The "big idea" behind integrative medicine is not so big at all...

I’ve frequently referred to “integrative medicine” as the “integration” of quackery with conventional, science-based medicine for the very good reason that that’s what it really is. However, advocates of medicine not based in science are nothing if not masters of marketing, which is how, over the course of three decades or so, “alternative medicine” morphed into “complementary and alternative medicine” (CAM), which ultimately morphed into its most recent incarnation, “integrative medicine.” The term “integrative medicine” is fantastic from a marketing perspective because it implies (and is marketed as) the “best of both worlds,” the “best” of science-based medicine and alternative medicine. Of course, as Mark Crislip once put it, integrating cow pie with apple pie does not make the apple pie better, and integrating the cow pie of pseudoscience and quackery that makes up so much of the “alternative” part of “complementary and alternative medicine” does not make the apple pie of science-based medicine better, nor does it validate the quackery.

The key deception at the heart of integrative medicine, however, is based on a claim that I find particularly galling. Specifically, we are told, time and time again, that in order to be a truly caring, “holistic” doctor, integrative medicine is the way to go. In other words, to be a “holistic doctor,” you must embrace quackery. Another aspect of “integrative medicine” that similarly irritates me is its appropriation of several science-based medical modalities, such as nutrition and lifestyle changes, as somehow being “integrative” rather than just good medicine. None of this is anything I haven’t said on numerous occasions over the last nearly dozen years that I’ve been blogging, but I was reminded of it yesterday when I saw as near-perfect example of CAM apologia as I’ve ever seen in—where else?—The Huffington Post. It’s by someone I had never heard of before, Alan Briskin, someone whose posts at HuffPo don’t really include anything about medicine. He did author a book, The Power of Collective Wisdom & the Trap of Collective Folly. However he learned it, though, Briskin is clearly expert at trotting out the tropes commonly used to justify integrating quackery with medicine, and he does so with gusto in his HuffPo post The Big Idea Behind Integrative Medicine. Of course, the idea isn’t nearly as big as he thinks it is, as you will see.

First, on his own blog, Briskin explains what his purpose was in writing this bit of dreck:

My new Huffington Post piece explores the emerging field of integrative medicine. I have been involved in the medical field as far back as 1972 when I did an internship at the Berkeley Free Clinic. It’s where I first began to understand how optimal health is a joining together of the individual body-mind-spirit with the pro-social behaviors necessary for thriving in community. And care providers can play a critical role at the intersection of these two domains.

There are no clear boundaries regarding what is meant by integrative medicine although terms like integrated care, complementary medicine, and alternative medicine have been used interchangeably for decades, sometimes meaning very different things.

This post is meant to start a conversation and bring into awareness an emergent philosophy of care that is something of a new species.

OK, now I know how Briskin got to where he is. Now let’s see how she characterizes integrative medicine. You know how my good bud Kimball Atwood used to do a regular series that he called the “Weekly Waluation of the Weasel Words of Woo.” Briskin’s post is a prime example, and it starts right in the first paragraph:

Integrative medicine is an ecosystem of support for pursuing your own health and well-being. Inside that ecosystem is someone who cares about you. Integrative medicine is emerging from a successful history of treating physical ailments that often eluded Western modalities of care to become an ecosystem of support for health and wellness. Possibly the most visible sign of this development is the increasing attention of integrative medicine to primary care, where prevention and regard for the whole person is most critical.

WTF? Isn’t this a bit repetitive? Integrative medicine is an “ecosystem of support for pursuing your own health and well-being” and that it’s emerging from a “successful history of treating physical ailments that often eluded Western modalities of care to become an ecosystem of support for health and wellness”? What does this even mean? An “ecosystem of support for pursuing your own health and well-being”? It sounds all science-y but in reality it’s a meaningless set of buzzwords. Unfortunately, Briskin doesn’t get any better from there. Here’s what I mean:

What distinguishes integrative medicine as an approach is that it distances itself from the traditional model of a patient dependent on an expert. Rather, it embraces a genuine clinical partnership in which both the patient and the care provider have something to offer in pursuit of the patient’s optimal health. The care provider embodies not only clinical knowledge, which is the result of his or her training, but also qualities not always associated with experts. These include curiosity, emotional support, collaboration, humor, and the ability to articulate options and alternatives without judgment. Patients are participants as well, offering knowledge of what has worked for them in the past, providing information that can’t be quantified on a medical report, and finding meaning and purpose in their response to the challenges faced when confronted by illness.

OK, this is complete and total bullshit. Yes, forging a “genuine partnership in which both the patient and the care provider have something to offer in pursuit of the patient’s optimal health” is a good thing. No, you don’t have to embrace pseudoscience and quackery in order to forge that partnership. Let’s not forget what “integrative medicine” integrates into medicine: Prescientific belief systems like traditional Chinese medicine; naturopathy, which, remember, includes The One Quackery To Rule Them All (homeopathy) as an integral part of its knowledge base and treatments, and, of course, a whole lot of pseudoscience. Let’s also not forget that curiosity, emotional support, collaboration, humor, and the ability to articulate options and alternatives without judgment do not require the embrace of quackery. They just don’t.

Of course, that is not the narrative apologists for CAM/”integrative medicine” want you to believe. To them, it is not possible to be humanistic” and “holistic” if you don’t buy into their world view and their pseudoscience. In fact, Briskin makes that pretty explicit:

I am reminded of the support that the poet W.H. Auden gave Dr. Oliver Sacks when he was composing Awakenings, a book about his work with a group of patients who had been in a decades-long sleep and were now coming back to consciousness. Auden wrote: “You’re going to have to go beyond the clinical. ... Be metaphorical, be mystical, be whatever you need.” I find here the implication that it is our deep regard for the human condition that moves us beyond the complacent and routine. It is in our profound respect for service to others that we touch mystery and wholeness. At the heart of integrative medicine is a bold invitation to go beyond the clinical, into regions that capture our hearts and imagination. Caring is fundamental. Nothing else really matters without love as an organizing principle. Or as one patient I know told her physician, “I just want someone who gives a damn.”

Here we go again. Once again, it is quite possible—nay, mandatory!—to care for patients and, just as importantly, show them that you care for them without selling them lies. I realize that integrative medicine practitioners would object strongly to that characterization, but my response to that would be to tell them to get real and join the reality-based community. If you are telling patients that reiki works, you are selling patients lies. If you are telling them that traditional Chinese medicine is anything more than a prescientific belief system, the vast majority of which is without scientific support or medical benefit, you are selling patients lies. If you co-opt recommendations to eat good food and avoid bad food as somehow “alternative” or “integrative” rather than just good, old-fashioned science-based medicine, you are selling patients lies. If you co-opt the latest findings in neuroscience to support mystical ideas about human consciousness, you are selling patients lies.

If you claim that integrative medicine is some sort of awesomely “big idea,” rather than the latest evolution of a strategy to make pseudoscience and quackery acceptable medicine, you are selling patients lies.

Here are a few of the lies about integrative medicine that Briskin is selling, whether he realizes they’re lies or not:

It cares for the whole person by addressing mind, body, and spirit as three interacting elements that together result in health and well-being.

Integrative medicine might say that it cares for the “whole person” and addresses “mind, body, and spirit,” but what it really does is to claim that you need to integrate pseudoscience into medicine to accomplish this end.

It treats nutrition — what we put in our body — as medicine. Beyond diets and supplements is an understanding of what helps our body to feel vital and how best to decrease the effects of toxins.

I’m sorry, but food is not medicine, no matter how much integrative medicine apologists try to convince people that it is. Moreover, the body is more than capable of eliminating “toxins” by itself, thanks to its kidneys and liver. The obsessive belief that all diseases are caused by unnamed (and often fantastical) “toxins” is pseudoscience patients don’t need. “Detoxification,” which is much beloved of “integrative medicine” specialists, is a sham. It’s rarely needed and almost never the cause of all the diseases that integrative medicine specialists try to pin on “toxins.”

And, the biggest lie of all:

It creates a true partnership that joins the best of Western medicine with ancient healing traditions and complementary modalities. The guiding intent is to restore harmony and address imbalances that detract from optimal health.

No, no, no, no. There is no “Western” or “Eastern” medicine. There is no “alternative” medicine. There are only medicine that has been scientifically demonstrated to work, medicine that has not been scientifically shown to work, and medicine that has been scientifically demonstrated not to work. Alternative medicine, the sort that people like Briskin want to “integrate” into real medicine, almost always falls into one of the latter two categories.

Alan Briskin thinks that all of this is the “big idea” behind the concept that is integrative medicine. Unfortunately, the idea is not nearly as big as he thinks it is. Rather, it’s the distillation of a bunch of warmed-over tropes and “weasel words of woo” that we’ve all heard many, many times before. They don’t impress coming from Briskin any more than they impress coming from Andrew Weil or any number of other apologists for the integration of quackery into medicine.

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Gaaah!!

I want to post the gif of the bunny banging its head against a wall.

Smarmy, vegan fart-sniffing, "I buy only raw butter from organic cows" hippycrits believing that their naturotwat is the best thing since sliced gluten-free bread because they sell them a bunch of warm and fuzzy bullsh!t really irk me.

I understand the appeal in saying - well if you're convinced then you're welcome to it. But the problem is all the less than die-hard people who get suckered in to these expensive lies, believing that people simply would not be able to set up shop as a health practitioner if they weren't legit - and they certainly wouldn't be registered by an official government body, would they?

Grrrrr.

By Can't remember… (not verified) on 26 Jul 2016 #permalink

I have been involved in the medical field as far back as 1972 when I did an internship at the Berkeley Free Clinic.

Kingsley Hall or bust, I say.

ecosystem of support for pursuing your own health and well-being

Did she mention this is a paradigm shift?

By Helianthus (not verified) on 27 Jul 2016 #permalink

ecosystem

You keep using that word, Mr. Briskin. I don't think it means what you think it means.

By Eric Lund (not verified) on 27 Jul 2016 #permalink

"Rather, it embraces a genuine clinical partnership in which both the patient and the care provider have something to offer in pursuit of the patient’s optimal health."

To me, this suggests that the business model being pursued is a subscription, a rent to be paid for access to a regular service. I'm sure that a company offering such a service will always find more things to test and diagnose to make it look like the subscription is a good deal.

Terrible stuff.

By The Vodka Diet Guru (not verified) on 27 Jul 2016 #permalink

Eric @7

Beat me to it!

I was going to add a side order of snark, as one whose degree included an awful lot of ecology, about how ecosystems include a whole heap of unpleasant things whose sole purpose is to kill,maim or eat you...

"These include curiosity, emotional support, collaboration, humor, and the ability to articulate options and alternatives without judgment. Patients are participants as well, offering knowledge of what has worked for them in the past, providing information that can’t be quantified on a medical report, and finding meaning and purpose in their response to the challenges faced when confronted by illness."

This bit really f***ing annoyed me, as it encapsulates a lot of what I did every day as a MH clinician and I thoroughly reject any implication that I was "alternative" or "integrative".

Integrative medicine: it isn't integrative and it isn't medicine...

@ The Vodka Diet Guru

To me, this suggests that the business model being pursued is a subscription

I was thinking how nice it would be to have the money to hire this type of "ecosystem" - something I translated as "dedicated personal medical team" (being loose on "medical").

By Helianthus (not verified) on 27 Jul 2016 #permalink

@#1...nym

Why do otherwise well-versed people have to sterotype vegans? I am as science-devoted as anyone, and I am a vegan, simply because I find it helpful in maintaining a good weight and I have issues with aspects of factory farming. I’m not an organic vegan, not a gluten-fee vegan, not a purist at all times. I have the occasional egg, for example or a bit of cheese, and I wear leather shoes but 95+ percent of the time, I’m vegan and I hate that that seems to put me in the same boat as these integrative idiots, or that I would be lumped with them in any way.

Try to find a better adjective than vegan for your stereotype, please.

By darwinslapdog (not verified) on 27 Jul 2016 #permalink

Hmph. I remember my nursing instructors telling me about the holistic approach on Day One of the program.

They taught me that holistic care is a wheel; on that wheel is the physical, mental, emotional, and spiritual needs of the patient.

I can meet every one of those needs without resorting to unproven gobbletygook and utter nonsense.

@ darwinslapdog:

I'll venture a guess about why people stereotype vegans:
because there are so many loons who broadcast their wacky add-ons ( organic, pure, GMO-free, GFCF etc), write dense
books about it and get press.

Actually by admitting that you have eggs or cheese, you are technically not TRULY ( in their parlance) a real vegan. Wearing leather seals the deal.

Perhaps you should portray yourself as a 'vegetarian' like many from India/ Indian culture. Yoghurt and milk-based
desserts/sauces are good enough reason.

By Denice Walter (not verified) on 27 Jul 2016 #permalink

@Panacea #10:

I can meet every one of those needs without resorting to unproven gobbletygook and utter nonsense.

I'd be interested to hear your definition of 'spiritual needs'.

By Rich Woods (not verified) on 27 Jul 2016 #permalink

-btw- some designers are offering 'vegan' purses . Sounds better than cheap plastic, faux leather and facsimile.

By Denice Walter (not verified) on 27 Jul 2016 #permalink

Forty years ago, "Holistic Medicine" was the new hotness. It was essentially the same as "Integrative Medicine" is now: platitudes about caring for the "whole person" mixed up with the same old woo-woo. I asked then and I still ask: "What does quackery have to do caring for the Whole Person?"
No one has ever been able to give me a satisfactory answer other than "Nothing".

" a successful history of treating physical ailments that often eluded Western modalities. " Name one. Just one.

By DANIEL GAUTREAU (not verified) on 27 Jul 2016 #permalink

To quote Tim Minchin: "Do you know what they call alternative medicine that's been proved to work? Medicine."

Actually by admitting that you have eggs or cheese, you are technically not TRULY ( in their parlance) a real vegan.

They are correct on that point. Vegetarians do not eat meat, but some will consume eggs and/or dairy products. Vegans do not (at least knowingly) consume any animal products at all. All vegans are vegetarians, but not all vegetarians are vegans.

I suspect the original poster was snarking. He mentioned "gluten-free bread". Bread is normally made from wheat, which contains gluten.

By Eric Lund (not verified) on 27 Jul 2016 #permalink

My waluation:

These include curiosity, emotional support, collaboration, humor, and the ability to articulate options and alternatives without judgment. Patients are participants as well, offering knowledge of what has worked for them in the past, providing information that can’t be quantified on a medical report, and finding meaning and purpose in their response to the challenges faced when confronted by illness.

This probably translates into "if you tell me you heard baking soda can cure your condition, then I will smile and allow that this is a perfectly reasonable choice, one which I was just about to mention, among others -- and no matter what you choose, you have my support and good wishes."

It’s where I first began to understand how optimal health is a joining together of the individual body-mind-spirit ...

translation: I invoked the Spiritual so we can now wheel in the mighty, though someone loose, standards of religious faith.

...with the pro-social behaviors necessary for thriving in community.

translation: I'm going to ask a lot of questions about your personal life and give soothing feedback.

optimal health is a joining together of the individual body-mind-spirit with the pro-social behaviors necessary for thriving in community.

If some new-age-fascism crank thinks that his job is to reshape me to be a better-functioning cog within the social machinery, or a better-adapted cell within the communal body, then I hope Society is going to pay the creep, because I'll be looking for a different doctor.

By herr doktor bimler (not verified) on 27 Jul 2016 #permalink
Actually by admitting that you have eggs or cheese, you are technically not TRULY ( in their parlance) a real vegan.

They are correct on that point.

This has Melody Beattie dollar signs written all over it. Somebody should get in on the ground floor.

Whilst I agreee with your article, I feel that the statement "If you are telling them that traditional Chinese medicine is anything more than a prescientific belief system, the vast majority of which is without scientific support or medical benefit." is a unfair to a large part of Chinese medicine. Having lived in China for 13 years and with a Chinese family, I think putting all Chinese medicinal practices into one basket (admitted you do say the vast majority) is a bit simplistic. In my experience there are two sides to Chinese medicine. The prescientific nonsense such as pressure points on the feet, humours in the body, hitting your head being good for the brain, walking backwards etc still exists here, but not for a majority of the people. They understand it is useless or use it as a last resort. The Chinese herb based medicine, on the other hand, in many cases is a very useful and natural alternative to manufactured drugs. All of my family have used various Chinese medicines for a variety of minor problems, such as muscle pain, tight chests in a cold, headaches and have had effective relief. For more serious problems all Chinese use western drugs often with some Chinese remedies for the minor symptoms, as i did after contracting pneumonia. The hospitals here use this integrated approach, western and Chinese herbal medicine, without the nonsense.

By Dave Morris (not verified) on 27 Jul 2016 #permalink

how optimal health is a joining together of the individual body-mind-spirit with the pro-social behaviors necessary for thriving in community.

This quote says it all to me.

Medicine is not chosen on the basis of whether it makes you and keeps you well, but on whether it fits in with your philosophical view of the world.

Starting from such a premise, anything expounded is certain to contain large helpings of bollocks.

By Chris Preston (not verified) on 27 Jul 2016 #permalink

Hi Darwinslapdog,

If I had said, "smarmy, vegan, fart-sniffing..." you'd have a point, but I mean that the smarmy hippycrits like to sniff the farts of vegans. They do smell less offensive than those of omnivores, kind of like horse poo. It is the meat that makes farts smell so bad, I certainly noticed a change when I introduced meat to my kids' diets.

If anything, I was actually complimenting vegans :D

By Can't remember… (not verified) on 28 Jul 2016 #permalink

Modern medicine and pharmaceuticals kill more people than they heal. You must be focus on nutrition and exercise to prevent disease before it happens because most "traditional doctors" only make people drug addicts!

Listen to the actual science (Ben Greenfield, Dave Aspery) you really have a poor understanding of what integrative medicine really is.

By Nikhil Verma (not verified) on 28 Jul 2016 #permalink

@darwinslapdog if you "have the occasional egg (etc.)", then you aren't a vegan. If anything not being a vegan but telling everyone you are a vegan probably makes you worse (even if you aren't gluten free)......

@Rich Woods

I can meet every one of those needs without resorting to unproven gobbletygook and utter nonsense.
>>I’d be interested to hear your definition of ‘spiritual needs’.<<

It seems to me that a lot of people these days are redefining the word "spiritual" to mean things like "appreciating nature or beauty, etc." which is hogwash, IMO, and a reaction to the (also hogwash) idea that you can't be rational without being a cold, emotionless robot.

Otherwise, yeah, I would be interested in hearing a definition of "spiritual needs" that doesn't include "unproven gobbleygook and utter nonsense," which, well, is pretty much what spirituality is, last I checked.

I think the "holistic" "doctors" just use it to mean either whatever the patient wants it to be, or whatever they think it should be. I once had a doctor (when I was a teenager, so I couldn't change docs since my parents were paying) who actually prayed in the examination room, undoubtedly thinking that was something helpful to my "spiritual well being."

@ darwinslapdog:
You can call yourself what you want, I suppose, but I don't think many vegans would call you a vegan if you eat eggs and cheese and wear leather. Not a vegan, but I'd just call that either being vegetarian or restricting the animal products in your diet. There are plenty of days when I don't eat meat, but I don't call myself a vegetarian because I don't always avoid eating meat.

By Amy Balot (not verified) on 28 Jul 2016 #permalink

Mycotoxins in coffee?
Perhaps. But you can get wet processed highland coffee from Costa Rica for much cheaper than Asprey's stuff. The coffee I get is $6/lb and it quite good.

Asprey puts Butter in coffee? WTF? This is not even soluble. If you want saturated fat with your coffee then your best bet is probably coconut milk.

The only reason

By James Castle (not verified) on 28 Jul 2016 #permalink

@25

I believe the correct form here is "citation needed"...

Exercise and nutrition were going to do bog all to prevent most of what I dealt with or my parents or my sister...

Panacea @10 and Rich @12

I did my nurse training in the mid-80s and heard all the "holistic" stuff.

The bit no-one ever defined was "spiritual": I would ask what that meant, but all I ever got was "everyone knows..." or some handy wavy and eye rolling. I genuinely do not understand what folk mean by the word, despite (or is it because of?) a church and Sunday school going upbringing.

Can anyone enlighten me?

I honestly can't believe that there is such ignorance or articles still being written like this in 2016. You belittle common sense, values and proven healing modes.

Unfortunately, 'alternative/complimentary/holistic' etc is a term used for anything outside of drugging a patient.. However, whilst people can prove they can get well and fight disease with nutrition alone (for example) then you don't have a leg to stand on. Or did you forget that vitamins actually have a critical part to play in our health? Without proper nutrition we become ill - sorry to point out the obvious!

Our immune systems fight disease - not drugs. They kill viruses, bacteria, cancer cells, parasites etc etc every day. Doesn't it make perfect sense that if an immune system becomes overwhelmed by cancer cells (caused by poor nutrition etc) that we develop cancer? Therefore the common sense answer is not to drug the patient but to nuture the immune system back to a good state in order to reverse the disease, not kill it off with treatments like chemotherapy. Whilst people are surviving terminal cancer diagnosis without drugs, you are just going to get more and more pissed off with 'quackery'. Which delights me because this sort of healthcare presented here is prehistoric ,and like all prehistoric things, it is becoming extinct.

I live in the UK too. We have a pain clinic in my town funded by the NHS that uses acupuncture. I know many people that have been tremendously helped by it. Our doctors and medical staff are far more receptive to therapies that get scoffed at elsewhere because they see the results every day for themselves. Just as Germany prescribes herbs for many ailments or other countries are way ahead of us in terms of acupuncture referrals. It's not difficult to find the data, especially as a doctor. I think you need to try harder.

The UK is actually behind other counties in CAM. I thank God for the internet and for having the right to take responsibility for my health through correct nutrition, exercise and 'alternative' therapies. These healing modes have saved my life (literally) and the lives of millions (possibly billions) of others. All without a single drug. Why anyone thinks that is a bad thing is beyond me unless you are big pharma or trained by big pharma of course.

I was unable to comment upon another one of your articles that scoffs at Urine therapy. I thought I would mention that it amused me very much. Whilst I have no idea whether UT is a cure for Ebola or not, it might very well be if urine acts like it is thought to. The point is, you don't know either. The studies on Urine therapy and Urea are very positive. Also, why do we have so many people (millions) who attribute their healing to it ? I cannot find a single case of damage caused through UT either so why does the close minded or so called 'scientific' portion of the medical community get their knickers in such a twist over the subject? You know as well as I do that no drug company is going to fund clinical trials to prove that ingesting one's own urine can help the common man in his own home. However, big pharma DOES spend millions trying to extract parts of urine to synthesise and sell as drugs. Therefore, urine has been proven to have medicinal worth just by this act alone. Along with all the case study history from various doctors and clinics then I would say that UT is pretty well studied and appears to have proven itself as effective.

When you are so ill that the 'cure' is going to kill you like chemotherapy (or increase your risk of secondary cancers if you happen to survive) then can you really blame people for trying what appears to millions as a 'common sense' approach? I.e focusing on the immune system and strengthening the body? May be you need to look through the 'spontaneous remission' (very insulting term to those that worked hard to recover their health) records that you have access to and wonder how many more thousands of cases of 'spontaneous remssion' there are unrecorded every year?

Doesn’t it make perfect sense that if an immune system becomes overwhelmed by cancer cells (caused by poor nutrition etc) that we develop cancer? [...]

Your reasoning is based on the assumption that people get cancer because of lacks of vitamins. You may want to prove this before jumping on the next part.
It's true that our immune system is supposed to kill tumor cells before they become a nuisance. So any successful cancer has, by definition, overwhelmed the immune system.
Or evaded it.
But the reason of this success is not necessarily a lack in nutrition; even more so because cancer cells would suffer from it, too.

Therefore the common sense answer is not to drug the patient but to nurture the immune system back to a good state in order to reverse the disease

Even assuming the premise, that reasoning is still lacking in ontological inertia*. Things which started happening won't stop happening because you get rid of the item which allowed them to start.
If you start a fire with a matchstick, your fire won't get snuffed out when you extinguish your match.
If your bathtub has a leaky faucet which filled it with water, fixing the faucet is not going to empty the bathtub.
If a sentinel at the entrance of some warehouse fell asleep and let a mob of thieves get in, sending a second sentinel to keep the first awake is not going to flush out the thieves which are already inside. The thieves may well be strong enough to overwhelm the two sentinels, actually.
Our immune system may be good enough to stop cancer at the budding stage. Once it got overwhelmed, on the other hand, even if it is doing overtime...

I cannot find a single case of damage caused through UT either.

If it's mostly done by "the common man in his own home", any damage may well be not reported. Survivors won't talk out of embarrassment, and non-survivors won't talk at all.
If it's done in alt-med clinics, those are notorious for being very shy when it's time to report their failures.

However, big pharma DOES spend millions trying to extract parts of urine to synthesize and sell as drugs.

And are these parts of urine effective as it is, or should they be better used injected, purified, and/or concentrated?
In the latter case, straight UT is not that effective, and there are merits to the pharma approach.
There are some good reasons why we don't tell people to chew bark to relieve an headache.

* sorry, a big word I learned recently
Although I was primed on looking for this logic gap in the "Melt Down" episode of a very old sci-fi TV series, The Man from Atlantis. The example of the bathtub was used, quite appropriately.

By Helianthus (not verified) on 29 Jul 2016 #permalink

Doesn’t it make perfect sense that

Any sentence that starts that way is not going to end well.

By herr doktor bimler (not verified) on 29 Jul 2016 #permalink

The cancer theories abound.

I think that cancer it is a respiration defect of the mitochondria.

The "genetic time-bomb" theory is just some convenient way of shifting blame to nobody, and away from environmental toxins and the corporations responsible.

By James Castle (not verified) on 29 Jul 2016 #permalink

I can't speak for Briskin's intent, natch, but just doing basic semiotics, in the formula, "mind, body, and spirit" the 'spirit' wouldn't reference spirituality, but something like 'attitude'. Dictionary definitions of 'spirit':
"The attitude or intentions with which someone undertakes or regards something."
"Enthusiasm and energy."

Brisken's piece is typical of IM-speak, in that puts forward some laudable general principles, and then twists them into conclusions that range from dubious to disgusting. There's always a verbal sleight of hand concealing unjustifiable leaps in argument. Not everyone advocating something they call 'Integrative Medicine' may, as Orac writes "say that it cares for the “whole person” and addresses “mind, body, and spirit,” but what it really does is to claim that you need to integrate pseudoscience into medicine to accomplish this end," ... but... well OK.. Briskin doesn't actually say you need pseudoscience to do this, though he does seem to imply that, but he does say pseudo-science is a way to accomplish this end, and that is just false.

@33

I'd say that pretty much everyone I know/knew working in mainstream medicine was aware of vitamins and the role adequate nutrition plays in maintaining health and well-being. Can't recall meeting anyone who didn't and do recall many conversations had with patients about diet...

This is not the same as diet "curing" diseases".

As for acupuncture on the NHS: I am all too aware of this and regard it as an unevidenced waste of scarce resources. When someone shows me decent evidence, as opposed to random anecdotes, for its effectiveness I will change my mind.

To supply my own anecdote on acupuncture: a local NHS physio offered my wife acupuncture for chronic shoulder pain. On seeing her look of disdain he admitted that he didn't believe it worked but some people seem to like it so they offer it...

And that is before we get into the inconvenient lack of any convincing biological basis for acupuncture (can someone show me a scan picture of a "meridian", please?).

Oh, and the bulk of what I did clinically did NOT involve drugging patients and I am resolutely NOT involved in anything alt/CAM/whatever. Same was true of my parents.

Oh, and if someone might explain how diet and exercise and the like could have helped my sister when she ran a haematology unit at a major hospital in south London, whose catchment area had a significant population of Afro-Caribbean descent...Go away and work out what the main blood disorder presenting to that unit was ("Do your research!"), then come back and tell me how diet would in any way help there.

Not everyone advocating something they call ‘Integrative Medicine’ may, as Orac writes “say that it cares for the “whole person” and addresses “mind, body, and spirit,” but what it really does is to claim that you need to integrate pseudoscience into medicine to accomplish this end,” … but… well OK.. Briskin doesn’t actually say you need pseudoscience to do this, though he does seem to imply that, but he does say pseudo-science is a way to accomplish this end, and that is just false.

A better way to say this is that not everyone advocating integrative medicine realizes that what they are in fact doing is implying that you have to "integrate" pseudoscience into medicine in order to heal "mind, body, and spirit," but that is what they are, in practice, doing. :-)

Well I'm all for Integrative Medicine, mind, body and spirit, a great idea! I just don't think it goes far enough!!

Many patients, even when healthy can be tense and frustrated. What they really need is Sexual Healing*

It makes them feel fine, helps relieve their mind and is something that is good for them.*

FSM speed the day, when CAM practitioners who truly care for their patients will go that extra mile. ;)

*(TM Marvin Gaye)

Pshaw! Your Dr M. Gaye learned everything he knew from Dr Alex Harvey.

By herr doktor bimler (not verified) on 30 Jul 2016 #permalink

Our immune systems fight disease – not drugs.

Well, one might observe that the immune system sometimes has a certain habit of "fighting" certain drugs, but that's neither here nor there.

But if one is going to bring up teh magikality of the immune system, current events certainly cry out for an explanation of antibody-dependent enhancement within this caring, benign system.

^ Dammit, that word repetition is just getting worse and worse.

@ Orac #41

A genuine 'holistic' approach to health isn't just a good thing, it's a necessary thing in many cases. For one thing, maladies of the body can mess with the mind and crush the spirit, which then need some attention if the patient is to 'follow drs. orders' properly to do what is necessary to help the body. However well or poorly individual physicians may be able or inclined to treat 'the whole person' (basically, showing that ''they give a damn' about the 'whole person' in the exam room), as a systemic and institutional level, contemporary conventional medicine does very badly on this score.

Part of what I was trying to say in #37 is that the quacky methods favored by IM advocates like Briskin are either lousy means of achieving their stated goals or downright counterproductive to them. That is, in material reality there's no connection between the two. However, in large part because 'conventional medicine' has abandoned the field, on the turf of ideology, the two have become "articulated", meaning one wagon has been hitched (articulated) to the other, such that they commonly get spoken (articulated) as one term.

So realizing's got nothin' to do with it. In practice, anyone calling for healthcare to address "mind, body and spirit" IS giving a boost to the "integration of psuedoscience into medicine." Thus, the particular subset of CAM involved here has engineered themselves into a scenario that's win-win for them and lose-lose for sbm. When you (Orac) scourge IM, you subvert a proper concern for addressing mind and spirit that is exactly conventional medicine's most glaring shortcoming (not as 'science,' but as the social institution that actually delivers healthcare to human beings). When I (sadmar) assert we desperately need a more holistic medicine that cares for the mind and spirit – for example, in repulsion at the hell JP is going through these days – that inevitably helps the WHACII (Weil-Hyman Acupuncture Clinic Integration Initiative). Like it or not, where either the baby or bathwater go, the other is going to follow.

What's going on here is that despite the lip service IM-CAM gives to mind and spirit, it's still stuck in the broader antipathy to treating those as legitimate concerns for healthcare. This is most obvious in the stigmas surrounding even minor mental heath issues, and most pernicious in the reluctance of anyone, but especially insurance companies, to pay for care of the mind and spirit under any circumstances. What IM-CAM actually does is offer low-quality psychological support for patients suffering in mind and spirit from chronic pain, the effects of chemo and radiation, etc. etc.

In this, it throws in the towel, because the mind and spirit stuff is masquerading as magical physiological cure, since only with a claim of physiological cure will various stakeholders consider 'health' treatment worthwhile/valid/legitimate. Which is to say, at this point, as a practical matter, it's all but impossible to provide services to care for 'the whole person' without either telling patients lies, or letting them believe lies, because no one will pay for the TIME it takes otherwise.

The only way out of the double-bind here, to separate the baby and bathwater, to get rid of the magical claims, is to validate care of the mind and spirit as essential aspects of healthcare independent of physiological efficacy. That's not going to happen quickly or easily, and I don't expect to see it my lifetime. I can imagine a system that would integrate care of the body with care of the mind/soul (or rather re-integrate, but that's another comment): covered access to counseling, support groups, physical therapy, diet and exercise programs, organized recreation-activities-as-therapy... but right now I can't imagine how we'd get there.

But when good, sharp people are so soured on quackery they can only respond to concepts of pro-social, community-enhancing holistic care with the sort of smack hdb delivered in #19, we're on the wrong track, and the quacks gain even more advantage...

@James Castle #36

So educate us, James, on just what caused cancer back in the day before your corporations were around to bombard our Mesopotamian predecessors with toxins?

They had the disease, you know, they wrote about it and you yourself could even read about it if you exerted yourself to learn the language.

By Robert L Bell (not verified) on 30 Jul 2016 #permalink

@Johnny I wonder what corporation caused that.

There were no corporations back then Johnny.

Now let the adults talk now Johnny.

I think that cancer it is a respiration defect of the mitochondria.

Do go on.

And just in case anyone was wondering, the blood disorder I referred to previously is sickle cell anaemia...Well known for responding to dietary changes and exercise...

so soured on quackery they can only respond to concepts of pro-social, community-enhancing holistic care with the sort of smack hdb delivered in #19

I remain steadfast in my lack of enthusiasm for "pro-social , community-enhancing holistic care". Being a socially dysfunctional loner is perfectly normal for my people. Society may have a problem with that, but it's not my problem.

By herr doktor bimler (not verified) on 31 Jul 2016 #permalink

I don't know anything about expirations of midichlorians, or whatever, but if you want to refute "the genetic time-bomb theory of cancer is just some convenient way of shifting blame to nobody, and away from environmental toxins and the corporations responsible" observing that cancer existed 1.7M years ago hardly does the job.... OK, it's a pathetic rhetorical 'Fail'. The claim is obviously not about all cancers, nor does it put exclusive responsibility on corporations.

Rephrased more precisely, "The genetic time-bomb theory of cancer is just a convenient way of shifting blame to nobody, which includes shifting blame away from environmental carcinogens for the cancers they produce, and away from the corporations responsible for causing cancers by releasing carcinogens into the environment."

The 'includes' is inferred in James Castle's language by any fair interpretation. So either 1) you're nit-picking at Castle's lack of grammatical precision; 2) straw-manning him, or 3) dense as day-old doggie-doo.

If you think these issues matter, you need to do better than that. Try harder.

Sheesh, I hope bimmler's just yanking my chain, and left of the [irony] tag.

I remain steadfast in my lack of enthusiasm for pro-social, community-protecting immunization efforts. Being a socially dysfunctional lone-eagle is perfectly normal for my people here iat AoA Society may have a problem with my choice to leave my kids as walking VPD vectors, but it’s not my problem. – J. B. Handley

Maybe hdb's neighbors have been playing old Rush albums with subliminal codings of passages from Atlas Shrugged underneath or something...

@sadmar, who are you writing to?

Al

In #55 that is...

Alain:

#55 is addressed to anyone here and no one in particular. I'm trying to take a jab at the sentiment in hdb's #53, which appears to reject pro-social action for the common good in favor of I'll-do-what-I-want-damnit Liberturdianism: "Society may have a problem with that, but it’s not my problem." I honestly don't know if he was joking, going back to the context of #19, which I did not take as irony, but as sincere smack against the syrupy new-agey sentiments in which Briskin wrapped his philosophy of IM. Since my argument is that the broad strokes of the philosophy are actually good, and that the rest of Brisken's assertions either just don't follow from it, or actually undermine it, regardless of hdb's intent, I wanted to note that an un-ironic interpretation of "Society may have a problem with that, but it’s not my problem," is a direct parallel to anti-vax ideology and rhetoric.

I stand with herr doktor bimler - I dispute anyone's right to join together my mind-body-spirit with pro-social behaviors. Only amateur-social behaviors for me. If I'm not going to be paid I refuse to go pro..

By Mephistopheles… (not verified) on 31 Jul 2016 #permalink

Ice cream social behaviors would also be acceptable.

By Mephistopheles… (not verified) on 31 Jul 2016 #permalink

@sadmar,

Thanks. I had the impression that you jabbed at more comments than #53 and #19 (#49 among other which I'm tempted to take care of...)

Alain

Alain: Different and, I think, unrelated jabs.

Meph: Ice cream can make unpleasant things not just acceptable, but worth pursuing. However, I'll pass on the social ice cream if it means anybody else is going to lick my Drumstick. But as long as everyone in society has their own dipped cone, I'm chill with that.

Rephrased more precisely, “The genetic time-bomb theory of cancer is just a convenient way of shifting blame to nobody, which includes shifting blame away from environmental carcinogens for the cancers they produce, and away from the corporations responsible for causing cancers by releasing carcinogens into the environment.”

Well, I don't see it. I admit that, other than a comment above saying oil and water don't mix, I don't recall anything posted by Castle, but maybe you do. Bell at 47 seems to have read it the same way I did.

Let's look at what Castle did post.

The cancer theories abound.

True enough. My understanding is that there are many causes of cancer - sometimes environmental, yes, as well as genetics, lifestyle choices, infection and sometimes we just don't know. It just happens.

I think that cancer it is a respiration defect of the mitochondria.

The great and powerful Google tells me this might be part of the cancer puzzle, but if the claim is that all cancers are caused by cell respiration defects, I'll just say 'citation needed'.

The “genetic time-bomb” theory is just some convenient way of shifting blame to nobody, and away from environmental toxins and the corporations responsible.

This seems to suggest that all cancers are caused by man-made environmental toxins. Even if i'm generous, and allow that some toxins exist naturally in concentrations that could cause cancer, it's the bit about shifting the blame to nobody that bothers me.

True, corporate pollution can cause cancer, and some cancers can be blamed on the actions of others. But sometimes, cancer just happens, and it's nobody's fault. It sounds to me that Castle can't deal with that.

But, hey, maybe I'm wrong. I often am. If I misunderstood Castle's comment, I apologize for the rhetorical shortcut.

hdb’s #53, which appears to reject pro-social action for the common good in favor of I’ll-do-what-I-want-damnit Liberturdianism

I like to think that my ire is directed at the idea of inculcating pro-sociality by confusing it with personal health. For the misuse of language is far more important to me than trivial abstractions like "liberty" or "individual".

If I took a car to a mechanic for maintenance, and instead received lectures on the proper observance of road rules, that would be admirably pro-social, but I would still change quickly to a different and more competent mechanic.

(purely hypothetical analogy since I don't drive).

By herr doktor bimler (not verified) on 31 Jul 2016 #permalink

If anyone wants to set up shop as a Holistic Garage, offering non-Western modalities of engine tuning -- also Integrative Mechanics services like adjusting your car's crankshaft chakras -- go straight ahead. I will not try to patent the idea. That's how pro-social I am.

By herr doktor bimler (not verified) on 31 Jul 2016 #permalink

By way of another analogy... let us suppose that I have need of legal services, as a consequence of my innovative but ethically-questionable experiments at the forefront of medicine. Suppose, further, that the first lawyer I visit is an adherent of Holistic, Integrative Jurisprudence, who believes in treating the whole person rather than winning particular cases. He offers a range of traditional and non-western modalities of courtroom performance, augments his cross-examination with acupuncture, and when deciding which expert witnesses to call, he bases the choice on omens, auguries, entrail examination, and the movements of large mustelids.*

In my particular case, he thinks that I can probably escape the charges, but he plans to enter a guilty plea for me anyway, for it is better for the wider community if Society can make an example of me.
Am I justified in deciding that this lawyer is an incompetent fool?
-------------------------------------
* "Objection, your honour! The defense is witnessing the badger!"

By herr doktor bimler (not verified) on 31 Jul 2016 #permalink

This article is what happens when God is removed from science. There would be no science without creation.
This article also seems to represent symptom based medicine ( meaning they can soak you for the long haul) as compared to treating the illness itself.
Wouldn't surprise me if this guy was just as "in bed" with the pharmaceutical companies as the doctors he knows.