“Integrative medicine” is a frequent topic on this blog because, as a pseudo-specialty it represents as well as quackademic medicine just how deeply pseudoscience has insinuated itself into academic and, increasingly, community medical centers. It’s a process that’s occurred over the last 25-30 years or so, as, increasingly, ostensibly science-based academic medical centers, started studying and then embracing mystical and pseudoscientific alternative medicine modalities like reiki, acupuncture, and even anthroposophic medicine. Billionaires like Susan and Henry Samueli donated hundreds of millions of dollars to UC-Irvine to transform it into a center for quackademic medicine, while Georgetown University embraced all manner of nonsense and the Cleveland Clinic started peddling traditional Chinese medicine and functional medicine to the point that its brains fall out and one of its leaders embarrassingly spewed antivaccine nonsense before opening his own quack clinic. Meanwhile, Andrew Weil promotes a “board certification” in “integrative medicine” that isn’t real, at least not in the sense that most board certifications are, but it does allow him to promote a residency curriculum in “integrative medicine.”
Compared to some of these developments, what I’m about to discuss might seem to be a minor thing. Indeed, it might be the equivalent of a pebble in an avalanche. Still, I think it’s telling and worth discussing. After all, it is through an accumulation of these minor triumphs that “integrative medicine” is increasingly blurring the line between science and pseudoscience in academic medical centers. I’ll start with something I saw on Twitter last week:
Great news in #integrative medicine! New @CedarsSinai integrative clinic led by medical doctor-naturopathic doctor team, Janet White, MD and Steven Meeneghan, ND, LAc. Learn more! https://t.co/FzYRdPlfSi @Bastyr @NUNM_EDU @AANP pic.twitter.com/fqIbqoTQL6
— AANMC (@AANMC) April 6, 2018
Cedars-Sinai Medical Center is a huge academic medical center in Los Angeles that’s affiliated with UCLA, USC, and other universities. It’s a level I trauma center and has 958 beds. It was founded in 1902, and in 2013 opened its 800,000-square-foot Advanced Health Sciences Pavilion, which is touted as bringing patient care and translational research together in one site. Basically, Cedars-Sinai has a long and storied history of patient care, along with medical research and education.
So let’s take a look at what John Weeks (a major proponent of and cheerleader for “integrative medicine” whom I’ve discussed multiple times before here) had to say about this:
In the late 1990s, Cedars Sinai medical center, one of the West Coast’s most prominent medical institutions, looked to be an early adopter of complementary medicine. In the integrative-friendly Los Angeles environment, a 1,150 square foot clinic was created with a break even plan of four years.
Yet like many early models, the clinic’s response to consumer interest was shuttered for lack of integration with specialty groups and a failure to generate projected revenues. All integrative practice did not end at Cedars. A sprinkling of acupuncturists remains credentialed in inpatient services to support an integrative oncology program, for instance, and an employee wellness program offers some integrative services.
Two decades after the first clinic, the Cedars Sinai has a new initiative. This time, instead of being part of the hospital, the new site for integrative health is part of the Cedars Sinai Medical Group (CSMG). Contacts with CSMG personnel make clear that this is an entirely new initiative.
The now 4000 square foot operation is a few blocks from the main Cedars-Sinai campus. And according to director Janet White, MD, the new effort – developed with her partner in the initiative, Steven Meeneghan, ND, LAc – is tracking toward their break even goals. After a slower than projected start, “in the last 2-3 months,” says White, “our revenues are ramping up faster than we had projected.”
It is not uncommon for the medical group under which an academic medical center’s physicians work to be a separate entity from the hospital itself, with outpatient facilities that are affiliated but not part of the actual hospital. I myself work under such an arrangement and did so at my previous job as well. In my current job, I get two paychecks, one from the university and one from the medical group, which add up to my total compensation. It can sometimes cause issues at tax time, for instance, of I miscalculate how much money from each entity is being placed into each retirement fund and over-contribute. It’s also somewhat confusing to have two different retirement funds, particularly when the medical group decided to switch companies a few years back. None of this, however, means that I’m not faculty at my university and medical staff at my hospital. It’s also not uncommon for academic medical centers to farm the quackery out to a separate facility, the better to maintain plausible deniability. The Cleveland Clinic Wellness Center, for instance, is not located on the main campus, but rather in Lyndhurst, a suburb east of Cleveland close to affluent suburbs like Pepper Pike and Beechwood. A quick look at its Integrative Health program reveals several of the usual suspects, like acupuncture, herbal medicine, and the like. It also has the same “expert team” of Dr. White and Not-A-Doctor Meeneghan.
It’s interesting to note where this new integrative medicine center is, on Wilshire Boulevard. A quick look at Google Maps shows me that it is indeed only a few blocks away from the Cedars-Sinai main campus, about a 15 minute walk, but it’s in Beverly Hills, making it hard not to think that this is an effort to attract a wealthy, woo-loving, West Coast clientele.
So let’s take a look. We’ll start with the naturopath and acupuncturist, Not-A-Doctor Meeneghan, because to me it is utterly egregious and unacceptable that an academic medical center or its medical group would employ a naturopath for anything involving patient care. His Cedars-Sinai web page indicates that Meeneghan graduated from the National University of Natural Medicine in 2012 and completed a “residency” (such as it is) at Bastyr University in 2014. He lists his clinical areas as including acupuncture, alternative medicine, integrative medicine, as well as the usual list of conditions for integrative medicine, such as fibromyalgia, insomnia, back pain, and the like, plus breast cancer, colorectal cancer, and other serious conditions.
In his LinkedIn profile, Meeneghan states:
I use a functional medicine approach to evaluate my patients, allowing me to see the complex patterns that make up the whole person, not just their symptoms. By thoroughly listening to each patient’s history and utilizing conventional and specialized functional testing methods, the root causes of disease can be revealed.
As a practitioner of natural medicine, my approach is different than that of the conventional disease-focused model. Rather than trying to take away disease, my goal is to help my patients to add health, thereby supporting the body in healing itself. To do so, I utilize diet and lifestyle counseling, gentle detoxification techniques, targeted vitamin and mineral supplementation, botanical medicine, bio-identical hormone therapy, and traditional Chinese and Japanese medicine.
I practice Chinese and Japanese traditional medicine in combination with naturopathic medicine in order to further individualize the assessment and treatment of each patient. Using pulse, tongue and abdominal diagnosis, these traditional medicines offer unique insights into my patients’ symptom presentation and underlying constitution. I integrate acupuncture, moxibustion, bodywork, qi gong and herbal formulas with naturopathic medicine in order to treat the mind, body and spirit as a whole.
Functional medicine is, of course, quackery that combines the worst of both worlds of conventional and alternative medicine, pairing massive overtesting and overtreatment that aren’t even evidence-based with quackery like homeopathy, acupuncture, and beyond. Its name is the ultimate misnomer in medicine. I do like the bit about how he’s not trying to “take away disease,” to which I can only respond: Why the hell not? Strike that. I know the answer. The reason he doesn’t try to “take away disease” is because he can’t. He can’t cure anyone with his pseudoscience. After all, “detoxification” as practiced by naturopaths and other alternative medicine practitioners is quackery that often involves purges, treatments to remove “heavy metals,” and even coffee enemas. Never mind that the body rarely needs detoxification because the lungs, liver, and kidneys do a fine job of removing real toxins.”Detox” is worthless and potentially dangerous, basically ritual purification masquerading as medicine, no matter how fashionable it might seem. Similarly, traditional Chinese medicine techniques of pulse, tongue, and abdominal diagnosis are based on prescientific mystical ideas and have not been validated by modern medicine.
I also learned from his LinkedIn profile that Meeneghan bounced around a bit before he landed at Cedars-Sinai. He was on staff at San Francisco Natural Medicine for a year, where a perusal of the website reveals that the clinic offers craniosacral therapy, detoxification, traditional Chinese medicine, intravenous nutrient therapy and injection therapy, and more. He also worked for 14 months at Thyme Integrative Health, which offers a similar suite of quackery, but larger, with homeopathy and biotherapeutic drainage added to the mix.
Other oddities exist in Meeneghan’s history. For instance, on Twitter, our very own Clay Jones pointed out:
Back in 2014 while working for SFNM he used Black Lives Matter protests to drum up business. pic.twitter.com/4HzpT1hxGy
— Clay Jones (@skepticpedi) April 6, 2018
Yes, here’s the original page, and he touted it on his Facebook page:
In other words, Meeneghan is a pretty typical naturopath, which is why he should be nowhere near an academic medical center.
But what about Dr. White? She’s a real MD, having graduated from the UCLA David Geffen School of Medicine in 1992, completed an internal medicine residency at Stanford, and undertaken Andrew Weil’s integrative medicine fellowship at the University of Arizona. Interestingly, she finished her internal medicine residency in 1995 but didn’t finish her integrative medicine fellowship until 2016. This suggests to me that she practiced rather normally as an internist for close to 20 years but then somehow had a mid- to late-career conversion and, for whatever reason, decided to go woo. As Weeks notes:
White, a 22-year-member of CSMG, has been upping her own integrative skills in recent years. She completed the University of Arizona Fellowship in Integrative Medicine and maintains memberships with the clinically-oriented Academy of Integrative Health and Medicine and Society for Integrative Oncology. She is presently working on submitting an application for Cedars Sinai to become a member of the Academic Consortium for Integrative Medicine and Health to allow her team the learning and collegiality of that North American organization.
So basically, after around 20 years of practice at Cedars-Sinai, she decided to undertake Weil’s fellowship, which, fortunately for her, is a distance learning program. She didn’t have to take a leave of absence from Cedars-Sinai or the huge pay cut that leaving to do a fellowship would entail for most specialties. (Rather considerate of Dr. Weil, don’t you think?) She only had to travel to Phoenix for three one-week sessions over two years. It’s supposed to be a 1,000 hour curriculum, though, and that’s basically 25 weeks. So I’m sure there were lots of nights and weekends spent learning a mixture of nonsense like energy medicine and acupuncture plus some nutrition (which probably wasn’t particularly science-based).
Now here’s a particularly disturbing passage from Weeks:
The clinic has been in the works for over three years. Much of the planning has involved Meeneghan, who was also her first hire. White said she found no resistance to hiring a naturopathic doctor-acupuncturist: “His specialty didn’t exist here before so it took him awhile to get credentialed since it was learning from scratch for the system. And it was easier for us because we were only credentialing him for outpatient care – our focus.” (Cedars has credentialed acupuncturists across the board, for inpatient and outpatient services.) She noted that doctors from oncology, pain, labor and delivery and two pediatric specialties have already expressed interest in how the integrative health team may enhance their care options.
No, it isn’t disturbing that the clinic had been in the works for three years. What disturbed me is that no one opposed hiring a naturopath for this clinic. If true, that bespeaks an astounding lack of awareness or concern among the CSMG and its credentialing committee over what naturopathy really is and really involves. (I’m not sure what would be worse, a lack of knowledge or lack of concern.) Worse, the reported interest from Cedar-Sinai’s oncologists in integrative medicine disturbs me personally as a cancer surgeon. Clearly, they, too, have no clue what “naturopathic oncology” involves. Naturopathic oncologists (like Not-A-Doctor Meeneghan apparently has attained as an additional certification) like to pretend that theirs is a real specialty, but it’s no more science-based than naturopathy.
Finally:
The payment model is cash. The clinic provides patients with a super bill. White was not aware of what percentage of the clientele may have Health Savings Accounts.
Because, of course it is. What else would it be, but cash on the barrelhead? I couldn’t help but chuckle, though, at Weeks referring to providing the patients with a “super” bill. (I bet it’s a super bill.) I know, I know. There really is such a thing as a superbill for healthcare. It’s nothing special, basically nothing more than an itemized form used by healthcare providers for listing rendered services. It’s just that Weeks’ separating it into two words was unintentionally hilarious in its implication. Freudian slip, perhaps?
It is gratifying to note that the Cedars-Sinai integrative medicine clinic appears not (yet) to be as successful as the Cleveland Clinic’s functional medicine clinic, which has been, alas, wildly successful. However, it does appear to be moving towards being in the black:
Marketing has been internal, via such mechanisms as grand rounds, and bringing some big-name speakers – Wayne Jonas, MD first, and soon Dean Ornish, MD — for events. White notes that it hasn’t hurt that she has all the relationships that she has built up in 22 years as a physician practicing in the CSMG.
On the Cedars-Sinai website, White and her team offer a list of 18 conditions that “respond well to an integrative approach.” While they are effectively a specialist model within the medical group, the net they cast is wide. Referrals are picking up from a couple groups within the system, notably oncology. Yet word of mouth – integrative health marketing’s best friend – appears to be driving the recent up-turn in patient volume and will be the necessary engine for the near future toward hitting the break-even targets this time around.
Yes, I know that this is one incident, one academic medical center embracing quackery up to and including naturopathy. It’s a big and important academic medical center, but it’s just one. The problem is that academic medical centers all over the country are launching similar initiatives, either through wanting to capture market share (or at least preserve market share by making sure that woo-prone patients don’t go somewhere else) or through the same “open-mindedness” towards pseudoscience that’s contributed so much to the existence of quackademic and integrative medicine—or both. As they say, an avalanche starts with one pebble. What I fear is an echo of the words of Kosh, the Vorlon ambassador, in one of my favorite SF TV series of all time, Babylon 5. True, they were used in another context, but they also fit here: “The avalanche has already started, it is too late for the pebbles to vote.” The Cedars-Sinai integrative medicine clinic is clearly not the pebble starting an avalanche. I fear we might already be in the middle of the quackademic avalanche and that it’s too late for us pebbles to vote. I still won’t give up, though.
18 replies on “The quackademic avalanche: Is it too late for the pebbles to vote?”
I share Orac’s concerns. But as long as there’s money (and touchy-feely street cred) in affiliating with quacks, academic and non-academic med centers will be tempted to abandon core principles and enable this nonsense.
Speaking of disturbing images – how is it that Not-A-Doctor Meeneghan used a stock image of multicolored syringes on Facebook to illustrate his B12 shot giveaway? Such images are typically used in anti-GMO harangues (for instance, showing the syringes injecting Colored DNA Toxins into an apple).
Yes, it looks like several people are in this for the money. Most of the consumers of this nonsense pay cash up front, and Beverly Hills is loaded with gullible rich people (as are many of the neighborhoods surrounding Beverly Hills). Probably the reason CSMG’s previous attempt at an integrative health clinic failed is because there weren’t enough gullible rich people around at the time, but a bunch of persistent evangelists have converted lots of people since then.
I do have a definite opinion on whether “didn’t know” or “didn’t show concern” is the worse. The former is ordinary ignorance, which is curable. The latter is willful ignorance, which is not. I’d definitely be concerned if the board of trustees (or equivalent body) of a prominent medical center knew what integrative medicine was, and nevertheless allowed an integrative medicine clinic to operate under their banner.
Query; what can be done to try to reverse this trend? I’m planning on going to medical school, and frankly I’d rather not be forced to learn this bullshit under the guise of “holistic” medicine.
What causes these “conversions” in MD’s anyway? It seems that for every Britt Hermes seeing the light, there are a whole bunch of Dr White’s going to the Dark Side.
Grand Rounds? Aren’t those supposed to be science oriented?
Re. Acalanthis: “….planning on going to med school, and frankly I’d rather not be forced to learn this BS…”
1) It may be useful to learn this BS specifically to be able to refute it soundly when your future patients ask about it. Knowing the “theories” and the language that’s used, demonstrates credibility to patients who are already steeped in it. Then you can lead them through the facts & reasoning showing that (whatever-it-is) is useless.
2) In the BS classes, you might be able to subvert the paradigm by asking, in a tone of voice that demonstrates curiosity rather than cynicism, “this is intriguing, where can I find peer-reviewed articles in quality journals, supporting these ideas…?” (The answer of course is “nowhere,” and the absence of any such articles may help convince undecideds who aren’t already alert to the problem.) Don’t overdo it, just occasionally ask, and let the absence of a convincing answer speak for itself.
Better to ask about the existence of any large randomized controlled studies or comprehensive reviews supporting a wooist practice (and be prepared to respond to any defensive misdirection about lack of such studies for some mainstream therapies, by saying you’re prepared to question them too). There are all too many lousy “peer-reviewed” publications in lower-tier journals that woo promoters can get away with citing, if allowed to.
Without even going into predatory or lousy territory*, pick any community big enough and you will have niche journals catering to them. As an example, there is a Journal of Complementary and Alternative Medicine.
Its content is exactly what it says on the tin. It’s peer-reviewed, all right. Just by peers who happen to be into CAMs.
Similarly, in a recent post, Jen Gunter pointed to a medical journal which is mainly for physicians and lawmakers, let’s say, firmly on the right side of the US political spectrum.
OK, it could be All of the Above.
Yet like many early models, the clinic’s response to consumer interest …
Why does this make me feel like vomiting? Of course, I live in a communist-fascist more-or-less single payer country.
The payment model is cash.
Oh, right.
This critique reflects the bias, politics, and inefficiencies of msm medicine and its failure to fill real needs with nicer methods and extant materials. The cash and price aspects show how poor the competitiveness of msm often is, trying to fill the gap with vitriol rather than results.
Some fraction of natural medicine will be shown to have a medical, health or wellness basis long ignored and/or disparaged by current or recent medical authorities and authoritarians. This is clearly occurring with vitamin D3, and more slowly, vitamin C.
30-50 years ago, there were CAM doctors prescribing 2000 iu to perhaps 8,000 iu of vitamin D3 (vs D2) per day fairly frequently, along with other supplements, like magnesium. They were roundly denounced and attacked by right thinking MDs as dangerous and foolish with such “toxic doses”. If anything time will probably show them to have been a little, to a lot low, for such walking wounded to frankly ill populations.
IV vitamin C, with thiamine etc, recently scored PMID points for sepsis. Something some alternative drs stated in the 1950s and 60s. Sadly, even now, the vitamin C doses published still seem to be suboptimal to achieve more uniform and rapid recoveries compared to earlier authors and common experience.
Actually, recent research has found hazards in taking the sort of vitamin D dosages that “alternative” practitioners were supposedly recommending 30-50 years ago, including an increase in fractures and the incidence of some cancers (high vitamin A intake was previously linked to elevated cancer risks).
https://www.reuters.com/article/us-health-vitamind-supplements/many-americans-taking-too-much-vitamin-d-idUSKBN19B2F0
The “cash and price aspects” of vitamin megadosage are attractive to supplement companies and woo promoters, not so good for consumers.
Sure, multi nutrient failures, often with still inadequate or intermittent vitamin D. A lot those were contaminated with vitamin D2, excess vitamin A, excess calcium, deficient magnesium, boron and/or vitamin C and K2. High vitamin A recommendations largely died out 10-12-15 years ago, although I’m sure you can find holdouts. Your fracture patients disappear with more correct, more complete bone formulas. You can actually track the slowed bone loss or even rebuild on scans, rebuild even in the face of bone dissolving chemo.
The more modern studies and (re)analysis with better, more complete models show the big oops on vitamin D. The gross deficiencies in vitamin D really are not arguable, fubar, perhaps blame both msm nutrition more broadly and dermas narrowly.
Add high dose B6 and B12 supplementation to the list of vitamins associated with increased cancer risk:
https://cancer.osu.edu/news-and-media/news/long-term-high-dose-vitamin-b6-b12-use-associated-with-increased-lung-cancer-risk-among-men
Naturopaths are among the quackticians promoting vitamin B12 and vitamin C in higher than recommended amounts, for very dubious indications.
It’s true that some supplement companies sell products with contaminants or inaccurate dosage measurements, but the excuse that “my product is pure” doesn’t make megadosing safe.
Gary Null would be able to tell you more about that. 😉
‘What causes these “conversions” in MD’s anyway?’
Most MDs aren’t scientists, and many got out of med school by memorizing symptoms and treatments. As humans, they tend to think of themselves as more expert than they are, and fall for pseudoscience (and well-paying grateful patients).
Somewhere in Quackwatch , the author opines that medical personnel with less control over outcomes- perhaps para-professionals- can be attracted to the certainties/ “power” of woo.
Similarly, serious illnesses with negative outcomes may even make doctors seek out magic.
Which might place this firmly in the realm of unrealistic beliefs founded in emotion.
Similarly, serious illnesses with negative outcomes may even make doctors seek out magic.
Hopefully, serious illnesses with negative outcomes may make some doctors seek out better answers, rather than remain stuck in a rut 20 – 80 years long. Big Medicine methodologies are slow, expensive, and catastrophic for patients living, and dying, in the right now.
Several times now, I’ve seen motivated, nonmedical outsiders walk up, use their professional research and experimental skills for results well outside the max range of current therapies, using natural and off label materials. No magic.
If I consult a doctor that was first in his group from UCSF, researched his specific topic for 30 years with extended clinical experience and observation, his unvarnished opinion on application of 1-2 (mega)vitamins is not magical. In honest EBM, it is just based on a lower level of evidence, outside the experimental range of standard medicine.
D’Bacon
A lot of studies are contaminated by inferior forms of vitamins or grossly wrong combinations of nutrients, often undocumented or ignored in the study. I’m actually a little less interested on some aspects of purity, and in some cases, “antipurity” for some natural mixtures. I’m more interested in the specific nutrient molecules quantities not bland generalizations like “vitamin E”, “B12” or “vitamin D”. Solo applications are often dubious much beyond vitamin C. To avoid those fractures a good bone formula might include magnesium, a few trace mineral, higher amounts of K2, and even some vitamin C.
At some levels of megadosing, a little skill and information are important. Funny, how a lot of msm studies totally miss any prior research and totally sabotage the possibility of the desirable effects, or induce long known side effects of fubar choices.
Smokers getting lung cancer and having perverse metabolism of vitamins is increasingly well known. At least for some vitamins, smoking is associated with disrupted redox chains, measurable in oxidized vitamin metabolite built up or glutathione, or on some other bindings.
One CAM doctor I knew in passing years ago, commented on how much extra time she spent on getting her new patients to stop smoking but would tell them she wouldn’t continue them if they didn’t quit smoking.
Claims that woo remedies don’t work and/or are dangerous because “you did it wrong” are legion. As are paranoid delusions about evidence-based medicine “sabotaging” studies of alt med (the assumption that sabotage is at work when negative results ensue, omits the very strong likelihood that the product/treatment does indeed lack positive attributes).
“nonmedical outsiders walk up, use their professional research”
You may want to research the meaning of the word “professional”. 🙂