As 2009 comes to an end, it seems that everyone is creating year-in-review lists. I thought I’d jump on the list band wagon and offer my purely subjective top 5 threats to rational thought in healthcare and medicine.

Of course, it strikes me as rather ironic that we’re having this discussion – who knew that medicine could be divorced from science in the first place? I thought the two went hand-in-hand, like a nice antigen and its receptor… and yet, here we are, on the verge of tremendous technological breakthroughs (thanks to advances in our understanding of molecular genetics, immunology, and biochemistry, etc.), faced with a growing number of people who prefer to resort to placebo-based remedies (such as heavy-metal laced herbs or vigorously shaken water) and Christian Science Prayer.

And so, without further ado, here’s my list of the top 5 threats to science in medicine for 2009 and beyond:

#1: Congress

Money is the most powerful gasoline that can be poured on the fire of pseudoscience. And thanks to Senator Tom Harkin, and a few merry enablers, there is now legislation in the Senate healthcare reform bill that would allocate tax dollars to disproven and unproven medical therapies. Healthcare providers recognized by CMS will include alternative medicine practitioners – many of whom can meet licensing requirements with online degrees from schools that do not teach actual science. They will be eligible to become primary care providers, use “doctor” in their self-designation, and do untold harm to patients nationwide through misdiagnosis and mistreatment.

Please refer to this post for detailed amendment language, and for goodness sake – call your congressman or woman and ask them to move to strike this language from the reconciled house and senate bills before it becomes law. Seriously. Go call them NOW.

#2:  Mainstream Media

For some reason, snake oil has captured the imagination of the mainstream media. Thanks to people like Oprah and the major news networks, there is a steady parade of pseudoscientific poppy cock being spoon fed to the public. And because of the lack of critical thinking taught in schools, Americans (on average) have a 6th grade understanding of medicine. They have a hard time distinguishing science from pseudoscience, and with the constant barrage of miracle cures, “scientific” breakthroughs, and conspiracy theories about anything that actually works (e.g. vaccines). They have become skeptical of science while often totally accepting of snake oil.

Before we become completely despairing of any sliver of health enlightenment reaching the public through mainstream media – let’s recall that 2009 brought us a handful of journalists willing to stand up for truth and critical thinking.Newsweek’s Weston Kosova, the Associated Press’ Marilynn Marchione, Wired’s Amy Wallace, Chicago Tribune’s Trine Tsouderos, and The Washington Post’s Clive Thompson deserve praise and encouragement for standing up for science.

#3: Academic Medical Centers

Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care. Because of the economic realities of decreasing healthcare reimbursements – these once proud defenders of science are now accepting money to “study” implausible and often disproven medical treatments because they’re trendy. Scientists at these centers are forced to look the other way while patients (who trust the center’s reputation that took tens of decades to build) are exposed to placebo medicine under the guise of “holistic” healthcare.

I believe that patients are crying out for compassionate care – for more time with their providers, more dignity in their choices, and more participation in their care. In my opinion, these needs can and should be met by science-based professionals who offer patients the truth about the strengths and limitations of their options – there is no need to fill this emotional need with false cures and placebo treatments, and spin it as if the patient is getting better “integrated” care. Quackademic medicine is neither compassionate nor scientifically honest. It’s just a complex new way of providing placebo care to patients who need some common human kindness.

#4: NCCAM

Even though we’ve invested $2.5 billion tax payer dollars and 10+ years of time on studying complementary and alternative medicines – we have discovered NO single breakthrough in medical treatment as a result. Not only does this Institute appear to be a real waste of scarce resources, but In fact, the TACT trial (in particular) offers a stark example of the unethical practices that can arise when vigorous scientific standards are not met. Thanks to Dr. Atwood’s diligent review, we have a clear understanding of the shenanigans at play:

The NIH approved a research study (called the TACT Trial – Trial to Assess Chelation Therapy – a supposed treatment for arteriosclerosis) in which the treatment had no evidence for potential benefit, and clear evidence of potential harm – and even the risk of death. Amazingly, the researchers neglected to mention this risk in their informed consent document. The NIH awarded $30 million of our tax dollars to ~100 researchers to enroll 2000 patients in this risky study (ongoing from 2003-present). Even more astounding is the fact that several of the researchers have been disciplined for substandard practices by state medical boards; several have been involved in insurance fraud; at least 3 are convicted felons.

Many have called for defunding the NCCAM, and that certainly seems like a reasonable request under the circumstances of such a low ROI and ethical breaches.

#5: New Media

Just as mainstream media is beginning to fade in its influence and popularity, online and “new” media are making exponential leaps in influence.  The Huffington Post and Age Of Autism are two strongholds of health misinformation that come to mind. Of course, “user generated content” and unvetted health advice and claims are easily made by anyone anytime. And thanks to the magic of Google, a health claim need only be popular to be promoted. Truth, accuracy, and scientific rigor aren’t always rewarded in this brave new world of digital influence. Being right has been uncoupled from being influential. The “wisdom of crowds” now decides what people see first when they attempt to educate themselves about health matters.

And so, dear readers of Science-Based Medicine, we face formidable foes in our quest for honesty and integrity in medicine. I predict that the next decade will favor the organized, not the accurate. And so with that in mind, let us strive towards building our network of critical thinkers (in the government, media, research and clinical centers, and online), organizing our efforts to promote science and rational thought. We’ll each need to channel our inner “community organizer” to counter the pseudoscience movement. And we can win this, because in the end…

Science works.