The infiltration of quackademic medicine metastasizes to the community

The infiltration of quackademic medicine continues apace, except that it’s not just quackademic medicine. Now, it goes way, way beyond that to encompass not just academic medical centers but community hospitals, hospitals of all sizes, large private hospitals, and health care institutions of all shapes and sizes. Frequently, proponents of quackademic medicine try to portray those of us who oppose the infiltration of pseudoscience into medicine as being behind the times, as futilely resisting the wave of the future. They portray so-called “complementary and alternative medicine” (CAM) as the future and proponents of science-based medicine (SBM) as the past, as Luddites who resist the tsunami of CAM not because of science but because of ideology. It’s a neat switch, given that in reality support of CAM has far less to do with science than it does with human cognitive frailties and either religion or ideology, while the reason we who support SBM object to CAM is because we don’t like the double standard it demands. Rather, we insist on one scientific standard for all medicine, such that “alternative” medicine that is shown to work becomes simply “medicine.”

I must admit, though, that sometimes I feel as though the characterization of us SBM supporters as holdouts against CAM sometimes hits too close to home when I see articles like this one that I just saw in Crain’s Business:

Most hospital systems in Southeast Michigan created integrated medicine clinics in the late 1990s to provide alternative health care.

They include Beaumont Health System, Crittenton Hospital Medical Center, Henry Ford Health System, University of Michigan Health System, Botsford Hospital and St. John Providence Health System.

Yes, my alma mater the University of Michigan, is on the list. I graduated from medical school there and have been persistently disappointed to see what used to be a hard-ass, science-based institution embrace quackademic medicine, giving it a big, sloppy wet kiss on the lips. At least, certain departments at U. of M. have done so. As far as I can tell, the university as a whole has not. Be that as it may, U. of M.’s even gone so far as to “integrate” mystical nonsense like anthroposophic medicine into its medical offerings. It makes me feel like Sylvester’s son putting a paper bag over his head, and lamenting, “Oh! The shame of it all!” At least, that’s how I feel when I read about things like U. of M. embracing anthroposophic medicine. Even if it is just a small division and not indicative of the scientific basis of the school as a whole, the very presence of quackademic medicine at my alma mater risks tainting everything.

Sadly, U.of M. is not alone. It turns out that most of the major health systems in my hometown (with at least one notable exception, which reassures me) are heavily into the woo. What I normally consider to be very good or even excellent health care systems are joining the University of Michigan in this race to “integrate” quackery with real medicine. It’s truly depressing to behold, and I wish there were a way to shake the executives at these hospitals and make them see how embracing non-science-based medicine can’t do anything good for their patients or reputations.

There is a problem noted that might slow down the infiltration of quackademic medicine, however:

“Ten years ago, a number of hospitals went into alternative medicine and set up clinics, but it has not taken off because of a lack of insurance” coverage, said Paul LaCasse, D.O., CEO of Botsford Health Care in Farmington Hills.

On the other hand, I’d wonder why health care systems keep setting up these “integrative” medicine clinics if they don’t expect to realize some profit from them. After all, the lack of insurance coverage might prevent large numbers of people from using these clinics, but that very lack of insurance coverage for “integrative medicine” services, but that very same lack means that these services are all cash (or credit card) on the barrelhead. There’s no mucking about with insurance company paperwork, co-pays, or preapprovals. Just deliver the woo and get paid. What more could a business ask for? It almost makes me wonder why CAMsters are lobbying so fiercely to have insurance coverage for their services, given the huge paperwork burden and the loss of freedom of action that would ensue if insurance companies began paying for these services. Actually, no it doesn’t. Cash on the barrelhead might well be profitable, but it’s a small market compared to the potential market that would become available if insurance companies covered IM services. The increase in potential market is more than enough to be worth the increased hassle and loss of freedom.

In any case, my heart sank when I read this:

“At our clinic, we have three family practice physicians and an integrative medicine fellow who are all training in conventional medicine and holistic and alternative medicine,” she said. “We all come from different points of view. I spent 14 years studying with a Native American healer for spiritual healing, nutrition and herbal medicine.”

Other physicians at UM focus on acupuncture, massage, Rolfing and guided imagery, Warber said.

Let’s see. Acupuncture? Not good, but it’s so common that I tend to look at it as one of the gateway woos of quackademic medicine. It’s so common that I’ve become numb to seeing it almost anywhere. Massage? I’ve never had a problem with massage. It makes people feel good. The problem is that all too often it’s covered with layer upon layer of vitalistic, mystical woo about “qi” and “energy flows.” If it’s offered as just “massage,” I have no problem with it, but when it gets rolled into “massage therapy,” chances are high that the woo quotient will be intolerable. In any case, why is massage therapy considered “alternative” anyway? It’s more of the successful rebranding and “bait and switch” of alternative medicine.

And then there’s Rolfing.

Rolfing?

Holy crap! U. of M., my medical alma mater, is offering Rolfing? Seriously? Rolfing is a close cousin to chiropractic, except that Rolfers don’t think that just the spine needs to be aligned, as chiropractors do. Rather, everything has to be “balanced’ or “aligned”. If your body parts are properly aligned, then, according to Dr. Rolf, “Rolfers make a life study of relating bodies and their fields to the earth and its gravity field, and we so organize the body that the gravity field can reinforce the body’s energy field.” You know, I’ve been meaning to do a post on Rolfing for the longest time now, and, after nearly seven years of blogging, I find it hard to believe that somehow Rolfing has escaped anything but an off-hand mention or a mild taste of not-so-Respectful Insolence. Oh, well. Add it to the folder of potential topics. In the meantime, I’ll just mention that I’ve seen a breast cancer patient whose alternative medicine practitioner tried to Rolf the tumor away by deep massage of the breast in which the tumor arose. It didn’t work. Big surprise.

Elsewhere, the St. John Providence Health System goes one woo beyond that:

St. John Providence Health System in Warren operates several alternative medicine clinics through its oncology program, said Elena Weismann, director of the Providence Healing Arts Center. The Providence center has offices in Southfield and Novi.

To help cancer patients, St. John offers massage, Reiki, yoga, cooking classes, meditation, reflexology, hypnosis and guided imagery and nutritional counseling.

How many times do I need to repeat it? Reiki is faith healing substituting Eastern mystical beliefs for Christianity. Instead of God, reiki appeals to the “universal source” of energy, which is claimed to be channeled through the “healer” into the patient. Unfortunately, reiki has sprung up like a weed among reputable hospitals all over the U.S., sometimes even in the most surprising places (like one of the hospitals where I did my trauma training as a resident) and found its way into all manner of “integrative” medical clinics in hospitals big and small, private and academic. Personally, I view reiki as more akin to religion than anything medical. I’d have no objection to reiki practitioners being treated by hospitals the same way as priests, rabbis, imams, and chaplains, but that’s not what hospitals are doing with reiki. Instead, they’re offering the magic words, gestures, and (sometimes) touch as though they were real medicine.

As for reflexology, that’s only marginally less magical. Well, not really. Basically, reflexology postulates that pretty much every organ and function in the body maps to the feet or the hands and that reflexologists can diagnose and treat many illnesses by looking at the hands and feet and, in essence, massaging the right points on them. Now, there’s no doubt that foot massages and hand massages feel good, but reflexology is extremity massage with delusions of grandeur. For instance, it’s quite true that there are a lot of things you can tell about a patient by looking at his feet and hands. Clubbing of the nails can tell you that the patient has chronic respiratory or cardiac disease, and pedal edema can indicate heart failure, for example, but reflexology is not about that in that it maps organs to parts of the feet or hands where there is no known (or even plausible) physiologic or anatomic connection. In other words, reflexology is another medical modality based on prescientific thinking and vitalism, just like acupuncture.

And it’s in our hospitals alongside real, scientific medicine, as though it had the same validity.

In fact, apparently even insurance companies are starting to fund this stuff:

Earlier this year, Blue Cross Blue Shield of Michigan provided $400,000 to the Center for Integrative Wellness to conduct wellness services and research to 600 Blue Cross members who have pain and stress-related problems.

While offering conventional medicine and wellness programs, the Blues’ wellness project also incorporates alternative medicine techniques such as somatic movement and guided relaxation.

Yes, it’s times like these that I wonder why I keep doing what I do. Maybe the CAMsters are right. Maybe this is a tsunami, and docs like myself relics about to get swept away. Expecting evidence of efficacy based on science and well-designed clinical trials before introducing a therapy and believing that medicine had moved beyond prescientific vitalism seem so old-fashioned these days.