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Complementary and alternative medicine Medicine Pseudoscience Quackery

Credulous promotion of “integrating” quackery into medicine

Over the last 25 years, medical academia has increasingly embraced “integrative medicine” (i.e., the “integration” of pseudoscience and quackery with medicine). However, it has had help normalizing this new situation. That help comes from the press. Here’s yet another example.

I frequently complain about the increasing infiltration—or should I say “integration”—of quackery into medicine in the form of what is now called “integrative medicine.” One of the key driving forces for this integration of naturopathy, traditional Chinese medicine, functional medicine, and supplements. Medical academia has, unfortunately, been a major driving force behind this infiltrative pseudoscience finding its way into medicine, but it is not alone. After all, academic medicine alone cannot popularize such a paradigm shift among the public. There had to be accomplices.

One of the most effective accomplices quacks have is the press. I’m not just talking about local press or even national press. The press at all levels is complicit, be it Dr. Nancy Snyderman of NBC News promoting the infiltration of quackery at Memorial Sloan-Kettering Cancer Center or a local newspaper promoting “integrative medicine.” Basically, all too many media outlets are willing to regurgitate the preferred narrative normalizing pseudoscience in medicine. I saw yet another example of this phenomenon the other day in Richmondmag. It’s an article by Elizabeth Faris entitled All Together Now: Conventional medicine melds with non-mainstream practices in complementary health care. As the title implies the article basically accepts the arguments of proponents of integrative medicine without an ounce of skepticism.

As is the template with most of these articles, the story begins with a testimonial:

Monica Batica has dealt with persistent, troubling health issues throughout her adult life. A diagnosis of a thyroid disease, Hashimoto’s thyroiditis, in 2009 brought her answers, but little relief. “I got treatment with conventional medicine, but I didn’t notice much improvement,” she says. Frustration led Batica to do her own research and join online communities for people with the disorder. There, she became interested in alternative and complementary treatments that others with her condition have used to find relief.

Her research led her to Aaron Hartman, a Richmond-based family physician who is one of a growing number of conventionally trained practitioners in the Richmond area incorporating non-mainstream modalities into their practices. In addition to practicing with Family Practice Associates, Hartman sees patients through Richmond Integrative & Functional Medicine, which he launched in early 2017.

Right away, Batica felt like she and Hartman were “speaking the same language,” she says. Hartman manages her disorder with prescription thyroid medication, as well as less conventional interventions including a major diet overhaul, intravenous vitamin C and other supplements. After years of disappointment, Batica says the treatment combination has her starting to feel better.

Note that we never quite find out how Ms. Batica feels better or by how much. It’s all very vague and feel good, just like integrative medicine. Of course, as I’ve pointed out many times, intravenous vitamin C is basically quackery, particularly for cancer but not limited to cancer. The evidence for its efficacy against, well, basically anything (other than treating scurvy, for which using intravenous vitamin C is massive overkill) is exceedingly weak.

Just for yucks, I wandered over to look at Dr. Hartman’s website. Yes, he’s a functional medicine quack. Why do I say quack? Easy. Functional medicine is quackery, as I’ve explained more times than I can remember. He also offers a membership program, which tells me that he runs a quack concierge medical service. The regular plan requires a membership induction fee of $730 then a monthly maintenance fee of $135 per month during the next 12 months of membership. Then there’s the executive “optimum wellness” plan, which is a cool $1,500. Of course, for this fee, you get more than just access to the practice. You get to use “advanced testing,” including organic acid analysis, comprehensive stool genomic and functional analysis, nutritional analysis, and something called a comprehensive vascular biological inflammatory analysis.

Next up, we get the appeal to popularity:

Across the country there is rising interest in complementary and integrative health care. The National Institutes of Health has a center on it: The National Center for Complementary and Integrative Health. (They define a complementary approach as one in which non-mainstream practices are used in addition to conventional medicine, and they use the term “integrative medicine” for care that brings together complementary and conventional approaches in a coordinated way.) Duke Health opened an integrative medicine facility in 2006. The Cleveland Clinic also has such a center. George Washington University offers a program in integrative medicine, as do the University of Arizona and Yale. At VCU, integrative medicine has been part of the curriculum for four years.

Shall introduces her students to a range of therapies as well as research on the safety and efficacy of each. “We talk about Chinese medicine, acupuncture, some of the herbal treatments,” she says. Her students also learn about other techniques and practices, including energy work, yoga and meditation.

But it’s not a class on alternative medicine, Shall emphasizes. “I’m not talking about alternative therapy, but things you would do in complement to Western medicine.”

Where one might see a happy listing of the triumphs of integrative medicine here, I see a profoundly depressing narrative about how quackery has infiltrated conventional medicine at the highest levels of academia. It also introduces a characterization of alternative medicine that I consider profoundly racist, where “Western medicine” is characterized as scientific, reductionistic, and unfeeling, while “Eastern” medicine or alternative medicine is portrayed as “holistic” and empathetic. In any case, I cringed (as I usually do) when I saw that energy medicine was included in Dr. Shall’s curriculum. In reality, I don’t have a huge objection to teaching about quackery like energy medicine in medical school. My objection is to teaching it as though it were anything other than mystical faith healing and suggesting that it has any scientific validity whatsoever. It doesn’t.

No story promoting integrative medicine is complete without an anecdote promoting the co-optation of modalities that are science-based as somehow being “alternative” or “integrative”:

The third Saturday of every month, doctors and health experts from VCU Women’s Health Center at Stony Point and Massey Cancer Center gather with patients at Stony Point Fashion Park for a morning walk and talk called the RAMble.

“The idea is basically to get moving, to join the community of people who are trying to get out and exercise,” says Masey Ross, an oncologist at Massey specializing in breast cancer. Since August 2017, Ross has also served as the director of integrative health care services for the center.

While Massey has been offering integrative services like nutritional counseling and a dog therapy program, Dogs on Call, for years, they began the process of formalizing their programs in 2016.

Exercise is not “integrative.” It’s part of medicine. Nutrition is not “integrative.” It’s part of medicine. Pet therapy, in my estimation, is an example of the medicalization of something we in medicine used to call patient support services, things we did in the hospital and in clinics to lift patient spirits. Other examples include “art therapy” and “music therapy.”

And what article about integrative medicine would be complete without a portrait of a physician who was “converted” to quackery:

Dr. David Groopman was working as an emergency room doctor in Richmond when he visited a friend running an in-patient substance abuse treatment clinic.

“One of the things he was using was auricular or ear acupuncture as a means of enhancing detox and calming people down while they were withdrawing,” explains Groopman, who received his medical degree in internal medicine from New York University. “If you’ve ever seen a population who’s in that state, they’re pretty fractious. I watched him put five needles in each of their ears, and within about 10 minutes; they all kind of calmed down.”

Then:

He enrolled in a program at UCLA School of Medicine to train physicians in acupuncture and earned certification, though he continued to practice emergency medicine, too. In 2007, he went full-time, becoming a fully specialized medical acupuncturist. (Medical acupuncture refers specifically to acupuncture practiced by physicians.)

Groopman says he’s often “the court of last resort” for patients who’ve exhausted conventional treatments for their conditions and still haven’t found symptom relief. Some of these patients use his services as stand-alone treatment for their conditions, while others use it in addition to other conventional and nonconventional therapies.

If there’s a medical specialty that should have nothing to do with acupuncture or other alternative medicine, it’s emergency medicine.

Then, of course, there’s the false claim that, somehow, some way, integrative medicine is more “holistic”:

In addition to their conventional training, Mannell, who started Richmond Integrative Psychiatric & Nutrition Services, and Hartman, who runs Richmond Integrative & Functional Medicine, are certified through the Institute of Functional Medicine. As an approach to health care, functional medicine considers the body a system and attempts to find root causes for patients’ conditions.

“It’s a way of looking at health through a systems biology approach or a network approach,” Hartman says. “So instead of looking at things from just a diagnostic or disease [perspective] … I look at how … everything interact[s] with everything else.”

The cornerstone of functional medicine is sound nutrition — healing the gut to heal overall health.

One more time, Functional medicine is quackery. It involves the worst aspects of conventional medicine combined with quackery. It’s basically making it up as you go along.

I will admit, though, that one passage in this article made me laugh out loud when I read it:

Neither Mannell nor Hartman is anti-medication, they say. “As a medical doctor, I have to at least do the standard of care,” Hartman explains. “But as an integrative guy, I’m not limited to the standard of care.”

Yeah. That’s kind of the problem.

So are articles like this, which make it seem as though going far outside the standard of care in medicine is a good thing.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

12 replies on “Credulous promotion of “integrating” quackery into medicine”

“But as an integrative guy, I’m not limited to the standard of care.”

Good thing I had swallowed my tea before reading that, or I would be sending you the bill for my new keyboard. But it’s definitely in the “ha ha only serious” category. If Dr. Hartman feels he is not bound by any standard of care, then how does he maintain a license to practice medicine?

An item I saw last week about a troubled VA Hospital turning things around noted how proud they were in reducing opioid usage – the flak flogged their use of massage (fine), as well as acupuncture and “healing touch” (no! and what?).

I know, from people who go to VA Hospitals, they are aggressively cutting back opioid prescriptions (not necessarily a bad thing) to include people with chronic pain conditions (busted up knee joints and arthritis).

All it’s it going to do, in my opinion, is leave people in pain and push them towards even worse methods of pain relief, like copious amounts of booze, illegal trading of prescription pills, and illegal drugs.

I’m not saying send every patient out the door with a fentanyl script, I’m saying, let’s recognize some people have crippling conditions that are incredibly painful. And if you don’t want those folks using opioids, let them use the reefer.

I’m waiting for NY State to legalize medical marijuana, because I think it would help my pain. The opioid I take doesn’t do much, but it does keep the pain down to a dull roar. I think the marijuana might be more helpful.

Taking away my opioid and sticking me with needles would definitely not be better.

Med marijuana isn’t legal there already? Heck, it’s legal in Texas already (but the VA being federal, has weird rules about it).

If “healing touch” is, as I suspect, a synonym for “theraputic touch”, then the person responsible for introducing it should stop smoking whatever (s)he has been smoking. Theraputic touch is a form of woo so obvious that it was debunked by a fourth-grader’s science fair project. If there is a form of woo that is even more obviously nonsense than homeopathy, theraputic touch is it.

I don’t want to venture down the medical marijuana rabbit hole, but IIUC the alleged medical benefits of marijuana are still at best unproven. Nevertheless, there is at least some plausibility to the idea. Whatever plausibility acupuncture once had has been thoroughly debunked, and theraputic touch never had plausibility in the first place.

Opioid addiction is a hard problem, and I can’t blame doctors for being overcautious about prescribing it. But I would prefer that hospitals, especially ones like the VA system that spend tax dollars, at least try methods with some plausibility to them.

I just noticed that Leon Gussow last month posted his Alexander Awards for best toxicology paper of the year, two of which deal with the Sacklers, Purdue Pharma, and oxycontin (I’ve yet to read them, but The Poison Review is a fun blog, if somewhat infrequently updated).

RIchmond has been a hot spot for this kind of thing for years. I recall several years ago having an autistic patient present with a report from a doc on MCV letterhead (whose name escapes me, getting old sucks!) explaining that he should not get vaccines due to his “elevated uranium levels” and needed to get EDTA treatment, but his insurance had denied it so he was coming to me for it. I explained the sheer quackery of this and declined to prescribe for her. It did not go well.

It is–nutrution is part of medicine. People just don’t think so because there’s little hoopla surrounding it in real medicine. Basic nutrition isn’t complicated. Eat real food, not too much, mostly plants (Michael Pollan found a way to put it quite succinctly), but people don’t believe or want to hear that. They want to be told that there are magic ways of excluding certain food groups or eating exotic combinations of foods–diets that are pretty much made up and can’t produce any long term successes.

I admit that doctors need to become more engaged with people about diet, and lets face it, when we say “diet” we are ususally talking about weight management, and doctors have a terrible track record here–but so do authors of diet books.

The overlooked person in all this is the Registered Dietician–more referrals need to be made and more coverage provided by insurance. If clinics want to get all “integrative”, they should open weight management clinics that operate on proven methods but offer tons of feel-good support including anything that helps people–just don’t claim it’s medicine if it isn’t– because that is what is sorely lacking when the doctor says, “lose some weight” and hands you a pamphlet that offers little beyond a few boring recipes. Of course it has to be said that the RD profession as also vulnerable to woo, so that needs to be addressed.

All this rubbish about doctors not having any training in nutrition and being ignorant of their patients’ diet needs to stop. Obesity is not epidemic because of stupid doctors, it is our entire food environment/culture/food industry. Doctors alone cannot address this, but show me one, even ONE, alternative practitioner that has evidence of getting significant numbers of people to lose meaningful weight and keep it off for five or ten years–or even one year.

Beyond weight management, diet doesn’t have an awful lot to do with disease–withing reasonable parameters. Thinking otherwise is the result of marketing, not science. Of course there are weaknesses in the American diet, but they revolve around low fiber intake and empty calories, not a lack of açaí berries or “toxins” in our food.

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