Dec 09 2011
Several of us have written about how contemporary quacks have artfully pitched their wares to a higherbrow market than their predecessors were accustomed to, back in the day. Through clever packaging,* quacks today can reasonably hope to become professors at prestigious medical schools, to control and receive substantial grant money from the NIH, to preside over reviews for the Cochrane Collaboration, to be featured as guests and even as hosts on mainstream television networks and on PBS, to issue opinions in the name of the National Academy of Sciences, to be patronized by powerful politicians, and even to be chosen by U.S. presidents to chair influential government commissions.
The most successful pitch so far, and the one that the fattest quack-cats of all have apparently decided to bet the farm on, is “integrative medicine” (IM). Good call: the term avoids any direct mention of the only thing that distinguishes it from plain medicine. Its proponents, unsurprisingly, have increasingly come to understand that when they are asked to explain what IM is, it is prudent to leave some things to the imagination. They’re more likely to get a warm reception if they lead people to believe that IM has to do with reaching goals that almost everyone agrees are worthy: compassionate, affordable health care for all, for example.
In that vein, the two most consistent IM pitches in recent years—seen repeatedly in statements found in links from this post—are that IM is “preventive medicine” and that it involves “patient-centered care.” I demolished the “preventive” claim a couple of years ago, as did Drs. Lipson, Gorski, and probably others. Today I’ll explain why the “patient-centered care” claim is worse than fatuous.
Patient-Centered Care and Respect for Autonomy
“Patient-centered” is a term of recent vintage, used in legitmate contexts to emphasize the modern view that patients (or their competent surrogates) are free agents who are entitled to make their own health care decisions. Thus “patient-centered” is to be contrasted with “paternalistic,” the bad old style in which physicians merely told patients what to do, with explanations varying from none to fanciful (“take this [placebo], it’ll help”).
Physicians are now, ideally, expert consultants whose job is to give patients the information that they need to make rational decisions (even if patients don’t always make rational decisions). The formal ethical basis for this new “patient-centered” practice is the principle of Respect for Autonomy. This is also the ethical basis for the requirement of informed consent—both in trials and in medical practice. Thus informed consent is the sine qua non of patient-centered practice.
Integrative Medicine: “Patient-Centered Care” is the new Medical Paternalism
Do IM practitioners inform patients adequately? Let’s find out. Here are the first five M.D. practices that appear in the Google search, “Integrative Medicine Ontario” (can you guess why I chose Ontario?):
- Integrative Medicine Consultants Inc.
- Integrative Medicine Clinic
- Seekers Centre for Integrative Medicine
- Markham Integrative Medicine
- Toronto Clinic for Preventive Medicine
Rather than spend my usual many hours copying, pasting, and explaining lengthy quotations from those sites, in order to demonstrate the wellspring of misinformation that each of them is, I’ll simply guarantee you that I am correct in that assertion. As difficult as it is to be fighting this uphill battle against modern quackery, one thing is utterly predictable: between the nature of the claims and the apparently irresistible urge that all quacks have to make them, you will almost always find whatever flim-flam you’re looking for. I’ve perused those sites just enough to see that the stuff is rampant, but I confess that I’m too tired to do the busywork now; perhaps I’ll add it piecemeal over the weekend. Alternatively, if any of you is moved to cull a juicy passage or two, I’ll be happy to heap praise upon you in the comment section.
Yes, there are vast deficits of informed consent in integrative medicine. Hence, when an integrative medicine advocate uses the term “patient-centered,” he actually means its historical opposite: medical paternalism. Now take another look at Andrew Weil, and you’ll see him in a whole, new, er, make that old, light. He doesn’t just pine for the days of pre-scientific treatments; he pines for the days of doctor-as-mystical-priest-figure. That, of course, is what IM advocates really mean by “patient-centered”: “my patients want me to be a shaman who can weave magic, damn it, and I really get a kick out of that ego trip myself!”
*A sampling from our 4 years of speaking truth to packaging:
The Misleading Language and Weekly Waluation of the Weasel Words of Woo series:
- Lies, Damned Lies, and ‘Integrative Medicine’
- Integrative Medicine: “Patient-Centered Care” is the new Medical Paternalism
32 Responses to “Integrative Medicine: “Patient-Centered Care” is the new Medical Paternalism”