On the "integration" of quackery into the medical school curriculum

QEDCon is fast approaching (indeed, I can’t believe I have to leave for Manchester tomorrow night), and because my talk there will be about the phenomenon of “integrative medicine,” I’ve been thinking a lot about it. As I put together my slides, I can’t help but see my talk evolving to encompass both “integrative” medicine and what I like to refer to as quackademic medicine, but that’s not surprising. The two phenomenon are related, and it’s hard to determine which has a more pernicious effect on science in medicine.

One aspect of quackademic medicine that I probably don’t write about as much as I should is the “integration” of quackery into the curricula of medical schools. Part of the reason for that, I suspect, is that I am fortunate enough to be faculty at a medical school and cancer center that remain relatively untouched by the pseudoscience of integrative medicine. True, our medical school does have at least one credulous lecture about “complementary and alternative medicine” (CAM) that the medical students have to imbibe, but it really is pretty close to the bare minimum required by the accrediting agencies. Oh, yes. Proponents of integrative medicine have been so successful that one requirement for accreditation by the Liaison Committee on Medical Education (LCME) is that there be adequate instruction about CAM. Actually, that’s not quite true. Among the educational objectives in the LCME requirements is ED-10: “The curriculum of a medical education program must include behavioral and socioeconomic subjects in addition to basic science and clinical disciplines.” This is where CAM and integrative medicine are slipped in. That’s because the Academic Consortium for Integrative Medicine and Health successfully lobbied the LCME to include CAM in its list of topics addressed in the LCME Medical Education Database relative to accreditation standard ED-10. Unfortunately, how that is done in practice is often in the form of entirely credulous teaching of CAM.

Last month, when I wrote about the $200 million donation to the University of California, Irvine (UCI) by the billionaire couple Susan and Henry Samueli to create a college of health sciences that will encompass several UCI schools, including its school of medicine and nursing school, dedicated to “integrating” quackery at all levels into medicine thusly:

The Samuelis’ gift will provide $50 million toward construction of a facility to house the college and $5 million for state-of-the-art technology and labs – forming the foundation of a national showcase for integrative health. It also earmarks $145 million to create an endowment for:

• Up to 15 faculty chairs across the medicine, nursing, pharmacy and population health disciplines for senior, midcareer and junior faculty with expertise in integrative health
• Integrative health training and mentoring for interested medical school students
• Scholarships and fellowships for undergraduate and graduate students planning careers in related fields
• Innovative curricular development and campuswide interdisciplinary research projects
• Ongoing clinical services, research and education in the Susan Samueli Integrative Health Institute, including investigations of nonconventional interventions as part of medical treatment and educating medical and lay communities about benefits and risks associated with new healthcare approaches

What I didn’t talk about so much was number 3: “innovative curricular development.” That’s CAM-speak for teaching CAM alongside real medicine as though homeopathy has scientific validity. This brings us to an article by noted cheerleader for “integrative medicine” Glenn Sabin, Integrative health’s place in the medical school curriculum. If you want to know where Sabin’s coming from, consider my previous discussions related to his promotion of alternative medicine, such as his “history” of the integration of quackery with medicine and his advocacy for anecdotal evidence disguised as “N-of-1 trials” over clinical trials in determining if various alternative medicines “work.” He also first got my attention for openly admitting that integrative medicine is a brand, not a specialty. Also consider this paragraph from his latest:

My colleague, John Weeks, wrote a terrific response in Huffington Post to the media’s shameful coverage of the visionary and game-changing Samueli gift to UCI. He cogently supports his position with actual research, facts, and developments that illustrate just how out-of-touch these dwindling skeptics are—and how a few media outlets took the bait that led them down a narrow-minded narrative centering on one controversial therapy: homeopathy.

For me, though, the back-and-forth with the cynics is not worth the expended energy. This is not just about acupuncture or chiropractic or massage or dietary supplements. It’s much bigger.

The Samueli gift is about the future of health, led by the doctors of tomorrow, like my nephew, Max, who is in his first year of medical school at George Washington University.

Homeopathy is not “controversial.” It is rank pseudoscience. This is not even in dispute. Just look at the way UCI started furiously scrubbing its websites of references to homeopathy as soon as critics started looking at the Samuelis’ gift in detail. Clearly, the administration was embarrassed. I also note that one earlier gift agreement between the Samuelis to UCI explicitly mentioned that it was to be used to promote research into homeopathy, among other pseudoscientific modalities and that until recently UCI advertised the services of a naturopath and homeopath on its website. Even proponents of integrating quackery into medicine are embarrassed by homeopathy.

When discussing the “integration” of quackery into medical school, I like to discuss another “George” university namely Georgetown. In many ways, it was a “trailblazer” in “integrating” quackery into medicine. I recounted its history just a couple of years ago, citing a 2003 Georgetown brochure:

One of the reasons CAM is usually offered as an elective is that there’s just no time or room in U.S. medical schools to fit in one more massive subject,” says Michael Lumpkin, Ph.D., professor and chair of the department of physiology and biophysics at Georgetown. “When the course is an elective, a self-selected group – maybe 10 or 20 students in a class of 180 medical students – will take it,” Lumpkin says. “What we’ve tried at Georgetown is rather than create all new courses, we take relevant CAM issues and modalities and weave them seamlessly into existing courses.

The “seamless” weaving of CAM into existing classes includes, for instance, a presentation by an acupuncturist on the “anatomy of acupuncture” in the gross anatomy course for first-year students. The same lecturer explores acupuncture’s application in pain relief in the neuroscience course…

Haramati and Lumpkin say Georgetown’s program is distinct from CAM initiatives in other medical schools in two ways: The school is integrating CAM education into existing course work across all four years of each student’s medical education, and the initiative includes a mind-body class to help students use techniques to manage their own health and improve self-care.

Yes, fourteen years ago, Georgetown was “integrating” pseudoscience into its medical school curriculum at every level, starting from day one. Twelve years later, it was celebrating pseudoscience on the cover of the medical school’s magazine. That’s not all, though. Reflexology is taught as fact, along with prescientific medical systems, such as traditional Chinese medicine (TCM), “energy healing” like reiki and therapeutic touch, and pretty much every “integrative” quackery you can think of. In 2007, Georgetown partnered with the naturopathy school Bastyr University to train the next generation of integrative medicine practitioners.

This is the sort of future of medicine that Weeks and Sabin so strongly desire.

It’s also not as though George Washington University isn’t itself a bastion of quackademic medicine. Three years ago, I wrote about all the quackery advertised on its website. GWCIM’s list of services includes acupuncture (of course!), chiropractic, craniosacral therapy, infrared light therapies, glutathione infusions, Myers’ Cocktail, naturopathy (again, of course!), reiki, intravenous high dose vitamin C, and genetic profile results that include “customized interpretation of 23andme.com genetic profile results with specific accent on methylation and detoxification profiles.” It’s a truly horrifying website to contemplate, given how little of it has any resemblance to science-based medicine and how much of it includes outright quackery like reiki. In addition, its website’s descriptions of various alternative medicine modalities are depressingly and similarly credulous. Acupuncture is described as being used for “for treatment of respiratory, digestive, urinary and reproductive systems, as well as the disorders of muscle tone, hormone production, circulation, and allergic responses” plus “pain relief, gynecological conditions and symptoms, insomnia, anxiety, and to enhance wellness.” Naturopathy is described as a “comprehensive approach to health and healing that combines modern scientific knowledge with traditional and natural forms of medicine,” with naturopaths addressing “the mental, emotional and physical aspects of an individual, and aim to treat the root causes as well as the symptoms of illness.” According to GWCIM, naturopaths are “trained as primary care doctors at accredited four-year naturopathic medical schools.”

No. They. Aren’t.

I also can’t help but note that John Weeks’ article was really nasty broadside against critics of the Samuelis’ gift to UCI in which he accused them of having “blood on their hands.” Apparently, Sabin approves of such rhetoric, as long as it’s directed against his opponents.

Sabin’s article is yet another example of how “integrative medicine” rebrands science-based modalities, such as nutrition, exercise, and lifestyle modification as somehow “alternative” or “integrative” and then uses them as the vehicle in which quackery is also “integrated” into medicine, while trying to dismiss anyone who points out the pseudoscience as the “old guard—the few out-of-touch, aging critics pushing back.” (I note that Sabin and Weeks aren’t exactly spring chickens themselves.) Naturally, he tries to push back against the critics’ narrative:

These same integrative health and medicine naysayers essentially conflate quackery—which ought to be called out and confronted—with the larger, progressive, and impactful, integrative health and medicine movement.

Critics also purport that nutrition, physical activity, and stress reduction are already consistently applied (or taught) clinically—that it’s already ‘part of medicine’. These few critics are wrong. Their view is incorrect. Their statements are patently false. We know this because, if these truly preventative measures were applied—if this was remotely the case—our healthcare delivery system would be consistently delivering ‘health care’, not ‘chronic disease care’.

Proponents of integrative medicine always try to sweep all the quackery their specialty embraces under the rug. Pay no attention to that quackery behind the curtain, they say. We’re all about nutrition, lifestyle, and stress reduction. They somehow never manage to address the question: Why is quackery so associated with integrative medicine? If integrative medicine really were about “nutrition, lifestyle, and stress reduction” and nothing else, the quackery would be unnecessary. Homeopathy, naturopathy, acupuncture, “energy healing,” functional medicine, bogus allergy testing, and more forms of pseudoscience and quackery than I can list here (but have discussed over the years on this very blog) would not find such a comfortable home in “integrative medicine.” That they do fit so nicely in “integrative medicine” is by design, not accident.

Consider this. Let’s, for the sake of argument, concede that Sabin has a point. Perhaps nutrition, physical activity, and stress reduction are not sufficiently consistently applied in clinical medicine. If that is indeed the case, the answer is to develop strategies to change this shortcoming in medicine. Those strategies, assuming they’re science based (as they should be), will not involve embracing pseudoscience and quackery. Sabin and Weeks go on and on and on about promoting the “nutrition, physical activity, and stress reduction” aspect of medicine, but fail to explain why a separate specialty is needed to emphasize these health promotion activities more. That’s because they can’t. The entire unspoken rationale that they cannot admit is that “nutrition, physical activity, and stress reduction” function, in essence, as a Trojan horse for hardcore quackery. Integrative medicine shows up at the gates of academic medicine looking like “”nutrition, physical activity, and stress reduction,” but once the horse is pulled into the ivory tower of academia, out jumps the real quackery, like naturopathy, homeopathy, acupuncture, functional medicine, and the like.

Also unspoken is that the reason integrative medicine proponents want so badly to insinuate their specialty and thinking into medical school is because they want “nutrition, physical activity, and stress reduction” forever linked with the quackery that they also champion. At schools like GWU and Georgetown, it’s working, too. I fear, however, that UCI will soon far surpass both GWU and Georgetown as bastions of quackademic medicine.