Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not make the apple pie better. Yet that is what’s going on in medical academia these days—witha vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”
Quackademic medicine has been infiltrating many formerly science-based academic medical centers. Such centers have a seemingly amazing ability to compartmentalize, insisting on rigorous science for most treatments but possessing an amazing blind spot when it comes to anything having to do with “integrative medicine.” Unfortunately, in few places is this tendency as intense as it is at the Cleveland Clinic Foundation (CCF). It’s an institution with which I have some familiarity, given that I lived in Cleveland for eight years from the late 1980s to the mid 1990s because I did my general surgery residency at Case Western Reserve University and University Hospitals of Cleveland just down the street. At least, that’s what it was called at the time. I also worked as a flight physician for Metro LifeFlight, and a frequent destination for cardiac patients that we picked up from outlying hospitals was—you guessed it—the Cleveland Clinic. Twenty years ago, the CCF was Case’s chief rival in terms of medicine, science, and competition for patients. These days, their relationship is no longer as acrimonious as it was when I was at Case, but unfortunately the two institutions appear to have become rivals in quackademic medicine.
It’s a rivalry the CCF appears to be winning. Sure, Case has a big integrative medicine program and sponsored a meeting of the Society for Integrative Oncology and has been caught recommending reflexology, but that’s nothing compared to the CCF’s promotion of “energy healing’ (in particular reiki), acupuncture for children, and, most recently, the opening of a traditional Chinese medicine clinic run by a naturopath.
So what can CCF do to top that quackery? I wish I hadn’t asked. The reason is that I just learned over the weekend that the CCF has ratcheted up the quackery to 11 and beyond. How? Simple. See this article in the Cleveland Plain Dealer:
In its ongoing focus on wellness and disease prevention, the Cleveland Clinic is opening a new Center for Functional Medicine. In doing so, the Clinic is the first academic medical center in the United States to embrace functional medicine, the focus of which is more on identifying underlying causes of illness and less on symptom management.
The center will work together with Clinic specialists to study the impact functional medicine has on certain chronic diseases.
Within the next few weeks, screening will begin for the first of up to 300 patients for one of four clinical trials comparing the standard treatment for asthma, inflammatory bowel disease, type 2 diabetes and migraines with that of functional medicine approaches.
The new center at the Clinic's main campus is a collaboration between the Clinic and The Institute for Functional Medicine. Dr. Mark Hyman, chairman of The Institute for Functional Medicine, whose offices are in Washington state and New Mexico, and founder of The UltraWellness Center in Massachusetts, will serve as director of the new Center for Functional Medicine.
That’s right. The CCF has embraced the quackery that is “functional medicine” and even hired the most famous practitioner of that quackery, Dr. Mark Hyman. We’ve met Dr. Hyman before many times on this blog. For instance, he has argued for turning back the clock and relying on anecdotal medicine instead of scientific medicine, mangled cancer research and systems biology to justify the quackery that is “functional medicine,” and twisted autism science even worse. Most recently, it’s been reported that Bill and Hillary Clinton have fallen under Dr. Hyman’s spell.
So what does this mean for CCF? Quackery. That’s what it means. Don’t believe me? Go back and read my description of functional medicine. Look at Wally Sampson’s multi-part analysis of what functional medicine is claimed to be here, here, here, here, and here. Basically, it’s a vaguely defined “discipline” in which it is claimed that measuring a whole bunch of metabolic factors and other lab values will lead to a “holistic” approach to disease. Never mind that just what “functional medicine” actually entails is kept quite vague. That vagueness is the very thing that allows Dr. Hyman to claim:
“Functional Medicine looks at the underlying causes of disease, while focusing on the whole person rather than an isolated set of symptoms,” Hyman said in the news release. “We look at a patient’s history and the personalized interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease.”
The new center is a collaboration with The Institute for Functional Medicine, an organization also led by Hyman.
Of course, “functional medicine” does nothing of the sort, at least not any better than conventional medicine. According to news reports, Hyman will only set foot in Cleveland three days a month, which makes me wonder how he can be the director of anything there, much less a center at a large institution like the CCF. Of course, there’s been a doctor hired to do the day-to-day grunt work of running this new center: Dr. Patrick Hanaway, was the chief medical officer of Genova Diagnostics from 2002-2012, a laboratory that offers all sorts of tests of dubious medical value, including a saliva adrenal stress profile, comprehensive diagnostic stool analysis, and toxic effects CORE, among others. Of course, Dr. Hanaway is an integrative “holistic” practitioner. After that, he apparently became the director of medical eduction for Dr. Hyman’s Institute for Functional Medicine. Frighteningly, the practice where Dr. Hanaway works offers “holistic newborn and pediatric care,” including what is characterized as “grounded discussions” on vaccines:
Each talk is facilitated by Dr. Susan Bradt or Dr. Lisa Lichtig, board certified family physicians who practice holistic medicine. We cover the hot topics of controversy including links made to autism and asthma, the ingredient thimerosal (mercury), individualizing schedules and current outbreaks of vaccine preventable disease in our community. We review each disease and its associated vaccine and discuss vaccine ingredients, school requirements and legal issues. An extensive handout is provided to supplement the class and serve as a future reference. This class is essential for all families so they can be more informed about vaccinations. It is especially helpful for parents feeling concerned or hesitant about vaccinating their children according to the standard schedule. It provides a grounded explanation of the issues and helps remove fear surrounding the topic thus helping parents navigate decision making from a more balanced and educated starting place. You will walk away with a great foundation on the topic of childhood vaccines and be able to confidently make choices that feel safe for your family.
I recognize the code words, as, I’m sure, do many of you who follow the vaccine manufactroversy from a science-based perspective. The big giveaway is that the clinic website doesn’t dismiss the “links made to autism and asthma” (hint: there are not, at least none that are evidence-based) and claims to discuss “ingredients,” a sure sign that the class involves the “toxin gambit,” a fallacious gambit designed to cause great. It's of a piece with Dr. Hanaway's boss Dr. Hyman's recent foray into anti vaccine fear mongering with Robert F. Kennedy, Jr. One wonders why the CCF would hire someone who spreads such blatant antivaccine propaganda as Dr. Hyman does.
Then there’s this:
For uncomplicated pregnancies we encourage laboring at home as long as possible with the support of a birth partner and/or doula. Once at the hospital we help create an intimate and encouraging atmosphere utilizing low lighting, freedom of movement, homeopathy, vocalization, massage, water, birthing ball and stool to support women in labor as it intensifies. Medications and epidurals are available upon request. Woman birth in a variety of positions including in the water and squatting.
Yep, Dr. Hanaway’s partners practice “natural childbirth” woo.
So how on earth was someone like Dr. Hyman or Dr. Hanaway offered a job at an institution as prestigious as the CCF? Listen to the CEO of the CCF, Dr. Toby Cosgrove. He’ll tell you:
In the release, Clinic CEO Dr. Toby Cosgrove said the new center is “not a departure for Cleveland Clinic, but a continuation of the innovative, holistic approach that we have embraced.” Cosgrove cited the Clinic’s wellness institute, Center for Integrative Medicine, its Chinese herbal therapy clinic and the Center for Personalized Healthcare.
I can’t argue with this. The CCF has been traveling down the road of quackademic medicine for a long time. This new initiative is nothing more than a continuation of the “integration” of quackery into medical practice at the CCF. There’s nothing “innovative” about its practice; it’s just embracing ancient, pre-scientific medicine on the one hand (the traditional Chinese medicine clinic) and a modern version of the same sort of thing, in which the idea seems to be to check as many lab values as possible until something is found to be wrong (as it will be with virtually everyone if you check enough lab values) and then to “treat it,” labeling the “treatment” as somehow “holistic.”
Unfortunately, I can’t argue that CCF isn’t a trailblazer. Unfortunately, it’s a trailblazer in introducing quackery into conventional medicine. Cosgrove ought to rename the CCF to the Cleveland Quackademic Clinic, as sad as it is for me to contemplate the decline of a once-great institution.
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Could you please explain what you mean by natural childbirth woo? What was so objectionable about that quoted content? It reads as nothing inherently dangerous and basically supportive of the birth experience, with interventions available as required. What's the issue there? (Aside from some nice placebos)
There are issues with "natural childbirth woo", when it includes immersion in water during the first stage and second stage of labor. The joint opinion of the ACOG and the AAP (April, 2014) is here:
http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Obste…
Thanks, lilady. It doesn't read as strictly out, at least not for first stage. Perhaps if that is what is sought by mothers (and may be associated with decreased pain and anaesthesia and duration), it is better off being provided in the kind of context of this clinic. The Orac quote is framed as for 'uncomplicated pregnancies' so it does indicate screening and 'integration,' not an entirely separate pathway.
Here, Dr. Mark Hyman, who "collaborated" with Robert Kennedy Jr., who wrote a dreadful book on the dangers of vaccines, claims he is "pro vaccine". He brags about the Cleveland Clinic's adoption of his "functional medicine":
http://blogs.discovermagazine.com/collideascape/2014/08/20/robert-kenne…
Oh, my, this is bad.
I can only imagine how much more difficult it would be to, say, fight global warming denialism if earth science departments were being bribed by oil money into hiring denialist crackpots.
This shows yet again that many physicians don't understand much about science. There are, of course, many laudable exceptions -- present company included.
It looks very much as though Cleveland Clinic, through this new program will be encouraging patients to follow "individualized" vaccine schedules for their children - meaning delaying or even dropping some vaccines.
What's important is that parental decisions will "feel safe" (according to Cleveland Clinic) - not that they _are_ safe.
I know of no other major medical facility that's promoting such a thing.
@Eliot
The idea of 'if people are going to use quackery, isn't it better that they use it under proper medical care?' is one of the ways that quackery creeps into real medicine. Because no one says 'the following techniques are utter bullshit and potentially dangerous, but you can do them here if you really insist'. They dress quackery up with the kind of fluffy language that Orac quotes, and by positioning it next to real medicine they legitimize it in the view of patients who trust their doctors to tell them what works and what doesn't.
Well, whatever vaccine rates are in the Cleveland Clinic area, they are sure to go down. Vaccine-preventable disease rates are sure to go up.
My question is this--where are all the pediatricians who ought to be speaking up and out about Hyman and his scientifically and medically illiterate "holistic" family physicians? The apathy from pediatricians over this surging anti-vaccine movement is so profound that I have to wonder if: (1) pediatricians are just feeling beaten down by the increasing tide of AV parents, or (2) most pediatricians just don't care, or (3) they just don't have time to debate, or (4) there a lot more medical/scientific illiteracy among pediatricians than I'd like to think there is.
To sum it up neutrally, there are conflicting views about childbirth, in US as well as in Old Europe.
A majority of physicians and gynecologists would prefer a pregnant woman to be followed by a team of a specialists in a clinical setting - or at least to have these specialists at hand, should a complication occur; which means going to some sort of hospital when the time comes.
Especially for a first pregnancy; complications of pregnancy or delivery are rare, but do happen, and saving the baby and/or the mother and limiting lasting damage is often more likely if the right personal/equipment is waiting in the next room.
For pregnancies after the first, now that there is a baseline, both the mother and her medical staff can do a more accurate risk prediction. In the context of previously uneventful deliveries, I could grant that delivering home does not seem unreasonable.
(gosh, it's obvious I didn't attend many childbirths, isn't it? "uneventful deliveries")
On the other side, there are those who feel that pregnancy and childbirth is over-medicalized. If you look into specific interventions, there is room for legitimate debate - when to use of c-section, when labor should be induced...
Science marches on for medicine, as for all other human technologies. There are certainly things we overdo, and others we don't do enough of. Hopefully, ideally, accumulation of data will allow us to correct and improve.
However, when people start talking about how "pregnancy is natural" and "pregnancy is not a disease", we hit the naturalistic fallacy and veer head-on into "natural childbirth" woo territory.
More precisely, these people are going to take health-related decisions based upon an emotional, and above all, false view of reality. Last time I checked, miscarriages are natural and a pregnant woman is not exactly in her usual physiological state. She may not have a disease, but pregnancy definitively qualify as a medical condition.
In the specific case of this Cleveland clinic, the use of homeopathy, and the word "hollistic", are big woo red flags for Orac and most regulars of this blog.
Disclosure of COI: I was born premature and my sister's delivery had to be induced. My mom didn't have ‘uncomplicated pregnancies'.
Well, that's the core of the issue. Until something happens the wrong way, all pregnancies are uncomplicated pregnancies.
And what is wrong with testing functional medicine treatment for various maladies through clinical trials at CCF?
@Eliot
You appear to be ignoring this bit:
Newborns have drowned or suffered aspiration to name but two entirely avoidable complications. There is no evidence that water births have ever been the norm in any culture.
As pointed out by the Skeptical OB, most people would not choose to stick their head in water contaminated with blood and faeces, so why would you force a baby to do so.
http://www.skepticalob.com/2014/03/whats-the-difference-between-waterbi…
Dr. Hickie: I'd be willing to bet on #1. Anti-vax parents are so spectacularly aggressive that it's not even worth engaging with them. I suspect that most peds who have to deal with them just don't discuss vaccines more than once, or look for ways to drop the anti-vaxxers as discreetly and fast as possible. It must be very difficult dealing with people who can't hear anything but their own voices and who absolutely despise the doctor for no other reason then their chosen profession. (I wonder why anti-vax people don't just go all the way and learn to set bones themselves.)
Traditional medicine only treats symptoms, like removing a cancer by cutting it surgically, burning it with radiation, or poisoning it with chemotherapy. Integrative medicine treats the underlying cause, which could be something like congested liver qi. Fortunately, there are now advanced scientific instruments to image conditions like this.
http://www.auraphoto.com/products/auracam.shtml
Install one next to the MRI, and you'll be all set.
re #13 Mark Thorson
You couldn't make this up.
Further thoughts on #13
What could save us from this tsunami of drivel is the fact that its purveyors don't accept any test of its effectiveness other than their own opinions. So one man's woo is as good as another's. All woo must be accepted - or none?
Or am I being over-optimistic?
Point well taken about this disappointing focus from CC. However, I must point out that it is VERY misleading to lump natural childbirth in with VAX/autism and metabolic panel science. Many of the practices they list there ARE evidence based (Cochrane on doula support:
(Sorry got cut off- continued http://www.ncbi.nlm.nih.gov/pubmed/23076901) and many interventions considered standard in OB are not at all evidence based (Cochrane review on continuous fetal monitoring: http://www.ncbi.nlm.nih.gov/pubmed/16856111). A portion of the terrifying increase in maternal mortality in the US has been due to an excess of medical interventions (http://www.arhp.org/publications-and-resources/contraception-journal/ma…) and thus dismissing these alternative practices poses a danger to the health and safety of women. We must used evidence based methods to determine proper procedures for any aspect of healthcare but we also must not throw the baby out with the bath, dismissing interventions that aren't familiar without looking at the solid evidence.
oderb #10,
Functional medicine appears to me to be more of a marketing strategy than a field of medicine: IMO, to quote the Bard, "it is a tale, told by an idiot, full of sound and fury, signifying nothing". If you want an in-depth analysis you could do a lot worse than read Wallace Sampson's articles linked to by Orac in his post.
There are plenty of desperately underfunded scientists with truly promising new treatments that are far more deserving of being tested in clinical trials than "functional medicine".
Oderb, what body of evidence supports prior plausibility for function medicine's efficacy--i.e., leads one to expect functional medicine is tlikely to produce better outcomes than current standard-of-care science based medicine?
In the absence of such prior plausibility we're better served committing the resources we'd expend pursuing clinical trials of functional medicine to other potential treatments where there is evidence suggesting potential efficacy--and the community the hospital serves would be better served if they committed the resources going to support ther functional medicine program to hiring more nursing staff, reducing wit tiems at their ER, etc/
So what can the average person do to stop the spread of quackademic medicine?
I met someone this weekend who was a patient at the woo part of George Washington University Medical School. The Center for Integrative Medicine that offers quite the menu of quackery.
Recommending dietary and life-style changes, promoting exercise, providing support and counseling to deal with the emotional effects of illness, etc., only treats symptoms? Really?
Or are you actually unaware that these are all integral parts of conventional (i.e., 'traditional') science based medicine.
By what rational argument does removing cancerous tumors surgically, administering radiation or chemo therapy as curative or adjunct therapies to reduce tumor burden and prevent the recurrence of cancer only treating symptoms of an illnes, not directly treating the illness itself? Explain that one to me.
"Integrative medicine treats the underlying cause, which could be something like congested liver qi."
And your evidence that 'qi' exists, that congestio of liver qi can cause illness. and finally that integrative medicine is capable of releiving that congestion would be...what, exactly?
I mean, you do have some--right?\
Please provide evidence that instrumentsyou claim exist (such as at the website you provided a link to) are actually detecting, imaging, and capable of measuring 'qi', and that they allow the accurate diagnosis of qi 'congestion'.
All set to do what? make personalized trippy black light posters?
oderb@10: Your question was answered in this part of Orac's post:
Or to put that another way, it's basically an "underpants gnomes" approach to medicine:
1. Measure metabolic factors
2. ????
3. Patient cured!
The Grouchybeast @ 7. My query was framed around my (now disabused) understanding that none of what was listed in the quote was dangerous. I'm not advocating the idea of integrated sham as a 'pragmatic' rationale for its medical endorsement. However, I'd be concerned with blanket dismissal of benign 'treatments' or approaches that contribute to a woman's birth experience and autonomy over that experience (with the boundary conditions of access/concedance to intervention if required).
DrBollocks @ 11. Not ignoring, merely ignorant on that particular point. Thank you for the link.
Helianthus @ 9. Thank you for the response. I'd think that there is a point between the naturalistic fallacy and recognising the legitimate concerns about the cascade of intervention (and perhaps doctors excessive risk adversity contributing to this?) in childbirth. An expectant mother's birth experience is not irrelevant also, and without understanding any specific point of problematic woo Orac referred to, his brief complaint read (and kind of still reads) as deriding efforts focused on that experience (even if within a medical setting).
No. It isn't. Not really, and especially not when homeopathy is mentioned in the same paragraph.
As a healthcare provider with a chronic, idiopathic, and often disabling disease who has seen some of the top specialists in the country, I can attest to the frustration patients feel in the current healthcare system. I've spent thousands of dollars and untold hours of time trying to find something more than a band aid for my symptoms which seems to be all conventional medicine has for many of us right now. I support EBM and only practice evidenced-based nutrition on my own patients. I totally get it. But the "experts" I've had the privledge to see have spent no more than 10-15 minutes of their time to tell me the same thing: we don't know, deal with it. I hear from my friends who pursue treatment through alternative providers that they spend up to an hour with the "doctor", who then heaps on a lot compassion and willingness to explore "alternatives". So I get why the public is demanding this type of "medicine". They are tired of being treated like ignorant cattle. My husband and I are both highly educated in scientific fields, yet no doctor I've met has been willing to engage in anything more than lay-speak about what "might" be the underlying cause of my disease and symptoms. I attribute this to the fact that they are forced to see way too many patients and have no time to stop and get to know or engage their patients in any kind of meaningful discourse. Until this changes, patient will continue to run to alternative provideres who will. Apparently big centers are realizing this and want a piece of that pie.
As a long-time CCF user, I canned my doctor when she transferred to the wooey "Wellness Dept" and changed to a regular, plain-old primary care doctor who is not interested in the woo in the slightest. She is a no-nonsense, "diet/exercise/get your flu shot" kind of Dr. I tend to think that the majority of Drs. there are like this.
Not that this is news to the people who post here regularly, but doing what "feels" safe for your family is one of the worst ideas I've heard in a long time. It's well established that humans suck at calculating risk - even pigeons do it better than we do! Delaying or forgoing vaccines because it "feels" safer would be like driving your family across America instead of taking a plane because driving "feels" safer, even though you're much more likely to be killed in an auto accident than a plane crash.
Not that this is news to the people who post here regularly, but doing what "feels" safe for your family is one of the worst ideas I've heard in a long time. It's well established that humans suck at calculating risk - even pigeons do it better than we do! Delaying or forgoing vaccines because it "feels" safer would be like driving your family across America instead of taking a plane because driving "feels" safer, even though you're much more likely to be killed in an auto accident than a plane crash.
Argh - repeat comment <i<and tag-closing fail! The link still works if you click the phrase "even pigeons do it better than we do."
"...humans suck at calculating risk – even pigeons do it better than we do!"
Piazza San Marco in Venice is often carpeted with pigeons. While there (as a tourist) I was horrified to see a couple of young children standing amidst the pigeons and repeatedly trying to stomp them.
Somehow as each foot came down there was bare pavement, not birds. Always. Without seeming to even try they always moved out from under the foot as it descended. It was fascinating to watch. At least once I realized the kids weren't really trying to kill them.
I think, perhaps, if they were woo-believers rather than pigeons they'd get stomped. Every time.
JGC @21
You might want to check the connections on your sarcasm meter.
Quackademic medicine is a weird phenomenon, isn't it? It doesn't happen in other professions - the media don't give Dara O'Briain's "Barry who believes the sky is a carpet painted by God" (it never gets stale) the same credence as professional astronomers, and Barry certainly isn't given an office in the astrophysics department of the local university.
Please provide evidence that instrumentsyou claim exist (such as at the website you provided a link to) are actually detecting, imaging, and capable of measuring ‘qi’, and that they allow the accurate diagnosis of qi ‘congestion’.
I suspect that people are missing Mark Thorson's irony.
Unfortunately, the rise of Quackacademia is often paraded about in woo-ville as evidence that we are indeed in the midst of the Great Paradigm-Shift (tm) which they've been predicting these many years.
'
An idiotic woo-meister can say, " See here: even those in the most admired bastions of SBM are coming over to OUR side!"**
and anti-vaxxers can yelp that " The tide is turning against standard practitioners".
** for some reason,I wanted to write that in LOLspeak. Am I tired or just uncannily perceptive?
About the childbirth stuff some posts back --
Back in the old days, women felt an entirely legitimate beef at OBs who put them up in stirrups and did all sorts of other degrading interventions that had no actual medical legitimacy at all. Natural childbirth arose as a reaction to this.
Nowadays any reasonable hospital offers a much wider variety of options, including getting no interventions unless medically indicated. Given how intrinsically risky the whole business is (as a visit to any 19th century graveyard will attest) I can't see any good reason to choose home birth.
The name *O' Briain* spelt that way always makes me laugh ( so why not *Ui'Briain* whilst you're at it?)
as I know people from (both) Ireland(s) who were persuaded to learn Gaelic- one of whom even finds the trad spelling of Maeve -* Medbh* IIRC- which her neice named her daughter- a bit much.
NIECE- since we're spelling
I could get behind every aspect of "natural childbirth" except the homeopathy & "in the water." While pregnancy is a natural state (not caused by a disease, unless you count the invasion of sperm a root cause), I agree with #9 Helianthus, that it definitely qualifies as a medical condition.
Of course, women have given birth for millennia without professional medical involvement, albeit medical involvement has certainly improved the standard of care (but mostly after the acceptance of germ theory).
Of course, imaging the qi only shows you what is wrong. It doesn't guide treatment. A qi imbalance is usually caused by a blockage of the flow of qi, most commonly a subluxation of a spinal nerve. Fortunately, there are advanced scientific instruments for that too.
http://www.subluxation.com/the-insight-subluxation-station/
Get an AuraCam 6000 and an Insight Subluxation Station, and you'll be all set to practice Integrative Medicine!
AnonRD @ #25: I also have a chronic debilitating condition that has forced me to give up some of the things that I love. My regular MD (whom I see every 2-3 months, because I need monitoring at my medication levels) *always* has time for me, will *always* ask how I'm doing, and the visit isn't over until I have no more questions or reports on my condition. Not every doctor is terrible, but *all* of the woo-meisters are money-stealing frauds who take advantage of people when they are dealing with difficult situations.
I would walk out of a doctor's office if they started suggesting the "alternative" non-working therapies I've seen advertised for my particular condition and its related issues. I know there's no cure for what I have, but easing the symptoms properly matters a lot. I don't want a medical center offering me faith healing or needles in my arms, because they don't work, and it's completely unethical to claim that they do.
One person's bad experience, however bad, does not mean that the woo should be allowed in. Ever.
Since we all already know CCF is following the yellow brick woo, can we have some more thought on WHY they're doing this, such that we could build a case against it that goes beyond pointing out of the umpteen thousandth time that this isn't scientifically sound practice? I mean, do you really think the directors of CCF believe Dr. Hyman is the future of medicine (not rhetorical; I don't know...), or even if so that's all that's going on?
There's exactly one hypothesis in this thread so far, posted by AnonRD.
"No doctor I’ve met has been willing to engage in anything more than lay-speak about what “might” be the underlying cause of my disease and symptoms. I attribute this to the fact that they are forced to see way too many patients and have no time to stop and get to know or engage their patients in any kind of meaningful discourse. Until this changes, patient will continue to run to alternative providers who will. Apparently big centers are realizing this and want a piece of that pie."
So, first of all, are woo patients indeed a significant revenue source for CC? This strikes me as a bit counter-intuitive. If SBM has been Taylorized at CC so real MDs are overloaded and have no time to deal with 'the whole patient' in not-scientifically-invalid ways, why would CAM providers be allowed the extra time for appropriate hand-holding, as that would mean they see fewer patients and, I assume, generate less payment from insurance companies. Am I wrong? Is the profit margin in CAM higher in some way? Hit' em up twice: first for the BS, then the real thing when the B fails? Could they really be that cynical? (again, not rhetorical) Have the CC bosses just thrown up their hands, decided X many people are going to seek CAM regardless, and they might as well get in on the action as their cut will help keep the SBM side of the clinic afloat? Is some other financial incentive other than insurance payments involved? Is there some deep pocket funding source backing these CAM initiatives? A Koch-brother type? Hillary's Wall Street pals? Are some wacko State or Federal legislators pushing this stuff, e.g. the laws in Washington State that essentially REQUIRE Kaiser Permanente to offer woo whether they like it or not?
Could it be that scientific medicine finds itself in a pickle posed by questions the community of scientific researchers is not equipped to answer?
T. J. Jackson Lears
If science can't separate it's own strings from social agendas, how's it going to cut the strings pulling up pseudoscience? Follow scientists like Rush Holt out of the lab and into the political arena maybe?
Mike @ #20 asks. "So what can the average person do to stop the spread of quackademic medicine?" and the only thing resembling a strategy I see here is "lump natural childbirth in with VAX/autism" because one woo is a bad as another. I mean, couldn't we just advocate cutting out the homeoquackery, putting the birth-tub down the hall from the OR and having an attending on call nearby?
Yeah, great plan! Let's alienate all the women who want to take a more active, conscious role in childbirth. And it's just a Model of how to win-friends-and-influence people when the first woman to join the thread says 'Many natural childbirth practices are evidence-based and dismissing these practices poses a danger to the health and safety of women.' with three supporting scientific citations, and immediately gets rebuked, 'No. It's not. Because homeopathy.' Shut up, honey, and get on the gurney. You're just irrational because you didn't get the Skeptic Gene that comes with the coconuts.
Hey, there's an idea! We'll get Richard Mellon Scaife to back an advice website for expectant and newborn mom where they learn Rational Thinking from Richard Dawkins, Sam Harris and Michael Shermer (the ladies just Love that guy!). It'll be a subscription-based site, naturally, with a webstore offering copies of 'Atlas Shrugged" autographed by Ayaan Hirsi Ali herself for under $100. There has to be some free content of course, so all the moms who sign up will get an email newsletter featuring reasoned commentary from Ali's colleagues at the American Enterprise Institute about such Mom-crucial issues as getting prayer back in schools, exposing that Anthropogenic Global Warming nonsense as a Commie scheme for the redistribution of wealth, and how Obamacare will rob from their children to give a free lunch to a bunch of wetbacks.
That'll show those woo-meisters in Cleveland in the hard light of Truth, and our troubles here will be over very quickly!
@sadmar
You know, I felt like maybe some of the commenters were a bit hasty in assuming that "natural childbirth" is always code for "scientifically unsupported nonsense that sacrifices women's health and safety to a misguided ideology" (but understandably so since that's so often turned out to be exactly what it is ), but your comment was far more sarcastic and condescending than the ones you're complaining about. As far as the accusation of sexism goes, keep in mind that the natural childbirth movement is prone to its own brand of sexism, namely, "its wrong to use artificial means to make childbirth easier and less painful because childbirth is supposed to hurt, its part of Eve's curse/nature (depending on whether you're dealing with fundamentalist bs or new age bs.)
"why would CAM providers be allowed the extra time for appropriate hand-holding, as that would mean they see fewer patients and, I assume, generate less payment from insurance companies."
Probably because the woo-masters themselves are paid a lot less. To produce a good physician takes more than a decade of hard, expensive training. To produce a good Reiki master or homeopathist takes a couple of weekends to learn the patter. And, of course, a physician requires competent supporting staff and science-based (often expensive) equipment.
What supporting staff or equipment does a Reiki master need? A comfortable "treatment" room is about it.
What about a homeopathist? Well, I guess you need a bunch of little bottles of tap-water, or a pile of sugar pills, plus a bunch of blank labels you can print Latiny names on, but that's about it.
@Sarah A: "your comment was far more sarcastic and condescending than the ones you’re complaining about."
Yeah, that was my reaction too. Of course, sadmar has always been sneeringly condescending to everyone who comments here, so it's not really surprising.
No, no, that approach is all wrong. You'll be dismissed as a reductionist who hasn't learned a darn thing that wasn't taught in allopathic medical school. You're so close-minded you haven't changed your mind about anything since the Reagan administration.
The right approach is to ask how do you image qi? Where is your objective, scientific instrument for locating subluxations? You're using your hands? This is the 21st century, and you're using 19th century technology! You're not competent to practice Integrative Medicine! Either do it right, or get out of the business! This department should be shut down!
What, you're still using needles for acupunture?
http://holistic-healing-center.com/Intro-Seminar-Colorpuncture.html
@sadmar 41
"we could build a case against it that goes beyond pointing out ... that this isn’t scientifically sound practice?"
I thought that was the complete statement of the case against it - what more is there? What else needs (or you feel needs) pointed out in this respect?
@Catherine #16 and #17. Reading through the links you provided, it doesn't support the argument that "dismissing these alternative practices poses a danger to the health and safety of women."
First, the arhp link does not do a great job comparing the different causes of the increase maternal mortality. However, it is very clear that a lot of the increase is due to inadequate access to prenatal, intrapartum, and postpartum care, especially for low income areas. This is not really an argument for alternative practices. It is an argument for building a better health care system with equal acces for all, which I'm sure most here would support.
As to the one of the other link and the arhp, they do indicate that there may be too many medical interventions. However, a decrease in medical intervention does not mean an increase in alternative practices. The author's conclusion from abstract of the article you cite to for doula support states "Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth."
This again seems tied to the strained resources of the medical system in the United States and supports the development of a better public health care system where medical professionals can get additional information about the mother in order to avoid unnecessary medical intervention. It does not mean alternative birth practices are good and should be supported.
I have to weigh in on the 'natural birth' thing. I'm sorry but I have found only two types of settings for women to birth their babies. You either go with an OB in a hospital with trained staff or you end up at home or a 'natural' birth center. The OB in the hospital may poke and prod more than you like but the epidural is available when you want it (and I wanted it after the first 20 hours or so) and intervention was close at hand. The 'natural' birth center that I had friends who went too offered all the hoopla above, a ball, a water bath (though to be fair I also had a ball before the epidural and did get an hour in the tub) a doula, and assurances you didn't need any 'nasty' painkillers. I know women who wear the badge of honor that they survived their labor with no painkillers and no OB. I don't know why they do this. I was in labor. It hurt, it hurt quite a lot WITH the epidural. Selling women that it will be magic unicorns farting fairy dust and rainbows while they sit in a tub with a doula or half-trained midwife to guide them through is a bunch of baloney. Yeah, we should talk about C-section rates and we could do a lot to make hospital birth better but I'll take it any day over sitting in a water bath for two days being denied pain medication and hoping my baby doesn't drown in the water or get caught in my pelvis or that I bleed to death after delivery.
Kiiri -- Our local hospital (an academic medical center) offers the option of a nurse-midwife service for normal birth - no poking or prodding except as needed and/or desired, and the midwives are highly trained, with nursing degrees and advanced training (Certified Nurse Midwives).
The moment something goes wrong, in comes the OB to consult -- everyone's on salary so there are no turf wars over patients, and the OBs and midwives have an excellent working relationship. And the moment things start to go seriously off the rails, it's onto the gurney and into the OR, usually within a matter of minutes.
palindrom, as usual, beat me to it.
A birthing center...just down the hall from the OR, attended by advance practice nurses/certified nurse midwife, is the third option.
And, there is no shame if you require pain relief for the delivery.
If anyone is interested in a through dissection of natural childbirth I recommend the blog The Skeptical OB.
I love your blog btw Orac.
As someone who sufferers from CFS I am deeply disturbed by the level of woo around it. I go to an integrative medical clinic that is publicly funded. Its called Integrated Chronic Care Services, I think. There is a lot of paraben free, scent free woo- as well as "the dirty dozen' produce, organic, multiple chemical sensitivity etc. People with CFS shouldn't be treated among people with fake diseases like multiple chemical sensitivity. I go because there is a doctor, a nurse, a dietitian, a psychologist and an OT.
I am not happy at all with the woo though being funded by our tax dollars and I am not happy at being suggested by my GP (more than once!) to see a naturopath. If I was an MD I would be so insulted by naturopaths, trying to pass themselves off as legit health providers and all.
I fear that the woo is part of the reason why there is no drug to treat CFS yet. I miss being able to handle a normal amount of exercise and have gained weight from not being able to exercise as much as when I was healthy due to post exertional malaise.
Does Cleveland Clinic still do legit medicine?
I am imagining it as that you only get alt med if that's what you choose but if they are mixing it into real medicine outside of their little Chinese medicine clinic that is very worrisome. Do they choose the integrated pediatricians or is that just what the patients are given by default? I can only imagine how disconcerting it would be to see a highly rated facility you worked at drown into obscurity.
http://www.skepticalob.com/2014/09/microbirth-an-object-lesson-in-the-i…
Actually I lied, there is one drug to treat CFS called Ampligen, which has a lot of interesting controversy around it. Even if Ampligen does end up working I doubt it will help post exertional malaise. They have claimed it could be used to treat Ebola. Sorry to comment spam you btw.