Over the last two decades, quackery has been slowly but steadily infiltrating conventional scientific medicine. It began in earnest back in the 1990s, but the groundwork had been laid for at least a couple of decades before, going back to when traditional Chinese medicine made its first foray into the “West.” Unfortunately, over the last couple of decades, the pace of infiltration as accelerated, with the foundation of an NIH center dedicated to studying and promoting quackery and the increasing number of departments and institutes of quackademic medicine. Basically, quackery became alternative medicine, which then became “complementary and alternative medicine, which has now morphed into “integrative medicine,” a term intended imply combining the “best of both worlds” but that really means integrating quackery with medicine.
Unfortunately, what that also means is that the message finds its way into the mainstream press. When a message is so pervasive that it starts to be come normal and accepted. How else can I explain the fawning interview with Heather Greenlee by Karen Weintraub over at Stat, which normally sets a higher standard. I mean, Stat has Carl Zimmer, Ed Silverman, and Sharon Begley. Although I must admit that I’m not a regular reader, I have seen enough there without seeing anything resembling apologetics for quackery that this surprised me when I saw it. Clearly, Weintraub is not familiar with the language of “complementary and alternative medicine” (CAM) or “integrative” medicine. She should have been. A naturopath with an MPH degree as well, Greenlee is a rising star in the world of integrative medicine. She was even the first author on the Society for Integrative Oncology’s guidelines for the “complementary” treatment of breast cancer. Heather Greenlee dishes it up in abundance, which makes this interview a suitable topic for me.
For generations, people with cancer were treated solely for their tumor — not for the pain and other symptoms that came with it. So patients quietly turned to alternative and complementary therapies, outside the halls of medicine.
Now, researchers like Heather Greenlee, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, are trying to bring those two approaches into harmony.
Ah, harmony? The “integration” of the best of both worlds, of “Eastern” medicine and “Western” medicine, of hardcore science and touchy feely needs of the patient, of science-based medicine and quackery. Oh, wait. Greenlee didn’t say that. It’s what she meant, though, whether she realizes it or not or whether she’d ever admit it or not. Of course, practitioners like Greenlee are true believers Also note the narrative: That nasty, cold, unfeeling “Western” medicine doesn’t care about the “whole person” and therefore doesn’t treat the whole person. To those nasty, white coated reductionist doctors in their ivory towers, patients aren’t people; they’re just diseases that need to be cured. Cancer patients are just tumors, and as long as the tumor is shrinking doctors don’t care about anything else. At least, so goes the “integrative medicine” narrative, and Greenlee is laying it down perfectly. The reason that the narrative resonates is that there is a grain of truth there. Certainly the system can be impersonal at times, and, as is the case with any profession, there are sometimes doctors who are not very caring. However, the narrative peddled by integrative medicine is just what Greenlee is peddling: That cancer doctors never cared much about their patients; they just treated their cancer.
It’s a narrative that is pure bullshit that takes a small core of truth and ladles on the nonsense. It takes one bad experience or a handful of experiences and generalizes it:
What inspired you to go into this area of research?
My stepfather was diagnosed with a brain tumor when I was pretty young. I quickly saw where the medical system failed him. Seeing how our whole family really suffered through that, I thought there was a lot of room for improvement.
Again, no one is denying that the medical system has problems, that it’s imperfect. However, the answer to those imperfections is not to compromise the scientific basis of medicine by integrating quackery with it. Just because modern medicine might not always be as caring as patients would like it to be does not mean that the solution to this coldness is to embrace warm quackery.
Then, of course, there is the rebranding:
Are there things cancer patients can do that might reduce their risk of a recurrence?
We’re testing a plant-based diet — increasing fruits and vegetables and decreasing fat, red and processed meats, sugars, processed, refined foods. One of our chefs says she’s teaching people to cook like their grandmothers.
Do you eat this way yourself?
I try! It’s better for cardiovascular disease and diabetes prevention. Also, I just feel better.
One more time, there is nothing “integrative” about any of these. All of these dietary interventions are potentially science-based measures. Of course, although there is evidence supporting that certain diets can decrease the risk of developing specific cancers. In contrast, the evidence that diet can decrease the risk of recurrence after successful initial treatment for cancer. It’s worth studying whether diet can do that, but, again, there’s nothing “alternative” or “integrative” about such studies. They’re just science and medicine. That’s why practitioners like Greenlee co-opt and rebrand interventions like diet and exercise as integrative medicine when they are just medicine, or at least potentially medicine if they work.
Indeed, here’s the problem with integrative medicine. Actually it’s just one of many. Arguably, associating such interventions with quackery like acupuncture, energy medicine, and the other pseudoscience that integrative medicine integrates with medicine does advocates of diet as promoting health and preventing disease no favors. As a marketing ploy, lumping diet and exercise together with the other quackery is a coup, because the fact that these modalities are lumped together allows the plausibility and potential efficacy of science-based diet and lifestyle interventions rub off on the quackery. The flip side of that is that the quackery also taints diet and lifestyle interventions, which have, unfortunately, in integrative medicine become the bailiwick of quacks.
Along with this:
What are the most effective complementary therapies?
There’s a lot of strong evidence on the use of mind-body therapies for things like stress management, anxiety, depression. And there’s a growing body of evidence on acupuncture for pain management.
As I’ve discussed before, “mind-body” is a term that’s so vague, so undefined, as to be almost meaningless. Heck, these days the NCCIH basically calls everything that isn’t herbal medicine “mind-body” interventions. I’ve discussed on more occasions than I can remember why acupuncture is quackery, nothing more than a theatrical placebo, a description used by David Colquhoun and Steve Novella that I wish I had thought of. Yet integrative medicine sure does love it some acupuncture, and the rest of traditional Chinese medicine, even though it’s based on a vitalistic, prescientific belief system about how the human body works.
Here’s a part that I found particularly telling:
How do you personally hope to change integrative medicine?
Historically, integrative therapies have been only available to people who were wealthy. If these are really beneficial therapies that have low toxicity, we want to get them to everybody.
Yes, integrative medical specialists are evangelists, but they never seem to ask themselves why such “therapies” were only available to the well-off. That’s because many of them were expensive, but, more importantly, most of them weren’t covered by health insurance. The reason, of course, is that most of these modalities have little or no evidence that they work, and some even have evidence that they don’t work. As I like to say, to paraphrase a famous aphorism, there are three kinds of medicine: Medicine that’s been scientifically demonstrated to work, medicine that has not been demonstrated to work, and medicine that’s been demonstrated not to work. Alternative medicine that’s being “integrated” into integrative medicine largely falls into the latter two categories. Again, there’s no need for a separate category. Alternative medicine that is scientifically demonstrated to work ceases to be “alternative” and become just medicine, no need for any additional qualifier like “integrative.” I’ll give Greenlee credit for recognizing that there’s a lot of quackery out there, but just like Barrie Cassileth, she seems unable to recognize that a lot of similar quackery.
Basically, Heather Greenlee laid down a whole lot of integrative medicine propaganda. I’ve heard it all before, as have regular readers of this blog. Apparently Weintraub didn’t, because she fell for it, hook, line, and sinker.