It’s an AMSA Rodeo, and you’re invited!

Upon arriving to Houston for the 2012 AMSA convention and learning that there is, in fact, a straight-up rodeo in town, my first thoughts turned to the concept of rodeo clowns, and then to clowns more generally.

Harsh? Perhaps. This is, however, the organization of medical students that:

 

• Denounce drug companies and urge physicians and medical schools to cut ties with them, while allowing drug and device companies to buy exhibitors’ booths to reach our innocent medical student eyeballs;
• Advocates for changes in policy on issues from healthcare reform to resident work-hours based mainly on emotive appeals, and whose policy “leaders” don’t seem to have the best sense of the subject matter they’re lobbying about, and;
• Unabashedly supports quacks and quackery… practices that are harmful to patients, and not in keeping with the professional and scientific heritage of the medical profession that their members will soon join.

Sounds a bit clownish to me. That’s what makes it fun to watch. So for the second year in a row, your intrepid blogger will brave the ghastly Houston weather (and jet lag!) and suffer the slings and arrows of those conference attendees who can’t bear disagreement.

Follow my postings to this blog and to Twitter (under the #amsaconv12 hashtag) to get a bug’s-eye view of the goings-on at the 2012 annual convention of the country’s largest association of medical students.

Is it worth legislating science to have science-based regulation?

I’m no fan of quackery, whether it’s of the homeopathic, naturopathic, chiropractic, craniosacral, ayurvedic, or other woo-tastic flavour. I’m even less of a fan when it’s practiced by people with the letters MD or DO after their name. I think it’s deceptive and unethical to promote these unproven and often disproven practices to patients who come to you for professional advice.

Earlier this year, a Florida-based lawyer wrote a piece at SBM arguing that many quacktitioners are likely committing misrepresentation, in the legal sense, and possibly fraud in some cases. This was followed up with a series examining the background and historical legal status of naturopathy, acupuncture, and chiropractic, and now a proposal to enshrine science-based medicine in law.

Read the whole blog post to get a better sense for what’s proposed. The short version is that the proposed law would limit the scope of practice of licensed healthcare professionals by imposing a two-part test to be interpreted “according to its generally accepted meaning in the scientific community”:

1. Is it (a diagnosis, treatment, procedure, medication, etc.) plausible, based on “well-established laws, principles, or empirical findings in chemistry, biology, anatomy or physiology?”
2. If not, is it “supported, to a reasonable degree of scientific certainty” by either “good quality randomized, placebo-controlled trials” or “by a Cochrane Collaboration Systematic Review or a systematic review or meta-analysis of like quality.” If not… it’s verboten.[a trial that would pass the legal test would have a placebo control group, random assignment, no more than 25% attrition, at least 50 participants in each study arm, and publication in a “high-impact, peer-reviewed journal.”]

   If so, has its ineffectiveness been “demonstrate[d], within a reasonable degree of scientific certainty” by the aforementioned controlled trials or Cochrane Reviews? If so, plausibility won’t save it from being forbidden.

With a scheme like this, the devil is usually in the details. In this case, I don’t think one needs to dive in too deep to realize why this is a bad idea.

Politics is a sausage factory, and the science-based medical community should be hesitant to get it unnecessarily involved. Just because something is wrong/a bad idea (like quackery) does not necessarily mean that it should be forbidden in an ideal world. Just because something wouldn’t exist in an ideal world (like quackery), it doesn’t mean that it’s a good idea to use the force of law to ban it.

As narrowly-tailored as it aims to be, this proposed law will have the effect of legislating scientific truth. What constitutes scientific consensus? Plausibility? A high-impact journal? Do we really want these and other scientific questions that are now debated in the literature and the public sphere to be decided definitively by judge and jury? Do we want to give the power to certify science to our legislatures? The same legislatures that have already licensed all sorts of quacks at the behest of their lobbyists?

Science is politicized too easily. Where a scientific conclusion is translated by law into an inevitable legal and policy consequence, the science will make a better political target than the legislation. See this piece on the Endangered Species Act for an example of what I mean.

The best of policies can be undone by politics. I’ve given a fair bit of thought to how one might design an anti-quack law that doesn’t have the potential to go drastically awry. I can’t, though this is likely a result of insufficient creativity on my part.

In general, there are two types of people in government. “Our people” and “their people.” Who they are may vary based on the party or based on the issue, but both types will always be there. And both types win and lose elections.

Here’s the question: do you trust “their people” to exercise good stewardship of scientific truth? If not, let’s not be too hasty in handing over the reins to the politicians.

AMSA Follies: Swagalicious

I’ve alluded to AMSA’s… interesting choices regarding who they will and will not take money from (or at least, who they will claim not to take money from). Here’s the long-promised photographic evidence: the swag I collected from conference exhibitors.

What you’ll find below the cut includes:

• A pamphlet, a bag, and some pens from Medical Protective, a professional liability insurance company owned by Berkshire Hathaway.
• A Merck Manual (yes, that Merck… the one that makes all these ”pharms” of which AMSA claims to be ”free”).
• Materials from various academies of quackery (as seen earlier).
• A pen, a magnet, and some other swag from the FDA.
• Application forms for various forms of insurance/consumer credit provided by or through AMSA.
• Some stuff from banks.
• Swag NOS.

AMSA Follies: The Duck Pond

Q: What’s bipedal, featherless, and quacks like a duck?

A: The quacks representatives of the Association of Accredited Naturopathic Medical Colleges.

That’s right… AMSA sold them a booth at the 2011 convention, to say nothing of the smattering of naturopathic students in attendance as participants.

AMSA won’t quite take pharm money (more on that tomorrow), but they have no problem selling out to pseudoscience (that term is far too generous).

I went up to the booth and feigned ignorance as to what naturopathy is. I was told that they are “primary care physicians” who treat the “whole patient in a holistic way.” I pushed harder and harder, and for the longest time they continued to maintain that they’re “just like MD physicians.” Finally, one of their reps cracked, and poured forth the litany of quackery to which they subscribe: homeopathy, herbalism, acupuncture, therapeutic touch, and all sorts of other nonsense.

Fortunately, their written materials were more straightforward about their quackishness, though there were also some materials to recruit MD students for “integrative medicine” training at “Bastyr University“ in the Pacific Northwest (of course). Too bad they’re competing with AMSA’s own summer pseudoscience academy, whose flyers I also picked up.

For an organization that professes to support evidence-based medicine in other realms, and that ostensibly represents those students who are training to become applied scientists, this is really sad. The political gripes I might have with AMSA are one thing, but legitimizing quackery of this sort is truly beyond the pale. A poll of an unrepresentative convenience sample indicated that this is a non-partisan issue. “Open-mindedness” and “tolerance” are great, but when it comes to practices that don’t work, that mislead patients and that cast a pall on scientific medicine, organized medicine (AMSA included!) shouldn’t hesitate to take a stand.

If AMSA could be a forceful voice against pseudoscience much as they are a forceful voice for a variety of health policies with much less evidentiary support, they would be doing medicine, science, and patients a great service indeed.

***

I almost forgot, at the other end of the exhibition hall was the ayurvedic quack booth. I hope these pictures speak for themselves.

 

 

 

 

 

AMSA Follies: The (In)Famous Patch Adams

The keynote speaker at AMSA 2011 was Patch Adams accompanied by a sidekick/collaborator of some sort, Susan Parenti. Only knowing of Patch Adams from the Robin Williams cinematic depiction so many years ago, I didn’t quite know what to expect. In lieu of extended [commentary], I present to you here the highlights:

Dr. Parenti:

• The 3% of the country who own 97% of the assets think that health insurance is a market in which to make money. The horrors! [capitalism is morally repugnant? not the most nuanced argument]
• The Gesundheit Institute [Patch Adams’ facility] has never carried malpractice insurance and has never been sued. [Am I alone in thinking that there might be a causal relationship].
• The Gesundheit Institute is open to all sorts of “medicine:” homeopathy, naturopathy, ayurveda, reiki, and a few others I’ve never heard of.

Dr. Adams

• “Depression is not a mental illness. It is a pharmaceutical company diagnosis. Depression is simply a symptom of loneliness.”
• One of the scariest phrases in the world: “AMSA could lead the way on…”

Inspiration is easily muted by unrelated fringe beliefs. Would that the audience have been more critical.

Live from AMSA 2011…

The American Medical Students’ Association (AMSA) is one of the many professional (or in this case, pre-professional) organizations that represents various slices of the medical community. Of these, they are by far the biggest embarrassment to the medical community that I have encountered. Not just because they take positions with which I wildly disagree — that would be entirely acceptable. Rather, because they base their support for their policy positions on nothing more substantive than vague generalities and pleasant-sounding buzzwords and phrases.

Of course, this means that when the SUMS AMSA chapter sent out a call for students interested in attending AMSA’s 2011 annual conference in Washington DC, I pounced.

So here I am, braving the (acute) rainy weather and the (chronic) oppressive sterility of DC and its suburbs to bring you, my loyal readers, the latest and greatest updates from what is already promising to be a most entertaining boondoggle.

A sampling of macro-level AMSA Follies that pre-date the conference:

• AMSA believes strongly in left-wing solutions to healthcare, and are particular fans of single-payer. Nothing wrong with that, disagree though I might. Of course, that their senior advocacy and policy staff regularly confuse “single-payer” and “universal coverage” could lead one to believe that they don’t have the intellectual backing for the talk they’re talking. Most of their stated rationale consists of the usual empty mom-and-apple-pie rhetoric that one expects from a campaigning politician, not a group that expects to be taken seriously on the policy issues.
• AMSA is a big pusher of the pharm-free movement, releasing an annual scorecard comparing medical schools’ policies on physician-pharm conflicts of interest. There are many polemical t-shirts on sale to this effect.In my view (and in that of many others), they’ve gone way too far… almost to the point of McCarthyism. Of course, this hasn’t stopped their conference from taking sponsorship money and selling booths to all manner of medical informatics companies, medical device companies, medical publishers, medical test prep companies, and of course… government.
• AMSA is a big believer in “woo” (aka quackery of all stripes). Not only do they sponsor summer courses in such delightful nonsense as “therapeutic touch” (“reiki”), but they also invite the quacks into their conference. The Association of Accredited Naturopathic Medical Colleges has a booth here, and various naturopathic “schools” from across North America have sent students.

This group claims to represent the future doctors of America. What scares me is that they actually might.

Stick around for the weekend for more AMSA Follies, and be sure to see what I’m up to on Twitter (@nwsblog), or by following the #amsaconv2011 hashtag. The connectivity here is spotty, but I hope to provide commentary in as real-time-as-possible on the weekend’s shenanigans.

This is one window into the world of medical organizations you won’t want to miss.