Avery Comarow attacked by America's Natural Physician™

[Note: I originally posted this last Thursday under another title but it got lost in other events of that day. As I find it ironic that Mr Comarow has been attacked by an alternative medicine practitioner and advocate, I find this story worthy of reposting.]

A few weeks ago the skeptical blogosphere was up in arms about an article in US News & World Report by Avery Comarow on alternative medicine services in US academic medical centers. Mr Comarow is a senior medical writer for USN&WR and best known as editor for the last 18 years of the magazine's annual feature, America's Best Hospitals.

To my med blogger colleagues, Mr Comarow's article came off as unjustifiably sympathetic toward alternative medicine being practiced in major academic medical centers. Mr Comarow has two blog posts of his own on this story, here and here, the latter of which responded to the unanticipated deluge of critical comments on his story.

Truth be told, I was interviewed on background by Mr Comarow and felt that some of my most critical comments did not make it into the piece, due most likely to the complications with citing me as a pseudonymous source. While I am not a physician, I have been involved with integrative or alternative medical centers at four different US academic medical centers. However, my feeling (and my feeling alone) was that his primary intention was to get inside the mind of the patients, understand why they were pursuing alternative therapies, and grasp why major evidence-based medical centers were establishing centers of alternative/integrative medicine whose standards of proof were below that of each respective health system.

Interestingly, the accompanying video commentary on the article (here), was cited by a commenter on Science Based Medicine as follows: "The US News & World Report article has a video segment by the senior health editor. He seems to be more skeptical than the article's author."

The irony: the video segment was done by the same Avery Comarow who wrote the article.

So, you'd think that at least the alternative medicine community would be singing the praises of Mr Comarow's article. You would be wrong. From Bottom Line Secrets:

U.S. News Got it Wrong on Integrative Medicine
Integrated Practice Can and Does Improve Medical Care at Reduced Cost
Mark A. Stengler, ND
La Jolla Whole Health Clinic

. . .A recent major news magazine cover says: "Top hospitals are now embracing such unconventional techniques as acupuncture, homeopathy and energy healing." Sadly, one journalist wants you to be very afraid of this very important movement that has the potential to significantly reduce medical costs and improve the health and wellness of our nation. . .

. . .It has an upbeat title -- "Embracing Alternative Care: Top Hospitals Put Unorthodox Therapies Into Practice" -- but really the article is a thinly veiled CAM-slam. Heavy-handed and bordering on journalistic sensationalism, Comarow's piece is replete with erroneous research conclusions about CAM and sweeping omissions on its documented benefits and efficacy.

Let me begin by stating that "Doctor" Stengler bills himself as America's Natural Physician^TM (yes, he has really trademarked the designation). And unlike medical websites offering support for their practices with clinical trials results or references to peer-reviewed literature, Dr Stengler's La Jolla Whole Health website prominently lists "testimonials", the first choice under 'Home" as the primary support for his healing modalities.

With that background, let's see how he criticizes Mr Comarow, a journalist who has been vilified for being too soft on alternative/integrative medicine:

Right from the get-go, the article's title contains the word "unorthodox" to mean "unconventional" therapies. Most telling about the U.S. News article's intentions is the usage of loaded language about CAM and the "thicket of therapies deemed to fall within CAM's broad reach"... citing "at one extreme" yoga and massage as having "some benefit, if only to lower stress and anxiety" and at the other end, therapies that "even many who applaud CAM's newfound academic popularity call 'woo-woo medicine' because of the sheer implausibility of their rationale," such as homeopathy. In what he calls "the broad middle," Comarow puts acupuncture, herbal medicine and "other CAM approaches that seem to benefit some people with certain conditions." In a dismissive review of CAM's history, he likens CAM's presence in academic centers before the mid-1990s to "a pack of scruffy mutts, noisy and unworthy of notice."

Well first, "unconventional" and "unorthodox" were the exact terms used by Harvard's Dr David Eisenberg in his two New England Journal of Medicine and JAMA articles that alternative practitioners cite most often as evidence of huge public acceptance of alternative therapies. Yet Stengler goes on later in the article to cite data from the very same JAMA article in support of CAM use trends - we call this practice "cherrypicking": only cite that parts of papers that support your contention and discard that which you don't fancy.

The rest of Comarow's assessment of the spectrum of CAM approaches is pretty accurate and one that would be held by most physicians: homeopathy is nothing more than magical thinking while yoga and massage have well-documented effects in the medical literature for reducing anxiety and improving muscle tone and joint flexibility. In fact, some may argue that yoga and massage are not necessarily alternative but are rather extensions of conventional exercise recommended by physicians that have been adopted by CAM advocates as "alternative."

So, I really don't see Dr Stengler's rationale with his objection to the previous passage.

Stengler does try to take issue with the relative safety of prescription drugs relative to dietary supplements. Stengler is indeed correct regarding the large number of deaths associated with the use of prescription drugs in the US but then cites a much lower amount for dietary supplements. However, dietary supplement adverse event reporting mechanisms are in their infancy and nowhere near the complexity and rigor of reporting drug-related actions, nor are dietary supplement manufacturers required to disclose to the FDA such information (as is required of pharma). Moreover, these data do not take into account the number of AERs relative to number of users; finally, most dietary supplements are of insufficient quality to produce positive biological effects and, therefore, are unlikely to produce adverse effects as well.

Stengler also goes on to take Comarow to task for his alleged misrepresentation of the background of naturopathic doctors. While some naturopathic training does indeed included didactic work similar to four-year US medical schools, Comarow is correct in describing the inconsistencies in naturopathic training and the limitations in calling such individuals "physicians," particularly since the quality of naturopathic training varies considerably in North America, including one school that offers correspondence degrees. For a more detailed analysis of naturopathy, the reader should refer to Naturowatch, a page of Quackwatch devoted specifically to the benefits and risks of naturopathic medicine.

There is more in the Stengler article that castigates Mr Comarow for representing statements in his article that are based in fact. So, I leave it to the reader to decide whether Mr Comarow drank the integrative medicine Kool-Aid on one hand or whether he was a ruthless tool of a conventional journalistic enterprise that is hostile toward integrative/alternative medicine.

Having communicated with Mr Comarow throughout the course of his development of the original piece, I understand the difficulties in balancing medical facts with actual health care trends., a challenge for even for such a highly-seasoned reporter. My primary criticism of the final product was that there was an inadequate discussion of the ethics of offering alternative (non-proven) therapies under the masthead of our most highly-respected academic medical centers that enforce the implementation of evidence-based medicine in all other facets of their health systems. My guess is that the latter might not be very entrancing content to the average USN&WR audience, but it is certainly the key issue to medical bloggers critical of the non-critical adopting of CAM by major academic medical centers.

I've watched these exchanges and reactions for a little over a month since Mr Comarow first pre-released his article via his blog. As a result, I can say this: mainstream journalists should not fear for their jobs with the proliferation of sci/med bloggers. I don't believe you could pay me to absorb the amount of grief levied against Mr Comarow who tried to take a contentious and inflammatory area and try to explain the public and medical acceptance of practices so poorly based in evidence. I certainly did not envy him for taking on this task but I respect him for doing so, even if I have some issues with the final product.

So, I'd suggest reading Comarow's original article, the largely scathing comments of CAM skeptics on his blogpost, and this unusual critique of the very same article by America's Natural Physician^TM.

For now, this is Abel Pharmboy, PhD, America's Natural Medicine Blogger^TM.