Preventive Medicine Column

Dr. David L. Katz

Friends recently forwarded to my attention a commentary in the Atlantic in which the following is said about a presentation I gave at Yale:

“…

[He] listed a lot of things he’d tried and which failed to work. His conclusion was not that they should be abandoned, but that we needed a ‘a more fluid concept of evidence.’ “

Those same friends know me, of course, so they- along with anyone else who knows me- know this characterization to be absurd.

I have run a research lab for 15 years, secured and managed roughly $30 million in research funding, and published over 120 peer-reviewed papers.  Among those papers are reports of studies in complementary and alternative medicine, the alleged threat to science the commentator in the Atlantic and other self-proclaimed guardians of science, oppose.

But doing science is not, and cannot be, a threat to science.  We have studied CAM modalities with an open-mind, and unbiased methods.  We have shown that massage therapy does indeed appear to be a very promising treatment for osteoarthritis.  Our research in that area is on-going.

But we have also shown that chromium supplementation does not appear to be effective in treating insulin resistance.  The results of our own research along with the weight of evidence have, of course, prompted us to stop using chromium supplements for this purpose.  We published evidence, at odds with our hopes, indicating that yoga is not effective adjuvant therapy for asthma.  Why would anyone continue to use what doesn’t work?

If the guardians contend that under the expansive rubrics of “CAM” and “integrative medicine” there is nonsense and charlatanism, they are of course correct.  If because of that they contend that nothing legitimate can be done under those banners, they might look more closely at the glass walls of the houses of conventional medicine before throwing such stones.

The guardians contend that CAM is all about lies, and its practitioners all authorized, and inclined, to lie to their patients.  But telling a patient “I will never stop trying to find something to make you feel better” is neither lie, nor false promise, nor source of false hope- if, indeed, one never does stop trying.  The promise, and the hope, are then real.

A commitment to patients should not attenuate one’s devotion to science and evidence.  But it does require- wait for it!- that notorious ‘more fluid’ concept of evidence!   This, according to the guardians of science, puts us into the realm of what they call ‘woo.’  Does it really?

Of course not.  Fluidity is simply the opposite of rigidity.  A rigid view of evidence is that it works like a light switch: on/off, pure illumination versus utter darkness.  Any true scientist would consider this sheer nonsense.  Even the brilliance of Einstein’s relativity theory is the subject of on-going validations, decades after his death.  Science itself is fluid, constantly flowing in accord with new and better theories, new and better evidence.

What, exactly, is this dangerous ‘fluidity’ I espouse?  Actually, it is represented by a construct we have published on a number of occasions, and which I have presented at an Institute of Medicine summit.  I call the construct CARE, standing for “clinical applications of research evidence.”

Consider a therapy that appears to be safe.  There are indications in the literature that it might be effective.  There is some relevant research, but no definitive clinical trials.  The patient has tried everything that is routinely recommended for their condition, and is not better- and wants to try ‘something else.’  There is no something else to try that is safer or better substantiated than the therapy under consideration.

The CARE construct, along with an awareness that evidence is not limited to flavors of ‘iron clad’ or ‘absent,’ suggests that a promising but uncertain therapy is, indeed, the reasonable next thing to try in a patient who has already tried more conventional therapies which have failed.  Take this incremental step along the spectrum of evidence, and you are into the realm of integrative medicine- no hucksterism or false promises required.

Science subjects itself to the scientific method, which sometimes validates what one wishes to be true, and other times refutes it.  A scientist accepts the results, whether hoped for or otherwise.

Science is advanced by an open mind that seeks knowledge, while acknowledging its current limits.  Science does not make assertions about what cannot be true, simply because evidence that it is true has not yet been generated.  Science does not mistake absence of evidence for evidence of absence.  Science itself is fluid.

The self-proclaimed guardians of science defend science as they prefer it with a religious fervor.  Applying religious fervor to science is oxymoronic- give or take the ‘oxy.’

 

-fin

 

Dr. David L. Katz; www.davidkatzmd.com