No, it is not okay to give patients a treatment with no proved medical benefits

Et tu, Scientific American?

A few of you seem to know what will catch my attention and push my buttons, because over the past couple of days a few of you sent me an article published in Scientific America by an internal medicine resident named Allison Bond entitled Sometimes It's Okay to Give Patients a Treatment with No Proved Medical Benefits. Yes, a title like that is akin to waving the proverbial cape in front of a bull. Of course, I doubt that Bond herself came up with that title; editors usually come up with such titles. Still, the title is a fairly accurate summation of what is being argued in Bond's article. Unfortunately, it's a profoundly misguided argument.

The article begins with a sad tale, but one that is unfortunately not that uncommon: a young woman in her 20s with a very severe chronic disease that had "ravaged her body, giving her the appearance of a woman 30 years her senior." A grim picture is painted:

As a first-year resident physician, I was caring for her in the intensive care unit during her fourth hospitalization in just a few months. She had life-threatening liver disease and signs of a serious infection, and when she first was admitted, she was tearful and shivering, writhing in pain and clutching her mother's hand. Her body's own defense mechanisms had destroyed her liver, which in turn had seriously hampered her immune system. It unfortunately wasn't surprising, then, that we found numerous infections in her liver and lungs. Once these pockets of fluid were drained, and after she had received antibiotics and pain medicine, she became more comfortable and more stable.

I remember caring for equally ill (or even sicker) patients with stories just as tragic and who were suffering. It's a hard lesson that we as physicians learn in our first couple of years of residency, because being a resident is categorically different from being a medical student. Medical students do help to care for patients on the service, but they are nowhere near primarily responsible for them. When you're a resident, suddenly you're responsible for everything. You become involved in a way that you couldn't be before, while at the same time you are responsible for more patients than you ever have been before. Patients like this woman are hard because for the first time they challenge you in a way you've never been challenged before: You find that you can't do nearly as much as you might have thought to relieve her suffering, and you went into medical school in the first place, at least in major part, to relieve suffering. It's easy to understand how young doctors might be tempted to "try anything."

So Bond witnessed this:

One morning after rounds, I glanced over at Ms. W's room and saw an unfamiliar woman walk in and pull the curtain closed at the room’s entrance. The visitor was a reiki practitioner who had come at Ms. W’s request. In reiki, the practitioner uses his or her hands to transfer so-called vibrational energy to the recipient in an effort to promote healing or increase well-being. It hasn’t been shown to be an effective treatment for any condition, and numerous medical organizations—including the American Cancer Society and the National Center for Complementary and Integrative Health—recommend against reiki as a primary treatment for illnesses such as cancer. My patient was sick frequently enough to be well known to many services at the hospital, including the one that provides reiki to patients who desire it.

Reiki? As I've discussed many times before, reiki is nothing more than faith healing that substitutes Eastern mystical beliefs for Christian beliefs. For those who don't know enough about reiki to see the analogy, I'll briefly repeat it. Reiki involves a reiki master channeling what is described as "energy" (that, of course, can't be detected) from what reiki masters call the "universal source" through the reiki master and into the patient for healing effect. Now, to make the analogy to faith healing crystal clear: Substitute the words "faith healer" for "reiki master," "god" for "universal source," and "power" for "energy," and you have a faith healer channeling the healing power of god into the patient. There really is no difference in concept, and it really is that simple. On the other hand, reiki does provide "innovations" over run-of-the=mill faith healing. For instance, reiki masters claim to be able to heal at a distance and even to be able to send the reiki energy backwards and forwards in time. (One wonders if The Doctor does reiki, or if maybe reiki energy is what powers the TARDIS.) Most faith healers that I'm aware of won't go quite that far.

I also noted another thing. Note that Bond describes the service that provides reiki. In other words, her hospital provides it. She happens to be a resident at Boston University; so I did a quick trip over to the Boston University Medical Campus website and looked for its offerings in "complementary and alternative medicine" (CAM), now more frequently called "integrative medicine" because it integrates quackery with real medicine. At BU, oddly enough, the CAM program is referred to as the Program for Integrative Medicine and Health Care Disparities. What health disparities have to do with integrative medicine, I have no idea. Perhaps BU is trying to bring quackery to the poor and underserved. Interestingly, although there's lots of reference to acupuncture, massage, and the like, but no mention of reiki, although reiki is briefly mentioned in this brochure. It's almost as though BU doesn't want to advertise too much that it offers Eastern mystical faith healing (reiki) to its patients.

So what's the problem? What's the harm? For example, Bond seems to understand that the benefits of yoga and tai chi have nothing to do with their mystical underpinnings and everything to do with the fact that they are simply forms of gentle exercise, and physical activity and exercise are almost universally beneficial. Like so many who have drunk the Kool Aid of "integrative medicine," she also goes to great lengths to differentiate "integrative" medicine to "alternative medicine," using (of course) the example of a patient with cancer who had eschewed effective treatment "in favor of receiving injections of a caustic chemical the patient thought was more 'natural.'" The results were predictable:

Predictably, these injections did not shrink his cancer. Worst of all, repeat imaging showed that the cancer had become widely metastatic. The patient had lost precious time that would have been crucial to halting the spread of his cancer, and now his prognosis was much worse.

Yes, this is the sort of thing I've railed about for over a decade now, ever since this blog was first started. No one is arguing that physicians should support the use of ineffective alternative medicine in place of real medicine. The problem, of course, is that a lot of those bogus treatments are the same treatments that are now being "integrated" into real medicine. So if it's not OK to use pseudoscientific treatments in place of effective, science-based treatments, why is it acceptable to "integrate" such treatments with real medicine?

Bond tries this tack in making her argument:

Yet not all alternative therapies have proven benefits, and in many cases, high-quality scientific data are sparse. Reiki, for example, is widely considered pseudoscience in the medical and scientific communities. One study found reiki improved mood and quality of life among patients receiving chemotherapy for breast cancer – but so did simply being assigned a companion with whom to spend time. In other words, perhaps it is not reiki’s purported “energy exchange” that is beneficial, but rather the sense of companionship and support stemming from spending time with another person.

Interestingly, some patients who use alternative therapies freely acknowledge that the benefits of such practices may arise simply from the respite or companionship they provide. Ms. H, for example, was a patient of mine who suffered from severe pain as a result of advanced breast cancer. When I asked her why she enjoyed receiving acupuncture, she shrugged, saying she enjoyed the company and found that lying still during the hourlong session provided a refreshing period of rest.

This is, of course, a seductive argument. If it's really just companionship and the interaction with an empathetic fellow human being that is responsible for the perceived "benefits" of modalities like reiki and acupuncture, then there is no rationale for reiki and acupuncture, particularly the latter, which involves sticking needles into human flesh and therefore has real risks, albeit small. Why not just eliminate the mysticism and pseudoscience and provide companions and counselors, who will spend time with the patient and lend support and a sympathetic ear? This is a role that used to be filled by volunteers, chaplains, and the like. Indeed, because reiki is basically a form of religion, I've also frequently said that I have no problem with reiki masters coming into the hospital to give comfort to patients. What I object to is treating reiki masters like actual medical practitioners and having the hospital offer reiki as another medical service. It is not. Reiki masters are much more akin to chaplains and should be treated the same way as priests, rabbis, reverends, and other religious figures who are allowed into the hospital as chaplains to tend to patients' religious beliefs. Unfortunately, by offering reiki as a "medical" service, hospitals are putting their imprimatur on it and representing it as what it is not (medicine) rather than what it is (religion/spirituality).

There is a false dichotomy here that Bond, whether she realizes it or not, seems to buy into. "Integrative" medicine advocates will argue that what their specialty provides is the "human touch" and "holistic care," as though they somehow care for the "whole patient" and science-based medicine does not. Medicine does not have to embrace quackery to provide that "human touch" that made patients like Mrs. W and Mrs. H feel better and helped them to get through their hospitalizations. It is not necessary to stick needles into the skin, as acupuncturists do, or to make symbols with one's hands over the patient and play act channeling "healing energy" into them, as reiki masters do, to tend to the psychosocial needs of patients.

The problem is that we do not choose to do so. We do not value the human touch, which is why simply talking to patients and spending time with them are services that are not generally not paid for, unless they are psychiatric or counseling services for specific purposes. That's why the "human touch" is left mostly to chaplains, volunteers, family and friends, and, haphazardly, to hospital staff who are so inclined when they have a couple of minutes between running around to do their numerous duties. Indeed, one can look at reiki and much of "integrative medicine" as a stealth method to sneak in human interaction in the form of billable services that do nothing. The problem, of course, is that this strategy "integrates" pseudoscience with medicine and that these treatments (e.g., acupuncture) are not without risks and adverse effects. Worse, representing such quackery as real medicine subverts the informed consent process, as physicians and quacks tell patients that, for example, reiki will do things that it cannot do. In essence, "integrating" quackery into science-based medicine as a means of providing the human interaction lacking in current medicine involves deceiving patients, lying to them, even.

There has to be a better way that doesn't involve tarting up the human interaction with ritualistic pseudo-"treatments" based on mysticism and pseudoscience sold as medicine. Unfortunately, doctors in training, like Dr. Bond, have been inculcated since the 1990s with a world view that somehow "integrating" quackery with real medicine represents the "best of both worlds" and that pseudoscience like acupuncture actually works. How we reverse this pernicious attitude, which has been around long enough to have become ossified in the curricula of medical schools across the country will be the challenge for the next generation of physicians, those in high school and college now.

ADDENDUM: Steve Novella has commented as well.

Categories

More like this

I’ve been writing about this topic so long—ever since the very beginning of this blog—that it seems as though I’ve always been doing it even though this blog has been in existence only 11 years and I didn’t really come to appreciate the problem until after I had started this blog. No, I’m not…
A lot of medical specialties have throwaway newspapers/magazines that are supported by advertising and somehow mysteriously managed to show up for free in the mailboxes of their practitioners. In my case, I’ve found myself on the subscription list for such papers about oncology, but, given that…
I frequently discuss a disturbing phenomenon known as "quackademic medicine." Basically, quackademic medicine is a phenomenon that has taken hold over the last two decades in medical academia in which once ostensibly science-based medical schools and academic medical centers embrace quackery. This…
Yesterday, I expressed my dismay at learning that what used to be a bastion of science-based medicine, the Cleveland Clinic Foundation, is now peddling the quackery known as acupuncture to children, or, as I put it, "integrating" nonsense with science. Sadly, as I've written about all too often…

Given time pressures and, especially what I hear of mad US payment policies it is hard to see how physicians can give more hands-on time but it clearly is needed, at least to judge from a few studies I have seen that suggest that "alterntive" medicine works. No extra attention of various types works!

On the reiki issue, A study comparing reiki versus cat therapy might be interesting. I’d bet on the cat.

By jrkrideau (not verified) on 09 Dec 2015 #permalink

^ No, extra ...

By jrkrideau (not verified) on 09 Dec 2015 #permalink

Allison Bond writes,

Of course, when it comes to treating patients with painful, life-threatening diseases, the goal of our care should be to lessen suffering, regardless of where such relief originates.

MJD says,

Loneliness is a form of suffering that is often difficult to diagnose and treat.

A quote:

"I'm lonely. And I'm lonely in some horribly deep way and for a flash of an instant, I can see just how lonely, and how deep this feeling runs. And it scares the shit out of me to be this lonely because it seems catastrophic.”
― Augusten Burroughs

@Orac,

Maybe this blog could be used as a "loneliness treatment" for some of your patients?

By Michael J. Dochniak (not verified) on 09 Dec 2015 #permalink

Michael, SBM doesn't include providing friendship, family support or spiritual guidance for patients.
-btw- there is a thing called 'counselling' that has been around for a while.

By Denice Walter (not verified) on 09 Dec 2015 #permalink

AND 'loneliness treatment' is indeed the gateway drug providers by woo-meisters who opportunistically take advantage of their customers' unhappiness and lack of connection to caring friends and family.

By Denice Walter (not verified) on 09 Dec 2015 #permalink

PROVIDED

By Denice Walter (not verified) on 09 Dec 2015 #permalink

Maybe this blog could be used as a “loneliness treatment” for some of your patients?

Hmm. Maybe?

Orac,
You're not against placebos, are you?

By See Noevo (not verified) on 09 Dec 2015 #permalink

Of course he is, as is any reputable medical professional....

Sloane Kettering never responded to my comment asking why it wasn't ok to treat cancer with alternative medicine but they'd be perfectly happy to sell you fake treatments like reiki and acupuncture to treat side effects of cancer treatment, even after they did their own negative study.

Even more tone deaf is their response to Mark Crislip pointing out the hypocrisy of casting aspersions at laetrile, cannabis, and alkaline diet while promoting acupuncture and reflexology.

And I forgot to paste the comment from Dr. Yeung at Sloane Kettering :

These complementary therapies [reiki, reflexology, qi gong acupuncture] do not cure cancer. They are used to relieve symptoms, such as pain and fatigue, associated with cancer or cancer treatments, and to improve quality of life of both patients and survivors. Several studies show that these therapies are safe and effective when performed by trained practitioners.

SN,
You don't think that placebos have some objective effect, do you? They don't. The AMA frowns on the use of placebos in clinical practice because, "the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient".

By Krebiozen (not verified) on 09 Dec 2015 #permalink

Placebo is the last option when every thing fails. The placebo includes all non-proven treatment, objects, faith/religion. Faith/religion can very good placebo(opium for the mass like Karl Marx said). The best example is Buddism which considers suffer as unfufilled human desire. If you get rid of desire, you might not suffer from that unfullfiled desire. Human have no desire to eat feces like dung beetles. If a meal of shit was snatched away from you, you were not going to suffer from loss sicne you had no desire to eat feces. There are many ways to develop psychological defense or denial for survival. Country music targets suffering population with lyrics like this

Dolly Parton – Silver And Gold Lyrics | MetroLyrics

“Well I met an old man walkin’ down the street
His clothes were torn and tattered
With sandals on his feet
And I stopped to help him, and lend him a hand
He said, “I love you so much”
But you must understand

Silver and gold, might buy you a home
But things of this world
They won’t last you long
And time has a way of turning us old
And time can’t be bought back, with silver and gold

And he said to me, “Let’s rest for a while
‘Cause I have some good news to share with you, child”
He said, “You can’t change this old world”
The people need to know
That a dear Savior died here
A long, long time ago

And silver and gold, might buy you a home
But things of this world
They won’t last you long
And time has a way of turning us old
And time can’t be bought back, with silver and gold

His eyes shown like diamonds
And his smile was Heaven sent
His hair was long and flowing
And his back was slightly bent
And I knew, he knew it
‘Cause that day I changed
And as I watched him walk on, I forgot to get his name

He said, “Silver and gold, can’t buy you a home”
When this life has ended, and your time is gone
But you can live in a world where
You’ll never grow old
And things can’t be bought there, with silver and gold
And time can’t be bought back, with silver and gold”

Self-delusion/fantacy is very useful when every thing fails.

Paliliative care

Agree. All these placebo/psychological defense mechanism should not be considered as medical science which is based on objective evidences.

The nut of the issue comes in this sentence where Orac appears to contradict himself

One can look at reiki and much of “integrative medicine” as a stealth method to sneak in human interaction in the form of billable services that do nothing.

It seems the word 'medical' has been chopped off the end of the sentence, as Orac knows that human interaction Is a 'something', and an important one. He says, "there has to be a better way" to provide it.

Of course. But providing that 'better way' would involve a large change in social attitudes, the ideologies of decision-makers in health care management, systematic reform of the health care insurance and delivery systems. "Integrative medicine" may just be very real human need, like water flowing toward the sea, finding the only paths that are open to it in the moment. In Dr. Bond's tale, Mrs. H. is self-aware that the value of acupuncture is cloaked in a ruse. If other patients are not so aware, does that necessarily make it a bad thing? Can we reasonably expect people to confront their 'issues' directly, in naked honesty?

Orac refers to reiki as "tarting up the human interaction with ritualistic pseudo-treatments based on mysticism." He asks: "Why not just eliminate the mysticism and provide companions and counselors, who will spend time with the patient and lend support and a sympathetic ear?" He's already supplied the most immediate answer: without the pretense of medical intervention, insurance isn't going to pay for it. But there are deeper answers.

We're talking about psychological support here. Just a few days back, Orac discussed the sad tale of Jenny Fry, a depressed teen who took her own life in part because everyone was in denial that she had serious mental health needs. So strong is the stigma around those needs that her parents are now attributing her symptoms and death to a totally ludicrous 'allergy to her school's wifi', and this is actually getting a lot of play in the press.

On a much smaller scale, any psych issue – even the stress of chronic illness or major surgery – remains stigmatized, and tends to be dealt-with informally by family, friends – and, of course, clergy – through some sort of pretense or another. Even professional counseling and talking therapy are typically based on some kind of ruse such that "they only work if you believe they do."

Now, let's step back further from mental states we might label 'illness', and consider everyday human interaction regarding the assorted trials and troubles of life. It strikes me that we rarely address our issues directly, and any of us aren't even aware of what they are, or at least how they manifest in our thoughts and conversations.

We may not do outright mysticism, but the workings of our psyches remain mysteries, and we deal with them routinely through (informal) ritual, myth etc. often unaware that we are projecting disturbing thoughts into 'safer' referential frames. These days, my oldest-most-close-lifetime friend only emails me to express deep traumatic angst over the fortunes of our hometown college and pro football teams. This is completely 'irrational', but he's far from stupid – a history professor at a Uni you've heard of. I know his sports rants are channeling a variety of other serious things. But in the place and time where we grew up there were things that were OK for guys to talk about, and things that weren't, and stuff you didn't admit even to yourself. And when I reflect on my instances of 'human interactions' in general, it strikes me that many if not most of them are very much about some unspoken thing lying behind the surface to one degree or another.

It's a false dichotomy to draw a bright line between, 'lying' and 'truth-telling' in human interactions. There's 'just not talking about it', 'pretending', 'projecting', 'displacing'... etc. etc. It's not necessarily the case that patients who see quacks to fill a psychosocial need are gullible rubes seduced by the lies of con artists. A lot (most?) of them may be role-playing, or conning themselves. Nor, in all cases, is it necessarily prudent or helpful to strip away the defense mechanisms of repression/deflection/projection and force people to face their sh** head on...

In sum, then, that providers represent a pseudoscience 'modality' as a treatment that "actually works" medically, that representation may have a function that goes far beyond placebo affects. It can be the justifying Macguffin in a largely patient-written fiction that helps people deal with their psycho-social problems. Maybe some Macguffin is necessary, and in our ideal solution, the pretense would no longer be faith-healing of physiological maladies, but simply some sort of 'faith' (not necessarily religious) brought to bear against maladies of the spirit/soul/mind. (??)

It occurs to me that if woo-meisters are now filling the role once played by chaplains, that's partly a by-product of the success of science in shaping the practices and thoughts that characterize modernity. We no longer pray, and no longer believe 'God' has answers, as we imagine all ills are dysfunctions of the physiological body, and that someone, somewhere has a technique that can fix them. Old-school 'positive thinking' seems inadequate as well. The 'healers' have to do something with their hands patients believe to be concrete, be it manipulate a spinal subluxation, give a reflexology foot massage, prick into an acupoint or just make hand-waving adjustments to energy fields...

If the human condition is one of regularly BSing ourselves, it would follow that a generic condemnation of BS is not just impractical, but imprudent. Woo can be dangerous and even deadly. But it can also be just another of the many little fictions we write to help us get through the day. If Mrs. W and Mrs. H. are getting the psycho-social help they need via the only pragmatic path open to them, we can hardly condemn that, or deny them that unless we can offer them "a better way" that tarts up human interaction with something besides the promise of physiological medical miracles.

The ‘healers’ have to do something with their hands patients believe to be concrete, be it manipulate a spinal subluxation, give a reflexology foot massage, prick into an acupoint or just make hand-waving adjustments to energy fields…

I was thinking about this earlier today for a bit whilst pacing around my room with the radio on. (I get to go home in about half an hour!)

I mean, medicine men have been around for a very long time, IIRC. They certainly served a function, and one which wasn't solely, or even mostly, "medical" in nature. They were usually shamans, too. Drums, etc.*

Just something to think about it.

*I know, I know, drum circles are corny hippy silliness, but, well I have this story I might tell you some time.

You're taught in medical school that "it didn't happen if you didn't write it down".

After med school you learn that often times "It didn't happen if it couldn't be billed."

By Chris Hickie (not verified) on 09 Dec 2015 #permalink

BU has a long and sordid history of embracing bullshit. They even have endorsed facilitated communication, the zombie that will never die.

Lawrence says (#10),

Of course he is, as is any reputable medical professional.

MJD says,

I've been looking for Orac (The One) my whole professional life...

I believe he is "The One" who will unify that which is perceived as medical science and medical pseudoscience, through the Scienceblog Respectful-Insolence, allowing medicine to evolve.

@Lawrence,

I sense that Orac is starting to believe that his efforts are having a greater influence on those concerned with health & wellness.

By Michael J. Dochniak (not verified) on 09 Dec 2015 #permalink

I had to look up MJD @ 21: where do these loons come from?

facilitated communication, the zombie that will never die.

I find myselfimagining how FC would work with zombies.
"He's spelling something out... B, R, A, I, N, Z..."

By herr doktor bimler (not verified) on 09 Dec 2015 #permalink

You’re not against placebos, are you?

You're not in favor of reiki (PDF) or accepting the notion of qi, are you?

I have used placebos in clinical practice. I did it very sparingly.
They can be ethically used if you understand what you are trying to accomplish and limit use to very short term goals.
The cases that I used them in were to buy time until full assessment could be done and effective treatment started or trying to provide relief to pain or anxiety to someone who couldn't receive get effective treatment right then because of overmedication or drug interactions. To avoid a bad habit, I rationed myself to no more than one a month and no more than four times in a year. It forced me to ration myself and save them up for when I desperately needed one. Knowing I had a placebo to fall back on was kind of a self-administered placebo. I always had one more big gun in the armory, and if I didn't use it today, I could have it available tomorrow if I really, really needed it.
One of the things that can make pain worse is anxiety. reduce the anxiety and the pain may become more tolerable. The nice reiki master or chiropractor tells that anxious patient that he's doing something that will help and the patient feels relief even before anything starts.

By Old Rockin' Dave (not verified) on 09 Dec 2015 #permalink

Where this stuff becomes harmful is where it diverts resources from genuine clinical areas.

I know of at least 2 NHS organisations offering reiki: one is a child and adolescent MH service for eating disorders (part of my old bit of the forest), the other is palliative care (my sister's current professional area.

Since 2010 both CAMHS and paliative care (amongst others) have had funding, and thus clinical staffing cut, and yet someone has found money in both of those fields top employ f*c*ing reiki practitioners? While having cut nursing, psychology, occupational therapy and...and...

Please excuse the trypos above: I blame annoyance.

Ha! Murmer misspelled "Tripos".

By herr doktor bimler (not verified) on 10 Dec 2015 #permalink

Sadmar #19,

"role playing"

Perfect-- the rest is hardly necessary.

When people decide to be "a patient", they are being no more rational than that-- they have not studied the statistics or the biology and chemistry of any of it, at least very few have.

They are assuming a role defined by society and the system.

All the world's a stage, when ya think about it, eh?

Ah, "placebo" may be from the Latin Psalm 116.9:

"Placebo Domino in Regione Vivorum" translates
"I will walk before before the Lord in the land of
the living."

So "placebo" became a derogatory term to describe
the work of priests constantly badgering people for
money to sing vespers for their dead.

...from Patrick Wall's 1999 "Textbook of Pain".

Hmm, derogatory in religion and medicine? Such power.

By Old One Eye (not verified) on 10 Dec 2015 #permalink

Just noticed this in the NYT-- the old mote and beam thing makes Orac's excessive self-righteousness a bit embarrassing.

Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-aged youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.

What, S.N. ran away?

zebra,

Until you can demonstrate that Orac is advocating non-science based medicine and in particular giving children age 2 and younger psychiatric meds, I'd say your comment doesn't hold water.

By Not a Troll (not verified) on 10 Dec 2015 #permalink

Not a Troll,

Until Orac grows a pair and takes a position one way or the other, I'd say your comment is lacking in content.

Takes a position on what exactly? I am sure he has positions on many things. Whether he shares them here or not is irrelevant.

By Not a Troll (not verified) on 10 Dec 2015 #permalink

There has to be a better way that doesn’t involve tarting up the human interaction with ritualistic pseudo-“treatments” based on mysticism and pseudoscience sold as medicine.

This a million times. If society wants to cop-out to false beliefs (which we are very good at) science and medicine still should not for the very reason that they will need to be the ones to point us in the correct direction so we are not subject to the treatment du jour based on who has the best PR Dept.

What happens when more rational thinkers complain about their Reiki doing nothing for them? What comes next? And why does Reiki and accupuncture get to be institutionalized? What about voodoo, Scientology and reading entrails. There are some days I'd really like to stick a pins in a doll even though it is a bunch of garbage.

There was a reason faith based medicine was debunked and if gaps remain in emotional/spiritual needs (which I am sure there are), then anything that fulfills them but is not based on science and is not medicine will need to be compartmentalized from them. It isn't a slippery slope, it is the law of unintended consequences.

By Not a Troll (not verified) on 10 Dec 2015 #permalink

It's understandable that people will try anything if they are desperate enough. It's understandable that compassionless people exploit desperate people to make money. It's understandable that compassionate people wish to do something to help desperate people. The compassionate and the uncompassionate alike may be complicit in telling the desperate all manner of untruths-fictions-lies.

Medical professionals should be proficient at medicine. That cannot be unless their practice is founded on up-to-date scientific understanding of the human psycho-social and physical animal.

Medical professionals should not sanction scientific nonsense. If people are going to turn to stuff like Reiki let them; but please, medical people, don't tell suffering human beings that Reiki or prayer or meditation (mindfulness) or acupuncture or any of the rest, is scientifically-blessed "symptom medicine". Please don't tell compassionate lies. Don't talk about such things. Be dignified and treat your patients with dignity. Be doctors and nurses. Be not witch-doctors or (shudder) "healers". They are out there. Those who need them will seek them out when medicine fails. Let that function pass to the medically unqualified.

By Leigh Jackson (not verified) on 10 Dec 2015 #permalink

@ zebra # 30 When people decide to be “a patient”...

Suppose I get very sick and I decide not to be a patient. Suppose the role doesn't feel right to me. What would you suggest?

By George Locke (not verified) on 10 Dec 2015 #permalink

George Locke 39,

?

I don't know if you are asking a serious question or trying to make some point, and I can't figure out what the point would be. Obviously, you can go it alone without seeking assistance from other people.

Maybe you should think about it in the context of the comment to which I am replying?

He's back?

Great, more inane banter unrelated to the topic at hand.....

Just noticed this in the NYT– the old mote and beam thing makes Orac’s excessive self-righteousness a bit embarrassing.

Oh, the irony.

Oh joy, and he's still embracing the tu quoque fallacy. We can't criticize altmed until every aspect of conventional medicine is perfect, right?

By Krebiozen (not verified) on 10 Dec 2015 #permalink

The fact that quackery can provide needed "human interaction", and cause placebo effects, is neither a basis for accepting it nor a justification for it. The benefits it provides, interaction and placebos, are not exclusive to it, and are overshadowed by the provision of useless and potentially dangerous treatments as well as the implicit subversion of actual science. Without any exclusive benefits, such as those that exist in actual medicine, any negative effect of a treatment is reason enough to discard that treatment.

There is no dichotomy preventing one from receiving both care for their mental/emotional health and effective medical care. Medicine in general may underestimate the value of mental health, but that is not some fundamental of medicine. Medicine could (easier said than done) include mental health by teaching its practioners HOW to care for their patients' mental health, or through the training and provision of counselors to patients. There is no reason to think that science-based counseling is impossible, or that it needs pseudoscience.

In short, there is no justification for quackery when training doctors to have better bedside manners or training specialist counselors would solve the problems without "integrating" quackery. The person who wrote the article, which is so aptly criticized above, is blind if they that the best way to fix the problem is by using something that will give you a new set of even worse problems in the place of the previous one.

By Jackson Ayres (not verified) on 10 Dec 2015 #permalink

Zebra, you do realize he was being sarcastic. People don't usually decide to get sick. And while one can make a decision to not see a doctor, they usually go because they need to, not to break into the acting biz. (And while there are such things as professional patients, they are only found around med schools, and they aren't actually sick.)

I'm on board with placebos for really minor illnesses, but mine usually take liquid form. Bring on the soup, the soda and the lemon and honey..just hold the reiki and the acupuncture. And if something's *really* off kilter, I do appreciate a real medical professional's advice.

Off topic- one time when I had a cold, I had oxtail soup with avocado. Better than codeine.

By Politicalguineapig (not verified) on 10 Dec 2015 #permalink

To clarify, I meant "providing no benefits, if it provides any at all, that are equal or superior to what medical science can provide" when I used the word "useless".

By Jackson Ayres (not verified) on 10 Dec 2015 #permalink

Good Herr Doktor #29

Well, I did go to Sheffield rather than Cambridge...

Political #45,

I suggest as I did to George that you consider what I said in context-- replying to Sadmar.

Also read the NYT article, and what the mother in the cited case said.

dean (#22) says,

...where do these loons come from?

MJD says,

If your sick in the hospital and another doctor says "Bless you" after you sneeze, is this "integrating" quackery with real medicine?

Or, is the doctor trying to ease suffering through empathy?

Empathy is a valuable human experience that must continue to be part of real medicine.

Finally, in my opinion, integrative medicine may be a valuable human experience and must continue to be part of real medicine when applicable.

By Michael J. Dochniak (not verified) on 11 Dec 2015 #permalink

What's the difference between a loon and a quack?

These non-empathetic words are often viciously used here at RI by Orac (Respectfully-Insolent Surgeon) and his subservient minions.

By Michael J. Dochniak (not verified) on 11 Dec 2015 #permalink

How dare an oncologist criticize the use of reiki in hospitals while some pediatricians are using off-label drugs on children? It's like an astrophysicist rubbishing astrology when she can't even figure out where all the dark matter is.

By Krebiozen (not verified) on 11 Dec 2015 #permalink

Dude, I did read your reply to Sadmar. Basically, you think anyone who goes to a doctor or ends up in a hospital is roleplaying and is not actually sick or injured- at least, that's what I managed to decode. It might help if you tried to make coherent and clear remarks, since you tend to speak in waves of jargon when you're not vomiting up links.

By Politicalguineapig (not verified) on 11 Dec 2015 #permalink

Dude, I think it is impolite to not indicate to whom your comment is addressed. But here's what I actually said.

Political #45,

I suggest as I did to George that you consider what I said in context– replying to Sadmar.

Also read the NYT article, and what the mother in the cited case said.

end quote

Leigh Jackson #38 - as a patient I second your thoughts.

Jackson Ayres #44 - Beautifully stated. I am going to file your comment away to be reused in these types of discussions.

Krebiozen #51 - it's a great analogy. I marvel at how people can't grasp that the two are independent issues.

By Not a Troll (not verified) on 11 Dec 2015 #permalink

Zebra: Look jerk, when I posted that, I assumed my comment would be right below yours. I didn't know it'd get caught in the queue. And I'll be as rude as I want.
Again, I did consider your remark in context, and that's still what I got. Try a little clarity sometimes, it'll do wonders for clearing up misunderstandings, not to mention what it'll do for your social life.
Secondly, that article doesn't have anything to do with the topic, as other people have said, so will you drop it already? We are dealing here with unscientific, unproven methods used inappropriately, not proven medicine used inappropriately.

By Politicalguineapig (not verified) on 11 Dec 2015 #permalink

Murmur, @ 44
M, I am sure HDB was making a joke about someone's vicious pleasure to evidentiate typo- slips on posts. Didn't you notice he misspelled Murmer?

By perodatrent (not verified) on 12 Dec 2015 #permalink

"No, it is not okay to give patients a treatment with no proved medical benefits", says Orac.

MJD says,

The ideal doctor is medically knowledgeable, affordable, kind, sensitive, compassionate, honest, and empathetic.

4/7 of the characteristics described above are not quantifiable and/or difficult to prove that they have a medical benefit.

Is the way a doctor treats a patient a valuable part of a treatment? Yes/No

If the answer is "Yes" the statement, "No, it is not okay to give patients a treatment with no proved medical benefits" is invalid.

By Michael J. Dochniak (not verified) on 12 Dec 2015 #permalink

But you say the ideal doctor is honest. Is it honest to give a treatment (and charge for a treatment) that has no proven value?

Johnny asks (#58),

Is it honest to give a treatment (and charge for a treatment) that has no proven value?

MJD says,

Rephrased:

Q. Is it honest to give a treatment (and charge for a treatment) that has no physiological and psychological value?
A. No, it's not honest

In an article entitled, "Technology will Replace 80% of what Doctors do" author Vinod Khosla writes:

"Computers are better at organizing and recalling complex information than a hotshot Harvard MD. They’re also better at integrating and balancing considerations of patient symptoms, history, demeanor, environmental factors, and population management guidelines than the average physician."

http://fortune.com/2012/12/04/technology-will-replace-80-of-what-doctor…

Computers may be medically knowledgeable and honest but lack the human quality of kindness, sensitivity, compassion, and empathy.

For some patients, the humanistic aspect of integrative medicine brings a "psychological value" that is priceless.

By Michael J. Dochniak (not verified) on 12 Dec 2015 #permalink

perodatrent #56

Yup, I saw that and countered with the comment about universities (tripos being the name of an exam at Cambridge - there being a few Cambridge alumni around here, as well as graduates of other UKadian universities).

Being nice to your patients is great and all, but I don't think anybody would refer to kindness an actual medical treatment. Acupuncturist, reiki practitioners, and the like on the other hand do make claims of treatment, without the benefit of proper evidence. That, to me, crosses a line and shouldn't be accepted in medicine.

By Secret Cisco (not verified) on 12 Dec 2015 #permalink

Secret Cisco says (#61),

...but I don’t think anybody would refer to kindness an actual medical treatment.

MJD says,

Scientific Literature Review Shows Health Care Delivered with Kindness and Compassion Leads to Faster Healing, Reduced Pain

http://www.businesswire.com/news/home/20141112005352/en/Scientific-Lite…

@Secret Cisco,

Some patients insist that acupuncturist, reiki practitioners, and the like benefit THEM.

In kindness, I believe THEM!

By Michael J. Dochniak (not verified) on 13 Dec 2015 #permalink

Paraphrasing MJD (because that too is honest, it seems) -

It honest for a medical doctor to preform acupuncture, a treatment with no proven medical value, and proven to cause actual medical harm in some cases, and charge the patient for that treatment, if the patient says 'spend more time on ME'. An honest doctor should be a 'rent-a-friend' if the patient is lonely, and indeed lie to the patient so that the patient doesn't get their feelings hurt.

Speaking for myself, I disagree.

Johnny says (#63),

...,and proven to cause actual medical harm in some cases,...

MJD asks,

Should there be an Integrative-Medicine Injury Compensation Program (IMICP) similar to the Vaccine Injury Compensation Program (VICP)?

Johnny which compensation program do you think would have a higher payout?

By Michael J. Dochniak (not verified) on 13 Dec 2015 #permalink

MJD: Should there be an Integrative-Medicine Injury Compensation Program (IMICP) similar to the Vaccine Injury Compensation Program (VICP)?

I'm pretty sure most fraud laws will cover injuries sustained by improper treatment, so there's no need to set up a separate court system. Any legal eagles want to comment? Of course there's the separate issue that most people who want acupuncture/reiki/ etc/ want to be fooled and therefore won't sue.

By Politicalguineapig (not verified) on 13 Dec 2015 #permalink

If Scientific American can endorse placebos for patients suffering horribly from fatal illnesses it makes sense that New Scientist would go the full monty and tell us how we can all "harness the power of positive thinking" that is the placebo effect. Positive thinking - says SA - not the power of suggestion. IMO since we are dealing in duplicitous suggestion it is not right to call it "positive thinking". Duplicitous suggestion doth make suckers of us all. Placebos are powerless. Suggestion is powerful. But deceitful suggestion, even with the best of motives is not good form for someone holding a position of power and trust.

SA and NS are just following the money presumably.

https://www.newscientist.com/article/mg22830510-400-how-you-can-harness…;

By Leigh Jackson (not verified) on 13 Dec 2015 #permalink

Correction: New Scientist says "positive thinking" not SA.

By Leigh Jackson (not verified) on 13 Dec 2015 #permalink

Should there be an Integrative-Medicine Injury Compensation Program (IMICP) similar to the Vaccine Injury Compensation Program (VICP)?

Johnny which compensation program do you think would have a higher payout?

Provided survivors of scammed patients are allowed to file suit, and if the standards of evidence were the same, I rather suspect the IMICP would be broke in a week.

As you have raised no objections, may I assume my paraphrased statement of your position is accurate?

Johnny says (#68),

As you have raised no objections, may I assume my paraphrased statement of your position is accurate?

MJD says,

We may not agree but your the only one who really talks to me on this blog post. Thx!

By Michael J. Dochniak (not verified) on 13 Dec 2015 #permalink

Being nice to your patients is great and all, but I don’t think anybody would refer to kindness an actual medical treatment.

I agree.
Let's put in this way:
If you have a broken leg, would you prefer:
- have your leg put in a plaster by Dr House (effective painkillers in option)
- have a nice chat with the old lady feeding pigeons in the park next to your house

By Helianthus (not verified) on 13 Dec 2015 #permalink

Didn’t you notice he misspelled Murmer?

In the furtherance of full disclosure I am forced to admit that it was a stupid-clumsy-fingers misspelling rather than deliberate and ironic.

By herr doktor bimler (not verified) on 13 Dec 2015 #permalink

Leigh Jackson,
I have written for New Scientist, so I am particularly disappointed to see such a credulous piece. They even cite the sham knee surgery I have often referred to here as evidence of the placebo effect, even though neither it nor real debridement or lavage led to any objective improvement in function:

The authors found that all three treatment groups fared equally: each reported subjective symptomatic relief, but no objective improvement in function was noted in any of the groups.

By Krebiozen (not verified) on 13 Dec 2015 #permalink

Interestingly enough, when I broke my leg a while back the first doctor I saw had a poster about "holistic medicine". The second doctor (not because of the poster, just a referral) gave me a cast and a prescription for Vicodin.

By Secret Cisco (not verified) on 13 Dec 2015 #permalink