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Quackademia update: The Cleveland Clinic, George Washington University, and the continued infiltration of quackery into medical academia

Collingewheel

Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not improve the apple pie. Yet that is what’s going on in medical academia these days—with a vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”

In fact, it was my two recent publications bemoaning the infiltration of quackademic medicine into medical academia, one in Nature Reviews Cancer and one with Steve Novella in Trends in Molecular Medicine, that got me thinking again about this phenomenon. Actually, it was more my learning of yet another step deeper into quackademia by a once well-respected academic medical institution, occurring so soon after having just published two articles bemoaning that very tendency, that served as a harsh reminder of just what we’re up against. So I decided to greatly expand a post that I did for my not-so-super-secret other blog recently beyond a focus on just one institution, in order to try to demonstrate for you a bit more how and why quackery has found a comfortable place in medical academia and how, just when I thought things can’t get worse, they do. There is also room for hope in that I also found evidence that our criticisms are at least starting to be noticed. I begin with the sad tale of the Cleveland Clinic Foundation, which has gone one step beyond its previous embrace of traditional Chinese medicine. I’ll then discuss another unfortunate example, after which I’ll look a bit at the pushback and marketing of “integrative” medicine.
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Posted in: Acupuncture, Energy Medicine, Medical Academia, Science and the Media

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Hiccups: From Acupuncture to Quantum Touch

hiccupcure

Foolproof cure for hiccups?

nOne of the most common questions I get in the newborn nursery, especially from first time parents, involves hiccups. Babies hiccup in the womb and most, if not all of them, will have periodic bouts of hiccups in the neonatal period. But many new parents are surprised by their baby’s first spasmodic contractions of the diaphragm. When brought up, it is often to simply acknowledge that their baby had a run of a few hiccups, usually associated with a feed, with some parents expressing surprise and others nervousness. Regardless of their assumed motivation, I always provide reassurance that hiccups are a normal experience for babies, as they are across the entire spectrum of age.

The medical term for hiccups, which I admit I only learned while researching this topic, is “singultus.” We doctors like to use our own peculiar language as much as possible in order to maintain a sense of superiority when dealing with today’s internet savvy customers, I mean patients, and their families. The rumbling of your stomach, that’s actually borborygmus. You don’t have a unibrow above your nose, that’s a synophrys. It isn’t abdominal or pelvic discomfort associated with ovulation that keeps annoying you midway through your menstrual cycle, it’s mittelschmerz. But since this is a forum meant for general public consumption, I’ll use the rather pedestrian and philistine “hiccup” for the duration of the post. (more…)

Posted in: Science and Medicine

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If you don’t buy this supplement for your child, you’re a terrible parent

kids-dha-cerebrum-small

The supplement industry wants you to buy their products, and they’re not above using a little parental guilt to make you into a customer. In the photo above, the promoter is my local pharmacy, where the large window display caught my eye:

Give your Child The Tools to SUCCEED in School!

Who doesn’t want their child to succeed? And if you knew a supplement could give you or your child a learning edge, would you consider it? I’d imagine many do. Supplements have a remarkable health halo. As a pharmacist myself, I’ve noticed this when speaking with patients – few consumers identify any potential risk or downsides to supplement use. Some don’t even think of them as medicine at all. The marketing has resonated: Supplements are perceived as “safe”, “natural” and “effective”. But whether you’re giving your child a prescription medicine to treat attention deficit hyperactivity disorder, or you’re giving a supplement to “improve focus and brain function”, you’re still administering a chemical substance to a child with the intent of changing brain function. We’d probably think twice before pouring an unknown substance in our car’s gas tank, especially one claimed to boost performance. We’d probably ask for some evidence that it works, and some assurance it wouldn’t harm our vehicle. A decision to use a drug or supplement in a child deserves just as much consideration of benefits and risks. (more…)

Posted in: Science and Medicine

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“Mystery” Illness in Colombia

900px-Flag_of_Colombia.svg

It looks like we can file this one under “here we go again.” A small town in Colombia, El Carmen de Bolivar, has seen more than 200 girls hospitalized with a mysterious illness since May of this year. The symptoms include dizziness, headaches, and fainting. So far, all of the girls hospitalized have been found to be healthy and were quickly released from the hospital without discovering any specific disease or pathology.

Unfortunately I have to depend on news outlets to provide information about this case, and most are skimpy on details. However, taking what is being reported, the case has all the features of mass psychogenic illness. Specifically, the cases are clustering in a small community, which is typical for typical for episodes of mass delusions. The symptoms being reported are all subjective and the kinds of symptoms that can result entirely from psychological stress. I have seen no reports of objective clinical findings, such as fever, rash, abnormal laboratory findings, strange lesions, or objective findings on exam.

Doctors who have examined the patient feel that the presentation is consistent with psychogenic illness. I have discussed this at length previously. A psychogenic illness results from the physical manifestation of psychological stress. This is always partly a diagnosis of exclusion, meaning that other causes of the presenting symptoms need to be ruled out. However, it is more than just a diagnosis of exclusion, as there are sometimes clinical features that can be positively demonstrated to be psychological rather than physical. The ultimate test of the psychogenic diagnosis is that patients should improve with support and encouragement.

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Posted in: Neuroscience/Mental Health

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Bad News and Good News from Down Under: Science-Based Medicine in Australia

iridology-signage

The bad news: in a disturbing attempt to woo customers, some Australian pharmacists are offering in-store consultations with naturopaths. The good news: Australian skeptics and supporters of science have had a lot of recent successes in combatting quackery.

Non-Doc in a Box

In an article in the Australian magazine The Skeptic, Loretta Marron reports on naturopaths in pharmacies. You can read it here. Pharmacy customers who want natural treatment alternatives are referred by pharmacy staff to an in-house naturopathy clinic. The cost, $90 for a one-hour consultation, is often covered by insurance. You can even get a Loyalty Card to make your fifth consultation free. They claim to “correct underlying causative factors,” advise about stress, diet, how to promote your vitality and immune system, etc. And they help you make informed decisions about your health (informed by their brand of misinformation).

They offer disproven diagnostic methods like iridology, live blood analysis, and bio-energetic screening with bogus machines that they claim can detect everything from vitamin deficiencies and parasites to “spinal energy” and “vaccination disturbance.” Marron doesn’t describe the treatments they recommend, but we can assume they are offering the usual naturopathic remedies, including homeopathy, in lieu of the pharmaceuticals that are the reason for the pharmacy’s existence. (more…)

Posted in: Naturopathy, Science and the Media

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Do doctors pay attention to negative randomized clinical trials?

vertebroplasty

We at the Science-Based Medicine blog believe that all medicine, regardless of where it comes from, should be held to a single science-based standard with regards to efficacy, effectiveness, and safety. We tend to focus primarily on “complementary and alternative medicine” (CAM), now more commonly known as “integrative medicine,” because (1) we believe it to be undermining the scientific basis of medicine and allowing outright quackery (or, as I like to refer to it, quackademic medicine) to infiltrate medical academia, which is fast becoming medical quackademia and (2) because when it comes to the other threats to the scientific basis of medicine as it is practiced today, such as pharma influence and various medical dogmatism, there are a whole host of active critics better equipped and more energetic than we are who can do the job (usually) better. That is why, whenever I hear advocates of CAM/”integrative medicine” attack us for not spending enough time on various corruptions of clinical trial processes or the perfidy of big pharma, I tend to gently tell them in my characteristically diplomatic manner that that’s what I like to call the “Why don’t you blog about what I think is important and interesting instead of what you think is important and interesting?” criticism, then I refer them to our posts on John Ioannidis, overdiagnosis and overtreatment, the shortcomings of mammography, or any number of other posts we at SBM have done through the years pointing out where current medical practice falls short. Indeed, it never fails to amuse me to point out how angry an eminent radiologist became at me for my posts criticizing him for his misleading attacks on certain studies that question the value of screening mammography.

In particular, though, I like to point out a post I did on vertebroplasty as a treatment for vertebral compression fractures (VCFs) due to osteoporosis. Basically, I discussed then recent evidence showing how vertebroplasty for such fractures is, basically, placebo medicine, no better than acupuncture. Indeed, I likened the state of evidence regarding vertebroplasty to that of acupuncture, in which small, pilot studies appear to be positive, but then the follow-up rigorous randomized clinical trials fail to find a benefit greater than that of placebo. It turns out that a rather telling study regarding vertebroplasty was published earlier this year that I somehow missed that addresses a problem we have in “conventional” medicine.
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Posted in: Clinical Trials, Medical devices

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Announcement: “Integrative oncology” – Really the best of both worlds?

pancreatic-cancer-diagnostics-l

One of our goals here at SBM is to do more than just blog about the issues of science and pseudoscience in medicine that are our raison d’être. We also want to publish our science-based critiques in the peer-reviewed medical literature. Our first crack at this was an article by Steve Novella and myself published last month in Trends In Molecular Medicine entitled “Clinical trials of integrative medicine: testing whether magic works?” Even better, thanks to a press release and how the editors made the article free to all, it garnered more social media attention than any article previously published in TMM, and the editor has informed me that it “shot straight to the top of TMM’s ‘Most read’ article list and I anticipate it staying there for quite some time.” For this, Steve and I thank you, our readers, and those of you who spread the news. We’re hoping that this success garners more offers to write review and commentary articles for the peer-reviewed literature about topics near and dear to us.

Now, I’m happy to announce another commentary in the peer-reviewed literature. It’s an article I wrote for Nature Reviews Cancer that just appeared online yesterday entitled “Integrative oncology: Really the best of both worlds?” I must say, I’m quite proud of this one, and it is a big deal, hopefully to more people than just me. If you look up the impact factor for NRC, you’ll see it’s around 35, which is between The Lancet and JAMA.
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Posted in: Announcements, Cancer

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Rationalizing the Ridiculous

410px-Chinese_barefoot_doctor_performing_acupuncture

Pictured: Cutting-edge medicine

I remain flummoxed. How do physicians and health care systems, trained in all the sciences that lie at the heart of medicine, justify the use of pseudo-medical interventions with no basis in reality? Rationalization. Making excuses:

a defense mechanism in which controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation, and are made consciously tolerable – or even admirable and superior – by plausible means.

Rationalization of the ridiculous comes in many forms. It has been said that it is a mark of a first rate intelligence to able to hold two contradictory ideas in the mind at the same time and still retain the ability to function. Clever as it is, I suspect the opposite is true. (more…)

Posted in: Acupuncture, Naturopathy, Science and Medicine

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Missouri tackles primary care shortage with “assistant physicians”

Medical school clinical training

Medical school clinical training

A new law in Missouri will allow medical school graduates who have not completed a residency to practice in underserved areas. They will be able to call themselves “doctor” but will be licensed as “assistant physicians” with significant limitations on their practice. (The first link is to Senate Bill 716, the bill that was passed and signed by the governor. It covers several subjects, so you will need to skip to page 8 to find the portion we’re discussing.)

The Missouri State Medical Association supports the new law and helped draft the original bill. It is designed to address the state’s critical need for primary care physicians – 40% of Missouri’s population lives in underserved areas but only 25% of the state’s physicians practice there, according to a 2009 survey. Underserved areas have high poverty rates, high infant mortality, large senior populations and fewer primary care physicians per capita. (more…)

Posted in: Chiropractic, Legal, Naturopathy, Politics and Regulation, Science and Medicine

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Privileged Antivaxxers

hollywood

The Hollywood Reporter recently published what is mostly an exposé on privileged Hollywood parents who have elected to delay, limit, or avoid altogether immunizing their children. The most common headline coming out of this article is that some LA communities have vaccination rates at third-world levels, such as South Sudan. The issues raises many questions pertinent to the promotion of science-based medicine – what leads an otherwise well-educated individual with financial security to make decisions that actually put their own children (and others) at risk?

Some background

We have often observed at SBM that the anti-vaccine movement is likely to experience a serious backlash once epidemics of vaccine-preventable diseases start to emerge. I think we are seeing the beginning of this prediction coming true. Vaccines are partly the victim of their own success. The diseases they prevent, such as polio, measles, whooping cough, and others, are now uncommon. Modern parents have the privilege of not fearing these diseases because the vaccination program has reduced them to sporadic cases. Therefore, when pseudoscientists or ideologues stoke fears against vaccines, the fear of the diseases they prevent is not there as a balancing force.

That may be changing, however. The CDC reports:

During 2012, 48,277 cases of pertussis were reported to CDC, including 20 pertussis-related deaths. This was the most reported cases since 1955. The majority of deaths occurred among infants younger than 3 months of age.

From January 1-August 16, 2014, 17,325 cases of pertussis have been reported to CDC by 50 states and Washington, D.C.; this represents a 30% increase compared with the same time period in 2013.

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Posted in: Vaccines

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