If you were a medical school dean or a hospital administrator and had $37 million for a project, how woud you use it? What would you build? What would you renovate? What research projects would you fund? What infrastructure improvements would you make? Yes, $37 million is a lot of green. Back at my old job, if memory serves me correctly, a whole new addition to the cancer center that nearly tripled its square footage cost somewhere in the range of $35-40 million. True, that was nearly ten years ago; so building the same building might now cost more than $37 million. My point remains, though. You can do a lot of good for a lot of people with $37 million. If you are part of the administration of a medical school or academic medical center, you could fund some major infrastructure improvements with $37 million.
Look at it this way. Imagine that you’re rich and have millions of dollars to throw around, $37 million, to be precise. You want to help a hospital and/or medical school. What would you do with the money? To which medical school or hospital would you give it? For what purpose? What would be your goals? For example, $37 million could fund close to 20 R01-level grants for R01-level research projects, for instance. Or, if you as a donor were so inclined, you could divvy up the money into finer chunks and let the medical school use it for startup packages, which typically range from $250,000 to $1,000,000 (but can be much more for “superstars”), to be used to recruit top research talent, who would bring exciting science (not to mention their grants) to the institution. If those research projects were good science, a lot of useful discoveries could be had for $37 million. Or you could use it to fund scholarships, so that students could attend medical school without going $200,000 into debt. You could mint a lot of new doctors that way.
Or, if you’re Bernard and Barbro Osher and the school is the University of California at San Francisco, you could use the $37 million to expand the “integrative” medical offerings there, and if you’re the administration of UCSF you could snap up the money and build a towering monument to quackademic medicine in the form of the UCSF Osher Center for Integrative Medicine:
UCSF’s center for integrative medicine has opened the doors of its new home at the UCSF Mount Zion campus. The UCSF Osher Center for Integrative Medicine offers the best of modern medicine with established healing practices from around the world, and is a major hub of research, education and patient care in integrative medicine.
The new Osher building underscores UCSF’s commitment to increasing access to integrative medicine and making it a larger part of the treatment relationship between medical caregivers and patients. It is the first center of its kind to offer fully developed programs in research, clinical care and education for health care professionals, practitioners and patients seeking an integrated, healing-oriented approach to health.
Oh, goody. More and spiffier space for “integrating” pseudoscience with science-based medicine. Just what we need. But let’s see what the Osher Center will be offering those in San Francisco who might be woo-inclined:
The center provides treatment, wellness and prevention programs for adults and children in areas including cancer, chronic pain and women’s health. Physicians and therapists are trained in general integrative medicine, integrative oncology, integrative psychiatry, Traditional Chinese Medicine, Ayurveda (a traditional healing science from India), mindfulness meditation, and manual therapies such as physical therapy and breath work.
The building includes spaces not usually found in conventional medical clinics or academic institutions, such as:
- Group rooms for yoga and tai chi instruction;
- Quiet areas for meditation and reflection;
- The Takahashi Japanese Meditative Garden, accented with Japanese maples;
- Treatment rooms for acupuncture, massage therapy, biofeedback and mind-body awareness;
- Air conditioning that uses 100 percent outside air; and
- Sustainable building materials like bamboo and recycled-content carpet.
The facility enables all of the center’s programs and its 80 scientists, faculty and staff to be housed under one roof, with room to grow over time.
Much is also made of how the interior features “natural light, fresh air, and simply organized spaces,” as well as how the building’s “size and exterior, veneered in brick and wood resin materials, were designed to be responsive to the surrounding neighborhood, and the construction involved sustainable building practices that received LEED Silver certification from the United States Green Building Council.” I love how not only have the architects designed this building for woo, but have made it environmentally friendly, something particularly amusing when one considers how many animals are endangered by the trade in alt-med remedies like rhino’s horn and bear bile. But that’s just the nasty cynic in me. Bad cynic! Nasty cynic! The good people of the Osher Center are so much better than you because not only are they in tune with their mind and body but they’re eco-friendly!
But let’s get back to the services. “Integrative oncology”? Quackademic medicine victorious! “Integrative medicine”? Integrating quackery with science-based medicine, something I whose advantage over–oh, you know–medicine I could never figure out. Not that the Osher Center doesn’t try to explain it. Check out this video that the Osher Center uses for fundraising (sorry, I couldn’t figure out how to embed it). It’s loaded with the usual claims that somehow “integrative” medicine is all about “prevention”; a truly nauseating bit about how “you” are so distinct and “you” know your body better than anyone else (the latter of which is true to a point, but that doesn’t mean you have a clue about how your body works or what represents a good treatment for it, although it does seem a custom-tailored appeal to placebo medicine); and a part about how at the Osher Center the “vested interest of the status quo is being challenged.” Of course, this video does confirm a sneaking suspicion I’ve always had, namely that much of alt-med is about self-absorption. In any case, here’s a hint: Challenging the status quo can be good, but not when the alternative offered is more faith-based than science-based.
If you want to see the sorts of nonsense the Osher Center is peddling, there’s no better place to see it than straight from the proverbial horse’s mouth. Here’s the UCSF Guide to Integrative Medicine, 2009 Edition, linked to from the Osher Center website. I think I’ll go through and make like an integrative medicine doctor and cherry pick a few choice quotes from this guide, the better to show how complete the infiltration of quackademic medicine has become at UCSF. I’ll start with what I always start with as a litmus test of just how deluded an alt-med advocate is, homeopathy. Any publication that says anything other than that homeopathy is pseudoscience, impossible, doesn’t work, etc., fails the test, and boy does the UCSF guide fail the test:
Dr. Hahnemann first formulated his principle of the Law of Similars after testing quinine, a cure for malaria. He found that it produced the symptoms of malaria in a healthy individual. However, when he discontinued the quinine, the symptoms disappeared. After several similar studies, Hahnemann found that very small doses of the substance are nontoxic and yet still work to produce the desired symptoms of the illness in healthy individuals. Homeopathic remedies are therefore diluted to different degrees so that only essences of the original substance are present. Often chemical testing will show no presence of the active ingredient. This, however, is consistent with the homeopathic philosophical belief that the ingredient leaves an imprint on the remedy and it is this “ghost” print that acts within the body, 4,6.
In other words, homeopathy is water, but it’s a ghost of a memory in the water of the original substance that gives homeopathy’s magic water its mojo. OK, OK, you say. But this is just a description of what homeopaths believe, right? Well, yes, but get a load of what the UCSF guide says about the clinical evidence for homeopathy:
The effectiveness of homeopathy has been disputed since its inception. While there are patients who swear that homeopathic medicine cured them, skeptics attribute successful outcomes to preconceptions and a placebo effect. Several clinical trials failed to find differences between remedies and placebos. For example, a study of the efficacy of homeopathic A. nitricum 12X (diluted in a one-to-ten ingredient- to- alcohol/water ratio twelve successive times) in test anxiety concluded that the substance had no effect.1 Another study found that although use of homeopathic remedies did not differ from placebo in treating anxiety disorder, both showed a substantial reduction in anxiety.2 Other trials have found homeopathic remedies to be effective, including one involving patients undergoing hemodialysis in which pruritis was found to be significantly reduced through homeopathic treatment. 3 Overall there is a need for more clinical research in this area.
No. There. Is. Not.
Homeopathy is water. There’s no active substance left in homeopathic dilutions greater than at most 12C. How many times does this have to be repeated? It is to UCSF’s eternal shame that it publishes such wishy-washing pablum that gives credence to the principles upon which homeopathy is based.
Let’s zip on down to another modality that I like to examine as another litmust test to see if a source is reliable. This time, let’s look at reflexology, which, as you recall, is the treatment system whereby it is claimed that every organ and body part maps to some part of the foot or hand and that massaging the foot or hand in the correct area can thus treat that organ. Feels nice? Probably. Treats any disease? Unless it’s something that can be treated by a glorified foot massage, not so much. I challenge you to go to p. 39 in the guide and read the two-page section on reflexology. Go on. I’ll wait. Then come back here. What do you think? Have you seen such a credulous load of nonsense in your life? No? Then read the section on reiki:
Ki refers to the life force or free energy that flows through all living organisms. Ki passes through chakras and meridians to nourish the body and support cells and organs in their fundamental functions. When this flow of life force is disrupted, it causes diminished function in one or more of the organs and tissues of the physical body. A restricted life force leads to compromised immunity and susceptibility to illness, as well as associated emotional distress. The body heals with ease when the life force is uninterrupted. Reiki heals by raising the vibratory level of the energy field in and around the physical body, causing negative thoughts and feelings to break apart and clearing the energy pathways, resulting in a healthy and natural flow of life force.
That’s right. An official publication of UCSF is speaking favorably of a modality that is nothing more than faith healing that substitutes Eastern mysticism for Christianity as the faith that underlies it. Instead of channeling the healing power of god, reiki practitioners claim to be channeling the healing power of the “universal source” through themselves and into patients. Personally, I fail to see much of a distinction between the two. To believers, both are some sort of universal spirit; the main difference is the name and how Christians attribute a much more personal nature to their god, as compared to the much more aloof energy-like nature of the reiki god.
But if there’s one section that disturbs the hell out of me, it’s the section on cancer therapies:
Many different types of complementary and alternative cancer therapies exist. These therapies are frequently incorporated into standard cancer treatment plans for patients in Europe and other parts of the world but are less commonly prescribed by medical professionals in the United States, possibly due to the relative lack of formal CAM training in U.S. medical schools. The most common complementary therapies include meditation and relaxation, acupuncture, massage, dietary treatment, herbal medicine, hypnotherapy, homeopathy, megadose vitamins, ozone therapy, therapeutic touch, bromelain, and spiritual healing. Currently used alternative therapies include antineoplastons, metabolic therapy, shark cartilage, botanical and herbal medicine, and immunoaugmentive regimens.
Alternative therapies may be dangerous because they are often unproven and administered in lieu of traditional treatment such as chemotherapy or radiation. Using alternative therapies instead of conventional treatment for highly curable, early-stage cancers is not recommended.
CAM therapies are also considered useful approaches to recurrence, metastatic cancers, and secondary cancers.
Uh, no. There’s no evidence I’m aware of that CAM therapies are considered useful approaches to recurrence, metastastic disease, or secondary cancers. Similarly, although it’s good that UCSF mentions that CAM treatments for cancer are dangerous when used instead of science-based treatments. It’s bad that UCSF lumps all this pseudoscience in with its list of CAM therapies. Even worse is this video, which advocates the use of traditional Chinese medicine for breast cancer:
It’s all right there, including tongue diagnosis, pulse diagnosis, and moxibustion. That’s right, here we have an acupuncturist working for UCSF Osher Center, peddling the pseudoscience that is TCM. If that ain’t quackademic medicine, I don’t know what is. As well it should be, given that UCSF has some heavy hitters in the world of quackademic woo, such as Dr. Donald Abrams, who is currently the president of the Society for Integrative Oncology.
Sadly, this is the way medicine is continuing to go. On Education page, the Osher Center provides a big “Did you know?” that asks:
Did you Know? Just ten years ago, integrative medicine content was not required at medical schools.
Today, UCSF is a leader in both required and elective curricula in integrative medicine for health professional students, as well as residents and fellows.
To me, that’s exactly the problem. We had it right ten years ago. We don’t now. Quackademic medicine is on the ascent. I worry about this, too, given that I’m not getting any younger these days. All I can say is that, when I’m 80, if I see a young punk doctor coming at me with herbs, reiki gestures, or acupuncture needles, I’ll show him what he can do with his needles. Either that, or I’ll make like Frank Zappa and:
I wrapped a newspaper ’round my head
So I’d look like I was Deep
I said some Mumbo Jumbos then
An’ told him he was goin’ to sleep
I robbed his rings
An’ pocket watch
An’ everything else I found
I had that sucker hypnotized
He couldn’t even make a sound
I proceeded to tell him his future then
As long as he was hanging around,
“The price of meat has just gone up
An’ yer ol’ lady has just gone dow
And for good measure, here’s the real thing. Why? Because I’ll use any excuse to lay down a Frank Zappa video:
Sadly, the real cosmik debris is embedding itself in our medical schools and academic medical centers. I feel really sorry for medical students and residents who are science-minded. What do you do if you’re in medical school and some TCM practitioner is talking to you about moxibustion and tongue diagnosis as though they were scientifically established? Or if a naturopath starts spewing prescientific vitalistic pseudoscience? Or if a reiki practitioner starts talking about channeling “energy” from the “universal source”? Yet these very things are going on in schools like UCSF across the country and even around the world.
I fear for the future of medicine.