Articles

“Integrative medicine”: A brand, not a specialty

Author’s note: This post was inspired in part by a post by Wally Sampson entitled Why would medical schools associate with quackery? Or, How we did it.

PRELUDE

Once upon a time, there was quackery.

Long ago, back in the mists of time before many of our current readers were even born and far back in the memory of even our wizened elders of medicine, “quackery” was the preferred term used to refer to ineffective and potentially harmful medical practices not supported by evidence. Physicians, having a grounding in science and prior plausibility, for the most part understood that modalities such as homeopathy, reflexology, and various “energy healing” (i.e., faith healing) methodologies were based either on prescientific vitalism, magical thinking, and/or science that was at best incorrect or at the very least grossly distorted. More importantly, physicians weren’t afraid to call quackery quackery, quacks quacks, and charlatans charlatans.

Not surprisingly, quacks and charlatans did not like this.

Then, a few decades ago, most likely beginning in the 1960s and 1970s, supporters of quackery decided that they would never get anywhere selling their products, except to a small minority of people, if they continued to allow physicians to define their favorite quackery as being…well, quackery. To change this, they joined with physicians whose scientific rigor could best be described as…questionable. Together, these practitioners of pseudoscience and the credulous physicians smitten with the romance of that pseudoscience decided that a new term was needed, a more soothing, reassuring term, a term that was not so derogatory. As a consequence, the term “quackery” somehow morphed into “alternative medicine.” Alternative medicine was (and, when the term is used, still is) medicine that does not fit into the current scientific paradigm, a term used to describe medical practices that were not supported by evidence, were ineffective and potentially harmful, and were used instead of effective therapies. Physicians understood that modalities such as homeopathy, reflexology and various “energy healing” (i.e., faith healing) methodologies were based either on prescientific vitalism, magical thinking, and/or on science that was at best incorrect or grossly distorted. More importantly, they weren’t afraid to say so.

Although practitioners of alternative medicine liked this term better than the terms “quackery” and “quacks,” they were, not surprisingly, still not satisfied.

That’s why, sometime lost in the mists of time of the 1990s, alternative medicine practitioners (i.e., quacks) decided that they would never get anywhere selling their products, outside of a small minority of people, if they themselves defined their very own products as somehow being outside the mainstream of scientific medicine by calling them “alternative.” Such was not the way to win friends, influence people, and, above all, become (or at least seem) respectable. Thus was born the term “complementary and alternative medicine,” which had the nice, pithy abbreviation of “CAM.”

CAM was (and is) medicine that does not fit into the current scientific paradigm, including treatments that are not supported by evidence and are ineffective and/or potentially harmful. The difference? CAM therapies are used in addition to real medicine. Over a relatively brief period of time, the name change had its intended effect. No longer did many physicians automatically view modalities that were once considered quackery, later considered “alternative,” and now considered “CAM” as quackery, and those that still did were dismissed as close-minded, stubborn, and dogmatic, relics who were trying to swim against the coming wave of wonderful CAM magic. Modalities such as homeopathy, reiki, various energy healing methods, and even reflexology were no longer reflexively (sorry, couldn’t help it) dismissed. Despite several of them (especially homeopathy and the various energy healing modalities) violating known laws of physics and requiring that our understanding of physics be not just wrong, but spectacularly wrong, for them to work, somehow methodolatrists preaching “evidence-based medicine,” valuing randomized, double-blind, placebo-controlled trials above all else even when physics, chemistry, and common sense should tell them that a treatment (such as homeopathy) cannot work, allowed the background noise of clinical research caused by the occasional false positive clinical trial to convince them that there might be something to these modalities. Also, by using their former quackery in addition (i.e., as complementary) to real medicine, CAM practitioners (mostly) neutered the biggest complaint about alternative medicine, namely the concern that patients forego effective therapy in order to pursue alternative medicine. Meanwhile, many physicians who might have in the past opposed the infiltration of such quackery/alternative/CAM therapies turned into shruggies and no longer cared enough to speak out. The stage was set for the widespread adoption of CAM by medical schools.

And CAM practitioners did declare that this was indeed good–but not good enough.

That’s why CAM advocates, even though they had made huge inroads introducing quackademic medicine into medical schools and academic medical centers, bolstered by the influence of the National Center for Complementary and Alternative Medicine (NCCAM) and the Bravewell Collaborative, an organization founded by Christy Mack, the wife of a wealthy investment banker, for the express purpose of promoting the study and use of CAM in medical academia, decided that even their remarkable success was not good enough. Thus was born in recent years a new term for CAM. CAM practitioners (formerly alternative medicine practitioners, formerly quacks) hit upon the perfect term for their treatments. It is a term so media-friendly, so seemingly reasonable that it is a wonder that no one had thought of it before.

“Integrative medicine.”

No longer were CAM practitioners content to have their favorite quackery be “complementary” to real medicine. After all, “complementary” implied a subsidiary position. Medicine was the cake, and their wares were just the icing. That wasn’t good enough. They craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine. The term “integrative medicine” (IM) served their purpose perfectly. No longer were their treatments merely “complementary” to real medicine. Oh, no. Now they were “integrating” their treatments with those of science- and evidence-based medicine! The implication, the very, very, very intentional implication, was that alternative medicine was co-equal to science- and evidence-based medicine, an equal partner in the “integrating.”

And to IM practitioners, it was very good indeed. Quackery had successfully infiltrated scientific medicine to such an extent that it could metastasize everywhere.

It’s all about the branding

No doubt, there will be some who proclaim my little introduction above to be too “harsh.” Too “strident,” even. Not nearly diplomatic or “respectful” enough. So be it. My narrative has the advantage of being largely true, and only mildly exaggerated for (I hope) dramatic effect. The terms “CAM” and “integrative medicine” are not serious, sober names for a serious, sober, science-based specialty. They are about the branding of quackery. They have always been about the branding of quackery. They are about double standards whereby treatments that can’t pass scientific muster are admitted to the “club” of science-based medicine under lowered standards. I frequently repeat a cliche, but just because it’s become a cliche does not make it untrue. There is no such thing as “alternative” medicine. There is medicine that has been proven safe and effective through science; there is medicine that has not; and there as medicine that has been proven unsafe and/or ineffective through science. Whatever you call it, “alternative,” “CAM,” or “integrative” medicine, when medicine, whatever its source, is demonstrated to be safe and effective through science, it ceases to be “alternative” or “complementary.” It becomes simply “medicine” and is automatically integrated into the current armamentarium of medicine, no special name needed, no special consideration needed to provide a lower standard of evidence.

If you have any doubt that the term “integrative medicine” is all about the branding, I present to you a couple of examples. First, here’s Mark Stoiber on both that wretched hive of scum and quackery, The Huffington Post asking Who Will Own the Brand of Integrative Medicine? His post is mirrored on his own blog as well. In this post, Stoiber, who is an advertising talent who describes himself as “creative director, entrepreneur, green brand specialist and writer,” describes a model of “integrative medicine” pharmacies that stock everything from real medicine to fake medicine (i.e., homeopathic remedies). In this case, he is talking about “integrating” pharmacies with the “vitamin shop model” and the “natural remedies” model, using the Pharmaca pharmacy chain as an example:

Pharmaca has demonstrated the market power of this common sense, scaling from one pharmacy in Boulder to 23 stores in Colorado, New Mexico, California, Oregon and Washington State.

Panzer attributes the success not to stocking shelves with products running the gamut from conventional pharma to natural remedies and homeopathy. Instead, it’s about creating crossover expertise.

The common US model is one pharmacist, and a bunch of clerks stocking shelves. In our case, we have the highly trained pharmacist, but also highly skilled practitioners with homeopathic or naturopathic backgrounds. No one expert has the full answer. Instead, we collaborate to offer our customers a more holistic approach to managing their health.

Stoiber then cites another advocate of “integrative” pharmacy:

Speaking with Bob Mehr, President of Pure Pharmacy in Vancouver, the importance of evidence-based remedies becomes apparent.

Up to now, there’s been a polarization between advocates of traditional and conventional pharmacy. We believe the way forward lies in using treatments that are backed by evidence, regardless of their origin.

Mehr says the only path to mass-market acceptance of integrative medicine will be with evidence. “I want to get rid of the whole east meets west stereotype. This isn’t about east meets west. It’s about getting the best product, or combination of products, for our customers. And those products come with proof of efficacy.”

The evidence-based model of integrative medicine is de facto in Europe. In Germany, for example, pharmacists at the ‘Apotheke’ feel completely comfortable prescribing conventional pharma, along with herbal and homeopathic supplements to augment recovery.

I realize that it’s just the reductionistic, “Western,” materialism-based scientist in me, but I have to say to Mr. Mehr and Mr. Stoiber: “Evidence.” You keep using that word. I do not think it means what you think it means. After all, if the “integration” in medicine that they recommend were truly evidence-based, then homeopathy would not be a part of it at all. In fact, any truly evidence-based paradigm, be it science-based medicine (SBM) or IM, homeopathy should be excluded because in the end homeopathic remedies are, after all, water. Indeed, for homeopathy to work, huge swaths of well-established sciences, such as physics, chemistry, and biochemistry, would have to be not just wrong, but spectacularly wrong. Both Pharmaca and Pure Pharmacy sell homeopathic remedies; they cannot plausibly claim to be evidence-based, regardless of how much they “integrate” such nonsense with scientific medicine. Indeed, Pure Pharmacy has a homeopath on its staff and offers non-evidence-based services such as thermography, which is not a validated or reliable test for the early detection of breast cancer; bioenergetic health scans, which are devices akin to William C. Nelson’s infamous Quantum Xrroid Interface System; various detoxification products, none of which have any value; and bioidentical hormones, which are neither safer nor more effective than conventional hormone replacement therapy.

I said it at our panel discussion at TAM9, and I’ll say it again: “Integrative medicine” is in reality the “integration” of quackery with real medicine.

CAM is dead?

But back to the marketing aspect of the term “integrative medicine.” Last week, I saw a post from a supporter of IM who made the case, albeit inadvertently, better than I ever could. In fact, the man who wrote this is Glenn Sabin, a board member for the Society of Integrative Oncology who is described as a “staunch proponent and leader in the area of integrative medicine” even goes so far as to proclaim that CAM is dead:

Over the past 25 years, practitioners integrating the best of Western, Eastern and other evidence-based models of medicine into their practices have endured a series of catch-all titles that describe their model of care. Not long ago, all medicine not tacking closely to conventional allopathic care was termed “alternative”. Then about 15 years ago the term complementary and alternative medicine (CAM) began to seep into the medical vernacular. NIH’s National Center for Cancer and Alternative Medicine (NCCAM) became a full-fledged center in 1991. Although most of the major hospitals and cancer centers did not introduce their integrative centers until a decade later, NCCAM’s “CAM” acronym stuck, and had an influence on new private clinics and centers across the country.

Mr. Sabin apparently doesn’t know much about history of NCCAM. In 1991, NCCAM was indeed born, except that it was not a full-fledged center. Rather, thanks to woo-friendly Senator Tom Harkin (D-IA) and $2 million of discretionary funding, NCCAM started its life as the Office of Unconventional Medicine, which was soon renamed the Office of Alternative Medicine (OAM). It was not until October 1998 that NCCAM received its current name and was elevated to a full center. Mostly, this was a big “screw you” from Tom Harkin to the then director of the NIH, Harold Varmus, who, responding to objections to the OAM from the scientific academic community, moved to place the OAM under tighter NIH control. The result? Tom Harkin introduced and passed legislation that elevated the OAM to an independent center within the NIH. Soon after, appropriations skyrocketed to over $100 million a year. NCCAM’s current budget hovers in the $125 million range.

One wonders what else Sabin gets wrong.

Whatever he might get wrong or right on a factual basis, Sabin echoes Stoiber’s message about “integrative medicine” that reveals the mindset of promoters of non-science-based medical treatments in the very next paragraph:

Today several integrative centers across the country still contain the words CAM in their name. This is both confusing to health consumers and damaging for these centers’ brand. Most clinics and centers launched during the last decade have evolved with their branding to include today’s more appropriate terminology of “integrative medicine”, “integrative services” or “integrative therapies”.

(Bold not mine, but rather Sabin’s.)

I will give Sabin credit. Whether he realizes it or not, he’s basically just admitted that the move to rename CAM as IM is all about the marketing of quackery. Yes, I know that he would never, ever admit that’s what he just did. After all, like Stoiber, Sabin liberally sprinkles his post with terms like “evidence-based integrative medicine,” which makes me wonder why IM aficionados haven’t renamed IM to “EBIM.” Perhaps that’s coming later in the next iteration of marketing buzzwords for quackery.

But I digress.

Getting back on track, I note that Mr. Sabin does a wonderful job of expressing the confusion at the heart of so-called “evidence-based integrative medicine,” almost certainly without realizing that he is doing so. See if you can figure out what I mean before I explain it:

Alternative medicine is often pushed in lieu of proven conventional care. Alternative medicine does not have an adequate science base behind it and is not practiced in clinics within an academic setting. Integrative medicine integrates proven therapies into conventional medicine. True, not all methods of mindfulness-based stress reduction techniques like, say, Reiki have a solid evidence base behind it, but in this case, many clinicians that offer services like Reiki do so because their clinical observations tell them that it helps many of their patients relax and may lessen the need of certain pain meds.

So, let me get this straight. IM is better than “alternative medicine” because alternative medicine is “often pushed in lieu of proven conventional care” while in contrast (allegedly) IM “integrates proven therapies into conventional medicine”? Is that what Sabin is saying? Yes, it is. Then, right after saying that, Sabin admits that “not all” IM methods have a solid evidence base behind them but that clinicians use them because of anecdotal observations. Here’s a hint for Mr. Sabin: Anecdotal observations are not the same thing as being “proven.” Far from it! As we have explained many times before right here on this very blog, anecdotal observations can be profoundly misleading, thanks to well-known phenomena that confound “clinical observations,” such as regression to the mean, confirmation bias, and placebo responses. That’s why “conventional” medical researchers long ago realized that well-designed clinical trials, preferably randomized and well-controlled, are necessary to minimize these biases and to correct for placebo responses. Mr. Sabin comes across as profoundly confused about the science in that he doesn’t seem to realize that the vast majority of “alternative medicine” modalities that he wants to see “integrated” with conventional medicine are not “proven” by any stretch of the imagination.

“Evidence-based.” You keep using that word, Mr. Sabin. I do not think it means what you think it means. Oh, wait. I used the same Princess Bride joke twice in one post. Inconceivable! (Sorry about that.)

Not that any of this stops Sabin from misrepresenting CAM as “personalized” medicine when it is anything but and the whole appeal to “personalized medicine” is a classic CAM bait-and-switch. Here’s how Sabin himself puts it:

CAM is dead. The evolution of evidence-based, personalized integrative medicine, and its implementation in clinic, lives on.

A similar sort of “bait-and-switch” is used by Stoiber near the end of his HuffPo article:

Speaking with Mehr and Panzer, I began to understand that the brand of integrative medicine demanded a shift in perspective. Instead of creating an omnipotent pharmacist, their models relied on collaboration. This bodes well for any integrative medicine brand that can open its doors to feedback, information sharing, education and ongoing learning.

This bait-and-switch is the bait-and-switch of representing CAM/IM as being all about “patient empowerment.” It is a ploy that I find particularly galling and very much akin to the trap that journalist David Freedman fell for when he wrote a completely credulous pro-CAM story for The Atlantic. His argument basically boiled down to this: Medicine as currently practiced all too often doesn’t permit doctors the time to spend with their patients to maximize the benefits of a caring physician-patient relationship, while CAM practitioners are all about spending that time. So let’s just cede that part of medicine to the quacks. As I said before, no, that’s not a straw man, either. Stoiber’s argument boils down to the same thing. If scientific medicine doesn’t sufficiently “empower” patients, then let’s “integrate” quackery into scientific medicine in order to give them choices that make them feel empowered. That’s it. Both are, of course, false dichotomies. It is not necessary to “integrate” quackery with scientific medicine to improve the doctor-patient relationship and realize the benefits that come from that or to “empower” patients. Neither require the quackery that is CAM or IM to achieve, but IM advocates really, really want you to think that they do.

As I said, first and foremost, IM is all about the marketing.

In the end, off course CAM is dead! CAM advocates themselves killed it because they sensed a better marketing opportunity if they could come up with a term that didn’t have the connotation that their treatments are inferior to those of conventional medicine. The killing of CAM was deliberate, calculated, and premeditated, but it is not yet complete. Rather, it is an ongoing process. But don’t worry. Marketers like Glenn Sabin and Marc Stoiber will make sure that before too long the corpse of CAM will be well and truly dead, cold, and buried. In its place will rise the zombie that is “integrative medicine.”

In fact, it’s already happening.

Posted in: Homeopathy, Science and Medicine, Science and the Media

Leave a Comment (45) ↓

45 thoughts on ““Integrative medicine”: A brand, not a specialty

  1. kathy says:

    It’s possible that ‘Integrative medicine’ is the opening shot in a battle to brand CAM as not just equal, but SUPERIOR to ‘Non-integrative’ medicine? It certainly can claim to integrate/include every aspect of human ‘wellness’ including semi-religion, music, nice smells, soothing massages and the feeling of being really truly interesting to a person of percieved authority/status (our highly-trained pharmacy staff). Not to mention feeling like you now have a gospel to proclaim to all your friends and relations, and even strangers in the checkout queue. This is wonderfully superior to what you can expect from a visit to your local doctor … nobody wants to hear about that.

    Integrate everything and never say ‘No’, how can dull old ‘conventional’ medicine compete? Woo triumphant! Just needed the right p.c. word to describe it.

  2. Jurjen S. says:

    Why am I strongly reminded of Creationism and “Intelligent Design”? And, indeed, of a remark made by Judge Jones during Kitzmiller v. Dover to the effect of “we’re not going to be here again five years from now having this same discussion about ‘directed development’?” (or some similar term that Behe, IIRC, was using interchangeably with ID).

  3. DW says:

    While I’m completely in sympathy with your overall viewpoint, I do think the history is a bit skewed here. It’s not so much that “First there was real medicine and everyone knew quacks were quacks, now somehow quacks are starting to get the upper hand.” The quackery was in fact the earlier state of medicine. It’s the evidence-based thing that’s the new upstart. All for the good IMO, but it’s not like we had evidence-based medicine BEFORE these quacks came along. The quacks really were here first :)

  4. ConspicuousCarl says:

    Jurjen S.on 15 Aug 2011 at 5:41 am
    Why am I strongly reminded of Creationism and “Intelligent Design”?

    This is definitely a model for creationists. Medical schools and newspapers are using the propaganda of a scam in the name of fairness. I think “ID” fails because it doesn’t offer the “empowerment” which cable news viewers get from CAM.

    Reading Gorski’s and Wally Sampson’s pieces makes me wonder by what intellectual standards institutions like CNN and Columbia University don’t merge with pornography producers. They both share a practice of pushing absurd fantasies for the sake of emotionally placating their patrons, which makes them good candidates for merger under the business theory of “merger of equals”.

    Marketing would be easy, given that the various categories are already perfectly analogous…

    Barefoot Doctors: The Pizza Delivery Porn of Medicine. Every knock on the door promises something real and something fake. Dualism has already proved popular in philosophy, so offer this formula for success with confidence!

    Anti-Vaccine Hysteria: The Politically Correct Gateway to Nazi S&M. For the client who doesn’t feel special unless they think they are being abused by The Establishment, the next level up may provide them with a whole new state of wellness.

    Reflexology: Hard Pounding Foot-Vibrating Action. Reflexology is by far the strangest and most perverse form of pornography I have ever seen, and I doubt that it will ever find a socially-acceptable analogue in medicine.

    Well, 2 out of 3 is OK but maybe not up to Columbia standards. I guess it wouldn’t work after all.

  5. David Gorski says:

    All for the good IMO, but it’s not like we had evidence-based medicine BEFORE these quacks came along. The quacks really were here first

    I was referring mainly to 20th century, from mid-20th century on. Notice this phrase in the opening sentence: “Long ago, back in the mists of time before many of our current readers were even born and far back in the memory of even our wizened elders of medicine…” That sounds like 50 or 60 years ago, tops.

    A little artistic license here…you’re being a total buzzkill. :-)

    In any case, CAMsters are already moving even beyond “integrative medicine.” They’re actively trying out new terms now (I even saw an article describing at least one of these new terms), but the new terms just aren’t as pithy and punchy as “integrative medicine.” The next generation of “rebranding” of quackery might make for a brief (and hopefully amusing) follow up post.

  6. ConspicuousCarl says:

    DWon 15 Aug 2011 at 8:06 am

    While I’m completely in sympathy with your overall viewpoint, I do think the history is a bit skewed here. It’s not so much that “First there was real medicine and everyone knew quacks were quacks, now somehow quacks are starting to get the upper hand.” The quackery was in fact the earlier state of medicine. It’s the evidence-based thing that’s the new upstart. All for the good IMO, but it’s not like we had evidence-based medicine BEFORE these quacks came along. The quacks really were here first

    Somewhat, but not entirely. You can go back far enough to make all “medicine” look absurd, but not all forms of quackery are merely holdovers from ancient times of ignorance. Chiropractors were considered nutty from the beginning. Homeopathy was pretty much the same, and required a special exemption to medical standards once the concept of medical standards was legally adopted.

    http://en.wikipedia.org/wiki/Homeopathy#19th_century:_rise_to_popularity_and_early_criticism

    From its inception, however, homeopathy was criticized by mainstream science. Sir John Forbes, physician to Queen Victoria, said in 1843 that the extremely small doses of homeopathy were regularly derided as useless, “an outrage to human reason”.

    http://en.wikipedia.org/wiki/Chiropractic#History

    Chiropractors faced heavy opposition from organized medicine. Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. [Palmer] and many other chiropractors were jailed.

  7. DW says:

    True there are always new forms of nuttiness, on top of the old … sorry to be a buzzkill! I think it may help though, to take a very long view of things … on the one hand from where we now stand, it wasn’t so very long ago that much of medicine did indeed look absurd; on the other hand, it indicates how very far we’ve come in such a short time, and how it’s not really surprising that much of the nuttiness is still with us and still finds plenty of customers.

  8. cervantes says:

    While the whole argument about branding appears valid, it’s a highly insufficient explanation of the success quackery has had in infiltrating academic medicine. After all, Intelligent Design has had zero success getting into biology departments.

    I always encourage Dr. Gorski and any alter ego he may happen to have to pay more attention to why quackery has so much appeal — not only out in the real world but also within medical schools. If, as you suggest in this post, there are perhaps legitimate complaints about physicians not having enough time for their patients and not establishing satisfying therapeutic relationships, then we ought to spend some time worrying about that within the context of science based medicine.

    Also, there is a real problem with the health literacy of the public — they are susceptible to quackery not only because it may offer some interpersonal or other forms of intangible satisfaction, but also because they don’t understand science. It seems to me that we also need to pay much more attention to how we can communicate biomedical science to the general public and also to individual patients within the context of treatment decision making. Just ranting about charlatanry on this and other web sites that attract an already sympathetic audience isn’t going to do it.

  9. You’re quite wrong, cervantes. I used to be as alt-meddie as they come, but exposure to well-written blogs by doctors who ridicule and rant about CAM changed my mind.

    Except for reflexology. All offices everywhere in the whole world should offer that, only they should call it the MOST AWESOME FOOT RUB EVAR. That’s truth in advertising, is what that is! :D

  10. David Gorski says:

    @cervantes

    One wonders how you could have missed the posts we at SBM have written over the last three and a half years of the existence of this blog examining exactly the questions you chastise us for allegedly not addressing adequately. This is only a single post addressing a single issue. I know that over the years I myself have addressed these issues so many times (for example, here), both here and as my alter-ego, that sometimes I think I’m repeating myself too often. In any case, branding is but one of the strategies promoters of unscientific medicine have used successfully. It is by no means the only one.

    That being said, never underestimate the power of language to frame the debate.

  11. woo-fu says:

    To address these problems, the public does need better health and science education in general, starting at the earliest possible age. This would go a long way in allowing individuals to make more informed decisions regarding their health. However, there are major cultural obstacles in the way of this goal.

    First, health classes are where children learn about their bodies, and, dare I say it, possibly S-E-X. Funny how so many of the same people who argue against nanny-states turn into little blushing, giggling or simply disgusted children when the subject of human sexuality enters the picture. As a result, especially in the Bible Belt, many health classes have been so watered down that they are little more than basic hygiene courses, if that.

    Second, just as children grow into teenagers whose need to understand human sexuality becomes crucial, many schools are cutting off access to information completely. This is achieved by going after physical education classes, where health education is traditionally dovetailed for middle and high school students. The excuses given usually involve needing to save the school money. The argument is that students can “play” on their own time.

    Even odder is that while little is being done to remedy the increasing lack of health information and physical education, driver’s ed, which also use to be taught during PE, is being accommodated through separate special programs. It seems so completely backwards to me. Let’s teach them to drive a very heavy, fast vehicle, risking not only their lives but the lives of others. However, talking to them about health care and sexuality at the same time just “robs them of their innocence”–an actual excuse I heard during a debate.

    I know it isn’t like that across the US, but in southern, socially conservative religious areas, removing PE from the education program isn’t simply about the budget, it’s about dodging all those pesky problems of teaching human sexuality. In the process, health and science education suffers overall, and a more credulous populace is cultivated.

  12. ConspicuousCarl says:

    cervanteson 15 Aug 2011 at 11:04 am
    After all, Intelligent Design has had zero success getting into biology departments.

    I think the main reason why “ID” does not catch on is because it has an identifiable religious motive and meaning. You can point to the “bad guy”, and that bad guy is prevented from entering schools by law and by a stronger apprehension on the part of educated scientists.

    The response of scientists matches the response of the government on many issues. If you do something wrong for a bad reason (greed, hate, or subversive ideology), it’s an offense which invites punishment. But if you do something bad for no reason (other than poor intellect), then you get shrugs or even coddling.

  13. cervantes says:

    Dr. G, you have occasionally (I would say it’s pretty rare) talked about why people believe this stuff, but you have had almost nothing to say — at least that I’ve ever noticed — about what to do about it. That’s what I am urging you to focus on more.

  14. nybgrus says:

    @cervantes:

    What would you do about it?

    Pass new laws or repeal bad ones (DSHEA)? Already been suggested

    Educate people better in critical thinking and science? Already been suggested

    Educate people better on specific reasons why CAM is garbage? Done regularly here

    Educate people on some of the finer and more complicated points of science and medicine and explain them for the lay reader (and not even touch on CAM)? Already done

    Suggest that the readership here act within their communities in whatever capacity they have to help educate and speak about critical, skeptical thinking? Already done

    Short of actually writing new laws, organizing local/regional events or lobbying, or going from door to door and bashing people over the head with Feynman and Sagan if they have echinacea in their medicine cabinet I fail to see what else the authorship here (particularly the loquacious and prolific Dr. Gorski) could be doing.

    The reality is that education about these topics is “what to do about it.” When I speak to credulous people (lay, med student, pharmacists, doctor) at least 80-90% of the time it is because they don’t know the history of CAM, what exactly a specific CAM is, or that supplements are essentially unregulated. When I inform them of these things I usually turn a shruggie into an interested, active person. This blog accomplished these goals because it gives people an opportunity to read and understand these topics and become educated on them. IMO, the only thing left for the authorship to “do about it” is to increase their readership – which they are doing by going to TAM, showing up on extremely popular daytime TV shows hosted by credulous doofs, and writing in other places as well – from personal blogs to quackwatch etc.

    But if you have some ideas as to what else to do about it, I’d certainly be keen to hear them. I am trying to do my best in my medical school and have had some pretty good successes, IMO. And I was inspired to do so by this blog. I think that the role of this blog is to educate people away from CAM (as Perky Skeptic pointed out) and motivate people to do what is right in their situation and their community (as I have done). What more would you have them do?

  15. pmoran says:

    I agree with Cervantes that we need to look a bit deeper.

    Look at the train therapy of Indonesia. It illustrates how folk medicine, the most primitive form of “quackery”, can arise and spread rapidly without fraud, without deluded “genius”, without a business model, or any of the other attributes that we skeptics usually see as the sinister forces behind “sCAM”.

    1. Harriet Hall says:

      @pmoran,

      I don’t think we skeptics usually see sinister forces behind sCAM. I mostly see wishful thinking and a lack of critical thinking skills.

  16. nybgrus says:

    train therapy arises because of ignorance and lack of resources (desperation), pmoran.

    In the US (and developed world in general) we still have the ignorance, we have some lack of resources, but we also have the marketing and “deluded geniuses” and a business model.

    You keep wanting to look deeper because you arent satisfied with that answer, yet you have offered nothing further except that “we need to look a bit deeper”

  17. JPZ says:

    @David Gorski

    Would you prefer that CAM research were funded by those profiting from its use rather than a government agency subject to congressional oversight (Harkin and Hatch have to make deals with their many colleagues – they are not omnipotent)? It may not be perfect because NCCAM has to serve so many masters, but there is accountability.

    I get your point that CAM is re-branding as IM. How about you provide ideas and direction as to how to confront this re-branding? And I ask for something more specific than saying “evidence.” Whom should we contact? How should we approach administrators of medical schools? Are there congressional representative who are open to this issue? Should we scream at street corners for hours on end? Or are you just (figuratively) pissing in the wind?

    Considering that I can’t get a scientific debate about nutritional products on SBM, I don’t know what to expect from logic and reason about this issue.

  18. pmoran says:

    Harriet:I don’t think we skeptics usually see sinister forces behind sCAM. I mostly see wishful thinking and a lack of critical thinking skills

    So commonly used constructions like “sCAM” and “$CAM” are not meant to imply the intent to defraud?

    We are not likely to dissipate wishful thinking any time soon, and I don’t believe education in critical thinking provides a practical answer to anything, no matter how often some skeptics may say so. At least there is no evidence that it will, and some against, including, very tellingly, how some aspects of CAM have eased themselves into academia and once sacrosanct scientific literature.

    So here is what I consider we are really mainly up against –

    1. Unmet medical needs including aspirations towards better health and longevity, aroused in part by the early successes of emergent medical science.

    2. The almost irresistible power of the personal testimonial.

    3. A preparedness to try treatments out without committing to a scientific judgment. The “nothing is true until it has been shown to be true” approach of science is irrelevant to persons who don’t care that a treatment might not work for them, being prepared to try it and find out for themselves.

    3. Loss of trust in the medical profession and in scientists generally.

    There are other minor threads. I do observe more people in the US saying that they seeking alternatives because they cannot afford a doctor.

    The first two are all that is needed to sustain “alternative” medicine, independently of anything else.

  19. Harriet Hall says:

    @pmoran,

    I personally don’t use SCAM to mean necessarily deliberate fraud, but to signify that both the users and the providers are deceiving themselves and have been “scammed” by false ideas. Rose Shapiro called her book about CAM “Suckers”to mean exactly that.

    “I don’t believe education in critical thinking provides a practical answer to anything,”

    I must disagree. Critical thinking is the only answer – we are programmed by evolution to make errors like post hoc ergo propter hoc, valuing testimonials over evidence, being swayed by emotion, and “trying things for ourselves.” Critical thinking, in science and in all other fields, is the only corrective.

    I’m not sure the motivations you describe are accurate. Many of those using CAM are well able to afford mainstream medical care and are using CAM in addition to it. Many are using CAM when mainstream medicine would actually meet their real needs much better. Educated people are using it because of misinformation and the misperception that it is somehow superior. Loss of trust in science and the medical profession is often due to misunderstanding, and it is not rational to place more trust in sources that are even less deserving of trust.

    I don’t imagine that anything could ever abolish CAM, but making accurate information available (through SBM and other efforts) and education in critical thinking skills are the only way to reduce its influence.

  20. Mojo says:

    @JPZ

    Would you prefer that CAM research were funded by those profiting from its use rather than a government agency…

    I can’t speak for Dr. Gorski, but I would certainly prefer CAM to fund its own research rather than wasting taxpayers’ money on it.

  21. Nate Dogg says:

    Removing NCCAM would also deny CAM the “Funded by the NIH!” imprimatur of respectability it can currently attach to its research.

    Personally I’m hoping that the impending budget crunch to NIH resulting from the debt ceiling bill will spell the death of NCCAM.

    I always hate to see research defunded, but getting rid of NCCAM would at least be a silver lining.

  22. pmoran says:

    Harriet:I’m not sure the motivations you describe are accurate. Many of those using CAM are well able to afford mainstream medical care and are using CAM in addition to it.

    Why, if the mainstream care is proving adequate?

    I have commented on critical thinking under the next blog post.

    I fully agree that faulty perceptions facilitate CAM use but it is rare for them not to have some foundation in fact.

    For example effective drugs are regrettably prone to side effects. “Alternative” methods are generally safer, precisely because most of them don’t do anything, beyond placebo. Yet with many very common minor conditions outcomes are going to be much the same with either except that fewer patients will experience drug side effects with CAM.

    Is that bad? Those with unsatisfactory outcomes still have the drug option.

    Medicine is a complicated field. We should be wary of the assumption that it would be an unqualified good thing if mainstream medical care was all that was available.

    As you say, that will never happen, or at least until in the mainstream has entirely effective and safe treatments for everything.

    I am suggesting that we concentrate on trying to keep people safe. We cannot controleveryone, or their thinking, even if we tried.

  23. Harriet Hall says:

    @pmoran,

    “Why, if the mainstream care is proving adequate?”
    That’s a disingenuous question. You and I both know that modern medicine can’t cure every disease or eliminate every symptom, and that some doctors have a poor bedside manner. Patients are given false hope by CAM hype. We should aspire to do a better job of providing realistic hope with science, not to condone or encourage untested treatments.

    “I am suggesting that we concentrate on trying to keep people safe”

    I am suggesting that offering them untested treatments is not the best way to keep them safe.

    You come across as supporting science to a certain point and then being willing to discard it in favor of anything that you think “might” make patients “feel better” if only temporarily or illusorily. You are trying to wear two hats, and the second one is not worthy of you. I don’t know how you think your comments should be perceived, but you are starting to sound like an apologist for non-scientific medicine or a doctor-bashing troll.

  24. rlquinn1980 says:

    I don’t like scary stories. Please don’t read that one again.

  25. JPZ
    “Should we scream at street corners for hours on end? Or are you just (figuratively) pissing in the wind?”

    Boy, am I glad that you were clear on that being figurative… :)

  26. David Gorski “The terms “CAM” and “integrative medicine” are not serious, sober names for a serious, sober, science-based specialty.”

    I hate to tell you this, but choosing a serious and sober name for a science-based specialty is also branding. You are just communicating a different image.

    Speaking with my creative director’s hat on… In today’s world everything for sale is a brand, the only difference is whether you are controlling your brand or whether you are just letting your brand happen.

    If science based medicine’s advocates think they are above branding their services, then the brand will just happen, willy nilly, perhaps with undesirable results.

    I think it’s perfectly honorable to look at the services you are selling, organize why you think the buyer needs and/or will like your services, then use language and images to communicate those thoughts in a memorable and cohesive way. That is branding.

    Now spin, that is different than branding and often not honorable.

  27. JPZ says:

    @micheleinmichigan

    Excellent point! How many hospitals nowadays are selling themselves based on their “Women’s Centre” or “Heart Clinic” or other branding? Some of these may indeed have the top OB/GYNs or cardiologists in the region, but, even if they don’t, it is a form of branding to bring in more revenue.

    Even top medical schools (like Yale) go out of their way to promote research results and new techniques to support the brand of “Yale.” These can even contain considerable spin. Last year I was asked by management to look into a study that media reports said linked one of our products with a major disease outcome. I found out that the Public Affairs office of the medical school that did the research was the source of the spin (and yes, it was a top-ranked medical school). The researchers had studied an in vitro mechanism of disease using a form of our product, and the scientists mentioned the various diseases to which the mechanism applies in a press conference. The headline in the university press release was along the lines of, “X product does Y to disease Z.” I wonder how many patients were mislead by that press release.

    I am not saying that university press offices are doing anything wrong, it is just that many of them are doing exactly what David is attacking. It is branding, just like you said, Michele.

  28. JPZ says:

    @Mojo

    That is a fair statement. But, would you (or others here – no need to speak for them) then criticize the results for being the biased product of commercialism? I have seen groups (e.g. CSPI) criticize good-quality science for the sole reason that it was funded by industry. One can see government funding of CAM research as a smoke-screen to give CAM legitimacy, or one can see it as a way to test CAM assumptions (note: I have criticized NCCAM here before for not drawing conclusions about ineffective CAM treatments – so, they could do a much better job).

  29. nybgrus says:

    @JPZ:

    Recently on the 1st year facebook group at my medical school, someone popped up an article and an immediate comment was that the study must be biased because they had a COI – namely, the active and placebo forms of the supplement they were testing were supplied for free to the researchers by the manufacturer. Before I had a chance to say anything there were about 6 or 7 back-and-forths about it. I jumped in and said ” I havent read the paper yet (I will soon), but on the topic of COI, there will always be times when someone has some sort of COI. If the COI is not declared at all, then that should REALLY raise eyebrows. If it is declared, it should make you a bit more wary, but it doesn’t necessarily mean the study or data aren’t good. I’ll see what the actual article says….” in response to a comment by another student “Well it’s not so much a recognised conflict of interest (which your latter example would be) as a matter of scientific integrity. They *could* have paid for the pills, but they didn’t. There’s no such thing as a free lunch.”

    Clearly, I think that just because something comes from a party with vested interest, it doesn’t necessitate that the study will be bad. But it should raise your eyebrows and motivate you to make extra sure. That is the way it should be – if the data is good, then it is good. The problem is that we are seeing people unwilling to call bad data bad.

  30. JPZ says:

    @nybgrus

    I was on the Editorial Board of a journal in my field. I fear that I was rather harsh on authors from industry who did not declare that as a COI. Largely, these were high quality papers, but they needed to be clear that their employers may benefit from the publication of these studies. My POV was that good data should be judged on its own merits.

  31. nybgrus says:

    @JPZ:

    From our interactions to date, I’d reckon you were probably just harsh enough ;-)

    Good data should always be judged on its merits, but if you knowingly omit declaring a COI that makes me very suspect. As you undoubtedly well know, there are myriad ways to fudge data and if you give me reason to think you were underhanded on one aspect I am forced to think you may have been underhanded somewhere else and even if you have very good data, the impact factor of the study immediately drops. But that is also why I will fiercely defend a good paper with properly declared COIs and why I would also defend a good paper if there was a legitimate reason why a COI may have not been declared (though these would be few and far between, especially in higher impact journals).

  32. WilliamLawrenceUtridge says:

    Dr. Gorski, responding to a comment from the 15th, I think there’s tremendous value in repetition, particularly repetition that is brief and includes weblinks. Decisions and information based on “I-heard-it-on-the-news” tend to build up due to repetition of short bits of information with no context – akin to slogans and catch phrases. Consistently repeating things like “it doesn’t matter where you put the needle, it doesn’t matter whether you use needles, it doesn’t matter if you use toothpicks” get at the core of the issues. I think your pithy intro summaries are valuable to new readers and fence-sitters. A skeptic may find it repetetive, but a skeptic only needs to read a well-reasoned, empirical argument once to modify their opinion (either incrementally or wholesale). It’s the naively open-minded who need the repetition, and sometimes simple repeitition will slowly open a mind.

    I mean sure, if they don’t click on the underlying links it’s basically just a propaganda poster sans the picture, but as long as you’ve got those links then you’re being honest, transparent and informative.

  33. Simmerja says:

    @nybgrus

    I’m also a medical student, starting my second year now and continuing to be amazed/dismayed by the ignorance/credulity of many of my peers…been considering using some of my copious spare time this year to start some kind of organized skeptical outreach campaign. Or something – any ideas or guidelines from your experience I’d love to hear.

  34. nybgrus says:

    @ Simmerja:

    You have copious free time? lol… I kid.

    I actually do have copious free time but I spend it representing the academic needs of my cohort to the faculty and designing, implementing, and teaching academic material to the 1st year students.

    I’ve been wanting to organize a sort of CAM symposium for students that would give people the history of and low-down on CAM (i.e. make sure they know about the branding, “integration,” that acupuncture is NOT a millenia old tradition, and what homeopathy actually is). It is tough getting something off the ground though. But I end up posting up stuff and ruffling a few feathers… then people get annoyed and think I am wrong… and then want to meet up with me to prove it to me. I have yet to have anyone leave such a meet-up without being convinced their stance was poorly informed and incorrect.

    PM me on reddit and we can go from there if you are keen.

  35. Artour says:

    In my view, the real integrative medicine, as well as CAM therapy, is breathing retraining. Chronic diseases are based on low oxygen levels in body cells. Consider, this statement:
    “All chronic pain, suffering and diseases are caused from a lack of oxygen at the cell level.”
    Prof. Arthur C. Guyton, MD, The Textbook of Medical Physiology*

    * World’s most widely used medical textbook of any kind
    * World’s best-selling physiology book

    We can add here another piece of knowledge or this Table that shows that sick people MUST have low oxygen levels in cells since they breathe about 2-3 times more air at rest than the norms (or healthy people):
    http://www.normalbreathing.com/buteyko.php

    I claim that respiration or our outer breathing is the integrative feedback system that reflects human health. It intensifies when there is anything abnormal (stress, strong emotions, overeating, overheating, sleep, supine sleep, mouth breathing, poor posture, lack of essential nutrients, and so forth). Breathing can also get lighter and slower when we do smart things, like exercise with nose breathing only, eating only when really hungry, straight spine 24/7, reason and forgiveness, and many others.

  36. Harriet Hall says:

    Don’t feed the troll.

  37. David Gorski says:

    Personally I’m hoping that the impending budget crunch to NIH resulting from the debt ceiling bill will spell the death of NCCAM.
    I always hate to see research defunded, but getting rid of NCCAM would at least be a silver lining.

    Unfortunately, defunding NCCAM is very unlikely ever to happen, no matter how bad the budget situation gets. And it’s bad; I have a friend being considered for an NIH job, and he tells me that there is a distinct possibility that there will be an NIH-wide hiring freeze on all positions for FY2012, meaning that he needs to be hired by the end of September or he’s SOL. There’s already a hiring freeze for laboratory positions at the NIH.

    In any case, Tom Harkin and Orrin Hatch are powerful patrons of NCCAM in the Senate, particularly Tom Harkin, who more than anyone else is responsible for the creation of NCCAM. They will protect NCCAM, no matter what is happening with the NIH budget. Given that NCCAM is less than 1% of the NIH budget, it won’t be hard to protect, either.

  38. I’m very jaded. And for this reason, I believe that people cannot be changed and stuff like “CAM” will always be around, and people will always fall for it.

    I’m also logical. And for this reason, I observe that there are people who don’t think mechanistically and tend to be attracted to anti-intellectual movements that encourage belief-based decision making and emotional reactions to life. These people will always like CAM better than reality. These are also people who like things like religion and it’s secular non-Jesusy alternative — new age thought.

    Education does little for these people, because any appeal to fact and reason will not resonate with them. It is not how their brains happen to work. You have to communicate with them through belief and emotion because that is how they originally arrived at their current worldview.

    On the other hand, education does a great deal for someone who thinks logically but has been lead astray by alternative medicine because of the compelling nature of false hope. Personal struggles can bring even the most rational person to their knees. Rational thinkers have the ability to consider sound arguments and the humility to change their worldview if new experiences refute previous ones. This blog reaches those types of people quite effectively.

    So what I’m saying is, the people who are going to see reason will see it eventually, and the ones who won’t won’t.

Comments are closed.