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The ultimate in “integrative medicine,” continued

It’s been a recurring theme on this blog to discuss and dissect the infiltration of quackademic medicine into our medical schools. Whether it be called “complementary and alternative medicine” (CAM) or “integrative medicine” (IM), its infiltration into various academic medical centers has been one of the more alarming developments I’ve noted over the last several years. The reason is that “integrative” medicine is all too often in reality nothing more than “integrating” pseudoscience with science, quackery with medicine. The most popular modalities that medical schools and academic medicine centers can’t seem to resist are acupuncture and various forms of “energy” healing, such as reiki and therapeutic touch. Unfortunately, when you “integrate” something like reiki or therapeutic touch (TT), which basically assert that there is mystical, magical energy source (called the “universal source” by reiki practitioners, for example) that practitioners can tap into and channel into patients for healing effect, you are in essence integrating a prescientific understanding of the world with science, religious faith healing (which, let’s face it, is all that reiki is), and magic with reality.

Why would medical institutions ostensibly based on science do that?

I don’t know, but I know it’s happening. There are many forces that conspire to insert sectarian versions of medicine into bastions of scientific medicine. These include cultural relativism leading to a reluctance to call quackery quackery; financial forces such as the Bravewell Collaborative, which funds a number of IM programs at academic centers; the National Center for Complementary and Alternative Medicine (NCCAM); and a variety of other factors. It’s been a depressing slide, and periodically I wonder just how much more pseudoscience can be “integrated” into medical schools and academic medical centers or how much further medical schools can go in pandering to nonsense. I’m not wondering anymore, at least for now, not after learning about a cooperative agreement between Georgetown University and the National University of Health Sciences:

National University of Health Sciences (NUHS) has announced a new cooperative arrangement with the Graduate Program in Complementary and Alternative Medicine at Georgetown University Medical Center in Washington D.C., which will benefit students preparing for careers in health care and integrative medicine.

Faculty at the two schools will now work together to help students seeking advanced degrees in health care, by advising students of the benefits of each other’s programs and providing preferential seating and advanced standing in each other’s programs when appropriate.

Take a look at the NUHS website. Look at its offerings: chiropractic, naturopathy, traditional Chinese medicine, acupuncture, massage therapy, and “biomedical science,” which, given all the other woo being taught at NUHS, I have to wonder about. Just take a look, too, at the curriculum for obtaining a doctor of naturopathy degree. It’s full of homeopathy, traditional Chinese medicine, hydrotherapy and, of course, naturopathy. I must admit, however, to some amusement when I saw that there is a course entitled, “Evidence Based Practice: Critical Appraisal of the Biomedical Literature.” Quite frankly, if this course truly taught evidence-based practice, then it would teach that all that homeopathy taught in other courses is nonsense, along with naturopathy itself.

Fat chance of that happening, not with “integration” like this:

Program directors at Georgetown selected NUHS as a top-tier institution providing educational excellence in its professional degree programs, thus meriting Georgetown’s recommendation for its graduates seeking professional degrees. According to Aviad “Adi” Haramati, who co-directs the program with Hakima Amri, PhD, the academic affiliation is intended to “…break down the silos that hold the disciplines apart and create relationships between the disciplines and the educational institutions that prepare the nation’s future healthcare providers.”

Great. Just what we need: “breaking down silos” separating pseudoscience from science-based medicine. That’s exactly what’s happening here, and Georgetown is leading the way, so much so, in fact, that this is not the first time it has forged a partnership with an institute dedicated to teaching pseudoscience and quackery. If you want to see another example of this sort of “integration,” behold this academic “integration” model championed by Georgetown University, this time with the infamous school of naturopathy, Bastyr University:

A model inter-institutional relationship may help bridge the chasm that separates health professions education in conventional academic health centers from institutions educating students for the distinctly licensed integrative practice (“CAM”) professions. Says one leader: “I believe we are poised to make an important advance in how the future training of health professionals may evolve.” The speaker is Adi Haramati, PhD, integrative medicine leader at Georgetown University, describing a new relationship between Georgetown and Bastyr University relative to Bastyr’s naturopathic medical program and Georgetown’s MS CAM program. Haramati and his co-director Hakima Amri, PhD are exploring similar relationships with chiropractic schools and other health professions institutions. The developers “would like nothing more” than to see this bridge-building relationship be used as a model for other academic health centers and CAM institutions.

That’s right. Georgetown is partnering with schools of pseudoscience in order to train the next generation of CAM practitioners. It’s not enough to team up with the naturopaths. Even several months ago, when Georgetown first teamed up with a naturopathic school, Dr. Haramati had been envisioning teaming up with chiropractic schools. That’s what the NUHS is, mostly, and the agreement between Georgetown and NUHS seems to be the first step towards realizing the vision he presented at the time he teamed up with Bastyr.

But it’s more than that. More than five years ago, Georgetown decided that CAM should be “integrated” into its curriculum to the point where it was made part of its medical school curriculum. However, Georgetown went way beyond simply having a lecture or two on CAM here and there and offering clinical electives to fourth year medical students in CAM. That wasn’t enough. The vision was far more bold and—dare I say, given what’s happened in the last five years?—forward-looking. What Georgetown offered was what it referred to in its own brochures as:

The “seamless” weaving of CAM into existing classes includes, for instance, a presentation by an acupuncturist on the “anatomy of acupuncture” in the gross anatomy course for first-year students. The same lecturer explores acupuncture’s application in pain relief in the neuroscience course.

I wish this were a joke, but it’s not. The “anatomy” of acupuncture? Which “anatomy,” given that the magical, mystical meridians along which a life energy that science can’t detect allegedly flows? Teaching such material in anatomy class is indeed the ultimate seamless “integration” of pseudoscience with science, quackery with science-based medicine. Breaking down silos, indeed. Fast forward five years, and here is the vision for true “integration” in medical education towards which Georgetown is working with Bastyr (and now, NUHS), in which it isn’t just Georgetown but Georgetown teaming up with institutions of quackery:

Student A completes an academic Masters of Science program at a highly esteemed academic health center. He or she is wondering her/his future. The program focused on the science of complementary and integrative medicine. But what does the individual’s future hold? Go on to medical school? Personnel with the program lay out options. Among them, without prejudice: Have you considered this naturopathic medical school?

Meantime, Student B is considering naturopathic medical college. The field of complementary and alternative medicine intrigues. But is he or she ready to make the jump for that 4-year, residential commitment? Is naturopathic medicine or regular medical school or chiropractic medical education what they want? Personnel with the naturopathic medical program say: You might consider this year-long Masters of Science in complementary and alternative medicine at this academic health center.

The basis of this relationship between Bastyr and Georgetown, we hear, is a new “respect” being shown towards CAM modalities, and this is the way that the joint program will be structured:

The fundamental aim of this program is to provide students with competencies in three areas: grounding in science (especially systems and cell physiology), introductory exposure and understanding of CAM disciplines and philosophies, and the ability to rigorously assess the state of evidence regarding safety and efficacy of various CAM therapies.

Let’s see. Science…good. We like to see medical students exposed to science. Exposure to CAM disciplines…not so good. Don’t get me wrong. I very much believe that medical students should be taught about CAM modalities, but they should be taught about them from a the perspective of the state of the science, the evidence, and clinical trials. They should be taught about skepticism and critical thinking. They should be taught about how various CAM remedies, such as herbal medicines, interact with pharmaceuticals. That is not what this program sounds like, as a science-based perspective leads to the conclusion that the vast majority of CAM either hasn’t been shown to work or has been shown to work. If such weren’t the case, CAM wouldn’t have the word “alternative” in it.

Let me just put it this way. When this program claims to teach students how to “rigorously” assess the state of evidence regarding the safety and efficacy of various CAM therapies, the word “rigorously” applied to such teaching doesn’t mean the same thing that “rigorously” means when scientists actually do rigorously assess the evidence. What it usually means is buying into the aforementioned philosophy of various CAM disciplines and then proceeding from there. Either that, or it means what Harriet Hall likes to call Tooth Fairy science, which refers to doing research on a phenomenon without first establishing that the phenomenon exists first. In essence, it’s like studying the Tooth Fairy. You can measure how much money she leaves under the pillow. You can study whether she leaves more or less money for the first or last tooth. You can get a whole lot of data that appear reproducible. You might even get data that is statistically significant. But at the end of the day you haven’t actually established that the Tooth Fairy actually exists.

A better metaphor for research into CAM modalities like reiki, TT, or homeopathy is hard for me to imagine. After all, reiki is nothing more than faith healing that substitutes Eastern mysticism for Christian beliefs. TT is basically reiki lite, where even the Eastern mysticism is stripped down to vague New Agey-sounding ideas like channeling “energy” into patients through their hands. (You know, whenever I picture reiki or TT, I visualize one of my favorite comic book characters of all time, Dr. Strange, casting a spell. In fact, as has been suggested before, that’s the only real way I can see of making homeopathy work: a fictional Sorcerer Supreme and Master of the Mystic Arts casting a spell.

But, wait, I hear: What about something that’s less highly improbable? Homeopathy is obviously utter nonsense. So are reiki and other “energy” therapies. What about herbal medicine? What about manipulative therapies (leaving aside the dubious philosophical underpinnings of some such therapies, like homeopathy, which similarly appeal to “energy flow” through various locations)? Well, there’s already a branch of pharmacology that can study herbal remedies. It’s called pharmacognosy, and it isolates the active fractions of natural products and studies them, just as pharmacologists have done for decades, if not centuries. There’s nothing “alternative” in that that needs to be “integrated” into science-based medicine. Similarly, manipulative therapies are not beyond the reach of science to study rigorously, either. However, to do such studies it is necessary first to verify that a phenomenon exists, which can be done using the scientific method. What I fear will happen in this new Bastyr-Georgetown integration will be Tooth Fairy science. There’ll be a lot of data, but it won’t mean anything.

The other purpose of this integrated program is explicitly promotional of CAM. It explicitly seeks the “integration” of quackery with science-based medicine. Don’t believe me? Check out this vision:

The Georgetown agreement with Bastyr, and those Haramati and Amri are seeking with other schools, are terrific steps, laying scaffolding toward the vision, articulated at NED and embraced by ACCAHC, of “a healthcare system that is multidisciplinary and enhances competence, mutual respect and collaboration across all CAM and conventional healthcare disciplines.”

Georgetown is the trailblazer in “integrating” quackery into science-based medicine, but, although it’s first, it won’t be the last. This is a well-coordinated, longstanding effort on the part of CAM advocates, in which they actively lobby for such partnerships and such “integration” with science-based practitioners. Indeed, the Academic Consortium for Complementary and Alternative Health Care supports what it calls the Center for Optimal Integration, which explicitly works towards the sorts of partnerships that Georgetown has undertaken with Bastyr and NUHS.

Personally, I don’t see how “integrating” CAM into science-based health care would enhance competence, but then that’s just the nasty reductionist in me who rejects the false dichotomy of “alternative” medicine. After all, “alternative” medicine is nothing more than medicine that either hasn’t been shown to work or has been shown not to work. “Alternative medicine” that works is no longer “alternative.” It’s just medicine. Naturopathy is a hodge-podge, a grab bag of all sorts of unscientific and pseudoscientific medical treatments, most of which fall squarely into the “alternative” camp in every definition, particularly the ones about either not working or not having been demonstrated to work.

Unfortunately, when it comes to quackademic medicine, the false dichotomy lives, and institutions like Georgetown are betraying science-based medicine by being so open to the point of its brains falling out—and partnering with Bastyr to integrate nonsense with sense, pseudoscience with science, and quackery with medicine.

Posted in: Chiropractic, Medical Academia, Naturopathy

Leave a Comment (26) ↓

26 thoughts on “The ultimate in “integrative medicine,” continued

  1. daijiyobu says:

    I guess it must be science, they say so in the school’s name and / or in the Peterson’s College Guide.

    ;)

    -r.c.

  2. Ken Hamer says:

    I think it’s time for me to become a hermit.

    I work for a very high tech outfit that develops ultra-cool state of the art products. (I can’t really say any more as they are military type thingees.)

    To develop these amazing gizmos we have a lot of very bright people. Very, very bright. Yet here are some of the things these apparently very bright people have told me over the years:

    - if I declare myself as a “natural person” I don’t have to pay federal income taxes
    - 9/11 was an inside job
    - everyone has auras which can be used to diagnose all disease
    - cooking food removes all nutrients
    - toothpaste is poisonous, and dangerous to your health
    - “zero point energy” (aka perpetual motion) is a proven fact.

    That’s disheartening enough, but on Friday I received an e-mail from our HR department stating in part:

    “We have gone through our annual group plan benefits renewal with our benefits broker and are making a couple of changes to our plan based on employee input received throughout the year:

    • We are adding acupuncture to our paramedical grouping – as of June 1, 2011, you can submit up to $500 each calendar year for acupuncture treatments from a registered practitioner.”

    How can so many people be so smart and so stupid at the same time?

    It’s really depressing.

  3. DevoutCatalyst says:

    “Consumer fraud is now available at our clinic.” I’d like to integrate some signage to that effect at the local level.

    Will there come a time when a doctor cannot call a quack a quack? Is integrity circling the drain as we speak?

  4. nybgrus says:

    @ken:

    Solution:

    1) Go take a weekend course and become a certified acupuncturist.

    2) On weekends, give your coworkers acuncture (or better yet accupressure) treatments.

    3) Charge them exactly $500.

    4) Earn a nice bonus off the company.

    5) Buy me a nice bottle of gin every month for giving you the idea.

    Problem solved!

    (in case anyone thought otherwise, I was totally joking, btw)

  5. art malernee dvm says:

    The doctors had a solution in the old days. To this unproven medical care mess we find medicine is heading toward today. In the old days Real doctors got together and started their own medical schools and called themselves MDs. When I was a child If you were not a MD you could not get into most of the hospitals in my city. Not sure if that is possible now days. The physicans by law cannot even keep the chiropractors out of their offices any more. The Florida Veterinarian medical school list acupuncture, because Acupuncture begins with A, as the first listing of what is offered to students and the pet owners in Florida. You can get online and find pictures of cock fighting roosters with 5-6 acupuncture needles hanging from the neck of the multicolored chicken as part of the Colorado veterinary school acupuncture promotions. When the Florida veterinary school comes to our local meetings asking for donations what vet is going to donate to a school who makes doctors look so silly unless we are making our living being comedians?
    art malernee dvm
    fla lic 1820

  6. cervantes says:

    Well let’s not forget that Georgetown University is established on certain foundational beliefs, including:

    A guy who lived about 2,000 years ago in Palestine was at the same time the Son of God and God, who performed various miracles such as raising a man from the dead, and then himself came back to life after he had been dead for three days, wandered around Jerusalem for a few weeks, and then ascended physically into the sky. If an only if you believe this will you also be resurrected in a magical kingdom in the sky after you die. It’s not enough just to believe it, you have to accede to the authority of an old man in Rome and also believe that every Sunday you drink wine that turns into the blood of the 2,000 year old guy.

    And a whole lot more. If you believe that, you can believe anything.

  7. Jan Willem Nienhuys says:

    also believe that every Sunday you drink wine that turns

    Ho ho ho! I don’t know about the U.S.A. but over here communion for the ordinary Roman Catholics used to be only a “host”, not wine. In Anglican churches (which don’t recognize the authority of the pope, basically because one of his predecessors refuted a divorce to a murderous king) the ordinary believers also take wine.

    I think there is a difference between believing in isolated miracles of long ago (and in mediaeval theories of what constitutes ‘substance’ and what are ‘accidental’ properties of objects) and in thoroughly refuted statements about how medicines and treatments and the human body works.

  8. cervantes says:

    Well JWN, maybe there is a difference, but the Church continues to “beatify” people who purportedly performed miraculous cures after they were dead. So to be a Catholic in good standing, you have to believe that miracle cures are going on right now, as we write, accomplished by praying to dead people.

  9. CarolM says:

    “If you believe that, you can believe anything.”

    I believe Georgetown has long been merely “in the Catholic tradition” i.e., Catholic but not really. Like Notre Dame. Catholics would be opposed to these competing Eastern religions, or should be, with proper discernment.

  10. AllieP says:

    You don’t have to be a Catholic to attend or teach at Georgetown. My doctor, who is also a family friend, is Georgetown-trained (in the 80s), vehemently science-minded and anti-woo, and an atheist of Jewish extraction. He’d be appalled to learn that he’d be required to study reiki.

    That being said, Georgetown is a little Catholic in their benefits packages — when I was on Georgetown’s health insurance, they would NOT cover birth control.

  11. windriven says:

    @cervantes

    I for one am thankful I was raised Catholic. Catholicism forced me to confront the divide between intelligent and rational thought versus blind and ignorant belief at quite an early age. I dug through texts biblical and modern searching for some way to reconcile the two and ultimately settled into a comfortable atheism that has stood me well through a long and happy life.

    @ art malernee dvm

    Well said. The solution to the growth of quackademic medicine is, at least in part, ostracization and ridicule. Medicine is giving way to marketing types and accountants who are rightly concerned about the bottom line and wrongly unconcerned about how they get there.

  12. S.C. former shruggie says:

    Veracity and inanity living together in harmony. Oh boy. The university I’m now attending offers CAM courses in the biology degree suggested as a precursor to entering the medical school, as anthropology electives. At least they aren’t compulsory. Yet.

    This nonsense puts patients at risk, and it needs to be exposed in mainstream media. A lot of unwelcome public scrutiny and ridicule would probably do more to shake up quackademic administrations than grumbling faculty or bad treatment endpoints (which are, after all, “just numbers,” and when have negative results and unflattering numbers in studies ever disuaded CAM afficianados?)

  13. Next we need to brake down the barriers between astrology and astronomy, and also the barriers between alchemy and chemistry.

    Modern science needs to not be so close minded and learn what’s old is new again. don’t be so reductionist and give alchemy and astrology a chance!

    Let’s hear it for integrated astronomy and integrated chemistry!

  14. aeauooo says:

    This sounds like little more than a marketing strategy for both the university and its enterprising students.

    Soon to come: pseudo-certification as a CAM-Literate MD.

    Living in Seattle in the mid-1990′s, I recall hearing a frequently-cited reason for enrolling in Bastyr University: “Jerry died.”

  15. SloFox says:

    Pseudo-scientific shifts such as these make me glad to be transitioning out of clinical medicine. Next we’ll have questions on licensing exams and board certifications regarding CAM/IM. Very disappointing. . .

  16. Jan Willem Nienhuys says:

    cervantres wrote:

    So to be a Catholic in good standing, you have to believe that miracle cures are going on right now, as we write, accomplished by praying to dead people.

    This has nothing to do at all with communion rites, but this is not correct as far as I know.

    I don’t think that belief in miracle cures is required for Roman Catholics. What is required is that one believes the dogmas.
    Among these are
    1. the dogma that Mary is the mother of God, that she was conceived free of original sin, that she was virgin before, during and after the birth of Jesus and the she ascended to heaven instead of dying in the ordinary way (that is actually four dogmas);
    2. the dogma that the pope is infallible in matters of belief or morals when he explicitly says so (this is called speaking ex cathedra).

    To my knowledge the pope has only once spoken ex cathedra claiming infallibility, namely when pronouncing the fourth Maria dogma (ascension). Even though some miracles are ‘recognized’ by a committee, they are not required belief.

    But 1 is, and I have always wondered how many Roman Catholics nowadays sincerely believe 1 above, i.e. are true Roman Catholics. Those who doubt 1 are crypto-apostates, or even – God forbid – crypto-atheists.

    If I am wrong, I would be interested in enlightenment.

  17. Badly Shaved Monkey says:

    Are the quackie components of these courses compulsory for medics being trained at these institutions?

    Never mind, for the moment, how terrible that is as a point of principle, what happens when students start asking sceptical questions and holding the course tutors to account for the nonsense they are teaching?

    Or is it, currently, just quacks teaching quacks, albeit under a roof where they should not have been given a home?

    If real medical students are being taught quackery as truth then there must be some scope to organise resistance via students. Or is the modern student too intent on keeping out of trouble and completing their course?

  18. Jan Willem Nienhuys says:

    the current pope’s declaration that a nun was cured of her Parkinson’s

    As I understand it there has been (since 1870, when the dogma of papal infallibility was pronounced) only 1 infallible pronouncement ex cathedra namely the dogma about Mary’s assumption.

    A statement by the pope can be infallible because of the general magisterium (i.e. the general authority that the RC Chruch claims), for instance when the pope says that priests should always be men.

    A declaration of sainthood is not infallible, because it relies on fallible testimony.

  19. nybgrus says:

    @monkey:

    In my case, we only get a few lectures during second year about it. I attended one and the problem is that during the lecture there was not much opportunity to say anything. I approached the lecturer after and we had a discussion where I started politely tearing him apart. At first he held his ground but when I started making good references and intelligent assertions (mostly based on this blog and from Orac as well) he promptly said I was a bright young man but needed to get to a meeting, shook my hand, and walked away. I don’t go to lecture much at all really (I find them low yield, plus it is a bit of a commute and all the lectures are turned into podcast videos with the slides, so I just watch them at home) and so haven’t had another opportunity. The next time something like the sCAM lecture came up I wanted to go but simply couldn’t for external reasons.

    In discussing it with a handful of my classmates they tell me that they don’t pay much attention and usually just tune him out and facebook during his lectures. They said it was all garbage to them anyways. I responded by saying that it is the 10% (my guess) of students that don’t realize it is garbage or that simply accept it and don’t think much about it that are the problem. Because when you are in residency you wont remember who said what all the time. You’ll have a patient ask you something and you’ll think, “Oh yeah, I remember in med school acupuncture had some kind of evidence for it” and pass that along. At that point one of my classmates said, “I can’t remember who said this but….” and then quoted me right back at me with the assumption that she was asserting a truth. And I said, “Congratulations – you just proved my point”

    @JWN:

    I never claimed that the Parkinson’s cure was infallible. But the fact that the pope would make the claim at all proves that the RC church believe that miracles, specifically of dead popes healing nuns, is at least something that is possible. I.e. – it is not out of the realm of reality to have actual supernatural miracles ongoing today and witnessed by humanity. Whether they correctly identify one or not doesn’t matter. The fact is that the RC church explicity endorses the notion that they are ongoing

  20. David Gorski says:

    Everyone,

    Do we really want to discuss and debate Catholic dogma here? This isn’t really the place for it, is it?

  21. GLaDOS says:

    It’s an easy derail: compare belief in pseudoscience with some common religious belief and suddenly the criticism of pseudoscience seems over-heated or even bigoted.

  22. Badly Shaved Monkey says:

    @nybgrus

    Does your experience reflect American quackademia or another country’s?

    Anyone, do we have any idea how much the quacks are currently contributing to core teaching in medical schools?

  23. nybgrus says:

    @Monkey:

    My experience is currently in Australian medical school – one of the “sandstone schools” (which is the Aussie equivalent of “Ivy League”).

    In speaking with my dear friend in American medical school, he has said his experience is roughly the same.

    Of course that is N=2 but based upon what I have been reading from authors here including a medical student author (Tim Kreider) it seems to be cropping up everywhere.

    And I can tell you that the sCAM lecturer was downright angry from the first word out of his mouth. Literally yelling about how the medical establishment won’t look at or use a CAM modality of treatment even if it has evidence to support it. He then went on to cite things like St. John’s wort and Saw Palmetto, and literally ran through a list of 20-30 other such herbals with “level 2 and 3″ evidence, all whilst pounding his fist on the podium and shouting about how it is ridiculous it is that doctors wont accept the use and role of CAM when there is all that evidence for it. Of course, he went on to say that acupuntcure has heaps of evidence as well. And in my private conversation with him he flat out said that there must be “something” to reiki and it was worth exploring. But at least he denounced homeopathy.

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