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The Triumph of New Age Medicine, part deux, courtesy of The Atlantic

There can be no doubt that, when it comes to medicine, The Atlantic has an enormous blind spot. Under the guise of being seemingly “skeptical,” the magazine has, over the last few years, published some truly atrocious articles about medicine. I first noticed this during the H1N1 pandemic, when The Atlantic published an article lionizing flu vaccine “skeptic” Tom Jefferson, who, unfortunately, happens to be head of the Vaccines Field at the Cochrane Collaboration, entitled “Does the Vaccine Matter?” It was so bad that Mark Crislip did a paragraph-by-paragraph fisking of the article, while Revere also explained just where the article went so very, very wrong. I myself asked the question whether The Atlantic (among other things) matters. It didn’t take The Atlantic long to cement its lack of judgment over medical stories by publishing, for example, a misguided defense of chelation therapy, a rather poor article by Megan McArdle on the relationship between health insurance status and mortality, and an article in which John Ioannidis’ work was represented as meaning we can’t believe anything in science-based medicine. Topping it all off was the most notorious article of all, the most blatant apologetics for alternative medicine in general and quackademic medicine in particular that Steve Novella or I have seen in a long time. The article was even entitled “The Triumph of New Age Medicine.”

Now The Atlantic has published an article that is, in essence, The Triumph of New Age Medicine, Part Deux. In this case, the article is by Jennie Rothenberg Gritz, a senior editor at The Atlantic, and entitled “The Evolution of Alternative Medicine.” It is, in essence, pure propaganda for the paired phenomena of “integrative” medicine and quackademic medicine, without which integrative medicine would likely not exist. The central message? It’s the same central (and false) message that advocates of quackademic medicine have been promoting for at least 25 years: “Hey, this stuff isn’t quackery any more! We’re scientific, ma-an!” You can even tell that’s going to be the central message from the tag line under the title:

When it comes to treating pain and chronic disease, many doctors are turning to treatments like acupuncture and meditation—but using them as part of a larger, integrative approach to health.


No, that’s what they say they are doing (and—who knows?—maybe they even believe it), but what that “integrative” approach to health actually involves is “integrating” quackery like acupuncture with scientific medicine. Elsewhere, in her introduction to the article in which she explains why she did the story, Rothenberg Gritz describes a visit to the National Center Complementary and Integrative Health (NCCIH), which is how the National Center for Complementary and Alternative Medicine (NCCAM) was renamed last December:

After visiting the NIH center and talking to leading integrative physicians, I can say pretty definitively that integrative health is not just another name for alternative medicine. There are 50 institutions around the country that have integrative in their name, at places like Harvard, Stanford, Duke, and the Mayo Clinic. Most of them offer treatments like acupuncture, massage, and nutrition counseling, along with conventional drugs and surgery.

One notes that the renaming of NCCAM to eliminate the word “alternative” was a longstanding goal of NCCAM, its supporters, and “integrative medicine” advocates. The reason is obvious: “Alternative” implies outside the mainstream in medicine, and that’s not the message that proponents of integrating quackery into medicine want to promote. One can’t help but wonder if it was a retirement present for Senator Tom Harkin (D-IA), the legislator most responsible for the creation and growth of NCCAM who retired at the end of the last Congressional term. Whatever the case, the name change was, as I put it, nothing more than polishing a turd.

Be that as it may, no one, least of all here at SBM, argues that “integrative” medicine is “just another name for alternative medicine.” It isn’t, as most integrative MDs use conventional, science-based medicine as well. The problem with “integrative” medicine is that, to paraphrase my good bud Mark Crislip, mixing cow pie with apple pie does not make the apple pie taste better; i.e., mixing unscientific, pseudoscientific, and mystical quackery like acupuncture and much of traditional Chinese medicine does not make science-based medicine better. Rather, it contaminates it with quackery, just as the cow pie contaminates the apple pie.

Basically, integrative medicine is a strategy for mainstreaming alternative medicine, even though the vast majority of alternative medicine has either not been proven scientifically to be efficacious and safe, has been proven not to be efficacious, or is based on physical principles that violate laws of physics (such as homeopathy or “energy healing). Indeed, if the term “integrative medicine” were not thus, it would be a completely unnecessary moniker. The reason is, to paraphrase Tim Minchin, Richard Dawkins, John Diamond, Dara Ó Briain, and any number of skeptics, there is no such thing as “alternative” medicine because “alternative” medicine that is shown through science to work becomes simply medicine. Thus, newly validated medical treatments have no need to be called “integrative” because medicine will integrate them just fine on its own. That’s what medicine does, although admittedly the process is often messier and takes longer than we would like. Integrative medicine, like alternative medicine before it, is a marketing term that is based on a false dichotomy. Only unproven or disproven medicine needs the crutch of being “integrative,” a double standard that asks us to “integrate” unproven treatments as co-equal with science-based medicine even though they have not earned that status.

Unfortunately, this is a false dichotomy that Rothenberg Gritz promotes wholeheartedly. The only hint of skepticism is a brief passage near the beginning in which she refers to Paul Offit’s 2013 book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine and briefly quotes him saying what I’ve been saying all along, that “integrative medicine” is a brand, a marketing term, rather than a specialty. She also noted his criticism in his book of what is now NCCIH, and includes a quote by Dr. Offit about Josephine Briggs (the current director of NCCIH) that she “certainly was very nice” and assured him that they “weren’t doing things like that any more” (referring to “things” NCCCIH studied in the past, like distance healing, and magnets for arthritis). This is, of course, hardly even a criticism at all, but rather getting Dr. Offit to state for her Dr. Briggs’ frequent claim that NCCIH doesn’t study pseudoscience any more. It’s a claim she made when Steve Novella, Kimball Atwood, and I met with her five years ago, and, yes, back then Dr. Briggs was also very nice to us, although she did rapidly turn around and, in a painful fit of false balance, use that meeting as evidence of her even-handedness in meeting with both critics and homeopaths. It’s a claim embedded in the 2011-2015 NCCAM strategic plan, which I now like to characterize in talks as “Hey, let’s do some real science for a change!” In any case, Rothenberg Gritz’s account isn’t false balance. It’s no balance at all, with the token skeptic role taken by Dr. Offit.

Integrative medicine wheel

Revisionist history about NCCIH

Advocates for “integrative medicine” have used a variety of talking points over the years, and Rothenberg Gritz hits most of them in her article quite credulously. Indeed, it is very clear from her introduction that she was predisposed to believe. Early in the article, she tells the tale by looking back to the early 1990s, when she was in high school and her father was a family physician who was clearly into some woo, including Transcendental Meditation, Ayurveda, and the like, even going so far as to incorporate them into his practice. The inescapable implication is that she considers her father a trailblazer for what is now integrative medicine.

Unfortunately, it is very clear that her knowledge of history in this area, particularly how NCCAM/NCCIH came to be, is sorely lacking, which leads her to parrot the version of history that integrative practitioners want you to believe:

Back in the 1990s, the word “alternative” was a synonym for hip and forward-thinking. There was alternative music and alternative energy; there were even high-profile alternative presidential candidates like Ross Perot and Ralph Nader. That was the decade when doctors started to realize just how many Americans were using alternative medicine, starting with a 1993 paper published in The New England Journal of Medicine. The paper reported that one in three Americans were using some kind of “unconventional therapy.” Only 28 percent of them were telling their primary-care doctors about it.

And:

Enough Americans had similar interests that, in the early 1990s, Congress established an Office of Alternative Medicine within the National Institutes of Health. Seven years later, that office expanded into the National Center for Complementary and Alternative Medicine (NCCAM), with a $50 million budget dedicated to studying just about every treatment that didn’t involve pharmaceuticals or surgery—traditional systems like Ayurveda and acupuncture along with more esoteric things like homeopathy and energy healing.

Now there’s some revisionist history! The word “alternative” was just popular because there was so much other “alternative” stuff (alternastuff?) going on in the early 1990s! But it’s not the 1990s any more; so “alternative” isn’t as cool as it used to be. Of course, the word “alternative” as applied to quackery dates back at least to the 1960s.

Longtime readers know how NCCAM really came about. One wonders if Rothenberg Gritz ever came across Wally Sampson’s classic 2002 article, “Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded” or Kimball Atwood’s “The Ongoing Problem with the National Center for Complementary and Alternative Medicine“. Even if you buy into the false notion that NCCIH (née NCCAM) has completely reformed itself and doesn’t study or promote quackery any more, a history lesson is important. What really happened matters.

Basically, Sen. Tom Harkin was a believer in a lot of alternative medicine. Thus, in 1991 he used his power as the chair of the Senate Appropriations Committee to create the precursor to the NCCIH. His committee declared itself “not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices” and, to “more adequately explore these unconventional medical practices,” ordered the NIH to create “an advisory panel to screen and select the procedures for investigation and to recommend a research program to fully test the most promising unconventional medical practices.” This advisory panel became the first incarnation of NCCIH, the Office of Unconventional Medicine, which was quickly renamed the Office of Alternative Medicine (OAM).

This next part is very important. NIH didn’t request this new office. There were no scientists and physicians in the NIH leadership clamoring for such an office. Congress didn’t respond to a “groundswell” of support to establish this office. The NEJM article cited by Rothenberg Gritz wasn’t even published until nearly two years after Harkin had already started the wheels rolling and a year after the founding of OAM. No, a single powerful senator with a proclivity for quackery used his power to get this enterprise off the ground, and he continued to nurture it over his remaining two decades in the Senate. The OAM was, in essence, imposed on a correctly-unwilling NIH, and has been ever since. Indeed, after she left as NIH director, Bernardine Healy revealed that she had considered the project to link research scientists with true believers in therapies like homeopathy to conduct experiments as foreshadowing nothing but disaster, but conceded that the NIH had “had no choice” because it couldn’t refuse to carry out a mandate from Congress.

And, make no mistake, Harkin was big into quackery, not to mention being in the pockets of quacks:

Harkin had been urged to take this legislative step by two constituents, Berkley Bedell and Frank Wiewel. Bedell, a former member of the House, believed that two crises in his own health had benefited from the use of unconventional medicine: colostrum derived from the milk of a Minnesota cow, he held, had cured his Lyme disease; and 714-X, derived from camphor in Quebec by Gaston Naessens, had prevented recurrence of his prostate cancer after surgery. Bedell, giving evidence of his Lyme disease recovery at a Senate committee hearing, observed: “Unfortunately, Little Miss Muffet is not available to testify that the curds and whey which she was eating are safe.” Wiewel had long been a vigorous champion of immunoaugmentative therapy for cancer, scorned by orthodox specialists; made in the Bahamas, this mixture of blood sera was finally barred from import by the Food and Drug Administration. Wiewel then began operating from his home in Otho, Iowa, an agency called People Against Cancer, a referral service for cancer treatments that orthodox medicine considered questionable.

Harkin, having lost two sisters to cancer, was susceptible to an interest in alternative therapies. Soon after sponsoring the law that launched the Office of Alternative Medicine, Harkin himself became a true believer in an unorthodox “cure.” On Capitol Hill, Bedell introduced the senator to Royden Brown of Arizona, promoter of High Desert bee pollen capsules. Harkin suffered from allergies; persuaded by Brown to take 250 bee pollen capsules within five days, he rejoiced that his allergies had disappeared. The senator did not know at the time that Brown had recently paid a $200,000 settlement under a consent agreement with the Federal Trade Commission, promising to cease disguising television infomercials as objective information programs and to stop including in his scripts dozens of false therapeutic claims for his capsules. These promotions also averred that “the risen Jesus Christ, when he came back to Earth,” had consumed bee pollen; a more recent customer, Brown’s infomercial declared, was Ronald Reagan. Brown later wrote Hillary Clinton, warning that her husband should begin dosing with bee pollen lest he develop fatal throat cancer.

So NCCIH started out at the urging of two quack constituents of Harkin; then Harkin became a believer himself. Not surprisingly, it soon became clear that the OAM was not intended to rigorously study alternative medicine, but rather to provide a seemingly scientific rationale to promote it. The office was initially set up with an acting director and an ad hoc panel of twenty members, many of whom Harkin hand-picked, including advocates of acupuncture, energy medicine, homeopathy, Ayurvedic medicine, and several varieties of alternative cancer treatments. Deepak Chopra and Bernard Siegel were also included. Critics of quackery were consulted and considered for panel membership but—surprise, surprise!—were not selected. These pro-alt med panel members became known in the OAM as “Harkinites.”

Against this background, the first director of the OAM, Joseph M. Jacobs, almost immediately ran afoul of Harkin by insisting on rigorous scientific methodology to study alternative medicine. To get an idea of what Jacobs was up against, consider that in 1995 the inaugural issue of Alternative Therapies in Health and Medicine featured not just one, but two, commentaries by Senator Harkin, “The Third Approach” and “A Journal and a Journey“. In these two articles, Harkin basically introduced the new journal as a “journey—an exploration into what has been called ‘left-out medicine,’ therapies that show promise but that have not yet been accepted into the mainstream of modern medicine.” and explicitly stated that “mainstreaming alternative practices that work is our next step.” Unfortunately, he had a bit of a problem with the way medical science goes about determining whether a health practice—any health practice—works and railed against what he characterized as the “unbendable rules of randomized clinical trials.” Citing his use of bee pollen to treat his allergies, went on to assert, “It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies.” It is an attitude that did not change. In 2009, Harkin famously criticized NCCAM thusly:

One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.

Truly, this was a profound misunderstanding of how science works. Also, the reason NCCAM had failed to “validate alternative approaches” is because they were, largely, pseudoscientific quackery that, as expected, failed scientific testing.

Ultimately Jacobs resigned under pressure from Harkin, who repeatedly sided with the quacks. It also didn’t help that Jacobs complained about various “Harkinites” on the advisory panel who represented cancer scams such as Laetrile and Tijuana cancer clinics. That Jacobs became tired of fighting and finally resigned is especially noteworthy given that Jacobs himself had been picked to run OAM precisely because of his openness to the idea that there were gems to be found in the muck of alternative therapies. Meddling by Harkin was a theme that kept repeating itself. Later, in 1998 after the then-NIH director had tried to impose more scientific rigor on the OAM, Harkin sponsored legislation to elevate the OAM to a full center, and thus was the NCCAM born. Not coincidentally, the NIH director has much less control over full centers than over offices.

Bad science and revisionist history about how alternative medicine evolved into “integrative” medicine

The key message promoters of unscientific medicine hammer home again and again is that they’re not quacks. Oh, no. They’re real scientists and don’t use medicine that’s not scientifically proven. Rothenberg Gritz drives that point home thusly:

But I was intrigued by the NIH center’s name change and what it says about a larger shift that’s been going on for years. The idea of alternative medicine—an outsider movement challenging the medical status quo—has fallen out of favor since my youth. Plenty of people still identify strongly with the label, but these days, they’re often the most extreme advocates, the ones who believe in using homeopathy instead of vaccines, “liver flushes” instead of HIV drugs, and garlic instead of chemotherapy.

In contrast, integrative doctors see themselves as part of the medical establishment. “I don’t like the term ‘alternative medicine,'” says Mimi Guarneri, a longtime cardiologist and researcher who founded the Academy of Integrative Health and Medicine as well as the integrative center at Scripps. “Because it implies, ‘I’m diagnosed with cancer and I’m going to not do any chemo, radiation, or any conventional medicine, I’m going to do juicing.'”

As I characterized it, “We’re not quacks! We’re not quacks!” Later Rothenberg asserts:

The actual treatments they use vary, but what ties integrative doctors together is their focus on chronic disease and their effort to create an abstract condition called wellness. In the process, they’re scrutinizing many therapies that were once considered alternative, subjecting them to the scientific method and then using them the same way they’d incorporate any other evidence-based medicine.

Except that that’s not the case. Here are a couple of examples that I like to use to show why this characterization of integrative medicine is a delusion.

First, I like to cite a certain medical society that I’ve butted heads with on more than one occasion and whose leadership really, really doesn’t like me, namely the Society for Integrative Oncology, declaring that it has “consistently encouraged rigorous scientific evaluation of both pre-clinical and clinical science, while advocating for the transformation of oncology care to integrate evidence-based complementary approaches. The vision of SIO is to have research inform the true integration of complementary modalities into oncology care, so that evidence-based complementary care is accessible and part of standard cancer care for all patients across the cancer continuum.” Would that this were true! If that truly is the case, then how does SIO reconcile itself with the fact that its current president, Suzanna Zick, and immediate past president, Heather Greenlee, are both naturopaths, one of whom authored official SIO guidelines for the integrative care of breast cancer patients? (Even more depressingly, Zick is a naturopath working in the Department of Family Medicine at my old alma mater the University of Michigan Medical School.) That alone puts the lie to any claims SIO has of being scientific, given that naturopathy is a cornucopia of quackery and pseudoscience. In particular, homeopathy—or, as I like to call it, The One Quackery To Rule Them All—is an integral part of naturopathy as a major component of the curricula of schools of naturopathy and is a required component of the naturopathic licensing examination (NPLEX). If you don’t believe just how quacky naturopathy is, read what they say to each other when they think no one is watching; learn about how full of pseudoscience their education and practice are, as related by a self-described “apostate“; and how unethical their research can be.

Despite all this, it’s not just integrative oncology that’s embracing naturopathy. (There’s even a specialty now known as naturopathic oncology that’s advertised by places like the Cancer Treatment Centers of America.) Meanwhile a whole host of integrative medicine programs offer the services of naturopaths, including Kansas University, UC Irvine, Beaumont Hospital (in my neck of the woods!), the University of Maryland, and, of course, the Cleveland Clinic, where a naturopath runs a traditional Chinese medicine clinic, just to name a few.

Now, here’s where the second point comes in. It goes way beyond naturopathy, whose tendrils have become firmly entwined with those of “integrative oncology,” perhaps more so than with other specialties. If, as its advocates claimed ad nauseam to Rothenberg Gritz, integrative medicine is all about the science, then its approach is all wrong. Let’s put it this way. They themselves admit that many of the modalities they are using are unproven. If they truly accept that, then for them to offer such services outside of the context of a clinical trial would be as unethical as offering a non-approved drug or unproven surgical treatment to patients. Yet, there are quite a few academic institutions out there offering reiki, which is just as quacky, if not more so, than homeopathy, given that it postulates the existence of a “healing energy” that has never been detected and in its particulars is no different than faith healing, except that it substitutes Eastern mystical beliefs for Christian beliefs. Under the banner of “integrative medicine,” academic medical centers are offering high dose vitamin C for cancer, anthroposophic medicine, and functional medicine. Indeed, there are academic medical centers out there that offer everything from acupuncture to chiropractic to craniosacral therapy to naturopathy. Heck, the University of Maryland offers reflexology, reiki, and rolfing, none of which have any good evidence to support them, while more integrative medicine programs than I can keep track of offer acupuncture and various other bits taken from traditional Chinese medicine, even though acupuncture is nothing more than a theatrical placebo.

In other words, integrative medicine puts the cart before the horse. Hilariously, Rothenberg Gritz inadvertently undermines her own praise of the science of integrative medicine by relating that Dr. Guarneri, whom she just represented as a paragon of science who only wants to use scientifically validated treatments, offers onsite massage therapy, herbal baths, craniosacral therapy, and acupuncture, the latter two of which are pure quackery. (Oh, and she teams with naturopaths, as well.) Indeed, craniosacral therapy is such ridiculous quackery that Guarneri’s offering it pretty much eliminates any chance I’ll buy her claim of adhering to science in her practice of “integrative medicine.”

My amusement at this aside, especially irritating is Rothenberg Gritz’s description of acupuncture. After noting that chronic pain is one reason why people seek out alternative medicine, she writes:

One reason pain is so hard to treat is that it isn’t just physical. It can carry on long after the initial illness or injury is over, and it can shift throughout the body in baffling ways, even lodging in phantom limbs. Two different people can have the same physical condition and experience the pain in dramatically different ways. As the Institute of Medicine report put it, pain flouts “the long-standing belief regarding the strict separation between mind and body, often attributed to the early 17th-century French philosopher René Descartes.”

This may be why so many chronic pain sufferers are drawn to traditional medicine: The Cartesian idea of mind-body duality never found its way into these ancient systems. Acupuncture, for instance, has been shown to help with problems like back, neck, and knee pain. But it’s very hard for science to figure out how it works, since it involves so many components that are mental as well as physical. The technique of inserting the needles, the attitude of the practitioner, the patient’s own attention—all of these are built into the treatment itself. In Acupuncture Research: Strategies for Developing an Evidence Base, researchers note that ancient Chinese physicians saw the mind and body as “necessarily connected and inseparable.”

Note that the study to which Rothenberg Gritz links is the acupuncture meta-analysis by Vickers et al., which so failed to show what it claimed to show that one SBM post wasn’t enough to explain why. It required discussion by Steve Novella, Mark Crislip, and myself, much to Vickers’ dismay.

The funny thing is, mind-body dualism is not a part of modern medicine, making it odd that the IOM would get it so very, very wrong 11 years ago. Remember, the concept of dualism posits that consciousness (the mind) is, in part or whole, something separate from the brain; i.e., not (entirely) caused by the brain. Now, if there’s anything modern neuroscience has taught us, it’s that dualism is untenable as a scientific hypothesis, that the “mind” is wholly a manifestation of the function and activity of the brain—or, as it’s sometimes stated, the brain causes the mind. In other words, science-based medicine rejected mind-body dualism a long time ago. Of course, as we’ve discussed here more times than I can remember, when rigorously studied acupuncture has never been convincingly shown to do anything more than placebo. Indeed, the reason why acupuncture “outcomes” (such as they are) are so dependent on practitioner and patient is because acupuncture is placebo.

In fact, my retort to Rothenberg Gritz’s outright silly argument about mind-body dualism is that it’s the integrative practitioners who emphasize mind-body dualism, whether they realize it or not. After all, they have a whole category of therapies known as “mind-body” medicine, an implicit acceptance, at least on some level, of dualism. Nor does their overblown appropriation of epigenetic studies as evidence that the “mind heals the body” (or, as I like to refer to it, wishing makes it so), which infuses so many alternative medicine practices, help. In actuality, given that the vast majority of alternative medicine practices, when rigorously studied, do no better than placebo, this new emphasis is basically integrative medicine rebranding the pseudoscientific practices it “integrates” as “harnessing the power of placebo.” Since placebo effects require that physicians in essence lie to their patients (albeit with good intent), it’s not for nothing that Kimball Atwood and others have dubbed the placebo medicine as practiced by integrative medicine practitioners as a rebirth of paternalism in medicine due to the lure of being the shaman-healer.

The rest of the article is full of the same old pro-integrative medicine tropes that I’ve seen over and over and over again. For example, Mark Hyman, the “functional medicine guru” now trusted by Bill and Hillary Clinton who regularly mangles science about autism and cancer while advocating anecdote-based medicine, opines that we have “an acute-disease system for a chronic-disease population,” that the “whole approach is to suppress and inhibit the manifestations of disease,” and that “the goal should be to enhance and optimize the body’s natural function,” whatever that means—and whatever “functional medicine” is. (For a reminder, it’s useful to look at the late Wally Sampson’s multi-part analysis of what functional medicine is claimed to be here, here, here, here, and here.)

Rothenberg Gritz also relies on the ever-annoying “science has been wrong before” canard, listing all sorts of areas where medicine got it wrong before getting it right, as though that justifies integrating alternative medicine into science-based medicine because, I suppose, science could be wrong about that too. It does not; it’s a fallacy. She also parrots the charge that doctors haven’t thought enough about prevention, a claim that has always irritated me. After all, what are vaccines, but prevention? What are diet and drugs to treat elevated blood sugar but prevention of diabetic complications? What are antihypertensive drugs but a means to prevent the complications of hypertension, such as heart attacks and strokes? What are smoking cessation programs but a means of preventing cancer, heart disease, and chronic obstructive pulmonary disease, the three most deadly consequences of smoking? (Note how integrative medicine only defines “prevention” as non-pharmacologic, or “natural,” approaches.) Yes, it’s difficult to practice some forms of prevention because making lifestyle changes, such as losing weight, drinking less, smoking less, and exercising are hard. Patients don’t want to do them and have a hard time achieving them. I’ve yet to see much evidence that “integrative” medicine will do any better after having appropriated lifestyle interventions and rebranding them as somehow being “integrative.”

What is integrative medicine, anyway?

Perhaps the most inadvertently telling passage in Rothenberg Gritz’s article comes near the end:

After months of speaking to leading integrative doctors and researchers, I found that I was still having trouble summing up exactly what integrative health was all about. It’s not a specialty like obstetrics or endocrinology. There are integrative training programs and certifications out there, but none of them has been universally recognized throughout the medical profession. “At this point it’s really a self-declaration,” Nancy Sudak, the chair of the Academy of Integrative Health and Medicine, told me. “And nobody has a tool kit that includes absolutely everything. It largely depends on who you are as a practitioner.”

In other words, integrative medicine is a brand, not a specialty. Pretty much every other specialty has a definition of what it encompasses that is clear. Integrative medicine is this fuzzy entity about which I can’t help but recall the words of Humpty Dumpty in Lewis Carroll’s Through the Looking Glass, who said scornfully, “When I use a word, it means just what I choose it to mean—neither more nor less.” So it is with integrative medicine, which is why last week integrative medicine could be defended on using a fallacious argument that science-based medicine is “nonsense” or that “Western medicine” has lost its soul, while this week I can sit back and grit my teeth reading an article regurgitating the advocate line that integrative medicine is just as scientific as science-based medicine.

Rothenberg Gritz is correct that integrative medicine has evolved, but it hasn’t evolved in the way she thinks it has. In her final paragraph, she wonders whether the rise of integrative medicine is a result of cultural shifts (which is possible) but comes to an untenable conclusion that it may be the only way to treat chronic disease. In actuality, it is only the language that has evolved. I was half-tempted to steal the introduction to a post on how integrative medicine is a brand not a specialty, where the evolution of integrative medicine is described, but instead I’ll just give you the CliffsNotes version instead.

Basically, starting around the late 1960s and early 1970s, in a bid to gain respectability for what was then called quackery or health fraud, the term “alternative medicine” was coined, which didn’t have all the harsh connotations of the usual language. Around that same time, James Reston, a New York Times editor, wrote about his experience undergoing an emergency appendectomy while visiting China in 1971. His story was represented as successful “acupuncture anesthesia,” when it was anything but, stimulating popular interest in “alternative” medical approaches. However, the word “alternative” implied that this was not “real” medicine, that it still was somehow unrespectable (which it was and still is, for good reason). Consequently, in the 1990s, around about the time Rothenberg Gritz was in high school admiring her dad’s woo-filled medical practice, a new term was born: complementary and alternative medicine (CAM). The idea was that you need not fear these quack medical practices because they would be used in addition to medicine, not instead of it. This term contributed greatly to the increasing embrace of CAM by medical academia, but it was still not good enough for its advocates. After all, the word “complementary” implies a subsidiary status, that CAM is not the main medicine but just icing on the cake, so to speak.

That did not sit well with advocates, who wanted their woo to be fully part of medicine, even though they didn’t have the evidence for that to happen naturally. Thus was born the current term “integ
rative medicine.” No longer did CAM practitioners have to settle for having their quackery be merely “complementary” to real medicine. They could use this term to claim co-equal status with practitioners of real medicine. The implication—the very, very, very intentional implication—was that alternative medicine was co-equal to science- and evidence-based medicine, an equal partner in the “integration.” Thus was further advanced the false dichotomy that has been used to justify alternative medicine from the very beginning, that a physician can’t be truly “holistic” unless he embraces pseudoscience.

The true evolution of integrative medicine is not that it has become more scientific. Rather, it is that its advocates have gotten much, much better at branding quackery as being medicine under the guise of being “holistic” and “patient-centered.” It’s a false dichotomy that I reject and that Rothenberg Gritz clearly doesn’t understand.The Triumph of New Age Medicine

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

243 replies on “The Triumph of New Age Medicine, part deux, courtesy of The Atlantic”

I agree – that New York Times article is interesting, concise, clearly written, and has no chi, no chakras, and no mind-body duality.

Orac is just way behind the curve on integrationist medicine, and needs to have an open mind and think outside the box of pharma-drive healthcare.

For instance, did you know that probiotics are good for preventing social anxiety?

“Now a new study, published in the journal Psychiatry Research shows that consuming these “good” bacteria in fermented foods may also help curb social anxiety. The study, from College of William and Mary, included more than 700 students (mostly women) enrolled in an intro psychology class. Each participant filled out a questionnaire about his or her consumption of fermented foods, like yogurt or sauerkraut. They also answered personality questionnaires designed to tease out patterns of neuroticism (a personality trait) and social anxiety. In the end, researchers found that people with neurotic personalities were more likely to experience social anxiety, and that eating fermented foods was tied to a lower likelihood of symptoms.”

http://abcnews.go.com/Health/probiotics-ease-social-anxiety/story?id=32193267

Sound rock solid to me.

I am planning to start eating lutefisk for mood elevation, since we know Scandinavians are happy-go-lucky and devil-may-care.

I suspect that one of the reasons that chronic pain sufferers are proan to using alternative therapies is that many doctors are not very good at supporting those patients emotionally, and the patients are often not getting enough information about what is going on, and when they do, it is sometimes not offered proactively.

I am an anecdote about this problem. I had two major surgical procedures. Afterwards, I developed severe pain, not just at the surgical site, but in a large area in a dermatomal distribution. The pain lasted for a very long time, and did not fade away to a level I would consider reasonable for about a year and a half. It was not ameliorated by any medication, not even narcotics. I was able to figure out what was happening to me because a paper appeared in Nature shortly after my surgery describing the neurons responsible for that syndrome. When I spoke about this at my next visit, the fellow nodded his head yes and said that it tends to get worse the higher up you go.

To me, that is just not acceptable. This was a major academic cancer center, and I think they should have been more proactive with pain management, and I should have at least heard of that syndrome before having to find out about it myself. Basically, nobody else would have been able to do that.

That is the one and only criticism I had about my care there, and I think it is at least part of the reason for the persistence of alternative therapies for pain.

I would say that eating kimchee, at the very least, would lead to social isolation.

Back in the 1990s, the word “alternative” was a synonym for hip and forward-thinking. There was alternative music and alternative energy; there were even high-profile alternative presidential candidates like Ross Perot and Ralph Nader.

The word “alternative” leads to the question, “Alternative to what?” and the follow-up, “Is the alternative better than the thing it is supposed to replace?” Most of the time the backers of the “alternative” can give a somewhat coherent answer to the first question, but “alternative” is not always better. Alternative music, like any other genre, has its gems among a lot of crud. As for alternative presidential candidates, suffice to say that Ralph Nader is a Berserk Button in certain circles. “Alternative energy” has fared somewhat better, but there are still issues with consistency. “Alternative medicine” is like alternative presidential candidates: harmless at best, and often quite damaging. It’s also quite telling that “alternative medicine” and “traditional medicine” are somewhat synonymous, and contrasted with standard science-based medicine.

Some of the idiots I survey use ‘alternative’ and ‘natural’ interchangeably. Oddly though, ‘traditional’ is sometimes used for woo as in TCM or to designate SBM in contradistinction to New Age, altie, natural woo.

But then again, their language skills aren’t exactly enviable.

Dr. Finfer #4,

A couple of questions.

First, continuing from a discussion on the previous comment thread, why do you think it is up to the doctors to provide emotional support? This puzzles me, and since you are an actual MD unlike the other commenters, I would be interested in your take on the matter.

I look for competence from doctors and emotional support from friends and family. For those without, I would think clergy for the religious or someone trained in social work or counseling would be more appropriate.

Second, if I understand correctly, there never was an effective intervention for your pain? It sounds like you got some satisfaction from figuring out what was going on, which makes sense for a professional, but even then there was nothing to be done but wait. But I wonder how much that would have helped a layperson– intractable pain for an indefinite period is hardly something most people would accept.

@Dangerous Bacon #3: well, we all know about the wondrous powers of bleach, don’t we! 😉 I’m sure lye must be just as good.

@shay #6: not if you’re Korean.

Seriously, though: I think Dr. Finfer has hit the nail on the head. People fall for woo because its practitioners do what too many doctors should be doing, but don’t: talking to their patients and taking their concerns seriously.

I don’t blame doctors; I can count on one hand the number I’ve known who truly didn’t give a damn about their patients. I blame the workings of the healthcare industry that make it impossible for physicians to give their patients the kind of time and attention they want to give them. If we would actually pay physicians to talk to their patients, and listen to their concerns, I think a lot of people who are into woo would stop.

First, continuing from a discussion on the previous comment thread *plonk*

FTFY.

DB:

Scadinavians are probably more well-balanced on average, and lower in anxiety and neuroses than most ethnicities. My hypothesis: they don’t repress their moodiness with forced cheerfulness. You see more angst, because they’re clearing out the tubes. The can be pretty funny, and know how to have a good time on Svenskarnasdag. Google “Ole. Lena, Sven” for Scandi-humor:

Ole was on his deathbed and implored his wife Lena, “Lena, ven I’m gone, I vant you to marry Sven Svenson”.
“Vy Sven Svenson?” his wife asked. “You’ve hated him all of your life!”
“Still do,” gasped Ole.

But, no, do NOT eat the lutefisk…
_______
That William and Mary ‘study’ is about par for the course for academic ‘scientific’ psychology. So much bogus causal ‘reasoning’…

@ sadmar:

I wonder how much vaunted ‘national differences’ in personality have to do with the latitude at which the culture originated and how cloudy or sunny it is on average:
if you live at ( frigging- or is it Frigging?) 60 degrees North, you’ll spend most of your winter in the dark! Being miserable and drinking hard liquor. -btw- Do people with light eyes may have more problems with alcohol dependence- I seem to have read something along that line?

Then we have Russians.
HOWEVER they do eat fermented food.

Zebra #8:

The physician is the team leader and the one with the medical license. It is ultimately his/her responsibility to see that things are done. I tend to use physician as a contraction, and what I really mean is the physician or designee, but it is the physician who does the designating.

Emotional support really needs to come from anyone who a patient interacts with, but it is the physician who sets the tone. There are support groups and other things for those who need it, but they tend to come after the immediate recovery when a surgical patient can easily get around on his/her own. It is the physician and staff who have to get the patient to that point.

Places like the one where is was at typically have teams for everything, including pain management. I was given lots of things to read, but I do not remember anything that would have clued me into the fact there that there are pain syndromes that do not respond to meds and asking me to call if I had an issue. That is all that most people need. Once I realized what was happening, I was able to just deal with it. I do admit that before that point, I had used kind of a lot of narcotics, but I used the knowledge to just stop them and get through it. I am not sure it would have been so easy for patients with no medical training.

As for clergy, I have no use for them.

You are correct. There are currently no drugs that address the type of pain that I had. It’s called cutaneous hypersensitivity. It sounds similar to post-herpetic neuralgia. There probably has not been enough time since the description of those neurons for a drug to come to market. I do hope someone is working on one. After five years, I still occasionally have some pain, just enough to remind me that something was done. It is just a minor annoyance now.

if you live at ( frigging- or is it Frigging?) 60 degrees North, you’ll spend most of your winter in the dark! Being miserable and drinking hard liquor. -btw- Do people with light eyes may have more problems with alcohol dependence- I seem to have read something along that line?

Then we have Russians.
HOWEVER they do eat fermented food.

There is apparently actually something to the blue eyes and alcohol dependency connection. I first heard of it, though, in a context that made me think it was just a bit of raving on the part of a particularly (in)famous late professor in our department.

I was in Old Russian Lit, sitting next to my friend Olga, while Omry was on one of his epic digressions, and had somehow gotten on the topic of Mussorgsky, and how he “drank very much” in order to “get closer to the soul of the Russian people,” and how it didn’t work out for him.

Olga says to me, under her breath, thinking he wouldn’t hear, “That’s my methodology.”
…”What is? Getting drr-unk? …You have… dark eyes?”
“Um, dark green.”
“Yes, well, then you must be careful. It is the light-eyed people, you see, who become alcoholics. The dark-eyed Mediterranean types might drink very much, but they do not become alcoholics. Just as long as you don’t eat the SOMA MUSHROOM!”

*blank, slightly terrified stares*

FWIW, I have almost-black eyes, and I’m pretty sure I drink more than Olga, although I did notice some empty vodka bottles sitting around when I was apartment-sitting for her a couple years back.

And speaking of digressions, I am sorely tempted to turn this into a Sven and Ole thread, but I am biting my tongue fingers.

Are you telling me that there are more than 6 Scandiwegian jokes? I am deeply skeptical.

#14 Dr Finfer,

“cutaneous hypersensitivity”

Maybe you mean cutaneous hyperesthesia?

@ JP:

I read about the light eyes/ alcohol at a news site: it was supposed to be based on research but we all know how _trustworthy_ that can be. I can’t seem to find it: it was about whether certain illnesses/ problems were associated with lighter eyes.

Interestingly enough, the part of my family with very light eyes seems to be rather resilient to alcohol – even the guy who had horrible war experiences only drank on weekends. My father had no interest in alcohol- the rest drink/ drank on and off, mostly at social events I can personally not drink for months and then have three a night for a week or two.

And yes, we could probably go on and on about how various cultures respond to alcohol but then, that wouldn’t be very nice of us, would it? Lots of jokes as well
-btw- I believe that my families’ ancient stomping grounds were at about 52 degrees but there HAD to be something Mediterranean way back.

@Panacea:

Bingo on the industry critique!

It IS trickling down into the physicians, though, as the young MDs who feel they need to take time with patients are giving up on primary care and going on to specializations. The Taylorized quick-turnover system is now so well established, new PCPs kind of self-select for being OK with that, and you get these young Drs. who just DO NOT LISTEN.

When Dr. Finfer says MDs are “not very good at supporting those patients emotionally” we may get an image of cold, haughty, disregard — but the young don’t-listen Docs I’ve had of late are cheerful, upbeat, ‘nice’… Giving emotional support isn’t about attitude, the practitioner actually has to DO something. To me, it’s worse that these guys blowing off my concerns are NOT grumps. It sort of whipsaws me when the Doc seems positively engaged, but then just gives a superficial quickie answer and disappears. In my case, the chronic complaint (sore-throat, laryngitis) the Dr. blew-off time and again turned out to be related to a potentially life-threatening condition (Barrett’s)…

Setting his answers aside though, zebra poses a good question: why should it be up to doctors to handle the emotional aspects of patient care? The Alt-Med practitioners who are taking time, listening to the patients, engaging them pro-actively ARE NOT DOCTORS! (They’re glorified physical behavioral therapists spewing a lot of false information.) So it doesn’t take a Dr. to get that part of the job done.

As you said, sbm is delivered by an industry. There are already divisions of labor at the health clinics that have largely replaced the old-school, one-or-two MD private-practice for primary care. It’s the INDUSTRY that’s responsible for listening to patients, getting all the info (physical and mental/emotional) about their maladies into their files, providing them the emotional support they need to deal with dealing with chronic physical ills at the clinic. The industry falls short because doing those things costs money, tit can can get away with not doing them, and it doesn’t care if sCAMmers thrive as a result as long as that isn’t messing with the bottom line in the next quarterly report.

It’s not Doctors failing so much as medical practice as a whole, so lets re-position the encounter from ‘patient-doctor’ to ‘patient-clinic.’ MDs aren’t the logical personel for the task.of ‘patient relations’, their expertise and training lies in a very different direction… So, I think primary care practices ought to have ‘patient relations’ medical staff to assist MDs — a sort of combo LCSW/PA/NP who can take the time, knows how to listen, knows enough medicine to get the right info to the MD, and can extract from the MD the concrete info they’ll need to inform the patient about what’s up in an emotionally supportive way.

I.e., the sbm delivery system COULD figure out a way to offer much of the positive experience patients are getting from quacks without spreading the woo of vitalism, magical thinking, etc.

@ JP- Come to think of it, resilience to alcohol might have been useful to my ancestor who manufactured gin. Kept him out of product.

Come to think of it, resilience to alcohol might have been useful to my ancestor who manufactured gin. Kept him out of product.

“Don’t get high off your own supply,” as they say.

Here’s the eye color & alcohol study.

#19 Sadmar,

How would your plan have helped with your anecdote? That wasn’t about emotional support, just poor diagnosis.

Perhaps it is the PCP that is the unnecessary layer of bureaucracy in the system.

Denice:
If you live at 60 degrees North, you’re likely the descendant of generations of forebears quite used to spending most of the winter in the dark. They’ve figured out, and passed down, lot’s of things to do in the dark besides drink and be miserable… including even a few not involving wanton getting of jiggy.

Now if you look at Yonnie’s picture, you might think he’s slow,
But he seems to know, ‘Bout cows and dogs and everything,
And when you talk about my Yonnie, you speak of the best,
I found out lots of things about that boy,
He’s so different from the rest.
Holy Yumpin’ Yiminy
How my Yonny can love,
When he kisses me, oh what yoy, makes me feel so oh! by Yiminy!
He bane my sweet Papa, I bane his Turtle dove,
He no bane much on reading books,
And he bane worse when it comes to looks,
but holy Yumpin Yiminy, how my Yonnie can love.

.
Now, it seems the Rooskies do love them from Vodka, but THE most drunk state in the U.S. is Wisconsin, which is full of Germans. In contrast, the much more Scandinavian Minnesota next door only allowed 3.2 beer until fairy recently. And for the Germans, we’re talkin’ more Bavaria than anything, and that ain’t that far North… (For the record, I have a Germanic surname, and predominantly German ancestry, and NO Scandinavian blood… so I’m talkin’ ’bout my own peeps, here… But, no, I ain’t touchin’ sauerkraut any more than I’m getting within a furlong of kimchee…
Bratwurst, on the other hand, totally rocks…)

zebra #22:

It’s about taking the time, listening, taking what I had to say seriously… The problem with assembly-line sbm that’s alienating the patients turning to Alties isn’t just ‘lack of emotional support’, it’s a functionally callous attitude leading to missed diagnoses.

I’d see the MD, complain about the chronic sore throat repeatedly, and every time he’d say, ‘well it’s just post-nasal drip’ give me a two-week Rx of anti-histamines and another routine appointment in 3 months. No follow up on whether the Rx helped, no continuity between visits registering the problem wasn’t going away. I think he only looked at his own medical records on me, because if the data had been coordinated with other providers I’d seen in referrals, he’d have noted that when I’d had a ‘routine’ upper and lower about a year earlier, the gastroenterologist had noted the problem with the stomach sphincter, and the lining creeping up into the esophagus (though HE hadn’t explained what that meant symptomatically, so _I_ couldn’t correlate that to the throat problems).

I know several other personal horror stories much worse than the anecdote I’ve related — failures of sbm delivery that were totally inexcusable, as no House-like mysterious diagnostic issues were involved, just Drs. too busy/distracted/disconnected to observe what should have been obvious, had they known their patients at all.

RE #4 and #8 there seems to be a lot of demand for “bedside manner” and handholding by physicians when the vast amont of education and expense involved in training an MD seems wasted when they basically sit there fielding the same questions that could be answered by a specialist LCSW or some kind of nurse or medical assistant. How much is spent and wasted on low level hypochondirasis and pep talks which could as well be provided by motivational therapists who would also perhaps be quite a bit better at it than most physicians anyway?

@ Barefoot:

Agreed.
And this is where the woo-meisters step in: so much of what they promulgate are pop psych solutions for everyday problems that a person might elicit from a trusted friend or relative especially when things aren’t awful enough for calling on a therapist, nurse or social worker.

Like AoA/ TMR, woo-centric outlets/ businesses cater to groups of like-minded people with gripes and axes to grind- obviously, facebook and other social sites work well for them.

@zebra – I agree, it is possible to have ineffective treatments and ones that aren’t backed by science that don’t depend on qi, chakras, mystic energy, or the power of gods. It would be perfectly appropriate for someone to take those clinics to task for making statements and promising results that are not backed by evidence.

Sadmar #24,

Sorry, I should have been more explicit. It’s the part where the person you talk to reports to the non-specialist MD that I’m questioning.

Why not let the person who spends time with you pass along your information to a specialist? Maybe that person could be trained by someone like yourself to write a clear, compelling narrative. There are lots of very smart people who can fill that kind of role for a reasonable price.

Barefoot #26,

You must have an exceptional bedside manner; I have been excoriated here for suggesting exactly that. See the comments on the previous post.

And for the Germans, we’re talkin’ more Bavaria than anything, and that ain’t that far North…

I know several people who either live or have lived in Munich, who tell me that beer is legally considered food in Bavaria. The standard beer serving there is one liter, compared to 0.3-0.6 liters elsewhere, depending on country.

Yes, the Scandinavians do drink. The Swedish word for beer is ö;, which is cognate with “oil”. In Sweden it comes in three grades, ranging from lättö; (light beer, both in alcohol content and excise tax) to starköl (strong in both senses). The Swedes have other ways of dealing with winter darkness: I understand they were the ones who started the tradition of putting lights on Christmas trees.

But if you are really looking for hard drinkers, head across the Gulf of Bothnia to Finland. From what I hear, the average Finn will drink the average person from any other country under the table.

I was really hoping that your second use of the meditating doctor picture in this article would have his pants on fire. (photoshopped of course. I’m not an advocate of self-immolation or spontaneous human combustion.)

#17
zebra

“July 6, 2015
#14 Dr Finfer,

“cutaneous hypersensitivity”

Maybe you mean cutaneous hyperesthesia?”

When I did a quick Google search for that term just now, most of the links I got were for a syndrome like that in cats.

None of the people caring for me used that term, but it is an apt description. It was like being on fire all the time. The slightest touch made it much worse.

Just to reiterate my original point, I can understand how people in the position I was in gravitate towards things like acupuncture. They are desperate, and if they don’t get what they need from their doctors, they will try anything.

I was able to supply the information I needed myself. Very few people will be able to do that. Personally, I wonder why, in a big center like that, the pain management group does not visit every surgical patient at least once before they leave the hospital. It seems to me that might be a good idea.

When I did a quick Google search for that term just now, most of the links I got were for a syndrome like that in cats.

More telling is the fact that this was the only response Z. had to your actual comment, which he solicited in the first place.

Medical training is what allows a doctor to be able to discern the difference between someone in need of a pep talk an an authority figure telling them everything is alright, and somebody who actually needs treatment or referral to a relevant specialist- and which specialist as well.

Trying to come up with some system that replaces the GP with a network of nurses, physiotherapists, personal trainers, motivational speakers, and such would create more problems than it would solve

Re the McArdle article, not at all surprising that she’d write an article from the point of view that having or not having health insurance is no big deal. Her position on such topics can be summarized by the title of an article she wrote recently for Bloomberg View:

“[Obamacare] endures. Let’s hope the Supreme Court’s legitimacy survives too.”

As I recall, she was having health problems about the time she left The Atlantic. Don’t know exactly how she paid for the care, but my guess would not be cash.

Are you telling me that there are more than 6 Scandiwegian jokes?

Don’t know how many this makes total (as told to me by a Swede):

Q: Why do Norwegian cars have windshield wipers on the inside?

A: Make engine noise with tongue protruding from lips (a/k/a a “raspberry”).

The premise of Firesign Theater’s 1974 record “Everything You Know is Wrong” is that the manager of a nudist trailer park in the California desert has put out a record containing his proof that aliens have lived among us for many years (pretending to be Indians). At one point during his narration, the phone rings, and he answers in exasperation: “Nude Age Enterprises! I’m busy!”.

Not exactly apropos, I know, but the memory makes me chuckle almost whenever I header the phrase “New Age”.

The record is hilarious, and holds up beautifully, by the way.

Ach, I just learned, by coincidence, that Phil Austin, one of the four members of Firesign, died on June 18 of cardiac arrest, a complication of cancer. Phil was perceded in death by Peter Bergman. Very sad news! They were simply amazing.

Be careful what you wish for. It is coming and Horatio is exactly correct.

Google “collaborative care”.

The push is to remove physicians from patient contact has started and it is going to be relentless all based upon financial considerations. Patients be damned.

Zebra,

I am more and more disappointed in what I read in your comments. In order to make your argument (which I have long since lost track of what exactly it is) you place yourself in more and more indefensible, reductionist arguments.

“…why do you think it is up to the doctors to provide emotional support?”

I am not sure who is insisting on this other than you but perhaps you missed the part where the doctor-patient relationship is one between two human beings. And it is a large part of the “art” of medicine. So do I want compassion from someone that provides it without enough clinical knowledge understand what they don’t know, a charlatan “selling” me compassion along with a lie or the doctor who is the one treating my condition. I’ll take the doctor thank you very much because he is the one most likely to use it to my benefit.

In contrast, the much more Scandinavian Minnesota next door only allowed 3.2 beer until fairy recently.

You would perhaps care to document this? Limiting sales in, e.g., grocery stores is not the same as “disallowing.” (Moreover, as I’ve mentioned before, “3.2 beer” is ABW, which is about 4% ABV, or right about ordinary bitter.)

I’m waiting for an outbreak of Sven and Ole jokes. When I first moved here, I’m sure I did many a head tilt when folks would tell me those jokes.
Michael Finfer, MD–I’m not an MD, but rather a veterinarian who works in science, and I too had to diagnose my own post surgical chronic pain problem, despite mentioning it to the nurse practitioner many times during followup. I never saw the surgeon after the day of surgery. I wonder if it would have made a difference. Damn thing still hurts, too.

not a troll #43

It is a puzzlement, really, how I could ask:

“Dr. Finfer #4,

A couple of questions.

First, continuing from a discussion on the previous comment thread, why do you think it is up to the doctors to provide emotional support?”

It’s not like Dr F said, in the clearly referenced #4 comment,

“I suspect that one of the reasons that chronic pain sufferers are proan to using alternative therapies is that many doctors are not very good at supporting those patients emotionally”

I don’t know, maybe I’m having some kind of delusional psychosis where I just imagined that he said that. Maybe I need to have a compassionate PCP diagnose me.

Or maybe you should lay off the sauce a little?

@ Barefoot #26

How much is spent and wasted on low level hypochondirasis and pep talks which could as well be provided by motivational therapists who would also perhaps be quite a bit better at it than most physicians anyway?

I’m agreeing there is some true in this, for whatever my opinion is worth.
As the previous threads hinted at by zebra may indicate, I am however very negative about the possibility of an easy fix
(that’s not a reason not to try, but I’m very upset when presented with “just do that” solutions*, so I like to have details – this part is for zebra).

In an ideal, enlightened world, people would be well-informed and self-aware enough as to which specialist they need to see, be it a therapist or a bona fide yoga teacher.

In a somewhat closer-to-real world, the primary care provider or, heck, why not, if their training is sufficient for it, an AP or RN could provide the info and do the referrals. It’s supposedly how the healthcare system should be working in my country, more or less.

In the real real world, hypochondriacs and people in need of talking** end up at the PCP office; or because doctors don’t have time enough for their patients, these people end up at the office of some naturopath/chiropractor/guru…
I believe it’s this issue you, Barefoot, are talking about (and also zebra – at least this part of his/her posts was clear).

I see two big difficulties with this issue:
– limited resources: it may not be true where you live, but competent specialists (notably therapists) are in short supply around me, and I was under the impression it’s true as well for North America. Or it may be that a good number of people simply don’t know that these specialists exist and how to find them.

– patient compliance: for various reasons, these hypochondriac or talkative patients end up at the doctor office. How do you convince them to go seek help somewhere else? And somewhere legit, to boot, ideally.
Especially if that they need is some therapist. There is a strong negative connotation attached to mind illness.
Not about therapy, but exercise: I know it took two decades for people to convince my dad to join some sort of sport class. And it was not his doctor, but my mom who eventually succeeded.
Well, I will admit compliance is far from impossible. It’s just going to take efforts on all sides of the issue, not just on the MD side.

* in French, it’s known as the Yaqua mentality (nothing to do with the Yaka languages)
** and let’s not forget that being in need of medical attention and being in need of talking are not mutually exclusive, so these people may actually have a perfectly valid reason to visit the doctor.

@ zebra

I have been excoriated here for suggesting exactly that.

No, you haven’t – made this suggestion, I mean. Or if you did, it was lost in the middle of your other pronunciations.

You started about the yoga teacher being better at making people move than the doctor (technically true, but, to repeat my objection, one doesn’t go at the doctor’s place with the same motivations as one goes to the yoga teacher’s – see compliance, above); you continued on how the doctor’s antechamber is filled with mentally ill and fat people who should better be somewhere else rather than in front of very-important you, and finished on how the woo-prone at the mainstream doctor’s place should be given the snake oil they secretly really want, and stat, and too bad if it’s ineffective. There was some mumbling about saving money, I’ll grant you that.
And just at the end, you reversed position and stated that the doctor should receive the fat people and try to talk them into changing their lifestyle anyway.

No therapist anywhere. The yoga teacher may count, except for the part where you failed to explain how people en route to the doctor’s office will suddenly veer off to the closest yoga room. As you framed it (or so I understood), a decision made at the doctor’s suggestion, a doctor whose advice these “yoga-prone” people are mistrusting. And to top it, an advice given free of charge, after a quick glance by someone, don’t know who, to be sure these people were not about to collapse just now (and thus, unequivocally determining that they are not “true” patients).

Now, if you feel like presenting again your opinion in a clear and concise manner, be my guest. But after the last few months trying to get something coherent out of you, I don’t have high hopes.

@palindrom (40),

Sad to hear that. I have fond memories of that group and a couple of their records on vinyl.

When I got my first mini-van in the 80’s, I put on a recording of “I Think We’re All Bozo’s On This Bus”. With the front and rear speakers going, it was an almost surreal experience!

I don’t know, maybe I’m having some kind of delusional psychosis where I just imagined that he said that. Maybe I need to have a compassionate PCP diagnose me.

Or some sort of neurotic repression of your only response’s being the droolingly idiotic “maybe you mean cutaneous hyperesthesia?”

Or maybe you should lay off the sauce a little?

And the predictable, revolting collapse continues apace. You have nobody but yourself to blame for the fruit of your perpetually sophomoric attention-whoring.

Helianthus #47,

Blah blah blah… maybe the problem is that some people work hard to use fewer words, and some people don’t work hard to understand, and use lots of words to hide that they don’t understand?

“Motivational therapist” doesn’t mean a psychiatrist or even a psychologist, although we do shortchange mental health everywhere, and those services should be more available.

A yoga teacher is a “motivational therapist”, just like many other jobs which involve getting people to exert or extend themselves. Think about a drill sergeant for the marines or rangers– people sign up, but that doesn’t mean they will continue through the pain and pick themselves up from the failures. They need “motivation” to continue with the “therapy”. It’s about getting people not to quit, not getting them to start.

Now, I can explain how we might improve things in my opinion, but not if you are going to continue misunderstanding (intentionally or not) what I am saying and being oppositional without explaining what you don’t understand.

I seem to communicate pretty well with people who are not part of the little minion corps.

Blah blah blah… maybe the problem is that some people work hard to use fewer words, and some people don’t work hard to understand, and use lots of words to hide that they don’t understand?

Oh noes! It’s the return of the “filibuster” creeping thing!

Tremble in the Face of Its Power!

I seem to communicate pretty well with people who are not part of the little minion corps.

Examples?

Narad,

I’m flattered and all that but your little crush is getting kind of embarrassing. I have a very serviceable wife whom I love more than life itself, after all, and I have resisted temptation for more decades than I care to think about. I’m just not that into you.

Zebra #46.

How did you know I have blue eyes? But I assure you, except for that time in college, I rarely drink. [To quantify because doctors always look surprised after they ask me “how rare?” and I say about six drinks a year, I am leaving open the possibility that my definition of rare may not match most people’s.]

In response to your reply, I took Dr. Finfer’s remark about emotional support as an observation. You appear to have taken it to the extreme as if it was an edict for doctor/patient relationships; similar to your “recipes for fat people” binge that you were on, on the last thread.

I get making a point but you pick the most absurd black and white, opposite end of the spectrum illustrations to further your arguments and it just makes me shake my head.

Maybe I am due for one of those drinks now.

I’m flattered and all that but your little crush is getting kind of embarrassing.

“Crush”? No, Zohnnycakes, I’m merely a documentarian.

It is true that I find a certain amount of amusement in seeing just how many ways you can come up with to make a fool of yourself, but that’s small potatoes.

Now, I presume that you concede that the assertion “I seem to communicate pretty well with people who are not part of the little minion corps,” in context, is precisely equivalent to the statement “you people are too stupid to recognize my brilliance,” given that the best response you could muster was invocation of having “a very serviceable wife.”

Hey, here’s an idea: Maybe she could chime in! I mean, she does know and admire how you spread your profound intelligence far and wide, right?

#39 You don’t know what busy is, Cox.

That and the Giant Rat of Sumatra were best beloved.

The first stage play I was in in college was a kind of pop culture collage that included a section where the ensemble cast acted out some of ‘The Wall of Science” from “Bozos” — IIRC, I portrayed a Hot Lump, a colliding moskweeto, and a small dying creature… We didn’t get up to Fudd’s Law (or Teslecle’s Deviant, but then we fell over without being pushed.

I wonder if the whole ‘quantum’ multiple-timeline thing came to some theoretical physicist listening to the interrupted flashback sequence near the end of “Nick Danger” while dosed.
https://youtu.be/RwG5c9IsgbA?t=19m49s

It galls me a little so few young-uns know Proctor and Bergman, given what passes for ‘comedy’ these days…

Zebra,

You have my apologies. The last thing I wanted to do was to make this personal. I am really not a troll.

I merely ask you to consider that there is a middle ground here and that many people who want a human being as a physician are not looking for them to be their BFF or mother/father figure. Or their yoga instructor.

I wonder if the whole ‘quantum’ multiple-timeline thing came to some theoretical physicist listening to the interrupted flashback sequence near the end of “Nick Danger” while dosed.

It didn’t, and perhaps it would help if you took the time to try to figure out what it means before reaching for the pop-culture fantasies.

@Dr Finger – sorry about your pain – sounds a lot like what I was left with on my foot after an ankle surgery – a light touch would feel like someone drove a hot spike through my foot. I suffer from a chronically painful condition and the pain was managed by my primary care doctor originally because I was diagnosed while uninsured. Have had the misfortune of having to replace doctors while being on pain management now. I have learned that there can be some serious jerks in medicine.

When it comes to “alternative” – Mr Woo loves the stuff, of course. When I was first diagnosed, he googled my disease and cure and spent as much as three hundred a month on pills, books, potions and crazy diets to fix me. Took me to faith healers… when they failed to heal me they suggested exorcists (I refused)!

Alternative will always be around. As long as there is a desperate patient and a creative huxter, there will be alternative medicine.

@Narad #61

Didn’t it? How do you know? Some linear time-thing since physicists were positing stuff about this over a decade before “Nick Danger” was recorded? C’mon! I know the J.J. Abrams Star Trek and Terminator: Genesis are just silly fantasies, but if you can prove Ted Theodore Logan and William S. Preston, Esquire didn’t go back in time, transport the physicists to San Dimas in 1989, get ’em high, and play the whole Firesign catalog through several times before dropping them back in their own time-space continuum, watch the end of Excellent Adventure again, then prove Bill and Ted Jr. aren’t going to do that NEXT week.
http://tinyurl.com/onf333q

Re #44. The 3.2 law in MN does NOT apply to establishments with a liquor license, and it’s still on the books. In 45 states, beer is beer, no matter where you buy it. In Colorado, Kansas, Minnesota, Oklahoma, and Utah general establishments can only sell 3.2. Some smaller municipalities in MN don’t like to issue liquor licenses, so there are “bars” that only serve 3.2. The POINT was related to a humorous tangent coming off a lutefisk joke by DB — Scandinavians aren’t big boozers. Or perhaps you’ve never heard of certain Norwegian-American Congressman from Minnesota named Andrew Volstead?
https://youtu.be/NLKwfHxq-zk?t=7s

@Narad #61

Didn’t it? How do you know? Some linear time-thing since physicists were positing stuff about this over a decade before “Nick Danger” was recorded? C’mon!

My comment was not an invitation to further “banter.” If you are wholly clueless about MWI – which seems clear – I can only suggest that you not make a fool of yourself by invoking it.

Not A Troll #60,

Thank you– I guess that drink worked?

I assume you can understand that I am a little testy about people saying they “can’t figure out what zebra is saying” when it appears they haven’t read very carefully. Let’s start again.

Dr F seems to have understood my point, and answered it. What he meant was that there should have been support as part of the service provided, not necessarily by someone with an MD or the surgeon. Pretty much consistent with what I and some others are saying.

Now, as to your “middle ground”, I don’t know. You say:

“many people who want a human being as a physician are not looking for them to be their BFF or mother/father figure.”

To me that’s pretty vague, and at the core of the vagueness is the term “physician”. Which is one of the things at the core of my argument.

I want someone to give a correct diagnosis, do good surgery, properly calibrate medication, and so on. If those functions turn out to be optimized by using AI, or a brash and unpleasant human, why should I care?

Consider Sadmar’s report of doctors being superficially pleasant but missing important and probably obvious signs.

Sadmar, don’t take #66 personally– Narad obviously doesn’t handle rejection well; the bitterness will pass with time.

Oh, dear, the Zony is down to attempts at parasitism.

Hey, Z., did you ever own up to the Colossal Shay Blunder?

Zebra,

Then I guess my only option If I want to visit a practitioner with ample time and the ability to be an active listener with enough compassion to elicit answers from me in order to be able to “give a correct diagnosis, do good surgery, properly calibrate medication, and so on” is to see someone who is not trained as a physician while likely paying for unproven/worthless treatments.

Not a troll #70,

You seem to be stuck in a circular-reasoning-loop here.

If you want to see a “physician”, meaning a traditional MD GP or PCP, then that’s what you want. Your choice, but I don’t see how that relates to what I said.

I can imagine each of the three items I listed being provided by different specialists who have specialized training not necessarily identical to current MD training. Indeed, it is obvious that you don’t really have to talk to your surgeon; certainly in ER situations a patient may be unconscious and have no available medical history, but still the work gets done.

So, either you have an argument that there will be better outcomes because you have a long, face-to-face talk with the traditional MD PCP, or you really do want that kind of in loco parentis reassurance because it is a time of stress and fear– which is certainly an understandable human reaction.

My point again, is, that there is really not an argument for getting that comfort from a very expensive and not appropriately trained practitioner.

There was no circular reasoning; it was a straight path from the body of your prior comments.

Compassionate care and medical care are not mutually exclusive as you seem to keep wanting to define it.

If you want to narrow it down to “getting comfort” only, that appears to support Orac’s stance of not introducing woo into medicine because it is the only thing it offers if that. Non-MD providers can be as crappy as any MD as far as attitudes.

.

There’s a common view that people go to CAM practitioners because they make more sympathetic noises than regular doctors. I suspect it is more because, to my knowledge, a CAM practitioner has never in recorded history said to a patient, “I’m sorry there is nothing more I can do for you”. As I have said here before, I think these false promises have more to do with the popularity of CAM than the time spent with the patient or bedside manner.

Anecdotally, I saw two alternative practitioners some decades ago. The first was for a whiplash injury after a car accident, and a friend highly recommended an osteopath/acupuncturist (i.e. a UK-style osteopath), in a trendy part of North London.

The young man I saw was practically taciturn and didn’t make eye contact. After a very brief history he mumbled something, then cracked my neck and back, stuck some needles in me and left me for half an hour. The practice was very busy, with two receptionists and several other patients. I guess if you can pack patients in if you needle one while back-cracking another, without wasting time on small-talk.

The second CAMster was a TCM practioner; an ancient (and very grumpy) Chinese man in silk robes, who barked questions through a translator, wordlessly stuck needles in and sent me away with a bottle of epedra tablets. So much for empathy and bedside manner in both cases. I have had far more friendly GPs, who have on occasion been very helpful too.

Maybe my experiences are unusual, but I have seen no sign of the extended time and sympathy CAMsters are supposedly able to provide patients. Isn’t it just homeopaths who have the legendarily long consult where they ask about everything from your dreams to the color of your feces?

Anyway, Given proper triage, I agree that we could probably use qualified doctors a great deal more effectively. Why get someone paid $200,000 pa to do a job that someone earning far less can do just as well? It’s the triage bit that concerns me.

“I agree that we could probably use qualified doctors a great deal more effectively.”

Yes, in America, we use them as typists.

“It’s the triage bit that concerns me.”

This, a 1000 times. [an Americanism. It means I agree with you whole-heartily]

So, Zebra, what’s your solution?

If you’re not comfortable typing it in English, feel free to type it in the language you are most comfortable in, or simply copy-paste the link from CollectiveEvolution and we’ll sort it out.

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