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Disintegrating Integrative Medicine: Lessons From Baking

Suppose I were to bake you a cake and my ingredient list included the following:

  • Eggs
  • Milk
  • Butter
  • Sand
  • Flour
  • Baking Powder
  • Vanilla
  • Melamine
  • Sugar
  • Chocolate icing

What is the problem with the ingredient list? It has integrated inedible and poisonous items into the very fine basic ingredients that make a good cake. This is the exact same problem that the medical profession faces with the “integrative medicine” movement. Insofar as it espouses and promotes well-vetted, healthy ingredients, it is a boon to patients. But when inordinate emphasis is placed on placebos (“sand”) or when dangerous practices (“melamine”) are inserted into the prescription for our patients’ “health and wellness,” that attractive-appearing cake becomes a recipe for disaster.

Many of my shruggie friends have peered at integrative bakery items with vague interest. The fudgy exteriors are pleasing to the eye, the aroma is indistinguishable from cakes of their youth, and the packaging is elaborate and attractive. They simply can’t imagine why some of us would get so worked up about what appears to be a display case of cupcakes.

But as physicians and scientists it is our duty to inspect integrative medicine’s ingredient list, in the same way that it is our duty to learn about the side effect profiles of pharmaceutical items and medical devices. Blandly gazing at the sweet promises of “natural health” without fully investigating the claims made by its proponents, puts us at a serious disadvantage. Our patients have learned about “alternative” bakeries (probably via the Internet) and want to check with us about whether or not they should purchase items from them. It is our job to give them sound advice.

In these economic times, it is more important than ever for us to channel our limited resources into health solutions that work. For example, the supplement industry rakes in 22 billion dollars a year, and that money could be put to far better use. I believe that it would, if we healthcare professionals made a more concerted effort to explain the wasted investment to our patients.

In addition, we must encourage NCCAM to require plausibility as a condition for medical research. We have already wasted millions of dollars on studies that essentially define the properties of sand, when it’s clear to the very casual observer that sand will never add value to food items.  As Barker Bausell has so clearly explained in his book, “Snake Oil Science: The Truth About Complementary And Alternative Medicine” there hasn’t yet been a single CAM treatment or practice that has been definitively shown to have an effect beyond placebo. Can someone say, “The Emperor has no clothes?” It’s time to use our common sense in selecting studies that could in fact provide important information about curing illnesses.

And as for those of you who are just beginning this journey of scientific enlightenment, please continue reading the wonderful deconstructions provided to you by the authors of this blog. I doubt you’ll find a clearer explanation of the machinations of the integrative medicine movement – and you’ll learn how to carefully separate the flour from the sand in this jumbled blend of scientific truth and error.

Then we can all have our cake and eat it too.

Posted in: Science and Medicine

Leave a Comment (23) ↓

23 thoughts on “Disintegrating Integrative Medicine: Lessons From Baking

  1. Joe says:

    Val, How did you get our secret, family recipe?

    There’s some good information on melamine here:
    http://scienceblogs.com/terrasig/2008/09/melamine_and_cyanuric_acid_rev.php

  2. Alexander Han says:

    I’ve been a regular reader, but haven’t commented before, so forgive me for starting off with something mildly negative. The term “shruggie” sort of rubs me the wrong way, and I think I’ve figured out why: the more neologisms we introduce to our speech and writing, the less accessible it becomes to the general public. To take an extreme example, Scientology does something similar with the intent of creating an in-group/out-group that can be controlled via access to explanations of jargon and identified via these shibboleths (one of the ways in which the Anonymous campaign against them has been somewhat successful is in the refusal to engage nonsense like “what is your crime” with anything except nonsense, which tends to throw Scientology apologists off their stride).

    While “shruggie” makes sense after being explained, unlike “Mercury Militia” or “total quackery”, I don’t think it’s a categorization that’s immediately obvious, and it’s not clear to me that most people will search for an explanation rather than writing it off as a neologism indicating a fringe opinion.

    That said, the integrative cake metaphor is absolutely beautiful, and I sadly expect to get a lot of use out of it.

  3. Oldfart says:

    The problem is getting all these concepts along to the political sphere. Obama, looking to use a “scapel” on the budget to find programs that don’t work has never mentioned cutting NCCAM off at the roots which would have been a good start to eliminating “programs that don’t work.” But someone has to get him that message. Just how do you get through to these people when some of them, like my Senator Bombast …. I mean Brownback believe in creationism? There are some real nutcases in Congress and few have the balls to confront them. I heard a in McCain’s voice during the debate last night while referring to autistic kids and how we have to help them. I have no idea what he meant by that. Did he mean CURE them? Did he mean stop the vaccinations? Just what DID he mean and why has no one asked him? Does he know the difference between Palin’s Down’s Syndrome baby and an autistic baby? He thinks the fact that she has a Down’s Syndrome child makes her an expert on autism? or other disabled children? Palin is ripe for infection by the likes of “I can haz meezuls” Jenny and “I haz a sekret” Oprah. How do you stop the people who are responsible for the funding of scientific research from putting our vanishing research dollars into garbage research? These questions are important.

  4. Val Jones says:

    I feel your pain, Oldfart. Sometimes you have to fight fire with fire – meaning, we need to make science “cool” and popularize our message. We need to be out there in “mainstream media,” offering an attractive and reasonable alternative to pseudoscience.

    I once heard that people who are trained to sniff out counterfeit bills spend most of their time analyzing (and becoming familiar with) the look and feel of true currency. When you’re intimately acquainted with the truth – error is far more obvious and easy to spot.

    I think that we physicians and scientists need to do a better job with our PR and communications efforts. The politicians fall victim to the messages being peddled because that’s all they hear. The time for shruggieness must end. We must have the courage to take the spotlight, grow our numbers, and hone our own message. Our patients’ lives are truly at stake.

  5. jonny_eh says:

    Here’s a great example of integrative medicine interfering with real medicine.

  6. oderb says:

    I don’t think it’s such a ‘great’ example…though if it appears to debunk a natural substance it automatically becomes a ‘great’ example in some people’s minds….

    see my comment on http://www.sciencebasedmedicine.org/?p=236

  7. overshoot says:

    Obama, looking to use a “scapel” on the budget to find programs that don’t work has never mentioned cutting NCCAM off at the roots which would have been a good start to eliminating “programs that don’t work.”

    That would put him on a collision course with Dan Burton, who is only going to be replaced if either the Republican Party of some Higher Power takes him out of the race.

    Barring either unlikely event [1] he’s still a power in the House and any President will have to trade off the political cost of knifing Dan’s baby for the relatively minor savings to be had from removing the NCCAM from the budget.

    Then there’s Orrin Hatch.

    [1] He did have to actually work at getting the nomination this year.

  8. Fifi says:

    Dr Jones – Thanks for coining “shruggle” – my one concern with it would be that it’s so cute everyone will want to be one ;-)

    I am a bit worried though, that you seem to think politicians “fall victim” to misinformation about science. Politicians (and their advisers who run their campaigns and set their agendas) aren’t that naive, they often choose to support certain positions because it’s politically expedient – they aren’t being bamboozled, they’re simply being self-serving. Just as “pro-science” politicians are often being self-serving – or politicians flip flop when it’s personally or politically rofitable (wasn’t it Rove who was invested in a manufacturer of flu vaccines while pushing for increased stockpiles?). Medicine and science are so tied into corporate profit (from public and private sources, and including health insurance) and religious politics in the US that they’re bargaining chips that are consciously used by politicians who are interested in personally and politically profiting from supporting certain industry lobby groups. I’d suggest science needs lobbyists and the type of resources that CAM and Supplement lobbyists (and pharmaceutical companies) have simply because that’s what most politicians respond to – facts and honesty not exactly being particularly important in US politics.

    I agree that in some areas science is losing the communications battle and this is a rather predictable consequence of the way some scientists and institutions interact with the public. There are lots of people who love science out there that would balk at some of the political/ideological trappings that some people attach to science and medicine (and the whole culture war thing turns a lot of reasonable, intelligent people off). That said, there are also brilliant examples of scientists who are excellent communicators and excellent science communicators and teachers. Perhaps an analysis of what works and why in communications might be useful? Certainly it’s an issue that’s been raised by quite a few of us who comment here before – sadly it’s often been dismissed. With all due respect to the intelligence and passion of the other bloggers here, it’s great to see someone blogging here who is concerned with communicating in language people understand rather than getting annoyed that people don’t speak or misunderstand the language of science. :-)

  9. jonny_eh says:

    oderb: Orac addressed that press release here.

    It’s a great example because intravenous vitamin C is touted as a great alternative treatment for cancer. Turns out that if it’s used with chemo (making it an integrative treatment) it could interfere with the scientific treatment. In other words, unscientific treatments are not harmless in the worst case scenario, like many proponents claim.

  10. Val Jones says:

    Hi Fifi,

    Thanks for the comment – I do agree with you that the political decision-making process is very convoluted. We should have a science lobby in Washington (where’s our Bravewell equivalent to fund it? It could be like the non-pharma detail movement.)

    However, almost no politicians that I’ve met have any sort of medical or science training. So what I see (from my admittedly narrow view) is that they couldn’t fight for the right thing even if they wanted to because they just don’t understand basic issues. As the Onion rightly states, “Science is Hard.” That’s part of the reason why politicians are easily suggestible – anyone with a convincing-sounding argument (and a business case for it) gets attention.

    We need to make things really clear, really simple (as simple as we can without affecting the truth of the message of course), and easily digestible. The public needs that, the politicians need that, and modern attention spans require it. How can we save a generation – addicted to Twitter and sound bites – from pseudoscience? We have to reach them through those kind of outlets (and “speak their language” as you put it). I know that seems kinda crazy – but until the journalistic and health information “cream” rises to the top of this Internet messaging free-for-all, we may have to beat the misinformation mongers at their own game.

    Marketing may be the missing link in our ability to lead people back to the safe shores of reason.

  11. delaneypa says:

    I just finished “Snake Oil Science”, a very interesting read, if looking at a lot of graphs and tables would not bore you.

    The most curious part of the book was at the end where he gave tips on picking out a CAM provider. He emphasized that you try to maximize the placebo effect they are selling — really believe in the therapy, see someone you trust, etc. An interesting close to any otherwise thorough debunking of CAM.

    When I tell patients that such-and-such quackery is no better than placebo, they frequently will ask where they could get a placebo instead! To their mind, a placebo is still better than nothing. As Mr. Bausell mentioned in his book, MDs had prescribed placebos (in a variety of colors, sizes and forms) up until the 1960′s…sometimes I wish I could prescribe placebos. Then I snap out if it.

  12. David Gorski says:

    Marketing may be the missing link in our ability to lead people back to the safe shores of reason.

    It may well be, but how do we make these issues “simple” without dumbing them down to being too simplistic? This is a problem that’s not unique to quackery vs. science-based medicine, by the way. It comes up all the time in the creationism-evolution wars and in trying to explain the science of anthropogenic climate change.

  13. Fifi says:

    Dr Jones – You make an excellent point about science literacy and politicians – no doubt you’re right that some of them are scientifically illiterate but that’s no different than the general population and speaks to a general lack of basic science education. (I’d also think that politicians from privileged backgrounds at least had the opportunity to become educated in science.) Unfortunately, in the US it seems to be all about power and money and science, like religion, is merely one more tool to be used to accumulate both. Politicians really are making a choice and aren’t naive and being manipulated. Even Gore – who many would see as being “pro-science” because of his environmental agenda – has no actual respect for science and sees it as a tool to be used in a propaganda war. (Don’t get me wrong, I happen to think the evidence supports global warming, I just don’t think it’s that fundamentally important to Gore.)

    It’s worth noting that politicians routinely ignore evidence that contradicts their beliefs or goals in ALL manner of things, not just science. The recent bank collapses being an obvious example of a situation where a little bit of reality based thinking would have gone a long way. It’s also worth noting that while the Roves of the world work to “energize” a religious, reactionary/fear-motivated/xenophobic and anti-science voting base (a fact that contributed to the ban on stem cell research in the US), they also promote fear of bird flu and see their stocks in vaccines go up. While the whole autism/vaccine thing is a crock, it’s also a very handy diversion from the very real political (for profit) manipulations going on around healthcare policies and vaccines in the US. You really can’t be too cynical about some of the very big players in US politics who have been pushing their agendas since the Nixon era and are the shadow puppetmasters who have more to do with policy making and public manipulation than the politicians who face the public. It’s worth remembering that politics is showbiz for ugly people! ;-) And, like in showbiz, it’s the people behind the “talent” that really define the message and have the power – the “talent” is just the delivery system.

  14. Fifi says:

    It’s actually quite easy to simplify an explanation but it requires one drop the mindset of “dumbing down”. Making something simpler isn’t making it stupider – just as making something more difficult to understand doesn’t actually add depth or intelligence. So-called “smart”, educated and well off people people consume the most woo – not because they’re too stupid to understand the science but because the people working the con have found their mark’s fear/desire and are applying pressure at the appropriate point. Cons are essentially emotional in nature (no matter the con being worked), this is why reason doesn’t work as an antidote.

    As for the current mediascape – advertising is also essentially emotional in nature, and visual, in terms of how it functions. (As is propaganda, whether presented as news or advertising.) Visual language (and how our brains process imagery) is quite different than how we process words. The question becomes, are you merely interested in manipulating people? (Becoming a propagandist yourself!) Or are you interested in creating a context for a more honest dialogue and/or education? I can see particular approaches being effective in different contexts.

  15. Fifi says:

    Dr Gorski – This is an issue whenever dealing with specialized language – whether it’s a scientific lexicon or a hip hop one. Specialized languages are generally created to be hermetic, they function within a closed area of activity or culture within the larger language or culture. Sometimes people who spend all their time with their own “kind” (be they scientists or a posse) even forget what a word means in common usage!

    As far as ID vs evolution – that’s an ideological battle about emotion and belief for most people participating (including some of those claiming to be defending science). Thinking that people don’t agree because they just don’t understand because they’re too stupid is, well, missing the point and what’s actually going on. It’s also missing many of the subtextual cultural aspects of these debates for many involved – culture wars are all about beliefs (on both sides, both of whom consider themselves “right” due to their attachment to a certain authority). I’d say this kind of thing turns off many people who are pro-science from supporting groups who claim to be “protecting” science. I’m not sure if bloggers here realize it but science stopped being nerdy in pop culture quite a long time ago – at least as an idea if not as a practice.

  16. overshoot says:

    If we really want to raise the public awareness of the difference between woo and medical science, why not go for the high-octane stuff?

    Drama.

    Seriously — has anyone ever done a TV series on woo? There have been scoundrel shows before, there are plenty of detective shows, there have been countless doctor shows — but who has done a TV show on medical fraud?

    It could either be inserted in one of the usual medical TV shows most easily. IMHO it would be best to stay away from any current fraud and concentrate instead on the victims and the process that sucks them in.

  17. pmoran says:

    Overshoot, know that Goethe, a contemporary of Hannemann has already nicely lampooned the “like cures like” principle.

    Faust
    Johann Wolfgang Von Goethe
    Faust Part II
    (Act I: Scenes I to VII)
    State Rooms

    A Dark-haired Lady:
    The crowd are pressing round to squeeze you dry.
    I ask a cure! For a frozen foot
    That hinders me in dancing, walking by,
    And I curtsey awkwardly to boot.

    Mephistopheles:
    Permit a little kick from my foot.

    The Dark-haired Lady:
    Well, between lovers that’s occurred before.

    Mephistopheles:
    Child! My kick means something
    more.
    *Like cures like*, when one’s suffering:
    Foot heals foot, and so with every member.
    Come! Pay attention! No retaliation there.

    The Dark-haired Lady (Crying out.):
    Ouch! Ouch! That hurt! I call that kicking
    Like a horse’s hoof.

    Mephistopheles:
    With that the cure I bring.
    You can indulge in any amount of dancing,
    Touch feet under the table with your darling.

    A. S. Kline (c) 2003 All Rights Reserved
    This work may be freely reproduced, stored, and transmitted,
    electronically or otherwise, for any non-commercial purpose.

  18. overshoot says:

    Peter, you devil you!

    Now I’ll have to drag out my old copy of Faust and post the Deutsche to MHA. I wonder how long it will be before someone catches on?

  19. theobromine says:

    It occurs to me that when I bake a cake, I often use sand (except that it has been melted down and cast as my measuring cup and mixing bowl), as well as melamine (except that it is in the form of a durable plastic spoon.

    Never being one to turn away from extending (or perhaps over-extending) an analogy: If I were a woo-peddler, I could then explain and defend my use of sand and melamine in the cake by telling my innocent victims of the harmless and beneficial uses to which these substances are put *every day*!!! In their own homes!!!

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