations, apparently). And by the way, the person who ran the study, Sarina Grosswald, has a strongly self-promoting website where she claims that she "recent directed a landmark research study" - this one! - and trumpeted the fact that it was widely reported in the media.  Calling your own study a "landmark", especially when it was self-labeled a "pilot" and published in an obscure journal, really takes some chutzpah.

So here's a big raspberry to Reuters for terrible medical news reporting. They can do better. And a big thumbs-up to Skepticpedi for calling them on it.

Optimism for science in 2009 (and two budget-saving ideas)

As 2008 ends, I’m feeling very optimistic about the new year, principally because we here in the U.S. have elected Barack Obama, a new President who represents a dramatic change away from the policies of the past eight years. In the scientific arena, the Bush administration has been a disaster in more ways than I care to list. Not only have the Bushies politicized many, many areas of science, but their political views have almost always hindered or reversed progress in important scientific areas. But let’s look forward to the new year and to a new, re-invigorated U.S. science program.

Of course, the Bushies have also saddled us with an enormous debt burden, over $10 trillion dollars by one recent estimate (Harper’s magazine, December 2008). That number is so stunningly large that it might seem to leave no room for optimism – with such a gigantic debt, how can we hope for progress in anything, much less “discretionary” areas like scientific research?

Well, I’m still optimistic, but I know we’ll see little or no increase in the budgets of the U.S.’s top scientific agencies, including NIH, NSF, NASA, NOAA, and others. So here are two constructive suggestions for how to save significant funds at one agency, NIH, without adversely affecting scientific progress.

1. Get rid of the security fence and all the additional pointless security operations at NIH headquarters in Bethesda, Maryland. For those who haven’t visited NIH in the past few years, there is now a high metal fence (operational since 2005) surrounding the entire campus, and an elaborate security screening operation that every visitor must go through. Getting a car onto campus is now nearly impossible – every car has to be searched – and visitors have to plan for at least 20 minutes of extra time to get to their destination. This makes it much more difficult for NIH scientists to have visitors or to host conferences on the NIH campus – and it’s an utter waste of money.

Over at scienceblogs.com, there was an entertaining post on this topic last month by Mark Hoofnagle, who offered the opinion that “NIH security is run by paranoid idiots.” While I can’t say I agree with that sentiment, I share his feeling when he writes, “I hope in the next administration the first thing they do is tear down that stupid fence and treat the NIH like any other academic medical campus.” And if they get rid of all the accompanying security – which is really just “security theater”, as a writer in The Atlantic recently opined – they can save millions (probably tens of millions) of dollars per year.

2. Readers of my blog will probably guess my second cost-cutting suggestion for NIH: eliminate the National Center for Complementary and Alternative Medicine (NCCAM). This center was created at the behest of Iowa Senator Tom Harkin in 1992, not for any scientific reason, but because he personally believed in the efficacy of bee pollen as a medical treatment (see this NY Times article). There was never any need for this – any promising therapy can be studied in one of the existing Institutes, as has happened many times in the past. NCCAM has become a center for a raft of poorly-designed studies that would not pass review at the other institutes. Furthermore, in its 16 years of existence, NCCAM has failed to show that any “alternative” treatment works – the best that I can say about it is that some of its studies have showed that some pseudo-scientific treatments don’t work.

Like many government projects, though, part of NCCAM’s mission now is to perpetuate itself. So one of its major activities is to fund training centers that will educate health professionals in CAM treatments – even though its own studies have failed to show that those treatments work. This is how a government agency perpetuates itself. NCCAM is hopeless: its advisory council is required to include at least half its members from CAM disciplines such as “chiropractic, acupuncture and Oriental medicine. naturopathic medicine and massage therapy” – and when the board recently dropped below that percentage, CAM advocacy groups such as he Integrated Healthcare Policy Consortium and Academic Consortium for Complementary and Alternative Health Care wrote to NIH to complain. These groups are very active in promoting NCCAM, and they will continue to be as long as they make money by offering their various (and ineffective) alternative therapies.

Let’s get rid of NCCAM entirely before it’s too late. Former NIH Director Harold Varmus tried to put more scientific controls on the original CAM office, and Harkin responded with legislation that made NCCAM into a much-larger Center, with a budget that now exceeds $200 million. These funds could be put to far better use elsewhere in NIH. So without increasing the NIH budget, we could effectively increase the funds available for research by eliminating NCCAM.
(Note that others have suggested eliminating NCCAM too – see the excellent article by Wallace Sampson at Quackwatch).

I know that both these suggestions – modest as they are – are unlikely to be followed any time soon. But I will remain stubbornly optimistic that the Obama administration will choose a new NIH Director who has a strong, positive vision for the future of biomedical research, and who will be willing to take on anti-science interest groups – including Senators who want to promote pseudoscience – and start reversing the last eight years of policies. A few weeks ago the Obama administration announced that Varmus will be co-chair of its scientific advisory committee, and Varmus has shown in the past that he’s willing to take on NCCAM. Perhaps with stronger support from the President this time, he and others who agree with him will succeed.

Astonishingly stupid pseudoscience claim of the week

This week’s Parade magazine, distributed to millions of U.S. households in their Sunday newspaper, contains an article called “Alternative therapies that really work,” by Mark Liponis, an M.D. who’s promoting his books on how to live longer. I haven’t read his books, and based on this article, I certainly wouldn’t recommend them. He claims that he's found 3 alternative therapies that “have scientific backing and have passed the litmus test of rigorous medical inquiry” (Parade, Dec 14, 2008): acupuncture, meditation, and biofeedback. Let me just address the first one.

According to Dr. Liponis, “stimulating an acupuncture point in the toe may even help to correct the breech position of babies in the last trimester and allow more women to avoid C-sections, according to a study in the Journal of the American Medical Association.” This is so astonishingly stupid that I had to look it up. Is there really an article in JAMA that supports this?

Well, sort of. The study that Liponis refers to – I don’t know if he read it – is an old 1998 study by F. Cardini and H. Weixin (JAMA 1998;280:1580-1584). It’s a poorly done study, without placebo controls and without blinding (meaning the patients knew if they were in the “treatment” or “control” group), and it was done in a Chinese hospital.

What did they do? They burned the herb Artemisia vulgaris (mugwort) to stimulate acupuncture point BL 67, located beside the outer corner of the fifth toenail. Why? Because “traditional Chinese medicine” claims that this will encourage fetuses in breech presentation (feet down) to turn around so that they will be born normally; i.e., head first. Crazy, right?

Well, the 1998 study claimed that the treatment worked, although it was a small study and the authors admitted that there were methodological problems. To the lead author’s credit (but not to Dr. Liponis's), he conducted a follow-up study much more recently, this time in Italy, and reported on it in April 2005 in the British Journal of Obstetrics and Gynaecology (Cardini et al., BJOG 112(6): 743-747). This time none of the women were Chinese. And this time, there was no positive effect from this bizarre therapy. As the authors wrote, “The results of this study do not confirm those of the original study.”

So no, Dr. Liponis, stimulating an acupuncture point in the toe does not correct the breech position of babies in pregnant women. If you were even the slightest bit skeptical, you’d never have reported this in your article in Parade. It didn’t take me long at all to find the followup study. And the claim itself is so laughably stupid that it’s hard to see how an intelligent person could repeat it without embarrassment. But it’s clear from your article that you believe this nonsense.

I’ll bet that the Parade article – written by someone with the title “Dr.”, after all - convinces at least some pregnant women to seek acupuncture. Liponis should be embarrassed, but somehow I doubt that he is.

I'm thinking of making "astonishingly stupid quack claim of the week" into a recurring blog topic - the popular press seems to provide plenty of material for me.

Top 10 genome papers of all time

It’s December, and that means “top 10” lists are starting to appear for the year. I’ve put together a top 10 list, but it’s not just for the year 2008. The genome era is far enough along that we can now ask the question, “what are the top 10 genome papers to date?” The first complete genome of a free-living organism was published in 1995 (Haemophilus influenzae) and literally hundreds of genomes have appeared since then - thousands, if you count virus genomes.

How does one measure the importance of a genome to science? Of course I could give you my subjective list, but I was looking for an objective measurement, one that anyone would have to admit is reasonable. The one I chose – the obvious one, really – is the number of scientific citations that the original genome paper has collected. This measure has a bias towards older papers, because newer papers haven’t yet had time to accumulate as many citations, but all of the papers on the Top 10 Genomes list are at least 6 years old. I will revise this list in the future to accommodate updates in the citation counts.

The other question is how to count citations. After looking at several sources, I chose ISI’s Web of Science citation index. Google Scholar is another option, and I used it as well, but I found that Google is less accurate – it uses a heuristic method to collect citations, and it frequently double-counts references, especially for papers with large numbers of authors. I listed both counts in the Top 10 list, but the ranking follows ISI where there’s a disagreement.

So here they are! The Top 10 Genome Papers include 5 bacteria, 3 model organisms, and the two human genome papers right at the top. Not surprisingly, all 10 appear in Nature or Science (5 in each journal). All of the first authors are different, and three were authored by consortia without a traditional first author. And for those who want to argue about which of the two human papers deserves #1, ISI gives a clear edge to the publicly-funded effort, while Google Scholar, curiously, ranks the Celera Genomics effort (which I was part of) well ahead of the public project. My subjective list would have included the malaria genome paper (MJ Gardner et al, Nature 2002) – TB and malaria are the two greatest infectious disease killers of humans – but it came in at #12 using citation criteria. But it’s much newer than #9 and #10, so I'm betting it will move up in the future – stay tuned.

[Note that I’ve also created a separate web page for this list.]

Top 10 genome papers of all time

Criteria for inclusion: a paper must be the first description of the complete or near-complete genome of a species, and it must describe the DNA sequence as well as relevant sequencing methods and biological discoveries revealed by the initial sequencing of the genome. Rankings are based on citation counts, with the ISI Web of Science taking priority over Google Scholar, which is less accurate as it uses heuristic rules to gather citations. Counts from both databases are provided. Citation counts are current as of December 2008.

1. Initial sequencing and analysis of the human genome
International Human Genome Sequencing Consortium
Nature 409:6822 (15 Feb 2001), 860-921.
Times Cited: 6,416
Google Scholar: 5,542

2. The sequence of the human genome
JC Venter, MD Adams, EW Myers, et al. (274 authors)
Science (16 Feb 2001), 1304-1351.
Times Cited: 4,588
Google Scholar: 6,502 [Note that Google places this paper at #1]

3. The Complete Genome Sequence of Escherichia coli K-12
FR Blattner, G Plunkett, CA Bloch, et al.
Science 277:5331 (5 Sept 1997), 1453-1462.
Times Cited: 3,327
Google Scholar: 3,625

4. Whole-genome random sequencing and assembly of Haemophilus influenzae RD
RD Fleischmann, MD Adams, O White, et al.
Science 269:5223 (28 July 1995), 496-512.
Times Cited: 3,075
Google Scholar: 2,651

5. Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence
ST Cole, R Brosch, J Parkhill, et al.
Nature 393:6685 (11 June 1998), 537-544.
Times Cited: 2,858
Google Scholar: 3,163 [Note that Google places this paper at #4]

6. Analysis of the genome sequence of the flowering plant Arabidopsis thaliana
The Arabidopsis Genome Initiative (143 authors)
Nature 408:6814 (14 Dec 2000), 796-815.
Times Cited: 2,689
Google Scholar: 1,728 (Google has real trouble tracking this "group author" name)

7. The genome sequence of Drosophila melanogaster
MD Adams, SE Celniker, RA Holt, et al.
Science 287:5461 (24 Mar 2000), 2185-2195.
Times Cited: 2,632
Google Scholar: 3,002

8. Initial sequencing and comparative analysis of the mouse genome
Mouse Genome Sequencing Consortium
Nature 420:6915 (5 Dec 2002), 520-562.
Times Cited: 2,188
Google Scholar: 1,763

9. The complete genome sequence of the gastric pathogen Helicobacter pylori
JF Tomb, O White, AR Kerlavage, et al.
Nature 388:6642 (7 Aug 1997), 539-547.
Times Cited: 1,960
Google Scholar: 1,325

10. Complete genome sequence of the methanogenic archaeon, Methanococcus jannaschii
CJ Bult, O White, GJ Olsen, et al.
Science 273:5278 (23 Aug 1996), 1058-1073.
Times Cited: 1,811
Google Scholar: 1,425 [Note that Google places this paper at #9]

Autism's false theories

The St. Petersburg (Florida) Times last week ran a feature story on the controversy surrounding autism and vaccines. I’ve written about this before and you can found many blogs and websites devoted entirely to autism - some good, some bad. The “controversy” is due to some people’s belief that autism is caused by the measles, mumps, and rubella (MMR) vaccine, which was first proposed in a 1998 article – later revealed to contain fraudulent data – by by Andrew Wakefield and colleagues. (10 of Wakefield’s 12 co-authors retracted their findings and repudiated the study.)

The St. Pete Times article does a better-than-average job at presenting the issue, although its title - “Debate rages over need for vaccines” – is very misleading, and I worry that the title alone will make some parents withhold vaccines from their children. But if you read the article, the reporter (Lisa Greene) does point out clearly that:

“Since then, the study [by Wakefield and colleagues] has been harshly criticized. Most of the researchers involved have retracted their results. In September, researchers who conducted a similar study said they found no link between measles virus and autism.”

Vaccines do not cause autism. After >20 studies, some of them quite large, there is no serious scientific debate over this question. But Greene makes an interesting point when she writes: “This is no longer principally a debate about science. The real question is whether Americans still believe in science — or at least, in the nation's scientists.”

That’s a good question. The anti-vaccine camp often uses conspiracy-theory arguments to make their case, as in “the government is hiding the truth” or “big pharma” doesn’t want us to know that vaccines are harmful. If you want to read some really extreme conspiracy-theory arguments, just look at what Robert F. Kennedy Jr. has been saying about thimerosal and vaccines. (And it worries me that his name is being floated for possible high-level positions in the Obama administration.) These arguments are indeed an effort to convince people (not just Americans, of course) not to believe scientists, but instead to believe, well, non-scientists, who make all sorts of other claims, ranging from the merely ignorant to the outright fraudulent. These frauds include people such as Mark and David Geier, who offer testosterone-reduction and chelation drugs to autistic children and claim that these treatments work, despite evidence that they don't - and that they might even cause serious harm.

Why do people prefer to trust quacks rather than science? Neurologist and skeptic Steven Novella has one explanation: “I know that when you are a parent of a sick child the gears of science may grind maddeningly slowly” and science hasn’t yet determined the cause, or a cure, for autism. So when someone comes along, perhaps someone with seemingly respectable credentials (but not always), and says he knows the answer, parents understandably want to believe it.

The St. Pete Times article includes a very interesting set of tables and charts (as a special supplement, not in the main article, alas) with real numbers showing the dramatic reductions over the years in the prevalence of measles and other diseases as vaccines were introduced. The press rarely does enough to point out what a major public health benefit vaccines represent, so kudos to SPT for their special report. As the Vaccine Ethics site at U. Penn says, “Vaccines are credited with having saved more lives than any medical treatment ever developed.”

Note: the title of this posting is a reference to Paul Offit’s outstanding new book, Autism’s False Prophets. I highly recommend it – Offit is a terrific writer who knows the science and the history of research on autism as well as anyone I've ever read.

Serious doubts about new study of statins and heart disease

The news this past week was filled with reports of a new study in the New England Journal of Medicine (NEJM), which reported a “dramatic risk reduction” in heart attack risk for men using Crestor, a statin drug made by AstraZeneca. This was all over the news, getting headlines on the Sunday (Nov 9) major TV networks and front page reports Monday in The New York Times, the Washington Post, and other major papers. What was striking about this study was that it claimed that people with normal cholesterol levels could get significant health benefits. If true, this new study implies that millions more people should start taking statins to protect themselves against heart attacks.

Wow. Should we all rush out and get some statins? Should we all buy AstraZeneca stock (which went up 20% on the news of this report)? Both?

Hold on a minute. This new finding is rife with problems, despite the breathless news reporting about it. Actually, there are two studies: one published in NEJM, and the second published in Circulation. I’ve read them both. Study 1, in NEJM, got most of the headlines. Study 2 reports on a new diagnostic test that looks at levels of C-reactive protein (CRP), a marker of inflammation. Study 2 found that use of a test called hsCRP – for high-sensitivity C-reactive protein – improved the predictions of cardiovascular risk in men. In other words, the study said, using this test would let you predict more accurately who’s going to have heart problems. Let’s go over the problems one by one. (This is a long blog post, so if you want to know the REAL problem with the study, scroll down to Problem 5 below.)

Problem 1 (raise an eyebrow): Both studies were funded by AstraZeneca, the drug company that sells Crestor. Obviously, AstraZeneca must be pleased that the results suggest that millions more people – those currently considered at low risk for heart disease – should start taking Crestor. However, the funding was disclosed in the reports, and AstraZeneca did not interfere in the analysis, so the funding source does not invalidate the results – not at all. It just makes me a bit more skeptical.

Robert Bazell, a journalist at NBC, was much more credulous. He reported that the study was “squeaky clean.” Well, it’s awfully nice of Mr. Bazell to give his stamp of approval, but disclosure alone does not mean the study had no bias. We’ll get to that in a minute.

Problem 2 (raise the other eyebrow): Both studies also say that high levels of C-reactive protein (CRP) are linked to heart disease, even in men with normal cholesterol levels. The lead author of both studies was Paul Ridker. Paul Ridker owns the patent on the hsCRP test for CRP. Another consequence of these studies is that millions of people are now likely to get tested for CRP, using Ridker’s test. Clearly, Ridker has an interest in the results coming out the way they did. NBC’s Bazell gives him a pass: “As for Dr. Ridker, he says flat out that the financial interest in the test had no effect on the outcome. I certainly believe that. Dr. Ridker has spent most of career working on c-RP and this study validates all his work.”

So let me get this straight: because Ridker has spent his career working on CRP and this study validates his work, we shouldn’t question it? I don’t think so. What this meant to me was that the parties conducting and funding both studies had a very strong interest in the results coming out the way they did. That doesn't mean the results are wrong - again, it just makes me more skeptical. But that’s why we have placebo-controlled trials: to eliminate the effect of bias. So I read the papers, carefully, to see what the data actually said.

Problem 3: the Circulation study didn’t report separately on the effect of CRP and family history of heart disease. In this study, Ridker and colleagues looked at 10,724 men retrospectively (over a 10-year time period), and used a “traditional” model to predict the risk of heart disease. The traditional model had 5 variables: age, blood pressure, smoking status, total cholesterol, and HDL cholesterol. They then added two more variables to the model: (a) the hsCRP test and (b) family history of a heart attack before the age of 60. The report shows that the new, 7-variable model is somewhat more accurate. The study has several methodological problems that I won’t try to describe here, but the biggest problem is that the fail to report the separate effects of the two new variables. In other words, they report only that both variables should be used to measure risk, which means (of course) that patients should be getting the hsCRP test. But what if the entire effect of the study is due to the family history of heart disease? The study doesn’t say. We simply can't tell if the hsCRP test has added value or not. And the leader of this study - Ridker - has the patent on the hsCRP test.

Problem 4: the NEJM study actually reports a very small benefit. All the glowing press reports emphasized the “44% reduction in risk” in those taking Crestor, making it sound very dramatic, but they neglected to report the absolute risk. What I mean here is that if the risk is very, very small, then a relative reduction of 44% is not so significant. Here are the actual numbers: this was a large study, with 17,802 subjects, 8901 getting Crestor and 8901 getting a placebo. The placebo group suffered 251 “events” (one of five cardiac problems, including heart attack), and the Crestor group had 142 events.

This looks pretty significant – and statistically speaking, it is. But the clinical significance is different: you’d have to treat 95 people for 2 years with statins to prevent 1 heart attack. Is that worth it? And if we put millions of people on statins for the rest of their life, which might indeed prevent some heart attacks, will there be other consequences that we can’t yet foresee?
Having an NNT (number needed to treat) of 95 might not sound so bad, but that’s a very high number. An article in Business Week a few years ago pointed out that such high NNT numbers might just represent statistical noise. That article quoted Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina, who said, "Anything over an NNT of 50 is worse than a lottery ticket; there may be no winners.” The article goes on to point out that “an estimated 10% to 15% of statin users suffer side effects, including muscle pain, cognitive impairments, and sexual dysfunction.” Furthermore, it is highly likely that lifestyle changes – getting more exercise, for example – will have a better NNT than 95. So rather than prescribing Crestor, perhaps physicians should explain the greater benefits – possibly much greater - that patients will have from changes in diet and exercise.

Problem 5: This one is the biggest problem of all. The patients in the NEJM study were randomly divided into two groups, treatment (Crestor) and placebo. Table 1 in the paper describes the groups according to a long list of features, and the groups are virtually indistinguishable for most of these – average age, blood pressure, LDL cholesterol levels, body mass index, etc. However, there are 3 critical variables where the two groups are not identical. Presumably this happened by chance, but when you have such a small effect as the one found in this study, small differences can have huge consequences. Let’s look at these 3 variables and at the number of patients in each group (Crestor vs. placebo) with these factors:

Numbers of subjects in Crestor vs. placebo groups

Treatment group:	Crestor	Placebo
Current smoker	1400	1420
Family history of premature CHD	997	1048
Metabolic syndrome	3652	3723

Notice that the Placebo number is higher in all 3 cases. There were 20 more smokers in the placebo group, 51 more people with a family history of CHD (coronary heart disease), and 71 more with metabolic syndrome. All 3 of these variables are risk factors for heart disease – in fact, 2 of them were used by Ridker in his Circulation paper as part of a test to predict risk!

Even if these differences are accidental, all 3 of them put the placebo group at higher risk of heart disease. We don’t know if these totals represent separate people (one person might be a smoker and have a family history of CHD), but if they were, we have as many as 142 more “at risk” people in the placebo group.

Remember, the total number of excess events in the placebo group was only 109 (252 events versus 141 in the placebo group). How many of those events occurred in people with the 3 “bad” variables above? It is entirely possible that these differences in the two study groups could dramatically reduce – even eliminate – the supposed benefit observed in the study.

So what does this all mean? Well, I am not convinced that Crestor has a clinically significant benefit for patients with normal cholesterol. My guess is that further studies, if done properly, will show that the benefit is smaller than that reported last week, and perhaps the benefit is nonexistent.

Finally, on a lighter note, I was pleased that one of my favorite “fake news” reporters, Stephen Colbert, wasn’t fooled at all – he made fun of the study on his show (The Colbert Report) on Wed 12 November. (Scott Hensley over at The Wall St. Journal blog has a nice post about this.) Colbert reported the study in his “Cheating Death with Dr. Stephen T. Colbert, D.F.A.”:

“This is a great breakthrough in the battle to find things to prescribe to people who don’t need them. True, the drug costs $100 a month, but that is a small price to pay to not have the heart attack that there’s no way of knowing if you would have had it.”

Colbert then showed a video clip of Stanford cardiologist Mark Hlatky. Hlatky was interviewed on PBS, where he said “we need to be cautious before we expand the numbers of patients so drastically.” Colbert responded: “sounds like someone hasn’t gotten enough free Crestor pens.”

I guess I haven’t gotten enough free Crestor pens either.

Johns Hopkins University offers quack medicine as "herbal consultations"

Well, it's sad to see, but one of the top medical research institutions in the world, Johns Hopkins University, is now offering - and advertising - a quack treatment for its students. This comes as part of its new "Integrative Medical Center", where "Integrative" is a code word for quackery. Oh, I'm sorry, that's not what JHU calls it: they say "integrative medicine refers to the practice of combining Western treatments such as pills and vaccinations with the traditional treatments of the East. It holds that curing a disease means treating the whole patient, not just the patient's illness."
Sorry, JHU, but there's only one kind of medicine: treatments that work. Using words such as "traditional," "integrative," and "alternative" is little more than marketing hype to disguise the fact that none of these treatments actually cure anything.

Having JHU endorse this nonsense is a big coup for proponents of these bogus treatments. But I should point out that many - I would venture to bet most - JHU medical researchers and physicians don't support this apparent endorsement by their institution. I was a professor at JHU myself not long ago, and I have many good friends and colleagues there who don't buy into quackery.

So just for entertainment, let's look at what JHU's own newsletter says about the new "herbal consultations":

"Allegra Hamman, CRNP, clinical herbalist and wellness consultant, will be administering the new services for the SHWC. Over the past three years, she has studied herbal medicine at the Tai Sophia Institute, where she received her master's degree in June. As part of her studies, Hamman spent a year and a half treating patients using herbal remedies."

Great! The Tai Sophia Institute is a hotbed of quack treatments, including homoepathy, Qi Gong, and acupuncture. Their own website says their "values" include:

- Operate from an acknowledgement and declaration of Oneness.
- Use nature and the rhythms of the earth as a guide in teaching our students and one another.

This is New Age gobbledegook, not medicine. Gee, it's a good thing that Hopkins has a nurse who trained at Tai Sophia! I wonder how much they're paying for these valuable services.

By the way, the University of Pennsylvania Medical School started a joint master's degree program with Tai Sophia in 2005, but they came to their senses shortly thereafter and severed the relationship. Before they did, though, they were fiercely criticized by skeptics such as David Colquhoun:

"What on earth was the University of Pennsylvania thinking about when it associated itself with such pathetic twaddle [as Tai Sophia]? Is it that their senior people are so in the grip of the delusional age that they no longer care what's true and what isn't? Or did they just spot a good chance to make money from the gullible public?"

Too bad JHU didn't talk to UPenn before they went down this path. Here's more from nurse Hamman about her new herbal consulting practice: "From the point of view of the medical community, I function as a bridge," she said. "I can speak the language of herbs, and I can speak the language of medicine." The language of herbs? What? Is that supposed to mean something, or is it just more New Age nonsense?

She goes on: "Herbalists would say that there's an enormous written record: thousands of years of information about herbal medicines. Traditional use counts for a lot."

Actually, Ms. Hamman: no, it doesn't. What counts is scientific evidence that we can gather through proper studies. Some plant products do indeed have great benefit - take aspirin, for example - but before we can offer them as medicine, we need to show that they work. (Not to mention we need to understand how to identify the active ingredients and how to provide a controlled dose.)

The JHU Newsletter also published an Editorial on this article in which they expressed mild criticism of the move: "While a clinical herbalist may provide an alternative option that appeals to students who do not wish to undergo conventional treatments, the addition of a general practitioner rather than a specialist should be prioritized. Yet, if the University were to hire specialists, there are others who would better serve the needs of the student body, such as a gynecologist or dentist, whose availability should take precedence over the option of an alternative medicine practitioner."

The Editorial misses the main point entirely, though, when it endorses alternative medicine: "Alternative medicine has been proven to be a safe and effective form of treatment for some conditions, and the attractiveness of this more natural form of medicine has propelled it into the realm of mainstream Western medicine including at Hopkins's own Hospital and medical school." And they also say "we supported the Hospital in taking the progressive step of creating a branch for alternative medicine." Sorry, Newsletter editorial staff, but you're wrong. You've been sold by the marketing hype of quack practitioners. "Alternative" medicine has not been proven to be safe and effective for anything, and I challenge you to provide examples. There's only one kind of medicine - the kind that works - and we don't label it "alternative."

Surprisingly, the JHU Newsletter includes a skeptical comment from a student, junior Rick Carrick: "I think that Health and Wellness has some issues just servicing people with regular medicine," he said. "I think that they should focus on getting people the treatment they need normally before they focus on any sort of essentially fake medicine."

Bravo! At least some of the students are too smart to be fooled by this nonsense. Now if only JHU would listen to its own students - and doctors.