One topic that I revisit frequently is quackademic medicine. As regular readers know, the term “quackademic medicine” refers to the creeping infiltration of unscientific, pseudoscientific, and mysticism-riddled medicine into academic medical centers and medical schools. It’s a phenomenon that’s been occurring over the last 25 years or so, with traditional Chinese medicine, acupuncture, naturopathy, and even The One Quackery To Rule Them All, homeopathy, finding their way into what should be bastions of science-based medicine. We’re talking big names here, like Harvard, Stanford, the University of California, the University of Michigan, NCI-designated comprehensive cancer centers, and, yes, the Cleveland Clinic, which is home to Dr. Mark Hyman, functional medicine guru.
Now, you’re probably thinking at this point: The Cleveland Clinic? Not again? After all, I’ve been hammering the Clinic for its creation of a traditional Chinese medicine herbalism clinic, its opening of its Center for Functional Medicine run by über-quack and functional medicine guru Dr. Mark Hyman. A year and a half ago, the culture of tolerance for “complementary and alternative medicine” (CAM) or “integrative medicine” quackery led to the director of its Wellness Institute, Dr. Daniel Neides, to go off on an antivaccine rant, which is what happens when you let magical thinking take hold. Naturally, the leadership was shocked—shocked, I say!—that antivaccine sentiment existed among the faculty in its Wellness Institute, but that didn’t stop them from doubling down on the pseudoscience and quackery (other than antivaccine pseudoscience, which embarrassed the leadership and resulted in a lot of bad PR).
Unfortunately, the Cleveland Clinic’s functional medicine program has been wildly successful, leading CAM proponents to laud it as “disruptive.” Sadly, functional medicine mixes the worst of both worlds, combining massive overtesting and overtreatment with quackery. That success, it appears, seems to be driven by carefully selected anecdotes fed to credulous media sources, anecdotes like that of a patient named Cindy Tedrow, who lives in a small town in northwest Ohio, about 130 miles west of Cleveland. Here’s her story as it showed up on a local Toledo TV station’s news broadcast, under the title, Local woman who lived with chronic illnesses for 44 years gets relief.
A northwest Ohio woman suffered from a number of chronic health problems for decades, including hypothyroidism, arthritis, fibromyalgia , heart problems and autoimmune deficiencies. She wasn’t sure she would ever be cured, but a trip to Cleveland changed all that.
Cindy Tedrow lives with her husband on a farm in Delta. She dealt with that long list of health problems for 44 years As you can imagine, it was physically and emotionally draining. Cindy says a trip to The Cleveland Clinic’s Center for Functional Medicine was a prayer answered, “Some days just walking would take all the energy I had.”
Here’s the video:
This news report is basically pure propaganda for the Cleveland Clinic Center for Functional Medicine. The Cleveland Clinic could easily have paid to air parts of it as an advertisement, but in the end it got free advertising. What about Ms. Tedrow’s story itself? Let’s take a look at how it was presented:
As the years went by Cindy’s health problems continued to pile on, “When the seizures started that was the worst. The seizures were extremely scary. My dog Molly even alerted me to a few of them before I had them. It was amazing because she had no formal training to do that.”
The seizures were in addition to the long list of other ailments like chronic fatigue syndrome, migraines, dysautonomia and blood sugar issues, “I was on 22 prescriptions at one time, and it kept getting worse. I wasn’t going to give up though, I had a family to raise. I also had faith and I knew that someday I would get answers.”
OK, so she had a seizure disorder. That’s bad. She also had a whole lot of chronic conditions, including what sounds like it was probably type II diabetes (blood sugar issues), although I can’t be sure from this report. Next up, we get the usual blather about “holistic” medicine, straight from Dr. Mark Hyman himself:
Cindy enrolled in the Functional Medicine Program at The Cleveland Clinic, “For the first time in 44 years someone said to me we can help you.”
The program is designed to treat the body as a whole organism rather than a collection of organs. Dr, Mark Hyman is an internationally recognized physician in the field of functional medicine,”We removed Cindy’s impediments to health. We gave her the ingredients to her health. We gave her a whole food diet, eliminated inflammatory foods. We gave her nutritional and lifestyle support. Within a short time, she not only lost 80 pounds, but she was able to get her energy back and truly regain her life.”
According to Dr. Hyman, Cindy say a more than 60% reduction in all her disease symptoms in just eight weeks, “Functional medicine is a new way to think about disease that gets to the root cause. It doesn’t focus on the symptoms, it focuses on the questions of why you have those symptoms.”
First, let me just say how much I detest how “integrative” and “functional” medicine doctors have claimed the term “holistic” as their own, as though no one does “holistic medicine.” As I’ve said many times before, such doctors posit what is in essence a false dichotomy: Either embrace dubious medicine and pseudoscience or you aren’t truly being “holistic.” You have to accept Dr. Hyman’s “make it up as you go along” mish-mash of scientifically defensible medical advice plus dubious claims, such as “inflammatory foods,” the removal of which is often portrayed as a panacea that will cure whatever ails you.
Dr. Hyman likes to think that he’s practicing a radical new form of medicine that takes account of the “whole person” or all organ systems, but he’s not. Not really. As I’ve discussed before, Dr. Hyman likes to take the emerging science from systems biology and basically mangle it, as he did, referring to it as the “original precision medicine,” a claim that, whenever I hear it, makes me want to run to my liquor cabinet and hit the scotch. Fortunately, I can resist, particularly given that I’m on call this week and can’t afford to imbibe anything stronger than iced tea, but don’t get me started on some of the utter nonsense that he’s spewed about cancer and autism or how he appears to want to turn back the clock in science to emphasize anecdotes over clinical trials.
In reality, as I’ve described before and illustrated with an actual case report of functional medicine use in a breast cancer patient published by functional medicine practitioners, what functional medicine really involves is running dozens—or even hundreds—of laboratory tests and then trying to correct every abnormality in every vitamin, mineral, or enzyme level they detect using supplements. Then they add quackery, like traditional Chinese medicine. It’s not for nothing that I refer to functional medicine as the “worst of both worlds,” as I mentioned above. It combines the massive overtesting and overtreatment of every laboratory abnormality found that conventional medicine is too often guilty of and then adds the pseudoscience and quackery of alternative medicine, selling it as a package with (usually) uncontroversial lifestyle modifications, such as diet and exercise.
In Ms. Tedrow’s case, I can’t help but think that the loss of 80 lbs is almost certainly responsible for most of her improvement. If you’re that overweight and lose that much weight, chances are good there will be improvement in symptoms common in chronic fatigue syndrome, such as joint pain, low energy, and the like, and it’s very likely that your type II diabetes will come under much better control. It’s also not as though there aren’t dietary interventions that can be helpful in chronic fatigue syndrome. There are, but they’re very limited. Also, a battery of tests of the sort ordered by functional medicine doctors isn’t necessary to identify them. Indeed, obesity is associated with migraine, with the chances of having migraines increased in those who are obese, a risk that increases as someone gains weight and changes physical stature from normal weight to overweight to obese. Basically, obesity is a modifiable risk factor for migraine. Now, I will say one good thing about the functional medicine program at the Clinic. If its doctors and nutritionists were able to get Ms. Tedrow to alter her diet and lifestyle in such a way that she managed to lose 80 lbs in a few months, that is a good accomplishment and probably explains a whole lot of her improvement in symptoms. It’s just that you don’t need pseudoscience to accomplish that.
Not surprisingly, the Cleveland Clinic’s marketing department is using Ms. Tedrow’s story. She’s appeared in a press release and on one of its podcasts, The Comeback. There, I learned a bit more about her story than what appeared in the Toledo news report. For instance:
Cindy: It was it started after the birth of my first son and within three months after he was born I would get up in the morning and I, I’d make the bed and that would be it, I could hardly function during the day that I but I did. I was a new mom and kept going and as things progressed something else would happen. They discovered I had mitral valve prolapse, I got worse eventually and I was saying to you earlier that when my second son was born I always tease him, because he’s a little Eveready bunny, that when he was born he sucked all my energy out of me and he got all my energy that’s when I really started taking a turn for the worse. Blood sugar issues, fainting, fainting was a problem for me my whole life. Diagnosed with dysautonomia, Potts then, and then when I was 42, I had a hysterectomy and that’s when things went really, really downhill. That’s when the seizures started but I kept, I kept going and I kept pushing, I kept, I was teaching and I basically through the years, it was to the point I would take everything I had to get through the week and then I would recover all weekend so I could teach again on Monday. I kept searching and searching and searching, going from one specialist to another specialist and at one point I was 21 medications, prescriptions, getting worse and it was to the point then the seizures were so all consuming, I never knew when they would I would have them, I started having them in school. One day in school, I remember I was teaching and the kids were looking at me very strange and they said Mrs. Tedrow are you all right? And I had had a seizure and I was speaking and it didn’t make sense.
This leads Dr. Hyman to lay down his usual line of word-heavy, meaning-light, but very impressive-sounding blather:
Hyman: Cindy was talking about this whole list of problems that she had that all seem unrelated from seizures, to fatigue, to fibromyalgia, to migraines, to irritable bowel and she was a mess and I joke, we take care people with a whole list of problems which is why we call ourselves holistic doctors, right? Because we’re dealing with all these things that aren’t disconnected, they’re all related and functional medicine is a model of thinking about how to solve the puzzle of chronic disease. You went to doctor, after doctor and we’re trained as subspecialists or specialists who look at the body is a series of different parts, you each have a specialist for different parts, we don’t actually understand how everything is connected. So, functional medicine is about connecting the dots about understanding the patterns in the story that lead to the symptoms. The symptoms are just factors that are caused by something. So we’re working at the cause level what’s the root cause, why as opposed to what, we can give labels to a disease like fibromyalgia or seizures but the question is why are they happening? And so at the Center for Functional Medicine at Cleveland Clinic we’ve designed a program called Functioning for Life which is a 10 week program that’s immersive, you do it as a group together because we find that people do better together. Friend power is better than willpower to change behavior and change lifestyle and we, it’s a foundational lifestyle program but it’s also designed to actually create health you know functional medicine, we don’t just treat disease we actually create health and often, and when we create health, we just take away the things that cause imbalance in the body and giving the things that create balance, the body often just recovers on its own. It’s like disease goes away as a side effect of creating health and that’s really the approach and it’s, it’s pretty novel and new and it’s based on emerging research that teaches us how the body is one whole dynamic system and through that approach we’re able to help people like Cindy get rid of problems that they’ve had for decades that haven’t been able to be helped with traditional methods and every doctor does their best but the question is, you know, they’re not taught how to think differently, they’re not taught, for example, the power of food. Food is the most powerful drug on the planet. Period. There is no drug, for example, that can get people off of insulin in ten days but using this approach we see type 2 diabetics literally get off insulin, or relieve migraines, or seizures, you know, you were on seizure medication on fairly high doses that were making you sleepy and groggy and causing dysfunction and were still not even working and when we dealt with the underlying causes your seizures got better and you said what you’re saying to me earlier before the show, before we started this show, that you now don’t have any seizures, you’ve been able to reduce your medications and are you driving again? Yes, you’re driving again where you couldn’t drive before. I mean this is a massive change in your life, from a, a few simple things that have profound effects.
We create health and disease goes away as a side effect? To travel back in time some 35 years, gag me with a spoon. The bottom line is that what Dr. Hyman is describing above is a support group. Did Dr. Hyman do anything that a science-based primary care doctor couldn’t? I would say no. Ms. Tedrow seemed to be a victim of too many specialists and needed someone to take control and start pruning medicines. There’s nothing new or radical required to achieve that, and Dr. Hyman’s insistence on wrapping it all in functional medicine woo-language is infuriating.
We also learn that some changes that occurred with Ms. Tedrow are not as impressive as advertised:
Kyle: Cindy you were on 21 medications before you started this program. How many are you on today?
Cindy: I think I’m down to 16, I think now, 15 or 16 but I have asthma and a lot of those are asthma and sinus issues.
Hyman: Those get better at all?
Cindy: Yes, actually they have. My sinuses have gotten a lot better. Usually in the fall, and I live on a farm, so and I’m allergic to dust, in the fall it was terrible, it was terrible. But I did very well this fall. Yeah I did very well.
So Dr. Hyman only decreased the number of medications that Ms. Tedrow is on from 21 to 15 or 16? She’s still on at least 15 different medications? That doesn’t sound so miraculous to me. Any halfway decent primary care doctor could have winnowed a regimen of 21 medications down by that much. And she’s now on a bunch of what look like essential oils. Overall, I’m guessing she’s on the same number of different compounds.
So what has Dr. Hyman accomplished with Ms. Tedrow? To his credit, his team has enabled her to change her diet and stick with it so that she successfully lost a lot of weight, with a resultant major improvement in her overall health and decrease in many of her symptoms. If you don’t know what functional medicine really is, you might be very impressed by that. I also can’t help but note that Delta is a small town in an area with a lot of farms. The nearest medical center is a small community hospital, and the nearest large hospitals are in Toledo. The nearest heavy-duty academic medical centers are in Cleveland (Case Western Reserve University and the Cleveland Clinic) and in Columbus (The Ohio State University). So, chances are that many of Ms. Tedrow’s doctors were ill-equipped to handle a patient as complex and with as many medical problems as she had.
Don’t get me wrong. In the end, I’m happy that Ms. Tedrow is doing so much better now, but I remain unconvinced that most of her improvement isn’t due to her successful loss of 80 lbs. That Dr. Hyman’s team could enable her to do that does him credit. That being said, all the functional medicine pseudoscience and woo-babble (like Star Trek technobabble, only with medical woo) are unnecessary. Dr. Hyman has never been able to demonstrate that they add anything to the basics of improving patients’ diets and getting them to exercise, plus removing unnecessary medications, and, as I’ve documented before, I do know that he spews a lot of pseudoscience in justification of “functional medicine.” I also know that when local news stations pick up on local human interest stories like this they’re doing nothing more than given places like the Cleveland Clinic free advertising.