The “big idea” behind integrative medicine is not so big at all…

I’ve frequently referred to “integrative medicine” as the “integration” of quackery with conventional, science-based medicine for the very good reason that that’s what it really is. However, advocates of medicine not based in science are nothing if not masters of marketing, which is how, over the course of three decades or so, “alternative medicine” morphed into “complementary and alternative medicine” (CAM), which ultimately morphed into its most recent incarnation, “integrative medicine.” The term “integrative medicine” is fantastic from a marketing perspective because it implies (and is marketed as) the “best of both worlds,” the “best” of science-based medicine and alternative medicine. Of course, as Mark Crislip once put it, integrating cow pie with apple pie does not make the apple pie better, and integrating the cow pie of pseudoscience and quackery that makes up so much of the “alternative” part of “complementary and alternative medicine” does not make the apple pie of science-based medicine better, nor does it validate the quackery.

The key deception at the heart of integrative medicine, however, is based on a claim that I find particularly galling. Specifically, we are told, time and time again, that in order to be a truly caring, “holistic” doctor, integrative medicine is the way to go. In other words, to be a “holistic doctor,” you must embrace quackery. Another aspect of “integrative medicine” that similarly irritates me is its appropriation of several science-based medical modalities, such as nutrition and lifestyle changes, as somehow being “integrative” rather than just good medicine. None of this is anything I haven’t said on numerous occasions over the last nearly dozen years that I’ve been blogging, but I was reminded of it yesterday when I saw as near-perfect example of CAM apologia as I’ve ever seen in—where else?—The Huffington Post. It’s by someone I had never heard of before, Alan Briskin, someone whose posts at HuffPo don’t really include anything about medicine. He did author a book, The Power of Collective Wisdom & the Trap of Collective Folly. However he learned it, though, Briskin is clearly expert at trotting out the tropes commonly used to justify integrating quackery with medicine, and he does so with gusto in his HuffPo post The Big Idea Behind Integrative Medicine. Of course, the idea isn’t nearly as big as he thinks it is, as you will see.

First, on his own blog, Briskin explains what his purpose was in writing this bit of dreck:

My new Huffington Post piece explores the emerging field of integrative medicine. I have been involved in the medical field as far back as 1972 when I did an internship at the Berkeley Free Clinic. It’s where I first began to understand how optimal health is a joining together of the individual body-mind-spirit with the pro-social behaviors necessary for thriving in community. And care providers can play a critical role at the intersection of these two domains.

There are no clear boundaries regarding what is meant by integrative medicine although terms like integrated care, complementary medicine, and alternative medicine have been used interchangeably for decades, sometimes meaning very different things.

This post is meant to start a conversation and bring into awareness an emergent philosophy of care that is something of a new species.

OK, now I know how Briskin got to where he is. Now let’s see how she characterizes integrative medicine. You know how my good bud Kimball Atwood used to do a regular series that he called the “Weekly Waluation of the Weasel Words of Woo.” Briskin’s post is a prime example, and it starts right in the first paragraph:

Integrative medicine is an ecosystem of support for pursuing your own health and well-being. Inside that ecosystem is someone who cares about you. Integrative medicine is emerging from a successful history of treating physical ailments that often eluded Western modalities of care to become an ecosystem of support for health and wellness. Possibly the most visible sign of this development is the increasing attention of integrative medicine to primary care, where prevention and regard for the whole person is most critical.

WTF? Isn’t this a bit repetitive? Integrative medicine is an “ecosystem of support for pursuing your own health and well-being” and that it’s emerging from a “successful history of treating physical ailments that often eluded Western modalities of care to become an ecosystem of support for health and wellness”? What does this even mean? An “ecosystem of support for pursuing your own health and well-being”? It sounds all science-y but in reality it’s a meaningless set of buzzwords. Unfortunately, Briskin doesn’t get any better from there. Here’s what I mean:

What distinguishes integrative medicine as an approach is that it distances itself from the traditional model of a patient dependent on an expert. Rather, it embraces a genuine clinical partnership in which both the patient and the care provider have something to offer in pursuit of the patient’s optimal health. The care provider embodies not only clinical knowledge, which is the result of his or her training, but also qualities not always associated with experts. These include curiosity, emotional support, collaboration, humor, and the ability to articulate options and alternatives without judgment. Patients are participants as well, offering knowledge of what has worked for them in the past, providing information that can’t be quantified on a medical report, and finding meaning and purpose in their response to the challenges faced when confronted by illness.

OK, this is complete and total bullshit. Yes, forging a “genuine partnership in which both the patient and the care provider have something to offer in pursuit of the patient’s optimal health” is a good thing. No, you don’t have to embrace pseudoscience and quackery in order to forge that partnership. Let’s not forget what “integrative medicine” integrates into medicine: Prescientific belief systems like traditional Chinese medicine; naturopathy, which, remember, includes The One Quackery To Rule Them All (homeopathy) as an integral part of its knowledge base and treatments, and, of course, a whole lot of pseudoscience. Let’s also not forget that curiosity, emotional support, collaboration, humor, and the ability to articulate options and alternatives without judgment do not require the embrace of quackery. They just don’t.

Of course, that is not the narrative apologists for CAM/”integrative medicine” want you to believe. To them, it is not possible to be humanistic” and “holistic” if you don’t buy into their world view and their pseudoscience. In fact, Briskin makes that pretty explicit:

I am reminded of the support that the poet W.H. Auden gave Dr. Oliver Sacks when he was composing Awakenings, a book about his work with a group of patients who had been in a decades-long sleep and were now coming back to consciousness. Auden wrote: “You’re going to have to go beyond the clinical. … Be metaphorical, be mystical, be whatever you need.” I find here the implication that it is our deep regard for the human condition that moves us beyond the complacent and routine. It is in our profound respect for service to others that we touch mystery and wholeness. At the heart of integrative medicine is a bold invitation to go beyond the clinical, into regions that capture our hearts and imagination. Caring is fundamental. Nothing else really matters without love as an organizing principle. Or as one patient I know told her physician, “I just want someone who gives a damn.”

Here we go again. Once again, it is quite possible—nay, mandatory!—to care for patients and, just as importantly, show them that you care for them without selling them lies. I realize that integrative medicine practitioners would object strongly to that characterization, but my response to that would be to tell them to get real and join the reality-based community. If you are telling patients that reiki works, you are selling patients lies. If you are telling them that traditional Chinese medicine is anything more than a prescientific belief system, the vast majority of which is without scientific support or medical benefit, you are selling patients lies. If you co-opt recommendations to eat good food and avoid bad food as somehow “alternative” or “integrative” rather than just good, old-fashioned science-based medicine, you are selling patients lies. If you co-opt the latest findings in neuroscience to support mystical ideas about human consciousness, you are selling patients lies.

If you claim that integrative medicine is some sort of awesomely “big idea,” rather than the latest evolution of a strategy to make pseudoscience and quackery acceptable medicine, you are selling patients lies.

Here are a few of the lies about integrative medicine that Briskin is selling, whether he realizes they’re lies or not:

It cares for the whole person by addressing mind, body, and spirit as three interacting elements that together result in health and well-being.

Integrative medicine might say that it cares for the “whole person” and addresses “mind, body, and spirit,” but what it really does is to claim that you need to integrate pseudoscience into medicine to accomplish this end.

It treats nutrition — what we put in our body — as medicine. Beyond diets and supplements is an understanding of what helps our body to feel vital and how best to decrease the effects of toxins.

I’m sorry, but food is not medicine, no matter how much integrative medicine apologists try to convince people that it is. Moreover, the body is more than capable of eliminating “toxins” by itself, thanks to its kidneys and liver. The obsessive belief that all diseases are caused by unnamed (and often fantastical) “toxins” is pseudoscience patients don’t need. “Detoxification,” which is much beloved of “integrative medicine” specialists, is a sham. It’s rarely needed and almost never the cause of all the diseases that integrative medicine specialists try to pin on “toxins.”

And, the biggest lie of all:

It creates a true partnership that joins the best of Western medicine with ancient healing traditions and complementary modalities. The guiding intent is to restore harmony and address imbalances that detract from optimal health.

No, no, no, no. There is no “Western” or “Eastern” medicine. There is no “alternative” medicine. There are only medicine that has been scientifically demonstrated to work, medicine that has not been scientifically shown to work, and medicine that has been scientifically demonstrated not to work. Alternative medicine, the sort that people like Briskin want to “integrate” into real medicine, almost always falls into one of the latter two categories.

Alan Briskin thinks that all of this is the “big idea” behind the concept that is integrative medicine. Unfortunately, the idea is not nearly as big as he thinks it is. Rather, it’s the distillation of a bunch of warmed-over tropes and “weasel words of woo” that we’ve all heard many, many times before. They don’t impress coming from Briskin any more than they impress coming from Andrew Weil or any number of other apologists for the integration of quackery into medicine.