Using language to achieve the appearance of legitimacy for quacks

The whole concept of “complementary and alternative medicine” (CAM) and “integrative medicine” (IM), the former of which “complements” science-based medicine with quackery and the latter of which “integrates” pseudoscience-based with science-based medicine. The reason I start out by saying this is to emphasize that CAM/IM is all about using language to persuade that pseudoscience is actually science-based. It’s far more about marketing than accurately communicating concepts. In CAM, everything is “holistic,” and doctors “care for the whole patient,” while “Western medicine” is “reductionistic” and “allopathic.” At the very heart of this language is a false dichotomy: That you either embrace woo or you can’t provide care as compassionate and caring as what the quacks supposedly provide. and can’t provide for the emotional needs of your patients. Two false dichotomies, actually, in that the world is divided into “Eastern” and “Western” medicine, “holistic” versus “reductionistic,” with not-so-subtle implication being that you can’t be “holistic” without–you guessed it–embracing pseudoscience.

It turns out that this use and abuse of language for propagandistic purposes in CAM/IM is not limited to just these examples. In fact, it infuses the whole enterprise to the point that its adherents, not content with being mere “practitioners,” are trying to claim the very title of “physician” for themselves. I learned this from John Weeks, who first let me know about Andrew Weil’s attempt to put together a board certification in woo. This time around, he’s educating me about how alternative/CAM/integrative practitioners now covet the title of “physician”. He begins with the story of a non-physician (i.e., non-MD, non-DO) practitioner of CAM distinguished chiropractors, naturopaths, and acupuncturists from physicians. To me, of course, that’s an utterly appropriate distinction (it’s not for nothing, after all, that I frequently refer to the naturopath’s ND title as meaning “not a doctor”), but to Weeks it’s “stepping into a militarized zone”:

All of us knew that this studied academic was referring to licensed medical doctors, a.k.a. the kings (and queens) of the hill in U.S. medicine. At the same time, many of us were acutely aware by his comment that, while common and even professional usage of the term “physician” may connote MDs, legal realities are shifting. In fact, trends suggest that one endpoint of the movement toward integrative medicine is that “physician” will increasingly umbrella a rainbow of disciplines.

It turns out that there is a conscious effort under way by promoters of CAM/IM to co-opt and appropriate the title of “physician” for themselves. Unfortunately, they’ve apparently had some legislative and regulatory success. Weeks reports that the United States Department of Labor recently published something called O Net Online which replaces the Department’s Dictionary of Occupational Titles and that in that online dictionary there is reference to “naturopathic physicians” and “chiropractic physicians.” Worse, if you look under the sample of reported job titles for chiropractors, a synonym for chiropractor is apparently just “physician.” I also can’t help but notice that the descriptions of these jobs are pretty funny in a morbid sort of way, for example, listing one of the functions of a naturopath as administering “treatments or therapies, such as homeopathy, hydrotherapy, Oriental or Ayurvedic medicine, electrotherapy and diathermy, using physical agents including air, heat, cold, water, sound, or ultraviolet light to catalyze the body to heal itself.” Yes, it’s depressingly accurate, but it’s funny in that there is no recognition that homeopathy is quackery, as is much of what naturopaths do.

Even acupuncturists are apparently getting in on the act, trying to claim the title of “acupuncture physician,” even proposing an abbreviation of AP. In Florida, for instance, acupuncturists are legally entitled to work under this title, although “not through accredited, doctoral-level educational means. Of course not. Acupuncturists are not physicians, nor should they ever be referred to as physicians unless they also have an MD or a DO degree. (And in that case I’d seriously question whether a physicians who has become an acupuncturist and practices acupuncture deserves the title of “physician” any more.) Somehow, apparently acupuncturists managed to get the legislature to give them the right to refer to themselves as “physicians,” and boy do they take advantage of it! Meanwhile naturopaths in 15 of the 16 states in which naturopaths are licensed are allowed to call themselves “physicians.” (Apparently California is the only holdout willing to put its foot down.”

Weeks is shockingly (to me, at least) honest about the reason for this:

Success in claiming the physician title, linked to privilege, status and particularly third party payment – some insurers will only cover certain services if provided by a “physician” – figured heavily in an October 2, 2009 mailing to members from the American Chiropractic Association (ACA). The ACA credited its hard work for insuring that the title stayed in the language defining the Federal Employee Benefit Plan. Blue Cross Blue Shield, which manages the plan, attempted to demote chiropractors to a status as “other health care providers.” (6)

As I said, it’s all about the status. Chiropractors, acupuncturists, naturopaths, and other specialties of woo crave the respectability that comes with being a physician. They also have delusions of grandeur in thinking that they can do what physicians do, namely provide primary care services, even though none of them have adequate training in the administration of drugs, the proper screening for cancer, heart disease, and other common diseases to function as primary care doctors. Nor can they deal with common diseases, such as diabetes, hypertension, coronary artery disease, or other diseases, at least not using science- or evidence-based guidelines. Unfortunately, this delusion of grandeur leads them to want to blur the line between real physicians and practitioners of pseudoscientific medicine.

Which is why Weeks is very unhappy at the quite reasonable attempts by physicians to protect the title of “physician” by opposing the licensing of naturopaths, as if it were a bad thing to prevent the state from putting its imprimatur on specialties taht are not based in science and evidence. He also confirms something that I’ve always suspected about the near-obsessive use of the word “allopathic” to describe conventional MDs and DOs:

Then again, the AMA leaders in keeping “physician” out of reach of other professions are probably not as comfortable with the additional 2008-2009 language: “MDs are also known as allopathic physicians.” The modifier “allopathic” is a hole in the dike through which may flow naturopathic physicians, chiropractic physicians, perhaps more acupuncture physicians, and the first through, osteopathic physicians.

Of course, the way that osteopathic physicians (DOs) practice medicine, at least in the U.S., is usually indistinguishable from the way that MDs practice medicine. They do the same residencies, are subject to the same standards and board certifications, and are licensed in the same way. In most osteopathic medical schools, osteopathy is a historical vestige that continues to be taught even though very few DOs actually ever use it or practice it anymore. Most, in fact, are rather embarrassed by these reminders of the chiropractor-like beliefs that used to be central to osteopathy. We can only hope that naturopaths go that way, but it’s highly unlikely, given the sheer extent of woo practiced by naturopaths, who are not only not embarrassed by their woo but downright proud of it.

If you want to get an idea of how far Weeks and presumably his non-science-based holistic cohorts are willing to go to redefine what a “physician” is, look to the last part of his post, where he actually invokes Webster (as in the dictionary) to convince his readers that physician should mean what he wants it to mean. He lists various definitions of “physician” that he’s found in different versions of Webster and picking the ones he likes, the ones that are seemingly most inclusive. In other words, he exercises one of the lamest arguments known to humankind. When you’re reduced to arguing based on dictionary definitions, you’ve sunk about as low as you can go.

My amusement at such lame arguments notwithstanding, I can’t resist pointing out Weeks’ one last envious broadside at physicians:

The physician term is power. Professions so denominated stand at the top of the hill, waving about highfalutin reasons why their recognition as such is in the public good. The sub-text includes the know motivator that the title lands one on the road to the bank.

I must conclude by saying again that I’m surprised at just how honest Weeks is about the motivation for trying to redefine the term “physician” to include quacks. It’s all about power, money, and prestige, and the quacks want as much of all three as physicians have. Unfortunately, they appear to be succeeding in co-opting the term in order to achieve their goal of more power.