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The “integration” of pseudoscience into medicine continues apace

Beginning not long after this blog began, one recurring theme has been the infiltration of “quackademic medicine” into academic medical centers. Whether it be called “complementary and alternative medicine” (CAM) or “integrative medicine” (IM), its infiltration into various academic medical centers has been one of the more alarming developments I’ve noted over the last several years. The reason is that “integrative” medicine is all too often in reality nothing more than “integrating” pseudoscience with science, quackery with medicine. After all, when you “integrate” something like reiki or therapeutic touch (TT), which basically assert that there is mystical, magical energy source (called the “universal source” by reiki practitioners, for example) that practitioners can tap into and channel into patients for healing effect, you are in essence integrating a prescientific understanding of the world with science, religious faith healing (which, let’s face it, is all that reiki is), and magic with reality.

Why would medical institutions ostensibly based on science do that?

I don’t know, but I know it’s happening. There are many forces that conspire to insert sectarian versions of medicine into bastions of scientific medicine. These include cultural relativism leading to a reluctance to call quackery quackery; financial forces such as the Bravewell Collaborative, which funds a number of IM programs at academic centers; the National Center for Complementary and Alternative Medicine (NCCAM); and a variety of other factors. It’s been a depressing slide, and periodically I wonder just how much more pseudoscience can be “integrated” into medical schools and academic medical centers or how much further medical schools can go in pandering to nonsense. I’m not wondering anymore, at last for now. If you want to see “integration,” behold the academic “integration” model championed by Georgetown University, a school of science-based medicine, and Bastyr University, a school of naturopathy:

A model inter-institutional relationship may help bridge the chasm that separates health professions education in conventional academic health centers from institutions educating students for the distinctly licensed integrative practice (“CAM”) professions. Says one leader: “I believe we are poised to make an important advance in how the future training of health professionals may evolve.” The speaker is Adi Haramati, PhD, integrative medicine leader at Georgetown University, describing a new relationship between Georgetown and Bastyr University relative to Bastyr’s naturopathic medical program and Georgetown’s MS CAM program. Haramati and his co-director Hakima Amri, PhD are exploring similar relationships with chiropractic schools and other health professions institutions. The developers “would like nothing more” than to see this bridge-building relationship be used as a model for other academic health centers and CAM institutions.

That’s right. Georgetown is partnering with schools of pseudoscience in order to train the next generation of CAM practitioners. It’s not enough to team up with the naturopaths. Oh, no. Harmati wants to team up with chiropractors and other similarly dubious disciplines. But it’s more than that. Here is the vision for true “integration” in medical education:

Student A completes an academic Masters of Science program at a highly esteemed academic health center. He or she is wondering her/his future. The program focused on the science of complementary and integrative medicine. But what does the individual’s future hold? Go on to medical school? Personnel with the program lay out options. Among them, without prejudice: Have you considered this naturopathic medical school?

Meantime, Student B is considering naturopathic medical college. The field of complementary and alternative medicine intrigues. But is he or she ready to make the jump for that 4-year, residential commitment? Is naturopathic medicine or regular medical school or chiropractic medical education what they want? Personnel with the naturopathic medical program say: You might consider this year-long Masters of Science in complementary and alternative medicine at this academic health center.

The basis of this relationship between Bastyr and Georgetown, we hear, is a new “respect” being shown towards CAM modalities, and this is the way that the joint program will be structured:

The fundamental aim of this program is to provide students with competencies in three areas: grounding in science (especially systems and cell physiology), introductory exposure and understanding of CAM disciplines and philosophies, and the ability to rigorously assess the state of evidence regarding safety and efficacy of various CAM therapies.

Let’s see…Science, good. Exposure to CAM disciplines…not so good. Don’t get me wrong. I think that medical students should be taught about CAM modalities, but they should be taught about them from a the perspective of the state of the science, the evidence, and clinical trials. They should be taught about skepticism and critical thinking. They should be taught about how various CAM remedies, such as herbal medicines, interact with pharmaceuticals. That is not what this program sounds like.

Let me just put it this way. When this program claims to teach students how to “rigorously” assess the state of evidence regarding the safety and efficacy of various CAM therapies, the word “rigorously” applied to such teaching doesn’t mean the same thing that “rigorously” means when scientists actually do rigorously assess the evidence. What it usually means is buying into the aforementioned philosophy of various CAM disciplines and then proceeding from there. Either that, or it means what Harriet Hall likes to call Tooth Fairy science, which refers to doing research on a phenomenon without first establishing that the phenomenon exists first. In essence, it’s like studying the Tooth Fairy. You can measure how much money she leaves under the pillow. You can study whether she leaves more or less money for the first or last tooth. You can get a whole lot of data that appear reproducible. You might even get data that is statistically significant. But at the end of the day you haven’t actually established that the Tooth Fairy actually exists.

i-07d0cd8a1bd48b3c93ef58e81c7edc6c-newavengers_28.jpgA better metaphor for research into CAM modalities like reiki, TT, or homeopathy is hard for me to imagine. After all, reiki is nothing more than faith healing that substitutes Eastern mysticism for Christian beliefs. TT is basically reiki lite, where even the Eastern mysticism is stripped down to vague New Agey-sounding ideas like channeling “energy” into patients through their hands. (You know, whenever I picture reiki or TT, I visualize one of my favorite comic book characters of all time, Dr. Strange, casting a spell. In fact, as I’ve said before, that’s the only real way I can see of making homeopathy work: A fictional Sorcerer Supreme and Master of the Mystic Arts casting a spell.

But, wait, I hear: What about something that’s less highly improbable? Homeopathy is obviously utter nonsense. So are reiki and other “energy” therapies. What about herbal medicine? What about manipulative therapies (leaving aside the dubious philosophical underpinnings of some such therapies, like homeopathy, which similarly appeal to “energy flow” through various locations)? Well, there’s already a branch of pharmacology that can study herbal remedies. It’s called pharmacognosy, and it isolates the active fractions of natural products and studies them, just as pharmacologists have done for decades, if not centuries. There’s nothing “alternative” in that that needs to be “integrated” into science-based medicine. Similarly, manipulative therapies are not beyond the reach of science to study rigorously, either. However, to do such studies it is necessary first to verify that a phenomenon exists, which can be done using the scientific method. What I fear will happen in this new Bastyr-Georgetown integration will be Tooth Fairy science. There’ll be a lot of data, but it won’t mean anything.

The other purpose of this integrated program is explicitly promotional of CAM. It explicitly seeks the “integration” of quackery with science-based medicine. Don’t believe me? Check out this vision:

The Georgetown agreement with Bastyr, and those Haramati and Amri are seeking with other schools, are terrific steps, laying scaffolding toward the vision, articulated at NED and embraced by ACCAHC, of “a healthcare system that is multidisciplinary and enhances competence, mutual respect and collaboration across all CAM and conventional healthcare disciplines.”

Personally, I don’t see how “integrating” CAM into science-based health care would enhance competence, but then that’s just the nasty reductionist in me who rejects the false dichotomy of “alternative” medicine. After all, “alternative” medicine is nothing more than medicine that either hasn’t been shown to work or has been shown not to work. “Alternative medicine” that works is no longer “alternative.” It’s just medicine. Naturopathy is a hodge-podge, a grab bag of all sorts of unscientific and pseudoscientific medical treatments, most of which fall squarely into the “alternative” camp in every definition, particularly the ones about either not working or not having been demonstrated to work.

Unfortunately, when it comes to quackademic medicine, the false dichotomy lives, and institutions like Georgetown are betraying science-based medicine by being so open to the point of its brains falling out–and partnering with Bastyr to integrate nonsense with sense, pseudoscience with science, and quackery with medicine.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

167 replies on “The “integration” of pseudoscience into medicine continues apace”

Ignorance.

If you really had done any research on CAM, especially the way it is taught at Bastyr and the University of Washington, by the way, you would know that they use hard science to evaluate the effectiveness of CAM procedures, including randomized controlled trials.

Ignorance.

If you really had done any research on CAM, especially the way it is taught at Bastyr and the University of Washington, by the way, you would know that they use hard science to evaluate the effectiveness of CAM procedures, including double-blind, placebo-controlled, randomized controlled trials.

This post is almost a perfect narrative of a discussion I had with our med school dean. The dean met with our department (a basic research department) to discuss the plan for changes to the medical school. One thing noted as being critical is a curriculum for med students in evidence based medicine. I then asked the dean to explain why we have an institute devoted to pseudoscience and spirituality in the medical school where students can learn about homeopathy reiki and any other feel-good-quick-fix-magic-approach to health. I got the reasonable “need to know about these things to avoid adverse interactions” defense (well it wasn’t reasonable because we were dealing with the homeopathy issue at the time and I am unaware of adverse effects between evidence based treatments and water, although Im not a doctor). I pointed out that the institute sponors talks by quacks like Deepak Chopra and offered classes to teach these approaches, which is not what the dean just stated were the goals of the institute. I then received the rebuttal that NCAAM exists therefore it must be real type response. I responded that if that were true, there should be some evidence that we could teach, but I was unaware of any and if the dean was unaware of any (which based on the dean’s initial defense seems likely), brought us back to square one.

It made for an uncomfortable few minutes in the department meeting, but several colleagues were very happy with me afterwards. Oh and for the record vive-le-tenure, because I certainly wouldn’t confront the dean in this economic reality without it.

Ignorance.

If you had really researched the way CAM is studied at Bastyr AND the University of Washington, by the way, you would know that they use rigorous scientific processes to evaluate the effectiveness of CAM, including double-blind, placebo-controlled, randomized controlled trials.

I have been struggling with these same issues for a while. I have a case in point: a GI physician I know very well – Studied and trained in the United States, Board-certified gastroenterologist, very successful, well-known and well-respected in the field, Chief of the Division at the prestigious hospital ranked No. 1 in the US for, like, 16 consecutive years.

And yet, this doctor also heads the Integrative Medicine division in the same hospital. And the office of this doctor offers acupuncture and mind-body therapy (apart from regular GI consultations), and openly stocks various so-called homeopathic remedies including oscillococcinum.

The doctor, knowing my dislike for alternative medicine, never brings it up during our conversations. But there must be other patients whom this doctor’s “integrative medicine” office caters to. The massive degree of cognitive dissonance (if not downright dishonesty) that is involved here frankly boggles my mind.

Orac – I believe this has nothing to do with the legitimacy of CAM and everything to do with giving doctors the ability to make a greater profit in their practices.

Right now, doctors are hamstrung by the rates the insurance industry allows them to charge for legitimate medical procedures. All one has to do is look at your regular statements to see what the medical professional (or hospital) charges & what the insurance will actually pay.

By incorporating Reiki, homeopathy, etc – doctors and medical organizations can charge whatever they like & because there are no expensive tests, rigorous certifications, etc. this becomes an almost 100% profit center for a medical practice. And since insurance won’t cover these types of treatments, doctors will be more than happy to accept cash payments from those woo-minded individuals and laugh all the way to the bank.

I’m sorry to be so cynical – but I do believe it is all about the Benjamins here.

Sure, that’s unethical. Are you suggesting conventional medicine has NEVER done anything corrupt or unethical?
Of course it has. Um, syphilis testing on African Americans? The recent apolgogy the US made to the Guatemalan government for testing on their people?

Just because corruption exists in one area of something doesn’t disregard that subject entirely.

Lori,

After Bastyr applies these throughly rigorous, randomized, double-blind, placebo-controlled scientific study protocols to the modalities of naturopathy, what modalities are left to teach under the “naturopathy” program? Are there any beyond taking a person interest in the patient? Why even create a separate program then when one “professional” has no scientific data behind it?

Every time I have seen good studies that have data displaying a complete lack of efficacy for a modality, the CAM-influenced authors generally either argue that more research is needed or because the placebo worked, the modalities inherently works.

Look on the bright side:

1) Any medical student with half a functioning brain is going to ask hard questions: What’s this “energy”? How can it be measured? What are its physical properties? And upon getting vague and vacuous answers, students will tend to become vaccinated against further exposures to blatant nonsense.

2) Earth is presently overpopulated by about 50% and heading toward a climate catastrophe. Voluntary self-darwinization of imbeciles and morons is second only to voluntary use of contraception as a humane means of bringing down the population to a sustainable level.

Lori,

After Bastyr applies these throughly rigorous, randomized, double-blind, placebo-controlled scientific study protocols to the modalities of naturopathy, what modalities are left to teach under the “naturopathy” program? Are there any beyond taking a person interest in the patient? Why even create a separate program then when one “professional” has no scientific data behind it?

Every time I have seen good studies that have data displaying a complete lack of efficacy for a modality, the CAM-influenced authors generally either argue that more research is needed or because the placebo worked, the modalities inherently works.

I second Lawrence. Now that Oprah and others have convinced mainstream upper middle class America that the world around us is “toxic” and all you have to do is drink memory water and lie on a table while someone waves a tuning fork over you to reverse the damage… I see easy $$$$$

I mean, how many people bought the shake weight or a bottle of ‘Extenze’ last year?

@Lori

Just because there may be ethical lapses in medical science does not mean that alternative medicine is somehow “correct” or that their ethical lapses are okay.

The way to show that something like reiki, homeopathy, etc. work is to provide evidence. You can rail against medicine all you want, but it still won’t support a claim that alt-med works.

I’m not saying there isn’t nonsense in some of this stuff. But it can’t all be disregarded when there is solid scientific evidence showing that some of this stuff actually works, evidence revealed using the same rigorous scientific testing used in conventional medicine. And if you deny that it’s out there, go educate yourself. Have access to pubmed?

Just because corruption exists in one area of something doesn’t disregard that subject entirely.

Nice straw man, ya got there. The point in mentioning the Honduras homeopathy study was to point out that this “rigorous” CAM research you tout as coming from Washington is in general not so rigorous.

Please provide me the names of the specific modality and the specific scientific evidence you feel is compelling.

You are making this wild and unsubstantiated claim here, and the burden of proof is on you to provide the evidence. If you are willing to break the fundamental laws of biology, chemistry and physics- I want to at least see a meta analysis.

The question is Lori – do you?

Please feel free to post away on any studies that show solid evidence for Reiki or homeopathy.

@Lori

So, present some of this evidence. Herbal medicine has some basis in reality, as Orac noted about the field of pharmacognosy. However, not all herbal medicines work for what they claim, and some are actually quite dangerous.

As for reiki and TT, there’s no evidence that it actually works beyond placebo effects and wishful thinking. (Feel free to prove me wrong with evidence, though.)

Acupuncture has some scant evidence suggesting that it might work for some types of pain or nausea, but even then it doesn’t matter where the needles are placed or if they even break the skin. In short, again, most likely placebo.

Homeopathy is in the same realm as reiki and TT.

Chiropractic is good for some musculoskeletal problems, but not any better, really, than most physical therapy programs. As far as it being used to treat asthma, allergies, bed wetting, hearing loss, etc., it’s utter crap. And dangerous crap at that.

As I said, if you feel that there is some alternative medicine that has some basis in reality and actually works, provide the evidence.

But it can’t all be disregarded when there is solid scientific evidence showing that some of this stuff actually works, evidence revealed using the same rigorous scientific testing used in conventional medicine.

Citations needed. PMIDs will suffice.

And if you deny that it’s out there, go educate yourself. Have access to pubmed?

You’ll find that all regular posters here are well familiar with pubmed. But you don’t get to make us do your homework; if you wish to claim that there is “solid scientific evidence” demonstrating that these modalities are anything other than quackery, it is YOUR obligation to present it.

Agent Smith,

Medical studies practically ALWAYS conclude with “more research is needed”. This doesn’t just happen in CAM.

As I work with premature babies, one example I can provide is the extensive and growing evidence supporting the technique known as “kangaroo care” for mothers and infants. All it involves is laying a baby wearing nothing but a diaper on the bare chest of his or her mother. This could be considered a type of “therapeutic touch” that would seem like nonsense. Yet rigorous controlled trials have demonstrated decreased nosocomial infections, increased early weight gains, reduced length of hospital stay, and high levels of maternal satisfaction.

you would know that they use hard science to evaluate the effectiveness of CAM procedures, including double-blind, placebo-controlled, randomized controlled trials.

Apologies for the double post, but I just figured out how to express the real problem with this statement. It reminds me of a math department promoting their rigorous mathematical inquiry of applications of the fact that 1+1=3. Namely, that if one ACTUALLY does such things rigorously, one can only conclude that they’re bogus (word choice intentional), yet said rigor is claimed alongside uncritical acceptance.

Lori – it sounds like this is something that will, if all of the studies pan out, become part of standard medical care. This isn’t CAM – if this is supported by actual evidence, it is conventional medicine.

As I work with premature babies, one example I can provide is the extensive and growing evidence supporting the technique known as “kangaroo care” for mothers and infants.

[citation needed]

@Lori

This could be considered a type of “therapeutic touch”

You may want to educate yourself on what Therapeutic Touch (capital Ts) actually is. What you are describing has absolutely no connection to TT. In fact, TT doesn’t even involve touching the patient. You may also be interested in the research into TT done by Emily Rosa.

Orac,

My point was that ONE CAM study was being pointed out purely BECAUSE it was unethical. I’m not saying it’s right. But that’s like me saying that because the US tested syphilis on African Americans years ago that all of medical science should be disregarded. Your argument is a straw man.

You guys should educate yourself about CAM because your patients will be asking you about it. If you purely disregard all their concerns, they will not trust you anymore. Especially if they read all the studies in support of CAM therapies or know someone that those therapies have worked for and your response suggests you think they are crazy because it is all bunk.

I’m not into reiki or even homeopathy for that matter. So, I’m not saying that there is science behind that. I haven’t studied that area. But conventional medicine has a lot to learn about preventing illness and maintaining health. Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Indeed, Todd hit the nail on the head on this one.

The problem with the “kangaroo care is good” claim is not whether it works or not, but in this attempt to call it “therapeutic touch.”

It’s like when people take some natural supplement and call it homeopathy, regardless of the dilution, or where sCAMmers try to jump on the results of studies of the electrical stimulation of nerve endings all call it acupuncture.

Laying the naked newborn skin-to-skin, regardless of whether it has positive outcomes or not, is not TT. Not even close, and any attempt to falsely equate them is either dishonest or ignorant.

All it involves is laying a baby wearing nothing but a diaper on the bare chest of his or her mother. This could be considered a type of “therapeutic touch”…

Not really, because it involves actual contact.

@Lori

I would venture that, if you really get down to the nitty gritty, the folks here in general probably know much more about the various popular alt-med treatments than the average patient or doctor, for that matter.

Pablo and Lawrence,

Tiffany Field has done a lot of studies on therapeutic touch. And yes, you are right, it’s not the actual Therapeutic Touch that involves holding the hands a little above the patient’s skin. My point is that Pablo and Lawrence are going to claim this as “conventional medicine”, but I would bet not everyone else would agree with that, despite scientific research for its support, just because of its nature.

This is the kind of CAM I am talking about that is taught at Bastyr and University of Washington, not reiki or crystals or that bed-wetting can be cured by acupuncture.

Lori – you offer a false comparison here. When a treatment is proven, it is no longer CAM. So, you reject Reiki & Homeopathy – well, that’s a start at least.

So, what else is left?

My point was that ONE CAM study was being pointed out purely BECAUSE it was unethical.

Then again, Lori, it’s the only actual study that has been mentioned so far. You mention all these supposedly wonderful double-blinded, placebo controlled studies, but apparently we are all unaware, and the only example we have is an unethical study.

You talk about us getting educated, so why don’t you help. Direct us to all that great work coming out of Bastyr so that we can learn about it. Just saying, “It’s being done, you need to learn up on it” doesn’t teach us anything.

And keep in mind, you aren’t talking to dummies here. We are very familiar with using the medical literature, so we will need more than “search the literature.” We’ve done that.

So if you want us to learn, you could help. Instead of complaining that the one paper we have is not fair, why not bring out your own examples of stuff that IS good?

I would be all for CAM if it worked. But by definition it is NOT alternative medicine if it works-once something has been proven as a successful medical treatment it becomes part of science based medicine.
It saddens me to see medical insurance covering some of the more dubious therapies. It is bad enough that our laws are not keeping on top of these schemes to pray on persons with serious diseases.

@Lori: yes, “kangaroo care” works and has several good peer-reviewed studies to show that it does do so. It has become a standard of care in many NICU areas when possible to do so. However, it is NOT the same as TT. Kangaroo care works because the mother’s breathing stimulates the baby to breath, her body temperature keeps the baby’s temp stable, and her heartbeat and body noises are familiar to the baby. They grow better, gain weight faster, and have fewer apnic spells.

As pointed out by others, TT involves waving your hands over a body, “wiping the aura clean”. It does not involve touching the body at all. Please do not confuse actual medically accepted care with quackery. I learned about the theory of TT in nursing school (and have had it “practiced” on me once, as part of a medical massage! Never saw that massage therapist again.) so am well aware what it is.

MI Dawn

But conventional medicine has a lot to learn about preventing illness and maintaining health.

Examples of what CAM can offer in terms of “preventing illness and maintaining health” are needed, with citations to demonstrate efficacy.

Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Pure straw man. Lifestyle interventions are a core and universally accepted part of mainstream medicine. MDs harp incessantly on stopping smoking, getting more exercise, eating better, losing weight, etc.

The only sense in which mainstream medicine denies such is the sense of not blindly accepting “[insert fad food du jour] cures all medical problems!” in the absence of evidence demonstrating such.

I’ve found that, when someone makes a statement like yours quoted above, it pretty much always is connected to blind and uncritical acceptance of claims that, for instance, megadoses of vitamin C will cure cancer. I’d be happy to be shown that you’re not in that category, but it doesn’t look good.

People are turning away from rigid, positivistic science because it continues to fail to address aspects of reality that people consider important, such as people’s inner lives. The alternative to the rise of unrestrained superstition (whether as alternative medicine or creationism or the like) is integration of scientific and non/pre-scientific ways of thinking. The shape of this next world view is a work in progress and can of course evolve in an irresponsible, anti-scientific manner, but this possibility is not an argument against such integration.

Hence there is no going back: science will either have to evolve to be able to encapsulate all of reality (explanatorily rather than dismissively), or it will sadly atrophy as people turn back to superstition. The most fruitful approach is not to resist this trend but to make the best of it, recognizing that reductionist science has inadequacies that cannot be overcome at its own level of complexity.

Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Well, I guess that rules out homoeopathy, then.

@David:

“People are turning away from rigid, positivistic science because” they want to believe stuff that ain’t so.

My point is that Pablo and Lawrence are going to claim this as “conventional medicine”, but I would bet not everyone else would agree with that, despite scientific research for its support, just because of its nature.

What nature is that?

In the end, if it is shown to help, then of course it is medicine. We may not currently know the mechanism, but that is an issue of time, and, for something like this, I can imagine there are many possible, reasonable mechanisms that could be explored.

As opposed to something like TT or homeopathy or acupuncture, which are claimed to work by processes that make no sense at all to explain non-existent effects.

Surprizingly, a great deal of magical thinking surrounds an area of CAM that *has* value from the perspective of SBM(actually, it *is* SB): dietary change and exercise**. Most of the woo I survey invokes “lifestyle change” as panacaea: where would our web woo-meisters be if they could not scold lesser beings(i.e their audience, SBM advocates, rational people) about their miserable American diets and lack of exercise and then substitute their professed extreme measures : veganism, organic raw food, ultra low fat, one hour of aerobic activity every day, marathons, ad nauseum.

Magical thinking(about a realistic subject) involves the spurious claims and exaggerations about *how much* these measures can affect outcomes- cures and prevention of CV disease and cancer are commonplace claims. If there is a study that shows, let’s say, that a certain type of cancer occurs in people that ingest- on the average- higher amounts of fat, telling people to cut out *all* fat ( or cut back to 10%) to _prevent_ that type of cancer is not warranted. Magical foods (green juices) also provide magical cures. Acai,mangosteen, anyone?

Magical thinking goes downright mythological when woo-meisters “counsel” their marks about dietary change and exercise programs. After the scolding, the sinner is shown the error of his or her ways and told exactly how to emulate the master’s “proper” method. Eat this way, exercise this way, and buy these supplements. The magic and myth creep in because the guru does not account for the real world and how difficult it is to implement _any_ change, never mind the drastic measures recommended. Of course, any failure rests solely on the penitent not on the method or its perpetrator.

For a sampling of these regimes, consult any ultra low dietary fat plan ( e.g. Ornish), raw food bible, or if you’re feeling adventuresome, the HealthRanger.com or Gary Null.com, for dietary and exercise “wisdom”.

** Several family members have used reasonable dietary measures and exercise to control illness successfully. I exercise, play tennis, and eat relatively low fat, no red meat, little salt, not much processed food, very little alcohol, etc.

Kangaroo care works because the mother’s breathing stimulates the baby to breath, her body temperature keeps the baby’s temp stable, and her heartbeat and body noises are familiar to the baby.

Hmmm, Dawn, you actually said this without resorting to claims of the healing energy of the mother’s aura, or anything like that.

So much for being just like TT….

@ David:

You display a grossly wrongheaded view of science. There are things that it makes no attempt to explain precisely because they are not susceptible to empirical investigation. Trying to demand that science “evolve” to explain such is as ludicrous as demanding that the Bible evolve to provide blueprints for the Space Shuttle.

Yes Pablo – it is amazing when someone can actually explain the benefits of a particular treatment or regimen without referring to “auras” and “magic touching.”

And I have no idea what David is smoking, but it is probably a bit more than weed. Why on earth would we want to “dumb down” science?

Lori: You imply that you accept the well-demonstrated facts that homeopethy and reiki are nonsense. So, should we trust a “University” that teaches them as fact (i.e. Bastyr)? I think not.

The problem we all have with CAM is that no concept can ever be proved wrong in the minds of CAM proponents. In real medicine, we continue to discover that things don’t always work the way we thought. We throw those things out and move on. It’s called progress.

Triskelthecat/MI Dawn @34

Kangaroo care works because the mother’s breathing stimulates the baby to breath, her body temperature keeps the baby’s temp stable, and her heartbeat and body noises are familiar to the baby. They grow better, gain weight faster, and have fewer apnic spells.

All very good but wouldn’t the leaping about cause brain or spinal injury? 🙂

Orac, with all the writings you’ve done on various “alternative” treatments, why don’t you summarize them into a textbook for a class on SBM and CAM. It would give academics a nice source to teach an elective to expose medical students to the “alternatives”.

Lori, about twenty years ago I literally lived down the street from Bastyr, when they were renting a building from the school district (before they moved to the former seminary across the lake). I remember they put out a big press release saying they were going to do a definitive study on homeopathy. That is where I first learned exactly what homeopathy consisted of.

Since then I never heard anything else about it. I cannot find any papers, or anything on their website. I could understand if the study was not positive how it could have succumbed to the file drawer effect, but not why they still have it as part of their curriculum. That does not sound very honest, does it?

Now flash forward fifteen years and a relative of mine was released from the county psyche ward. After several years she is feeling healthier than she had been, since she was finally diagnosed and on real meds. So she goes back to her Bastyr trained ND (also known as Not a Doctor) who tells her that the psychiatrist is an idiot and to stop taking the real meds, but instead take her special expensive homoepathic remedies.

My relative actually left the ND because the homoepathy did not work. But unfortunately, all of the work of the real psychiatrist was gone and she spiraled down again (and ended up in the psyche ward of another county).

Ten months ago she committed suicide.

Tell me exactly which CAM is a better treatment for bi-polar disorder than real medicine. Do provide some real references.

As I work with premature babies

Good lord that is terrifying.

…the technique known as “kangaroo care” for mothers and infants. All it involves is laying a baby wearing nothing but a diaper on the bare chest of his or her mother. This could be considered a type of “therapeutic touch”

This has nothing to do with the therapeutic touch discussed in this post. That’s simple human contact, totally unrelated to the existence of undetectable energy. There are probable mechanisms through which this could work (reduced stress, hormones, pheromones, even simple warmth) that don’t invoke energies that violate the laws of physics.

…high levels of maternal satisfaction.

Being satisfied with something isn’t the same thing as that “something” actually working. I’m sure patients were “satisfied” with bloodletting, enemas and purging for centuries, that doesn’t make it less dangerous or more effective.

You guys should educate yourself about CAM because your patients will be asking you about it. If you purely disregard all their concerns, they will not trust you anymore. Especially if they read all the studies in support of CAM therapies or know someone that those therapies have worked for and your response suggests you think they are crazy because it is all bunk.

Not all of us are doctors, and by reading this blog we are educating ourselves. And I would argue that we would be disregarding their best interest (both in terms of health and finances) by not pointing out the shoddy evidence base and even worse theoretical base for most of these treatments. A consistent point on this blog is that the evidence base is usually quite bad, with poorly-designed studies being the only ones showing consistent positive effect, and better designed studies showing no effect. Orac, and most readers, wouldn’t think patients were crazy for wanting CAM, we would probably think they are poorly informed and unaware of the many cognitive biases that exist and are responsible for many ostensibly “positive” results.

But conventional medicine has a lot to learn about preventing illness and maintaining health. Having an open mind to the possibility that anything besides a pill (especially as an automatic first solution) could be healing might help move us as a country toward better health.

Is there any doctor out there that doesn’t recommend diet and exercise to sedentary patients? These interventions are not CAM, they are standard lifestyle advice that are incredibly mainstream, to the point that considerable research money is poured into figuring out the best ways to make people eat better and exercise. Holy strawman. Not to mention vaccination, the best way to prevent infectious diseases. If patients actually followed the evidence-based instructions for health – that would be good diet, adequate exercise, up-to-date vaccinations, proper sanitation, adequate sleep and positive relations with other human beings – then yes most nations would be more healthy. The problem is, most people do not. Prevention isn’t magic, it’s just hard.

Have you ever read this blog before? Orac has made these very points many times. In fact, it appears that if you sat down and exchanged actual definitions and operational terminology, you’d probably agree. You’re not saying anything Orac hasn’t said before, but you’re sure working hard at making it seem like you’re talking about different things.

Lori said: “If you really had done any research on CAM, especially the way it is taught at Bastyr and the University of Washington, by the way, you would know that they use hard science to evaluate the effectiveness of CAM procedures, including randomized controlled trials.”

From the Bastyr website:

“In November 2010 the (Bastyr) Center for Spirituality, Science and Medicine hosted “Earthanima” with kinesthetic poet and contemplative juggler Thomas Arthur.”

So, how exactly did they do randomized controlled trials of “contemplative juggling”? Were ordinary jugglers recruited into the placebo arm of the studies? (One thing for sure – not only do I want no part of “therapeutic touch” when I’m in the hospital, contemplative jugglers get the same reception as mimes – out the door, fast).

I’m also interested to see when and how “kangaroo care” was ever a CAM innovation, derided and dismissed by contemptuous mainstream doctors (“they LAUGHED!”) only to be adopted once the courageous CAMsters did their rigorous studies. This claim sounds like attempts by alt med proponents to claim credit for nutrition advice or any accepted medical modality that doesn’t involve drugs or surgery.

MI Dawn beat me to the punch. Her assessment of kangaroo care is spot-on, and exactly as the NICU nurses described it to my husband and I – in purely scientific terms. (We had a 27 weeker and did lots of kangaroo care; on top of the reported benefits, it was awesome to snuggle with our wee one and give her some parent time out of the incubator).

“Alternative medicine” that works is no longer “alternative.” It’s just medicine

That’s not quite how cheap herbal, or some foreign therapies seem to be applied in the US by my observations.

Medicine with 1-2 active principals that are extensively documented, lots of lawyers etc, and FDA approved eventually become expensive medicine, perhaps only slightly better than nothing (placebo). The rest have to be alt med supplements, or disappear. The FDA czars seem incapable of dealing with mixed molecular entities like herbal extracts registered in countries with more advanced development.

Before anyone jumps me, consider this: I just got the CBC results that show a cheap supplement, an American clone of a long registered asian medicine, an extract for oral use, that allowed higher chemotherapeutic dosage while substantially *increasing* depressed WBC, RBC and platelets on treatment. Pretty much like the asian literature describes, and apparently they can do this for years on continuous chemo. Better than anything FDA registered in the US, for ca $2/day.

The regular therapeutic alternatives on a given chemo treatment with a shot CBC: temporarily stop the chemo when WBC, RBC or platelets erode (drop) too low, or, permanently stop because the chemo is ineffective at the tolerable dose; AND/OR use expensive, $$$$/month, sometimes painful daily shots of multiple RBC/WBC/platelet stimulators during resistance building chemo stoppage(s). Drugs that may be less effective, or may even stimulate cancer growth(e.g. VEGF for RBCs).

If it’s all “just medicine”, how come I can’t get this extract prescribed by an average, or even a “size” 38R, American MD? Whereas, more likely, the lowly ND would suggest or support it.

The problem we all have with CAM is that no concept can ever be proved wrong in the minds of CAM proponents.

CAM proponents don’t even have a problem with mutually contradictory modalities such as Reiki versus Therapeutic Touch. Although they are similar, they can not both be right since a Reiki practitioner must be “attuned” by a Reiki master and be given special symbols in order to project the healing “energy”.

Lawrence @8

It is all about the Benjamins in Canada as well be integrating woo, doctors have the security of practicing within the provincial health care system while adding what the market will bear, cash up front CAM treatments.

(We had a 27 weeker and did lots of kangaroo care; on top of the reported benefits, it was awesome to snuggle with our wee one and give her some parent time out of the incubator).

I love the feel of my baby’s skin against mine. Baby skin is so soft, it feels awesome. I do this “kangaroo care” regardless of any medical benefit (and I’m a guy).

I had a great comment about this in an earlier post, but I deleted it. I likened it to a claim that having lots of sex makes you live longer. I mean, how great would that be? Irrespective of whether it actually helps you live longer, you get to have lots of sex! Man, what a great modality!

@Dr. Jay

As I pointed out before, Sharon Begley i three months late and a dollar short:

http://www.sciencebasedmedicine.org/?p=7734

In fact, she’s much later than that. Try searching for “Ioannidis” in my search box, and you will find that I have written about his work many times in mostly flattering tones.

Try again.

As for your comments about “corporate masters,” all I can say is that I’m grateful you didn’t parrot your tired old “tobacco science” cliche. Seriously, can you actually criticize the details of the science you don’t like, citing actual peer-reviewed research? Just saying science is “biased” as a reason to dismiss it is intellectually lazy and convinces no one who knows the issues.

@Lori
RE: ‘Ignorance” & “You guys should educate yourself about CAM because your patients will be asking you about it. ”

Before you throw out a word like ignorance, you should be certain of whom it is best applied to. It seems obvious you are new to this blog and have failed to do any cursory browsing of the previous content on this site before commenting. The bloggers here are highly educated on “CAM”. They have spent large amounts of time investigating and researching “CAM” and have read and analyzed a seemingly endless plethora of CAM studies and papers. You may disagree with their positions, but you are in error to claim they are uneducated on CAM. They are arguably far more educated on CAM than many practitioners of such.

But please, make your logically supported case. Present your evidence, reference the specific studies you claim are of quality that support your position on CAM. Perhaps you should first clarify which “CAM” modalities you are speaking of since the term “CAM” is a catch all term for a broad range of various practices, some of which (homeopathy, reiki) you have already admitted are bunk.

Orac says: Just saying science is “biased” as a reason to dismiss it is intellectually lazy and convinces no one who knows the issues.

Just saying that this is “intellectually lazy” without proof of that laziness is really lazy, David.

Best,

Jay

To quote Dara O’Briain on the subject of herbal medicines: “They tested it, and the stuff that worked became…MEDICINE. The rest is just a nice cup of tea and some potpourri.”

As for the rest: “Get in the feckin’ sack.”

@Militant Agnostic: If it doesn’t hurt a kangaroo’s joey, it doesn’t hurt a human baby. (LOL…my coworkers are all wondering why, in this lousy weather and crazy work day, I am laughing my head off.)

OT story: I worked in a Level II nursery so we would transport really “premie” babies to another hospital but they would often be sent back to us to “feed and grow” before they could go home. One set of parents was very afraid to touch/handle their now healthy baby. The pediatrician picked up the baby by (sex deleted) arm and leg and very gently swung the baby back and forth then laid the baby back down, looked at the parents and said: “See? XX won’t break”. (Mom nearly fainted – we had to sit her down FAST! But that’s how this pediatrician – and father of 6 children – was. No coddling of the babies in HIS practice!)

@Jay

Uh, Orac did show why it was lazy. It is because you do not provide substantive criticism. You simply drive in, say “Science is biased!” and drive off. You don’t say how it is biased. But even then, you’re making a blanket statement, rather than specific criticism of specific studies.

It would be similar to simply saying that Jay Gordon, MD, FAAP is biased, without actually saying why.

Now, do you have something of substance to contribute, or are you just going to whine?

Orac says: “Try searching for “Ioannidis” in my search box, and you will find that I have written about his work many times in mostly flattering tones”

That’s great! But his work is just beginning to come to the attention of the lay press in a big way.

“Science” as a monolithic deity to be worshipped at all costs is an outdated concept. Have you followed the controversy about The Lancet–one of the world’s most prestigious journals–publishing an article some years ago about vaccines and autism which contained only 12 subjects?! If you’ve missed this controversy, I suggest you have a look.

This sort of publication/confirmation bias happens every day.

Have a wonderful day!

Jay

Lori, I suggest that you learn about naturopathy at http://www.naturowatch.org

Also, while you correctly describe that people can find supporting literature on CAM- what you (and they) miss is that such “literature” is junk. If one does not know how to interpret the research, one is easily misled (and yes, PubMed indexes junk literature).

You may enjoy reading “Suckers” by Rose Shapiro. Also, look at http://www.ebm-first.com http://www.skepdic.com and http://www.quackwatch.org and its subsidiaries.

Very well written article. I have checked various university affiliated hospitals in New York City and other large metropolitan areas and the majority of them do have “centers for complementary and alternative medicine” BTW, Sanjay Gupta is affiliated with such a “center” in NYC.

There is an interesting article in the New York Times (Sunday,January 23, 2011 “National Section”). It is available on line…if you key in the exact headline “A New Federal Center Will Help Develop Medicines”.

An interesting paragraph in the article “For the plan to go into effect by October, the administration must by law get rid of of one on the 27 centers already in existence at the NIH-something that has never been done before. So the administration plans to downgrade the National Center for Research Resources, in part by giving some of its resources to the new drug center”.

As expected, those who work at the National Center for Research Resources have inundate a complaint blog about the the coming change. I don’t want to open a debate here about bureaucracies and private institutions and companies which seek to consolidate divisions for financial reasons…or because their function may be redundant and resources would be more effectively used elsewhere. It is the only one of the twenty-seven Centers in the NIH that has be “targeted”.

I’m wondering why other Centers in the NIH, such as the NCCAM (National Center for Complementary and Alternative Medicine) haven’t been considered for downsizing/elimination as well?

Just musing…..

Lori:

Tiffany Field has done a lot of studies on therapeutic touch. And yes, you are right, it’s not the actual Therapeutic Touch that involves holding the hands a little above the patient’s skin. My point is that Pablo and Lawrence are going to claim this as “conventional medicine”, but I would bet not everyone else would agree with that, despite scientific research for its support, just because of its nature.

So you *already know* that kangaroo care has absolutely zip-doodle to do with Therapeutic Touch, and yet you still offered it up as a reason to think there might be something to TT, as some sort of defense of alternative medicine? And you want us to think you’re not being disingenuous here?

It’s true that many laypeople have become confused about what medicine will support, but I would argue this is mostly because of the totally unnecessary creation of a false dichotomy between “medicine” and “alternative medicine”. If the goal is to find modalities that work, why do we need a special category for ones that some people think are sorta hippy or new agey? (Note: I don’t use the word “hippy” as a pejorative, just a descriptive.) If teaching hospitals use the “CAM” term, they are deliberately choosing to constrain their medical practice by barring it from receiving anything out of the CAM arena. What could they possibly gain from that? Well, medicine doesn’t gain anything from that, but CAM does. The hospital suddenly gets to use therapies which aren’t medicine, which haven’t been shown to work, and which may in fact be total bunk, and this is profitable.

It’s all about money. It is not about health freedom. That’s the marketing divisions talking. They want freedom to make money; the only freedom they want the consumer to have is the freedom to hear their advertising.

All medicine should be held to the same standard. No free rides just because a modality is fashionable in certain circles, or excitingly novel. That applies whether it’s natural-orifice surgery, a new pharmaceutical, or distance healing or iridology.

@ Jay Gordon

Scientists create the findings their sponsors want and delay the results of research which is “negative.”

Are you talking about Wakefield?

Jay Gordon: Scientists create the findings their sponsors want and delay the results of research which is “negative.”

Then how do you explain the fact that most new drugs fail preliminary studies?

That’s great! But his work is just beginning to come to the attention of the lay press in a big way.

Perhaps you would care to explain how the lay press’ attention to Ionnidis has anything whatsoever to do with quackery and fraud becoming part of medical school?

“Science” as a monolithic deity to be worshipped at all costs is an outdated concept.

And a straw man. What exactly makes you think anybody here thinks (or thought) that way? And again, what relevance does it have to the topic of the post?

Exactly Karl – I don’t see why this kind of corrective action is a problem? There is plenty of stuff we still don’t know, but scientists don’t seem to have a problem filling in the gaps or changing theories over time as new information is made available.

Science also doesn’t turn on a dime – it takes time to either confirm results/information or find flaws that may result in changes being necessary. This applies to every scientific field, from astronomy and physics, to geology and medicine (and everything in-between).

Again, I don’t understand how this process is “bad.”

Lori:

I live in Seattle and am well aware of what Bastyr is and what “research” it does. I suggest before you try and defend Bastyr as anything but a source of pseudoscience and magical thinking (to quote a frequently used term), I suggest you go and look at the classes offered there … including reiki and homeopathy, which even you seem to agree are utter nonsense.

As those before me have said in many different ways, if you have examples of these well done, “double blinded, placebo controlled trial” that show CAM to be effective.

As to “kangaroo care”, I believe that was first started in an NICU, by a neonatologist … not, as you will note, by a reiki master or specialist in touch therapy.

I apologize for my ignorance on the subject, but what the hell is Bastyr? Is it like the ITT Tech of medical schools? Or is just a naturopathic degree-mill that loads students full of nondischaragable debt that they will never be able to pay back w/ meaningful employment?

There was a guy (a failed attorney) that was talking about going to one of those naturopathic schools on jdunderground. Apparently the requirements were like 2 basic, lower-division science classes and that was the extent of it. School cost like 50k a year, ouch!

Just a speculation, but Lori’s attitude about Bastyr may be the result of their expertise at public relations. My wife, for example, has no use for nonsense like homeopathy, but tends to take umbrage at negative references to Bastyr. This is because both she and I have had great experiences dealing with them on things having nothing to do with CAM practices.

Bastyr is (or has been in the past) generous with the use of their facilities. They have a lovely chapel on their campus which has been made available for musical and other events, and they tend to be supportive of the community. Of course, this has nothing to do with what they teach.

It is the same sort of successful PR that is used by churches – if people feel good about the institution, they tend to think that what the institution does must be okay too, without digging too deeply into it. I think that explains my wife’s attitude, and I’d bet it has something to do with Lori’s, too.

Myself, I’m just dour old skeptic who thinks they are full of bull but good at promoting themselves.

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