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A University of Michigan Medical School alumnus confronts anthroposophic medicine at his alma mater

I graduated from the University of Michigan Medical School in the late 1980s. If there’s one thing I remember about the four years I was there, it’s that U. of M. was really hardcore about science back then. In fact, one of the things I remember is that U. of M. was viewed as being rather old-fashioned. No new (at the time) organ system approach for us! Every four weeks, like clockwork, we’d have what was called a concurrent examination, which basically meant that we were tested (with multiple choice tests, of course) on every subject on the same morning. The medical curriculum for the first two years had been fairly constant for quite some time, with a heaping helpin’ of anatomy, histology, biochemistry, and physiology in the first year and the second year packed full of pharmacology, pathology, and neurosciences. Nowhere to be found was anything resembling “energy medicine” or anything that wasn’t science-based!

Of course, back in the 1980s, the infiltration of quackademic medicine into medical schools and academic medical centers hadn’t really begun in earnest yet, although the rumblings of what is now called “complementary and alternative medicine” (CAM) and, more frequently these days, “integrative medicine” (IM) were starting to be heard in East Coast and West Coast schools. Even there, though, the incipient CAM movement was viewed as fringe, not worthy of the attention of serious academic physicians. Indeed, in the late 1980s, even at what are now havens of quackademic medicine if someone had suggested that diluting substances until there is nothing left, as in homeopathy, or waving your hands over a patient in order to channel the “universal source” of energy into a patient in order to heal a patient, as in reiki, had any place in scientific medicine, he’d have been laughed out of medical school–and rightly so.

Not so today, unfortunately. Although the problem of infiltration of quackademic medicine into academic medical centers goes way beyond this example, I can point out that faith healing based on Eastern mystical beliefs instead of Christianity is alive and well and ensconced in academic medical centers such as the University of Maryland School of Medicine Center for Integrative Medicine, where reiki masters are roaming the halls of the University of Maryland R. Adam Cowley Shock Trauma Center and Bonnie Tarantino, a Melchizedek practitioner, holographic sound healer, and an Usui and Karuna Reiki Master holds sway. Meanwhile, all manner of woo, such as acupuncture, homeopathy, craniosacral therapy, reiki, and reflexology are offered. Truly, you know that when an academic medical center has gone so far as to offer homeopathy, reflexology, and reiki, it’s all over as far as academic credibility is concerned, and it has become a center of quackademic medicine. Sadly, even a hospital where I trained, MetroHealth Medical Center, has succumbed to the temptation to add the quackery that is reiki to its armamentarium. That aside, I had never expected that my old, hardcore University of Michigan would go woo in such a big way.

I was wrong.

Over the last decade, the University of Michigan Medical School has gotten into alternative medicine, adding IM to its curriculum and even having a fellowship in IM. At the time I first learned of this a few years ago, as disturbed as I was, I reassured myself that at least U. of M. seemed to be sticking to the milder woo, like acupuncture and massage. Then, while browsing the blogs last month, I came across reports by P.Z. Myers and Tufted Titmouse, both of which contained a link to the University of Michigan Integrative Medicine (UMIM) resource page. And what to my wondering eyes did appear? (Actually, I should rephrase that as, “What to my despairing eyes should appear?”) The answer: Anthroposophic Medicine. Yes, it’s anthroposophy, Rudolf Steiner’s mystical, magical system that is the bottom of a lot of quackery and anti-vaccine beliefs. Indeed, outbreaks of vaccine-preventable disease have been distressingly common at Waldorf schools, where the educational philosophy is based on the teachings of Rudolf Steiner, which is why they are sometimes called Steiner schools or Steiner-Waldorf schools. Although the European Council for Steiner-Waldorf Education, which represents approximately 700 of the 1000 Waldorf schools world wide, has stated unequivocally that opposition to immunization forms no part of the goals of Waldorf education, Waldorf schools are magnets for parents opposed to vaccination. One example occurred in California in 2008, when there was a measles outbreak at the East Bay Waldorf School in El Sobrante. Given that the UMIM program, although interdisciplinary, boasts heavy involvement of family medicine faculty, I can’t imagine the cognitive dissonance that must be going on. After all, many family medicine doctors also take care of children and are responsible for making sure they are properly immunized just as much as any pediatrician.

But let’s look at what UMIM’s webpage on anthroposophy says about it:

Anthroposophic medicine views health as a matter of mind-body-spirit balance. It is centered on the idea that humans are not independent organisms but, instead, beings composed of the interactions of physical body, inner life body, soul (mind and emotions), and spiritual ego (self-awareness). Whereas conventional medicine focuses on “fixing” the part of the physical body that is “broken,” anthroposophic medicine prescribes treatment for the whole being through conventional methods in combination with holistic methods. As such, anthroposophic medicine integrates theories and practices of modern medicine with alternative, nature-based treatments and a spiritual-scientific understanding of the human being. The practice is based on Austrian philosopher Rudolf Steiner’s concept of anthroposophy, a scientific and philosophical world view that connects the spiritual within the human being to the spiritual in nature, the world and the cosmos.

This is consistent with what the Holistic Health Internet Community says about anthroposophic medicine:

Austrian scientist and philosopher Rudolf Steiner (1861-1925) refused to accept the contemporary scientific view of the body as a purely physical entity. From that conviction was born the doctrine of anthroposophy, a word he coined from the Greek words for “man” and “divine wisdom.” Steiner believed in the uniqueness of each human being, and contended that health and well-being deteriorated without that belief. Trained as a scientist and a mathematician, he was influenced by Hindu and Buddhist beliefs and founded a school in which his theories became practice.

Anthroposophical medicine determines the nature of illness based on Steiner’s principal of polarity. His system attempts to link and harmonize both the upper and lower poles of the body. Good health then depends on a harmonious relationship between the physical, etheric and astral bodies, and the ego. Practitioners are trained as medical doctors and may treat childhood infections, hay fever and asthma, anxiety, depression, cancer, musculoskeletal problems and fatigue.

If twenty years ago someone had told me that one day that not only would my medical alma mater be publishing dreck like this, but that it would have formed an interdisciplinary program devoted to it, I would have told that person he was delusional. If you had told me that anthroposophy would be part of a larger program of woo run by a physician who is described as having “studied herbalism and spiritual healing for 14 years with a Native American Healer” and as having research interests that include the “use of herbs, energy healing, environmental healing, and the therapeutic relationship” or that a physician trained in “functional medicine” would be a big part of a program in anthroposophic medicine there, I wouldn’t have believed it. All I can wonder is what Bill Kelley, the infamously hardcore scientific chair of the Department of Internal Medicine while I was at Michigan, would think or say if he were still at U. of M. In fact, having read the section on anthroposophy on U. of M.’s website, I wish I were delusional. But I’m not. The section is real, and the medical school from which I graduated has not only started to tolerate such nonsense, but begun to embrace it.

Anthroposophical medicine, it turns out, is rooted in prescientific vitalism. Rudolf Steiner, before he came up with the idea of anthroposophy, had led the German section of Theosophy. When he became enamored of his spiritual concept of anthroposophy, Steiner in essence caused a schism. Anthroposophy, it further turns out, is far more a religious and spiritual philosophy than a scientific or medical one. Based on his philosophy, Steiner created Waldorf schools, anthroposophic medicine, and biodynamic farming, the last of which would be a suitable topic for an amusing post on a non-medical blog. Suffice to say that some of the practices of biodynamic farming involve stuffing Yarrow blossoms (Achillea millefolium) into urinary bladders from Cervus elaphus, Red Deers, placing them in the sun during summer, burying them in earth during winter and retrieving them in the spring, all to strengthen the “life force” of the farm. There’s also a lot of use of cow horns, based on Steiner’s rationale, “The cow has horns in order to reflect inwards the astral and etheric formative forces, which then penetrate right into the metabolic system so that increased activity in the digestive organism arises by reason of this radiation from horns and hoofs.” Moreover, many of the concepts of homeopathy are combined with Steiner’s woo, such that many of the concoctions of biodynamic farming, which consist of various bits of dead animals plus or minus ground quartz crystals, are diluted into many tons of compost, to be spread over acres of farmland.

But let’s get back to anthroposophic medicine, which is based on the same sort of mystical philosophy that biodynamic farming is. Simon Singh and Edzard Ernst characterize this form of medicine thusly in their book Trick or Treatment?:

Applying his philosophical concepts to health, he [Rudolf Steiner] founded, together with Dr. Ita Wegman, an entirely new school of medicine. It assumes metaphysical relations between planets, metals, and human organs, which provide the basis for therapeutic strategies. Diseases are believed to be related to actions in previous lives; in order to redeem oneself, it may be best to live through them without conventional therapy. Instead, a range of other therapeutic modalities is employed in anthroposophic medicine: herbal extracts, art therapy, massage, exercise therapy, and other unconventional approaches.

Perhaps the most common example of anthroposophic medicine is the use of mistletoe extracts for the treatment of cancer. Perhaps you’ve heard of Iscador? While Iscador might actually have some activity against, for example, breast cancer, it is not without toxicity, and the evidence for its efficacy in cancer is at best conflicting. Even if Iscador turned out to be an effective treatment for breast cancer, it would be an example of being right for a reason that is spectacularly wrong. That’s because Steiner argued that mistletoe is a parasitic plant that eventually kills its host. To him, this represented a striking parallel to malignant tumors, which, like mistletoe, are parasitic entities that eventually kill their hosts. Steiner’s conclusion? Because of this resemblance, mistletoe must be an effective treatment for cancer. Readers knowledgeable about homeopathy will immediately recognize that Steiner clearly must have believed in the homeopathic principle of “like cures like.” In fact, he even went beyond that to generalize that “a plant is a healing plant when it has a distortion or an abnormality in its physiology and morphology,” presumably related to human disease. Indeed, according to Dr. Peter Hindenberger this represents a “modern, scientific reformulation of what, in former times, existed in the ‘doctrine of signatures‘”; i.e., the belief that God has marked everything he created with a sign (signature) that is an indication of the purpose for which the item was created.

Although you can read more about anthroposophic medicine, either at a Steiner website or the Physician’s Association for Anthroposophic Medicine (to get it right from the horse’s mouth, so to speak) or over at The Skeptic’s Dictionary and Quackwatch, including a description of what being a student at a Waldorf school is like, because this is about UMIM’s apparent embrace of anthroposophical medicine, I think that I will close by discussing what UMIM says about it. But, before I do so, let me quote a passage from what PAAM says about it in a PDF booklet. After all, U. of M. includes a link to PAAM on its website, which leads me to assume that the UMIM program in anthroposophic medicine endorses PAAM. So does the fact that PAAM is based in Ann Arbor. But back to the PAAM pamphlet:

Medicine based purely on material science is limited to explaining an illness solely on the basis of the laws of physics and chemistry.

I’m sorry. I can’t help but interject here that PAAM says this as though it were a bad thing. Personally, though, I’m curious as to how we can explain illness not based on the laws of physics and chemistry. Unfortunately, PAAM is more than happy to tell us how anthroposophic medicine is “more ambitious” than us mere practitioners and proponents of science-based medicine. I suppose it is, casting off, as it does, all those inconvenient laws of physics and chemistry that took hundreds of years to discover and understand:

Anthroposophic medicine is more ambitious. It takes into account additional factors, both general and individual, that may affect the patient’s life, mind, and soul, and their physical manifestation: in growth, regeneration, microcirculation, fluid retention in the skin, muscle tone, biorhythms, head distribution, posture, uprightness, gait, mental focus, speech. When illness occurs, examination of the above may reveal deviations, imbalances, and extremes–additional diagnostic parameters that need to be considered when selecting a therapy. Anthroposophic medicine also has a different understanding of the role played by the patient in overcoming illness. The patient is not simply a passive recipient of medical skill, but an equal partner with the doctor. After all, nobody can know the patient better than the patient. During an illness, the patient has the opportunity to recognise the state of imbalance body and soul have reached, to understand this and rectify it. The illness can provide an opportunity to learn new modes of behaviour, to develop further insights, and acquire greater maturity.

And, yes, anthroposophic medicine embraces homeopathy:

In addition, other substances tailored to the patient’s unique characteristics are administered. These are frequently homeopathic substances designed to stimulate the organism and its powers of self-healing.

Science-based medicine, anthroposophy clearly is not. Of course, that’s quite obvious from what UMIM itself says about the anthroposophic view of health. According to UMIM, this consists of these tenets, with my comments in brackets after each item:

  • Health involves a dynamic balance and high functioning of all aspects of a person’s life. [This is so vague as to be meaningless and all but impossible to argue with, but it's the sort of trope common in alt-med circles.]
  • Illness is the result of disharmony and imbalance amongst the three systems of the body and their related forces and effects. [This sounds very much like attributing disease to imbalances in the four humors. Four-fold Man!]
  • Illness is a tragedy, but also an opportunity for learning and transformation. [This sounds very much like the quackery that is the German New Medicine and Biologie Totale to me; that is, if you strip away Steiner's belief in reincarnation wherein illness isn't the working through of unrecognized emotional traumas in this life (as German New Medicine teaches) but is rather the working through of issues from previous lives.]
  • The signs and symptoms of an illness are often the body’s attempts at healing and, in general, should not be suppressed, but rather, aided, observed and resolved. [More German New Medicine- and Biologie Totale-like gobbledygook. Again, odd how U. of M. leaves out Steiner's belief that these body's attempts at healing are related to past life experiences.]
  • Many illnesses, especially benign ones, should not be artificially prevented, but should be allowed to occur and be treated and healed. The patient thereby gains strength and experience, both biologically and spiritually. [This would appear to be the basis for so many anti-vaccine beliefs that permeate every aspect of anthroposophic medicine and the education taught in Waldorf schools. After all, what is vaccination, but preventing illness? I guess your kids get so much stronger, spiritually and biologically, if you just let them, take their chances with measles, mumps, whooping cough, and Haemophilus influenzae type B. Because, you know, that worked out so well for children in terms of childhood mortality back in the days before vaccines could prevent these diseases. Oh, wait. No it didn't.]
  • True prevention of illnesses involves a healthy lifestyle with positive habits, strengthening the biological, psychological and spiritual aspects of a person, and avoiding the detrimental and illness-producing effects of much of modern civilization. [Do I detect a reference to "toxins" here? I think I do.]

UMIM even goes on to link to a company that produces skin care products and medicines based on Steiner’s biodynamic farming (including Iscador and homeopathic remedies), as well as to point out that many anthroposophical remedies can only be administered as an inpatient at a facility like the Rudolf Steiner Health Center in Ann Arbor, Michigan. There, you can find a video about anthroposophic medicine:

Check out the part around 24:25, where a chemist describes how anthroposophic medicines are made, including the part about how he “potentizes” many of them in decimal fractions, just as homeopaths do with their remedies. His goal is, as he puts it, to “strengthen the vital forces within the living organism while at the same time respecting its natural rhythm.” He also heads out to the French border at 4 AM during the summer so that he can harvest Arnica plants at dawn, thus allowing the “morning strength” to be maintained in them. I kid you not. Then, get a load of this description of anthroposophic medicines, right off the U. of M. website:

Many anthroposophic remedies are specially prepared using homeopathic or modern alchemical pharmaceutical processes to naturally stimulate healing processes in the ill person.

Yes, it would appear that alchemy is alive and well at U. of M.!

Fortunately, the Rudolf Steiner Health Center does not appear to be affiliated with the University of Michigan, at least as far as I can tell. Unfortunately, it’s still very disturbing that UMIM would recommend such an institution and even more disturbing that “anthroposophic physicians at the University of Michigan” appear to be partnering with the Rudolf Steiner Health Center to research anthroposophic medicine as supportive care for cancer patients.

Personally, I think that Robert Carroll gets it exactly right when he characterizes anthroposophic medicine as being “even more out of touch with modern, science-based medicine than homeopathy.” Think about it. Homeopathy is based on just two magical ideas: The Law of Similars and the Law of Infinitesimals, which together can be viewed as an expression of the ancient principles of sympathetic magic. In marked contrast, anthroposophic medicine is based on many ideas with no basis in science that can best be described as pure magical thinking. Indeed, to me at least, anthroposophic medicine resembles more than anything else naturopathy in that there doesn’t appear to be a form of unscientific, prescientific, vitalism-based woo that it doesn’t embrace. In fact, anthroposophic medicine appears to go far beyond naturopathy in that respect. It also brings into play a veritable cornucopia of mystical concepts, including the etheric body, the astral body, and the ego. It postulates that the soul, the senses, and the consciousness are beings that have an independent existence outside of the body and further asserts that herbs, essential oils, and movement therapy known as eurythmy can bring these things into harmony and balance with each other and the physical body. Reading about anthroposophy and anthroposophic medicine, I had some serious acid flashbacks to my youth, when I used to be an avid Dungeons & Dragons player. My personal oddities during my high school and college years aside, anthroposophic medicine openly denigrates science-based medicine for only being able to diagnose and treat disease according to its understanding of the laws of physics and chemistry, to which I respond: Upon what else would a physician base his understanding of disease? As Carroll put it:

Steiner approached medicine the same way he approached everything else from astrology to Atlantis to education to farming to metaphysics: He dictated his visions. Why anyone considers him a scientist is a great mystery. His notion of science as involving the explanation of how immaterial entities affect material entities is the very opposite of science.

Indeed, and the medical school from which I graduated over 20 years ago now has a program dedicated to teaching physicians and medical students as fact the medical philosophy of this very man, whose philosophy is not only far more religion and mysticism than science but is indeed antiscience at its very core despite its superficial declaration of allegiance to science. Indeed anthroposophic medicine’s assertion of relationships between the various bodies (physical, etheric, etc.) and astronomical bodies is far more akin to astrology than science. Would that it were only homeopathy U. of M. were teaching and practicing!

I used to be very proud to have graduated from the University of Michigan Medical School. When I was there, it was one of the top public medical schools in the country and compared quite well with any private medical school in the U.S. you could name. In many ways, it still does. Unfortunately, like those other top medical schools, including Harvard, Yale, Stanford, and Columbia, U. of M. appears to have embraced quackademic medicine. I only wish it had, instead of imitating such schools, resisted the siren call of unscientific, prescientific, and pseudoscientific medicine. Unfortunately, as its embrace of anthroposophy demonstrates, it has not. As a result, the pride I have as a U. of M. alumnus is now tarnished with the knowledge that, even though the vast majority of what happens at the medical school and its affiliated hospitals is still solidly science-based and U. of M. boasts some of the best medical research programs anywhere, there now exists section within it that teaches pseudoscientific nonsense as if it were science. It makes me very sad and depressed to contemplate.

No doubt the U. of M. faculty and leadership responsible for this travesty will say that they pick and choose only the bits from anthroposophic medicine that are evidence-based and ignore all the woo. Quite frankly, to me anthroposophic medicine is pretty much all woo as far as I can tell. Or perhaps they would argue that the anthroposophic medicine program is a tiny part of a vast enterprise of science-based medicine. This is almost certainly true. It’s also probably true that relatively few U. of M. faculty even know about the existence of a Steiner-inspired program at their school. To me, however, there is zero place for such religious- and mysticism-inspired nonsense in any reputable medical school, other than as a footnote in courses in the history of medicine. Certainly there is no place for it being taught or practiced as though it had any validity whatsoever anywhere near medical students, residents, or fellows–and especially nowhere near patients.

Finally, knowing that U. of M. is teaching and practicing anthroposophic medicine makes me very irritated whenever I get mail soliciting donations for its medical school. From here on out, I think that, whenever a U. of M. Medical School solicitation arrives in the mail, I’ll send it back with a link to this post as the reason why I must decline.

Posted in: Faith Healing & Spirituality, Homeopathy, Medical Academia, Religion

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151 thoughts on “A University of Michigan Medical School alumnus confronts anthroposophic medicine at his alma mater

  1. Dr Benway says:

    The tl;dr version: anthroposophy = homeopathy + ghosts

    which means anthroposophy is even MOAR STOOPID than homeopathy.

    Nice sciencey machine and white coat!

  2. I am glad you are writing about this. My experience with Mott, U of M Children’s Hospital has been very good. I have talked with other parents who had similar good experiences. Luckily, I have not experienced any hints of metaphysical mumbo jumbo there*.

    It is sad to me that U of M would undermine their accomplishments in children’s health with this sort of destructive nonsense.

    I am curious if anyone with decision-making responsibilities at U of M will have a response to this.

  3. oops, ignore that * I meant to delete it.

  4. Dr Benway – Ghost should stay in their place. Around campfires, in moody gothic films, even wandering through my bedroom at night,* are all acceptable places.

    A doctor’s office is not.

    *hallucinations (hypnopompic or hypnagogic)

  5. marilynmann says:

    “This would appear to be the basis for so many anti-vaccine beliefs that permeate every aspect of … the education taught in Waldorf schools.”

    I was wondering about this. My two nieces used to attend the East Bay Waldorf School. My brother told me the school had no policy against vaccination. Rather, the kind of parents who send their kids to a Waldorf School are less likely to vaccinate their children. They tend to be liberal crunchy granola types of people, as you would guess.

  6. art malernee dvm says:

    I am curious if anyone with decision-making responsibilities at U of M will have a response to this.>>>>>

    those who control the school is to busy trying to fiqure out a way to beat OSU at football and basketball. We need a new sport on TV where intra state quackery is measured by FDA officials and the biggest quack college team looses the game.

    art malernee dvm
    osu 73

  7. Jann Bellamy says:

    Quackademic medicine is having a “trickle down” effect. A local hospital now has an “Integrative Medicine Committee” of the Medical Staff. The “IM” committee recently recommended that the hospital allow acupuncture for pain and now the issue is before the Credentialing Committee, the Medical Staff Executive Committee having approved the idea. This hospital has a family practice residency program so the residents will see this nonsense going on during their training. One of the rationales for allowing acupuncture given by the “IM” Committee is that Harvard, Stanford, etc., now employ “IM.”

    I and others are trying to stop this from going forward. Step # 1: a meeting with the hospital’s Medical Director today.

  8. DavidCT says:

    I have to wonder just how much money the embrace of woo is bringing in. At the end of the day our trusted institutions seem to be unwilling to forgo a new “profit center”. They can use the excuse that people want these treatments. I now have trouble finding a drug store that does not offer homeopathic products. The stores I have complained to use this very argument. Familiarity with these products and having woo accepted by major institutions only adds to the belief on the part of the public that there must be “something to” these treatments.

    I wonder if some well publicized wrongful death suits would take the luster off these “money makers”. Unfortunately the deaths caused with quacks seem to stay off the radar. In the meantime I wonder if attending a Harry Potter film could now be used toward my continuing education requirements. After all they do talk about potions in these films and how to use them. Whether or not they work in the real world seems no longer to have any relevance.

  9. Jan Willem Nienhuys says:

    I agree that anthroposophic medicine (AM) is not to be trusted, but I will say something in defence. One of the tenets of AM is that it is only possible to practice AM if one is a fully licenced MD.

    In homeopathy and so on (insert here 400 most popular forms of quackery) the healers don’t have to be physicians. Not so with AM (at least in Europe as far as I know): to become a practitioner of anthroposophic medicine one must be a fully trained MD.

    One of the reasons why anthroposophic health care is popular (at least over here) is that these anthros have very high opinions about what it means to be human. So their care for retarded children, the demented and the insane is – as far as I know – based on the idea that these people all have a precious soul and have the right to be respected just like any other person. Steiner gave the example by acting as tutor for the hydrocephalic child (Otto Specht, 1873-1915) of a wealthy Jewish family. When Steiner started, the ten year old boy was ‘difficult’ and could hardly read. Later Otto became a dermatologist.

    AM is full of incomprehensible occultism. One of the ideas is (all hearsay) that if a patient is given, say, a highly diluted preparation of a plant that was harvested at full moon at a particular position of Saturn and that had grown on lead containing soil, all this should be carefully explained to the patient, so the patient really understands how the Saturn powers or the lead force or the moon process or whatever is going to improve his health. Just a prescription without an explanation won’t do. How a fully trained MD can do this I don’t know. Maybe the idea is that you reserve this treatment for patients that are willing to believe this.

    Among AM there is a remarkable theory about how the heart works. The heart (dixit AM) is not a pump. No, the beating of the heart should be compared to the action of a water ram. You may not be familiar with a water ram. It is a simple system of pipes and valves, which converts the kinetic energy of fast flowing water into potential energy of part of the water. It works all by itself and doesn’t need an external source of power. This theory is not thought up by AM, it is borrowed from a certain K. Smith (1882). Of course the ram equation: “fast flowing water -> slow flowing water + water with high potential energy” is quite different from the heart energy equation: “slow flowing blood + muscle energy -> fast flowing blood” but this kind of physics is lost on AM. For Steiner it was the analogy that counted: the sun is the ulterior source of energy for the fastflowing water, just like the spirit is the source of energy for the blood. Blood moves by itself. Mixed with this are also opinions that the heart is necessary to stop the blood for just a moment, to make the existence of the spirit possible in this endless alternation of death and rebirth every second. Beings with a continuous fluid flow, like plants, cannot be conscious. And so on. Even in the 1960s and 1970s there appeared scientific papers on this subject (incomprehensible stuff where the hydrology of the Rhine and Donau basins featured as well as schemes about solar energy and blood).

    Now for the optimistic bit. Because AM teaches that humans are completely autonomous free beings, it is required of the faithful that they not mindlessly parrot what others have said: one must be held individually responsible for what one believes. So an AM physician is at liberty to believe or discard any part of AM. So if s/he thinks the ‘heart is a water ram’-theory of the Saturn powers of medicine to be nonsense, that is quite OK. AM is not like RC doctrine. That is why it is so difficult to grasp: all these AM doctors think differently. Most of them believe in reincarnation, probably, because that is also one of the principal parts of anthroposophy. Some of them give this a rational twist: ‘because I know I will be reborn, it is in my own interest to make the world a better place’.

    So if you want to do something against AM, insist that all MDs get a rigorous scientific training. If that doesn’t help, I don’t know what will.

  10. David Gorski says:

    One of the reasons why anthroposophic health care is popular (at least over here) is that these anthros have very high opinions about what it means to be human. So their care for retarded children, the demented and the insane is – as far as I know – based on the idea that these people all have a precious soul and have the right to be respected just like any other person.

    It is quite possible to have a high opinion of what it means to be human and to care for the ill and disabled with respect and compassion without embracing pure astrology-grade mystical nonsense. Just sayin’.

  11. wbgleason says:

    If you want a good laugh about the denial going on over homeopathy at the University of Minnesota Academic Health Center, have a look at this:

    1. Why Would an Academic Health Center Support Homeopathy? (Chronicle of Higher Education) link: http://bit.ly/ea9qNI

    2. Response to: Why Would an Academic Health Center Support Homeopathy (present and immediate past med school dean/Academic Health Center VP, Cerra and Friedman) link: http://bit.ly/goqI79

    3. My comments on #2 in Minneapolis Star-Tribune:
    link: http://bit.ly/fdrrIq

    I’d be happy to write a post for SBM outlining the ludicrous situation at the University of Minnesota Academic Health Center with respect to homoeopathy.

    Bill Gleason

    Dept Lab Med & Path
    U of Minnesota Medical School
    and U of M alum

  12. Jan Willem Nienhuys says:

    I guess you’ll have to compare anthroposophic institutions for retarded children with non-anthroposophic ones. I think that if you point out quite correctly that a certain ideological drive has many undesirable effects (you could add the silly blood crystallisation tests of the AM) then you shouldn’t ignore that the same drive can have some positive effects too. If only because the anthros will use such ignorance against you. That’s a nasty part of the anthros: they extremely vigilant about people attacking them.

  13. David Gorski says:

    I doubt the anthros have anything on antivaxers as far as attacking critics. I guess we’ll find out.

    Oh, wait. Most anthros are antivaxers…

  14. Adam_Y says:

    Reading about anthroposophy and anthroposophic medicine, I had acid flashbacks to my youth, when I used to be an avid Dungeons & Dragons player.

    Hey. Hey. Hey. At least Dungeons and Dragons admits that it is a fantasy world which anthroposophy refuses to acknowledge.

  15. DW says:

    There is one fundamental tenet of anthroposophic medicine not mentioned thus far that is crucial to understanding what anthroposophic physicians are trying to do.

    Anthroposophy is based on karma and reincarnation. Illnesses have karmic explanations; they are often straightforward punishments for transgressions in past lives. Steiner outlined numerous direct karmic meanings; smallpox, for instance, comes from “unlovingness” in a past life. Epidemics occur because large groups of people have shared karma to work out, or shared “spiritual tasks” to accomplish. Suffering is good for the soul. Suffering pain in one lifetime may even make you physically very beautiful in the next life.

    It is particularly important to understand how this works with vaccination. Steiner did not assert unequivocally that vaccination should be avoided, but he did state that since many diseases are karmic, if you avoid the disease by means of vaccination, you are simply postponing the working out of that karma until another lifetime. Many Steiner teachers and Steiner parents logically conclude that it would actually be better for the child to get the disease. “Chicken pox parties” are popular in Waldorf communities, i.e., deliberately exposing children to the disease.

    This is *not* done because “natural healing” is thought to be better. Illness is seen as actually karmically *beneficial*. This is really important to understanding the philosophy. The goal is not necessarily to avoid or treat an illness at all, in the way the rest of us would understand.

    I can provide quotes from Steiner on all these topics a bit later, if desired.

    It’s very important to understand that this form of “medicine” does not necessarily always have the goal of healing the patient. Children who suffer illnesses or die young are thought to have simply completed their life’s “task” in the current lifetime.

    These bullet points:

    • Illness is the result of disharmony and imbalance amongst the three systems of the body and their related forces and effects.

    • Illness is a tragedy, but also an opportunity for learning and transformation.

    • The signs and symptoms of an illness are often the body’s attempts at healing and, in general, should not be suppressed, but rather, aided, observed and resolved

    … purporting to explain the principles of anthroposophic medicine are thus a bit deceptive. They’re leaving out quite a bit of their philosophy that they know will be extremely unpalatable to a lot of people. Most people reading those innocuous talking points (even physicians, obviously) will not have a clue what is actually meant by calling illness an “opportunity.” Most parents would really prefer their children have the opportunity to GROW UP rather than die of a vaccine-preventable illness.

    Obviously, the “natural healing” rhetoric appeals to a lot of people, apparently even medical school faculty, probably owing to the anthroposophical community that grew up around the Waldorf school in Ann Arbor. Perhaps though, if the people who are responsible for letting this stuff get a foothold at the University of Michigan medical school took a FULLER look at these doctrines, at the underlying world view, it might help to get the point across as to why this practice is completely unacceptable.

    Anthroposophic medicine fails on the most basic ethical principles of medicine – the goal of actually curing disease or at least alleviating suffering.

  16. Do you know anything about the personalities/politics at U of M that led to this? Who’s responsible? And how did they get anything this bizarre past the rationalists who are presumably still on duty at U of M? I mean it’s one thing for an institution to come down with the a touch of the touchy feelies, but crikey: anthroposophy?!

    It’s baffling and disturbing. You must feel a bit like the Trojans felt: “Hey, how did these assholes get in here?”

  17. cervantes says:

    Well, I’d bet the farm that they’re doing this because there’s money for it. Have you investigated the funding behind this? In addition to the chance for NCCAM funding, of course, I presume there is some wealthy alum who is making it happen. Universities have a very hard time turning down filthy lucre.

  18. or

    David Gorski “Reading about anthroposophy and anthroposophic medicine, I had acid flashbacks to my youth, when I used to be an avid Dungeons & Dragons player.”

    Actually, reading this article, I had flashbacks to my youth too. Unfortunately it wasn’t to pleasant memories of D&D, it was to memories of a small time metaphysical guru who some of my friends became involved with. The abuses that can be rationalized and propagated with that kind of “compassionate” all encompassing mind/body/spirit/soul metaphysical healing doctrine boggle the mind.

    One would hope that a trained doctor has more ethics than this guy did (one would hope a turtle has more ethics). But I still think that anyone who suggests that they can help you heal your mind/body/spirit/soul(altogether) is a dangerous person to be around.

  19. David Gorski says:

    I don’t know. I haven’t had much connection with the medical school in years. It would be interesting to find out, though.

    The Integrative Medicine fellowship at U. of M. is supported by a grant from the Fannie E. Rippel Foundation:

    http://www.med.umich.edu/umim/education/fellowship.htm

    UMIM is also a member of the Bravewell Consortium.

    The fact that UMIM lists links to Weleda, a company that manufactures and sells anthroposophic medicines, at the end of its page, makes me wonder if Weleda has provided any support to its AM program:

    http://www.med.umich.edu/umim/education/fellowship.htm
    http://usa.weleda.com/

    NCCAM has also supported UMIM in the past with a training grant:

    http://projectreporter.nih.gov/project_info_details.cfm?aid=6952264&icde=7399332

  20. DW says:

    Perusing the Web site of the Anthroposophical Society in Ann Arbor gives a good indication of just how organized this group is in this geographical area, and the extent of their activities. This probably has hints of where some of the influence at University of Michigan comes from.

    http://www.anthroposophy.org/index.php?id=156

    Under Articles, check out “The Seven Levels of Illness & Healing” by Dr. Philip Incao.

  21. windriven says:

    Does anyone have any information on the Rippel Foundation (funders of woo at U of M)?

    This from the “Founders and Members” page of their website:

    “Since 2007, the Foundation-led effort has grown from an initial exploration of the relationship between health and energy…”

    The relationship between health and energy? It is all quite vague, at least at a first glance at their site.

  22. S.C. former shruggie says:

    @Jan Willem Nienhuys

    AM practitioners may have one MD more than homeopaths, but from all that talk of red deer kidneys stuffed with yarrow and the position of Saturn in the sky, I doubt it makes much difference. Kind of like a geocentrist with an astronomy degree.

    Having read the Quackwatch account of attending a Waldorf school, I must say I know a lot of crunchy people who would not be discouraged in the least by that account. They’d count it all a positive and rationalize away the racism as a thing of the past.

    My own public (“secular”) elementary school experience involves group punishment by denied lunches, Christian prayer, and talk of creeping invasion by Chinese Godless Communists. I got the impression early on that schools are mostly a political battleground over who gets to indoctrinate who into what.

    A reality based education of knowledge instead of dogmas would be a refreshingly novel idea. Might even prove useful to graduates. Awful shame for a medical school to be moving away from that.

  23. Anthro says:

    I just want to be clear that my screen name is short for:

    ANTHROPOLIGIST

    –not Anthroposophy

    We study this stuff and sadly, there is some contamination currently going on in my field too, but generally, we don’t confuse respecting someone’s cultural practices with adopting them without question as our own. Don’t these people (who adopt all these “ancient practices”) realize that the most successful way to make contact with a different culture was to offer medical treatment? Cultures will hang on to their traditional practices (just as we hang on to ours; i.e., religion), but most individuals will quickly line up to see the real doctor, especially if they are actually sick or suffering form some chronic condition.

    This phenomenon (using medicine alongside traditional belief systems) gets to the heart of all this. The average person, with a limited scientific education, isn’t much different from the recently contacted “primitive” person in the (perhaps hard-wired) need for belief-centered healing. I’m certainly not condoning what’s going on in major universities. They are in a position to combat this trend and should be ashamed for encouraging it instead. The NIH definitely needs to stand up to the dimwits in Congress who fund the absurd Alt Med division and get rid of it. It’s mere existence just adds to the confusion of fence-sitters and gives a seeming stamp-of-approval to the already reality-challenged.

  24. daedalus2u says:

    I am just thinking out loud, but if a large number of graduates of the medical school started an online petition to the “medical school accreditation authorities” to have the school delisted because it has become a force for quackery and a blanket recommendation than no med students apply there because it teaches quackery, would that put the fear of de-accreditation in them?

    It would be a death sentence for the school, but better to kill it than to let it become a force for evil.

  25. windriven says:

    @wbgleason

    I followed your links and was particularly struck by this from Dr. Aaron Friedman, DEAN of U of Minnesota Medical School:

    “The University of Minnesota’s Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers. In 2011, what we don’t know about improving human health still exceeds that which we do know. Perhaps this will always be the case.

    But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.”

    I almost choked on the irony. Friedman finds arrogance in the presumption that ‘Western’ medicine has all the answers but apparently finds no arrogance whatsoever in abandoning the scientific framework that upon which virtually every important medical advance in the last 100 years rests – in favor of mysticism and wishful thinking.

    Bravo, Dr. Friedman. You are a credit to your profession and your university.

  26. S.C. former shruggie says:

    I just read wbgleason’s articles too.

    The response is truly dreadful, and incredibly evasive. The comments can basically be summed up as argumentum ad populum (lots of people use CAM / a billion Chinese people can’t be wrong) ad hominem (Western science is arrogant and all Pharma Shills motivated by greed) and argument from ignorance (How can we really be sure it doesn’t work?) with a bit of concern trolling. Which is, apart from the extreme evasiveness, not much different from Dr. Friedman’s response.

    Anthro said:

    The average person, with a limited scientific education, isn’t much different from the recently contacted “primitive” person in the (perhaps hard-wired) need for belief-centered healing.

    My guess is Deans of Medicine and University amdins are in the same painted bamboo boat.

  27. Joe says:

    Anthro on 14 Mar 2011 at 12:30 pm wrote “… The NIH definitely needs to stand up to the dimwits in Congress who fund the absurd Alt Med division and get rid of it. …”

    Actually, that has been tried and it failed due to Sen. Tom Harkin (D, IA) holding the entire NIH budget hostage till they relented. Harkin is still there.

    In addition, when Gonzalez’s clinical trial (mentioned in the main article, above) was rejected by the NCCAM, Rep. Dan (The Loose Cannon) Burton (R, IN) called the head of NCCAM to his office. We don’t know what Burton said; but Gonzalez’s trial was funded. And Burton is still there.

  28. NYUDDS says:

    The following was taken from SkepDoc, Harriet Hall, MD site. It would seem to be a fitting, if somewhat coarse, response to Dr. Friedman:

    “It’s very common, and very silly, to point out that there are many
    questions as yet unanswered by science, and then to claim it’s legitimate to
    fill in the gaps with whatever arbitrary shit you want to make up.”

  29. windriven says:

    @Joe-

    Harkin has been in the Senate for nearly 30 years. Burton has been in the House for nearly 30 years. Darryl Issa, another Luddite, has been in the House for a decade.

    Good grief.

  30. Harriet Hall says:

    @NYUDDS,
    “It’s very common, and very silly, to point out that there are many
    questions as yet unanswered by science, and then to claim it’s legitimate to fill in the gaps with whatever arbitrary shit you want to make up.”

    I’d like to clarify that I was quoting one of the commenters on this blog. He or she goes by a screen name, so I can’t provide proper attribution.

  31. Dr Benway says:

    I am just thinking out loud, but if a large number of graduates of the medical school started an online petition to the “medical school accreditation authorities” to have the school delisted because it has become a force for quackery and a blanket recommendation than no med students apply there because it teaches quackery, would that put the fear of de-accreditation in them?

    You are too late. The bad people have stacked all the decks. CAMsters sit on accreditation committees, JCHAO, the IOM, and state licensing boards. Since the IOM report in 2005, the teaching of CAM to med students “at all levels” is required.

  32. Dr Benway says:

    Dan Burton’s right-hand man for many years was Scientologist Beth Clay. She likely still has Burton on speed dial.

    Just sayin’.

  33. As so often the problem is slightly different in the UK. Steiner (Waldorf) High Schools have been pushing hard for government funding.

    I had on my blog recently, three seriously scholarly guest posts on Steiner education.

    The first part was The true nature of Steiner (Waldorf) education. Mystical barmpottery at taxpayers’ expense. Part 1

    The part 2 is The Steiner Waldorf cult uses bait and switch to get state funding. Part 2.

    The part 3 is Steiner Waldorf Schools Part 3. The problem of racism.

  34. Scott says:

    Harkin has been in the Senate for nearly 30 years. Burton has been in the House for nearly 30 years. Darryl Issa, another Luddite, has been in the House for a decade.

    Yeah, it’s unfortunately not like the newcomers have a monopoly on scientific illiteracy.

  35. David Gorski says:

    Harkin has been in the Senate for nearly 30 years. Burton has been in the House for nearly 30 years. Darryl Issa, another Luddite, has been in the House for a decade.

    Indeed.

  36. David Gorski says:

    @David Colquhoun

    Oh, we have lots of Waldorf schools on this side of the pond, as well. However, giving public money to private schools is a lot more problematic here, I suspect, than it is in the UK, although certainly lots of legislators, particularly those who want to support religion, sure enough do try by advocating vouchers that can be used at religious schools.

  37. windriven says:

    @Scott-

    Yes, and my larger point was that there seems little political cost – at least in their districts.

  38. Scott says:

    These days it seems like an actual advantage. People who THINK won’t necessarily agree with the extremists’ knee-jerk prejudices. (True on either side.)

  39. Dr Benway says:

    Now for the optimistic bit. Because AM teaches that humans are completely autonomous free beings…

    The insidious danger is largely contained in the words, “AM teaches that…”

    Those words are anti-science. They are not okay.

    Authority based upon spiritual intuition deserves a kick in the shins.

  40. pmoran says:

    I am probably nearly as uncomfortable at this kind of thing as anyone here. But I worry that that feeling in my gut derives from how we scientists habitually analyse the world, rather than a complete awareness of how the world of medicine actually operates in 2011.

    Medicine once had a much clearer scope. Priests handled our existential angst, and large, extended families provided any other support that the sick might need.

    Society is different now. CAM may not merely be a response to those areas where conventional medicine performs weakly. It may reflect people having to turn to medicine for other human needs.

    This could be a key to understanding CAM. It explains the touching, the long seemingly medically irrelevant interviews, the intense practitioner-patient bonds, and that “spirituality crap”. .

    The implication is that if we succeeded in restricting ourselves to a more narrow “working better than placebo” model of medicine we would not solve anything. We may find ourselves forced to work alongside less fettered and more dangerous elements of AM.

    It’s worth a thought before entirely condemning those who seem to be selling science out.

  41. ConspicuousCarl says:

    Well here’s their problem right here:

    The Metabolic-Limb System (centered in the limbs, reproductive and digestive systems – those systems in constant inner and outer motion).

    Limbs and digestion are one system? These people literally don’t know their assholes from their elbows.

  42. overshoot says:

    I can’t imagine the cognitive dissonance that must be going on. After all, many family medicine doctors also take care of children and are responsible for making sure they are properly immunized just as much as any pediatrician.

    Surely, given that it’s obviously possible for a paediatrician with thirty years of clinical experience™ it must be possible for others as well.

  43. lizditz says:

    This is wandering bit afield but
    @davidgorski

    Oh, we have lots of Waldorf schools on this side of the pond, as well. However, giving public money to private schools is a lot more problematic here, I suspect, than it is in the UK, although certainly lots of legislators, particularly those who want to support religion, sure enough do try by advocating vouchers that can be used at religious schools.

    It’s more pernicious than that in the US . For many years, the Waldorf Education movement has had an ambitious scheme to open Waldorf charter schools (publicly funded schools with a particular mission or organizational apparatus). The scheme was handicapped for years by litigation from People for Legal and Non-Sectarian Schools (PLANS) a group specifically organized to counter “Waldorf influenced” charter schools.

    Dan Dugan, part of PLANS leadership, wrote a list of “What can be taken from Waldorf” http://groups.yahoo.com/group/waldorf-critics/message/17476 and a much longer list of “What Can Not Be Done In Publicly Funded Waldorf Schools” http://groups.yahoo.com/group/waldorf-critics/message/17597.

    There’s bad news and good news on the Waldorf-influenced charter front: The bad news:

    Alliance for Public Waldorf Education
    *Did you know there are 44 public charter schools inspired by Waldorf education and another 15 new emerging school initiatives?

    The good news: the financial crisis means that most of the “15 new emerging” have stalled for lack of funding.

    Back to the issue of Waldorf & vaccines: no, there’s no public anti-vaccination policy at Waldorf schools. What there is, is incredible peer pressure to cease vaccination for younger students, and never to begin vaccination for subsequent siblings.

  44. Dr Benway says:

    pmoran,

    Let the priest come visit the patient at the bedside, if that is helpful to the patient emotionally. Just do not call him “doctor” and imbue him with “scientifically proven” healing gifts.

    Let the people have their CAM. Just don’t “integrate” it with science.

    Science is a system for saying “no.” Remove the “no” and and you get Lysenkoism instead of science.

  45. David Gorski says:

    The implication is that if we succeeded in restricting ourselves to a more narrow “working better than placebo” model of medicine we would not solve anything. We may find ourselves forced to work alongside less fettered and more dangerous elements of AM.

    It’s worth a thought before entirely condemning those who seem to be selling science out.

    OK, I’ve thought about it.

    And I’ve rejected it.

    What Dr. Benway said.

    But maybe you can change my mind; so I’ll ask again: What, specifically, would you have SBM do in the face of anthroposophy infiltrating academic medical centers? I hear lots of hand wringing about how we practitioners and advocates of SBM are so very, very insensitive to human needs compared to you and so tied to scientific “dogma” that we dismiss out of hand, but little or nothing in the way of suggestions for concrete solutions.

  46. daedalus2u says:

    Dr Benway, if you called him/her a Witch Doctor, I think it would be appropriate.

    PM, what is needed is a better “placebo”. Trigger the placebo effect pharmacologically and there won’t be a need for Witch Doctors, or the need will be greatly reduced. That is what my nitric oxide bacteria can do.

  47. Reading Frame says:

    I’m not sure I could bring myself to sit through a lecture on quackery in medical school, regardless of the requirements. I also don’t think I would have an easy time of keeping my mouth shut if some of this nonsense were taught as fact.

    I wonder how much of an ethical obligation I have to these quacks’ future patients. I also wonder if I can file complaints to the medical school that will be taking approximately $172,000 (avg. med school cost) of my money. If I am giving them that much of my time and money, perhaps it is not outrageous to suggest that I be taught science and not idiocy.

    -RF

  48. pmoran says:

    But maybe you can change my mind; so I’ll ask again: What, specifically, would you have SBM do in the face of anthroposophy infiltrating academic medical centers? I hear lots of hand wringing about how we practitioners and advocates of SBM are so very, very insensitive to human needs compared to you and so tied to scientific “dogma” that we dismiss out of hand, but little or nothing in the way of suggestions for concrete solutions.

    Good question — perhaps better directed at those constantly lamenting situations that have developed on their/(our?) watch.

    I seem to be the only one with enough confidence in medical science and in even my American medical colleagues :-) to be somewhat relaxed about what is happening.

    I know the pendulum will swing back and that integrative medicine has little potential for harm. The patients are receiving proper medical care under proper supervision, and there will be a reaction the instant that ceases to apply to any patient’s detriment.

    So I don’t see the same slippery slope potential.

    But I would not be inactive. I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine. They seem able to help some people with some kinds of illness, but the systems have not the least connection to the underlying physical basis of any illness. That, in a few words, is all they need to know.

  49. nybgrus says:

    “I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine. They seem able to help some people with some kinds of illness, but the systems have not the least connection to the underlying physical basis of any illness. That, in a few words, is all they need to know.”

    And how would you do this pmoran? I am here to tell you that it is not being done and that it is being taught with credulity in medical schools. It is not being taught in a manner to indicate that you speak of. Things like nutrition and exercise are being taught to students as falling within the domain of CAM and that other modalities therefore must “have something to them.” I was personally told by the director of our “Integrative Medicine” department and lecturing professor that there “must be something” to reiki since more experienced practitioners get better results than less experienced. He said this was exactly analogous to an attending getting better outcomes than a first year resident.

    So your “plan,” it seems, has failed.

    I now ask anyone here – especially Drs. Groski and Benway – what should I, personally, do about this? What could I do about it? I have been contemplating writing a letter complaining about the lectures and their lack of basis – but I do not know what the repercussions may be or even if it would be effective at all

  50. pmoran says:

    Nybgrus:” So your “plan,” it seems, has failed.

    My plan? Plan A was the same as yours and most SBMers, i.e. not giving an inch to alternative practitioners, or to CAM, or to IM — anywhere, anyhow.

    Plan B, if it matures, may be more subtle.

    It probably won’t take the theories of alternative medicine so seriously as to dignify them with more than perfunctory rebuttal and an explanation of how misleading their anecdotal foundations can be .

    It will recognize that the public already shows considerable discrimination in their employment of CAM and try to build upon that.

    It probably won’t waste a lot of time arguing science with CAM practitioners. It will simply allow that they can help people via other mechanisms that are well-known to science, while reacting with vigour at any suggestion that they can go beyond symptomatic relief of some conditions.

  51. nybgrus says:

    pmoran: My comment was essentially saying that you don’t have a plan. You responded to Dr. Gorski’s direct question for what, specifically, you would do.

    “What, specifically, would you have SBM do in the face of anthroposophy infiltrating academic medical centers? I hear lots of hand wringing about how we practitioners and advocates of SBM are so very, very insensitive to human needs compared to you and so tied to scientific “dogma” that we dismiss out of hand, but little or nothing in the way of suggestions for concrete solutions.

    Your response:

    “But I would not be inactive. I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine.”

    First off – that is not a concrete plan that is a generalization. How would you go about ensuring every medical students understands? But I did not need to even ask you that question – I gave you an illustration of exactly how the exact opposite is actually taking place… so whatever concrete plan you may have been attempting to imply in order to achieve your goal has failed.

    How to stop CAM? Teach med students the proper things. Then CAM becomes further marginalized. That is how I am interpreting your response to Gorski – correct me if I am wrong.

    Since it is clear from myself, Tim Krieder, and numerous other med students that med students are not being taught the proper things what is your solution? That answer is what I am searching for from you and what I believe Gorski was as well.

  52. DW says:

    “… integrative medicine has little potential for harm.”

    That’s certainly not true. First, “integrative medicine” involves a wide spectrum of practices and remedies, and if a medical school, or their own doctor, appears to endorse it, patients aren’t necessarily going to go on ALSO seeing their regular physician. It sends the message that these other therapies are viable options. (U of M is sending this message now *institutionally*.) Some patients will feel it’s just like getting a second opinion, and will then dispense with regular medical care. That’s the first place the possibility for harm comes in.

    Secondly, some “natural remedies” interact in harmful ways with other drugs the patient may be taking, and because people think they’re “natural” they’re harmless, and therefore don’t even report them to their doctor. Third, there have certainly been plenty of cases where some bogus “remedy” actually harmed someone, again often because people think they’re harmless they take vast quantitites, other times because the stuff is actually toxic.

    “The patients are receiving proper medical care under proper supervision, and there will be a reaction the instant that ceases to apply to any patient’s detriment.”

    Not so simple. If the doctor is sending the message that the “integrative” treatments are just as good, some patients will believe they are equally valid options. Who’s to say they then go on seeking “proper medical care”? Some don’t. People who take quack remedies talk like this all the time: “Well, I decided chemotherapy wasn’t right for me … for ME, mistletoe is better.” As if they had weighed two options with actual evidence.

    “I would be doing my very best to ensure that every medical student understands that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine. They seem able to help some people with some kinds of illness, but the systems have not the least connection to the underlying physical basis of any illness. That, in a few words, is all they need to know.”

    No, that is hardly all they need to know! They also need to know how potentially dangerous some of these treatments are, and that they have an obligation to warn patients of this. Endorsing them is the very opposite of the physician’s responsibility.

    Doctors also have a responsibility to advise patients against taking treatments such as homeopathy that not only clear don’t work, they literally *can’t* work as there is no active ingredient.

    Finally, doctors have a responsibility to not sit back and do nothing when patients are getting ripped off by con artists or snake oil salesmen. Even when it’s a harmless sugar pill, there is harm being done to the patient’s pocketbook. This is morally wrong and definitely within the physician’s responsibility to protest it and to advise his/her patient away from it.

    Especially with health care costs in such crisis, doctors have a responsibility to speak out overall against blatant waste of resources. Funding a whole frickin’ department at a medical school for useless treatments is an unconscionable waste of resources.

  53. David Gorski says:

    I know the pendulum will swing back and that integrative medicine has little potential for harm. The patients are receiving proper medical care under proper supervision, and there will be a reaction the instant that ceases to apply to any patient’s detriment.

    I wish I could be as blithe as you in dismissing the potential for harm. Nor am I as confident as you are that the “pendulum will swing back,” at least not any time soon. In fact, having watched the trend for about a decade and then spent the time studying what’s happened since the 1970s and the 1980s, there is no sign of the pendulum even slowing down, much less swinging back. If it’s going to swing back, at the rate it’s going, it’ll happen long after I’m either retired or dead (probably long after the latter given my age). Judging by its velocity right now, the pendulum is still early in its swing, picking up speed as it swings towards quackery.

    I don’t think we can afford to wait 40 or 50 years for things to right themselves. Moreover, Kimball at the very least has provided plenty of examples as to how quackademic medicine has directly harmed patients or placed patients in harm’s way. His posts on the Gonzalez protocol and the TACT trial are perfect examples. In other words, if you think that this stuff doesn’t harm patients, you are putting your fingers in your ears, holding your eyes shut, and chanting, “Lalalala, I can’t hear you.”

    As for “teaching medical students proper things,” what, exactly, would you do to ensure that? Let’s say that you’re faculty at a medical school, and you find out that there is a program there teaching anthroposophy. What do you do? Do you go to the dean and try to convince him that a science-based medical school shouldn’t be practicing or teaching mystical gobbledygook? Do you shrug and look the other way, happy it’s not your department? Steve Novella has faced this very problem at his own university, albeit not with something as loony as anthroposophy. Thus far, I have been fortunate enough not to have to have faced this problem at my university (which, the wag in me can’t help but point out, is at least one way that my university is better than U. of M.), but it’s coming some day. The tide in medical academia is running that way, and I’m under no illusion that my university will escape the tsunami of woo now engulfing many of the bigger centers.

    In the meantime, if your comment here:

    http://www.sciencebasedmedicine.org/?p=9912#comment-63111

    is any indication, your solution seems to be to acquiesce and let woo in that you don’t consider harmful. In fact, you yourself said:

    CAM thrives mainly on unmet medical needs, but it is helped along by ever-changing fashion and novelty, the “forbidden fruit” illusion, and the innate mystique of some of its methods. Thus it is that Australia may have unwittingly (or witlessly) stumbled upon a way of defusing one aspect of it — make it commonplace!

    I’m sorry, but I reject this solution.

  54. pmoran “It may reflect people having to turn to medicine for other human needs.

    This could be a key to understanding CAM. It explains the touching, the long seemingly medically irrelevant interviews, the intense practitioner-patient bonds, and that “spirituality crap”. .”

    pmoran – as a patient and parent of a child with medical needs, my concern is not fully that anthro is non-scientific, I believe that the blend of medicine and spirituality give the doctor an undue influence over the patient’s decision making process. I also believe it is highly questionable, ethically, for them to attempt to play spiritual leader and doctor at the same time.

    I don’t know about AU, but here in the states there is some belief that a person should have the freedom to accept OR reject medical options without physical or emotional coercion. There is also the belief that people should be able to accept OR reject religious or spiritual options without physical or emotional coercion.

    But I do not believe that a doctor can both advocate for a particular spiritual approach (as anthro seems to do) and maintain the neutrally needed for a patient to make independent medical decisions.

    Being a doctor and being a spiritual or religious leader both given a practitioner power over the patient or flock. Doctors are supposed to be trained to recognize how to ethically handle this power. Many religion train their leaders how to ethically handle that influence as well.

    But, is it ethical to advocate, even in a gentle compassionate way for a particular spiritual approach to end of life, abortion, cancer, a chronic illness and at the same time be the doctor who the patient hopes will carry through with the patient’s decision or wishes?

    If a patient is halfway through a course of chemotherapy that their life may depend upon, that their doctor is managing, does that patient really have the emotional autonomy to reject the doctor’s spiritual advocacy, even if it is subtle?

    I do not think it’s a good solution for fulfilling spiritual needs that a patient might have. The doctor as a non-judgmental neutral party gives the patient the room they need to arrive at their own decisions or seek help from a religious or spiritual adviser, who has probably done more advising than any doctor and who may have special training in dealing with those issues.

    A kind voice, taking the patient seriously, being thoughtful, a gentle gesture when needed*, those things can be tremendously helpful when a patient is dealing with a shock or illness. Real knowledge and expertise can also be tremendously helpful, one doesn’t need to be a spiritual guide to be a compassionate helpful human being. And being a spiritual guide may actually cause harm to the patient.

    *And talk slower. What’s up with the young doctors talking so fast these days?

  55. horse says:

    worth mentioning is that Stockholm University successfully managed to close the Steiner Waldorf (Anthroposophy) teacher training course in 2008 after being alerted to the course materials. Stefan Nordland, dean of Stockholm University’s faculty of natural sciences said:

    “The syllabus contains literature which conveys scientific inaccuracies that are worse than woolly; they are downright dangerous.”
    http://www.thelocal.se/13944/20080826/

    Statement from the VC here: http://bit.ly/g07tn8

  56. windriven says:

    @pmoran

    “So I don’t see the same slippery slope potential.”

    I would have heartily agreed with you right up to the point that doctors, medical schools and hospital systems started buying and selling woo. That wasn’t a slippery slope, that was an event horizon that we may never escape.

  57. David Gorski says:

    Indeed. I’ll give you an example. The Samueli Center at UC Irvine:

    http://www.sscim.uci.edu/

    This center sells FirstLine Therapy, which is a line of supplements marketed by Metagenics:

    http://www.sscim.uci.edu/Content/Clinic/WhatWeTreat.html

    http://www.metagenics.com/practitioners/programs/firstline-therapy-program

    http://www.metagenics.com/products/product-categories

    The founder of Metagenics is Jeffrey Bland:

    http://www.quackwatch.com/04ConsumerEducation/bland.html

    Is this bad enough to set off Peter’s quackery alarms?

  58. overshoot says:

    Where is the patient harm?

    Well, in the USA there’s a limited amount of money available for medicine (this may not be true in Australia, but I assure you it is true here.) The budget for physical therapy, reiki “therapy,” and for that matter surgery is at best a zero-sum game where patients get less effective treatment thanks to dilution by ineffective treatment.

    However, that’s a best-case scenario.

    In actuality, it’s a negative-sum operation because stirring in homeopathy with real medicine doesn’t make real medicine stronger (what a shock!) and as a result the patient outcomes per dollar get worse. Which means that the benefit/cost results for real medicine drop below the “worth reimbursement” level and aren’t covered at all (something that US insurers love to rule.)

    Where do people go when they can’t afford real medicine? You got it: full-up “alternative care [1].” It’s less expensive, even if it doesn’t work.

    I’m not saying that this is all part of the plan, but it’s the way things work: “integrative medicine” is a pipeline for moving patients clear out of SBM.

    [1] Not speculative, although anecdotal: e.g. ephedra for ADHD or asthma may be relatively ineffective and have undesirable side effects, but it doesn’t require a quarterly $100 out of pocket appointment for prescription refill either. Lest people forget, that’s more than 10% of some people’s take home pay and comes straight out of the grocery budget.

  59. What micheleinmichigan said.*

    There’s also something else micheleinmichigan said in another thread:
    “Often people are more committed to a plan that they understand and have been allowed to arrive at themselves.”

    I think this is a fundamental appeal of CAM. Reality is hard. Lots of people have minds that work in vitalistic ways. Thoughtful counselling by a reality-based MD will help most people feel as though they understand the rationale for their care – and have made enough decisions about it – to commit to it. Other people will reject reality-based explanations because they just don’t think that way. That doesn’t mean that they want their doctor to be a spiritual guide, it means that they may be more likely to follow counsel by someone who is able to communicate a plan using metaphor.

    I’ve never heard anyone tell me they wanted their MD to be a spiritual guide. I really think this is a distraction. MDs can offer compassion, use different approaches to help people understand their situation and their care, and help people make choices.

    Woo-practitioners will still often be more effective helping people follow weight-loss diets that call on (for example) atavistic concerns about purity.

    That doesn’t mean that MDs should be teaching their patients things that just ain’t so. It probably means that they will always need to hold back if someone is engaging in desirable behaviour supported by a magical worldview. But holding back is different from offering spiritual leadership, and different again from making shit up.

    *And said very, very well.

    *** *** ***
    Sorry for the incoherent comment. I’m not at my best these days.

  60. Jan Willem Nienhuys says:

    I had never thought that I would have to pose as a defender of anthroposophic medicine, sort of.

    Let me be clear.
    1. Steiner was a nut, scientifically speaking. He put a lot of energy in educating his fellow humans, and everything he said in lectuires and so on was taken down and still can be read in his almost endless collected works. Anyone with a smattering of scientific knowledge can make a rich harvest of total nonsense. This includes the so-called racist remarks. His knowledge of biology and evolution was more inspired by the nonsense of H.P. Blavatsky than by what was known in his time. It is just utter dumbness all over.

    2. Anthroposophical agriculture and anthroposophical philosophy of education, as implemented in their Waldorf schools, are of equally dubious quality.

    3. However, anthroposophical medicine (AM) was developed by a real doctor, Ita Wegman . The things anthroposophical physicians say and do should be judged on their own merit, not by pointing at Steiner or Waldorf schools. Maybe the fact that she was Dutch makes me feel that it can’t be all bad.

    4. There is enough to criticize in AM:
    A. their use of fermented mistletoe preparations (Iscador by Weleda, there are other brands too) against cancer.
    B. Blood crystallisation tests.
    C. Ultra diluted (homeopathy style) medicines.
    D. Crazy and occult theories about how the human body works (I mentioned their theory of how the heart works); also views on so-called types.
    E. Opposition to vaccination in combination with the theory that being sick is good for your spirit.

    Maybe there is more. I mentioned that AM has a tradition of putting a lot of effort into care for the mentally handicapped, but here I also saw that some anthroposophs have a callous attitude (‘your problems are karmic, good for you’) towards mentally hadicapped. I don’t know whether this is what AM doctors learn in their courses on AM medicine.

    5. AM is also known for recommending art (painting in pastel colors) and dancing as therapeutic modalities. I cannot judge whether this is helpful for people who feel miserable or is just some kind of lesser woo.

    6. I know of cases where people had created an own form of quackery vaguely resembling AM, which amounted to advising cancer patients to avoid regular treatment, but eat wheat grass and play the piano – much to the embarassment of real AM doctors.

    7. It is very difficult to get an understanding of what AM is. This is compounded by the fact that many of these AM doctors all have their own views. People believing anthroposophy may find it reassuring to have phsyician that shares their views. It is not certain that AM physicians will try to proselitize non-anthro patients, or try to look for karmic explanations or cures for their patients.

    8. In the Netherlands a government report on research in alternative treatments (the term medicine was avoided) was issued in 1993. The chapter on AM was incomprehensible to me. In comparison homeopathic theory is a paragon of lucidity. There was lots of crazy philosophy (see D above), but the only connection with treatment seems to be that all this philosophy supposedly broadens the view of the AM doctor and improves his or her ability to intuit what’s really wrong with a patient. This general introduction was followed by examples of and proposals for research. I cherry pick a few:

    - how can one use the blood crystallization test to establish the AM diagnosis of hysteria and neurasthenia;

    - the effectiveness of treatment of patients with AM diagnosis ‘weak kidney radiation’. (Supposedly the name for a symptom complex of which lassitude is a major component; one has to be very familiar with AM to understand what this means; AM doctors seem to have little difficulty in diagnosing this. Look at

    http://www.anthromed.org/Article.aspx?artpk=811

    where weak kidney radiation is used as a term that is self evident. For more explanation see:
    http://system-sat.de/anthroposofie.htm
    It has lots of literal quotes of Steiner in relation to medicine.

    When the activity of the kidneys and adrenal glands is increased, the resulting plethora can, in turn, lead to cardiovascular disorders and sclerosis. The pyknic constitution and the choleric temperament have this tendency. People with a weak kidney radiation tend to have low blood pressure and a melancholic temperament of the longilineous type.

    I don’t understand this, but I am not a doctor. )

    - investigation into the prevalence of rachitis among patients of AM general practictioners.

    - investigation of Arnica montana, more specifically the difference between cultured and wild plants if used in rubbing gels for muscle pain.

    - Iscador as immune stimulant in cancer patients.

    Summarizing: there is enough to criticise in AM, one doesn’t have to bring in Steiner’s nuttiness (unless it is of direct consequence for the training of AM physicians) or Waldorf schools or reincarnation. This is just common sense. If we judge people we hold the opinions of others that look like them not against them.

    On the other hand Big AM Pharma may be involved. Possibly Weleda is playing an active role in getting AM into US universities.

  61. DW says:

    “there is enough to criticise in AM, one doesn’t have to bring in Steiner’s nuttiness”

    Steiner’s nuttiness is the origin of all those theories, regardless of whether Wegman was actually an MD.

    Karma is the philosophical basis of it. Things like, getting sick may be good for your soul, are not minor points, they’re the *basis* of the theory and the treatments. Particularly in regards to vaccination. With a karma theory there is dubious motivation for certain treatments in the first place, but *preventive* measures in particular appear contraindicated. Preventing someone getting a disease they’re “supposed” to get or have “chosen” to get is a dire mistake in anthroposophy.

    The stuff about upside down plants and the four humours (sanguine, melancholic, choleric and phlegmatic) etc. are *derived* from the theories of karma and reincarnation. Diseases you don’t survive make you stronger in the next lifetime. Karma is not tacked on as an afterthought, “Oh, and maybe it’ll be good for you.” Karma is the starting point.

    I am not a doctor, but it seems to me it these theories are incompatible with medical ethics.

  62. DW – just a nitpick and a sidetrack. There are different approaches to karma and Buddhist philosophies. You are succinctly stating one of them, apparently followed by some of the anthroposophic folks, but there are other approaches too.

    “Dalai Lama launches anti-polio campaign

    The Dalai Lama administers pulse polio drop to an infant in Bodh Gaya, India, on 10 January 2010. India is observing National Immunisation Day today to eradicate polio.
    [snip]
    The Tibetan leader, who has been in Buddhism’s holiest site of Bodh Gaya since 4 January, administered a few anti-polio drops to two infants on India’ National Immunisation Day, observed on 10 January.

    He said he saw a few polio-affected youths in the streets of Bodh Gaya. “Preventive measure is very important for protection of the children for good and normal life.”

    http://www.tibetsun.com/archive/2010/01/10/dalai-lama-launches-anti-polio-campaign/

    Not a Buddhist myself, but have family/friends who are attached to the philosophy and they do vaccinate and they do not let their children get sick for spiritual reasons.

  63. Dr Benway says:

    Well pmoran, I suppose it’s helpful to the discussion to have someone representing the “what’s the harm?” position. However, it’s my understanding that you had been a practicing physician, now retired. Thus I am distracted by the dog that is not barking –I am distracted by the lack of physicianly feeling toward, for example, the autistic children under my care right now. I am distracted by your disinterest in the problem of communicating with Dr. Woo regarding a shared patient.

    Do you have a first degree relative or some other important figure in your life who is invested in cultish healthcare practices?

  64. horse says:

    @micheleinmichigan Buddhist ‘Karma’ (translated from the Pali) is measured by one’s present actions – the birth and death of each moment.

    Anthroposophical ‘Karma’ is measured by one’s past – the birth and death of each lifetime.

  65. @horse – interesting – thanks for that.

  66. DW says:

    Thanks Michele and horse, very interesting. Yes, I know there are different understandings of karma, and Eastern and Western perspectives can be very different. I was referring specifically to anthroposophical beliefs. Steiner culled a lot of things from Eastern philosophies, but he may not have really understood Eastern notions of karma, which, from what I understand, are cylical while Western notions are more linear. Steiner’s version of karma is firmly retributive (not sure that’s the right word …) – meaning events in one’s life are either consequences of earlier deeds or misdeeds, or sometimes they are thought to be spiritual “preparation” for future lifetimes (i.e., illness isn’t necessarily a punishment, but sometimes a way of strengthening a person spiritually for future lifetimes). Either way, not a notion I want a doctor applying to my child.

  67. DW regarding retributive karma – “not a notion I want a doctor applying to my child.”

    Yes, I certainly agree. Conflict of interest :)

  68. nybgrus says:

    @Dr. Gorski – I am ashamed of my alma mater. I did my undergrad at UCI (both degrees) and did post-grad pharmaceutical research there. The director of pharma sciences at UCI is a friend of mine and was begged to teach the medical students pharmacology. She didn’t want to stating she had too much work to do on her own projects. Perhaps this was another reason why but she didn’t want to say so. After all, she is not the kind of person who would like to market the effects of “SuperGarlic 6000″

    http://www.metagenics.com/products/a-z-products-list/SuperGarlic-6000

    The science program at UCI undergrad was extremely robust – in fact I started out there as an anthropology major and when I went to add biosci as a major they were very snide and said “Our program is extremely hard are you sure you want to add this?” and went on to say “It will take us a week or so to let you know if you are approved or not.” I was called the next day and said I was in – they checked my transcripts and saw that I had already aced a year of ochem and physics. 5 nobel laureates were on the faculty when I did my undergrad. It was all taken extremely seriously. How is it that the medical school, which is literally 100meters across the street from where I had some of the most intense science classes ever, can just chuck the science out the window? I know they do science over there – I once had to walk over and borrow some lab supplies to do my assay!

    pmoran: I await your concrete response as to how to educate us medical students properly or to refute what I have said. And just in case you want to claim it is an American thing and that the Aussies have your ideology well in place and it is working… I am here in Australia as well. At what is considered to be a top 50 worldwide medical school. At a “sandstone” uni (the Aussie version of “Ivy League, I’m told). And I am being taught by a guy who goes to conferences to sell a “7-hormone saliva test” in order to administer and monitor anti-aging therapy to your patients. And he charges $595 to attend the session and gives you a free saliva test (valued at $300).

    http://www.accs.org.au/pdf/antiageing.pdf

    Yep, that guy told me reiki must be doing something to help our patients.

  69. pmoran says:

    I am gob-smacked that so many have so little faith in their institutions and their colleagues. Or is there something I don’t know about? Has someone come across “the Hulda Clark version” of integrative medicine? I have the more measured Andrew Weil version in mind.

    We can be fairly sure that anthrosopophy was the worst aspect that David could find in his local version, and we have as yet little information as to what will actually be taught about that and in what context in relation to the rest of medicine.

    We merely assume it will all turn out badly, even that an obviously scientifically naive IM tutor like nybgrus’s will be able to persuade medical students out of the rational approaches to medicine that they are encountering elsewhere for six years(?) or so. If he can do that in such a way that they will go on to do real harm to their patients later then there IS no hope for us.

    I reiterate that my whole point is risk vs harm, but in a more global sense than the approaches I see displayed here i.e. what attitudes, rhetoric and strategies can optimize any benefits that our public may derive from CAM, while minimizing its risk?

    Offering selected elements of CAM under the supervision of proper doctors could be a rational approach, unpalatable as it obviously is to those for whom the science of it all (actually selected aspects of the science) is of such overriding importance that they see only an unlikely slippery slope, not the intricate cost/risk/benefit judgment it probably should be.

    This is an extremely complex field. It demands at least normal levels of scientific caution and precision in our judgments.

    “Some aspects of CAM can sometimes be dangerous” leads to effective strategy only if you can convince everyone, or nearly everyone that CAM is totally useless. That is impossible while there are unmet medical needs driving a lot of people to try them out and being liable to conclude that perhaps they do work (“so are those scientists full of it, or what?”).

    We must understand what we are dealing with.

  70. nybgrus says:

    “We merely assume it will all turn out badly, even that an obviously scientifically naive IM tutor like nybgrus’s will be able to persuade medical students out of the rational approaches to medicine that they are encountering elsewhere for six years(?) or so. If he can do that in such a way that they will go on to do real harm to their patients later then there IS no hope for us.”

    4 years – UQ is now a 4 year postgrad MBBS degree. However, for me and my cohort it is only two years. I spend years 3 and 4 doing my clinical rotations back in the States at Ochsner in New Orleans.

    But more to the point – this is not a “scientifically naive IM tutor” this is a full professor and if you are in Australia you should know what that means. He was a graduate of Uni of Melbourne and worked at USyd as well. He is considered to be very well credentialed and a full fledged physician. He comes to lecture pounding the desk and yelling that homeopathy is crap but that there is evidence for a lot of CAM. He goes on to co-opt pharmacognosy (as Gorski has pointed out numerous times) and has these huge charts he makes us look at about how much evidence there is for all sorts of CAM modalities. He generally sticks to bioactive herbals, probiotics, and the like but also puts acupuncture as having “high levels of evidence” that it works quite effectively. He also lists chiropractics as having positive evidence. He says that there is plenty of garbage out there, but that for the stuff that has evidence for it we should “integrate” it. And then he tells me that reiki works.

    He does not teach that there is no scientific basis for these CAM modalities. He does not teach “every medical student [to] understand that the various “systems” of AM-style medicine are symbolic/metaphorical/ ritualistic approaches to medicine.” He teaches them with full credulity and teaches that indeed, there is a dichotomy between “western medicine” and “alternative medicine.” He is the head of the department and teaches directly to the second year students. However there are others and we had similar lectures during first year.

    “If he can do that in such a way that they will go on to do real harm to their patients later then there IS no hope for us.”

    Now you are starting to understand.

  71. pmoran “I am gob-smacked that so many have so little faith in their institutions and their colleagues.”

    I think this is not really not addressed in my direction, but I would make the observation that “Hope for the best, plan for the worst.” is a pretty good motto, that is applicable here.

  72. weing says:

    We have made great progress in medical care through science based medicine only for a short period in our history. Unfortunately, we have become infected by incompetents in our centers of learning that, for whatever reason, are condoning and even promoting cargo cult medicine. I wonder, if any pilots ever mistook a cargo cult landing strip for a real one? The outcome would have been similar to mistaking cargo cult medicine for science based medicine by a patient with a real disease. In order to prevent harm, it behooves us to identify this nonsense as such and warn our patients and to eliminate it from our institutions. Would it help if a medical student would sue the school for fraud? He/she expected to be taught something that really works but was given a counterfeit instead.

  73. …integrative medicine has little potential for harm. The patients are receiving proper medical care under proper supervision, and there will be a reaction the instant that ceases to apply to any patient’s detriment.

    So I don’t see the same slippery slope potential.

    And:

    I am gob-smacked that so many have so little faith in their institutions and their colleagues. Or is there something I don’t know about? Has someone come across “the Hulda Clark version” of integrative medicine? I have the more measured Andrew Weil version in mind…

    I reiterate that my whole point is risk vs harm…

    Peter:

    You’ve been reading this blog since it began. You must be aware of the numerous examples of harm that we’ve reported. Almost all of it has been aided and abetted by the medical academy’s recent, childish fetish with what only 20 years ago was still recognized as snake oil. How many examples are too many? Whatever happened to “first, do no harm”? Where, other than here and a few other places whose efforts have been mostly unheeded, is the reaction that you prophesy?

    The Andrew Weil version? Did you notice that about a year ago several people died in Arizona during a ‘sweat lodge ceremony’, the same sort of “facilitated sessions [for] examining [one's] humanity” that “occur regularly” for Weil’s “integrative medicine” fellows? Can you imagine other risks of the unmeasured drivel that Weil feeds to these trainees (look under “The Wooification of Health Care”)?

    There’s a real-life example in this post:

    “Integrative Medicine Experts”: Another Barrier to Effective Discipline

    KA

  74. overshoot says:

    Offering selected elements of CAM under the supervision of proper doctors could be a rational approach

    Sure: diet and exercise. Relaxation techniques. Those would totally revolutionize scientific medicine.

  75. Dr Benway says:

    We merely assume it will all turn out badly…

    I don’t want to repeat anecdotes about patients who have been diagnosed with adrenal fatigue, chronic Lyme, chronic candidiasis, and gluten enteropathy –all with reams of results from labs running expensive non-FDA approved tests.

    I remain gob-smacked by your lack of feeling toward the little bedwetters under my care. Maybe you are not actually Dr. Moran but someone borrowing his account?

    A real doctor would understand that we are judged by the quality of our history taking, exam, diagnostic formulation, and medical decision making. The outcomes we leave to Allah and His mercy.

  76. David Gorski says:

    I am gob-smacked that so many have so little faith in their institutions and their colleagues. Or is there something I don’t know about? Has someone come across “the Hulda Clark version” of integrative medicine? I have the more measured Andrew Weil version in mind.

    What Kimball said. Seriously, I’m a bit puzzled and frustrated here. Have you actually been reading this blog since the very beginning? Or even over the last year? It’s not as if we haven’t listed examples of harm that can come about because of the infiltration of quackademic medicine into medical academia. To Kimball’s response, I’d add my own emphasis: Read our posts about the Gonzalez trial for pancreatic cancer. Patients with pancreatic cancer were subjected to an ineffective treatment and ended up living only 1/3 as long as patients undergoing standard-of–care science-based medical therapy.

    The reason I have so little faith in our institutions is because they’ve betrayed that faith!

  77. “Offering selected elements of CAM under the supervision of proper doctors could be a rational approach.”

    No it would not.

    It’s one thing for a patient to ask their doctor about acupuncture and be told, “It might help you feel better but can’t actually treat anything.” Another for the doctor to refer them to the acupuncturist in their own clinic. The first is rational. The second is not.

    A third option would be to refer them to the massage therapist in their own clinic. Also likely to help them feel better. Less likely to be taken as an endorsement of a treatment modality.

    Nutrition classes offered by or through the clinic – great! Referrals to swim gym workouts – wonderful! But there is nothing rational about a doctor offering acupuncture.

    This seems to be related to what you said earlier about doctors needing to offer spiritual leadership. You want to be the source of everything for your patient. Can’t you be happy for a patient who is getting their needs met elsewhere? Do you really have to meet all of them yourself? (Sex is likely to help your patient feel better too, and is too often an unmet need, but it would not be rational of you to have sex with your lonely patients.)

    I think there’s an epistle of Paul where he says something along the lines of not being jealous if someone is healed by herbs gathered by another. (You’re familiar with the reference, I’m sure.) In this case we aren’t even talking about healing. Just feeling better.

  78. nybgrus says:

    I couldn’t agree more. When I say I want the physician to do everything the patient needs, I mean from science-based medicine perspective. To me, that also includes being compassionate, listening, having empathy, including the patient in decision making, taking the time to explain risks and benefits well, and referring them to proper sources for anything else they might need. If you are an internist you would refer them to an orthopod, not try and do it yourself. You would also refer them to a grief counselor or a chaplain if they needed that as well. Or even to a priest/rabbi/what have you if they needed that. A nutritionist or psychiatrist. The point is that as a physician you can embody those non-specific traits that makes CAM so alluring by actually listening to your patients and then properly referring them to quality and qualified allied health groups.

    In no way, shape, or form, ever should a physician also be the spiritual guidance for a patient. Besides the fact that I am an atheist, even if I were also a doctor of divinity it would be an inappropriate thing to do. Period.

    I think you are losing some serious ground here pmoran. And the fact that you have supposedly been reading this blog for so long, and are reading all this different critiques from everyone here (from lay people to med students to physicians) and still not budging an inch on what you say makes me think the evidence and argument for you is moot. Anyone who cannot change their mind when faced with good evidence and argumentation is no friend of mine.

  79. JMB says:

    @nybrgus

    Currently I wouldn’t expect to be faced with such a situation, but you can not always predict what will happen. Imagine you know somebody is devout in their religious beliefs. Now consider the possibility that they are tempted to try a CAM therapy that has it’s origins in an ancient religion. Would you not warn them that they are trying a therapy based on a religion different from the patient’s professed beliefs? Wouldn’t an individual who believes in one of the Abrahamic religions be embarrassed to find out they are considering a therapy with its basis in a pagan religion? That is spiritual guidance even an atheist should be able to provide.

  80. nybgrus says:

    @JMB: I see your point, but I don’t think that will ever be an issue for me. I have been in a situation before working trauma in the ER when an older lady whom I was attending to suddenly grabbed my hand and thanked me for saving her life (not that I had really done it – I reckon the physician did more than I did, I was just closest at hand). I said that it was a team effort and she was welcome – then she said, “Isn’t God great? Pray with me” and grabbed my hand and began to pray. I wasn’t even inclined to say, “I’m an atheist, I don’t do this.” I merely looked down and waited till she was done. It is easy enough to respect someone else, even when their beliefs are completely contradictory to mine. It is, after all, about the best for the patient, not proselytizing.

    As for dissuading a patient because the woo they are considering is opposite the religion they are currently ascribed to – definitely not what I would consider proper or ethical. For me, religion is woo. So to say “Don’t go do that woo because the woo you currently believe in is actually from a different mystical authority.” If I can’t make the case against the woo based in science, evidence, and reason I certainly would not resort to spiritual extortion.

  81. Regarding woo that is contrary to a patient’s religious beliefs, there is also the ironic (and amusing) issue of woo that is contrary to the woo-practitioner’s religious beliefs—even if she doesn’t know it. In my region (Greater Boston), Reiki is offered mainly by nurses, and nurses—including those who do Reiki, as far as I can tell—are mainly Roman Catholic. But look at what the United States Conference of Catholic Bishops has to say about Reiki:

    http://www.usccb.org/doctrine/Evaluation_Guidelines_finaltext_2009-03.pdf

    KA

  82. David Gorski says:

    Indeed. There is this amusing little article about how an Assembly of God pastor was upset at reiki being offered at Pocono Medical Center:

    http://healing.about.com/b/2011/02/18/assembly-of-god-pastor-fears-reiki.htm

    http://www.poconorecord.com/apps/pbcs.dll/article?AID=%2F20110218%2FNEWS%2F102180330%2F-1%2Frss01

    My “good buddy” Orac wrote about this a while ago:

    http://scienceblogs.com/insolence/2009/04/reiki_versus_the_catholic_church.php

  83. Jan Willem Nienhuys says:

    DWon 15 Mar 2011 at 11:12 am
    and
    DW on 15 Mar 2011 at 1:55 pm

    has stressed that the ideas of anthroposophy on karma and reincarnation form the basis of the rest of anthroposophy and more in particular that this is a socalled ‘retributive’ form of the belief. He implies that it is also the basis of anthroposophic medicine (AM).

    Now I know that Ernst and Singh said so on their one page summary of AM on p. 298 of their book, but I disagree. Rudolf Steiner’s collected works encompass 89,000 pages. The man was trained as a philosopher (he studied also mathematics and physics around 1880, but must have forgotten most of that) and he had an opinion about everything, and from a scientific point of view these 89,000 pages are a hotchpotch of the most diverse nonsense.

    The whole idea that anthroposophy is a rigorously thought out system with a simple basis is unsupportable.

    The main idea in the Steiner writings is what it means to be human. His reincarnation ideas are subordinate to this. According to Steiner people have all kinds of different bodies (astral, etheric and so on) with an upper and an lower pole and after death some of these bodies survive and are cleansed or destroyed and then the supernatural core essence (the ‘I’) looks for a new incarnation, usually in another sex and another ethnic group and starts preparing the ancestors of its new birth by modifying their genes. It takes several centuries. I don’t know how Steiner thought he knew this, but I think he just made it up or stole the idea from H.P. Blavatsky. What would happen if five souls were working on the same ancestors of five children I don’t know. The whole idea is that the soul should gradually evolve by having a very wide experience. Like a wealthy westerner who every year takes a vacation in another far far away country.

    Here is what one anthroposopher (an MD, but not one that practiced AM or had been trained as AM practitioner) wrote (I’ll translate and summarize, because anthroposophers tend to be longwinded and woolly):

    “Reincarnation is mainly a general idea, not something related to experiences with individuals. So an AM doctor on the one hand believes that in every human there is a supernatural core, but on the other hand he would be very reticent to talk about anything in a patient that might be related to reincarnation, let alone to translate this into explanations of disease. So in AM there is no regression therapy.”

    It seems that at least half of the anthroposophers really believe this karma stuff in whole or in part. (Not all of them do, because every person must decide for himself what to believe.) Now in almost every religion with ideas about afterlives you will find ‘retributive’ variants and ideas about immortal souls. After all, this afterlife business supposedly accounts for the sad fact that life is unjust. So if someone is in pain you can believe that the pain will be compensated for in heaven. Or, if someone drowns in a tsunami, that it is a punishment by a Higher Authority. You’ll find that in all religions with an afterlife belief (and you’ll also find writings like the book of Job that say that it isn’t that simple). That doesn’t imply at all that even devout adherents of such religions will think the sick and disabled don’t need treatment.

    There is much more in antroposophy (consult Wikipedia: http://en.wikipedia.org/wiki/Anthroposophy and http://en.wikipedia.org/wiki/Anthroposophical_view_of_the_human_being ) and the only thing all these things have in common is that they stem from the Steiner hotchpotch. I admit that I haven’t had the courage and energy to read all those 89,000 pages, I gave up when I tried The Philosophy of Freedom. But in what I have read, there is not an all pervasive odor of karma and reincarnation in anthrosophical writings. (Incidentally, in the US and Western Europe about 20-25 percent believe in reincarnation.)

    AM is full of nonsense (all this upper and lower pole and different bodies and threefold and fourfold aspects and much more) and on top of that one has Iscador, homeopathy and strange blood tests. It is impossible to make a direct link between karma and reincarnation with the idea that copper chloride crystallisation patterns say something about the diseases of the person who contributed a drop of blood that is mixed into the solution.

    If you want to convince a school that they shouldn’t have AM, it seems best to stick to what is medically unsound, rather than emphasizing one aspect of the anthro religion.

  84. Kimball Atwood “In my region (Greater Boston), Reiki is offered mainly by nurses, and nurses–including those who do Reiki, as far as I can tell–are mainly Roman Catholic.”

    I have to be brief, so I will just say Christmas trees, Easter eggs.

  85. OK, I just checked out Orac’s 2009 post (linked above). Not only does it include Reiki practitioners’ rebuttals to the Catholic Bishops, it also has a not-to-be missed comment section.

  86. DW says:

    Jan,

    “The whole idea that anthroposophy is a rigorously thought out system with a simple basis is unsupportable.”

    I didn’t say it was simple; I said reincarnation and karma are central in anthroposophy, and that’s correct. Nothing to do with the number of pages Steiner wrote.

    “The main idea in the Steiner writings is what it means to be human. His reincarnation ideas are subordinate to this.”

    Reincarnation and karma are the center of what Steiner thought it meant to be human.

    “The whole idea is that the soul should gradually evolve by having a very wide experience. Like a wealthy westerner who every year takes a vacation in another far far away country.”

    LOL – never thought of it that way, but that’s quite an apt description!

    “Here is what one anthroposopher (an MD, but not one that practiced AM or had been trained as AM practitioner) wrote (I’ll translate and summarize, because anthroposophers tend to be longwinded and woolly):
    “Reincarnation is mainly a general idea, not something related to experiences with individuals.”

    That’s disingenuous. It most definitely applies to individuals. The doctor is trying to say something soothing to distract critics from the parts of his/her belief system that they find worrying.

    “So an AM doctor on the one hand believes that in every human there is a supernatural core, but on the other hand he would be very reticent to talk about anything in a patient that might be related to reincarnation, let alone to translate this into explanations of disease. So in AM there is no regression therapy.”

    It’s true they’re not at all into regression therapy. IMO, though, this is more about flying under the radar than an actual difference in beliefs. Anthroposophists do not want a lot of publicity for their beliefs. The success of their enterprises actually depends on a lot of customers not really knowing much about the underlying beliefs. Holding a regression therapy workshop would “out” them. They want to be considered intellectuals. Their beliefs differ only in detail from the folks holding regression therapy workshops where everyone closes their eyes and breathes deep and suddenly remembers they were once Cleopatra or Aristotle. (Steiner’s followers, btw, believe he was the reincarnation of Aristotle.)

    “It seems that at least half of the anthroposophers really believe this karma stuff in whole or in part. (Not all of them do, because every person must decide for himself what to believe.)”

    Anthroposophists love to insist they’re all really free thinkers, but really statements about “everyone must decide for himself” are just boiler plate. True of any religion.

    “Now in almost every religion with ideas about afterlives you will find ‘retributive’ variants and ideas about immortal souls.”

    I am not sure if we have some disagreement here. My issue is that these notions should not be applied as part of a medical treatment plan. Patient and doctor are both free to follow their own beliefs.

    “After all, this afterlife business supposedly accounts for the sad fact that life is unjust. So if someone is in pain you can believe that the pain will be compensated for in heaven. Or, if someone drowns in a tsunami, that it is a punishment by a Higher Authority. You’ll find that in all religions with an afterlife belief (and you’ll also find writings like the book of Job that say that it isn’t that simple). That doesn’t imply at all that even devout adherents of such religions will think the sick and disabled don’t need treatment.”

    It doesn’t, but karma is different. Christians (some) believe you’ll be punished or rewarded in an afterlife. They are not looking at you in *this* life and thinking maybe you got cancer as a punishment for something in an earlier life.

    “There is much more in antroposophy (consult Wikipedia: http://en.wikipedia.org/wiki/Anthroposophy and http://en.wikipedia.org/wiki/Anthroposophical_view_of_the_human_being ) ”

    Consulting Wikipedia would be a bad idea. The Wikipedia pages on Steiner, anthroposophy, Waldorf education, anthroposophic medicine, biodynamics, etc. are all entirely controlled by anthroposophists. They watch those pages around the clock and block any attempts to introduce outside perspectives. Wikipedia is never a neutral source on controversial matters such as religion.

    “and the only thing all these things have in common is that they stem from the Steiner hotchpotch. I admit that I haven’t had the courage and energy to read all those 89,000 pages, I gave up when I tried The Philosophy of Freedom. But in what I have read, there is not an all pervasive odor of karma and reincarnation in anthrosophical writings. (Incidentally, in the US and Western Europe about 20-25 percent believe in reincarnation.)”

    Philosophy of Freedom has no “odor” of karma and reincarnation because it was written before Steiner’s turn to theosophy, and later founding of anthroposophy. It’s a strictly philosophical work.

    As to how many people believe in reincarnation, I don’t see that as having any purchase in these arguments. Isn’t that just recourse to the “3 billion Chinese believe it so it can’t be wrong” argument?

    “If you want to convince a school that they shouldn’t have AM, it seems best to stick to what is medically unsound, rather than emphasizing one aspect of the anthro religion.”

    That may be good advice; I just wanted to set the record straight on some of the actual beliefs. Karma and reincarnation are central, not just “one aspect.”

    Also, I believe it’s important that people trying to block or combat the creep of AM into mainstream medicine understand that this philosophy is not just about “natural remedies.” It’s not just an even stranger version of homeopathy. The notion that you may be SUPPOSED to be sick – actually, karma means you CHOSE to be sick – or that the illness may be good for you spiritually is central.

    I believe it is hard to reconcile a practice based on this philosophy with medical ethics.

  87. DW says:

    Again, I should clarify that other versions of karma do not necessarily imply that you choose to be sick or that sickness is a punishment. In Steiner, however, these connections are explicit. He outlined specific connections between various diseases and their karmic meanings.

  88. DW “It doesn’t, but karma is different. Christians (some) believe you’ll be punished or rewarded in an afterlife. They are not looking at you in *this* life and thinking maybe you got cancer as a punishment for something in an earlier life. ”

    It is different, but it’s appropriate to add that it least one Catholic figure may have had an approach that was similair in the “it’s good for your soul to experience suffering.” and possibly erring on the side of helping the soul. Here’s a criticism of Mother Theresa from Wikipedia

    “She has also been criticized for her view on suffering. She felt that suffering would bring people closer to Jesus.[44] Sanal Edamaruku, President of Rationalist International , criticised the failure to give pain killers, [snip] On principle, strong painkillers are even in hard cases not given. According to Mother Teresa’s bizarre philosophy, it is ‘the most beautiful gift for a person that he can participate in the sufferings of Christ’.”[45]

    http://en.wikipedia.org/wiki/Mother_Teresa

  89. Jan Willem Nienhuys says:

    The Wikipedia pages on Steiner … etc. are all entirely controlled by anthroposophists.

    Precisely. That is why they are a good source if you want to find out what they think. DW disagrees because he insists that the anthros have their own special brand of reincarnation theory which is (1) of the retributive kind and (2) central to their whole world view and (3) of importance in the practice of AM physicians and (4) carefully kept secret from the public.

    I have argued that retributive ideas occur in other religions too. In the Netherlands strict protestants in ‘our’ Bible Belt are against vaccination because this would limit the power of God (to either punish or test piety); for the same reason they refuse insurance and lightning conductors. But they don’t hide the fact that they think like that.

    I have argued that belief in reincarnation is widespread. DW counters it by suggesting that the anthroposophic version is of a special kind, but the anthros keep it secret.

    I have argued that Steiner had so many opinions that were quite unrelated to each other on all kinds of subjects that necessarily reincarnation was just one among many, maybe an important one, but not the basis of it all.

    I have argued that the writings of anthroposophers go on and on about how man is composed. They are a garrulous lot. But reincarnation isn’t a major part, let alone a foundation of it. DW says the opposite, and the fact that Wikipedia proves my point is countered by stating that this is what the anthroposophers say themselves, implying that they keep this aspect of their views a secret.

    I could add that in criticisms of anthroposophy I have read karma and reincarnation were mentioned, but not prominently. Most criticism was directed at the stupidity of Steiner’s remarks. Example: Steiner makes a remark about white women who get a colored baby after reading ‘negro novels’. Modern anthroposophers think this is a reprehensible remark because of the suggestion that being black or colored is something bad. Critics say that this is a typical example of utter dumbth: dumbth of Steiner, whose writings are riddled with dumbth, and stupidity of the anthros who don’t notice how silly their idol is. Neither the critics nor the defenders relate this to karma.

    It smacks too much of a conspirational theory of the type that suspects or suspected the Catholics, Jesuits, Freemasons, Illuminati and many more groups of having a secret agenda to take over power.

    I think the burden is on DW to provide evidence of the importance of karma and ‘retributive’ reincarnation for present day American physicians who practice AM.

    Quoting Steiner won’t do. The doctors themselves should believe it too. Doctors have a tendency to think that the opinions of lay people in medical matters don’t have to be taken seriously, and maybe AM doctors are not different. If I may give an example from outside of anthroposophy: Roman Catholics are required to adhere to the official views of the RC Church on birth control. Whether they do so is quite a different matter, and it is doubtful whether RC gynecologists toe the official line. (What do RC obsgyn think about the virgin birth?)

    Incidentally there aren’t many of these AM doctors in the US: the PAAM lists 33 MDs in the whole of the US. The McMullen-Laird couple that runs the Rudolf Steiner Health Center in Ann Arbor is not on that list, and there may some more. That’s about 1/4 of the number of AM physicians in the Netherlands and about 0.5% of the 6,000 in Germany.

    A German consumer’s union guide to alternative medicine (written by two skeptics, Krista Federspiel and Vera Herbst, first ed. 1992, many updated new editions) gives the following explicit criticisms of AM:
    1. use of heavy metals in not very high dilutions;
    2. the precancerosis diagnosis: this diagnosis is often made, and then treated with many years of injections with fermented mistletoe;
    3. AM is an incomprehensible occult science;
    4. medicines of AM are not tested by scientific methods, merely anecdotic reports are known;
    5. the system for determining which medicine a patient should get is only understandable by AM itself; it is incomprehensible;
    6. diagnostic tests like blood crystallisation test are nonsense;
    7. mistletoe medicin is rubbish.

    The authors mention that AM considers illness as a positive opportunity to learn from conquering a disease and so obtain new powers and abilities. They also mention that some critics think Steiner was crazy and that his theories are those of a madman.

  90. nybgrus says:

    @JMB: Michelle touched on it, and I was posting late last night before going to bed so I forgot to add:

    Besides all the other reasons for not telling a patient their woo is incompatible with their religion is that most people are cafeteria religious. Meaning that they pick and choose the bits of religion that they like the best and eschew the rest – and are completely oblivious or in denial about the cognitive dissonance inherent to that. So I doubt that me telling them that would serve any purpose except to maybe piss them off, since talking about religion is a big no-no.

  91. previous comment “The Wikipedia pages on Steiner … etc. are all entirely controlled by anthroposophists. ”

    # Jan Willem Nienhuyson responded “Precisely. That is why they are a good source if you want to find out what they think. ”

    Ahhh, it is a good source if you want to know what they want the general public to think they think (I think).

  92. pmoran says:

    i>”Peter:
    You’ve been reading this blog since it began. You must be aware of the numerous examples of harm that we’ve reported. Almost all of it has been aided and abetted by the medical academy’s recent, childish fetish with what only 20 years ago was still recognized as snake oil. How many examples are too many? Whatever happened to “first, do no harm”?

    Having come into this field via cancer quackery, I am aware of very frustrating, horrible examples of where quackery can lead. Such cases trigger the same “down with CAM!” reflex in me that they do in anyone else.

    Yet that is what it is — an emotional response to worst case scenarios many of which can never be prevented within the limitations of reasonable personal freedoms.

    Nevertheless, when combined with justifiable outrage at medical beliefs that are (to us) transparently ridiculous, what more do we need? Who can argue against giving free reign to the instinct to demonize and destroy CAM wherever we encounter it? As Dr Benway asks, why am I being so weird?

    Well, bear with me. There are quite direct ways of drawing attention to the precise areas where CAM is dangerous. Most of us are already so engaged. If those approaches are not working well, even within our hallowed halls, it is not clear that an instinct-driven all-out assault on pseudoscience will do any better. The underlying causes of the CAM phenomenon will still be there.

    I have elsewhere tried to convey that CAM has little to do with science. Arguments from the harm also don’t work well.

    CAM users and sympathizers rightly or wrongly see their personal versions of CAM as a low-risk but potentially beneficial activity.

    It should then be no surprise that whenever we try to alert them to the harm the response is an instantaneous: “Ha! Look at all YOUR deaths!”. We are immediately on the back foot trying to justify ourselves on risk vs benefit arguments that I will come back to in a little while.

    The intensity and the aggression behind some skeptical attacks is also beyond their comprehension. It can seem to them WE feel threatened by CAM and they wonder why. It cannot be for wholesome reasons.

    So perhaps we would be better off showing them we don’t care much about it so long as it remains a harmless and possibly beneficial bit of “let’s pretend medicine” (not in those words, obviously).

    We might even display some impartiality by checking whether selected bits of CAM might help patients with some very serious problems of our own such as cancer pain or chemotherapy side effects. (This is why I can find pragmatic real-world studies of acupuncture and some other modalities tolerable in some contexts even though I understand precisely why they are anathema to the “working better than placebo” model of medicine. )

    In all settings, even within academia, the “potential for harm” argument faces two major hurdles.

    1. Can you prove that CAM is of no value to its users? Whenever you are asked this, or to “prove it doesn’t work” that is not a plea for you to prove a negative. The average skeptic is with every breath implying that everything about CAM is so useless that it can be peremptorily discarded. Asking for the basis of that stance is only fair.

    In my opinion that is an untenable position, but we can argue that out elsewhere if you like. Even followers of astrology are presumably satisfying some human need.

    2. Yet once you allow that CAM is of value to some, you are faced with a very complex cost/risk/benefit assessment, especially when dealing with CAM’s more benign manifestations.

    In fact skeptical rampages can look a little silly when applied to matters that have about as much cosmic significance as a cosmetic commercial. “Why do they get so excited about those harmless little homeopathy pills? What are they in fear of, if not trying to protect their turf?”

    There are also ways of expressing sound scientific opinions on such methods without making people feel small or stupid for doing things that everyone does at some time or other, unless they never had a mother “kiss it better”.

    We are on more solid ground when discussing who should pay for it or whether there are better uses of funds. It may often also be a trifle easier to discredit a cancer “cure” than a placebo treatment for anxiety, but with cancer there is the additional burden of having to be convincing enough to counter the willingness of desperate people to try out dubious methods. That is never an easy task and one of the reasons why sciency arguments are of limited effectiveness in countering CAM.

    And a probably far more important than any of this as an overall objective is the need to foster trust, such that patients will use effective methods whenever they are available, regardless of what they may do about CAM. To do that we should try to behave like reasonable people in their eyes not as blundering zealots. Among other things we should neither oversell the effectiveness of mainstream care nor downplay its side effects, things that the average skeptic also does much of the time.

    If we had a clearer case that the risks of CAM outweigh any benefits, we would also get more support from politicians. the legal system, and , probably, other academics. Although SD would disagree, a partial answer to some of the bad aspects of CAM almost certainly will be better regulation and legislation, just as applies to conventional medicine. This is another arena where there will be reactions to CAM if the instances of harm exceed present tolerances.

    If you talk to the people on an alternative medical newsgroup for a while you will see that even the moderates think we greatly exaggerate the risks of CAM while refusing to allow it any benefits even when it tests “positive” according to our own demands. At least that is how it seems to them.

    The scientific argument is tortured and sophisticated. We may think we are presenting a clear, irrefutable case. What so easily comes across is double standards, bias, shifting the goalposts and blindness to some of the medical realities that lead many quite rational people to dabble in CAM. How many times have we seen all this on these very comments pages?

    So it is all about perceptions and where people are prepared to invest their trust. Yes, it has more in common with politics than the scientific disputation that is our usual stamping ground.

    Kim, you are also asking me to accept that the dangers have some direct linkage to academic circles trying to reach some kind of rapprochement with (hopefully) selected elements of CAM.

    For all I know there are some integrative centres that have made a poor choice of personnel, or have inadequate input into what is taught and practiced. But any thread connecting integrative medicine as usually defined to the dangers of CAM extremes is surely long and tenuous, and entwined with other much stronger influences. They include human foolishness, irresponsibility and delusion. These are not unique to CAM and you will never stamp them out.

    With regard to the pseudomedical? paramedical? activities of aging hippies like Andrew Weil (is he still into all that?), perhaps we need to also start debunking “pseudo-spirituality” if that term is not itself something of an oxymoron. But it would be wise to understand what human needs are driving people to seek pseudo-enlightenment.

    Some telling comments from others — I will try and respond, unless people prefer that I shut up for a while.

  93. Harriet Hall says:

    I have no problem with people using CAM because they think it makes them feel better. I draw the line at claiming it is supported by scientific evidence when it isn’t. I think we can find a way to support rigorous science without interfering with patients’ rights to autonomy and to choices based on non-scientific considerations.

  94. DW says:

    Michele: “It is different, but it’s appropriate to add that it least one Catholic figure may have had an approach that was similair in the “it’s good for your soul to experience suffering.” and possibly erring on the side of helping the soul.”

    Sure. Anthroposophy isn’t unique in any of this. Unusual, but not unique. Yes, Mother Theresa was also criticized for allowing a little sadism to slip into her lovingkindness now and then. I think it’s exactly the same problem – a religious ethic that is in conflict with the medical one.

  95. DW says:

    About wikipedia:

    “That is why they are a good source if you want to find out what they think. DW disagrees because he insists that the anthros have their own special brand of reincarnation theory which is (1) of the retributive kind and (2) central to their whole world view and (3) of importance in the practice of AM physicians and (4) carefully kept secret from the public.

    I am not sure why the idea that karma is central in anthroposophy seems like a point worth arguing over. Do you see that as some extravagant claim? What difference does this make? If you don’t believe me that it’s central, you need to read a little Steiner. I think you said you only read Philosophy of Freedom. That book is from before Steiner’s turn to occultism/invention of anthroposophy.

    “I have argued that retributive ideas occur in other religions too.”

    I haven’t disputed this, and am really not sure why I would need to. We just happen to be talking about anthroposophic medicine here. We could talk about other religions, but the subject of the blog post was anthroposophic medicine. If you want to get a handle on anthroposophic medicine, examining the underlying philosophy is a good idea, I think. Yes, many other religions include punishment of sins.

    ” In the Netherlands strict protestants in ‘our’ Bible Belt are against vaccination because this would limit the power of God (to either punish or test piety); for the same reason they refuse insurance and lightning conductors. But they don’t hide the fact that they think like that.”

    Mainstream religions don’t generally hide their beliefs. Anthroposophy is not a mainstream religion; it’s a small sect, with a history of secrecy like many small sects.

    “I have argued that belief in reincarnation is widespread. DW counters it by suggesting that the anthroposophic version is of a special kind, but the anthros keep it secret.”

    That’s a bit of an exaggeration, but like many small sects or cults, they do definitely downplay their stranger beliefs in public. Note that before I brought it up, a lively discussion had gone on for quite some time with no one mentioning the role of this central belief in anthroposophy. It is definitely central to the understanding of disease in anthroposophic medicine.

    “I have argued that Steiner had so many opinions that were quite unrelated to each other on all kinds of subjects that necessarily reincarnation was just one among many, maybe an important one, but not the basis of it all.”

    Reincarnation and karma are tied. There are other religions that believe in reincarnation, but it isn’t necessarily tied to your karmic progress from lifetime to lifetime. In anthroposophy, this is a big part of the explanation for why you would get a particular disease. It also explains accidents, injuries, and disabilities. It is thought that immediately before birth, the soul about to incarnate is allowed a brief “preview” of the life to come. Some souls “hesitate” before this tableau, and this is the explanation for disabilities.

    I guess we could have a big argument about which beliefs are most important in anthroposophy, but I’m not sure why we should. Yes, anthroposophy is complex and includes a lot of very complicated doctrines. In terms of explaining health and illness, karma is important.

    “I have argued that the writings of anthroposophers go on and on about how man is composed. They are a garrulous lot. But reincarnation isn’t a major part, let alone a foundation of it. DW says the opposite,”

    Yes, and DW is right. If you’ve only read Philosophy of Freedom, you haven’t read any actual anthroposophy, so I’m not sure how you would know.

    ” and the fact that Wikipedia proves my point is countered by stating that this is what the anthroposophers say themselves, implying that they keep this aspect of their views a secret.”

    I think we’re going in circles. I’m not sure I understand the point of your arguments in circles here. The rest of your post seems to just go on reiterating that karma is not so important in anthroposophy and you are simply uninformed on this point.

    “I could add that in criticisms of anthroposophy I have read karma and reincarnation were mentioned, but not prominently. Most criticism was directed at the stupidity of Steiner’s remarks. Example: Steiner makes a remark about white women who get a colored baby after reading ‘negro novels’. Modern anthroposophers think this is a reprehensible remark because of the suggestion that being black or colored is something bad. Critics say that this is a typical example of utter dumbth: dumbth of Steiner, whose writings are riddled with dumbth, and stupidity of the anthros who don’t notice how silly their idol is. Neither the critics nor the defenders relate this to karma.”

    You haven’t read much of the criticism, then.

    “It smacks too much of a conspirational theory of the type that suspects or suspected the Catholics, Jesuits, Freemasons, Illuminati and many more groups of having a secret agenda to take over power.”

    To the extent that most small unpopular religious groups have such an agenda, they do, basically. This isn’t some big conspiracy theory. Are anthroposophists some huge threat in the sense they will likely take over the world? No. The danger is the type of thing we are discussing on this blog – creeping “woo” in medicine, for instance.

    “I think the burden is on DW to provide evidence of the importance of karma and ‘retributive’ reincarnation for present day American physicians who practice AM.
    Quoting Steiner won’t do. The doctors themselves should believe it too. ”

    I don’t think it’s quite reasonable to suggest that adherents to the philosophy, maybe don’t believe in the philosophy. if they’re *anthroposophic* physicians, it is likely they adhere to anthroposophy. If you’d like I can post some quotes; I disagree that “quoting Steiner won’t do.” Steiner founded anthroposophy.

    I don’t want to tie up this blog with endless disputation on just this point. I agree that it is not necessarily the most useful angle in combating AM’s infiltration into mainstream medicine. I do think it’s important to understand this point in understanding AM.

    “Doctors have a tendency to think that the opinions of lay people in medical matters don’t have to be taken seriously, and maybe AM doctors are not different. If I may give an example from outside of anthroposophy: Roman Catholics are required to adhere to the official views of the RC Church on birth control. Whether they do so is quite a different matter, and it is doubtful whether RC gynecologists toe the official line. (What do RC obsgyn think about the virgin birth?)
    Incidentally there aren’t many of these AM doctors in the US: the PAAM lists 33 MDs in the whole of the US.”

    I have to say I get the impression your basic gist here is to downplay the significance or seriousness of this problem. Am I correct? Otherwise why are we playing this numbers game? Percents of people who believe in reincarnation, now “Well why worry there’s really only a few anthroposophic physicians anyway?” See the original blog post: they’re institutionalized at the University of Michigan medical school. One of the best medical schools in the country. That was kind of the point.

    “The McMullen-Laird couple that runs the Rudolf Steiner Health Center in Ann Arbor is not on that list, and there may some more. That’s about 1/4 of the number of AM physicians in the Netherlands and about 0.5% of the 6,000 in Germany.”

    Okay so let’s just not worry then. This is your point?

    “A German consumer’s union guide to alternative medicine (written by two skeptics, Krista Federspiel and Vera Herbst, first ed. 1992, many updated new editions) gives the following explicit criticisms of AM:
    1. use of heavy metals in not very high dilutions;
    2. the precancerosis diagnosis: this diagnosis is often made, and then treated with many years of injections with fermented mistletoe;
    3. AM is an incomprehensible occult science;
    4. medicines of AM are not tested by scientific methods, merely anecdotic reports are known;
    5. the system for determining which medicine a patient should get is only understandable by AM itself; it is incomprehensible;
    6. diagnostic tests like blood crystallisation test are nonsense;
    7. mistletoe medicin is rubbish.
    The authors mention that AM considers illness as a positive opportunity to learn from conquering a disease and so obtain new powers and abilities. They also mention that some critics think Steiner was crazy and that his theories are those of a madman.”

    A very good list. Is there some disagreement we have on this point? I am unclear why it is important to you to make it seem karma is *not* important in anthroposophy.

    When anthroposophic physicians state that illness is a “positive opportunity” for the patient to “learn from conquering” a disease, they’re not speaking of one lifetime. They’re speaking of multiple lifetimes. What you learn from it, you may not make use of until the next lifetime. You may not literally “conquer” it in this lifetime but in the next. When they mention new powers and abilities, similarly, they don’t necessarily mean in this lifetime. Karma means that in one lifetime, one is developing powers and abilities that will manifest in future lifetimes. I’m sorry, you can dispute this if you like but it was one of Rudolf Steiner’s central teachings.

  96. DW says:

    If you’ve gotten your information about anthroposophy off wikipedia, that explains your confusion. Karma and reincarnation are definitely downplayed in the discussion there. For a reason. Anthroposophists downplay it.

  97. DW says:

    Strikes me as ironic, having to argue on a “science-based medicine” blog that we shouldn’t be taking stuff off wikipedia at face value. Do you know how wikipedia works? Peer review it ain’t.

  98. DW says:

    “1. Can you prove that CAM is of no value to its users? Whenever you are asked this, or to “prove it doesn’t work” that is not a plea for you to prove a negative. The average skeptic is with every breath implying that everything about CAM is so useless that it can be peremptorily discarded. Asking for the basis of that stance is only fair.”

    Yes, that’s a demand to prove a negative. You’ve just added ad hominem to the situation, basically, characterizing those asking for proof of effectiveness in negative terms (they’re asking “peremptorily” and “with every breath”). Doesn’t matter how they’re asking; they’re right to be asking for proof. Science based medicine *does* mean that until it is proven it’s useless. So if you want an answer to the basis of that stance, that is it.

  99. David Gorski says:

    I have no problem with people using CAM because they think it makes them feel better. I draw the line at claiming it is supported by scientific evidence when it isn’t. I think we can find a way to support rigorous science without interfering with patients’ rights to autonomy and to choices based on non-scientific considerations.

    Exactly. I look at it from the angle of health fraud and professional ethics, the former of which a lot of CAM (but not all) is and the latter of which much of CAM violates. I’ve said time and time again that people can do whatever they wish with their own bodies. They can choose the rankest quackery if they wish. They can choose no treatment at all. However, it is a physician’s duty to provide to patients his best assessment, based on evidence and science, of whether treatments are potentially effective. Physicians who promote CAM fail in this and promote misinformed consent among patients.

  100. David Gorski says:

    Yes, that’s a demand to prove a negative. You’ve just added ad hominem to the situation, basically, characterizing those asking for proof of effectiveness in negative terms (they’re asking “peremptorily” and “with every breath”). Doesn’t matter how they’re asking; they’re right to be asking for proof.

    Yes, I agree. Peter is indeed demanding that we prove a negative, his protestations otherwise notwithstanding. Also, I, too, noticed that Peter’s description of skeptics is unrelentingly negative and has been for a long time. To him, in just this comment thread alone, skeptics are characterized as demonstrating “emotional responses”; “giving free rein to the instinct to demonize and destroy CAM wherever we encounter it”; engaging in an “instinct-driven all-out assault on pseudoscience”; showing “intensity and aggression”; taking part in “skeptical rampages” (what are we, The Incredible Hulk or something?); and all manner of other mean and nasty things. Why is that? Never is heard a good word from Peter about skeptics; or at least so it seems. Something emotional is going on here, every bit as emotional as the reactions to CAM Peter attributes to skeptics. Something visceral. Peter really detests skeptics, and it shows. I want to know why.

    One can’t help but note, as well, that Peter is also engaging in a massive strawman argument when he says, “The average skeptic is with every breath implying that everything about CAM is so useless that it can be peremptorily discarded.” I challenge him to read some of my analyses of acupuncture studies and see if I “peremptorily discard” acupuncture claims. I do not. I spend a lot of time analyzing them seriously. Maybe a bit sarcastically at times, but seriously. I wouldn’t bother to go through so many studies examining CAM modalities if I was “peremptorily” dismissing them. Quite frankly, I find it insulting to have my efforts characterized in that way.

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