American Academy of Family Physicians embraces quackademic medicine

In a week and a half, Harriet Hall, Kimball Atwood, and I will be joining Eugenie C. Scott at CSICon to do a session entitled Teaching Pseudoscience in Medical (and Other) Schools. As you might imagine, we will be discussing the infiltration of pseudoscience into medical academia and medical training, a phenomenon I frequently refer to as “quackademic medicine.” It’s a topic that has been much discussed on this blog; so I am quite confident that we are the people to tell our audience just how bad it is, why it’s happening, and why you should be concerned about it. Also, from my perpective, bringing Eugenie Scott, the executive director of the National Center for Science Education into the mix is entirely appropriate, because there are parallels between how the pseudoscience that is creationism has been infiltrating K-12 education and how various forms of pseudoscience are creeping into medicine.

If there’s one consistent theme that I’ve hammered at over the years, it’s the influx of medicine based not on science, but on prescientific notions of disease, including—and I do not exaggerate—vitalism and magic. Examples abound and include homeopathy (which is nothing more than a form of sympathetic magic), reiki (which is faith healing), other forms of energy medicine (which are also variations on the theme of faith healing or wishing makes it so), In general, we expect professional societies to maintain and support the scientific basis of medicine. Unfortunately, increasingly, medical societies have been failing us. I happened to be working on my talk when I became aware of a perfect example of just such a failure. It’s a story that illustrates how a professional organization that really should know better unfortunately does not. I first became aware of part one of this particular story back in August.

This time, as I pointed out a couple of months ago, it’s the American Academy of Family Physicians that has failed utterly, abjectly, and embarrassingly to maintain even the most basic scientific standard in how it conducts its business. What I’m referring to specifically is a particularly misguided choice it made for its keynote speaker at its 2012 AAFP Scientific Assembly:

The 2012 Assembly will commence with a captivating, inspirational keynote address from Dr. Andrew Weil speaking on “Why Our Health Matters.” Dr. Weil is one of the world’s foremost authorities on health and wellness. He founded the field of integrative medicine which endeavors to create an intersection of alternative and conventional medicines.

Dr. Weil is in demand. He was ranked the #1 choice for keynote speaker by recent Assembly attendees.

I’ve written about Andrew Weil on multiple occasions. The reason should be obvious. If there’s one single person who has had the most influence in promoting pseudoscience in academia, in facilitating—nay, actively pursuing—the infiltration of magical thinking into medical academia, it is arguably Andrew Weil. In many ways, he is the most important figure in the movement to “integrate” quackery with scientific medicine. He considers his influence and what he as accomplished a good thing. I do not.

Let’s take a look at what I mean. As hard as it is to believe, it’s been a year since I wrote about how Andrew Weil is trying to create a board certification in “integrative medicine” and the rather amusing reaction of his fellow woo-meisters to the proposal. Unfortunately, Dr. Weil has has considerable success, at least in medical schools. Indeed, he has almost single-handedly birthed a distinction track in quackery for medical students to pursue. This particular misbegotten specialty, regular readers will remember, is often sold as “integrating” the “best of both worlds” into medical care. In reality, it involves “integrating” pseudoscience and magical thinking, like the aforementioned reiki, “energy medicine,” and various other pseudoscience into medicine. Before that, it was known as “complementary and alternative medicine” (CAM) because supposedly the quackery was being used to “complement” science-based medicine. CAM morphed into “integrative medicine,” as I’ve described before, because “”complementing” science-based medicine still implies a subsidiary, lesser value than the actual science-based medicine. CAM practitioners couldn’t abide that; so they came up with a name that implies a co-equal status of their woo with science-based medicine. Even Dr. Josephine Briggs, the director of the National Center for Complementary and Alternative Medicine (NCCAM) buys into this terminology to the point where she defends it on the NCCAM Research Blog.

That’s not all that Weil has done. For one thing, he is very much He sells supplements. Lots of supplements. For another thing, he has on more than one occasion demonstrated that he most definitely does not like evidence- and science-based medicine, his protestations otherwise notwithstanding. It’s depressing to think that Weil was the number one choice of AAFP members who attended recent Assemblies.

But it’s even worse than that.

Jumping into the breach, the Institute for Science in Medicine (ISM) wrote a letter of protest to the AAFP for implicitly endorsing quackademic medicine by featuring Dr. Weil as its keynote speaker. It hits all the right notes (and is a lot less—shall we say?—insolent than any letter that I might have penned). I think it’s worth reproducing in its entirety:

I am writing on behalf of the Institute for Science in Medicine. We are gravely concerned about AAFP’s invitation to Dr. Andrew Weil to keynote at the AAFP Scientific Assembly on October 17, 2012.

We know that after years of hosting scientific assemblies AAFP knows full well that a keynote address is not mere entertainment for the attendees. What AAFP bills as an “exciting opportunity” is actually an authoritative statement of policy on what AAFP now considers acceptable standard practice in family medicine.

AAFP has told attendees that the topic of the keynote address for this year’s Scientific Assembly is “Why Our Health Matters,” and that Dr. Weil, author of a 2010 book with that same title, will “speak peer-to-peer on how you can remain healthy and best able to care for your family, your patients, and your community.” Presumptively, the AAFP policy being put forth this year is to be found in Dr. Weil’s book.

Among the many scientifically objectionable pronouncements in Dr. Weil’s book, the following seems pertinent to AAFP:

Some qualities that I value very much are … “The doctor exemplifies and models health and health-promoting behavior … [and] The doctor knows all the factors that influence health and all the strategies for treating disease.” As I have written, many doctors don’t know much about key elements of health care, such as the body’s ability to heal itself, dietary and other lifestyle influences on health, and non-drug-based methods of treatment.

Doctors of the future must also be open-minded and intellectually flexible. … [M]y independent thinking caused friction with some of my [medical school] instructors. The more I saw conventional medicine in action, the more wary I became of drastic interventions that too often caused harm. [page 79]

ISM’s fellows find Dr. Weil’s hostility to scientific practice disturbing, but what is even more unsettling is that AAFP would take this step towards abandoning science, and transmogrifying family practice, by embracing Weil’s vision:

[Thomas Edison declared in 1902], “The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease. … [T]he simple truth [is] that you can’t improve on nature.”

The wisdom of Edison … holds true today and should guide us to the future. Tomorrow’s doctors will differ from most of today’s in all four of the most basic aspects of a physician’s professional life: his or her personal qualities, education and training, philosophy of treatment, and ways of interacting with the community. [page 81]

In point after point in his book, Dr. Weil ignores or defies the practice of scientific medicine in vital areas of patient care. As if to underscore that attitude, at the very time that Weil was writing his manifesto, he was the target of a joint enforcement action by the FDA and FTC, demanding that he stop marketing his herbal “Immune Support Formula” for alleging, without objective evidence, that it possesses anti-influenza properties.

Though acclaimed by AAFP as a leading authority on “integrative” medicine, Dr. Weil is in reality committed to re-introducing pre-scientific beliefs—such as homeopathy—into medicine, an unfortunate return to what far-sighted Abraham Flexner decried over a hundred years ago as “sectarian” (i.e., belief-based) medicine.

It is especially alarming to us to see AAFP adopt Dr. Weil’s antediluvian agenda at a time when the “medical home” model is coming to the fore in the reform of American health care.

Dr. Weil will fairly claim that his AAFP keynote is acceptance into one of the bastions of conventional medicine. That is bad enough. But the scientific integrity of medicine will have received a self-inflicted wound, and that is tragic.

Tragic indeed. Weil has basically never met a form of woo that he didn’t like with perhaps one exception. OK, I’ll admit, that one exception is so utterly quacky that even Andrew Weil can’t handle it. I suppose that’s one point in his favor, but barely.

Unfortunately, the AAFP’s response, which I also consider to be worth reproducing in full so that you can see its utter intellectual bankruptcy and refusal to accept responsibility for a decision made on behalf of the organization, basically boils down to “hey, it’s what our membership wants.” And, oh, by the way, this isn’t the “scientific” part of our assembly; so we can bring in whatever quackery that we want in order to “celebrate” our family docs. That’s why we don’t give any CME credits for this nonsense. We know it’s nonsense but we’re doing it anyway:

Thank you for reaching out to the AAFP on behalf of the Institute for Science in Medicine.

I want to clarify your interpretation of the purpose of our Scientific Assembly opening ceremony. While our Scientific Assembly is focused on providing four days of quality continuing medical education, the opening ceremony event is designed purely as a time to celebrate our family physician attendees. We do this via touching video presentations, award recognitions, and energetic, entertaining speakers. Past keynote speakers have been as varied as Irish tenor Ronan Tynan, high-powered political couple James Carville and Mary Matalin, and mountain climber Aron Ralston. This session is not about AAFP policy, nor is any continuing medical education credit given to those physicians who choose to attend.

The selection of Dr. Andrew Weil as the keynote speaker for this year’s opening ceremony was based directly on feedback from AAFP members who are past Assembly attendees. In 2010, we conducted focus groups of Assembly attendees during the meeting; one of the questions we asked was for participants to rank a listing of 18 potential keynote speakers – people ranging from “Tuesdays with Morrie” author Mitch Albom to (then) CMS administrator Dr. Don Berwick, from Dr. Georges Benjamin, Executive Director of the American Public Health Association to Dr. Andrew Weil. The overwhelming choice of these members — receiving both the most total points and the most first place votes – was Dr. Weil.

Finally, having Dr. Weil speak in no way indicates our endorsement of any of his work or products.

I realize that this information may not sway your opinion of Dr. Weil as the keynote speaker, and I certainly respect that, Ms. Rosa. However, I did want you to have the background provided above.

Douglas E. Henley, M.D., FAAFP

My friend and collaborator Harriet Hall has come up with a totally spot on analogy for having someone like Andrew Weil give the keynote address for the AAFP annual convention. She has described it as being akin to having an astrologer give the keynote address for an astronomy convention. Imagine, if you will, astronomers using excuses like the ones that Dr. Henley uses for doing the equivalent thing in medicine. Carl Sagan would be doing high speed backflips in his grave. No doubt Abraham Flexner is doing the same. Think of it this way. What the AAFP is doing is akin to Harriet’s most apt analogy. It’s also akin to having a flack from the Discovery Institute like Casey Luskin give the keynote address at a conference of evolutionary biologists or, at the risk of skating a bit too close to Godwin territory, having David Irving give the keynote address at a meeting of Holocaust scholars. It’s giving the most important speaking gig in a meeting to someone whose very world view is antithetical to that of the organization hosting the meeting.

Or maybe Weil’s views aren’t antithetical to the views of the AAFP. In fact, that would be even more concerning. After all, what Weil stands for is the “integration” of quackery like reiki, acupuncture, “energy healing,” and various supplements with scientific medicine. Sure, he also “rebrands” what should be science-based modalities, such as exercise, a healthy diet, and the like as somehow being “alternative” or “integrative,” but that’s not the main problem. Unfortunately, as I’ve pointed out time and time again, if you integrate quackery with real medicine, you do not produce better medicine. Instead, you turn quackery into medicine and medicine into quackery, which is exactly what’s happening in medicine right now. Much of the so-called “integrative medicine” that Weil champions represents a return to the past, and not in a good way. Rather, it’s a return to the past where the four humors qi determined health and disease, miasmas unspecified and unknowable “toxins” were responsible for many diseases, and praying to God (or the gods) for healing energy healing and reiki was the order of the day. That’s what we’re “integrating” into scientific medicine.

And that’s what the AAFP has just implicitly endorsed, or at least has decided to be unimportant to the mission of its yearly conference, no matter how much Dr. Henley tries to use weasel words to argue otherwise. He ought to hang his head in shame.