What the Department of Family Medicine at the University of Michigan teaches about acupuncture

About a month ago, I noted with horror that the Department of Family Medicine at my medical alma mater, the University of Michigan Medical School had gone woo. My alarm was in response to the department’s having invited two famous homeopaths to give a joint lecture, which turned out to be every bit as bad as you might expect. Even worse, there was no sign of skepticism in the audience. This is the same department that had years ago embraced the utter quackery that is anthroposophic medicine. Worse, the department hired a naturopath, Suzanna Zick, who is co-director of the integrative medicine program in the department. We’ve met her before, both doing an acupressure study and being part of the team who developed the Society for Integrative Oncology’s breast cancer guidelines. (She was SIO President from 2015-2016.) She’s pictured above with the rest of the faculty of the Integrative Family Medicine Program.

So, you might ask, given the leadership role in resident education held by a naturopath, the lack of skepticism towards homeopathy, and the presence of an anthroposophic medicine advocate in the department, what the U. of M. Department of Family Medicine is teaching its residents and the medical students rotating through its clinics? (At least, I asked that question.) The answer, it turns out, was on the U. of M. website, where the Department of Family Medicine provides a helpful webpage entitled Family Medicine Education Modules, which are:

Our education modules are made available through a partnership with Open.Michigan, a University of Michigan initiative committed to open content licensing and supporting the use, redistribution, and remixing of educational materials. Open.Michigan has reviewed this material in accordance with U.S. Copyright Law and has tried to maximize your ability to use, share, and adapt.

There are three integrative medicine modules:

Integrative Medicine Based Approach to Care

• Asthma
• Depression
• Diabetes Type 2
• Gastroesophageal Reflux Disease (GERD)
• Headache
• Menopause
• Obesity and Weight Loss
• Prenatal Care
• Upper Respiratory Infection (URI)

Integrative Medicine: Body-Based Therapies

• Acupuncture
• Manual Medicine
• Massage Therapy

Integrative Medicine: Mind-Body Therapies

• Overview
• Guided Imagery
• Hypertension

I perused the list, and zeroed in on the most pseudoscientific treatment there, acupuncture. I was somewhat surprised there wasn’t anything on naturopathy in the modules, but I predicted that a lot of what naturopaths do would just be “integrated” into the education. I also realized that I really wish I had a U. of M. login, because there were pre- and post-tests that I could have looked at but didn’t have access to. In any event, the acupuncture module is listed has having been developed by “U-M Department of Family Medicine integrative medicine fellow, Andrew H. Heyman, MD, MPH, in 2007” and is currently being “maintained by faculty member, Tarannum A. Master-Hunter, MD,” with the last review being in February 2018. Her clinical interests are listed as family medicine, sports medicine, and clinical acupuncture. Great! We have a physician administering what I consider to be quackery at my alma mater!

What about the module? Ever the optimist, I was hoping for better, but what I got was typical misinformation about acupuncture. For instance, we get the narrative that acupuncture is ancient:

“The superior physician controls disease before any illness has declared itself;
the average physician practices acupuncture before the disease has come to crisis; the inferior practitioner treats the patient when illness is already dying away.”
– Zhen Jiu Jia Yi Jing
(Comprehensive Manual of Acupuncture and Moxibustion, 282 AD)

Chinese medicine has evolved from a theoretically and clinically heterogeneous heritage that includes ancestor healing, demon exorcism, magic correspondences and herbal medicine.

• Its history is well documented in more than 10,000 medical treatises.
• The first European reports on Chinese medicine came from 16th and 17th century Jesuits.
• Missionaries to Asia brought back the theory and practice of Traditional Chinese Medicine to Europe (see Acupuncture – European history).

Today, Chinese medicine embraces a complex, internally consistent and comprehensive medical tradition that includes acupuncture, herbology, nutrition, meditation, exercise, and manual therapy.

Aside from treating disease, Chinese medicine has maintained a vigilant position on health prevention.

Of course, there are wildly varying estimates for how old acupuncture is that depend on how reliable one considers ancient texts and what, exactly, one counts as acupuncture. I like to think of it by asking a simple question: Did the technology exist to make fine needles 2,000 years ago? The answer, of course, is no. So if acupuncture existed, it must have been very different then than it is now, given that the technology to produce such thin needles didn’t exist until much, much later. Indeed, it is very likely that acupuncture started out as no more than an Asian variety of the bloodletting practiced in Europe, with acupuncture points and meridians being near veins to be opened. There was also a strong connection between ancient acupuncture and astrology, such that it has on at least one occasion been referred to as “astrology with needles.” Indeed, it’s pretty clear that acupuncture was likely an offshoot of bloodletting.

There are a lot of other things about the history of acupuncture that its advocates forget. For instance, although needling is often cited in the Yellow Emperor’s Canon of Medicine, relatively little has been written about it elsewhere and that, reportedly, by the middle of the second millennium, the practice had been largely abandoned, with Chinese and other Asian societies actually taking steps to eliminate it, even by outlawing it. Indeed, by 1757 a book documenting the history of Chinese medicine called acupuncture a “lost art.” For example, in 1822 an edict banned its practice and teaching from the Imperial Medical Institute in China, and the practice was banned in Japan in 1876 and finally outlawed in China in 1929. Then in the 1930s a Chinese pediatrician named Cheng Dan’an proposed that needling therapy be resurrected because now its actions could be explained through neurology. He also replaced the previously used coarse needles with the fine filiform needles in use today.

If you want to read what acupuncture was like over 100 years ago, read Harriet Hall’s review of a book by a Scottish surgeon Dugald Christie, who was stationed in China from 1883 to 1913. The descriptions feature children with needles left plunged deep in their bodies for days, including one who died. Of course, I’ve picked up the history of acupuncture beginning with the era of Chairman Mao Zedong, who basically retconned the history of traditional Chinese medicine (TCM) and acupuncture and promoted it to the world, a promotion that is still going on today. This retconned version of the history of TCM, in which it is presented as a unified whole philosophy of medicine and acupuncture uses very fine needles, is what U. of M. is teaching. Never mind that acupuncture as we know it has existed for probably less than 100 years. No wonder there are so many varieties of acupuncture.

Let’s just say that if the module gets the history so wrong, opting for propaganda over actual history, I have grave doubts about the rest of it. I was not wrong to have them. For instance, qi is described pretty much as “energy” or the “vivifying force contained in (and circulating through) all natural phenomena and life forms” and as flowing “through these meridians in an organized fashion to provide nourishment and protection to the organism,” with acupuncture points described as “nodes” along the meridians that “serve as access gates or switches that send information and can influence internal physiologic processes.” There are also a lot of hand-waving “explanations” for how acupuncture “works” like this:

Since nerve conduction alone does not explain all biologically-related phenomena induced by acupuncture, new explanatory theories are emerging. One set of explanations include the cell to cell depolarization of electro-ionic shifts in sodium, potassium and calcium causing the stimulus to pass along tissue planes such as fascia. Additionally, small shifts in electro-magnetic potentials occur during acupuncture treatment that can accumulate to cause larger organ system responses once thought unlikely.

This is, of course, nonsense, as is the claim that acupuncture is good for a large number of conditions, such as those listed here. Apparently, the Department of Family Medicine doesn’t understand that acupuncture is nothing more than a theatrical placebo. It has no specific effects for anything or that “pulse diagnosis” is bogus—or that whenever you hear a quack make a statement like this, it’s nonsense:

Symptoms may worsen 24 hours after a treatment, followed by marked improvements, which usually signals a positive response.

Ugh.

Basically, there is no skepticism in the entire module. It’s taught the way that an acupuncturist would teach acupuncture. There isn’t even anything resembling a serious acknowledgement that science doesn’t support acupuncture. It’s just assumed that it works, and presumably that’s what family practice residents and medical students are learning.

I’ll have to go through the rest of the modules when I get a chance.

It saddens me that even one department in the medical school that trained me has drunk deeply from the quackademic medicine firehose. I only reassure myself by telling myself that the department of surgery there is relatively free of this nonsense, as is (most) of the rest of the medical center. I only hope it doesn’t metastasize from the Department of Family Medicine.

Of course, it’s not just Michigan. I’ve been documenting for nearly 14 years the infiltration of quackademic medicine pseudoscience into some of the most prestigious medical schools and academic medical centers in the world, institutions as storied as Memorial Sloan-Kettering Cancer Center, M.D. Anderson Cancer Center, Georgetown, Harvard, Duke, Stanford, Yale, UC-Irvine, and the University of Arizona. I’d be naïve indeed to think that my alma mater couldn’t fall prey to the same sort of pseudoscience. I reassure myself by noting that, as far as I can tell, it’s just one department and that my current institution, although not completely free of “integrative oncology” and “integrative medicine,” has a far smaller amount of it than a lot of the most prestigious medical schools in the country. I aim to do what I can as faculty to keep it that way.