One of the main topics that I've covered over the last four or five of laying down a swath of not-so-Respectful Insolence directed at pseudoscience is the relatively rapid, seemingly relentless infiltration of pseudoscience into what should be bastions of science-based medicine (SBM), namely medical schools and academic medical centers promoted by academics who should, but apparently don't, know better. This infiltration has been facilitated by a variety of factors, including changes in the culture of medical academia and our own culture in general, not to mention a dedicated cadre of ideologues such as the Bravewell Collaboration, whose purpose is to blur the lines between science and pseudoscience and promote the "integration" of quackery into science-based medicine. Certainly promoters of what Dr. Robert W. Donnell termed "quackademic medicine" wouldn't put it that way, but I would. ("Quackademic medicine," by the way, is a beautiful term to describe this phenomenon that I dearly wish I could claim to be the one to have coined but, alas, cannot.) Indeed, promoters of quackademic medicine scored a major victory last month, when a credulous piece of tripe about acupuncture passing as a review article managed to find its way into the New England Journal Medicine, a misstep that was promptly skewered by Mark Crislip, Steve Novella, and myself, among others.
Today, I want to riff a bit on one aspect of this phenomenon. As a cancer surgeon, I've dedicated myself to treating patients with cancer and then subspecialized even further, dedicating myself to the surgical treatment of breast cancer. Consequently, the interface of so-called "complementary and alternative medicine" (CAM) in the treatment of cancer both interests and appalls me. The reason for my horror at the application of CAM to cancer patients, as you might expect, is that cancer is a disease that is highly feared and can be highly deadly, depending upon the specific kind of cancer. Cancer patients deserve nothing less than the best science-based evidence that we have to offer, free of pseudoscience. Yet in even the most highly respected cancer centers, such as M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center, there are departments or divisions of what is increasingly called "integrative oncology." The claim behind "integrative oncology" is that it is "integrating the best of science-based and 'alternative' medicine," but in reality all too often it is "integrating" quackery with science-based medicine. I have yet to hear an explanation of how "integrating" pseudoscience or nonscience into science-based oncology benefits cancer patients, but, then, that's probably just the nasty old reductionist in me. Let's find out.
I was reminded by the level of "progress" in integrating woo into oncology last month when the July 25 issue of HemeOnc Today showed up. Right there on the front page I saw a story Integrative oncology combines conventional, CAM therapies, with a subtitle reading "This growing medical discipline incorporates methods such as yoga, acupuncture and stress management." And so it does. But I worry that that's just the beginning:
The National Center for Complementary and Alternative Medicine defines integrative medicine as treatment that combines conventional medicine with complementary and alternative therapies that have been reported to be safe and effective after being studied in patients.
Lorenzo Cohen, MD, PhD, of M.D. Anderson Cancer Center is conducting a phase 3 trial of the effects of yoga on women with breast cancer.
"Integrative medicine is a philosophy based on treating patients by focusing on the whole person and using both conventional and complementary therapies in a multidisciplinary care fashion," Lorenzo Cohen, MD, PhD, director and professor of the Integrative Medicine Program at The University of Texas M.D. Anderson Cancer Center, told HemOnc Today.
"It is similar to complementary medicine, but one key difference is that there is an open communication between practitioners of the different traditions," he said.
"Between the traditions"? Note the clever use of language that Kimball Atwood is so fond of pointing out. Note how Dr. Cohen equates "conventional" and "alternative" therapies (the latter of which he calls "complementary") as though they had equal validity and equal efficacy. It's just two different traditions! What's the problem with bringing them together, and integrating one into the other? It's the best of both worlds, right?
Also notice another thing. I've referred to certain aspects of CAM, sometimes called "integrative medicine" (IM) and, in this case called "integrative oncology" (IO), as a "Trojan horse" to bring woo into medical schools and academic medical centers. Most -- but not all -- academic medical centers do not use hard core quackery like homeopathy, although many appear to be using a modality just as bad, reiki, which happens to be Dr. Mehmet Oz's favorite modality. In any case, whenever you see discussions of "integrative medicine" and in particular "integrative oncology," chances are, the modalities discussed generally include yoga, various dietary modalities, exercise, and, quite frequently, acupuncture. Sometimes, they include various herbal remedies. In other words, "integrative oncology" rebrands modalities that have no reason not to be counted as part of science-based medicine as "alternative" or "integrative" and points to them as having some promise. They then lump together pseudoscience like reiki and acupuncture with the rebranded modalities, such as herbal therapies. This story demonstrates exactly what I mean in this passage:
According to Cohen, integrative medicine includes a plethora of therapies and methods but can be most easily classified into five categories: biologically based therapies, mind/body medicine, manipulative body-based practices, energy medicine and whole medical systems.
Biologically based therapies include ingestibles such as herbs and supplements, megadoses of vitamins or specialized diets. Mind/body medicine consists of techniques that typically help with stress management. These techniques include meditation, yoga, guided imagery and other forms of relaxation, according to Cohen. Manipulative body-based practices include therapies such as massage, medical acupuncture and chiropractic work.
The most controversial area of integrative medicine, according to Cohen, is energy medicine, which includes techniques such as healing touch, Reiki, a Japanese form of energy healing, or the use of magnets for healing. Healing touch techniques such as Reiki and Qigong, an ancient Chinese healing therapy, are based on the theory that human beings are energetic bodies and certain individuals with specific training can emit energy into another person for therapeutic purpose.
I realize that HemeOnc Today isn't the NEJM, but on the other hand, given how the NEJM recently fell for the pseudoscience that is acupuncture, maybe they aren't so different after all. In any case, this entire article is the sort of credulous treatment that drives me crazy, particularly the last paragraph quoted above. Energy medicine isn't just "controversial": it's quackery, pure and simple, and Dr. Cohen should know that. The best that can be said about so-called "energy medicine" is that it is religion, not science, or that the various modalities that fall under the rubric of "energy medicine" are based on a prescientific understanding of how the human body works and how diseases attack it. Some of them are not even "ancient." Reiki, for instance, only dates back to 1922. It was invented by a man named Mikao Usui, who wanted to find out how Jesus healed the sick. His answer, reiki, is no more than faith healing; the only difference between it and what Benny Hinn does is that reiki is based on Eastern mysticism instead of Christian faith. None of this discussion of "energetic bodies" and the claims that practitioners can either channel some form of "universal energy" or manipulate the flow of human "life energy" for therapeutic intent belongs in science-based medicine, at least until someone can characterize the claimed energy and actually show that these practitioners can actually do anything other than wave their hands over patients.
Cohen also speaks of "whole medical systems." In other words he refers to ancient medical systems, such as traditional Chinese medicine and Ayurvedic medicine, characterizing them as having "their own methods and techniques for diagnosing patients, prescribing treatments and following patients over time." That much is certainly true, but none of these techniques were based on science, either. They were based on much the same thoughts that early "Western" medicine was based on. After all, when you come right down to it, "balancing" or "adjusting" the flow of qi is not that different than the idea that the four humors must be balanced or that disease comes from "contamination" due to miasmas. As Ben Kavoussi has pointed out, there isn't that much difference between the concepts used to justify blood letting as a treatment for disease. Yet, somehow "integrative medicine" and CAM love modalities based on Eastern mysticism. Where's the love for black bile, yellow bile, phlegm, and blood, which make just as much sense, from a science-based standpoint as the concept of qi? In fact, they make more sense, because they, at least, exist and can be observed.
The Trojan horse
Time and time again, when I observe integrative oncology programs, I notice that many of them heavily emphasize modalities like diet and exercise. Indeed, in the HemeOnc Today article, the various advocates and "experts" in integrative oncology emphasized time and time modalities like yoga:
Karen Mustian, PhD, MPH, assistant professor of radiation oncology and preventive medicine at the University of Rochester Medical Center, discussed the findings of a yoga study at the 2010 ASCO Annual Meeting, held in Chicago in June.
Researchers enrolled 410 survivors of non-metastatic disease who participated in the Yoga for Cancer Survivors program. Survivors reported suffering from moderate or severe sleep disruption 2 months to 24 months after completing adjuvant therapy.
The participants were assigned to breathing exercises, 18 gentle Hatha and restorative yoga postures and meditation for 4 weeks with twice-weekly sessions.
Patients practicing yoga had greater improved sleep quality (22% vs. 12%), decreased incidence of clinically impaired sleep (31% vs. 16%) and less daytime sleepiness (29% vs. 5%) compared with those who did not practice yoga.
Adding to these findings, a study of the effects of yoga on women with breast cancer is also in the works. In April, Cohen received a $4.5 million grant to conduct a phase 3 trial in women with breast cancer to determine the improvement in physical function and quality of life during and after radiation treatment.
The results of the study presented at ASCO described above are, of course, utterly unsurprising and unremarkable, at least to me. Would anyone expect that gentle exercise and meditation would harm quality of life and sleep quality? My guess is that substituting gentle exercise and prayer or non-yoga meditation would likely produce very similar results. But yoga is "Eastern," so, you know, it's automatically way, way, way more cool than any boring old "Western" exercises. In any case, I bet I could save the NIH $4.5 million by predicting the results of Dr. Cohen's study. Yes, yoga very likely will be found to improve physical functioning and quality of life, because, by and large as it is practiced in this country (I'm aware that yoga can be quite a workout if you do the more rigorous forms), yoga is relatively gentle, low-impact flexibility exercise. In fact, in women who have undergone axillary dissection (removal of the lymph nodes under their arms), I would predict that yoga probably will decrease the incidence of impaired range of motion. The reason I make this latter prediction is because I already prescribe gentle stretching exercises to women who have undergone axillary surgery because it does decrease the incidence of impairments in range of motion. In fact, I would go so far as to predict that virtually any low impact exercise, be it yoga, Tai Chi, or simply low impact "Western" forms of exercise, such as walking and stretching, would produce the same results.
Oddly enough, I have been unaware of any investigators being awarded $4.5 million to study whether walking preceded by some gentle "limbering up" has all these effects in cancer patients. Why is that? This is the sort of stuff that is well-within the purview of science-based medicine, leading me to ask: Since when did exercise become "alternative" or "integrative"? Dr. Cohen's study compares yoga versus "stretching/relaxation" (which is what I thought much of yoga was; so I'm not sure what the difference is) versus a wait list control group. So my being unaware of such a study is at an end, because apparently that's just what Dr. Cohen will study. But does anyone think that the NIH would have funded such a study if it were about exercise and relaxation rather than yoga? My prediction for the outcome: the first two groups will both do better than the control group in terms of the outcome measures. I also wonder why on earth it will take $4.5 million and five years to answer this question. In any case, given the copious science already demonstrating that low impact exercise results in better quality of life outcomes for cancer patients, I would question the value, the "bang for the buck," of spending $4.5 million in order to study an "alternative" or "complementary" therapy that is nothing more than a fancy form of stretching exercises and relaxation, the former of which is already known to be of benefit in cancer patients undergoing chemotherapy, surgery, and radiation. Surely such a study could be done for $1 million? Heck, for $4.5 million, I could start up a multi-investigator P01 with teams of investigators doing heavy duty basic science.
I know, I know. Sour apples. I really am in the wrong business, at least when it comes to getting research funding. Figuring out how cancer cells grow and metastasize and how to stop them is really, really hard.
In any case, the HemeOnc Today article, as credulous as it is, though, is merely an indication of just how far the concept of "integrative oncology" has gone. To appreciate just how far it has gone, I thought I'd peruse the websites of what are commonly accepted as two of the most respected institutions devoted to cancer in the United States, if not the world.
"Integrative oncology" invades and metastasizes
"Inspired" by the HemeOnc Today article, I decided to peruse the "integrative oncology" website of one of the two premier cancer centers in the country, that of the M.D. Anderson Cancer Center, as well as to take a peak at what the National Cancer Institute website says about various "alternative," "complementary," or "integrative" modalities. What many readers may not know is that the NCI has an Office of Cancer Complementary and Alternative Medicine (OCCAM, perhaps the most unfortunate acronym ever thought of, given what it stands for). Moreover, OCCAM has a budget that is of approximately the same magnitude as that of the National Center for Complementary and Alternative Medicine (NCCAM), in the range of $121 million a year. Thus, OCCAM is potentially as large a force in studying and promoting CAM as NCCAM has ever been.
Let's start with M.D. Anderson first. On its website, it has a webpage called Complementary/Integrative Medicine Education Resources (CIMER). On the CIMER webpage, perhaps the most telling and useful "resource" is a page on therapies. On this page are links to several review articles authored by CIMER staff and physicians in the Integrative Medicine Program of the M.D. Anderson Cancer Center.
Whenever I take a look at a cancer center's website, I go straight for the most hard core quackery to see what it says about it. Usually, I go straight for homeopathy. If a website concludes anything other than that homeopathy is pure quackery and that there is not a single molecule of active substance in most true hemopathic remedies (the dilution and succussion process having diluted it to nothing), then I know I'm dealing with quackademic medicine. Here's an excerpt from what the great M.D. Anderson says about homeopathy:
The practice of homeopathy is based on its "law of similars" which proposes that "like cures like". That is, a substance that causes specific symptoms in a healthy person is believed to ultimately relieve those same symptoms in a sick person. A few homeopathic physicians treat cancer by prescribing minute doses of tumors and carcinogenic substances.
The intent of homeopathic medicine is to help the body begin the healing process. Rather than focusing on a specific diagnosis, prescriptions are tailored to an entire set of symptoms and may vary between individuals with the same disease.
Significant reduction of some side effects of cancer treatments has been reported in two randomized controlled trials justifying further research with larger trials.
Current research includes a National Cancer Institute (NCI) clinical trial of a homeopathic substance for chemotherapy induced mucositis in children.
So far, not so good. The passage above is completely credulous, without the least bit of skepticism about the very basis of homeopathy. It reports homeopathy as a homeopath would report it, which makes me wonder if it was written by a homeopath. Particularly disturbing is the "detailed scientific review" of homeopathy. I'll give the author credit because he at least mentions Avogadro's number. That's "science-y" and at least admits that there is a serious plausibility problem with homeopathy right from the get-go. Unfortunately, the article then credulously parrots the typical homeopath claim that water has "memory" and cites primarily articles from that journal of pure woo, whose editorial standards I've lambasted here and elsewhere time and time again, the Journal of Alternative and Complementary Medicine, as well as homeopathy journals, such as the British Homeopathic Journal. It is beyond the scope of this post to explain why such journals are generally not good sources (someday...someday), but they aren't. The only "real" journal article I saw was the infamous TRAUMEEL S study from 2001 looking at whether homeopathic TRAUMEEL S can alleviate stomatitis in children undergoing treatment for lymphoma and leukemia. (I shudder at the unethical nature of testing magic water in a clinical trial with children as the subjects.) In any case, this study reported a positive effect; however, one might also note this from the study itself:
TRAUMEEL SÂ® is a homeopathic-complex remedy that has been sold over the counter in pharmacies in Germany, Austria, and Switzerland for over 50 years. It contains extracts from the following plants and minerals, all of them highly diluted (10â1-10â9 of the stem solution): Arnica montana, Calendula officinalis, Achillea millefolium, Matricaria chamomilla, Symphytum officinale, Atropa belladonna, Aconitum napellus, Bellis perennis, Hypericum perforatum, chinacea angustifolia, Echinacea purpurea, Hamamelis virginica, Mercurius solubilis, and Hepar sulfuris. Information from the manufacturer indicates that TRAUMEEL S is used normally to treat trauma, inflammation, and degenerative processes.
In other words, this is an herbal remedy in which there is still ingredient, given that even a 10-9 dilution is not enough to dilute away what's in there. Why it's even called homeopathic, I have a hard time figuring out, given that there are many herbs and minerals in there, with no rationale of "like curing like" obvious for them all. If TRAUMEEL S "works," it's not any sort of validation of homeopathy; all it shows is that maybe some of the herbs or minerals in the concoction have a beneficial effect. One also notes that this is a small study (N=30, 15 per group) and that the distribution of disease in the two groups was very different and that this study has never been replicated. Both Edzard Ernst and the Cochrane Reviews note this study but conclude that there is no evidence that homepathy is any better than placebo for cancer side effects.
But apparently not M.D. Anderson. M.D. Anderson appears to believe in magic. If you don't believe me, just take a look at its review on reiki, including the "scientific evidence" for its efficacy in cancer patients, or its review on healing touch, which is more or less reiki shorn of the explicit Eastern mysticism. Particularly nauseating is this introduction to "energy therapy" methods, which divides the very concept of energy itself into "Western" and "Eastern" notions of energy. (Silly me, I thought that energy was energy, and it was defined scientifically.) The author then postulates the "blending" of "Eastern" and "Western" concepts of energy thusly:
Modern physics has shown that light can exist as two interchangeable forms: a particle (form and structure) and a wave (movement and vibration). The rest of nature can also be experienced in the form of a particle and a wave. For example, water in the ocean is both particles of water and movement of coastal currents, thermal layers and tides. As in the ocean, the human body contains and is affected by energy that can be blocked, flow freely or vary in frequency. Various forms have been postulated:
- An all-pervasive background frequency without form that extends beyond the limits of the body structure
- Vertical energy flows that serve as conduits to external energy
- Additional currents of energy with identifiable paths and patterns
The extent to which a background field extends beyond a person reportedly varies with each individual. Some people have said that they are sensitive to these fields - seeing or hearing these projections. Heat emanating from a body is one form of energy and one expression of that person's energy field8.
Notice that no evidence is presented showing that these claims are valid.
The introduction concludes:
Contemporary energy therapies are only recent manifestations of a larger and more ancient body of energetic and spiritual concepts that are beyond the scope of these reviews of a few contemporary energetic healing practices. MD Anderson recognizes that physical healing is only part of the cancer treatment process and also offers spiritual support through many different programs such as the Chaplaincy Services -- representing a wide range of faiths and spiritual beliefs -- and the Place ... of wellness -- where people touched by cancer can enhance their quality of life with activities that help to heal the mind, body and spirit.
Remember, this is the website of the M.D. Anderson Cancer Center, which is widely viewed to be one of the top two or three cancer centers in the United States, if not the world, and its Integrative Medicine Program appears to be based on magic more than anything else. Quackademic medicine, indeed.
Unfortunately, the NCI's OCCAM website isn't all that much better. Because I spent longer than anticipated going through the M.D. Anderson website, I'll wrap it up fairly quickly. OCCAM has some fairly disturbing pages itself. For instance, its Categories of CAM Therapies is a simple list of CAM therapies with little discussion at all other than defining what they are in the way any woo-meister would be happy with. OCCAM is superior to M.D. Anderson's CAM pages in that it does from time to time throw in passages like this:
Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven.
If there is no good science to show that these fields even exist, then why study trying to manipulate them? I never understood putting the cart before the horse like that. There's a lot of that sort of stuff going on in the list of CAM therapies referenced by OCCAM, although a lot of the articles are in fact NCCAM articles. One article on a CAM therapy that is hosted by the NCI and apparently was written by NCI staff is entitled Questions and answers about acupuncture. Depressingly, it begins with a credulous discussion of qi and meridians that is credulous and full of magic. It also contains statements like:
Scientific studies on the use of acupuncture to treat cancer and side effects of cancer began only recently. Laboratory and animal studies suggest that acupuncture can reduce vomiting caused by chemotherapy and may help the immune system be stronger during chemotherapy. Animal studies support the use of electroacupuncture to relieve cancer pain.
Human studies on the effect of acupuncture on the immune system of cancer patients showed that it improved immune system response.
One wonders just how critically the studies to which this article refers were evaluated. Certainly, the lists mix "electroacupuncture" (which is not acupuncture at all -- as Mark says, where were those batteries in ancient China to hook up to the acupuncture needles?) with acupuncture studies. One wonders if this is another case of accepting the authors' misinterpretation of their own results, as I discussed for one such study a couple of months ago. As for the effects of acupuncture on the immune system, the physician's version of the review points out that all these studies were conducted in China, and, unfortunately, it's well known that acupuncture studies from China tend to be overwhelmingly positive, in marked contrast to acupuncture studies from other countries, leading some writers of meta-analyses to question how to handle these studies. In any case, it would appear that the NCI, although its material on its website is not as credulous as that of M.D. Anderson, is not exactly a bastion of science when it comes to some "alternative" medical modalities.
Indeed, let me tell you a brief anecdote. Two years ago, at the AACR Meeting, I visited the NCI booth on the convention floor because I knew there was going to be a representative from OCCAM there. My confidence in the scientific rigor of the entire OCCAM enterprise was not boosted by the conversation I had there. In brief, after a brief (and neutral) conversation about what OCCAM does, I gently challenged the OCCAM representative regarding alternative medicine by pointing out that there really isn't that much evidence for much of it and asking him if he could point me in the right direction. In particular, I asked him why one would think that a mixture of herbal medicines would do better than pharmaceuticals. He then began to pontificate about "royal herbs" and couldn't provide a good rationale why anyone should conclude that impure mixtures of compounds would be more effective or reliable than pharmaceuticals. When he started going on about "emperor" herbs, "minister" herbs, and "assistant" herbs, I couldn't take it anymore and looked for an opportunity to politely excuse myself.
"Integrative oncology": The quackademic oncology that's here to stay?
I first became aware of the phenomenon of quackademic medicine several years ago. Before then, I was blissfully ignorant. Over the last several years, in particular the last couple of years, I've become increasingly alarmed at just how much pseudoscience is finding its way into medical academia in general and into oncology in particular in the form of "integrative" oncology. When the websites of what have in the past been a bastion of science-based oncology, M.D. Anderson Cancer Center and the NCI, become infiltrated with this sort of pseudoscience, I become alarmed. But it's far, far worse than that. I only picked two websites. There are many more out there, thanks to promoters of woo like the Bravewell Collaborative and others. I only picked on M.D. Anderson and the NCI because of their reputation for being much better than this, a reputation they are endangering by their embrace of woo. Cancer patients, as I say frequently, are among the most vulnerable of patients. Many of them are facing a very unpleasant death without treatment; seeing that they receive the most effective medicines and treatments we have, free of quackery, is a moral imperative, and I fear that we will soon be failing our patients. We now even have a Society of Integrative Oncology promoting the "integration" of pseudoscience into oncology.
The Trojan horse of herbals, diet, and exercise in the form of yoga may have breeched the walls of academia, bringing with it pseudoscience like acupuncture, reiki, and even homeopathy, but still I see reason for hope. Val Jones once coined the term "shruggie" for health care professionals who have seen the infiltration of pseudoscience into medicine and in essence shrug their shoulders, dismissing it as not being important or as not being their business if people choose quackery instead of science-based medicine. However, as the infiltration of pseudoscience reached a critical mass, it started to alarm even some of the shruggies. There has been pushback. We here at SBM like to think that we have been a significant part of that reaction, but we also know that there are many others, such as Edzard Ernst, Ben Goldacre, and Simon Singh. Even though a disturbing number of skeptics seem to have a blind spot when it comes to quackery, the broader skeptical movement appears to be taking more and more notice. I only hope that it's not too late. When an admired and esteemed institution like M.D. Anderson goes woo, the woo-meisters are not only at the gate, but they've stormed the bastions, driving defenders of SBM to the keep to make a last stand.
This gives me a great idea for a study. I'm pretty sure you can show a low incidence of cancer in Africa (you have to get past 40 in most cases to develop it). It should be correlated to exposure to witch doctors (which might have to do a lot with the early demise, but we're only studying death by cancer after all). It will require me to spend 6 months in a luxury hotel in Kenya (I need climatised rooms to keep my samples) while studying the local treatment modalities (well documented on expensive recording equipment paid with grant money). When I get to the Phase III I will personally have to go to Africa and shoot the 50 lions required for the lion head dresses for the practitioners, and I'm sure I can find a need to get some leopard skins as well, so it will require creative writing to get by CITES. Inviting Tom Harkin on a fact finding mission should guarantee the follow on funding for commercialization of the practice, so the need for an open fire for the burnt offerings might slow acceptance by some of the major hospital chains.
Would you mind to provide the background section on allopathic oncology and why it's not good unless integrated with full body/mind dualism, and probably some booze?
". . . prescriptions are tailored to an entire set of symptoms . . ."
Isn't that what many woo providers, homeopaths among them, accuse SBM practitioners of doing, treating the symptoms and not the underlying problem? Obviously, M D Anderson must not have got the memo.
Also, from the same page:
Substituting homeopathy for conventional treatment of cancer has been associated with progression of cancer for some people. . .
Why do I want to translate that as "homeopathy does not work, but we will take money for it anyway, since it is a very high profit item"?
My concern about the integrative medical centers at cancer meccas like MSKCC and MDACC is not that they're not helpful to patients - for they sometimes are - but that the reason they're there is largely so that those institutions 1) can draw grants to evaluate "alternative" treatments and 2) bring in more patients, i.e. $$$.
But even if the institution's motivation is greed, and some of alternative Rx is junk (as is, of course, much of what most oncologists offer their patients anyway), still I think it's good that more people have access to unconventional therapies through top cancer hospitals, and that more doctors and scientists are attempting, at least, to describe and examine those "novel" and ancient treatments.
I am unhappily imagining ((shudder)) how alt med supporters will spin this.... similarly alarming is the attempt of woo-meisters to hook up with accredited institutes of higher learning : recently, I looked into the Institute of Integrative Nutrition ( linked via the RI post on NJ *maitresse de woo*, Louise Kuo Habakus ) and found that it is in a "partnership" with Purchase College ( guess the name, unfortunately, says it all) of SUNY offering "distance learning" ( *I'd* certainly distance myself), a "certificate", and c.e.u.'s! Additionally, a well-known woo-meister ( who shall remain nameless temporarily) is promoting his future liaison with an "East Coast University" offering nutritional and life coaching "degrees" ( at a "graduate level"). Consider the incongruity of charlatans with ersatz degrees unholily creating curricula at reasonably respectable accredited colleges/universities! In the immortal words of E.Waugh : it's truely "Sick-making!"
The bottom line: people trust doctors to offer the best options for health. Doctors and hospitals that are involved in ripping their patients off with a "medicine show" are betraying that trust.
Just on the notion of useful alternative treatments for cancer, might i suggest you take a look at this?
Seems to show a large effect on psychological health (which is to be expected) and a small effect on physical health (which is interesting, though definitely not certain).
I think it's good that more people have access to unconventional therapies through top cancer hospitals, and that more doctors and scientists are attempting, at least, to describe and examine those "novel" and ancient treatments.
Do you think Reiki or homeopathy have any chance of working, beyond frank placebo effects? Hopefully not. So why is it good for doctors and scientists to examine these treatments? Wouldn't their time be infintely better spent examining treatments that have an measurable chance of working?
You're doing exactly what Orac wrote about: lumping all those 'novel' and 'ancient' 'treatments' together, as if they all have similar merit. They don't, and you should know that.
The hospitals are happy to lump them all together for exactly the reason you note: greed. What's your justification?
This is all very unfortunate because it's, let's say, drowning the baby in the bathwater. People with cancer are, as Orac says, often frightened and vulnerable and interventions to relieve stress and keep them active and so no are definitely useful. There is a pretty well-developed practice of massage for cancer patients, and as long as people don't make any nonsensical claims for it, obviously it can make people feel better. I was involved in a well-designed trial of an intervention to teach massage techniques to the "natural supports" -- spouses, siblings, adult children, parents, etc. -- of cancer patients and it measured cortisol levels as well as getting questionnaire data. It's not only effective but it's a great way to give concerned loved ones something they can do to help, it can bring people closer together, etc.
So it's terrific for physicians to support that sort of thing for what it is -- yoga, tai chi, meditation, all can be helpful I should think, as Orac says. But mixing it up with nonsense is deeply harmful. It legitimizes the nonsense, on the one hand, while potentially delegitimizing useful palliative techniques on the other hand.
These institutions can easily give people what they want -- some measure of comfort, community and human support -- without getting tangled up in mysticism and fraud. But for some reason they won't do that.
On "homeopathic remedies" I've noticed a similar, disturbing trend to label certain OTC medications as "homeopathic", and then labelling the ingredients (which actually exist in actual quantities in the products making them not truly representative homeopathic medicine) in homeopathic measurements 1X 5X 10X, instead of more traditional percent measurements.
Indeed, as demonstrated by Dr. Strange, homeopathy has become a "buzz-word", not unlike "all-natural" or "organic", and is now being included in places where it just doesn't belong, giving it some undeserved legitimacy.
Just the other day my fiance proudly proclaimed that she'd obtained some "homeopathic" medicine for her horse. When I asked her if she actually knew what homeopathy meant or was, she was completely clueless, but either she'd heard or it sounded to her that homeopathy was "cutting-edge" or in some way better than a bunch of nasty western chemicals. Indeed her defense of it fell under the typical mantra of: "there's no side-effects", to which I duly pointed out that consuming water usually doesn't show side-effects unless you manage to drown in it.
I'm not certain whether this subtle manipulation and inclusion of homeopathy where it doesn't belong is a conscious effort on the part of alt-med practitioners to legitimze themselves, or whether it's advertisers cashing in on consumers who seem to be willing to pay 20-30% more for a package as long as it contains the correct buzz words on the outside.
I can understand the reasoning behind this so called integration and if they existed in a vacuum, it might not be so harmful. But how does one explain to their mother that wasting a large part of her fixed income on "magic hand waving" and water, is a bad idea when some of the best hospitals in a country advocate it?
There are certain professions where you have a higher responsibility to reality than others. Peddlers of woo, who just don't know any better are one thing, but its simply inexcusable for doctors, scientists and people who run hospitals to promote anything that isn't science based. How does anyone get a medical degree and still buy into any of this?
there oughta be a law.
like Poe's law for any modality that incorporates "energy", "quantum" or "eastern" in its title or explanation.
Why are wasting patients time and money on esoteric quack cures in major hospitals when we could offer them leeches at a fraction of the cost? Leeches are plentiful, very obvious and dramatic (and so have the potential to be good placebos). We could rent them leeches at a fraction of the cost of a homeopath, and tell them about how by ancient wisdom it draws out the bad humors in the blood. They are at least strongly in our medical tradition.
The MD Anderson website is a goldmine of woo,including such TCM "treatments" as toad venom,"You basically boil the toad with hot water.The uterus and the brain are "strange organs" "outside the realm of TCM".
And so much more.I'm listening to the talk on Tibetan herbs right now.I just finished Dr.Li Zhishui's memoir about his life as Chairman,and Madame Mao's personal physician.He is especially harsh on TCM as quackery.I highly recommend it.
No, don't rent them; single-use leeches only, and they must be humanely euthanized afterwards. :-P
Would it be possible to have similar woo treatments pitted against each other in the fight for fundings. For example, have Therapeutic ouch (TT) battle it out with St. Blaise's Day's blessing of the throats, and Reiki thunderdome style for funding?
No, don't rent them; single-use leeches only, and they must be humanely euthanized afterwards.
Definitely. Need to think about blood-borne pathogens that might be transmitted from one patient to another, after all.
Peer reviewed studies have shown acupuncture to be effective at treating nausea associated with chemotherapy and both local and generalized pain.
I guess your ego is more important than helping the patient in every way possible.
I doubt there's enough residual "active ingredient" in that poison ivy cream to have any real pharmacological effect. Even though it's only diluted 3X, that's still a 1003 = one million-fold dilution. Thus, the entire tube would only contain ~ 0.1 mg of the original plant (or extract, or whatever they started with). Even most proven efficacious topical drugs wouldn't be active at that dose.
So don't worry - it's still just a placebo! ;-)
But your point is still valid. A better example, IMO, is the Zicam nasal gel that's supposed to treat cold. That's also advertised as homeopathic (or was?), but it contained something like 33 mM zinc! That's a lot of zinc - more than 1000 times the level in your bloodstream.
In that case, I think the company went the homeopathic route because (a) they could, and (b) you don't really have to prove that it even works.
However, I no longer see the nasal gel listed on the Zicam website. There were a bunch of warnings not long ago that it was causing temporary or even permanent loss of smell. Maybe they stopped selling it.
I'm always amused when these sorts of woo are called "ancient."
Homeopathy: Hahnemann, 1796.
Chiropractic: Palmer, 1890s.
Reiki: Usui, 1922.
Acupuncture: In a form that would be recognized as acupuncture today, invented by Mao Zedong, circa 1965.
Peer reviewed studies have shown acupuncture to be effective at treating nausea associated with chemotherapy and both local and generalized pain.
Larger peer reviewed studies have also shown acupuncture to be no more effective than placebo at treating nausea associated with chemotherapy and both local and generalized pain.
I guess your ego is more important than helping the patient in every way possible.
With such conflicting evidence, how is lying to the patient helping them? Ego has nothing to do with it. Evidence and ethics, on the other hand...
Peer reviewed studies have shown acupuncture to be effective at treating nausea associated with chemotherapy and both local and generalized pain.
I guess your ego is more important than helping the patient in every way possible.
But NOT more effective than placebo, which is the relevant question.
Interesting that they place acupuncture in manipulative body based rather than energy medicine even though it's pure vitalism.
Acupuncture may be manipulative in execution, but it is energy based in understanding.
Todd W @14:
"You can reuse the same leech."
"They are neat little creatures...although about 20% will develop infections...from leech gut flora"
"Swallowed or eaten,leeches can be a hazard....Survivors have developed severe infections from wounds inside the throat or nose,when sores from swallowed leeches hae becoe infected."
US Army Survival Handbook,retrieved Google Books
What am I now supposed to think of the integrity of the doctors working at MDACC?
The MD Anderson site is a goldmine of woo.
"Huachansu, a Chinese medicine that comes from venom secreted by the skin glands of toads, may slow the growth of cancer in some patients and do so without significant side effects."
"Basically we boil the toad to death."
"Qi is "mountains forming, forests growing, rivers streaming and creatures proliferating."3 As an internal life force, Qi travels through a fixed network of 12 primary invisible channels or meridians that extend from head to toe. Blood is considered to be a dense form of Qi...
, organs such as the brain and uterus were considered as "strange organs" outside of yin-yang theory. "
Anybody who is interested,ought to read Li Zhisui's memoir. Dr.Li was the personal physician to Chairman and Madame Mao,and was especially hard on TCM as quackery.
Roger Kulp -- I would cook the leeches first if I intended to eat them, and decapitate them. Of course, that presumed I'd ever intend to eat them. :-D
BTW, I was only being slightly silly earlier. There are actually leech farms that produce them for medicinal use in the first world (mainly for limb reattachment surgeries). The leeches are raised in an entirely sterile environment to avoid them developing in any gut flora to produce infection. Still gives me the willies, though. I've only ever had one leech on me, and that was quite enough. Ugly little annelids. Fascinating, but I'd rather not share my personal space with one. (Note, however, that most leeches are actually not parasitic. Just the ones we all know and "love".)
Is UFT/tegafur-PSK-cimetidine or Apatone related infusions for mCRC considered alternative and/or woo here?
"Therapeutic ouch" -- that's accupuncture, right?
Calli, I'm with you. I know that there's some good, solid, scientific reasons for using leeches in medicine. But if they ever have to use them on me, I'd better be unconscious, or I will flip out. The mere thought of it gives me the creepy crawlies.
I was utterly disgusted when I was sent an email from the AMSA (American Medical Student Association) for a CAM conference.
"...a huge opportunity for those interested in CAM, integrative medicine, or in not being stressed."
Plus the only reason why I was interested in attending a med student conference in Davis was to picket the CAM lectures. That or offering my own lecture: SBM and how to spot the woo! It would involve that acupuncture paper from NEJM, some critical thinking exercises while evaluating the paper, and hopefully some minds would start to look at medicine differently.
Talk about hooking them while they are young. I truly have doubts about the future of medicine when this sort of woo is being peddled as an alternative career path to prospective and pre- med students.
Lucrative? Certainly. Disingenuous? Absolutely.
Well if leeches really become popular we might find some way of purging them between patients to get rid of blood borne sickness.
Believe it or not when I first went to the Caribbean back in the lat 60's, I knew a store where they kept a big jar of leeches for rent.
And just like all the other woo, there are many people who have made wonderful recoveries after being treated by leeches.
I have had one on me from swimming in a pond. When you put them in a jug of pond water their body movements and they way they change shape is quite fascinating.
If they can only be used once, we can return them to the wild.
I'd like to take a moment from the usual Viewing With Concern and occasional joke to a rather more practical question:
How does one avoid falling into the power of these quacks? Living in the State of Andrew Weil makes the question rather more immediate for me than for some, but when considering a specialist in a field like cancer (which seems more prone to this nonsense than, say, orthopedics) I need to pick a provider without telegraphing what I'm after.
I should point out that some start by pushing woo on the staff. For instance Stanford has a Health Improvement Program for staff.
Because of HIP's location within the School of Medicine, our health education classes and individualized behavior change programs have a strong foundation in science with an emphasis on sustainable, gradual change. In addition, our experienced staff incorporates new trends into our fitness class offerings, while never sacrificing our commitment to quality instruction.
Good so the staff should be getting scientifically based classes.
Among the classes
Reiki Level 1 Energy Healing
There are several other classes I'm deeply suspicious of and I can't really trust any of the classes to be scientifically based given the company being kept.
(OCCAM, perhaps the most unfortunate acronym ever thought of, given what it stands for)
The philosopher's name can be taken as Ockham, his birthplace.
I am of several minds about the "hardcore" stuff like homeopathy.
1. In many cases, historically and even presently, doing nothing more than placebo IS safer than medicine that turns out to be black boxed or rigged. [I don't agree that this is the correct answer.]
2. If one says that the US is in financial and industrial devolution, such intellectual nihilism is an institutional management way of dealing with some problems that has painted the medical system into (seemingly) their unresolvable corner. Where are the magic answers, and can we afford them?
3. Continuing on devolution, if this society is going to throw the retirees and the poor overboard, as broke societies do, homeopathy is nicer to hear for the gullible than just saying "f- o-"? Much less "euth debates", like in Europe, whether amongst the staff, or the fmailies.
I am of several minds about the "hardcore" stuff like homeopathy. The Mad Max version:
1. In many cases, historically and even presently, doing nothing more than placebo IS safer than new medicine that turns out to be black boxed or rigged. [I don't agree that homeopathy is the correct answer.]
2. If one says that the US is in financial and industrial devolution, such intellectual nihilism is an institutional management response to dealing with problems that have painted the medical system into (seemingly) their unresolvable corner. Management: Where are the magic answers? "beam me out, Scottie"
3. Continuing on devolution, if this society is going to throw the retirees and the poor overboard, as broke societies tend to do, homeopathy is nicer to hear for the gullible than just saying "f- o-"? Much less "euth debates", like in Europe, whether amongst the staff, or the families.
After breast cancer surgery that includes axillary lymph node removal, patients are routinely given a series of gentle stretching exercise to do daily (preferably several times a day) in order to regain full arm mobility.
They work; for a while I thought I'd have to make do with about 80% mobility, but perisited and one day noticed I had full reach once more.
Cancer treatments make you tired; I found that a short walk every day helped me feel less tired. Not a very exciting walk; I'd walk 5 -10 minutes from home, go back to my starting point and walk 5 - 10 minutes in another direction - the idea being I was never too far from home if fatigue overwhelmed me, which happened once.
Taking daily walks or other gentle exercise is advice routinely given on breast cancer support forums from people who've been there to people asking how to combat the tiredness many feel during radiotherapy.
Pay me $4.5 million for that advice...
My God, I love this.
As a Stage 4 breast cancer patient, the whole concept of integrative oncology and its tactic approval/acceptance by reputable institutions saddens and terrifies me.
I belong to an international, on-line support group specific to my stage and type of cancer and there are always several members who are desperately throwing away good money (and time) on assorted modalities of woo, most frequently Americans (Asians mostly shun the woo for SBM). If there is a type of woo being hyped as a cancer "cure", I've known someone who has tried it and almost always swears by it.
Almost without exception, those who are practicing woo (often several types at once) are also receiving conventional treatment. But when the inevitable progression (it is the nature of the disease, no matter the treatment)occurs, the woo continues "because it is working" and the standard treatment is changed or sometimes even dropped entirely.
Now, to me, when progression happens, it means whatever I was using is not effective and it is on to the next in a finite list of drugs. After 7 years with my disease, I still cannot fathom why otherwise rational and intelligent people continue to insist that their woo is working in the face of overwhelmingly contradictory evidence. No amount of valid evidence to the contrary will convince them that the woo is a useless sham.
I depend on my oncologist to give me the often cold, hard facts about where we are and what is next on deck, if anything, and the likelihood of its effectiveness. And perhaps this is where the difference lies, many will shop around for an oncologist who soft-sells this disease and a woo-meister who promises them an easy cure. And well, if healing crystals, vitamin C, Iscador and reiki haven't worked yet, a good naturopath always has had a patient who was cured by a Mexican coffee enemas or a million other woo cures.
A cancer patient, terminal or otherwise, is desperate for a cure, particularly one that promises to be gentle as well as effective and there are few oncologists who could describe chemo and radiation as gentle. In other words, easy pickings for the schysters who offer it, especially if their method has been endorsed by Oprah, Dr Oz, articles in real news papers (not just the HuffPo) and now places like MD Anderson.
qetzal - just on a factual point, 3X is just 10^3, and 0.1% is well within typical therapeutic ranges for certain topical preparations - you're thinking of 3C when you calculate 100^3. Presumably the confusion arises when one considers that if it were really a homeopathic dilution, C (a 1/100 dilution) would be considered highly preferable to X (a mere 1/10 dilution), which further illustrates the confusion when conflating real dosages of stuff with the homeopathic woo. Using X means you can make even totally reasonable dilutions seem mystical.
"many appear to be using a modality just as bad, reiki"
I would disagree. As I understand it, reiki openly claims to have a supernatural basis. (It also appears to incorporate massage techniques that could be beneficial. Homeopathy, in contrast, is a system of magical beliefs that have been rationalized with pseudoscience. Personally, I would have little problem with homeopathy, if they replaced "water memory" with "magic".
Incidentally, Heidi stevenson has followed up her ill-advised hatchet job on Barrett with criticism of Christopher Hitchens' choice to receive chemotherapy.
Healing & Wellness
By John Boles
Healing: I have noticed a strange trend afoot in popular New Age culture. For several years I have been keeping an eye on this area with a sort of morbid fascination, always wondering what silly new quack trend will surface to fleece gullible marks. Along with the internet, I read paper publications like Natural Awakenings, Body Mind Spirit Guide, CoSozo Living, and formerly the now defunct Phenome News. I find these free magazines in the entrance of my nearby WHOLE FOODS, the grocery store with the homeopathy department. These magazines are a mix of stories about nutrition, psychology, most anything from rearing children to pet care, yoga to weight loss. The advice given ranges from obvious things like eat vegetables, exercise, donât smoke, etc., to soundly debunked notions like human energy fields, crystal therapy and astrology.
These publications use key buzz words like holistic, alternative, integrative, intuitive, which to me are red flags of magical thinking. In some ways it reminds me of optimistic business-speak like âleveraging synergies to energize new paradigms.â When done correctly it can fill a page without actually saying anything meaningful.
What strikes me is their use of the word âhealingâ. On the front page of CoSozo Living is always the phrase âHealing Togetherâ. I wonder what they mean by healing. I bet it is not healing a broken bone or a bleeding cut, but rather a vague psychological kind of healing which would respond to placebo treatments. Who is the typical mark, er, client for such things? It seems to me that these publications aim mainly for suggestible middle aged women who are feeling the years, donât eat right or exercise enough and are gaining weight. They seek magic bullet âtreatmentsâ to relieve the little chronic pains (both physical and emotional) of aging, where a placebo is well suited to provide temporary relief.
Just what do they mean by healing? Steve Salerno, in his blog âSHAMblogâ said, ââ¦womenâs magazines and their collective assault on female body image and the likeâ¦â Then perhaps the word âhealingâ is an attempt at emotional recovery from the combined damage done by womenâs magazines and the popular âself helpâ movement, which critics claim has done more harm than good. I perceive a vicious cycle in it all; womenâs magazines and self help books do the damage, then the victims seek relief offered by those advertising in the magazines named above. Of course since it was all in the mind anyway, the placebo âtreatmentsâ seem to heal the damaged psyches.
New Age is religion in a jump suit, and offers an amazing range of laughable âhealing modalitiesâ such as âchanneled healingsâ, âenergy healing for animalsâ, âreconnective healingâ, âspiritual healingâ and âcrystal healing therapyâ to name a few. Deep down, I feel sorry for those who pay good money for some ditzy âenergy healerâ to essentially play ouija board with them.
Wellness: More alarming is the use of the word âwellnessâ by mainstream health care providers. It seems to me that they should use only the word âhealthâ in describing a patientâs condition, but more and more the word wellness is creeping in. What exactly do they mean by wellness? To me it suggests that they are making room for quack providers of âhealing modalitiesâ in to what used to be scientific evidence-based medicine. So when you go to the hospital for a broken leg, you will not only get the leg set in a cast but also have a session with a therapeutic touch provider, a Reiki master, and an acupuncturist. The quacks have been pounding on the door of HMO companies and hospitals for decades, they want their piece of the huge pie that is the US health care, $2.5 trillion each year.
I get a kick out of all these âenergy healingâ claims. If they can heal anything then they should go to hospitals as teams of ten and go from patient to patient, stand as a group around each bed and do some healing. Show the world that energy healing works! Look at how well scientific medicine works; antibiotics and surgery and all the rest. Thus far, no energy healer has ever done anything beyond a placebo!
Found your articles while looking for an Integrative Oncologist to to follow me now that I have completed the best of allopathic care for lobular breast cancer- sentinel node biopsy, neoadjuvent chemo, mastectomy and radiation. And while I appreciate and even share your "show me the evidence" attitude, I find your articles seriously misleading and misinformed starting with basic definitions. The term 'Complementary medicine" most often refers to traditional therapies(many with much more longstanding evidence based track record than allopathic medicine) that can be used ALONG WITH the allopathic standard of care. 'Alternative medicine' includes therapies to be used instead of the allopathic standard of care. If you are going to slam CAM at least have a few acupunture treatments for a particular problem, or experience Reiki or Healing Touch before putting them down as a waste of time. And while I agree that $4.5 million to study the effects of yoga as a complementary approach is a no brainer, many physicians treating women with breast cancer still do not recommend any specific regiment of exercise or movement thereby leaving the newly diagnosed woman without any clear guidance or assistance. Talk to your patients!!!
Some basic rules before commenting on a blog or forum:
1) If you find an article through Google, before commenting go to the first page and see what is under discussion (especially today!)
2) Get to know the place, lurk for a while.
3) Become familiar with the writing style, especially in how issues are discussed. Anecdotes are not considered data.
4) Actually read the article and comments before commenting.
5) Try to proof read your comments (okay, we don't all do that).
6) If you think you want to bring a subject up to the participants' attention, please use the search box on the upper left side of this page to see if it has been discussed before. (I would suggest you use the search box on "allopath", which is considered an insult term)
7) If you get an error when posting a comment, before posting again... open another window to see if it was actually posted.
"If you are going to slam CAM at least have a few acupunture treatments for a particular problem, or experience Reiki or Healing Touch before putting them down as a waste of time."
The problem is in the scientific data: 'healing touch' is complete nonsense and was proven to be bullshit by a gradeschooler. See:
Stuff like acupuncture and Reiki have proven to work no better (no has the existence of anything like 'chi' been demonstrated scientifically). As far as I'm aware, you could be jabbing knitting needles at random into your back and get the same effect - any of the benefits have come from the massaging or stimulation of the muscles and not from any special qualities about acupuncture, hence, letting yourself get stabbed by needles to stimulate 'chi' is rightfully considered stupid.
Re: Reiki and Healing Touch
You may be interested in this study on therapeutic touch. Basically, reiki, TT and similar "energy healing" methods are nothing other than faith healing. They might make you feel good; they may help you to relax. When it comes down to it, though, they don't actually do anything real. Rather than waste your time and money on someone waving their hands over you, get a massage or take some time to meditate or drink a cup of tea. The end result will be the same, and the meditation and/or tea are a lot cheaper.