The vast majority of what is known as “alternative medicine” is quackery. Let’s just get that right out front right from the very beginning of this post. That’s where I’m coming from, and where I’m coming from is a science- and evidence-based viewpoint. To quote a cliche that is true and modified to my own view of medicine, there is no such thing as “alternative medicine.” There is medicine that has been scientifically demonstrated to work. There is medicine that has been scientifically demonstrated not to work. And there is medicine that has not been shown to work. What makes up “alternative” medicine consists of the latter two, because once a medicine is shown scientifically to work it ceases to be “alternative.”
What, then, is the value of “integrative” medicine? Recall that “integrative” medicine is simply the latest iteration of the name of what was once, as recently as 30 or 40 years ago, referred to widely as quackery, but became instead “unconventional” or “alternative medicine,” to evolve later into “complementary and alternative medicine” (CAM), the idea being that the “alternative” medicine somehow “complements” real, science-based medicine. However, that wasn’t enough for the advocates of pseudoscientific medicine because “complementary” implies a subsidiary position, a position not equal to that of scientific medicine. Thus was born out of quackademic medicine (the infiltration of quackery into academic medicine) a term, “integrative” medicine, intended to paint a picture in the mind of the “integration” of a co-equal set of modalities with science-based medicine, to produce what its advocates bill as the “best of both worlds.” The problem, of course, is that, as my good bud Mark Crislip put it, “integrating” cowpie with apple pie doesn’t make the cowpie better; it makes the apple pie worse. Similarly, “integrating” pseudoscience and quackery with science-based medicine doesn’t make the quackery more credible; it dilutes real medicine with nonsense.
So it was with amusement that I read an article I came across on the Alliance for Natural Health USA (ANH-USA) website entitled War on Integrative Medicine, Part One: Eliminate the Integrative Doctors. My first thought was, “Gee, you say that as though it were a bad thing!” My second thought was that it would be a very good thing indeed if the specialty of “integrative medicine” was utterly ripped from body of medicine like the tumor it is, because, again, “integrating” nonsense with sense, pseudoscience with science, quackery with real medicine adds nothing to medicine that couldn’t be added without such “integration.” The ANH-USA, as you might remember, is a group dedicated to “health freedom,” which in practice means freedom from pesky science- and evidence-based standards of care, oversight by state medical boards, or regulations of supplements and quack medicine by the FDA and medical advertising by the FTC. Most recently, the ANH-USA has been supporting Stanislaw Burzynski in his never-ending war against the FDA to get his unproven and almost certainly ineffective cancer chemotherapy known as antineoplastons approved.
Particularly amusing is the way that ANH-USA paints it all as a grand conspiracy between the American Medical Association (AMA), which is basically a medical trade/professional association; the Federation of State Medical Boards (FSMB), an umbrella organization overseeing and coordinating state medical boards; and the American Board of Medical Specialties (ABMS), the umbrella organization to which medical specialty boards belong, the boards that administer the tests that result in physicians being board-certified. Of course, quacks frequently attack the AMA as though it were this overarching supervillain like Ernst Stavro Blofeld to “natural healers'” James Bond, but it’s really more like Dr. Evil to Austin Powers. However, although once powerful, the AMA has been in decline for at least a decade, with its membership having fallen from 278,000 in 2002 to 217,490 in 2011. In the early 1950s, 75% of U.S. physicians were members of the AMA; by 2011, around 15% of practicing physicians are full, dues-paying members of the AMA. Personally, I’m not a member of the AMA because, like a lot of doctors, I don’t see much benefit to me in it. To hear the ANH-USA tell it, though, the AMA is like the Empire in Star Wars, the Lannisters in Game of Thrones, and Sauron in The Lord of the Rings all rolled up into one, with a dash of the computer empire in The Matrix movies thrown in for good measure. Its sole purpose? To team up with its evil allies in the FSMB and ABMS to crush integrative medicine:
The three organizations described above work so closely together that they seem to us to be virtually one entity led by the AMA. The AMA and FSMB openly collaborate on projects and initiatives, while the FSMB is officially affiliated with ABMS.
Until now, doctors who are board-certified by the AMBS must be recertified every ten years. That gives the organization considerable control over doctors, though the control is loose. But, starting this year, the AMBS is requiring that doctors go through “mini” recertification every two to five years. This would make it much easier to keep tabs on and rein in anyone daring to dissent from standard orthodoxy.
Would it were so!
Don’t get me wrong. Personally, I find the new recertification requirements to be rather onerous, as I just completed one of these “mini-recertifications,” although I’m not due to do the full recertification until 2018 (2017, actually, given that you really should try to recertify at least a year before your certification expires, just in case you don’t pass the test on the first try and need to take it again, which is all too easy when you’re hyperspecialized like I am and in essence have to learn huge swaths of general surgery, complete with changes since I trained, in order to pass the test. However, it’s not a bad thing to have to check in more often to be certified. Basically, for surgery, what this consists of is verifying CME credits more often, taking CME courses that require a post-test, and keeping track of your cases in a database in order to track your complications and develop plans for quality improvement for your practice.
Amusingly, the ANH-USA complains about how the AMBS refuses to work with integrative medical doctors as a specialty. Again, the ANH-USA says this as though it were a bad thing. It’s not, as I explained when I discussed the birth of an “integrative medicine” board certification through a rival board, the American Board of Physician Specialties (ABPS), which has little cachet, to the point where few hospitals accept its board certifications as acceptable to fulfill their requirements to acquire admitting privileges. Amusingly, when Andrew Weil’s plan to set up a board certification process for “integrative medicine” was first revealed more than two years ago, the reaction of the “natural practitioners” championed by the ANH-USA was highly mixed, with many of them viewing it as a naked power grab designed to shut out non-physician “holistic” practitioners as blatant as anything the ANH-USA accuses the AMA and ABMS of doing. All is not well in woo-ville, contrary to the picture the ANH-USA wants to paint.
Besides, the ANH-USA paints a dire picture for its “natural healing” specialties that is quite at odds with reality. In fact, the doyens of quackademic medicine, have had astounding success over the last 30 years in inserting quackery into medical schools and academic medical centers while co-opting various modalities that are science-based (like nutrition and exercise) to “rebrand” them as somehow “alternative” and naturally part of “integrative medicine.” The AMA, FSMB, and ASMB have been quite powerless to stop this infiltration of quackademic medicine and “integrative” medicine into scientific medicine. In fact, arguably, they haven’t even really tried that hard and today are not even trying at all. Naturopathy is considered a valid specialty in the 17 states that license it, plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, no matter how full of quackery it is. Chiropractors are licensed in every state of the union, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. (Indeed, chiropractors even have their own equivalent to the FSBM, the Federation of Chiropractic Licensing Boards.) Acupuncturists can be licensed in 43 states and the District of Columbia. This is an astonishing accomplishment on the part of advocates of quackery, the equivalent of setting up a Ministry of Magic in each of the states that license such specialties rooted in prescientific vitalism and magical thinking. The only difference is that in the world of Harry Potter, magic works.
If there’s a war against integrative medicine, contrary to the self-serving whining of the ANH-USA, it is not the AMA, FSMB, and ABMS who are winning.