More than just quackademic medicine

For years now, one of the major themes of this blog, between laying the cluestick on anti-vaccine loons and examining quackery and pseudoscience in all its forms, has been to examine the infiltration of quackademic medicine into medical academia. The reason, as you might expect, is because, as an academic surgeon myself who runs his own laboratory, seeing pseudoscience and religious quackery such as reiki, therapeutic touch, naturopathy, and even homeopathy and anthroposophic medicine, has in the past usually disturbed me far more than seeing this sort of nonsense in private practice settings has. Arguably, perhaps it shouldn’t; both should bother me equally. However, one can’t deny one’s roots, and my roots are in academic medicine. There, they more than likely will stay. Even in the event that the crappy funding environment ever forces me to close my laboratory, I’m at home in an academic medical center; so I’d have to adapt and figure out how to rebrand myself as a clinical researcher and/or educator. Hopefully, it’ll never come to that, but I’m under no illusion that I’m so good that such a fate could never await me.

Leaving all that aside, I still think that the infiltration of quackademic medicine into academic medical centers is still the most important driver behind the influx of quackery in to what should be bastions of science-based medicine. The reason is that, for hospital administrators and the private practice physicians who provide the vast majority of every day medical care to Americans, particularly in the heartland, one of the most potent arguments in favor of permitting quackademic medicine a foothold into the local community hospital or offering it in the local health clinic is the observation that Harvard, Yale, and Stanford study it and offer it to their patients. Quackademic medicine is indeed a powerful legitimizer, giving modalities that 20 or 30 years ago would have been called the rankest quackery the patina of scientific legitimacy. I was reminded of the results of this legitimization of quackery by academic medical centers by an article from a couple of days ago that appeared, in all places, in the Asheville Citizen-Times. That’s Asheville, North Carolina, as in western North Carolina. Yesterday, I just learned that Asheville is apparently thriving as a regional center of “integrative medicine”:

The city’s sole acupuncturist worked in secret in 1985, the year Cissy Majebe moved here to practice Chinese medicine.

“Back then when people heard acupuncture, they thought it was voodoo,” she said. “I would never have thought I’d be sitting here practicing with seven other acupuncturists and be president of a college.”

Today, Majebe is one of at least 50 acupuncturists in Asheville. She helped to open the Daoist Traditions College of Chinese Medical Arts in 2003 across the street from her Chinese Acupuncture and Herbology Clinic in Montford.

People from across the country now travel to attend Asheville’s herbal medicine and massage schools, something economic development groups want to promote, along with the city’s abundance of alternative medicine practitioners.

Twenty-five years ago, the residents of Asheville had it right. How things have changed! Now physicians integrate quackery with science-based medicine, which is all that “integrative medicine” really is. Of course, Asheville is well known as being a bit of a hip city, having been named “America’s new freak capital” by Rolling Stone. On the other hand, AARP named it as one of its “Best Places to Reinvent Your Life.” Contrary to the surrounding countryside in western North Carolina, Asheville is clearly hipper and there appears to be a New Age contingent. Even so, it’s still the heartland. It’s still the Bible Belt. And it’s a major center for quackery.

The spin put on this story that really caught my attention, more so than the typical story about some “alternative medicine” clinic or other opening or about a concentration of woo in some city or other, is the economic angle. Woo sells, in Asheville at least, and the city elders see it as an economic engine that will bring prosperity to the city:

The Institute for Emerging Issues at N.C. State University recently said Western North Carolina should invest in integrative medicine — the intersection of Western and alternative medicine — to generate high-quality jobs.

The Asheville Hub Alliance, a regional economic development group, hopes to grow the sector in the way it’s helped generate action around green jobs.

“Green jobs”? I suppose so, but only if no traditional Chinese medicine remedies made of bear bile or rhinoceros horn, which result in the death of animals from endangered species. TCM is big, and it consumes lots of animal parts to produce various nostrums and medicines.

Critter parts as medicines aside, the alt-med business is really booming in Asheville, so much so that it’s becoming known as a hub for quackery alternative medicine. Indeed, it’s become an educational center for quackery, complete with schools of acupuncture and traditional Chinese medicine, including the Daoist Traditions College of Chinese Medical Arts, three herbal medicine schools, and numerous massage schools. The name of one of them sounds as though it comes straight out of Deliverance, namely the Appalachia School of Holistic Herbalism and the name of one of the clinics in the area sounds as though it could be featured in a Harry Potter book, namely Chinese Acupuncture and Herbology Clinic. Calling Madam Professor Pomona Sprout! And calling all woo-friendly students who want to turn themselves in to quacks:

Executive Director David Brown said the area has a high concentration of Western and alternative medical providers and the health industry is one of the few areas that has grown during the recession.

“If you put all these things together, you conclude that Asheville could have a competitive advantage in advancing integrative health,” Brown said. “We have something unique in the Southeast region.”

For the region and even the country, the number of alternative practitioners and the opportunities to study alternative medicine in Asheville stands out.

And to use their new found skills to go beyond just sticking needles into people:

In other areas, students are looking beyond seeing patients.

The majority of graduates at the Appalachia School of Holistic Herbalism end up using their knowledge to make their own product line of body care products or herbal medicines, rather than becoming practitioners, said Ceara Foley, the school’s owner.

Although Asheville is more woo-friendly than one might expect given its location in western North Carolina, the infiltration of woo has definitely proceeded from the coasts and from the academic medical centers that first made the mistake of abandoning scientific principles and embracing quackery, be it in the name of a misguided “tolerance” or for whatever reason. It used to be mainly chiropractors, who can be found in virtually any city and small town throughout the U.S., but it’s gone beyond that now. Naturopaths, acupuncturists, practitioners of TCM, you can find them all deep in the heartland, where you wouldn’t expect such modalities. At least, you wouldn’t have expected them up until around a decade ago.

More importantly, this story is an indication that woo can pay well. In fact, if this is any indication it can pay so well that local governments and chambers of commerce can come to view it as a potential engine of economic development through the proliferation of alternative medicine clinics, the founding of schools to teach practitioners, the production of herbal medicines, and various other facets of a growing industry. This sort of transformation of attitudes towards what used to be viewed as quackery and this proliferation of an industry that depends on unproven methods and medicines are unlikely ever to have occurred without the embrace of these modalities by academic medicine centers like Duke (the North Carolina connection, of course), my alma mater the University of Michigan, Harvard, Yale, UCSF, Stanford, and many others. These quackademic medical centers legitimize what used to be correctly characterized as quackery. Once legitimized, once the stigma of quackery is stripped of it, once it is “integrated” with science-based medicine, the woo that used to be known as quackery no longer has to hide in the shadows. It can become big business, and that’s what appears to be happening. Asheville is just one example.

Now, I know what your’e thinking. Asheville is the Berkeley of the South; it’s woo-ey, crunchy, and full of New Age nonsense. True enough, but it is in the middle of the South. Another example: Even where I live, in the heart of the conservative Midwest, I’m within walking distance of at least four chiropractors, a psychic, an “angel healer,” a “functional medicine” center, and a big time “alternative medical” center that offers everything from chiropractic (complete with–I kid you not–prenatal chiropractic care!) to naturopathy to “detoxification,” even “detox” foot baths, to “biophoton” scanners. It’s in the same shopping center as one of my favorite diners; so I see it all the time; its fliers are all over town. Just the other day, I saw them in the cleaners where I take my shirts and suits. A major woo concentration exists there, less than a mile from my house. And as goes middle America, so goes the rest of America.

Unfortunately, this trend for what once was woo to become respectable business is a major impediment to dislodging it from medicine once “integrated.” That is exactly what I fear is happening right now. The only question is whether this “integration” has gone beyond the point where removing the parasite will cause irreparable damage to the host.