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

The Department of Family Medicine at the University of Michigan has embraced integrating quackery with medicine in its “integrative medicine” program. But what is it teaching its trainees? Unfortunately, I’ve started to find out.

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.

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]

38 replies on “What the Department of Family Medicine at the University of Michigan teaches about acupuncture”

So what we aren’t stating explicitly as in the case of acupuncture, but I am assuming many of the people in the program acknowledge tacitly accept, is that we are performing – as you note – placebo therapy on patients with improvement in the symptoms.

It is in this, and only in this am I willing to entertain value in this therapy.

The placebo effect.

The problem is we can’t always control who will benefit from the placebo effect.

And the other problem is, the woo meisters really believe their BS, and charge high prices for it.

…but I am assuming many of the people in the program acknowledge tacitly accept, is that we are performing – as you note – placebo therapy on patients with improvement in the symptoms.

That is a large assumption that I wouldn’t make. Patients are not generally informed that acupuncture is placebo nor are they savvy enough to know that it is.

But the placebo effect depends on lying to patients, which is inherently unethical. (Use of a placebo in an RTC is different because study participants are told in advance they might receive the placebo.)

It’s simplistic to say that the placebo effect depends on lying to patients. Nor is it accurate to characterize the placebo effect as simply being tricked, especially given what we know nowadays about the biological underpinnings of the placebo effect itself. Re: https://www.nytimes.com/2018/11/07/magazine/placebo-effect-medicine.html

Moreover, between the mythology of acupuncture’s historical presence–however disjointed it may be–to the fact that, you know, you’re getting stuck with long needles, there’s a lot to like about acupuncture theatrically. We talk about the efficacy of acupuncture at the urgent care center where I work.

come on orac give it a rest u been going on for months on a couple of narrow subjects would think most of your followers are over it ??? pull on the cannabis cbd /thc debate and the fact bigphama are now in the game with 3 synthetic products …fda approved… and more in the pipe line??? yes in australia there are gov licensed farms growing huge crops to get into the worlds export markets & for home in oz licenced production … etc suggest u bone up on this as in usa we in oz get heaps of info whats going on their re this matter & thru out the world u tube is flooded with believe able peoples home stories re cancer & other matters ….yes ive said before to u that break thru’s will come from the masses in the near future …so spice your show up a bit & put this on the drawing board …cheers from oz…happy bob.8..

I’m going with Mother Tongue, although being too incoherent to figure out how to do it is a tempting option. I suppose they’re not mutually exclusive.

Though I would be interested in reading what the hallucinogenic toad had to write about his/her experience…is the human tongue really useful as a cure or is it just a placebo?

University of Michigan Medical School teaches that “Chi” is the finest material quality still available to human perception. Everything that is, is made of Chi <a href="http://www.bbc.co.uk/religion/religions/taoism/beliefs/concepts.shtml"according to the BBC. Oceans and rivers of it flow through the human body – which is made of it. All is Chi. Mi-Chi-gan Medical School.

Acupuncture taps into flows of Chi. Flows of money. Ker-Ching, Ker-Ching.

I am sick and tired of people talking about the placebo effect related to CAM, although it can happen sometimes. Most of what is observed is spontaneous improvement, and this occurs frequently, even with conventional medicine. But it’s better for the doctor that the patient thinks he is responsible for the improvement.

Improvements upon acupuncture are also spontaneous improvements for most of them. Where is the strawman?

Improvements upon acupuncture are also spontaneous improvements for most of them. Where is the strawman?

Acupuncture alone was referred to as a placebo, not CAM; that is a strawman. But please feel free to qualify acupuncture as regression to the mean moreso than placebo effect since you mentioned it.

@ sciencemom
1) If I say “I am sick and tired of people talking about the placebo effect related to acupuncture, although it can happen sometimes”, it has the same meaning in this context: everybody can judge that the initial message was about acupuncture.
2) “Regression to the mean” is a pompous term for spontaneous improvement.

Acupuncture needles evolved from bian-stone, bamboo and bone to metals such as bronze, gold, silver and stainless steel.

Question: If bamboo was still used today in acupuncture, what would conventional medicine call the end result.

Answer: Slivers

Oh my god!
If you’re trying to make a ( rather prosaic) joke , AT LEAST get it right: it would be:
SPLINTERS
( and get the grammar right as well)

Every time I think I’m out, they drag me back in

@ Denice Walter,

If you’re always going to be in disagreement with MJD, please consider joining Narad’s very small SPLINTER group within Respectful Insolence (RI).

@ Orac,

To avoid the perception of RI becoming a cult, allow me to write a guest post ASAP.

Did you ever see that episode of Mythbusters where they tried to see if Bamboo really will grow straight through a human body (to see if it could be a viable form of torture)? It didn’t work, but it would still be very uncomfortable. Kind of like reading MJD’s posts.

This is just sickening. My Medicare Advandage plan now covers acupuncture as well–only for pain I think, but so what? It’s just as bogus. It was all bad enough when only alties were practicing this crap, but now MD’s and med schools are blindly embracing all this quackery. Between the spread of woo and the current political morass, I really am glad I’m old and won’t live to see the end of all this.

Could it be that the reason acupuncture promoters have such difficulty coming up with a mechanism by which acupuncture works (chi, fascial stretching, quantum mechanics etc.), is that it doesn’t work in the first place?

Unfortunately, the woo-meisters I survey frequently applaud the infiltration of fantasy-based medicine into well-known universities and medical schools as proof that paradigm shift is happening. They’ll gloat how Harvard or Memorial Sloan Kettering are discovering what they- brave maverick geniuses that they are- knew long ago. The are thrilled with the spread of Quackedemia. Usually, they’ll expand what is actually being promoted to include their own alternatives to medicine.

Like Orac, I am disheartened when I read that an alma mater of mine is offering courses or researching woo. It happens more than I like : the Biggest Name of them has woo at its medical school and sometimes crap that I despise in social science. So far, AFAIK, no anti-AGW, hiv/aids denialism, pray-away-the-gay therapy or supply side economics.**
Small consolation, that.

** Of course I’m joking – they are dens of liberalism.

@ MJD:

You can’t estimate proportions, can you?

I can recall reading many commenters insulting you, telling you to get lost ( or worse), get a life, take courses etc. BUT I cannot seem to recall anyone ever supporting your ideas.. I have never once heard encouragement to you by anyone including our esteemed host. If there is a Narad-leaning faction, most everyone here is in it ( making it not a splinter)
If you don’t believe me, you can go to a comment section where people have responded to you and count how many support you vs how many disparage you.
Or, we can take a poll.

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