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Cancer Treatment Centers of America and “naturopathic oncology”

EDITOR’S NOTICE: NOTE THE DISCLAIMER.

On “wholistic” medicine

If there’s one aspect of so-called “alternative medicine” and “complementary and alternative medicine” (CAM) is that its practitioners tout as being a huge advantage over what they often refer to sneeringly as “conventional” or “scientific” medicine is that — or so its practitioners claim — alt-med treats the “whole patient,” that it’s “wholistic” in a way that the evil reductionist “Western” science-based medicine can’t be. Supposedly, we reductionistic, unimaginative physicians only focus on disease and ignore the “whole patient.” Of course, to me this claim is belied by the hectoring to which my own primary care physician has subjected me about my horrible diet and lack of exercise on pretty much every visit I’ve had with her, but then maybe she’s an anomaly, along with Dr. Lipson on this very blog and pretty much every other primary care doctor I’ve ever dealt with. Anecdotal experience, I know, but since alt-med mavens appear to value anecdotal evidence above pretty much all else I thought it appropriate to mention here. Also belying the claim of alt-med practitioners that they “individualize” treatments to their patients in a way that science-based medicine does not is the maddening tendency of various alt-med modalities to settle on just One True Cause of All Disease, be it liver flukes as the One True Cause of Cancer, heavy metal toxicity as the One True Cause of cancer, autism, and various other diseases, or “allergies,” acid, or obstruction of the flow of qi as the One True Cause of All Disease.

Given the claim of “wholism” that is such an advertising gimmick among many of the varieties of woo, I’m always interested when I see evidence that alt-med is imitating its envied and disliked reductionistic competition. True, this is nothing new, given how alt-med has tried to seek legitimacy by taking on the mantle of science-based medicine wherever it can. Examples include the National Center for Complementary and Alternative Medicine (NCCAM), various organizations that try to confer legitimacy to pseudoscience by providing “certification” in various flavors of woo, and moves to push state medical boards to go further than that and confer legally protected status to practitioners by actually licensing them. This latter tactic has been very successful in that many states now license acupuncturists, while some states even license naturopaths and “homeopathic physicians,” the latter of which I find quite amusing because the term perfectly encapsulates what must remain of such a physician’s medical training after being diluted to 30C with woo. The only difference is that, unlike what is claimed with homeopathy, diluting MD medical knowledge with woo does not make it stronger. In terms of naturopathy, though, one of the most alarming aspects of the infiltration of naturopaths into the health care system is that some states in the U.S. and provinces in Canada are seriously considering allowing them to prescribe real pharmaceutical medications, even though they lack the training and knowledge to use such drugs safely.

Imagine my combination of bemusement and alarm, then, when I learned of a new specialty of pseudoscience, namely the field of naturopathic oncology.

Be afraid. Be very afraid. (I know I was when I first encountered this specialty.)

Naturopathic oncology

It’s not surprising that I first discovered the “discipline” of naturopathic oncology at the Seattle Cancer Treatment and Wellness Center, which is affiliated with the Cancer Treatment Centers of America. As a science-based physician and surgeon I really detest CTCA because it is expert at combining state-of-the-art science-based medicine with pseudoscience like naturopathy, chiropractic, and acupuncture, as well as scientifically tested modalities known not to be particularly helpful in the clinical management of cancer, such as chemotherapy resistance testing (which could be the topic of an entire post). Suffice it to say that the last of these was prominently featured in Suzanne Somers’ cancer book last year. In any case, CTCA covers a continuum from the boringly “conventional” (traditional surgery, chemotherapy, and radiation) to the questionable (chemotherapy resistance testing), to pure pseudoscience (naturopathy, acupuncture, homeopathy) mixing them together to the point where it is impossible for the average consumer to know which is science-based and which is not.

We’ve written about naturopathy on multiple occasions here on SBM, but what is naturopathic oncology? Apparently it’s an “emerging field” within naturopathy concerned with applying naturopathy to cancer. I don’t know about you, but to be an “emerging field” within naturopathy is akin to being an emerging new paranormal phenomenon in the field of parapsychology. But, then, I’m just one of those nasty, reductionistic, skeptical, scientific physicians, so what do I know? On the other hand, Kimball Atwood characterized naturopathy as a “pseudoscientific cult“; so maybe I’m not that nasty, at least not in comparison. Be that as it may, let’s take a look at a couple of definitions, written by naturopaths themselves. First, there’s the Oncology Association of Naturopathic Physicians (OncANP) (yes, there is an Oncology Association of Naturopathic Physicians). This is how OncANP defines “naturopathic oncology“:

Naturopathic oncology is the application of the art and science of naturopathic medicine to the field of cancer care and treatment. Naturopathic oncologists work both in hospital oncology settings and in private practices bringing their wisdom, perspective and experience to aid oncology treatment teams that seek the best positive outcomes for their patients.

It all sounds relatively benign; that is, unless you know what naturopathy is. OncANP tries to justify the “need” for naturopathic oncology thusly:

Aware that modern medicine has made little advance in its War on Cancer, many people with cancer choose to also include complementary and alternative medicine in their fight against cancer. They reach out and employ a wide range of therapies including meditation, prayer, acupuncture, herbal, botanical, nutritional, homeopathic, dietary and other holistic practices seeking benefit.

Naturopathic doctors and physicians are trained in accredited naturopathic medical schools in modern scientific nature cure. They are trained in both modern science and natural medicine. They emerge from their training well versed in the use of botanical medicine, homeopathy, diet, fasting, nutritional supplementation, orthomolecular medicine, psycho-immunology and other complementary and alternative medical techniques; they serve as capable guides for patients interested in exploring alternative medicine.

Those naturopathic doctors who choose to specialize in naturopathic oncology understand both the standard treatments employed by medical oncologists and how best to work with them in a collaborative model of cancer co-treatment. They are well aware of the multitude of ‘alternative therapies’ promoted to cure cancer and can help patients understand which might be useful and why.

Note the common CAM claim that we have made “little advance” in the War on Cancer used as a justification for offering pseudoscience. Most of the “therapies” offered are fairly benign, such as meditation and prayer, although I can’t figure out why meditation and prayer are represented as “therapies” rather than manifestations of religion. Of course, much of what else falls under rubric of “naturopathic medicine” and “naturopathic oncology” is pure pseudoscience, in particular, orthomolecular medicine, a construct popularized by the late Nobel Prize winner gone woo Linus Pauling, is pure quackery, advocating as it does megadoses of various vitamins and supplements. Given how late in his life Pauling had come to believe that megadoses of vitamin C would cure cancer (they don’t, alas), it’s not surprising that Pauling was attracted to this particular form of quackery.

Then there’s acupuncture, the Jack of All Trades in CAM. It’s one of those modalities that, it seems, can do anything. Treat pain? Acupuncture. Improve the success rate of in vitro fertilization? Acupuncture. Reduce menopausal symptoms in women with breast cancer requiring anti-estrogen therapy. Acupuncture. Got migraines? Acupuncture. Asthma, allergies, bronchitis, sinusitis, sore throat, laryngitis, colds and flu? Acupuncture. Irritable bowel, colitis, constipation, diarrhea, gastritis, heartburn, food allergies, ulcers? Acupuncture. Cystitis, menstrual cramps, irregular or heavy periods, infertility, menopausal symptoms? Acupuncture.

I think you get the idea.

Naturopathic oncologists even have their own board certification, just like real oncologists. They even put the letters after their name, FABNO, which stands for “Fellow of the American Board of Naturopathic Oncology.” (Personally, I think it stands for “FAB? NO!”) Of course, given the panoply of dubious therapies, some of them contradictory to each other, that naturopaths use, I really wonder what the certifying test is like. When, for instance, do you choose megadoses of vitamin C over acupuncture or vice-versa? When do you choose live cell therapy over this supplement or that supplement? And what is the scientific evidence that any of it does cancer patients any good whatsoever? Especially homeopathy. (More on that in the next section.)

The mind boggles that this “specialty” has its own board certification. How long before naturopathic oncologists push for special privileges in the states that license naturopaths? It’s not even beyond my imagination to visualize them applying for, and getting, the prescribing power to administer chemotherapy along with their herbs, supplements, and other woo. Why would naturopathic oncologists even want this? Easy. For the same reason that naturopaths in general seem to be seeking prescribing power: Real drugs work, and if one mixes real drugs with naturopathy then patients will tend to attribute the success not to the evil pharmaceutical drug but rather to the naturopathic nostrum.

The Cancer Treatment Centers of America, naturopathic oncology, and other woo

I and other SBM bloggers have complained about the infiltration of what sometimes refer to as “quackademic medicine” into medical academia. Quackademic medicine, as you recall, is the term we use to describe how so many medical schools have taken to studying fairy dust treatments like reiki and acupuncture as though they are science-based, often justifying this study with the rationale that they are “ancient” treatments and that lots of people use them. Promoters of pseudoscience have even managed to carve out a whole center at that bastion of science-based medicine, the crown jewel of the biomedical research effort of the United States the National Institutes of Health. That center is the National Center for Complementary and Alternative Medicine (NCCAM).

While we’ve spent a lot of time on SBM lamenting and doing our part to combat the infiltration of pseudoscience into medical academia, we’ve spent comparatively little time on what is arguably an equally serious threat to science-based medicine. That is the infiltration of “integrative medicine” into private medical institutions that use integrative medicine as a marketing tool in order to distinguish themselves from the rest of the pack. Arguably, no hospital chain has been more successful at this than The Cancer Treatment Centers of America. Over more than 20 years, CTCA has built up a network of hospitals in suburban Chicago, Philadelphia, Tulsa, and suburban Phoenix, as well as a network of physician practice groups in Seattle and elsewhere. CTCA was founded in 1988 after its founder’s mother lost her battle with cancer, its mission being to “change the face of cancer.” Unfortunately, at least in its hospitals it is succeeding, and not in a good way. This is how CTCA describes its founder, Richard J. Stephenson’s, mission to find treatment for his mother:

After his mother’s diagnosis, Mr. Stephenson embarked on a mission to find the most advanced and effective cancer treatments available. He hoped his efforts would enable his mother to recover and remain an integral, irreplaceable part of his life and the lives of his children.

The Stephensons were sorely disappointed by what they found. What were regarded as world-renowned cancer treatment facilities were singularly focused on the clinical and technical aspects of cancer treatment, ignoring the individual needs of the patient and the multi-faceted nature of the disease. Tragically Mrs. Stephenson did not live to watch her grandchildren grow and mature.

To keep his mother’s memory and spirit alive, Richard vowed to change the face of cancer care. He selected a group of outstanding oncologists and challenged them to find a way to deliver whole-person cancer treatment in a compassionate, nurturing environment.

Death from cancer is tragic; it’s often painful and slow, and the sense of helplessness and loss that accompany watching the decline of a loved one to cancer is sometimes more than a person can bear. Mr. Stephenson might have done more good if he had dedicated his grief to founding truly science-based cancer hospitals that had ingrained in their culture caring and the “human touch.” Unfortunately, he appears to have confused compassion and the human touch with “integrating” pseudoscience into science-based medicine. Instead of producing an institution that could really transform cancer care by preventing the tendency of large institutions to become impersonal, he’s created a Frankenstein monster cobbled together using a lot of perfectly sound science-based treatments, including surgery, chemotherapy, and radiation with pure pseudoscience like naturopathy and traditional Chinese medicine bolted on like the head of the Frankenstein monster.

Let me show you what I mean. I happen to have a few quick-and-dirty rules of thumb that allow me to rapidly identify a practice that is full of woo. These are just my opinion, but I find them fairly useful, much like identifying the weasel words of woo can be for Dr. Atwood. One of these rules of thumb states that, if a CAM practitioner offers “detox foot baths” as one of his services, he’s a quack until proven otherwise (and he’s unlikely to be proven otherwise if he’s actually cynical enough or enough of a true believer to charge for quackery like “detox foot baths”). I haven’t seen a naturopathic oncologist, either at CTCA or elsewhere, offer detox foot baths (yet), but I have seen them offer homeopathy, and I’ve seen them advertise it at CTCA. In my opinion, homeopathy is rank quackery; there’s just no other way to put it. In fact, these are the treatments that the naturopaths at CTCA offer:

  • Nutritional supplements, including vitamins, minerals and amino acids
  • Botanical medicine (the use of herbs)
  • Homeopathic medicine
  • Hydrotherapy

I’m always irritated when I see nutrition co-opted this way. If you go to the nutrition page of CTCA, you’ll find a lot of verbiage that sounds perfectly reasonable and science-based (albeit with exaggerated claims that science-based physicians don’t pay any attention to nutrition). It’s also claimed that malnutrition is one of the main causes of cancer death, accounting for perhaps one third of them, which is one of those claims that is superficially true but also ignores the fact that many cancers cause cachexia (wasting syndrome) by mechanisms that are poorly understood. Cachexia can’t be reversed just by providing nutritional support, nor can it be so easily prevented. Worse, CTCA uses the term “superfoods,” which is a marketing term designed to make claims about various foods far beyond what science will support. Certainly, it’s not a medical or scientific term, and it’s particularly annoying when CTCA claims that “superfoods” actually “fortify the immune system,” as that’s the same trivially meaningless claim made by woo peddlers of all stripes. In any case, the claim that CTCA is any better than any other cancer center at nutrition falls apart when I see things like this on its website:

According to the National Cancer Institute, 20% to 40% of cancer patients die from causes related to malnutrition, not from the cancer itself. CTCA chef Kenny Wagnor suggests loading your diet with anti-oxidants, which are found in bright colored foods such as berries. Chef Wagnor prepares a blackberry strudel packed with tasty berries and pecans — a great combination of cancer fighting foods!

At the risk of annoying certain readers, I will point out the logical fallacy here: non sequitur. It does not follow from the observation that 20-40% of cancer deaths are related to malnutrition that eating lots of antioxidants will help you beat cancer. In fact, it’s controversial whether antioxidants help or hinder chemotherapy, as I’ve written about before. My pet peeve about how CAM practitioners abuse nutrition as being somehow “alternative” and not considered important by scientific medicine, note how CTCA naturopaths actually offer homeopathy to cancer patients. Yes, cancer patients are being given magic water in order to relieve the side effects of their cancer therapy.

The coopting of science-based modalities like nutrition at CTCA doesn’t end there. It’s everywhere. For instance, look at the CTCA webpage on Oncology Rehabilitation. In addition to standard physical and occupational therapy treatments, CTCA also offers:

  • Swedish Massage
  • Reflexology
  • Lymphedema Massage
  • Myofascial Release

I certainly don’t have any problem with Swedish massage. It’s not a “therapy” per se, but there’s little doubt that it makes patients feel better. Lymphedema massage, if done according to science-based principles and not according to some “alternative” medicine techniques, is a valid technique to try to reduce the lymphedema that can occur as a complication of lymph node dissections performed for breast cancer and melanoma. However, reflexology is pseudoscience, as is myofascial release. Once again, CTCA is “integrating” woo with science. This is not surprising, given that its entire website is permeated with what Dr. Atwood would call the Weasel Words of Woo. Here is an example from the Bone Cancer Treatment page:

Your body is designed to inherently establish, maintain, and restore health. The healing process is ordered and intelligent; nature heals through the response of the life force. The role of the naturopathic practitioner is to facilitate and augment this process, to identify and remove obstacles to your health and recovery, to help your body maintain its healthy equilibrium, and to support the creation of a healthy internal and external environment for you.

Note the vitalism inherent in this brief passage, in which nature heals through the “life force.” This is not science. It has no place in science-based medicine.

Naturopathic oncologists versus science-based medicine

Given the vitalism that permeates naturopathy, it’s not surprising that naturopathic oncologists, like naturopaths in general, are not too receptive to scientific testing of their “art.” Sure, they say they are, but when it comes right down to it, in contrast to science-based physicians, naturopaths can’t accept negative clinical trials. For example, take a look at what naturopath Timothy Birdsall, FABNO, who is Vice President of Integrative Medicine for CTCA, says about research finding that his favored therapies don’t work. In the American Association of Naturopathic Physicians’ blog, he wrote an essay earlier this month entitled The Problem With Research in response to clinical trial results showing that selenium doesn’t help patients with lung cancer. Here are some choice quotes:

To top it off, the reason I was out of the office last week was that I was attending the National Advisory Council for Complementary and Alternative Medicine, the advisory body to NIH’s NCCAM. On that council, we have talked about just this issue — why do therapies which seem to make biological and physiological sense, which have some epidemiologic data to support their use, and which naturopathic physicians (and other alternatively-minded practitioners) have been using for decades (or much longer), seem to fail in double blind, randomized clinical trials?

We science-based physicians ask ourselves the very same question time and time again. Many are the seemingly plausible therapies that, when tested in humans, failed to show benefit in cancer. Here’s the difference: when we see therapies, no matter how plausible, that fail in randomized clinical trials, we abandon them. True, it may take more time than we’d like. The process may be messier than we like, as some physicians who are wedded to these therapies are reluctant to give them up when science doesn’t support them. We then move on to try to figure out where our understanding of the biology went wrong. But abandon them we do. We don’t blame science and the randomized clinical trial (RCT), as Birdsall does. First, he trots out the favored canard of CAM practitioners everywhere and argues that RCTs “answer simple, straightforward questions” and (presumably) his woo isn’t simple. Of course, the question of whether selenium can, as he believes, be useful in treating lung cancer is actually a pretty simple, straightforward question not unlike the question of whether a certain chemotherapy can prolong survival or increase the cure rate of a cancer. Instead of realizing that, Birdsall attacks science:

And so I began to ponder the question, “What’s wrong with research?” A part of me becomes enraged at the reductionistic, allopathic, biomedical model, which breaks things down into components so small that all synergism, all interdependence is stripped away, and then declares those components to be ineffective. Another part argues that the wrong component was selected, or was a synthetic form (although in the lung cancer study, they used selenium yeast). But ultimately, I find myself becoming offended because I believe that these therapies work… Whoa! Believe? OK, but where is the role for evidence? I used to believe that stress caused gastric ulcers. And then along came Helicobacter pylori, and I had to change my belief to match the evidence.

Note the standard attack on “reductionism” and “allopathy” and the “biochemical model.” Then note the irony as Birdsall, while declaring that naturopathic oncologists must become science-based and train the next generation of naturopaths to be “great scientists” (I spit up my iced tea when I read that line), he proposes in essence destroying science in order to save it for naturopathy — or, more precisely, to use it to legitimize naturopathy:

Third, we should collaborate with other professions and institutions to craft the research models necessary to adequately perform “whole systems” naturopathic research. There are examples of this type of approach already existing in the health systems research literature which can be adapted to our needs. In the end, we must create and validate the tools to dethrone the randomized controlled trial as the gold standard, and construct new ways to validate clinical approaches to health issues. Much as the homeopaths of 2+ centuries ago created the proving as a way to better understand and utilize their remedies, we must refuse to be limited by the way conventional medicine views health and disease.

I would argue that invoking the magical techniques of people who believe that diluting a remedy makes it stronger and that water remembers all the good bits that have been in it but forgets all the urine and poo (as Tim Minchin so hilariously put it) is not the way to argue for science. Of course, the short version of this is: If RCTs don’t show that naturopathy works, we need to dethrone RCTs and make up our own research methods. Yes, I know RCTs have problems and limitations, but those problems and limitations don’t include not being able to answer the question of whether selenium and antioxidants can improve survival in lung cancer patients.

Sadly, it’s not just academia that is under siege by unscientific medical philosphies and treatment systems. True, academia sets the stage and promotes the spread of pseudoscience-based medicine because it is medical academia that does the research and trains the next generation of physicians. However, most medical care in this country is still provided by private physicians and private hospitals, and some private hospitals like CTCA have discovered that “integrating” pseudoscience-based medicine with science-based medicine can be a recipe for success. As “alternative” medicine infiltrates academia more and more, I fear that the stigma for offering these therapies will decrease more and more, leading to more hospitals and clinics like CTCA.

Posted in: Cancer, Chiropractic, Homeopathy, Science and Medicine

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36 thoughts on “Cancer Treatment Centers of America and “naturopathic oncology”

  1. Ken Hamer says:

    “… the hectoring to which my own primary care physician has subjected me about my horrible diet and lack of exercise on pretty much every visit I’ve had with her…”

    Wow, you and I must have the same doctor, although my evil reductionist “Western” science-based doctor is always sticking her nose in places like how things are at home, at work, how am I sleeping, any big life changes, any thing bothering me, and so on.

    Come to think of it though, I suspect she says the same things to all her patients, which I suppose means she uses a one-size-fits-all approach to her clientele (or at least that’s what the hole-istics would probably say.)

  2. Ken Hamer says:

    “Aware that modern medicine has made little advance in its War on Cancer,…”

    Huh?

    A few years ago a friend of mine was diagnosed with an advanced case of Acute Lymphoblastic Leukemia (ALL), but instead of embarking on “a wide range of therapies including meditation, prayer, acupuncture, herbal, botanical, nutritional, homeopathic, dietary and other holistic practices” they put her on a withering regimen of particularly nasty drugs (the only one which I can remember being Mercaptopurine – with potential side effects that include diarrhea, nausea, vomiting, loss of appetite, stomach/abdominal pain, weakness, skin rash, darkening of the skin, hair loss, mouth sores, fever, sore throat, easy bruising or bleeding, pinpoint red spots on the skin, yellowing of eyes or skin, dark urine, painful or difficult urination, black or tarry stools (melena), bloody stools, bloody urine, rash, itching, swelling, dizziness, trouble breathing, and pancreatitis.)

    After about 2½ years of this business she was essentially completely cured, and recently gave birth to a beautiful, healthy and happy baby girl. Had she been victimized by the sCAMmers, I imagine a much different outcome.

    That strikes me as amazing progress.

  3. Ken Hamer says:

    “They are well aware of the multitude of ‘alternative therapies’ promoted to cure cancer”

    I find it telling that they use the word “promoted” instead of “proven” or even “shown.”

  4. Just a quick note, although I’m not going to get a chance to finish the article, must come back to it later.

    Meditation is not always used in a religious context. My understanding is that it can also be purely a mental exercise, without any focus on the supernatural… depends on the instructor.

  5. Millicent says:

    I was part of a frustrating conversation the other day. I was in a room with a group of people and a young woman there had just been diagnosed with a condition. She was very upset about this because it will have a negative impact on her future career. One of the guys started advising her to seek out alternative treatments such as reiki, acupuncture and chiropractic.

    It then came out that he believes in these therapies because he sought then out when he had treatment for cancer. From what I could gather, his conventional medicine doctors went all out to save him, seriously tried every possible treatment and, as a result, he’s now in remission and still alive today. But of course this guy thinks it was the reiki that helped!!! When I did my skeptical face, he told me that doctors “don’t know everything”. Um, yes, but at least doctors KNOW that they don’t know everything, or they wouldn’t be trying to find new treatments for illnesses like cancer.

  6. Millicent says:

    I should add, the woman this was directed at was also looking very skeptical so I don’t think she’ll be following his advice.

  7. WilliamLawrenceUtridge says:

    I bet the FABNO exams are multiple choice, and involve a lot of d) all of the above

    Which of these treatments would you use against XXXX:

    a) Acupuncture
    b) Homeopathy
    c) The most profitable
    d) All of the above

  8. rork says:

    “A part of me becomes enraged at the reductionistic, allopathic, biomedical model, which breaks things down into components so small that all synergism, all interdependence is stripped away, and then declares those components to be ineffective.”

    Models can have multiple components and terms for synergy (interaction), but if you want an “everything” approach, you might need a study with hundreds of arms to estimate the effects. Of course we suspect that advocates of , will want to throw so many things in with X when testing it, that it will be impossible to tell if X itself did anything. Science helps avoid error.

    Excellent article, thank you.
    (And thanks to Utridge too.)

  9. Diane Henry says:

    Nothing makes me more enraged than people who think that they can shove multiple supplements and other superfoods into someone who’s cachexic. Somehow the cachexia will miraculously resolve? My mother could barely eat. It got to the point where all that mattered was that she got calories, no matter where they came from. Zero-calorie supplements? I don’t think so. Low calorie fruits and veggies? Not when you are desperate for calories.

  10. Bogeymama says:

    How can they believe that little progress has been made in the fight against cancer? 20 years experience has shown me that progress has come in leaps and bounds. Terry Fox would be alive today if current therapies had been made available back in 1980. Look at survival rates of breast cancer, leukemia! Wilm’s tumour in children – looking back just a few decades puts that myth to rest.

  11. cervantes says:

    Well Dr. G., your own doctor would get a lot more credit for holism if, instead of hectoring you ineffectually about diet and physical activity, he had the skills and resources to work with you effectively on these issues. This would mean understanding the science of behavior change, and communication and counseling skills which, unfortunately, physicians are not taught.

    In other words, he knows these things matter — as do you — but doesn’t know what to do about them — as it appears, you do not know either. So in that very important sense, few M.D.’s effectively practice holistic medicine nowadays. In addition to the obesity epidemic, we have a situation in which only about 50% of people take their prescribed meds as they are supposed to. Unless doctors really learn how to work with people, instead of just biological entities, we aren’t going to make progress on these problems.

    That doesn’t mean, obviously, that unscientific nonsense is the answer but it does mean we need a kind of “integrative” medicine — not one that integrates BS, but one that integrates the psychological and social dimensions of humans better than the kind of medicine most people practice today. That’s even more scientific than a purely biological medicine, and it would also help beat the competition for public affection.

  12. cervantes,

    I think you’re ascribing far too much power to physicians. They can help, and many primary care providers love the part of their job that consists of being a cheering squad. I know my sister gets really excited when she can help a patient lose weight, though she doesn’t take credit for the weight loss herself. But they can’t make someone do something they aren’t interested in doing.

    A proposed dialogue might have a doctor discussing with a pregnant patient that many crack addicts find that pregnancy is a time that motivates them to quit. Would the patient like the doctor to help them to quit?

    No matter how tactfully this discussion is presented, there are always going to be those who say no, they aren’t interested. And the doctor isn’t going to be able to do beans about it.

    It’s true, some doctors’ social skills/ psychotherapeutic technique/ androgogy/ motivational effectivenss suck. But these aspects of effective care are already well-studied in medicine. Not everyone is good at encouraging a patient to quit smoking; not everyone is good at intubating a patient in respiratory arrest. But both are skills that are considered an integral part of medicine today, not an adjunct.

  13. My late father used to say, “if there’s one thing that I hope you will have learned before you die, it’s that everything is a matter of taste.” What he meant by this was not some PoMO notion that everything is merely a matter of opinion; no, he said it in reference to contexts similar to what Dr. Gorski has reported here: that in the face of the nearly unbelievable extents to which people will fool themselves or attempt to fool others in the service of wishful thinking or making money or whatever, the only way for a rational person to retain his sanity is to step back for a moment and remind himself of the aphorism.

    So, to add to the absurdity:

    they serve as capable guides for patients interested in exploring alternative medicine.

    I always love it when I see that claim. The truth is, naturopaths don’t even know much about the very things that they claim to know best. That’s obviously true for such flimflam as homeopathy, but it’s also true for fields in which a bit of real knowledge exists, such as “botanical medicine.”

  14. Sastra says:

    Supposedly, we reductionistic, unimaginative physicians only focus on disease and ignore the “whole patient.”

    Their definition of “whole patient” can be summarized in the common phrase “mind, body, and soul.” Your doctor may ask you about your weight and exercise habits, but does he discuss your relationship with God? And wouldn’t it just be so peachy and reassuring if he did??

    The real reason they don’t like controlled trials is that alt med only “works” when you know what it’s supposed to do (as opposed to something like antibiotics, say, which will work even if you’re in a coma.) Presumably, your mind or attitude has to control or be involved in what happens — again, it’s religion in new form. Blinded studies mean that patients aren’t mentally, emotionally, or spiritually involved in their healing process. So they’re the wrong tool; you need belief. Belief is magic.

    Sure, this resembles placebo — but placebo is magic too! Ask them.

  15. cervantes says:

    AC — I don’t think doctors can be dispositive about people’s health related behavior, but they can be much more effective than they are now. You write, “It’s true, some doctors’ social skills/ psychotherapeutic technique/ androgogy/ motivational effectivenss suck. But these aspects of effective care are already well-studied in medicine. Not everyone is good at encouraging a patient to quit smoking; not everyone is good at intubating a patient in respiratory arrest. But both are skills that are considered an integral part of medicine today, not an adjunct.”

    I disagree with every single assertion. These aspects of effective care are not already well studied in medicine. We are barely beginning to understand them. I ought to know because that’s what I do for a living. And if somebody is not good at intubating a patient in respiratory arrest, they shouldn’t be practicing in a setting where they might have to do that, obviously.

    If someone is not good at encouraging a patient to quite smoking, that person should not be practicing primary care. But that is absolutely not considered an integral part of medicine today, it is not taught in medical school and it is not required for licensing. Whereas intubating is.

    It’s not just a question of what a physician can do in a 15 or 20 minute visit, it’s also about the entire organization and resource structure of medicine. Primary care settings need more resources allocated to behavioral health beyond physician time; but physicians need to be good at doing their part, which includes diagnosis and referral, as well as what they can accomplish in their own interactions with patients.

  16. Joe says:

    My NPR radio station (which has 21 transmitters and call numbers, essentially it is WAMC, Albany, NY) is rife with sCAM. In Nov. 2007, their “Health Show” broadcast an item on cancer prevention by an ND at CTCA. http://www.healthshow.org/archive/week_2007_11_18.shtml#2352 At the time I contacted Drs. Hall and Gorski who provided useful comments.

    If I may digress, I have had helpful contacts with each of the founders of SBM, before its inception.

    Basically, the ND speaks on the show about the proper way to cook vegetables- and neglects to mention causative factors like, say, tobacco, sunlight or alcohol. I have since abandoned attempts to get medically qualified people on any of their health programs. (At 2 pm today, just minutes off, they are going to devote an hour, on another program, to integrative medicine).

  17. cervantes – I find your comment on a different approach being needed intriguing, although I wouldn’t try to co-op the “intergrative medicine” label, how about “behavioral medicine” or some such? I do wonder if it’s a matter of expanding primary care physician’s training or bringing another person with another area of expertise into the conversation. For instance what if primary care offices had social workers (or the like) on staff to consults with doctors and patients on some of the thornier lifestyle issues?

  18. Millicent
    “a young woman there had just been diagnosed with a condition. She was very upset about this because it will have a negative impact on her future career. One of the guys started advising her to seek out alternative treatments such as reiki, acupuncture and chiropractic.”

    This reminds me of something I was thinking the other day. I’ve come across this idea that some people have that modern medicine should be able to do miracles without inconveniencing the patient much.

    When medicine falls short of that idea, they think something must be wrong. It’s either the fault of the patient (or patient’s parents), who must not be looking into alternative medicine enough, or counting on conventional medicine to much, or has the wrong conventional doctor and doesn’t realize it.

    Or the fault of the doctor, who must be incompetent or not trying or apparently a pharma shill.

    For instance, because of my son’s cleft lip and palate, I’m often told. “Oh that’s an easy fix these days.” When some people find out how many surgeries, recovery times, and how much therapy, how slow the speech progress is. I start getting “helpful” suggestions of things I should do differently or different kinds of doctors I should consult.

    It’s a bit confounding.

    Sorry if this seems disconnected from the original article, but it seems to me they’re related. Conventional cancer treatment sometimes completely sucks, therefore there must be something wrong with it. Try these “helpful” suggestions.

    Is it just human nature? Is it just that people are so healthy these days that they are naive? I don’t know.

  19. valleyviolet says:

    I want to second the previous person who mentioned that meditation doesn’t have to be religious in nature. I suffer from chronic migraines, and in high school I was sent to learn biofeedback meditation as a stress coping technique. There was some guided meditation with visualization that involved energy flow, but it was not presented as a reality or “chi”, only as an imaginary visualization to help you focus. I also spent time hooked up to things like heart monitors for more direct quantitative feedback about how relaxed I was.

    I don’t know if this practice has been abandoned since then or if it’s been studded with any rigor. Either way, it certainly wasn’t religious in nature.

  20. daijiyobu says:

    Ah, naturopathy’s “wisdom.” It is absurdity — disguised. It is the medicine of Mordor!

    To quote from LOTR:

    “Saruman: We must join with Him, Gandalf. We must join with Sauron. It would be wise, my friend.

    Gandalf: Tell me, ‘friend’, when did Saruman the Wise abandon reason for madness?”

    And regarding naturopathy being “aware that modern medicine has made little advance in its war on cancer”, this reminds me of a point Dr. Atwood made in his Medscape naturopathy article follow-up. In spite of the very low but real risk of commercial airplane travel, just because flying carpets are safer doesn’t make them therefore a viable substitute.

    Funny how naturopathy chooses to be aware only of the things that benefit its archaic ideology. They seem to choose not to be aware of the fact that their central vitalistically premised belief amalgam has been science-ejected for several decades.

    Remember, homeopathy is labeled “clinic science” on their boards!

    Madness!

    If this is of any comfort, Dr. G., just keep in mind that in the future — perhaps — when NDs are defending themselves in court for some kind of huge obvious harm they’ve caused, posts such as these may very-well be useful for the apportioning of justice.

    -r.c.

  21. JJ from Cowtown says:

    A common trend among woo-peddlers lately is to spread uncertainty about RCTs, while simultaneously offering ‘proof’ they in the form of case studies and other forms of weaker evidence.

    I suspect that form of evidence is widely accepted because it seems to be giving a lot of examples. If you can find a half dozen case studies about, say, treating autism with a gluten-fre-casein-free diet (you’ll probably find more) then that’s worth a lot to some people. Examples are better evidence to many people than all the well-formed critical thinking in the world.

    Given the strength of examples maybe we should consider the same tactic. There have to be examples of plausible proposed interventions that showed a reasonable mechanism, showed results during in vitro testing, showed results during animal in vivo testing, but didn’t show any worthwhile results in human RCTs and were (eventually) abandoned as a result.

    I’m pretty sure examples have made it into either this blog or some of the contributor’s podcasts in the past.

  22. Sure, this resembles placebo — but placebo is magic too! Ask them.

    How right you are, Sastra. Here is Wayne Jonas, former Director of the Office of Alternative Medicine, responding to the inconvenient Shang meta-analysis of homeopathy trials:

    …the therapeutic effect seen in placebo groups receiving complementary medicines such as homoeopathy may be stronger than the specific effects of conventional medications in the therapeutic groups of conventional trials…

    The challenge is not to be better than placebo, but to produce the largest clinical effect, safely and ethically. We believe that homoeopathy has been inadequately tested in this context.

    KA

  23. pmoran says:

    Kimbal: “How right you are, Sastra. Here is Wayne Jonas, former Director of the Office of Alternative Medicine, responding to the inconvenient Shang meta-analysis of homeopathy trials:

    …the therapeutic effect seen in placebo groups receiving complementary medicines such as homoeopathy may be stronger than the specific effects of conventional medications in the therapeutic groups of conventional trials…”

    This study raises the same question.

    http://www.bmj.com/cgi/content/full/336/7651/999

    What do you have to set against the possibility of unusually strong responses to unusually strong placebo influence? Some testimonials are highly suggestive of this.

    I am searching for a secure footing on this and some related questions.

  24. Peter:

    Here’s the abstract of a systematic review that finds no difference in placebo effects in homeopathy trials compared to those in trials of ‘conventional’ medicine:

    http://www.ncbi.nlm.nih.gov/pubmed/20129180

    I haven’t read the whole article. I can imagine that if many of the homeopathy trials included in the review had been “positive,” one could still argue that the “active” effects, i.e., what we would call the placebo effects of homeopathy, were greater than the placebo effects in the ‘conventional’ trials. If so, of course, that would betray inadequate blinding or some other error in the homeopathy trials (at least to us).

  25. TsuDhoNimh says:

    Birdsall wrote, “But ultimately, I find myself becoming offended because I believe that these therapies work… Whoa! Believe? OK, but where is the role for evidence? I used to believe that stress caused gastric ulcers. And then along came Helicobacter pylori, and I had to change my belief to match the evidence.”

    So what’s the problem with changing your belief in homeopathy when it no longer matches the evidence? Or reiki?

    Some beliefs are too cherished? Too lucrative?

  26. daijiyobu says:

    TsuDhoNimh wrote: “so what’s the problem with changing your belief in homeopathy when it no longer matches the evidence? Or reiki? Some beliefs are too cherished?”

    I’d argue: yes, for many alt.med. meisters / ‘health sectarians’ they are ‘creed-bound.’

    Perhaps one could say science is progressivist / tentative, and sectarianism is conservativist dogmatic. Though I’m not trying to politicize the issue.

    I cite this Popular Science quote often:

    “Science is never sectarian; philosophy is never sectarian. Sectarian teaching begins when you ask a man or a child to assume what can not be proved, for the sake of keeping within the dogmatic lines that fence round some particular creed.”

    From 1890!

    See naturopathy’s creed archived at http://web.archive.org/web/20040821130658/http://www.oregon.gov/OBNE/docs/Philosophy.htm .

    It’s what I call ‘rampant absurdity,’ wherein science and huge nonscience are heaped together as if one thing and then is called science.

    OBNM used to call themselves “naturopathic examiners” per OBNE, but now they’ve replaced that with “naturopathic medicine.”

    Examination, of course, brings you to the irrationality that is the naturopathic.

    Better to stay the course and not self-examine, in their realm!

    -r.c.

  27. pmoran says:

    Kimball: “Here’s the abstract of a systematic review that finds no difference in placebo effects in homeopathy trials compared to those in trials of ‘conventional’ medicine:

    http://www.ncbi.nlm.nih.gov/pubmed/20129180

    Thanks. Interesting study. It certainly tends to exclude enhanced placebo responses from what they describe as “classical homeopathy”, which I assume includes the detailed homeopathic “diagnosis”.

    There is still some doubt on the possibility of enhanced placebo responses, since patient responses are likely to be generally dampened in placebo-controlled clinical studies. The patients don’t know whether they are supposed to get better or not.

  28. Jann Bellamy says:

    Naturopaths and their fellow travelers break down food in its natural form (plants, animals) into various components (vitamins, minerals, herbal extracts, etc.), or synthesize those components, package them into pills and sell them to patients, as “natural remedies.” My understanding is that it is not clear these components are effective (if they are needed at all) in the human body when divorced from their natural state, that is, the actual plant or animal. I’m no chemist, but this does not seem to be “wholistic” or “synergistic” at all. In fact, it would seem just the opposite.
    Of course, there is a tremendous enviornmental impact in the production of these supplements: plastics, paper, glass, metal — to house the “natural” product, plus manufacturing and transportation.

  29. Fifi says:

    ValleyViolet – You’re quite right and non-religious meditation is being studied and used to help people manage chronic pain. There are many forms of meditation – some are awareness meditations and some are trance meditations meant to induce esoteric feeling states. The ones most commonly used and studied are awareness and compassion meditations. Awareness meditations are particularly useful in conjunction with Cognitive Behavioral Therapy since they’re both using the same approach – awareness of feelings and thoughts and how thoughts and feelings influence behavior (and generate other thoughts and feelings) and then how behavior creates outcomes. It’s basic retraining in cause and effect based in being aware of cause and effect, and being aware of one’s thoughts and feelings, and actions, in the moment. Nothing magical or religious about it. And it’s about neurobiology and neuroplasticity – and the subjective nature of experience – and not chi. Even doing visualizations isn’t magic, it’s once again just harnessing the nature of the brain and mind instead of having it work against you.

  30. Jann Bellamy on nutrients and phytopharmaceuticals:
    “My understanding is that it is not clear these components are effective (if they are needed at all) in the human body when divorced from their natural state, that is, the actual plant or animal.”

    That’s very easy: your understanding is wrong. The human body is clearly able to use nutrients that are not presented in the form of an intact plant or animal. For an everyday instance, the human body is able to burn white sugar for energy. A less common example is total parenteral nutrition, where people without a functioning GI tract survive entirely on a predigested chemical soup that goes directly into a vein to the heart. People have lived for 35 years on nothing but these purified chemicals.

    What you may be thinking of is that humans cannot burn white sugar unless they also have B vitamins. This is true, but carbohydrate and B vitamins can be used by the human body even if they are not delivered in the form of an intact plant or animal. A varied diet of whole foods will provide both the carbohydrates needed to supply energy and the vitamins needed to use the carbohydrates; but so will a bottle of soda pop and a B-complex vitamin pill. B-vitamins are water-soluble meaning that if you take in more than your body needs you will not store much excess. However, we do maintain enough B-vitamins in our bodies to get us through many, many soda pops without having to pop a supplement pill for each one. (Enough vitamin B-12 can be stored in the liver that a person could survive decades without absorbing any new B-12 before starting to show deficiency symptoms.)

    There are various reasons a varied diet of whole foods is preferable, but not being able to live on anything else is not one of them.

    The pharmaceutically active components of plants can also be isolated and be just as pharmaceutically active when taken in a purified preparation. Aspirin and digitalis are well-known examples. They are taken in pill form and they are active in the body.

    A controversial variation to this may be antibiotic effects.* Since soil is full of bacteria and fungi, anything that lives in soil (bacteria, fungi and plants) needs to be able to protect itself from bacteria and fungi. Goldenseal has some antibiotic activity and some people use it for that. In laboratory tests, none of the individual chemical components are that impressive. There is an argument that the individual components show most antibiotic activity when they are combined and work in synergy. This has not been demonstrated.

    If it were to be demonstrated, however, this would not mean that goldenseal must be used as an intact plant to be effective. The components that work in synergy to have antibiotic activity could theoretically be isolated or synthesised and presented in pill or liquid form, and they would have as much or more effectiveness as the whole plant.

    * Antibiotic effects are different because these are effects beneficial both to the organism that produces the chemicals and to us. (We hope.) Poppies do not make morphine to feel good; willow trees to not make salicylic acid to relieve their pain; foxgloves do not make digitalis to regulate their heartbeats. The fact that we get these benefits from chemicals that the plant produces for completely different reasons is just a coincidence. There is no reason to look in willow bark for other chemicals to potentiate the pain relief of salicylic acid. Because plants and soil organisms are going for the same antibiotic effects we are, it’s not unreasonable for us to look for a package of chemicals together in the same place.

  31. pbford says:

    Thanks for this wonderful post. As an academic nutritional epidemiologist, I am particularly appreciative of your discussion of the nutritional quackery espoused by so many within CAM. On a personal note, I am also an inflammatory breast cancer (IBC)patient and participant in a list-serv for IBC patients (many of whom are Stage IV) and I have seen the real damage that is done by those with false nutritional claims of cure. I read the SBM blog well before I was diagnosed, but now have an even greater appreciation for the need to actively educate on the potential dangers of CAM.

    Thanks,

  32. Jann Bellamy says:

    Alison Cummins:
    You are correct and I was overbroad in my statement — clearly there are cases of chemical components derived from plants — or otherwise manufactured — being used for legitimate medical purposes. I was not referring to plants like willow, from which chemicals can be derived to make medicine, but I did not make that clear.. I was referring only to the stuff naturopaths push. I still see irony in the fact that naturopaths sell as “natural” what is actually manufactured, separated from “nature” by several degrees.
    I shouldn’t have skipped chemistry:)

  33. Jann Bellamy on cognitive dissonance:
    “I still see irony in the fact that naturopaths sell as “natural” what is actually manufactured, separated from “nature” by several degrees.”

    Yes, that is so weird. I don’t get it.

  34. LindaRosaRN says:

    My opinions:

    Dr. Gorski links to a statement by Jacob Schor, an ND currently on the Board of the *Oncology Assoc. of Naturopathic Physicians.” Schor also serves as the organization’s Vice-President and public relations guy.

    “In the Summer of 2009 Dr. Schor received the OncANP’s President’s Award for service to the organization and furthering the group’s mission.”

    Schor claims to have helped set up the standards for the practice of ND oncology.

    Did that include establishing any ethical standards, such as suggesting that it might be a good thing if “naturopathic oncologists” adhered to laws governing the practice of medicine?

    Schor himself works as a “naturopathic oncologist” in Colorado, providing “Cancer Cotreatment.” Naturopaths, however, are not licensed to practice in Colorado. According to the description of his services on his website (www.denvernaturopathic.com/qa.html), Schor is practicing medicine without a license, something that if proven in a court of law, carries criminal penalties.

    Schor openly admits to having no license to practice in Colorado.
    His business website states: “Colorado law does not regulate the practice of naturopathic medicine and it still remains illegal for [Schor and his partner] to call themselves naturopathic physicians.” (www.denvernaturopathic.com/intro.html)

    Certainly the other members of Oncology Assoc. of Naturopathic Physicians would be aware that Schor is not licensed to practice in Colorado. Apparently that isn’t a concern for them either.

  35. Richard says:

    Thank you for this article. I see ads for CTCA all the time on CNN, and I listen with concern when they talk about treating the whole person, which usually implies infiltration by pseudoscience.

  36. Mark says:

    Interesting post. I am just now getting to it prompted by an email from Memorial Sloane-Kettering advertising their new “Integrative Oncology” training program. They advertise an “evidence based evaluation of therapies” – wonder what that means. All this for only $5000 for 6 months of training. The most concerning is for respected institutions such as MSKCC to be loaning their good name to such falderal. It gives credence to less scrupulous CAM practitioners. The email I rec’d was recruiting internal medicine residents for this training program – and what a terrible waste of skills it would be for them to spend 6 – 12 months in such an activity.

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