I’ve been pretty hard on The Cleveland Clinic over the years, but justifiably so. After all, The Cleveland Clinic is one of the leading centers of quackademic medicine in the US; i.e., an academic medical center that studies and uses quackery as though it were legitimate medicine. Of course, this is a problem that is not in any way limited to The Cleveland Clinic. A decade ago, I tried to keep track of which academic medical centers had “complementary and alternative medicine” (CAM) or “integrative medicine” programs that integrated quackery like acupuncture, chiropractic, naturopathy, reiki, and even homeopathy into their medicine in a little list that I liked to refer to as the “Academic Woo Aggregator.” However, that little list didn’t remain little for long, and soon I found the Academic Woo Aggregator to be too difficult to maintain and I gave it up. Sadly, the reason was that there were just too many medical schools and academic medical centers that embrace quackademic medicine.
Since then, the situation has only gotten worse as the number of academic medical centers embracing pseudoscience has skyrocketed, with The Cleveland Clinic arguably leading the way. For instance, it was, as far as I know, the first to actually integrate a traditional Chinese medicine herbal clinic into its offerings. That same year, it hired Mark Hyman, MD of “Ultrawellness” fame to open its Center for Functional Medicine. “Functional medicine,” recall, is basically a form of quackery that combines one of the worst aspects of conventional medicine (over testing, except that functional medicine makes the over-testing we see in conventional medicine look puny and quaint by comparison) with a whole lot of “make it up as you go along” quackery to “correct” abnormal lab tests and remove “toxins” in the name of “biochemical individuality,” which functional medicine fetishizes above all else and uses as an excuse to do just about anything. Sometimes the quackery of functional medicine reaches truly ridiculous proportions. Unfortunately, functional medicine has been wildly successful at the Clinic.
So I was only somewhat surprised last week when a social media kerfuffle erupted over the publication of what can only be described as an antivaccine screed by Daniel Neides, MD, the director of The Cleveland Clinic’s Wellness Institute. It was a screed that would not have been the least bit out of place on antivaccine websites like Age of Autism, NaturalNews.com, The Thinking Moms’ Revolution, or the like. This incident led me to ask: What the heck do you expect? That’s what happens when you embrace quackery, particularly when a lot of it is “detox” quackery, a prominent component of functional medicine, naturopathy, and the like. Given that a lot of antivaccine pseudoscience is based on the idea that vaccines are full of “toxins,” there’s a natural affinity between antivaccine beliefs and any form of pseudomedicine that embraces “detoxification.” And, make no mistake, The Cleveland Clinic embraces “detox,” even selling such products on its website, while Dr. Neides is very much into “detox” quackery himself.
In the wake of the controversy, The Cleveland Clinic issued a statement that it really, truly supports vaccination and promised that Dr. Neides would be “disciplined.” It also suffered tsunami of negative press, with bloggers like me taking it to task for its quackademic medicine, refreshingly (to me, at least) joined by a handful of mainstream news organizations like The Washington Post and STAT News where reporters didn’t miss the broader picture of how the culture of pseudoscience at The Cleveland Clinic Wellness Institutes facilitates antivaccine views. In any event, a few days ago, I figured the controversy was finished but still held out hope that it will spark some intrepid health reporter somewhere to look into the wider problem of quackery in academic medicine.
Apparently, I was mistaken. It wasn’t over. Worse, instead of admitting its mistake, The Cleveland Clinic is doubling down on its promotion of quackery because, apparently, Toby Cosgrove, MD, CEO of The Cleveland Clinic, is unhappy at the negative press. As a result, he wanted to defend his hospital’s Wellness Institute and decided to do so in an opinion piece released by The Cleveland Clinic Newsroom entitled Vaccines, Wellness and a Healthier America. The whole post is evidence of how conventional physicians can be seduced by the tropes of “integrative medicine” to the point of parroting its propaganda.
Dr. Cosgrove starts out by observing that smoking, poor diet, and lack of exercise were the leading factors that led patients to requiring his service as a cardiac surgeon, all of which is true enough. No one—and I mean no one—with any credibility denies this. Indeed, no one denies this other than the doctor caricatures who are portrayed as denying that diet or exercise can be used to improve health. These caricatures are constructed by quacks and most commonly utilized by proponents of “integrative medicine” to denigrate what they disparagingly call “conventional medicine.” Of course, primary care doctors do prevention every day and try very hard to get their patients to stop smoking, eat a healthier diet, and exercise. It’s very difficult to succeed when patient visits are so short, constrained by the economics of reimbursement for medical services. So, yes, certainly “conventional medicine” could do a better job at helping patients use lifestyle interventions to improve their health, but no it’s a caricature to claim that medicine is all about “sick care” and not “wellness.” None of that stops CAM advocates from pointing to conventional medicine’s shortcomings in this area and invoking a false dichotomy in which it is necessary to embrace quackery in order to promote “wellness.” It’s a key talking point frequently invoked by advocates. Although he doesn’t say it explicitly, it’s implicitly clear from Dr. Cosgrove’s editorial that he buys into this false dichotomy or that he doesn’t understand that much of what is being “integrated” with diet, exercise, and smoking cessation is rank quackery. If all The Cleveland Clinic Wellness Institute were doing was promoting healthy eating, smoking cessation, and exercise, I certainly wouldn’t have a problem with it.
Let’s get to Dr. Cosgrove’s op-ed. First, Dr. Cosgrove has to deny most vociferously that there are any elements in his institution that are antivaccine:
Historically, healthcare has not done a good job of promoting disease prevention. Our Wellness Institute has built a framework to guide patients to healthier lifestyle choices. However, in a recent online column, the Wellness Institute’s medical director shared his personal views about vaccination – views that do not represent Cleveland Clinic in any way.
Vaccinations are a key component to preventing disease and maintaining a healthy society. There is no debating that; the research is clear. To say otherwise is irresponsible and runs counter to Cleveland Clinic’s commitment to evidence-based medicine.
Deadly, debilitating diseases like polio, smallpox and measles are no longer the threats they once were, thanks to vaccines. In fact, according to Healthy People 2020, routine childhood immunization (DTap, Td, Hib, Polio, MMR, Hep B, and varicella vaccines) saves 33,000 lives, prevents 14 million cases of disease, and reduces direct health care costs by $9.9 billion.
Harmful myths, untruths and junk science about vaccinations have been scientifically debunked. Serious adverse effects are incredibly rare. And there is no demonstrated link between autism and vaccination.
So far, so good. This is about as unequivocal a rejection of Dr. Neides’ ignorant antivaccine nonsense as one could expect from the CEO of any internationally known academic medical center. True, I can’t help but note that Dr. Cosgrove hasn’t said exactly what action he’s decided to take against Dr. Neides, even though it’s been well over a week since his antivaccine column made national news. Clearly Dr. Neides hasn’t been fired yet (which would be appropriate), or likely we would have heard about it. Presumably he has suffered some “discipline” less than firing. I also know that Dr. Cosgrove did send out a mass e-mail to Cleveland Clinic employees instructing them not to speak or write publicly in situations where their speech might be construed as representing the position of The Cleveland Clinic, which is what Dr. Neides did.
The Cleveland Clinic has apparently also initiated action that appears designed far more to give the appearance of concrete action to correct the problems that led to someone like Dr. Neides feeling comfortable publishing antivaccine rants under The Cleveland Clinic’s logo than to actually do something substantive:
After the director of its Wellness Institute was forced to walk back an anti-vaccine blog post over the weekend, the Cleveland Clinic revealed Monday that it has already spent months reevaluating the institute’s focus and expects to halt the sale of some alternative medicine products.
Clinic spokeswoman Eileen Shiel told STAT that hospital administrators are concerned that the institute’s focus has grown too unwieldy and less connected to the clinic’s broader mission of providing the best, evidence-based medicine and services to patients. She said the wellness center will likely stop selling some of its commercial products, such as homeopathy kits sold in the gift shop of its suburban Lyndhurst location, and move toward general wellness programs that would improve diet and lifestyle decisions by patients and its own employees.
Yes, The Cleveland Clinic sells a homeopathic detox kit on its own website. It has also begun offering pure quackery like reiki, craniosacral therapy, myofascial release, and acupuncture to children. It even offers the “energy medicine” quackery that is “therapeutic touch” to babies. Let me repeat that: The Cleveland Clinic subjects babies to rank quackery.
What would have served Dr. Cosgrove best would have been to stop with the statement defending vaccines, but he just couldn’t do it. Of course he couldn’t! He just started his column bragging about how important the Wellness Institute is to The Cleveland Clinic, how he had established it in 2007 and “placed its leader in the C-suite with the title of Chief Wellness Officer.” He couldn’t let the criticism go. The Wellness Institute and the Center for Functional Medicine are Cosgrove’s babies. He owns them. That’s why he had to pivot rapidly and complain about those of us who didn’t miss the broader point about The Cleveland Clinic’s embrace of quackery:
Still, critics have used the column to disparage the Wellness Institute as a whole and the concept of wellness in general.
Gee, Dr. Cosgrove. You say that as though it were a bad thing. Actually, Dr. Cosgrove’s whine contains only half a straw man. First, as to the charge of using Dr. Neides’ column as a jumping off point to “disparage” the Wellness Institute, I plead guilty as charged—and proud of it! The Cleveland Clinic Wellness Institute is a cesspit of quackery mixed with more reasonable and evidence based treatments, and I have no qualms about pointing out how if you embrace “detox” quackery, antivaccine quackery can’t be far behind. I’m also very happy to see that at least a couple of mainstream news outlets started to “grok” the general outlines of that point. Second, as for disparaging “the concept of wellness in general”? Er, not so much. Here, Dr. Cosgrove is disingenuously conflating criticism of the quackery that the Wellness Institute has “integrated” with sensible advice on diet, exercise, and smoking cessation with “disparagement” of wellness in general. The two are not the same thing, and what is being “disparaged” is the amount of pseudoscience passing for medicine under the auspices of the Clinic’s Wellness Institute, not the concept of wellness in general.
Dr. Cosgrove then goes on to use an appeal to need to justify the Wellness Institute by arguing that chronic disease is rampant (which is, of course, true, given the obesity epidemic and the general aging of the population) and that health care costs are on track to reach 20% of the the GDP by 2024, which is also true. The rest, however, is a non sequitur. It does not follow from these observations that what Dr. Cosgrove is doing at The Cleveland Clinic is the answer. True, some of what the Wellness Institute does can help:
At Cleveland Clinic, the Wellness Institute works hand-in-hand with the Medicine Institute to help patients and employees change unhealthy behaviors and to make healthy life choices. These goals align with public health initiatives set by the CDC, such as immunizations, safe healthy food, smoking cessation, control of infectious disease, and a focus on heart disease and stroke.
Yes, they do, and, again, no one is criticizing The Cleveland Clinic or its Wellness Institute for promoting these things. These are the interventions that every science-based hospital should be promoting. They are the default. No one argues against them. What we do argue against is the quackery that the Wellness Institute, as unwittingly admitted by Dr. Cosgrove himself, promotes:
Some approaches may be considered unconventional, but most – acupuncture, yoga, Chinese herbal medicine, guided imagery and relaxation techniques – have scientific backing. We have heard from our patients that they want more than conventional medicine can offer and we believe it is best that they undertake these alternative therapies under the guidance of their Cleveland Clinic physician.
No, no, no, no, no. Acupuncture is a theatrical placebo. Yoga is fine, but nothing more than a form of gently exercise overlaid with Eastern mysticism. It has nothing special to offer compared to other forms of exercise. Guided imagery might have some evidence, as might relaxation techniques, but, again, they’re being lumped together with the quackery. The most telling statement is the last one, however. I’d rephrase it, though: We at The Cleveland Clinic know that patients want this quackery, and we know we can make money selling it to affluent suburbanites in Beachwood, Shaker Heights, and Pepper Pike. So we will sell it, but we will assuage our consciences by telling ourselves that the best “safe” way to provide the quackery to patients is through our facility and that our embrace of pseudoscience is “justified by the magnitude of the disease challenge.”
And that the Cleveland Clinic is somehow doing cutting edge research:
In the meantime, we will move the science forward. Our Center for Functional Medicine is the first in the country to conduct research studies on the impact of functional medicine when combined with traditional approaches for certain disease – asthma, inflammatory bowel disease and diabetes.
OK, my irony meter melted down here. Remember how Dr. Cosgrove, reassuringly, started his column by saying how pro-vaccine The Cleveland Clinic is and how all the horrible things about vaccines written by Dr. Neides in his column do not represent the position of The Cleveland Clinic? Throw that all out the window, because, whether he realizes it or not, Dr. Cosgrove’s embrace of Dr. Hyman and functional medicine completely contradicts his previous pro-vaccine statements, as does his bragging about the Clinic’s Center for Functional Medicine is supposedly doing cutting edge research into asthma, inflammatory bowel disease, and diabetes. Does Dr. Cosgrove have even clue one that Dr. Mark Hyman, the guru of functional medicine that he hired to found the Center for Functional Medicine co-authored a an antivaccine book of the thimerosal/mercury fear mongering variety with Robert F. Kennedy, Jr. in 2014, right around the time that the Cleveland Clinic hired him? Yes, that Robert F. Kennedy, Jr., the one with whom Donald Trump met last week to discuss “vaccine safety,” thereby alarming physicians, medical professionals, and public health officials throughout the country and provoking a firestorm of justifiably outraged criticism. Does Dr. Cosgrove know that Dr. Hyman even appeared on The Dr. Oz Show with RFK Jr. to promote their antivaccine book a mere 10 days before The Cleveland Clinic announced that it had hired Dr. Hyman to found its functional medicine center.
I don’t buy it. I’d really love to ask him personally what he knew about Dr. Hyman and when, but my gut tells me that there’s no way he didn’t know about Dr. Hyman’s antivaccine book with RFK Jr. Indeed, it stretches credibility to the extreme to believe that Dr. Cosgrove didn’t know about the appearance of someone he had just hired to found a high profile Cleveland Clinic Center on a nationally syndicated TV show with one of the icons of the antivaccine movement to promote the antivaccine book that they had co-authored together. Clearly, Dr. Cosgrove was either ignorant that they were antivaccine or fine with Dr. Hyman’s views then, or at least Dr. Hyman’s antivaccine propaganda didn’t bother the oh-so-pious pro-vaccine Dr. Cosgrove enough for him to scuttle the launch of the Center for Functional Medicine or to tell Dr. Hyman to zip it. Nor did Dr. Hyman’s long history of mangling autism science and clinical treatment based on antivaccine preconceptions appear to bother Dr. Cosgrove. If Dr. Cosgrove knew about these things and hired Dr. Hyman anyway, that’s medical malpractice in my book. If he didn’t know about these things, then it was an utter failure of basic due diligence.
So I call BS on Dr. Cosgrove’s self-righteous indignation and his assertion that The Cleveland Clinic under his leadership is so very, very pro-vaccine. That’s not to say that the vast majority of physicians and other health care professionals working at the Clinic aren’t pro-vaccine. I have no doubt that they are. It is, however, to say that Dr. Cosgrove doth protest too much. He championed the Wellness Institute. He turned a blind eye to Dr. Hyman’s antivaccine views. He now claims that he is shocked—shocked, I say—to find an antivaccine loon in charge of his Wellness Institute. Now that said antivaccine loon has publicly embarrassed The Cleveland Clinic, Dr. Cosgrove seeks to reassure the public (and perhaps himself) that Dr. Neides is an anomaly. Taken over the whole Cleveland Clinic physician population, I have no doubt that he is. Taken over the providers at the Wellness Institute, I’d bet that he isn’t. We just won’t hear from them publicly again because they’ll know now to keep their mouths shut.
All of this is why I call BS on Dr. Cosgrove and assertion that The Cleveland Clinic is as pro-vaccine as he says it is and will continue to do so as long as Dr. Hyman has an important position within the organization that Dr. Cosgrove runs. If I see Dr. Hyman fired, the Center for Functional Medicine disbanded, and the Wellness Institute purged of traditional Chinese medicine, naturopathy, chiropractic, craniosacral therapy, and its other quackery that tends to align with antivaccine views and focus only on diet, exercise, and help stopping the use of substances that contribute to chronic disease (like smoking), then—and only then—would I start to think that maybe—just maybe—Dr. Cosgrove is serious about not permitting antivaccine views at The Cleveland Clinic.