I’ve been pretty hard on The Cleveland Clinic over the years, but justifiably so. After all, The Cleveland Clinic is one of the leading centers of quackademic medicine in the US; i.e., an academic medical center that studies and uses quackery as though it were legitimate medicine. Of course, this is a problem that is not in any way limited to The Cleveland Clinic. A decade ago, I tried to keep track of which academic medical centers had “complementary and alternative medicine” (CAM) or “integrative medicine” programs that integrated quackery like acupuncture, chiropractic, naturopathy, reiki, and even homeopathy into their medicine in a little list that I liked to refer to as the “Academic Woo Aggregator.” However, that little list didn’t remain little for long, and soon I found the Academic Woo Aggregator to be too difficult to maintain and I gave it up. Sadly, the reason was that there were just too many medical schools and academic medical centers that embrace quackademic medicine.

Since then, the situation has only gotten worse as the number of academic medical centers embracing pseudoscience has skyrocketed, with The Cleveland Clinic arguably leading the way. For instance, it was, as far as I know, the first to actually integrate a traditional Chinese medicine herbal clinic into its offerings. That same year, it hired Mark Hyman, MD of “Ultrawellness” fame to open its Center for Functional Medicine. “Functional medicine,” recall, is basically a form of quackery that combines one of the worst aspects of conventional medicine (over testing, except that functional medicine makes the over-testing we see in conventional medicine look puny and quaint by comparison) with a whole lot of “make it up as you go alongquackery to “correct” abnormal lab tests and remove “toxins” in the name of “biochemical individuality,” which functional medicine fetishizes above all else and uses as an excuse to do just about anything. Sometimes the quackery of functional medicine reaches truly ridiculous proportions. Unfortunately, functional medicine has been wildly successful at the Clinic.

So I was only somewhat surprised last week when a social media kerfuffle erupted over the publication of what can only be described as an antivaccine screed by Daniel Neides, MD, the director of The Cleveland Clinic’s Wellness Institute. It was a screed that would not have been the least bit out of place on antivaccine websites like Age of Autism, NaturalNews.com, The Thinking Moms’ Revolution, or the like. This incident led me to ask: What the heck do you expect? That’s what happens when you embrace quackery, particularly when a lot of it is “detox” quackery, a prominent component of functional medicine, naturopathy, and the like. Given that a lot of antivaccine pseudoscience is based on the idea that vaccines are full of “toxins,” there’s a natural affinity between antivaccine beliefs and any form of pseudomedicine that embraces “detoxification.” And, make no mistake, The Cleveland Clinic embraces “detox,” even selling such products on its website, while Dr. Neides is very much into “detox” quackery himself.

In the wake of the controversy, The Cleveland Clinic issued a statement that it really, truly supports vaccination and promised that Dr. Neides would be “disciplined.” It also suffered tsunami of negative press, with bloggers like me taking it to task for its quackademic medicine, refreshingly (to me, at least) joined by a handful of mainstream news organizations like The Washington Post and STAT News where reporters didn’t miss the broader picture of how the culture of pseudoscience at The Cleveland Clinic Wellness Institutes facilitates antivaccine views. In any event, a few days ago, I figured the controversy was finished but still held out hope that it will spark some intrepid health reporter somewhere to look into the wider problem of quackery in academic medicine.

Apparently, I was mistaken. It wasn’t over. Worse, instead of admitting its mistake, The Cleveland Clinic is doubling down on its promotion of quackery because, apparently, Toby Cosgrove, MD, CEO of The Cleveland Clinic, is unhappy at the negative press. As a result, he wanted to defend his hospital’s Wellness Institute and decided to do so in an opinion piece released by The Cleveland Clinic Newsroom entitled Vaccines, Wellness and a Healthier America. The whole post is evidence of how conventional physicians can be seduced by the tropes of “integrative medicine” to the point of parroting its propaganda.

Dr. Cosgrove starts out by observing that smoking, poor diet, and lack of exercise were the leading factors that led patients to requiring his service as a cardiac surgeon, all of which is true enough. No one—and I mean no one—with any credibility denies this. Indeed, no one denies this other than the doctor caricatures who are portrayed as denying that diet or exercise can be used to improve health. These caricatures are constructed by quacks and most commonly utilized by proponents of “integrative medicine” to denigrate what they disparagingly call “conventional medicine.” Of course, primary care doctors do prevention every day and try very hard to get their patients to stop smoking, eat a healthier diet, and exercise. It’s very difficult to succeed when patient visits are so short, constrained by the economics of reimbursement for medical services. So, yes, certainly “conventional medicine” could do a better job at helping patients use lifestyle interventions to improve their health, but no it’s a caricature to claim that medicine is all about “sick care” and not “wellness.” None of that stops CAM advocates from pointing to conventional medicine’s shortcomings in this area and invoking a false dichotomy in which it is necessary to embrace quackery in order to promote “wellness.” It’s a key talking point frequently invoked by advocates. Although he doesn’t say it explicitly, it’s implicitly clear from Dr. Cosgrove’s editorial that he buys into this false dichotomy or that he doesn’t understand that much of what is being “integrated” with diet, exercise, and smoking cessation is rank quackery. If all The Cleveland Clinic Wellness Institute were doing was promoting healthy eating, smoking cessation, and exercise, I certainly wouldn’t have a problem with it.

Let’s get to Dr. Cosgrove’s op-ed. First, Dr. Cosgrove has to deny most vociferously that there are any elements in his institution that are antivaccine:

Historically, healthcare has not done a good job of promoting disease prevention. Our Wellness Institute has built a framework to guide patients to healthier lifestyle choices. However, in a recent online column, the Wellness Institute’s medical director shared his personal views about vaccination – views that do not represent Cleveland Clinic in any way.

Vaccinations are a key component to preventing disease and maintaining a healthy society. There is no debating that; the research is clear. To say otherwise is irresponsible and runs counter to Cleveland Clinic’s commitment to evidence-based medicine.

Deadly, debilitating diseases like polio, smallpox and measles are no longer the threats they once were, thanks to vaccines. In fact, according to Healthy People 2020, routine childhood immunization (DTap, Td, Hib, Polio, MMR, Hep B, and varicella vaccines) saves 33,000 lives, prevents 14 million cases of disease, and reduces direct health care costs by $9.9 billion.

Harmful myths, untruths and junk science about vaccinations have been scientifically debunked. Serious adverse effects are incredibly rare. And there is no demonstrated link between autism and vaccination.

So far, so good. This is about as unequivocal a rejection of Dr. Neides’ ignorant antivaccine nonsense as one could expect from the CEO of any internationally known academic medical center. True, I can’t help but note that Dr. Cosgrove hasn’t said exactly what action he’s decided to take against Dr. Neides, even though it’s been well over a week since his antivaccine column made national news. Clearly Dr. Neides hasn’t been fired yet (which would be appropriate), or likely we would have heard about it. Presumably he has suffered some “discipline” less than firing. I also know that Dr. Cosgrove did send out a mass e-mail to Cleveland Clinic employees instructing them not to speak or write publicly in situations where their speech might be construed as representing the position of The Cleveland Clinic, which is what Dr. Neides did.

The Cleveland Clinic has apparently also initiated action that appears designed far more to give the appearance of concrete action to correct the problems that led to someone like Dr. Neides feeling comfortable publishing antivaccine rants under The Cleveland Clinic’s logo than to actually do something substantive:

After the director of its Wellness Institute was forced to walk back an anti-vaccine blog post over the weekend, the Cleveland Clinic revealed Monday that it has already spent months reevaluating the institute’s focus and expects to halt the sale of some alternative medicine products.

Clinic spokeswoman Eileen Shiel told STAT that hospital administrators are concerned that the institute’s focus has grown too unwieldy and less connected to the clinic’s broader mission of providing the best, evidence-based medicine and services to patients. She said the wellness center will likely stop selling some of its commercial products, such as homeopathy kits sold in the gift shop of its suburban Lyndhurst location, and move toward general wellness programs that would improve diet and lifestyle decisions by patients and its own employees.

Yes, The Cleveland Clinic sells a homeopathic detox kit on its own website. It has also begun offering pure quackery like reiki, craniosacral therapy, myofascial release, and acupuncture to children. It even offers the “energy medicine” quackery that is “therapeutic touch” to babies. Let me repeat that: The Cleveland Clinic subjects babies to rank quackery.

What would have served Dr. Cosgrove best would have been to stop with the statement defending vaccines, but he just couldn’t do it. Of course he couldn’t! He just started his column bragging about how important the Wellness Institute is to The Cleveland Clinic, how he had established it in 2007 and “placed its leader in the C-suite with the title of Chief Wellness Officer.” He couldn’t let the criticism go. The Wellness Institute and the Center for Functional Medicine are Cosgrove’s babies. He owns them. That’s why he had to pivot rapidly and complain about those of us who didn’t miss the broader point about The Cleveland Clinic’s embrace of quackery:

Still, critics have used the column to disparage the Wellness Institute as a whole and the concept of wellness in general.

Gee, Dr. Cosgrove. You say that as though it were a bad thing. Actually, Dr. Cosgrove’s whine contains only half a straw man. First, as to the charge of using Dr. Neides’ column as a jumping off point to “disparage” the Wellness Institute, I plead guilty as charged—and proud of it! The Cleveland Clinic Wellness Institute is a cesspit of quackery mixed with more reasonable and evidence based treatments, and I have no qualms about pointing out how if you embrace “detox” quackery, antivaccine quackery can’t be far behind. I’m also very happy to see that at least a couple of mainstream news outlets started to “grok” the general outlines of that point. Second, as for disparaging “the concept of wellness in general”? Er, not so much. Here, Dr. Cosgrove is disingenuously conflating criticism of the quackery that the Wellness Institute has “integrated” with sensible advice on diet, exercise, and smoking cessation with “disparagement” of wellness in general. The two are not the same thing, and what is being “disparaged” is the amount of pseudoscience passing for medicine under the auspices of the Clinic’s Wellness Institute, not the concept of wellness in general.

Dr. Cosgrove then goes on to use an appeal to need to justify the Wellness Institute by arguing that chronic disease is rampant (which is, of course, true, given the obesity epidemic and the general aging of the population) and that health care costs are on track to reach 20% of the the GDP by 2024, which is also true. The rest, however, is a non sequitur. It does not follow from these observations that what Dr. Cosgrove is doing at The Cleveland Clinic is the answer. True, some of what the Wellness Institute does can help:

At Cleveland Clinic, the Wellness Institute works hand-in-hand with the Medicine Institute to help patients and employees change unhealthy behaviors and to make healthy life choices. These goals align with public health initiatives set by the CDC, such as immunizations, safe healthy food, smoking cessation, control of infectious disease, and a focus on heart disease and stroke.

Yes, they do, and, again, no one is criticizing The Cleveland Clinic or its Wellness Institute for promoting these things. These are the interventions that every science-based hospital should be promoting. They are the default. No one argues against them. What we do argue against is the quackery that the Wellness Institute, as unwittingly admitted by Dr. Cosgrove himself, promotes:

Some approaches may be considered unconventional, but most – acupuncture, yoga, Chinese herbal medicine, guided imagery and relaxation techniques – have scientific backing. We have heard from our patients that they want more than conventional medicine can offer and we believe it is best that they undertake these alternative therapies under the guidance of their Cleveland Clinic physician.

No, no, no, no, no. Acupuncture is a theatrical placebo. Yoga is fine, but nothing more than a form of gently exercise overlaid with Eastern mysticism. It has nothing special to offer compared to other forms of exercise. Guided imagery might have some evidence, as might relaxation techniques, but, again, they’re being lumped together with the quackery. The most telling statement is the last one, however. I’d rephrase it, though: We at The Cleveland Clinic know that patients want this quackery, and we know we can make money selling it to affluent suburbanites in Beachwood, Shaker Heights, and Pepper Pike. So we will sell it, but we will assuage our consciences by telling ourselves that the best “safe” way to provide the quackery to patients is through our facility and that our embrace of pseudoscience is “justified by the magnitude of the disease challenge.”

And that the Cleveland Clinic is somehow doing cutting edge research:

In the meantime, we will move the science forward. Our Center for Functional Medicine is the first in the country to conduct research studies on the impact of functional medicine when combined with traditional approaches for certain disease – asthma, inflammatory bowel disease and diabetes.

OK, my irony meter melted down here. Remember how Dr. Cosgrove, reassuringly, started his column by saying how pro-vaccine The Cleveland Clinic is and how all the horrible things about vaccines written by Dr. Neides in his column do not represent the position of The Cleveland Clinic? Throw that all out the window, because, whether he realizes it or not, Dr. Cosgrove’s embrace of Dr. Hyman and functional medicine completely contradicts his previous pro-vaccine statements, as does his bragging about the Clinic’s Center for Functional Medicine is supposedly doing cutting edge research into asthma, inflammatory bowel disease, and diabetes. Does Dr. Cosgrove have even clue one that Dr. Mark Hyman, the guru of functional medicine that he hired to found the Center for Functional Medicine co-authored a an antivaccine book of the thimerosal/mercury fear mongering variety with Robert F. Kennedy, Jr. in 2014, right around the time that the Cleveland Clinic hired him? Yes, that Robert F. Kennedy, Jr., the one with whom Donald Trump met last week to discuss “vaccine safety,” thereby alarming physicians, medical professionals, and public health officials throughout the country and provoking a firestorm of justifiably outraged criticism. Does Dr. Cosgrove know that Dr. Hyman even appeared on The Dr. Oz Show with RFK Jr. to promote their antivaccine book a mere 10 days before The Cleveland Clinic announced that it had hired Dr. Hyman to found its functional medicine center.

I don’t buy it. I’d really love to ask him personally what he knew about Dr. Hyman and when, but my gut tells me that there’s no way he didn’t know about Dr. Hyman’s antivaccine book with RFK Jr. Indeed, it stretches credibility to the extreme to believe that Dr. Cosgrove didn’t know about the appearance of someone he had just hired to found a high profile Cleveland Clinic Center on a nationally syndicated TV show with one of the icons of the antivaccine movement to promote the antivaccine book that they had co-authored together. Clearly, Dr. Cosgrove was either ignorant that they were antivaccine or fine with Dr. Hyman’s views then, or at least Dr. Hyman’s antivaccine propaganda didn’t bother the oh-so-pious pro-vaccine Dr. Cosgrove enough for him to scuttle the launch of the Center for Functional Medicine or to tell Dr. Hyman to zip it. Nor did Dr. Hyman’s long history of mangling autism science and clinical treatment based on antivaccine preconceptions appear to bother Dr. Cosgrove. If Dr. Cosgrove knew about these things and hired Dr. Hyman anyway, that’s medical malpractice in my book. If he didn’t know about these things, then it was an utter failure of basic due diligence.

So I call BS on Dr. Cosgrove’s self-righteous indignation and his assertion that The Cleveland Clinic under his leadership is so very, very pro-vaccine. That’s not to say that the vast majority of physicians and other health care professionals working at the Clinic aren’t pro-vaccine. I have no doubt that they are. It is, however, to say that Dr. Cosgrove doth protest too much. He championed the Wellness Institute. He turned a blind eye to Dr. Hyman’s antivaccine views. He now claims that he is shocked—shocked, I say—to find an antivaccine loon in charge of his Wellness Institute. Now that said antivaccine loon has publicly embarrassed The Cleveland Clinic, Dr. Cosgrove seeks to reassure the public (and perhaps himself) that Dr. Neides is an anomaly. Taken over the whole Cleveland Clinic physician population, I have no doubt that he is. Taken over the providers at the Wellness Institute, I’d bet that he isn’t. We just won’t hear from them publicly again because they’ll know now to keep their mouths shut.

All of this is why I call BS on Dr. Cosgrove and assertion that The Cleveland Clinic is as pro-vaccine as he says it is and will continue to do so as long as Dr. Hyman has an important position within the organization that Dr. Cosgrove runs. If I see Dr. Hyman fired, the Center for Functional Medicine disbanded, and the Wellness Institute purged of traditional Chinese medicine, naturopathy, chiropractic, craniosacral therapy, and its other quackery that tends to align with antivaccine views and focus only on diet, exercise, and help stopping the use of substances that contribute to chronic disease (like smoking), then—and only then—would I start to think that maybe—just maybe—Dr. Cosgrove is serious about not permitting antivaccine views at The Cleveland Clinic.

Comments

  1. #1 prn
    January 18, 2017

    To the extent “functional medicine” reflects disparaged therapeutic nutrition, it might be an institutional survival reflex to keep customers and attract more business.

    Although I cringe over the terminology and supposed models of many marketing pitches for various parts of therapeutic nutrition, many nutrients do involve benefits that need to enter or displace backwards hospital nutrition practice.

    Conventional medicine either reforms on therapeutic nutrition or loses its paying customers. Maybe Cleveland Clinic will be a leader and evolve toward the most beneficial parts.

    For the “skeptic” diehards, good luck with all the no pays who are stuck with 20th century superstitions and medical politics…

  2. #2 has
    January 18, 2017

    And that the Cleveland Clinic is somehow doing cutting edge research

    Marketing research. The Lies ARE the Product. Whatever sells best to the vast market of all those who WANT to be lied to.

  3. #3 Lighthorse
    January 18, 2017

    Cosgrove may have taken some acts out of the show, but he still has a way to go. By imitating the menus of clinical institutions in China, he may be hoping to set up satellite operations in Shanghai or perhaps the smog-ridden real estate of Beijing. So, the acupuncture stays, but the homeopathic detox kits in the store could go. None of that changes the fact that what he and Hyman have concoted is an Institute of Dysfunctional Medicine with steaming piles of pseudoscience to go.

  4. #4 Eric Lund
    January 18, 2017

    @prn: I can see that straw man from orbit. Certain nutritional interventions are indeed science-based, and science-based medical doctors routinely do recommend them to their patients. But there is also a lot of dietary woo out there: supplements, gluten-free diets (for people not actually diagnosed with celiac disorders), “detox” regimens, and so forth. Orac has always made this distinction clear, and there is nothing inherently wrong or logically inconsistent about supporting science-based nutritional interventions while rejecting the woo.

    There is also a difference between a businessman selling woo, and a research hospital selling woo. The former has identified a market niche and is exploiting it; he does not necessarily have the background to know that what he is selling is woo (though if he is selling homeopathic remedies, he should). Research hospitals are supposed to be on the forefront of medicine, and they should know better than to indulge in woo. The FDA can also come down hard on a woo-pusher who goes too far. With hospitals, you are counting on the typically spineless state licensing boards to enforce standards.

  5. #5 Vincent Iannelli, MD
    https://vaxopedia.org/
    January 18, 2017

    “For the “skeptic” diehards, good luck with all the no pays who are stuck with 20th century superstitions and medical politics…”

    So we should push 18th and 19th century healing superstitions on folks because they want them?

    • #6 Orac
      January 18, 2017

      Those, and healing superstitions dating back to Hippocrates and earlier as well. 🙂

  6. #7 BKsea
    January 18, 2017

    It seems to be taken as a given that these wellness centers are at least helpful in promoting lifestyle improvements. I question even that. I expect they are successful at attracting patients who are already healthier and those who are more motivated to make changes. Thus any apparent improvement in health may just be down to selection bias. Has anyone ever done a study based on intent to treat that shows these centers are good at anything other than sucking wallets dry?

  7. #8 Brandon Tracy
    Helena Montana
    January 18, 2017

    Last year my wife who has hypoactive thyroid switch to desiccated thyroid from thyroxine and she has never felt better I think you’re ignorant for bashing homeopathic remedies that have been around for longer than recorded human history some of them work some of them don’t who’s supposed to be a man of science not a naysayer quit acting like a douchebag

    • #9 Orac
      January 18, 2017

      You do realize, don’t you, that homeopathy was only invented in 1796 by Samuel Hahnemann? It’s only been around 221 years.

  8. #10 TBruce
    January 18, 2017

    We have heard from our patients that they want more than conventional medicine can offer and we believe it is best that they undertake these alternative therapies under the guidance of their Cleveland Clinic physician.

    And any physician could tell you that they have heard from some of their patients that they want more than their doctor is offering, such as Valium, Oxycontin, Percocet and Fentanyl.

    An esteemed institute like the Cleveland Clinic is supposed to be a leader. What a joke.

  9. #11 TBruce
    January 18, 2017

    @Brandon:
    You might want to see a gynecologist for those missed periods.

  10. #12 Science Mom
    http://justthevax.blogspot.com/
    January 18, 2017

    Last year my wife who has hypoactive thyroid switch to desiccated thyroid from thyroxine and she has never felt better I think you’re ignorant for bashing homeopathic remedies…
    That’s not a homeopathic remedy.

    TBruce for the win.

  11. #13 Wzrd1
    January 18, 2017

    Well, I do love my herbs and herbal teas.
    They cure me of bland food and drinks. 🙂

    Although, I do have to keep an eye out on which ones I try that are new to me, lest I get an odd interaction with my real medicines.
    Which means, I’ll avoid kale tea, as I am being treated by an endocrinologist for hyperthyroidism. Just as a singular example.
    But, I think I’ll enjoy a nice artichoke tea with lunch. 🙂

  12. #14 Chuck Niwrad
    January 18, 2017

    It’s only been around 222 years

    A person with a 222 in a prominent position in their numerology chart is likely to be concerned about others.

    Coincidence? I think not.

  13. #15 Panacea
    January 18, 2017

    @TBruce: Oh Snap!

    Well, at the risk of embarrassment, I’ll tell on myself. Orac’s comment about the Cleveland Clinic doing Therapeutic Touch on babies, stirred a memory my friends are still teasing me about to this day.

    When I was in my BSN program, I needed to fill out my schedule, so I took an elective called Therapeutic Touch for one credit hour. The professor was one of my favorites on the faculty (ironically, she also taught my Nursing Research class).

    My sister had just had her first child, and she had a terrible time with colic. My sister will call me, expressing such frustration, I would come over and use TT on the baby just to get her (my sister) to calm down. Every time, my niece would stop crying, look at me, and let out a massive fart (sometimes followed by a massive poo). Every single time.

    Don’t get me wrong. I never thought I changed her “energy patterns” or “flow” to cure her colic. She probably just wondered what the hell I was doing and relaxed just long enough for her bowels to do their job.

    The problem went away for good when I finally convinced my sister to stop eating broccoli (she was breast feeding).

    Oh, but the look on my niece’s face . . . .

    • #16 Wzrd1
      January 18, 2017

      Heh, two out of our three grandchildren had severe colic. Of the two, one was eventually diagnosed with reflux.
      I was the only one who could keep them from crying incessantly.
      I held them facing forward, one hand supporting chest and abdomen, going between the legs to support the buttocks, the other hand linked from the side, supporting the buttocks.
      Which had the effect of splinting the entire abdomen and thorax, relieving some of the discomfort of gas or reflux and at the same time, providing a varying view as I walked around, which also distracted them from their discomfort.

      I did help their energy flow though, preparing bottles, feeding them, burping them and changing soiled diapers. Gotta keep the chemical energy flow clear! 😉
      Or something.

  14. #17 Orac
    January 18, 2017

    A person with a 222 in a prominent position in their numerology chart is likely to be concerned about others.

    Especially since I meant to type 221, given that homeopathy was first reported in 1796. Oh, well…

  15. #18 shay simmons
    January 18, 2017

    So we should push 18th and 19th century healing superstitions on folks because they want them?

    If bleeding, blistering and purging were good enough for the founding fathers, they ought to be good enough for us!

    • #19 Wzrd1
      January 18, 2017

      If bleeding, blistering and purging were good enough for the founding fathers, they ought to be good enough for us!

      Ah, for my wife, that’d be trivial. A bit of hot pepper exposure, all three would be her fate.
      She literally blisters on contact with an exposure to oleoresin capsicum.

  16. #20 herr doktor bimler
    January 18, 2017

    combined with traditional approaches for certain disease – asthma, inflammatory bowel disease and diabetes.

    “Traditional approaches for asthma”? I think that’s called “dying”.

  17. #21 TBruce
    January 18, 2017
  18. #22 Richard Smith
    January 18, 2017

    Meanwhile, a pill with a 222 in a prominent position is likely to be concerned about others’ pain. Well, as concerned as any inanimate object is capable of being.

    • #23 Wzrd1
      January 18, 2017

      And one with 223 in a prominent position would be concerned about inflicting pain in others.
      5.56 times over.

  19. #24 prn
    January 18, 2017

    re: #8 – 12:
    In a lot of instances, “homeopathic” doctors clearly were doing nutrition and natural medicine, not the high purity water and sugar pills version.

    re #5, 6
    We are still arguing over the practical application of 20th century science like nutrition in medicine.

    Those from other fields of research slowly realize, often toward the end of their lives, how bad medicine has become in the application of simple, old 20th century science. Typically too late. There has been a lot of disappointment amongst my older friends with brand name MSM medicine, for suffering and wasting their time…

    Eric Lund@4
    …science-based medical doctors routinely do recommend them to their patients.
    So explain the grossly C and D deficient cancer patients that have been so common, if you (n)ever measure them.
    e.g. for 25 OH-D I mean 1-10 ng/ml.

    But there is also a lot of dietary woo out there: supplements, gluten-free diets (for people not actually diagnosed with celiac disorders), “detox” regimens, and so forth. … Orac has always made this distinction clear, and there is nothing inherently wrong or logically inconsistent about supporting science-based nutritional interventions while rejecting the woo. … necessarily have the background to know that what he is selling is woo
    More and more, (self)educated people realize MSM doctors are often biased charletons hostile against supplements, n=0 types with little or no training. Then people seek other information sources. Sometimes they err about who and how for a particular problem.

    Research hospitals are supposed to be on the forefront of medicine, and they should know better than to indulge in woo.
    In America, businesses have long been recognized that it is more profitable to woo customers. ;>

  20. #25 Vincent Iannelli, MD
    https://vaxopedia.org/
    January 18, 2017

    “That’s not a homeopathic remedy.”

    No, the homeopathic remedy for hypothyroidism is sea kelp – heavily diluted and vigorously shaken…

  21. #26 Ben
    January 18, 2017

    @prn

    I’ll bite.
    So what exactly are deficiencies in vitamins C and D associated with? All cancers? Certain types of cancers? Cancer-related mortality?

  22. #27 brian
    January 18, 2017

    You do realize, don’t you, that homeopathy was only invented in 1796 by Samuel Hahnemann? It’s only been around 221 years.

    Ah, but homeopathy is based on ancient wisdom! Before Hahnemann coined the term, “homeopathic remedies that have been around for longer than recorded human history” were simply called “water.”

  23. #28 Chuck Niwrad
    January 18, 2017

    Especially since I meant to type 221

    This is getting spooky. It’s been 221 years since 1796, but this is the 222nd year of homeopathy. Try as you might, you just can’t deny the power of numerology. “Homeopathic” has 11 letter times 2 = 22. Yes, 2017 will surely be the year of homeopathy.

  24. #29 prn
    January 18, 2017

    Ben I’ll bite.
    So what exactly are deficiencies in vitamins C and D associated with? All cancers? Certain types of cancers?

    In advanced colorectal patients near first diagnosis, vitamin D difficiency is almost a good marker, even in patients since ca 2009.
    Vitamin C difficiency symptoms are common amongst advanced cancer patients in many areas throughout, from dx to death if not aggressively treated. Blood data, or even urine data for C, are also commonly difficient…

    • #30 Wzrd1
      January 18, 2017

      Vitamin C deficiency is easy enough to spot, as it causes scurvy.
      Vitamin D deficiency isn’t uncommon in northern latitudes, my wife is on supplements due to osteoporosis and confirmed (by a real physician) vitamin D deficiency. As we also supplement our milk supply with vitamin A and D, it’s less common than in the past, save in the elderly.
      Who, for some odd reason, tend toward cancers and would also test low for both vitamins, due to fixed income lowering their consumption of foods rich in said vitamins and a lower amount of outdoor activity.
      Note the well documented pathophysiological pathway that none would consider woo, as both vitamins are known to be deficient in the elderly.

  25. #31 Eric Lund
    January 18, 2017

    More and more, (self)educated people realize MSM doctors are often biased charletons [sic] hostile against supplements, n=0 [sic] types with little or no training.

    So much to unpack in one sentence. First, “self-educated” how, University of Google? Orac’s archives are full of cautionary tales about the woo someone can get into by that route. Most people need a guide to get through recommendations, and the MD degree is specifically intended to signify that the recipient has been so trained. They aren’t the only ones who have that training–my PCP is a PRN, not an MD. And I’ll admit that some of them don’t do the job so well, in particular the ones on the receiving end of Orac’s Respectful Insolence. The good doctors will even recognize when they have reached the limits of their knowledge, and refer you to an appropriate specialist. Oddly, many woo practitioners never do that–can you say Dunning-Kruger?

    “Hostile against supplements”: There are good reasons for that. In the US, supplements are specifically exempt from most FDA oversight as long as the seller is careful not to make specific medical claims about the product. That means the potency of the product can vary widely between manufacturing lots, and there is no systematic way of watching out for interactions with other products, whether they are other supplements or genuine pharmaceutical products. There have even been cases where a supplement actually contained a genuine pharmaceutical product. These supplements aren’t cheap, either, and seldom if ever covered by insurance. It’s almost as effective as drinking Chateau Lafitte Rothschild every night for giving you seriously overpriced urine.

    I’m not sure what the antecedent is for the last clause–are you referring to the doctors or the patients? The presumed typo “n=0” (I assume you meant “n=1”) is almost Freudian, as you seem to disdain statistics as a method for making sense of data. I understand the reluctance to be thought of as a number, but seriously, unless you know it works for a bunch of people like you, how do you have any assurance that it will work for you? The alternative to statistics is to make data the plural of anecdote, which is not a good idea.

    Finally, the bit about “little or no training” makes sense if you are talking about the Google U. graduates–very few people who are not in the business have significant medical training–but earning the MD involves a fair amount of specific training. Whether that training is effective is a legitimate question, but it is required, and in both amount and rigor it far exceeds what you need for an ND (as Orac aptly calls it, “Not a Doctor”) and certainly a BS.

  26. #32 Delphine
    talking with the taxman about popery
    January 18, 2017

    MSM doctors are often biased charletons

    Or BLOODY GREAT FOOTBALLERS!

    http://i.dailymail.co.uk/i/pix/2007/08_03/bobjack2508_468x830.jpg

  27. #33 Eric Lund
    January 18, 2017

    Chuck’s arguments somehow remind me of the infamous Indiana Pi Bill. It’s easy to “prove” things with numerology: just wait for coincidences to pile up.

    For instance, I can “prove” that all numbers are interesting. The proof is by reductio ad absurdam: Assume that non-interesting numbers exist. It follows that there must be a smallest such number. But that’s interesting! Therefore, all numbers must be interesting. QED.

  28. #34 herr doktor bimler
    January 18, 2017

    it hired Mark Hyman, MD of “Ultrawellness” fame to open its Center for Functional Medicine.
    Hyman spends so much time schmoozing and attention-whoring with gossip / lifestyle columnists, inventing stories about his supposed celebrity clients, I am surprised he has any time left for the Clinic. Perhaps his role at the CFM does not require his actual presence.

  29. #35 Orac
    January 18, 2017

    It doesn’t. He founded the clinic and sets its overall scope, guidelines, and programs, but running its day-to-day operations has been farmed out to a crony, Dr. Patrick Hanaway:

    http://scienceblogs.com/insolence/2014/09/23/quackademic-medicine-now-reigns-supreme-at-the-cleveland-clinic

    http://scienceblogs.com/insolence/2016/03/02/quackademic-medicine-wildly-successful-at-the-cleveland-clinic/

    After all, you couldn’t expect Dr. Hyman to leave his glamorous surroundings to move to…Cleveland! So beneath his station! My understanding is that Dr. Hyman only sullies himself to set foot in Cleveland something like once a month or so, but he might be at The Cleveland Clinic even less often.

    Besides, Dr. Hyman has offices all over the country. The Institute for Functional Medicine, for example, has offices in Washington state and New Mexico and The UltraWellness Center in Massachusetts.

  30. #36 Leigh Jackson
    January 18, 2017

    Acupuncture has as much scientific backing as homeopathy: Zero.

    Artemisinin has as much to do with traditional Chinese Herbalism as a kite has to a satellite.

    Does the Cleveland Clinic know precisely what ingredients and from what source, they are dishing out to rich clients to enrich their “wellness”.

  31. #37 Leigh Jackson
    January 18, 2017

    ?

  32. #38 sadmar
    January 18, 2017

    Lots of funny comments in this thread. Brightens the day. Kudos to Chuck especially for the numerology jokes. Unless he’s being serious. But, I think not!

    Orac really nailed Cosgrove’s rhetorical trcik of conflating his institute with “the concept of wellness in general.” Are there any notable institutions offering ‘wellness’ programs trying to “do a better job at helping patients use lifestyle interventions to improve their health” without embracing quackery? I have healthcare from Kaiser, and get an occasional email about ‘wellness’, but that hardly qualifies as the kind of ‘intervention’ that can actually help people begin and stay with the diet and exercise ‘interventions’ a conscientious physician would recommend.

    Along those lines, I will make an objection to a minor point in the OP as I think it points to a deeper issue. I wouldn’t say “Yoga has nothing special to offer compared to other forms of exercise.” The language is ambiguous as to whether “other” means “all other” or just “some other”. Certainly there are other forms of exercise that also offer what yoga does and most exercise doesn’t: a more psychological component similar to relaxation. mediation, guided imagery, or CBT/DBT exercies, for that matter. That is, yoga is not just physical exercise. While the way yoga goes about that psychological element has no appeal to me, I can appreciate the concept, and wouldn’t pooh-pooh it’s benefits for those who can appreciate it. it points to how ‘wellness’ should differ from the diet and execise advice you get from your PCP: it doesn’t just tell you what you should do, but actually helps you do it. Also, more broadly, a proper concept of ‘wellness’ embraces not just physical health, but mental health. If yoga helps folks keep their heads straight better than hitting a stairmaster, that’s worth something.

  33. #39 Leigh Jackson
    January 19, 2017

    @Panacea

    If fraught parents are to be pacified by the infliction of woo upon their babies, for poo’s sake, let it be therapeutic touch, and not acupuncture as is common practice in Scandinavia.

  34. #40 Panacea
    January 19, 2017

    @ Leigh: No joke 🙁 I just read Orac’s post for today on that.

    Oh my ever loving God.

  35. #41 Francois
    San Diego, CA
    January 19, 2017

    Speaking of Hyman, antivaxxers and those people…

    The Shadow Network of Anti-Vax Doctors
    https://www.theatlantic.com/health/archive/2017/01/when-the-doctor-is-a-vaccine-skeptic/513383/

  36. #42 Dick
    A2
    January 19, 2017

    @Eric Lund (#33)
    To be nitpicky, that proof requires there be a least element for any arbitrary set of numbers, which is true if we restrict ourselves to natural numbers (1,2,3,…) but not for many other sets we are familiar with (integers, rationals, reals). Now, according to the well-ordering theorem we can construct an artificial order on any set so that the least element always exists, but it doesn’t tell us how to go about doing it.

  37. #43 Chris Preston
    January 19, 2017

    Wellness as something apart from medical care?

    My doctor always asks me about diet and exercise when I go there. My medical insurance provider offers subsidised entry to health programs. I can even get a cut price fitbit.

    They are doing this because they understand that getting their members off their arses and out doing stuff cuts down on medical bills – particularly those expensive ones.

  38. #44 Paul Ernsberger
    Cleveland
    January 21, 2017

    If patients want nutritional advice and therapy, it is difficult for an MD to offer it in a 15-minute office visit. Physicians do not have time to carry out a full analysis of a person’s diet and offer specific recommendations. We do have other health professionals trained to do exactly that: registered dieticians. There are dieticians at the Cleveland Clinic and at every major health system. Sadly, their services are poorly covered by insurance even though they cost a fraction of an MD visit. Coverage of dietician services could replace quackademic medicine and probably lower total costs while improving care.

  39. #45 prn
    January 22, 2017

    Eric, n=0 refers to MSM doctors’ and skeptics’ experience levels and tests with nutrients and formulations for CAM, e.g. IV vitamin C, say 30 – 60 grams C/ meter2 per infusion, up to several times a day for viral infections. There are virtually no relevant MSM “high quality” test data or papers allowed in the major US journals for the past 65-70 years. More recently, some for cancer. Cancer is a much more difficult application vs the easy acute viral ones.

    “N=0” authors often quote irrelevant low dose, inadequate period tests or low dose oral tests as failures of that treatment category. Truth is, they have no relevant data. While IV vitamin C admirers have sparse data, they actually do have data and observations against the naysayers’ nada.

    A lot of your arguments are handwringing. Any idiot can pay far too much – look at even US generic drugs; supplements are typically available at affordable prices from many places. Modern QA/QC with known supplement suppliers provide many reliable sources. MSM drugs injure and kill orders of magnitude more people.

  40. #46 prn
    January 22, 2017

    Paul@44
    Registered dieticians are typically far behind on therapeutic nutrition for serious illness. Even some of their own literature admits that their version of therapeutic nutrition is in its early stages.

    I have seen substantial differences between average BS level personnel and texts vs some PhD level RDs and advances graduate references.

    Outside a minority of PhDs, RDs were still disconnected from reality about the high dose stuff last time I looked (several years ago). So useless to me and mine for serious, fast(er) results.

  41. #49 TBruce
    January 22, 2017

    Outside a minority of PhDs, RDs were still disconnected from reality about the high dose stuff last time I looked (several years ago).

    You say that like it’s a bad thing.

  42. #50 Paul Ernsberger
    Cleveland
    January 22, 2017

    prn: Registered dieticians are well aware of nutritional quackery. That is why they do not recommend it.

  43. #51 prn
    January 24, 2017

    The way you say it, your statements sound biased and faith based. Some biochemically savvy ND versions will be taking a lot business from purblind RDs. Total RD roadkill.

    Even in my limited experience, I’ve seen gross RD nutritional failures in nursing home, hospital, and diabetics then succeed with methods closer to ND nutrition.

    Doctrinaire RD advice with fails prescriptively, predictively and methodologically.

  44. #52 Sandra D.
    January 28, 2017

    Hey! I work in this building. The new facility is gorgeous yes?

    I am all for diversity in medicine. You men need to stop your infighting and look out for the common good.

  45. […] Dr. Toby Cosgrove, CEO of The Cleveland Clinic later doubled down on his hospital’s support for the pseudoscience and fake medicine that it has embraced through its Wellness Institute, Center for Functional Medicine, and […]