Two sad stories about the state of medicine

Medical therapies should be based upon science. That is a recurrent theme, indeed, the major theme, of this blog. Based on that simple thesis, I’ve spent the last decade examining “unconventional” treatments and evaluating the scientific basis (or, much more usually, the lack of a scientific basis) for various treatments. Yes, I’ve looked at other issues, including general skeptical issues, the occasional political rant, Holocaust denial, and, of course the odd self-indulgent bit of twaddle that every blogger engages in every now and then, but I always come back to the question of the scientific basis of medicine and the lack thereof exhibited by so-called “complementary and alternative medicine (CAM) or “integrative medicine.” Whether it be antivaccine pseudoscience, cancer quackery, or other medical topics, I always come home to my niche.

Unfortunately, as part of that discussion, I’ve been forced to confront time and time again the infiltration of outright quackery into medical venues that should know better. Whether it’s utter nonsense like acupuncture, “energy healing,” or other forms of woo infiltrating academic medical centers (a phenomenon that I frequently refer to as “quackademic medicine”) or changes in the law that legitimize quackery, such as the licensing of naturopaths. So it was yesterday that I was depressed to read two stories that speak to both of these points—and not in a good way.

I’ve mentioned before that I did my surgery residency in Cleveland. I didn’t do it at Cleveland’s more famous institution, the Cleveland Clinic, but I did do it at what used to be the bitter rival of the Clinic, University Hospitals of Cleveland (UH). Actually, it was the Case Western Reserve University combined surgical residency, and we rotated at multiple hospitals, including UH, MetroHealth Medical Center (where we got most of our trauma and critical care experience), the Cleveland Wade Park VA, and Mt. Sinai, the last of which no longer exists. However, we did spend a lot of time at UH, and that’s why I’m very saddened to have seen this story, University Hospitals integrating alternative therapies into patient care.

Truly, it is sad to see the great institution that trained me fall so low. I’ll show you what I mean:

CLEVELAND, Ohio — Dr. Roy Buchinsky had a male patient in his 50s with chronic pain in his right ankle and pain in many of his joints. Anti-inflammatories and narcotics had not helped.

So Buchinsky, an internal medicine physician, recommended something else.

Acupuncture.

“You wouldn’t think it’s the kind of thing a middle-aged guy would do,” said Buchinsky, who works for University Hospitals Case Medical Center. “And normally, this fellow wouldn’t have, but he said, ‘At this point, I’ve tried everything else, what can I lose?'”

Six weeks later, his patient was no longer taking pain medication. “Now he’s a believer,” said Buchinsky.

He’s joined by hundreds of other patients who, since last fall, have received reiki, acupuncture, reflexology and massage at University Hospitals, often based on a doctor’s referral.

Reflexology? Seriously? At my surgical alma mater? Are they kidding me? They might as well offer “detox” foot baths or Kinoki “detox” foot pads while they’re at it? Why not? Detox foot baths and foot pads are no more ridiculous, from a scientific standpoint, than reiki or reflexology. By offering reiki, they’re offering a modality that is nothing more than magical thinking, faith healing that substitutes Eastern mysticism for Christianity as it belief system. Reiki masters claim to be able to channel the “energy of the universal source” to heal patients, while faith healers claim to channel the healing power of God. What’s the difference? It’s all basically the same thing; only the names have changed. As for reflexology, that’s just about as bad. True, almost everyone enjoys a good foot massage, but that foot massage passes into the magical thinking that is reflexology when reflexologists claim to be able to affect specific organs by linking them to where they are “mapped” on the soles of the feet and palms of the hands. And, yes, this magical mystical modality is being offered by UH. What a depressing thought. First it was my medical school alma mater starting a program in anthroposophic medicine, now this. No academic institution appears to be safe from the scourge of quackademic medicine.

Even more annoying, the way this article is written makes it basically a press release for the new “integrative medicine” center at UH, the Connor Integrative Medicine Network, whose home base is the University Hospitals Ahuja Medical Center. There, apparently, you can get many forms of what used to be justifiably called quackery, including reiki and reflexology. Let’s just let that sink in for a moment That means that at UH you can see a practitioner who claims to be able to channel mystical, magical “energy” into you to fix what tails you. Or you can see a practitioner who thinks that you can diagnose specific organ abnormalities by feeling the hands or the feet. Through it all, instead of science, anecdotes are the order of the day:

He’s joined by hundreds of other patients who, since last fall, have received reiki, acupuncture, reflexology and massage at University Hospitals, often based on a doctor’s referral.

That’s a huge shift, said Buchinsky, who has been practicing for 17 years.

“In the past, doctors would never have considered making such referrals,” he said. “But as science continues to confirm what we think we know, this will happen more and more.” The alternative therapies he recommends most often to patients are acupuncture, reiki and massage therapy.

University Hospitals is one of a growing group of hospitals around the country that are integrating such therapies into patient care. Many of the UH patients availing themselves of such alternative treatments are trying them because they have been recommended by their doctors — physicians who not so many years ago would have considered these treatments fringe, if not outright quackery.

No longer. As Dr. Francoise Adan, medical director of UH’s new Connor Integrative Medicine Network, explained, “We are an academic center, so these are evidence-based therapies.”

“Evidence-based.” You keep using that word. I do not think it means what you think it means. Let’s just put it this way: It doesn’t mean “a crappy study or two whose results could easily been due to bias, placebo effects, and other confounders suggested that it might work.” It also doesn’t mean, “ridiculously implausible therapies with no basis in science that are based on prescientific and/or religious ideas about how disease occurs.” I shouldn’t have to point this out, but apparently I do, again and again. As for acupuncture, that is, as I have said before, the “gateway woo,” that leads to so much other nonsense. Of course, as I’ve pointed out time and time again, it doesn’t matter where you put the needles in or even if you put the needles in; acupuncture still “works,” even if it consists of twirling a toothpick against the skin.

No, Dr. Adan, neither acupuncture, reflexology, and reiki is “evidence-based,” unless your standards of evidence are risibly low. Don’t believe me? Take a look at the Connor Integrative Medicine Network’s pages on reflexology, reiki, and acupuncture. There you will find no clear references to specific clinical trials, meta-analyses, or Cochrane reviews (although there are vague references to “studies” with no citations to allow one to look up the study). Instead, what you will find are many mentions of “natural energy,” “removing energy blocks,” “restoring balance and flow in the body,” “universal energy,” the body’s “innate healing power,” and “reviving energy flow.” These are not scientific terms. They do not belong anywhere near a website of a facility claiming to provide only “evidence-based” therapies. They belong on websites like Whale.to, NaturalNews.com, Mercola.com, and other quack websites, which is, not surprisingly, where such terms are usually found.

So how did the Connor Integrative Medicine Network come to be? As is often the case, a wealthy donor is responsible for inflicting this bit of quackademic medicine on the academic medical world:

That’s one of the reasons Chris and Sara Connor of Chagrin Falls funded the program at UH last year with a $1 million gift — knowing that people would be more open to such therapies if they were offered through a medical center. (Chris Connor, chairman and CEO of the Sherwin-Williams Co., has been a board member at UH for more than 10 years.)

The integrative medicine program is technically based at the UH Ahuja Medical Center in Beachwood, and Adan has a small office there. By fall, the practitioners of treatments such as acupuncture and reiki will be setting up appointments throughout the system. On some days, classes or appointments will be offered at the Westlake campus, for example, or at other suburban UH locations.

Lovely. Just what UH needs. In fact, the woo is metastasizing. Later in the article, I learn that more than 1,500 employees of UH have been treated with “integrative medicine,” but, worse, 356 of them have undergone reiki 1 training. True, they’re not reiki masters because of that (it is, after all, the most “basic” level of training), but it’s disturbing that so many employees of what should be a science-based hospital are being educated in mysticism and having it called medicine. I will give the Connors credit, however, for their honesty. The very reason quackademic medicine exists is because promoters of pseudoscientific treatment modalities know that being associated with an academic medical center gives their favored pseudoscience the imprimatur of great medical centers like UH, the Cleveland Clinic, Yale, Harvard, and the like.

Which brings us to the second story. I won’t spend as much verbiage on it, but I will tell you: If you live in Alberta, Canada be careful. Be very, very careful with your health care. Why do I say that? Because the government of Alberta just set the province’s naturopaths loose:

Alberta has beefed up the powers of its naturopathic doctors, giving them full status as medical professionals but stopping short of funding treatment.

The move – chiefly, the creation of a College of Naturopathic Doctors of Alberta – allows the profession to self-regulate and weed out those who don’t meet certain standards.

It will likely mean more private health plans will cover naturopathic treatment, Alberta Health Minister Fred Horne said, and will allow patients to claim receipts as medical expenses on tax returns.

Naturopaths are celebrating this, claiming that it will allow them to regulate their own and to “weed out” naturopaths who don’t practice up to the standard of care. Of course, I have no idea what this means with respect to naturopathy, given that naturopathy itself is a collection of virtually every woo known to humans, up to and including homeopathy, which is an integral part of naturopathy. How, specifically, do naturopaths determine if a naturopath is practicing up to the standard of care? What is the standard of naturopathic care? No one’s been able to define it, as far as I’m aware. For instance, when is it correct to choose homeopathy? The correct answer should be that it’s never correct to choose homeopathy, but naturopaths love homeopathy. The same question can be asked of traditional Chinese medicine, chelation therapy, and the rest of the cornucopia of woo that makes up naturopathy. The bottom line is that there is no science-based naturopathic standard of care. Actually, as far as I can tell, there is no naturopathic standard of care, period, science-based or otherwise. Perhaps a naturopath could tell me what sort of treatment or diagnostic naturopathic misadventures would be considered severe enough to warrant taking away a naturopath’s license to practice. We in medicine can rattle off all sorts of examples of the sorts of actions that would fall so far below the standard of care that they should result in sanctions up to and including stripping a doctor of his license. I have yet to see a naturopath state concrete violations of the naturopathic standard of care that warrant such penalties.

Perhaps it’s because there is no naturopathic standard of care, as I have just said.

I must admit that, after seeing those two articles, I can’t help but feel a little depressed. The “integration” of quackery into real medicine continues apace.