Articles

Integrative Medicine’s Collateral Damage

Integrative medicine combines the practice of medicine with alternative medicine. Proponents tend to take a paragraph or two to say this, but that is what remains when boiled down to its essence. By putting this more concise definition together with Tim Minchin’s often-quoted observation about alternative medicine, you get: integrative medicine is the practice of medicine combined with medicine that either has not been proved to work or proved not to work. If it is proved to work, it is medicine.

I couldn’t find an official start date for integrative medicine, but it seems to have been around for about 15-20 years. (Osher Center for Integrative Medicine at the University of California, San Francisco, an early adapter, opened in 1997.) Yet despite some lofty pronouncements about transforming patient care, there is still no good evidence that integrative medicine improves patient outcomes. It seems unlikely that such evidence is forthcoming. It is illogical to assume that adding therapies that do not work, or are proven not to work, would benefit a patient except by inducing the ethically problematic placebo response.

Whatever its goals initially, integrative medicine now appears to serve two purposes. First, it attracts funding from wealthy patrons (Samueli, Bravewell) and the government (the military, NCCAM). Second, it is a marketing device used by hospitals, academic medical centers and individual practitioners. As an added bonus, alternative medicine is usually fee-for-service because very little of it is covered by insurance. And whatever its charms as a money-making device, given the lack of proven health benefit it is fair to ask: is integrative medicine worth it? To answer that question, let us look at what might be called the supply side of integrative medicine practitioners’ delivery of alternative medicine. Here we run into some unpleasant facts proponents seem unwilling to acknowledge: integrative medicine’s collateral damage. The alternative medicine services and products offered by integrative medicine practitioners do not exist in a vacuum. They are supplied by chiropractors, naturopaths, acupuncturists, and reiki masters, among others. They include dietary supplements, botanicals and homeopathic remedies. Let’s look at just a few of the less savory aspects of these practices and products we’ve discussed at SBM. (SBM devotees can skip this part. You’ve heard it all before.)

Chiropractic

Chiropractors purport to diagnose and treat imaginary subluxations. They claim they can treat asthma, allergies, ADHD, menstrual problems, endocrine disorders, and a host of other conditions and attract patients with practice-building schemes. They also promote the idea that they are primary care physicians able to diagnose and treat the general population, including children. (A claim convincingly refuted by one of their own studies.) Their use of disproven diagnostic techniques and treatments is well-documented: applied kinesiology, cranial sacral therapy, and machines which purport to detect nutritional deficiencies, to name a few. Their disproven treatments can cause stroke and death although there is no systematic data collection, so the real incidence is unknown. Many chiropractors are anti-vaccination.

Naturopathy

Naturopathy is simply a collection of treatments, not a systematic approach to human health. As he has done before, David Gorski summarized naturopathy practice nicely just last week:

The problem with naturopathy, of course, is that it is so diffuse and encompasses so many different forms of quackery that it’s hard to categorize. Basically, it’s anything that can be portrayed as “natural,” be it traditional Chinese medicine, homeopathy (which is an integral component of naturopathy, something that should tell you all you need to know about naturopathy), herbalism, energy healing, Ayurvedic medicine, the four humors, or whatever. Add to that a number of bogus diagnostic modalities, such as applied kinesiology, live blood cell analysis, iridology, tests for imaginary “food allergies” and “nutrient deficiencies” that conventional medicine doesn’t recognize, plus an overwhelming emphasis on purging the body of “toxins,” unnamed and named but all unvalidated by science, and it rapidly becomes apparent that naturopathy is a veritable cornucopia of pseudoscience and quackery. Seemingly, there is no quackery that naturopathy does not credulously embrace . . . Basically, naturopathy is a hodge-podge of quackery mixed with science-based modalities magically “rebranded” as “alternative” and “natural.” In that, naturopathy is the ultimate in “integrative medicine,” in which quackery is “integrated” with science-based medicine.

Naturopaths have simply invented diseases to treat, use bogus diagnostic methods and are anti-vaccination. Naturopathic care is associated with worse outcomes and you needn’t look any further than David Gorski’s post on Tuesday to see the horrible consequences of their practices. Yet they are making a huge effort to become licensed primary care physicians in all 50 states, with the same scope of practice as M.D. and D.O. primary care physicians. Like chiropractic, there is anecdotal evidence that their treatments can cause injury and death, although their failure to systematically collect data means the true incidence is unknown.

Acupuncture

Acupuncture is an elaborate placebo although proponents continuously attempt to portray it otherwise. It is based on the pre-scientific notion that energy (or “qi”) flows through the body which, when blocked, causes health problems. Unblocking this energy with needles supposedly restores the proper flow. None of this has any plausible basis in human physiology. Acupuncturists, like chiropractors and naturopaths, use bogus diagnostic devices, as well as offering iridology, Kirlian photography and other disproven methods. Again, there is anecdotal evidence of harm cause by acupuncture but the true incidence is unknown because of lack of data collection.

Dietary supplements and homeopathy

The extremely lucrative dietary supplement industry refuses to reveal its effectiveness and safety research to the public and fights all efforts to make it do so. It opposes government funding of additional safety research. Homeopathy is nothing more than fraud and unregulated fraud at that. The federal government has defaulted to a private agency run by homeopaths to police its own industry. Two medical toxicology organizations recently stated, flat out, that no one should take dietary supplements, botanicals or homeopathic products, a warning that will no doubt be ignored by alternative medicine providers because evidence of safety or effectiveness is not a requisite for their practices.

“Mind and body” practices

Favorite offerings of integrative medicine centers include “energy medicine” techniques like reiki, reflexology and cranial sacral therapy. None of these have any plausible basis in human physiology. All have been studied in clinical trials and none perform any better than placebo.

In sum, alternative medicine practitioners regularly take patients’ money for treatments we know are ineffective, unsafe or both. They diagnose conditions we know don’t exist using bogus diagnostic methods. Alternative medicine injures and even kills patients with treatments that provide no benefit. And practitioners spread anti-vaccination misinformation, even to the point of supporting anti-vaccination organizations.

Alternative medicine doesn’t exist for the convenience of integrative medicine. Nor could it. Providing the limited supply of alternative medicine used by integrative medicine practitioners is not an economically sustainable model. The sole purpose of alternative medicine is to put into practice its varied (and conflicting) philosophies and to make money doing so. Alternative medicine schools don’t send their graduates out into the world to become handmaidens to integrative medicine practitioners. And alternative medicine practitioners aren’t going to stand for some role subordinate to medical doctors, limited in their practices to what integrative physicians think they should be doing. In fact, alternative medicine practitioners regularly denigrate medical doctors. Nor do dietary supplement and homeopathic remedy manufacturers make products for consumption on the recommendation of integrative medicine practitioners. They make products to sell to the public and they want to make as much money as possible, often without regard to whether their products are effective and, for some, without regard for safety.

I have to assume that even the most devoted integrative medicine practitioner would not endorse much of what their compatriots in the alternative medicine field do, if they bothered to research the subject. I hope I am right. (If not, integrative medicine is an even bigger problem than we thought.) Yet by incorporating alternative medicine providers and products into their practices, integrative medicine must face the fact that it is supporting alternative medicine in all its guises – the quackery, the deceit, the wasted money, the injury and death. The naturopaths employed by Cancer Treatment Centers of America come from the same system that produces the naturopath who treats Chris Wark. The chiropractors employed by CTCA come from the same schools that educated the chiropractors who misinform patients about the safety and efficacy of vaccinations. And these practitioners aren’t outliers. They are part of the mainstream. The treatments employed by Wark’s naturopath are standard naturopathic treatments. Neither the American Chiropractic Association nor the International Chiropractic Association, the two main chiropractic trade associations, endorses the CDC vaccination schedule for patients. Two chiropractic organizations actually support the notoriously anti-vaccination National Vaccine Information Center. (Or, as we prefer to call it, the National Vaccine (Mis)Information Center.)

Integrative medicine helps keep this entire alternative medicine enterprise afloat. It’s reminiscent of that saying about women (or men, depending on your perspective): “you can’t live with them but you can’t live without them.” Integrative medicine practitioners cannot endorse much of what alternative medicine practitioners do, but they can’t live without them either. Integrative medicine’s defense would no doubt be that it is actually helping patients navigate this world of snake oil, quackery and pseudoscience by vetting alternative medicine and delivering only the “best” to patients, even if it is admittedly unproven or disproven. But that doesn’t let them off the hook. That excuse is no different from an art museum admitting it buys from art thieves but defending itself by saying it buys only the best of what they have to offer. It is the same as the fashion and computer retailers who turn blind eye to the appalling conditions under which their products are manufactured.

So let’s return to the question: is integrative medicine worth it? Is it worth the collateral damage? It certainly appears to benefit a limited segment of the medical industry when employed as a marketing device or to attract funding. To my mind, that hardly outweighs the harm, especially without any demonstrated improvement in patients’ health. Perhaps integrative medicine can make the case that somehow these financial benefits outweigh the damage. A good start would be by addressing the issue at all.

Posted in: Acupuncture, Chiropractic, Energy Medicine, Herbs & Supplements, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Traditional Chinese Medicine, Vaccines

Leave a Comment (43) ↓

43 thoughts on “Integrative Medicine’s Collateral Damage

  1. FastBuckArtist says:

    Our resident lawyer is on another anti-integration rant I see…

    In other health news, US autism rates rose 78% between 2004 and 2008, mirroring a rise in consumption of prescription drugs.

    1. WilliamLawrenceUtridge says:

      Our resident lawyer is on another anti-integration rant I see…

      Our resident parasitic homeopath on another “oh, the perils of science” rant I see. Rather than indulging in an ad hominem attack on Ms. Bellamy’s heavily linked discussion of the perils of integrative medicine, why not add something of substance? Because otherwise it looks like you’re trying to be the first comment in order to discount the topic without having read it. Why does inegrating CAM make sense when so much of it is unproven? Where is the proof it improves patient outcomes? Not just patient satisfaction, which could be improved by funding longer appointment times with real doctors or a realistic health care system – real patient outcomes. Reduced morbidity and mortality. Fewer deaths and less misery. Where’s the proof beyond made-up testimonials by the very people who profit from making them up?

      In other health news, US autism rates rose 78% between 2004 and 2008, mirroring a rise in consumption of prescription drugs.

      So what, given the changes to the autistic diagnostic categories and the preference given to the diagnosis due to the increased resources available to patients with said diagnosis? You know what else increased between 2004 and 2008? Advertising for and promotion of alternative medicine. Perhaps all those homeopaths, naturopaths and chiropractors are discouraging vaccines so much, the vaccine preventable diseases are causing more autism.

      1. Pleiadianwaves says:

        I doubt very much that alternative medicine and the lack of vaccines is the cause for the increase in autism. I too believe it’s caused by big pharma and what is happening to our food supply with all the chemicals and engineering.

        This article is way to biased to be taken seriously. 13 years as a complimentary practitioner myself, and I am yet to see anyone injured from my work, nor the hundreds of other practitioners across the board that I know. What I have seen is the major, and I mean MAJOR damage done to people by our mainstream medicine practices. I don’t have anything against modern medicine, I’m just stating facts.

        1. Chris says:

          “I’m just stating facts.”

          Sorry. I just see blatant assertions. Without actual evidence to back them up, they are not quite “facts.”

        2. WilliamLawrenceUtridge says:

          What happens if one of your customers dies of cancer? Do you follow up with all of them routinely to make sure they are still alive? Because if you don’t, the reason you don’t see anyone injured from your practice is your treatments are largely inert, and your customers simply stop showing up. It’s called selection bias.

          Your “facts” are selective and self-serving.

          1. Largely inert, eh? I have been practicing integrative medicine since 1994 and have a practice jammed with failures from “evidence based” disasters from the overuse of statin drugs, antidepressants, and pain drugs. Let’s do this by induction: please review the following peer reviewed study — clearly supporting an integrative strategy — take some time to let it sink in, then kindly reply with how it is “inert”, unscientific, placebo-driven, or otherwise. Feel free to respond directly if that makes you feels better.

            Nutr Cancer. 2011;63(4):573-82. doi: 10.1080/01635581.2011.553022.
            Specialty supplements and prostate cancer risk in the VITamins and Lifestyle (VITAL) cohort.
            Brasky TM, Kristal AR, Navarro SL, Lampe JW, Peters U, Patterson RE, White E.
            Source

            Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA. tbrasky@fhcrc.org
            Abstract

            Although there is evidence from studies of prostate cancer cell lines and rodent models that several supplements may have antiinflammatory, antioxidant, or other anticancer properties, few epidemiologic studies have examined the association between nonvitamin, nonmineral, “specialty” supplement use and prostate cancer risk. Participants, 50-76 yr, were 35,239 male members of the VITamins and Lifestyle (VITAL) cohort who were residents of western Washington state, and who completed an extensive baseline questionnaire in 2000-2002. Participants responded about their frequency (days/wk) and duration (yr) of specialty supplement uses. 1,602 incident invasive prostate cancers were obtained from the Surveillance, Epidemiology, and End Results registry. Multivariate-adjusted hazards ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox proportional hazards models. Any use of grapeseed supplements was associated with a 41% (HR 0.59, 95% CI: 0.40-0.86) reduced risk of total prostate cancer. There were no associations for use of chondroitin, coenzyme Q10, fish oil, garlic, ginkgo biloba, ginseng, glucosamine, or saw palmetto. Grapeseed may be a potential chemopreventive agent; however, as current evidence is limited, it should not yet be promoted for prevention of prostate cancer.

            1. WilliamLawrenceUtridge says:

              1) Doesn’t that rather undercut your claim that integrative medicine helps? Integrative medicine has been recommending the use of chondroitin, coenzyme Q10, fish oil, garlic, ginkgo biloba, ginseng, glucosamine, and saw palmetto for years. This study suggests they don’t help. Doesn’t that suggest that integrative physicians such as yourself have been wasting your patient’s time and money for all that time?

              2) Be careful about the grapeseed claims. Your epidemiological study isn’t the same thing as a randomized, controlled trial. Given the number of compounds studied, there’s a chance the correlation is spurious, were compensations made for conducting multiple comparisons? But either way – this suggests the need for a placebo-controlled trial. If that trial finds that grapeseeds have a genuine benefit in prostate cancer, then it will be adopted as a mainstream medical intervention and everyone will be better off.

              Given the results of pubmed, it suggests that this is an active area of research. Hopefully it pans out, in which case, out of nine agents recommended by integrative physicians like yourself, one might have objective benefit.

              Meanwhile, the other 89% appear to be a rather large waste of time, don’t you think?

            2. Harriet Hall says:

              You’re not going to convince anyone if the best you can do to support “integrative” treatments is the abstract of a study whose last sentence reads “Grapeseed may be a potential chemopreventive agent; however, as current evidence is limited, it should not yet be promoted for prevention of prostate cancer.”

    2. nutrition prof says:

      So, FBA, we aren’t blaming vaccines for autism anymore?

      1. FastBuckArtist says:

        Live virus vaccines are teratogenic, vaccinating a pregnant woman with one could do that, but thats not what I was referring to.

        The allopathic practice of feeding prescription drugs to pregnant women has led to a rise in birth disorders, including autism, its well documented. In particular, useless drugs for psychiatric disorders have done the most harm to fetuses.

        1. WilliamLawrenceUtridge says:

          Live virus vaccines are teratogenic, vaccinating a pregnant woman with one could do that, but thats not what I was referring to.

          Wow, it’s a good thing that the CDC “who should not get vaccinated” page talks about whether a pregnant woman should be vaccinated then. Once again – your opinions are crazy, or parasitic on real medicine. Not to mention, what’s the risk of being infected with these diseases while pregnant? Live vaccines may be teratogenic, are the diseases they prevent? Is measles? Seems to cause miscarriage, stillbirth and preterm delivery. Rubella? Yup, highly teratogenic. Mumps? Possible miscarriage. Not to mention, what happens if the mom transmits any of these diseases to the baby? Live virus vaccines may be teratogenic, many diseases they prevent are highly teratogenic. That’s why we vaccinate.

          The allopathic practice of feeding prescription drugs to pregnant women has led to a rise in birth disorders, including autism, its well documented. In particular, useless drugs for psychiatric disorders have done the most harm to fetuses.

          What about the CAM practice of leaving these conditions untreated? Your first link is to a study of the effects of medication used to control epileptic seizures. Turns out pregnancy itself is risky for women with epilepsy, and epilepsy is risky for pregnant women and their babies – plus, unsurprisingly, the risks of the medications are complicated. So once again, you are pretending medicines are straight-up risk with no benefits. Your cartoonish caricature of the situation is decpetive as usual, fear-inducing for anyone with epilepsy, offers no real solutions (because if you did, you know you’d get shot down), and completely overlooks the benefits of medications.

          As for your second link, it is to a letter to the editor; the actual article suggests that at best medication may be responsible for 0.6% of cases of autism, assuming this correlational study is pointing to the correct indicator and not a confound. Depression itself is correlated with an increased risk of autism, and the authors note that medication use might be confounded with severity of depression rather than medication itself. But honestly depicting the study would undercut your point, so instead you just went with the lie. Also, you know what’s not great for pregnant women and their children? Suicide or infanticide related to untreated depression.

          And, as always, you’re criticizing “allopathy” (i.e. medicine) for being unaware of the effects of medciation on pregnant women and children – by citing the “allpathic” (i.e. medical) literature. So, “medicine isn’t aware of the effects of medication on mothers and children, and to prove my point here is a medical study of the effects of medication on mothers and children.”

          Hypocrite.

        2. lilady says:

          “Live virus vaccines are teratogenic, vaccinating a pregnant woman with one could do that, but thats not what I was referring to.”

          Wow, thanks for that information FBA. Wouldn’t you think that the CDC should set up some sort of monitoring system or registry to monitor pregnancy outcomes when a pregnant woman is inadvertently vaccinated with live attentuated vaccines that are protective against measles-mumps-rubella and varicella?

          Oops, the CDC and the manufacturers of those vaccines actually have those registries…

          http://www.cfp.ca/content/57/5/555.full

          Vaccination during pregnancy

          Pina Bozzo,
          Andrea Narducci, RPh and
          Adrienne Einarson, RN

          “…Live vaccines during pregnancy

          Theoretically the live attenuated virus in a vaccine could cross the placenta and result in viral infection of the fetus. Owing to this concern, most live attenuated vaccines, including the measles-mumps-rubella (MMR) and varicella vaccines, are contraindicated during pregnancy.1

          Measles-mumps-rubella vaccine

          Wild-type rubella infection might result in spontaneous abortion, stillbirth, and, of most concern, congenital rubella syndrome (CRS), with its hallmark characteristics of sensorineural deafness, congenital heart defects, microcephaly, learning difficulties, and eye and bone defects. Measles infection in pregnancy might result in substantial maternal morbidity, an increased abortion rate, prematurity, stillbirth, and possibly congenital malformations. The data for mumps infection are not consistent, with some studies showing a possible increased rate of spontaneous abortion.

          There have been no reports of congenital malformations attributable to the MMR vaccine virus. The Centers for Disease Control and Prevention (CDC) estimated the theoretical risk to the fetus of CRS following vaccination with the rubella vaccine to be 0% to 1.6%.2 In 1971, the CDC established the Vaccine in Pregnancy registry of women who had received rubella vaccines within 3 months before or after conception. By 1989 there were data on 1221 inadvertently vaccinated pregnant women. There was no evidence of an increase in fetal abnormalities or cases of CRS in the enrolled women or the 321 rubella-susceptible women; therefore, enrolment in the registry ended.2,3

          Motherisk conducted a prospective controlled study that included 94 women exposed to the rubella vaccine in the 3 months before conception or during the first trimester of pregnancy. The Motherisk team reported no difference in pregnancy outcomes or malformation rates between the exposed and the nonexposed groups, and no adverse effects consistent with CRS.4 These data have been confirmed in other immunization campaigns and studies.

          Varicella vaccine

          Varicella virus infection during pregnancy is associated with a risk of congenital varicella syndrome, characterized by low birth weight, skin scarring, ophthalmologic defects, limb hypoplasia of bone and muscle, neuropathic bladder, and gastrointestinal and neurologic abnormalities.

          There are no reports of congenital varicella syndrome after exposure to varicella vaccine during pregnancy. A registry was established by the manufacturer in collaboration with the CDC to monitor maternal and fetal outcomes of women who were inadvertently immunized with varicella vaccine in the 3 months before conception or at any time during pregnancy. Among the 737 women with pregnancy outcomes available, there were no patterns of defects and no infants were born with features consistent with congenital varicella syndrome among any of the women enrolled or among the seronegative women.”

          Read on about other vaccines given during pregnancy, FBA. You never know, you just might learn something about vaccines. (I doubt it.)

    3. windriven says:

      Thank goodness we can always count on FBA to make a total ass of himself! In a rapidly changing world it is comforting to know that some things just never change.

      Today FBA brings us another round of ‘the one true cause of autism’ game. First he elides the distinction between incidence and diagnosis, then he confuses correlation with causation by linking prescription drug use in the broadest terms with autism. One supposes that it hasn’t occurred to FBA that a similar argument could be made linking the rise in US autism diagnoses between 2004 and 2008 with the rise in ‘liar loans’ in the real estate mortgage market during the same period. So much for his theory.

      My theory is that stupidity is proportionately linked to consumption of woo.

      1. WilliamLawrenceUtridge says:

        My theory is that stupidity is proportionately linked to consumption of woo.

        It could be linked to fluoride deficiency.

    4. Harriet Hall says:

      Look at the graph on this page: http://justthevax.blogspot.com/2013/01/organic-food-causes-autism-r9971-p00001.html

      It shows that the rise in autism is perfectly correlated with the sales of organic food. Save our children from autism: prohibit organic food! :-)

      1. FastBuckArtist says:

        :)
        Extend that graph to 19th century when 100% of the food was organic.

        1. WilliamLawrenceUtridge says:

          …and the mentally ill (including those with autism) were left to die and warehoused.

          …and more people died of infectious diseasese.

          …and more people died in their 30s and 40s.

          …and people had access to all the treatments that exist as part of CAM today but still died.

          …and people got ergot poisoning and ate spoiled food all the time.

          …and the water carried cholera and polio but wasnt’ filtered.

          …and people routinely starved to death because organic food isn’t particularly efficient.

          Yep, the good ol’ days sure were great.

          1. Young CC Prof says:

            Like all science denialists, FBA doesn’t believe in the child mortality or limited life expectancy of the past. He skips straight from the Garden of Eden to the early industrial era.

          2. Limited Life Expectancy – Yes
            Higher Child mortality – Yes
            Autism – No

            1. Harriet Hall says:

              Autism – Yes. There are many historical accounts compatible with autism.
              Diagnosis of autism – No, because it hadn’t yet been identified and given a name.

          3. @Harriet First case of Autism was diagnosed well into 20th century.
            For years pharma has swept the problem under the rug saying that “we dont have an increase in autism, we just diagnose it better now!”

            The significance of the new BMJ paper is to show that there is an increase in autism cases, it’s not just a shuffling of definitions.

            The criminal pharma cartel however will continue to deny their poisonous products are driving an epidemic of autism, despite mounting evidence:
            - Antibiotic Use
            - Tylenol Use
            - AntiDepressant Use
            - AntiConvulsant Drug Use

            Most of these drugs were prescribed unnecessarily by the drug dealers (the MDs) on behalf of the drug lords (the Pfizers) for conditions that do not require drug use or can be treated with safe natural alternatives.

            1. Allie says:

              FBA, if you HAD any credibility it would all be lost by referring to doctors as drug dealers. Your bias shines like Rudolph’s nose.

          4. WilliamLawrenceUtridge says:

            Legionnaire’s disease was not identified until 1976. Do you think that means it suddenly popped into existence out of nothing, or perhaps it existed but merely wasn’t named? Kinda like…autism? And let’s not forget that autism is developmental delay, not necessarily stasis, and the large-scale warehousing of the mentally ill and developmentally delayed in decades and centuries past, along with the stigma of having such relations, such that the existence of such groups was deliberately hidden. I love your complete lack of context, it’s refreshing.

            For years pharma has swept the problem under the rug saying that “we dont have an increase in autism, we just diagnose it better now!”

            …despite the researchers making the case for diagnostic substitution not working for Big Pharma, not being funded by Big Pharma, and in fact not even researching pharmaceutical products? And how do you explain the rather distinct lack of links between autism and drugs in the peer-reviewed literature, since the causes are thought to be primarily genetic? Oh, of course, conspiracy. The first thing anyone says when they don’t have any real evidence to support their opinions.

            Most of these drugs were prescribed unnecessarily by the drug dealers (the MDs) on behalf of the drug lords (the Pfizers) for conditions that do not require drug use or can be treated with safe natural alternatives.

            …and there it is. Sure, drug treatment is totally unnecessary. Antibiotics are for fun, not to save lives! People take them trivially, just to get high! I’ll note, by the way, a new low in the citations you link to – a press release that cites Medical “Mongoloid Autistic Kids Like Chopsticks/AIDS Doesn’t Exist” Hypotheses. From 2005. Then we have antidepressants, the same study you cited yesterday that I addressed yesterday, that didn’t control for maternal depression. And of course, your link to the article about anticonvulsive medication I also dealt with tomorrow, though the study you link to this time failed to include a control group. How do you know autism is caused by anticonvulsive medications and not, say, genetic transmission related to maternal epilepsy? You don’t.

            Then there’s of course, the trope that “natural alternatives” exist to treat epilepsy. If they exist, why weren’t they used historically? Those “natural treatments” would have existed in the past, but treatment for epilepsy didn’t. It’s almost as if you’re completely making this whole thing up.

        2. SNFinVA says:

          “Extend that graph to 19th century when 100% of the food was organic.”

          Wrong!

          http://soils.tfrec.wsu.edu/leadhistory.htm

  2. oldmanjenkins says:

    I feel bad for FBA. They just don’t understand correlation versus causation. Example: There is a dramatic rise in drowning deaths that correlates to an increase in the consumption of ice cream. You see there is a correlation, a connection that is occurring. Does that mean consumption of ice cream leads to drowning? Well you see, as the temperature increases during the summer, more people swim (beaches, public pools, private pools).

    In addition to an increase in swimming as the weather outside increases, more people are consuming a frozen dairy beverage. So the connection (not cause) was an increase in outside temperature which increased the number of people swimming at any given time thereby increasing the overall risk of drowning.

    I feel bad (for 1 second) that you (FBA) do not see the massive waste that is going on at a federal level investigating products and services which have no prior plausibility. When these monies could be better invested in other more worthwhile endeavors. But too each there own.

  3. FilipinoMDstudent says:

    Here in the Philippines, I lament that people are starting to become more open to all types of medical woo. Many locals are proud that there are Filipino naturopaths, chiropractors, practitioners of Ayurvedic medicine, acupuncture, traditional healing, etc. It is also highly disturbing that NOBODY in our country is criticizing these quacks. We, Filipinos, are in dire need of more vocal skeptics.

    1. Allie says:

      YOU can be the one!

  4. rork says:

    Very nice review, thankyou.
    Small criticism: The analogies in the next to last paragraph – they aren’t that apt and a writer with your command doesn’t need them. It was clear enough.

    PS: I thought the usual criticism was going to be that real medicine kills so many people, a possible danger when you’re actually administering treatments that do stuff. Maybe it’s coming,

  5. The only reason alternative/integrative medicine exist is because of two things – psychology and greed.

    People often think with their emotions instead of their brains.

    Many greedy bad apples in allopathic medicine have caused people to lose faith in it and turn to the dark side of health care. Unfortunately, a growing number of people view allopathic medicine as being more about profits instead of being more about “their” health care. These patients want to “feel” cared about. They demand the false emotional aspects often associated with alternative treatments.

    Many other bad apples also see an opportunity to enrich themselves at the expense of those who’ve lost faith in allopathic medicine. Some of these bad apples may also be healthcare professionals. Their emotion of greed seems to overcome any ethical sensibility generated by their brain.

    Regardless of the quackery involved in alternative/integrative treatment, these bad apples understand the human psyche. They know that there’s a growing demand for alternative treatment by those patients who’ve lost faith in allopathic medicine, and will gladly provide them with the false hope/emotional support associated with alternative treatments in return for larger profits.

    Ethics be gone! It’s all about supply and demand. Pretty sad, huh?

  6. krelnik says:

    Google Ngrams supports your estimate of 20 years for the use of “integrative medicine” (at least in the books Google has scanned). See this graph of uses from 1970 to 2000. Some sporadic use prior, but it definitely starts to jump around 1993 or 1994.

    1. David Gorski says:

      Based on my reading and experience, twenty years seems a bit too soon. Perhaps the term started percolating in books, but then it started really infiltrating the world of “complementary and alternative medicine” (which definitely started getting popular around 20 years ago). Who knows? I should ask Wally Sampson; I was too busy doing my surgery residency and PhD 20 years ago and wasn’t paying attention to quackademic medicine and the infiltration of quackery into medicine. :-)

    2. mousethatroared says:

      Has integrative medicine always had the same meaning? Seems to me that I had a doctor in Ann Arbor around 1997 and the group was called Integrative something or other. But I don’t remember them being at all wooish. I thought the integrative was to promote a focused on partnering with PT, dietician and lifestyle counseling, which they seemed to refer to more than my previous doctor or the one after that. Maybe I am misremembering the name, though.

  7. RobRN says:

    The “Scripps Center for Integrative Medicine” in La Jolla, CA was established in 1999… I was a QA/PI coordinator & quality data analyst at Scripps Memorial at the time and I was aghast that Scripps was getting involved with woo. At perhaps the risk of my position, I went so far as to send a lengthy email to the center’s director expressing my dismay that a well-known and well respected health care organization like Scripps was delving into the “Integrative” realm. I mentioned some of the things that are reflected in this article plus my educated opinion that it would be impossible to establish a “standard of care” or quality assurance program for integrative modalities. I received a response with the usual logical fallacies included – Appeal to popularity and appeal to antiquity. Interestingly, the director also stated that the organization would rather have patients seeking integrative within the system so providers could better know what their patients are doing that might interfere with conventional treatments. I was only slightly oriented to CAM/Int med at the time but the incident piqued my interest in the subject and now I worship daily at the altar of SBM and the scientific method! With my accumuted knowledge in the subject since, if I were to send the same communication now, it would be a blockbuster!

  8. RobRN says:

    Additionally… I’m sure there was a heavy marketing angle because Scripps had all the right clientele to successfully launch an integrative program. There was an ample supply of trendy California coastal high income patients and retired movie stars living in Santa Fe Springs!

  9. Ahriman says:

    This article that was just released by our academic health center is a perfect illustration of how integrative practioners routinely cross ethical boundaries by blurring the lines between what makes patients “feel better” versus treatment for their disease – in this case brain cancer: http://healthnews.uc.edu/news/?%2F23311%2F

    First they present the idea that eating healthy gives patients some sense of control over their lives, improving their mood, making it more likely that they will follow their treatment plans.

    Then, they argue for eating a vegetarian anti-inflammatory diet that they suggest will actually influence the progress of the cancer.

    It’s as if the first argument is used to keep the shruggies satisfied, then the second is just all woo mixed with some science-y sounding terms to legitimize unsubstantiated claims.

    It’s embarrassing.

    1. Jason says:

      “Then, they argue for eating a vegetarian anti-inflammatory diet that they suggest will actually influence the progress of the cancer.”

      I couldn’t find this part. I read it as saying the brain cancer thrives in an inflammatory environment and so reducing inflammation via diet is a good thing. True or not, I didn’t see them say reducing inflammation increase cancer growth. Can you quote it?

      1. WilliamLawrenceUtridge says:

        “Progress” doesn’t necessarily mean reducing inflammation increases cancer growth. I think you’re reading the wrong meaning into that sentence.

  10. Taurus says:

    I’ve been an SBM reader for some time now, but I felt it was time to extend my own personal thanks FWIW. I am currently an undergrad pursuing an MD-PhD career path; words can’t express the bitter cognitive dissonance I feel towards the occasional fellow student I come across who is otherwise intelligent, knowledgeable, and sincerely well-meaning, whose personal aspiration to help others would be laudable…but for their seemingly thoughtless espousal of frank quackery.

    As someone committed to realizing advances in healthcare science to allow for a better future for everyone, it’s deeply saddening to be confronted with the fact that witchcraft and its practitioners can still thrive in the 21st century; that our familiar human flaws and failings are so deeply ingrained that even now, as we stand before an unprecedented wealth of knowledge, a world in which a child has greater access to information than any scholar of antiquity could have dreamed, we remained handicapped by the comfort of our own biases and ignorance.

    This article offers a concise response towards which I can point others.
    Thanks.

    - T.L.

  11. This is what happens when people who have zero experience, understanding, or scientific acumen for medicine are allowed to publish meaningless editorials. Someone needs to inform people like this that “integrative medicine” will now be an American Board of Medical Specialities endorsed subspeciality with all the “rights and privileges thereto”. If the writer of this tome would like to begin their education by emailing me, I will be happy to share the “scientific basis” of integrative medicine with a peer reviewed article a week for the next 100 years.

    1. WilliamLawrenceUtridge says:

      Someone needs to inform people like this that “integrative medicine” will now be an American Board of Medical Specialities endorsed subspeciality with all the “rights and privileges thereto”.

      Sure, but the regulation of nonsense is still nonsense. Why are you so happy about the board-certification of a speciality that is predicated on the delivery of unproven treatments? Because if it’s proven, it just gets adopted by real doctors. So, integrative medicine is at its heart simply a collection of people prescribing on the basis of assertions that lack evidence. That doesn’t seem like something to be proud of.

      The board-certification of integrative medicine has been addressed previously.

    2. Harriet Hall says:

      Integrative medicine is not listed by the American Board of Medical Specialties, and there are no plans to list it. http://www.abms.org/who_we_help/physicians/specialties.aspx

  12. Gregor Samsa says:

    It was sad to see that Duke University, where my late partner received top notch cancer care, has bought into integrative medicine. http://acupuncturists.healthprofs.com/cam/name/Duke+Integrative+Medicine_Durham_North+Carolina_538864 The website rehearses all the jargon and nonsense described in Science Based Medicine, and newspaper ads show ungloved fingers inserting needles into flesh that, no doubt, has not been swabbed.

  13. vic says:

    Perhaps a lot of attacks on alternative medicine (I prefer the term complementary medicine) are from the conventional medical establishment who have not considered the following: if the complementary practitioner can cause the powerful “placebo” to help the patient, why poo-poo it?

    The “elaborate” one hour procedure results in the relief of symptom the patient experiences, so he/she continues the treatment – its their choice and their money, surely! The people who come to see me have exhausted what help conventional medicine can give them and about 80% of who I treat get the relief they are looking for. They would not come back if they did not value the results they get. Very few of us in the profession do it to become wealthy and very few (if any) have become rich from our job. We do it because we enjoy the work and like being able to make a difference to people we treat.

    Acupuncture is very difficult to trial with double-blind tests because putting a needle in a “non-point” cannot be guaranteed to have no effect! Not all proper points have been charted. And choosing the point is not one done by mechanical computation but is a complex, individual assessment that changes as the patient changes and gets better.

    So please – don’t knock procedures that help people, especially as the UK’s NHS is crippled by lack of resources and many UK hospitals are under investigation for incompetence and negligence. It is more likely that allopathic medicine kills more people that complementary medicine.

Comments are closed.