On Friday, one of my partners in crime here at Science-Based Medicine, Dr. Kimball Atwood, wrote an excellent Open Letter to Dr. Josephine Briggs. Dr. Briggs, as most regular readers of SBM know, is the Director of the National Center for Complementary and Alternative Medicine (NCCAM). As most regular readers of SBM also know, we at SBM have been quite critical of NCCAM for its funding of studies of dubious scientific value, including one that I mentioned quite early on in the history of this blog, in which an R21 grant was awarded to investigators at the University of Arizona for a project entitled Dilution and succussion in homeopathic remedy dose-response patterns. The purpose of this project was to compare the effectiveness of a homeopathic remedy at different dilutions. It even compared remedies that are succussed (vigorously shaken) at each dilution step against remedies that were merely stirred. Although this is merely the most egregious example I could find at the time, two years ago I did catalog many more examples, as well as the “educational” grants disbursed through NCCAM in order to teach (and, by doing so, promote) CAM.

Given NCCAM’s long history of promoting pseudoscience, we were all quite surprised when early this year we received an e-mail from Dr. Briggs herself inviting us to NCCAM to meet with her. Unfortunately, due to our work obligations, Steve Novella, Kimball Atwood, and I were not able to coordinate our schedules to travel to Bethesda and enter the heart of darkness itself until early April. Our conversation with Dr. Briggs and her staff was cordial and mutually respectful, as Steve Novella described, and we assured her that we understood that studies such as the one I mentioned above were funded before her tenure. At the same time we were a bit disappointed that Dr. Briggs appeared far too eager to dismiss such problems as being before her time. Still, we understood and approved of Dr. Briggs’ stated goal of making NCCAM more scientifically rigorous, even though we did point out that there is nothing done at NCCAM that couldn’t be done as well in the NIH’s structure before NCCAM existed.

Unfortunately, not too long before or after Dr. Briggs met with us, she also met with a group of homeopaths, leading us to worry that perhaps in her quest to appear “open-minded,” Dr. Briggs was being so open-minded that her brain was in acute danger of falling out, particularly after we saw her infamous “science must be neutral” director’s newsletter a month later, which Dr. Kimball skewered as part of his open letter and I recently used as an example of misinterpreting what scientific “neutrality” means during my talk at the SBM Workshop at TAM8 a couple of weeks ago. In fact, I now wonder if I missed a little gray matter oozing out of Dr. Briggs’ ears during the meeting even though I sat right next to her.

Unfortunately, Dr. Atwood’s open letter gives me even more reason to despair, because in it he pointed out that Dr. Briggs will be speaking at the 25th Anniversary Convention of the American Association of Naturopathic Physicians (AANP) from August 11-15 in Portland, OR. (One wonders if Mark Crislip would be willing to make an appearance there for a Very Special Episode of his Quackcast and thereby continue to expand his Internet empire. I realize that doing so would really be “taking one for the team,” but think of the blogging and podcast material!) Kimball’s explanation why this is disturbing is excellent and detailed, as usual, but one thing he didn’t do as much of as I would have is to go into a bit more detail of what sorts of dubious medical modalities and even outright quackery Dr. Briggs will be associating herself with by speaking at this particular convention. He probably didn’t feel the need, given that he referenced his two comprehensive deconstructions of the quackery that is naturopathy, but I’m not as well-versed in naturopathy as he is, and, I suspect, neither are you. Dr. Atwood didn’t need to delve into the woo that will be presented at the AANP. I do. That’s why I thought a bit of a survey of what will be presented at the conference was in order.

A selection of AANP speakers

Before I discuss the speakers with whom Dr. Briggs will be sharing the podium in Portland, let’s take a look at the title of Dr. Briggs’ talk, which will be “Complementary and Alternative Medicine: Promising Ideas from Outside the Mainstream.” As Dr. Atwood speculates, this is probably a variation or expansion of a slide Dr. Briggs used in her talk at the 2nd Yale Research Symposium on Complementary and Integrative Medicine entitled “Quirky ideas from outside the mainstream” that listed ideas that once weren’t considered mainstream medicine but ultimately became accepted, the implication being, of course, that there are such ideas in CAM that are now considered “quirky” but will become accepted. Of course, ideas such as those embodied in reiki, therapeutic touch, homeopathy, and many other CAM modalities go far beyond merely “quirky,” and the “quirky” ideas that Dr. Briggs mentioned in her Yale talk weren’t really ever considered that “quirky,” but the probable implication of her talk at the AANP convention will be that some of the ideas about health to which naturopaths cling may well be accepted one day.

So, based on the panel of speakers, which, according to the AANP blog, will make this year’s woo-fest “one of the best gatherings to date,” what ideas might Dr. Briggs consider to be quirky but likely to be accepted as mainstream in the future? Given that the speakers are listed in alphabetical order, I couldn’t help but notice immediately as I perused the list this “quirky idea” from Mikhael Adams, BSc, ND, who will be giving a talk entitled Viruses & Pandemics in the 21 st Century: Truth or Dare and the Case for Nature Cure. His talk is described thusly:

This presentation will explore the researched and documented facts relating to viruses and pandemics in the modern age and the vaccinations offered to prevent them, as well the immense toxic burden the average human presents with and its effects on the immune system. Historically, Nature Cure has provided us with a template for repairing and maintaining the “self-healing” and “auto-regulating” mechanisms of our body. This presentation will focus on updated, detailed, effective, and successful “Nature Cure” for today’s chronic conditions.

Connoisseurs of CAM language will recognize immediately a number of code words and phrases in this paragraph, chief among them being the “immense toxic burden” and how it allegedly destroys our immune systems. It’s highly unlikely, of course, that Adams will present anything resembling actual scientific evidence to support his claims of an “immense toxic burden,” but previous experience tells me that it’s extremely likely that he will be laying down a swath of anti-vaccine propaganda, given his reference to “facts” relating to viruses, pandemics, and vaccinations, particularly given how deeply imbedded anti-vaccine beliefs are in naturopathy (only 20% of whom even recommend vaccination), coupled with the belief that uncharacterized (and often unnamed) “toxins” are responsible for most disease. Anyone want to lay down money that Adams’ talk will blame vaccines for some of this “immense toxic burden” from which we all supposedly suffer? I don’t blame you for saying no. It’d be a sucker’s bet. It’s disappointing that Dr. Briggs would associate herself with a speaker who is very likely to be spewing anti-vaccine pseudoscience, given that one area of agreement we found with her in our discussion was that NCCAM must not support the anti-vaccine beliefs that are associated with so many “alternative medical” modalities.

The description of Adams’ “qualifications” reads:

Dr. Mikhael Adams, B.Sc., N.D., received his Doctor of Naturopathy from the National College of Naturopathic Medicine in 1981. He practiced for ten years in Seattle, and is now in private practice in Milton, Ontario. He uses drainage, nutrition, homeopathy, acupuncture and auricular medicine as his primary therapeutic tools. He has studied homeopathy since 1977. Dr. Adams is the president of the International Association of Auricular and Bioenergetic Medicine, past president of the North American Association of Auricular Medicine, and has studied intensively with Dr. Paul Nogier in France. Dr. Adams taught Clinical Pathology at the Northwest Institute of Acupuncture & Oriental Medicine from 1987 to 1993 and has been giving workshops in auricular medicine since 1984. Dr. Adams has been lecturing in North America on homeopathy and drainage since 1988.

So he’s a homeopath, and, as SBM readers know, homeopathy is The One Quackery To Rule Them All. It’s disappointing that Dr. Briggs would associate herself uncritically with homeopathy, as well, although I suppose we shouldn’t be surprised, given her earlier meeting with homeopaths.

Next, “drainage” refers to lymphatic drainage a treatment modality favored by many naturopaths that claims to aid in “detoxification” by improving lymphatic drainage using various nostrums, the claim being that all sorts of symptoms are in reality due to a failure of lymphatic drainage to “detoxify” the body properly. Methods as varied as massage (which is used in science-based medicine, by the way, to improve lymphatic drainage in patients with documented lymphedema) and castor oil, although the “alternative” medical practitioners advocating this latter approach often appear not to understand the significance of pitting edema. (Hint: Lymphedema is usually not pitting, and pitting edema is usually due to cardiac, liver, or kidney abnormalities, although venous insufficiency can also cause it.) While there is a science-based rationale for using various physical techniques to improve lymphatic drainage in people who suffer from lymphedema, be it post surgical or due to other causes, science-based uses of lymphatic drainage are not what we’re talking about here.

If you really want to get a feel for what kind of practitioner Mr. Adams is, you should check out the webpage of his group naturopathy practice, The Renascent Integral Health Center in Milton, Ontario, which describes its approach to patient care thusly:

The emphasis of treatment is placed on removing the blockages that keep the individual from being a self-healing, auto-regulating organism. Therapies are implemented that support the individual’s body, as it specifically responds to external stress, toxic challenges and energetic impressions held by the body, that have manifested into the current state of disease. Whether entering treatment at the centre, or having a Medical Intuitive Scan done by distance, the goal becomes to target disease by identifying and addressing the body’s underlying imbalances that have created its symptoms. To resolve the symptoms, Mikhael and Alison’s approaches go beyond the given diagnosis, to reinitiate the body’s ability to recognize the challenges it faces, and support its ability to resolve its state of disease.

It gets better. I didn’t really know for sure what Auricular Medicine or a “Medical Intuitive” scan is. Fortunately, Adams is happy to tell us, given that he has a “medical intuitive” on his staff, namely his wife Alison Feather Adams. A medical intuitive scan is:

A Medical Intuitive Scan can be done by distance, a written report is sent, and a follow-up phone consultation is arranged to discuss the scan. The Scan records the information held in the body, at a subconscious level, therefore during the phone consult the information presented will be discussed in relation to what the individual is currently experiencing on a conscious level. Medical Intuition can give insight into the emotional and energetic components of the disease state that are not detected using standard diagnostic equipment.

Meanwhile, as best as I can figure it out, Auricular Medicine is reflexology, only with the “mappings” of various body parts and organs to the ears, rather than to the feet and hands. Here’s Adams’ description:

Auricular Medicine is an energetic reflex technique in which the pulse and filters are used to detect points on the ear. The points that show up on the ear can indicate the location of specific imbalances within the body. Through the use of filters we are able to identify specific dysfunctions within the body.

Auricular Medicine is a specialized field of Energetic Medicine…The Doctors in this clinic use Auricular Medicine as their key diagnostic tool and work with their clients to stimulate self-healing (vis medicatrix naturae) through assessment of the disease state, prevention of disease, evaluation of a client’s state of health, and treatment and care of client’s using means and substances that are in harmony with the client’s own self healing processes.

Auricular Medicine in conjunction with conventional medical tests can find and treat the cause of disease. Many conditions, acute and chronic, can be treated by Auricular Medicine.

I’m sure many diseases and conditions “can” be treated by Auricular Medicine. Whether they can be treated successfully with Auricular Medicine is another question entirely. I wonder if Adams uses Col. Niemtzow’s auricular acupuncture as well. He does, however, use something that he calls Inner Alchemy, which promises to help you:

…reconnect with your inner potential by taking you past your discomfort into the wisdom of subtle energy where your intuition can guide you to see things the way they really are, in truth. Truth is the foundation for healing and reinitiating your physical body as well as the mental, emotional and spiritual bodies to work together to bring you back to the state of ease and health again. You come to experience the essence of who you are, and release the outdated programming that the body is compensating for, and outgrown impressions about yourself that has been influencing you unknowingly.

I think we’ve found a new candidate for Dr. Atwood’s Weekly Waluation of the Weasel Words of Woo.

I spent more verbiage than I had expected on just one speaker, but I suppose I was just fortunate that the very first speaker on the list happened to provide me with such a rich source of evidence to demonstrate how unscientific naturopathic modalities are. In fact, the title of one of the talks listed piqued my interest for just this reason, specifically a panel discussion by Thomas Kruzel, M.T., ND; Dickson Thom, ND; Stephen Myers, ND, Bmed, PhD; Kate Broderick, ND entitled Emunctorology: An Old Clinical Science Brought to a New Generation of Naturopathic Physicians. Kimball mentioned this briefly in his post, but I had never heard of emunctorology, either. It’s not a simple matter to figure out what it is, other than that it has something to do with the “organs of elimination,” namely the kidneys, colon, skin, etc., and that the group of naturopaths writing the naturopathy text Foundations of Naturopathic Medicine are trying to codify it as some sort of formal naturopathic study. Also, a naturopath named Sabine Thomas, who Tweets under the ‘nym @emunctorology, rejoiced that apparently there are FINALLY emunctorology courses at that bastion of naturopathy, Bastyr University. Given how obsessed naturopaths are with “detoxification,” one can only imagine what sort of “detox” woo is encompassed by this new/old naturopathic “discipline.” No doubt it will include colon cleanses and sweat lodges to “flush the toxins out.”

Speaking of “toxins,” Charles Masur, ND will be giving a talk on that favorite “toxin” in many branches of “alt-med,” namely the dreaded heavy metals, with a talk entitled Toxic Metals in the Environment and their Role in Oxidative Stress. One wonders if he’ll advocate provoked urine testing for heavy metals of the kind championed by Doctor’s Data, which is currently suing Stephen Barrett for having had the temerity to point out that there is no scientific basis for such a test. The optimist in me hopes not. The pessimist in me realizes that pretty much any naturopath I’ve ever seen blaming all sorts of chronic disease on some sort of fantastical, never adequately documented, heavy metal toxicity also advocates chelation therapy, which is rank quackery, except in unusual case real cases of heavy metal toxicity. Maybe Masur will be the exception. Even if he is, he can count on Jessica Tran, ND, to take up the slack with a talk entitled Overview of heavy metal detoxification strategies using natural and pharmaceutical medicines, which explicitly promises to discuss chelation therapy.

Finally, here are a couple more “quirky” ideas being presented at the AANP meeting. One comes from an actual medical doctor named Dr. E. Denis Wilson, whose talk is entitled The use of T3 and herbal medicine to reset the body temperature and recalibrate many bodily functions. Dr. Wilson promises:

Body temperature is one of the most fundamental physiologic parameters but is often overlooked. Dr. Wilson will discuss the synergy between the use of T3 and herbal medicine to recalibrate body temperature patterns to aid in the restoration of good health. Thyroid endocrinology and physiology will also be discussed.

Quackwatch retorts:

“Wilson’s Syndrome” entered the health marketplace in 1990, when E. Denis Wilson, M.D., of Longwood, Florida, coined its name. Its supposed manifestations include fatigue, headaches, PMS, hair loss, irritability, fluid retention, depression, decreased memory, low sex drive, unhealthy nails, easy weight gain, and about sixty other symptoms. However, Wilson claims that his “syndrome” can cause “virtually every symptom known to man.” He also claims that it is “the most common of all chronic” ailments and probably takes a greater toll on society than any other medical condition.” Wilson claims to have discovered a type of abnormally low thyroid function in which routine blood tests of thyroid are often normal. He states that the condition is “especially brought on by stress” and can persist after the stress has passed. He claims that the main diagnostic sign is a body temperature that averages below 98.6° F (oral), and that the diagnosis is confirmed if the patient responds to treatment with a “special thyroid hormone treatment.”

Dr. Wilson’s also apparently killed at least one patient by prescribing too much thyroid hormone. As a result, according to Quackwatch, he lost a malpractice suit and hasn’t practiced medicine since 1992, which is when the Florida Board of Medicine suspended his license and ordered him to undergo psychological testing. At least he isn’t speaking the same day that Dr. Briggs is, although a talk by Jim Paoletti, RPh, FAARFM entitled A Holistic Natural Approach to Treating Hypothyroidism will occur in the session right after Dr. Briggs speaks.

Perhaps my favorite talk, at least judging by its title, will be the talk by Sharum Sharif, ND entitled Visual Homeopathy – Identifying a Person’s Constitutional Homeopathic Remedy in Minutes, which promises:

Patient and Hollywood videos will be used to demonstrate how to quickly identify a patient’s constitutional remedy by looking for simple behavioral cues and asking 2-5 questions. The presentation will be focused on the most common remedies accounting for the majority of the population of a general naturopathic clinic.

Who knew it was that easy? As a couple of questions, and pick out some water to treat your patient.

Overall, there appear to be at least seven homeopaths speaking. There’s also Matthew Baral, ND, who is a certified Defeat Autism Now! practitioner, and if there’s a richer source of autism and anti-vaccine quackery besides the roster of DAN! practitioners, I am unaware of it. There’s so much more than even this lengthy post can encompass.

What Dr. Briggs should say

I realize that Dr. Briggs is in a delicate situation. Her heart appears to be in the right place as far as wanting to make NCCAM more science-based, but her head doesn’t seem able to acknowledge just how deep into pseudoscience she’s buried herself. Given that NCCAM is not going away unless somehow the public can be rallied against it to the point where even its patron, Senator Tom Harkin (D-IA), can no longer protect it against demands for its dissolution, something exceedingly unlikely to happen any time soon, I realize that NCCAM could do a lot worse for a director than Dr. Briggs and probably will some day if its “stakeholders” get their way. However, as some readers chastised me in the comments of Dr. Atwood’s post, Dr. Briggs chose to accept the directorship of NCCAM when offered, and, as was pointed out, a scientist doesn’t get to be the director of a major center in the NIH if she isn’t a capable politician as well as scientist. In fact, although I don’t believe this to be the case for Dr. Briggs, sometimes being a politician counts for more than being a scientist, as the appointment of Dr. Bernadine Healy to head the NIH in 1991 demonstrates. I also understand that, when one holds a position like director of NCCAM, it is necessary to do things like speak to the AANP, given that, in the U.S., at least, naturopaths probably represent the most politically connected group of CAM practitioners, perhaps as much as homeopaths in the U.K. So turning down an invitation to speak would probably have caused Dr. Briggs trouble.

But wouldn’t it be really cool if Dr. Briggs were to walk into the lions’ den and speak science to woo? I realize it’s as unlikely to happen as it is for me to find a single molecule of original remedy in a 30C homeopathic remedy, but I’d love to see Dr. Briggs use the opportunity to speak to a large gathering of naturopaths to set a few things straight. For example, not too long ago, as I pointed out in my post about “naturopathic oncology” being practiced at the Cancer Treatment Centers of America, Timothy Birdsall, ND, FABNO, wrote a rather telling post for the AANP blog entitled The problem with research after having attended the National Advisory Council for Complementary and Alternative Medicine, the advisory body to NCCAM. Presumably Dr. Briggs knows, or at least has met, Dr. Birdsall, given that she must deal with NCCAM’s advisory council as part of her job. In his post, Dr. Birdsall challenged the next generation of naturopaths to be more science-based and to produce “great scientists,” while at the same time attacking “reductionism,” “allopathy,” and the “biochemical model,” characterizing research as an “impediment” to homeopaths and writing:

In the end, we must create and validate the tools to dethrone the randomized controlled trial as the gold standard, and construct new ways to validate clinical approaches to health issues. Much as the homeopaths of 2+ centuries ago created the proving as a way to better understand and utilize their remedies, we must refuse to be limited by the way conventional medicine views health and disease.

In particular, Birdsall writes:

But ultimately, I find myself becoming offended because I believe that these therapies work… Whoa! Believe? OK, but where is the role for evidence?

Where, indeed? Remember, this is the 2009 AANP Physician of the Year.

Wouldn’t it be cool if Dr. Briggs were to quote Dr. Birdsall’s article, point out to the naturopaths that medicine is not a matter of “belief,” and educate them that, while randomized trials have shortcomings, they are currently the best tool we have for answering many medical questions, including many of those of naturopathy? Wouldn’t it be even cooler if Dr. Briggs correctly pointed out that what Dr. Birdsall really appears to be advocating is not improving how science is applied to medicine, but changing our medical paradigm so that naturopathy can gain scientific acceptance using a different, much weaker standard of evidence? If she would state boldly that, if naturopathy can’t be scientifically validated, then it should be abandoned, I’d give her extra points.

Then there are other things I fantasize seeing Dr. Briggs do with her talk to the AANP:

• Say outright that homeopathy is water, that water doesn’t have memory (at least not the way homeopaths claim), and that, for homeopathy to be true, many of the laws of physics would have to be not just wrong, but spectacularly and completely wrong. Then point out that there’s no evidence that our understanding of physics and chemistry is that spectacularly wrong and challenge the AANP to give up homeopathy.
• Outline the real history of H. pylori, reminding the assembled naturopaths that the idea that H. pylori causes duodenal and gastric ulcers was accepted less than a decade after it was first proposed by Warren and Marshall in 1984, with treatment for H. pylori being the standard of care for duodenal ulcers by the mid-1990s. Challenge the naturopaths to gain acceptance for their “quirky” ideas the same way Warren and Marshall did for their quirky idea, through real science and real clinical trials.
• Point out that using provoked urine levels of heavy metals for any diagnosis or monitoring of treatment is not scientifically supported and is thus best viewed as quackery.
• Reiterate that vaccines are the single greatest medical advance there has ever been, arguably saving more lives than any other and tell the naturopaths that it is disgraceful that only 20% of naturopaths support vaccination. Tell them that there is no convincing scientific evidence that vaccines cause autism or any of the other conditions and diseases attributed to them by many naturopaths. Then point out that naturopaths who “don’t believe in vaccination” or won’t vaccinate should not be practicing medicine.
• Argue that there is no good scientific evidence that there is a human “life energy” field or that people, needles, or touch can manipulate such a field, meaning that “energy medicine” produces nothing but placebo effects.
• Challenge the naturopaths to change their practices based on what science shows, just as “conventional” physicians practicing science-based medicine do, rather than clinging to prescientific notions of “life energy,” sympathetic magic (homeopathy), and ritual purification (”detoxification”) as the basis of their treatments.

I know. It’ll never happen. But a guy can dream, can’t he?

Unfortunately, whether Dr. Briggs realizes it or not, by speaking to the AANP convention without criticism, she is giving it her imprimatur of approval. I once mentioned George Annas, who is a bit of a contrarian and agreed to speak at the National Vaccine Information Center quackfest last fall. Even after he was informed of the nature of the conference, he did not withdraw. According to reports I’ve gotten, he did, however, tell it like it is and refuse to kowtow to the anti-vaccine audience. I didn’t agree with his decision to go through with the talk, but I could respect it. Apparently Annas is the sort of person who actually does like to speak to hostile audiences and rile them up by telling them what they don’t want to hear. Similarly, I could understand and even respect Dr. Briggs if she were to do the same and refuse to kowtow to the pseudoscience that will be surrounding her as she gives her talk to the AANP, if she were to point out that the ideas of the AANP go beyond “quirky” and straight into the woo.

She won’t, though, at least not if she wants to keep her job.