Respectful Insolence

One of the themes of this blog since the very beginning of this blog is the threat to scientific medicine represented by a phenomenon that I like to call quackademic medicine. Although I did not coin the term, I frequently use the term and have done my best to popularize it among skeptics to describe the infiltration of pseudoscience into academic medicine, be it in the form of fellowships, research and clinical trials studying prescientific magic like homeopathy or “energy medicine,” or even the offering of such services under the auspices of an academic medical center, thus putting the imprimatur of science on pseudoscience, prescientific vitalism, and outright quackery.

Here we go again.

It happened when I came across a press release. For some reason, academic medical centers are often proud enough of these programs integrating quackery into their cutting edge scientific medicine that they issue press releases about them. This time it’s the University of Florida in Gainesville, hot on the heels of approving a new chemistry building to do—oh, you know, actual science—doing the releasing in a press release entitled New UF Health program blends holistic therapies, modern medicine. As it typical of such propaganda, it’s chock full of the same deceptive language inherent in “integrative medicine,” whose proponents represent it as the “best of both worlds,” when in reality it represents the contamination of science-based medicine with pseudoscience. This is what I mean:

Acupuncture, meditation, massage — practices once considered “alternatives” to conventional medicine — are now becoming mainstream in hospitals and medical schools nationwide, and University of Florida Health’s Integrative Medicine Program is leading the way by expanding its services for patients.

As research continues to validate many of these ancient practices as effective treatments for chronic pain, nausea and stress, they’ve earned a new name that represents this unique partnership of conventional and holistic treatments: integrative medicine. This summer marks the one-year anniversary of the integrative medicine program at UF Health, led by the first fellowship-trained integrative medicine physician in Gainesville, Dr. Irene Estores. The program provides patients and staff with services such as guided imagery, medical acupuncture and yoga.

“Integrative medicine addresses the needs of the whole person — mind, body, spirit — in the context of community,” said Estores, the program’s medical director. “We’re coming back to our roots and honoring what was effective in other healing traditions and using that to be able to be more effective in caring for our patients.”


Ack! Not the “holistic” trope. Not the “taking care of the whole person” trope. Not the “integrative medicine is becoming mainstream” trope. As I’ve said many times before, being a good “holistic” physician and taking care of the “whole patient” do not require embracing pseudoscience or quackery. That is the false dilemma at the heart of integrative medicine and put on steroids by its practitioners like Dr. David Katz. Apparently the occasion for this press release was the one year anniversary of the founding of the integrative medicine program at UF. Sadly, the only thing that amazes me is that the program is that recent, that it’s only been in existence for a year. That puts UF behind the curve. Unfortunately, UF appears to be making up for lost time, as it’s offering integrative medicine services all over the UF hospital system.

The sad thing is, the integrative medicine program appears to have grown out of a potentially useful activity, Shands Arts in Medicine, an arts in health care program. Personally, I don’t mind art programs in medicine. Art beautifies the patients’ surroundings, and making art can be a fun activity for patients to help them take their minds off their illness. I do, however, have a bit of an objection to “art therapy.” Art’s a wonderful thing, but it’s not really a specific therapy for anything. I really hate to see art be the impetus for woo like this, but the UF integrative medicine program grew out of its art program. Where did the money come from? Wealthy donors, who made “several key donations,” of course.

If there’s another thing I’ve learned from this is that employee wellness programs can be an excellent Trojan horse to get integrative medicine into academic medical centers:

The Integrative Medicine Program is also unique in that it’s an outgrowth of UF Health Shands Arts in Medicine, one of the largest arts in health care programs in the nation, Mullen said. After years of providing services such as massage and yoga to staff but not having the resources or medical expertise to provide these services to patients, Arts in Medicine received several key donations that helped establish the program.

The medical director is Irene Estores, MD, and I find her biography quite telling. She was a trainee in Andrew Weil’s integrative medicine program at the University of Arizona. She’s also a Bravewell fellow as well as an acupuncturist. How an MD would ever want to learn the quackery that is acupuncture, I have yet to figure out, but acupuncture is what I like to call the “gateway woo,” which leads to additional interest in quackademic medicine. Even though it’s nothing more than a theatrical placebo, people tend to be more willing to believe acupuncture works because it involves an actual physical act of sticking needles into people. Never mind that the explanations for how acupuncture “works’ involve epic handwaving and special pleading, even as they try to brush aside the vitalistic origins of acupuncture, in which the thin needles stuck into non-existent meridians are somehow supposed to redirect the flow of “qi” (or life energy), to therapeutic effect.

So, yes, of course UF offers medical acupuncture. Pretty much every quackademic medical program offers acupuncture. It also offers meditation, massage, “wellness coaching” (whatever that is in practice), an a variety of other modalities that range from potentially evidence based to, well, integrative medicine consultations, with everything that goes with them:

Recommendations may include use of dietary supplements and botanicals, changes in eating and physical activity, mind-body procedures such as meditation, acupuncture and massage, and referrals to practitioners of other healing systems such as Traditional Chinese medicine, Ayurveda (a holistic medicine system from India), or homeopathy.

Homeopathy? Seriously? Homeopathy is The One Quackery To Rule Them All, and “integrative” doctors at UF are willing to refer patients to homeopaths. The same is true of practitioners of traditional Chinese medicine and Ayurveda, but to a slightly lesser extent. Even though both medical systems are based on prescientific vitalistic thinking, for sheer ridiculousness it’s hard to beat homeopathy and its law saying that diluting a remedy can make it stronger, particularly how so many homeopathic remedies are diluted away to nonexistence. In any case, homeopathy is something that no science-based medical school or academic medical center should have anywhere near it. While it’s true that there don’t appear to be any homeopaths actually working for UF (unlike a few places I’ve encountered), it’s also true that integrative practitioners at UF will use them, which is almost as bad. A science-based practice would never refer a patient to a homeopath to receive his magic water under pretty much any circumstances.

I suppose, then, it shouldn’t be too surprising that Dr. Estores characterizes her involvement in integrative medicine thusly:

Irene’s interest in integrative medicine grew out of self-exploration of other healing and belief systems, the deepening of her spiritual practice of prayer, self-reflection and meditation, and a mindful experience of both the good and bad things that have happened in her life as an individual and as a physician. She considers her practice of medicine as a vocation and a spiritual path.

Beware a physician who says medicine is a spiritual practice, who came to their beliefs through “explorations” and the “deepening of her spiritual practice.” While it’s true that religion coupled with a desire to help people often drive people to become physicians and that some physicians talk about a “spiritual” side to medicine, relatively few are the physicians who let it drive them into embracing practices that are not science-based to the extent that acupuncture, TCM, and homeopathy are not science-based. Dr. Estores’ story does, however, suggest the close connection between religion, faith, spirituality, or whatever you want to call it and the embrace of non-science-based treatments like acupuncture. Unfortunately, more and more, this sort of mystical pseudoscience is exactly sort of quackademic medicine that is infiltrating medical centers like UF.

Comments

  1. #1 tgobbi
    May 8, 2014

    Is this the same Florida university that tried to start up a chiropractic school several years ago?

  2. #2 Andy
    United States
    May 8, 2014

    I don’t get it…shouldn’t there be a host of doctors and scientists at UF that would oppose this sort of thing? Are MD’s like you really in the minority? Is everyone too busy to bother fighting this sort of stuff?

  3. #3 Chadwick Jones
    May 8, 2014

    @tgobbi

    You’re close, it was actually Florida State University.

    http://imgur.com/SJbiUGu <— campus map created by other faculty in protest of said chiro school.

    http://content.time.com/time/health/article/0,8599,1021206,00.html

  4. #4 Denice Walter
    May 8, 2014

    Orac’s last paragraph inspires me to ask:
    is quackademic ( I also love the word!) medicine more welcomed in areas which are more populated by more conservative religious groups?

  5. #5 Eric Lund
    May 8, 2014

    Andy @2: In many cases, it doesn’t really matter what the doctors think. If the university’s board of trustees (or equivalent body) wants it, it will happen. If some wealthy donor gives the university a bunch of money to create such a program, it will happen. If there is research money to be had looking into this stuff, it will happen (this is perhaps the most pernicious thing about NCCAM and OCCAM). If the university in question is state supported (which UF is) and the state legislature wants it, it will happen. Faculty don’t really run universities anymore, particularly not R1 universities or state universities (UF is both).

  6. #6 Todd W.
    http://www.harpocratesspeaks.com
    May 8, 2014

    @Andy

    What Eric said. Money drives the creation of these programs. For the most part, the other physicians may not even know about the program’s creation, and if they do, most are “shruggies” who figure there’s no harm in it and don’t really care, largely because they don’t know anything about it or why it’s wrong. it doesn’t help that prestigious universities and hospitals like Johns Hopkins, Harvard, Massachusetts General Hospital and so on offer this stuff. It gives the impression that there must be something to it since they offer it.

    The key to changing things is to give the administration of these places heat about it.

  7. #7 BA
    Former Floridian
    May 8, 2014

    Unfortunately, the UF administration has always had more concern about the almighty dollar than they ever have for their faculty. There are some fine scientists at that institution and I’m sure this burns some of them up. I know a bunch of folks there who have just sort of thrown their hands up in the air when it comes to administrative maneuvering. They haven’t been able to have an impact and are resigned to being rolled over.

  8. #8 CT150
    May 8, 2014

    This was probably approved after someone was shown the likelihood of profitability, donor revenue, etc. (not to mention the pandering to the scientifically and medically illiterate).
    UF is not immune to questionable decisions made by those who sit around board room tables and only care about one thing – money.

  9. #9 Mike
    May 8, 2014

    I have some experience with some branches of conservative Christianity. They were highly skeptical of new age spirituality or foreign (Chinese, Indian) mysticism. They tended to add prayer and placing of hands to science based medicine.

  10. #10 Narad
    May 8, 2014

    is quackademic ( I also love the word!) medicine more welcomed in areas which are more populated by more conservative religious groups?

    Anything New Agey is as likely as not to be condemned in such circles, I’d say. This guy is mainly on about yoga, but acupuncture and reiki are in there.

  11. #11 Denice Walter
    May 8, 2014

    Narad, I know about that
    but what I’m getting at is if these quackademic places set up in American cities where there are many evangelicans ( as opposed to the usual heathens and Anglicans/ Episcopalians) Notice that she talks about ‘prayer’ etc. This is a southern place, no?

  12. #12 JerryA
    May 8, 2014

    I agree with Orac’s last paragraph- quackademic medicine is an (evidence-free) belief system, more akin to religion not science. Anyone who really believes in it (acupuncture, homeopathy, naturopathy, chiropracty, aromatherapy, reiki, etc. ad nauseum) is intellectually unfit to practice medicine. Anyone who promotes it without believing in it is doing it for the money and is therefore ethically unfit to practice medicine. Either way, I would not want one of these quacks anywhere near me if I were ill.

  13. #13 Eric Lund
    May 8, 2014

    is quackademic ( I also love the word!) medicine more welcomed in areas which are more populated by more conservative religious groups?

    It depends on the type of alt med under discussion. Fundamentalists may be skeptical of Eastern mysticism and such, but they are neutral to supportive of other kinds of woo like homeopathy or touch therapy, and they are especially prone to the “pray harder” trap.

    The Kellogg brothers, best known today as the founders of the cereal company that bears their name, were top rank woo pushers in their day, and religious nuts as well. The Road to Wellville is based on their careers as woo pushers. One of the alleged benefits of their Corn Flakes was reduced masturbation, although I suspect (N=1) that this claim is false.

  14. #14 Eric Lund
    May 8, 2014

    This is a southern place, no?

    Gainesville is in northern Florida, so yes, it is a Southern place. Southern Florida (especially Miami) is not culturally Southern, but the part north of the I-4 corridor (Tampa-Orlando-Daytona Beach) is definitely the South, and Gainesville is well north of Tampa and Orlando.

  15. #15 Kiiri
    May 8, 2014

    Having grown up in the South I can say that most of the conservative Christians I have encountered think of all Eastern mysticism as some sort of ‘voodoo’ or commie plot. I doubt they would be lining up. However, the upper middle class, well educated, money to burn, hippie types will be out the door wanting some of that ‘integrative’ medicine. Particularly the sort of semi-affluent stay-at-home mommy brigade and blog types. I have noticed that most of the ‘mommy’ groups on FB or similar range from accepting of woo to actively promoting its use among the members. Another good reason not to join mommy groups. The first being that I have committed the cardinal sin of going back to work after having my child. And the second, I didn’t breastfeed him. Not for lack of trying, I am aware of the health benefits, but a lack of production of the necessary milk. So add to that I am a scientist who heavily supports vaccination and I am virtual pariah amongst the mommy groups. Oh well, back to work.

  16. #16 Overseasvet
    May 8, 2014

    @Eric Lund. “(this is perhaps the most pernicious thing about NCCAM and OCCAM)”
    Now I’m really bummed. I knew about NCCAM but until your post didn’t know about OCCAM. Sad that the lesson of Steve Jobs and other less famous cancer patients and CAM victims have not been learned from whatever government committee spawned this bit of money grabbing. “Evaluation of Homeopathic Treatment for Hot Flashes in Non Metastatic Breast Cancer” is actually in phase III testing.

  17. #17 Narad
    May 8, 2014

    Fundamentalists may be skeptical of Eastern mysticism and such, but they are neutral to supportive of other kinds of woo like homeopathy or touch therapy….

    Homeopathy is open to attack. All vitalism is.

  18. #18 Mephistopheles O'Brien
    May 8, 2014

    Before we get too excited about proving a connection between the US South, evangelical religion, and alternatives to medicine, please consider that the Cleveland Clinic cannot reasonably be thought of as being in the south. The theory also does not hold up when trying to explain the popularity of homeopathy in London.

  19. #19 Pierce R. Butler
    May 8, 2014

    As a Gainesville-area resident, I find a couple of minor factual points in this piece which need clarifying.

    First of all, the Shands hospital, though on a corner of the UF campus, is mostly an independent project (UF has a small [~10%] ownership stake, which facilitates sharing of programs and personnel, but relatively little say-so).

    The internal politics of Shands are widely considered a nightmare, from top to bottom, and most health care workers in the area with a choice take jobs as the commercial or VA hospitals or smaller practices around the area. Through a multitude of shell organizations, Shands apparently played a major role in the shutting-down of the county-own hospital, but a lot of details seem to have been successfully hushed up.

    The current president of UF is a (Jeb!) Bush appointee, whose first move on arrival was an attempt to squash the faculty union; he failed at that, but succeeded in effectively making all support workers de facto temps. Both UF and Shands respond very eagerly to big donors, but barely at all to community, labor, or student concerns.

    The Arts in Medicine project, which emphasizes programs for children, has an excellent reputation, and lots of talented local creatives volunteer for it happily.

  20. #20 Orac
    May 8, 2014

    The Arts in Medicine project, which emphasizes programs for children, has an excellent reputation, and lots of talented local creatives volunteer for it happily.

    Then it’s sad to see it so corrupted by quackery.

  21. #21 Denice Walter
    May 8, 2014

    @ Mephistopheles O’Brien:

    I’m not guessing that woo is purely a fx of conservatism BUT that woo in more conservative areas might emphasis *prayer* whilst one in hippie-er LA might talk chakras and chi.

    Actually it was the quote about Estores that sparked my curiosity: it seems tailored for a certain audience.

    As you might know, alt media woomeisters try to incite both ends of the political spectrum- health choice is for the libertarians and Gaia-ness is for the liberals. Don’t ask me about how they manage to keep this balancing act straight:
    however one mercenary dork calls himself a “progressive libertarian” – so go figure.

  22. #22 Andrew
    Cleveland
    May 8, 2014

    Wow, in only a three week period both my current employer (CCF) and my residency program (UF) have released big news in “integrative” BS. I am so proud (sarcasm). Unfortunately I think this trend will only continue. I am not quite sure if my med school and fellowship locations have given in yet, but I don’t have much hope.

  23. #23 Lurker
    May 8, 2014

    It’s time to play Translations:

    ‘Recommendations may include use of dietary supplements and botanicals, changes in eating and physical activity, mind-body procedures such as meditation, acupuncture and massage, and referrals to practitioners of other healing systems such as Traditional Chinese medicine, Ayurveda (a holistic medicine system from India), or homeopathy.’

    Translation:

    Drink some orange juice, sniff some flowers, eat less and exercise more, and reduce stress. If those things don’t help, then we’ll frighten you into getting better with all these scary needles, and if that doesn’t work we’ll twist your arms and make you drink tea that tastes as bad as it smells. If all else fails we’ll throw up our hands and give you some guru water.

    Right!

  24. #24 Steven St. John
    Winter Springs, FL
    May 9, 2014

    I am ashamed of my degrees today. BS ’93, MS ’95, PhD ’97, University of Florida. NOOOOO!

  25. #25 Thor
    May 10, 2014

    Dollar Dollar bills ya-all. Hospitals and other instutions of health care and not governed or run by Doctors of Medicine they are run by CFOs, Business and marketing types who see this type of alternative care going to another facility view the loss of revenue. Science and the actual quality care will be the baby with the bath water.

  26. #26 Narad
    May 10, 2014

    I am ashamed of my degrees today. BS ’93, MS ’95, PhD ’97, University of Florida.

    Hey, I’ve got an X’90 (they really list those in the alumni magazine). Top that.

  27. #27 Wijo
    May 10, 2014

    A Southerner’s perspective:

    I don’t think it’s fair at all to stereotype the religious from the South as more accepting of alternative medicine. I’m one of them and I’m VERY science/evidence based when it comes to human medicine AND veterinary care for our animals. Having worked at a University Hospital and having many friends who work at this hospital, most of them are very pro-vaccine, and pro-evidence/science based medicine.

    My observation is that a lot of the nurses/other healthcare workers who are anti-vaccine, and lean more toward holistic medicine are the ones with lower education levels. I’ve started asking some of these people if they have had microbiology, immunology, or vaccinology and I haven’t had one of them to say they have.

    One of the reasons I started reading this blog was to counter the woo on veterinary forums. The woo is REALLY bad on veterinary social media sites. I so wish there were more people like the readers of this blog to counter the craziness on these forums, especially dog breed forums. I got tired of fighting and gave up. I personally don’t think religious affiliation, income, nor geographical location has as much influence as maybe lack of education.

  28. #28 G
    May 15, 2014

    #11: “This is a southern place, no?”

    No, as a matter of fact.

    Gainesville–not the county or region, just the small university city–is a small community of liberals [sometimes nearly to the point of fanaticism], in the middle of the rest of NorthEast Florida.

    With scatterings of conservatives here and there, of course (remember Terry Jones of Dove World Outreach Center? –but they left.)

    So while the overall region’s politics may be conservative, and it may sometimes appear that the area is conservative when taken as a whole–looking at national election results, etc–Gainesville itself is seriously to the left.

    So my biases are clear, I approve of most of Gainesville’s political agenda. I’m in the county, and wish I could benefit from a lot of the city’s legislation. So I’m not saying this in criticism. But really, especially in contrast to the surrounding rural FL, Gainesville is crazy liberal.

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