Integrative oncology: Where “individualization” really means “making it up as you go along”

As a cancer surgeon, one aspect of the infiltration of quackademic medicine into academic medical centers that bothers me more than most others is how willingly academia has been to “integrate” quackery with science-based oncology to form the bastard stepchild known as “integrative oncology” that has metastasized to numerous cancer centers that should know better. Metastatic deposits of quackademia have infiltrated the University of TexasM.D. Anderson Cancer Center, UCSF, Memorial Sloan-Kettering, and many others. It’s quackademic medicine victorious out there; or at least so it seems.

Yet, sometimes we forget that, for all the progress that “integrative” medicine has made into respectable medical institutions, things are not entirely as bad as they seem. It may seem that “integrative medicine” (IM) reins supreme, but thus far it’s still a fairly small proportion of medicine, at least compared to science-based medicine. Moreover, reliable data are hard to come by; so it’s not even clear how fast it’s growing as a segment of the medical business. However, there are many indications that it is growing, including the story I blogged about just the other day, where “alternative medicine” has become such a lucrative segment of the local business in Asheville that the city leadership is working to promote its growth. Couple this with the undeniable infiltration of what used to be considered quackery into medical schools and academic medical centers up to and including fellowships in woo and the very existence of the National Center for Complementary and Alternative Medicine (NCCAM), the picture is definitely far more consistent with increasing use of “integrative” medicine, rather than decreasing use.

Still, advocates of IM feel an almost–dare I say it?–evangelical need to proselytize, and one of their favorite techniques is to repeat constantly just how popular IM is, unleashing a relentless stream of argumentum ad populum to make it sound as though only close-minded curmudgeonly skeptics who don’t want anyone to feel better, so dogmatically tied to a completely narrow view of science are we. (I wonder how long it will take that sentence to be quote-mined.) This leads to articles like the one I saw yesterday in–where else?–that wretched hive of scum and quackery, The Huffington Post. We’ve met the blogger before, “Dr.” Nalini Chilkov, an acupuncturist and practitioner of traditional Chinese medicine whom we’ve met before who promoted a testimonial by Hollie Quinn, who was convinced that she had cured herself of breast cancer. Chilkov posted a paean to IM entitled Why 80 Percent of Cancer Patients Use Integrative Medicine.

Before I get into the article, let’s be reminded who Chilkov is again:

Dr. Nalini Chilkov, L.Ac.O.M.D. combines her diverse training in Traditional Oriental Medicine, Modern Biomedicine and Cell Biology with 30 years in private practice.

Dr. Chilkov primarily serves patients with cancer and complex, chronic
illnesses alongside her Optimal Health and Wellness practice.

She is a respected expert in Collaborative Integrative Cancer Care known both for her meticulous attention to detail and individualized treatment plans as well as her warmth and compassion.

Dr. Chilkov is a seasoned clinician and an innovator building bridges between modern and traditional healing paradigms, partnering with physicians to provide best outcomes for patients. She has been a lecturer at the School of Medicine at UCLA and UC Irvine in California as well as many schools of Traditional Oriental and Naturopathic Medicine over her long career.

Oh, goody. The scary thing is, Chilkov not only cares for cancer patients; she “specializes” in cancer, offering all manner of woo to cancer patients, including traditional Chinese medicine and acupuncture, as well as “integrative functional medicine,” a truly frightening concept based on “functional medicine.” And, boy, is she anxious to convince you that “everybody’s doing it”:

Approximately 83 percent of people with cancer use at least one complementary and alternative medicine (CAM) modality (11).

It even has a reference! So I looked it up. As you might imagine, it’s pretty thin gruel. Basically, it’s a followup to an oft-cited study from 2000 of IM usage among cancer patients. This study suffers from the same problems that many studies of IM usage suffer from, including selection bias (people who agree to take place in the survey are more likely to be IM users) and the inclusion of “spirituality” and psychological support therapies (the latter of which is not–or at least should not be–anything other than science-based) as being part of “alternative” medicine. Another problem is that “complementary and alternative medicine” CAM is a political/ideological entity, not a scientific one. It’s a category of unproven, questionable, unscientific, pseudoscientific, or even downright fraudulent health practices lumped together more because they are outside of science rather than because they have any good evidence or science supporting them. These modalities are often then mixed together with what should be perfectly respectable, science-based modalities, like diet and exercise, co-opting them in order to provide a patina of plausibility. As I’ve said many times before, diet and exercise, among other things associated with CAM, are the Trojan horse. Out of their belly leaps the quackery, such as naturopathy, homeopathy, reiki, and many others. A further advantage to CAMsters of this approach is that it inflates the apparent numbers of CAM users, making CAM seem a lot more popular.

Be that as it may, CAM usage is probably considerably lower than reported in this study, although admittedly distressingly high, even excluding prayer and spiritual modalities. For instance, just last month Paisley et al reported that 82% of pediatric patients whose tumors had relapsed used CAM. However, looking at the numbers, I see that this was a small study (only 54 patients) and that CAM usage was by far dominated by prayer/spiritual healing (83%), supplements (31%), and diet (19%). If you look at the more “out there” bits of woo, acupuncture, “detoxification,” aromatherapy, and mind-body treatments all hovered around 6-8%.

Back to Chilkov. The rest of her post is a mish-mash of familiar CAM/IM tropes, mixed in with irresponsible health advice for cancer patients. For example, we get all the usual rhetoric about “empowerment” of the patient. Patient empowerment is, of course, not woo, but it is often equated with choosing CAM/IM, the implication being that CAM/IM use “empowers” patients somehow in a way that scientific medicine does not. Of course, if choosing to shoot coffee up my butt multiple times a day is “empowerment,” I think I’ll choose enslavement. Jests aside, “empowerment” is not really empowering if you are not provided with truly informed consent, which means a realistic assessment of risks and benefits based on science and evidence, not wishful thinking and prescientific beliefs. Yet, here we go with the rhetoric equating CAM with “taking control”:

Using my experience as a health and wellness expert, I have compiled a list of what cancer patients say about the choices they make regarding cancer treatment:

To be proactive, to take control, to take charge of decisions that affect my care, my health, my experience, my results and outcomes.

To participate in my own care and my own decisions rather than giving power to make all decisions away to my care providers.

To feel a sense of empowerment rather than be disenfranchised and disempowered.

To decrease and manage my fear, stress and anxiety and to support, increase and improve my peace of mind.

To ask my care providers to work with me as a team and to show respect for my values, my feelings and my choices in all decisions.

Once again, the use of “conventional” science-based medicine does not preclude any of these things, but Chilkov feeds the myth that they do, because it allows her to paint her favored woo as “breaking the shackles.” Not coincidentally, it feeds the self-image of CAM users as being “smarter,” “more independent,” and less of a “sheeple” than the rest of us drones who actually listen to our doctors. It also feeds their self-image that they are special, different, and, above all, “unique”:

I choose to reject an approach based solely on a ‘war on cancer’ that only targets my cancer tumor cells and neglects the whole person and the environment.

I choose a comprehensive care approach using a wide range of therapies, tools and resources from many traditions and many points of view.

I choose individualized and targeted care which views me and my cancer as unique and in which decisions and choices are based on a careful analysis of the traits and characteristics of my cancer cells and my unique physiology, genetics and risk factors rather than a generic one size fits all approach.

Uh, Nalini, baby. We practitioners of science-based medicine already do “individualize” and “target” our care, and we do a lot of research to try to figure out the best way to do it. (For just one example, there’s this study.) The difference between us and woo-meisters like you is that we tailor our treatments for our patients based on actual science and evidence. Unlike woo-meisters like “Dr.” Chilkov, we do not “make it up as we go along, which is basically what practitioners like Chilkov really mean when they refer to “personalized” care or “tailoring” their therapy to their patients’ uniqueness. In reality, the appeal to the individualization of therapies is nothing more than intellectual laziness. Chilkov no more knows what it means than she knows anything about science. All she knows is that it sounds good and it appeals to her natural customer base. It’s what they want to hear.