Hallelujah! The mainstream press finally notices quackademic medicine! [Respectful Insolence]

I’ve been writing about a phenomenon that I like to refer to as “quackademic medicine,” defined as the infiltration into academic medical centers and medical school of unscientific and pseudoscientific treatment modalities that are unproven or disproven. I didn’t coin the term. To the best of my knowledge, Dr. Robert W. Donnell did nine years ago. However, I adopted it with a vengeance, so much so that a lot of people think I coined the term. In any case, I first began sounding the alarm about the infiltration of quackery like acupuncture, “energy medicine,” naturopathy, homeopathy, chiropractic, and others from near the very beginning, but I didn’t really start warning about it in a big way until the first iteration of my Academic Woo Aggregator, which listed all the academic centers that I could find at the time, what “complementary and alternative medicine” (i.e., CAM, or “complementing” medicine with quackery) modalities. I counted 45 at the time. Within less than a year I gave up trying to keep the Woo Aggregator up to date, because there was just too much. Depressing, I know.

By the time I wrote my (in)famous article for Nature Reviews Cancer on “integrative oncology” in 2014, I counted a high proportion of National Cancer Institute-Comprehensive Cancer Centers were either affiliated with academic medical centers into quackademic medicine or had “integrative medicine” themselves. (Remember, CAM morphed into “integrative medicine,” which is represented as the “best of both worlds” but in reality is the “integration” of quackery with real medicine.) By the time I gave a talk on integrative medicine last fall, I counted well over 60 North American institutions, many of them highly respected, offering quackery. It is this development that I’ve been doing my small part to combat for over a decade now and that Science-Based Medicine has been combatting for nine years. It seemed like a long, lonely batte. Many people didn’t believe us, and many physicians are “shruggies” in that they realize that modalities like acupuncture and naturopathy are quackery but don’t care enough to speak out against it. Sometimes it takes rubbing their nose in it by showing them what is really said in integrative medical centers to get a reaction. I was particularly amused by the reaction of Dr. Toby Cosgrove, CEO of the Cleveland Clinic was shocked—shocked!—to find out that the director of his Wellness Institute, Dr. Daniel Neides, had antivaccine tendencies, as evidenced by an op-ed that he wrote. That’s what happens when you allow pseudoscience to take hold at an institution like the Cleveland Clinic, and, make no mistake, quackademic medicine reigns supreme there.

Interestingly enough, Toby Cosgrove features in an article that I’ve been waiting to see in a mainstream publication ever since I’ve been at this, in this case STAT News, where yesterday was published an article entitled Medicine with a side of mysticism: Top hospitals promote unproven therapies by Casey Ross, Max Blau, and Kate Sheridan. Basically, it’s the highest profile article I’ve yet seen on quackademic medicine. True, it’s not the New York Times, but it’ll definitely do. The reporters do a very good job cataloguing the quackery being promoted by 15 major academic medical centers with little or no evidence to support it.

My only complaint is that I wish it could have been more comprehensive. There’s a lot more quackery in academic medical centers than even Ross, Blau, and Sheridan realize. A lot more. Believe me, I’ve been at this for years, and I know. My other minor nit pick is that the list of alternative therapies offered by these medical centers doesn’t strikes me as missing some things. For example, I know the University of Michigan offers more than just acupuncture. The co-director of the Integrative Medicine Program is a friggin’ naturopath, fer cryin’ out loud! Given that naturopathy is a cornucopia of quackery ranging from homeopathy to traditional Chinese medicine to many, many others, I find it hard to believe that the Integrative Medicine Program only offers acupuncture, particularly given that U. of M. offers an integrative medicine fellowship. And don’t even get me started on the anthroposophic medicine offered at U. of M., as I’ve already ranted about it. Let’s just put it this way. It doesn’t get much quackier than anthroposophic medicine. (Cough! Cough! Rudolf Steiner!) Also, U. of M. studies acupuncture, nutrition, herbal medicine, spirituality, mind-body therapies, and energy medicine. They have to offer such treatments in order to be able to study them.

I don’t mean to be too hard on the reporters. This is a far better article than I’ve seen in a major mainstream media source. Usually, I’m seeing people like Nancy Snyderman doing credulous pieces in which she waxes poetic about how awesome integrative medicine is and how all hospitals should be offering it. I hope they’ll just consider it constructive criticism, hopefully for next time.

I can’t resist getting into the good stuff of the article by starting in the middle, given my mention of Dr. Cosgrove:

Asked about the Cleveland Clinic’s promotion of reiki, Dr. Richard Lang, the recently named interim director of the clinic’s Wellness Institute, said he hadn’t had a chance to think about it. “I don’t know that I could give you a plus or minus on that,” he said. Lang served as a vice chair of the wellness institute for nearly a decade before taking the top post.

Notice something? Dr. Daniel Neides is no longer the director of the Wellness Institute. Cosgrove actually fired him! Funny how it only came out in this article in passing, and that only someone who had paid attention to the story. In any case, I’ve mocked the reiki pamphlet that the Cleveland Clinic has on its website and how it describes channeling “healing energy” from the “universal source.” It basically accepts the quackery that is reiki, which is basically faith healing that substitutes Eastern mysticism for Christian belief, as real. (There’s a reason the Catholic Church doesn’t like reiki in its hospitals; it recognizes another religion when it sees one.) Guess what? It’s still there on the Cleveland Clinic website! Apparently the Cleveland Clinic is still offering it for cancer, infertility, Parkinson’s disease, chronic pain, and more. If there’s one thing this article is good at, it’s letting advocates of quackademic medicine hang themselves with their own words, such as here, where STAT notes how he disavowed the antivaccine article in January. They cite Dr. Cosgrove’s doubling down on quackademic medicine in the wake of Dr. Neides’ article.

I also like how shining the light on the embrace of “energy medicine” by many of these academic medical centers makes their leadership very uncomfortable—as well it should:

MedStar Georgetown quietly edited its website, citing changes to its clinical offerings, after a reporter asked why it listed the energy healing practice of reiki as a therapy for blood cancer. Cleveland Clinic struggled to find anyone on its staff to defend the hospital’s energy medicine program, ultimately issuing a statement that it’s “responding to the needs of our patients and patient demand.”

And the director of an alternative medicine program at another prestigious hospital declined to speak on the record — out of fear, he said, that his remarks would be construed as “fake news” and stir a backlash.

The rise of alternative therapies has sparked tension in some hospitals, with doctors openly accusing their peers of peddling snake oil and undermining the credibility of their institutions.

Good. But my reaction to that bit about “fake news”? WTF? Is this the new excuse spokespeople are going to use to get out of answering questions that they don’t want to answer? Be that as it may, I would quibble here, too, but not so much because the reporters got it wrong. They didn’t. I realize that I’m not a reporter. One huge difference between a reporter and me is that I can editorialize to my heart’s content. It’s what I do here. They cannot. From my perspective, the problem is not that the rise of alternative therapies at academic medical centers has caused tension and backlashes. The problem is that the rise of alternative medicine at prestigious academic medical centers hasn’t provoked nearly as intense and prolonged a backlash as it should, because these “integrative medicine” programs are selling snake oil under the name of prestigious medical schools, such as Yale, Harvard, Stanford, and many others. Physicians who practice science-based medicine should be up in arms at the first sign of this quackery entering their hospitals, but, alas, the vast majority of them are shruggies. In a way, I can understand it. What do docs who speak out against quackery medicine get in return for their trouble? Well, Steve Novella was sued. I’ve been the target of a ten month campaign of online defamation by Mike Adams. Before that, I’ve had people complain to my state medical board for my online activities, and antivaccine activists tried to get me fired from my job. I’m not alone, either. Standing up for science makes waves, and waves make trouble.

One very important point is driven home in this article. Several quackademic docs are quoted defending their practice by saying that alternative medicine is never offered without conventional medicine, dropping meaningless platitudes that will be familiar to readers of this blog like:

“Here at UF [University of Florida], we do not have alternative medicine. We do not have complementary medicine. We have integrative medicine,” said Dr. Irene Estores, medical director of the integrative medicine program at the University of Florida Shands Hospital in Gainesville, Fla.

Ugh. Double ugh. Has there been a more smarmy, more disingenuous defense of “integrative medicine.” My response is: Bullshit. You “integrate” alternative medicine with medicine. Also, as they say, integrating cow pie with apple pie doesn’t make the cow pie better; it makes the apple pie worse. That’s exactly what’s happening at UF and all these programs.

It’s also not true in a lot of cases that these universities don’t ever promote or use alternative medicine other than with real medicine. I’ve pointed this out myself. Rather, there’s money to be made, and these quackademic medicine centers are going after it. I’ve already discussed how the Cleveland Clinic was selling a homeopathic detox kit on its website. Unfortunately, the Clinic is not alone:

But while those cautions may come through in the clinic, the hospitals also promote alternative medicine online — often, without any nuance.

Duke’s Integrative Medicine store, for instance, sells “Po Chai Pills” that are touted on the hospital’s website as a cure for everything from belching to hangovers to headaches. The site explains that taking a pill “harmonizes the stomach, stems counterflow ascent of stomach qi, dispels damp, dispels pathogenic factors, subdues yang, relieves pain.” None of that makes sense in modern biomedical terms.

Thomas Jefferson University Hospital’s website touts homeopathic bee venom as useful to relieve symptoms for arthritis, nerve pain, and other conditions. The site does tell patients that the biological mechanism for the treatment is “unexplained” but asserts that studies “have been published in medical journals showing homeopathic medicines may provide clinical benefit.”

You know, there was a time, early on, when I would be shocked at finding an academic medical center using or selling homeopathy. Indeed, early on in the history of my Academic Woo Aggregator, I would call sites “super woo sites” if they offered reiki or homeopathy. Obviously, it’s because reiki is faith healing, and homeopathy is what I like to call The One Quackery To Rule Them All. These days, practically all of them offer reiki, and a disturbing number of them offer homeopathy. Granted, in the case of homeopathy it might not be obvious that that’s what’s being offered. Just think of it this way. Naturopathy is infiltrating medical schools and organizations like the Society for Integrative Oncology, and, wherever you find naturopaths, there’s a very good chance you’ll find homeopathy, because you can’t have naturopathy without homeopathy. Homeopathy is a big part of naturopathic training. Indeed, I bet there are more than two of the fifteen hospitals offering homeopathy under the guise of naturopathy.

So how does TJUH defend offering homeopathy? Prepare to groan:

Asked about the therapy, Dr. Daniel Monti, who directs the integrative health center, acknowledged that the data is “largely anecdotal,” and said the hospital offers the treatment only rarely, “when there are few other options.” But those caveats don’t come through on the website.

In other words, there’s no compelling evidence, but Dr. Monti offers it anyway. Meanwhile, another director of another integrative medical program, this one at Duke, opines:

The counterargument: Modern medicine clearly can’t cure everyone. It fails a great many patients. So why not encourage them to try an ancient Indian remedy or a spiritual healing technique that’s unlikely to cause harm — and may provide some relief, if only from the placebo effect?

“Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what’s best for a patient. Who am I to say that’s hogwash?” said Dr. Linda Lee.

Hmmmm. If only there were a method to figure out what’s best for a patient. What would that method be…? I wonder… Oh, yes!

Science.

Also, the “appeal to the placebo” is a tired old trope. For one thing, invoking placebo effects requires lying to patients. For another thing, because, as larger, more rigorous clinical trials of alternative medicine modalities fail to find benefit above and beyond placebo, increasingly apologists for integrative medicine are increasingly falling back on the claim that placebo effects can heal. Note the double standard here. No pharmaceutical or device would ever be approved by the FDA if its manufacturer were to acknowledge that it does no better than placebo and to fall back on attributing whatever perceived benefits it has to placebo effects. Yet that is exactly the standard of evidence that defenders of “ancient Indian remedies or a spiritual healing technique” want you to accept for their woo. The bottom line is that placebos don’t heal, and thinking doesn’t make it so. Indeed, I argue that integrative medicine is the resurrection of medical paternalism, in which the doctor knows best and can even lie to the patient if he thinks it in the patient’s best interest. This is, of course, in marked contrast to the “patient-centered” care and “empowering” image that integrative medicine practitioners like to portray.

If there’s one area where the reporters were a bit too credulous, it was on acupuncture. This is common. A lot of doctors are too credulous about it too. That does not excuse this howler:

And while the evidence of its [acupuncture’s] efficacy is not ironclad, neither is the evidence for various pharmaceutical therapies that are routinely provided by hospitals and covered by insurance. Some of those solutions, such as opioids to treat pain, have resulted in addiction and harm to patients.

Can you say “false equivalence”? Sure, I knew you could. Sorry, guys. You were doing so well, but that won’t stop me from being a little…Insolent…when I see something that makes me cringe when I read it. Acupuncture is a theatrical placebo, nothing more. In contrast, we know how opioids work, as well as the risks and benefits. Again, if you haven’t been following these issues for years and aren’t familiar with the corruption of language that integrative medicine has engendered, it’s very, very easy to accept explanations like this one:

They note, too, that traditional doctors sometimes stray from proven treatments, for instance when they prescribe medicines off-label for conditions the drugs have not been approved to treat.

“We do use things that aren’t necessarily 100 percent evidence-based, but I would argue that’s also true within all of medicine,” said Dr. Jill Schneiderhan, co-director of the University of Michigan’s integrative family medicine program. “I feel like it’s not black and white.”

No, medicine is not black and white. It’s never been black and white. Interpreting scientific evidence to apply it to individual patients is especially not black and white. Yes, sometimes we use treatments on patients that aren’t entirely evidence-based, but that’s because there are factors other than science that impact treatment, such as patient desires and values. Leaving that aside, there’s the difference. For most medical treatments, there is science behind it that produces scientific plausibility. In contrast, for much of alternative medicine, there is little or no scientific plausibility. Homeopathy, for instance, in which remedies are diluted to the point where there is unlikely to be a single molecule left, has about as close to zero plausibility as can be imagined. Ditto “energy healing,” which is based on mysticism, not science. When there is little or no scientific plausibility, what you end up seeing in clinical trials are noise and bias, not a real signal. Yet, integrative medicine routinely mistakes that noise and bias for a signal.

Sadly, as this article shows, it’s popular too. Nearly all the directors of integrative medicine programs interviewed reported that their patient volume has been growing. It just goes to show that many academic medical centers are more than willing to sell snake oil to attract patients. This is what skeptics are up against.

Worse, depressingly, it’s not getting better. Remember how I said that this was the first article in a major mainstream news media outlet that was close to as skeptical about integrative medicine as I would like? It turns out that’s not true. It’s the first one I can remember, but as I was doing searches related to this post, I came across this article from USA Today from 2008 with a very similar headline, Top Hospitals Embrace Alternative Medicine. It’s basically the same article, only not as skeptical, with human interest story anecdotes about how alternative medicine helped people. But the overall message is the same: Top medical centers are embracing this. One difference is that it seems to assume there’s something to alternative medicine, in contrast to the STAT article, which emphasizes the patient demand and the financial incentive. Either way, the problem is the same. Nine years later, if anything, it’s worse.