Note: I was busy doing something last night that left me no time to compose any fresh Insolence, which will become apparent by this weekend. In the meantime, however, I'm betting quite a few of you haven't seen this before, and those who have might want to discuss it further in a different environment.
Quackademic medicine.
I love that term, because it succinctly describes the infiltration of pseudoscientific medicine into medical academia. As I've said many times, I wish I had been the one to coin the phrase, but I wasn't. To the best of my ability to determine, I first picked it up from Dr. R. W. Donnell back in 2008 and haven't been able to find an earlier use of the term. As much as I try to give credit where credit is due, I have, however, appropriated the term "quackademic medicine" (not to mention its variants, like "quackademia"), used it, and tried my best to popularize it among supporters of science-based medicine, writing frequently about examples of how quackery has infiltrated the hallowed halls of medical academia, complete with links to medical schools that have "integrative medicine" programs and even medical schools that promoted the purely magic-based medical modalities known as reiki and homeopathy. It's been a recurrent topic on this blog ever since, leading to a number posts on the unethical clinical trials of treatments with zero or minimal pre-trial plausibility, the degradation of the scientific basis of medicine, and the acceptance of magical thinking as a means of treating patients in all too many medical centers.
One strong candidate for quackademic ground zero, if there can be such a thing for the phenomenon like quackademic medicine, which is creeping up like so much kudzu in the cracks of the edifice of science-based medicine (SBM), is the University of Arizona. U. of A. is, of course, the home of one of the originators of the concept of quackademic medicine and one of its most famous and tireless promoters, Dr. Andrew Weil. Dr. Weil, as you might recall, has even been the driving force for creating a highly dubious "board certification" in integrative medicine. Sadly, apparently this new board certification has been so popular among physicians wanting to "integrate" a little quackery into their practices, that its first examination has been delayed from May to November 2014, so that the American Board of Physician Specialties can figure out how to accommodate the unexpectedly large number of applicants.
So what happens when a patient arrives at U. of A. for treatment? I found out last week when I received an e-mail, which led to a fairly long e-mail exchange, with a man whose son was diagnosed with leukemia and is being treated at the University of Arizona Cancer Center (UACC). Although I was given permission to use his name, I decline to do so because there is a child involved, although anyone involved in his case at U. of A. will likely quickly be able to identify who the man is. It turns out that he is a professor at U. of A. in a humanities department (which is why I'll refer to him henceforth as the Professor, as tempted as I was to refer to him as the Real Professor, in contrast to the fake "Professor" over at a certain antivaccine website), and, even though he is not a scientist, he clearly knows how to think (which would not be surprising if you knew what department he was in). In his e-mail, he told me how appalled he was at the sorts of treatments being offered to his son:
I was appalled to discover that the center offers treatments like Reiki, Reflexology, Acupuncture, Cranial massage, etc. These treatments are advertised as "healing"--including boosting one's immune system, complementing conventional chemotherapy etc. I wrote the the [sic] director of the center who at first expressed concern and thanked me for calling these things to her attention. She said she would convene a board of physicians to look into it. After three months went by, I wrote to her asking for an update. She told me the board was still working on it and that she was "confident they would take care of it". I have been asking her for a timeline and she is not returning my emails.
At first I thought this was probably the pernicious influence of Andrew Weil, but I have since discovered that cancer centers around the country are offering these "treatments" including places like Sloan-Kettering. Because of this, I've concluded there is no point in going to the media to try to expose what's going on.
The Professor is probably correct about going to the traditional media, though. There probably is little point in going to the press, although we can always hope. Most of the time, when the press looks into the infiltration of quackademic medicine into medical academia, the result is a story like this appalling one from a year and a half ago in which NBC News chief medical correspondent Nancy Snyderman strongly embraced quackademic medicine to the point that she even said that if a doctor "doesn't know" about integrative medicine, "I think it’s time to ask for a referral to someone who does." It made me sad to see a woman who normally stands up for science, at least with respect to vaccines and combatting the antivaccine movement, to fall so hard for pseudoscience when it exists at Memorial Sloan-Kettering Cancer Center. Even I have had to hang my head in shame when I discovered that my alma mater both for medical and undergraduate school, the University of Michigan, actually has a program in anthroposophic medicine.
Unfortunately, although I hoped that the Professor would make as much of a stink as he could, I felt compelled to warn him that I doubted he would be successful because this sort of “integration” of quackery with academic medicine is very much entrenched at the University of Arizona. It started with the pernicious influence of Andrew Weil, but if Dr. Weil were to drop dead or retire today I doubt that it would change much, if at all, because quackademic medicine has had years to become embedded in the culture there. To put it bluntly, U. of A. is one of the centers of quackademic medicine in the US, if not the world, and I don’t see that changing any time soon. I also looked up UACC's director, Dr. Ann E. Cress, and noted that she’s an interim director, which makes it highly unlikely that, even if she were so inclined, she could do much of anything. An interim cancer center director isn’t going to be able to take on Andrew Weil. It also doesn't help that there are researchers at U. of A. like Dr. Myra Muramoto, who recently scored a $3.1 million from the National Cancer Institute (NCI)—not the National Center for Complementary and Alternative Medicine, mind you, the NCI—to do this:
Dr. Myra Muramoto, Arizona Cancer Center member and associate professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine, has received $3.1 million from the National Cancer Institute to develop and evaluate a new program to train chiropractors, acupuncturists and massage therapists in effective ways to help their patients and clients quit tobacco.
The grant will fund "Project Reach," which will partner over the next five years with Pima County chiropractors, acupuncturists, massage therapists and their office staff to evaluate ways they can best help their patients quit tobacco.
That's a big chunk of change of the sort that cancer centers value above all, money from NCI grants. When cancer centers are being considered for NCI-designated comprehensive cancer center status (NCI-CCC)—or trying to renew their status—one huge consideration is the level of NCI funding its investigators have. Basically, for this purpose NIH grants are good, but NCI grants are the best. That's why any investigator with a $3.1 million NCI grant will have outsized influence and an NCI-CCC or any cancer center seeking NCI designation. Of course, because chiropractors, acupuncturists, and massage therapists often claim, without valid scientific evidence, to be able to help people quit smoking with their woo, such a grant would almost certainly have the effect of encouraging referrals of smokers to these practitioners, to make sure enough patients accrue to the study funded by the grant.
Quackademic medicine at UACC
It turns out that U. of A. does indeed offer its patients tons of "supportive" care therapies not rooted in science. A quick look at its Survivorship Care page reveals:
In collaboration with the medical and psychosocial services at The University of Arizona Cancer Center, we will work with patients to:
- Reduce physical symptoms associated with cancer and its treatment (e.g., pain, fatigue, insomnia, etc.)
- Manage side effects of chemotherapy and radiation with therapies such as acupuncture, botanicals, and mind-body medicine
- Examine lifestyle factors and situations (e.g., diet, risk for undernutrition, physical activity, emotional coping skills, support network, and spirituality) that may affect symptoms and/or course of disease
- Develop and work toward goals for health, wellness, and what is most meaningful and valuable after diagnosis, as well as during and after treatment
- Actively participate in their health care
- Regain a sense of control and well-being despite the diagnosis
Notice the quackademic medicine "integrated" with potentially science-based modalities for supportive care: acupuncture, botanicals, "mind-body" medicine. Note how such useless modalities like acupuncture are listed as being, in essence, co-equal with various dietary, lifestyle, and coping modalities. This is basically how quackademic medicine "rebrands" what should be science-based modalities as somehow being "alternative" or outside the mainstream. It then lumps them together with modalities that are pure quackery (acupuncture, reiki, therapeutic touch, etc.), the implication being that it's all part of a lovely "complementary and alternative medicine" (CAM) package that represents the "best of both worlds." Of course, we at SBM reject the idea that there are "two worlds," citing the oft-repeated adage that there is no such thing as "alternative medicine." Rather, there is medicine that has been scientifically demonstrated to work. There is medicine that has not been scientifically shown to work. There is medicine that has been shown not to work. The reason "alternative medicine" is alternative is because it falls into one of the latter two categories. What do you call alternative medicine that's been shown scientifically to work?
Medicine.
I know, I know. We say this a lot here, but it's true. Also true is Mark Crislip's almost famous adage, which I like to use in almost all of the talks I give about "integrative" medicine these days:
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.
As I've said many times before, I wish I had thought of this quote.
Trying to hide the stench of cow pie in the apple pie
Make no mistake about it, UACC is "integrating" fantasy with reality by offering reflexology (or, as I like to call it, a nice foot and hand massage with delusions of grandeur), reiki (or, as I like to call it, faith healing substituting Eastern mysticism for Judeo-Christian beliefs), craniosacral massage (or, as I like to call it, a nice scalp massage with delusions of grandeur), healing touch (also known as therapeutic touch, which I like to call reiki without the foreign name), and many others. At least, I wasn't able to find anywhere that the UACC offers homeopathy to patients, although one of the most famous of the "magical grants" awarded by NCCAM was to a University of Arizona researcher in Dr. Weil's department to study homeopathy.
It didn't take too long for it to become clear to the Professor that UACC was not dealing with him in good faith. At least, that's what he told me in a subsequent e-mail. What led him to believe this was a combination of not getting his e-mails answered and then what happened after he complained about perhaps the most egregious example that he found at UACC. He first brought this issue up back in December, and, after several requests to have a meeting, the Professor became frustrated and basically sent a threat to go to the media. Shortly after that, the web page on the UACC site that had so disturbed the Professor became this:
Yes, that's a big "Access Denied" message. One wonders whether UACC deleted the page or just hid it so that you need a University of Arizona login to see it. Maybe one of our readers from U. of A. could check and report back here.
Thankfully, due to the magic of Google Cache, we can see what was there until as recently as a week ago:
One wonders if the administration of UACC, out of concern that the Professor might actually do what he said he would do (shop his story around to newspapers), got rid of the web page for Frank Schuster. Of course, it's not so easy, as I showed above, and, in case anyone's interested, I've saved a web archive of the page for permanent archival purposes (for me, that is).
I can see why the UACC administration would be embarrassed enough to act like this. On the now defunct page, potential patients for UACC were treated to incredible claims like:
Very simply, Reiki is energy that flows through the body of the practitioner, and conveyed through the hands into the body of the recipient. It is subtle energy, but it can be felt – usually as a warmth, tingles or slight pressure.
And, perhaps the most ridiculous claim of all:
Any particular effects cannot be predicted. The energy is intelligent and it will do whatever is best. What can be stated is that it will help any condition.
That's right. Apparently this "healing energy" from the "universal source" is so intelligent that it will do whatever is needed or best. That totally must be why it can't be studied! Its effects are so darned unpredictable! It's also hard not to note that on the old web page about Mr. Schuster there was a link to his practice's web page Energy-Therapy.net, where there's also a link to his blog Energy Therapies, which appears not to have been updated since 2005 but is quite revealing nonetheless. Indeed, in one post on Mr. Schuster's web page, we see a claim that speaks for itself:
ALL illness and disease are indications of an unbalanced or depleted energetic condition. The resulting manifestation as pain or anxiety is the body’s way of letting you know that something in your life is out of balance.
But don't worry, Mr. Schuster can help. You don't even have to come to his practice or UACC! That's because, you see, Mr. Schuster offers distance healing:
Distant Healing is defined as a "mental intention on behalf of one person, to benefit another at a distance."
In this context, prayer is a mental act of intercession in which the believer (pray-er) puts himself “between” God and the recipient.
God then uses the prayer (pray-er) as the conduit for the request – be it healing, therapy, or another type of petition. God’s healing power is directed through the healer to the person in need. If that person is present, the power can be conveyed through touch. In the event that person cannot be present, God’s healing power is effectively conveyed by mental intention through the thought process. In this realm distance is not a consideration.
One might not believe any of this, nor have faith that this kind of healing can occur. Actually, that is irrelevant. The only faith that really matters is that of the healer or pray-er. The single requirement of the recipient is to be in a receptive mode, open to healing possibilities. It is not necessary to believe that the acts of prayer, distant healing or touch healing are effective.
This is, of course, completely unscientific. It's religion, pure and simple. In fact, I would argue that it's just another form of faith healing, given how Mr. Schuster invokes God as the source of the "healing power." And it's only $25 for four 15 minute sessions! (More if you want to donate more.) What a bargain! At least there's a quack Miranda warning at the bottom of the page, and one notes that Mr. Schuster also includes a plug for NCCAM.
I don't know whether Mr. Schuster actually offers distance healing to UACC patients, although it's clear from his web page that he offers it. Regardless of whether he offers it to UACC patients or not, I hope that I would not be alone in arguing that mystical nonsense like reiki (which Mr. Schuster appears to implicitly admit to be faith healing) has no place in an academic medical center, much less an NCI-CCC like UACC. There are only 41 NCI-CCCs in the entire country. I'm faculty at one and am proud of having been on the faculty of two different NCI-CCC's. The NCI designation is supposed to mean that these cancer centers are the best of the best, adhering to only the highest standards of patient care, research, and community engagement. To see an NCI-CCC offering faith healing, distance healing, and treatments based far more on magical thinking, religious and mystical ideas, and prescientific concepts of disease, such as reiki, reflexology, and acupuncture, embarrasses me almost as it would to learn these modalities were being promoted for patients by my own cancer center as though they were legitimate treatment modalities. Fortunately, they are not, which is one reason I'm proud of my cancer center, but I nonetheless fear this occurrence. After all, if M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center can fall so deep into the rabbit hole of woo, I'm under no illusion that it can't happen where I work too. All it would take is a new cancer center director, a new director of supportive services who is more "open" to these sorts of treatments, or maybe a new member of the board of directors who is woo-friendly. SBM is fragile these days.
Perhaps Dr. Cress feels the same way, along with many of the other excellent science-based clinicians and researchers based at UACC. I doubt it's a coincidence that there isn't a single mention of CAM or "integrative medicine" in a recent history of UACC published on the UACC blog last fall. In a way, I feel a bit sorry for Dr. Cress in that, as an interim director, she probably has neither the authority nor inclination to deal with this issue definitively. She probably wants to let whoever is appointed the next permanent director deal with it. Whatever the case, the Professor still doesn't know whether Mr. Schuster is still affiliated with UACC or not, the removal of his web page from public view notwithstanding. I'm not sure that even the minimal action of removing from the UACC website a webpage that links to a website offering distance healing would have happened if the Professor hadn't been faculty at the University of Arizona and threatened to go to the press.
Maybe they were concerned that people would also notice that Mr. Schuster's other website, Paths-Mind-Is-It.com, offers a veritable cornucopia of dubious products, such as Increased Synchronicity, which claims to be able to:
- Increase in awareness of the present moment. Fully appreciating the here and now
- Have future self send information back through time to current moment. This is specific for the following periods of time...1 minute, 1 day, 1 week, 1 month and 3 months
- Have current self send current information back through time to past self. This is also specific for the following periods of time...1 minute, 1 day, 1 week, 1 month and 3 months
- Increasing unity/harmony between past, present and future self
Hey, if Mr. Schuster can send healing messages over distances, why not forward or backward in time, too? Yes, basically, his PATHS "utilize proprietary breakthrough technology" that claims this:
Rapid Data Transfer (RDT) GENERATION II embodies a quantum leap in Mind Technology. RDT Gen. II is a unique technology that helps you use the potential of your own mind without any drugs or medications. It can help you to improve in almost every area of your life including, health (physical, mental, emotional & spiritual), enlightenment, productivity, success, communication, finances, relationships, fitness and sports - even improve your memory!
RDT has been helping thousands of individuals, like you, improve their lives in many ways (click here to read success stories) in as little as 3 minutes a week.
RDT or Rapid Data Transfer facilitates high-speed communication between an on-line Theater Presentation and the human subconscious.
As best I can figure, PATHS are multimedia computer presentations that claim to be able to do all sorts of things for you, including improving your stem cell health, strengthening your connective tissue, and doing quantum meditation. Note that the word "quantum" features prominently in this "technology," and regular readers know what the use of that word almost always indicates in this context.
What remains of the cow pie
Even if Mr. Schuster is indeed gone from UACC, there's a lot of woo that remains there, as the Professor mentioned in his e-mails. Specifically, he pointed out something called The Seven Levels of Healing, a program created and offered by Dr. Jeremy Geffen, MD, FACP, who is described as a "board certified medical oncologist and leading expert in integrative medicine and oncology and is the author of the book The Journey Through Cancer: Healing and Transforming the Whole Person." I think I'll quote the Professor about why he found this so objectionable, because, really, without letting myself go, I'd have a hard time putting it better myself. In his criticism, the Professor also cites examples from Dr. Geffen's website:
Today I'm in the cancer center and I've noticed something else. You offer here something called "The Seven Levels of Healing". I looked up this program. Level 7 is about the nature of spirit. Here's one thing they say:
Spirit is our true nature: timeless, eternal, and dimensionless, the source from which all awareness, all creativity and, ultimately, all healing flows.
As you know, this claim is scientific nonsense. One may have religious faith in such a claim, but is it appropriate for this claim to be made by the cancer center? The description continues:
The goal of "The Nature of Spirit" is to assist each person to discover this spiritual aspect of themselves, and to bring this into full, ongoing awareness. When what we experience as physical reality is threatened, it is more important than ever before to remember that another part of us is timeless and eternal, and remains strong, healthy, and powerful, no matter what our physical circumstances may be. In recognizing the nature of our spiritual selves, and the incredible mystery of awareness itself, we uncover the source of ultimate love and freedom -- an infinite ocean from which healing can be drawn.
Again, completely unscientific claims about healing. As far as I know, the "Seven Levels of Healing" program is free. This makes it less objectionable, although in my mind, it is still objectionable for the cancer center, a supposedly scientific, evidence-based institution, to be pushing what is essentially religion. Moreover, in the description of level 3: "The Body as Garden", they say the following:
Here we explore the full spectrum of complementary approaches to healing: nutrition; exercise; massage; yoga; herbal therapies; Ayurvedic, Tibetan and Chinese medicine; acupuncture; homeopathy: chiropractic; and visualization. We do not offer or promote these approaches as cancer treatments per se, and we do not believe that they should be viewed in this manner. However, we do believe that they can supplement conventional care by cleansing, toning, relaxing, and strengthening the body, thus giving health and well-being the greatest chance to emerge.
Although these claims are vague, it would be quite natural for someone to interpret them as meaning that these treatments, some of which are offered at the center for a fee, can aid in one's recovery from cancer. I know of no evidence to support this claim. And do you have any idea what they mean by 'cleansing' and 'toning' the body? Do these terms have any scientific meaning in this context?
Likely, the Professor learned of this program through a fliers or pamphlet like this one. He is quite correct, too. By offering this particular program, UACC has irresponsibly placed its imprimatur and thus the assumed imprimatur of science on pseudoscience and mystical, religious mumbo-jumbo. There is no excuse for this.
This "Seven Levels of Healing" represents a program by a physician who is not UACC faculty but is promoted by UACC to its patients. It offers homeopathy, which, no matter how much homeopaths try to deny it, is pure quackery, as we've described many, many times here. Ayurveda and traditional Chinese medicine are modalities based on prescientific ideas of how diseases work not unlike the four humors in prescientific European medical traditions. Worse, according to the biography on the website, Dr. Geffen is apparently "focused on implementing 'The Seven Levels of Healing' program in cancer centers throughout the United States, along with writing, speaking, and consulting with hospitals, cancer centers, and professional organizations in developing leading-edge integrative programs for medicine, wellness, and life." Although several cancer centers appear to have adopted the "Seven Levels of Healing" woo, from what I can tell, UACC is the only NCI-CCC that is involved, making it by far the most prominent cancer center to be using Dr. Geffen's program. I really hope that I don't learn of any more.
Given the infiltration of quackademic medicine into even the most respectable medical centers, it's hard to know whether UACC is merely the cancer center that's gone the farthest down the rabbit hole of pseudoscience or whether I just don't know of ones that are even worse. Given the large shadow that Andrew Weil casts over the medical school there, it might well be so that, when it comes to quackademic medicine in oncology, UACC reigns supreme. As prominent as M.D. Anderson and Memorial Sloan-Kettering Cancer Centers are, as far as I can tell, neither of them has yet offered distance healing to their patients, although many are the academic medical centers that offer a quackery only slightly removed from distance healing, namely reiki. After all, what's the difference between saying you can channel "healing energy" from the "universal source" into a patient if you're in the room with him or if you're thousands of miles away? In my mind, not much. At least one academic medical center offers homeopathy. (Actually, I wish it were only one.)
Can anything be done?
Often, I'm asked something like, "What's the harm?" After all, UACC and the other cancer centers that offer up "integrative oncology" don't deny patients science-based treatments for their cancer. True enough. However, as the Professor demonstrates, the existence of "integrative oncology" programs has a profoundly confusing effect on patients and their families, who, quite reasonably, assume that an NCI-CCC would not offer any treatments that were not science-based. Consequently, the line between science and pseudoscience is becoming increasingly blurred, to the point where even a lot of physicians have a hard time telling the difference when it comes to modalities like acupuncture, which has been the most successful at projecting a facade of science over prescientific mystical origins and a mid-20th century resurrection based on political need in China, thanks to low quality studies and random noise in clinical trials. Worse, this infiltration has led to grossly unethical clinical trials, such as the Gonzalez trial, in which patients undergoing a "natural" therapy for cancer did much worse than conventional therapy, even for a disease with as grim a prognosis as pancreatic cancer. Perhaps an even more pernicious effect (actually, there's no "perhaps” about it) is that this blurring of the lines between science and pseudoscience so badly batters the filters against pseudoscience that a cancer center like UACC can allow practitioners like Frank Schuster and Dr. Jeremy Geffen to be associated with its programs, and even hire them to provide unscientific medicine.
My first wish is that more patients like the Professor would so vigorously protest the infiltration of quackery into academic medical centers like UACC. My second wish is that it would take more than the potential embarrassment of publicity about a practitioner that even the quackiest of quackademics can't defend to push a cancer center to act to protect the scientific basis of cancer care. Maybe the Professor can serve as an example of the first wish, but I fear I will not live to see the second ever fulfilled.
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Pushback will have to come from patients.
Otherwise, quackademic centers will continue to feel a need to compete with the woo offered at places like Cancer Treatment Centers of America. For instance, laughter therapy.
Who cares about survival rates, when you can have laughter clubs?
http://www.cancercenter.com/treatments/laughter-therapy/
This is why I worry somewhere there is a peds heme-onc physician who just might cave/fall for Burzynski's snake oil.
Have there been any articles by oncologists that have come out strongly against this quackademic infiltration of science-based medicine (other than, of course, ours truly)?
@ Chris Hickie:
I have a cousin who has terminal lung cancer - he lives thousands of miles away- I only talk by phone- but from what I can gather, both he and his wife could benefit from *science based* services at this time. I suspect that most of these are readily available but they are currently in a frozen state of shock. Hopefully, they will respond when the services are offered- he does receive home visits from a nurse weekly.
People undergoing this situation need professional help- such as counselling and perhaps guidance about dietary interventions and pain medication.
Should institutions and governmental supplements for health care be squandered on reiki and accupuncture when money might be better spent on dieticians and counsellors?
AND I'm not just saying that because of my own area but because this assistance is based on DATA.
What's truly insidious about quackademic medicine is that most laymen aren't (and cannot be expected to be) as well informed as the Professor. He seems to have an especially well-developed BS detector (possibly due to his teaching and grading duties), and he is confident enough to recognize that someone affiliated with Erehwon University Hospital might be spouting nonsense. Most laymen would see the Erehwon University Hospital seal of approval and reasonably assume that there was something to it, even if "it" were an alt-med treatment mode as ridiculous as homeopathy or touch therapy (the latter was debunked by a then nine-year-old girl in a science fair project, for crying out loud).
I am a skeptic and a critic! HOWEVER I used to weight about 240 Pounds, then i lost over 70 pounds. The problem was my posture was very misaligned, my neck and back. I did 4 months of chiropractic and my back actually straightened by more than 15˚ and my neck by more than 18˚. How are you going to sit here and tell me that this is quackademic when it made me better??? Of course I did phyiscal therapy (a few minutes lifting weights at the center) after each adjustment. I have xrays that show the difference in change in my back and neck. How can you say this didn't help me?
Speaking of homeopathy...
http://www.wired.co.uk/news/archive/2014-03/25/homeopathy-contains-medi…
I know it's cliche, but this may be one of those things that may have to get worse before it gets better. I just hope we don't have to get plunged into a new Dark Ages by the anti-science movement before everyone else wakes up and starts pushing back, demanding real science and real medicine. I'm glad this Professor is doing all he can to fight against it. Let's hope he can rally his colleagues in the science departments into backing him.
Integrative Medicine is here to stay, for now. It's sad to see so many doctors taken in by it, including Dr Snyderman; it's difficult to know who are the true-believers and who embrace it to stay competitive.
As far as Dr Weil is concerned, he is actually a rather divisive figure in the alt-med community. Sure he's popular, but there are many people in the alt-med movement who see Dr Weil as a "traitor", or some kind of "allopathic" infiltrator of the movement. Many resent him for helping create the board certification in integrative medicine. Some also resent him for creating integrative medicine to begin with, since they believe all scientific or "allopathic" medicine is worthless or evil, and they're not integrating their homeopathy, or reiki, or herbalism with that!
Uh-huh. Apparently, Ayurveda and TCM just weren't obscure enough. The irony of holding that "Lhüng disorders" are caused by materialism and attachment ("Bheygan disorders" are due to ignorance) while simultaneously fetishizing the Dalai Lama is predictably lost on this crowd.
Cooper @6 - I'm not an expert, but I think that most folks around here don't dismiss the idea that chiropractors could have some benefit in cases such as yours -- you had a structural issue, and manipulation could have helped it a lot.
But hard-core chiropractors believe that practically every disease traces to some kind of misalignment of the spine -- they base these beliefs on the 19th-century doctor who started the field. At this point can be pretty sure that that part of the subject is nonsense.
#6 Cooper
Well, posture doesn't seem to be emphasized today as part of medicine, but it was commonly considered part of health and character in the first part of the 20th century. It still is, but it is appreciated in fewer places.
It sounds like your back was severely out of line, and the crude methods used by chiro were better than doing nothing. Glad to hear it worked out for you.
But ... if one either doesn't have severely misaligned spine or has that problem and a good physical therapist able to deal with it, I'd avoid the chiropractor.
I used one myself for a while to deal with back pain as I had an acquaintance who said he got good results from one particular chiro, and I thought chiros as "the back pain fixit people". I now understand them as an odd combo of useful physical therapy, excessive x-rays and possible back injury from forceful spine movement. So ... now l look elsewhere to fix back and posture issues.
We've fumed for a long time over patient testimonials. Quackademic alt med, I think, implies a testimonial from respected mainstream institutions. Just after reading this blog this morning, I stumbled on this discussion of Ayurvedic treatments on a cancer patient message board:
"I have not tried it, but I noticed that it is offered at our big comprehensive cancer centers in Ohio... [she names three mainstream cancer centers]...so it's not too far out there."
It's a really good way to lull the patients so they don't notice they've entered fantasyland.
" I was busy doing something last night that left me no time to compose any fresh Insolence, which will become apparent by this weekend. In the meantime,"
Will there be an announcement, or should we just check arrest records?
Patience, Grasshopper. When you can snatch the pebble from my hand...
The Center for Integrative Medicine at University of Colorado Hospital (NCI-CCC)
http://www.uch.edu/conditions/integrative-medicine/
With a big ole front page "Featured News Story: Acupuncture for Cancer."
Shoot me now.
University of Pittsburgh (NCI-CCC)
http://www.upmccancercenter.com/SupportiveCare/integrativeMedicine.cfm
UPMC CancerCenter Integrative Medicine Information Service (IMIS) provides access to complementary and alternative therapies to assist in managing your symptoms. These types of therapies may also assist in preventing a cancer from forming or returning.
The program offers information regarding:
Herbal and dietary supplements
Acupuncture
Healthy eating
Mind-body medicine
Additional therapeutic approaches
IMIS specialists work directly with your cancer care team to integrate alternative medicine approaches into your treatment plan.
Dana-Farber (NCI-CCC)
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and…
Despite the documented benefits of complementary therapies, most insurance plans will not pay for them. Our mission is to make integrative therapies available and affordable for all Dana-Farber patients.
A past president of the American Cancer Society and a professor at Harvard Medical School, Dr. Rosenthal has embraced integrative therapies as a vital component of his own oncology practice.
Yep, even Barbara Ann Karmanos/ Wayne State University
http://www.karmanos.org/cancer-care/patient-center/support-education/in…
Integrative Therapies & Services
Integrative therapies are used in combination with cancer treatment to treat the whole patient, mind, body and soul. These therapies place an emphasis on decreasing stress and anxiety, while improving one’s general sense of well-being. At the Karmanos Cancer Center we offer a variety of integrative therapies including:
Art therapy
Healing touch
Massage therapy
Pet therapy
Reiki
Yoga
Ayurvedic, Tibetan and Chinese medicine
Uh-huh. Apparently, Ayurveda and TCM just weren’t obscure enough.
A situation, I suspect, of some fantasist deciding "I want to make stuff up" and feeling his imagination too constrained by the body of made-up stuff that already exists for Ayurveda and TCM.
A situation, I suspect, of some fantasist deciding “I want to make stuff up”
"Therapeutic fan-fic", is basically what I'm saying.
Pet therapy -- when my uncle was dealing with dreadful health problems (including cancer) toward the end of his smoking-truncated life, he had a little dog who cheered him up greatly.
It's more than doubtful that this had any effect on his cancer, but it enhanced his quality of life quite a bit.
Palindrom,
Absolutely! The touchy-feely, stress relieving, comforting, make-you-feel-nice, distraction, massage, friendly shoulder to cry on, puppy kiss, etc., treatments are a HUGE and welcome benefit to many patients. No doubt about that! My issue is simply the exaggerated and bogus "healing" claims surrounding them.
When the AMA did a federally funded study comparing naturopathic medicine with pill and cut methods they were embarrassed when they had to admit naturopahic medicine was more effective. They tried to supress their own research but had to release it due to the federal grant that paid for it.
Pubmed link, please?
thenewme @22 -- We are in perfect agreement.
I think it's important for science-based medicine folks to be very clear that they understand the palliative and quality-of-life value of SOME of this stuff, so they don't come across as inhuman scolds. But of course, humane sympathy and warm-heartedness do not require checking one's brains at the door.
(Excessive capital letters below by deliberate design, heh heh;-)
Dear Mr. Schuster:
Can you use Distance Healing to channel some Reiki Energy for me? I am on a Quest for the True Nature of Energy, and since you say the Energy is Intelligent, it should be able to do this.
I have here on my desk, a BBC/Goerz-Metrawatt MA3E multimeter, with the Negative lead connected to Ground (I understand that for Healing Energy to work, one needs to be Grounded), and the Positive lead pointing straight up in the Air. The meter is set to read 10 Microamps full-scale, so even one Microamp will be sufficient to give an unambiguous Reading.
If you agree to provide your Help in my Energy Quest, I shall switch on the meter at a time of your choosing. I am eager to receive a good Reading on my Meter, so I'll be happy to send payment for your Services before we proceed.
Sincerely yours....
The point of the preceding comment being, if something is claimed to be energy (or, ahem!, Energy), then it should certainly be measurable. As I like to ask when I hear people talk about 'Energy', 'How many milliwatts per square metre, and how is it measured?'
As for the woo poo at NCI-CCCs, IMHO it would be legitimate if they said something like the following (this is serious, not sarcasm):
"Many cancer patients and their families find it is very helpful to engage more fully with whatever philosophical, religious, or spiritual beliefs they may hold. We can provide a list of local resources that cover the range of Western, Eastern, Indigenous, and Non-Theistic beliefs, traditions, and practices. This list does not constitute and endorsement by the Cancer Centre of any system of belief or practice, and no medical benefits should be expected from participation." Full stop, nothing more.
While it is reasonable for a doctor to ask patients and families about their 'emotional and spiritual wellbeing' in a general sense, I for one would be rather upset to be subjected to proselytising for a belief system that had no basis in empirical science and that I did not hold as a philosophical matter. Contemplating Max Tegmark's multiverse theory is one thing; getting asked if I'm 'saved' or the Eastern equivalent thereof, is decidedly another.
Capital TOM:
i'm going to stick my neck out and call Bullshite.
Lurker #27 -- if it's milliwatts per square meter, it's power flux, not energy.
I, for one, do not confine my insufferable pedantry to linguistic matters.
Lurker - sadly, your experiment is doomed to failure because your meter is Grounded in Negativity! While it is to your meter's credit that it is waving its Positive lead in the air, the Energy will avoid all that Negativity lest it be Bummed Out. The only solution would be to eliminate the Negative Pole entirely and Positively Ground your machine, possibly with a Coffee Grinder.
If or more likely when I get cancer or some other disease, and someone offers to sell me magic water or reiki or some other garbage, then I will most likely try to recall any of my old Tae Kwon Do training and give them some decidedly therapeutic touch. It'll make me feel better, at any rate, and perhaps make the world a better place. Maybe they'll even get a Darwin Award out of it, so wins all around.
Of course the first thing I did after reading your post (my first introduction to your work - nice job) was to look at the Comprehensive Cancer Center at my institution - Northwestern University. Sure enough, under "Specialty Cancer Services," they advertise a program in Integrative Medicine: http://cancer.northwestern.edu/public/why_northwestern/specialty_progra…
I should also like to note the official motto that has graced Northwestern's seal since 1890: Quaecumque sunt vera (Whatsoever things are true)
(excessive capitalisations intentional;-)
Palindrom @ 29: Ooops. I based that on 'watts per square metre' which is a measure of solar radiation and used in conjunction with photovoltaic (solar power) installations. What I'm looking for is a pithy way of saying 'show me an objective measure of your so-called Healing Energy.'
Mephistopheles @ 30: Oops again!, Grounded in Negativity, glad I checked it here before sending that to Schuster. But if the Positive is Grounded, then we have the problem of the Negative probe in the air, which would be seeking to receive Negative Energy. Maybe I should ask Schuster which setup his Intelligent Energy would prefer.
Herry @ 31: Now now, it's not up to you to be an Agent of Karma, much less launch any hapless fools into their Next Incarnation. Instead, seek to Channel some Life-Affirming Energy to illuminate the errors of their ways, and trust the Spirit to guide them.
---
Seriously though:
Thinking of martial arts manoeuvres, I wonder about the possibility of 'grounding' all this 'integrative medicine' by way of finding science-based treatments and palliative modalities that can be described in vaguely wooey terms to make them attractive to the woo-seeking crowd? Also, removing all diagnostic/treatment language from the more harmless forms of woo, and describing them in ways that are attractive to that audience but don't promise any medical benefits as such?
Yoga (as exercise), massage (for relaxation), meditation (for reducing stress), etc. etc. The woo modality that consists of looking at coloured light could be reframed as purely an exercise in sensory pleasure, like looking at the blue sky or a sunset.
The goal here is to 'speak their language' and offer something that provides emotional affirmation, sufficient to help get them onboard with SBM for the actual diagnoses & treatments.
For example I wonder how often oncologists who are mainstream-religious, say to their patients who are also conventionally-religious, something like 'I'll be thinking of you in my prayers'? From the doctor's perspective, it's a sincere kindness. From the patient's perspective, it's affirmation of their faith and it shows solidarity. Objectively, it's emotional support, even though it's not part of the treatment (e.g. chemotherapy).
If something like that could be done for patients who subscribe to various forms of animism, I can't see that it would be harmful. It doesn't do to proeslytise atheism to one's Protestant or Catholic patients, so the same case should obtain for one's animist patients. Just as long as they agree to use SBM for the actual diagnoses and treatments, other things that help them feel better emotionally should be OK.
Radiation therapy really sends the healing energy into the body where it can kill the bad cancer cells. And, if you're not trying to cover the whole body so you can kill the nasty cancer cells wherever they pop up, there are ways of targeting the healing energy such as choosing the energy for charged particle irradiation to deposit most of the energy at the depth of the cancer site.
It's been a while since I studied health physics, but I'm sure the box of blinking lights is much more aware of current techniques.
And, with charged particle accelerators, you direct either positive or negative energy!
Lurker,
I am ok with sharing belief systems, but there are a few requirements that I would require of my medical team:
a. Be sincere. Don't pander to me.
b. Be upfront about it being palliative not a treatment.
c. Free is best, but if you are going to charge for it don't offer it to me unless I understand item b. thoroughly.
d. Don't replace SBM with it because you can charge a lot for it and deliver it cheaply relative to SBM - which I think is where we are headed in the States at least.
"requirements that I would require"
I apologize for the redundancy; NyQuil wore off and fever is kicking in.
I had intended on writing a more scathing/in-depth response to your egotistical out-pouring's but I'll say this instead: There are none so blind as he who will not see. The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance. To dismiss something because the jargon that is used doesn't fit your palate is unscientific and again arrogant. Search the NIH for reiki and 87,000 results will emerge, yoga and 219,000 will. You are in a lesser group that thinks these ideas aren't worth looking into for patient care. Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell. It would be in the doctors best interest to be a master of health and not a master of sickness.
"The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance."
Citation needed.
"Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell."
How would that work for those who have genetic conditions like cystic fibrosis or obstructive hypertrophic cardiomyopathy? Or perhaps getting cancer, like leukemia or cervical cancer?
Or do you just think it is cool to blame the patient? And why demonize those who try to educate the public on useless things like "energy" medicine?
(by the way, yoga is a nice kind of exercise, and exercise is part of mainstream medical practice)
If you mean PubMed, you're off by a factor of 468, and a glance suggests that a good number are in the usual low-quality places.
And here, I was thinking that Reiki is a hands-off treatment. I was wrong.
http://www.ncbi.nlm.nih.gov/pubmed/23617447
The University of Colorado Hospital stuff, at least, looked to me as if it fell short of "bogus." (As one might expect, in light of the potential legal repercussions.)
It definitely disturbs and distresses me that people evidently can't tell when the words in the "Our Services" brochures they're reading mean anything or not. The unhappy implications of it aren't confined to alt-med. (Or, ftm, med.)
But I'm not sure I'm outraged by all of it, per se.
And (more to the point) I'm also not sure that TCM-as-offered-and-practiced-at-the-University-of-Colorado-Hospital (as opposed to TCM) is harmful, per se.
A lie-down-with-dogs argument could be made, I guess.
...
I don't know. I don't see a good argument in support of it. And it wouldn't be for me, personally.*** I'm just not sure I oppose it adamantly.
*** Although I might like the pet and/or art therapy. Lanyards!
This is a thing of beauty:
You (and the Professor) don't appear to understand the difference between complementary treatments designed to offer symptom relief and reduce the side effects of conventional cancer treatment and alternative treatments that purport to affect the disease process itself. Integrative medicine is generally careful to align itself primarily with complementary treatments and with the best research-supported alternative treatments. Your assumption that integrative medicine practitioners make no such distinctions is contradicted by the fact that there have been integrative medicine practitioners and researchers in major medical centers for more than two decades, and virtually all of them would support the use of conventional therapies that have a research-supported track record of effectiveness (it may surprise you to discover that not all conventional therapies can make that claim). Check out Deng and Cassileth in the November, 2013 issue of National Review of Clinical Oncology: "Complementary and alternative medicine in cancer care - myths and realities" for a good statement of integrative medicine's perspective on this.
Meanwhile, I would suggest that you do less name-calling and read more of the research literature about complementary and alternative medicine. The term "quackademic" is basically short for "I've stopped thinking about this because of my prejudice for mainstream science and I want you to stop thinking about it, too."
Oh, I understand the difference between "complementary" treatments designed to relieve symptoms and alternative treatments. You're also attacking a massive straw man, as I never said that "integrative practitioners" make no distinction. Rather, I view that distinction as being one without a real difference. They still use a lot of quackery.
Reiki is quackery. Acupuncture? Quackery. Homeopathy? Quackery. "Therapeutic touch"? Quackery. "Energy healing"? Quackery. Chiropractic? Large swaths of it are quackery. Naturopathy? Ditto. That's the point. "integrating" these modalities with SBM, as "complementary" therapies or whatever is still quackery. I suppose it's not as bad as using quackery to try to treat the cancer itself, but just because it's "not as bad" as using alternative medicine to treat cancer doesn't make it good. It's still bad.
If only all the quack modalities are offered with a nice big upfront bold statement that "This modality may make you feel better but it will not make you better"
Are you sure you've read it yourself? That's not the name of the journal, and it's paywalled. Anyway, it's not too difficult to find Cassileth's distinction:
"Complementary therapies are distinct from so-called 'alternative' therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind-body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences."
("Xerostomia, or extreme dry mouth, following head and neck radiation therapy is also very responsive to acupuncture treatments with increased salivation compared with control." [Self-citation].)
It seems that AB would have us consider Integrative "Medicine" as using the nice fresh juicy cowpie as a topping for the apple pie, rather than mixing the two willy-nilly.
Would that happen to be Barrie Cassileth?
Acupuncture for breast-cancer-related-lymphedema...not a good idea:
http://scienceblogs.com/insolence/2013/07/02/acupuncture-and-breast-can…
Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell. It would be in the doctors best interest to be a master of health and not a master of sickness.
Isn't that the business model of the health insurance market? The main effect seems to have been to incentivise insurers to deny coverage & treatment to anyone who might get sick.
The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance.
Someone remind me how many million Americans signed up for "this perception of healthcare" once they were given the opportunity
I f you mean the Affordable Care Care a.k.a "Obamacare", it met its goal of enrolling (more than) 7 million people as of the cutoff date of March 31, 2014.
"...Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective...."
Somebody forgot to mention the inexpensive part to all these complementary folk.
Not to be a trouble-maker or anything.
But when I canvas myself for a position regarding the above, I feel a strong impulse to agree with it, followed immediately by profound unease and uncertainty.
Would you call pet therapy and art therapy quackery? Or....I'm not really sure how best to frame the question. But to use this page here...
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and…
...as an example, they offer the following "integrative therapies":
Accupunture
Creative Arts Therapy
Massage Therapy
Meditation
Nutrition/Herb/Food Supplement Counseling
Qigong
Reiki
And they appear to me to be offering them on equal -- or at least comparable -- terms to one another.
So.
I personally think that Reiki is ridiculous, and that "traditional Reiki" is even more ridiculous. It's only been around since 1922.
However, they don't appear to me to be offering it on terms that meet the definition of the word "quackery" better than the terms on which they're offering the creative arts and music.
Furthermore, I myself might very well derive benefits very like those they're describing from not only the arts 'n' music, but also the meditation:
Of course, that's so true in my experience as to be too self-evident for the practice to require guidance by a hospital service-provider. But with or without the service, it's still true. Relaxation is relaxing. There's no arguing with it.
Granted, they do go on to cite research purporting to show that meditation has therapeutic benefits that may not, in reality, exist.
But they do the same for the music therapy. And since I wouldn't say they were promoting magical thinking -- or parting fools from their money, or otherwise crossing any lines that shouldn't be crossed -- by doing that, I don't think I have a justification to say it about meditation (or, ftm, reiki), apart from bias in favor of my own cultural-aesthetic-intellectual preferences.
I mean, it's not as if science understands how or why music has the powers it does, or as if anyone can say with any precision what they are. It's just a matter of general, anecdotal consensus that it has some.
People sometimes make claims for them that others probably regard as a threat to the cultural values they'd prefer to see privileged, in fact:
https://www.youtube.com/watch?v=4avM0qzEF5I
There's no arguing about taste. And maybe this is not such an argument. But I'd be curious to know on what grounds people who hold that it isn't think so. I'm not sure I see any.
______________
(I'm assuming a definition for "quackery" that's either something like (per Wikipedia), Stephen Barret's....
...or Paul Offit's:
FWIW.)
@ ann:
I used to counsel people who had a serious dx and encouraged them to seek out life-enhancing experiences and to make healthiER choices in daily life so that they would feel better ( which would not necessarily make them BE better)- see movies, listen to music, interact with friends, eat better, avoid alcohol and drugs etc.
I know that woo-meisters will argue that mediation and exercise reduce stress hormones and liberate either neurotransmitters/ endorphins or the *life force* itself ( depending upon how far gone they are) but I think that most sane people will recognise that there's a world of difference between *medicine* and self- care.
I refer to the latter as 'grandmothers' medicine' or 'spa medicine'. Drink tea if you have a cold or get a massage if you feel stress. Exercise to decrease anxiety or weight problems. Sure, all of these activities have physiological effects that can be measured as well as being subjectively experienced by the subject. Most of these activities are also recommended by SBM despite the claims of alties. Most can either be done by the person him or herself or by non-medical personnel.
Woo goes too far when it prescribes these activities as curative or uses them as replacements for therapies that have been found to treat illness through meaningful research; woo also makes diagnoses without benefit of real world methods of measurement and analysis: you may have 'low chi' BUT how could chi be measured since it doesn't exist?
OBVIOUSLY there's much more but I have to get ready to get to my train,
An addendum:
I'm not saying: "Oh, well, anything goes, if the people want it and it doesn't hurt them, where's the harm?" or anything like that.
Ostensibly reputable facilities do sometimes promote quackery and I am immovably opposed to it when they do.
For example: Sierra Tuscon offers brain-SPECT-scanning, a la the Amen Clinic:
http://sierratucson.crchealth.com/treatment/brain-spect/
And while that's not more or less of a pile of absolute crap than reiki is when it comes to demonstrable efficacy/benefit, it is -- by my standards -- quackier. Because there's no extra-medical cultural or human affinity for neuro-imaging. So there's no reason to cater to or accommodate one. They're just mystifying medicine for profit. It's a blight. Moreover, the language they use, while qualified, does definitely suggest that it's science, not art. They speak of "clinical indications," for instance.
But they also offer 12-step -- ie, relating to a "higher power" part of one of their treatment modalities. And I have no problem with that, assuming the usual disregard-if-you-wish terms of 12-step apply.
I agree.
My point is that I'm not sure I see how the integrative-therapy (or, in the case of the University of Colarado, "integrative medicine") services of the three facilities linked to on this thread meet those criteria.
Or four. However many there are.
I guess it's the blanket assertion that offering reiki and acupunture as a complement to cancer treatment in an otherwise legitimate and responsible medical setting is -- in itself, existentially- - quackery that I'm querying.
I see the point with energy healing, homeopathy, and healing touch. Because they have no basis, purpose or function -- conceptually, historically, culturally -- that isn't in direct, oppositional conflict with science-based medicine and/or science.
First, they misrepresent reiki:
"Based on the belief that an unseen 'life-force energy' flows through us and helps keep us alive"
No; the reiki power is out there: Per the Usui memorial, "On the beginning of the 21st day, suddenly he felt one large Reiki over his head and he comprehended the truth. At that moment he got Reiki Ryoho."
Reiki is an occult healing practice that still involves the "transmission" of "secret" signs of "power" and has, moreover, been rejected by the U.S. Conference of Catholic Bishops. Describing it as "Japanese" also suggests that it is used in Japan, although it in fact had to be reintroduced from the West (perhaps predictable, being in the hands of a secret society) in the 1980s and doesn't seem to have caught on.
"In addition to making you feel more relaxed, safe, and secure, a proficient instructor can facilitate energy flow to the areas where you need it most"
If this isn't promoting magical thinking, I don't know what is. It's pure superstition.
Brain-Spectrometry covered here:
http://scienceblogs.com/insolence/2013/07/24/a-board-certification-in-i…
Pet therapy in a hospital? No way, no how, would I ever agree that an acute care hospital should allow pets in patient care settings, especially cancer wards, where patients are undergoing immune suppressing treatments.
I'm not sure what Sierra Tucson has to do with anything, but...
"The 12-Step process is utilized as a basis for the treatment programs at Sierra Tucson, and individuals are encouraged to use the 12-Step process in their recovery."
This seems to be more that "offering," despite the backpedaling.
I do, to the extent that it's essentially misrepresented:
"Research has shown that the quality of recovery from all addictive and mental health disorders is enhanced by the many components of the 12-Step Process, such as mutual support, honesty, accountability, acceptance, and spirituality."
Twelve-step programs are essentially cults, with an evidence base that ranges from negligible to actively destructive.
Would you call pet therapy and art therapy quackery?
I have concerns about feel-good, emotional-wellbring activities being described as "therapy", especially in a medical context designed to smuggle them in and create the impression that they improve *physical* health.
The local hospice provides a drinks trolley to the clients, and many terminally-ill patients feel better after a glass or two of decent malt, but they do not call it "alcohol therapy". They provide a Biography Service where volunteers interview clients and lend their transcribing / editorial skills to help them write an autobiography... many clients feel better to see their lives in retrospect, edited to emphasise the plot arc and the closure... but they do not call it Biography Therapy.
No they're not. They're not even non-essentially cults. They're not even necessarily religious.
That could be said evidence base for just about every form of alcoholism and addiction treatment there is, sometimes accurately, as with equine therapy (negligible) or Narconon, the descendants of Synanon/The Seed, and countless others (destructive).
Addiction and alcoholism are frequently treatment-refractory, and sometimes lethal. No single thing works for all -- or all that many. And nothing at all works for some.
A lot of people get clean and sober in twelve-step programs with no excess or unnecessary ill effects or suffering whatsoever. Most don't stay that way. But some do. Writing the whole shebang off in the terms you just did is thoughtless, at best. I'm surprised at you.
(No, I'm not. It's not a personal thing. It's just my considered opinion.)
@herr doktor bimler --
I'd rather see a drinks trolley called drinks trolley, certainly.
But I don't know that I'd conclude it had been designed to smuggle a feel-good activity into a medical context and create the impression that it improved *physical* health if it were called "alcohol therapy," assuming that was the only basis to do so that I had.
I probably wouldn't, though.
AA and friends are unquestionably cults. There is only The Way. Lifelong dependence on The Program is a necessity. Anyone who brings an addiction to a halt without The Program is a "dry drunk," etc. The rhetoric of "codependence" (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.
I don't have the time or energy tonight to dissect it much further.
Ceremonially standing in a circle holding hands while reciting the L-rd's Prayer tends to say otherwise.
Synanon is not worth mentioning, and equine therapy is hardly an "addiction treatment." Twelve-step programs exist by definition to foster a culture of powerlessness. It is no surprise that predators are attracted to them. Also imperative is the instilling of shame, because it's not really anonymous and there's a pressure to confess.
CBT and pharmacotherapies do not rely on any such weirdness or insist that the underlying problem is an irreparable character flaw. The problem with "just about every form of alcoholism and addiction treatment there is" is that 12-step programs just about are the only form of treatment there is.
Yup.
Define "works."
Define "a lot of people."
No, it is not.
^ Note that I did not mean include methadone or disulfiram under 'pharmacotherapies'.
No. That's a ludicrously overstated mischaracterization.
That too.
And that.
Huh?
Meaning disconnection, a la CoS?
Are you serious?
Insofar as I know you from reading your posts here, I'm in awe of your intelligence, ability. wit, heart, soul and integrity.
However, you appear to have been misinformed about what 12-step programs are and how they work by a source that represented the rhetoric and practices commonly used in them in an extremely distorted light.
For one thing, even within a single 12-step program -- ie, within AA or what-have-you -- practice and custom vary enormously by region and group. It's not a monolithic thing, being as it's peer-run and not centrally administered.
But if they're run in the typical spirit, it's not fear-based. There's no leadership. There are no outpoints, brownie-points, sanctions, or punishment. There are no coercive tactics, or even coercive-persuasion tactics.
And -- as they say, quite distinctly -- there are no rules, just suggestions, the only requirement for membership is a desire to stop drinking, yada, yada, yada.. Belief in most of the steps and principles is customary, but disbelieving some of them is common. And, per the framework of the program, both optional and voluntary.
^^I'm talking about the program there. Obviously, I can't vouch for or against every individual group.
People in 12-step recovery sometimes go through a conversion-type stage that's reminiscent of cultiness. But that doesn't make it a cult. They're just converts.
Not if you don't have to say it, it has no fixed meaning, and belief in it would be optional even if it did.
It's not, as I already said, even necessarily religious.
Sierra Tuscon is famous for the latter. Not that I disagree with you.
That's crazy talk. They do not. They exist to provide peer-support groups for people who wish to use them to get clean and/or sober. Primarily.
I have no idea what that means. What kind of predation are people who attend 12-step meetings likely to encounter?
Oh, is there.
Applied by whom? In what way? And what are the rituals whereby shame is instilled?
There's not a lot, too often. But there aren't a lot of people with fresh ideas in hand rushing to meet the need, simply out of the passionate desire to work with drunks and junkies for the sheer glamour, joy and ease of the thing.
And even still, 12-step is not regarded as the gold-standard in the addiction-treatment biz, these days, which it still was several decades ago. Harm-reduction would probably take over if 12-step wasn't so much cheaper/easier to get up and running. There's not much that's cheaper and easier than a volunteer-run enterprise.
In any event. It's not a cult, or even cult-like. You're mistaken.
BTW, I'm happy to agree to disagree.
I take it for granted that your opinion is both considered and thoughtful, and that you hold it in good faith.
It's also always possible that I have more to learn. I'd be surprised if that were the case, in this instance. But I can't say that it's never happened before.
Okay? Okay.
ann:
http://www.ncbi.nlm.nih.gov/pubmed/24647726
I will deal with this piecemeal.
About every part. It's not an apt comparison.
I should say that I know much less about 12-step for what I believe are termed process addictions than I do about 12-step for substance addictions, apart from anecdotal knowledge. But as far as anecdotal knowledge goes:
That would be news the half-dozen or so women I've known who attended CoDA meetings for the support they got there. All of them were in horrendous relationships with drunks and drug addicts, whom they didn't show the least sign of being told to shun.
Furthermore, if CoDA is indeed run on the 12-step model, nobody in it is in a position to insist on anybody else doing anything, nor is anybody empowered or authorized to enforce the action putatively being insisted upon. Nobody (in fact) is in a position to know a single damn thing about you that you don't volunteer yourself. And there are no routines or procedures in which anybody gives anybody else advice -- let alone ultimatums -- about any matter, issue or question when it hasn't been asked for.
On top of which, membership, attendance, and association are voluntary. There are no fees, and no demands on the time and/or energy of the participants apart from what they elect to expend. And there are no consequences or penalties for not following the advice of another group member. Or, indeed, of all the group members in concert.
But it's somewhat far-fetched to suppose that they'd be acting in concert. It's not that organized. People just show up when they want to attend a meeting. They're under no pressure to do more. And they're under no penalty if they do less.
None of that is how it's done in cults. It takes systematic effort and concentrated, extended periods of time to deprive people of their freely exercised will.
As I said, I'm sure your opinion is considered and thoughtful.
I doubt anything the U.S. circuit courts have felt the need to observe is going to convince me that a loosely organized, non-hierarchical, non-coercive program with virtually no rules and no way of enforcing them that's not concerned with either power or money is a cult.
But I'm always open to being wrong.
@Adam G --
Thanks. The word "mindfulness" seems to be everywhere in the mental-healthcare field, I've recently been noticing.
I'm emphatically not saying that 12-step is the best treatment modality. I'm just saying that it's not a cult and that it works well for many people.
Which reminds me:
@Narad --
I don't know the number of people it works well for. But I certainly wouldn't claim that it isn't many times smaller than the number of people for whom it does nothing, if that's the issue.. And....Well. I guess that if you're just disputing that "a lot" is accurate, tell me. I can look it up.
By "works," I mean "helps people to remain clean and sober for long enough to attain whatever object or goal motivated them to." IIRC, most of those who don't become part of the first-year attrition rate get lives and largely drift away in the five-to-ten-year range.
Maybe that's true. I doubt it. My anecdotal experience with these programs is much, much more in line with what Narad has described.
There's no reason for anyone who doesn't want to attend meetings to go to them, unless it's court-ordered.
Once there voluntarily, they're not under any pressure to participate in any, all or some parts of the program if they don't feel like it. There's no process that each newbie has to undergo in order to progress to the goal. They don't have to get sponsors if they don't want them. They don't have to stay with the sponsors they have if they prefer not. They don't even have to open their mouths to communicate with a single, solitary other soul unless they wish to. It's entirely self-determined.
That's not how cults do.
It's an unnecessarily doctrinaire program on paper, as well as -- to a lesser and inherently mutable degree -- in practice. But it's not a cult.
And -- afaik -- its practices are not destructive, per se. Many people find them distasteful and/or intolerable. That's a serious problem. But it's a different problem. It's still not a cult.
Here's another perspective, ann. I hope you do read it through.
http://www.csudh.edu/dearhabermas/aacultbk01.htm
I've read it.
It's an insane misapplication of Lifton (who I am certain would at least agree that it's a misapplication).
I actually care about that more because I don't like to see what cults do misunderstood than because I don't like to see what 12-step programs do misunderstood.
I have strong feelings about cults.
I dislike the "higher power" nonsense of 12-step, nor the scramble by some group leaders to say that "higher power" doesn't really mean "God".
LifeRing has a secular approach to addiction recovery, with an emphasis on personal responsibility and, yes, mindfulness.
It's worth remembering that there are no statistics for whether/how effective AA is, and never will be, by policy, because there's no way to both say "everyone here is anonymous" and usefully track effectiveness. At best, you can have self-reported "I have been attending AA for X amount of time and haven't had a drink" and "but have gotten drunk three times, I'm still working on this." There's no way to connect that to how many people are sitting in the back of the room, got drunk last night and the night before and are going to go to a bar after the meeting, and haven't said a word because they don't feel comfortable doing so. Or with the people who stop going to meetings and are still drinking too much (however they or you would define "too much." Since there's no way to know how effective AA is, just that there are at least a few people who say it worked for them, there's no meaningful way to compare that with other approaches.
I have a friend who credits both Narcotics Anonymous and the love and support of his wife and husband for his having stayed drug-free for many years, as well as giving himself some of the credit. Does that mean that NA works, or does it mean that the key to quitting narcotics is a strong but unconventional marriage? (I'd say it supports the idea that support from other people, including but not limited to spouses and/or other addicts, can help. But that's a much weaker statement.)
Once again:
I am not making any claims for 12-step apart from that it's not a cult and that it helps many people with substance addictions get clean and/or sober.
The truth is that it's such an incredibly underserved population that there's not a whole lot more out there now than there was back in 1935 when Bill W. and his little band of lunatic Xtian drunks decided to help themselves, since no one else was going to.
It's still now what it was then -- someplace for the addicted and alcoholics to go where people will listen and talk to them and where they won't be demeaned, punished, or kicked out.
There's very little more to it than that. There's not really a lot of there there, in reality. It's mostly just people and a lot of simplistic, positive, affirming slogans and mottos.
Despite (or maybe because of) which, someone who's highly motivated for treatment stands a reasonable chance of being able to find a way to piece together a workable program for recovery out of its components, since it's a somewhat anarchic enterprise.
There's not a whole lot else. And that's a shame. But it's not AA's shame. Or NA's. Or anyone's, especially. It's just a shame, same as it is for the legions of people with non-substance-addiction-related psychiatric disorders who don't even have some dumb, annoying, hackneyed out-of-date, sentimental 12-step meeting to go to.
There are an awful lot of addicts and alcoholics who are not highly motivated for treatment, and that's a serious drawback. In case it needs saying.
@Johanna
It's not a scramble. That's been the official position of the organization since the get. That's why the preamble concludes by stating that they're not allied with any sect, denomination or creed and neither endorse nor oppose any causes.
In short: "Higher power" means whatever you understand it to mean, by intent and design.
That said, I personally don't much like it either. It's true that I don't have to. But if I did, I think I'd be capable of finding a work-around on the terms of the program as they stand.
@Vicki
It's a true one, nevertheless.
"get clean and/or sober"
Just what the hell is this "clean" bullshit? Are alcoholics dirty? Do they disgust you and need to be tidied up to be presentable to you? Jesus Haploid Vishnu what a load!
Allow me to first observe that the lone "theoretical" underpinning of all 12-step groups is Bill Wilson's "G-d" moment, which came after four days' "treatment" with Towns's "belladonna cure" and none for incipient delirium tremens. There is now a movement afoot to search for how it "works." This bears a strong similarity to what is known as "Tooth Fairy Science."
There has also been a churning out of what appear to me to be extremely narrow studies (with numerous "corrections" for "confounders") to demonstrate that it's not actually TFS. This appears to be in response to the Cochrane review.
As effectiveness is not the subject at hand, I'll leave it at that and try to get to the explicit matter of psychodynamics and cultishness next.
In order to tie up some loose ends, though, I'll briefly note two things: (1) Regarding "predation," the General Service Board has only grudgingly considered considering the matter, and only in a narrow realm (PDF). (2) With respect to "confession," one well-known mantra is "you're only as sick as your secrets." This derives from Wilson: "Time after time newcomers have tried to keep to themselves certain facts about their lives."
OK, so a précis of the cult argument. One instantiation of "the usual disregard-if-you-wish terms of 12-step" is that The Program itself can substitute for "G-d," right? Let's revisit the original steps in this light:
That's without interpolation.
Narad --
I tell you again, courteously and respectfully:
You are mistaken to think that AA is a cult.
Unlike 12-step, the subject of cults is one I have strong personal feelings about, as well as considerable first-hand experience regarding, though not as a member of one.
There's no definition or conception of "cult" that means a single damn thing that you can apply to the 12-step model. It simply can't be done.
I mean...
Yep.
Do you know how any of those steps is used or understood in practice? Or even if they're used or understood in practice?
Because it really doesn't seem as if you do.
However, I don't want to fight with you. Nor do I want to waste my time trying to convey (guaranteed true and genuine) information to you that you're not interested in hearing.
So let's skip it. If you find the meaning that you're imputing to those words objectionable, I probably don't disagree with you about it, whatever it is.
How's that?
Not only can it be done, it's a commonplace.
If you mean dropping the subject, that's fine. If you mean suggesting that I'm failing to grasp "guaranteed true and genuine" information because I don't seem to "know," then no, but I'll drop it all the same.
No, no, no. Not so fast.
What you said was that predators were attracted to it.
I don't see anything in that PDF except for an organization acknowledging that the same abuse, exploitation and harassment of women that occurs everywhere in the damn world that men and women frequent is occurring and needs to be addressed.
If that's enough to meet your criteria, you might also say the same thing of skeptics.
Yeah. That doesn't mean you're under any pressure to confess them to anyone, or that you'll be shamed for doing so, which was what you'd claimed.
And it's not (in fact) an exhortation to confess anyway. It's just the twelve-step way of saying "You don't need to live in shame. You have nothing to be ashamed of here."
Uh-huh. So that's your proof that there's pressure on people to confess and be shamed? A not-particularly-well-known or widely quoted sentence from a book that was published in 1939?
That's not very compelling, especially when considered in the context of 12-step meetings:
(a) using a format in which people who don't raise their hands because they have something to say don't even get the opportunity to be pressured to confess, or -- indeed -- to say anything at all; and
(b) the prohibition on cross-talk (responding to what those who do raise their hands have said).
Are you proposing that AA pressures people to confess by giving them the Big Book; murmuring "You're only as sick as your secrets" occasionally while waiting for them to stumble across that sentence; and then sitting back and letting them see if they can resist raising their hands?
Or what?
Do you want to drop it, or not?
Yikes. what a repellent thing for me to have said.
Please forgive me.
Believe it or not, I didn't mean to imply, suggest or hint anything negative about you. I was just feeling frustrated and confused. I respect you very much.
In re: Dropping it.
Sorry. We cross-posted.
I don't know. As you wish.
I appreciate the apology; the matter is forgotten. As the subject is not really on-topic to cancer centers, I'd like to close all these PubMed windows, and I've mentally prepared a comparison to Western misconceptions about Rinzai Zen and Ch'an's losing out to Neo-Confucianism, I think it's best dropped.
I'm perfectly willing to revert to attacking reiki, though.