Quackademic Medicine at Jefferson University Hospitals

I detest the term “integrative medicine,” which is what promoters of “alternative medicine” pivoted to call “complementary and alternative medicine” (CAM) when they decided that they needed to lose the word “alternative” altogether. After all, no longer were CAM practitioners content to have their favorite quackery be “complementary” to real medicine because “complementary” implied a subsidiary position and they wanted to be co-equals with physicians and science- and evidence-based medicine. The term “integrative medicine” (IM) served their purpose perfectly, and “integrative medicine” departments, centers, and divisions have sprouted up in academia like kudzu growing over a telephone pole. Or perhaps it’s more appropriate to say that it’s invaded and metastasized like a cancer.

The most recent bit of evidence that I see for the triumph of “integrative medicine” in academia, or, as I like to call it, quackademic medicine, comes from Thomas Jefferson University and Jefferson University Hospitals. There, it comes in the form of a post to the JUH Blog entitled Is Integrative Medicine Right for Your Kids? 5 Myths Debunked When I first saw this post, I must admit that it really disturbed me to learn that there is an actual Integrative Pediatrics Program at Jefferson, of which the author of this blog post, Dr. Christina DiNicola, is the director. This bastion of quackademic medicine appears to be part of the the Myrna Brind Center Of Integrative Medicine. As if that weren’t bad enough, it appears that Jefferson has a lot of woo embedded in it, and that makes me sad. Actually, seeing woo like this in any academic medical center makes me sad.

To counter that sadness, rather amusingly, I observed that in “debunking” these “myths” about integrative medicine Dr. DiNicola actually went a long way towards inadvertently confirming just how unscientific “integrative” medicine is. It starts out in another most amusing fashion:

Dr. DiNicola says integrative pediatrics can help parents achieve their goals of raising healthy and happy children, but recognizes that sometimes it is challenging to distinguish between the fact and fiction that swirls around these issues. One thing to keep in mind is that her practice does not replace a child’s primary pediatrician, but rather works in conjunction with that physician.

All of this makes me wonder: Isn’t Dr. DiNicola a pediatrician? Why does she need a real pediatrician to work with her? Isn’t she a real pediatrician? Apparently not anymore, since she became an “integrative” pediatrician. According to the blog post, Dr. DiNicola completed her medical training at the UMDNJ Robert Wood Johnson Medical School and completed a full residency training in pediatrics at The Children’s Hospital of Philadelphia. After that, she worked for several years in primary care pediatrics.

And then…

Dr. DiNicola did an additional two-year integrative medicine fellowship under the direction of Dr. Andrew Weil, at the University of Arizona.

Damn. Well, that explains a lot. As we used to joke about orthopedics residents after they finished their internship in general surgery, as soon as they finished the general surgery internship they had to purge their brains of general surgery knowledge in order to make room for the orthopedics knowledge. Apparently, it must be similar in “integrative medicine.” Apparently Dr. DiNicola had to purge all the knowledge of real medicine in her head in order to make room for all the woo she learned studying at Andrew Weil’s feet. More’s the pity, because, if anything, one would hope it would go the other way. Not in Dr. DiNicola’s case, apparently.

In any case, she starts by trying to answer Myth #1: All of the integrative therapies on the market are unproven. Her answer? This:

It is true that many integrative therapies sold on the market are unproven and if used inappropriately may cause harm. But at Jefferson, Dr. DiNicola guides her patients through the maze of available treatments sold over the counter and gives them sound, reliable, evidence-based advice on how to select quality and proven therapies, if and when appropriate, alongside their necessary conventional care.

She is also clear with patients and their parents that while she has extensive training and experience in primary care pediatrics, her services are different from and not a replacement for good primary care pediatric services.

Once again, out goes the real medicine, in goes the woo. As for integrative medicine, the sad fact is that the vast majority of it is unproven. If that weren’t the case, it would have ceased to be “alternative,” “complementary and alternative,” or “integrative” and would just be medicine. Again, it’s a false dichotomy. Either medicine is supported by good science, or it isn’t, and the vast majority of what falls under the rubric of integrative medicine isn’t, which makes me wonder: Why on earth would anyone want to “integrate” unproven therapies with proven therapies? Is it just me, or doesn’t this make zero sense? But then that’s just the nasty reductionist scientist in me talking. Obviously I must not be empathetic enough and “caring” enough.

I like “myth #2”: Myth #2: If my pediatrician doesn’t mention or recommend integrative medicine, then I shouldn’t consider it. Well, actually, I’d say that that’s probably a pretty good indication that it’s not something you need or want. I could be wrong, but I doubt it. Of course, Dr. DiNicola tries to paint such a lack of recommendation as being due to lack of education or familiarity with integrative medicine:

Parents are sometimes already familiar with integrative therapies such as yoga and acupuncture for their children but may not mention these therapies to their child’s primary pediatrician for fear of criticism and judgment. In addition, their primary pediatrician may not yet be aware of the ongoing research that supports the use of some of these therapies alongside state-of-the-art conventional therapy.

Or their primary pediatrician might be well aware of such “research” and consider it to be the quackademic medicine that it usually is.

So what’s Myth #3? It’s a horrible, horrible myth: Myth #3: Integrative medicine is not considered safe. Actually, it’s hard to say whether integrative medicine is safe or not. What’s not hard to say is that the vast majority of it is probably not efficacious, and that’s what matters. Who cares if it’s safe if it doesn’t work?

Perhaps the most amusing of the five “myths” is this: Myth #5: Integrative medicine only benefits certain diseases and conditions. I bet you know the answer to this particular “myth.” That’s right, according to Dr. DiNicola, it’s total B.S.! In actuality, integrative medicine can be used for anything! Here is but a sample:

  • General/preventive health
  • Obesity /nutrition
  • Allergies (environmental, animal, food)
  • Asthma
  • Dermatologic conditions (eczema, hives)
  • Sleep dysfunction
  • Recurrent sinusitis
  • Gastrointestinal distress (inflammatory bowel disease – Crohn’s, ulcerative colitis, GERD, dyspepsia, irritable bowel syndrome)
  • Pre- and post-surgery stress management

Pre- and post-surgery stress management? Let me tell you, if somehow I were forced to put up with one of these “integrative medicine” docs dealing with my patients before or after surgery I’d watch her like a hawk, and looking at that list leads me to ask: Is there any disease for which “integrative medicine” is not appropriate? Apparently not.

It’s also hard not to notice that Dr. DiNicola is pretty darned vague, as is the description of what therapies are included under the rubric of “integrative pediatrics” other than a mention of yoga and acupuncture. However, poking around the website for the integrative pediatrics program at Jefferson, I’m hard-pressed to know exactly what it is that integrative pediatrics does at Jefferson, much less what value it adds to conventional pediatric care. One wonders if that’s because even proponents and practitioners of integrative pediatrics have a hard time defining what value they add, other than gauzy and meaningless platitudes about “holistic” care. Even though the program lists, for instance, “complementary and alternative medicine” (CAM) therapies for cancer, nowhere on the site is it made obvious which of these the practitioners at the Brind Center consider to be worthwhile and why, much less the scientific basis behind each therapy. There is, however, plenty of brain dead CAM apologia, including brain-meltingly dumb analogies like:

Some people believe external forces (energies) from objects or other sources directly affect a person’s health. An example of external energy therapy is electromagnetic therapy.

Uh, no. Magical, mystical life “energy fields,” such as those that reiki masters claim to be able to direct from the “universal source” into patients are not the same thing as electromagnetic energy, which can be quantified and whose effects can easily be measured.

After reading all this nonsense about quackademic medicine, I just had to go to find the wellspring from which Dr. DiNicola’s propaganda flows, the Myrna Brind Center Of Integrative Medicine. Poking around its website, I find clinical trials of high dose intravenous vitamin C in pancreatic cancer, lots of acupuncture, bioidentical hormones, and, perhaps scariest of all, the integrative mental health program.

Yes, it would appear that quackademic medicine is deeply ensconced at Jefferson, so much so that there’s now even an “ask the experts” program in integrative medicine. I also find it disturbing that, given the existing largely negative evidence for the efficacy of intravenous vitamin C as a treatment for cancer, an issue I’ve written about on multiple occasions first in 2006, then again a couple of times in 2008, and finally in 2009 when I asked whether Linus Pauling had been vindicated (hint: he hadn’t) patients at Jefferson are being recruited for this dubious (at best) trial. Such is the deleterious effect of quackademic medicine on clinical trial ethics at major universities.

Jefferson has apparently become a hotbed of quackademic medicine, trying hard to “integrate” quackery with the practice of medicine. Dr. DiNicola is but a symptom of the deeper problem in the institution. Unfortunately, Jefferson is not alone. Thanks to the Bravewell Consortium, the National Center for Complementary and Alternative Medicine (NCCAM), and many other forces, quackademic medicine is washing over our medical schools and academic medical centers like the rainfall from Hurricane Irene over low lying lands in its path.