University of Arizona

The University of Arizona Mel and Enid Zuckerman College of Public Health teams up with quacks

oracknows — Thu, 01 Oct 2015 01:00:20 +0000

The University of Arizona Mel and Enid Zuckerman College of Public Health teams up with quacks

I like to start most, if not all, posts about naturopathy with that simple statement. The reasons are simple. First, it's true. Second, most people—including doctors—are unaware of this simple fact. Finally, it irritates naturopaths and their fans. It also has the benefit of setting the tone I want to convey whenever I hear about naturopathy being granted the appearance of academic legitimacy by being embraced by a real academic medical institution. Such were my thoughts when I was made aware of this press release entitled SCNM Offers Dual-Degree Program for Master's of Public Health and Naturopathic Medical Degree in Collaboration with University of Arizona:

In collaboration with the University of Arizona Mel and Enid Zuckerman College of Public Health, Southwest College of Naturopathic Medicine (SCNM) is pleased to offer a dual-degree program for a naturopathic medical degree (ND) and a master’s degree in public health (MPH). Naturopathic medical students will begin classes in the fall 2016.

Students must apply and be accepted into both programs in order to qualify. For the master’s degree in public health, students can choose to concentrate in either public health practice (PHP) or in health services administration (HSA). “For a student interested in leadership positions in public health at government agencies, international health organizations and non-governmental associations, this is a tremendous opportunity to develop a career path,” said SCNM President Paul Mittman. “For SCNM, this collaboration represents another milestone in our strategic plans to grow the college’s academic side as well as our ability to reach and engage more students, faculty and staff.”

Yes, you heard that right. The UA's College of Public Health has made a deal with a school of naturopathy to offer a dual degree consisting of a fake degree from a fake medical school, namely a degree in naturopathic medicine (ND, or, as I prefer to call it, "not a doctor") and a real degree from a real school of public health, or an MPH. It's like a bizarro world copying of a trend that's been going on in medicine for a while, namely for physicians to obtain both an MD and an MPH in order to be able to do a combination of medical research and public health research. It's a powerful combination; so I suppose it shouldn't be too surprising that naturopathy schools, mimicks of all things medicine as they are, saw this trend and tried to copy it for their not-doctors. What I am surprised at is that any reputable school of public health would fall for it. On the other hand, I suppose if medical schools have gotten into bed with naturopathy schools before, as the the Georgetown University has done with Bastyr University and National University of Health Sciences.

So what is the rationale for this collaboration? This:

“Students of naturopathic medicine seek formal public health training. The fundamental principles of naturopathic medicine are similar to those of public health in such areas as health promotion, prevention, and patient education,” said Dr. Cecilia Rosales, assistant dean of Phoenix programs at the UA Zuckerman College of Public Health. “NDs are trained to be more proactive in their approach to wellness than reactive approaches to disease management and treatment.”

“We think it is important to offer public health training to all health-care providers responsible for individual care. This is especially important with the new health-care law that seeks to keep the population well rather than treating and managing illness.”

Dr. Rosales said the collaboration enhances career opportunities for SCNM students as well as opens up wider inclusion of naturopathic medicine in the broader public health community. “At the same time, we are at the very front end of what we expect to be a tremendous partnership with the Southwest College of Naturopathic Medicine.”

No, the fundamental principles of naturopathy sound superficially similar to those of public health, but that's it. Naturopaths claim to be about health promotion and prevention. When their teachings overlap science-based medicine, which they sometimes do by coincidence alone coupled with their co-opting of the science-based modalities like exercise and diet, there is a tiny amount of truth to the claim. However, naturopathic "prevention" comes at a high price, and that price is exposure to pure quackery. As I like to say, you can't have naturopathy without homeopathy. It's a mandatory part of the curriculum in naturopathy schools. It's even in the examination naturopaths take to become certified, the NPLEX. Many naturopaths use it in their practice. Given that homeopathy is The One Quackery To Rule Them All, the very fact that naturopaths so readily embrace homeopathy should tell you all you need to know about how weak their commitment to science is and how much their specialty is infused with pseudoscience.

Homeopathy, of course, is not the only quackery that naturopaths learn and practice, just the most quacky. As Britt Hermes, a former naturopath who gave up naturopathy up when she realized how ridiculously full of pseudoscience it is, points out, naturopathy school also requires its students to master hydrotherapy, herbology, acupuncture and energy medicine (or, as I like to call it, faith healing).

Of course, among all medical institutions, the University of Arizona would have been one of the first ones I'd expect to team up with quacks because the University of Arizona School of Medicine is already highly infused with quackademic medicine, thanks to its resident "integrative medicine" guru, arguably the most famous quackademic in the world, Andrew Weil. Indeed, a year and a half ago, I learned that the University of Arizona Cancer Center was offering the faith healing that is reiki to its pediatric cancer patients, indeed to all of its cancer patients. Meanwhile, Dr. Weil has founded an "integrative medicine" residency program and developed a board certification in this specialty that "integrates" quackery like naturopathy into medicine. Meanwhile, UA rakes in the dollars from the National Center Complementary and Integrative Health (NCCIH) to study acupuncture and other alternative therapies. So, unfortunately, the precedent had been set. It also doesn't help that Arizona as a state is about as quack-friendly as it gets, licensing homeopathic physicians and naturopathic not-doctors.

Britt Hermes makes an excellent point about the claim that naturopaths like to make that they are all about "prevention" while regular doctors are not:

This notion accuses the medical community of being incompetent and misguided. It is an old argument from the late 19th century when scientific medicine was still figuring itself out while homeopaths, osteopaths, chiropractors and naturopaths aggressively marketed fanciful methods designed “to treat the root cause of disease, not just symptoms.” For buying into this archaic ideology, the UA is being academically disingenuous, hindering the scientific process and tarnishing its reputation.

To be clear, there is nothing “proactive,” let alone safe, about giving patients sugar pills, recommending severe dietary restrictions, prescribing untested plant extracts, discouraging vaccines or injecting a cornucopia of substances from high-dose vitamins to ozone gas into patients’ veins.

Exactly. It is not a good thing to be "proactive" when being "proactive" involves subjecting patients to homeopathy, IV ozone, unproven supplements, using thermography to diagnose breast cancer and many other diseases (as naturopaths like to do). Being proactive should involve applying the best science to medicine and prevention. Good MPH programs teach their students how to do just that. By embracing the quackery and pseudoscience that is naturopathy, the University of Arizona Mel and Enid Zuckerman College of Public Health has abdicated its responsibility to teach their students about prevention, health maintenance, and public education about medicine.

oracknows Wed, 09/30/2015 - 21:00

Categories

Education

From the linked LTTE by Britt Hermes:

In the press release about the SCNM alliance, UA’s assistant dean at the College of Public Health program in Pheonix, Dr. Cecilia Rosales, reiterates a common naturopathic trope of prevention: “[Naturopathic doctors] are trained to be more proactive in their approach to wellness than reactive approaches to disease management and treatment.”

As Ms. Hermes correctly notes, this is premium fertilizer. In order to be "proactive", one must have some idea what the bad outcome needs to be prevented. And it needs to be more specific than "the patient gets sick".

There are things that SBM doctors do that are proactive. Vaccines prevent specific diseases. Doctors who know the patient's medical history can spot susceptibilities to certain conditions, e.g., cancer or heart disease, and recommend steps to reduce the risk. Likewise, naturopaths are being reactive when they advise their patients to take 60C nihilis nostrum or whatever homeopathic "remedy" is "indicated" for the patient's symptoms (and even taking the claims of homeopaths at face value, their remedies are specifically designed to treat the symptoms).

The main difference is that SBM doctors actually have reasons other than wishful thinking to believe that their treatments will work. Wishful thinking is all the naturopaths have.

Developments like these ( UA, Georgetown) enable woo-pushers to claim that paradigm shift has occurred: I hear this frequently "even MEDICAL SCHOOLS are changing". Or "Research at the UNIVERSITY of wherever shows.." Or " DR So and So at HARVARD".

Interestingly, (from Hermes's quote about the late 19th century being a time when SBM was "figuring itself out")
I've heard via PRN that this era was when alt med practitioners were being forcibly replaced by the Rockefellers' coal-tar based pharma-based medicine using unscrupulous tactics aimed at eliminating their art forms entirely through governmental regulation and the funding of universities.

Thus, the alties provide alternative history as well as alt med.

Thanks for the info, Orac.

I did my pediatric residency at the U of A in Tucson. I will be writing a letter to the Dean of the Medical School as well as the chair of pediatrics demanding they oppose this dual-degree program based especially on the anti-vaccine stance of naturopaths. I hope there is someone at Arizona Mel and Enid Zuckerman College of Public Health that understands how large a contribution vaccines have made to improving public health.

Arizona has one of the highest non-medical vaccine exemption rates in the country and this year's CDC vaccination survey shows AZ with the worst (of all 50 states) MMR vaccination rates in the US.

This is a boneheaded and dangerous move, Arizona Mel and Enid Zuckerman College of Public Health.

I’ve heard via PRN that this era was when alt med practitioners were being forcibly replaced by the Rockefellers’ coal-tar based pharma-based medicine using unscrupulous tactics aimed at eliminating their art forms entirely through governmental regulation and the funding of universities.

Which is quite a trick considering that the FDA and the NIH didn't exist at the time. And a remarkably ineffective conspiracy at that, since homeopathic remedies have never been subjected to the sort of federal regulations that apply to Big Pharma's products.

But it points to a major problem we are facing in this country (one which, alas, is not limited to medicine): certain groups of people believe they are entitled to their own facts. There is no way to win an argument with such people.

@ Eric Lund:

How I understand his tale:
the Rockefellers had excess coal tar/ petrol products which they wanted to aggressively market so they attacked the alt med folk in order to supplant the latter's wholesome healing herbals with coal/ oil pharma so they introduced governmental controls, bribed officials, encouraged journalistic outrage and used generalised sculduggery in order to tarnish the alties' sterling reputations amongst the public and then replaced that natural artistry with high priced chemical poisons and university-trained MDs! They continue to oppose natural medicine to this VERY day!

-btw- I perused Mikey's Truth Wiki and stumbled upon the entry about esteemed host ( under his real name).

This is very sad to read. My daughter just graduated from UA with her MPH. I'm forwarding this to her.

Thank you, Orac, for giving this news wider attention. As an alumnus of the UA, I am very disappointed. It has not been fun defending this letter to some very upset cultural anthropology friends.

Is quackademic medicine on the march like this in the rest of the world,or is it just a North American thing?I have read very little about this outside of your blog,and over at SBM.This is a subject that the media at large seems to have completely ignored.It seems to me the rise of quackademia is just another symptom of the increasing revolt against science as a whole in America.Dan Rather wrote a very good article last week about the movement against science by both the left and the right in America.Rather admits the media helps promote this bias against science,by not educating the public at large about science.

Is it possible more universities are offering programs like this because this is what the tuition paying public,and big donors want?That universities and medical schools may just be doing this just to get money?

Is it possible more universities are offering programs like this because this is what the tuition paying public,and big donors want?That universities and medical schools may just be doing this just to get money?

It wouldn't be so much the tuition-paying public (in many cases, tuition payments, even without the state subsidy, don't cover the cost of educating the student), but big donors, definitely. Campuses want top-notch facilities to attract prestige, top-notch faculty, and the best students they can recruit. So if some deep-pocketed prospective donor is offering umpteen million dollars to found the $DONOR Center for Integrated Medicine at a university with a medical school, he'll get an audience, just as if the request were for a new $DONOR Biological Sciences Building. The President (or equivalent) of the university may not know the difference; depending on his academic background, he may not have had a hard science course since high school. All he knows is that $DONOR wants to give his university a bunch of money, and his job is to get people like $DONOR to give bunches of money to his university. Every university I have ever been affiliated with operates this way; the only reason my current employer will never have a $DONOR Center for Integrative Medicine is because we do not have a medical school.

For a state university like UA, insufficient state subsidies is part of the problem, but Georgetown (to take an example mentioned upthread) is a private university, so this constraint does not apply.

NDs are real doctors, with equal training and hours as MDs in the USA. The U of A has been open to NDs for a long time via Andrew Weil, MD and NDs on that board; but we keep getting paid assassins like this (paid by the AMA, etc) and others who are conventionally trained (and brain washed, really, via politics and a strict agenda based on money and rarely science). And Britt Hermes was an unhappy student from Bastyr (probably flunked out) who moved to Germany and continues to slander NDs, even has a group of "editors" (assassins) on Wikipedia, which long has had a bias as well! So NDs continue to get no respect, publicly. But their patients sure are happy. My insurance agent even said there is so little complaints and virtually no law suits against real NDs that they can offer extremely low premiums. I guess we will just have to be content with those last two points, for now!

Is quackademic medicine on the march like this in the rest of the world,or is it just a North American thing?

Not at all. It's a global phenomenon seen in most developed countries. Particularly affected are the UK, Europe, and Australia, but it's not limited to there.

For most of my life, I shared that same erroneous opinion about Naturopathic physicians, chiropractors, etc. After all, this is what I was taught by my medical profession. It was only after I began to witness first hand the incredible successes achieved in many lives where traditional Allopathic medicine was limited or failed, did I then have to admit THE TRUTH. There IS a place SIDE BY SIDE for these two modalities for the purpose of achieving optimal health for patients. I truly applaud these honorable institutions of higher learning for incorporating Naturopathic training and the possibilities that it brings.
By doing so, we are taking the medical profession forward rather than limiting patient care by our own lack of knowledge, prejudices or "soap boxes". It is humbling to admit that we can be wrong but also a good place to start in moving forward in health care!

NDs are real doctors, with equal training and hours as MDs in the USA.

Come on, this is obviously false. How many MDs learn homeopathy?

a strict agenda based on money and rarely science

please, do describe the science that supports homeopathy, let's discuss that!

ND's are real doctors; really. I guess this technically true in that they received a piece of paper that states they received a degree. However, when I hear of an ND that has a woman jump up and down to induce labor I know they are a real doctor.

Currently there is a news story about a group of US medical tourists that received live cell therapy and contracted Q fever from it. Yep real medical doctors.

Brad: "And Britt Hermes was an unhappy student from Bastyr (probably flunked out) ..."

You are obviously illiterate. You should probably have someone help you to read and understand the articles she wrote at SBM.

Plus you must be innumerate. This is why you are confused about the number of hours taken, and the length and type of residency training. I have seen MD and DO graduates as residents at local hospitals, but never an ND. The only way anyone would think studying homeopathy is worthwhile (and it is required at Bastyr) is that they flunked both basic arithmetic and chemistry.

@Chris Hickie #3:

This is a boneheaded and dangerous move, Arizona Mel and Enid Zuckerman College of Public Health.

Yes yes yes, but does it mean the college will profit? After all, what use is a college to anyone if it can't make money from what it does?

To Whomever you are @ #12
If you have to capitalize "THE TRUTH" it's probably not true.

Dear NDs:

You don't know crap. You've never cared from critically ill patients. You don't understand science, anatomy or physiology. And, since you are anti-vaccine, allow me to tell you as a pediatrician to go jump in a damn lake with your "equality" claims. You are quacks through and through.

Sincerely,
a real physician

I would challenge our newest visitors to name a specific evidence-based treatment offered by NDs that isn't offered by MDs or DOs (or MBBSs, or MBChBs, of course!).

Or rather, let me clarify: I would do that, but then we all know it's futile to bother.

we keep getting paid assassins like this

You should always request a paid assassin if you want a quality job. I'm not saying you couldn't find an amateur assassin who would be suitable for, say, a wedding or bar mitzvah, but why would you risk your important assassinations on an amateur who might bungle it? If you want the job done right and you don't want to do it yourself, spend the bucks and hire a professional. And remember to look for the union label.

I began to witness first hand the incredible successes achieved in many lives where traditional Allopathic medicine was limited or failed,

Could you please tell us:
- what were these successes?
- what were the treatments?
- why do you think the successes were a result of the treatments rather than in spite of them?

Thanks.

Oh, by the way, "allopathic" is a term used to distinguish any medicine that isn't "homeopathic". Did you really mean to use that term?

Naturopathy is quackery.

I like to start most, if not all, posts about naturopathy with that simple statement. The reasons are simple. First, it’s true. Second, most people—including doctors—are unaware of this simple fact. Finally, it irritates naturopaths and their fans.

Mission accomplished, at least with Susan Werner and Brad. :-)

It is humbling to admit that we can be wrong

'Dr.' Werner:

I began to witness first hand the incredible successes achieved in many lives

Could you be wrong about what caused these 'successes?' What, hypothetically, would convince you that these successes had nothing to do with whatever alternative treatment you're referencing?

Oh, looks like the Kid missed out on the perfect program to meet his distorted view of reality.

My insurance agent even said there is so little complaints and virtually no law suits against real NDs that they can offer extremely low premiums.

As noted above, NDs tend to have low-risk patients. So they rarely have things go catastrophically wrong. That doesn't exclude treatments going wrong in non-catastrophic ways, such as having no efficacy beyond the placebo effect. And they have been using many of these non-efficacious treatments for a century or more. At least science- and evidence-based practitioners eventually weed out treatments that don't work.

Furthermore, extraordinary claims require extraordinary evidence. For homeopathy and energy medicine to be correct, much of what we know about chemistry and physics would have to be wrong. Specifically, aspects of chemistry and physics that have been thoroughly tested to high precision would have to be wrong. So not only do you have to come up with versions that allow homeopathy to be correct, you would have to come up with something that passes these experimental tests at least as well as our existing framework. You're welcome to try it. You'll almost certainly win a Nobel prize if you succeed. But I won't wait up nights for these new theories to come in.

"There IS a place SIDE BY SIDE for these two modalities for the purpose of achieving optimal health for patients. "

Dr. Werner, what exactly does naturopathy offer that standard of care evidence -based medicine does not, such that we'd reasonably expect patients receiving both naturopathic and standard of care evidence-based treatment to acheive better outcomes than patients receiving standard of care treatment alone?

Orac,

Yesterday, I was able to irritate a "believer" using you and this site. One of our wellness team nurse (real medical) came into my office and I showed this site and commented about it to her.

Her reply was that this site would never make any good comments about alternative medicine. I told her yes good comments could be had if some treatment by alternative medicine was actually proven to work.

Of course we all know how soon that will be.

Susan Werner and Brad-- After reading through a substantial amount of the conversations in a Yahoo group between ND's regarding treatments, I was thoroughly convinced that they didn't have nearly enough training of clinical relevance to do anything. It was almost like they would play Boggle with medical literature, just looking for a specific term here or there.

this is what I was taught by my medical profession.

Are you an MD, by the way? Because there is no MD with that name in Arizona. Did you mean to type Stefanie by any chance?

Naturopaths without borders...what a joke.

And Susan? May I ask what field your doctorate is in? The Arizona State Medical Board has no record of a licensed MD or osteopath named Susan Werner.

To Chris Hickie #3:

“I did my pediatric residency at the U of A in Tucson…Arizona has one of the highest non-medical vaccine exemption rates in the country and this year’s CDC vaccination survey shows AZ with the worst (of all 50 states) MMR vaccination rates in the US. This is a boneheaded and dangerous move…”

I have nothing against vaccinations, personally, but I’d like to play Devil’s Advocate.
Specifically, Devil’s Advocate from the point of an evolutionist, an evolutionist who is also
a) AGAINST “stupid” and “religious” people, and
b) FOR population control, and even, perhaps, reducing the world’s population.
(I think most contributors and commenters here fit this description.)

The smart people who get vaccinated have nothing to fear from the dumb people who don’t. The smart people are protected by their vaccines.
And if the dumb people who don’t get vaccinated die as a result, it serves them right, and will be a lesson to the possibly-dumb people who are still on-the-fence about vaccinations.

The silver lining is that the world would then have fewer people, and more importantly, fewer “stupid” and “religious” people.

No coercion, no murder involved here. Just natural societal evolution, a type of social Darwinism, if you will.

So, my Devil asks: What’s the problem, Chris?

#31 The dumb people still risk infecting people, especially vulnerable populations.

Wikipedia, which long has had a bias as well!

True, they do aspire to be reality-based.

SN: "The smart people who get vaccinated have nothing to fear from the dumb people who don’t. "

So what is your plan to protect babies under age one from measles, mumps and chicken pox? Do you consider their parents as "dumb people" because they wait until the child is eligible for those vaccines, which after their first birthday?

According to the CDC the last measles outbreak included "26 (16%) were aged <12 months." (sorry for the wonky grammar, direct cut and past from the report)

There IS a place SIDE BY SIDE for these two modalities for the purpose of achieving optimal health for patients.

Are you saying you're ragged and funny? Inquiring minds want to know.

See, vaccines aren't 100% effective: some 'smart people' who get vaccinated are expected to fail to develop protective antibody titers, just as people contract an infectious disease sometomes fail to develop sufficient antibody titers to protect them against subsequent reinfection by teh same disease (my son, for example, has had chicken pox 3 times).

Finally there are a significant number of people who for legitimate medical reasons aren't suitable candidates for vaccination (people undergoing chenotherapy, for example).

These people can rely on herd immunity for preotection from infectious disease, and those 'dumb people' (your characterization, not mine) compromise that herd immunity, placing them at increased risk of infection.

There is also the little fact of hundreds of thousands of babies, who are too young for some vaccinations....so I'd rather protect them then watch them suffer from measles, mumps, rubella or the other host of childhood VPDs that they could be exposed to.

The smart people who get vaccinated have nothing to fear from the dumb people who don’t.

This is at best an exaggeration. As you're doubtless aware, no vaccine is 100% effective. While it can reduce the chances of infection by, say, 90% * on average, some people will not receive full benefit, some may temporarily become more susceptible due to a depressed immune system, and some may be exposed before being vaccinated. Thus being vaccinated (or intending to be vaccinated) does not provide an absolute protection against the disease.

And if the dumb people who don’t get vaccinated die as a result, it serves them right, and will be a lesson to the possibly-dumb people who are still on-the-fence about vaccinations.
The silver lining is that the world would then have fewer people, and more importantly, fewer “stupid” and “religious” people.

The guiding factor in being unvaccinated until the age of majority is not one's own views, but one's parents' views. While there is certainly a genetic component to intelligence, this oblique form of eugenics is unlikely to raise the overall intelligence of the race. Additionally, remember that diseases like polio or measles may cause non-fatal but undesirable side effects like, say, paralysis or permanent deafness which don't necessarily preclude one from contributing to the gene pool even if one were to later decide "I survived measles, my kids can too."**

* Number given for illustrative purposes only, since IANAENDIPOOT.

** I do not know anyone who had a permanent injury from disease who has ever said that , and I probably am excessively insensitive in positing that someone could. I apologize, but use it for effect.

And remember to look for the union label.
The Assassins' Guild does not encourage free-lancers.

Britt Hermes was an unhappy student from Bastyr (probably flunked out)
If only there were some way to look up information on the Intertubes, and encounter facts such as

[Hermes] graduated from Bastyr University with an N.D. degree and practiced as a naturopath for about 3 years

Alas, such possibilities remain in the realms of fantasy.

he Assassins’ Guild does not encourage free-lancers.

Lord Vetinari would agree.

Next from the U. of Arizona Astronomy Department:
"Students of astrology seek formal astronomy training. The fundamental principles of astrology are similar to those of astronomy in such areas as calculation of orbits, eclipses and other significant astral events."

This will then lead to a comment like that from Dr. S. Werner (#12)
"It was only after I began to witness first hand the incredible successes achieved in many lives where traditional Astronomy was limited or failed and destroyed their families (all these night shifts observing stars) , did I then have to admit THE TRUTH.
There IS a place SIDE BY SIDE for these two modalities for the purpose of achieving optimal predictions of the future, be it eclipses or your love life."

have nothing against vaccinations, personally, but I’d like to play Devil’s Advocate.

No, you're just an attention whore.

The smart people who get vaccinated have nothing to fear from the dumb people who don’t.

That you would post that places you squarely in the "dumb" camp.

How many of those babies in Chicago last winter who caught the measles were old enough to be vaccinated?

This sort of stuff really makes me want to not live on this planet anymore.

Additionally, remember that diseases like polio or measles may cause non-fatal but undesirable side effects like, say, paralysis or permanent deafness which don’t necessarily preclude one from contributing to the gene pool

And there's always mumps, which can keep a young man from contributing to the gene pool, ever.

I’d like to play Devil’s Advocate

To be fair, the role of Promotor Fidei in the canonisation procedure was really just to lend a vague air of skeptical credibility to the marketing charade; the Advocatus Diaboli was not expected to advance serious or convincing reasons or evidence against the candidate

Chris Hickie@3

I will be writing a letter to the Dean of the Medical School as well as the chair of pediatrics demanding they oppose this dual-degree program based especially on the anti-vaccine stance of naturopaths.

I fear that the antivaccine criticism won't hold sway. The current AANP statement[1] is very wishy-washy but doesn't actually say anything bad about vaccines. The new draft one[2] specifically advocates the CDC schedule. Never mind what goes on in reality, no true naturopath is antivaccine.

Especially when there's money involved I imagine the University will take the official statement at face value and dismiss evidence like Britt Hermes posts and the Read what naturopaths say to one another subreddit as false flags.

Maybe being affiliated with a real university will shine some light on their syllibi and textbooks. I think it's possible that there's no blatantly antivax stuff in their coursework but a good chance that homeopathy is taught as an alternative to the flu vaccine. I think the flu vaccine specifically (rather than general AV leanings) will prove to be the weakest point in this proposal. Both their stance on giving it to patients and getting it themselves as healthcare workers are potentially problematic.

[1] h[]p://www.naturopathicdiaries.com/wp-content/uploads/2015/02/Immunizations.pdf
[2] h[]p://www.naturopathicdiaries.com/wp-content/uploads/2015/08/AANP-vaccine-pos…

In (slight) defense of Dr. Cecilia Rosales, and the Zuckerman College of Public Health:

We think it is important to offer public health training to all health-care providers responsible for individual care.

...seems like a valid interpretation of mission to me. And since

Arizona as a state is about as quack-friendly as it gets, licensing homeopathic and naturopathic not-doctors.

...it's kind of the University's responsibility to offer Public Health education to whoever the state licenses as "health-care providers responsible for individual care."

Or – since we're being realistic about funding – imagine what might happen to the budget of the Zuckerman School if it took a vocal public stance AGAINST 'health-care providers' validated by the State of Arizona. Once-excellent public universities all over the country have been decimated by round after round of budget cuts since The Reagan Era, when governors' houses and state legislators began to be populated by Norquist-pledging Republicans who put education at the top of their list of expendables.

As an alum of The Uni of Iowa, I know the budget reversions there have resulted in any number of precipitous declines in academic programs, and if that's happening in a 'purple' state like Iowa, I can only that the public unis in solid-red Arizona have to be even worse off. Dr. Rosales might need to scramble for every dime she can get to keep the doors open (ok that's figurative, but speaking literally they may be struggling to keep faculty lines open when professors jump ship for institutions where they can paid a competitive wage and maybe get some research support...), and in addition to sucking-up to 'integrative health' friendly donors be properly concerned not to agitate the legislators who passed those laws licensing the homeo-and-naturo-pathetic-excuses-for-doctors. Being tuned-in to that kind of stuff was probably a pre-requisite for becoming a Dean.

Poop rolls down-hill, and I'll target my ire at the folks taking dumps at the crest, which in this case would seem to be the elected officials of Azizona, and the bone-head 'conservatives' voting them into office...

'Hey, we've got GREAT education institutions in this state. Just look at The University of Phoenix!'

#2 @Denice Walter

”DR So and So at HARVARD” is all too often a charlatan, like Granjean and his cronies, from the Chan School of Public Health. That place has become a disgrace to the entire University.

Interesting, then, to see Arizona as well going for a blend of public health and naked quackery.

@ Roger Kulp #8:

I checked the Rtaher article. it's awful. Call it 'false balance' or 'fallacy of the appeal to the middle' or whatever, there is simply no comparison much less equivalence when it comes to Dems vs. the GOP on science. ALL the major GOP players support loopy policies impinging on sound scientific practice. On the other side, there's Bernie Sanders – who is not actually a Democrat, but a Socialist (yay, Bernie!) – who authored an amendment to the Farm Bill that would allow states to require GMO labeling. That's it. One major candidate, who doesn't want to restrict practice in any way, doesn't even demand labels, just asks that states be allowed to require labels if they want them.

The assertion that Sanders is somehow 'anti-science' because he's against legislation that impinges states from requiring GMO labels is patently absurd. There's a question of precedent and general principle here. If the Feds can restrict consumer-information requirements on one type of product, they can do it on another, and every lobbyist representing an industry with something to hide – the supplement industry, for example, and (yes) the organic and 'natural' food industries (which often rely on pest control practices arguably worse than glysophate) – gets a wide open door to plead for whatever they want NOT-labeled written into law, too.

Ingredient labeling is information, not rhetoric. The anti-labeling argument is based on the premise that consumers are so bamboozled they'll panic if they see a 'GMO' ingredient on a product. (As if the average consumer reads the 'Ingredients' and 'Nutrition Information' on frozen pizza or Count Chocula...)
____
Hey, Monsanto and Genetic Literacy Project! Ever hear of "the marketplace of ideas"? If GMOs are the great world-saving innovation you say they are, it's YOUR responsibility to make that case to the public. See, if your PR people were actually good at their jobs, GMO labeling would be to your advantage, because plenty of people would prefer products employing technologies that could help reduce starvation and human misery (...if, you know, that was actually happening instead of just profit maximization by establishing functional monopolies in seed markets...).
And a good number of other people would buy your stuff just to spite the 'health' scolds. While McDonald's financial fortunes are sinking, the big winner in the fast-food biz of late is CKE Restauarants, which operates Hardee's and Carl's Jr. They're making bank on being proudly UN-health-conscious. The big item at Hardee's is the Monster Thickburger – 1,410 calories (5,900 kJ), 107 grams of fat, and 2,740 mg of sodium. The State of California requires a warning label to be displayed at restaurants that serve certain types of food:

Chemicals known to the state of California to cause cancer, or birth defects or other reproductive harm may be present in foods or beverages sold or served here.

The law requires the warning to be a certain minimum size and displayed in a certain way. If you look, you'll find the warning in every fast food outlet, usually at the bottom of a 'Nutrition Information' poster off to the side of the main counter, and in that minimum size box. Carl's Jr. posts it right on the front door in a bold-face sign maybe 4-5 times larger than required. So they're doing that by their own choice and killing most of their competitors in sales in the process.
Dudes, your problem with GMO labels isn't 'Big Guvment', it's private enterprise. Really, what does it matter if a 'contains GMO ingredients' notation is added to that 'Nutrition Information'panel on the side or back of the package, when General Mills, of all people, blazons "Not made with genetically modified ingredients" right on the front of every box of Cheerios?
_____

Taking a step back, the whole idea of an "anti-science left" is a crock. There ain't no such thing. What does exist is a population of people who are both decidedly not-conservative and not-science-minded. They're not 'anti'-science, in that while they may not accept certain principles validated by science, they're not working to undermine science in public policy the way creationists and AGW-deniers are. And by-and-large they're not the 'left' in that they're not significant players in electoral politics or the functioning apparatus of liberal/progressive Democratic Party campaigns. Neo-hippies tend not to vote, and they're not the folks manning phone banks and stuffing envelopes in the offices of any sort of partisan political organization. In contrast, the creationists and AGW-deniers are indeed on the (far) right, because they're extremely active in the nitty-gritty everyday work of politics. They vote, they volunteer, they go to rallies to cheer Ben Carson and Donald Trump...

But if you're concerned about anti-science politics, the first thing you might do is take Deep Throat's admonition and "follow the money." A major funding source for the worst anti-science Republicans is the corporate lobbying group ALEC, which in turn has among its biggest donors... Surprise!.. virtually all of the major pharmaceutical companies.

In short, then, Dan Rather's attack on Bernie Sanders is (to employ a Rather-ism) "shakier than cafeteria Jell-O". What's the frequency, indeed?

Wow, most of you are so angry and ignorant of the facts. NDs who graduate 4 year medical school in the US and Canada are accredited by the US Dept of Ed and licensed by their state. Every state is different bu the scope of training is the same in all 8 schools. Very similar amounts of basic science courses (actually NDs have more hours and labs and are required to attend classes and pass all courses, unlike most MD/DO schools). NDs do have residencies, though not as rigorous ( where most of the brain washing occures for allopaths - think "forget your biochem and physiology and jsut Rx this drug, you only have 7 minutes with the patient".) NDs have 4 years of nutrition and all thousands of clinical hours of training in all the 'ologies, so that they can start as a family doc right after graduation. NDs do have to study a few homeopathy courses but most are electives and most never use it (as its too far of a leap, like it is for most of you, though there is strong evidence it works when done correctly).

NDs are real doctors because the Govt, schools and accrediting agencies make sure they well trained by graduation with thousands of clinical hours and more actual course work and time than MDs because they have to study all of allopathic, naturopathic and chiropractic medicine.

NDs are real doctors because they follow the Hippocratic oath and first due no harm (drugs and surgery as a last option); treat the real cause by spending much more time, often hours HOURS with patients taking a history, ordering and reviewing complex, much more detailed blood work and putting together evidence-based or clinically proven treatment plans, while educating the patient how to better take care of themselves, and OMG,, cure themselves.

NDs are real doctors (and better doctors most of the time) because of all of the above... the training, ability to step outside the box of conventional, allopathic, pharmaceutical-based-driven medicine, to listen, care about the patient, spend time teaching (doctor=docere) and be brave enough to attempt a medical practice in such a hostile env't, mostly because they have seen the vis medicatrix naturae, the healing power of nature, work on themselves, family and patients for decades. It is real traditional medicine; using science, traditional and conventional wisdom as well as real evidence based and clinically supported medicine (not just DBPC trials which are geared and steered by the pharmaceutical industry) because there is no hidden agenda, dogma and false science/research driven by pharmaceutical dollars. Like all MD association, hospitals and medical schools.

NDs have strong training in emergency medicine and minor surgery but rarely use it because most states (due to medical associations and their lobbyists). And NDs do not specialize in advanced surgeries because there is no platform for that due to the fraternity of allopaths and the lack of need. Because most of the need in medicine is for chronic care and true prevention (diet, lifestyle, staying away for doctors, drugs and hospitals - the number 1 and 3 killers of Americans), not acute care. The US and its allopathic MDs are #1 in the world at acute and emergency care, according the WHO but 41st in chronic care(where it is needed by far, the most). Behind costa rica and Morocco. Very sad.

So, just keep beating your chests, spewing the fictitious party line and ignorantly slandering NDs if you must, but you are gravely mistaken.

Should have said:
NDs have strong training in emergency medicine and minor surgery but rarely use it because most states (due to medical associations and their lobbyists). And NDs do not specialize in advanced surgeries because there is no platform for that due to the fraternity of allopaths and the lack of need. Because most of the need in medicine is for chronic care and true prevention (diet, lifestyle, staying away for doctors, drugs and hospitals – the number 1 and 3 killers of Americans), not acute care. The US and its allopathic MDs are #1 in the world at acute and emergency care, great, but according to the WHO just 41st in chronic care (where it is desperately needed - think out of control diabetes, autoimmune, Lyme, Cancer and heart disease rates!). Behind costa rica and Morocco. Very sad and reversible if we can just grab our power back from the politicians and corporations (lobbyist and pharm industry, to be exact).

Super hard to swallow this perspective and these truths, I am sure Dr 'orac' and others. But do some more research, get to know some NDs and talk to others besides Bret Hermes and wiki.

Brad
Homeopathy is taught in the naturopath schools. Homeopathy is on the NPLEX. 'Nuff said.

Orac: Yours are among the most ignorant writings I have ever heard. You don't piss me off, you just make me aware of how much work still needs to be done on educating the public about naturopathy. And you make me laugh. When I cover for a board certified M.D. and write the exact some prescriptions and refills and do the same testing they do, I'm a quack, but when they do it they are not a quack. LMAO.

Should have said:
NDs have strong training in emergency medicine

You really should have quit when you were behind.

Brad, given that you have averred the strength of naturopathic "doctors" in the realm of emergency medicine, which, you know, generally requires poor, deluded MDs to complete a nonsensical, additional three-year fellowship, how do you feel about playing a bit of Naturopath Meets Emergent Condition?

Allow me to remind you in advance that the "MCSE" certification is well known as shorthand for "must call somebody else."

NDs have strong training in emergency medicine and minor surgery
"Have arrived at the crash site. We have two closed-head traumas with possible cervical damage; one abdominal injury, probable ruptured spleen; one crushed rib-cage with pneumothorax. Send all available naturopaths."

^ Oh, and...

The big item at Hardee’s is the Monster Thickburger – 1,410 calories (5,900 kJ)

Please (1) state the meaning of "big item," as this tends to suggest "most popular,"* and (2) explain, in your own words, what the 'J' in "kJ" means.

I mean, you'd look pretty freaking stupid if you were just thoughtlessly embellishing cut-and-paste jobs, wholly aside from their failing to do anything other than illustrating to the commentariat that you're not even competent to read your lines.

Seriously, where's the "allopathic" [sic] training only includes 45 minutes two hours a negligible amount of hopelessly misguided "training" in "nutrition" bit?

* This made news, what, 11 years ago? "If anyone eats this and can’t clearly see that it is a novelty item, the issue isn’t the burger, it is education." Hence... naturopaths?

“Have arrived at the crash site. We have two closed-head traumas with possible cervical damage; one abdominal injury, probable ruptured spleen; one crushed rib-cage with pneumothorax. Send all available naturopaths.”

Is it just me, or is this the the best OMICS link ever?

But anyway, Brad, PT presents to ND ED with sudden-onset flaccid paralysis. First symptoms were tingling around the mouth, followed by symmetric blurred vision and drooping eyelids. The condition is descending.

1. What's the immediate naturopathic management plan?

2. What information does the naturopath need to elicit about what preceded the onset?

3. It is ascertained that PT hasn't yet pursued his regular naturopath's offhand recommendation to consume homemade fermented foods. Where does the naturopathic differential go from here?

@Brad #50:

Wow! I couldn't have said it better myself. But then I can't see any grounds for saying any of it at all...

though there is strong evidence it works when done correctly

How do you define 'correctly'? Wait,let me guess. Is it 'when no-one is looking at all'?

I gotta say, the regular commentariat here are absolute masters of the art of calling out nonsense and handing people's behinds to them.

It's an education in itself, and oftem very entertaining as well. Thanks, everyone!

Also, I know the commenter earlier suggesting that the U of A astronomy dept was going to give equal time to astrology was making a funny (and a pretty good one), but itt should be noted in passing that the U of A department is very strong.

Dr. Nordin -- Glad to hear that you actually use so-called allopathic methods.

I'm curious, though. Do you also prescribe homeopathic medicines? Do you think that they have any mechanism of action other than as a placebo?

Dr. Anna Nordin's LinkedIn profile states that "Scope of practice includes alllopathic treatment including pharmaceuticals, urgent care, minor surgery, botanical medicine, acupuncture and Chinese Medicine, homeopathic, physical adjustments, hydrotherapy, lifestyle counselling, psychotherapy, rejuvenative/anti-aging medicine...I use only integrative methods with strong scientific demonstration of their efficacy."

Would love to hear what the "strong scientific demonstration of...efficacy" is for the homeopathy, acupuncture and "rejuvenative" treatments she offers.

NDs do have residencies, though not as rigorous

That's one way of putting it.

Almost one-quarter (22.5%) of naturopathic doctors licensed in Washington had completed at least one year of post-graduate residency training compared with only 8.5% of those in Connecticut. (Residency training is not required for licensure in either state.)

^^And that's another.

The only prevention that the MDs practice is by using vaccines. That too only because the law requires it. Otherwise it is prescribe, slash and burn. There is barely a whisper about healthy eating, healthy lifestyle. The folks at SBM and their fans must live in some alternate universe. They usually want to talk about emergencies and acute situations where MDs do hold a major advantage. But most health issues, in fact most people even before they have any health issues, do not require prescription medicines or any medical intervention. Instead they need guidance about how to live a healthy life. This is the advice that our MD community is utterly incapable or unwilling to give. No wonder US is one of the least healthy country in the Western Hemisphere.

Having engaged in a protracted argument (it was raining, there was nothing on TV) with a naturopath on NN about the plausibility of germ theory and whether pathogens could cause disease I would say naturopathy has nothing to do with medicine.

Strangely he did turn down the opportunity to be injected with the rabies virus offered by another commenter, so I guess he hadn't had enough turmeric that week.

From Ms. (Not a Doctor) Nordin's LinkedIn page, under "Scope of Practice":

"... recommend integrative therapies where appropriate such as herbal medicines, homeopathic medicines, counseling, chiropractic care, acupuncture."

She also uses the word "allopathic" a lot.

Quack quack.

Dangerous Bacon:

I am SO SORRY! I'm using a new borowed laptop and the scrolling function is wonky. Of course I only saw your post after I posted the identical comment.

Oh well, it never hurts to emphasize how useless homeopathy is and how the NDs scam their customers.

@ herr doktor bimler

one crushed rib-cage with pneumothorax

They could always follow the Mad Max's school of emergency medicine and use a knife to puncture the ribcage, and then do a transfusion of their own blood to treat the internal bleeding.*

I prefer myself the Taltos treatment, as described by Steven Brust in Teckla. Only issue is finding two sword-sheaths, a jug of water and a candle, for the sterile intubation of the lungs' cavity.

*Don't try this home, kids. It won't work.

@ Narad

homemade fermented foods

OT, sort of. Just be reading on maize overly contaminated with Fusarium mycotoxins in Summer 2012 in Italy, as reported by a local scientist.
Bit of nightmare fuel...

@ Anna Nordin

When I cover for a board certified M.D. and write the exact some prescriptions and refills and do the same testing they do

There is a bit more to MD work than filling prescriptions.
And that worries us is not when you do as a MD would, but when you don't.

@RK: I don't know about what doctors YOU are seeing, but I've never been to my primary care doctor where they haven't reviewed my diet, encouraged me to exercise more, and asked about smoking, alcohol, work, life.

None of them have suggested slash and burn. I've only been put on medications (BP) AFTER the diet and exercise steps failed to keep my blood pressure in check. And at every visit the doctor reviews whether they can be stopped. (Unfortunately, genetics is against me in that circumstance.)

Maybe you just need to see a better set of doctors, and don't start off by antagonizing them as pill pushers!

"There is barely a whisper about healthy eating, healthy lifestyle.The folks at SBM and their fans must live in some alternate universe."

In my universe, my family doc focuses on things like optimal weight, correcting low vitamin D levels, avoiding excess drinking etc. I am sorry that your world is so different, and invite you to visit Earth instead.

"They usually want to talk about emergencies and acute situations where MDs do hold a major advantage."

Funny, but it's alties who seem to obsessively focus on advantages of "allopathic" medicine in emergency care (probably because it's hard to convince people to schedule an appointment with a naturopath when experiencing severe belly pain or when they've been in a car crash).
I've also never been able to figure how alties can accept evidence-based medical principles when it comes to emergency care, but throw those same principles out the window when deciding on how to get their diabetes, heart disease, kidney problems etc. treated. I'm pretty sure ER docs get the same basic training and employ many of the same diagnostic methods and drugs as internists and other primary care physicians.

The "[alt practitioners] spend [vast amounts of time] with each patient" rather amuses me. They can do this for the simple reason that the ratio of practitioners to patient demand is extraordinarily low.

^ should be extraordinarily high

No wonder US is one of the least healthy country in the Western Hemisphere.

Maybe you could tell us what the most healthy countries in the Western Hemisphere are.
And then you could tell us what system of medical care they use.

"The only prevention that the MDs practice is by using vaccines."

What doctor do you see, chum? Because I'd really like to find one who'll stop nagging me about caffeine intake, stress management, diet and exercise.

@shay...you and me both....

@Dangerous Bacon,

There is a big difference between acute health issues and chronic issues. Chronic issues can be prevented in most cases by good lifestyle and diet choices. This is where your MD fails miserably. I have no objection to acute treatments such as antibiotics in severe infections, surgery when absolutely needed, and other short term procedures. Your medical science may be short sighted and limited, but it may be the best in such situations.

In my universe, my family doc focuses on things like optimal weight, correcting low vitamin D levels, avoiding excess drinking etc.

Just by the by, does anybody know how much good this does? I ask this not in the sense that I doubt it does any good, but just as a literal question. My de facto primary care doc had me get my D levels tested a couple months ago, and they were waaaaay down in the basement. (She said she almost doesn't need to have most Michiganders tested, she can just assume their levels are low.) Anyway, I looked up the symptoms of a deficiency, and some of them look similar to, say, a depressive episode, but I think I've read that supplementing with vit. D doesn't actually do anything to help with depression per se. Just thought somebody here might know more than me.

^ I mean, I did what she told me to regardless, which was to take 8 high-dose capsules over 8 weeks, then start taking 2,000 IU daily.

Chronic issues can be prevented in most cases by good lifestyle and diet choices.

Citations needed, RK: which chronic issues, prevented by what lifestyle and diet choices, and what is the evidence demonstrating those choices can actually prevent those chronic diseases to any clinically significant degree?

After that, you can attempt to demonstrate that standard of care evidence based medicine does not already advocate for those same good lifestyle and dietary choices.

RK,
I'm an RI fan but hold no illusions about conventional medicine. My doctors are quick to prescribe, slow to counsel and hampered by restricted thinking. But how in the heck does that mean I want something worse, and to pay dearly out of pocket for it? I would like medical care delivery improved not replaced by BS. And, I don't need to pay for knowledge about lifestyle changes. I can find that anywhere; I need an invested individual and see no reason why that can't be my GP/PCP if we could work on changing the current system instead of diverting attention to a totally bogus alt med practice paradigm.

Yes, I went to a Bayster grad ND once and she was as bad if not worse than MDs Threw herbals at problems I wasn't asking her treat, guessing what would work and advising me to raise melatonin dosages until it worked even if I reached 21 mg a night. WTH?

JP - Vit D supplementation (Rx variety D2) which nautropaths claim doesn't work made a world of difference to me. I noticed a change in how I was feeling just shy of a month of taking it. Prescription was for 12 weeks and I needed that long to get levels in high normal which is where i feel best.

@Brad You are lying about the number of hours that naturopaths get at their "accredited" schools. Anyone can review my Bastyr transcript and figure this out: http://www.naturopathicdiaries.com/wp-content/uploads/2015/03/BU-Transc…

RK: "Chronic issues can be prevented in most cases by good lifestyle and diet choices."

Oh, do please tell us how to prevent obstructive hypertrophic cardiomyopathy, cystic fibrosis and type 1 diabetes.

Helianthus@70

They could always follow the Mad Max’s school of emergency medicine and use a knife to puncture the ribcage, and then do a transfusion of their own blood to treat the internal bleeding.*

My mom swears up and down that in lifeguard school when she was in highschool they were taught to stick a pen through someone's neck into the trachea to help them breath. I think she remembers wrong but it was in Canada...

Brad@51

NDs have strong training in emergency medicine and minor surgery

Pfft. As always, here's the obligatory satires.

Company president and naturopathic physician Mort Fishman, who leads the team and is certified in Acupuncture Cardiovascular Life Support (ACLS), says that in situations like this there is a golden hour where appropriate intervention can make the difference between life and irreversible chakra degradation.

That Mitchell and Webb Look: Homeopathic A&E - https://youtu.be/HMGIbOGu8q0

RK,

There is a big difference between acute health issues and chronic issues. Chronic issues can be prevented in most cases by good lifestyle and diet choices. This is where your MD fails miserably.

My MD doesn't make my lifestyle and diet choices, I do, nor do I expect her to motivate me to make better ones, I take full responsibility for that. Everyone has a pretty good idea of what is a healthy lifestyle and diet these days.

I don't believe people who go to see a naturopath generally require additional motivation to make lifestyle changes. I would love to see a naturopath try to persuade some of the patients my colleague saw in her lipid clinic in one of the most deprived areas of London UK. She told me that the great majority were either unable or unwilling to make the changes she suggested, had mental health or other serious health or social problems, and were often poorly compliant even when she prescribed medication. She confided in me that she wondered at times if what she was doing made any difference at all to most of her patients. Other than telling people they will die or suffer serious disability if they don't change their diet and lifestyle, what do you expect an MD to do?

"Chronic issues can be prevented in most cases by good lifestyle and diet choices. This is where your MD fails miserably."

Well, it's true that physicians should stop stuffing their patients with cheeseburgers and Krispy Kreme donuts and insisting that they give up exercise in order to hang out on the couch and watch TV.

Doctors have a lot to answer for, you betcha.

Patients, too. In addition to the chronic issues Chris describes (which are the patients' fault), how about those women with BRCA mutations who brought their breast cancer on themselves by not living right, or the people with Lynch syndrome who are susceptible to multiple cancers because they didn't fix their bad genes by drinking apple cider vinegar and coconut oil.

@ Narad #58

Yes, I pasted the stats on the Thickburger from Wikipedia without proofing them, not that I would have cared what kJ is. Upon reading your query, my first thought was a wild-ass-guess that the J is for 'Joule', which – again according to Wikipedia – actually turns out to be the case.

[calories] have been superseded in the International System of Units by the joule... one [dietary] calorie is about 4.2 kilojoules

Not that I care, or that this has anything to do with my point, which had nothing to do with naturopathy.

I used 'big item', which is vague by intent, as it seemed to fit the self-consciously cheeky tone of that part of the comment. More literally, I was not suggesting the Thickburger is the most popular entree offered by CKE, but rather the 'signature' item that is cited regularly as establishing the chain's brand identity and market positioning.

From a 2011 press release posted on the Carl's Jr. website:

"[Our ads] communicate the core of what we are all about: big, indulgent burgers with no apologies and no B.S." said Brad Haley [executive VP of marketing for CKE]. "The ads speak to the straight-shooting mindset of our core audience of young, hungry guys... The campaign focuses on basic truths about our food and our attitude..." These “truths,” which are boldly outlined in the commercial, include... “We believe in burgers. Big, fat, juices-running-down-your-arm kind of burgers... We believe that life is short. So if it feels good, do it, and if it tastes good, eat it.”

Yes, none of this is 'news', not that I claimed it to be. CKE actually began the 'indulgence' marketing in the late 90s, and by 2004 had indeed ramped it up to be more explicitly un-health-conscious. The fact this has been a highly profitable marketing strategy for well over a decade only enforces the point: thumbing your nose at health food scolds sells.

As for the quote from GrubGrade (also from 2011): food reviewer 'Chefprotoss' is just showing Dunning-Kruger about marketing, and the economics of the fast food biz. I don't know what he means by "novelty item" exactly, but products don't stay on the menus of chains for 7+ years if they don't sell, no matter what the marketing department wants. And lack of education in nutrition has nothing to do with those sales. The whole point of the Monster Thickburger is that it hides nothing, and requires no special knowledge for consumers to understand what it is: 'heart attack on a bun.' "Life is short. So if it tastes good, eat it."

Thus, CKE's appeals are more-or-less opposite to those of naturopathy, which ARE based in false advertising and mis-information we might expect would be countered by better general education in medical science.

But, I wasn't discussing naturopathy – which I consider to be the most dangerous form of medi-woo, and regard with utter contempt. So how anything I wrote might connect to totally bogus comparisons between naturopathic and "allopathic” [sic] training is beyond me...

For some lighter note, here is a video from a Dutch band, with anti-quack lyrics. The lyrics are in English, everything else is Dutch.
https://cryptocheilus.wordpress.com/2015/10/02/witch-doctor-krachtig-ui…

@capnkrunch: your mom actually remembers correctly. That was taught as a way to establish an emergency airway until the patient was in trained medical hands. Note that the "pen" was a fountain pen, which in those days had a fairly nice sharp nib and open tube to hold ink.

Dr Anna Nordin@54

When I cover for a board certified M.D. and write the exact some prescriptions and refills and do the same testing they do, I’m a quack, but when they do it they are not a quack.

No, when you use homeopathy, naturopathic manipulation, and acupuncture you are a quack. When you advocate against vaccines you are a quack. When you use untested treatments for imaginary diseases you are a quack.

A doctor doing the same things would also be a quack. The difference in the professions is that a doctor doing that would be far outside of best practices while this junk is baked into naturopathy.

I don't think I would want to live in a state where a ND can cover In an ER for someone with medical training. That's just scary to me.

As well it should be.

Kreb:

I just shake my head when anyone on RI makes comments of the "I do just fine with the way my MD does it" form. It's one of the worst forms of anecdota, as there's no warrant whatsoever to assume you or your MD are typical. As far as lifestyle choice goes, even if you're in the majority, there's still a hell of a lot of people for whom a lecture that they'll "die or suffer serious disability if they don’t change their diet and lifestyle" does absolutely nothing, and not just folks like your colleague encountered with issues that make them all but intractable. It's hardly scientific to chalk this up to simplistic concepts of "choice", wrapped up in dubious mythology about poor character, lack of willpower, etc. Many if not most patients with lifestyle issues do try to make changes, they just fail. [sarcasm] If only those laggards could indeed grab their inner power and pull themselves up by their bootstraps! The solution seems obvious: MDs should just hand out prescriptions for Tony Robbins seminars after they give the 'change or die' lecture. [/sarcasm]

Whatever 'choice' is, it's hardly moral to say "Well, let 'em get heart disease and type 2, because they made their own choices." (Like your colleagues patients 'chose' to be poor and vulnerable.) It's also poor public health policy, since one way or another society winds up paying for treatments of too many cases of illness that could have had reduced incidence at lower cost.

RK's comment is so reductive and hyperbolic it obfuscates the grain of truth that may lie behind it: the delivery systems of conventional medicine have structural barriers that mitigate against patients receiving the support they need to actually implement lifestyle changes. That's not the fault of individual MD's, who indeed should not be expected to have the skills or time to motivate patients to eat right, quit smoking etc. Nor is it the fault of "our MD community". PCPs are just working stiffs, bound by the mandates of short-sighted bean-counter management. It's not like programs that do have good success rates for countering chronic conditions (obesity, for example), are unknown to conventional medicine. They're just not readily available to most patients of typical means, and/or too 'out-of-system' to be available to PCPs for referral. That's wrong, and reform is in order, but that's a matter of moving deeply entrenched bureaucracies, not hectoring MDs already over-burdened by Taylorist speed-ups.

NaT's experience suggests naturopaths may merely be boasting about their claimed focus on lifestyle, rather than actually delivering better results. (Got any valid evidence, naturofans? And, no, self-reports don't count.) And you make an excellent point that if indeed naturopaths do have better results, that may be largely due to the predispositions of the patients they see. I suppose it's possible some naturopaths have developed skills in supporting lifestyle change that are unknown to dieticians and clinical psychologists, and we might be able to learn something useful from their practices, but I doubt it.

Chris:

To be fair, RK said "most cases" of chronic illness could be "prevented" by "good lifestyle and diet choices", not most chronic conditions. My lay person's understanding is that the majority of chronic illness cases fall under heart disease, type 2, obesity, hypertension – in which lifestyle certainly does play a role. However, my lay person's understanding is also that it's seriously woo-ish to claim lifestyle choices "prevent" anything, that it's all a matter of relative odds.

The quote from RK functions as sophistry, framing a direct connection between a straw-man characterization of practice ("prescribe, slash and burn" with "barely a whisper about healthy lifestyle") and a straw-man standard of results ('failure to prevent'). The implication seems to be that if medical practitioners only talked about lifestyle change more and/or in some different way, "prevention" would indeed occur. But, grammatically, RK's claim reduces to 'MDs fail to prevent chronic health issues', which is both 'Captain Obvious' obvious, and pointless. If 'failing to prevent a chronic health issue' is cause for delegitimation, then if any patient of a naturopath gets heart disease or type 2, naturopathy's no good either. Now, if there was an RCT that showed naturopathic care was more effective than conventional care at reducing the incidence of chronic disease among similar populations, RK would have something to talk about. I'd like to think the absence of a coherent and meaningful claim ought to speak for itself. But, alas, these days I find any such optimism has been thoroughly Trumped.

I have a doctorate in education and teach in public health sciences at a large state university. Additionally, I spent almost two decades working in graduate medical education.

On top of that, I have a chronic condition of rheumatoid arthritis and high cholesterol. My MD primary care physician had no problem with me changing my diet when I had a cholesterol test of over 300. I changed my diet which was already vegetarian and also began taking red rice yeast and fish oil. Six months later, my cholesterol hadn't changed. I now take medication.

With a serious, degenerative, painful chronic condition of rheumatoid arthritis, I cannot tell you how angry I get at those who suggest if my diet were changed, if I drank cabbage juice, or take vitamins, or use a magnetic pad to reduce my symptoms and pain. If only it were that simple! I would happily do all of those things for my condition if only they worked.

sadmar: " My lay person’s understanding is that the majority of chronic illness cases fall under heart disease, type 2, obesity, hypertension"

Hypertrophic cardiomyopathy is a type of heart disease, and occurs at a rate in the population at about one in five hundred, though the obstructive bit does not always occur. It is the most common cause of sudden cardiac death in young athletes. There are other "heart diseases" like Long QT and Marfan's syndrome that are also genetic.

When my son had open heart surgery at the Mayo Clinic a few years ago we got to talk to other families. At least two were families of children who born with congenital heart defects, and one wife of a man in his forties who just found out that his heart had been mis-plumbed since birth.

I learned from this book that the first heart surgeries attempted were to repair heart damage from rheumatic fever caused by strep infections. I don't think suffering from strep infections before the age of antibiotics is much of a life style "choice."

My stepmother's family had a genetic form of hypertension (it had something to do with their kidneys). They used die a slow and painful death in their forties. Then the first diuretic blood pressure medication came in the middle of the 20th century. While one of her brothers died the very slow death, she and her four surviving siblings lived into their 80s and 90s.

Do not try to tell me that heart disease and hypertension are just from life style choices.

There is a problem when someone decides to denigrate real medicine by using the "chronic disease" gambit. They do not realize that many they think are preventable are actually genetic. This ignorance is pathetic.

Though what is more pathetic is claiming naturopaths have a better handle in treating health style decisions. Dear hubby brought down his blood sugar on the advice of our family doctor with diet and many many many miles on his bicycle (including doing a 25 mile ride for a cystic fibrosis charity).

Renate:

Thanks for the link! There's are 'translate choose language' links near the top right of the page.

Headline: "Witch Doctor: powerfully depicted indictment against quackery"

Torre Florim - lead singer of De Staat :
"It's a cynical view of alternative medicine. In essence, it is about people being dragged from a gut feeling with the masses, without a scientific basis."
And then the Google translation flails at Dutch syntax:
"I'm in a kind of clip demagogue people physically excites the finger."
Great dada poetry as is, but if anyone can offer a better translation, I'm curious.

The source article in Volksrant is on a page that won't translate directly for me due to a cookie thing. I cut and pasted the text into the translator. One possible note of interest: the 'Witch Doctor' video is new, coinciding with the release of a new album, but the song is from an album released two years ago. I wonder if he choice to use this track to promote a new release reflects concern over an increased spread of quackery in Holland during the intervening years, or, on the contrary, that opposition to quackery there has increased, creating a larger audience for the video than it would have had at the time of the song's original release.

In my very first class of my MPH out of (prestigious state) I was horrified to discover that I had a substantial number of quacks for classmates. I was so upset I e-mailed the program directors, asking (politely) if the program was science and research based, and if not I wanted my money back.

They were *very* quick to assure me that, yes, of course the program was reality based (my words) and always would be. I still haven't figure out why so many acupuncturists want an MPH. (Oh, and some of them have MDs, too.)

Here's my personal test for NDs: When you can give me something that works as well as 12 hour Sudafed, then we can talk. Until then, I'll keep my modern pharmacopoeia.

@ JustaTech:

So true. Decongestants achieve miracles in a short time.
Never have had an herb or a supplement act like that.

My mom swears up and down that in lifeguard school when she was in highschool they were taught to stick a pen through someone’s neck into the trachea to help them breath.

That sounds familiar -- I also remember from combat first aid training (this would have been in 1979) learning how to treat a sucking chest wound using the plastic wrap off a pack of cigarettes*. I seem to remember the term "field expedient medicine" being tossed around a lot.

(*I guess smoking is good for you, under certain circumstances)

Since we got on the subject of battlefield medicine, a quick note before I run off for a meditation retreat for a couple days:

I've been translating these interviews of Soviet Jewish World War II veterans lately. (I really like doing it, and it pays decently.) So I've been hearing and reading (they send me transcripts in Russian, which helps) quite a bit about battlefield medicine, wounds, etc. Anyway, I just wrapped up this one interview which could have been appropriately titled: "Breakin' out the hospital. Three times." I wish I could tell the story, but I had to sign an NDA. But man, incredibly tough people.

My mom swears up and down that in lifeguard school when she was in highschool they were taught to stick a pen through someone’s neck into the trachea to help them breath.

It's called a cricothyroidotomy, or cric for short, as in "cric him." It's a way to rapidly establish an airway that, while less permanent than a good tracheostomy, is far quicker and safer to perform, particularly under less than optimal conditions. I've never actually had to do a field cric, but some of my fellow residents when I was doing trauma did.

http://www.nejm.org/doi/full/10.1056/NEJMvcm0706755

In the field, straws, a ball point pen with the pen part removed, or any solid tube of approximately that diameter or a bit larger can be used. As an aside, I watched an episode of "The Knick" the other night where Dr. Thackery performed an emergency cric on the dealer of the opium den he frequented, who was choking. I believe he used a fountain pen.

So true. Decongestants achieve miracles in a short time.
Never have had an herb or a supplement act like that.

Well ... Sudafed is pseudoephedrine, which, along with its diastereomer, ephedrine, is found in (minor ta-da fanfare required) Ephedra.
I used to use psuedoephedrine occasionally to deal with horrible congestion from getting swimming pool water up my schnoz. I'm pretty sure it would make my heart explode it I took it now.

And it's only one oxygen atom away from methamphetamine.

Just today I watched an episode of Call the Midwife where the doctor cric'd a woman with diphtheria. He actually used a scalpel and metal stoma thingy (intended for a proper tracheostomy ??)

Doc Martin used a pocket knife and some sort of hose that just happened to be lying conveniently at hand. Somebody in Leverage used a knife suitable for dicing a bison, but I don't remember what was used for a tube.

Hey Chris:

I wasn't trying to tell you heart disease and hypertension are just from life style choices. As I'd hope my reply to Kreb indicated, I completely sympathize with anyone facing illnesses beyond their pragmatic control having to hear they could have prevented their troubles by making different choices. The last thing anyone with a condition tied to chance splashes in the gene pool needs is a scolding that it's their fault they got sick and/or can't 'deal with it' like everybody else and make themselves better. I've got one – depression runs in my family independent of 'inherited' interpersonal influence – nowhere near as clear cut as a congenital heart defect, so it's hard for me to say how much of troubles were coded into my DNA, and how much they might be 'my fault'. But I've sure been judged like it's ALL 'my fault', which I'm pretty sure it's not, and yeah, it stings.

The reason I wanted to note that 'lifestyle choice' does seem to be a factor in many individual cases of chronic illness is that being as fair to RK's comment as possible, the whole idea of 'prevention' is still a load of horsedung.

Take this gem of faux argument by grammatical contortion:

But most health issues, in fact most people even before they have any health issues, do not require prescription medicines or any medical intervention. Instead they need guidance about how to live a healthy life.

Let's say we untangle that to two claims: 1) most health issues do not require prescription medicines or any medical intervention. 2) most people do not require medical intervention; instead they need guidance about how to live a healthy life.

Both would probably be true, but trivial in substance, and deflecting in implication if technically 'correct'. Let's say the majority of cases of "health issues" in the U.S. are minor self-limiting conditions having no cure, but only symptomatic relief, e.g. the common cold. That hardly moots the need for MDs, as the population is so large that the 'minority' of cases requiring medical intervention is still massive in number. And, duh, most people don't require medical intervention because most people aren't sick. So of course, "guidance about how to live a healthy life" is more useful to them — which most of them get without ever visiting a naturopath.

The implied meaning of that mash-up, though, would seem to be something like 'most health issues can be avoided by receiving guidance about how to live a healthy life'. Which would be bat guano wrong in at least two ways, but let's remove one of them, and pretend the assertion 'most health issues can be avoided by living a healthy life' (also bat guano wrong in the real world) is actually true. That wouldn't in any way warrant a claim that any sort of "guidance" had anything to do with it.

Thus, I agree it's pathetic to claim "naturopaths have a better handle in treating health-style decisions." But that doesn't mean MDs are good at it. Not only is the case of your hubby irrelevant being merely one anecdote, he may well have cleaned up his diet and taken up vigorous cycling without the advice of his physician, or for reasons other than receiving that advice from an MD. Like, maybe you'd have dropped a hint, it's pretty much a no brainer plan if your blood sugar is elevated, and maybe he just wants to take care of himself because he loves you and your son.

Here's my anecdotal evidence: I've had plenty of good advice on 'lifestyle' from conscientious physicians; I absolutely know what I should do for my health; I've gotten over the death-wish tendencies that made me not care about my health in the past; and I still do a horrible job overall of taking care of myself. Having successfully addressed a few of my health issues, I think I know what works for me – a level of psychological support initiated by some small measure of pro-active intervention beyond "just say no" admonitions. I don't, can't, get that from my health plan, which pisses me off. And as far as i can tell, there's a lot of other folks in similar shoes, which makes me more pissed off... [Not that I blame my physicians, or imagine a naturopath would be anything but worse... somehow I don't imagine homeopathy, acupuncture, reiki, exotic plant extracts, or high-dose vitamins make good advice on diet/exercise/hygeine/self-destructive habits any more persuasive :-) ]

To be perhaps too honest about an emotion-colored response, it occurs to me that those who sufferings fall into the categories conventional medicine can address effectively with a good rate of success might consider themselves lucky, and show some compassion for those whose maladies either cannot be resolved with existing treatments, or who face economic, bureaucratic or psychological barriers impinging them from accessing proven care, or following the path of known best-practices.

Yeah, keeping them away from naturoquacks is undoubtedly part of that, but methinks it's not enough...

sadmar, one reason why this is a sore point with me is that the company's health insurance company has decided to remind us on healthy life style choices... they are usually in nag mode.

It took all I could to not yell at the kind nurse calling from the insurance company after my son's surgery wanting to talk to him about preventative measures. I really wanted to know what in the bloody blue blazes we were supposed to do to prevent what seems to be a de novo mutation that caused his heart muscle to grow during puberty so that it almost blocked his aortic valve. But I just muttered it as I handed the phone to my autistic son... smirking about her trying to understand what he said (he has a speech disorder... obviously something that Brad and RK have some special way to prevent).

@ diug:

Believe it or not, I've never experimented with Ephedra. But I've heard from women I knew years ago that it is an effective weight loss drug.

I don’t think I would want to live in a state where a ND can cover In an ER for someone with medical training.

The "five year internship at the Carl Jung Institute" is an interesting touch, but... I've found it to be a somewhat confusing exercise to compare the (seemingly semiliterate) LumpedIn profile of "Dr. Anna Nordin," "Phoenix, Arizona Area" (hereafter "Nordin 1") with the entry from the Arizona Physicians Licensing Board ("Nordin–2"; if one starts from the top, "dispense for profit" No. 13-745 expired at the end of June).

The former is a noteworthy artifact in and of itself, but the only thing that seems to glue them together is the locum middleman association, which leads me to wonder about the core fantasy is either (1) financially unsustainable or (2) just so much crap that be chucked overboard – in the hope that nobody will notice the difference from the rest of the cargo – in the Great State of Flag Failure.

I usually refrain from commenting on this site as, being a farmer, I have no training in science or medicine. But since I did spend a lot of years studying my profession, at least as long as @Brad implied NDs spend studying theirs, let's see if I can use my not-a-doctor AG training to provide some of that complicated lifestyle advice my MD never provides:
1. Don't smoke
2. Get regular exercise, at least 1/2 hour a day if not more
3. Drink moderately
4. Eat a balanced diet, plenty of fruits and veg, lean meats
5. Watch your weight
6. Get enough sleep
7. Wear your seatbelt
8. Never run the PTO with the guards removed (I know this one's obvious but a reminder is always good)

Did I miss anything? Everyone from farmers to fishers know this stuff - I don't need my highly-trained MD to tell me. What I want my MD to do is to use the best available science to determine whether my body is operating correctly and if not, to fix it if possible. The fix may include advice about correcting operator error, but just as well may involve identifying a faulty component or worn out part. Sometimes the part can be replace and sometimes you just have to figure out how to get along with it as is.

Oh yeah, now that I think about it, my AG training didn't include homeopathy. I guess that's the added value an ND brings.

^ Sorry, the "Arizona Naturopathic Physicians Licensing Board"; the real one has never heard of an Anna Nordin (but, NPI 1871713214, yay). That was part of why I was perplexed about these entries from Nordin 1:

Certifications

license to practice medicine, Arizona
State Board of Medicine, License on file
December 2005 – December 2013

license to practice medicine, California
State Board of Medicine, License on file
January 2008 – January 2014

The California Board of Medical Examiners, by way of "BreEZe," also reports only two entries under "Nordin," both canceled likely as a matter of retirement. I am thus intrigued about where this, ah, "file" is.

But I'm sure that this will all be cleared up in short order.

I've haven't been exposed to this many who've wanted to play doctor* since elementary school.

*not to mention the scientist or grad student posers here.

MI Dawn@90

@capnkrunch: your mom actually remembers correctly.

Well, apologies for doubting her were in order and given.

Orac@100
What's bizarre to me was that anyone thought teaching it with pens to laypeople as first aid was a good idea. Every part of that sentence makes me shudder.

@Orac,
You did trauma at University of Chicago right? Did you ever ride with UCAN?

^^ I was taught about the emergency trachetomy hack in a high school health class (about the same time I was informed not to place a tornique around someone's neck for a bleeding head wound). But it wasn't to teach how to do it; it was to let us know that it was possible with a pen and that we should not attempt it unless it we were medically trained to do it.

Btw, I went to the first half of medic school in the military and it wasn't taught at that point. I don't know if they ever addressed it. I went onto my choosen MOS training before the medics even hit the IV starts.

Yeah, my baby sister was a Navy orthopedic surgical tech. She doesn't remember the field expedient tracheotomy part, either.

She's now an ambulatory care nurse with the VA, and like the cap'n, the thought of letting a bunch of Marines work on a casualty equipped only with a Ka-Bar and a fountain pen terrifies her.

I am SHOCKED to find that that the $2000000 Texas taxpayers shelled out for a test of chiroquactic treatment for veterans was wasted (because the test was worthless and incompetently-designed) :
http://interactives.dallasnews.com/2015/carrick/janek.html

Yeah, my baby sister was a Navy orthopedic surgical tech. She doesn’t remember the field expedient tracheotomy part, either.

It was featured in a 1976 episode of MASH, just by the by.

A disturbing example of quackademic medicine at an NCI-designated comprehensive cancer center

oracknows — Thu, 27 Mar 2014 06:00:31 +0000

A disturbing example of quackademic medicine at an NCI-designated comprehensive cancer center

Note: I was busy doing something last night that left me no time to compose any fresh Insolence, which will become apparent by this weekend. In the meantime, however, I'm betting quite a few of you haven't seen this before, and those who have might want to discuss it further in a different environment.

Quackademic medicine.

I love that term, because it succinctly describes the infiltration of pseudoscientific medicine into medical academia. As I've said many times, I wish I had been the one to coin the phrase, but I wasn't. To the best of my ability to determine, I first picked it up from Dr. R. W. Donnell back in 2008 and haven't been able to find an earlier use of the term. As much as I try to give credit where credit is due, I have, however, appropriated the term "quackademic medicine" (not to mention its variants, like "quackademia"), used it, and tried my best to popularize it among supporters of science-based medicine, writing frequently about examples of how quackery has infiltrated the hallowed halls of medical academia, complete with links to medical schools that have "integrative medicine" programs and even medical schools that promoted the purely magic-based medical modalities known as reiki and homeopathy. It's been a recurrent topic on this blog ever since, leading to a number posts on the unethical clinical trials of treatments with zero or minimal pre-trial plausibility, the degradation of the scientific basis of medicine, and the acceptance of magical thinking as a means of treating patients in all too many medical centers.

One strong candidate for quackademic ground zero, if there can be such a thing for the phenomenon like quackademic medicine, which is creeping up like so much kudzu in the cracks of the edifice of science-based medicine (SBM), is the University of Arizona. U. of A. is, of course, the home of one of the originators of the concept of quackademic medicine and one of its most famous and tireless promoters, Dr. Andrew Weil. Dr. Weil, as you might recall, has even been the driving force for creating a highly dubious "board certification" in integrative medicine. Sadly, apparently this new board certification has been so popular among physicians wanting to "integrate" a little quackery into their practices, that its first examination has been delayed from May to November 2014, so that the American Board of Physician Specialties can figure out how to accommodate the unexpectedly large number of applicants.

So what happens when a patient arrives at U. of A. for treatment? I found out last week when I received an e-mail, which led to a fairly long e-mail exchange, with a man whose son was diagnosed with leukemia and is being treated at the University of Arizona Cancer Center (UACC). Although I was given permission to use his name, I decline to do so because there is a child involved, although anyone involved in his case at U. of A. will likely quickly be able to identify who the man is. It turns out that he is a professor at U. of A. in a humanities department (which is why I'll refer to him henceforth as the Professor, as tempted as I was to refer to him as the Real Professor, in contrast to the fake "Professor" over at a certain antivaccine website), and, even though he is not a scientist, he clearly knows how to think (which would not be surprising if you knew what department he was in). In his e-mail, he told me how appalled he was at the sorts of treatments being offered to his son:

I was appalled to discover that the center offers treatments like Reiki, Reflexology, Acupuncture, Cranial massage, etc. These treatments are advertised as "healing"--including boosting one's immune system, complementing conventional chemotherapy etc. I wrote the the [sic] director of the center who at first expressed concern and thanked me for calling these things to her attention. She said she would convene a board of physicians to look into it. After three months went by, I wrote to her asking for an update. She told me the board was still working on it and that she was "confident they would take care of it". I have been asking her for a timeline and she is not returning my emails.

At first I thought this was probably the pernicious influence of Andrew Weil, but I have since discovered that cancer centers around the country are offering these "treatments" including places like Sloan-Kettering. Because of this, I've concluded there is no point in going to the media to try to expose what's going on.

The Professor is probably correct about going to the traditional media, though. There probably is little point in going to the press, although we can always hope. Most of the time, when the press looks into the infiltration of quackademic medicine into medical academia, the result is a story like this appalling one from a year and a half ago in which NBC News chief medical correspondent Nancy Snyderman strongly embraced quackademic medicine to the point that she even said that if a doctor "doesn't know" about integrative medicine, "I think it’s time to ask for a referral to someone who does." It made me sad to see a woman who normally stands up for science, at least with respect to vaccines and combatting the antivaccine movement, to fall so hard for pseudoscience when it exists at Memorial Sloan-Kettering Cancer Center. Even I have had to hang my head in shame when I discovered that my alma mater both for medical and undergraduate school, the University of Michigan, actually has a program in anthroposophic medicine.

Unfortunately, although I hoped that the Professor would make as much of a stink as he could, I felt compelled to warn him that I doubted he would be successful because this sort of “integration” of quackery with academic medicine is very much entrenched at the University of Arizona. It started with the pernicious influence of Andrew Weil, but if Dr. Weil were to drop dead or retire today I doubt that it would change much, if at all, because quackademic medicine has had years to become embedded in the culture there. To put it bluntly, U. of A. is one of the centers of quackademic medicine in the US, if not the world, and I don’t see that changing any time soon. I also looked up UACC's director, Dr. Ann E. Cress, and noted that she’s an interim director, which makes it highly unlikely that, even if she were so inclined, she could do much of anything. An interim cancer center director isn’t going to be able to take on Andrew Weil. It also doesn't help that there are researchers at U. of A. like Dr. Myra Muramoto, who recently scored a $3.1 million from the National Cancer Institute (NCI)—not the National Center for Complementary and Alternative Medicine, mind you, the NCI—to do this:

Dr. Myra Muramoto, Arizona Cancer Center member and associate professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine, has received $3.1 million from the National Cancer Institute to develop and evaluate a new program to train chiropractors, acupuncturists and massage therapists in effective ways to help their patients and clients quit tobacco.

The grant will fund "Project Reach," which will partner over the next five years with Pima County chiropractors, acupuncturists, massage therapists and their office staff to evaluate ways they can best help their patients quit tobacco.

That's a big chunk of change of the sort that cancer centers value above all, money from NCI grants. When cancer centers are being considered for NCI-designated comprehensive cancer center status (NCI-CCC)—or trying to renew their status—one huge consideration is the level of NCI funding its investigators have. Basically, for this purpose NIH grants are good, but NCI grants are the best. That's why any investigator with a $3.1 million NCI grant will have outsized influence and an NCI-CCC or any cancer center seeking NCI designation. Of course, because chiropractors, acupuncturists, and massage therapists often claim, without valid scientific evidence, to be able to help people quit smoking with their woo, such a grant would almost certainly have the effect of encouraging referrals of smokers to these practitioners, to make sure enough patients accrue to the study funded by the grant.

Quackademic medicine at UACC

It turns out that U. of A. does indeed offer its patients tons of "supportive" care therapies not rooted in science. A quick look at its Survivorship Care page reveals:

In collaboration with the medical and psychosocial services at The University of Arizona Cancer Center, we will work with patients to:

Reduce physical symptoms associated with cancer and its treatment (e.g., pain, fatigue, insomnia, etc.)

Manage side effects of chemotherapy and radiation with therapies such as acupuncture, botanicals, and mind-body medicine

Examine lifestyle factors and situations (e.g., diet, risk for undernutrition, physical activity, emotional coping skills, support network, and spirituality) that may affect symptoms and/or course of disease

Develop and work toward goals for health, wellness, and what is most meaningful and valuable after diagnosis, as well as during and after treatment

Actively participate in their health care

Regain a sense of control and well-being despite the diagnosis

Notice the quackademic medicine "integrated" with potentially science-based modalities for supportive care: acupuncture, botanicals, "mind-body" medicine. Note how such useless modalities like acupuncture are listed as being, in essence, co-equal with various dietary, lifestyle, and coping modalities. This is basically how quackademic medicine "rebrands" what should be science-based modalities as somehow being "alternative" or outside the mainstream. It then lumps them together with modalities that are pure quackery (acupuncture, reiki, therapeutic touch, etc.), the implication being that it's all part of a lovely "complementary and alternative medicine" (CAM) package that represents the "best of both worlds." Of course, we at SBM reject the idea that there are "two worlds," citing the oft-repeated adage that there is no such thing as "alternative medicine." Rather, there is medicine that has been scientifically demonstrated to work. There is medicine that has not been scientifically shown to work. There is medicine that has been shown not to work. The reason "alternative medicine" is alternative is because it falls into one of the latter two categories. What do you call alternative medicine that's been shown scientifically to work?

Medicine.

I know, I know. We say this a lot here, but it's true. Also true is Mark Crislip's almost famous adage, which I like to use in almost all of the talks I give about "integrative" medicine these days:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

As I've said many times before, I wish I had thought of this quote.

Trying to hide the stench of cow pie in the apple pie

Make no mistake about it, UACC is "integrating" fantasy with reality by offering reflexology (or, as I like to call it, a nice foot and hand massage with delusions of grandeur), reiki (or, as I like to call it, faith healing substituting Eastern mysticism for Judeo-Christian beliefs), craniosacral massage (or, as I like to call it, a nice scalp massage with delusions of grandeur), healing touch (also known as therapeutic touch, which I like to call reiki without the foreign name), and many others. At least, I wasn't able to find anywhere that the UACC offers homeopathy to patients, although one of the most famous of the "magical grants" awarded by NCCAM was to a University of Arizona researcher in Dr. Weil's department to study homeopathy.

It didn't take too long for it to become clear to the Professor that UACC was not dealing with him in good faith. At least, that's what he told me in a subsequent e-mail. What led him to believe this was a combination of not getting his e-mails answered and then what happened after he complained about perhaps the most egregious example that he found at UACC. He first brought this issue up back in December, and, after several requests to have a meeting, the Professor became frustrated and basically sent a threat to go to the media. Shortly after that, the web page on the UACC site that had so disturbed the Professor became this:

Yes, that's a big "Access Denied" message. One wonders whether UACC deleted the page or just hid it so that you need a University of Arizona login to see it. Maybe one of our readers from U. of A. could check and report back here.

Thankfully, due to the magic of Google Cache, we can see what was there until as recently as a week ago:

One wonders if the administration of UACC, out of concern that the Professor might actually do what he said he would do (shop his story around to newspapers), got rid of the web page for Frank Schuster. Of course, it's not so easy, as I showed above, and, in case anyone's interested, I've saved a web archive of the page for permanent archival purposes (for me, that is).

I can see why the UACC administration would be embarrassed enough to act like this. On the now defunct page, potential patients for UACC were treated to incredible claims like:

Very simply, Reiki is energy that flows through the body of the practitioner, and conveyed through the hands into the body of the recipient. It is subtle energy, but it can be felt – usually as a warmth, tingles or slight pressure.

And, perhaps the most ridiculous claim of all:

Any particular effects cannot be predicted. The energy is intelligent and it will do whatever is best. What can be stated is that it will help any condition.

That's right. Apparently this "healing energy" from the "universal source" is so intelligent that it will do whatever is needed or best. That totally must be why it can't be studied! Its effects are so darned unpredictable! It's also hard not to note that on the old web page about Mr. Schuster there was a link to his practice's web page Energy-Therapy.net, where there's also a link to his blog Energy Therapies, which appears not to have been updated since 2005 but is quite revealing nonetheless. Indeed, in one post on Mr. Schuster's web page, we see a claim that speaks for itself:

ALL illness and disease are indications of an unbalanced or depleted energetic condition. The resulting manifestation as pain or anxiety is the body’s way of letting you know that something in your life is out of balance.

But don't worry, Mr. Schuster can help. You don't even have to come to his practice or UACC! That's because, you see, Mr. Schuster offers distance healing:

Distant Healing is defined as a "mental intention on behalf of one person, to benefit another at a distance."

In this context, prayer is a mental act of intercession in which the believer (pray-er) puts himself “between” God and the recipient.

God then uses the prayer (pray-er) as the conduit for the request – be it healing, therapy, or another type of petition. God’s healing power is directed through the healer to the person in need. If that person is present, the power can be conveyed through touch. In the event that person cannot be present, God’s healing power is effectively conveyed by mental intention through the thought process. In this realm distance is not a consideration.

One might not believe any of this, nor have faith that this kind of healing can occur. Actually, that is irrelevant. The only faith that really matters is that of the healer or pray-er. The single requirement of the recipient is to be in a receptive mode, open to healing possibilities. It is not necessary to believe that the acts of prayer, distant healing or touch healing are effective.

This is, of course, completely unscientific. It's religion, pure and simple. In fact, I would argue that it's just another form of faith healing, given how Mr. Schuster invokes God as the source of the "healing power." And it's only $25 for four 15 minute sessions! (More if you want to donate more.) What a bargain! At least there's a quack Miranda warning at the bottom of the page, and one notes that Mr. Schuster also includes a plug for NCCAM.

I don't know whether Mr. Schuster actually offers distance healing to UACC patients, although it's clear from his web page that he offers it. Regardless of whether he offers it to UACC patients or not, I hope that I would not be alone in arguing that mystical nonsense like reiki (which Mr. Schuster appears to implicitly admit to be faith healing) has no place in an academic medical center, much less an NCI-CCC like UACC. There are only 41 NCI-CCCs in the entire country. I'm faculty at one and am proud of having been on the faculty of two different NCI-CCC's. The NCI designation is supposed to mean that these cancer centers are the best of the best, adhering to only the highest standards of patient care, research, and community engagement. To see an NCI-CCC offering faith healing, distance healing, and treatments based far more on magical thinking, religious and mystical ideas, and prescientific concepts of disease, such as reiki, reflexology, and acupuncture, embarrasses me almost as it would to learn these modalities were being promoted for patients by my own cancer center as though they were legitimate treatment modalities. Fortunately, they are not, which is one reason I'm proud of my cancer center, but I nonetheless fear this occurrence. After all, if M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center can fall so deep into the rabbit hole of woo, I'm under no illusion that it can't happen where I work too. All it would take is a new cancer center director, a new director of supportive services who is more "open" to these sorts of treatments, or maybe a new member of the board of directors who is woo-friendly. SBM is fragile these days.

Perhaps Dr. Cress feels the same way, along with many of the other excellent science-based clinicians and researchers based at UACC. I doubt it's a coincidence that there isn't a single mention of CAM or "integrative medicine" in a recent history of UACC published on the UACC blog last fall. In a way, I feel a bit sorry for Dr. Cress in that, as an interim director, she probably has neither the authority nor inclination to deal with this issue definitively. She probably wants to let whoever is appointed the next permanent director deal with it. Whatever the case, the Professor still doesn't know whether Mr. Schuster is still affiliated with UACC or not, the removal of his web page from public view notwithstanding. I'm not sure that even the minimal action of removing from the UACC website a webpage that links to a website offering distance healing would have happened if the Professor hadn't been faculty at the University of Arizona and threatened to go to the press.

Maybe they were concerned that people would also notice that Mr. Schuster's other website, Paths-Mind-Is-It.com, offers a veritable cornucopia of dubious products, such as Increased Synchronicity, which claims to be able to:

Increase in awareness of the present moment. Fully appreciating the here and now

Have future self send information back through time to current moment. This is specific for the following periods of time...1 minute, 1 day, 1 week, 1 month and 3 months

Have current self send current information back through time to past self. This is also specific for the following periods of time...1 minute, 1 day, 1 week, 1 month and 3 months

Increasing unity/harmony between past, present and future self

Hey, if Mr. Schuster can send healing messages over distances, why not forward or backward in time, too? Yes, basically, his PATHS "utilize proprietary breakthrough technology" that claims this:

Rapid Data Transfer (RDT) GENERATION II embodies a quantum leap in Mind Technology. RDT Gen. II is a unique technology that helps you use the potential of your own mind without any drugs or medications. It can help you to improve in almost every area of your life including, health (physical, mental, emotional & spiritual), enlightenment, productivity, success, communication, finances, relationships, fitness and sports - even improve your memory!

RDT has been helping thousands of individuals, like you, improve their lives in many ways (click here to read success stories) in as little as 3 minutes a week.
RDT or Rapid Data Transfer facilitates high-speed communication between an on-line Theater Presentation and the human subconscious.

As best I can figure, PATHS are multimedia computer presentations that claim to be able to do all sorts of things for you, including improving your stem cell health, strengthening your connective tissue, and doing quantum meditation. Note that the word "quantum" features prominently in this "technology," and regular readers know what the use of that word almost always indicates in this context.

What remains of the cow pie

Even if Mr. Schuster is indeed gone from UACC, there's a lot of woo that remains there, as the Professor mentioned in his e-mails. Specifically, he pointed out something called The Seven Levels of Healing, a program created and offered by Dr. Jeremy Geffen, MD, FACP, who is described as a "board certified medical oncologist and leading expert in integrative medicine and oncology and is the author of the book The Journey Through Cancer: Healing and Transforming the Whole Person." I think I'll quote the Professor about why he found this so objectionable, because, really, without letting myself go, I'd have a hard time putting it better myself. In his criticism, the Professor also cites examples from Dr. Geffen's website:

Today I'm in the cancer center and I've noticed something else. You offer here something called "The Seven Levels of Healing". I looked up this program. Level 7 is about the nature of spirit. Here's one thing they say:

Spirit is our true nature: timeless, eternal, and dimensionless, the source from which all awareness, all creativity and, ultimately, all healing flows.

As you know, this claim is scientific nonsense. One may have religious faith in such a claim, but is it appropriate for this claim to be made by the cancer center? The description continues:

The goal of "The Nature of Spirit" is to assist each person to discover this spiritual aspect of themselves, and to bring this into full, ongoing awareness. When what we experience as physical reality is threatened, it is more important than ever before to remember that another part of us is timeless and eternal, and remains strong, healthy, and powerful, no matter what our physical circumstances may be. In recognizing the nature of our spiritual selves, and the incredible mystery of awareness itself, we uncover the source of ultimate love and freedom -- an infinite ocean from which healing can be drawn.

Again, completely unscientific claims about healing. As far as I know, the "Seven Levels of Healing" program is free. This makes it less objectionable, although in my mind, it is still objectionable for the cancer center, a supposedly scientific, evidence-based institution, to be pushing what is essentially religion. Moreover, in the description of level 3: "The Body as Garden", they say the following:

Here we explore the full spectrum of complementary approaches to healing: nutrition; exercise; massage; yoga; herbal therapies; Ayurvedic, Tibetan and Chinese medicine; acupuncture; homeopathy: chiropractic; and visualization. We do not offer or promote these approaches as cancer treatments per se, and we do not believe that they should be viewed in this manner. However, we do believe that they can supplement conventional care by cleansing, toning, relaxing, and strengthening the body, thus giving health and well-being the greatest chance to emerge.

Although these claims are vague, it would be quite natural for someone to interpret them as meaning that these treatments, some of which are offered at the center for a fee, can aid in one's recovery from cancer. I know of no evidence to support this claim. And do you have any idea what they mean by 'cleansing' and 'toning' the body? Do these terms have any scientific meaning in this context?

Likely, the Professor learned of this program through a fliers or pamphlet like this one. He is quite correct, too. By offering this particular program, UACC has irresponsibly placed its imprimatur and thus the assumed imprimatur of science on pseudoscience and mystical, religious mumbo-jumbo. There is no excuse for this.

This "Seven Levels of Healing" represents a program by a physician who is not UACC faculty but is promoted by UACC to its patients. It offers homeopathy, which, no matter how much homeopaths try to deny it, is pure quackery, as we've described many, many times here. Ayurveda and traditional Chinese medicine are modalities based on prescientific ideas of how diseases work not unlike the four humors in prescientific European medical traditions. Worse, according to the biography on the website, Dr. Geffen is apparently "focused on implementing 'The Seven Levels of Healing' program in cancer centers throughout the United States, along with writing, speaking, and consulting with hospitals, cancer centers, and professional organizations in developing leading-edge integrative programs for medicine, wellness, and life." Although several cancer centers appear to have adopted the "Seven Levels of Healing" woo, from what I can tell, UACC is the only NCI-CCC that is involved, making it by far the most prominent cancer center to be using Dr. Geffen's program. I really hope that I don't learn of any more.

Given the infiltration of quackademic medicine into even the most respectable medical centers, it's hard to know whether UACC is merely the cancer center that's gone the farthest down the rabbit hole of pseudoscience or whether I just don't know of ones that are even worse. Given the large shadow that Andrew Weil casts over the medical school there, it might well be so that, when it comes to quackademic medicine in oncology, UACC reigns supreme. As prominent as M.D. Anderson and Memorial Sloan-Kettering Cancer Centers are, as far as I can tell, neither of them has yet offered distance healing to their patients, although many are the academic medical centers that offer a quackery only slightly removed from distance healing, namely reiki. After all, what's the difference between saying you can channel "healing energy" from the "universal source" into a patient if you're in the room with him or if you're thousands of miles away? In my mind, not much. At least one academic medical center offers homeopathy. (Actually, I wish it were only one.)

Can anything be done?

Often, I'm asked something like, "What's the harm?" After all, UACC and the other cancer centers that offer up "integrative oncology" don't deny patients science-based treatments for their cancer. True enough. However, as the Professor demonstrates, the existence of "integrative oncology" programs has a profoundly confusing effect on patients and their families, who, quite reasonably, assume that an NCI-CCC would not offer any treatments that were not science-based. Consequently, the line between science and pseudoscience is becoming increasingly blurred, to the point where even a lot of physicians have a hard time telling the difference when it comes to modalities like acupuncture, which has been the most successful at projecting a facade of science over prescientific mystical origins and a mid-20th century resurrection based on political need in China, thanks to low quality studies and random noise in clinical trials. Worse, this infiltration has led to grossly unethical clinical trials, such as the Gonzalez trial, in which patients undergoing a "natural" therapy for cancer did much worse than conventional therapy, even for a disease with as grim a prognosis as pancreatic cancer. Perhaps an even more pernicious effect (actually, there's no "perhaps” about it) is that this blurring of the lines between science and pseudoscience so badly batters the filters against pseudoscience that a cancer center like UACC can allow practitioners like Frank Schuster and Dr. Jeremy Geffen to be associated with its programs, and even hire them to provide unscientific medicine.

My first wish is that more patients like the Professor would so vigorously protest the infiltration of quackery into academic medical centers like UACC. My second wish is that it would take more than the potential embarrassment of publicity about a practitioner that even the quackiest of quackademics can't defend to push a cancer center to act to protect the scientific basis of cancer care. Maybe the Professor can serve as an example of the first wish, but I fear I will not live to see the second ever fulfilled.

oracknows Thu, 03/27/2014 - 02:00

Categories

Education

Pushback will have to come from patients.

Otherwise, quackademic centers will continue to feel a need to compete with the woo offered at places like Cancer Treatment Centers of America. For instance, laughter therapy.

Who cares about survival rates, when you can have laughter clubs?

http://www.cancercenter.com/treatments/laughter-therapy/

This is why I worry somewhere there is a peds heme-onc physician who just might cave/fall for Burzynski's snake oil.

Have there been any articles by oncologists that have come out strongly against this quackademic infiltration of science-based medicine (other than, of course, ours truly)?

@ Chris Hickie:

I have a cousin who has terminal lung cancer - he lives thousands of miles away- I only talk by phone- but from what I can gather, both he and his wife could benefit from *science based* services at this time. I suspect that most of these are readily available but they are currently in a frozen state of shock. Hopefully, they will respond when the services are offered- he does receive home visits from a nurse weekly.

People undergoing this situation need professional help- such as counselling and perhaps guidance about dietary interventions and pain medication.

Should institutions and governmental supplements for health care be squandered on reiki and accupuncture when money might be better spent on dieticians and counsellors?

AND I'm not just saying that because of my own area but because this assistance is based on DATA.

What's truly insidious about quackademic medicine is that most laymen aren't (and cannot be expected to be) as well informed as the Professor. He seems to have an especially well-developed BS detector (possibly due to his teaching and grading duties), and he is confident enough to recognize that someone affiliated with Erehwon University Hospital might be spouting nonsense. Most laymen would see the Erehwon University Hospital seal of approval and reasonably assume that there was something to it, even if "it" were an alt-med treatment mode as ridiculous as homeopathy or touch therapy (the latter was debunked by a then nine-year-old girl in a science fair project, for crying out loud).

I am a skeptic and a critic! HOWEVER I used to weight about 240 Pounds, then i lost over 70 pounds. The problem was my posture was very misaligned, my neck and back. I did 4 months of chiropractic and my back actually straightened by more than 15˚ and my neck by more than 18˚. How are you going to sit here and tell me that this is quackademic when it made me better??? Of course I did phyiscal therapy (a few minutes lifting weights at the center) after each adjustment. I have xrays that show the difference in change in my back and neck. How can you say this didn't help me?

Speaking of homeopathy...

http://www.wired.co.uk/news/archive/2014-03/25/homeopathy-contains-medi…

I know it's cliche, but this may be one of those things that may have to get worse before it gets better. I just hope we don't have to get plunged into a new Dark Ages by the anti-science movement before everyone else wakes up and starts pushing back, demanding real science and real medicine. I'm glad this Professor is doing all he can to fight against it. Let's hope he can rally his colleagues in the science departments into backing him.

Integrative Medicine is here to stay, for now. It's sad to see so many doctors taken in by it, including Dr Snyderman; it's difficult to know who are the true-believers and who embrace it to stay competitive.

As far as Dr Weil is concerned, he is actually a rather divisive figure in the alt-med community. Sure he's popular, but there are many people in the alt-med movement who see Dr Weil as a "traitor", or some kind of "allopathic" infiltrator of the movement. Many resent him for helping create the board certification in integrative medicine. Some also resent him for creating integrative medicine to begin with, since they believe all scientific or "allopathic" medicine is worthless or evil, and they're not integrating their homeopathy, or reiki, or herbalism with that!

Ayurvedic, Tibetan and Chinese medicine

Uh-huh. Apparently, Ayurveda and TCM just weren't obscure enough. The irony of holding that "Lhüng disorders" are caused by materialism and attachment ("Bheygan disorders" are due to ignorance) while simultaneously fetishizing the Dalai Lama is predictably lost on this crowd.

Cooper @6 - I'm not an expert, but I think that most folks around here don't dismiss the idea that chiropractors could have some benefit in cases such as yours -- you had a structural issue, and manipulation could have helped it a lot.

But hard-core chiropractors believe that practically every disease traces to some kind of misalignment of the spine -- they base these beliefs on the 19th-century doctor who started the field. At this point can be pretty sure that that part of the subject is nonsense.

#6 Cooper

Well, posture doesn't seem to be emphasized today as part of medicine, but it was commonly considered part of health and character in the first part of the 20th century. It still is, but it is appreciated in fewer places.

It sounds like your back was severely out of line, and the crude methods used by chiro were better than doing nothing. Glad to hear it worked out for you.

But ... if one either doesn't have severely misaligned spine or has that problem and a good physical therapist able to deal with it, I'd avoid the chiropractor.

I used one myself for a while to deal with back pain as I had an acquaintance who said he got good results from one particular chiro, and I thought chiros as "the back pain fixit people". I now understand them as an odd combo of useful physical therapy, excessive x-rays and possible back injury from forceful spine movement. So ... now l look elsewhere to fix back and posture issues.

We've fumed for a long time over patient testimonials. Quackademic alt med, I think, implies a testimonial from respected mainstream institutions. Just after reading this blog this morning, I stumbled on this discussion of Ayurvedic treatments on a cancer patient message board:

"I have not tried it, but I noticed that it is offered at our big comprehensive cancer centers in Ohio... [she names three mainstream cancer centers]...so it's not too far out there."

It's a really good way to lull the patients so they don't notice they've entered fantasyland.

" I was busy doing something last night that left me no time to compose any fresh Insolence, which will become apparent by this weekend. In the meantime,"

Will there be an announcement, or should we just check arrest records?

Patience, Grasshopper. When you can snatch the pebble from my hand...

The Center for Integrative Medicine at University of Colorado Hospital (NCI-CCC)
http://www.uch.edu/conditions/integrative-medicine/

With a big ole front page "Featured News Story: Acupuncture for Cancer."

Shoot me now.

University of Pittsburgh (NCI-CCC)
http://www.upmccancercenter.com/SupportiveCare/integrativeMedicine.cfm

UPMC CancerCenter Integrative Medicine Information Service (IMIS) provides access to complementary and alternative therapies to assist in managing your symptoms. These types of therapies may also assist in preventing a cancer from forming or returning.

The program offers information regarding:

Herbal and dietary supplements
Acupuncture
Healthy eating
Mind-body medicine
Additional therapeutic approaches

IMIS specialists work directly with your cancer care team to integrate alternative medicine approaches into your treatment plan.

Dana-Farber (NCI-CCC)
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and…

Despite the documented benefits of complementary therapies, most insurance plans will not pay for them. Our mission is to make integrative therapies available and affordable for all Dana-Farber patients.

A past president of the American Cancer Society and a professor at Harvard Medical School, Dr. Rosenthal has embraced integrative therapies as a vital component of his own oncology practice.

Yep, even Barbara Ann Karmanos/ Wayne State University
http://www.karmanos.org/cancer-care/patient-center/support-education/in…

Integrative Therapies & Services

Integrative therapies are used in combination with cancer treatment to treat the whole patient, mind, body and soul. These therapies place an emphasis on decreasing stress and anxiety, while improving one’s general sense of well-being. At the Karmanos Cancer Center we offer a variety of integrative therapies including:

Art therapy
Healing touch
Massage therapy
Pet therapy
Reiki
Yoga

Ayurvedic, Tibetan and Chinese medicine
Uh-huh. Apparently, Ayurveda and TCM just weren’t obscure enough.

A situation, I suspect, of some fantasist deciding "I want to make stuff up" and feeling his imagination too constrained by the body of made-up stuff that already exists for Ayurveda and TCM.

A situation, I suspect, of some fantasist deciding “I want to make stuff up”

"Therapeutic fan-fic", is basically what I'm saying.

Pet therapy -- when my uncle was dealing with dreadful health problems (including cancer) toward the end of his smoking-truncated life, he had a little dog who cheered him up greatly.

It's more than doubtful that this had any effect on his cancer, but it enhanced his quality of life quite a bit.

Palindrom,
Absolutely! The touchy-feely, stress relieving, comforting, make-you-feel-nice, distraction, massage, friendly shoulder to cry on, puppy kiss, etc., treatments are a HUGE and welcome benefit to many patients. No doubt about that! My issue is simply the exaggerated and bogus "healing" claims surrounding them.

When the AMA did a federally funded study comparing naturopathic medicine with pill and cut methods they were embarrassed when they had to admit naturopahic medicine was more effective. They tried to supress their own research but had to release it due to the federal grant that paid for it.

Pubmed link, please?

thenewme @22 -- We are in perfect agreement.

I think it's important for science-based medicine folks to be very clear that they understand the palliative and quality-of-life value of SOME of this stuff, so they don't come across as inhuman scolds. But of course, humane sympathy and warm-heartedness do not require checking one's brains at the door.

(Excessive capital letters below by deliberate design, heh heh;-)

Dear Mr. Schuster:

Can you use Distance Healing to channel some Reiki Energy for me? I am on a Quest for the True Nature of Energy, and since you say the Energy is Intelligent, it should be able to do this.

I have here on my desk, a BBC/Goerz-Metrawatt MA3E multimeter, with the Negative lead connected to Ground (I understand that for Healing Energy to work, one needs to be Grounded), and the Positive lead pointing straight up in the Air. The meter is set to read 10 Microamps full-scale, so even one Microamp will be sufficient to give an unambiguous Reading.

If you agree to provide your Help in my Energy Quest, I shall switch on the meter at a time of your choosing. I am eager to receive a good Reading on my Meter, so I'll be happy to send payment for your Services before we proceed.

Sincerely yours....

The point of the preceding comment being, if something is claimed to be energy (or, ahem!, Energy), then it should certainly be measurable. As I like to ask when I hear people talk about 'Energy', 'How many milliwatts per square metre, and how is it measured?'

As for the woo poo at NCI-CCCs, IMHO it would be legitimate if they said something like the following (this is serious, not sarcasm):

"Many cancer patients and their families find it is very helpful to engage more fully with whatever philosophical, religious, or spiritual beliefs they may hold. We can provide a list of local resources that cover the range of Western, Eastern, Indigenous, and Non-Theistic beliefs, traditions, and practices. This list does not constitute and endorsement by the Cancer Centre of any system of belief or practice, and no medical benefits should be expected from participation." Full stop, nothing more.

While it is reasonable for a doctor to ask patients and families about their 'emotional and spiritual wellbeing' in a general sense, I for one would be rather upset to be subjected to proselytising for a belief system that had no basis in empirical science and that I did not hold as a philosophical matter. Contemplating Max Tegmark's multiverse theory is one thing; getting asked if I'm 'saved' or the Eastern equivalent thereof, is decidedly another.

Capital TOM:

i'm going to stick my neck out and call Bullshite.

Lurker #27 -- if it's milliwatts per square meter, it's power flux, not energy.

I, for one, do not confine my insufferable pedantry to linguistic matters.

Lurker - sadly, your experiment is doomed to failure because your meter is Grounded in Negativity! While it is to your meter's credit that it is waving its Positive lead in the air, the Energy will avoid all that Negativity lest it be Bummed Out. The only solution would be to eliminate the Negative Pole entirely and Positively Ground your machine, possibly with a Coffee Grinder.

If or more likely when I get cancer or some other disease, and someone offers to sell me magic water or reiki or some other garbage, then I will most likely try to recall any of my old Tae Kwon Do training and give them some decidedly therapeutic touch. It'll make me feel better, at any rate, and perhaps make the world a better place. Maybe they'll even get a Darwin Award out of it, so wins all around.

Of course the first thing I did after reading your post (my first introduction to your work - nice job) was to look at the Comprehensive Cancer Center at my institution - Northwestern University. Sure enough, under "Specialty Cancer Services," they advertise a program in Integrative Medicine: http://cancer.northwestern.edu/public/why_northwestern/specialty_progra…

I should also like to note the official motto that has graced Northwestern's seal since 1890: Quaecumque sunt vera (Whatsoever things are true)

(excessive capitalisations intentional;-)

Palindrom @ 29: Ooops. I based that on 'watts per square metre' which is a measure of solar radiation and used in conjunction with photovoltaic (solar power) installations. What I'm looking for is a pithy way of saying 'show me an objective measure of your so-called Healing Energy.'

Mephistopheles @ 30: Oops again!, Grounded in Negativity, glad I checked it here before sending that to Schuster. But if the Positive is Grounded, then we have the problem of the Negative probe in the air, which would be seeking to receive Negative Energy. Maybe I should ask Schuster which setup his Intelligent Energy would prefer.

Herry @ 31: Now now, it's not up to you to be an Agent of Karma, much less launch any hapless fools into their Next Incarnation. Instead, seek to Channel some Life-Affirming Energy to illuminate the errors of their ways, and trust the Spirit to guide them.

---

Seriously though:

Thinking of martial arts manoeuvres, I wonder about the possibility of 'grounding' all this 'integrative medicine' by way of finding science-based treatments and palliative modalities that can be described in vaguely wooey terms to make them attractive to the woo-seeking crowd? Also, removing all diagnostic/treatment language from the more harmless forms of woo, and describing them in ways that are attractive to that audience but don't promise any medical benefits as such?

Yoga (as exercise), massage (for relaxation), meditation (for reducing stress), etc. etc. The woo modality that consists of looking at coloured light could be reframed as purely an exercise in sensory pleasure, like looking at the blue sky or a sunset.

The goal here is to 'speak their language' and offer something that provides emotional affirmation, sufficient to help get them onboard with SBM for the actual diagnoses & treatments.

For example I wonder how often oncologists who are mainstream-religious, say to their patients who are also conventionally-religious, something like 'I'll be thinking of you in my prayers'? From the doctor's perspective, it's a sincere kindness. From the patient's perspective, it's affirmation of their faith and it shows solidarity. Objectively, it's emotional support, even though it's not part of the treatment (e.g. chemotherapy).

If something like that could be done for patients who subscribe to various forms of animism, I can't see that it would be harmful. It doesn't do to proeslytise atheism to one's Protestant or Catholic patients, so the same case should obtain for one's animist patients. Just as long as they agree to use SBM for the actual diagnoses and treatments, other things that help them feel better emotionally should be OK.

Radiation therapy really sends the healing energy into the body where it can kill the bad cancer cells. And, if you're not trying to cover the whole body so you can kill the nasty cancer cells wherever they pop up, there are ways of targeting the healing energy such as choosing the energy for charged particle irradiation to deposit most of the energy at the depth of the cancer site.
It's been a while since I studied health physics, but I'm sure the box of blinking lights is much more aware of current techniques.
And, with charged particle accelerators, you direct either positive or negative energy!

Lurker,

I am ok with sharing belief systems, but there are a few requirements that I would require of my medical team:

a. Be sincere. Don't pander to me.
b. Be upfront about it being palliative not a treatment.
c. Free is best, but if you are going to charge for it don't offer it to me unless I understand item b. thoroughly.
d. Don't replace SBM with it because you can charge a lot for it and deliver it cheaply relative to SBM - which I think is where we are headed in the States at least.

"requirements that I would require"

I apologize for the redundancy; NyQuil wore off and fever is kicking in.

I had intended on writing a more scathing/in-depth response to your egotistical out-pouring's but I'll say this instead: There are none so blind as he who will not see. The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance. To dismiss something because the jargon that is used doesn't fit your palate is unscientific and again arrogant. Search the NIH for reiki and 87,000 results will emerge, yoga and 219,000 will. You are in a lesser group that thinks these ideas aren't worth looking into for patient care. Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell. It would be in the doctors best interest to be a master of health and not a master of sickness.

"The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance."

Citation needed.

"Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell."

How would that work for those who have genetic conditions like cystic fibrosis or obstructive hypertrophic cardiomyopathy? Or perhaps getting cancer, like leukemia or cervical cancer?

Or do you just think it is cool to blame the patient? And why demonize those who try to educate the public on useless things like "energy" medicine?

(by the way, yoga is a nice kind of exercise, and exercise is part of mainstream medical practice)

Search the NIH for reiki and 87,000 results will emerge

If you mean PubMed, you're off by a factor of 468, and a glance suggests that a good number are in the usual low-quality places.

And here, I was thinking that Reiki is a hands-off treatment. I was wrong.

http://www.ncbi.nlm.nih.gov/pubmed/23617447

Absolutely! The touchy-feely, stress relieving, comforting, make-you-feel-nice, distraction, massage, friendly shoulder to cry on, puppy kiss, etc., treatments are a HUGE and welcome benefit to many patients. No doubt about that! My issue is simply the exaggerated and bogus “healing” claims surrounding them.

The University of Colorado Hospital stuff, at least, looked to me as if it fell short of "bogus." (As one might expect, in light of the potential legal repercussions.)

It definitely disturbs and distresses me that people evidently can't tell when the words in the "Our Services" brochures they're reading mean anything or not. The unhappy implications of it aren't confined to alt-med. (Or, ftm, med.)

But I'm not sure I'm outraged by all of it, per se.

And (more to the point) I'm also not sure that TCM-as-offered-and-practiced-at-the-University-of-Colorado-Hospital (as opposed to TCM) is harmful, per se.

A lie-down-with-dogs argument could be made, I guess.

...

I don't know. I don't see a good argument in support of it. And it wouldn't be for me, personally.*** I'm just not sure I oppose it adamantly.

*** Although I might like the pet and/or art therapy. Lanyards!

This is a thing of beauty:

The treatment of cells with acupuncture involved opening the flask in a level 2 biosafety cabinet and placing a standard steel acupuncture needle in the flask of cells making sure the cell layer was in contact with the needle tip for 20 mins. Sham controls included opening the flask for the same length of time with no needles or exposure using plastic toothpicks instead of acupuncture needles.

You (and the Professor) don't appear to understand the difference between complementary treatments designed to offer symptom relief and reduce the side effects of conventional cancer treatment and alternative treatments that purport to affect the disease process itself. Integrative medicine is generally careful to align itself primarily with complementary treatments and with the best research-supported alternative treatments. Your assumption that integrative medicine practitioners make no such distinctions is contradicted by the fact that there have been integrative medicine practitioners and researchers in major medical centers for more than two decades, and virtually all of them would support the use of conventional therapies that have a research-supported track record of effectiveness (it may surprise you to discover that not all conventional therapies can make that claim). Check out Deng and Cassileth in the November, 2013 issue of National Review of Clinical Oncology: "Complementary and alternative medicine in cancer care - myths and realities" for a good statement of integrative medicine's perspective on this.

Meanwhile, I would suggest that you do less name-calling and read more of the research literature about complementary and alternative medicine. The term "quackademic" is basically short for "I've stopped thinking about this because of my prejudice for mainstream science and I want you to stop thinking about it, too."

Oh, I understand the difference between "complementary" treatments designed to relieve symptoms and alternative treatments. You're also attacking a massive straw man, as I never said that "integrative practitioners" make no distinction. Rather, I view that distinction as being one without a real difference. They still use a lot of quackery.

Reiki is quackery. Acupuncture? Quackery. Homeopathy? Quackery. "Therapeutic touch"? Quackery. "Energy healing"? Quackery. Chiropractic? Large swaths of it are quackery. Naturopathy? Ditto. That's the point. "integrating" these modalities with SBM, as "complementary" therapies or whatever is still quackery. I suppose it's not as bad as using quackery to try to treat the cancer itself, but just because it's "not as bad" as using alternative medicine to treat cancer doesn't make it good. It's still bad.

If only all the quack modalities are offered with a nice big upfront bold statement that "This modality may make you feel better but it will not make you better"

Check out Deng and Cassileth in the November, 2013 issue of National Review of Clinical Oncology: “Complementary and alternative medicine in cancer care – myths and realities” for a good statement of integrative medicine’s perspective on this.

Are you sure you've read it yourself? That's not the name of the journal, and it's paywalled. Anyway, it's not too difficult to find Cassileth's distinction:

"Complementary therapies are distinct from so-called 'alternative' therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind-body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences."

("Xerostomia, or extreme dry mouth, following head and neck radiation therapy is also very responsive to acupuncture treatments with increased salivation compared with control." [Self-citation].)

It seems that AB would have us consider Integrative "Medicine" as using the nice fresh juicy cowpie as a topping for the apple pie, rather than mixing the two willy-nilly.

Would that happen to be Barrie Cassileth?

Acupuncture for breast-cancer-related-lymphedema...not a good idea:

http://scienceblogs.com/insolence/2013/07/02/acupuncture-and-breast-can…

Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell. It would be in the doctors best interest to be a master of health and not a master of sickness.

Isn't that the business model of the health insurance market? The main effect seems to have been to incentivise insurers to deny coverage & treatment to anyone who might get sick.

The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance.
Someone remind me how many million Americans signed up for "this perception of healthcare" once they were given the opportunity

I f you mean the Affordable Care Care a.k.a "Obamacare", it met its goal of enrolling (more than) 7 million people as of the cutoff date of March 31, 2014.

"...Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective...."

Somebody forgot to mention the inexpensive part to all these complementary folk.

Reiki is quackery. Acupuncture? Quackery. Homeopathy? Quackery. “Therapeutic touch”? Quackery. “Energy healing”? Quackery. Chiropractic? Large swaths of it are quackery. Naturopathy? Ditto. That’s the point. “integrating” these modalities with SBM, as “complementary” therapies or whatever is still quackery.

Not to be a trouble-maker or anything.

But when I canvas myself for a position regarding the above, I feel a strong impulse to agree with it, followed immediately by profound unease and uncertainty.

Would you call pet therapy and art therapy quackery? Or....I'm not really sure how best to frame the question. But to use this page here...

http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and…

...as an example, they offer the following "integrative therapies":

Accupunture
Creative Arts Therapy
Massage Therapy
Meditation
Nutrition/Herb/Food Supplement Counseling
Qigong
Reiki

And they appear to me to be offering them on equal -- or at least comparable -- terms to one another.

So.

I personally think that Reiki is ridiculous, and that "traditional Reiki" is even more ridiculous. It's only been around since 1922.

However, they don't appear to me to be offering it on terms that meet the definition of the word "quackery" better than the terms on which they're offering the creative arts and music.

Furthermore, I myself might very well derive benefits very like those they're describing from not only the arts 'n' music, but also the meditation:

Cancer patients credit meditation for helping reduce anxiety, pain, chronic stress, and depression. Learning to let go of negative or fearful thoughts can help you reach a more peaceful state of mind and feel more physically relaxed.

By finding a peaceful space to focus your attention and control your breathing, you can take your mind and body to a quieter, more comfortable place.

Of course, that's so true in my experience as to be too self-evident for the practice to require guidance by a hospital service-provider. But with or without the service, it's still true. Relaxation is relaxing. There's no arguing with it.

Granted, they do go on to cite research purporting to show that meditation has therapeutic benefits that may not, in reality, exist.

But they do the same for the music therapy. And since I wouldn't say they were promoting magical thinking -- or parting fools from their money, or otherwise crossing any lines that shouldn't be crossed -- by doing that, I don't think I have a justification to say it about meditation (or, ftm, reiki), apart from bias in favor of my own cultural-aesthetic-intellectual preferences.

I mean, it's not as if science understands how or why music has the powers it does, or as if anyone can say with any precision what they are. It's just a matter of general, anecdotal consensus that it has some.

People sometimes make claims for them that others probably regard as a threat to the cultural values they'd prefer to see privileged, in fact:

https://www.youtube.com/watch?v=4avM0qzEF5I

There's no arguing about taste. And maybe this is not such an argument. But I'd be curious to know on what grounds people who hold that it isn't think so. I'm not sure I see any.

______________

(I'm assuming a definition for "quackery" that's either something like (per Wikipedia), Stephen Barret's....

To avoid semantic problems, quackery could be broadly defined as "anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters.

...or Paul Offit's:

[A]lternative medicine becomes quackery:
"...by recommending against conventional therapies that are helpful."
"...by promoting potentially harmful therapies without adequate warning."
"...by draining patients' bank accounts,..."
"...by promoting magical thinking,..."

FWIW.)

@ ann:

I used to counsel people who had a serious dx and encouraged them to seek out life-enhancing experiences and to make healthiER choices in daily life so that they would feel better ( which would not necessarily make them BE better)- see movies, listen to music, interact with friends, eat better, avoid alcohol and drugs etc.

I know that woo-meisters will argue that mediation and exercise reduce stress hormones and liberate either neurotransmitters/ endorphins or the *life force* itself ( depending upon how far gone they are) but I think that most sane people will recognise that there's a world of difference between *medicine* and self- care.

I refer to the latter as 'grandmothers' medicine' or 'spa medicine'. Drink tea if you have a cold or get a massage if you feel stress. Exercise to decrease anxiety or weight problems. Sure, all of these activities have physiological effects that can be measured as well as being subjectively experienced by the subject. Most of these activities are also recommended by SBM despite the claims of alties. Most can either be done by the person him or herself or by non-medical personnel.

Woo goes too far when it prescribes these activities as curative or uses them as replacements for therapies that have been found to treat illness through meaningful research; woo also makes diagnoses without benefit of real world methods of measurement and analysis: you may have 'low chi' BUT how could chi be measured since it doesn't exist?

OBVIOUSLY there's much more but I have to get ready to get to my train,

An addendum:

I'm not saying: "Oh, well, anything goes, if the people want it and it doesn't hurt them, where's the harm?" or anything like that.

Ostensibly reputable facilities do sometimes promote quackery and I am immovably opposed to it when they do.

For example: Sierra Tuscon offers brain-SPECT-scanning, a la the Amen Clinic:

http://sierratucson.crchealth.com/treatment/brain-spect/

And while that's not more or less of a pile of absolute crap than reiki is when it comes to demonstrable efficacy/benefit, it is -- by my standards -- quackier. Because there's no extra-medical cultural or human affinity for neuro-imaging. So there's no reason to cater to or accommodate one. They're just mystifying medicine for profit. It's a blight. Moreover, the language they use, while qualified, does definitely suggest that it's science, not art. They speak of "clinical indications," for instance.

But they also offer 12-step -- ie, relating to a "higher power" part of one of their treatment modalities. And I have no problem with that, assuming the usual disregard-if-you-wish terms of 12-step apply.

Woo goes too far when it prescribes these activities as curative or uses them as replacements for therapies that have been found to treat illness through meaningful research; woo also makes diagnoses without benefit of real world methods of measurement and analysis: you may have ‘low chi’ BUT how could chi be measured since it doesn’t exist?

I agree.

My point is that I'm not sure I see how the integrative-therapy (or, in the case of the University of Colarado, "integrative medicine") services of the three facilities linked to on this thread meet those criteria.

the three facilities linked to on this thread

Or four. However many there are.

I guess it's the blanket assertion that offering reiki and acupunture as a complement to cancer treatment in an otherwise legitimate and responsible medical setting is -- in itself, existentially- - quackery that I'm querying.

I see the point with energy healing, homeopathy, and healing touch. Because they have no basis, purpose or function -- conceptually, historically, culturally -- that isn't in direct, oppositional conflict with science-based medicine and/or science.

However, they don’t appear to me to be offering it on terms that meet the definition of the word “quackery” better than the terms on which they’re offering the creative arts and music.

First, they misrepresent reiki:

"Based on the belief that an unseen 'life-force energy' flows through us and helps keep us alive"

No; the reiki power is out there: Per the Usui memorial, "On the beginning of the 21st day, suddenly he felt one large Reiki over his head and he comprehended the truth. At that moment he got Reiki Ryoho."

Reiki is a Japanese technique for stress reduction that is safe, natural, and easy to learn."

Reiki is an occult healing practice that still involves the "transmission" of "secret" signs of "power" and has, moreover, been rejected by the U.S. Conference of Catholic Bishops. Describing it as "Japanese" also suggests that it is used in Japan, although it in fact had to be reintroduced from the West (perhaps predictable, being in the hands of a secret society) in the 1980s and doesn't seem to have caught on.

"In addition to making you feel more relaxed, safe, and secure, a proficient instructor can facilitate energy flow to the areas where you need it most"

If this isn't promoting magical thinking, I don't know what is. It's pure superstition.

Brain-Spectrometry covered here:

http://scienceblogs.com/insolence/2013/07/24/a-board-certification-in-i…

Pet therapy in a hospital? No way, no how, would I ever agree that an acute care hospital should allow pets in patient care settings, especially cancer wards, where patients are undergoing immune suppressing treatments.

I'm not sure what Sierra Tucson has to do with anything, but...

But they also offer 12-step — ie, relating to a “higher power” part of one of their treatment modalities.

"The 12-Step process is utilized as a basis for the treatment programs at Sierra Tucson, and individuals are encouraged to use the 12-Step process in their recovery."

This seems to be more that "offering," despite the backpedaling.

And I have no problem with that, assuming the usual disregard-if-you-wish terms of 12-step apply.

I do, to the extent that it's essentially misrepresented:

"Research has shown that the quality of recovery from all addictive and mental health disorders is enhanced by the many components of the 12-Step Process, such as mutual support, honesty, accountability, acceptance, and spirituality."

Twelve-step programs are essentially cults, with an evidence base that ranges from negligible to actively destructive.

Would you call pet therapy and art therapy quackery?

I have concerns about feel-good, emotional-wellbring activities being described as "therapy", especially in a medical context designed to smuggle them in and create the impression that they improve *physical* health.

The local hospice provides a drinks trolley to the clients, and many terminally-ill patients feel better after a glass or two of decent malt, but they do not call it "alcohol therapy". They provide a Biography Service where volunteers interview clients and lend their transcribing / editorial skills to help them write an autobiography... many clients feel better to see their lives in retrospect, edited to emphasise the plot arc and the closure... but they do not call it Biography Therapy.

Twelve-step programs are essentially cults,

No they're not. They're not even non-essentially cults. They're not even necessarily religious.

with an evidence base that ranges from negligible to actively destructive.

That could be said evidence base for just about every form of alcoholism and addiction treatment there is, sometimes accurately, as with equine therapy (negligible) or Narconon, the descendants of Synanon/The Seed, and countless others (destructive).

Addiction and alcoholism are frequently treatment-refractory, and sometimes lethal. No single thing works for all -- or all that many. And nothing at all works for some.

A lot of people get clean and sober in twelve-step programs with no excess or unnecessary ill effects or suffering whatsoever. Most don't stay that way. But some do. Writing the whole shebang off in the terms you just did is thoughtless, at best. I'm surprised at you.

(No, I'm not. It's not a personal thing. It's just my considered opinion.)

@herr doktor bimler --

I'd rather see a drinks trolley called drinks trolley, certainly.

But I don't know that I'd conclude it had been designed to smuggle a feel-good activity into a medical context and create the impression that it improved *physical* health if it were called "alcohol therapy," assuming that was the only basis to do so that I had.

I probably wouldn't, though.

No they’re not. They’re not even non-essentially cults.

AA and friends are unquestionably cults. There is only The Way. Lifelong dependence on The Program is a necessity. Anyone who brings an addiction to a halt without The Program is a "dry drunk," etc. The rhetoric of "codependence" (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.

I don't have the time or energy tonight to dissect it much further.

They’re not even necessarily religious.

Ceremonially standing in a circle holding hands while reciting the L-rd's Prayer tends to say otherwise.

with an evidence base that ranges from negligible to actively destructive

That could be said evidence base for just about every form of alcoholism and addiction treatment there is, sometimes accurately, as with equine therapy (negligible) or Narconon, the descendants of Synanon/The Seed, and countless others (destructive).

Synanon is not worth mentioning, and equine therapy is hardly an "addiction treatment." Twelve-step programs exist by definition to foster a culture of powerlessness. It is no surprise that predators are attracted to them. Also imperative is the instilling of shame, because it's not really anonymous and there's a pressure to confess.

CBT and pharmacotherapies do not rely on any such weirdness or insist that the underlying problem is an irreparable character flaw. The problem with "just about every form of alcoholism and addiction treatment there is" is that 12-step programs just about are the only form of treatment there is.

Addiction and alcoholism are frequently treatment-refractory, and sometimes lethal.

Yup.

No single thing works for all — or all that many. And nothing at all works for some.

Define "works."

A lot of people get clean and sober in twelve-step programs with no excess or unnecessary ill effects or suffering whatsoever.

Define "a lot of people."

Most don’t stay that way. But some do. Writing the whole shebang off in the terms you just did is thoughtless, at best.

No, it is not.

^ Note that I did not mean include methadone or disulfiram under 'pharmacotherapies'.

AA and friends are unquestionably cults. There is only The Way.

No. That's a ludicrously overstated mischaracterization.

Lifelong dependence on The Program is a necessity.

That too.

Anyone who brings an addiction to a halt without The Program is a “dry drunk,” etc.

And that.

The rhetoric of “codependence” (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.

Huh?

Meaning disconnection, a la CoS?

Are you serious?

I don’t have the time or energy tonight to dissect it much further.

Insofar as I know you from reading your posts here, I'm in awe of your intelligence, ability. wit, heart, soul and integrity.

However, you appear to have been misinformed about what 12-step programs are and how they work by a source that represented the rhetoric and practices commonly used in them in an extremely distorted light.

For one thing, even within a single 12-step program -- ie, within AA or what-have-you -- practice and custom vary enormously by region and group. It's not a monolithic thing, being as it's peer-run and not centrally administered.

But if they're run in the typical spirit, it's not fear-based. There's no leadership. There are no outpoints, brownie-points, sanctions, or punishment. There are no coercive tactics, or even coercive-persuasion tactics.

And -- as they say, quite distinctly -- there are no rules, just suggestions, the only requirement for membership is a desire to stop drinking, yada, yada, yada.. Belief in most of the steps and principles is customary, but disbelieving some of them is common. And, per the framework of the program, both optional and voluntary.

^^I'm talking about the program there. Obviously, I can't vouch for or against every individual group.

People in 12-step recovery sometimes go through a conversion-type stage that's reminiscent of cultiness. But that doesn't make it a cult. They're just converts.

Ceremonially standing in a circle holding hands while reciting the L-rd’s Prayer tends to say otherwise.

Not if you don't have to say it, it has no fixed meaning, and belief in it would be optional even if it did.

It's not, as I already said, even necessarily religious.

Synanon is not worth mentioning, and equine therapy is hardly an “addiction treatment.”

Sierra Tuscon is famous for the latter. Not that I disagree with you.

Twelve-step programs exist by definition to foster a culture of powerlessness.

That's crazy talk. They do not. They exist to provide peer-support groups for people who wish to use them to get clean and/or sober. Primarily.

It is no surprise that predators are attracted to them.

I have no idea what that means. What kind of predation are people who attend 12-step meetings likely to encounter?

Also imperative is the instilling of shame, because it’s not really anonymous and there’s a pressure to confess.

Oh, is there.

Applied by whom? In what way? And what are the rituals whereby shame is instilled?

The problem with “just about every form of alcoholism and addiction treatment there is” is that 12-step programs just about are the only form of treatment there is.

There's not a lot, too often. But there aren't a lot of people with fresh ideas in hand rushing to meet the need, simply out of the passionate desire to work with drunks and junkies for the sheer glamour, joy and ease of the thing.

And even still, 12-step is not regarded as the gold-standard in the addiction-treatment biz, these days, which it still was several decades ago. Harm-reduction would probably take over if 12-step wasn't so much cheaper/easier to get up and running. There's not much that's cheaper and easier than a volunteer-run enterprise.

In any event. It's not a cult, or even cult-like. You're mistaken.

BTW, I'm happy to agree to disagree.

I take it for granted that your opinion is both considered and thoughtful, and that you hold it in good faith.

It's also always possible that I have more to learn. I'd be surprised if that were the case, in this instance. But I can't say that it's never happened before.

Okay? Okay.

ann:

http://www.ncbi.nlm.nih.gov/pubmed/24647726

I will deal with this piecemeal.

The rhetoric of “codependence” (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.

Huh?

Meaning disconnection, a la CoS?

Are you serious?

About which part? "Codependence" had no currency whatever before Melody Beattie, who had no qualifications whatever. Where do you think CODA came from? Shunning is exactly what it's used for. It is held to be morally wrong to help a family member suffering from addiction unless it is to insist upon a 12-step program.

However, you appear to have been misinformed about what 12-step programs are and how they work by a source that represented the rhetoric and practices commonly used in them in an extremely distorted light.

If you think I am speaking from an eyrie or something, you're mistaken. Stating that 12-step programs for addiction are not "monolithic" ignores the fact, at very least, that the U.S. circuit courts have felt no need to observe such niceties.

About which part? “Codependence” had no currency whatever before Melody Beattie, who had no qualifications whatever. Where do you think CODA came from? Shunning is exactly what it’s used for. It is held to be morally wrong to help a family member suffering from addiction unless it is to insist upon a 12-step program.

About every part. It's not an apt comparison.

I should say that I know much less about 12-step for what I believe are termed process addictions than I do about 12-step for substance addictions, apart from anecdotal knowledge. But as far as anecdotal knowledge goes:

That would be news the half-dozen or so women I've known who attended CoDA meetings for the support they got there. All of them were in horrendous relationships with drunks and drug addicts, whom they didn't show the least sign of being told to shun.

Furthermore, if CoDA is indeed run on the 12-step model, nobody in it is in a position to insist on anybody else doing anything, nor is anybody empowered or authorized to enforce the action putatively being insisted upon. Nobody (in fact) is in a position to know a single damn thing about you that you don't volunteer yourself. And there are no routines or procedures in which anybody gives anybody else advice -- let alone ultimatums -- about any matter, issue or question when it hasn't been asked for.

On top of which, membership, attendance, and association are voluntary. There are no fees, and no demands on the time and/or energy of the participants apart from what they elect to expend. And there are no consequences or penalties for not following the advice of another group member. Or, indeed, of all the group members in concert.

But it's somewhat far-fetched to suppose that they'd be acting in concert. It's not that organized. People just show up when they want to attend a meeting. They're under no pressure to do more. And they're under no penalty if they do less.

None of that is how it's done in cults. It takes systematic effort and concentrated, extended periods of time to deprive people of their freely exercised will.

If you think I am speaking from an eyrie or something, you’re mistaken. Stating that 12-step programs for addiction are not “monolithic” ignores the fact, at very least, that the U.S. circuit courts have felt no need to observe such niceties.

As I said, I'm sure your opinion is considered and thoughtful.

I doubt anything the U.S. circuit courts have felt the need to observe is going to convince me that a loosely organized, non-hierarchical, non-coercive program with virtually no rules and no way of enforcing them that's not concerned with either power or money is a cult.

But I'm always open to being wrong.

@Adam G --

Thanks. The word "mindfulness" seems to be everywhere in the mental-healthcare field, I've recently been noticing.

I'm emphatically not saying that 12-step is the best treatment modality. I'm just saying that it's not a cult and that it works well for many people.

Which reminds me:

@Narad --

I don't know the number of people it works well for. But I certainly wouldn't claim that it isn't many times smaller than the number of people for whom it does nothing, if that's the issue.. And....Well. I guess that if you're just disputing that "a lot" is accurate, tell me. I can look it up.

By "works," I mean "helps people to remain clean and sober for long enough to attain whatever object or goal motivated them to." IIRC, most of those who don't become part of the first-year attrition rate get lives and largely drift away in the five-to-ten-year range.

I’m just saying that it’s not a cult and that it works well for many people.

Maybe that's true. I doubt it. My anecdotal experience with these programs is much, much more in line with what Narad has described.

There's no reason for anyone who doesn't want to attend meetings to go to them, unless it's court-ordered.

Once there voluntarily, they're not under any pressure to participate in any, all or some parts of the program if they don't feel like it. There's no process that each newbie has to undergo in order to progress to the goal. They don't have to get sponsors if they don't want them. They don't have to stay with the sponsors they have if they prefer not. They don't even have to open their mouths to communicate with a single, solitary other soul unless they wish to. It's entirely self-determined.

That's not how cults do.

It's an unnecessarily doctrinaire program on paper, as well as -- to a lesser and inherently mutable degree -- in practice. But it's not a cult.

And -- afaik -- its practices are not destructive, per se. Many people find them distasteful and/or intolerable. That's a serious problem. But it's a different problem. It's still not a cult.

Here's another perspective, ann. I hope you do read it through.

http://www.csudh.edu/dearhabermas/aacultbk01.htm

I've read it.

It's an insane misapplication of Lifton (who I am certain would at least agree that it's a misapplication).

I actually care about that more because I don't like to see what cults do misunderstood than because I don't like to see what 12-step programs do misunderstood.

I have strong feelings about cults.

I dislike the "higher power" nonsense of 12-step, nor the scramble by some group leaders to say that "higher power" doesn't really mean "God".

LifeRing has a secular approach to addiction recovery, with an emphasis on personal responsibility and, yes, mindfulness.

It's worth remembering that there are no statistics for whether/how effective AA is, and never will be, by policy, because there's no way to both say "everyone here is anonymous" and usefully track effectiveness. At best, you can have self-reported "I have been attending AA for X amount of time and haven't had a drink" and "but have gotten drunk three times, I'm still working on this." There's no way to connect that to how many people are sitting in the back of the room, got drunk last night and the night before and are going to go to a bar after the meeting, and haven't said a word because they don't feel comfortable doing so. Or with the people who stop going to meetings and are still drinking too much (however they or you would define "too much." Since there's no way to know how effective AA is, just that there are at least a few people who say it worked for them, there's no meaningful way to compare that with other approaches.

I have a friend who credits both Narcotics Anonymous and the love and support of his wife and husband for his having stayed drug-free for many years, as well as giving himself some of the credit. Does that mean that NA works, or does it mean that the key to quitting narcotics is a strong but unconventional marriage? (I'd say it supports the idea that support from other people, including but not limited to spouses and/or other addicts, can help. But that's a much weaker statement.)

Once again:

I am not making any claims for 12-step apart from that it's not a cult and that it helps many people with substance addictions get clean and/or sober.

The truth is that it's such an incredibly underserved population that there's not a whole lot more out there now than there was back in 1935 when Bill W. and his little band of lunatic Xtian drunks decided to help themselves, since no one else was going to.

It's still now what it was then -- someplace for the addicted and alcoholics to go where people will listen and talk to them and where they won't be demeaned, punished, or kicked out.

There's very little more to it than that. There's not really a lot of there there, in reality. It's mostly just people and a lot of simplistic, positive, affirming slogans and mottos.

Despite (or maybe because of) which, someone who's highly motivated for treatment stands a reasonable chance of being able to find a way to piece together a workable program for recovery out of its components, since it's a somewhat anarchic enterprise.

There's not a whole lot else. And that's a shame. But it's not AA's shame. Or NA's. Or anyone's, especially. It's just a shame, same as it is for the legions of people with non-substance-addiction-related psychiatric disorders who don't even have some dumb, annoying, hackneyed out-of-date, sentimental 12-step meeting to go to.

There are an awful lot of addicts and alcoholics who are not highly motivated for treatment, and that's a serious drawback. In case it needs saying.

@Johanna

I dislike the “higher power” nonsense of 12-step, nor the scramble by some group leaders to say that “higher power” doesn’t really mean “God”.

It's not a scramble. That's been the official position of the organization since the get. That's why the preamble concludes by stating that they're not allied with any sect, denomination or creed and neither endorse nor oppose any causes.

In short: "Higher power" means whatever you understand it to mean, by intent and design.

That said, I personally don't much like it either. It's true that I don't have to. But if I did, I think I'd be capable of finding a work-around on the terms of the program as they stand.

@Vicki

I’d say it supports the idea that support from other people, including but not limited to spouses and/or other addicts, can help. But that’s a much weaker statement.

It's a true one, nevertheless.

"get clean and/or sober"

Just what the hell is this "clean" bullshit? Are alcoholics dirty? Do they disgust you and need to be tidied up to be presentable to you? Jesus Haploid Vishnu what a load!

That’s been the official position of the organization since the get. That’s why the preamble concludes by stating that they’re not allied with any sect, denomination or creed and neither endorse nor oppose any causes.

Allow me to first observe that the lone "theoretical" underpinning of all 12-step groups is Bill Wilson's "G-d" moment, which came after four days' "treatment" with Towns's "belladonna cure" and none for incipient delirium tremens. There is now a movement afoot to search for how it "works." This bears a strong similarity to what is known as "Tooth Fairy Science."

There has also been a churning out of what appear to me to be extremely narrow studies (with numerous "corrections" for "confounders") to demonstrate that it's not actually TFS. This appears to be in response to the Cochrane review.

As effectiveness is not the subject at hand, I'll leave it at that and try to get to the explicit matter of psychodynamics and cultishness next.

In order to tie up some loose ends, though, I'll briefly note two things: (1) Regarding "predation," the General Service Board has only grudgingly considered considering the matter, and only in a narrow realm (PDF). (2) With respect to "confession," one well-known mantra is "you're only as sick as your secrets." This derives from Wilson: "Time after time newcomers have tried to keep to themselves certain facts about their lives."

OK, so a précis of the cult argument. One instantiation of "the usual disregard-if-you-wish terms of 12-step" is that The Program itself can substitute for "G-d," right? Let's revisit the original steps in this light:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that [AA] could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of [AA].
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to [AA], to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have [AA] remove all these defects of character.
7. Humbly asked [AA] to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with [AA], praying only for knowledge of [AA's] will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of [AA], we tried to carry [AA's] message to alcoholics, and to practice [AA's] principles in all our affairs.

That's without interpolation.

Narad --

I tell you again, courteously and respectfully:

You are mistaken to think that AA is a cult.

Unlike 12-step, the subject of cults is one I have strong personal feelings about, as well as considerable first-hand experience regarding, though not as a member of one.

There's no definition or conception of "cult" that means a single damn thing that you can apply to the 12-step model. It simply can't be done.

I mean...

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that [AA] could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of [AA].
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to [AA], to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have [AA] remove all these defects of character.
7. Humbly asked [AA] to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with [AA], praying only for knowledge of [AA's] will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of [AA], we tried to carry [AA's] message to alcoholics, and to practice [AA's] principles in all our affairs.

That’s without interpolation.

Yep.

Do you know how any of those steps is used or understood in practice? Or even if they're used or understood in practice?

Because it really doesn't seem as if you do.

However, I don't want to fight with you. Nor do I want to waste my time trying to convey (guaranteed true and genuine) information to you that you're not interested in hearing.

So let's skip it. If you find the meaning that you're imputing to those words objectionable, I probably don't disagree with you about it, whatever it is.

How's that?

There’s no definition or conception of “cult” that means a single damn thing that you can apply to the 12-step model. It simply can’t be done.

Not only can it be done, it's a commonplace.

How’s that?

If you mean dropping the subject, that's fine. If you mean suggesting that I'm failing to grasp "guaranteed true and genuine" information because I don't seem to "know," then no, but I'll drop it all the same.

In order to tie up some loose ends, though, I’ll briefly note two things: (1) Regarding “predation,” the General Service Board has only grudgingly considered considering the matter, and only in a narrow realm (PDF).

No, no, no. Not so fast.

What you said was that predators were attracted to it.

I don't see anything in that PDF except for an organization acknowledging that the same abuse, exploitation and harassment of women that occurs everywhere in the damn world that men and women frequent is occurring and needs to be addressed.

If that's enough to meet your criteria, you might also say the same thing of skeptics.

(2) With respect to “confession,” one well-known mantra is “you’re only as sick as your secrets.”

Yeah. That doesn't mean you're under any pressure to confess them to anyone, or that you'll be shamed for doing so, which was what you'd claimed.

And it's not (in fact) an exhortation to confess anyway. It's just the twelve-step way of saying "You don't need to live in shame. You have nothing to be ashamed of here."

This derives from Wilson: “Time after time newcomers have tried to keep to themselves certain facts about their lives.”

Uh-huh. So that's your proof that there's pressure on people to confess and be shamed? A not-particularly-well-known or widely quoted sentence from a book that was published in 1939?

That's not very compelling, especially when considered in the context of 12-step meetings:

(a) using a format in which people who don't raise their hands because they have something to say don't even get the opportunity to be pressured to confess, or -- indeed -- to say anything at all; and

(b) the prohibition on cross-talk (responding to what those who do raise their hands have said).

Are you proposing that AA pressures people to confess by giving them the Big Book; murmuring "You're only as sick as your secrets" occasionally while waiting for them to stumble across that sentence; and then sitting back and letting them see if they can resist raising their hands?

Or what?

Do you want to drop it, or not?

If you mean suggesting that I’m failing to grasp “guaranteed true and genuine” information because I don’t seem to “know,” then no, but I’ll drop it all the same.

Yikes. what a repellent thing for me to have said.

Please forgive me.

Believe it or not, I didn't mean to imply, suggest or hint anything negative about you. I was just feeling frustrated and confused. I respect you very much.

Not only can it be done, it’s a commonplace./blockquote>

I've seen arguments to that effect made many times. But they're nearly always mostly rhetorical exercises in reading stuff into AA literature that bears no relation to 12-step practice.

I've never seen a convincing one. Plus I've known so many addicts and alcoholics over the years that it's just ridiculous. So I've also seen enough people go through 12-step recovery to be confident that it doesn't use cult tactics.

Nevertheless, I would definitely read what you were linking to, if I could. But the link is busted.

____________

Again, please accept my sincere apologies. I didn't mean it.

In re: Dropping it.

Sorry. We cross-posted.

I don't know. As you wish.

I appreciate the apology; the matter is forgotten. As the subject is not really on-topic to cancer centers, I'd like to close all these PubMed windows, and I've mentally prepared a comparison to Western misconceptions about Rinzai Zen and Ch'an's losing out to Neo-Confucianism, I think it's best dropped.

I'm perfectly willing to revert to attacking reiki, though.