Tuesday, May 27, 2008

Fitchburg's Cancer Center: Now with more placebos!

Fitchburg seems to have a pretty good thing in the form of the Simonds-Sinon Regional Cancer Center.

While I don't have any direct experience with it (or cancer, happily), it appears to be a fairly well-respected medical facility. It's been commended by the Commission on Cancer of the American College of Surgeons, which sounds like a pretty good thing.

They've also got a nice linear accelerator on-site for use in radiation therapy. And linear accelerators are cool. Plus, you know, they save lives.

So the cancer center seems to be a pretty good place. Which is what makes their apparent embrace of pseudoscientific bullshit "therapies" so disturbing.

The Sentinel has an article about the cancer center's "Evening of Wellness." I'll quote from it in a moment, but let me just start by saying that whenever someone talks to you about "wellness" it means they're bullshitting you.

Okay, article:
The Fitchburg cancer center offered some types of complimentary [sic] care through a 2007 grant, such as music and art.

HealthAlliance CEO and President Patrick Muldoon announced Thursday night at the center's "Evening of Wellness" that a new donation will help the hospital integrate even more complementary care.

Complementary care refers to art, music, exercise and traditional Eastern therapies in conjunction with traditional medical care administered to cancer patients.
What a second. So "traditional Eastern therapies" basically equals "ancient Chinese medicine," but "traditional medical care" equals scientifically sound and evidence-based modern medical treatments? Man, we're playing fast and loose with the word "traditional!"

No matter... Music and art are great things. They can undoubtedly improve the lives of people with cancer. I don't think anyone has a problem with them being offered. Same goes for exercise. That's just obvious.

"[T]raditional Eastern therapies," on the other hand, are total and utter crap. Neither "traditional" nor "Eastern" is something you should be looking for in your medical care (and yes, the "traditional" term used above to refer to evidence-based medicine is inappropriate).

The current life expectancy in China (where a huge amount of this "traditional" crap comes from) is 73.18 years, and that's with modern medicine. In the US, it's 78.14 years. Yes, please take five years off my life with your dumbass therapies, China!

Of course, at the time most of these "therapies" were made up (and "made up" is the correct way to refer to their creation), the life expectancy was probably closer to 30 or 35. So we're really talking about 40-45 years lower. But why split hairs?

Let's look at a couple of the "complementary" therapies used here. First, a quote:
[Patient Barbara] Patterson also utilized the center's LeBed [sic] exercise program to increase patient's physical strength and immune systems. The therapeutic exercise focuses on movement and dance for women with breast cancer.

"I was just coming out of treatment," she said. "It (exercise programs) opens your lymphatic glands and gets you moving. A lot of breast cancer patients can develop lymphedema."
Hmmm...

I wasn't familiar with the Lebed program, but here's its website. I recommend you watch the video on the front page. As you can see, it appears to be a low-impact dance program. Which may or may not involve blowing bubbles.

Now, Ms. Patterson is right. Lymphedema can be caused by radiation therapy. Furthermore, light exercise is a pretty decent treatment. So we're all good.

But what's this crap about "increas[ing]... immune systems"? I assume it's the reporter's own little touch, since as far as I can tell not even the Lebed people make that claim. They do say it increases "femininity" right after saying it was designed "for women and men," which is a little strange.

Incidentally, much like talking about "wellness," anyone talking about "strengthening the immune system" is at least 99% likely to be bullshitting you.

Anyway, while the Lebed method seems a little odd, I have no problem with it. Hell, it's just a dance class. It even has at least one study (pdf) on it published in a peer-reviewed journal! Sure, it's not a very well-done study (they do admit to some of the limitations in the study itself), but it does suggest that the program has some quality-of-life benefits, even if the actual medical benefits are not well-proven. So again, no worries!

Man, what am I so annoyed about then?

Oh yeah, this:
Dr. Betsy Burbank , who will offer acupuncture to patients at the center in the fall, was the night's guest speaker.

"Science is just catching with what you already know deep in your bones," Burbank said to gathered patients. "You know these (alternative programs) help your wellness."
Umm, way to throw out the "wellness" bullshit along with making a totally idiotic claim that "science is just catching up"! And offering acupuncture on top of it!

Dr. Burbank, believe it or not, actually is a real doctor. Not an oncologist, mind you, but a family doctor. Which is fine, and no doubt more than qualifies her to perform acupuncture.

On the other hand, I'm about equally qualified to perform acupuncture. Though you may want to give me a chart of where the major nerves are, just so I don't hit anything bad. But seeing as how "real" acupuncturists and people just faking it and inserting needles randomly are equally effective, I think I could do just fine. And since it's not like you actually need a medical license to do it, I think I'm plenty qualified!

Acupuncture is bullshit. It's a big fat placebo, nothing more.

"So what?" you might ask. After all, placebos are powerful things. People do sometimes feel better from them. So what's the harm?

Well, there's actually significant harm. Hopefully it doesn't affect anyone actually being treated at the cancer center. After all, they're getting real medical care in addition to the useless crap.

But offering and, more importantly, promoting the totally absurd practice of acupuncture is a problem for several reasons:
  • It diverts resources from actual medicine: For every penny spent on acupuncture and its pseudoscientific brethren, that's one less penny spent on curing cancer. Go ahead, ask me which I think is more important...
  • It gives the impression that acupuncture is a valid therapy for cancer: It is not. People at the cancer center get real treatments with real medicines and techniques that have been proven to work. But people not at the cancer center may get the impression that they can go to their local quack acupuncturist, save a few bucks, and treat their cancer cheaply. And die of cancer, because acupuncture doesn't fucking do anything.
  • It promotes a lie: Simple morality should suggest that a hospital promoting quackery is not a good thing to do.
There are actually many more reasons, but this post is starting to get pretty long, so I won't go into them just now. Suffice it to say that a hospital shouldn't be promoting something that's totally at odds not just with medicine (by which I mean the practice of medicine, not pharmaceuticals), but also at odds with reality!

And it gets worse:
Several patients traveled the corridors of cancer center, watching demonstrations of complementary care, including Reiki and Massage Therapy.
Reiki? Seriously, Reiki? That makes acupuncture look like hardcore science!

Don't know about Reiki? Let me put it in a nutshell for you.

Step 1: Maybe put on some soothing music or something.
Step 2: Wave your hands around on and over somebody's body.
Step 3: Claim you're moving their aura or "energy field" around.
Step 4: Maybe get a placebo effect if you're lucky.

Whoopdy-doo! That's Reiki. One of the most inane and ridiculous of all the pseudoscientific gibberish out there. So bad I don't even really feel the need to debunk it. If its idiocy isn't obvious to you, you're probably not reading this.

As for massage therapy... well, who doesn't like a good massage? It's not going to cure your cancer, but no doubt it feels quite nice.

Look, cancer center people. I know you mean well, and probably think what you're doing is noble. In general, it actually is pretty noble. But not the alternative medicine shit! It's exploiting the gullibility of people who are already suffering enough, dammit.

There are a lot of things you can do to improve the lives of cancer patients. The arts and exercise classes are good, why not expand them? I'm sure they could always be better. You don't need stupid "therapies" like acupuncture and Reiki (and who knows what else!) that purport to help without actually doing a damn thing. Your doctors deserve the credit when they heal someone, but at least a few people are going to walk away truly thinking that these placebo therapies actually cured them. Not because they did, but because these lies have a nasty tendency of fooling people. Even doctors, apparently.

You're better than that, cancer center. Ditch the pseudoscientific nonsense and just work on helping people with cancer!

20 comments:

PussieRuxpin said...

Thought you might find this interesting: http://www.mindhacks.com/blog/2008/05/placebo_is_not_what_.html
I know, the NYT isn't exactly the best scientific source, but there are a couple of peer-reviewed articles here, too.

The behaviorist perspective on placebos is pretty interesting, even though I usually pick fights with behaviorists just for the fun of it...for my part, I've managed sometimes to get a headache to go away with a combination of a hot bath, aspirin and one of those silly homeopathic "head-on" kind of things, and now, if I just use the homeopathic thing, it helps somewhat. Not because of the law of similars, but just because of a conditioned response. And that improves my life - even if it is a placebo.

Really Rachel said...
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The Unicow said...

Pussie,

Oddly enough, I actually heard about Obecalp just last night. It strikes me as terribly misguided. At least it's not false advertising, though.

But is your homeopathic headache stick going away because of the head-on crap or because headaches sometimes just go away? I don't put a lot of stock in many of the behaviorist theories on these things.

The Unicow said...

Oh my dear Rachel, you're old and yet you've learned so little...

First off, art, music, exercise, etc are good things. I already said as much. So what are you getting at?

Aside from that, you seem to be awfully fuzzy on the difference between correlation and causation, throw out "testimonials" about things as if they're supposed to be convincing, make a few fallacious appeals to authority, make a lot of flowery statements that don't mean anything, and fail to actually respond to anything in my post.

Wow, call me unconvinced.

You can live in a fantasy world if you prefer, but don't pretend that the reason I won't join you there is because of my age.

And the fact of the matter remains, a medical institution should not be pushing quackery. Period.

PussieRuxpin said...

Mmm, no, I completely agree. Certainly, sometimes headaches just go away. And I'm completely fine with not knowing (for myself) whether this is "really" working, or whether I'm fooling myself. I agree with you that medical institutions need a higher standard of proof for treating patients than I need for rubbing some peppermint oil on my forehead.

I don't actually buy the behaviorist stuff myself, either. BUT, for me, the theory is interesting. Since science is about the interpretation of evidence, those whacky behaviorists are often able to defend their theory with a particular interpretation of data. I often disagree, personally, with that interpretation, but I enjoy trying to approach questions from any theoretical perspective - the fun for me is in seeing whether I can really understand that interpretation from within that theoretical framework. That's what my analogy with the homeopathic thing was about - if I'm a behaviorist, that should work, and my explanation would be about conditioned responses, and I would interpret this as evidence that my theory is correct. I like that I can play with those ideas and take them that far, even if I don't believe that's the best explanation.

I guess my point is just that the story in science is about theory and interpretation as much as it is about data. Now, I'm not in medicine, but I do understand that there are reasons in medicine to have an epistemology that's weighted more heavily in the empiricist direction. Nonetheless, it strikes me that even here, there can be benefit in evaluating data from alternative theoretical orientations. And then, when you find them lacking, you can poke holes in them and laugh. Dismissing theories is hard - proving that the logic behind an interpretation of data is flawed (or that the data itself isn't really qualified data) is easier.

I recognize this isn't directly related to your post. Sorry for the rambling, you just happened to post on a day when I was already hip-deep in thinking about what we consider data, how we interpret it, and why proponents of conflicting theories can each "know" they're right.

The Unicow said...

I guess my point is just that the story in science is about theory and interpretation as much as it is about data.

This is an interesting point. I both agree and disagree with it.

Theory and interpretation are of course important. You can take perfectly good data and interpret them in a totally idiotic way, for instance.

However, a well-designed study should cut down the number of different interpretations possible (through the use of tight controls, double binding, etc.). And the more research is done, the closer you get to coming up with a good idea of the way things are. Which is really all science is.

As for a theory, it's only useful insofar as it accurately describes the world. Whichever works better wins.

Proponents of conflicting theories can "know" they're right for any of a number of reasons, I'd think. The most common one I see in this context is cherry-picking of data to lead to the outcome they want. Very few alt-med supporters will bother to ever dig very far into the actual research, and certainly they seem to avoid or dismiss anything that might prove them wrong. Oddly, they want to use science to support their stuff, but refuse to accept it when science debunks their stuff.

Of course, when science does support their claims then they cease to be "alternative." St. John's Wort, for instance. The alternative stuff lives on not because their theories are accurate, but more because these "therapies" are compelling to people for reasons that have nothing to do with their efficacy (which perhaps I'll get into more at another time).

Then there's the issue of some things just not being adequately studied, and some theories being so poor or vague that they can't ever be proven or disproven. Like the God hypothesis.

In the end, you can choose any method you want to look at something. Reality doesn't care.

Epistemology makes my head hurt.

The Unicow said...

On a side note, there's a very interesting blog post here which deals specifically with how a highly-respected scientist can devolve into a HIV-denialist.

More generally, it also addresses how doctors (the blogger is a surgeon and cancer researcher) are perhaps uniquely prone to buying into the whole "alternative" medicine sham.

Orac (the blogger) can sometimes be a bit long-winded, but he's always nicely thought-provoking and it's worth a read for anyone interested in such things.

Also, if you're confused by his use of the word "crank," here's an explanation. It's sort of a cross between "quack" and "kook."

Really Rachel said...
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The Unicow said...

Rachel,

Holy crap.

Your comment is so full of bullshit, strawmen, and red herrings that I barely know where to start.

Let's take the beginning!

It's really disappointing that you've turned into a pseudoscientist. What is your background in medicine?

First, do you actually understand what that term means?

I'm promoting science and arguing against psuedoscience. I'm about as far as one can get from being a pseudoscientist. Nice try though! Also nice try with the appeal to authority (another logical fallacy).

Second, I've worked in the medical field (and will go into no more detail than that) for the last 8 years. I'd ask about your qualifications, but I don't actually care. It's not relevant (fallacious appeal to authority).

Here's your science on music (the process of making thereof) and its effects on stroke rehab.

Did I disparage music? No, in fact I approved of it repeatedly! So... ummm... thanks for supporting what I already encouraged?

What probably has not occurred to you is that music is math and physics.

Umm... actually, that's occurred to anyone who's ever come within 100 yards of a music theory class. Music is highly mathematical. And yes, physics is involved (because physics is involved in everything).

Additionally, it's long been known that some people who suffer from aphasia can actually communicate by singing. Music therapy, as I've said consistently, is fine!

Perhaps you might try reading the actual scientific sites instead of the quack claims sites and you would find why mainstream medicine is excited about certain "alternative" medical approaches.

First, I do read the actual scientific studies (not just sites). Regularly. I link to sites like quackwatch here because the general audience reading this blog is probably not well-trained in how to properly assess a scientific paper. (Though I do on occasion link to an abstract or scientific paper just for the hell of it.)

Second, the claim that "mainstream medicine is excited about certain 'alternative' medical approaches" is total and utter bullshit. Feel free to provide evidence for your claim. But I won't hold my breath.

After all, there was a time when mainstream medicine heated up someone with a fever rather than reducing temperature, and when the "cure" for many diseases was bloodletting. There was a time when vitamins were pooh poohed as being useless placebos.

Yes there was. Around that same time most of these "alternative" therapies were developed. And indeed, they were better than the often-harmful treatments being promoted by mainstream medicine at the time. Because by not doing anything at all they at least didn't make things worse.

That ended roughly 100 years ago. Time to move on.

If you really think the only valid "medicine" is what's cooked up in a Big Pharma lab, that's sad.

First, I don't. Second, your strawman of "Big Pharma" isn't going to fly here. Valid treatments are those supported by evidence, pure and simple. It doesn't matter one bit who comes up with them.

Catch up with the times, Unicow. You're too young to be so skeptical - and so dead wrong, my friend.

"Catch up with the times"??? Oh yeah, in this age of shitty science education and credulous reports of UFOs and the Virgin Mary appearing in someone's toast on the evening newscast how dare I actually think critically!?

You're entitled to think I'm wrong. Though it would be nice if you offered the tiniest bit of proof to support that claim. Just saying I'm wrong really doesn't accomplish anything. Of course, since you haven't presented any substantive arguments opposing anything I've said, it's hard for me to elucidate how you're wrong. At this point, you're just a troll.

I'm proud to describe myself as a skeptic. If you view it as some kind of insult, then it's no wonder we disagree.

Do me a favor. Give me one cogent argument against something I've said here. Just one. Give me data to back it up. Links would be good. Don't argue against something I have no problem with (like music, art, exercise, etc.). Argue with something I've attacked (mainly acupuncture and Reiki)! Give me something substantive! A peer-reviewed study would be nice.

I'm more than eager to address these things. If you have a case, present it. If not, stop acting like an idiot. Either shit or get off the pot, as they say..

regards,
unicow

Really Rachel said...
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Really Rachel said...
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The Unicow said...

Rachel, did you even read my post?

That first Lebed study is already linked to (in its entirety) up above.

Here's how I described it:

Sure, it's not a very well-done study (they do admit to some of the limitations in the study itself), but it does suggest that the program has some quality-of-life benefits, even if the actual medical benefits are not well-proven. So again, no worries!

In other words, while I see some flaws in the study (one of which was the method in which the shoulder ROM was evaluated, and I'd also prefer an n higher than 19 per group), I'm accepting its basic premise. Also, as I've repeatedly stated, I have no issues with the exercise! I'm fine with the Lebed program, even if it's super-goofy looking.

Also, see that "no worries" bit? That is meant to indicate that my complaint is not with the Lebed program! My issue is with the acupuncture and Reiki!

If you're going to freak out about things we already agree on then yes, you're acting like a troll. Additionally, "I'm disappointed at your manners" is a classic concern troll statement.

Sorry, but I call it how I see it.

Now, do you want to actually address your arguments to something we disagree about or not?

The Unicow said...

Ah good, now we're into acupuncture!

Thank you for finally addressing the issue we're dealing with!

Okay, first study by Wesa et. al.:

Well, I tried to find the full text of the study, but couldn't. The abstract itself says absolutely nothing. I'd be happy to critique it, but there's nothing there to critique.

Second study: Chen et. al.:

As far as I can tell, this test totally lacked a control group. Junk science.

Third study: He et. al.:

Umm, yeah. They gave more Propofol to the group not getting acupuncture and then expect us to be impressed that they woke up sooner and had smaller differences in heart rate and blood pressure? Shocking!

Okay, those were totally unconvincing. Want to try again?

Really Rachel said...
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The Unicow said...

Well, I don't think I argued against massage therapy either, but what the hell...

First: Hernandez-Reif et al:

The conclusion is basically that massage improves mood (and its related neurotransmitters). Yup, I have no problems with that.

Second: no authors listed (?):

Another abstract that says nothing. How compelling.

Third: Hernandez-Reif et al (again):

Yep, massage helps stress. Not shocking! Was I ever arguing it doesn't? Because that doesn't sound like me.


You know the funny thing about all these? Researchers tend to put the best evidence to support their paper in the abstracts. Yet all the acupuncture and Reiki abstracts are notably absent of any meaningful data and/or are full of blatant flaws.

Perhaps we should move to full papers? Surely there are some of those out there.

Or maybe we could just cease this little charade right now and stop pretending like bullshit therapies are actually supported by science?

Really Rachel said...
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The Unicow said...

You said "my argument is with acupuncture and Reiki" ... I gave you abstracts from the medical journals physicians depend upon.

None of which were even close to scientifically sound...

You questioned the effects of alternative therapies on the immune system.

Not true. I said:
Incidentally, much like talking about "wellness," anyone talking about "strengthening the immune system" is at least 99% likely to be bullshitting you.

...which I stand by. I also questioned whether Lebed therapy affects the immune system (as suggested in the S&E article). As far as I can tell, it makes no claims to that effect.

"The longer term massage effects included reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes. "

I assume this was quoted to suggest I was arguing against it? When my response was actually "The conclusion is basically that massage improves mood (and its related neurotransmitters). Yup, I have no problems with that."

Okay, so NK cells and lymphocytes aren't neurotransmitters. The fact remains I never expressed a problem with massage therapy in the first place. So WTF?

I won't be bothering to read your idiotic rants any longer.

On no! Now I've offended Rachel too! I'm going to cry myself to sleep tonight!

All the best. Hope you feel better soon.

Actually, I feel great! I always get a happy feeling from squashing pseudoscientific bullshit. I know it can be hard for those who are on the receiving end, but thanks for the help!

The Unicow said...

Back on the topic of "ancient medicine," there's an interesting collection of ancient "medical" ideas here. Mostly just quotes from Celsus and Galen.

So they're basically Roman or Greek, and not the Eastern beliefs you see so commonly promoted these days as "alternative medicine." Still, it's from the same general era, and gives some insight into just how poorly the body was understood in those times.

I particularly like that hiccups indicate a liver inflammation. No wonder cartoon drunks are always hiccuping!

1970s Abraham Lincoln said...

No wonder cartoon drunks are always hiccuping!

I read this as "cartoon ducks", which I think I like even better.

stah said...

Two of my best friends were treated at the cancer center between 2000-2002. One made it, one didn't. Let's say it all together, cancer really sucks!!

If my friends families can take anything positive from their experiences, it's the fantastic care and support that they got from the staff. I spent too much time there, watching Steve and Dan stare as a bag of fluid drained into their veins, to not interact with the staff. The loss of the hospital to Health Allance is one of the many sins of past adminstrations, Rachel nailed it, but the cancer center makes that place worthwhile.

I don't know enough about science to keep up with Unicow and Rachel's entertaining arguement, nor am I familar with how the demise of Burbank came to be, but I needed to share my thoughts.

Steven Gionet Jr. 1971-2002 A true Fitchburg original!

Dan Lizotte 1972-and still around, a real sucess story!


Now if they would only let us slide ther in the winter we'd be in real business!!