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Integrative Medicine – Sectarians’ Trojan Horse

Integrative Medicine – Sectarians’ Trojan Horse leapfrogs science (Or, I can misuse language with the best of them…)

I stumbled across an article from Archives of Internal Medicine, 2002 (Integrative Medicine: Bringing medicine back to its roots. Arch Intern Med. 2002 Feb 25;162(4):395-7). It is one of the first authored by Andrew Weil on “Integrative Medicine “ – another is BMJ in 2001. This one he co-authored with Ralph Snyderman. Dr. Snyderman was dean of the Duke University med school, and is now upstairs as a chancellor of health affairs. He is one of the highest ranking academicians to express fondness for sectarian systems (they prefer “Integrative Medicine.”) Fondness in his case is an understatement. He appears to have fallen up to his frown into the sectarian vat and emerged transformed as the poster-prof for the Bravewell Collaboration, funding organization for the 36 departments and programs in US medical schools. Andrew Weil, of course is one of the prime movers of the “CAM” phenomenon, and may have invented the neo-term, “Integrative” – with the clever occult purpose of diverting attention away from plausibility and toward acceptance according to our suggested motto, “teach it and use it regardless of efficacy.“ He directs this activity from his spread near Tucson, where he also heads the U. of Arizona “integrative” program.

I experienced several problems on reading the article – mainly a cloud of dysphoria and a sense that of disagreement with it, but through a fog of obscure language, I could not identify why. One has to look closely at the language. The abstract alone yields enough for this entry. It displays language distortion by re-definition, as Kim Atwood recently explored, language obscurantism – use of generalizations and words with obscure or multiple meanings, and invented language. It also mis-states, misrepresents, assumes; these are established propaganda techniques and used to construct false labels on sectarianism’s Trojan Horse. After starting this I found a similar article by Edzard Ernst in Mayo Clinic Proceedings in 1993. Nothing new under the sun…

One might also look at the personalities of these two authors who keep the drum-beats of the movement going. I’ve not met Dr. Snyderman, but just observed some of his TV clips. He seems to have few doubts if any about the necessity for a revolutionary change in medicine. I shared a podium with Dr. Weil at a national meeting once, but again, know him mostly through his books, newsletter, and TV fund-raising ads on Public Television. And through the description by Arnold Relman MD (Stoned Thinking.)

I got some enjoyment from “deconstructing” the language of this Archives article, written soon after the appearance of “integrative” in literature. “Integrative” by the way, is now the official term adopted by several medical school departments or sections formerly called “CAM,” including UC San Francisco, and for the “New Medicine” promoted by the Bravewell Collaborative. Take a quick read of the abstract.

ABSTRACT The United States health system is in crisis. Amidst unprecedented opportunities to transform healthcare for the better, American medicine faces threats from two directions. One is financial and cannot be solved by the profession alone. Health care technologies are more expensive, more people want access to them, and reimbursement mechanisms neither provide universal coverage nor reward improved care or prospective planning.The second threat is intrinsic to our practice and must be solved from within. Facing the pressures of economic and bureaucratic strains as well as the seduction of technology, conventional medicine has become separated from its roots of caring, engaging with patients and meeting their real needs. This has caused many to seek alternative approaches. Integrative medicine is a movement that addresses this latter threat by retraining physicians to understand their roles as healers. To do this they must incorporate the best of science and technology with the appropriate use of complementary approaches, always remaining mindful of the centrality of the therapeutic relationship and the healing power of nature. Through its focus on health prevention, and meaningful physician-patient relationships, the Integrative Medicine movement can improve health care and the quality of medical practice, and perhaps reduce health care costs as well. In our view, it is essential that the leaders of American medicine consider adapting medical education to encompass the principles inherent in Integrative Medicine.

Let’s take a closer look:

“The United States health system is in crisis.” This proclamation has been posted for so long and so frequently without anything actually occurring, that it has become a non-sequitur. A crisis, according to Dictionary.com is,1. A stage of instability of events at which the trend of all future events, … is determined; a turning point. 2. A condition of instability or danger…leading to a decisive change 3. A dramatic or circumstantial upheaval in …life.

I disagree that medicine is in crisis – a state that critics maintain has been present for at least 40 years. Describing that as a crisis requires a re-definition of the word. Occurrence and persistence of defects in a system do not define the system as being in a crisis. During the past century, revolutionary advances brought through basic and applied science have changed medicine – for the better – we would not agree the system is in crisis. Yet people who stand to benefit from the concept continue to use it and many of the public and the press go along. The fact is that if a society is free from stultifying regulation, a certain degree of chaos results with swings in popularity and efficiency – yet, overall, a free system controlled mostly by voluntary ethical codes probably works more effectively and with less dissatisfaction than whatever regulatory system is proposed by critics. In this case, the authors’ proposal to correct their perceived “crisis” through understanding and empathy and use of ineffective sectarian methods would convince only true believers.

It continues:

Amidst unprecedented opportunities to transform healthcare for the better, American medicine faces threats from two directions. One is financial and cannot be solved by the profession alone. Health care technologies are more expensive, more people want access to them, and reimbursement mechanisms neither provide universal coverage nor reward improved care or prospective planning.

In the first sentence, the two ideas – opportunities to transform and the concept of threats to medicine are unconnected. What follows does not help to connect them, because 1) return to folkway and sectarian medical methods will not replace applied science and technology, and 2) countering threats or correcting deficits does not necessarily imply transformation – a rather radical concept that just happens to fit what the authors have in mind. That medical care (“health care” as they prefer to call it) is expensive is true, but that is largely due to increased technology, increased number and skill required of professional and support personnel, and the explosive changes brought through scientific research. The authors admit this in what follows, but neither they nor others show that expense or lack of coverage cause people to “seek alternative approaches,” nor will they show that their revolution would fix the problems. Most who “seek” have higher incomes or are well covered by insurance. Not mentioned is that sectarian followers share their leaders’ anti-scientific, anti-authoritarian views that shape their decisions. [My original interest in this began with interviews of 33 Laetrile-taking cancer patients, all of whom shared resentments against medicine and physicians that antedated their involvement in that quackery.] Involvement in sectarian systems is cult-like behavior.

“Health Care” has replaced medical care in many descriptions. A probable reason is that “medical care” implies physician-run or physician-performed care, while “health” opens the discussion and available roles to non-physicians. We found this in a recent survey of journal editors – nursing journal editors avoiding the term “medical“ entirely, even when in “Alternative and Complementary Medicine,“ preferring the term, “Alternative and Complementary Health…” I had wondered in passing about the popularity of “health care” but had not known it was specifically substituted for ideological, professional and perhaps turf-motivated reasons.

And then, “…universal coverage,… improved care, [and] prospective planning…“ seem to have little or nothing to do with ‘integrative medicine’ or whatever that means to the authors. They seem to be basic and reasonable enough. The abstract continues:

The second threat is intrinsic to our practice and must be solved from within. Facing the pressures of economic and bureaucratic strains as well as the seduction of technology, conventional medicine has become separated from its roots of caring, engaging with patients and meeting their real needs.

Note the wording. The authors use the first person plural possessive, “our” , inserting themselves into the mainstream of internist readers. Thus, the actual creators of the problem, the cultist and sectarian proponents, now complete the Trojan Horse entry into Fortress Medicine by assuming to be “one of us”, rather than being the outlying sectarian ideologues they are. From that position they offer their expertise and aid, as “all of us” solve the problem through the “New Medicine” they promote. [The New Medicine was the title of last year‘s Bravewell-sponsored several hour program on “Integrative Medicine“ on Public Television.]

Then comes the trite but never proved generalization that “conventional medicine has become separated from its roots of caring …etc”. First, “conventional” medicine is one of the ten or so original derogatory adjectives ideologues use to isolate medicine from its universality of science-based knowledge and ethically-based practice and to demean its stature, while allowing sectarian systems to be described as simply “unconventional” – the preferred term for the Congress-directed, Office of Technology Assessment, 1989 report on obstructions to acceptance of quack cancer cures.

Second, the “separation” generalization draws a mental picture of all physicians as a helpless, mythical, synthetic mass of cold, uncaring and hapless technology geeks. The power of one or two words, incorporated. Ask most docs and they will complain about scheduled time requirements, but few of them feel sacrificed to a life of unfeeling. It continues:

This has caused many to seek alternative approaches. Integrative medicine is a movement that addresses this latter threat by retraining physicians to understand their roles as healers. To do this they must incorporate the best of science and technology with the appropriate use of complementary approaches, always remaining mindful of the centrality of the therapeutic relationship and the healing power of nature. Through its focus on health prevention, and meaningful physician-patient relationships, the Integrative Medicine movement can improve health care and the quality of medical practice, and perhaps reduce health care costs as well. In our view, it is essential that the leaders of American medicine consider adapting medical education to encompass the principles inherent in Integrative Medicine.

Here they begin rubbing our wounds with insulting salt solutions conceived by ideologues of the anti-scientific Left. (Some might call it the Right, and I‘ll buy that, also) More: The solution of “retraining physicians” implies admission that Snyderman and colleagues failed to educate us. But of course he did not admit it. Nor could Weil, even though he is now part of “we” and assumed to be just as deficient in human qualities.

Even more prospects crouch in these wordings and in their minds. “Integrative Medicine will solve the threat of inhumanity by retraining physicians to understand their roles as healers.” How insulting and demeaning and arrogant! Yet their advocates and followers accuse physicians of arrogance. The clear definition of chutzpah.

Not only does this preposterous proposal imply changing our standards of behavior (our ethics), but also introduction of a coercive set of standards for “feeling.“ In other words, what Snyderman, Weil, and Bravewell think is that they have discovered the secrets of sensitivity and of being human, but that they will now bring courses of indoctrination of how to feel and how to relate.

Think about it. Oh, the chutzpah. Here are two people with MD’s after their names, one who never practiced, and another who spent his life in academic medicine, removed from primary responsibility, neither one responding to middle of the night phone and emergency calls, house calls on the sick and dying, and ministering to the bereaved. They have discovered the answer to being human, and want to bring their utopian concepts to the rest of “us.“

We already have such arrogance thrust on physicians through legislatively directed requirements of specific post-grad education hours in geriatrics, pain relief, and other legislatively perceived deficiencies. At age 70, I was required to sit through hours of instruction in the care of patients over 60.

More recently we hear calls for re-education in “cultural competence” in a nation with immigrants from scores of differing nations and cultures – as though it were possible even if that competence were ever defined. And, without courses for immigrant patients on how to relate to American physicians and the medical system, as if we bear the responsibility for educating ourselves for every group deciding to immigrate here. In other circumstances and other countries such activity this has been called anything from state coercion to tyranny. Re-education. Doesn’t that have a familiar ring to it? The intent and the inevitable conclusions are obvious and inescapable. Revolutionary. And we are supposed to take our behavior orders from these two and their cultist followers? And just how did reviewers and editors allow publication of such arrogant nonsense? I have yet to touch on the claim that “…Integrative Medicine can improve health care and the quality of medical practice, and perhaps reduce health care costs as well.“ I don’t have to at this point. We could wait for the evidence, right? Don’t they admit that their “IM” includes only the best and most effective of the “alternatives”? Hey, there’s a lot more buried in this paper, but I am out of steam, time, and your patience. You get the point. I’ll deconstruct more in a few weeks. Meanwhile, my resentment may increase.

Posted in: General, Medical Academia, Politics and Regulation, Science and Medicine

Leave a Comment (13) ↓

13 thoughts on “Integrative Medicine – Sectarians’ Trojan Horse

  1. Harriet Hall says:

    The underlying complaint seems to be “my scientifically oriented doctor wasn’t nice to me.”

    The rational response: Let’s encourage scientifically oriented doctors to be nicer, while simultaneously educating patients that niceness doesn’t equate to efficacy.

    The irrational response: Let’s welcome quackery into health care because quacks are nice to patients.

  2. David Gorski says:

    The irrational response: Let’s welcome quackery into health care because quacks are nice to patients.

    Actually, that’s often not true. Look at the case of Rashid Buttar, for instance. He was most definitely not nice to a lot of his patients. He never saw them and rarely returned their calls, leaving it to his nurse-assistant to do. He charged them huge amounts of money, and when his patients couldn’t pay he sicced collection agencies on them, sometimes even going after the estates of patients who had died. Perhaps he was nice to patients whom he actually saw on their first visit, but a lot of his behavior was even worse than the worst stories we hear about overburdened and seemingly uncaring “conventional doctors.”

  3. qetzal says:

    Which article are you excerpting here?

    The Arch Intern Med link seems to be broken, but when I go to the journal’s website and pull it up here, it doesn’t match any of your quoted material.

  4. Harriet Hall says:

    “Actually, that’s often not true.”
    It’s not often true that scientific doctors aren’t nice to patients either. We’re dealing with perceptions and beliefs, not objective truths.

  5. sashen says:

    “…centrality of the therapeutic relationship” = placebo effects.

    “… and the healing power of nature.” = uh, well, no clue here.

    I’m assuming the “nature” this phrase refers to is NOT the collection pharmaceutical compounds isolated by diligent scientific research.

  6. weing says:

    The Archives editors were clearly not on the ball by letting this crap through. They should have insisted that the only acceptable descriptors of medicine be either professional medicine, legitimate medicine, evidence or science based medicine and not conventional medicine. We have to stop letting these quacks define us. I suppose most of us are too busy practicing professional medicine to point this out, but I would expect the editors to be doing their jobs.

  7. pmoran says:

    Sashen > “…centrality of the therapeutic relationship” = placebo effects.

    Yes, Andrew Weil even allows this, when not speaking in code.

    http://www.drredwood.com/interviews/weil.shtml

    Quote –

    “I still think that placebos are really the meat of healing interactions. They are examples of pure healing responses from within that are triggered through the mind by belief. The mind is only on avenue to the healing system, but it’s a very interesting one and the advantage of it is that it requires little external paraphernalia, and there’s no [side effect of] toxicity involved. So I think the placebo response is the greatest ally that a practitioner has, and that the best kind of medicine is that which elicits the maximum placebo response with a minimum direct impact on the physical body. So I’m a big fan of placebo response, and I really try to get people to think differently about them”

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