I take back all those nice things I used to say about Nancy Snyderman.
There’s no doubt that she “gets it” about vaccines and, for the most part, even though she does occasionally go overboard, and her understanding of the issues involved in the use of various vaccines is anything but nuanced. I used to think that she “got it” with respect to SBM, but then I saw her recent segment on “complementary” medicine on NBC News the other night. Here’s part one, which aired Monday night:
The very introduction made me groan, with Tom Brokaw stating that it used to be called “alternative medicine” but, because it’s become so popular, it’s now called “complementary” medicine and—oh, by the way—”a lot of this has simply been demanded by patients of their doctors.”
Right at the beginning of the segment, we’re introduced to a breast cancer survivor named Diane Miller, who is portrayed as having endured the rigors of surgery, chemotherapy, and radiation and shown doing exercises in what is presumably her home. We are told that she has lymphedema, which is unfortunately a not-uncommon complication of breast cancer surgery, particularly when the cancer is advanced enough that it requires the removal of all the lymph nodes under the arm on the side of the cancer. It’s a major problem in breast cancer survivorship, because when it is bad it can seriously interfere with a woman’s quality of life. It is a complication of breast cancer surgery that, when it happens, is permanent, and it can happen at any time after surgery for the rest of a woman’s life.
One of the first things you’ll notice about part one of Dr. Snyderman’s report is that she completely falls for the “rebranding” of science-based modalities as being somehow “complementary” or “alternative,” so much so that I’m embarrassed for her. For instance, the very first thing that Ms. Miller discusses is exercise and how it feels so good and helps her so much. No kidding! There’s a large and robust body of research that shows the benefits of exercise in breast cancer patients.It is not “alternative.” It is not “complementary,” at least not in the way that CAM proponents try to represent it. In other words, exercise is SBM.
Not surprisingly, Ms. Miller is also a big fan of acupuncture in addition to exercise, and the next segment shows something that makes me cringe as a breast cancer surgeon, and that’s an acupuncturist sticking needles into her lymphedematous arm. It’s even worse than that, though. The acupuncturist is clearly not wearing any gloves! I kid you not! Yes, I did indeed cringe when I watched that segment. In fact, I more than cringed. I started ranting at the television set. Why was I so upset by this? It’s because lymphedematous limbs, because of the edema, are very susceptible to infection, and acupuncturists are not exactly known for their rigorous adherence to sterile technique. Indeed, in general we try to avoid as much as possible blood draws, IVs, and even blood pressure readings using lymphedematous limbs because they can cause problems; yet here, at Memorial Sloan Kettering Cancer Center, we see an acupuncturist blithely sticking sharp objects into a lymphedematous extremity after just doing a quick wipe with an alcohol swab and not even using gloves!
Most of the rest of the segment consists of an interview with Barrie Cassileth, who happens to head up the CAM program (or, as proponents like to call it these days, the “integrative medicine” program) of Memorial Sloan-Kettering Cancer Center. I was actually surprised, because I don’t recall ever having heard her be as declarative and definite about the benefits of acupuncture. After pointing out that acupuncture doesn’t cure cancer (at least she admits that!), she states that acupuncture is very useful for many cancer symptoms. Indeed, in an online chat, she refers to acupuncture as “a cornerstone of integrative medicine” and goes so far as to claim that some of them are “not even treatable by mainstream medicine.”
I call bullshit on Dr. Cassileth. I’m sorry. I know that since our NatGeo overlords have taken over ScienceBlogs I’m not supposed to use even mild profanity anymore, but sometimes it’s hard for me to hold myself back when I hear a statement this ridiculous. While it’s true that there are symptoms due to cancer that conventional medicine has a hard time treating, it is most definitely not true that there are symptoms due to cancer or cancer treatment that are “not treatable by conventional medicine.”
The rest of the segment spent a lot of verbiage and imagery touting how “complementary medicine has gone mainstream,” which is basically the entire message of the report. Were treated to cliche’s like “East meets West” and “old school meets new school” in a trite and, quite frankly, annoying way. Dr. Snyderman even laments at the end how insurance companies won’t pay for this stuff, even though patients want it. She’s not entirely correct; some insurance companies have started to pay for acupuncture, and many pay for chiropractic, for example. She also says that as though it were a bad thing, even going so far as to say that some insurance companies have some “catching up to do.” It’s not. It’s a good thing. I don’t want my health insurance company paying for quackery, because that expense comes out of my premiums, which are plenty high enough as it is.
In other words, Dr. Snyderman produced a puff piece to promote “alternative” medicine, “complementary medicine,” “CAM,” “integrative medicine,” or whatever you want to call the quackery that has infiltrated modern medicine. It is not a serious piece of journalism. Indeed, we’re even treated to an argument from authority stating that the “oldest cancer center in the world” has embraced woo (the implication being, of course, that it works and therefore other doctors should embrace it too). Then we see Barrie Cassileth setting up a massive strawman about conventional cancer care in which, once the chemotherapy, surgery, and radiation are done patients are abandoned and we don’t care about their symptoms anymore and tell them, “Goodbye, and have a good life.”
Again, I call bullshit.
This is, as I mentioned, a massive straw man. It is not reality. Indeed, in cancer centers like mine, survivorship is a major focus of our activities. Lest you’re tempted to think that I’m in an ivory tower because I work in an NCI-designated comprehensive cancer center, I will point out that any hospital that wants to have American College of Surgeons Committee on Cancer certification as a cancer center must now have an acceptable survivorship program. Yes, in the past “conventional medicine” might not have paid adequate attention to survivorship issues, but that is changing, and it’s changing fast. Moreover, that change is not driven by the existence of CAM or by some radical, forward-thinking programs based on CAM. Not at all! If anything, CAM is placebo medicine that can get in the way of the real medicine that patients need. It’s SBM rebranded as being somehow “alternative” because it’s exciting and sexy compared to boring old SBM.
Snyderman’s also been doing some promoting of her segment. For instance, she’s made an appearance at the local St. Louis NBC affiliate:
Dr. Snyderman is asked a simple question, “What is integrative medicine?” Surprisingly, she’s aware of the evolution of the word. As I’ve pointed out, alternative medicine became “complementary and alternative medicine” (CAM) became “integrative medicine.” She even notes that we’re now seeing acupuncture “and even prayer” being “integrated” with “mainstream medicine.” Of course, I’ve discussed the progression of language on several occasions, but I have pointed out that it was not really a natural progression but was rather driven by “branding” imperatives. Quacks did not like their quackery being called what it is (quackery); so they started calling it “alternative.” Then it became apparent to quacks that they would never get anywhere if they portrayed their woo as being outside of mainstream medicine (i.e., “alternative”); so “alternative” medicine became “complementary and alternative” medicine. But that still wasn’t enough, because “complementary” implies a subsidiary position in which mainstream medicine was real medicine and the woo was just “complementary” (i.e., icing on the cake). Thus was “integrative medicine” born, which is falsely presented as being the “best of both worlds,” and, more importantly to quacks, implies that their woo is co-equal with science-based medicine. It is not.
Particularly offensive is what Dr. Snyderman says next:
The idea is that the patient is the central focus. You don’t want to cure the patient and then create a narcotic addict. You don’t want to operate on someone but then leave them in worse pain. So when you combine East and West together, old and new, frankly it’s a patient-driven phenomenon, and I think doctors are increasingly listening.
Well, yes and no. To some extent it’s patient-driven, but to a large extent it’s driven by sectarian doctors who are true believers, people like Andrew Weil, and, yes, even though she isn’t a physician, Barrie Cassileth. Once again, Dr. Snyderman is attacking a massive straw man. As though SBM-practicing doctors don’t care if they cure the patient but create a narcotics addict! As if we don’t care if we operate on someone but leave them in worse pain than before. Dr. Snyderman is pandering to the very worst stereotypes of conventional medicine promoted by—you guessed it!—quacks. It sounds as though she’s been reading Joe Mercola’s website or Mike Adams’ rants and taking them to heart.
Notice one thing that Dr. Snyderman doesn’t discuss, and that’s evidence. That’s because there isn’t any good evidence. It’s nearly all low quality evidence, and the small amount of high quality evidence that is out there for acupuncture (for example) is consistent with the conclusion that acupuncture is nothing more than an elaborate placebo.
Even more offensive is this statement from Dr. Snyderman in response to a question about whether doctors know about integrative medicine:
Quite frankly, if a doctor doesn’t know, I think it’s time to ask for a referral to someone who does. Certainly in my world of cancer treatment, the really good cancer centers know the difference.
And once again she complains that insurance companies don’t cover this quackery!
Then there’s this web-only clip:
It’s a completely credulous report on acupuncture and contains more canards and talking points about acupuncture, including claims that it’s “natural,” that it “stimulates the flow of qi,” and that there are hundreds of acupuncture points that, you know, are like really, really real! Never mind that, as I’ve pointed out time and time again, acupuncture is indistinguishable from placebo when tested in well-designed, well-controlled clinical trials, so much so that I’ve lost track of how many acupuncture studies I’ve discussed, many of which were misrepresented by acupuncture advocates as supporting the contention that acupuncture can do better than placebo. The bottom line is: It doesn’t matter where you stick the needles (in other words, meridians are prescientific nonsense), and it doesn’t even matter if you stick the needles in. Indeed, twirling toothpicks against the skin works just as well. So what do we call a conventional treatment that is indistinguishable from placebo in well-designed clinical trials? We call it ineffective. So why does Nancy Snyderman give acupuncture a pass because it’s “alternative,” “complementary,” or “integrative”? There’s nary a whiff of skepticism, as the young appealing acupuncturist chirps merrily about just how awesome acupuncture is and how we should be “integrating” it with “Western medicine.” She also seems to share the first acupuncturist’s aversion to using gloves and proper sterile technique while sticking needles into people.
I fear that there is only one conclusion that we can make from Dr. Snyderman’s report, and I say this even though I haven’t yet seen the second part (which appears not to be online yet): Dr. Snyderman has gone woo. She has embraced the Dark Side. She has decided that quackademic medicine is OK. Completely credulous, she has decided that “integrating” quackery into conventional medicine is the wave of the future. I hope that someone will inform her of Mark Crislip’s immortal words, in which he boiled down “integrative medicine” into its very essence in a mere 34 words:
If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.
Dr. Snyderman is mixing cow pie into her apple pie, and trying to sell it to her audience as tasting great. I can only hope that she finds her way back to reality someday, but I am not optimistic.