User:CarlosXing/sandbox/atwood

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Kimball C. Atwood, IV, MD (Emeritus) is an American doctor and medical scientist from Newton, Massachusetts. He is retired as an assistant clinical professor at Tufts University School of Medicine and anesthesiologist at Newton-Wellesley Hospital.

Atwood is an active skeptic and an associate editor of the journal Scientific Review of Alternative Medicine. He is also co-editor (along with Stephen Barrett) of Naturowatch, one of Quackwatch's affiliated sites, and associate editor at Science Based Medicine. He is a Founding Fellow Board of Director for the Institute for Science in Medicine and a Fellow for Committee for Skeptical Inquiry.

Atwood is an outspoken critic of naturopathic medicine. His long term interest in pseudoscience was piqued in 2000 by a nursing conference held at his hospital. Therapeutic touch and other alternative healing practices were promoted as effective treatments for pleural mesothelioma. Atwood represented the opposition to naturopathic physicians licensing in his state. He was the primary author of the minority report opposing such licensure in Massachusetts.

Education
Atwood attended Harvard Medical School, did his internship and residency at Beth Israel Deaconess Medical Center and holds two board certifications:
 * American Board of Anesthesiology
 * American Board of Internal Medicine

He received his Massachusetts State Medical License in 1981 and retired as an anesthesiologist in 2019 from Newton-Wellesley Hospital.

Awards and recognition
Founding Fellow Board of Director for the Institute for Science in Medicine

Fellow for Committee for Skeptical Inquiry

Vice President: Citizens For Responsible Care and Research Incorporated (CIRCARE), 2013-2015

Board of Directors on Citizens For Responsible Care and Research Incorporated (CIRCARE), 2009-2014

Minority Report (Naturopathy licensure in Massachusetts)
In 2003 Atwood represented the Massachusetts Medical Society by opposing naturopathic licensure in Massachusetts to the Joint Committee on Health Care. After six attempts to become licensed as health care providers, a Special Commission convened in 2000. The Special Commission generated two reports. The majority report recommended licensure for naturopaths. Atwood coauthored the minority report which opposed the licensure. The minority report concluded by saying there was no point in pursuing the goal of naturopathic licensure until the field radically changed, otherwise healthcare in the state would suffer in terms of safety and reputation.

Naturopathic licensure did not succeed in the state of Massachusetts until 2017.

Criticism of Naturopathy
Atwood is especially critical of naturopathic medicine and is concerned with the influence this alternative medicine is having on medical institutions. Medical schools, medical journals and the National Institute of Health have tolerated and sometimes embraced alternative medical practices.

In an interview on the podcast The Skeptics Guide to the Universe, Atwood explains why he concentrates his efforts on naturopaths. He states that naturopaths have the trappings of legitimacy. There are campuses where students live and get a four year post graduate degree called Naturopathic Doctor (ND). The NDs have succeeded in getting state licensure and is recognized as primary healthcare providers in many states the USA. While the NDs claim to practice natural medicine along with conventional medicine, they are not trained in modern medical techniques.

They practice a hodgepodge of methods ranging from homeopathy, cranial sacral therapy, natural/herbal remedies, and even treatments for cancer. They claim to be experts on nutrition. Atwood points out the danger of officials both of state, Medicare, and federal legitimizing alternative medicine. While they claim to be scientifically based with over 10,000 references in their main textbook, the citations are not clinically relevant or simply do not scientifically support the claims. He gives an example of fish oil treatment for high blood pressure. There are over 60 double blind studies with four citations. But the reviews are mixed. At best the claims are clinically insignificant. At worst, the claims are scientifically dishonest.

Later in the same interview, he explains that NDs treat strep throat  without antibiotics. ND's claim such treatment results in a very low incidence of acute rheumatic fever. They claim to "know" when to refer their patients to get antibiotics. Antibiotics are not routinely given to patients to cure strep throat. Patients will recover in 3-4 days with or without any treatment. The antibiotics are given to prevent rheumatic fever. About 1-4% of untreated strep throat results in rheumatic fever 2-4 weeks later. Therefore treatment for strep throat by ND's becomes a self-fulfilling prophecy.

Science Based Medicine advocate
Advocates of Science Based Medicine (SBM) wish to enhance Evidence Based Medicine (EBM) to address certain shortcomings. "EBM is a vital and positive influence on the practice of medicine, but it has limitations and problems in practice: it often overemphasizes the value of evidence from clinical trials alone, with some unintended consequences, such as taxpayer dollars spent on “more research” of questionable value. The idea of SBM is not to compete with EBM, but a call to enhance it with a broader view: to answer the question “what works?” we must give more importance to our cumulative scientific knowledge from all relevant disciplines."

EBM is "a systemic approach to analyze published research as the basis of clinical decision making", first appeared in the 1990's, and was formally defined in 1996. The guidelines for EBM assume preclinical research and basic science were performed before applying the EBM guidelines. EBM does not give consideration to prior plausibility. As Atwood points out: "I am not a historian of EBM and don’t care to be, but I suspect that the explanation for this choice is that “they never saw ‘CAM’ [Complementary and Alternative Medicine] coming.” In other words, it probably didn’t occur to Sackett and other EBM pioneers that anyone would consider performing clinical trials of methods that couldn’t pass the muster of scientific plausibility. Their primary concern was to emphasize the insufficiency of basic science evidence in determining the safety and effectiveness of new treatments. In that they were quite correct, but trials of “CAM” have since reminded us that although established knowledge may be an insufficient basis for accepting a treatment claim, it is still a necessary one."

Atwood uses homeopathy as an example to point out the weakness of EBM. Homeopathy is a known pseudoscience and is a common "alternative medicine" practice. The randomized control trial (RCT, sometimes called clinical trial) is the gold standard in EBM. Under the guidelines of EBM, all health claims should be subjected to the clinical trials. Atwood points out this is a naive claim  because homeopathy is a health claim with no prior plausibility. Homeopathy fails at a basic scientific level and violates the laws of physics and physical chemistry.

Clinical trials are messy and are prone to multiple sources of error and biases. Most researchers are aware of this and attempt to correct for them. Studies funded and/or performed by advocates (such as drug companies, advocacy journals, or even backed by strong political motivations) are more prone to the known biases and errors. There are common characteristics of clinical trials of such ineffective claims:


 * Small studies of poor quality tend to be positive
 * The aggregate trials performed by advocates will yield equivocal rather than negative
 * The continual citations of small trials lead some to judge the aggregate data as weakly positive or the treatment is better than placebo
 * These weakly positive results call for more studies and reinforce the advocate's position
 * Over time, the early positive trial will give way to better designed better studies
 * The larger, better designed studies tend to be negative

However, it takes a long time before better designed studies are performed. The weakly positive results call for more studies. New studies performed by advocates are still of poor quality and give more weakly positive results.

Homeopathy studies follow the above pattern. Scientific trials of homeopathy has been carried out as far back as 1835. In 2006, one authoritative paper wrote: "‘the evidence of the effectiveness of homeopathy for specific clinical conditions is scant, is of uneven quality, and is generally of poorer quality than research done in allopathic (mainstream) medicine.’ Nevertheless ‘when only high quality studies have been selected... a surprising number show positive results’ although ‘even the best systematic reviews cannot disentangle components of bias in small trials.’ These authors conclude that ‘more and better research is needed, unobstructed by belief or disbelief in the system.’"

Atwood summarizes his position at a talk to the European Skeptics Congress in 2003: "Well-intentioned academic physicians often contend that the problem with many “alternative medicine” practices is that they have not been adequately studied. To them it seems clear that controlled trials are the key to determining the efficacy of homeopathy, “distant healing,” “applied kinesiology,” and other claims. But is this really true? These claims are so implausible that to study them is a bad idea. It is bad science because the prior probability of their being correct is very close to zero; hence equivocal results—which are entirely expected in such cases—are paradoxically viewed as implying efficacy or, at least, the need for more (equivocal) studies, on ad infinitum. It is bad public policy because it gives a scientifically-naïve citizenry the misleading impression that legitimate scientists think such claims have merit, thus encouraging health fraud and waste. It is bad ethics because it wastes resources and exploits human subjects."

Criticism of Chelation therapy
In 2008, Atwood was the lead author of "Why the NIH Trial to Assess Chelation Therapy (TACT) Should Be Abandoned" criticizing the National Institute of Health (NIH) and the National Center for Complementary and Alternative Medicine (NCCAM) for spending $30 million dollars on the Trial to Assess Chelation Therapy (TACT). Chelation therapy is a high risk (including death), medical procedure used to remove heavy metals from the body. The original study started in 2003. The criticism by Atwood is summarized:

"We have investigated the method and the trial. We present our findings in 4 parts: history, origin and nature of the TACT, state of the evidence, and risks. We present evidence that chelationists and their organization, the American College for Advancement in Medicine, used political connections to pressure the NIH to fund the TACT. The TACT protocols justified the trial by misrepresenting case series and by ignoring evidence of risks. The trial employs nearly 100 unfit co-investigators. It conflates disodium EDTA and another, somewhat safer drug. It lacks precautions necessary to minimize risks. The consent form reflects those shortcomings and fails to disclose apparent proprietary interests. The trial's outcome will be unreliable and almost certainly equivocal, thus defeating its stated purpose.

We conclude that the TACT is unethical, dangerous, pointless, and wasteful. It should be abandoned."

There was some political backlash. Atwood was called a "quackbuster". He was accused of causing "a long, labor-intensive, and costly investigation at taxpayer expense, as well as the temporary and voluntary suspension of recruitment in the study while these issues are sorted out."

Harriet Hall responded to political backlash. She pointed out the arguments against Atwood et al. can be boiled down to: "(1) I believe the testimonial evidence that chelation works. (2) Atwood and his co-authors are bad guys".

Once the study was over, public attention to the controversy grew. The Chicago Tribune pointed out several problems with the study including difficulty in finding enough patients, improper consent by failing to include death as a risk, the expense and a congressional push in 1999 by Representative Dan Burton of Indiana.

Proponents of the procedure pointed out a statistical significant difference in the results. The study concluded 26% of the chelation patients went on to suffer a heart attack, stroke, or other heart problems compared with 30% of the patients on placebo. Medical researchers question the results because: "30% of participants dropped out of the trial, undermining comparison between the treatment and placebo. Critics also note that nearly two dozen trial co-investigators have been disciplined by state medical boards for infractions ranging from insurance fraud to providing ineffective treatments. “They offer aromatherapy, crystal therapy and every imaginable wacky form of medicine. You can’t do high-quality research at sites like that,” says Steven Nissen, a cardiologist at the Cleveland Clinic in Ohio. “We wasted $30 million and 10 years on an unreliable study.”"

On November 4, 2012, Atwood responded to the results of TACT research which results agreed with his 2008 prediction. The results were ambiguous and the authors could not recommend chelation therapy for CAD. While the authors recommend further research, Atwood disagrees saying the study "convincingly demonstrates that the claims of chelationists have been bogus all along. That’s because those claims have been far more dramatic than even the small effect that the TACT may appear to support." Finally, Atwood points out that medical journal should not publish this study due to ethical violations of misleading the subjects in the consent form and many investigators had criminal records. Publishing this study would violate the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, established by the International Committee of Medical Journal Editors. The Uniform Requirements include honoring the Helsinki Declaration.

In 2016 Forbes announced the NIH will spend an additional $37 million on a follow up study called TACT2.