The infiltration of woo into mainstream academic medicine: The media notices

Along with Dr. R.W. and few others, I’ve made a bit of a name for myself in the medical blogosphere by bemoaning the infiltration of non-science- and non-evidence-based medicine into academia. It’s not a particularly popular viewpoint. The prevailing attitude seems to be: Why be so negative? It’s all good. Moreover, with a credulous media eager to publish stories of “healing” and “humanistic” medicine, those of us who remain skeptical of applying unproven and/or untested remedies in an academic setting, thus giving them the imprimatur of academic medicine and the respect associated with it, are easily painted as dinosaurs, unable to get with the plan, unaccepting of the new order of medicine.

About a month ago, I mentioned how the mainstream media is starting to take notice of what had heretofore been primarily discussed among physicians concerned with the issue and bloggers alarmed at the infiltration of pseudoscience into what should be the bastions of scientific medicine. For example, Julie Deardorff, the resident antivaccinationist and woo-friendly columnist and blogger for the Chicago Tribune, recently gloated about the newfound “respectability” of alternative medicine. However, as annoying as she might be, Julie’s strictly small fry. Granted, the Tribune is indeed an important newspaper. However, it’s primarily a regional paper servicing, aside from Chicago, the Midwest.

Now, it appears, the national media have started to stand up and take notice. A couple of weeks ago, there was a report in the U.S. News & World Report about how academic medical centers are “embracing” complementary and alternative medicine (CAM), a.k.a. “integrative medicine,” starting with, of course, an anecdote:

“To be blunt, if my wife and I didn’t think it was helping him, we wouldn’t have continued with it,” says Dan Polley. He’s talking about Mikey, the Polleys’ 2½-year-old in the next room, who was diagnosed with acute lymphocytic leukemia when he was 6 months old. Chemotherapy, radiation, and a bone marrow transplant have been crucial elements of Mikey’s treatment. But the “it” his father speaks of is nothing like these aggressive, costly, and heavily researched exemplars of western care–it is a kind of touch therapy, from the camp of alternative medicine. Gentle and benign, “healing touch” is intended to rebalance the energy field that its practitioners believe surrounds the body and flows through it along defined pathways, affecting health when disrupted. Several times a week, therapist Lynne Morrison spends 20 minutes unblocking and smoothing Mikey’s energy field, which energy healers like Morrison say they can feel and correct.

Before a recent session, Mikey was grouchy, drawing up his legs and issuing periodic yowls. His stomach hurt, said his father. But as the little boy nestled in his father’s arms and Morrison moved her hands around his body, lightly resting them here and then there, his tenseness loosened and he quieted for a few minutes at a time. The Polleys believe that the therapy not only calms their son but is aiding his return to health.

The setting for the unorthodox therapy–an academic medical center–would have been startling just five or 10 years ago. Morrison is on the staff of Children’s Memorial Hospital in Chicago, a hard-nosed, tough-cases, research-oriented emblem of western medicine. It perennially ranks among America’s premier hospitals and is the principal pediatric teaching hospital for Northwestern University’s Feinberg School of Medicine. And Mikey is only one of many children there receiving care that not long ago was called alternative medicine. Now it is more often called CAM, for complementary and alternative medicine, or integrative medicine, to avoid the loaded “alternative.” The message the new labels are meant to convey is that the therapies more often go hand in hand with traditional medicine than substitute for it.

As much as I’m sympathetic to parents of children with cancer, it irritates me to see an anecdote presented as though it means that the therapy is effective. With all due respect to Mr. Polley, I have to point out that his assessment of whether the reiki therapy being administered to his son is close to useless. Confirmation bias, regression to the mean, and all sorts of other biases make his assessment of whether the therapy has done anything for his son unreliable at best. Be that as it may, I guess that I’ll have to add Children’s Memorial Hospital to my Academic Woo Aggregator. After all, it offers all sorts of energy healing, along with this embarrassingly credulous description:

Our bodies are always trying to move toward balance and health. Energy healing encourages the flow of our natural energies. The term “energy healing” covers a wide range of styles and techniques which serve to positively affect the human energy field.  Hands-on energy work assesses disturbances in the human energy field, and helps to aid the individual’s body to enhance the natural flow of healthy life force.  Patients and their families report that energy healing often provides a sense of deep relaxation, and reduction in the experience of pain.  Energy healing is also called “touch healing” in our studies.  Research is presently being conducted to provide evidence to show how the disturbances and movement of these subtle energies may affect the physical condition of the human body.

The woo, it hurts. This is the sort of language I’d expect to find on Whale.to or Dr. Mercola’s website, not on that of a hospital affiliated with a major academic medical center. But, back to the article. It’s a bit of a mixed bag. On the one hand, it serves up risible quotes form luminaries such as Dr. Andrew Weil:

Most academic hospitals are fairly conservative when it comes to CAM; the usual menu offers acupuncture, yoga, meditation, and variations on massage such as reiki. This tracks the philosophy of Andrew Weil, founder of the University of Arizona Program in Integrative Medicine and CAM’s public face, if there is one. “I teach and urge people to use a sliding scale of evidence,” says Weil. “The greater the potential to cause harm, the greater the standard of evidence should be.”

The wag in me can’t help but point out that, using Dr. Weil’s “logic” (such as it is), the über-woo that is homeopathy should require no evidence whatsoever before widespread adoption. After all, true homeopathic remedies are nothing but water, given that the dilutions involved would result in not a single molecule of active substance remaining.

Although, overall the article is overly positive and solicitous of unscientific CAM modalities, dutifully repeating anecdotes that show nothing and could be due to confirmation bias or regression to the mean, it does include some skepticism and a few quotes pointing out how regression to the mean, the placebo effect, and confirmation bias can account for much of the apparent “efficacy” of CAM interventions. Unfortunately, the article is marred by credulous reporting of glowing patient testimonials. Too bad Avery Comarow, the reporter responsible, seems unaware that testimonials are almost useless as far as determining whether a particular therapy “worked” or not. Fortunately, he was able to put the myth that more than half of Americans use “alternative” therapies into perspective:

CAM’s ascendance isn’t entirely driven by money–researchers make frequent references to obligation. “We want patients to have access to these therapies in a responsible fashion,” says Lisa Corbin, medical director of the Center for Integrative Medicine at the University of Colorado Hospital. That implies a public clamor for such services, and patients may indeed talk about and ask for CAM more than they used to (although that isn’t clear). But surveys showing widespread use–like one issued by the Centers for Disease Control and Prevention in 2004 reporting that 62 percent of adult Americans had used some form of CAM in the previous year–are highly misleading. The big numbers reflect activities such as prayer, which few would consider CAM, and meditation, now routinely prescribed to help lower high blood pressure. The Atkins and Zone diets (“diet-based therapies”) were counted in the CDC survey, too. A more selective reading indicates that about 5 percent used yoga, 1.1 percent acupuncture, and 0.5 percent energy therapy, to pick three more-representative offerings.

This actually confirms what I had suspected, that the estimate of how many Americans use non-evidence-based modalities is grossly exaggerated, most likely because modalities not generally considered “alternative” by most (such as prayer) are included, as are modalities that have been coopted as “alternative” when in fact they are completely conventional (such as nutrition) were lumped into the total. Unfortunately, it also confirmed what I had feared, namely that serious, serious woo has become acceptable in some academic medical centers. I’ve already ranted about how several medical schools are offering homeopathy and “energy medicine” to patients, not to mention even reflexology and Rudolf Steiner’s “anthroposophically extended medicine.” Little did I suspect that detoxification woo could be found at what is otherwise a stronghold of scientific medicine:

Still, some academic hospitals give patients access to highly controversial therapies. Thomas Jefferson University Hospital in Philadelphia and Maryland’s integrative medicine center, for example, provide homeopathic services. And patients at Oregon Health and Science University Hospital in Portland and the University of Pittsburgh Medical Center can see a naturopath, generally a non-M.D. who advocates nonmedical aids such as proper nutrition, colonic irrigation (a polite term for enemas), and special water baths to stay healthy without drugs or surgery.

Noooo! Not the University of Pittsburgh! Colonic irrigation? Say it ain’t so!

I say this because I know that the Department of Surgery, at least, at the University of Pittsburgh is one of the most highly academic and scientific research-oriented departments of surgery there is.

The question that remains after looking at the increasing acceptance and even boosterism for CAM and integrative medicine in academia documented in this article is a simple one: Why? Insurance doesn’t pay for most of these therapies, insurance companies, whatever their greed and other shortcomings, having decided that there is no evidence that they work. Consequently, it’s cash on the barrelhead for academic medical centers reeling from recent cuts in Medicare and Medicaid reimbursement.

Still, that’s not enough to explain it. So what is? It turns out that, if you look closely at these centers, many of them are the result of a wealthy donor (or donors), as is the case for Duke University, Thomas Jefferson University, Columbia University, UC Irvine, Children’s Memorial Hospital, just to name a few. If it’s not a wealthy donor, it’s the Bravewell Collaborative. Alternatively (if you’ll excuse the term), it’s funding from the National Center for Complementary and Alternative Medicine (NCCAM) that drives the creation of these centers, which is a reason why I’m becoming more and more soured on the very concept of NCCAM. Finally, as Dr. Wally Sampson points out, the assault on science-based medicine being taken to the very heart of academia appears to be part of a broader agenda designed to transform the very nature of medicine away from science and evidence. That NCCAM is actively promoting this transformation is reason enough, as far as I’m concerned, to echo Dr. Sampson’s criticism of NCCAM, and, either willingly or as a useful but unwitting ally, NCCAM appears to be doing a lot to promote this transformation. Remember, NCCAM was not created because scientists or doctors clamored for it; it was created because powerful politicians with a penchant for alternative medicine demanded it.

The adoption of CAM in so many medical schools, with many more clamoring to jump on the bandwagon, appears to be a step backward for academic medicine. After all, medicine has finally, after over a hundred years, evolved to the point where it can actually become truly science- and evidence-based. Unfortunately, the growing uncritical acceptance of CAM in academic medicine is a threat to the continuation of that evolution. I’ve said it many times before, and I’ll emphasize it once again, there should be no such thing as “alternative” medicine (or “complementary” or “integrative” medicine). There is medicine that is effective, as determined by basic science and clinical trials, and there is medicine that is not or is as yet unproven. There is no good reason that I can come up with to justify “integrating” the latter with the former, particularly in academia.