In which Orac, amazingly, publishes an article on integrative oncology in Nature Reviews Cancer

Congratulations on this success for you personally and for science.

This accomplishment will drive Orac’s many PFC’lly-deficient critics madder still.
Hurrah!

Impressive, very impressive article. Congratulations to Orac and his “friend”.

lilady

Great article! I was able to get into the full article – Perhaps because my PC is on the network of a large healthcare organization?

Congrats! I’ve only skimmed so far, but IMHO the part at the end about placing SB oncology within a non-woo ‘holistic’ frame is really important. I think the reasons too few docs do so probably trace back to ‘efficiency’ mandates from insurance companies and hospitals, though physician training in surgery and ‘surgical culture’ probably play a role as well.

My point is, putting SBM in a beneficial holistic wrapper won’t be something individual surgeons can just do by themselves. They’ll need institutional support, and face a certain uphill battle to get it. This paper strikes me as as a good contribution to such an effort.

First, because it’s peer reviewed in a well-known journal, The Powers That Be will pay more attention to it than any blog post or even mainstream news item.

Second, although not stated explicitly, the article lays the groundwork for making an economic argument for HolisticSBM to TPTB.
a) HSBM is good medicine. It can lower costs by improving outcomes such that patients will require fewer additional services.
b) HSBM is good for hospital revenues since patients are now (rightly) demanding more ‘whole person’ treatment of serious disease, and meeting that demand means fewer folks will take their (ugh) ‘business’ outside the hospital to CAM profiteers. Moreover, patients will be more pleased with the services they receive, more willing to return to the Med Center for future care, and more likely to recommend it to friends.
c) I’m not sure about this, but I’d guess HSBM would be cheaper than adding CAM to the institutions program. I’d guess a ‘board certified integrative oncologist’ with a staff of acupuncturist ‘doctors’ (and maybe a guru or two) would come at a higher labor cost than adding some dieticians, exercise therapists and psychiatric social workers to the staff.
d) HSBM is less likely than CAM to get TPTB laughed at in the medical community, and pitched properly more likely to get support in the form of grants from legitimate funders.

Having been through one difficult major surgery in recent years — nothing that serious, life-threatening etc. — I know how alone and scared you can get while hospitalized. I had the benefit of being thoroughly prepped by the very HSBM team of my surgeon. But there are times when you just need someone you imagine knows something to comfort you. Your loved ones or the nursing staff can do some ‘hand-holding’ but it’s not the same because you know they don’t know what’s going on.

It would seem CAM-providers offer than kind of authoritative hand-holding. On the SBM blog today, an exasperated Mark Crislip links to a article from Kaiser Permanente’s in-house journal on integrating naturopathy with conventional care. This passage caught my eye:

Other features of naturopathic care may also be helpful to or resonate with patients. Naturopathic physicians may spend more time with their patients than their conventional medicine primary care peers, and their medical offices may provide for a less sterile and more pleasant and healing environment. Naturopaths will support and reinforce the world view of the patient who prefers dietary and herbal modalities to drugs in ways that allopathic physicians may not. Naturopaths will take time and effort to carefully review dietary and lifestyle patterns and may offer prescriptions in these areas at a level of detail that exceeds what is commonly provided by allopathic primary care physicians.

Other than the herbal remedies, there’s nothing in there SBM can’t do. Hospitals don’t have to look like Death. Somebody can explain the scrips instead of just handing out the pills or slips. Somebody can give the patients more time, and show more empathy. Time is money, of course, but IMHO this is a spend now save later proposition.

Instead of pain-management follow-ups with over-paid quacks, how about mandatory bi-weekly support-group meetings for 3 months (with the social-worker/facilitator paid for by insurance) for every patient emerging from major invasive surgery?

I understand surgeons don’t need to spend time with patients, and it can even be counter-productive to their work (if the sufferings of Wilson on House have any real-world referent). Speaking for myself, I don’t need that much attention attention from the surgeon. A skilled PA knowledgeable in the specialty fills the bill quite nicely.

Just off the top of my head I can come up with several other ‘holistic care’ strategies for hospitals. Somebody could come up with an un-embarassing hospital gown. The food doesn’t have to suck. There can be WiFi in every ward, so patients can surf/Skype/Netflix, and the hospital can aquire loaner laptops for folks who don’t have their own for nothing or next to — you wouldn’t believe what corporations and schools dump into recycling when they do periodic tech upgrades. Send a couple volunteer English majors down to Salvation Army or Goodwill with $500 and build a lending library… Build a lounge where those patients who wouldn’t be at undue risk could be wheeled and spend time with carefully selected docile shelter kitties they could even adopt when they go home… (OK, maybe that’s a stretch, but a little brainstorming would easily generate lots of ideas outside the current, uh, box.)

Of this I’m confident: If hospitals and med centers add CAM practitioners and make them play by the same rules as real doctors — same patient loads, schedules, facilities etc. — they will fail spectacularly. I’d guess any Integrative Oncologists worth their salt in the terms of Integrative Oncology would demand more: more time with patients, more ‘healing supportive’ environments. The SBM docs should go, “See? That’s what we need. Give that to us first. We’ve proved we deserved it!”

As Dr. Gorski wrote in Nature Reviews Cancer:

It is possible to introduce scientifically supportable elements of CAM, such as certain dietary and lifestyle interventions167, into oncology as science- and evidence-based supportive modalities, in essence reversing the rebranding that integrative oncology has been so successful at.

Bingo!

Will keep this handy for when I see people on Facebook promoting things that are going to get people killed. Happens depressingly often…my family, ugh…

Congratulations.
I think all the hard work from this blog, SBM and the various other skeptical blogs and podcasts is finally starting to pay off.

@ Sadmar

Build a lounge where those patients who wouldn’t be at undue risk could be wheeled and spend time with carefully selected docile shelter kitties they could even adopt when they go home… (OK, maybe that’s a stretch, but a little brainstorming would easily generate lots of ideas outside the current, uh, box.)

Maybe not that much a stretch (full disclosure of COI, I love kitties).
“Pet therapy” is being experimented upon in certain places, notably with the elderly. See the following example in a hospital in Montpellier (in French):
http://youtu.be/5YqiNw1dr_M