“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.
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.
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.