I've spent a lot of time in Cleveland. Indeed, I lived there for eight years in the late 1980s and early 1990s, during which time I completed my surgery residency training, completed my PhD, and, even more importantly, met and married my wife. Even though I haven't lived there for nearly 20 years—I can't believe it's been that long—I still have an affinity for the city, which is perhaps why I've had a tendency to come down hard on venerable Cleveland medical institutions that turn to quackademic medicine, one where I trained (I'm talking to you, University Hospitals of Cleveland) and one where I did not (you, too, Cleveland Clinic foundation). Both are hip-deep in quackademic medicine, but of the two, the Cleveland Clinic appears to have embraced woo far more tightly. For instance, it achieved notoriety for opening a traditional Chinese medicine clinic staffed by a naturopath who uses homeopathy (but I repeat myself) and then followed up that bold foray into quackification by hiring Dr. Mark Hyman, arguably the foremost proponent of the "holistic" specialty dubbed "functional medicine." Add to that the CCF's enthusiastic promotion of "complementary and alternative medicine" (CAM) including acupuncture, in pediatrics, and truly you have a paradise of quackademia. Clearly, pseudoscience is now "baked in" to the CCF's DNA.
Unfortunately, it goes beyond just the CCF and UH. Indeed, I was annoyed to see an article yesterday in a publication I routinely used to read when I lived in Cleveland, The Cleveland Scene, where Brandy Schillace, the public engagement fellow at the Dittrick Medical History Center and Museum and the managing editor of Culture, Medicine and Psychiatry. wrote a credulous fluff piece entitled On 'Alternative Medicine' in Cleveland, Where 'Hospital Medicine' is the Prescription of the Day. Starting out by tracing the history of hospital medicine in Cleveland back to the founding of the City Hospital in 1837 to the evolution of medical powerhouses like the CCF and UH, Schillace tries to put alternative practitioners smack in the center of things:
These days, Cleveland medicine brings to mind the Cleveland Clinic, University Hospital or Metro, but the history of Cleveland—once a wild and wooly western town—includes far more mavericks and bold independents than many realize. And while these institutions get a larger share of the press, alternative and independent practice continues to thrive.
How does this enclave support the Cleveland community? And in what ways has it captured the enterprising spirit that brought Cleveland from swampy Cuyahoga backwater to thriving medical center?
I have little doubt that some of these "alternative medicine" practitioners have an "enterprising spirit." So did Kevin Trudeau. The question is not the go-get-'em entrepreneurial spirit, but rather what they do, which ranges from the benign (yoga and Pilates) to the quacky (acupuncture and myoskeletal alignment):
Tom Ockler, an alternative physical therapist, hails from Buffalo but has been practicing in the Cleveland area for 37 years (Alternative Healthcare Solutions).
Anne Kinchen of Cleveland Acupuncture began her practice in 1999 as one of the first 10 acupuncturists in Ohio. They represent those working longest in our community, but they are joined by some relative newcomers.
Marque Garaux, a climber and former Marine, practices, teaches and leads Mysore Ashtanga yoga at Harmony Studios in Willoughby (Yoga Marque). He has studied at the K. Patthbi Jois Ashtanga Yoga Institute in India, where yoga is understood as a whole body health practice.
Newest to Cleveland are Joseph Watts (Watts Integrative Manual Therapy) and Kari Watts, relocated from Lexington, Kentucky. Joe practices a unique form of manual therapy; more than massage, he uses techniques from lymphatic drainage to myoskeletal alignment. Kari works as a small-class Pilates instructor.
For example, Anne Kinchen is an acupuncturist who uses acupuncture and traditional Chinese medicine to treat infertility, claiming, "Traditional Oriental medicine offers infertility patients much more than just adjunctive before and after acupuncture treatments" and that "TOM has a long and established history for the regulation of the woman’s menstrual cycle, as well as treatment for various male infertility issues." Neither of these are, of course true. Acupuncture does not improve, for instance, in vitro fertilization (IVF) success rates. No matter how much acupuncturists claim that acupuncture assists IVF, the very studies they cite do not support the hypothesis, nor does acupuncture help for polycystic ovary syndrome, one of the most common causes of female factor infertility. Yet, thanks to anecdotes and bad science, acupuncture is frequently offered not just at CAM and "integrative medicine" clinics but at actual fertility clinics. It doesn't work.
Then there's Joseph Watts. One thing that a quick Google search revealed was something that wasn't revealed in the article. Watts is Schillace's brother:
— Brandy Schillace (@bschillace) September 7, 2015
She's also not shy about promoting her brother's business on Twitter:
— Brandy Schillace (@bschillace) September 8, 2015
She also re-Tweets a fair number of his Tweets.
Personally, I think that disclosing that two of the people interviewed in the article are your brother and sister-in-law would not be just appropriate, but mandatory, but nowhere in the article does Schillace state that Watts is her brother. In any case, Watts offers everything from lymphatic drainage (which can be a legitimate technique to treat lymphedema but is often infused with serious woo) to myofascial release, the latter of which which is quackery. In any case, these "alternative" practitioners are presented as brave maverick practitioners. Naturally, they were quick to expound on the "individualization" of their treatments:
So what is this unique difference? As soon as I asked the question, I felt the energy of the room shift. Leaning forward in their chairs, the five practitioners eagerly shared: “Individualized attention.” “Getting to know the patient.” “Treating them as they need to be treated, not as time or insurance companies dictate.” Joe considered the difference to be threefold: Individual Orthopedic Testing, Time, and Self-Care.
Of course, without a sound scientific basis to "individualize" treatments, what "individualization" of therapies in alternative medicine usually means, more than anything else, is making it up as you go along.
They also expressed concern about the large hospital systems (such as the Cleveland Clinic and University Hospitals) offering alternative therapies now. What do you think their concern was? Basically, it was a fear of rules telling them what they can and cannot do:
Anne and Tom were quick to point out that alternative practices have been thriving elsewhere, as well. “Clearly, there are more people interested in medical alternatives,” Anne said—but the hospital systems have taken up that cause, too, which is a kind of double-edged sword. Physical therapists and acupuncturists who work within the system necessarily have to abide by the rules of that system, and that means potentially compromising on a patient’s needs.
In other words, medical centers, whose leaders delude themselves into thinking that the quackery they are "integrating" into their "integrative medicine" clinics and centers, is evidence-based, use what they perceive that evidence base to be to limit the true alt-med practitioners from making it up as they go along unfettered by concerns about evidence. I know, I know, that's not what they say, but it is what they very likely mean—other than the delusion about the quackery being evidence-based given that it's a delusion they share. This idea pops up again in a different form here:
Today, with the advent of Cleveland Clinic’s Center for Integrative Medicine, “alternative” therapies have become better accepted by the mainstream, and yet by mainstreaming the therapies such centers have overshadowed what was originally “alternative” about them. The received narrative becomes potentially one-dimensional, and, after all, a practice that evolves in the hospital system will necessarily take on the character of that system. Moving out of that system provides freedom, but can be isolating. “I miss sharing with colleagues,” Tom explains—adding “I also miss days off!” We laugh. But it’s true. These independents work long hours to make what they do transparent, translatable, and understood. And yet, they are the unheard voices.
It depends on what you mean by "unheard." Personally, I think such voices are, unfortunately, heard all too well. For instance, I once looked at how many alternative medical practices are just within a mile or so of my house. There are at least four chiropractors, one of which is a one-stop shop for quackery that offers everything from chiropractic, to infrared saunas, to "detox foot baths," to "energy healing." Then there are at least three or four other alternative medicine practices, including a reiki practitioner; a practitioner who offers naturopathy, traditional Chinese medicine, DNA activation (yes, DNA activation), homeopathic drainage, and cranial sacral therapy; and a practitioner within walking distance of my house who advertises her reiki and TCM services on cable TV. I'm sure I've probably missed one or two, and I also know that if I expand the search radius to five miles from my house there are probably a dozen such practitioners. Count the run-of-the-mill chiropractors, and the number is probably at least double that.
Quackery is everywhere. From the standpoint of economics and competition, I can understand why quacks might be afraid that the big guns are moving in on their action. For example, if I want to drive 25 miles or so, I could be treated with anthroposophic medicine at the University of Michigan. It's in Cleveland as well, big-time. Just the other day, Mark Hyman posted a picture of himself in a shelled out office space, exulting in the 18,000 sq. ft. space that will be the new home he Cleveland Clinic Center for Functional Medicine:
Yes, the highly dubious "integrative" medicine known as functional medicine is a centerpiece of the Cleveland Clinic's integrative medicine center, which already offers reiki, acupuncture, craniosacral therapy, traditional Chinese medicine, and more.
Not surprisingly, Schillace concludes with what I like to call the "they thought this was quackery, but now it's becoming accepted" appeal to popularity:
As Cleveland continues its rise as a medical city, some of its most foundational and hardest working members have been strangely overlooked. Some people likely don’t even consider massage—or yoga and Pilates—as therapies. Others might think acupuncture and physical therapy only work for the “believers.” And still others view independent practice with suspicion: surely “real” medicine belongs in a hospital…
History tells a different story. Looking back at the bizarre and brilliant tales that built our city—on doctors who took chances, who knew their patients as they knew their neighbors, and who sometimes went against the grain—I see Cleveland’s finest moments. Looking at this room of alternative practitioners, men and women working to heal the human at the center of medicine, I see our greatest inheritance.
I also can't help but point out that she also sees her brother.
When I see a room of such practitioners, I do not see the best Cleveland has to offer I see a part of medicine that is not supported by science and is thus far from the "greatest inheritance" of Cleveland medicine.
And they complain about Conflicts of Interest among skeptics, even when none exist. Here is a major COI - the writer indeed should have noted that the one practitioner and his wife are related to her, and that she is also a patient of theirs.
This is bad journalism.
Another well written article Orac!
I have tried acupuncture and it was....WORTHLESS.
My princess does it all the time and she is...PRICELESS.
Humans are wonderfully complex!
" I felt the energy of the room shift"
One thing that a quick Google search revealed was something that wasn’t revealed in the article. Watts is Schillace’s brother
Bad enough that the author did not disclose the relationship, but where was the editor? Schillace wasn't the only one who violated journalistic ethics here. The editor(s) should have known, as well.
And yet, they are the unheard voices.
If these voices were truly "unheard", why is there such a demand for their services? I'll go farther than Orac here: the author and editors knew, or should have known, that this statement is false.
Others might think acupuncture and physical therapy only work for the “believers.”
I hate that she lumps these two together. It’s sad that people don’t know that PT is valid with solid training behind it and is prescribed overseen by an MD . It’s similar (though not as egregious) with psychology and psychiatry. Loads of people don’t know the difference.
The more mainstream institutions adopt this sort of thing, the more people start to believe there's actually something there, the more demand there is, the more institutions feel pressure to adopt it.
So the alternative practitioners go along, taking money and delivering nothing in return, and all the while, the evidence that there's nothing there continues to pile up.
Personally, I think that disclosing that two of the people interviewed in the article are your brother and sister-in-law would not be just appropriate, but mandatory,
Hell to the yes. That requires disclosure.
@Eric Lund --
The editor(s) might not have known. In fact, assuming the publication has any kind of claim to journalistic integrity at all, they must not have. It's obviously a COI.
"They also expressed concern about the large hospital systems (such as the Cleveland Clinic and University Hospitals) offering alternative therapies now. What do you think their concern was? Basically, it was a fear of rules telling them what they can and cannot do:"
Fear of competition and angst over supplement industry money flowing to big-time institutions probably play a role in their "concern" as well.
Cleveland Clinic's "functional medicine" operation is getting a big cash infusion from a supplement company:
I doubt that Bozo Health Care and Yoga Solutions has access to the kind of money Cleveland Clinic is getting from Big Supplement.
A brand new 18,000 square foot office is one heck of a powerful placebo. That's even a testable hypothesis if there's any reliable way to keep track of the outcomes from that place, as compared to the dingy scruffy ones that have been around Cleveland since before the germ theory of disease.
COI: Time for everyone here with M.D. after their name to bombard the editor and publisher with email, and don't forget the postal mail on your office letterhead.
Yes it really did read like a puff piece. Whatever he was puffing on must have been strong. The only dead giveaway that's missing is a phrase that abuses the word "experience," as in, "a powerful healing experience." Sorry if that made anyone here queasy.
I am truly at a loss to understand how this dreck has oozed its way into every nook and cranny.
For example, if I want to drive 25 miles or so, I could be treated with anthroposophic medicine at the University of Michigan.
I'm still p!ssed off about this.
Remember, you can't spell "Schillace" without "Shill"!
Does this involve the memory of shit?
Not to quibble, but seeing that the NFL season is underway, shouldn't alternative medicine be "lionized" in Detroit?
The Cleveland Clinic is into "brown"-nosing the purveyors of woo.
(sorry about that)
I think the people responsible for this nonsense should be lionized...like the Romans lionized the Christians.
...and yet by mainstreaming the therapies such centers have overshadowed what was originally “alternative” about them.
So it's only good when it's fringe? That lends credence something I've long suspected: that for at least some people the draw of alternative medicine is the feeling of superiority that go along with knowing "secret knowledge".
Physical therapists and acupuncturists who work within the system necessarily have to abide by the rules of that system, and that means potentially compromising on a patient’s needs.
Those pesky rules like infection control. Everyone knows it's hard for acupuncturists to detect meridians through gloves.
I’m still p!ssed off about this.
As am I. I did, after all, graduate from U. of M. twice, once with an honors undergraduate chemistry degree and then again from U. of M. Medical School. Let me tell you, there was none of this quackery there when I attended.
A co-worker's daughter is now attending the Northern School of Medicine. I was sent the link to the textbook site, and one of the textbooks you can download is Rakel's Integrative Medicine.
I scanned through some chapters. They recommend homeopathy for headaches because there are little side-effects(!), they have some chapter authors claiming such-and-such herb is good (e.g. ginko) because "my patients" benefit from it (anecdotal evidence), the ginko studies which showed no effects on Alzheimer's were rejected as the people were too "old" to show improvement, yet the chapter author accepts one study that showed people could improve even though it too had "old" people.
There's a lot of nonsense from the chiropractor side too, some specific meditation techniques that elongate telomeres, which in turn promote a variety of health improvements,...
...and just read about reiki: "Although no specific
studies have been conducted in children with RAP (recurring abdominal pain), this therapy
has no serious side effects and is considered safe".
Craniosacral therapy is also given recommendations, and long-distance healing and prayer are also recommended for some situations (again, because there's little possibility of harm as long as more "traditional" medicine is adhered to.
Even the parts where they took a stand were weak. E.g. little evidence for link between mercury and autism, although some subgroups may be susceptible.
Some chapter authors seem to be a bit more evidence-based so the final book appears to be a conflicting mass of evidence vs anecdotes. Bad studies vs good studies but with no way of distinguishing between them (Geir and Geir are cited, btw, and not to debunk either).
I don't know how much the school will rely on the book, or what context they'll put it in, or even what courses they'll be teaching, so maybe they'll be using it sparingly or will skip over the alternative modalities.
…and yet by mainstreaming the therapies such centers have overshadowed what was originally “alternative” about them.
So it’s only good when it’s fringe? That lends credence something I’ve long suspected: that for at least some people the draw of alternative medicine is the feeling of superiority that go along with knowing “secret knowledge”.
I was into alternative medicine before it was cool, man.
Does ICD-10 have procedure codes for woo treatments?
Alternative medicine lionized
Wait, it was shot by a sociopathic dentist?
If Alternative Medicine turned off one of its X-chromosomes, it would be Lyonised.
a minor point worth consideration:
The use of the term "alternative medicine" implies that there is medicinal value to these treatments.
A better phrase would be "alternative TO medicine."
Bad studies vs good studies but with no way of distinguishing between them
Oh, it's easy to tell the difference. "Good studies" are the ones that show the kind of results the textbook authors/editors want, and "bad studies" are the ones that don't. As far as this textbook is concerned, methodological flaws or failures to replicate are irrelevant. Any questions?
True, that's not how it works in the reality-based community. But since when are these woo-pushers members in good standing of the reality-based community?
If Alternative Medicine turned off one of its X-chromosomes, it would be Lyonised.
If Alternative Medicine were sliced thin and pan fried with butter, caramelized onions, and parsley it would be Lyonnaised.
If Alternative Medicine were set to music by The Eagles, it would be Lyin' Eyesed.
While I don't "believe" in acupuncture, I can see that some temporary relief MIGHT be caused simply by stimulation of endorphins. The mystery to me is that I have seen close to "instant" improvement in HORSES after acupuncture that had long-lasting effects. I just don't get that. Obviously, the horse has no confirmation bias. The solution for many lamenesses/injuries in horses is simply rest, so had the horse(s) in question improved a week or a month after the acupuncture "treatment," I would simply ascribe it to, well, that's how long it took for the injury to heal. But this was an immediate and complete/long term improvement. I would not choose to use such treatment for my horse (the horse itself is a sufficient vehicle for spending $$$ without useless therapies). I don't know where the ALT canon using acupuncture with a TENS machine fits, but the cases I saw did have TENS hooked up to the acupuncture needles.
I was under the impression that lymphatic drainage was pure woo. Are there any sources about how it can be used in genuine therapy?
And if altmed were whisked together with an egg yolk, lemon juice and olive oil, would it be mayonnaised?
(I'm waiting for Groucho to make an appearance).
I'm not sure.
But if it became part of the international banker-communist global conspiracy for world control and domination, it would be zionized!
It looks to me like ICD-10 will have coding for woo. And there's some feeling that ICD-11 (which probably is only a few years away from adoption in the U.S.) will be more woo-friendly:
"ICD-11 also will include more non-traditional vocabulary. Western science does not represent the world’s only approach to health and wellness. Terms such as “prana” and “qi” (meaning “life force” in yoga and one form of Asian medicine, respectively) may be found alongside items like “blood pressure” in future code sets, since they are considered to be of equal importance in many parts of the world."
Of course, this doesn't mean that insurers will be paying out for treatments to enhance your qi. But they'll be under increasing pressure to do so.
And it if caught Bovine Spongiform Encephalopathy, it would be prionized.
If it got a little abscess in its eye, it'd be stye in eyes'd.
If altmed were recharged it would be LiON-ized.
Lions are negatively charged. Because cat-ions.
And if altmed was a giant huntsman who was killed by a scorpion and elevated to the stars by Zeus, it would be Orionized.
That's my last one, I swear. Maybe.
If it were run through a toxin-sucking footbath, it'd ionized.
If the future timeline of altmed were set down in a long-form calendar which was later hilariously misinterpreted, to the disappointment of New Agers everywhere, it'd be Mayanized.
To Erik1986: In 1984 I took a horse to a highly respected equine vet for another problem, and in the course of our long conversation he confided that he was quietly using acupuncture on some of his thoroughbred patients in training. He also said that he was not seeing an effect that coincided with recovery from rest. The results were sometimes immediate.
I've never read any compelling evidence for using acupuncture on any human problem, but people who study affective behavior and placebo in animals are beginning to talk about another perhaps unknown dimension to their response to such treatments.
I saw this dramatic improvement for myself in one of his patients who had a fetlock strain. It was remarkably fast and obvious--and very puzzling.
If altmed were a Vibrava that evolved it would be Flygon-ized.
I am all for dissolving Alternative Medicine in caustic soda so it is lyeonised.
Sara @38: How exactly was this "dramatic" improvement measured though? Was it something like length of stride or speed of walking? Or did it just look "improved" to everybody?
Also, was it pure acupuncture - i.e. just needles - or was it accompanied by something extra, such as massage or TENS?
I’ve never read any compelling evidence for using acupuncture on any human problem, but people who study affective behavior and placebo in animals are beginning to talk about another perhaps unknown dimension to their response to such treatments.
"Beginning"? Acupuncture on horses has been as common as dirt for years,* and been less valuable in the long run.
The real question is when someone will finally take serious note of anantine chiropractic.
* Oh, wait, you know this, as the quiet communication was 31 years ago.
If altmed was baked and served with pineapple slices and maraschino cherries on toothpicks, it would be Hawaiianized.
And if it was the lineal descendant of a wealthy or notable family, it would be scionized, though still not science-based.
Alright, enough. Any more "lionize" jokes, and I will change the title of this post. I mean it. It was amusing at first, but now it's starting to irritate me.
Well, now I can't use my one involving two meanings for "unionized". Dang.
Erik1986 @ 26 and Sara @ 38: Most interesting.
I'm highly skeptical of quackupuncture, but what you've described has two elements needed for a decent research project:
a) The horses have no beliefs about acupuncture so there is no issue of unblinded treatment or belief-related effects.
b) Presumably there are objective means to measure improvement if any in horses' conditions via standard tests of performance at movement tasks.
Ideally have five groups/conditions for testing: No treatment aside from rest, sham acupuncture (those pressure things that aren't needles), acupuncture only, TENS only, and acupuncture plus TENS.
Have skeptical observers watching closely, and take video of all treatment conditions.
Have independent, unrelated, blinded veterinarians diagnose each horse pre-treatment, and evaluate each horse post-treatment.
How to get sufficient N of horses remains to be seen, but not impossible.
I'd support a project like that getting funded. I'm inclined to think that if there's any benefit to be found, it would be in the TENS groups. If there's no "there" there for the acupuncture, this should put another "mysterious claims about animals" myth to rest. And if acupuncture actually does produce an improvement, that would be surprising but interesting enough to go looking for a mechanism.
@IKZ: Discussed when it came out.
And when the corresponding author was unhappy at criticism:
I sincerely apologize.
FWIW, none of what I wrote was intended to reflect on, mock or otherwise criticize the title of the post in any way whatsoever. In retrospect, I can see that it was thoughtless in that regard. But it was honestly just idle wordplay.
Nothing to apologize for. It wasn't your fault it got out of hand or that for some reason when I started perusing the blog this morning the "lionized" jokes started to irritate me enough that I thought about changing the title of the post.
@ Gray Squirrel
a) The horses have no beliefs about acupuncture so there is no issue of unblinded treatment or belief-related effects.
To nickpick, horses (and any animal cared for by humans in general) do have beliefs about human intervention: they know/have been conditioned to expect that whenever one of their caregivers is approaching them, something is going to happen.
This something could be good (food, petting, going for a ride) or it could be bad, of course. Either way, approaching an animal is not a neutral event for the animal.
Hence the need for a proper placebo, i.e. a sham treatment, which you appropriately included in your proposal, so I am somehow belaboring the point.
The story of Clever Hans is here to tell us that, if a horse "wants" to make us believe into something, it has a good chance to succeed in fooling us. Including skeptical and trained veterinarians.
It's just a matter of mutual expectations meeting midway: the animal wants to please his caregivers with the proper behavior, and the caregivers expect the animal's behavior to improve.
Regulars know by now the supposedly lack of placebo effects in animals is a trigger button for me :-)
Another regular remarked that a number of animals are good at hiding pain, especially out of fear, so if "pretending" to be better allows Fluffy to avoid being stuck again with a few dozens annoying needles...
Just a quick update on that Integrative Medicine textbook I mentioned in this thread. It isn't necessarily used by the medical school as students are able to upload any textbooks they have to the site providing they're relevant textbooks that have the potential to be used by the students. That is, the school doesn't strongly vet the books, and maybe the school itself hasn't gone all "integrative" by recommending homeopathy, distance-healing, reiki and prayer because "it will do little harm".
Being a clinical professor for only 3.5 years now all of my efforts to thwart the bs promoted by the Cleveland clinic have been fruitless. Makes me ashamed to work here.
"I could be treated with anthroposophic medicine at the University of Michigan"
Damn, I thought those pages were gone, but maybe you just can't get to them from the Cancer Center's web pages easily anymore. I suppose I will start lobbying again at medical school level, but I don't expect it to die easily. It appears we are looking for a new director of integrative medicine:
Hi there; yes, I wrote the article. My apologies, actually about non-disclosure. I didn't realize that hadn't made it in to the last version. You'll have to forgive me for the oversight--it's a local publication and I've been vocal about the connection round here so I somehow hadn't noted that the disclosure wasn't in the footnotes at least. (I emailed the editor, so thank you for pointing this up--). But: As to quackery: that is partly the interesting bit to me. I study historical quackery or things that were at least thought of as such. Fascinating material--but you have to be conscious too of cultural identification. That is, would you say these alternative therapies were 'quackery' in their own cultural contexts? Or only when they appear in the west? It's a good question to pursue, given how much the West tends to see its medical practice as primary and somehow more legitimate. I am mansging editor of an anthropology journal, and we talk a lot there about cultural blindness and the accidental patronizing of other cultures practices. At the same time, I see the problem of importing such things into our own culture without that crucial context. I think it's worth talking about. But be thing you are definitely right about (and which I mention): the Clinic has embraced much of it. Is that a problem in your estimation? Or just another avenue of care, offered in one place among others? (Or both). Useful discourse I think.