The ultimate in "integrative medicine," updated

Orac note: This is an updated post that appeared a few months ago. Events occurred that led me to think it would be a good idea simply to expand and update it.

It's been a recurring theme on this blog to discuss and dissect the infiltration of quackademic medicine into our medical schools. Whether it be called "complementary and alternative medicine" (CAM) or "integrative medicine" (IM), its infiltration into various academic medical centers has been one of the more alarming developments I've noted over the last several years. The reason is that "integrative" medicine is all too often in reality nothing more than "integrating" pseudoscience with science, quackery with medicine. The most popular modalities that medical schools and academic medicine centers can't seem to resist are acupuncture and various forms of "energy" healing, such as reiki and therapeutic touch. Unfortunately, when you "integrate" something like reiki or therapeutic touch (TT), which basically assert that there is mystical, magical energy source (called the "universal source" by reiki practitioners, for example) that practitioners can tap into and channel into patients for healing effect, you are in essence integrating a prescientific understanding of the world with science, religious faith healing (which, let's face it, is all that reiki is), and magic with reality.

Why would medical institutions ostensibly based on science do that?

I don't know, but I know it's happening. There are many forces that conspire to insert sectarian versions of medicine into bastions of scientific medicine. These include cultural relativism leading to a reluctance to call quackery quackery; financial forces such as the Bravewell Collaborative, which funds a number of IM programs at academic centers; the National Center for Complementary and Alternative Medicine (NCCAM); and a variety of other factors. It's been a depressing slide, and periodically I wonder just how much more pseudoscience can be "integrated" into medical schools and academic medical centers or how much further medical schools can go in pandering to nonsense. I'm not wondering anymore, at least for now, not after learning about a cooperative agreement between Georgetown University and the National University of Health Sciences:

National University of Health Sciences (NUHS) has announced a new cooperative arrangement with the Graduate Program in Complementary and Alternative Medicine at Georgetown University Medical Center in Washington D.C., which will benefit students preparing for careers in health care and integrative medicine.

Faculty at the two schools will now work together to help students seeking advanced degrees in health care, by advising students of the benefits of each other's programs and providing preferential seating and advanced standing in each other's programs when appropriate.

Take a look at the NUHS website. Look at its offerings: chiropractic, naturopathy, traditional Chinese medicine, acupuncture, massage therapy, and "biomedical science," which, given all the other woo being taught at NUHS, I have to wonder about. Just take a look, too, at the curriculum for obtaining a doctor of naturopathy degree. It's full of homeopathy, traditional Chinese medicine, hydrotherapy and, of course, naturopathy. I must admit, however, to some amusement when I saw that there is a course entitled, "Evidence Based Practice: Critical Appraisal of the Biomedical Literature." Quite frankly, if this course truly taught evidence-based practice, then it would teach that all that homeopathy taught in other courses is nonsense, along with naturopathy itself.

Fat chance of that happening, not with "integration" like this:

Program directors at Georgetown selected NUHS as a top-tier institution providing educational excellence in its professional degree programs, thus meriting Georgetown's recommendation for its graduates seeking professional degrees. According to Aviad "Adi" Haramati, who co-directs the program with Hakima Amri, PhD, the academic affiliation is intended to "...break down the silos that hold the disciplines apart and create relationships between the disciplines and the educational institutions that prepare the nation's future healthcare providers."

Great. Just what we need: "breaking down silos" separating pseudoscience from science-based medicine. That's exactly what's happening here, and Georgetown is leading the way, so much so, in fact, that this is not the first time it has forged a partnership with an institute dedicated to teaching pseudoscience and quackery. If you want to see another example of this sort of "integration," behold this academic "integration" model championed by Georgetown University, this time with the infamous school of naturopathy, Bastyr University:

A model inter-institutional relationship may help bridge the chasm that separates health professions education in conventional academic health centers from institutions educating students for the distinctly licensed integrative practice ("CAM") professions. Says one leader: "I believe we are poised to make an important advance in how the future training of health professionals may evolve." The speaker is Adi Haramati, PhD, integrative medicine leader at Georgetown University, describing a new relationship between Georgetown and Bastyr University relative to Bastyr's naturopathic medical program and Georgetown's MS CAM program. Haramati and his co-director Hakima Amri, PhD are exploring similar relationships with chiropractic schools and other health professions institutions. The developers "would like nothing more" than to see this bridge-building relationship be used as a model for other academic health centers and CAM institutions.

That's right. Georgetown is partnering with schools of pseudoscience in order to train the next generation of CAM practitioners. It's not enough to team up with the naturopaths. Even several months ago, when Georgetown first teamed up with a naturopathic school, Dr. Haramati had been envisioning teaming up with chiropractic schools. That's what the NUHS is, mostly, and the agreement between Georgetown and NUHS seems to be the first step towards realizing the vision he presented at the time he teamed up with Bastyr.

But it's more than that. More than five years ago, Georgetown decided that CAM should be "integrated" into its curriculum to the point where it was made part of its medical school curriculum. However, Georgetown went way beyond simply having a lecture or two on CAM here and there and offering clinical electives to fourth year medical students in CAM. That wasn't enough. The vision was far more bold and--dare I say, given what's happened in the last five years?--forward-looking. What Georgetown offered was what it referred to in its own brochures as:

The "seamless" weaving of CAM into existing classes includes, for instance, a presentation by an acupuncturist on the "anatomy of acupuncture" in the gross anatomy course for first-year students. The same lecturer explores acupuncture's application in pain relief in the neuroscience course.

I wish this were a joke, but it's not. The "anatomy" of acupuncture? Which "anatomy," given that the magical, mystical meridians along which a life energy that science can't detect allegedly flows? Teaching such material in anatomy class is indeed the ultimate seamless "integration" of pseudoscience with science, quackery with science-based medicine. Breaking down silos, indeed. Fast forward five years, and here is the vision for true "integration" in medical education towards which Georgetown is working with Bastyr (and now, NUHS), in which it isn't just Georgetown but Georgetown teaming up with institutions of quackery:

Student A completes an academic Masters of Science program at a highly esteemed academic health center. He or she is wondering her/his future. The program focused on the science of complementary and integrative medicine. But what does the individual's future hold? Go on to medical school? Personnel with the program lay out options. Among them, without prejudice: Have you considered this naturopathic medical school?

Meantime, Student B is considering naturopathic medical college. The field of complementary and alternative medicine intrigues. But is he or she ready to make the jump for that 4-year, residential commitment? Is naturopathic medicine or regular medical school or chiropractic medical education what they want? Personnel with the naturopathic medical program say: You might consider this year-long Masters of Science in complementary and alternative medicine at this academic health center.

The basis of this relationship between Bastyr and Georgetown, we hear, is a new "respect" being shown towards CAM modalities, and this is the way that the joint program will be structured:

The fundamental aim of this program is to provide students with competencies in three areas: grounding in science (especially systems and cell physiology), introductory exposure and understanding of CAM disciplines and philosophies, and the ability to rigorously assess the state of evidence regarding safety and efficacy of various CAM therapies.

Let's see. Science...good. We like to see medical students exposed to science. Exposure to CAM disciplines...not so good. Don't get me wrong. I very much believe that medical students should be taught about CAM modalities, but they should be taught about them from a the perspective of the state of the science, the evidence, and clinical trials. They should be taught about skepticism and critical thinking. They should be taught about how various CAM remedies, such as herbal medicines, interact with pharmaceuticals. That is not what this program sounds like, as a science-based perspective leads to the conclusion that the vast majority of CAM either hasn't been shown to work or has been shown to work. If such weren't the case, CAM wouldn't have the word "alternative" in it.

Let me just put it this way. When this program claims to teach students how to "rigorously" assess the state of evidence regarding the safety and efficacy of various CAM therapies, the word "rigorously" applied to such teaching doesn't mean the same thing that "rigorously" means when scientists actually do rigorously assess the evidence. What it usually means is buying into the aforementioned philosophy of various CAM disciplines and then proceeding from there. Either that, or it means what Harriet Hall likes to call Tooth Fairy science, which refers to doing research on a phenomenon without first establishing that the phenomenon exists first. In essence, it's like studying the Tooth Fairy. You can measure how much money she leaves under the pillow. You can study whether she leaves more or less money for the first or last tooth. You can get a whole lot of data that appear reproducible. You might even get data that is statistically significant. But at the end of the day you haven't actually established that the Tooth Fairy actually exists.

A better metaphor for research into CAM modalities like reiki, TT, or homeopathy is hard for me to imagine. After all, reiki is nothing more than faith healing that substitutes Eastern mysticism for Christian beliefs. TT is basically reiki lite, where even the Eastern mysticism is stripped down to vague New Agey-sounding ideas like channeling "energy" into patients through their hands. (You know, whenever I picture reiki or TT, I visualize one of my favorite comic book characters of all time, Dr. Strange, casting a spell. In fact, as has been suggested before, that's the only real way I can see of making homeopathy work: a fictional Sorcerer Supreme and Master of the Mystic Arts casting a spell.

But, wait, I hear: What about something that's less highly improbable? Homeopathy is obviously utter nonsense. So are reiki and other "energy" therapies. What about herbal medicine? What about manipulative therapies (leaving aside the dubious philosophical underpinnings of some such therapies, like homeopathy, which similarly appeal to "energy flow" through various locations)? Well, there's already a branch of pharmacology that can study herbal remedies. It's called pharmacognosy, and it isolates the active fractions of natural products and studies them, just as pharmacologists have done for decades, if not centuries. There's nothing "alternative" in that that needs to be "integrated" into science-based medicine. Similarly, manipulative therapies are not beyond the reach of science to study rigorously, either. However, to do such studies it is necessary first to verify that a phenomenon exists, which can be done using the scientific method. What I fear will happen in this new Bastyr-Georgetown integration will be Tooth Fairy science. There'll be a lot of data, but it won't mean anything.

The other purpose of this integrated program is explicitly promotional of CAM. It explicitly seeks the "integration" of quackery with science-based medicine. Don't believe me? Check out this vision:

The Georgetown agreement with Bastyr, and those Haramati and Amri are seeking with other schools, are terrific steps, laying scaffolding toward the vision, articulated at NED and embraced by ACCAHC, of "a healthcare system that is multidisciplinary and enhances competence, mutual respect and collaboration across all CAM and conventional healthcare disciplines."

Georgetown is the trailblazer in "integrating" quackery into science-based medicine, but, although it's first, it won't be the last. This is a well-coordinated, longstanding effort on the part of CAM advocates, in which they actively lobby for such partnerships and such "integration" with science-based practitioners. Indeed, the Academic Consortium for Complementary and Alternative Health Care supports what it calls the Center for Optimal Integration, which explicitly works towards the sorts of partnerships that Georgetown has undertaken with Bastyr and NUHS.

Personally, I don't see how "integrating" CAM into science-based health care would enhance competence, but then that's just the nasty reductionist in me who rejects the false dichotomy of "alternative" medicine. After all, "alternative" medicine is nothing more than medicine that either hasn't been shown to work or has been shown not to work. "Alternative medicine" that works is no longer "alternative." It's just medicine. Naturopathy is a hodge-podge, a grab bag of all sorts of unscientific and pseudoscientific medical treatments, most of which fall squarely into the "alternative" camp in every definition, particularly the ones about either not working or not having been demonstrated to work.

Unfortunately, when it comes to quackademic medicine, the false dichotomy lives, and institutions like Georgetown are betraying science-based medicine by being so open to the point of its brains falling out--and partnering with Bastyr to integrate nonsense with sense, pseudoscience with science, and quackery with medicine.