I frequently discuss a disturbing phenomenon known as "quackademic medicine." Basically, quackademic medicine is a phenomenon that has taken hold over the last two decades in medical academia in which once ostensibly science-based medical schools and academic medical centers embrace quackery. This embrace was once called "complementary and alternative medicine" (CAM) but among quackademics the preferred term is now "integrative medicine." Of course, when looked at objectively, integrative medicine is far more a brand than a specialty. Specifically, it's a combination of rebranding some science-based modalities, such as nutrition and exercise, as somehow being "alternative" or "integrative" with the integration of outright quackery, such as reiki and "energy healing," acupuncture, and naturopathy, into conventional medicine. As my good bud Mark Crislip put it, mixing cow pie with apple pie does not make the cow pie better, but we seem to be "integrating" the cow pie of quackery with the apple pie of science-based medicine thinking that somehow it will improve the smell, taste, and texture of the cow pie.
I remember how, when I first discovered how prevalent outright pseudoscience and quackery had become in medical academia, I was in denial. I couldn't believe it. Then I tracked this phenomenon with something I called the Academic Woo Aggregator. It turned out to be a hopeless endeavor because, as I soon discovered, the phenomenon was so pervasive that it was really hard to keep the Aggregator up to date. Since then, I've generally only focused on particularly egregious examples, naming names when institutions like my alma mater embrace anthroposophic medicine; "respectable" journals publish "integrative medicine" guidelines for breast cancer patients; cancer organizations include "integrative oncology" in their professional meetings; NCI-designated comprehensive cancer centers promote reiki to pediatric cancer patients or offer high dose unproven vitamin C treatment to patients; or respected academic institutions embrace traditional Chinese medicine (TCM) and the quackery that is function medicine. You get the idea. It's depressing just how far medical academia has fallen in terms of being "open-minded" to the point of brains falling out when it comes to medical pseudoscience.
From time to time, I've briefly thought about reviving the academic woo aggregator, but quickly and inevitably ended up giving up trying to come up with lists of the worst of the worst. There are just too many now, and keeping such an aggregator up to date would be too much work, as I discovered when I wrote my Nature Reviews Cancer article on integrative oncology last year. However, I do believe in featuring specific institutions when something comes up that draws my attention to them, and this just happened last week with Georgetown University. Basically, a reader at my not-so-super-secret other blog pointed out the Spring/Summer issue of Georgetown Medicine Magazine. It's an issue devoted to integrative medicine at Georgetown and it is horrifying to anyone who believes that medicine should be science-based. Not surprisingly, it was a Georgetown alumnus who was so shocked when he received this issue in the mail that his embarrassment knew no bounds for having come from that institution. Worse, from the tone of the articles in this issue, Georgetown is proud of its integrative medicine program, to the point where it is touting it as a strength and featuring it on the cover of its magazine. Just look at its cover, which features a picture of a woman preparing to get an acupuncture needle stuck somewhere, along with the title of the issue, "Caring for the whole person with integrative medicine". Yes, it's the "holistic" trope that drives me crazy because you don't have to embrace quackery to be a holistic physician.
Integrating pseudoscience into the medical curriculum
Longtime readers might remember that I've discussed Georgetown before because it was a "pioneer" (if you can call it that) in "integrating" quackery into the medical school curriculum. Having received a grant from the then-National Center for Complementary and Alternative Medicine (NCCAM), renamed in December the National Center for Complementary and Integrative Health (NCCIH), to integrate CAM into its core curriculum, Georgetown proceeded to do just that. Here's an example, a blast from the past if you will, quoted from a 2003 Georgetown brochure (retrieved again, thanks to Archive.org):
“One of the reasons CAM is usually offered as an elective is that there’s just no time or room in U.S. medical schools to fit in one more massive subject,” says Michael Lumpkin, Ph.D., professor and chair of the department of physiology and biophysics at Georgetown. “When the course is an elective, a self-selected group – maybe 10 or 20 students in a class of 180 medical students – will take it,” Lumpkin says. “What we’ve tried at Georgetown is rather than create all new courses, we take relevant CAM issues and modalities and weave them seamlessly into existing courses.
The “seamless” weaving of CAM into existing classes includes, for instance, a presentation by an acupuncturist on the “anatomy of acupuncture” in the gross anatomy course for first-year students. The same lecturer explores acupuncture’s application in pain relief in the neuroscience course…
Haramati and Lumpkin say Georgetown’s program is distinct from CAM initiatives in other medical schools in two ways: The school is integrating CAM education into existing course work across all four years of each student’s medical education, and the initiative includes a mind-body class to help students use techniques to manage their own health and improve self-care.
Teaching acupuncture points during gross anatomy? You can hear the cringing of advocates of science-based medicine everywhere, given that acupuncture points do not exist except in the minds of acupuncturists, as there are no anatomic correlates to them. So what's been going on since then? Jane Varner Malhotra tells us in Georgetown's Evolving Study in Complementary and Alternative Therapies. Here's what happened after Georgetown got the $1.7 million grant in 2001:
Haramati recalls some uncertainty around the method for how to actually make it happen. “We were walking a path where the advocates were saying, ‘You’ve got to do more,’ while skeptics were saying, ‘What are you doing teaching nonsense?’” he recalls. “And we were going down the path saying, ‘We’re going to look at this objectively.’”
Objectively. You keep using that word. I do not think it means what you think it means. An objective analysis of acupuncture would not support "integrating" the teaching of acupuncture points into gross anatomy and neurology class. Once again, acupuncture points do not exist except in the minds of acupuncturists, and even then I'm not so sure.
The article also does the requisite rebranding of natural products pharmacology as somehow being "CAM," when it's not. There's a pharmacologist named Hakima Amri, featured smiling with her arms crossed in one of those stereotypical poses that magazines like this like to use in their photos bragging how she had realized that in her research she was "using top-notch technology in the biomedical sciences," such as PCR, animal studies, cell culture, all "to study a plant extract" (Ginkgo biloba). None of this, of course, is CAM.
And Georgetown credulously teaches homeopathy, The One Quackery to Rule Them All:
Amri enjoys seeing students open their minds to new concepts. Learning disciplines like homeopathy may require students to radically disregard their previous understandings about receptors and responses in toxicology, for example. “I tell students that for the next few hours, put aside all they have learned in biochemistry, pharmacology and cell biology—empty their brains—because homeopathy is a completely different concept. Then I see big eyes on their faces!” laughs Amri.
Yes, Georgetown is telling its medical students, forget all that boring old reductionist "Western" science you've learned all these years. Open your mind to the sympathetic magic that is homeopathy. Never mind that it has no basis in science and its precepts violate multiple well-established laws of physics and chemistry. Personally, I don't mind a medical school teaching homeopathy, but only so that doctors know what it is and how utterly pseudoscientific it is. (Most doctors still think it's just herbal medicine.) However, clearly that's not what Georgetown is doing. How a pharmacologist can teach homeopathy as anything but as an example of the most abject pseudoscience is beyond me, but that's what Amri sure appears to be doing, her claim that "we are teaching them [medical students] how to evaluate the science of the therapy, critically analyze it and learn about these medical systems in the most open-minded way" notwithstanding. She seems to be all about the open-mindedness and not so much about critical thinking, similar to the entire Georgetown CAM curriculum.
And its faculty are proud of Georgetown's role in promoting quackademic medicine:
Since the early years of complementary medicine research and education at Georgetown, the university has held a critical place on the national scene. Hosting multiple cross-disciplinary dialogues, Georgetown has convened chiropractors and conventional doctors, acupuncturists and anesthesiologists to advance the science-based study of integrative medicine.
And:
Over the past 15 years, the way CAM has been taught at Georgetown has evolved, but the goals have remained constant: to train students to objectively and rigorously assess the safety and efficacy of various modalities, and explain the mechanistic basis for therapies like acupuncture, massage, herbs and supplements, and mind-body interactions.
If Georgetown teaches homeopathy as anything other than an example of pseudoscience and integrates acupuncture into its gross anatomy, physiology, and neuroscience curricula, it's doing nothing of the sort. Let's take a look at the sort of research into the "mechanisms" of acupuncture that Georgetown is so proud of.
Torturing rats in the name of acupuncture pseudoscience
In another article in the issue "Where's the Evidence? Probing the Underlying Mechanisms of Acupuncture", a recently-published study by a member of the Georgetown faculty is featured as a great example of how Georgetown is doing what it claims with respect to evidence for CAM. First, though, we learn that a nurse anesthetist and licensed acupuncturist Ladan Eshkevari, Ph.D., teaches sessions on acupuncture in the second year physiology class. There, she also teaches TCM medicine pulse analysis. Now, certainly every physician should know how to assess a pulse, but that's not what's going on here. What's going on here is the teaching of an ancient, prescientific method of assessing pulses:
The professor of nursing, pharmacology and physiology shows the students three different pulse points on each hand used in TCM to diagnose the health of specific anatomical organs. The best practitioners employ over 70 different ways to describe the subtle variations in the human pulse, she explains, as the students touch their own wrists. Is the pulse skipping, surging, floating, faint? Determining the right descriptor can be a challenge, Eshkevari adds, but the richness of the options reveals the complexity and nuance of the ancient practice.
“In traditional Chinese medicine, organs are viewed by their energy function, not their anatomic function,” Eshkevari continues, showing visual maps of the body linking heart and small intestine, lung and large intestine. She explains that with holistic medicine, everything is connected, versus the more typical American, allopathic medical practice of dividing the body into compartments and developing specialties.
One notes that these "subtle variations" are in general not reproducibly detected from practitioner to practitioner and have little or no evidence to show that they reliably link to specific organs. The same is true of tongue diagnosis in TCM, in which different organs are mapped to different parts of the tongue, such that examining the tongue can lead to diagnoses of abnormalities of specific organs. It's utter nonsense, of course, no more than a TCM version of reflexology, which does the same thing, only mapping organs and body parts to the soles of the feet and palms of the hand. Yet at Georgetown, TCM reflexology is taught as fact.
Let's take a look at the study that is featured in a large chunk of this article:
Eshkevari turned to rats to help her find answers. Using a successful stress model developed by a fellow researcher at Georgetown, she exposed three of four groups of animals to one hour a day in a container with a layer of ice water on the bottom. After two weeks, the rats measured high stress hormone levels that would not come down to baseline. They had chronic stress.
Won't someone think of the poor lab rats? Well, I already did. I wrote about this sorry excuse for an animal study and useless torturing of rats for no good scientific reason last week. I do note, however, that in the accompanying photo, Eshkevari is shown in the same pose as everyone else, arms crossed, with the exception that the smile is missing and she's wearing a lab coat standing in front of an impressive lab bench full of chemicals and instruments, the better to paint the picture of her in the mind of the reader as a Very Serious Scientist. At least the photographer restrained himself from filling up Erlenmyer flasks and beakers with multicolored solutions, which is the ultimate photographic cliché in stories of this sort.
Ladan Eshkevari, Ph.D. in her laboratory. Truly, I need to have a picture of myself taken with such a kick-ass “I’m a scientist, ma-an!” pose in my laboratory. Sadly, I don’t have as much stuff on my lab bench and shelves, which mean I must not be as much of a true scientist as Eshkevari, but I could add Erlenmeyer flasks with colored solutions in the background for an even more “science-y” feel.
Be that as it may, the sheer awfulness of this study hasn't deterred Eshkevari from wanting to "translate" these results to the clinic:
The next stage for her research will be human trials—an expensive and complicated endeavor but one she is determined to explore.
“This is where I’m now stuck,” she explains. “I’m trying to get grant funding to do research on humans to see if these discoveries translate.”
Eshkevari remains hopeful that, with rising interest from both the public and scientific communities, this next critical step will find support.
To me, it would be unethical to carry out a human study based on such poor quality and equivocal preclinical evidence. Unfortunately, it would not surprise me if Eshkevari succeeds in getting funding to do one. Such is the pernicious effect of quackademic medicine on clinical trial ethics. Eshkevari argues that doctors didn't know how inhalational anesthesia worked when it was first discovered but used it anyway, the implication being that we should not be uncomfortable using acupuncture because we don't yet understand its mechanism of action. Does anyone see the flaw in that reasoning? It's obvious. That inhalational anesthesia worked was indisputable. In contrast, there is no good evidence that acupuncture works better than placebo. This brings up another problematic attitude in the mindset of quackademics:
“Western, allopathic physicians and nurse practitioners want to be able to point to the evidence, and see the research published in peer-reviewed journals,” says Eshkevari. “This helps us comfortably recommend complementary medicine to our patients. Finding the evidence—I think that’s the biggest step.”
In other words, rather than finding out if acupuncture works, quackademics like Eshkevari assume that it does work and then go chasing mechanisms. It is, as Harriet Hall so aptly described it, Tooth Fairy science.
Faith healing in the chemotherapy suite
I frequently call homeopathy The One Quackery To Rule Them All. However, there is a definite challenger for that title, which can be looked at a different way as well; i.e., as Saruman trying to usurp Sauron on his dark throne. I'm referring, of course, to "energy medicine." Whatever form energy medicine takes, it's based on prescientific vitalism of a variety that posits the existence of a "life energy" that can be manipulated or infused into the patient for healing effect.
The two most common forms of energy medicine in quackademia are therapeutic touch and reiki. Therapeutic touch (TT) is a misnomer in that it doesn't usually involve actual touching (which negates the potential pleasure of a good massage or back rub), but rather involves the placing of hands close to the body. It rests on the concept that there is a human "energy field" that TT practitioners can manipulate to make patients feel better. It's a concept so ludicrous that even an 11 year old girl could show that TT practitioners cannot detect a human energy field any better than random chance alone would allow them to guess. Unfortunately, TT is almost ubiquitous in nursing programs and hospitals. The second is reiki. The main differences between the two are that (1) reiki involves more elaborate hand gestures and (2) reiki posits the existence of an external source of life energy (the "universal source") into which the reiki practitioner can tap to direct the healing energy into the patient. Reiki is, in essence, faith healing based on Eastern mysticism rather than the Christian religion. Unfortunately, reiki is commonly offered in many medical centers, academic or community, and even in NCI-designated comprehensive cancer centers.
Including Georgetown's, apparently, as shown in the Georgetown Medicine article, "A Patient's Experience With Energy Healing":
For a long time Denise von Hengst had a secret she kept from friends and physicians alike. As she was undergoing treatment at Georgetown Lombardi Comprehensive Cancer Center for a particularly aggressive type of breast cancer—triple positive, HER2 positive—she was also regularly receiving Reiki, an ancient form of Japanese healing, to mitigate the debilitating anxiety and fear that accompanied her cancer diagnosis.
“At first I told no one about the Reiki,” says von Hengst. “Fear of the ‘woo-woo’ factor. People might think I’m nuts.”
No, a patient like Denise von Hengst is not "nuts," although, it must be noted, she discovered reiki before coming to Georgetown for her cancer and ultimately became a reiki master. However, the Georgetown Lombardi Comprehensive Cancer Center is unethical and irresponsible for offering, in essence, magic to its patients as therapy. If I were not a physician and didn't know anything about reiki, if an NCI-designated comprehensive cancer center offered it I'd think it must be evidence-based. That's how most patients perceive it. The failure is on Georgetown's part for offering reiki as though it were anything more than prescientific vitalistic superstition and claiming that it has a scientific basis, not on the part of patients like von Hengst, who trust that doctors are offering science-based therapy. In this case, Georgetown reinforced von Hengst's initial attraction to reiki by giving it the appearance of scientific validity.
To her credit, the author of this article does acknowledge the "skepticism" that doctors have about reiki:
However, skepticism remains, not only in the general population, but also within the medical field. Recently, several clinical trials have emerged attempting to prove, or disprove, the effectiveness of Reiki. Many of these studies have been criticized for the trial. design, number of participants and reporting mechanisms. Results of the trials are often inconclusive.
Note that Bayes theorem tells us that "inconclusive" results plus an incredibly implausible mechanism = negative trial. So, yes, these are are negative trials. None of that matters, though, because the article quickly shifts gears to use anecdotal evidence and appeals to authority and popularity:
Yet as the anecdotal proof mounts and Reiki’s popularity increases, prestigious medical centers around the country are taking note and offering the treatment to patients at their facilities. Reiki can be found at hospitals and medical centers such as Boston Children’s Hospital, Dana Farber Cancer Institute, Stanford Health Care, Memorial Sloan Kettering Cancer Center, Duke University Health System and Cleveland Clinic, to name a few. Many academic medical centers such as Georgetown incorporate complementary therapies into their teaching curricula.
And all of these hospitals have failed to uphold a science-based standard of care. Sadly, they are not alone. Far from it. Worse, they are training the next generation of doctors to embrace pseudoscience.
Integrating quackery: The future of medicine?
Perhaps the most disturbing part of this issue of Georgetown Medicine is an article entitled "Putting Integrative Medicine Into Practice." Basically, it's a profile of medical students and recent Georgetown graduates doing exactly what the title says. It also includes a profile of an acupuncturist named Rebecca Berkson, who works at a Georgetown-affiliated facility, the Kaplan Center for Integrative Medicine in McLean, Virginia. In the name of Georgetown, she provides "acupuncture, its associated techniques including moxabustion and cupping, and Chinese herbal medicine." Cupping, remember, claims to remove unnamed "toxins" from the skin thusly:
It's a treatment almost as ridiculous as TT, and it's being offered at Georgetown as though it has validity.
There's also a medical student from the Howard University class of 2015 named Brian Nwannunu. He graduated from Georgetown's CAM master's degree program. Now he's a believer:
My plan is to go into orthopedic surgery. For my patients experiencing back pain, I will work with CAM practitioners such as acupuncturists and chiropractors in addition to offering allopathic medicine. After my own experience with a low-back injury during a workout, I went to a chiropractor for a few weeks and felt tremendously better.
And:
I took a holistic medicine and pediatrics course last summer, and people were speaking quietly about homeopathy. I find it interesting to see how many practitioners approach complementary medicine like it’s voodoo. But that is changing. As holistic medicine becomes more prevalent, more students are talking about it, and we’re being taught to be aware and accepting.
Pardon me while I pound my head against the nearest wall.
Then there's Megan Blunda, who graduated from Georgetown in 2011 and is now a family practice doctor:
I worked with Steve Schwartz, M.D., in the Introduction to Osteopathic Manipulative Medicine elective at Georgetown. I have carried the skills I learned in that course to my career as a family physician in Seattle. Over the last year and a half, I have been training in the art of cranial osteopathy. Through work with a mentor and an intensive 40-hour course, I have learned the skills to perform basic treatments for patients with headaches, neck pain and back pain. The ability to actually make a patient’s pain better, instead of masking it with medications, is incredibly fulfilling.
That's right. Here's a Georgetown graduate who is practicing cranial osteopathy, also known as craniosacral therapy, which is what Mark Crislip likes to call a "SCAM of infinite jest"—and for very good reason. Worse, Blunda is proud of this, claiming that her integration of such treatments into her practice allows her to "provide higher quality and more personalized care."
Conclusion: The future of medicine is quacky
Unless checked, this is the future of medicine. Indeed, this entire issue makes the case that integrating quackery into medicine, bringing the Hogwarts School of Witchcraft and Wizardry to life as medical schools, is the future of medicine. Unfortunately, strive as we might against it, I'm having a hard time disagreeing. Proponents of "integrating" witchcraft like reiki, acupuncture, homeopathy, and craniosacral therapy into medicine will say that it's not at all like Hogwarts. They have a point, but not in the way they think. In marked contrast to the magic gaining traction in the current world of quackademic medicine, in J.K. Rowling's fictional world of Hogwarts, magic could be studied rigorously and actually worked. Would that this Brave New World of integrative medicine could say the same thing.
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Amri's advice about "empty your brains" was at least solid. That would be the only way to have homeopathy make sense. This is so depressing.
My 21 year old has been seeing a very good cardiologist for sudden onset of heart pain. She has received very good diagnosis (nothing major we were happy to find out). Her office shares a waiting room with the integrative medicine group. It has a much faster turn over rate compared to the real medicine offices. That is the obvious draw for medical managers.
Steven@1: Yes, the joke writes itself.
What is even more depressing is that people who pretend to be serious academics still advocate "touch therapy". Ms. Rosa is now well into her 20s, yet the medical technique she so thoroughly debunked at age 9 (the paper was published when she was 11) has persisted as though she had never done the work.
Also, I assume that medical schools, like other educational institutions in the US, are subject to periodic review by some accreditation board. Where is the accreditation board here? Dr. Lumpkin admitted back in 2003 that the curriculum really didn't allow for teaching CAM, yet Georgetown still teaches this stuff--including homeopathy (for which there has been no excuse since Avogadro's day), touch therapy (if there ever was any excuse for that, it vanished when Ms. Rosa published her paper, which was before Georgetown started its CAM program), and acupuncture (which as our host has noted might have been forgivable in 2003, when the possibility of some causal mechanism was not yet ruled out, but is inexcusable today). In theory, the accreditation board should be a check on some of the curriculum committee's more egregious excesses, but that's not happening here.
If I were a student I think I'd insist that after the class the lecturer accompany me to the dissection suite and point out meridians in a cadaver.
If they are 'anatomic' they must represent physical structures present which can be isolated on dissection, right?
This is scary. As has been pointed out before medical doctors are not trained as scientists. They have so much material and so many skills to learn that they, probably quite reasonably, accept what they are taught, assuming that the instruciors know what they are doing---at least as far as existing medical knowledge reaches.
I'd say that Georgetown and any other medical school teaching CAM are engaged in medical and teaching malpractice.
JGC@4
You miss the point! The qi is a vital energy that cannot be detected physically, so the structures that guide it are also non-physical! You literalist, you!
Prove me wrong! Now prove me wrong when I assert that angels watch over my bed every night when I'm sleeping -- and allow me to assert any property of undetectability I like for my angels.
Man. This is such BS.
Wikip----
has a short article on TT- one of its creators, Dolores Krieger, believed that it worked because of "electron transfer resonance".
AS fate would have it, Grand Woo-meister Null often recounts how Krieger worked with him on his psi experiments in the 1970s at the Institute for Applied Biology ( which may or may not have actually existed,) along with other storied healers, healing mice. She had a great track record, he says. 100%.
The only reason these esteemed institutions have become involved in this quackery is pure and simple: money.
Harsh as this may sound, isn't all of this a malpractice suit or suits waiting to happen?
And, would several lawsuits be enough to shut down this move to unproven "treatments" as a standard of care?
Next. Georgetown will start offering its graduate psych students classes in phrenology.
Andy -- cupping and bleeding, and the "four humors" are next on the list.
Seriously, these "natural" med types need to do a little reading in 19th century medical history. It might open their eyes to how sadly ineffective these alleged cures are.
Troll -- I'm unit coordinator for the local branch of a volunteer medical organization and the folks at national are urging us to incorporate acupuncturists into our emergency response plans.
I'll be happy to accept any acupuncturist as a volunteer. They can answer phones and schlep boxes with the rest of the non-medical folks.
@ Andy:
How about mesmerism?
#10 Andy
Next. Georgetown will start offering its graduate psych students classes in phrenology.
http://www.psychologicalscience.org/index.php/news/were-only-human/the-…
Mind, given the high level of accuracy of MRI (fMRI ?) I am not sure they are past the naturopathy level.
shay,
I'm sure that any talent they possess outside of acupuncture as a treatment would be of value during an emergency.
For acupuncturists being incorporated into an emergency response, nothing says we expect hypochondriacs to show up better than this.
Note that I expect hypochondriacs to be treated as well as anyone else but I have a hard time accepting the "making up $h!t to do it" part.
If I want a hickey, and the last time that happened was in high school, over 40 years ago, I wouldn't go to a doctor.
"After my own experience with a low-back injury during a workout, I went to a chiropractor for a few weeks and felt tremendously better."
Huh. I hurt my back at work a few years ago. That was the week my wife finally got me to try feta cheese. Wouldn't you know a week later my back feels great. My doctor said it was getting better anyway, but he's a big-business pharma shill who doesn't respect the boundaries of my experential universe, so.............
Patrick Arambula, your feta cheese cure is pretty funny. I don't often have back pain but the next time I do, I'll have to try it. Will you stand by your cure if it doesn't work for me?
On my malpractice question, I see the law & malpractice industries are a thousand steps ahead of me (as well they should be). I found plenty of sites selling malpractice insurance for CAM/integrative medicine and even a CAMLAW web site but no real answer to my question that was driven by trying to think of a way to stop the integrative medicine explosion from the patient's side of things.
I guess I will just have to follow the age old practice of running from the office and not looking back for any MD/MD lite who would prescribe Reiki or homeopathic cures for me. At least as long as I am able to choose my provider.
Doesn't the standard Quack Miranda warning make CAM malpractice insurance unnecessary?
^ Who knows? Seems to be plenty of companies offering this insurance. Maybe it is just fake insurance for fake medicine.
"Integrative medicine" was first explained to me as medicine that looked at all aspects of illness, not just the physical, but the social and emotional aspects. Man, was I disgusted when I found that, instead of a new way of offering support for people with serious illness, it was a bunch of quackery.
“I tell students that for the next few hours, put aside all they have learned in biochemistry, pharmacology and cell biology—empty their brains—because homeopathy is a completely different concept."
I've heard that somewhere before........
Oh yeah.....here:
https://www.youtube.com/watch?v=X69NCLxwLEY
Many parallels between Woo and the Force. Obe Wan is the Woo master and Orac is Han Solo:
Obe wan:
"Let go your conscious self, and act on instinct. Your eyes can deceive you. Don't trust them. Stretch out with your feelings."
Han:
"Hokey religions and ancient weapons are no match for a good blaster at your side. "
"kid, I've flown from one side of this galaxy the other, and I've seen a lot of strange stuff, but I've never seen anything to make be believe there is one all powerful force controlling everything. There's no mystical energy force that controls my destiny. Its all a lot of simple tricks and nonsense."
C
Given that this stuff doesn't really work, an eventual major consumer backlash is inevitable -- accompanied no doubt with breathless rhetoric about how "doctors have been lying to you!" and other passionate accusations. Statements which will now actually be more or less accurate, given that the so-called liars will have themselves be deceived. Avoiding self-delusion is not only the tricky part of science, it's a basic precept.
The problem of course is in the time period involved. The mills of the gods grind slowly -- but they grind exceedingly small.
And then the chickens will come home to roost. What goes around, comes around. Hoist by their own scientific petard! And so forth ...
"Sadly, I don’t have as much stuff on my lab bench and shelves"
She needs to clean up her goddam bench. Sadly, I've seen a lot worse, but still - that's a pretty unprofessional amount of clutter, all of those plates and bottles and stands. Bonus points for the pipetter with the glass/plastic pipette still attached, lying on the bench.
"If they are ‘anatomic’ they must represent physical structures present which can be isolated on dissection, right?
You miss the point! The qi is a vital energy that cannot be detected physically, so the structures that guide it are also non-physical! You literalist, you!"
Since chinese pulse diagnosis detects imbalances! So you'd think that somewhere there must be a spot it enters or resides in the bod-ee. After all, Somewhere over the rainbow blue birds ski. The qi that you dreamed of can't be imaginar-ee.
'' After my own experience with a low-back injury during a workout, I went to a chiropractor for a few weeks and felt tremendously better.''
Sounds exactly like me! To be fair, I wouldn't put chiropractors in the same boats as all the other quacks; the mechanism they use to treat involves an actual physical manipulation of the patient, which makes it a whole lot more plausible than say, homeopathy.
Besides, it feels good, and the massage they do with the electrodes is pretty relaxing.
@jrkrideau
#5
I do agree to an extent. You would think that if you were getting that many years of schooling, at some point you would be taught how to evaluate evidence.
I'm a patient at Stanford's cancer center. It's been two years and three months since I ended a 9-week intensive course of chemo for pure seminoma that had escaped the surgery I'd had a year and a half earlier. (Or so my oncologist suspected. She couldn't do a biopsy of the lymph node that was swollen, but said that the node was where the cancer would show up again if the seminoma were to spread.)
I'm now at the point where my oncologist is going to transition me to longer-term care, since two years of CT scans, blood tests, and X-rays have been negative. I'm to start having double appointments every 6 months or so with her and another physician. However, I first need to meet with a rep from Stanford's cancer survivorship program for some reason. I've looked at the packet the program sent me and 1) it's patronizing, as if everyone who has had successful cancer treatment self-identifies as a "survivor" for the rest of their lives (which I don't; I saw both treatments as bumps in the road that I just wanted to get over so I could get on with life); and 2) the program offers reiki. The moment I read it's description of reiki and the purported benefits, I became angry that my long-term care is going to be decided in part by a rep from a program that promotes this nonsense. Then, I searched through this blog for posts about reiki, bookmarking them for study so I'll be prepared for this appointment. Really, I want to tell this rep exactly what I think about this program marring the reputation of the Stanford cancer center, and exactly how let down I feel that Stanford would permit someone from such a program access to their patients. If I hear anything about reiki being part of integrative medicine, I'll use the "cow pie/apple pie" analogy as a rejoinder. Damn! I did not entrust my life twice to this institution just to have them throw woo at me later.
There's some good stuff over there, but the last time I went to look for something, I got the sense that it had gone moribund.
At the risk of drifting off topic…
Just read an interview with Camille Paglia who claims to be an atheist but who also seems to have a sort of naturalistic, spiritual thing going on. Maybe I am just pissed because she dissed a personal hero of mine, Christopher Hitchens, but I think Ms. Paglia is looking for something more in the same way some doctors embrace IM.
For some, science is not enough, and while they may condemn organized religion, doing so leaves a void they feel compelled to fill with other nonsense and make-believe that connects them to something they consider superior to the material world. And then, of course, there are those who just know when there is a buck to be made.
@Bresson #28: Not that a single trial is ever sufficient to prove or disprove the effectiveness of a treatment, but have a look at the subject of reiki at Edzard Ernst's site. There, you can get clear idea of what constitutes a well controlled study, even though it failed to show any benefits compared to sham reiki.
I just received promotional materials in the mail for a big-time quackademic medicine-fest scheduled for this December in (how appropriate) Las Vegas, sponsored by none other than the Cleveland Clinic.
"Dr. Roizen's Preventive and Integrative Medicine Conference" (it evens sounds like something that should be held in a tent at a traveling carnival) will features oodles of good stuff - including yoga, how to cure chronic pain by eliminating "inflammation" via a plant-based diet, conquering gut imbalance etc.
At least one Friend Of The Blog will be featured - Patrick Hanaway, whose former medical practice (before he moved up to the big time at Cleveland Clinic) featured homeopathy and "grounded discussions" on vaccines.
Sadly, my budget for high-toned CME opportunities has been used up for the year. But surely Orac or one of the other physicians who posts here won't want to miss this terrific opportunity (only $595, not counting hotel accommodations, travel, special yoga session etc.).
http://www.clevelandclinicmeded.com/live/courses/wellness/overview.asp
re " eliminating 'inflammation' via a plant-based diet, conquering gut imbalance"
Oh jeesus!
I certainly am familiar with that!
And how exactly does inflammation manifest itself?
AS EVERY illness and condition known to mankind.
Everything is inflammation - even what isn't.
Well, it depends. I used to think that all chiropractors were quacks, but I've learned that only most of them are. The others are physical therapist with delusions of grandeur, and may actually do good.
But never let a chiropractor do anything to your neck. People die from that.
Narad,
Always a bit hard to tell when web sites don't display dates but you are correct. I found a link to updated content at "Michael H Cohen's FDA & Health Care Law Blog".
Of course, there they don't show dates either but I did find a date of March 2015 in the source code for one of their "News" entries. It's the one letting us know that "Michael H Cohen will be presenting Legal Issues In Integrative Healthcare for The Leadership Program in Integrative Healthcare at Duke University." Following the link over to Duke University it appears to be an active program currently.
Bresson,
I have not been through anything like you have but I already know I would be thinking similarly about the patronizing approach and the reiki plan if I was in the same situation.
I expect I would try to find the humor in it to buffer my anger, disbelief and disappointment at being lied to. And, also remembering that there are those in this world who want this type of thing.
But I would still give them a piece of mind and not waste anyone's time or money with the appointments even though I do think it would be fun to watch someone make a fool of themselves over me for at least one visit.
@Sastra (#23):
Would that this were so, but I expect that the backlash will not be against woo, but against the medical profession, because some few (I hope) of their members have subscribed to woo.
@Bresson (#28):
I'm a Palo Alto Medical Foundation patient whose ER is Stanford. When my on-call PAMF internist sent me to the Stanford ER for care on a Saturday night 4+ years ago because my blood counts were off the chart awful, Stanford did a good job looking after me overnight (4 units packed RBC, and call your doctor in the morning! - I joke about the last, in case someone thinks that Stanford is totally woo-permeated, they're not). They've also done a good job on analysis of bone marrow slides - as far as I (and UCSF Medical Center, who ought to know) can tell. But I have not had to deal with offers of woo; and I would be as scathing as you if I had.
@3Not a Troll (#35):
IAAL, and I would run as fast as I can from the program you listed.
If there are too many quackademic medical centers to keep up with, then perhaps we should take the opposite approach: create a list of hospitals etc. that don't indulge in or subject their patients to various forms of sillyopathy.
Spread the list around and give credit where credit is due. Rationalists and smart people in general will find the information useful in choosing who to patronize and where to go for care.
Eventually it's to be hoped that market demand for SBM will reach the point where certain medical practices and institutions will start advertising it. For example:
"At Central Hospital Cancer Center, we know that cancer is a pain in the butt and it can kill you. So we're not going to waste your time with Reiki and other hand-waving, or homeopathic power-placebos, or Maoist Medicine. Come in and receive the best care that real science can offer. We have world-class surgeons and a world-class chemotherapy program. Our psych staff can help with the social and emotional stuff without indulging in patronizing nonsense. We get to the point, so you can get on with your life. And isn't that what medicine should be about? Call us today or find us online, at www..."
Many parallels between Woo and the Force.
True, but there are two important differences: (1) the people who came up with the concept of the Force understand that it's fiction, and (2) the Force has observable in-universe effects, while woo has not had a demonstrated real-world effect other than to enlarge the bank accounts of certain people.
That second point is important. Han Solo is initially skeptical of the Force, but later on he gives it some respect because he has observed some of its in-universe effects. Orac has moved in the opposite direction with respect to acupuncture: it's not completely implausible that sticking needles in people might have some effect, but in the last ten years it has been demonstrated that acupuncture is no better than a placebo.
@ BBBlue #30
Camile Paglia is a professional humanities troll. Everything she says is logically inconsistent with something else she aays. It's all very meta – which is to say the 'point' is to demonstrate something by provocation. In Paglia's case, this amounts to staging her own (narcissistic) crypto-Nietzschean authority by sh!t-stirring that leaves other people befuddled and POed in her wake while she moves on ahead unfazed to the next opportunity for bomb-tossing. Her celebrity rests on the fact that the humanities folks she trolls are at least nominally 'liberal' or 'left', and her trolling provides usable pull quotes for conservatives attacking the academy. While she presents herself (and does actually consider herself, it seems) a lesbian 'feminist' outsider, her critiques always manage to twist themselves into expression consistent with right-wing ideologies. Thus the right loves to point to her and say 'well, she's one of them and look how she exposes their nonsense!' She meets the market demand for a 'multi-culturalist' who rips multiculturalism. This bothers her not at all, since she considers all the people arguing over her – pro and con – to be inferior fools.
A few smart people in the humanities do take this act seriously, for some reason, but most of them consider her a fame-whoring clown.
Which is not to say that she didn't have a point in dissing the very-dissable Hitch – just that I wouldn't bother with her rants on any subject as they'll ultimately fall apart as anything but evidence of her ability to get people to listen to her ranting. For Hitch-dis, go to Alex Cockburn for Hitch's drift to the neo-con right, and Terry Eagleton for the ahistorical and counter-productive aspects of anti-theism.
A lot of the discussion here (re: malpractice, etc.) seems to assume 'facts not in evidence' – that Georgetown Hospital will allow its 'Integrative' practitioners to substitute woo for conventional standard-of-care approaches of treatable physiological conditions. Chiropractors, acupuncturists and reiki masters might only be employed in cases similar to the Stanford long-term-care program mentioned by Bresson – an option that helps some patients deal with the psychological issues of chronic conditions. I say 'might' as despite all the posts I've read about 'quackdemia' on RI and SBM, I find no good explanations about how 'Integrative' treatments actually function in clinical practices at these institutions.
I don't want to get into arguments of whether palliative woo is 'OK' – IMHO it certainly doesn't justify teaching acu-points in anatomy or the ridiculously bad science of the rat 'acupuncture' study. But the people in charge at institutions engaged in 'quackademics' aren't fools, do have cautious attorneys on hand, and aren't going to put their institutions into a position of serious legal 'exposure'. So I very much doubt any patients will be placed in harms way. It seems to me Orac is primarily concerned about the more general and distant legitimation effects of quackademics. E.g., if patients know Georgetown and Stanford offer reiki, they may go directly to an independent woo-meister who WOULD just wave hands over some affliction that requires conventional medical intervention. And, of course, sbm is going to consider woocademics (you're welcome) a horrifying waste of resources in terms of money/time/energy...
My deeper 'problem' with this discussion is that it tends to take a narrow focus on the specific unscientific things medical institutions do without stepping back to consider elements of 'the big picture':
If this stuff is a problem, and calls for an effective push-back, it's not enough to point out that it's 'scientifically wrong; We ought to ask 'WHY are these institutions going this direction?' so that these motivations can be addressed and countered. And, frankly, for all my reading of RI and SBM, I don't get a clue on the 'why?'. The knee-jerk response "it's the money" isn't helpful, and evidences a failure of fact-checking proper to skepticism. Georgetown is endowed up the wazoo, and doesn't need to scramble for cash. I'm marxish enough to grant that at some level everything IS about the money, but not in the way it often gets framed in these comment threads.
2) None of this stuff is happening in a vacuum. Part of the 'big picture' is how little friction the institutions moving toward 'IM' are encountering from the larger medical establishment. Why aren't accrediting bodies balking as Eric Lund suggests they might? OK, there'd be other frictions working against that (Georgetown is politically connected enough that no accrediting board is likely to f*** with them...) But at least you'd expect a few hospitals and schools to 'position' themselves aganst IM as 'world-class REAL medicine' as Gray Squirrel suggests, if only for the marketing and PR advantages of the branding distinction. But that's not happening. The medical boards are silent. The AMA is silent. Why, why, why? These are complex social phenomena, and again one-liner answers like "shrugging is easier" aren't just appallingly simple-minded (even if more-or-less true) they offer no help in figuring out what to DO about any of this i terms of effective, pragmatic-real-world strategy.
Now, as physician-scientists, sbm-ers like Orac are naturally going to focus on the medical science. They aren't well equipped by training or predisposition for taking on key 'big picture' questions, or for skill in doing so. That's a task for sociologists, cultural studiers, and in the case of Georgetown perhaps theologians. So, all I'd like to see from sbm-ers is more 'if you don't know, ask somebody who might..."
A lot of the discussion here (re: malpractice, etc.) seems to assume ‘facts not in evidence’ – that Georgetown Hospital will allow its ‘Integrative’ practitioners to substitute woo for conventional standard-of-care approaches of treatable physiological conditions.
Then why is Georgetown Medical School teaching techniques that students will not be allowed to use in their hospital? If the hospital really is holding the line against this stuff (perhaps, as you imply, because their lawyers would not want to defend a lawsuit in the event that such a treatment went badly), and the curriculum committee is not, that's a major disconnect, and it will have to be resolved one way or the other. Preferably with the hospital winning this battle, but I am not optimistic about that.
sadmar,
Please forgive my bluntness. It is not a personal attack but one born of reading of these things for the past three years. The following may all be too simplistic for you but I ask that you at least consider them and then do your own research
1. The US medical system and probably most 1st world systems are not equipped to handle chronic syndromes - how is a misallocation of resources to anything not science based going to help with that?
2. There is a vast bias towards Somatic symptom disorder that has prescient in medical history. This is ripe for sending patients on to woo treatments. Side note: Many severely mental ill patients have extreme difficulty getting treatments for physical illness. Not a straw man; it goes to bias. Factual report here but the anecdotal reports I read often relate being dismissed as head cases ripe again for woo treatments. And, there is always the statistics of woman in the ED with heart attacks. If misdiagnosis is occurring already why bring mis-treatment into the mix?
3. It is not always making money but saving money that is the enticement.
4. Business initiatives usually involve ideas first, data capture afterwards. Usually if the data doesn't agree after the fact, well full-speed ahead anyway. Think patient surveys, medical homes, EMRs. Even the much touted airline safety checklists to medical care models have considerations. Read here. The whole article is worth reading but if you are short on time the Summary is good
5. I read the AMA is pushing back against alternative medicine MDs but even without that I don't put a lot of stock in an organization with their membership percentage and what I read physicians say about it and something like MOC.
6. Even if this paranoia of misdiagnosis increasing is all in my head, I see no justification for accepting treatments into medicine that are proven to be worthless. And, there will be a backlash against this someday, just like there was with HMOs. They started out with not much push back either and look at the debacle they became.
IDK - I think you sell Orac and others short on seeing things. They may not see things the way I do but as practitioners and patients, they see things.
Btw, are you someone who might know?
Errr...spell check fail. I meant "precedent" not prescient.
I wonder what the medical students at Georgetown say to the acupuncturist? Do any of them ask, "Is this science based? If not, what are you doing here?"
I don't think this is because Georgetown is scrambling for cash. I simply think it's become a haven for cash-motivated folks like this character. Of course, he's got books to sell you!
sadmar,
Isn't this guy clearly using Georgetown's name to sell his product?
@ sadmar #43
It's the money. You greatly overestimate Georgetown's endowment and financial position. The hospital was recently acquired by the Medstar system and it still struggles to stay in the black, and they are in some pretty tight competition with George Washington, the Inova Health system in Northern Virginia, and even Hopkins (which bought a hospital right in their backyard) for market share. I presume the hope is that by positioning themselves as more "advanced" or progressive in their integration of CAM, they would appeal to more patients in the DC area, and therefore make more money. No deep conspiracy or psychological investigation required here, I think.
Sadmar,
Medicine in the US is a business. Perhaps somewhat less so in other places. So your "always about the money" is what matters.
It is perfectly natural for fads and trends to gain traction if they help the bottom line-- consider mammography and yearly checkups and so on. Consider that pharmaceuticals sometimes really do end up "tested" on the general population and then withdrawn.
As for looking for answers here, the problem is that the people on the "SBM" side here are not that different from the woo-people, as I've pointed out in the past. They have their own fantasies and narratives and psychological needs. They are "stuck" inside the box, so why would they be able to see a bigger picture?
The system needs to be fixed. Woo stuff is a trivial issue, a distraction, that will be further marginalized when you make the practice of medicine scientific. And that requires, first, that it be acknowledged as a public good.
Here's the thing, though, that always bugs me about the "it's about the money" arguments and makes me think it's way more complicated than that. Most CAM programs struggle to make money. It's true. Indeed, many of them depend on a wealthy donor (hence the number of CAM centers named after wealthy donors). Now, it may be that having a CAM center keeps the those with a tendency towards CAM in the system, thus making money for the hospital indirectly, but CAM centers themselves, by and large, are not particularly profitable. I suppose in in come cases they might function as "loss leaders," but to say it's all about the money is painfully simplistic.
Orac 51,
But didn't you just answer your own objection?-- it's simplistic to just look at "profit" numbers narrowly constructed.
The point is that these "centers" are not a departure from the standard business model that already exists, just as magical homeopathic doctors or wise oriental herbalist doctors are not a departure from the magical wise heroic entrepreneurial MD.
It's easier to keep doing what you are doing than suffer constructive disruption.
My take on the money angle is that while "CAM centers themselves, by and large, are not particularly profitable", publicity about them financially benefits the academic medical center overall (by implanting the idea that the center is following a "holistic" model).
This may not boost the center's revenue significantly, but if it keeps some patients from fleeing the system entirely for woo (and attracts others who think there's something to that there reiki stuff), the center at least doesn't lose money to the competition. And it may attract a big donor or two who has a powerful interest in woo.
So while money is not the only motivation, it's by far the biggest one in my opinion.
I don't particularly know about the profitability of the CAM centers themselves, but I think the "loss leader" idea has it about right. As Dangerous Bacon suggests, and as I previously mentioned, capturing market share in a competitive area is likely the main motivation (or maybe it's only the justification?). "If I'm going to have my cancer treatment at a hospital, I want to go to the one that takes a more holistic/integrated approach."
I'm not sure we are looking at this broadly enough. The people who push to open these Integrative Centers are true believers and they are able to rouse support from their followers, who in some cases are wealthy donors. Because skeptics are not well organized or well represented in the development process, these endeavors go largely unchallenged. The institutions (now largely run by MBA's and CFO's) likely feel that it is a financial plus and are also likely shruggies, if not believers. We need organized letter writing campaigns to even begin to dent this. We have to make noise.
Years ago I worked for a major public institution which was exploring several options for including some components of what was then CAM into education and training. This was propelled by several very wealthy donors who leaned on our development office very heavily in what sounded to me like bribery/extortion--start including more of what we consider a worthy new innovation, or we will seriously reconsider our planned giving to other areas. It was very clear that the suits were vulnerable to this pressure, and I don't remember any of the clinical people standing up to the pressure with science-based arguments. Eventually a watered-down attempt to include CAM was tried for a few years and then abandoned when Donor 1 withdrew support for other reasons. So yes, I think money talked in that case, and skeptical voices were silent or absent.
The Liaison Committee on Medical Education (LCME)--which accredits US medical schools--should immediately revoke the accreditation of Georgetown Medical School. And, as the AMA is a sponsor of the LCME, it should--given it is finally going after quack physicians like Dr. Oz--push the LCME to revoke Georgetown's accreditation.
Of course, the gross incompetency of Georgetown Medical School explains a lot when it comes to one of their most infamous graduates--one Robert Sears, MD, FAAP.
I live here in DC, and there are an increasing number of TV ads for hospitals, especially for expensive treatments like cancer care. There are also lots of print ads in the newspaper and on the subway. My impression is that there is more and more competition for patients, especially ones with serious diseases. Georgetown's gambit is probably one way of attracting a certain subset of patients who are enamored of alternative medicine.
Ok, here is what appears to be a cop-out answer, but I assure you I have no need of one and merely think it the truth.
I don't think there is so much of a big picture here as there are pieces of one. And every motive mentioned in the thread is valid in this. From receipt of direct income to selling promo material under the name of an university to capturing market share to true believers to true wanna believe in something to those who just want to be cared for.
I hope I didn't miss any but you get my point.
I'll skip the reasoning in my previous comment because it was a lot of rambling. I just happen to see red when I read things like this from Duke alongside the selling of fake treatments. Emphasis mine.
"Integrative Healthcare, with its focus on patient engagement, holds a key to resolving many of the issues facing our nation’s healthcare system. By treating the whole person, and addressing all the influences that affect their life, we enhance people’s ability to get well and stay well."
As if they needed a lie to do that.
Anyway, in reading what Duke portrays to the public about their integrated primary care it sounds much like marketing to the healthy not to the ill - and yet another way to increase their market share.
For those interested in going higher still into the philosophy of it all, Dr. David Healy has an interesting series going on about the consumerism of medicine in The Crusoe Report series. Perhaps this is all a move to "Slow Medicine" as he hopes. But I doubt he is interested in woo.
And the other overarching thing would be placebos. I don't make comments about placebos in medicine much because I don't know where I stand on them yet. I found this article a couple of days ago Is It Ethical For Doctors To Prescribe Placebo? while thinking about sadmar's call for a big picture. Who knows if this is big picture or not, but I do think it is at the heart of the matter. Yet this article, although helping me to know that I am not alone in my quandary, did nothing to settle the ethical questions of "CAM medicine as placebo" for me.
Btw, I just noticed I used a lot of " " here. Would someone kindly spare some of their pharma shrill money so I can buy some more? TY.
Unfortunately most people pay little attention to alt med. except, of course, for its rabid followers. So much of it goes under the radar until it becomes "accepted" by more and more people just because they've heard of it somewhere and what harm can it do? I am guilty. Never paid any attention To what was going on within the alt med community because I never spent time at any doctor, hospital, etc. then wham! Cancer diagnosis, surgery with the apologetic(to give them credit) offering of TT by the hospital I was at. Even then I sort of shrugged my shoulders...like I've stated before I was on meds and thought the music was nice. I also liked the visiting dogs but I digress. Long story short, head home to deal with cancer and start reading(on cancer sites) all about alt. Med , the big Pharma conspiracy to keep alternative meds away from us and asked over and over why I'm so afraid of herbs, enemas, etc etc. try to explain that with a scientific background I like to see evidence of something working. Like talking evolution with religious wing nuts. Does no good. They Believe in their homeopathy, acupuncture, ginger, turmeric, Laetrile so facts mean nothing...always thought it was due to the scientific illiterate being defensive over their lack of knowledge- not sure Georgetowns excuse...guessing its financial. Medical centers that are "open-minded" enough to accept alt Med are probably more attractive to the general public.
Sigh.
http://www.crainscleveland.com/article/20150804/NEWS/150809953/clevelan…
When did it stop being CAM and start being "functional?"
Another follow-the-money reason for integrated healthcare
http://www.medalagroup.com/downloads/Part%201%20Integrative%20Health%20…