I’ve been writing about this topic so long—ever since the very beginning of this blog—that it seems as though I’ve always been doing it even though this blog has been in existence only 11 years and I didn’t really come to appreciate the problem until after I had started this blog. No, I’m not referring to the antivaccine movement, which is another longstanding concern of mine. This time, I’m referring to what I like to refer to as “quackademic medicine,” defined as the infiltration of unscientific and pseudoscientific medicine into medical academia. Indeed, there was a time when I tried to keep track of all the once proud bastions of medical science that had descended into “integrating” the rankest quackery with their real medicine. At the time, I referred to my list as my “Academic Woo Aggregator.” Unfortunately, the number of academic institutions became too large and the variety of quackery too unwieldy for me to keep up with. The Academic Woo Aggregator rapidly fell hopelessly out of date. I gave up.
Still, I haven’t given up so much that I don’t take notice when major new members forsake science and adopt quackery, and unfortunately that’s exactly what’s happened at the Dana Farber Cancer Institute and Children’s Hospital of Philadelphia (CHOP). (Yes, CHOP is the home institution of Paul Offit, and I suspect he didn’t take this lying down.) I learned of the shame of two institutions through two articles, one about Dana Farber (Easing a patient’s pain — even without proof it works) and one about CHOP (After rejecting alternative medicine, CHOP gives acupuncture a shot). Even the titles are annoying.
Let’s start with CHOP, because CHOP teaches a lesson. “Integrative medicine” is relentless. In a way, it’s like naturopaths seeking licensure. Every time their lobbying efforts fail, they come back again. And again. And again. They do not give up until they get what they want. So it is with quackademic medicine. CHOP was hostile to unscientific medicine:
In the past, alternative options were not welcome at Children’s Hospital. The institution removed most dietary supplements from its list of approved medications in 2013 because it could not guarantee their safety and effectiveness.
Paul Offit, chief of infectious diseases, said the hospital’s stance on supplements would remain unchanged.
Children’s Hospital of Philadelphia will offer acupuncture to all of its patients beginning in July, joining a growing number of pediatric medical centers providing alternative therapies.
The hospital plans to add other unconventional options, including therapeutic massage and aromatherapy, in the next year, said Maria R. Mascarenhas, medical director of the new Integrative Health Program.
“Our patients and families have been asking for it and seeking these therapies outside of CHOP,” said Mascarenhas. “It’s important for us to offer those services by providers who are up to CHOP’s standards.”
This is the same excuse quackademic programs always use, that they’ll somehow elevate the quackery, use it in an “evidence-based” manner, bring science to bear on it. The other claim is that they offer it because patients want it. My response to that is that patients often want a lot of things, but we’re under no obligation to give it to them if it’s unproven and not science-based. Unfortunately, the leaders of academic medicine don’t seem to see it that way any more. They’ll offer anything now: Acupuncture, traditional Chinese medicine, supplements, and worse. This program at CHOP is very modest at the moment. However, once pseudoscience gains a foothold in a medical institution, once an academic medical center gives itself over to quackademic medicine in the form of “complementary and alternative medicine” (CAM) or, the preferred term now, “integrative medicine,” it never goes back. Integrative medicine is like the Dark Side of the Force that way.
Meanwhile, Dr. Mascarenhas spews the same old nonsense about acupuncture as she justifies using it on children:
There is evidence that acupuncture works – specifically for pain. A 2012 analysis of dozens of randomized controlled trials concluded it effectively relieves some types of chronic pain.
“We don’t fully understand how it works,” said Mascarenhas, “but it’s therapy that lets the body naturally reduce pain and improve functioning.”
Children will have to be old enough to understand what the acupuncturist is doing.
“You need a cooperative patient,” Mascarenhas said. “You don’t want them moving during the therapy session.”
Dr. Mascarenhas is, without a doubt, referring to the 2012 meta-analysis by Andrew Vickers, which did not actually show that acupuncture has any clinically meaningful effect on chronic pain. None of this stops her from parroting the same old meaningless tropes about how acupuncture is “natural” and just works.
One wonders if she’s even considered the ethics of using acupuncture on children. The ethics of offering unproven treatments—and most integrative medicine practitioners will admit that a lot of their treatments are unproven—to adults outside of the context of a clinical trial. However, administering unproven treatments to children is definitely problematic from an ethical standpoint, if not downright unethical. None of this seems to stop “integrative medicine” practitioners like Dr. Mascarenhas from forging boldly forward integrating quackery with real medicine without concern for such niceties. It’s also depressing that this could happen at the institution where Dr. Offit is faculty. I’d be shocked if he didn’t fight this tooth and nail; indeed, you can tell from his quotes in this story that he’s probably holding back because it’s never a good idea to outright badmouth your employer in a news story.
If acupuncture and a little woo are where CHOP is now, take a look at Dana Farber to see where CHOP could be in a few years:
Massage therapist Maria Barbara “Bambi’’ Mathay roamed the pediatric clinic at Dana-Farber Cancer Institute, looking for takers. It wasn’t long before she spotted Carlie Gonzalez, 15, wrapped in a yellow blanket and weary from seven months of chemotherapy.
Carlie was playing freshman volleyball at Milford High School last fall when an ache in her collarbone became intolerable. A CT scan revealed an aggressive bone cancer that required surgery and potent anticancer drugs that make Carlie nauseated.
As the liquid dripped into her arm, Carlie rolled up a pant leg for a session of foot reflexology. “It kind of takes your mind off your stomach,’’ she said. While Mathay gently pressed on her toes, Carlie sleepily closed her eyes.
Dana-Farber is embarking on its largest expansion yet of unconventional therapies. Over the past year, it has taken the unusual step of offering reiki, an ancient Asian technique, and foot reflexology free of charge to adults and children — as well as acupuncture to adults — in its outpatient infusion clinics during chemotherapy treatments.
I hate this “bait and switch.” Notice how it’s a massage therapist mentioned first. As I’ve said before many times, I don’t mind massage being offered to patients because in general it just feels good and is highly unlikely to cause harm. What I don’t like is how it’s gone from being “massage” to “massage therapy,” with claims of efficacy for various conditions that are often not well supported by science. What’s even worse, though, is how reflexology is represented as being just massage therapy. Yes, reflexology is a foot and hand massage, but the idea behind it is pure pseudoscientific quackery. Basically, in reflexology, the idea is that various organs map to various areas on the soles of the feet and palms of the hands. Through these “pathways,” reflexologists claim to be able to diagnose and treat disease through feeling the hands and feet. It’s pure rubbish.
And it’s being offered at the Dana Farber Cancer Institute, one of the most respected cancer centers in the US, if not the world. Quackademic medicine reigns supreme.
It’s worse than that, though:
The hospital soon will start a nearly $2 million project to convert the first floor of one of its buildings into a new center for “integrative therapies,’’ which eventually could double the number of patients it can accommodate. More than 3,000 patients scheduled appointments for acupuncture and massage last year, a 25 percent jump over 2014.
A growing body of research supports acupuncture as a treatment for pain and nausea in oncology patients, but few high-quality studies exist on the effectiveness of reflexology and reiki.
The investment by Dana-Farber, a leading cancer treatment center, underscores a growing willingness among mainstream medical institutions nationally to offer complementary therapies that appear to help patients — even without definitive proof.
Yes, Dana Farber is wasting $2 million to offer fairy dust to its patients. Reflexology relies on “pathways” between organs and the soles of the feet and palms of the hands that don’t exist, but reiki takes that one step beyond. (Apologies to Madness.) Basically, reiki masters claim the existence of a “universal source” of energy that they can channel through themselves into patients for healing effect. I know I make this analogy fairly frequently, but I don’t think it can be emphasized enough. Consider what we would call reiki if you substitute the word “God” for “universal source”—which you might as well do because what else do you call a blob of energy with a life of its own? You’d call it faith healing. Just as faith healers claim to be able to channel the healing power of God through themselves and into patients, reiki practitioners claim to be able to channel the healing power from the universal source into patients. The only difference, conceptually, between reiki and faith healing is that the former invokes Eastern mystical religious beliefs and the latter invokes Judeo-Christian religious beliefs. Reiki goes faith healing one step beyond, though. (Apologies to Madness again.) It provides healing over a distance and even healing backward and forward in time. It’s not “ancient,” either. Reiki was invented in the 1920s in Japan.
Unfortunately, reiki is everywhere in hospitals.
I like how the article describes reiki and other “energy therapies” as “controversial”:
The technique is controversial, however. MD Anderson Cancer Center in Houston decided against providing reiki or other so-called “energy therapies’’ because of lack of convincing evidence. In one small study published five years ago in the journal Cancer, researchers found little overall difference in depression and anxiety levels for men with prostate cancer who underwent either reiki, “relaxation response therapy,’’ or were put on a wait list — though reiki seemed to have some benefit for men who were anxious to begin with.
“We can’t say it’s any more than placebo at this stage,’’ said Lorenzo Cohen, director of integrative medicine at MD Anderson. “Patients report feeling better after a session of reiki. Would they feel better just sitting and speaking with an empathic person? They probably would.’’
Ligibel said more research is needed to sort this out. “I struggle with the mechanism of a lot of these therapies, but I’ve seen them work for people,’’ she said.
Dr. Jennifer Ligibel, by the way, is the director of the Leonard P. Zakim Center for Integrative Therapies and a breast oncologist, in other words, one of my people who turned to the Dark Side. Seriously, though. Even M.D. Anderson has stopped offering reiki because it’s too ridiculous. I learned this after I published an article on integrative oncology that mentioned M.D. Anderson as having a reiki program, which it actually did. However, my information was old. So I got an indignant letter pointing out how M.D. Anderson doesn’t offer reiki any more, to which my response was basically, “Great. Glad to hear it. But what about all that other pseudoscientific ‘integrative’ medicine you offer?”
As for Cohen’s remark about how patients would probably feel better just sitting and speaking with an empathetic person, I can’t help but suggest to Dr. Ligibel that perhaps she should can the reiki and hire some counselors. Of course, that would cost money, and Dana-Farber is training volunteers to administer reiki. One wonders why its administration won’t pony up some green to hire some actual professionals.
I kid, I kid.
I do find it interesting that this article, too, mentions a study, this time describing it thusly:
There is broader agreement on the benefits of acupuncture, which involves inserting thin needles into the skin at strategic points on the body. Traditional Chinese medicine holds that it balances energy flow, while Western practitioners believe it stimulates nerves, perhaps releasing natural painkillers. Memorial Sloan-Kettering Cancer Center researchers reviewed results of clinical trials involving 17,922 patients and found, on average, that acupuncture reduced chronic pain by more than 50 percent. That compared to 42 percent for “sham acupuncture’’ and 30 percent for no acupuncture.
Yep, it’s the Vickers meta-analysis again. And I say again, the Vickers meta-analysis is not good evidence supporting the efficacy of acupuncture. It is rather interesting how this is the go-to article quackademics always seem to refer to to argue that acupuncture works. It just goes to show how thin the evidence for acupuncture is.
Stories like this always depress the hell out of me. Here are two bastions of science-based medicine; yet there are faculty who work there who are so eagerly throw away science in order to embrace magic, mysticism, and faith healing in order to exchange the scientific for the pre-scientific or pseudoscientific. Unfortunately, they are a microcosm of what is happening all over medical academia, from medical schools to academic medical centers. Quackademia marches on, relentlessly apparently. I fear that if I were to try to recreate the Academic Woo Aggregator in 2016 it would be a book—and not a thin one.