If there’s one thing about the proponents of “integrative medicine,” it’s that they delude themselves into thinking that what they are doing is all about “rigorous science.” Of course, sometimes it can be, such as when integrative medicine claims modalities like diet, exercise, and lifestyle interventions for which there is a scientific basis as its own, even though a separate specialty isn’t needed for medicine to “integrate” treatments and interventions like this. No, the real rationale for a separate specialty such as “integrative medicine” is to “integrate” pseudoscience and quackery with medicine. Examples abound, including acupuncture, traditional Chinese medicine, “energy medicine” like reiki, and a number of other pseudoscientific, unscientific, or mystical treatments, all of which are “integrated” into m real medicine. Of course, as Mark Crislip once put it, when you mix cow pie and apple pie, you don’t make the cow pie better. You make the apple pie worse. None of this stops integrative medicine propaganda, however, some of which comes from very prestigious hospitals and cancer centers. An example is the Fred Hutchinson Cancer Research Center, which is affiliated with the University of Washington, whose clinical care partner, the Seattle Cancer Care Alliance is introducing an integrative oncology program, and it’s issued a press release announcing it.
I can picture what regular readers might be thinking now. They could well be thinking: Why is Orac bothering with this? It’s just another example of quackademic medicine, another pebble in the integrative medicine avalanche. It’s just another press release announcing yet another program integrating quackery with real medicine. Patience, my minions. There is, as always, a method to Orac’s madness. You see, reading this particular press release, entitled Integrative oncology program opens at SCCA caused the proverbial lightbulb to go on in my head, specifically when I read the subtitle, Research and rigor will guide integrative therapies that help cancer patients tolerate standard treatment. You see, there is a template that these press releases follow, and it occurred to me that I’d never discussed it before. Even better, this particular press release followed the template so closely that it’s a perfect example to use as an educational example. When I’m through with this press release, I predict that you’ll never read such a press release the same way again. So let’s dig in to this Fred Hutchinson masterpiece.
The first element is nearly always, a patient anecdote:
When Yetta Marcus Jaworski was diagnosed with breast cancer back in 2009, she decided to try a blended approach to treatment. Along with standard therapies like chemotherapy and radiation, she sought out the traditional Chinese practice of acupuncture to combat her treatment’s side effects.
“I’m a huge fan of acupuncture and massage, which helped with side effects of chemo and radiation,” said the a 57-year-old project manager from Indian Rocks Beach, Florida. “When I was first diagnosed, I had to go to my own acupuncturist, but now I have one that comes to the oncology office.”
Read this passage and ask yourself: How many articles have you seen that start with a passage very much like it? It’s almost always someone with cancer who wants to try a “blended” approach or who wants to pursue the “best of both worlds.” Not infrequently, the patient sings the praise of whatever quackery she used and expresses how happy she is that it’s now available at the cancer center.
Next up comes the argument from popularity:
Like many cancer patients today, Jaworski doesn’t have a problem using what are often referred to as complementary or integrative therapies to help her tolerate the pain, nausea, fatigue and other toxic effects of standard treatments. She appreciates the integrated approach her cancer center in Florida and others across the country have come to embrace.
This approach to oncology can now be found at Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center’s clinical care partner, with the launch of its new Integrative Medicine Program.
That’s because the anecdote that introduces the press release has a purpose, and that purpose is to set up the appeal to popularity used by the cancer center to justify the integrative medicine program. In this case, if you follow the link to the integrative medicine program you’ll find that Seattle Cancer Care Alliance offers acupuncture, massage, and yoga, among other things, and there’s a naturopath there to provide the usual cornucopia of quackery that naturopaths provide. (Obviously, it’s not described that way, but any facility that offers naturopathy is basically going to offer quackery, perhaps even homeopathy, given that you can’t have naturopathy without homeopathy.)
Next up, after the appeal to popularity, comes the claim that the therapies being “integrated” into medicine are rigorously science-based. First, we learn that an “authority” is leading the program, in this case, Heather Greenlee, ND, PhD, who is described as “Dr. Heather Greenlee.” Greenlee, however, is not a physician, as regular readers will immediately realize seeing the letters after her name. ND means “naturopathic doctor,” or, as I prefer to read it, “Not-a-Doctor.” So, yes, Greenlee can use the title of “Dr.,” given her PhD, but she is not a physician; i.e., not a doctor. So here comes the appeal to science:
Only therapies that are evidence-based will be used; integrative therapies will only be used as an adjunct to traditional cancer treatment.
“Patients have been using these tools for a long time,” said Greenlee, a Fred Hutch epidemiologist, SCCA naturopathic physician and former president of the Society for Integrative Oncology. “But we want patients to receive state-of-the-art, consistent information, and we want to provide education to both patients and clinicians. We want to be very honest with patients where we do and don’t have evidence and maximize their resources, time and energy using therapies where there’s good evidence that the therapies can achieve what they want them to achieve.”
Actually, there are two parts to this part of the sales pitch. First is the claim that these treatments are science-based (which most of them are not), but there’s also the appeal to antiquity, as though just because a treatment is ancient there must be something to it. In this case, the appeal is not as blatant as I often see it, but it’s nonetheless there.
After this long preamble, we finally get to the pitch for this integrative oncology program, what supposedly makes this program better than all the other programs out there integrating quackery with medicine. This part of the pitch is more variable than the elements that precede or follow it, because it’s tailored to the specific program. Various programs have different setups and varying reasons for wanting to embrace pseudoscience. One common reason is the very reason SCCA proposes: It had been using other practitioners but now wants everything in-house:
SCCA has been working with integrative medicine practitioners in the community for several years, Greenlee said, but decided to create the in-house program to provide patients with more seamless care.
“Now patients can receive services from our integrative clinicians who can easily confer and consult with the full oncology care team,” she said. “The idea is to provide ‘integrated integrative medicine’ to cancer patients.”
Housed on the third floor of SCCA’s main clinic near South Lake Union, the Integrative Medicine Program is part of the Division of Wellness and Supportive Care Services, which includes palliative care, physical therapy, nutrition, pain management and other psychosocial services. Currently, the staff consists of a naturopathic physician (Greenlee); an acupuncturist (Jonathan Siman); and a nurse practitioner trained in mindfulness-based stress reduction, mindful eating, guided imagery and integrative medicine (Kathleen Sanders). Greenlee said the team will grow over time.
While there are other integrative oncology programs at academic cancer centers, Greenlee said the new program at SCCA will be one of the only, if not the only, program in the region to offer these services within a cancer treatment center.
I’m not so sure this is actually true, nationwide, but I’m guessing that it’s probably true for the Pacific Northwest. In any case, the justification here appears to be more about not using outside quacks and instead developing SCCA’s own quacks. Now, don’t get me wrong. There is value in having a dietician, a health coach, and the like available to cancer patients. That, however, is the boring stuff that could easily be encompassed in standard oncology. (In fact, it increasingly is.) I also have little objection to mindfulness, even though it is unclear what that is and the evidence for it is conflicting at best. What provokes my ire is having quacks like acupuncturists and naturopaths treat cancer patients—any patients, actually.
No such invocation of uniqueness is complete without citing an example of the institution’s own research. In this case:
Last year, Greenlee co-authored a paper on the first-ever randomized controlled trial assessing acupuncture’s efficacy in reducing pain in breast cancer patients, based on research she did with Dr. Dawn Hershman at Columbia University, where Greenlee retains an adjunct appointment as associate professor of clinical epidemiology. Their study, published in JAMA, showed acupuncture was effective at relieving the arthritis-type joint pain caused by a common class of breast cancer drugs called aromatase inhibitors.
Greenlee also led the development of clinical guidelines for the use of acupuncture and other integrative therapies with breast cancer patients with the Society for Integrative Oncology. Those guidelines were recently endorsed by the American Society of Clinical Oncology, or ASCO.
I’ve written about both of these before. For instance, the JAMA study does not show what its authors are claiming that it does. It was basically a negative study. And don’t even get me started on the Society for Integrative Oncology breast cancer guidelines and the travesty of their being endorsed by the American Society of Clinical Oncology.
Then of course, there’s the part about “separating snake oil from science” at Seattle Cancer Care Alliance. It’s mandatory in all press releases of this sort about any new integrative medicine program. At one point, reading this press release, I must admit that the Fred Hutchinson Cancer Research Center fried yet another irony meter of mine, leaving that sucker bubbling in a pool of plastic and metal goo, sparking plaintively:
“While many of these approaches, such as yoga and mindfulness, are beneficial and are unlikely to cause harm, others can cause side effects or interactions with standard therapies,” he said. “The integrative oncology program will provide expert, evidence-based guidance as to what is likely to work and what may even cause harm, financial and otherwise. Supplements and other integrative approaches are a multibillion-dollar industry in the U.S., and it’s extremely important that patients and their providers be properly informed.”
Both Lyman and Greenlee said cancer patients are particularly vulnerable to misinformation in the realm of dietary or herbal supplements. Oncologists frequently report patients coming in with dozens of supplements, recommended not by doctors or dieticians but friends, family, coworkers and shop clerks. Patients will use the supplements in combination with, or at times in lieu of, traditional cancer treatment, which can cause them harm. One recent study found patients who used supplements during cancer treatment frequently experienced drug-drug or herb-drug interactions.
Yes, be sure to cast yourselves as the defender of science against Big Supplement. Just be sure not to draw attention to all the pseudoscience that falls under the rubric of integrative medicine, whose very purpose is to integrate quackery into medicine. Sure, they mention the popular quackery like acupuncture, but forget the mystical nonsense like the mystical magical woo that is “energy healing,” such as reiki. Then brag about how we’re doing real research, ma-an, which this press release does, and then serve up this pièce de résistance of press release verbiage for these press releases. It’s another mandatory assurance for an academic medical center touting its offerings in quackery:
The key takeaway, Greenlee said, is that the Integrative Medicine Program will only offer therapies that Fred Hutch stands behind.
“We want to be leaders in conducting the trials of promising new therapies, and we’re very open-minded as to potentially what that could mean,” she said. “But we want data to support their use and we’re not offering anything in lieu of standard of care to treat the cancer.”
Sure you do. That’s why you offer acupuncture, even though it’s nothing more than a theatrical placebo. That’s why Fred Hutchinson Cancer Research Center promotes a negative study on the use of acupuncture to relieve joint pain caused by aromatase inhibitors as somehow being positive.
But let’s bring it on home, “Fred Hutch.” Let’s bring it on home with—of course!—another appeal to popularity:
SCCA breast cancer oncologist and Hutch clinical researcher Dr. V.K. Gadi seconded that emotion.
“The patients love it,” he said. “It’s great to be able to offer them these tools and offer them here on site.”
Monroe, who has been getting acupuncture to ease symptoms from treatment outside of SCCA, agreed.
“It just makes sense to me, especially with cancer,” Monroe said. “It’s one-stop shopping. You can get all the care right there for your mind, body and soul.“
And that’s how you finish a press release touting your integrative medicine or integrative oncology program.