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Integrative Medicine’s Collateral Damage

Integrative medicine combines the practice of medicine with alternative medicine. Proponents tend to take a paragraph or two to say this, but that is what remains when boiled down to its essence. By putting this more concise definition together with Tim Minchin’s often-quoted observation about alternative medicine, you get: integrative medicine is the practice of medicine combined with medicine that either has not been proved to work or proved not to work. If it is proved to work, it is medicine.

I couldn’t find an official start date for integrative medicine, but it seems to have been around for about 15-20 years. (Osher Center for Integrative Medicine at the University of California, San Francisco, an early adapter, opened in 1997.) Yet despite some lofty pronouncements about transforming patient care, there is still no good evidence that integrative medicine improves patient outcomes. It seems unlikely that such evidence is forthcoming. It is illogical to assume that adding therapies that do not work, or are proven not to work, would benefit a patient except by inducing the ethically problematic placebo response.

Whatever its goals initially, integrative medicine now appears to serve two purposes. First, it attracts funding from wealthy patrons (Samueli, Bravewell) and the government (the military, NCCAM). Second, it is a marketing device used by hospitals, academic medical centers and individual practitioners. As an added bonus, alternative medicine is usually fee-for-service because very little of it is covered by insurance. And whatever its charms as a money-making device, given the lack of proven health benefit it is fair to ask: is integrative medicine worth it? To answer that question, let us look at what might be called the supply side of integrative medicine practitioners’ delivery of alternative medicine. Here we run into some unpleasant facts proponents seem unwilling to acknowledge: integrative medicine’s collateral damage. (more…)

Posted in: Acupuncture, Chiropractic, Energy Medicine, Herbs & Supplements, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Traditional Chinese Medicine, Vaccines

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CAM practitioners as primary care providers under the Affordable Care Act: Part 2

In the last post, we took another look at Section 2607 of the Affordable Care Act, which prohibits “discrimination” against licensed CAM practitioners by insurers, and how chiropractors are continuing their PR campaign to rebrand themselves as primary care physicians. This time, we review a recent white paper by the Academic Consortium of Complementary and Alternative Healthcare, an organization that might be seen as CAM’s answer to the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM). The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is a group of “complementary and alternative medicine” educational organizations representing chiropractors, naturopaths, acupuncturists, homeopaths, ayurvedic practitioners, direct entry midwives and massage therapists. The executive director is John Weeks, a relentless promoter of “integrative medicine,” both on the Integrator Blog website and in the Huffington Post. The ACCAHC is dedicated to ensuring that its members and the practitioners they represent are included in all aspects of health care, such insurance reimbursement, financial resources for education and delivery models. ACCAHC’s stock-in-trade is its practitioners’ supposed expertise is being patient-centered, holistic, taking into account the whole person and such, as well as an alleged emphasis on healthy lifestyles, nutrition, well-being, and the like.

In fact, the stated vision of the ACCAHC is remarkably similar to that of the CAHCIM:

ACCAHC envisions a healthcare system that is multidisciplinary and enhances competence, mutual respect and collaboration across all healthcare disciplines. This system will deliver effective care that is patient centered, focused on health creation and healing, and readily accessible to all populations.

The CAHCIC’s vision is:

A comprehensive and compassionate health care system offering seamless integration of effective complementary and conventional approaches to promote healing and health in every individual and community.

Indeed, there is an overlap in governance of the two organizations. Benjamin Kligner, MD, Adam Perlman, MD, Mary Jo Kreitzer, PhD, RN, and Aviad Haramati, PhD, are all on the ACCAHC’s Board of Advisers, as well as being either current or former members of the CAHCIM’s Executive Committee. The Board of Advisers also includes other integrative medicine luminaries such as Brian Berman, MD, Wayne Jonas, MD, and David Katz, MD. The two organizations have worked together in several endeavors. One wonders why the they don’t just go ahead and merge. (Actually, one knows perfectly well why they don’t.)
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Posted in: Acupuncture, Chiropractic, Legal, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

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California Acupuncturists Don’t Need to Know English!

English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy and should not be used by the Board to discriminate against talented and skilled individuals who seek to provide high-quality acupuncture services in California.

— State Senators Curren D. Price Jr. and Darrell Steinberg, letter to the California Acupuncture Board, March 22, 2013.

To appreciate the recklessness of this statement, and to illustrate the Senators’ disconnect with the reality of Oriental medicine, let’s take a look at a consummate example of services provided by acupuncturists. The following video features the “Master” Kim Nam-soo demonstrating his moxibustion technique. He conducted a similar workshop for future acupuncturists in 2010 at Emperor’s College of Traditional Oriental Medicine in Santa Monica, CA. Make sure you do not miss the part where the Master is skillfully adding his own spit to the treatment!

Kim Nam-Soo (also known as “Gudang”) is a 97-year-old acupuncturist from South Korea. In this video, he is teaching a form of moxibustion (burning of a mugwort cone on or near the skin). He is first preparing a wad of mugwort (Artemisia vulgaris), he is then placing it on an acupuncture point and burning it with an incense stick. Note that he is using his own saliva to make the mugwort more malleable before sticking it to the patient’s skin!

Besides acupuncture and moxibustion, the other services these “talented and skilled” individuals provide consist of massage, cupping, breathing techniques, and the use of herbal, animal and mineral products. In most states, bloodletting is not part of their scope of practice — except for Arkansas.
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Posted in: Acupuncture, Politics and Regulation, Public Health, Science and Medicine, Traditional Chinese Medicine

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The Trojan Horse called Integrative Medicine arrives at another medical school

Trojan Rabbit

Medicine is a collaborative practice. Hospitals are the best example, where dozens of different health professionals work cooperatively, sharing responsibilities for patient care. Teamwork is essential, and that’s why health professionals obtain a large part of their education on the job, in teaching (academic) hospitals. The only way that all of these different professions are able to work together effectively is that their foundations are based on an important, yet simple, principle. All of us have education and training grounded in basic scientific principles of medicine. Biochemistry, pharmacology, physiology – we all work from within the same framework. As a pharmacist, my role might include working with physicians and nurses to manage and monitor medication use. A team approach is only possible when you’re working from the same playbook, and with the same aim. And in medicine, that playbook is science.

That’s why “integrative” medicine frightens me so much. Integrative medicine is a tactic embedding complementary and alternative medical practices into conventional medical care. Imagine “integrating” a practitioner into the health system that doesn’t accept germ theory. Or basic disease definitions. Or the effectiveness of vaccines. Or even basic biochemistry – perhaps they believe in treatments that restore the body’s “vital force” or manipulate some sort of “energy fields”. Instead of relying on objective signs and symptoms, they base treatments on pre-scientific beliefs, long discarded from medicine. There may be entirely different treatment goals, which are potentially antagonistic to the scientific standard. Imagine a hospital or academic setting where this occurs, and the potential impact on the quality of care that is delivered. (more…)

Posted in: Acupuncture, Medical Academia, Science and Medicine, Traditional Chinese Medicine

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Survey Says…

Surveys are evidently a popular way to get a paper published. Put “complementary alternative medicine survey” into Pubmed and get 2,353 hits. I would have trouble coming up with a hundred groups about whom I would be interested in their use of SCAMs, but I tend to be a lumper rather than a splitter. But if you want to know about SCAM use in chronic pain patients in one Singapore hospital, the information is available.

I am a survey magnet and a remarkable number of people send me dead tree and electronic surveys which I generally ignore. So people like me, those who ignore surveys (but support public television), are underrepresented in surveys. But evidently there is no group whose attitudes about SCAM are not amenable to analysis including my medical brethren, Infectious Disease doctors.

So I was understandably curious when I was sent a link to “Infectious Diseases Physicians’ Attitudes and Practices Related to Complementary and Integrative Medicine: Results of a National Survey“. The abstract makes it sound like my colleagues are a bunch of ignorant rubes who just fell off the turnip truck: (more…)

Posted in: Acupuncture, Clinical Trials, Critical Thinking, Homeopathy, Science and Medicine

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Improperly Performed Acupuncture Linked to Spontaneous Human Combustion

Experts in traditional Chinese medicine are warning patients to avoid unlicensed acupuncture practitioners after an apparent case of spontaneous human combustion.

Baton Rouge, LA-When investigators climbed from out of the smoldering debris that was the home of Hank Thomas, the looks on their faces told the gathering crowd what these hardened veterans of the Baton Rouge Fire Department couldn’t put into words. Thomas, a yoga instructor and avid fisherman who had lived in Baton Rouge his entire life, had exploded. And as the grisly details slowly emerge, people are asking questions about what might be to blame and how they can prevent being the next Baton Rougian to erupt into a massive fireball of body parts and Tony Chachere’s Creole Seasoning.

Some local medical professionals have proposed a controversial theory. Based on reports that Thomas has undergone acupuncture treatments for sciatica several times in the weeks preceding his untimely fulmination, a group of local experts are speaking out. They are warning the community to beware of discount acupuncture clinics.

“We aren’t saying that every incidence of spontaneous human combustion is linked to the incorrect placement of acupuncture needles,” Kuang Zhu LAC, Chief of Pragmatic Acupuncture in the Health and Wellness division of Vic’s Day Spa and Pet Grooming Center, explained during a recent press conference. “But in some cases, there is a relationship that is hard to explain otherwise.”
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Posted in: Acupuncture, Humor

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Integrative Medicine Invades the U.S. Military: Part Three

Nobody seems to know exactly how to define “integrative medicine” (“IM”) or to demonstrate what it does that is superior to the “conventional” kind. There is a lot of talk about addressing the “whole person” and not just the disease, patient-centeredness and the like, all of which are already aspects of conventional medicine. But, however defined, the central idea seems to be that if you incorporate complementary and alternative (CAM) into conventional medicine the practice of medicine will improve tremendously.

Despite not having any clear idea of what IM is, or does, the military, prestigious medical institutions, hospitals, and individuals practitioners are eager to imprint the integrative medicine brand firmly on their public images. Hence the Consortium of Academic Medical Centers for Integrative Medicine, a newly minted medical specialty in integrative medicine, societies devoted to integrative medicine practitioners, CME courses, conferences, and so on.

But – whoops! – proponents, in their overblown hype for IM, apparently didn’t give enough thought to the fact that there isn’t much of an evidence base for this loosely-defined but supposedly superior system. And – whoops again! – you can’t really research something unless you know what it is you are researching. These little oversights have brought about efforts to decide which of the competing definitions of integrative medicine should prevail and, whatever it is, whether there is any evidence of benefit for the patient. (more…)

Posted in: Acupuncture, Clinical Trials, Homeopathy, Legal, Politics and Regulation

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Integrative Medicine Invades the U.S. Military: Part Two

An unfortunate side effect (if you will) of states licensing of “CAM” practitioners is their ensuing insinuation of themselves into the nooks and crannies of the American health care system. Sometimes this is voluntary, such as their inclusion as providers of health care services in medical practices and other institutional settings in the form of integrative and quackademic medicine. Where voluntary action is not forthcoming, CAM practitioners and integrative medicine proponents are not shy about petitioning the state legislatures and Congress to wave the wand of legislative alchemy. “Poof!” and they appear. One example of this is the legislative mandates that their goods and services be covered by private insurance. Another is including CAM providers in publicly-funded health insurance, such as Medicare. And next year we will see the effects of the non-discrimination provisions of the Affordable Care Act begin to unfold.

Two bills currently before the U.S. Congress invoke the magic of legislative alchemy by expanding the availability of CAM to military veterans and funding CAM research at the expense of legitimate research. One deals with chiropractic, the other with CAM in general. As we saw last week, one of this country’s foremost supporters of integrative medicine, Wayne Jonas, M.D., recently testified before the Senate Committee on Veterans’ Affairs in favor of these bills. I think any fair review of his testimony would find it unpersuasive and I hope the Committee will agree.

VA chiropractors

Chiropractors have already forced their way into the Veterans Administration (VA) medical system. For our readers not familiar with the fragmented American health care system, in addition to having a combination of public and private health insurance, or, in some cases, no health insurance at all, we have an entirely separate system of medical care solely for the military that includes its own hospitals and out-patient clinics. Military veterans have had access for some time to chiropractors at a limited number of these VA hospitals and clinics. According to the American Chiropractic Association (ACA), the “military’s medical bureaucracy continues to try to impose new barriers to chiropractic care.” This meant the ACA had to get its supporters in Congress to pass several bills to speed up implementation of the 1995 law requiring the current limited chiropractic benefit. The subtext I read in all of this is that the Veterans’ Administration, or at least those in charge of medical care, was not particularly thrilled with having chiropractors working in their facilities and has dragged its feet in implementing the law.

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Posted in: Acupuncture, Chiropractic, Energy Medicine, Legal, Politics and Regulation

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Integrative Medicine Invades the U.S. Military: Part One

Integrative medicine proponents claim superiority over physicians practicing “conventional” medicine. (Which I will refer to as “medicine” so as not to buy into integrative medicine’s implied claim that medicine can be practiced with two separate standards.) While conceding that medicine is good for treating conditions like broken arms and heart attacks, physicians who purport to practice integrative medicine argue it ignores “the whole person, including all aspects of lifestyle.” Their vision of a new, improved practice of medicine “emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.””

But, as we know, the practice of medicine already takes into account “the whole person, including all aspects of lifestyle,” is “informed by evidence” and uses “all appropriate therapies.” This includes recommendations regarding diet, exercise, relaxation and vitamin and dietary supplement use, which are often erroneously labeled “CAM.” Medicine appears to be well aware of problems in the current model of health care delivery and is actively seeking ways to improve it. If integrative medical practitioners and their proponents were simply directing their time, energy and resources toward facilitating a better model for delivering health care I suppose no one would have any problem.

But they aren’t. They are claiming rights to an entirely new specialty in medicine. Proponents do this by advancing two dubious arguments. First, integrative medicine alone can deliver on this “whole person” model of care. Second, inclusion of alternative medicine is essential to good patient care.

From a consumer protection standpoint, I find integrative medicine troubling. Proponents are unfairly misrepresenting medical practice as inferior and offering themselves as the solution when there is no evidence that they can deliver on these claims. Unfortunately, despite this lack of evidence, integrative medicine has seized the imagination of public policy makers and legislative bodies. It is included in the Affordable Care Act and continues to metastasize throughout the military health care system, which together will soon control delivery of the vast majority of health care in this country.
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Posted in: Acupuncture, Chiropractic, Clinical Trials, Energy Medicine, Legal, Politics and Regulation

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A Trilogy of (Acupuncture) Terror

A Trilogy of (Acupuncture) Terror

TAM is fast approaching, and I’ve been frantically trying to get my talks together. The theme this year is “Fighting the Fakers,” and one of my talks will be for the Science-Based Medicine Workshop on Thursday, in which I will attempt in a mere 15 minutes to explain what Science-Based Medicine is and how it can be used to combat the infiltration of quackademic medicine into medical academia. Then, the second talk will be a tag-team spectacular with Bob Blaskiewicz about Stanislaw Burzynski as an example of how some cranks skirt the edges of science-based medicine. That doesn’t make them any less dangerous (if anything, it makes them more dangerous), but it does make them not as easy to identify as someone like, say, Hulda Clark.

Trilogy_of_Terror_Poster

Unfortunately, between working on these talks, revising some papers, and having an unusually busy weekend on call, I wasn’t sure what I was going to come up with for the edification of you, our readers. Fortunately, right on the 4th of July holiday, there was an article that gave me my idea, particularly given that I had noticed a couple of studies on the very subject of the article in the week leading up to the long holiday in the US (at least for people not on call). As a result, I’m half tempted to refer to this article as a trilogy of acupuncture terror.

Oh, wait. I just did. (more…)

Posted in: Acupuncture

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