The Society for Integrative Oncology (SIO) doesn’t like me much. I understand. I haven’t exactly been supportive of the group’s mission or activities. So it wasn’t surprising that SIO wrote letters trying to rebut a Perspectives article on “integrative oncology” that I published in Nature Reviews Cancer two years ago. What depressed me about that encounter was that one of the complaints the SIO had about my article was that it spent too much verbiage discussing homeopathy as one pseudoscientific treatment that “integrative” oncology “integrates” with science-based medicine and no one uses homeopathy. This led me to point out in my response that the SIO includes naturopaths as prominent members, including as co-authors of its guidelines for breast cancer supportive care. It also led me to point out that you can’t have naturopathy without homeopathy because naturopathy schools teach homeopathy, which makes up a prominent section of the NPLEX, the test naturopaths have to take to be licensed in states that license them. It further depressed me that apparently the doctors in the SIO who responded to my article didn’t realize that one of the naturopaths who was a co-author of the breast cancer guidelines was at the time actually running a clinical trial of homeopathy.
That incident, more than any other, convinced me that most “integrative medicine” MDs, even prominent ones and particularly ones who work with naturopaths, have no clue about the level of pseudoscience and quackery that they’ve embraced. No clue at all. They realize at some level that homeopathy is complete and utter quackery, with no basis in science, which is why they reacted so badly to my discussion of homeopathy. (Ironically, the homeopathy discussion in the first submission of the paper was much shorter, but I was forced to expand it because of comments from one of the peer reviewers.) However, they do not realize that all naturopaths are trained in homeopathy, most naturopaths use it, and that naturopaths used many treatments equally quacky. It’s not just naturopathy, either. Integrative medicine MDs have the same blind spot for traditional Chinese medicine (TCM), which they fail to recognize as a prescientific medical system based on religious and mystical beliefs that was in essence created by Chairman Mao through the “integration” of many Chinese folk medicine traditions because at the time Mao couldn’t bring science-based medicine to enough of his people.
I relate that story not because this post is about naturopathy or TCM, but rather to set the stage for a point that I want to make, illustrating it with the Chief of the Integrative Medicine Service at one of the most prestigious cancer centers in the world, Memorial Sloan-Kettering Cancer Center (MSKCC). On its website, there is an interview with Dr. Jun Mao, who is the Chief of the Integrative Medicine Service. It’s an interview chock full of the sorts of fallacies and what Kimball Atwood used to call the “weasel words of woo” that have facilitated the infiltration of pseudoscience and quackery into halls of medical academia as hallowed as those of MSKCC.
The first question was simple, basically about whether Dr. Mao always envisioned his career “bridging Eastern and Western medicine.” Of course, I hate the whole “Eastern medicine” construct. I view it as a racist term because it implies that those inscrutable Asians are all “holistic” and “natural,” in contrast to those “Western” (and white) doctors, who are all scientific and reductionist. Be that as it may, here’s Dr. Mao’s response:
I’m always interested in the system as a whole, while paying attention to the parts. If you look at a human being in that way, you can see cancer in the context of the entire body. As I pursued Western medicine training, it felt like some of that was missing —sometimes we focus so much on figuring out the exact parts of the body that we sort of forget the whole.
That led me to turn to Eastern medicine. Being the Chief of Integrative Medicine is my dream job. The goal is really to bring the best of conventional medicine together with therapeutics that originate from other cultures and traditions and apply scientific method to research them and eventually disseminate them into clinical practice. Ultimately, we want to allow cancer patients and their family members to have more tools available to them to deal with the physical, emotional, and spiritual impacts of cancer.
On the surface, this sounds reasonable, but you don’t have to dig too deeply or analyze too hard to see the problems with this view. First:
Seeing the body’s “system as a whole” ≠ TCM.
Think about it. TCM is based on the idea that disease is a result of imbalance in the five elements and various other permutations. For instance, some diseases are due to imbalances between damp and dry, heat and cold, and various other opposites. In its basic concept, TCM resembles ancient “Western” medicine; i.e., the humoral theory of medicine in which disease was thought to be a result of imbalances in the four humors. Also, it does no good to “see the whole system” if the lense through which you see that system is basically a kaleidoscope of pseudoscience that distorts everything you look at. That’s what TCM does as a prescientific medical system.
Dr. Mao goes on:
My research in acupuncture has shown that when used for these women, it can help reduce joint pain, decrease hot flashes and anxiety, and improve sleep. By combining Eastern and Western approaches, we allow them to have the best symptom control, hopefully adhere to their lifesaving drugs, and improve their longevity.
Another way to think about it may be that conventional drugs are more about targeting the disease and integrative medicine focuses more on healing the whole person.
This, I’m afraid, is utter and complete bullshit. There’s just no other accurate way to describe it. Unfortunately, it is the fallacy at the heart of so much rationalization of integrating quackery into medicine by advocates like Dr. Mao. Consider this aspect of TCM. TCM practitioners often use something they call “tongue diagnosis. What this involves is looking at the tongue and making diagnoses. So what’s the problem? After all, doctors look at the tongue all the time and can tell all sorts of things about the patient by doing so. Yes, that is true, but in TCM, tongue diagnosis functions a lot like reflexology, with different parts of the tongue thought to map to different organs and body parts. Also, TCM is based on prescientific vitalism, the idea that there is a “life energy” that flows through the body. After all, that’s what acupuncture is supposed to be affecting, the flow of this “life energy.” Let’s just put it this way. Basing treatment on pseudoscience and prescientific belief systems might be “taking care of the whole patient,” but it isn’t taking care of the whole patient correctly. My retort to this argument is that you don’t have to embrace pseudoscience and quackery to take care of the whole patient.
As for acupuncture, Dr. Mao is just plain wrong. It doesn’t help above placebo for pain, hot flashes, or anything else. It’s not as though I haven’t blogged about some of the very studies that Mao uses to support his belief in acupuncture.
Next up is my favorite: What’s the difference between alternative and integrative medicine? Dr. Mao’s happy to answer:
Unlike alternative medicine, integrative medicine focuses on using research to inform evidence-based practice of complementary therapies. Integrative medicine is also better integrated into patients’ treatment and survivorship care plans to help them adhere to conventional treatments while augmenting their symptom control and improving their quality of life through other means, such as yoga, acupuncture, or meditation.
As President of the Society for Integrative Oncology, I help lead our group to advocate for scientific research to understand both the safety and the efficacy of complementary therapies. There’s a continually emerging body of literature that suggests many of the therapeutics we use, such as massage, acupuncture, meditation, and yoga, have beneficial effects for psychological distress, insomnia, pain, and fatigue. And those are very common in cancer patients.
Alternative medicine often completely operates on empirical experience. In some contexts, there are people who take advantage of that and make unsubstantiated claims that some herbs or substance can cure cancer without scientific proof. And that’s really why integrative medicine tries to separate itself from alternative medicine.
Sigh. Yes, practitioners of “integrative medicine,” especially the ones at quackademic medical centers, take great umbrage if you mention alternative medicine and imply that what they do is in any way like it. They pull themselves up and say something along the lines of, “Oh, no, we don’t do that. We use only evidence-based treatments.” Then they go on about acupuncture, herbs that don’t work, and other aspects of TCM, mixing it with potentially real evidence-based modalities like exercise or massage. It is basically the central message of “integrative medicine,” and unfortunately it’s effective, a large reason why integrative medicine has infiltrated institutions like MSKCC.
It is rather interesting, however, to see what Dr. Mao says about skeptics:
I think skepticism is a healthy thing. Just like for a lot of conventional cancer treatment, there’s always skepticism, and that helps us to push the envelope more. Clinicians are always asking whether a therapy is working or whether it’s safe. I actually don’t think we should have a blind acceptance of everything.
In terms of people being concerned about a placebo effect, it’s a really great question. I am very intrigued and actually studying that.
Think about placebo effect as a mind-body effect: If you actively engage your mind in wanting a specific outcome, you achieve the outcome. I think the way we are answering whether acupuncture or other types of therapies are better than placebo is by trying to understand the mechanisms underlying the pain, depression, anxiety, and distress that people are experiencing, whether a lot of that is driven by the mind-body effect.
Ugh. This borders on what I like to refer to as the central dogma of alternative medicine, which is that thinking makes it so. It’s also combined with the fallback position that more and more advocates of “integrative medicine” have fallen back on as study after study have failed to find an effect due to their woo that is detectably different from placebo effects. That narrative is that, sure, something like acupuncture doesn’t do anything detectably better than placebo, but it’s the placebo effect that’s invoked that’s “healing.” Add a dash of Cartesian dualism to that, with the hole invocation of “mind-body” effects, as though the mind were somehow separate from the body when it is not, and you have a recipe to thoroughly depress me reading such words coming from a high ranking faculty member of an institution like MSKCC.
Sadly, SIO and the integrative medicine service at MSKCC are just two examples of all too many. All over the US—the world, even—once rigorously science-based institutions are embracing pseudoscience. Unfortunately, the reasons they give are the same all over the world and just as deluded.