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The future of “integrative medicine” is too close for comfort

I was the other day. I’ve been on vacation this week (staycation, actually, as I stayed at home and didn’t go on any trips); so you would think it would take a lot to depress me. Unfortunately, today is the last day of that vacation; so the thought of diving back into the fray trying to fund my lab. It didn’t help that I read Scott Gavura’s Thursday post how another once-proud academic medical center, the University of Toronto, is letting the Trojan horse that is “integrative medicine” into the halls of its medical school and school of pharmacy. As I frequently say, much to the annoyance of advocates of “complementary and alternative medicine” (CAM) and “integrative medicine,” what “integrative medicine” does is to “integrate” quackery with real medicine, which neither validates the quackery nor improves the real medicine. Or, as my good bud and fellow SBM blogger Mark Crislip so aptly put it:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

Yes, I’ve been trying to come up with a quote that captures the essence of “integrative medicine” better than Mark’s quote. I’ve yet to succeed; so I steal his quote whenever I need to. It’s sort of the same way that I didn’t actually coin the term “quackademic medicine” to describe the infiltration of quackery into academic medicine. (Dr. R. W. Donnell did, as far as I’ve been able to ascertain.) However, I believe I’ve done more than anyone else to use and promote the term, both here and at my not-so-super-secret other blog. As I like to say say, mediocre bloggers borrow. Great bloggers steal.

Be that as it may, Scott’s post reminded me that I hadn’t looked much at quackademic medicine, at least not at the status of its infiltration into medical academia, in a while. Then I saw a review article entitled The Future of Integrative Medicine in The American Journal of Medicine by Victor S. Sierpina, MD, ABFM, ABIHM and James E. Dalen, MD, MPH. (Note that ABIHM stands for the American Board of Integrative Holistic Medicine and ABFM stands for the American Board of Family Medicine.). The article itself has no place in any self-respecting peer-reviewed medical journal, but there it is, much the same way that quackademic woo has been intermittently infiltrating the New England Journal of Medicine. The article itself is one massive apologia for integrative medicine. In fact, it’s useful to look at because it follows a script that virtually all such articles follow, with only relatively minor variations.

Not surprisingly, it starts out, as virtually all such articles start out, with the logical fallacy known as the appeal to popularity. As I just alluded to, there must be a script for these sorts of articles about CAM, in which they all must begin with a paragraph trying to demonstrate how popular CAM is, the larger the percentage of people using CAM the better, even if the author has to include prayer and spirituality (which are religion and not medicine), exercise (which is a science-based modality rebranded as somehow “alternative”), and nutrition (which is similarly not “alternative” but a science-based modality similarly “rebranded” as “alternative”; that is, as long as the claims being made for it aren’t overblown). Sierpina and Dalen’s article is no exception. They immediately cite an article from 20 years ago that claimed that one in three people used “unconventional therapies.” (I can’t help but note that 20 years ago it was still acceptable to call quackery “unconventional” rather than to refer to it as CAM or “integrative medicine.” Unfortunately, that was also about the time that that started to change in a big way.) In any case, using this logical fallacy, they strongly imply that because CAM is popular that there must be something to it. I always respond to such arguments by pointing out that nearly half of U.S. adults don’t believe in evolution. Does that mean that evolution is not a valid scientific theory? Science is not a popularity contest.

Next in the script of these articles—and I’ve read more of them than I can remember—is to extend the appeal to popularity to imply that you, as a reader, should jump on the bandwagon. The reason, if they are to be believed, that you should jump on the bandwagon is because modern medicine is too high-tech, doctors have lost touch with their roots as healers, and patients “feel lost” in our health care system. For example, Sierpina and Dalen write:

In the past several decades we have seen a sea change in the medical landscape from the solo practice, primary care country doctor to large urbanized health care systems, from high-touch, low-cost care to high-tech, specialized, expensive, sometimes impersonal health care. Some patients feel lost in our current health care system. They see specialist after specialist and receive prescription after prescription and test after test. They wonder whether their specialists speak to each other.

In the context of these historical and social changes, a field of unconventional medicine has evolved that has been known by a progression of names: holistic medicine, complementary and alternative medicine, and now integrative medicine. It is hoped that the perspectives offered by integrative medicine will eventually transform mainstream medicine by improving patient outcomes, reducing costs, improving safety, and increasing patient satisfaction.

Of course, just because modern medicine can be impersonal and confusing is not a justification for introducing quackery into medicine. I like to remind people that the primary care country doctor of 50 or 100 years ago that is so lionized as the ideal by CAM providers because of the “human touch” he provided often couldn’t do a heck of a lot other than commiserate with their patients and provide that human touch. Don’t get me wrong. That’s a critically important part of medicine that is difficult to maintain in our current healthcare environment. However, a far better solution would be to reintroduce the human element of caring and retain the efficacy of science-based medicine without introducing the mysticism, vitalism, and prescientific thinking that is at the heart of so much CAM. It’s a false dichotomy that is being argued: It’s either impersonal, mechanized medicine or it’s “integrating” quackery into medicine. CAM apologists like Sierpina and Dalen like to imply that those are the only two choices. They aren’t. There is another way that does not involve weakening the scientific foundation of medicine.

Even more off-base, the script for this sort of article always includes a claim that somehow CAM will “transform” medicine. No doubt it will, if current trends continue and quackademic medicine continues to infiltrate unchecked. Indeed, it already has. Unfortunately, that “transformation” is not for the better, given that it involves injecting mystical faith healing like reiki and healing touch, vitalistic quackery like homeopathy and traditional Chinese medicine, and cornucopias of quackery like naturopathy into modern medicine. To CAM advocates this is a good thing that will somehow “humanize” medicine. To me it is unnecessary quackery. Unfortunately, it is ascendant right now.

Next up in these articles is often the attempt to define just what “integrative medicine” is. My definition is fairly clear: Integrating quackery with real medicine. (I know, I repeat myself, but I want to drive this point home.) However, let’s see how Sierpina and Dalen try to explain how it is defined:

Integrative medicine has been defined as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.”

This definition, quoted from the Consortium of Academic Health Centers for Integrative Medicine, is nonsense, of course. It’s complete gobbledygook that reinforces the false dichotomy that so irritates me. Once again, it is not necessary to embrace quackery in order to “reaffirm the importance of the relationship between practitioner and patient” or to “focus on the whole person.” It just isn’t. Yet that’s the false dichotomy at the heart of all these articles. Yet that is exactly the dichotomy that CAM apologists hammer advocates of SBM over the head with in an effort to paint us as uncaring and more concerned with science than with actual patients. Of course, it is because we are so concerned with patients that we reject this dichotomy and insist on science-based medicine, but that’s a message that is sometimes hard to communicate, which makes it easy for writers like Sierpina and Dalen to write things like this:

The most obvious differences between integrative and conventional medicine are its practitioners, who offer longer consultations and emphasize minimally invasive therapies, such as mind-body approaches, nutrition, prevention, and lifestyle changes, and focus on healing and wellness. In addition to conventional therapies, they may recommend alternatives, such as acupuncture, dietary supplements, and botanicals. The doctor-patient relationship emphasizes joint decision-making by the patient and the physician.

Once again, it is not necessary to abandon SBM in order to emphasize joint decision-making by the patient and the physician. As I’ve pointed out multiple times before, the days of “Dr. Kildare”-style paternalism of 60 years ago and earlier are over, and that is generally a good thing. These days, good science-based doctors emphasize joint decision-making. The reason CAM practitioners emphasize joint decision-making so much, to the point of fetishizing it, is because that’s all they have that’s of value. The rest of what they offer consists of either quackery or science-based modalities that have been rebranded as being somehow “alternative,” such as pharmacognosy (natural products pharmacology) rebranded as herbalism and supplements, nutrition, lifestyle interventions, and exercise.

Once again Sierpina and Dalen continue to hammer on the appeal to popularity by launching straight into a discussion of how many academic medical centers have integrative medicine programs, in essence gloating about how in 1999 there were only eight medical school deans who met to discuss CAM and create the Consortium of Academic Health Centers for Integrative Medicine, which ultimately had eleven members. In 2012, there were 54 medical and health professions schools belonging to the Consortium, and today, according to Sierpina and Dalen, here’s where integrative medicine stands in 2013:

There is clear evidence that integrative medicine is becoming part of current mainstream medicine. Increasing numbers of fellowships in integrative medicine are being offered in our academic health centers. In 2013, there are fellowships in integrative medicine in 13 medical schools. In 2000, the University of Arizona established a 1000-hour online fellowship that has been completed by more than 1000 physicians, nurse practitioners, and physician assistants. This online fellowship makes it possible for fellows to continue their clinical practice during their fellowship.

A 200-hour curriculum for Integrative Medicine in Residency has been developed and is now in place in 30 family practice and 2 internal medicine residencies. The curriculum includes many of the topics that are not covered in the medical school curriculum, such as nutrition, mind–body therapies, nutritional and botanical supplements, alternative therapies (eg, acupuncture, massage, and chiropractic), and lifestyle medicine. A similar curriculum for pediatric residencies is being developed. The eventual goal is to include integrative medicine skills and competencies in all residency programs.

Sadly, they say this as though it were a good thing. It’s not. Unfortunately, thanks to the University of Arizona, the efforts to “integrate” pseudoscience into science-based medicine continue apace. For example, just the other day I saw an article cum press release touting how the University of Arizona’s Pediatric Integrative Medicine in Residency recently expanded its online offerings:

UA’s Pediatric Integrative Medicine in Residency program recently expanded its online curriculum to include four other universities in the United States, making it the first national online pediatric integrative medicine program.

Still in its pilot stage, the online curriculum now includes pediatric departments at Stanford University, the University of Chicago, the University of Kansas and Eastern Virginia Medical School Children’s Hospital of the King’s Daughters. Prior to the national launch, the online pilot program was only used at UA’s College of Medicine.

The Pediatric Integrative Medicine in Residency program allows medical school graduates working on their specialization to learn a variety of methods to treat children beyond traditional medicine.

These practices range from nutritional treatment to the Chinese healing tradition of acupuncture. Pediatric residents also learn stress management and physical activity as forms of treatment for their patients.

It always makes me cringe to think about subjecting children to acupuncture, sticking needles into children for no therapeutic benefit.

In any case, as I said at the beginning of this post, now I’m depressed. On the other hand, I’m also getting recharged. I go back to work tomorrow. Not only is it time to get back into my research again and to take care of my patients again. It’s also time to dive back into the fray and promote SBM.

Posted in: Medical Academia, Science and Medicine

Leave a Comment (26) ↓

26 thoughts on “The future of “integrative medicine” is too close for comfort

  1. stuastro says:

    Quacks, they just keep on coming back!

  2. I give up.

    Really, I do.

    How can I present my arguments when “real” doctors are getting these ridiculous certifications?

    The line is now blurred beyond the ability to fight back with reason. As a species, we insist on believing. But couldn’t we find a better way to “integrate” the touchy-feeliness that so many people crave without any actual “treatments”? Couldn’t counselors and social workers–or even a new specialty, call them something like “health whisperers”. Let them listen, explain in detail (scientific detail) and pray, meditate, or massage, but limit it to stuff that that doesn’t make nonsensical claims and doesn’t stand up to testing.

  3. I sometimes just don’t know what to say anymore. I spent about 7 years trying to find a cure for my health problems in alternative medicine. Therapy after therapy failed (i tried all of them) and the practitioner always blamed me. I developed PTSD from the experience. I ended up getting well from a major surgery I had to have, plus some medications that control the PTSD. Thanks alternative medicine. Science is what ended up working, of course. And I had good doctors that cared and spent time answering my questions.

    There are probably a lot of reasons people seek this stuff out. One of the main reasons I think is that they are looking for cures that don’t exist. It’s really horrifying and frustrating to have a chronic incurable condition and go to specialist after specialist to get drugs that make you feel like shit and don’t cure your illness. I recall this from my own illness. Nobody likes taking 12 pills a day especially when the don’t control the symptoms that well. I was fortunate that surgery fixed me once and for all, but not everyone has this option. You begin to hope for a miracle. Alternative medicine is especially corrupt in that they claim to provide a path to wellness that science can’t offer. They claim so much that it works that if it doesn’t work, they blame the patient rather than accept that their treatment protocol might be flawed. The patient becomes brainwashed. It took me nearly dying to finally snap out of my holistic haze and seek real care. And I’m not a dumb person. I just really really wanted to believe I could become a whole human being again, like all the “normal” people.

    I also have had the experience of meeting a medical research scientist who is well respected in the community and has a sharp sense for good experimental design who also believes CAM is the future of medicine. This is something i can’t reconcile. How can someone of this stature, who reads papers everyday, who understands statistics, who is brilliant…not understand that the literature simply does not substantiate CAM? I left that job. It was one of the main reasons I couldn’t work for her anymore. Just when I thought I had escaped it, I got a job offer from another person who ALSO believes in CAM. We need to just accept that it’s swallowing us up. But we shouldn’t stop writing about it. I got a freelance gig with Demand Media and my main objective with this job is to find all the titles about nutrition and CAM and debunk them one by one. The articles get a lot of hits so I figure I’m doing my part. I figured it was the least I could do, and it helps my PTSD to feel like some justice is being served.

  4. Liberada says:

    The sheer arrogance and elitism astounds me, that your feeble mind cannot fathom other methods of validation other than the singular “active” ingredient used in RCTs. The use of the words “infiltration” suggesting medical systems other than conventional western medicine are some sort of infection. The whole notion of integrative medicine is to DERIVE AN EVIDENCE BASE for these therapies that have shown promise in numerous studies, and require further research in clinical practice. If they cannot find an evidence base, they will get rid of it, so what are you so scared of? that it may work? There are far less stringent studies upon which the plethora of pharmaceuticals are peddled, yet these interventions are thrown around like candy. There is no doubt that there is paucity in research for CAMs, but it takes a big ego and an incredibly narrow mind, no matter how many degrees you may have to completely dismiss something just because you haven’t found a way to quantify it. Its a sad day when a doctor goes out of his way to tear down therapies that are aimed to complement conventional medicine and could potentially benefit the very patients he treats.

    1. Harriet Hall says:

      “If they cannot find an evidence base, they will get rid of it,”

      I doubt that, based on their history. I can’t think of anything alternative medicine proponents have ever given up. They are willing to use treatments for their placebo effects, and studies can always be designed to support them.

    2. Edward C. Holmes says:

      Liberata, CAM is quite simply quackery. There is nothing to it. CAM wastes people’s time and money and gives false hope. CAM is snake oil.

      1. jran says:

        Tell me a little about snake oil? Isn’t modern pharmaceutical use the 3rd leading cause of death in the US?

        77K/year I think is the figure. Well that’s from the CDC. Here’s the reference below (1). Other iatrogenic deaths brings this number up towards 200k/yr according some sources (Like the Institute of Medicine, as one example).

        So I am wondering, why would MD’s, learned men and women like those on this message board, would be against nutrition as a method of health? Don’t get me wrong, surgery and emergency medicine in the US is top notch! I wouldn’t want to have a MVA or heart attack anywhere else in the world! But why would you call this all snake oil?

        I can’t wait to hear back – As I said, I am very interested in your opinions. And, I would love to hear more about some of the oncological success stories. Especially if there are any with pancreatic cancer cases.
        Thanks!

        “Think not that all wisdom is within your school”

        1. Paulozzi et al analyzed mortality figures and found that of 38,329 drug overdose deaths then reported in 2010, pharmaceutical drugs accounted for 22,134 deaths, of which 16,651 were opiod analgesic overdoses. The data was apparently revised slightly between the time the research letter was published in JAMA (February 2013) and release of the CDC’s Deaths: Final Data for 2010 publication report, officially dated May 8, 2013.

        1. Chris says:

          “Tell me a little about snake oil? Isn’t modern pharmaceutical use the 3rd leading cause of death in the US?”

          Citation needed. The last bit at the end was not an actual citation. Post at the minimum the title, journal and date of the article.

          Make sure it also notes how many people would have done well without pharmaceutical intervention. For instance, how many type 1 diabetics would suffer if they did not get insulin.

          Also, since the average age of death is around the late 70s, aren’t most deaths among the elderly? How does that fit it to pharmaceuticals being the third highest killer? Especially since this table says something different:

          Number of deaths for leading causes of death:

          Heart disease: 597,689
          Cancer: 574,743
          Chronic lower respiratory diseases: 138,080
          Stroke (cerebrovascular diseases): 129,476
          Accidents (unintentional injuries): 120,859
          Alzheimer’s disease: 83,494
          Diabetes: 69,071
          Nephritis, nephrotic syndrome, and nephrosis: 50,476
          Influenza and Pneumonia: 50,097
          Intentional self-harm (suicide): 38,364

        2. Chris says:

          (Apologies if this is a sort of a duplicate, my first reply disappeared into the ether)

          Tell me a little about snake oil? Isn’t modern pharmaceutical use the 3rd leading cause of death in the US?

          77K/year I think is the figure. Well that’s from the CDC. Here’s the reference below (1).

          Really? You might want to double check that source. Here is the actual data directly from the CDC:

          Number of deaths for leading causes of death:

          Heart disease: 597,689
          Cancer: 574,743
          Chronic lower respiratory diseases: 138,080
          Stroke (cerebrovascular diseases): 129,476
          Accidents (unintentional injuries): 120,859
          Alzheimer’s disease: 83,494
          Diabetes: 69,071
          Nephritis, nephrotic syndrome, and nephrosis: 50,476
          Influenza and Pneumonia: 50,097
          Intentional self-harm (suicide): 38,364

        3. Harriet Hall says:

          He was talking about CAM, and you responded by wondering about nutrition, which is not CAM at all. I have not read anything here that even remotely suggests that anyone is “against nutrition as a method of health.” And if you are “truly interested in our opinions,” you might try reading more carefully and reviewing http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/

        4. windriven says:

          CDC Final data for 2010 does not list pharmaceutical use as a cause of death, at least in the top ten causes* and certainly not in the top three as you claim. The list, verbatim from CDC is:

          Heart disease: 597,689
          Cancer: 574,743
          Chronic lower respiratory diseases: 138,080
          Stroke (cerebrovascular diseases): 129,476
          Accidents (unintentional injuries): 120,859
          Alzheimer’s disease: 83,494
          Diabetes: 69,071
          Nephritis, nephrotic syndrome, and nephrosis: 50,476
          Influenza and Pneumonia: 50,097
          Intentional self-harm (suicide): 38,364

          So are you a liar or a dupe? Just wondering.

          That disposed with, why would you suppose that misuse of powerful drugs would not have consequences including fatal consequences? Misuse of automobiles can have fatal consequences. Misuse of alcohol can have fatal consequences. Pharmaceuticals play a huge role in saving lives. Are there ADRs? Yes. Are there misadventures? Yes. Do the benefits of pharmaceuticals vastly outweigh the harms? Anyone with a microgram of sense and a smidgen of historical perspective knows the answer. You should ask one of them.

          *http://www.cdc.gov/nchs/fastats/lcod.htm

  5. Jerome Smith says:

    You get yourself all worked up into a tizzy, Dave. Take another week to unwind. You misunderstand others and then create strawmen to knock down, so your arguments appear more substantial. It’s becoming less and less bearable reading your articles.

    1. David Gorski says:

      So don’t read them if you dislike them so much. You’ll probably miss out on learning something, but oh well…

  6. WilliamLawrenceUtridge says:

    Oh goody :)

    The sheer arrogance and elitism astounds me, that your feeble mind cannot fathom other methods of validation other than the singular “active” ingredient used in RCTs.

    Like what? What do you propose as an alternative to the RCT? There are other options than RCT (challenge-dechallenge-rechallenge is my favourite, for individuals with idiosyncratic reactions to specific medications), but ultimately there’s no reason to suspect an RCT would work for real medicine but not for CAM. Generally when people freak out over CAM and RCT, it’s because the RCT didn’t support their preferred form of CAM and they’re looking for a reason, any reason, no matter how irrational, to discount the result.

    What is arrogant about asking for proof before embracing a treatment? When you buy a house, do you get it inspected first? Is that arrogant? When someone wants to sell you a car, do you get a mechanic to look over it? When someone offers to sell you the deed to the Brooklyn Bridge, do you bring it to a lawyer (your own lawyer) to have it examined first?

    The use of the words “infiltration” suggesting medical systems other than conventional western medicine are some sort of infection.

    It’s more like a cancer, since the modalities are often psesudoscientific and thus parasitic upon science – embracing the trappings of science to co-opt its social capital, without actually having any of the rigor or honesty of science that would force them to discard their pet modalities.

    The whole notion of integrative medicine is to DERIVE AN EVIDENCE BASE for these therapies that have shown promise in numerous studies, and require further research in clinical practice.

    Two points:

    1) What if that evidence base indicates that these therapies are ineffective, such as nearly every therapy investigated by Edzard Ernst?
    2) If the point is to derive an evidence-base, why are they being used as active treatments? In conventional medicine, a treatment is not delivered widely until after it is proven to work; such is not the case for most CAM treatments. If Pfizer tried to use the methods that Dr. Oz, or Gary Null, or Andrew Weil use to promote herbs and supplements to pitch their latest chemotherapy drug, the CAM world would hemorrhage their guts out into the streets. Why the double-standard?

    If they cannot find an evidence base, they will get rid of it, so what are you so scared of? that it may work?

    Nope, as I said above – the objections are, it’s being used now to treat people, before it has been proven. That wastes time and money. Plus, one of the more pernicious bits of baggage that accompanies CAM is the badmouthing of real medicine, and discouraging patients from seeking actual treatments – which can lead to a patient dying of untreated cancer. Or eczema.

    There are far less stringent studies upon which the plethora of pharmaceuticals are peddled, yet these interventions are thrown around like candy.

    I can buy candy at nearly every store I walk into. I can only buy drugs at a pharmacy, with a prescription, for anything that doesn’t have an enormous therapeutic index. Further, what does this have to do with CAM? If drugs demonstrate they are effective, but not safe – we should pull them (like was done with Celebrex, or natalizumab, or the whole-cell pertussis vaccine). The problem is, CAM modalities are not tested before being used and sold, so you have no idea if they are safe or not (most are because they are nothing but placebos). And the question of efficacy is rarely answered (and when actually answered through good research, such as St. John’s Wort, it turns out that things that are effective have side effects that were not previously appreciated).

    There is no doubt that there is paucity in research for CAMs, but it takes a big ego and an incredibly narrow mind, no matter how many degrees you may have to completely dismiss something just because you haven’t found a way to quantify it. Its a sad day when a doctor goes out of his way to tear down therapies that are aimed to complement conventional medicine and could potentially benefit the very patients he treats

    Actually, you’re showing your ignorance here. Many CAM modalities have been investigated, and there’s no proof they work (in many cases, there is proof they don’t work) but they are still sold and promoted by practitioners. CAM modalities that work are integrated into medicine (massage for muscle pain, digitalis, and unfortunately acupuncture). Most CAMs grossly violate the hundreds of years of research we have on biology, chemistry and physics; it’s not arrogance that dismisses homeopathy, it’s the fact that we understand how the body, water and dilutions work very well, and know that there’s no way it could ever do what it claims. There’s no such thing as qi to manipulate. Quantum physics have no medical effects on the body. The ones with the big egos are the ones claiming that they understand physics and chemistry sufficiently well to say that they have a mechanism everyone else has missed. Or, they claims that despite centuries of evidence that the human brain is terrible, just awful at determining causality, that they know vitamin C cures cancer or therapeutic touch works, despite numerous experimental trials failing to find any effect. That’s arrogance, the willingness to say “science is wrong” based purely on empty rhetoric and the unwillingness to even understand the evidence.

    1. weing says:

      “If Pfizer tried to use the methods that Dr. Oz, or Gary Null, or Andrew Weil use to promote herbs and supplements to pitch their latest chemotherapy drug, the CAM world would hemorrhage their guts out into the streets. Why the double-standard?”

      Not only CAM would find it unacceptable. Real medicine would not accept it either.

      BTW, Celebrex has not been pulled off the market, Bextra and Vioxx have been pulled.

      1. WilliamLawrenceUtridge says:

        Thanks for the correction, I always mix up the NSAIDs. Keep reminding me, one day it may stick :)

  7. Elizabeth Greene says:

    Why don’t you scrutinise the overuse of man made chemical pharmaceuticals that have often serious or deadly side effects.
    Change is normal and No doctor knows everything. You owe it to your patients to take a broader view when considering new treatments and diagnostic tools.

    1. Elizabeth, we do. Very regularly. And very… scrutinizingly. Why do you think drugs get pulled off the market? Why do we change drug regimens? Abandon old drugs in favor of new ones with better side effect profiles, efficacy, or both? Want to take a guess as to how much of my daily medical education and my licensing exams focus on ready knowledge of side effects and toxicities so that I can balance the risks and benefits of treatment and recognize adverse events early?

      On the other hand, how many supplements have been pulled from the market? How many homeopathic remedies have been removed or adjusted based on evidence of efficacy (or rather lack thereof)?

      Change is indeed normal. But we should progress in our change, not regress to ridiculous ancient ideologies that have been shown not to work just because they sound cool, flashy, sexy, or appeal to the fallacies of ancient knowledge and naturalism.

    2. WilliamLawrenceUtridge says:

      We do, that’s why the FDA has an approval process for new drugs, that’s why they do horrible, horrible things to rabbits when introducing new chemicals for human use. Change is indeed normal, but the issue is often that integrative medicine and CAM proponents resist it. For instance, they resist acknowledging that homeopathy doesn’t work. They resist changing their practice when it turns out shark cartilage has no magical anti-cancer properties. They continue to sell high-dose supplements when there is evidence it actually increases the risk of death. Your argument is actually a double-standard, because you are asking for proof that man-made chemicals be tested, but you appear to be omitting the nature-made chemicals that can harm humans. Deathscap mushrooms are far more lethal than most chemicals made by people, digitalis will kill you faster than a monoclonal antibody, and snake venom, a perfectly natural chemical, is far more lethal than man-made Vioxx.

      The people who claim they have certainty, the people who are truly arrogant, are the ones who claim they know acupuncture, herbs and homeopathy all “work” and don’t need to be tested. Please stop giving them the benefit of the doubt.

    3. Chris says:

      “man made chemical pharmaceuticals”

      I am presently reading a book by Amy Stewart called The Drunken Botanist. She is a garden writer whose previous books include Wicked Plants and Wicked Bugs, so there are all sorts of interesting facts about the plants, history, etc. in those books. This book is no different.

      Page 183 is about Star Anise, where it is noted that 90% of the world’s harvest of that particular spice are bought by the pharmaceutical industry to make TamiFlu.

      Obviously there are ingredients in modern medicine that are still straight from nature.

  8. Integrative medicine has been defined as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

    That sounds a lot like the biopsychosocial model of medicine which has been around for at least a couple of decades and is the way I am being trained. It also sounds a lot like how I interact with my own patients every day.

    The key, though, is the “informed by evidence” part. The problem with CAM is that it isn’t. Well, that’s not entirely true. In a large number of cases it is informed by evidence – it just happens to be really crappy and ignored whenever it demonstrates that they are wrong

  9. pmoran2013 says:

    Andrey:”That sounds a lot like the biopsychosocial model of medicine which has been around for at least a couple of decades and is the way I am being trained. It also sounds a lot like how I interact with my own patients every day.”

    That’s good. Even so, we will be judged by how good we all prove to be at that, not by what some of us aspire to in our better moments. It remains to be seen how well any patient-centred model of medicine can be applied under the conditions and constraints (including science-based ones) that apply today, while also facing historically high public expectations of medicine and declining sources of other psychosocial support.

    That is not to say that integrative medicine is the best answer. I am not entirely comfortable with that either.

    All I know is that medicine is a crazy quilt of a thing. It is unwise to think that we have nothing left to learn about it. We all thought that we were near that fifty years ago, yet there is little doubt that the upsurge of CAM has been one factor in forcing us take stock of what we were doing. These trials of integrative medicine can be looked upon as part of that process. We may yet learn something from them. The instant that patients came to harm the experiment will fold, and the practitioners involved will surely know that.

    1. David Gorski says:

      All I know is that medicine is a crazy quilt of a thing. It is unwise to think that we have nothing left to learn about it. We all thought that we were near that fifty years ago, yet there is little doubt that the upsurge of CAM has been one factor in forcing us take stock of what we were doing.

      Really? I find that a bit hard to believe, both that 50 years ago physicians really thought we had nothing left to learn about medicine, particularly given that the randomized clinical trial was only just coming into its own then, and several of the epidemiological techniques that we take for granted today were still primitive and new then. Medicine was more paternalistic then, to be sure (I’ve become a fan of the Dr. Kildare radio show, and the things portrayed as normal in medicine back then make me cringe), but doctors really thinking there wasn’t anything new to learn about medicine.

      As far as CAM goes, about the only thing I see CAM as having contributed is to provide examples of the noise inherent in clinical trials that allow inactive treatments to appear to have efficacy more than we would have thought 20 or 30 years ago.

  10. heresanother1foru@hotmail.com says:

    Hi David – I stumbled upon your SBM blog while searching the web for any an info pertaining to MALT-Lymphoma chemotherapy. There’s very little to almost none info/discussion or any history/science or statistical data posted on the web about this relatively rare type of cancer, let alone any info or case studies involving Maltoma* therapy. Do you suggest any publications, articles, or whatever the comments/commentary you may have in your own vast knowledge of resources in oncological field by virtue of your own observation/opinion through years of professional practice as an avid bloncologist*. Thanx ~ Maltoma Fighter
    *(PS: I just coined these terms myself while writing this comment. Yes, I have taken the time to read your credentials and, hats off, sir, they are impressive. Oh, you are very welcome! :)

  11. heresanother1foru@hotmail.com says:

    PS: my concern is not related to the common type (gastric) MALT but rather a lesser presented type which develops in an area of the lower GI tract.

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