#2803: David Eisenberg

Truly one of the grand old men in the efforts to mainstream quackery, few individuals have done more than David Eisenberg to undermine public health services’ foundation in evidence and accountability. Eisenberg’s power comes partially from his credentials: He has been the Director of the Osher Institute at Harvard Medical School and the Division for Research and Education in Complementary and Integrative Medical Therapies, and Bernard Osher Associate Professor of Medicine at Harvard Medical School, positions that have certainly helped him sustain the illusion of being someone to trust on medical issues: he’s served as medical advisor to (among other things) to the National Institutes of Health, the Department of Public Health, the Food and Drug Administration, and the Federation of State Medical Boards with regard to complementary and alternative medicine research, education and policy, and been consultant to TV series and participated in a large number of high-profile events (like chairing the Scientific Review Committee for the International Research Congress on Integrative Medicine and Health). In 2003, he was also appointed to the Institute of Medicine’s (IOM) committee to identify scientific and policy issues in “complementary and alternative medicine” (“CAM”) research, regulation, training, credentialing and “integration with conventional medicine” – which could, on the face of it, sound like a good thing, were the committee not crammed with quacks and hucksters of various kinds. As a representative for the Massachusetts Department of Public Health at the Mass. Special Commission to Study Complementary and Alternative Health Practitioners, he and Michael Cohen recommended that the Commonwealth license “naturopathic physicians” as health care providers to give them an official stamp of approval and legitimacy through legislative alchemy (Eisenberg conveniently neglected to disclose that he had accepted funds from the group).

 

Eisenberg’s annual CME conference at Harvard was designed to allow quack advocates to promote whatever they do, including spinal manipulation and acupuncture, without facing critics, so that they could bolster their CVs with entries that might, on the face of it, sound impressive and build trust. Indeed, Eisenberg must be credited with being largely responsible for Harvard Medical School’s descent into pseudoscience (here, here, here, here and here) as illustrated e.g. by the Harvard Complementary and Integrative Medicine Course he directed and which according to (more reason-oriented) participants “was more like a political rally or a religious revival than a scientific conference”. Here is Eisenberg waxing lyrical about chiropractic, inadvertently giving almost perfect descriptions and illustrations of how quackery works in the process – such as praising chiropractors for “never failing to find a problem” and thereby validating the concerns of their patients while being eminently billable.

 

Eisenberg has also written a large number of articles on complementary and integrative medical therapies. His 1993 article on “Unconventional Medicine in the United States”, for instance, has for a long time been widely cited since ‘quack treatments are very popular’ is a commonly used defense of the legitimacy of quackery among those who promote ‘alternative’ techniques – and even for that study, Eisenberg’s research design was abhorrently shoddy: for instance, to reach the conclusion that “[o]ne in three respondents (34%) reported using at least one unconventional therapy in the past year”, he and his coauthors defined ‘unconventional therapies’ as “medical intervention not taught widely at U.S. medical schools or generally available at U.S. hospitals”, thus including self-help groups and commercial relaxation and/or weight-loss programs. Later surveys conducted and promoted by Eisenberg similarly inflate (in a manner very popular by alternative medicine proponents) the numbers by rebranding all sorts of standard, medically justified methods as ‘alternative’. And whether the alternative therapies included are effective or even plausible is of less concern to Eisenberg; although he is careful to avoid making significant positive claims, his list of techniques that “warrant further investigation” and funding includes homeopathy (including “homeopathy as distinct from placebo”), distant healing and intercessory prayer. What matters to Eisenberg and requires a response from clinicians, is that “[t]he market for complementary and integrative medicine is vast and shows no sign of diminishing” – yes, the market; not medical needs.

 

Here is a discussion of an article by Eisenberg and Ted Kaptchuk on “Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations”. It is … revealing: there is much about how to develop an optimal product delivery model; the question of whether the product works, however, are at best an afterthought. Here is a discussion of an article by Eisenberg with naturopaths Patricia Herman and Beth L. Poindexter on the alleged “cost-effectiveness” of CAM treatments that completely misses the point by strenuously avoiding the awkward point that the fact that the CAM therapies under discussion are not effective matters to discussions of how ‘cost-effective’ they are.

 

Diagnosis: Yes, Eisenberg is all about how to solve practical obstacles to market and deliver alternative medicine, in an effective manner, to as many people as possible. And he’s admittedly good at it. What he seems clinically unable to recognize, however, is the importance of the rather basic question: does it work? We really don’t think he means harm; he just genuinely doesn’t recognize that there might be a gap between believing that something works and whether it actually works that ought to be bridged by evidence.