Quackademic medicine marches on, Stanford edition

One of the most pernicious changes in medicine that’s occurred over the last 25 years or so is the infiltration of what I like to refer to as “quackademic medicine.” It’s a term that was, as far as I know, coined by Dr. Robert W. Donnell in 2009 to describe the infiltration of pseudoscience and quackery into medical schools and academic medical centers under the mantle of “complementary and alternative medicine” (CAM), now more commonly referred to as “integrative medicine. However, over the years, I’ve embraced the term to describe the “integration” of quackery and pseudoscience into academic medicine, or, as Mark Crislip likes to put it, the “integration” of cow pie with apple pie. Unfortunately, over the last quarter century or so, quackademic medicine has invaded seemingly respectable bastions of academic medicine, such as traditional Chinese medicine, functional medicine quackery, and reiki at the Cleveland Clinic; a whole panoply of woo including naturopathy, functional medicine, and high dose vitamin C for cancer at the University of Kansas; “integrating” quackery to the point of teaching acupuncture points in gross anatomy class at Georgetown University; the embrace of naturopathy at more academic medical centers than I can count; and even homeopathy at Yale, courtesy of Dr. David Katz. It’s gotten so bad that there are even “integrative oncology” guidelines and “integrative oncology” has been featured at the yearly meeting of the American Society of Clinical Oncology (ASCO). Even institutions with champions of science-based medicine have fallen, such as when acupuncture was adopted by Children’s Hospital of Philadelphia, which is where Dr. Paul Offit is based.

Latest on the list (well not latest on the list but latest in the news) is Stanford University, which recently held a panel discussion on integrative medicine at its Medicine X Conference last weekend, a conference that Stanford describes as “our signature day of moonshot thinking and big idea inspiration.” As part of that conference, Stanford hosted a panel on integrative medicine, which was duly reported on its blog:

Ten years ago, Sangeeta Agarawal was a busy software engineer in Silicon Valley. Her lifestyle led to professional success, but eventually work-related stress began to take a toll on her health and she was diagnosed with a series of chronic health problems. She was able to maintain a facade of “being okay” on the outside, but Agarawal said she was “in pieces” on the inside. When her physician brought up the possibility of spinal surgery, she knew that something had to change — and a referral for physical therapy from her physician led her to yoga, ayurveda and eventually her life’s path. “Within a few years, I was a nurse. I was an ayurveda practitioner. I was a yoga teacher. I started to collect these credentials… and that was when I realized it was all about treating the whole person,” she said.

The founder of health startup Helpsy, Agawaral spoke as part of Sunday’s panel at Medicine X on integrative medicine’s role in treating chronic health conditions.

I took a look at the Helpsy website. The splash page portrays a woman, her hands raised, looking out over a beautiful hilly countryside. What is it about “integrative medicine” that it always—and I mean always—features images like this. Another favorite is someone, usually a woman, in a yoga pose in a beautiful natural setting, looking blissful. Be that as it may, here we note the usual tropes used to justify integrating quackery into medicine. As for Helpsy itself, it might have been a good idea if it didn’t integrate alternative medicine quackery, which basically fatally undermines the whole concept:

She [Sangeeta Agarawal] found her home in two key terms Quality of Life and Integrative Medicine. As she found ways to empower herself to be healthy and happy, she decided to devote her life to empowering everyone to living their best quality of life. She studied integrative medicine by studying, practicing and conducting research in both eastern and western medicine. She spent the next decade as a researcher, oncology nurse and integrative medicine practitioner at institutions including the Mayo Clinic, Stanford Cancer Center, and UCSF Cancer Center serving the community. She still found that most people continued to struggle with health and quality of life issues and access to such solutions was limited. Inspired to create a solution that can be accessible to all, Sangeeta created Helpsy, a platform that brings together health care experts from all evidence based health care modalities, researchers and health care centers to combine their efforts together to offer an all-in-one interdisciplinary health solution to treat all aspects of health. Our solution is ready to help everyone live their life to the fullest.

Prominently mentioned among the health care experts that Helpsy helps patients find are acupuncturists and chiropractors, for which it markets various services, including a Helpsy profile, management of online practice, and enhancement of online presence. Basically, Helpsy appears to be a marketing company for quacks.

Next up:

The 45-minute panel featured a lively and wide-ranging discussion, with all panelists acknowledging integrative medicine’s potential to help those struggling with chronic health conditions. But what exactly does integrative medicine mean? Victoria Maizes, MD, executive director of the Arizona Center for Integrative Medicine, clarified that it isn’t alternative medicine — but rather an approach that integrates complementary modalities with mainstream medicine. “We really respect Western conventional medicine,” she explained.

Maizes also stressed that integrative medicine is about more than just tapping into ancient traditions like acupuncture, ayurveda and yoga — that it’s also very much about moving into the future. “Which means we think a lot about genomics. We think a lot about the microbiome… It’s really integrating cutting edge science as well.”

Actually, it’s about tooth fairy science. Basically, tooth fairy science is the scientific investigation of an implausible phenomenon that has not yet been shown to be a real phenomenon, using the tooth fairy as the analogy. As Harriet Hall puts it:

You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.*

So much of what quackademic medical centers embrace and investigate is tooth fairy science: acupuncture, traditional Chinese medicine, naturopathy, functional medicine, homeopathy, reflexology, and so much more. When, for instance, scientists apply advanced genomics to these modalities, you get what I like to call “woo-omics,” something that the National Center for Complementary and Integrative Medicine (NCCIH) promoted and continues to promote. It’s basically a waste of sophisticated scientific tools to study phenomena that have not even been shown to exist. That’s why I actually laughed out loud when I saw this quote by Dr. Jeffrey White, an oncologist who used to be the Director of the Office of Cancer Complementary and Alternative Medicine (OCCAM) at the National Cancer Institute (NCI) for several years, who said, ““Ideally integrative medicine ought to be based on as high level of evidence as mainstream medicine.” Well, yes, as a concept that sounds all very well and good, but the statement is very, very problematic. The reason is that so much of “integrative medicine” is based on concepts that are either prescientific, pseudoscientific, or downright antiscientific. Modalities like acupuncture, homeopathy, reiki, and the like are so implausible on a basic science basis that clinical trials of them tend to be clinical trials of placebo versus placebo and “cutting edge science” to study their mechanisms are a form of scientific pareidolia, where scientists see what they want to see in random patterns seen in noise in their data.

Last up is Dr. David Spiegel, medical director of the Center for Integrative Medicine, who recaps the same sort of arguments he’s been using for a while now, portraying integrative medicine as being all about “empowering the patient.” My common response to this is simple. You don’t have to embrace pseudoscience and quackery in order to “empower” the patient and make him feel “more involved, more in control and responsible for their own health care.” It’s the false dichotomy at the heart of “integrative medicine.” That doesn’t stop Dr. Spiegel:

Stanford psychiatrist David Spiegel, MD, medical director of the Center for Integrative Medicine, brought up the fact that the desire for more integrative medicine is being driven by patients: “This isn’t a profession-driven movement. It’s a person-driven movement.” He told the audience that patients “don’t go to an acupuncturist for a heart attack. They go for chronic pain, stress and other things we have not dealt with well in mainstream medicine.” He also spoke about the importance of integrative medicine in treating the mental-health issues that often come along with chronic health conditions; it can provide “help with coping with the disease, not just help with the symptoms.” In fact, he explained, for this reason “integrative medicine becomes the default referral from oncology.”

Methinks Dr. Spiegel inadvertently admitted something. He’s absolutely correct about that one thing: Integrative medicine didn’t become popular because scientists and physicians cried out for it, because there was some sort of compelling science telling us that we in the medical profession really needed to start investigating this. As I’ve said many times, NCCIH was not formed because the physicians and scientists running the NIH demanded it. It was formed because Senator Tom Harkin, who believed that bee pollen cured his allergies and was interested in a lot of quackery, used his power to bring it into existence. Similarly, the adoption of integrative medicine by academic medical centers appears to be motivated far less by genuine scientific curiosity over a phenomenon compelling enough to draw scientists in to investigate than by marketing considerations.

Particularly chilling and irresponsible to me is Dr. Spiegel’s statement that “integrative medicine becomes the default referral for oncology. My reaction to that statement was: WTF? Is he serious? Sending patients to practitioners who “integrate” pseudoscience and quackery with real medicine becomes the “default” referral? Again, the false dichotomy at the heart of integrative medicine has eaten someone’s brain. It is not necessary to embrace quackery to provide “holistic” care to patients, and if medicine isn’t doing so well dealing with a condition or symptom, the answer is not to “integrate” magic like acupuncture into the patient’s treatment. It is to use science-based medicine to find ways to do better. It is to fix whatever systemic problems that lead to patients having trouble accessing care to find relief. Integrative medicine is a feel good delusion that lets eminent doctors like Dr. Spiegel feel good and believe they are doing something.

Let me remind you what Dr. Spiegel’s department offers at Stanford:

We provide an hour-long evaluation and counseling program to help patients match integrative medicine offerings with individual needs. This involves assessing medical problems, coping resources, family and social support, and evaluating patient goals, abilities, and opportunities.

We help patients evaluate available non-traditional treatment options. We help patients to combine “alternative” techniques, including acupuncture, hypnosis, mindfulness, and information regarding dietary supplements, with traditional medical care.

Our evaluation and counseling staff includes a physician-naturopath, an internal medicine/psychiatrist, and a psychiatrist.

Yes, everyone is evaluated by a naturopath at Stanford’s integrative medicine program. In fact, Stanford is a little bit sneaky about describing naturopath. I went perusing the list of its personnel for naturopaths by looking for an ND after names. I didn’t find any. But I did find Brian Karvelas, MD, who, it is noted, “did his internship at Santa Clara Valley Medical Center, and his residency in Physical Medicine and Rehabilitation at Stanford. He received a doctorate in Naturopathic Medicine from John Bastyr University, and graduated from the San Francisco College of Acupuncture and Oriental Medicine.” So why doesn’t he list himself as MD-ND? Does he feel ashamed of his ND? Maybe he is ashamed to use it at Stanford, because he uses it when providing a promotional blurb for a book. He should. No physician should ever become a naturopath, because naturopathy is a cornucopia of quackery that includes homeopathy as one of its core systems of medicine.

When I first saw the article describing the panel at Medicine X this weekend, I almost didn’t bother to blog about it. Universities and academic medical centers integrating quackery into medicine have become so numerous that such panels hardly register with me any more. However, Stanford is a big name in medicine, and to see it promoting integrative medicine at its own conference was noteworthy enough that I decided I couldn’t ignore it, no matter how much each new example of quackademic medicine depresses me.