Respectful Insolence

One of the most depressing things I regularly write about is, of course, the antivaccine movement. However, nearly as depressing to me is to watch the steady march of what I view as medical pseudoscience or even outright quackery into what should be bastions of science-based medicine, namely academic medical centers. As I’ve discussed many times before, it’s gotten to the point where a medical school, in order to remain accredited, has to teach a certain amount of so-called “complementary and alternative medicine” (CAM), or, as it’s increasingly called, “integrative medicine” (or, as I like to call it, “integrating” quackery with science-based medicine). Of course, there are huge differences between how medical schools implement this requirement, with some trying to remain as science- and evidence-based as possible and others wholeheartedly embracing what I like to refer to as “quackademic medicine.” Medical schools that, sadly, fall into the latter category number among some of our best, including Cornell University (which is where Dr. Mehmet Oz himself is in charge of the Integrative Medicine program of the Weill Cornell Medical College and Memorial Sloan-Kettering Cancer Center embraces quackademic medicine), Harvard University (Ted Kaptchuk), Yale University (David Katz), and UCSF, among others.

Still, periodically, I see credulous articles touting how this medical school or other has embraced quackery. This is yet another such article, which, although a few weeks old, popped up in my Google Alerts. It was entitled Exploring medical and healing options: Alternative medicine goes mainstream in the US. It’s a profoundly depressing article. You’ll see why in a minute. It starts out with a patient anecdote, which is typical for credulous stories of this type:

Kim Ricci is lying on her back on a table with hair-thin needles stuck in the hollows of her ears, five on each side. Several more puncture her wrists.

Ricci, 50, says she was surprised when her doctor suggested she get acupuncture to relieve the pain and discomfort she was experiencing after her breast-cancer surgery.

She was even more surprised when the therapy worked.

In other words, keep those acupuncture needles away from my lymphadematous arm!

The article notes, as I noted recently, that the University of Florida has embraced quackademic medicine. In particular, apparently the UF Health Cancer Center at Orlando Health has started an integrative medicine program last year, and at the University of Florida “course in alternative medicine is about to become part of the curriculum.” Worse:

At the University of Central Florida’s College of Medicine, students are learning how to make unconventional therapies part of conventional treatment plans.

“It heartens me to see more doctors starting to treat the whole person rather than just cutting them and giving them medicine,” said Diane Robinson, a neuropsychologist and the program director of integrative medicine at the cancer center.

Ugh. There it is, the “whole person” trope. As I’ve said many many times before, that’s a false dichotomy. Treating the “whole person” does not—I repeat, does not—require embracing quackery, pseudoscience, and mysticism. Yet, that’s exactly what promoters of such quackademic medicine would like you to believe, that you can’t treat the whole patient without accepting quackery. Yet, that’s the argument that Diane Robinson makes. Thus far, it would appear that UF Health Cancer Center at Orlando Health offers the usual woo, but nothing more quacky than acupuncture (which is, depressingly, quacky enough) and healing touch.

They also offer something I haven’t seen before, something that falls under the category of “mostly harmless,” but what’s not harmless is the rationale for it:

Modeled after the labyrinth at Chartres Cathedral near Paris, France, the labyrinth is located on the fourth floor terrace of UF Health Cancer Center at Orlando Health. We were the 2nd hospital in the country to begin offering a labyrinth for its patient/families, staff and local community. The labyrinth is an ancient healing tool used as a walking meditation or embodied prayer. Ninety-eight percent of walkers report feeling more peaceful after walking this simple path.

Walking the labyrinth can have a calming and restorative effect on blood pressure and stress levels.

I’m sure that it very well might be calming to walk the labyrinth, but this sort of language has no place in an ostensibly science-based cancer center. It’s as though UF is trying to become the University of Arizona.

Particularly pernicious is how supporters of “integrative medicine” have co-opted “diversity” and respect for other cultures in such a way as to justify anything that can be considered CAM or “integrative medicine”:

At UCF’s College of Medicine, Dr. Lisa Barkley, assistant dean for diversity and inclusion, said, “We teach our medical students to incorporate complementary methods into their care plans along with more traditional approaches. It’s important they understand other perspectives, alternatives and cultures.”

Personally, I find this attitude condescending to other cultures. Just because someone doesn’t come from a white, “Western” culture does not mean that person is more susceptible to quackery. Worse, Dr. Barkley seems not to understand what does and doesn’t constitute good evidence, because later in the article, she’s quotes thusly:

This is exactly how Orlando Health’s Robinson wants doctors and patients to use alternative therapies, she said, adding that good scientific evidence is emerging to support many alternative methods.

Acupuncture, for instance, has been shown to bring pain relief in animal studies, which would rule out a placebo effect.

Massage, yoga and mindfulness are also “very well supported by science for relieving pain, tension and stress,” she said. However, other areas, including light, energy or magnet therapies, are “very questionable.”

“Some treatments are not studied and not tested,” said UCF’s Barkley, who cautions medical students to note the line between evidence-based treatments and quackery.

Ugh. That’s a trope that really irritates me. It irritates me when Barrie Cassileth uses it. It irritates me when Lisa Barkley uses it. I realize that both Barrie Cassileth and Lisa Barkley think themselves to be science-based. They think that the modalities that they like to “integrate” with science-based medicine are somehow “different” from all that “quackery” that they disparage, but at their heart, they aren’t. That’s the problem. Much of that “science-based” CAM is based on exactly the same pseudoscience, the same pre-scientific beliefs, the same religious mysticism as the “evidence-based” CAM that they tout.

They just won’t admit it. And so the infiltration of quackademic medicine into academic medical centers and medical schools continues apace.

Comments

  1. #1 Helianthus
    June 30, 2014

    Modeled after the labyrinth at Chartres Cathedral near Paris, France

    If the architects who had the labyrinth included in the design of the cathedral did it as a gesture of rebellion against the catholic authorities, it worked beyond their wildest dreams. I mean, they set up a pagan cult inside the cathedral, and now it’s being exported oversea.
    If it was just a cool design, to give something for the visitors to look at, it worked, too.

    has been shown to bring pain relief in animal studies, which would rule out a placebo effect.

    Because animals are too dumb to notice someone is taking care of them. That’s why we were never able to tame horses, dogs, cats, birds…
    Oh, wait.

    Massage, yoga and mindfulness are also “very well supported by science[...]“

    So much supported they are not alt-med at all. Well, unless given an esoteric explanation (using words like quantum and chakras)
    Err, not sure about “mindfulness”. What is it?
    *googling*
    Ah, “pleine conscience”. A form of relaxation using meditation. Sounds OK, although I have a bad feeling the explanation is going to use “quantum” at some point.

    I hate this need to add spiritual mumbo jumbo to an otherwise perfectly reasonable exercise regimen. When the instructor started talking about the spleen’s meridian (and the liver’s, the kidneys’,…), it spoiled Tai Chi for me.

    “sigh”. I guess “adding spiritual mumbo jumbo” is a good summary of what “integrative medicine” is about.

  2. #2 Andrew
    June 30, 2014

    Geez! Another one of the various institutions I’ve trained or worked at has fallen for this crap! At this point I think SCAM has infiltrated them all!

  3. #3 Eric Lund
    June 30, 2014

    A labyrinth? Really? Somebody thought this was a good idea?

    I get that some people would find walking in a labyrinth to be relaxing. But other people would start to panic if they get lost in the labyrinth, and that would probably have the opposite effect of what was intended. And if it’s difficult or impossible to get lost in this labyrinth, that defeats the purpose of a labyrinth.

    nothing more quacky than acupuncture (which is, depressingly, quacky enough) and healing touch

    Healing touch belongs with homeopathy in the category of alleged medical treatments that any intelligent layman should know is bogus. Many forms of woo, including acupuncture, have been debunked because people with actual training in one or more relevant areas have performed studies demonstrating that the form of woo in question is, at best, no better than a placebo. Rare is the woo that is so obviously bogus that a nine-year-old girl’s science fair project suffices to refute it.

  4. #4 Rebecca Fisher
    June 30, 2014

    I read that as Orlando’s Heath Robinson. I was hoping for a really impressive machine involving lots of improbably pulleys and gears, and boots on the ends of sticks.

  5. #5 Rebecca Fisher
    June 30, 2014

    “improbable”

  6. #6 Militant Agnostic
    June 30, 2014

    @Eric Lund

    It is impossible to get lost in a labyrinth – this is what distinguishes it from a maze.

  7. #7 TBruce
    June 30, 2014

    A labyrinth? Really? Somebody thought this was a good idea?

    I get that some people would find walking in a labyrinth to be relaxing. But other people would start to panic if they get lost in the labyrinth, and that would probably have the opposite effect of what was intended. And if it’s difficult or impossible to get lost in this labyrinth, that defeats the purpose of a labyrinth.

    Not to mention the risk of getting eaten by a minotaur.

  8. #8 Shay
    June 30, 2014

    Darn you, TBruce — beat me to the punch (line).

  9. #9 Erp
    June 30, 2014

    Almost certainly the labyrinth is like the one many churches have (it is a craze of the last couple of decades to have labyrinth and I suspect a lot written about the antiquity of the current church use is complete hogwash) in that it is just a pattern on the floor. There is one in El Camino Hospital right in front of the information area, it may be calming for people waiting (or to keep the children occupied).

    http://www.elcaminohospital.org/About_El_Camino_Hospital/Newsroom/Videos/The_Labyrinth_Walk_at_El_Camino_Hospital

  10. #10 Mark Thorson
    June 30, 2014

    When I took neuroanatomy class at Berkeley from Marian Diamond, she had just come back from a trip to China and was very impressed by acupuncture. This was around 1977. She showed the class slides she had taken of acupuncture being used. She had a hazy theory that the needles were somehow producing anaesthesia by flooding the nervous system with stimulation, but she admitted a major problem with that theory was that the acupuncture meridians did not correspond to nerves. I asked why it couldn’t be placebo effect. “Belief can be a powerful thing,” I said.

    And to answer that, she pulled up a slide of a row of chickens in deep acupuncture sedation, as evidence it could not be placebo effect because animals won’t have beliefs or expectations. I wish I had known then that chickens have a peculiar reflex by which they can be put into a trance-like state. Google “hypnotizing chickens” for lots of information about that. It’s a real phenomenon, and you don’t need any needles to do it.

  11. #11 Todd W.
    http://www.harpocratesspeaks.com
    June 30, 2014

    On the whole placebo effect in animals thing, people also tend to conveniently forget about observer interpretation, and how that plays into the placebo effects recorded.

  12. #12 Helianthus
    June 30, 2014

    @Erp

    Almost certainly the labyrinth is like the one many churches have [...] in that it is just a pattern on the floor.

    For the Chartres cathedral, it is exactly this.
    The French version of this WIkipedia article has a more detailed paragraph on the labyrinth. It was apparently made in the 12th century.

    Apologies, I should have mentioned it in my previous post.

  13. #13 Stella B.
    June 30, 2014

    I was interested in alternative medicine when I was in medical school, long before it was taught as a subject. However, it was the dawn of the internet and I started reading about it on a newsgroup since blogs had yet to be invented. The believers were both completely clueless and already trying to sell their beliefs and then a couple of contributors named Orac and PJ Moran started contributing well written and reasoned posts which brought me back from the dark side.

    I think that I could have made more money selling crap, though.

  14. #14 Denice Walter
    June 30, 2014

    A few years ago, I spied a labyrinth in a woo-drenched Northern California town ( see Ukiah labyrinth/ OPAL) but am pleased to learn that it is part of an actual science-based project involving measurement of the earth’s wobble.

    But I’m sure most locals use it woofully.

  15. #15 Daniel Welch
    June 30, 2014

    The proponents of CAM love to hint that Western medicine is hostile to their methods for less-than-savory reasons, usually racism, cronyism, and/or greed. This puts them in the light of “fighting the good fight” against stuffy, outdated ideas.

    I find this extremely frustrating, since the scientific outlook is actually the MOST egalitarian one; as long as your ideas can be proven to have merit, it doesn’t matter where they come from. The problem is that the truly positive social changes over the last half-century have ingrained an attitude of “old ideas are bad” in a large part of our society, and the scientific method has become tainted by association. It’s seen as cold and uncaring — and in a sense it is, since all it is only concerned with what is true, not what is fair or just. But many people are simply unable to separate their view of how they think the world should work with how it actually does work.

    Striving to demonstrate why CAM methodologies don’t work can’t be the answer; if showing something to be scientifically implausible would convince people not to use it, CAM wouldn’t exist in the first place. Clearly, its proponents are not concerned with evidence or data. Maybe the solution is to convince people that “true” and “good” are orthogonal concepts, that being clinical is not the same as being uncaring — that, in fact, it is being MORE caring, because it can actually help.

  16. #16 Krebiozen
    June 30, 2014

    Stella B.,
    Some people have made a great deal of money literally selling crap (probably NSFW).

    Most of us do what we can, others can what they do…

  17. #17 palindrom
    June 30, 2014

    Kreb @16 — According to an article I read yesterday, exchanges have been set up where you can get hopefully healthy poop for transplantation as a treatment for chronic C. Difficile infection.

    This sounds a little suspicious at first, but apparently re-booting the intestinal fauna by a fecal transplantation can almost instantly cure certain gut problems which kill thousands of people annually. The FDA is insisting on regulating it as an experimental treatment. It would seem that they should refocus their regulatory zeal elsewhere, e.g. to the “good” Dr. Burzynski.

  18. #18 Obstreperous Applesauce
    June 30, 2014

    “mindfulness”

    Well, there’s probably no one authoritative definition or method, which is what makes it problematic. However in it’s essence, it should be just training your mind to watch itself and exert some self control instead of, you know, letting your imagination run wild and flapping around like a chicken with its head cut off. It’s not that different from what you more or less learn as part of other activities.

    Mindfulness training just provides specific exercises to help strengthen or habituate you to being focused and reflective… that is, to the extent that it’s stripped of romanticized indulgences. It may help people cope with pain, but it’s more about relieving the suffering that’s brought about by being ‘mindless’.

    That’s my take anyway. It’s both more prosaic and requires more effort than people let on.

  19. #19 Denice Walter
    June 30, 2014

    OT- but are the mindless meanderings of bigoted woo-meisters ever TRULY OT @ RI?
    I think not.
    PLUS I’ve been away and I apparently missed it

    It appears that dear Mikey-poo doesn’t like immigrants and thinks that they spread diseases.( Natural News, yesterday)

    (-btw-this is the same guy who cherishes anti-vax woo-meisters and parents)

  20. #20 Narad
    June 30, 2014

    It appears that dear Mikey-poo doesn’t like immigrants and thinks that they spread diseases.

    My standard reply.

  21. #21 JustaTech
    June 30, 2014

    “It heartens me to see doctors treating the whole person” Come on. If you (Diane Robinson, neuropsychologist) didn’t like how doctors were treating their patients, why didn’t you say something years ago? Or bring it up at medical schools? A doctor doesn’t have to use woo to treat “the whole person” they can say hello and take a decent history.

    From my experience, mindfulness can be a form of cognative behavioral therapy, which is a evidence-based treatment for some mental health issues. It can be full of woo, or it can be pretty woo-free, but still fuzzy-friendly.

  22. #22 herr doktor bimler
    June 30, 2014

    Modeled after the labyrinth at Chartres Cathedral near Paris, France, the labyrinth is located on the fourth floor terrace of UF Health Cancer Center at Orlando Health. We were the 2nd hospital in the country to begin offering a labyrinth for its patient/families, staff and local community. The labyrinth is an ancient healing tool used as a walking meditation or embodied prayer. Ninety-eight percent of walkers report feeling more peaceful after walking this simple path.

    The other 2% found themselves teleported across universes to Amber.

    A local hospital has a labyrinth from 2007. For anyone who’s been lost in the corridors of the hospital itself, an additional maze out in the courtyard is just adding insult to injury.

  23. #23 Lynn Eggers
    June 30, 2014

    “Mindfulness training just provides specific exercises to help strengthen or habituate you to being focused and reflective… that is, to the extent that it’s stripped of romanticized indulgences.”

    I took a mindfulness class a few years ago, at the urging of my physical therapist. Much of it was just what you suggest: learning techniques to focus and to avoid anxiety-provoking thoughts.

    And then there was the qi, which we “gathered in” as part of doing tai chi… that finished me off.

  24. #24 TBruce
    July 1, 2014

    Has anyone ever explained why “treating the whole person” requires (to put it bluntly) denying reality?
    I have probably related this before, but about 25 years ago I exchanged notes with the head of the Canadian Holistic Medical Association. I questioned why “treating the whole person” seemed to incorporate a whole lot of woo (phrased differently, of course). His answer basically was “We’re looking into that.”
    Haven’t heard back from him (or any one else, for that matter). Guess they’re still looking.

  25. #25 Helianthus
    July 1, 2014

    @ hdb

    The other 2% found themselves teleported across universes to Amber.

    Note to self: find time to read Zelazny again.

  26. #26 Delurked Lurker
    On a mote of dust suspended in a sunbeam
    July 1, 2014

    Damn it it is all too depressing.

    Science is getting a bad name. One particular branch is responsible, constant appeals to authority and the constant use of disgusting ad homs has finally blown back into their faces but unfortunately all science has suffered. The take up of science subjects in secondary and tertiary education has taken a dive in my country as a result.

    The most alarming aspect I see is the re-emergence of measles as a public health threat. It is all unnecessary and as I said totally depressing.

    Well off to my astronomy blogs where the constant appeals to authority are absent, where scientists respect each others views, make their finding known, show their methods for peer review and debate without hurling vicious ad homs. Oh and before anyone misinterprets that last sentence this particular brand of science is not the one I believe to be at fault. Hell from time to time even the commentators here can be civil.

    I wish you luck in your endeavours Orac but I think I may spare myself the torment of reading how magical thinking is winning the war in future. Oh and thanks for all your articles on cancer quackery they have been useful in educating many beyond this blog.

  27. #27 Incitatus
    July 1, 2014

    Labyrinths werent just decoration, they were used for prayer stations, which i suppose is relaxing.
    also in northern europe a tradition has it that the devil moves in straight lines. So walking a labyrinth would mean the devil could not follow your trail and would no longer trouble you.
    later tests showed that whilst it may be effective for demons it is not effective against tax collectors or double glazing salesmen and so they fell out of favour.

    However it might work against woomeisters. The chips on their shoulders make them less manouverable.

  28. #28 squirrelelite
    July 1, 2014

    @Herr Doktor Bimler and Helianthus,

    Unfortunately, La Tertulia (?) is no longer open in Santa Fe.

    It used to be a good place to go for paella and other Spanish dishes.

  29. #29 palindrom
    July 1, 2014

    Dedicated @26 — There’s actually no branch of internet science that is entirely free of invective. Just get on an astronomy blog that discusses the “Electric Universe” or plasma cosmology — there’s a community of believers out there who are sure that all of conventional astronomy and astrophysics are wrong. We (the professionals) call them cranks, when we bother with them at all — and they certainly fit the description to a T. They, on the other hand, call us hidebound, brainwashed, etc.