Terra Sigillata

Dr Kimball Atwood IV at Science-Based Medicine and my long-time blogging colleague Orac have spilled oceans of e-ink on the institutionalization of alternative or integrative medicine in North America’s top academic medical centers. Complementary and alternative medicine (CAM) is now often called “integrative medicine” to intellectually justify the incorporation of evidence-free, anecdotal practices into the business of academic medicine. Of course, integrative medicine does co-opt a few areas of conventional medicine, like nutritional and psychological counseling, supported by an evidence base just to add a veneer of legitimacy under which highly-questionable practices can proliferate and metastasize.

In these discussions by other bloggers, one question continually arises: Why do revered medical centers at places like Harvard, Cornell, UCSF, Mayo Clinic, risk their academic reputations by pandering to public demand for practices based in magical thinking?

Why else? Cash. Cold, hard cash.

Submitted for your approval: Leadership and Business Strategies for Integrative Health Care

The 6th Annual Conference on Integrative Medicine for Health Care Organizations is the only conference that focuses on business strategies for the implementation of complementary and alternative medicine (CAM) programs in hospital settings. Attendees will leave with practical, take-away tools and ideas while enjoying invaluable networking with peers and leaders in the field.

Yes, you can even begin your Saturday morning at the conference with a 45 min session of “Laughter Therapy” to ease one into the comfort of laughing one’s way to the bank.

Now, remember, I am an herbal medicine researcher who has spent at least a decade examining natural products for their potential therapeutic benefit. But again, this is another research area that has ever-so-slowly been claimed by integrative medicine as their own – all despite the fact that this research area has been called “pharmacognosy” for well over 50 years and has been a cornerstone of pharmacy and chemistry since the Hanover pharmacist Friedrich Wilhelm Sertürner first isolated and standardized opioid alkaloids from the poppy, Papaver somniferum, in 1805.

In this capacity, and as a young faculty member, I witnessed the emergence of complementary and alternative medicine on academic medical center campuses in the early and mid-1990s. In general, these centers were initially funded by interested philanthropists but I had difficulty in understanding how these centers would be sustainable financially. Even research grants from NIH’s National Center for Complementary and Alternative Medicine has never exceeded a national budget of $125 million or so and I anticipated that CAM, or integrative, centers would be jettisoned by academic hospital administrators and medical school deans as quickly as they sprung up.

But, alas, I do not have an MBA and probably don’t really understand the economics of integrative medicine. Thankfully, I can fly to Phoenix this May and learn where I have gone wrong:

Workshop #2: Philanthropy as a Key Component in Building an Integrative Medicine Program
Sid Mallory, executive vice president for philanthropy, Allina Hospitals and Clinics, Minneapolis, MN, and Mary Love (Bitsy) Henderson, president, Henderson Mallory Partners, Minneapolis, MN

The question of funding is upper most on the minds of hospital CEOs and other health care executives as they consider integrative medicine as a key strategy to improving the health of the population they serve. Many are wondering if philanthropy can provide a significant source of funding in building and sustaining a program. This workshop will focus on the philanthropic environment that must be in place to allow prospective donors to partner with a health care institution to build and support a campus-based integrative medicine program. Participants will examine a proven philanthropic case and learn about the key elements of the philanthropic plan and structure that must be in place to achieve a high level of community support.

Conversely, one can also learn how to get an integrative medicine program off the ground without philanthropy:

When There’s No Free Lunch: How One Integrative Clinic Started and Thrives Without Philanthropic Support
Lynn Durand, MD, medical director, Center for Integrative Medicine, Concord Hospital, NH

Most integrative medicine clinics get started with significant philanthropic gifts. Despite this, many clinics that are launched with financial backing or receive continuing philanthropy do not survive financially. This session describes how one hospital-based integrative medicine clinic started and continues to operate without external financial assistance. Participants will gain expert advice on how to articulate a compelling rationale for an integrative clinic, and learn effective strategies for structuring the clinic to ensure that it is supported by the medical staff and the public. Dr. Durand will share the steps that the Center for Integrative Medicine followed to successfully facilitate this endeavor.

There are too many other gems to list here, so I refer the reader to the session and event descriptions.

You might not be surprised to learn that no sessions are scheduled that discuss the ethics of plying evidence-free practices on patients in the name of “improved quality of care and a better patient experience.” Perhaps a session on how to live with one’s self while knowingly offering fraudulent services in the context of trusted professions and professional institutions might be in order.

I really don’t mean to be facetious here – a legitimate concern exists when health systems, academic or private, offer the trade of charlatans in the name of medicine.

But as with managed care organizations, pharmacy benefits management companies, and, dare I say, academic medical center administrations, all bets on medical ethics are off once business infiltrates the system.

The resulting situation is one where economics trumps science and medicine and the reputation of medical and allied health professionals become secondary concerns.

Comments

  1. #1 isles
    April 17, 2008

    I took a phone call this morning from one of the institutions named in this piece. They were asking for us to contribute to their “integrative health program” (or whatever, I was too incredulous and aggravated to listen very carefully!). I gave the caller an extremely cold turndown.

  2. #2 N.B.
    April 17, 2008

    We may, in fact, have to start talking about “Big Woo-ma.”

  3. #3 Liesl
    April 17, 2008

    Who are the people who monitor ethics in medicine? I’ve always wondered that. The only times I’ve been confronted with a necessity for ethical guidance in medicine (as a patient) it was always referred to an ethics board made up of people whose sole concern is the practice of medicine, in some way. Is that usually the case? If so, could that be another harbinger of the death of ethics through a lack of accountability? I wonder.

  4. #4 Dr. Val
    April 17, 2008

    Very interesting post. Imagine what we could do if alternative medicine philanthropists donated their funds to science based research instead? Such a terrible waste of resources when we can’t afford to provide all Americans with access to known effective therapies.

  5. #5 c. coe
    April 17, 2008

    a good friend neurologist from harvard sighed with embarrassment and gave me the same answers when i queried him about woo at his place—basically greed/money. i find this astonishing from one of the richest institutions in the world. have they no shame? it hurts personally too since i have a sweet but foolish cancer stricken relative who is wasting time and money on this rubbish (not at harvard though). And now places like harvard, etc,legitimise this crap. must the dollar always trump ethics and reality based science?

  6. #6 Phoenix Woman
    April 20, 2008

    Want to make this go away? Back universal free health care for all. It’s not a coincidence that alternative modalities started gaining popularity as a) trad-med costs started going up and b) insurance companies started to cut back on coverage. Altie therapies can be pricey, but most are still cheaper than, say, a week’s stay in a hospital. And if you’re someone in a desperate situation — in need of cancer treatment yet unwilling to drive your family into bankruptcy for it — then guess what? You’re easy meat for the woo brigade.

  7. #7 Abel Pharmboy
    April 21, 2008

    @Phoenix Woman – a superb point, and one I hope becomes a primary issue in the US presidential race once the Democratic nominee is firmed up. Your point plays in to Dr Val’s comment that it would be great to see this philanthropy money put instead toward folks unable to pay for science-based medical care.

  8. #8 Joe
    April 23, 2008

    Orac addressed Phoenix Woman’s point by observing that the British National Health System (NHS) supports quackery. As I recall, they granted licensure to chiros a few years ago. They are famous for their homeopathy, and herbalists flourish. Even if these are not paid-for by the NHS, there are people willing to pay out-of-pocket for quackery despite free medical care.

  9. #9 Joe
    April 23, 2008

    The UK bgan licensing chiros ca. 1999 http://www.chiroweb.com/world/uk.html

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