John Weeks accuses Orac of having "blood on his hands" for criticizing the Samuelis’ $200 million gift to UC-Irvine. Orac responds.

John Weeks has long been an activist for what is now known as “integrative medicine,” earlier known as “complementary and alternative medicine”(CAM). Basically, for many years Mr. Weeks has been at the forefront of encouraging the “integration” of quackery with real medicine and promoting what I like to refer to as “quackademic medicine,” a perfect term to describe the increasing encroachment of pseudoscience and quackery in medical academia in the form of—you guessed it—integrative medicine. Despite his having zero background in scientific research or the design and execution of experiments and clinical trials, for some bizarre reason in May 2016 he was appointed editor of the Journal of Alternative and Complementary Medicine (JACM), even though he has zero background in science or medicine of a type that one would expect in a journal editor. Once there, he wasted little time comparing doctors advocating science-based medicine and opposing pseudoscience in medicine to Donald Trump.

Fast forward a year and a half, when the University of California, Irvine (UCI) accepted a $200 million gift from Susan and Henry Samueli to vastly expand the integrative medicine offerings at UCI (which were already quite extensive) in the form of establishing the Susan and Henry Samueli College of Health Sciences, with the current Susan Samueli Center for Integrative Medicine becoming the Susan Samueli Integrative Health Institute. Amazingly, it wasn’t just skeptics like Steve Novella and myself writing negative articles about this development. Michael Hiltzik of the LA Times wrote an article in which Dr. Novella and I were quoted with a lovely headline, A $200-million donation threatens to tar UC Irvine’s medical school as a haven for quacks. Elsewhere, Usha Lee McFarling over at STAT News chimed in with a story with a somewhat less critical but still quite unflattering headline, A $200 million gift promotes alternative therapies at a California medical school — and critics recoil. Both articles contrasted the claims by Dr. Howard Federoff, CEO of UC Irvine’s health system that the new institute and college will be rigorously evidence-based with the reality of the homeopathy offered by UCI. Hiltzik, amusingly, pointed out how UCI was trying to send references to homeopathy on its website down the memory hole and failing miserably. Meanwhile, Rick Seltzer at Inside Higher Ed quoted Steve Novella as he asked, Does $200 million quack? (My answer: Yes. Very loudly.)

I, of course, used this observation to point out that UCI has long embraced homeopathy and that, because all naturopaths are trained in homeopathy, you can’t have naturopathy without homeopathy. Those of us who know how deeply “integrated” (couldn’t resist) quackery is in naturopathy couldn’t help but point out that Dr. Federoff’s claim that UCI’s new integrative medicine effort will be rigorously evidence-based is complete and utter bullshit unless UCI gets rid of naturopaths, at least as a start. Also, given that the Samuelis are very much believers in homeopathy, so much so that they mentioned support for research into homeopathy in one of their gift agreements with UCI in 2004, I highly doubt that UCI could dump homeopathy very easily even if Dr. Federoff wanted to. Indeed, given Dr. Federoff’s long history of integrating quackery into medicine at Georgetown, which was his gig before he moved to UCI, I doubt that Dr. Federoff is particularly serious about getting rid of the quackery, anyway. It’s now too entrenched.

This sort of coverage clearly enraged poor Mr. Weeks, who goes to great lengths to project a facade of civility in comparison to all the “anger” he portrays on “our” side. Indeed, his facade slipped so much that he misspelled Mr. Hiltzik’s name alternatively as “Hitzig” and “Tiltzig” in a post published—where else?—that original wretched hive of scum and quackery, The Huffington Post, in the form of an article entitled Shameful Media Response to the Samueli’s Visionary $200-Million Integrative Health Investment at UC Irvine, in which he refers to critics of integrative medicine as “antiscience” and as “having blood on our hands.” You can get a taste from the introduction:

The response of the LA Times, STAT, Medpage, and most media to the visionary $200-million integrative health investment of Susan and Henry Samueli at UC Irvine has been a shameful display of media descent into Trump-like, polarizing tweets. Worse yet, the coverage has been a profoundly anti-science. These media, and others, have chosen to provide platforms to a small handful of individuals who for decades have denied the evidence of acupuncture, chiropractic, mind-body and multiple other integrative approaches.

Mr. Weeks is nothing if not predictable. These days, to him any criticism of integrative medicine is “Trump-like” and “polarizing.” This is the schtick he came up with last year, before the election and continuing after it. To this recent but now familiar trope, Mr. Weeks adds a new epithet: “Anti-science.” In essence, he is doing exactly what climate science denialisms and antivaxers do: Try to flip the narrative and portray themselves as the true defenders of scientific inquiry and their critics as close-minded dogmatic skeptics who will not consider all the evidence. This is, of course, nonsense when antivaxers and climate science denialists do it, and it’s no less ridiculous when Mr. Weeks does it. Also, note how Mr. Weeks also tries to minimize the criticism by minimizing the critics, referring to us dismissively as a “small handful of individuals,” in order to portray us as being a tiny minority who can safely be ignored. Elsewhere in his article, he refers to Medscape “bleating” out a link to McFarling’s article in STAT. (Get it? We’re sheeple.) Sadly, Mr. Weeks’ tactics are all mind-numbingly obvious, but at this point in his jeremiad, Mr. Weeks turns out to be just getting started. It doesn’t take him long to work himself into a fine lather:

From his LA Times podium, Michael Hiltzig first gives voice to David Gorski and then to Steven Novella, long-time colleagues and back-slapping companions as anti-integrative medicine vigilantes. Hiltzig quotes Gorski first, shaping the Samueli’s investment this way: “The only reason ‘integrative medicine’ exists is to integrate quackery into medicine.” Tiltzig immediately turns to Novella to use the Trumpish, name-calling term that Gorski himself favors: “In a blog post, Novella flayed UCI’s establishment of an integrative medicine curriculum as ’quackademic medicine.’”

“Back-slapping companions as anti-integrative medicine vigilantes”? I laughed out loud when I read that line. Maybe I should change the name of the blog from Respectful Insolence to Anti-Integrative Medicine Vigilante. On second thought, “Respectful Insolence” rolls off the tongue much more nicely. The whole “vigilante” charge, though, is meant to further demonize Steve and me, who slap each other on the back like dudebros after each new takedown of integrative medicine. Maybe next he’ll portray us as bumping chests and shouting. (Seriously, could Mr. Weeks be any more obvious?)

The answer, apparently, is no:

It would be one thing if this were just journalistic laziness. Sure, go ahead and run polarizing copy based on a tweetish view of the universe that makes a story fit for afternoon TV. In fact, however, these media have chosen to trumpet fake news. They promote this polarizing grandstanding rather than honor the emerging scientific consensus that is yet poorly integrated into health professional education and practice – and that utterly backs the Samuelis’ investment and direction at UC Irvine:

He then cites four references that actually show how deeply embedded quackery has become in medicine, thanks to the efforts of people like Mr. Weeks. For instance, he mentions the Joint Commission’s 2015 revision of its pain management standard that recommends nonpharmacologic approaches to pain, and mentions acupuncture, chiropractic, and osteopathic manipulation. Now, I’ve discussed many times before how integrative medicine mavens have latched on to the opioid crisis as an opportunity to expand their influence by rebranding CAM/integrative medicine as “nonpharmacologic approaches to pain.” Indeed, the National Center for Complementary and Integrative Medicine (NCCIH) enshrined this in its 2016-2021 strategic plan. Ever since the opioid crisis inserted itself into the national consciousness, proponents of integrative medicine have seen a golden opportunity to use it to further the integration of quackery into medicine. Only they want to be seen as science-based; so when programs like the one at UCI are caught advertising The One Quackery To Rule Them All, homeopathy, they scramble to hide the evidence of it.

Mr. Weeks makes a great show of mentioning guidelines published by the Mayo Clinic, which, if anything, showed that the “complementary” approaches to pain examined do not have an effect greater than placebo. Truly, it was an awful review article. Predictably, he also mentioned American College of Physicians guidelines for low back pain. I can’t help but note that those recommendations characterized evidence base for acupuncture, for example, as low quality evidence, moderate at best, and cited the GERAC Study, which basically showed that acupuncture does not work. Another mixed “electroacupuncture” (which is basically TENS) with acupuncture. Truly this was thin gruel for the ACP. Finally, he referred to the National Academy of Medicine’s review on nonpharmacological approaches to pain. I perused it. It misrepresents the evidence base for acupuncture in a far too favorable a fashion, for instance claiming that recent “reviews and meta-analyses examining the effect of acupuncture on musculoskeletal pain (neck and back pain, osteoarthritis, chronic headache and shoulder pain, fibromyalgia) have found that overall, acupuncture is superior to sham and no acupuncture, but with relatively modest differences between true and sham acupuncture.” Yes, the NAM cited the Vickers meta-analysis, which showed that acupuncture doesn’t work, with no clinically significant effect on pain, although the conclusion was spun to be the exact opposite. Yes, Mr. Weeks is doing what any “thought leader” in integrative medicine has to do: Exaggerate or even misrepresent the evidence base supporting the quackery that integrative medicine is seeking to add to medicine.

Up until now, Mr. Weeks didn’t actually piss me off. Rather, he amused me, as he recycled the same tired, dubious arguments that he’s always used, complete with his dismissive comparison of critics of integrative medicine to Donald Trump, which he’s now done so often that to me it’s a cliché. Indeed, I’m half tempted to make a drinking game out of Mr. Weeks’ references to Donald Trump as a means of denigrating his opponents: Take a drink each time he compares our writing to Trump or to Tweets. The only problem is that I’d probably be at risk for alcohol poisoning if I were to play that game.

Here’s where Mr. Weeks actually managed to piss me off. It’s hard for an apologist for quackery to do, but Mr. Weeks managed it:

The roundhouse, condemnatory, “quackademic” perspectives of Gorski, Novella, Caulfield and their like toward complementary and integrative health and medicine need to be treated and dismissed by the LA Times and others as the anti-science that they are. Sure, discussion can be engaged over specific approaches or therapies. Yet giving a platform to this broad dismissal of the Sameulis’ investment is no different than repeatedly quoting non-believers in climate change at the top of an article about a massive, exciting effort to correct human environmental degradation.

And while the scale is different, both forms of science denial have blood on their hands. The residual, reactive, medical ideology of these anti-integrative careerists to which the LA Times and others give a platform is a barrier to potentially lifesaving directions toward which the Joint Commission-Mayo/NIH-American College of Physicians-NAM-Attorneys General jointly urge us – and the Samueli investment would propel us.

Fuck you, Mr. Weeks.

Longtime readers know that I pretty much never drop the F-bomb on this blog other than when quoting others, such as Jenny McCarthy’s famous quote about the MMR and autism. In this rare case, however, I think an exception to that rule is more than justified. When you accuse Steve Novella, Tim Caulfield, me, and those who make the same arguments as we do of having “blood on our hands,” telling you to fuck off is the only appropriate reaction. We’re doctors. Mr. Weeks is not. We save lives. Mr. Weeks does not. I’m a medical researcher. Mr. Weeks is not. I can deal with his unwarranted attacks on us as “antiscience.” I can laugh at them, even. I know we have the data, the science, and reason on our side. Also, contrary to how we are portrayed, we do not dismiss massage, mindfulness, exercise, diet, or other lifestyle aspects of integrative medicine. We merely point out that they are more appropriately a part of science-based medicine and that integrative medicine is “rebranding” them as somehow being “alternative” or “integrative” and then throwing in quackery like acupuncture, reiki, naturopathy, and the like. The purpose, of course, is to legitimize quackery. That’s why I say that there is no reason for integrative medicine to exist other than to provide a vessel through which quackery can be integrated into medicine.

As for being an “anti-integrative medicine careerist,” I view this as a thinly disguised variant of the “pharma shill” gambit, in which Mr. Weeks insinuates that we must be biased because we’ve made a career out of being “anti-integrative medicine.” Would this sort of thing were even possible! Seriously, though, Mr. Weeks should look at my publication record. Only two of my publications indexed on PubMed can be characterized as even being about integrative medicine. However, Mr. Weeks’ little tirade has med me think that maybe I should try much harder to publish more of this in the peer-reviewed scientific literature. The reason I haven’t is because I’m not an “anti-integrative medicine careerist.” Maybe I should become one, except that I’d call it being a pro-science careerist.

To get an idea of where Mr. Weeks comes from, he repeats a number of anti-medicine tropes. For instance, he does his best to paint critics of integrative medicine as a discipline as not caring about prevention. That’s an old chestnut, because integrative medicine proponents have tried very hard to rebrand any sort of interventions to prevent disease as their bailiwick. He also cites a BMJ paper concluding that medical errors result in 251,000 deaths per year and are the third largest cause of death in the US, clearly having selected that particular paper because it has one of the largest numbers of deaths estimated anywhere in the literature. (Über-quacks Mike Adams, Gary Null, and Joe Mercola would be proud.) As I pointed out when this study was published in 2016, the methodology used to calculate this number was highly questionable, at best, and basically custom-designed to inflate the number of deaths due to medical error, particularly through misattribution of the cause; i.e., mischaracterization of complications that had nothing to do with medical error as being due to error.

Mr. Weeks then defends the poor, put-upon Samuelis as being philanthropists of the highest order, listing their charitable donations over the last two decades. No one is denying that the Samuelis have made worthwhile charitable donations over the last 25 years. It is not those particular donations that I and people like Steve Novella and Tim Caulfield have a problem with. Rather, it is the Samuelis’ repeated donations in the cause of furthering integrative medicine that we criticize. Remember, as has been pointed out in multiple articles, the Samuelis are true believers in The One Quackery To Rule Them All, homeopathy. Does Mr. Weeks think that homeopathy is science-based? I’m sorry, but you cannot credibly claim the mantle of science if you believe in homeopathy. Period. You just can’t. You can try, but you will be called out, even laughed at—and deservedly so. Homeopathy is quackery based on concepts of vitalism and sympathetic magic.

Mr. Weeks concludes:

Reporters: stop giving a platform to anti-science. Do us all a favor and get serious, and scientific, about your reporting of an investment of the Samuelis at UC Irvine that – despite this apparently necessary stone throwing – may prove to be the most influential philanthropic investment in the substantial course correction that US academic medicine and medical industry need.

Actually, that’s what I’m afraid of, that the Samueli investment will be the most influential philanthropic donation in medicine. I agree that reporters should stop giving a platform to antiscience. What that means is not at all what Mr. Weeks thinks it means. As much as he thinks otherwise, it is he who is promoting antiscience. Indeed, the reporting on the Samueli donation represents one of the times that the mainstream press that bothered to pay attention to this story actually got it mostly right about integrative medicine. Mr. Weeks doesn’t like this, not one bit. That’s why he’s lashing out now.