Jun 11 2012
One of the major themes of this blog has been to combat what I, borrowing a term coined (as far as I can tell) by Dr. R. W. Donnell, like to refer to as “quackademic medicine.” Quackademic medicine is a lovely term designed to summarize everything that is wrong with the increasing embrace of so-called “complementary and alternative medicine” (CAM) or, as it’s increasingly called now, “integrative medicine” (IM) into academic medical centers. CAM/IM now a required part of the curriculum in many medical schools, and increasingly medical schools and academic medical centers seem to be setting up IM centers and divisions and departments. Fueled by government sources, such as the National Center for Complementary and Alternative Medicine (NCCAM) and private sources, such as the Bravewell Collaborative (which has been covered extensively recently not just by me but by Kimball Atwood, Steve Novella, and Mark Crislip), academic medical centers are increasingly “normalizing” what was once rightly considered quackery, hence the term “quackademic medicine.” The result over the last 20 years has been dramatic, so much so that even bastions of what were once completely hard-core in their insistence on basing medicine in science can embrace naturopathy, Rudolf Steiner’s anthroposophic medicine, reiki and other forms of “energy healing,” traditional Chinese medicine, and even homeopathy, all apparently in a quest to keep the customer satisfied.
Of course, in a way, academia is rather late to the party. CAM has been showing up in clinics, shops, and malls for quite a while now. For example, when I recently traveled to Scottsdale to attend the annual meeting of the American Society of Breast Surgeons, I happened to stop in a mall looking for a quick meal at a food court and saw this:
Basically, it’s a massage and reflexology stand. I’ve seen its like popping up in many malls throughout the country. Some go beyond a stand in the middle of the mall and actually have a storefront in the mall. More recently, unfortunately, I been noting similar stands selling various forms of woo in malls, but with a difference. For example, last year over the Christmas holidays, we visited friends in Cleveland and, while doing a little shopping at Beachwood Place, we noticed this:
Yes, it’s the Cleveland Clinic’s “Wellness” Institute, which offers acupuncture, “holistic psychotherapy” (whatever that is), reiki, chiropractic, and many other CAM modalities. (Look upon the CCF’s reiki page and weep at the spiritualistic mumbo-jumbo that is used to justify using reiki.) Then, just last week, a Facebook friend posted this on my wall:
Yes, it’s the Mayo Clinic providing its CAM services in the Mall of America. If you take a look at Mayo’s CAM program, you’ll see that it offers a lot of the same things that the Cleveland Clinic offers, including supplements and botanicals, acupuncture, traditional Chinese medicine, Ayurvedic medicine, hypnosis, and meditation.
One of the more insidious consequences of the infiltration of pseudoscience into academia in the form of quackademic medicine is that it gives the imprimatur of science to modalities that can best be described as pseudoscience. When people start seeing highly respected names in academic medicine, institutions generally viewed as the leaders in advancing the frontiers of medicine, such as the Mayo Clinic and the Cleveland Clinic selling acupuncture and reiki in malls, what are they supposed to think? Most of them, trusting in these hallowed names, will conclude that this stuff must be OK. It must be scientific. It must work. After all, would the Mayo Clinic and the Cleveland Clinic put their names on services offering these modalities if they didn’t work? Would they be selling them in stands and shops in malls if they didn’t work?
Alas, regular readers know the true answers to those questions (“yes” and “why not?”), but few others do. Quite reasonably, the average consumer might conclude that this stuff is actually medicine rather than quackery. In fact, even non-academic community hospitals, which previously hadn’t offered much in the way of CAM services, might conclude that they should get in on the act. And they are. Let me tell you the story of one example that is, unfortunately, right here in my own state. It’s a disturbing little tale, particularly given that the vast majority of health care is delivered by private physicians, the vast majority of whom have their admitting privileges not at huge academic medical center conglomerates like the Cleveland Clinic and the Mayo Clinic, but rather at hospitals like Oaklawn Hospital in Battle Creek, MI.
Quackery infiltrates the heartland
It’s not new that quackery has been infiltrating the heartland. Indeed, naturopathy, for example, has been showing up in places as remote as rural Montana. However, up until now, most of the hard core quackery has been restricted to clinics and individual practices, with maybe a little of the “gateway woo” that many academic medical centers promote, such as massage, acupuncture, and various “mind-body” interventions, making it to community hospitals. Then, a while back, Ed Brayton of CFI-Michigan contacted me because a reporter had contacted him for the skeptical viewpoint of a story he was doing on Oaklawn Hospital’s new Holistic Center. Ed sent me this press release:
Oaklawn Hospital is pleased to announce the April 2nd opening of a holistic care center that is located at 15217 W. Michigan Avenue on their Bear Creek campus, a quarter-mile west of I-69. “Our vision is that Oaklawn Holistic Center will provide health care choices that offer complementary therapies that can integrate with conventional medicine to enhance healing and promote wellness,” said Oaklawn President & CEO Rob Covert.
Holistic medicine dates back thousands of years and is focused on therapies that treat the patient as a whole person, as opposed to mainly treating a particular symptom or ailment. Its techniques are centered on improving the body’s immune system and looks at an individual’s overall physical, mental, and emotional well-being before recommending treatment. The practice of holistic medicine does not rule out allopathic or conventional medicine, and the Oaklawn Holistic Center will work closely with Oaklawn primary care physicians to assure that their patients are receiving effective complementary care.
Martin Holmes, MD, of Oaklawn Medical Group-Albion is the Center’s medical director and Karla Anderson, RN, CNHP oversees the daily operations and treatments that come from nutritional therapists, massage therapists, naturopathic practitioners, and other practitioners of complementary treatments.
It’s all blather, of course, standard boilerplate about CAM that we’ve heard time and time again and that inspired Kimball Atwood to produce his infamous serious of posts under the title of the Weekly Waluation of the Weasel Words of Woo. (In fact, I encourage you to do a W^5 “waluation” of this press release in the comments, along with commentary on the subject matter at hand.) Of course, I was more than happy to speak to the reporter, Andy Fitzpatrick of the Battle Creek Enquirer about this “holistic center.” I was even happier to do so after I read this part of the press release:
Anderson is a strong advocate of the holistic approach and using naturopathic therapies to strengthen the body’s immune system. “I’ve seen a lot of people turn to holistic medicine who suffered chronic ailments and were not experiencing much success through allopathic treatments. Often times these patients not only found relief for their chronic conditions, but found that other health problems improved as well due to improvement in the performance of their immune systems.” Naturopathic therapies emphasize using diet modification, nutritional supplements, herbal medicine, acupuncture, hydrotherapy, massage, joint manipulation, and lifestyle counseling.
The Center offers classes and treatment that include numerous modalities, initially specializing in Therapeutic Body Work, Functional Normalization, Pregnancy Massage, Trigger-point Therapy, Healing Touch, Reflexology, Migraine Headache Relief, Injury Rehabilitation, Essential Oil Massage, Hot stone Therapy, Lymphatic Drainage Therapy, Comprehensive Holistic Assessments, pH testing, Aromatherapy, Bach Flower Therapy, Loomis Digestive Health Assessments, Fastech Foot Forms, Ionic Foot Baths, Ear Candling, Natural Health Life Classes, Holistic Life Coaching Club, QiGong, and Live Foods.
My reaction after reading that last paragraph was stunned silence. I couldn’t believe that a reputable hospital would offer what I consider to be so much rank quackery. I was relieved, if you can call it that, that this center apparently doesn’t offer colon hydrotherapy or iridology. Yet. In any case, most hospitals are fairly careful. They offer modalities like acupuncture, for example, because they know that, if challenged, they can point to studies that seem to indicate that acupuncture works. We at SBM, of course, have written time and time again about how these studies do not show what advocates of acupuncture think they show and how acupuncture is almost certainly nothing more than an elaborate placebo. Usually, even the most die-hard quackademic institutions stay far away from the more hard core quackery for fear of damaging their reputations. Oh, sure, there are some academic centers that will delve into naturopathy and even occasionally homeopathy, but for the most part they tend to stick with the “safe” and (semi-)”respectable” CAM, such as meditation, massage, healing touch (and/or reiki, which is more or less the same thing), acupuncture, and maybe a few supplements here and there.
Not for Oaklawn Hospital is such a wimpy approach! Oh, no. Oaklawn has, for whatever reason, decided to offer what I consider to be some serious quackery to its patients. And I expressed my own amazement at this to Mr. Fitzpatrick, as I had never seen a hospital, academic or otherwise, offer ear candling. Ear candling, as you might recall, is a form of quackery in which a candle is inserted into the ear canal and lit. Supposedly, so it is claimed, this practice will “detoxify” by leeching out toxins, the better to relieve all manner of ailments, from sinus pressure and pain to vertigo to tinnitus to a number of other maladies. At the very least, it’s claimed to be able to remove ear wax. (It can’t.) Ear candling is pure quackery, of course, and potentially dangerous. How a reputable hospital could put its imprimatur on such a practice I’ll never know.
The same is true of ionic footbaths. These “detox footbaths” are infamous in the skeptical community. Basically, they involve putting electrodes in a salt water bath, having the patient put his feet in the bath, and then running a low level electric current through it. It is claimed that by doing this one can remove toxins, enhance the bioenergy (qi), realign the body’s energy field, increase vitality, and, of course, rid the body of toxins, chemicals, radiation, pollution, synthetics, and other foreign material trapped in the skin layers that have clogged up the body’s systems of elimination. But that’s not all! You might not believe this, little fella, but it’ll cure your asthma, too (or at least remove liver parasites). As “proof” that it works, they’ll often show you impressive pictures like this:
Wow! It really must work, right? What is all that nasty brown stuff showing up in the water? Ironically enough, one of the best deconstructions of this bit of quackery comes from, of all people, a denizen of CureZone, an alternative medicine online community:
I recently saw my wife and several friends get duped about supposed benefits of an Ionic Detoxification Unit. Don’t get suckered into buying or paying for a session in an ionic detoxification foot bath! Guess what, the water turns “toxic” colors whether your feet are in there or not, because it is just the corrosion of the electrodes that causes the water to change color. The manufacturer below says that “sales pitches” are used to make people think that different colors mean different toxins were ionically removed from the body through the soles of the feet; in reality it is just the results of passing an electric current between electrodes in a conductive solution of water. Their own studies (backed by other independent fraud investigation analyses) find only what you would expect to find in water where electrolysis took place, i.e., no “toxins” released from the body were found.
Think about it, how likely are your feet to start “leaking toxins”, if that happened then you’d find that happening in whirlpool spas etc. It doesn’t happen.
It turns out that the water changes color whether a person’s feet are in there or not. In fact, many manufacturers even admit this, but try to discount the fact that the change in water color is all due to electrolysis and claim that the exact shade of color indicates what organ is being effected or to argue, regardless of whether the water changes color or not, the feet are a great part of the body through which to “absorb negative ions.”
I could go on and on about how reflexology, pH testing, Bach flower remedies, aromatherapy, and the like are beyond utter nonsense, but regular readers already know this. Even so, I can’t help but note that even I didn’t know what Loomis digestive health assessments are. It didn’t take me long to find the Loomis Institute home page, and, let me tell you, I do think that a future post might be indicated on this, given that it appears to be a form of dietary pseudoscience that claims that dietary manipulations involving enzymes are the key to health.
In the meantime, I’d like to get to the article for which I was interviewed. Fitzpatrick did a decent job, but even with his known skeptical bent that led him to talk to CFI, his article turned out to fall too hard for the “tell both sides” trope that infects journalism. I have no way of knowing whether it was Fitzpatrick or his editor who was most responsible for this, but it is a frequent problem I see whenever journalists write about topics like the Oaklawn Holistic Center.
When “telling both sides” isn’t
The article appeared about a week ago in the Battle Creek Enquirer under the title Oaklawn Hospital gives alternative medicine a try: Holistic methods spark controversy. It starts out, as these stories often do, with a patient anecdote about a woman with lupus named Dorothy Height who believes that “holistic care” saved her life. It then proceeds to tell the tale of the center’s director, Dr. Martin Holmes, who gives his reasons for turning to CAM thusly:
Dr. Martin Holmes, the center’s director, said he’s been a family practice physician for about 40 years. However, he was struck by the number of patients who came to him that he couldn’t help by using only the skills and tools of what he calls an allopathic doctor.
Allopathy is a term used by those in the holistic or naturopath fields to refer to traditional, science-based medicine.
“I brought them the concept of going outside of the box of North American allopathic medicine, primarily giving evidence on essential oils, massage therapy, nutritional counseling, acupuncture, acupressure, which I use in my practice quite a bit, and, something I’ve recently learned, which is therapeutic qi- gong,” Holmes said.
You know, I don’t remember whether the issue of the use of the term “allopathy” ever came up in my interview, but if it did, I would have informed Mr. Fitzpatrick never to use that term. Why? It’s a derogatory term coined by the founder of that quackery of quackeries, homeopathy, to describe medicine that was not homeopathy; i.e., conventional medicine. The term is a false dichotomy. Unfortunately, it’s a false dichotomy that even too many science-based physicians accept. Be that as it may, Dr. Martin has fallen far down the rabbit hole of vitalism. Indeed, he explicitly calls qi the “life force,” and says that if you don’t have any qi, you’re “on the slab and you’re done.” Not surprisingly, he is also hostile to science-based medicine:
Holmes, of Oaklawn, described a reliance on double-blind, placebo-controlled studies a tragedy of mainstream medicine. In such a study, one group is given the treatment and another group is given a fake treatment without being told. These studies also account for the placebo effect; that is, an increase in health due to a reason other than being given a medication or procedure being tested.
“There are people who jump out of airplanes without parachutes who survive, and there are people who have jumped out of airplanes with parachutes who have not survived,” Holmes said. “There hasn’t been a placebo-controlled double-blind study (of parachutes), so we can’t in conscience give evidence that it’s better to jump out of a plane with a parachute.”
I’ll give Dr. Holmes credit for boldly stealing an example that skeptics and supporters of science-based medicine use to criticize the obsession of evidence-based medicine with only clinical trials. Indeed, this example is frequently used to criticize, what has been called methodolatry, or the profane worship of the randomized clinical trial as the only valid method of investigation. In fact, as Kimball Atwood has pointed out, the whole point of the analogy, which was used in an infamous BMJ article to ridicule the excesses of evidence-base medicine, is that there are some things that are so self-evident based on basic science considerations alone (such as the fact people without a parachute will reach terminal velocity and slam into the ground at a speed that is, except in very rare cases, incompatible with further life) that they do not need to be tested in randomized clinical trials. Ironically enough for Dr. Martin, other examples of such things that require no RCTs to dismiss include his reflexology, ear candling and several of the modalities he offers at his holistic center, because they are completely incompatible with well-established understandings of anatomy and physiology.
In addition, Karla Anderson, Dr. Holmes’ nurse, who also happens to be a naturopath, invokes placebo responses to claim that it’s impossible to test something like acupuncture using an RCT. This is a fallacy that we’ve dealt with time and time again, and it is quite possible to test such modalities using RCTs. what Anderson doesn’t like is that whenever treatments like acupuncture are tested in RCTs, they fail to do better than placebo. Particularly amusing is this little blurb:
Anderson added that in something such as acupuncture, which involves placing needles in the body’s various points that are believed by practitioners to be tied to a person’s well-being, a placebo-controlled study is impossible.
Even without doing a double-blind, placebo-controlled study, there is still real evidence for holistic practices to work, Anderson said. She said such evidence is on the Internet, although she did not specify any particular studies.
I declare a new logical fallacy: Argumentum ad Internetium!
Among the proponents of these modalities interviewed by Mr. Fitzpatrick, another popular argument is the argument from antiquity that says that the fact that these remedies have been around a long time means that they must work. In all fairness, Fitzpatrick did let us skeptics have our say. In particular, we refuted the argument to antiquity, pointed out how many of these treatments are pure quackery, and tried to answer the special pleading that whines that these treatments can’t be tested in RCTs. But we’re up against it when we come across statements like this from NCCAM that state unequivocally that acupuncture can relieve pain, as well as nausea and vomiting after surgery, when the state of the evidence is anything but that, and it is certain that acupuncture effects are anything above and beyond placebo effects.
All of which brings us back to the beginning.
I started this post by lamenting how when academic medical centers like the Mayo Clinic and the Cleveland Clinic start not only studying “alternative” medicine but embracing it to the point where they sell it in malls their aura of science and respectability encompasses the quackery they sell. Clinics offering various pseudoscientific treatments have existed for a long time and would probably exist regardless of whether quackademia existed or not. They do not depend upon their respectability and reputation to attract
marks patients in the same way that community hospitals do. Moreover, the latest innovations in treatment tend to be developed in academic medical centers and then, over time, filter out first to the larger community hospitals and then to even smaller community hospitals that have the resources. Unfortunately, the “innovation” of “integrative medicine” appears to be following that pattern just as much as the latest surgical breakthrough or latest form of chemotherapy does. From my perspective, I very much doubt that Oaklawn Hospital would be willing to offer so much pure quackery to its patients if it weren’t for institutions like the Mayo Clinic, Cleveland Clinic, Harvard, Stanford, and many others paving the way.
It is only part of the harm that quackademic medicine does.
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