Respectful Insolence

Yesterday, I expressed my dismay at learning that what used to be a bastion of science-based medicine, the Cleveland Clinic Foundation, is now peddling the quackery known as acupuncture to children, or, as I put it, “integrating” nonsense with science. Sadly, as I’ve written about all too often because I keep seeing it again and again, it’s an all too common trend. Hospitals are increasingly embracing pseudoscience and quackery, laboring under the misguided belief that by doing so they are somehow “cutting edge”; that the patients really, really want it; and as a marketing tool. Although I frequently refer to this trend to “integrate” quackery with real medicine “quackademic medicine” because it seems to be happening mostly in medical academia, sadly I’ve also documented it infiltrating community hospitals too. Worse, credulous reporters parrot the narrative of these places portraying themselves as “cutting edge” and the “wave of the future” in truly embarrassing ways that resemble advertising far more than journalism.

A perfect example popped up in the Louisville Courier-Journal just this weekend in the form of a title Louisville hospitals embracing alternative medicine. Before I get into the meat of the article, I must admit that I was surprised by the title. Clearly, either the reporter Laura Ungar or her editors didn’t get the message. Don’t they know? It’s not called “alternative’ medicine anymore, and it was a grave offense against the new nomenclature to refer to it as “alternative medicine” in the headlines. In fact, according to the evolution of quackery, the term “complementary and alternative medicine” (CAM) is falling out of favor among quackademics. The reason, of course, is that “alternative” implies “not real medicine” (which it’s not), while “CAM” still recognizes the primacy of science-based medicine such that the woo falling under the rubric of CAM is only “complementary” to real medicine. Actually, it’s not even complementary to medicine, itself being fake medicine, but selling it as being the “icing on the cake” to real medicine was at one time acceptable to CAM practitioners. No more. Now they want their woo “integrated” with real medicine. They frequently sell this as being the “best of both worlds,” the implication being that their pseudoscience is co-equal with science-based medicine. At least, that’s the message behind the move away from CAM and towards “integrative medicine” as the preferred term, and its practitioners aren’t shy about promoting the new party line. On the other hand, maybe it’s a subtle move by the editor signaling that he or she knows that this stuff is all fairy dust.

The title aside, even Ungar appears to have imbibed the message, because the term “integrative medicine” appears frequently in her article. She also promotes the desired message that this is the “wave of the future,” thus using the bandwagon argument to try to convince you that this stuff is great:

Coletta Campbell understood why she needed surgery, chemotherapy and radiation to treat her late-stage breast cancer — but when her doctors suggested she try massage, art therapy and Reiki, she was skeptical.

“I remember thinking: I’m not so sure about this,” said Campbell, a 62-year-old Louisvillian being treated at University Hospital’s James Graham Brown Cancer Center. “But I thought I’d give it a go.”

She did, and found herself more relaxed and able to cope — and now advises other patients: “Just try it.”

Hospitals across the region are increasingly weaving “complementary” services such as healing touch, yoga and art and music therapy into their care — reflecting a resurgence in these healing methods nationwide and an effort to combine them with traditional methods to form “integrative medicine.”

A passage like this more than deserves a heapin’ helpin’ of Insolence, in this case, the not-so-Respectful variety. First, from my perspective, any doctor who recommends reiki needs to be grabbed by the lapel, shaken, and have someone yell in his face, “Do you realize that what you’re recommending is nothing more than faith healing, magical thinking?” If he doesn’t, then he needs an education.

Nor is it an excuse that the quackery is being “seamlessly woven” into conventional care such that the patients don’t even get a bill at Norton Healthcare:

And patients often don’t get a bill for such therapies. Although insurers may or may not cover them outside the hospital, officials said integrative care generally doesn’t cost hospital patients extra because it’s woven into normal care.

In other words, the administration at Norton Healthcare is such a true believer in this that it’s willing to eat the cost of providing these “services.” One wonders if this is more of a cold, hard business decision. Most insurance companies won’t pay for most CAM therapies; so the hospital provides it as a “loss-leader” or marketing gimmick and eats the cost, hoping that they make up more than the cost by attracting a certain clientele. Of course, a lot of this is part of the old “bait and switch” or “rebranding” that I’ve written about before, in which “treatments” that aren’t really treatments at all but can be justified simply because they feel good (such as massage); interventions that are nothing more than “exotic” forms of more pedestrian recommendations that are science-based (yoga or tai chi as forms of exercise and mobility training), or recommendations that are nothing unusual and can, if properly done, be completely science-based (diet, exercise, relaxation) that have been “rebranded” as CAM.

Fear not, however. There is true woo here in abundance:

A steady stream of Norton employees laid down on padded tables or sat in a chair, getting massage; a light touch therapy called Jin Shin Jyutsu; and hands-on energy therapies called healing touch and Reiki.

As I’ve pointed out before more times than I can remember: Healing touch is nothing of the sort (the practitioner doesn’t even touch the patient, and it is claimed that the practitioner affects the patient’s “energy field” to healing intent), and reiki is simply a form of faith healing in which Eastern mysticism is substituted for Christianity as the religious belief at the core of the “healing.”

Meanwhile, over at the Brown Cancer Center, CAM rebranding is in full force. The real quackery doesn’t (yet) appear to be apparent, but the center is offering aromatherapy (if it smells good, it is good, I guess), massage therapy (which, as I’ve said before, feels good and doesn’t really need to be represented as “medicine” but often is), meditation (again, it probably doesn’t do any good but also probably doesn’t do any harm, depending on how it is recommended and performed), art therapy (why does this have to be called “therapy” when it’s simply something to do that might take one’s mind off of what’s happening?); and “nutrition.” Of these, the last is the most worrisome. It’s mentioned that there is an “oncology nutritionist” that the cancer center is bringing in. What does that mean? “Dietician” is a real specialty. Pretty much anyone can call himself a “nutritionist,” and the term tends to indicate a tendency towards woo in my experience. Dara O’Briain compares “nutritionist” to “dietician” as a “tootheologist” is to a dentist.

Later, Ungar cites more “evidence” of the bandwagon fallacy as justification for the infiltration of quackery into local hospitals, such as the recent Bravewell “jump on the bandwagon” report, Dean Ornish’s misunderstanding of cDNA microarray technology, and the like.

All of this concludes with testimonials of “skeptics” who became true believers:

“Stress is one of the major causes of illness,” said Reiki master Anna Menges, who recently worked with Norton’s Snack and Relax program. “This is a way of people taking time out of their day to be still and relax.”

Gerry Waddell, a surgical technician at Norton Suburban, said she’d never undergone touch therapy until she attended Snack and Relax. She said she arrived stressed, but left refreshed.

“I’m definitely relaxed, but energized as well,” she said shortly after getting Reiki and aromatherapy. “I’ve been a skeptic, but I definitely am going to seek out more.”

One suspects that Waddell was never much of a “skeptic” to begin with. Be that as it may, you don’t need to invoke magic like reiki (which, make no mistake about it, is definitely magical thinking) in order to relax. Yet, more and more, magical thinking is what is infiltrating medical centers. It’s not just academic centers anymore, either, but it’s clearly infiltrating the heartland. To look, for instance, at what Norton Healthcare posts on its website about “integrative” medicine is to be depressed about the state of medicine:

Integrative medicine looks at health in the context of nutrition, environment, and spiritual and emotional well-being. A growing body of scientific evidence documents the effectiveness and safety of integrative therapies, which have been used for centuries in non-Western cultures to optimize health and reduce suffering.

“An integrative approach may include things like nutrition, supplements, acupuncture, stress reduction or therapeutic touch,” said Rachel Busse, M.D., a family medicine physician with special training in integrative medicine. “We look at ways to support the body’s innate capacity to heal.”

The patented CAM-blather is there in abundance, concentrated into two brief paragraphs. There’s the false claim that CAM is “holistic” and treats the whole patient, with the implied false dichotomy that a good primary care doctor using science-based medicine is not. There’s the false claim that a “growing body of evidence™” is supporting quackery like reiki and therapeutic touch. There is the vacuous non-statement that somehow CAM “supports the body’s innate capacity to heal.” Here’s a hint: Every form of medicine relies on the body’s innate capacity to heal. When I take scalpel to skin and remove breast cancers, it wouldn’t work out so well if the tissue I cut and then sewed back together didn’t heal back together. Much of what we do in medicine is to try to prevent harm while the body heals itself, no matter what kind of medicine we practice. There’s nothing unique about CAM in this regard except that most of the time it doesn’t work and the body heals itself anyway.

In fact, the only thing true in the CAM blather is that CAM is trying to go back to “ancient therapies” from centuries ago. In other words, it’s trying to turn back the clock for medicine, and not in a good way. Just think of average life expectancy 500 years ago and compare it to average life expectancy to now.

Comments

  1. #1 AllieP
    February 28, 2013

    I don’t understand why the woo-peddlers get to lay claim to everything that isn’t actively technology/pharma in patient treatment. Back in the early 90s when I was candy striping the hospital I volunteered at, patients had access to free services of the “art and music” variety, as well as free yoga/stretching classes, nutrition lectures, support groups, etc. This wasn’t viewed as “alternative medicine” but as standard patient services/support, and community building and whatnot. Even as a highschooler, I could understand that a patient on chemo might like to hang out with other cancer patients, paint flowers, and talk about their feelings.

    They do not, I believe, offer reiki. Just classes/community stuff.

    What’s next, calling the clown that visits pediatrics an “altie therapist?” “Cheering sick people up” is not unfamiliar to science based medicine.

  2. #2 Eric Lund
    February 28, 2013

    Before I get into the meat of the article, I must admit that I was surprised by the title. Clearly, either the reporter Laura Ungar or her editors didn’t get the message.

    Reporters generally don’t write the headlines that appear above their articles, so in this case it would be the editors who didn’t get the message. Particularly since, as you point out, Ungar uses woo-friendly terminology in the article.

    Beyond that, what AllieP said. There are legitimate uses for yoga, nutrition lectures, etc. Those things are devalued when mixed in with reiki and “healing touch” (whatever that is supposed to mean, and I’m not sure I want to know).

  3. #3 Khani
    February 28, 2013

    Yeah, how come woo gets to claim relaxation techniques?

    They can keep the varieties of faith healing, but I’m going to take back my nice-smelling candles, art projects and an option on massage, which I’ve never tried because I don’t much like being touched by people I don’t know.

    I wonder if getting a massage right before a stressful procedure (even something like a CT scan or a Pap) would be helpful? Being somewhat of a nervous nellie in medical situations I do get very very tense during even simple blood draws…

  4. #4 Pareidolius
    In the studio . . .
    February 28, 2013

    Massage. Meditation. Food. Art.

    All of these are great. Relaxation is healthy. Eating well is better for you. Massage does feel good and is soothing. Art, however, has a body count going back to Lascaux. “The eyes aren’t right.” “Should his arm be doing that?” “Where’s the other leg?” “Too structured and self-conscious.” “You just didn’t deal with the issues.” Aside from criticism, both internal and external, there are the fumes, dust, metals, embers, blades, and repetitve stress injuries. The obssession with the final product. The drive to “say something.” You can call all the others “restful” or “healing.” But if you call art “restful” you’re probably just fingerpainting . . . maybe that works as a distraction, but my inner-critic assures me that doing it wrong.

    P.S.
    For an example of fingerpainting as art, see Richard Long’s 5-storey piece in Norman Foster’s brilliant Hearst Tower in New York . . . http://en.wikipedia.org/wiki/File:Richard_Long_Riverlines_Detail.jpg

  5. #5 Pareidolius
    HTMhell
    February 28, 2013

    I’ll tell you what would be restful and stress-reducing. A goddam edit feature.

  6. #6 eNOS
    close to home, literally
    February 28, 2013

    For the sake of disclosure, I’m an employee/graduate student of the Brown Cancer Center/University of Louisville, although I’m on the research side, so I don’t often venture over to the clinic. That said, I’m glad I would suspect JBCC is doing well with all the CAM mumbojumbo. A hefty population of Louisville is a hotbed for this junk, and people eat it up. If I hear one more person talk about their paleo diet I may explode. We’re like a transplanted Portland. (apologies to the non-sCAM Portlanders)

  7. #7 Chris
    Neither here nor there...
    February 28, 2013

    Orac:

    Most insurance companies won’t pay for most CAM therapies; so the hospital provides it as a “loss-leader” or marketing gimmick and eats the cost, hoping that they make up more than the cost by attracting a certain clientele

    And if baffles me why some CAM treatments are available at the Mayo Clinic, which is the largest non-profit in the country.

    Before our son’s surgery the surgeon’s office sent us pamphlets on what integrative therapies were available, plus a CD of relaxing music (it had a caution to not listen to while using heavy machinery). Though when we got there, those CAM therapies were never mentioned, and later I only saw a tiny ad for CAM near the nurses station in the recovery ward.

    I suspect it is because the Mayo Clinic gets large donations from patients who can afford the suites at St. Marys. Even though they are a non-profit, the extra cash from those suites and CAM services probably pay for the patients who have no insurance. (we met one as we walked from the shuttle to the motel that the Mayo Clinic social services paid for while she recovered, it was next door to our hotel)

  8. #8 eNOS
    February 28, 2013

    ughhhh, dammit. I agree with Paraidolius. That third sentence shows my Kentucky roots. I’ll extend further apologies to the English language.

  9. #9 JustNuts
    February 28, 2013

    #3 Khani… A CT scan is stressful? I fell asleep during my scan a couple of years ago!

  10. #10 JustNuts
    February 28, 2013

    Marketing… Yes! A regional marketing person for my organization used to be in the office next to me. The topic of insinuous CAM infiltration came up one day in conversation and she said that upper management was becoming resigned to offering some kinds of CAM had to be offered or patients would go elsewhere. There’s only a bit of it in my organization thus far but I did see a flyer on a bulletin board recently for a healing touch class taught by someone from outside the organizaiton. Apparently CEUs are offered! I WISH I had time to go and sharpshoot the presentation!

  11. #11 Krebiozen
    February 28, 2013

    Pareidolius,

    But if you call art “restful” you’re probably just fingerpainting . . .

    That comment immediately brought this scene (Brian in ‘Spaced’ – blocked in UK) to mind…

  12. #12 Krebiozen
    February 28, 2013
  13. #13 Roadstergal
    February 28, 2013

    “apologies to the non-sCAM Portlanders”

    Both of them? *ducks and runs*

    I do feel for them, living as a skeptic in the NorCal Bay Area. :(

    “and an option on massage, which I’ve never tried because I don’t much like being touched by people I don’t know”

    You’re allowed to be massaged by people you know. I find that latter kind even more stress-relieving, although I don’t pretend it’s medicine.

  14. #14 herr doktor bimler
    February 28, 2013

    You’re allowed to be massaged by people you know. I find that latter kind even more stress-relieving, although I don’t pretend it’s medicine.

    80 million cats can’t be wrong.

  15. #15 Narad
    February 28, 2013

    A CT scan is stressful? I fell asleep during my scan a couple of years ago!

    I’ve only had PET scans and MRI. I had to stay awake during the former, but when scheduling the latter, they issued a little handout “describing” the procedure, which suggested that I could chat with the tech and that many people dozed off during it. Then they get me in the tube. WHIRR! BANG! CLANK! Etc., right through the earplugs. Afterward, I suggested to the tech that it might have been simpler to just give people an audio CD with a sample of what it really was like, and he seemed surprised that nobody had thought of that before. Fortunately, I have not had to find out since whether anyone took up the suggestion.

  16. #16 Shay
    February 28, 2013

    @HDB

    And cats offer acupuncture, too.

  17. #17 Shay
    February 28, 2013

    @HDB

    And cats offer acupuncture, too.

  18. #18 prn
    February 28, 2013

    “Nutritionists” come in many stripes, some highly advanced, far beyond some financially tamed bachelors dietician finishing off the old folks at a “home”.

    One thing that doesn’t get much discussion is where or when dieticians might be wrong or even just dangerous.

    One comparison that comes to mind is an autodidact, like Richard K Bernstein, whose own personal research on diabetes was night and day different than dietician or standard medical advice.

  19. #19 Tom Herling
    February 28, 2013

    I’d hoped that the whole “alt-med” nonsense was a fad which would blow over sometime in the near future, but this embrace of it by more reputable institutions that ought to know better is causing me to be more pessimistic.

  20. #20 elburto
    March 1, 2013

    @JustNuts & Narad – I always fall asleep during MRI scans. For some reason the banging and clanking is really soothing.

    The hospital I used to visit for neurological services allowed patients to bring in a favourite CD to listen to while the scan took place. I’d make a mix-CD of random tracks from my collections, usually quite energetic stuff, and then let the noisy magnetic tube do the magic.

    Something about the combination of confinement and the incredibly loud noises is very relaxing. OTOH, the mention of CAM, by specialists, makes me incoherent with rage. A stunned look, paired with “What has science ever done to you?”, is usually the herald of an attack of spluttering disbelief and horror.

  21. #21 Khani
    March 1, 2013

    #9 @JustNuts

    I don’t know if a CT is stressful, as I’ve never had one.

    I am, however, a little claustrophobic and very very nervous about medical procedures in general. It’s not rational, and I know it’s not rational, but knowing it’s not rational doesn’t make it go away, unfortunately. So I suspect that unless I was in a very great deal of pain I’d be nervous about the CT as well. In the presence of pain I forget to fret.

    #13 Roadstergal Well, I do have a friend who is a masseuse. I suspect that’s not what you mean, but I am single and unattractive, and a bit sad about it, so we will leave it at that.

  22. #22 Narad
    March 1, 2013

    And cats offer acupuncture, too.

    With somewhat worse sterile technique and an idiosyncratic, if specific, notion of where the “meridians” are.

  23. #23 Narad
    March 1, 2013

    I am, however, a little claustrophobic and very very nervous about medical procedures in general.

    What really gets to me is the fluorescent lights in a closed, windowless exam room while waiting for the doc. This is serious freak-out territory for me. I will also note, with respect to the SBM warts thread, that the frequency choice is just plain wrong if one wants to find new players on the field.

  24. #24 prn
    AllieP@1
    March 1, 2013

    nutrition lectures, … wasn’t viewed as “alternative medicine” but as standard patient services/support
    Nutrition is a very wide category. Some kinds of nutrient applications have been fought tooth and nail for decades to avoid their proper testing, or use, in clinical environments. And standard medicine has often been just plain wrong or nuts about the subject, whether the CAM advocates were right or not.

  25. #25 herr doktor bimler
    March 1, 2013

    And cats offer acupuncture, too.
    With somewhat worse sterile technique

    So how many people have been hospitalised with pneumothorax from feline body-piercing therapy?

  26. #26 Narad
    March 1, 2013

    So how many people have been hospitalised with pneumothorax from feline body-piercing therapy?

    FTFY. With the correction, I know two, one first-hand, the other second.

  27. #27 Grant
    http://sciblogs.co.nz/code-for-life/2013/02/27/cricks-letter-to-son-aged-12-explaining-dna-discovery/
    March 1, 2013

    There must be an internet law akin to Godwin’s Law that says something along the lines that as the number of comments on an internet conversation increases there is an increased probability the conversation will turn to cats.

  28. […] by and large, harsher in my criticisms than even Professor Ernst himself gets. (Just look at my posts from the last couple of days if you don’t believe me.) However, even I have a hard time with […]

  29. #29 BrewandFerment
    trying to purge the Plants vs Zombies earworm that my kid left there
    March 1, 2013

    I once had to listen to a pitch to bring “healing touch” into a military work environment. When I asked the purveyor what were the hazardous waste procedures for dealing with the negative energy, he looked muchly puzzled. I said that since your literature says a practitioner must shake negative energy off the hands, it evidently is heavier than air and collects in a corner somewhere and we can’t have people walking into it by accident and causing their legs to fall off or some other dreadful accident. So how do I dispose of this negative energy? Oh, and how do I write a counseling form if someone claims that a technician performed “healing touch” with malicious intent instead of healing intent? He was most displeased…

  30. #30 flip
    March 3, 2013

    Part of me wonders whether or not the effort to combine art into therapy is more about artists who are trying to make more money. I’ve come across this thing – and even done it myself way back when – where artists try to impress on the ‘general public’ that art, and art funding, is important because it does important things.

    Forget enjoying art for arts’ sake, it can improve memory, teach math, be used in therapy, etc etc. I have no idea of the legitimacy of it outside of potential placebo and relaxation effects, although increase in motor skills might be useful in some art therapy areas, or for getting people to be more open emotionally… but I suspect that a number of artists hammer on it more than they should simply because they want and need to open their work to more doors, where it’s more financially sustainable.

    I’m not suggesting cynicism, rather that for some an attempt at legitimising and pushing for these things ensures that the arts stay funded and taught at schools, etc where they might not be otherwise.

    … Just a random slightly on-topic thought that nobody will see as this thread is dead.

  31. #31 Ausduck
    indoors on a sunny autumn day
    March 3, 2013

    Art therapy, yoga, aroma therapy… forgive me if I’m out of place here but I was always led to believe they fall under the auspices of the legitimate diversional or occupational therapists, and these therapies are great for people eg with chronic diseases or are undergoing cancer therapy.
    They are not the sole province of the woo set, and have been integrated into care for as long as I’ve been a nurse.
    Community Health provision here in Aus is built around the Allied Health professionals. It really really irritates me when the woomeisters think and act as though it’s never happened before they came onto the scene.

  32. #32 Tyler
    April 24, 2013

    I find the article to be disturbing. When people are in pain they need options, plain and simple. Some of the treatments mentioned above may work for some and it may not for others. How is this different than most over the counter medicines that have 10 different brands? You go with what works… but you don’t know until you try it. At 36, I’m a four-time, 14-year brain cancer survivor with two children under the ages of seven and I will try just about anything if it can help. So for anyone to insult and disregard a type of treatment that makes people fee better is an embarrassment.

  33. #33 JGC
    April 24, 2013

    You go with what works… but you don’t know until you try it.

    Actually, you don’t know until there’s actual evidence what you think works actually does work. This evidence is entirely lacking for CAM treatments.

    After all, ‘alternative’ medicine that’s been shown to work is simply called ‘medicine’.

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