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Lies, Damned Lies, and ‘Integrative Medicine’

Last week, two events took place in Washington that ought to inspire trepidation in the minds of all who value ethical, rational, science-based medicine and ethical, rational, biomedical research. One was the Senate Panel titled Integrative Care: A Pathway to a Healthier Nation, previously discussed by my fellow bloggers David Gorski, Peter Lipson, and Steve Novella, and also by the indefatigable Orac (here and here); the other was the ”Summit on Integrative Medicine and the Health of the Public“ convened by the Institute of Medicine (IOM) and paid for by the Bravewell Collaborative, previewed six weeks ago by fellow blogger Wally Sampson. This post will make a few additional comments about those meetings.

Senator Harkin and the Scientific Method

Thanks to Dr. Lipson, I didn’t have to listen to the Senate Panel video to find out that Senator Tom Harkin (D-Iowa) made this statement of disappointment regarding his own creation, the National Center for Complementary and Alternative Medicine (NCCAM):

One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving. (from last week’s hearings, time marker approx. 17:20)

Are scientists at the NIH really too afraid of Harkin to explain to him how science works? Apparently so. Otherwise Harkin might learn that his statement is more wrong-headed than it would be for one of us to complain that the Supreme Court ought to assume that a defendant is guilty until proven innocent, rather than the other way around. In scientific inquiry, for those who don’t know, good experimental design is always directed at disproving a hypothesis, even one that pleases its investigator. The rest of Harkin’s sentiment—”seeking out and approving”—is incoherent.

The Selling of ‘Integrative Medicine’: Snyderman Trumps Weil

Spin doctors shilling for ‘integrative medicine,’ which the NCCAM defines as “combining treatments from conventional medicine and CAM,” appear to have now decided that subtler language is more likely to sell the product. We’ve previously seen an example offered by ‘integrative’ Mad Man Andrew Weil:

The addition of proven CAM to conventional medicine would be an improvement, yet this combination alone is not what could be defined as integrative medicine….Integrative medicine is defined as healing-oriented medicine that reemphasizes the relationship between patient and physician, and integrates the best of complementary and alternative medicine with the best of conventional medicine. We believe that this synthesis of humanistic medicine, patient- and relationship-centered care, preventive health, allopathy, and CAM is the model for creating an improved system of health care.

It takes someone who knows his way around a faculty meeting much better than does ex-hippie Weil, however, to understand that the surest way to usher ‘integrative medicine’ into the curricula of medical schools is to press the delete button whenever the pesky ‘CAM’ term comes up, and to replace it with a few trendy slogans that everyone can agree on. Ralph Snyderman, MD, the former Chancellor for Health Affairs at Duke University, is just such a person. As far back as 2002, Snyderman wrote:

Integrative medicine is an approach to the practice of health care based on a sound scientific approach with an emphasis on the responsibility of the physician to engage the patient in his or her own unique plan for health. Essential aspects include the recognition of the importance of the mind-body relationship and a willingness to consider unconventional modalities with informed skepticism and scientific evaluation. Above all, integrative medicine encompasses the caring bond between the patient and the caregiver, and the responsibility of the latter to enable the patient to benefit from a full array of modalities that can be shown to benefit health.

No surprise, then, that Snyderman was a key figure in last week’s ”Summit.” Here is how he introduced the topic prior to the meeting:

“What we currently have is not a health care system, but a disease care system,” said Ralph Snyderman, M.D., chair of the Summit Planning Committee and chancellor emeritus of Duke University. “The summit will explore how science and a patient-centered, prospective, integrated approach to care can make a positive difference.”

It seems that ‘integrative medicine’ now might have something to do with preventive medicine, ‘patient-centered care,’ and fixing the health care system. The Summit’s Issue Background, authored by professional writer Vicki Weisfeld, makes it official:

Integrative medicine orients the health care process to create a seamless engagement by patients and caregivers in the full range factors known to be effective and necessary for the achievement of optimal health over the course of one’s life. In integrative medicine, patients are active partners in their health and providers care for them as individuals in different life circumstances, rather than just treating their illnesses. Thus, integrative medicine takes into account biological, psychological, social, and spiritual aspects of individuals’ lives, draws the best evidence for their needs and circumstances, and engages both treatment and prevention, including diet, exercise, stress management, emotional wellbeing, and socio-environmental factors. Integrative medicine makes use of the best conventional care and the latest advances in predictive, preventive, and personalized medicine and uses all appropriate evidence-based prevention, treatment and supportive approaches. Finally, it asks physicians to serve as guides, role models, and mentors and to recall that “healing is always possible, even when curing is not.”

Widespread implementation of an integrative medicine approach would fundamentally transform our nation’s current fragmented, inefficient, expensive, and reactive “sick care” system to one that is more proactive, personal, efficient, and appropriately focused on enhancing the health of each person and the population as a whole. Five chronic conditions—mood disorders, diabetes, heart disease, asthma, and high blood pressure—now account for more than half of all U.S. health expenditures. The onset and serious consequences of these conditions may have been partly or wholly preventable. Current patterns of care do little to enhance health, prevent illness, or treat it efficiently and effectively when it occurs. The reimbursement system encourages this pattern, by financially rewarding units of service, rather than outcomes, prevention, and the integration of care processes that each patient should expect. Little encouragement, through incentives or care patterns, is offered to individuals to take active part in their own care to enhance wellness and minimize disease.

Hmmm. No ‘CAM’ mentioned there. Nor will you find it until the bottom of page 3, where it is dressed up as “proven complementary approaches,” without further comment:

In 1910, the Flexner Report changed American medicine by insisting that doctors should be trained to diagnose and treat illnesses using the scientific tools of the day. Since then, the medical sciences have splintered into more and more specialties concerned with narrower and narrower aspects of the human body. Medicine’s focus on pathophysiology alone, and the reductionist perspective, do not well serve the many patients whose complex problems are incompletely understood
and treated by “find it and fix it” approaches.

As the Flexner centenary approaches, it is again time to reevaluate the training in U.S. medical schools…This requires taking a broader view of individual patients that takes into account the social, family, and physical environments in which they function as well as the patient’s own empowerment and motivation. It requires use of the best conventional medicine and cutting-edge diagnostic and treatment methods in combination with appropriate mentoring, compassion, and proven complementary approaches.

You don’t see it again until p. 9:

Some elements of an integrated approach to health care also have their roots in practices that began under the rubric of complementary and alternative medicine (CAM). The effectiveness of such approaches has been strengthened as experience and evidence has [sic] been gained.

Aha, you’re thinking: we’re about to find out what those mysterious, “proven complementary approaches” are! Think again, because here is the rest of the paragraph:

In 2003-2004, the National Center for Complementary and Alternative Medicine sponsored a series of grants to strengthen awareness and knowledge about complementary and alternative medicine practices among medical students. The goal was to broaden the array of evidence-based techniques that physicians have at their disposal. A common finding from these projects was that culture change, including faculty development, was a necessary accompaniment to curriculum changes, and the result is a growing presence of relevant courses in the nursing and medical curricula. Expansion of these trends will require additional research, resources, incentives, continuing education courses, licensure requirements, and, perhaps, ultimately, reimbursement incentives.

It seems that ‘experience and evidence’ have shown that the only way to foist implausible medical claims into medical and nursing school curricula is to dupe medical and nursing students, bribe faculty members, and twist some arms. Or, perhaps, to pretend that ‘integrative medicine’ does not involve prescribing non-existent drugs, manipulating non-existent ‘energy fields’ and non-existent ‘rhythms,’ balancing non-existent ‘qi’ in various non-existent organs through non-existent ‘meridians’ and non-existent ‘acupuncture points,’ correcting non-existent ‘subluxations,’ diagnosing and treating diseases by examining non-existent homunculi on ears, eyes, and feet, hosing non-existent toxins out of colons, and all the rest.

How much easier it must be, when faced with a profession that has become maddeningly wedded to science—that vexing ”reductionist perspective”—to pretend that one’s pet project doesn’t include such anti-scientific drivel (well, maybe it includes a little of the socially acceptable sort: “mindfulness meditation, acupuncture, massage and biofeedback…nutritional practices and dietary supplements” is what you get in this essay). Instead, why not claim that the program is about ‘patient-centered care,’ prevention, improving access to care, improving reimbursement for primary care physicians, making health care less expensive, considering psycho-social aspects of patient care, improving communication skills among health care professionals, and other uncontroversial topics?

So what if these have long been recognized as worthy goals, both individually and in the aggregate, since well before ‘integrative medicine’ or ‘CAM’ began to contaminate rational discourse in medical schools and government? So what if ‘integrative medicine’ has nothing new to add to them? This is all of little concern to the savvy chairman, who knows that the most important determinant of smooth sailing at a meeting is to avoid saying anything that might awaken the participants.

Is ‘Integrative Medicine’ Preventive Medicine?

Does ‘integrative medicine’ have anything to add to preventive medicine? You’d sure think so if you’d emerged from a 40-year coma last week to read the Issue Background:

Since integrative medicine begins from the perspective of maintaining and promoting individual health, it is necessarily closely attuned to the array of behavioral and environmental factors that put health at risk. Inevitably, the health system must look beyond the individual patient to broader social and environmental influences. As mentioned, many environmental factors require public health advocacy and intervention. However, even individual behavior, such as smoking and exercise, is susceptible to social and environmental approaches. Widespread anti-smoking advocacy and supportive public policies, like anti-smoking rules in workplaces and public spaces, increased tobacco taxes, and consumer education programs have changed the environment in the United States from a pro-smoking to largely anti-smoking culture. Similarly, public policies that promote exercise by building bike, jogging, and walking trails, corporations and city planners that encourage office and residential buildings to include gyms and showers, and an array of other public policies support a health-promotion culture. Health professionals have credibility in public discussions of such policies and can do a great deal for their own patients and the community by endorsing such pro-health initiatives. Medical researchers and health policy analysts can develop the clinical research and public policy assessments on which sound public policies can be based.

Really, now. That such spin was apparently composed with a straight face can only be a measure of how few people will read it. Which, alas, is exactly what the Bravewell crowd has in mind, and why Snyderman is such a brilliant choice as Propaganda Chief. The prevention hype is everywhere; here’s Harkin again, this time from his written statement:

We need a paradigm shift that places a much greater emphasis on preventing disease and keeping people healthy rather than merely treating people once they become sick. Integrative care can help us achieve this goal.

But has ‘integrative medicine’ or any of its ‘CAM’ progenitors contributed anything to real preventive medicine, as introduced yesterday by Peter Lipson? Have any of the preventive measures that most physicians can think of right off the bat—oh, in no particular order, by no means comprehensive, and not without uncertainties about usefulness or best uses: immunizations, blood pressure measurement and treatment, cholesterol screening and treatment, mammography, occult blood in stool, colonoscopy, smoking cessation, folate and iron in pregnancy, other prenatal care, bone density, weight, diet, exercise, pap smears, skin exams for melanoma, prostate-specific antigen, and many more—been introduced by ‘integrative medicine’? Let’s look. First, a list of

Preventive Measures Supported by Science that have been Advanced by Modern Medicine and Public Health

Guide to Clinical Preventive Services, 2008

Recommendations of the U.S. Preventive Services Task Force


The Guide to Clinical Preventive Services includes U.S. Preventive Services Task Force (USPSTF) recommendations on screening, counseling, and preventive medication topics and includes clinical considerations for each topic. This new pocket guide provides general practitioners, internists, family practitioners, pediatricians, nurses, and nurse practitioners with an authoritative source for making decisions about preventive services.

Contents
Foreword
Preface
Section 1. Preventive Services Recommended by the USPSTF
Section 2. Recommendations for Adults
Cancer
* Aspirin/NSAIDS for Prevention of Colorectal Cancer
Bladder Cancer in Adults, Screening
Breast and Ovarian Cancer Susceptibility, Genetic Risk Assessment and BRCA Mutation Testing
Breast Cancer, Chemoprevention
Breast Cancer, Screening
Cervical Cancer, Screening
Colorectal Cancer, Screening
Lung Cancer Screening
Oral Cancer, Screening
Ovarian Cancer, Screening
Pancreatic Cancer, Screening
Prostate Cancer, Screening
Skin Cancer, Counseling to Prevent
Skin Cancer, Screening
Testicular Cancer, Screening
Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease, Routine
Heart, Vascular, and Respiratory Diseases
Abdominal Aortic Aneurysm, Screening
Aspirin for the Primary Prevention of Cardiovascular Events
* Carotid Artery Stenosis, Screening
* Chronic Obstructive Pulmonary Disease, Screening
Coronary Heart Disease, Screening
* High Blood Pressure, Screening
Lipid Disorders in Adults, Screening
Peripheral Arterial Disease, Screening
Infectious Diseases
Asymptomatic Bacteriuria, Screening
* Chlamydial Infection, Screening
Genital Herpes, Screening
Gonorrhea, Screening
Hepatitis B Virus Infection, Screening
Hepatitis C in Adults, Screening
HIV, Screening
Syphilis Infection, Screening
Injury and Violence
Family and Intimate Partner Violence, Screening
* Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use While Driving, Counseling
Mental Health Conditions and Substance Abuse
Alcohol Misuse, Screening and Behavioral Counseling Interventions in Primary Care to Reduce
Dementia, Screening
Depression, Screening
* Illicit Drug Use, Screening
Suicide Risk, Screening
Tobacco Use and Tobacco-Caused Disease, Counseling to Prevent
Metabolic, Nutritional, and Endocrine Conditions
Diet, Behavioral Counseling in Primary Care to Promote a Healthy
Hemochromatosis, Screening
Hormone Therapy for the Prevention of Chronic Conditions in Postmenopausal Women
Iron Deficiency Anemia, Screening
Obesity in Adults, Screening
Physical Activity, Behavioral Counseling in Primary Care to Promote
Thyroid Disease, Screening
Type 2 Diabetes Mellitus in Adults, Screening
Musculoskeletal Conditions
Low Back Pain in Adults, Primary Care Interventions to Prevent
Osteoporosis in Postmenopausal Women, Screening
Obstetric and Gynecologic Conditions
* Bacterial Vaginosis in Pregnancy, Screening
Breastfeeding, Behavioral Interventions to Promote
Gestational Diabetes Mellitus, Screening
Rh (D) Incompatibility, Screening
Vision Disorders
Glaucoma, Screening
Section 3. Recommendations for Children
Blood Lead Levels in Children and Pregnant Women, Screening
Dental Caries in Preschool Children, Prevention
Hip Dysplasia, Screening
Idiopathic Scoliosis in Adolescents, Screening
* Lipid Disorders in Children, Screening
Newborn Hearing Screening
Overweight in Children and Adolescents, Screening and Interventions
* Sickle Cell Disease, Screening
Speech and Language Delay in Preschool Children, Screening
Visual Impairment in Children Younger Than Age 5 Years, Screening
Appendixes
Appendix A. How the U.S. Preventive Services Task Force Grades Its Recommendations
Appendix B. Members of the U.S. Preventive Services Task Force 2001-2004
Appendix C. Acknowledgments
Appendix D. ACIP Recommended Immunization Schedules

* New recommendations 2007 to March 2008.

And now:

Preventive Measures Supported by Science that have been Advanced by ‘Integrative Medicine’

Got it?

…………..

The Misleading Language and Weakly Waluation of the Weasel Words of Woo series:

  1. Lies, Damned Lies, and ‘Integrative Medicine’
  2. Integrative Medicine: “Patient-Centered Care” is the new Medical Paternalism

Posted in: Medical Academia, Medical Ethics, Politics and Regulation, Public Health, Science and Medicine, Science and the Media, Vaccines

Leave a Comment (41) ↓

41 thoughts on “Lies, Damned Lies, and ‘Integrative Medicine’

  1. Dr Benway says:

    Your Kung-fu is mighty.

    Mine is similar but has moar LOLspeak.

    I’ve heard people argue that without NCCAM we’d only have BigPharma studying novel, expensive drugs.

    WTF? How did the history of scientific work in nutrition, hygiene, sleep, psychology, excercise, toxicology, and on and on, just get erased?

    I hear a voice in my head saying, “We are at war with Eurasia. We have always been at war with Eurasia.”

  2. badrescher says:

    “Are scientists at the NIH really too afraid of Harkin to explain to him how science works? Apparently so. Otherwise Harkin might learn that his statement is more wrong-headed than it would be for one of us to complain that the Supreme Court ought to assume that a defendant is guilty until proven innocent, rather than the other way around.”

    Apparently, either someone told him or his staff found the criticisms. His entire opening statement appears on his website EXCEPT that paragraph.

  3. Dr Benway says:

    In integrative medicine, patients are active partners in their health and providers care for them as individuals in different life circumstances, rather than just treating their illnesses.

    Awr. Dats sweet. Each citizen will get a kindly doctor who will be like a wise friend. He will say, “good job!” when you pass a test, or you lose 5 pounds, or you give back the DVDs you stole to the store. He will give good advice like “don’t smoke!” and “don’t drink!” and “don’t have sex!” and “pay your taxes!”

    What friggin’ planet are these integraters from?

    The reimbursement system encourages this pattern, by financially rewarding units of service, rather than outcomes, prevention, and the integration of care processes that each patient should expect.

    Yes, because units of time can be measured reliably. Outcomes are more difficult to price. And further, no one will treat the poorly cooperative patients if they’re gonna be penalized for the outcomes.

  4. David Gorski says:

    Your Kung-fu is mighty.

    Actually, it’s his Blog-Fu that is mighty. :-)

    He nailed it, though. Relabeling CAM as “integrative” medicine and “prevention” is an Orwellian stroke of genius, and, unfortunately, it appears to be working.

  5. DevoutCatalyst says:

    Regarding Tom Harkin, the left denounce George Bush as “incurious”, yet, in the service of critical thinking, the left has its fair share of enantiomorphs of George Bush.

    “…Above all, integrative medicine encompasses the caring bond between the patient and the caregiver…”

    Are intergrative doctors going to start dating their patients? I mean, sure, I’d like to rub Andrew Weil’s bald head just once — for good luck — but that’s the end of any caring bond I’d ever hope to share with a physician.

    “…Finally, it asks physicians to serve as guides…”

    How about guide dogs? Put a handle on the back of your favorite integrative doctor, these guys can do everything !

  6. Jurjen S. says:

    Okay, here’s an anecdote:
    When I was fourteen, and attending secondary school A, I was subjected to an examination by the “school doctor” (which meant she went around the various schools in the municipality, not that she was attached to that particular school). She took my blood pressure, saw that it was high, and told me to cut down on salty snacks (i.e. potato chips and the like). Less than two years later, I had my blood pressure taken again, and it was on the lower end of what it should be. I had not cut down on salty snacks in the interim, but I had changed schools, and at my new secondary school B, I was far away from the bullies who had taunted me at school A.

    My point? To my mind, there’s no doubt the school doc was utterly wrong in attributing my high blood pressure to sodium intake without considering other possible sources of stress to which a 14 year-old might be subject. But before you cry “failure of allopathic medicine,” you have to ask whether any given CAM practitioner would have done any better, even in a merely complementary role. Probably, (s)he would have told to get my chakras in alignment, and equally ignored the simple fact that adolescents are subject to some nasty social pressures.

  7. DoctorLaw says:

    What makes Dr. Atwood think that “integrative” practitioners do not concur with and/or utilize the measures and procedures listed by the USPSTF?

  8. overshoot says:

    What makes Dr. Atwood think that “integrative” practitioners do not concur with and/or utilize the measures and procedures listed by the USPSTF?

    I certainly can’t speak for Dr. Atwood, but my own experience shows that:

    They’re consistently against vaccination,
    Many are germ-theory denialists,
    Many push dangerous idiocy such as “colon cleansing” to the exclusion of basic health practices,
    Most are so fixated on food that they deny any benefit to exercise,
    Most push magical diets that are patently unhealthy (lacking essential nutrients).
    etc.

    IMHO real preventive medicine is a threat to their businesses, which depend on selling magic. Their stock in trade is the illusion of perfect safety without serious effort (eating magical foods isn’t nearly the work that a good sweaty exercise session is.)

  9. Dr Benway says:

    DoctorLaw, I think Dr. Atwood’s point is that medicine was busy trying to prevent illness long before CAM came along. So no fair the CAM guys saying:

    “WE IZ IMPOTANT!!!! WE FIX BAD DOCTORIN CUZ WE EXPERTZ AT PREEVENSHIN!!!”

    I am still trying to figure out what “integrative” means.

  10. Karl Withakay says:

    “Apparently, either someone told him or his staff found the criticisms. His entire opening statement appears on his website EXCEPT that paragraph.”

    The internet memory hole strikes again!

  11. Karl Withakay says:

    … and fails again!

  12. David Gorski says:

    They’re consistently against vaccination,
    Many are germ-theory denialists,
    Many push dangerous idiocy such as “colon cleansing” to the exclusion of basic health practices,
    Most are so fixated on food that they deny any benefit to exercise,
    Most push magical diets that are patently unhealthy (lacking essential nutrients).
    etc.

    Exactly. We’ve written about these very things in this blog time and time again over the last year or so of its existence. I suggest that Doctor Law peruse the archives a bit.

  13. Joe says:

    Jurjen S. on 06 Mar 2009 at 9:13 am wrote “Okay, here’s an anecdote:”

    Why bother? Really.

  14. daedalus2u says:

    I think the term “integrative” was chosen because it connotes “adding to” and plays on the normal human intuition that more of something is always better. More food, more companionship, more sex, more money, more procedures, more chemotherapy, more radiation treatments, more surgery, longer hospital stays. Oh well, so the “more is better” paradigm doesn’t fit into a medicine-type model. Unless people think about it they will think “more is better” and as long as they are not paying for it, they don’t lose anything and can feel they are “hedging their bets”.

  15. Dr Benway says:

    I have to save this definition of “integrative medicine” from the NCCAM site, as linked to above. It’s just too preciously mindless and no doubt will be re-written soon.

    What is integrative medicine?
    Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.

  16. Dr Benway says:

    I think I’m catching on. The old meaning of “integrative” was “conventional + cam.”

    However, recently Weil put down the bong and went, “uhh… seemed to make sense when I was baked.”

    An aside for the noobs:
    1. “Medicine” is a set of therapies supported by evidence of safety and efficacy.
    2. “CAM” is a mixed collection of therapies not supported by evidence.
    3. When we find evidence in support of some CAM therapy, it becomes “medicine.”
    4. Only Schrodinger’s cat is quick enough to integrate medicine with CAM therapies “for which there is some quality evidence.”

    So now “integrative” means something vague about integrating mind and body, caring for the whole patient, blah blah blah.

  17. Dr Benway says:

    Jurjen, if that doc thought something was wrong, she’d have done something about it. At minimum, she should have checked your blood pressure in each arm.

    Vague advice like, “take it easy on salt” without action means she believed you were fine. Maybe she wanted to seem like she was addressing the high pressure reading, even though she wasn’t.

    Of course you didn’t know this at 14. You didn’t know adults could talk without engaging their brains. So you worried about the high reading, and remember the experience years later.

    I’ll bet you think about how kids might hear what you’re saying a bit more than that doctor did.

  18. LindaRosaRN says:

    Dr. Benway wrote: *I am still trying to figure out what “integrative” means.* Out here in Colorado, “fully reimbursed” is the equivalent.

    Dr. Atwood writes so perceptively, as do others on the blog. I wish such essays were showing up before policy makers. Are they?

    Is there’s any interest in starting an organization to combat the CAM PR machine in WashDC and elsewhere — with press releases, lobbyists, press contacts, white papers, etc.?

  19. Fifi says:

    “So now “integrative” means something vague about integrating mind and body, caring for the whole patient, blah blah blah.”

    If CAM’s giving up “holistic” for “integrative” does that mean that multidisciplinary pain clinics can “holistic” back? ;-)

  20. Fifi says:

    I highly suspect “integrative” was chosen because it sounds “sciency” and inclusive at the same time – it makes it sound like CAM is accepted by “conventional” medicine. Though, the term “conventional medicine” makes me laugh too since cutting edge experimental scientific medicine is hardly “conventional” and CAM is based on all kinds of outmoded conventions from pre-scientific medicine.

  21. overshoot says:

    I am still trying to figure out what “integrative” means.

    It doesn’t differentiate — primarily between “works reliably” and “who cares?”

  22. Zetetic says:

    “…emphasis on the responsibility of the physician to engage the patient in his or her own unique plan for health.”

    This is the antithesis to increasing emphasis by state and federal regulatory agencies as well as major health insurance consortiums to essenially mandate practice in concert with the “Standard of Care”. SBM is the strong basis for standard of care. Health care organizations are required to compile volumes quality related reports to support their compliance with mandated standard treatment modalities.

  23. Dr Benway says:

    Is there’s any interest in starting an organization to combat the CAM PR machine in WashDC and elsewhere — with press releases, lobbyists, press contacts, white papers, etc.?

    I make a passable foot soldier but a crap leader. My laziness, disorganization, and penchant for LOLspeak farks up the gravitas.

    I’m resting from a concussion last weekend while ice skating, otherwise I wouldn’t be posting so much. I’ll vanish soon to catch up with work.

    My lazy side wonders if there’s already a worthy group out there, rather than starting something new.

    As for leaders I would follow into the breach: Novella absolutely. The other bloggers here probably; just haven’t had the pleasure of hearing their voices and seeing them think on their feet.

    Oh, I made a cartoon for “integrative care.” Except there’s no pictures. The punchline:

    Dr. Camwoo: “Yes, we now have learned of the integrative sterile field, which combines the sterile with something that is not sterile, so nothing is left out.”

  24. daedalus2u says:

    I think the current interest in CAM and alternative medicine is related to the current interest in truthiness.

    http://en.wikipedia.org/wiki/Truthy

    As Stephen Colbert says of truthy:

    ”Truthiness is ‘What I say is right, and [nothing] anyone else says could possibly be true.’ It’s not only that I feel it to be true, but that I feel it to be true. There’s not only an emotional quality, but there’s a selfish quality. “

    That same selfish quality holds for CAM and the other non-science based belief systems. It isn’t just selfish, but hubristic as well. For CAM, it means putting your own want to be “correct” and have your ego massaged by being the Big Kahuna above a sick person’s need to have a treatment that is likely to be helpful. It is fundamentally an abusive and exploitive-type relationship.

  25. daedalus2u says:

    Dr Benway, my own thought is that the best way to eliminate CAM is by replacing it with something better. I think I have a science-based treatment modality that is better at what CAM does than CAM is.

    The mechanism for virtually all CAM treatments is the placebo effect. I have a write-up on that, where I explain the physiology behind the placebo effect as being due to the normal allocation of physiological resources between healing and things that are more important than healing.

    http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

    I see the placebo effect as being due to the neurogenic production of NO to switch physiology from a “fight or flight” state where ATP production capacity is held in reserve for possible use in fight or flight to a state where that ATP can be allocated to healing.

    I think the treatment I have, applying NO/nitrite producing bacteria to the external skin will supply NO and trigger the placebo effect pharmacologically. Once the placebo effect is triggered by any method there is nothing that any other placebo can do. A treatment that reliably and cheaply triggers the placebo effect will leave nothing for CAM procedures to work on.

    While you are recovering from a concussion, you should increase your nitrite intake. Nitrite specifically reduces cerebral vasospasm following hemorrhage. A way to increase your nitrite intake is via eating lots of green leafy vegetables. The nitrate they contain is concentrated ~10x from plasma into saliva and reduced to nitrite on the tongue.

  26. Dr Benway says:

    daedalus2u, you crack me up.

    On the one hand you’re tremendously well informed about nitrate physiology and I must respect your scholorship.

    On the other hand, well, um, how shall I put this without provoking offense… you do not appear to be interested in looking at situations apart from the nitrate angle.

    Keep being yourself.

  27. daedalus2u says:

    Dr Benway, no offense is taken. You are correct, I am someone who knows his limits. My expertise is pretty much limited to NO physiology. That covers a lot, but not everything (notice I virtually never make comments about cancer treatments, that isn’t something that I understand how NO fits with).

    If NO is important in a physiologic pathway, then having the right basal NO amount is important. If NO is important and the right basal NO level is not present, then the pathway will be skewed in a “stress” direction. Normalizing the NO level will improve performance of every NO pathway.

    I appreciate that this sounds like woo. It only sounds that way to people who don’t understand the details of NO physiology. There are a lot of details, so it isn’t easy to come up to speed on it. I don’t know what to do except try and educate people on it.

    I would be happy to send you stuff that isn’t yet on my blog and answer any questions you might have, just to try and bring you up to speed.

  28. Zetetic says:

    Who would FINANCE lobbying for the EBM cause? There’s no money to be made like with the supplement industry!

  29. daedalus2u says:

    If I can get help using my bacteria to displace CAM, I will finance it.

  30. LindaRosaRN says:

    BENWAY: My lazy side wonders if there’s already a worthy group out there, rather than starting something new.

    ME: The closest orgs are Quackwatch and ASCH. Great enterprises, but soley educational. They have no political action sister orgs. (like the Sierra Club has the Sierra Club Legal Defense Fund).

    ZETETIC: Who would FINANCE lobbying for the EBM cause?

    ME: The quacks will claim any such activist organization is funded by Big Pharma. I think concerned skeptics would make enough donations for an effective group… and grants?

    Do you all think this worthy of discussion?

    education

  31. marilynmann says:

    Excellent post. I have a minor clarification to add.

    “than it would be for one of us to complain that the Supreme Court ought to assume that a defendant is guilty until proven innocent”

    In practice, the U.S. Supreme Court would never have occasion to assume a defendant is innocent until proven guilty, the reason being that the Supremes do not try criminal cases. They do *review* convictions, so if an issue were raised as to whether at trial the presumption of innocence was properly applied, they could review that. But at that point, of course, the trial would be over and the defendant already convicted, so they themselves would not have occasion to apply the presumption. Rather, they would be reviewing whether the presumption of innocence (not explicitly stated in the Constitution but flowing from certain provisions thereof) had been upheld at trial. I would suggest you substitute “a trial court” for “the Supreme Court.”

    There are certain limited situations where the Supreme Court acts as a trial court, as in a dispute between the federal government and one of the states. In those cases, the Court generally appoints a special master to, in effect, act as a trial court. The special master produces a (generally voluminous) report, which the Court can review de novo, meaning that it acts as trier of fact and can overturn the factual findings of the special master if it disagrees. But these are not criminal cases.

  32. Marilyn,

    Thanks for that clarification. I had a feeling I’d stretched the analogy a bit, knowing that the SC doesn’t try criminal cases, but I couldn’t resist the temptation to cite the Big Court, not just any old trial court. It seemed more in keeping with the NIH being the Big Biomedical Research Institute. Here’s how I’d change it, if you think it’d work: “than it would be for one of us to complain that the Supreme Court ought not to apply the presumption of innocence when it reviews criminal cases, but should instead apply the presumption of guilt.” Er sumpthin’.

  33. marilynmann says:

    I think that works.

  34. Dr Benway says:

    Too wordy for a meme virus. How ’bout:

    Harken’s complaint that NCCAM ought to seek out and approve CAM therapies is as misguided as a judge telling a jury that its job is to prove the defendant guilty-as-charged.

  35. Dr B:

    You gottit. If this ever appears in another form, you’ll getta nod.

  36. Prometheus says:

    Maybe I’m missing something, but don’t the “CAM” (or “sCAM”, if you like) make a bundle of money with little or no work (or malpractice exposure)? Why are they trying to mess up the gravy train that is working so well for them?

    Consider these facts about “CAM”:

    [1] You don’t have to go to medical school – or any school – to practice “CAM”. You can hang out your “shingle” as a Holistic Energy Manipulating No-Touch Thought-Field Therapist with nothing more than the ability to read, write and – most importantly – do sums.

    [2] “CAM” practitioners don’t have to justify or “pre-authorize” their treatments with insurance companies or national health payers, since their “services” aren’t covered (exception: homeopathy in the UK).

    [3] “CAM” practitioners almost universally deny being a patient’s “primary care provider” – this reduces their risk of being sued for malpractice in the event they fail to diagnose or treat a real disorder. “I’m just realigning your chakras – see your regular doctor if you have any real medical problems.”

    This has been seen most dramatically in the chiropractic community in the US, where chiropractors lobby hard to be reimbursed as “primary care physicians” but claim that their training does not include diagnosis and treatment of real medical disorders when sued for malpractice.

    [4] Reimbursement for “CAM” practitioners is not currently being targeted for “cost savings”. Since it isn’t covered by most private or government health insurance, it isn’t on the “radar screen” of the cost-cutters.

    [5] Putting “CAM” practitioners on the panels of private and governmental insurance plans is almost certain to lead to undesirable outcomes such as increased scrutiny of the effectiveness and safety of “CAM” therapies as well as marked reduction in reimbursement, since the grateful and worshipful (and gullible) patient will no longer be paying out of pocket.

    With all of these “downsides”, why on earth are the CAMsters trying to get into the “mainstream”?

    Am I missing something? Are they just that stupid – don’t they see that what happened to real doctors will happen to them?

    Prometheus

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