Respectful Insolence

Since I’m almost never home in time to see the 6:30 PM news, it’s unlikely I’ll be seeing this series on NBC news about the “mind-body” connection when it airs, although I’ll search for video later when I get a chance. Apparently I missed this last night:

When we were planning this week’s series “the Mind Body Connection,” Alex Wallace the executive producer of Nightly News asked me what was new with the alternative medicine movement, which has been in full swing for more than a decade.

The answer is that a handful of billionaires have brought alternative medicine into many the nation’s major medical centers, long the bastion of opposition. The new approach is called “complementary and alternative medicine” (CAM) or integrative medicine. Tonight we profile the program at Duke where meditation, massage, biofeedback, and acupuncture among other alternative approaches are offered along with conventional medicine.

John Mack, the CEO of Morgan Stanley gave the money to set up the Duke facility. His wife Christy, the daughter of a physician, has long been a proponent of integrating alternative and mainstream medicine.

Other donors have set up similar programs at Harvard and the hospitals of the University of California in San Francisco and Irvine. The goal of these programs is to establish a model for medicine of the future focusing on wellness instead of disease.

Yes, that does appear to be the difference, although the whole schtick about a model for medicine “focusing on wellness instead of disease” is a big, fat, steaming load of B.S., because, its denunciations of “conventional” medicine and bold claims for promoting health notwithstanding, “focusing on wellness” is not what most so-called CAM therapies do. There’s also the issue of insurance, which generally doesn’t pay for treatments without at least a modicum of high quality evidence that it works better than a placebo, meaning that CAM services bring in good, old-fashioned, cold hard cash on the barrelhead without all that nasty mucking about with insurance company claims.

Dr. Bazell does characterize the CAM movement correctly:

The challenge they face is that alternative medicine includes not just meditation, massage, biofeedback, and acupuncture but herbs and supplements, extensive enemas, magnets, leeches, chelation, and a list that goes on almost endlessly. Clearly some of these treatments are harmless at worst and sometimes beneficial, while some can be horribly dangerous. As I have written many practitioners of alternative medicine either see no need for their claims to be tested with scientific studies or simply ignore results if they don’t like they way come out. They often see regular medicine as a conspiracy aligned against them.

Exactly. I hope this proper scientific skepticism comes out in the series, but I have real doubts. They’ll probably trot out the obligatory token skeptic or two over the course of the series’ installments, but I predict that the overall tone of the story will be credulous and supportive, as it almost always is for stories of this type–Dr. Bazell’s rightful skepticism and his previous characterization of how “CAM” advocates ignore negative studies notwithstanding.

Comments

  1. #1 Koray
    May 6, 2008

    Wow. Morgan-Stanley’s CEO’s wife’s father is a physician? Now I am truly intrigued by this CAM business…

  2. #2 N.B.
    May 6, 2008

    It’s fitting that they’re calling this the “mind-body connection series” given that they claim to be focusing on “wellness instead of disease.” The only way I can see to get to the whole wellness versus disease dichotomy is to create it, artificially, by separating the “self” from the body and implying that no matter how physically ill (or fine) you are that you’re ill (or fine) if you feel that way.

    The problem, of course, is that this validates all the hypochondriacs out there, or even just “the worried well,” which is the audience that faith-based treatment is ultimately marketed toward. If you feel sick, you are sick; if you feel well, you are well, or you will become well (despite strong evidence to the contrary).

    The medical professionals in the audience need to remember that we’re only going to win this battle by proving that the woo-meisters don’t have the monopoly on compassion. But even that may not be enough; look at Morgellon’s “sufferers,” most of whom are clearly not satisfied with being told that they have delusional parasitosis and being offered some Seroquel.

    In any case, like Orac, I’m skeptical that this presentation is going to be anything but lip-service to FBT. Ever notice how when skeptics do get pulled onto these things, they’re permitted to speak about two sentences and are convinced as doubters that shouldn’t convince you to disbelieve? After all, faith is beautiful and doubt is ugly. Ah, America’s celebration of ignorance continues.

  3. #3 N.B.
    May 6, 2008

    Curses! I clearly meant to say “portrayed as doubters” back there…

  4. #4 qetzal
    May 6, 2008

    Koray nails it in referring to “this CAM business.

  5. #5 Prometheus
    May 6, 2008

    I’m not so sure that we can “win the war” on “CAM” or other brands of superstition masquerading as medicine. From a purely moral and ethical point of view, of course, it is right to protect our fellow man (and woman) from being sold a “bill of goods”, but our approach may be counterproductive.

    I have a modest proposal for how to deal with the issue of “CAM”:

    To me, the psychology of the issue “feels” like what I’ve experienced dealing with teenage children. As Dr. Bazell notes, “They ["CAM" practitioners] often see regular medicine as a conspiracy aligned against them.” This is also true about the patients who are supporting these “practitioners”. The more we try to legislate, regulate and educate, the more they are convinced that “It’s all a conspiracy, man!”

    It is terribly typical of teenagers to perceive advice and legitimate “limit-setting” as an “intrusion” into their autonomy – as it is with the “CAM” practitioners and their prey. Likewise, teenagers – and most people seeking “CAM” therapies – are poorly equipped to function autonomously in the world they wish to navigate without guidance. In both situations, it may be more effective to let the person try and fail, so that they perceive their need for guidance (and, perhaps, gain a little experience in “how the world works”).

    Perhaps the most effective approach (although not necessarily the “best” or most humane) would be to “disengage”, as I have been told to do with my teenage child. Let people go to these “practitioners”, let them have their auras adjusted, their necks “popped” and their divalent cations chelated into oblivion. They will eventually end up at “mainstream” medicine’s door, begging for help (those that survive, that is).

    There is no financial incentive for doctors – real doctors – to eliminate “CAM” therapies (or therapists). The patients with a real medical problem will eventually see a “real” doctor (even if it is only the pathologist) and those with an imaginary problem…well, most doctors I’ve spoken to would rather have those patients go somewhere else and not bother them.

    If anything, patients who first seek out “CAM” therapies for real medical problems will end up making even more money for real doctors, because their problem will be more advanced and require more intensive (and expensive) treatments than it would have earlier. So, the efforts of so many doctors – like Orac – to persuade people to stay away from “CAM” can only be due to a quixotic sense of obligation to the population at large.

    Prometheus

  6. #6 Harry Eagar
    May 6, 2008

    The union I belong to recently negotiated a contract that switched health insurance from good ol’ Blue Cross to a slightly cheaper newcomer, Summerlin.

    Unlike BC, Summerlin covers naturopathy etc.

    I commented to the boss, who had to sign and has to pay for the coverage, that, over time, covering quack medicine has got to be more expensive. He shrugged and said, ‘Of course.’

    He’ll cross that bridge when he comes to it, I guess.

  7. #7 Liesl
    May 6, 2008

    This crap is never going to go away as long as we continue to assert that the mind and body are separate in the first place. As long as we allow for some sort of mysticism when talking about human biology there will be room for all kinds of mysticism in “medicine.” How can the mind be separate from the body if it is essentially indivisible from the biological process that houses it?

  8. #8 Steve
    May 6, 2008

    Mmm… I guess I hear that shit wrong. When someone says ‘wellness rather than disease”, what comes to my mind is things like “good neonatal care” and teaching people how to be healthier ( primarily, exercise) rather than just writing scripts for statin drugs and sending them home.

    Of course, we could significantly improve medicine in the US if the average doctor stayed “up” on changes in our understanding of health and diet.

    This is not to mean I think we should all willy-nilly get untested treatments. I agree, generally, with the ‘evidence based medicine’ stance that’s widespread here on SB, but I’m not quite so high as everyone else seems to be on the broken implementation we have here in the US (that’s a disclaimer because I’ve not lived anywhere else, not a suggestion that other countries necessarily do better at it). So just because purveyors of woo piss me off doesn’t mean I think that there aren’t a lot of doctors that are just as bad, regardless of their education.

  9. #9 ebohlman
    May 7, 2008

    Prometheus: It’s possible that offering CAM “treatments” for the Worried Well is actually cost-effective; it’s likely to keep many of them from burdening the real medical system with dubious complaints. The problem, of course, is that one of the CAM consumers (that’s the right word, not “patients”) might develop signs of a real medical problem as opposed to an everyday somatic complaint and might as a result forego proper treatment. I guess it’s one of those “optimization” problems that don’t really have good solutions. I suppose that as long as people don’t impose that sort of thing on their kids, it really ought to be a matter of “live and let live.” As W. Edwards Deming once said about rationality in business management, “survival is not mandatory.”

  10. #10 John
    May 7, 2008

    “Wellness” care of any kind, and the diagnosis and treatment of pathology/disease are two entirely different models and should not be confused.

    I would argue that a practitioner of any kind cannot ethically be “treating” a patient if they are claiming to provide wellness care, regardless of their degree. Treatment would require the diagnosis of a specific pathology and the administration of some type of therapy to reduce or alleviate the symptoms of that pathology.

    If someone is administering “treatment”, their objective is to alleviate a condition or reduce or prevent a symptom or disease process from occurring or progressing.

    If however, someone is providing wellness care, that person needs to inform the person receiving that care as to what wellness care actually is — that it is NOT an attempt to correct, reduce, alleviate or prevent a symptom or disease process.

    What then, is the point of wellness care? To optimize, enhance, and increase the functionality of the patient, physically, emotionally and mentally, not to “treat” their condition.

    There are many very intelligent, ethical and extremely “skeptical” (by that I mean believers in the scientific method and aware of the difference between high quality vs. shoddy study design)practicing various forms of wellness care, who are helping millions of people have an enhanced quality of life.

    Yes, people want guidance. Unfortunately, when some of the “real” doctors forget to be humble servants and start believing that the treatment of symptoms and alleviation of disease processes is what actually makes someone “well” they’ve let their egos get the best of them.

    Does the absence of symptoms mean someone is well?
    Does the presence of symptoms mean someone is ill?

    What is your criteria for determining wellness and illness? Is it the same or different than that used in determining whether someone is sick or “cured”?

    Wellness/Illness assessment takes into consideration the subjective component, the interior state of the person as well as the biology. It doesn’t view the mind and body as separate. Of the 75-100 trillion cells that make up the body, how many innervations are there amongst them? Some research has shown that there are between 3-9. So, there really is no body-mind connection, because there never was a separation in the first place!

    If something hurts, beyond the quality of the pain, what is the individual’s feeling about it? Are they scared? Are they angry about it? What role does their emotional state and their somatic awareness play in their experience of illness or wellness?

    I suggest reading a book by Donald Bakal PhD called Minding The Body, which offers some great insights into the body-mind. Bakal sites many studies and gives an interesting perspective on symptoms and wellness/illness. It is well worth a read.

  11. #11 Ginger
    May 7, 2008

    One reason patients turn to alternative medicine is that doctors are very quick to consign a healthy-appearing person to the “hypochondriac” or “worried-well” category. (And, you don’t even have to look all that healthy–just not acutely ill.) I know; I’ve been there. Few things are more frustrating than feeling like crap and being told that all is well; it’s probably just in your head.

    Many serious conditions, particularly in the early stages, present with vague symptoms that fluctuate over time. In my case, even relatively dramatic symptoms were ignored–it took several hospitalizations with atrial fibrillation before Graves’ Disease was diagnosed. The trembling, sweating, and bug-eyed look were dismissed as “anxiety.” The fever was “a virus.” The heart problems were “something that happens.” Proximal muscle weakness was a nonspecific “myopathy.” I kept going back, convinced that eventually, someone would diagnose my problem. But, until I was diagnosed, I was viewed, and treated, as a neurotic young woman.

    Diagnosis with Sjogren’s Syndrome was more straightforward, because I diagnosed myself and went to the rheumatologist merely for confirmation. And, yes, diagnosis makes a difference, because without the diagnosis, you don’t get treatment. Medication for the Sjogren’s has made a world of difference to my quality of life.

    So, don’t blame the poor patient who has tried the medical route and been left suffering. Few people have the persistence, ability to advocate, and medical insurance necessary to secure diagnosis and treatment for a condition that’s a little off the beaten track. So, failing that, they look for someone who treats them with compassion and understanding–something that is sorely lacking in many of the people who work in the “medical” model.

  12. #12 Mark P
    May 7, 2008

    The problem with CAM is not the buyers of snake oil, who will always be with us, or even the purveyors of snake oil, but the otherwise reputable institutions that sell their integrity to the purveyors.

  13. #13 mark's tails
    May 7, 2008

    I was able to see the first segment. They focused on a woman who had a great deal of anxiety regarding surgical biopsies she had to undergo on a routine basis due to her history of cancer. She used Guided imagery and relaxation techniques taught to her by the Duke Integrative Medicine Program and felt much more relaxed and in control.

    They also interviewed a person on staff who mentioned that they discourage patients from using unproven herbs and supplements.

    I’ve done my share of “woo bashing” and in general have always nodded my head in agreement with Orac’s posts. No one can dismantle woo like Orac. However, I find it difficult to criticize a program that can help patients without resorting to anti-anxiety meds or other drugs. Sure you can argue that it is only for the people that can afford it, but how many blogs have you read in which the writer criticizes those patients with ‘free’ healthcare that abuse the system and argue that if they only had to pay for a little they wouldn’t be using the ED for their primary care or otherwise ‘abusing’ the system?

    They are not touting their therapies as a cure for cancer, or diabetes, or whatever like other Woomeisters, but as an adjunct to traditional medicine, and it is certainly not being forced on anyone. I’m not saying I would want to participate in something like that, but if it helps those patients that do decide to participate, then why is that wrong?

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