FoSiM: The local "mini-me" of Institute of Science in Medicine: Same Bull, different faces.

[Post moved to other blog.]

Dr Harriet Hall and her 26 "Founding Fellows" created the "Institute of Science in Medicine" [ISM] in mid-2009 as a "501(c)(3) organization for US federal tax purposes" registered in Colorado.

It self-describes as:

ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health.

and in PDF files includes:

Institute for Science in Medicine, Inc. (ISM) is an international, educational and public-policy institute, incorporated in the State of Colorado, and recognized as a 501(c)(3) organization for US federal tax purposes.

The local Australian variant, "Friends of Science in Medicine" [FoSiM] self-describes as:

 Our Association was formed at the end of 2011 out of concern about the increasing number of dubious interventions, not supported by credible scientific evidence, now on offer to Australians.

• Dr Hall appears in the first list of "Friends", January 2012.
• The "mini-me" relationship extends further with their DNS names:
• Dr Hall's group has the obvious website name:
• www.scienceinmedicine.org
• Where the local "mini-me" has a website name unrelated to it registered name, "Friends of Science in Medicine", but exactly congruent with being the local arm of ISM.
• www.scienceinmedicine.org.au 
• There is a test/development site at:
• www.loretta.fosim.org

Why does this matter?
If you read the first policy document of ISM [PDF] as a Declaration of Intent, it finishes with some very worrying 'Recommendations':

NEEDED POLICY

The world’s health care systems need to be rooted in a single, science-based standard of care for all practitioners.

Effective, reliable care can only be delivered by qualified professionals who practice within a consistent framework of scientific knowledge and standards.

Practitioners whose diagnoses, diagnostic methods, and therapies have no plausible basis in the scientific model of medicine should not be licensed by any government, nor should they be allowed to practice under any other regulatory scheme.

Any statute permitting such practices should be amended or repealed as necessary to achieve this policy.

Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities.

 This unambiguous Declaration of Intent gives the ISM, and it's mini-me, FoSiM, a specific Agenda:

1. It is an explicit recognition that this is a Political not Academic or Scientific 'debate'. In no way are either of these bodies "Educational" or "about Science". They are only Political Lobby groups, yet aren't registered as such.
2. ISM/FoSiM want nothing less than making the practice of "Alternative" Medicines illegal ["change of statues"] and practitioners subject to "aggressive prosecution".
3. Who will judge what has, and has not, a "plausible basis in the scientific model of medicine"?
   • They don't define either "Science" or it antithesis, "Pseudo-Science", i.e. on the formal, strict basis for this rather extreme decision.
   • There seems to be no idea of Professions being able to defend themselves on any other grounds but an undefined "scientific model" and seemingly without means of Appeal or cause for Redress.
4. What isn't spelled out here, but is noted on the FoSiM site, is the assumed Dawkins Appropriation: anything ISM and their "mini-me"s decide is "Medicine" is automatically included in their Field of Practice. Which, by definition, makes that practice or technique now illegal for any other Profession to practice.

Given the extreme published position of ISM and the close alignment of ISM and its "mini-me", FoSiM, comments like this from Australian apologists strike me as ignorant, uninformed or disingenuous in the extreme:

Having an organisation like FSM to kick-start a public debate about the value of science in healthcare is invaluable. 

So to the extent that FSM can get the media and the general public thinking about how much they might value science as opposed to pseudoscience in their healthcare it can only be a good thing. That’s why I stopped sitting on the sidelines of the debate and signed up when I found out about them.

No, this is not a "debate", this is not something of little concern, an effort of well-intentioned, altruistic experts. It is anything but that.

ISM and their clones want any type of Healthcare they declare "not science" to be illegal, and practitioners "aggressively pursued". Once started, this is a very slippery slope.

Ultimately, internal Politics reliant on funding and 'connections' will determine what treatments are allowed and which will be deemed "unscientific".

The world of Medical Politics is already riven with such extreme dysfunction and violent internecine warfare that few outsiders understand how bad it is.

This campaign by ISM is hard-core Political Lobbying by the dominant Healthcare Profession for exclusive control of the domain.

They seem to not be happy with having captured over 99% of the Healthcare Dollar and now want everything, presumably in anticipation of making a grab for a much larger slice of our income.

After all, you wouldn't want to die from poor Medical care, would you?

EBM's and RCT: Doubt, Scientism and unquestioned Ideologies

[Full post moved to other blog.]

update 8-Apr-2012: Quotes from "Evidence-Based Medicine: Neither Good Evidence nor Good Medicine" by Steve Hickey, PhD and Hilary Roberts, PhD.

• The current approach to medicine is "evidence-based." This sounds obvious but, in practice, it means relying on a few large-scale studies and statistical techniques to choose the treatment for each patient. Practitioners of EBM incorrectly call this process using the "best evidence."
• Significant Does Not Mean Important...
• Large trials are powerful methods for detecting small differences.
• There is a further problem with the dangerous assertion implicit in EBM that large-scale studies are the best evidence for decisions concerning individual patients.
• As we have mentioned, EBM restricts variety to what it considers the "best evidence."
• A doctor who arrives at a correct diagnosis and treatment in an efficient manner is called, in cybernetic terms, a good regulator. 
• According to Roger Conant and Ross Ashby, every good regulator of a system must be a model of that system. Good regulators achieve their goal in the simplest way possible.
• In order to achieve this, the diagnostic processes must model the systems of the body, which is why doctors undergo years of training in all aspects of medical science.
• In addition, each patient must be treated as an individual.
• EBM's group statistics are irrelevant, since large-scale clinical trials do not model an individual patient and his or her condition, they model a population-albeit somewhat crudely.
• They are thus not good regulators.
• Once again, a rational patient would reject EBM as a poor method for finding an effective treatment for an illness.
• Diagnosing medical conditions is challenging, because we are each biochemically individual.
•  As explained by an originator of this concept, nutritional pioneer Dr. Roger Williams,
• "Nutrition is for real people. Statistical humans are of little interest."

---

The Friends of Doctors espouse an uncritical Ideological belief in a simplistic doctrine:

Evidence Based Medicine is the only source of Good Science and hence Good Medicine.
All else is, by definition, irrelevant, invalid and, at worst, quackery.

Which is a variation on Scientism, "the universal applicability of the scientific method and approach".

In 1898 you might've excused a Great Expert from declaring "We know everything and have invented everything" [paraphrased] - but in the 21st Century, for anyone to have the arrogance and hubris to make universal/absolute statements that are not dissimilar is unbelievable.
Doubly so, if like FoSiM, they hold themselves up as Great Experts (Professors with many awards and decades of experience).

I have a very specific objection to the FoSiM position, roughly, EBM/RCT's are OK as far as they go, but are far from being the only thing:

RCT's are a necessary, but not sufficient, way to gather evidence, but can never provide proof. Popper's "falsification" notion says theories can never be proven, only disprove with 1 counter-example. The source of the economics/finance term "Black Swan" - something completely new and unexpected.

Why would a group of eminent persons go out of their way to make themselves look complete fools, espousing an entrenched and immovable position that is obviously flawed?

The only reasonable answer I can come up with is:

They are fighting a Turf War and using EBM/RCT's as an overwhelming strength with which to beat-up their opponents. But if the opponents start to provide RCT's, then they can either play "Change the Rules" or "Move the Goal Posts" to force the opponents to waste time and resources.

The unreasonable explanation is these folks are uncritically and intractably wedded to the Ideology, "EBM and RCT's are everything".


In summary:

Medical Science uses RCT's because it's the best thing they've got, but belief in them "should be held lightly", they are not infallible nor free of serious deficiencies.

Evidence Based Medicine is a good servant and a poor Master. The emphasis must be on Medicine, not 'Evidence', on providing good patient care and outcomes. Chief of which is focussing on Patient Safety, not the glittering bauble of "efficacy". "First, do NO harm"...

"Friends of Science in Medicine": Credibility, Claims and Transparency

[Post moved to other blog.]

Yesterday I wrote up what I'd been able to find out on the web about "Friends of Science in Medicine" (FoSiM) - but it only begs more questions without any good answers. For a lobby group espousing the Scientific method in its very name and demanding the highest standards of evidence and rigour of others, this absence of transparency, rigour and completeness should be anathema. That it hasn't been addressed in a month starts to suggest this is no accident.

It's a long piece (3,000 wds) and, disturbingly, I could find few hard facts, only rather a lot of uncorroborated snippets. It's mostly "all smoke and mirrors".

Monday 30th January, 2012, I heard Fran Kelly of ABC Radio National, interview Prof. John Dwyer and Dr. Kerryn Phelps in "New lobby opposes teaching alternative medicine" and audio download.

Really interesting and important stuff, more so that someone whom I respect and consider a 'serious' journalist should seek to interview a former professor of Medicine and Oncology [in places falsely attributed as "Cervical Cancer Vaccine creator" - that was Ian Frazer, also a member of FoSiM] and an ex-President of the AMA and a very high-profile leader of "Integrative Medicine" in Australia.

I jumped on the 'Net and tried to find out more, but drew a blank.

Even though there has now been significant coverage in the mainstream media and a veritable barrage on-line, it's very difficult to get any information, let alone good answers, on anything to do with this lobby group.

Even something as simple as: "Who are you and what do you stand for?"
On-line, they are a vague, shadowy, even slippery group.

The ASIC "National Names" database has them incorporated in NSW (INC9896756) on 13-Feb 2012, which isn't consistent with the claim from "Quack Treatments Duck for Cover" republished/included by Neil Johnston.

It is all welcome news to the Friends of Science in Medicine (FSM), an Australian organisation formed in December of 2011...

A busy retirement: Loretta Marron, CEO FoSiM

[Post moved to other blog.]

A shy, retiring stay-at-home person the new CEO of "Friends of Science in Medicine" (FoSiM) is not, twice being declared "Australia Skeptic of the Year", appearing on TV and being written up in the media.

She become well known by Australian media, a 2009 piece, "Loretta Marron, Health Hero, On Australia’s A Current Affair", describes her as "a science graduate with a business background".

All this leaves me with questions about Loretta Marron and her motivations.

• Just what is Marron's background and expertise?
  She has no on-line CV, Publication list or Bio and makes a number of different claims about her expertise and working life.

• Just who is funding "Friends of Science in Medicine"?

• If FoSiM is a modern Association wanting to be taken seriously, where is its on-line presence?

• Is FoSiM just one person, working from home without pay?
  Is this whole thing just Marron engaging in a media beat-up and outrageous self-promotion?

• Marron demonstrated in her Crikey! piece that she has considerable networking and self-promotion skills and a fine ability to influence and persuade academics, researchers and medical experts to support her position and campaigns.
  Is FoSiM just the latest and largest version of this?

• Is Marron and FoSiM a 2012 rerun of Sheryle Moon and "Alliance of Australian Retailers" in 2010?
  Articles: SMH, ABC radio, Lateline.
  AAR Website and Disclosure statement:
  
  • We are supported by:
    
    • British American Tobacco Australia Limited (ACN 000 151 100);
    • Philip Morris Limited (ACN 004 694 428); and
    •  Imperial Tobacco Australia Limited (ACN 088 148 681).
    •  Authorised by R. Stanton for the Alliance of Australian Retailers Pty Ltd (ACN 145 378 589) of 14 Ross Street, North Parramatta, NSW, 2151.

All my concerns and questions can be summed up simply:

Show me the same Evidence about yourself and "Friends of Science in Medicine" that you are demanding of others.