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Traditional Chinese herbalism at the Cleveland Clinic? What happened to science-based medicine?

I don’t recall if I’ve ever mentioned my connection with the Cleveland Clinic Foundation (CCF). I probably have, but just don’t remember it. Long-time readers might recall that I did my general surgery training at Case Western Reserve University at University Hospitals of Cleveland. Indeed, I did my PhD there as well in the Department of Physiology and Biophysics. Up the road less than a mile from UH is the Cleveland Clinic. As it turns out, during my stint in Physiology and Biophysics at CWRU, I happened to do a research rotation in a lab at the CCF, which lasted a few months. OK, so it’s not much of a connection. It was over 20 years ago and only lasted a few months, but it’s something that gives me an obvious and blatant hook to start out this post, particularly given the number of cardiac patients I delivered to the CCF back in the early 1990s when I moonlighted as a flight physician for Metro LifeFlight.

Obvious and clunky introduction aside (hey, they can’t all be brilliant; so I’ll settle for nauseatingly self-deprecating), several of my readers have been sending me a link to a story that appeared in the Wall Street Journal the other day: A Top Hospital Opens Up to Chinese Herbs as Medicines: Evidence is lacking that herbs are effective. I also noticed that our fearless leader Steve Novella blogged about it and was tempted to let it pass, given that I had seemingly lost my window, but then I realized that there’s always something I can add to a post, even after the topic’s been blogged by Steve Novella. Whether that something is of value or not, I leave to the reader. So here we go. Besides, if this article truly indicates a new trend in academic medical centers, it’s—if you’ll excuse the term—quantum leap in the infiltration of quackademic medicine into formerly reputable medical centers. It’s a depressing thing, and it needs to be publicized.

Of course, the Cleveland Clinic has long been a poster child for the evils of quackademic medicine. Indeed, take a look at its Center for Integrative Medicine. Offerings there include acupuncture, chiropractic, something called “holistic psychotherapy,” reiki (of course!), and Chinese herbal therapy. I frequently use the CCF’s woo-ful description of reiki using the “universal life source energy” to heal patients as an example of the utter mystical-religious nonsense that has infiltrated once-proud medical institutions, along with other prime examples carefully curated from selections from other quackademic academic medical centers. So, naturally, it’s not surprising that the CCF would be a “pioneer” (if you can call it that) in bringing traditional Chinese herbal medicine right into the heart of an academic medical center.

The WSJ article isn’t too bad in that it’s not overly credulous and, as the title even proclaims, notes that there isn’t much evidence to support the use of herbal medicine. Of course, herbal medicine is among the most plausible of “complementary and alternative medicine” (CAM) or “integrative medicine” for the simple reason that, for an herb to have a medical effect, there must be a chemical (or chemicals) in it that have pharmacological activity. In other words, there have to be drugs in them thar plants! That’s why pharmaceutical companies and the NIH are so interested in screening natural compounds for chemical properties and pharmaceutical activities that might indicate that they could function as useful drugs. True, much of the low-hanging fruit in terms of naturally occurring chemicals that can make useful drugs has been found and turned into drugs, but there are likely to be lots more where that came from. It just won’t be as easy to identify and characterize them as it was in the past.

As I’ve also described many times and Steve Novella mentioned in his post, the problem with herbal medicines is that they are adulterated drugs (or, as Steve put it, “dirty” drugs). They are not pure. It’s almost impossible to control lot-to-lot consistency with respect to content of active ingredients, given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition. Let’s just put it this way. It’s much safer and more predictable to administer digoxin to a patient who needs its activity on the heart than it would be for the patient to chew on some foxglove leaves. Given digoxin’s relatively narrow therapeutic window (the difference between the doses needed to produce therapeutic effects and the lowest dose that will cause significant toxicity), that’s critical. There are lots of herbs that can cause significant toxicity, such as Aristolochia, which can cause kidney damage; kava, which can cause liver toxicity; and many others.

The reason physicians moved away from herbal medicine to pharmaceutical drugs is for predictability. Purified active components have a more predictable action because the amount of drug is tightly controlled and known to a very precise degree, while impurities are kept to a minimum. Moreover, these drugs can be combined with various inactive agents to control how fast they are absorbed into the bloodstream, thus providing another level of control. All of these characteristics make the drugs much more predictable than any drugs still contained in dead plant matter. None of this even takes into account the widespread problem with contamination of herbal remedies with heavy metals, such as lead or even arsenic. It’s such a problem that a particularly obnoxious supporter of quackery has started trying to “distinguish” himself and his supplements from the competition by setting up a lab, measuring heavy metals in his competitors’ products, and then periodically publishing scare stories about “contamination” of various supplements and herbal products. (Yes, I’m referring to Mike Adams.)

So what, exactly, is the CCF doing? Let’s take a look at the patient vignette that begins the WSJ article:

Christina Lunka appeared nervous and excited as she sat in the Chinese herbal therapy center recently opened by the Cleveland Clinic.

The 49-year-old had been to many doctors seeking help for ongoing issues that included joint pain and digestive problems. Now the Kirtland, Ohio, resident was hoping to find relief through herbal remedies.

“Do you have something for inflammation?” Ms. Lunka asked herbalist Galina Roofener during a one-hour consultation.

“Absolutely,” responded Ms. Roofener. “This is for pain, for digestion, for inflammation, all of the above,” she said, handing Ms. Lunka a bottle with capsules of an herbal combination called Xiao Yao San, which translates as free and easy wanderer. The capsules include about eight different herbs, including licorice, mint leaf and white peony root.

This is nonsense. I’d bet a dollar (to steal a cliche) that Roofener has no solid evidence to support any of these claims. It’d be among the safest of bets, particularly given that this isn’t even a single herb she’s talking about. It’s a bunch of herbs all ground together. Even Dr. Josephine Briggs, the director of the National Center for Complementary and Alternative Medicine (NCCAM), whom we’ve discussed many times before, is quoted in this article characterizing the “evidence base for these approaches using modern rigorous methods of randomized trials” as “quite thin,” which is an understatement. Surprisingly (to me at least) she also apparently admitted that, although NCCAM is looking at the basic science of some herbal products, it is currently not funding any efficacy studies involving humans (i.e., randomized clinical trials) of herbal remedies right now. If NCCAM isn’t even funding clinical trials of herbal medicines, they really must not be showing any promise lately. Actually, they aren’t, and haven’t been for quite some time. There are a number of trials now showing that various herbal remedies thought to be very promising don’t actually work, such as ginkgo biloba for memory, saw palmetto for benign prostatic hypertrophy, or black cohosh for menopausal symptoms.

It’s also some good money. Consultations are $100, and follow-up visits are $60. True, many visits to real doctors cost more, but in most cases insurance covers them, minus acopay, with all the paperwork that’s required. This sounds as though it’s pure cash on the barrelhead. Add to that the cost of a month’s supply of herbal remedies ($100), and it sounds as though the CCF could easily turn this clinic into a pretty nice profit center, after a slow start. The practitioner, Galina Roofener, is a graduate of the East West College of Natural Medicine in Sarasota, which is largely a school of acupuncture and traditional Chinese medicine (TCM). It seems a bit confused about what TCM is, though. Under a section of its website entitled What is traditional Chinese medicine? it lists electroacupuncture (who knew they had sources of usable electricity in ancient China?), biopuncture (yes, biopuncture), and homeopathy. Who knew? Maybe Samuel Hahnemann was Chinese.

In any case, Roofener worked at clinic called Asian Therapies Acupuncture Clinic before taking a job at CCF. All that’s there now is a message describing how she sold her practice and moved to Cleveland to work for the CCF. However, the Wayback Machine of Archive.org reveals what the website looked like in 2011. There, I found a number of interesting things. Unfortunately, even many of the Archive.org pages are gone, but the titles live on, titles touting the quackery that is thermography for breast cancer, acupuncture for the flu, and lots of evidence that Roofener used homeopathy, which is not surprising given that she’s a naturopath as well, apparently. (Her LinkedIn page also confirms her use of homeopathy.)

Deceptively, Roofener is required by law to invoke the quack Miranda warning as…well, I’ll let the WSJ article explain it to you:

Ms. Roofener’s license doesn’t allow her to claim she treats diseases, a Cleveland Clinic spokeswoman says. She can’t say that Chinese herbs will treat colitis, for instance, but she can say that she can stop diarrhea and pain. She cannot treat arthritis but can alleviate joint pain, the spokeswoman says.

And:

At the Cleveland Clinic’s herbal center, new patients are given a one-hour consultation that may include a battery of questions (How’s your sleep? Body temperature? Ringing in your ears? Headaches?), a physical examination of the tongue, and the traditional Chinese method for pulse-taking (three fingers on each wrist to check different pulses corresponding to various organ systems). They are asked to sign a waiver acknowledging that “herbal supplements are not a substitute for a medical diagnosis.”

Clearly.

Still, in another recent story about Galina Roofener and the herbal clinic at the CCF, Roofener is quotes thusly:

The center doesn’t take walk-ins and primarily sees patients with conditions that Western medicine has, for whatever reason, failed to remedy. “For something like acute pneumonia, Western antibiotics may be faster and more cost-effective,” says Roofener. “But if someone has antibiotic resistance, we can strengthen their immune system.”

Egad! “Strengthen the immune system”? Seriously? That’s one of the top quack claims, regardless of what the quackery is!

Yes, as Steve Novella noted, the CCF is out-and-out admitting in the quack Miranda warning on its consent form for its herbal medicine clinic that the TCM diagnoses Roofener is making and the herbal remedies she is prescribing to treat them are not real medical diagnoses and not real medicine. That’s a staggering admission for an academic medical center to make, that it is offering to its patients medicine that is not real medicine, a system of diagnosis that is not a science-based system of diagnosis. Worse, its physicians are actually referring patients to this clinic, even though they know that there’s no real evidence that it works. For example:

Maged Rizk, a gastroenterologist at Cleveland Clinic who referred Mr. McGeehan, says Chinese herbal medicine is still being critically evaluated. “In the past it wasn’t even considered seriously,” Dr. Rizk says. “At this point there is a thinking, ‘Some of the things we’re doing now aren’t very effective. Should we really be looking at alternatives a little more seriously?’ I think the verdict is still out,” he says.

So, basically, Dr. Rizk seems to be arguing that because current science- and evidence-based treatments for some conditions don’t work as well as we would like we should try treatments with no evidence to support them.

I think I know what’s going on here. I could be wrong, but it sure smells like it. Basically, what we are talking about here are patients with chronic conditions, particularly conditions causing chronic symptoms (there is, for instance, a patient in the story who suffers from chronic nausea), that are not well controlled or well treated with current science- and evidence-based medicine. Understandably, doctors become almost as frustrated as patients when they can’t alleviate their patients’ symptoms. They feel powerless. It’s not surprising that there is a strong temptation to fob the patient off on someone else. It’s also very easy—seductively so—to rationalize a referral to someone like Roofener based on the rationale that maybe she can do something. And if she can’t at least the patient will be someone else’s problem for a while. I know, I know. That’s harsh, but it’s a bit more complicated than that. Few doctors actually want to give up. It’s just that, given an “out” like Roofener’s clinic, it’s not surprising that even good doctors (you have to be good to be on the staff of the CCF) might be tempted to take that out.

Still, we rely on institutions like the CCF to be at the cutting edge of science. We expect that the treatments they offer will be based on the best available science. We do not expect that institutions like the CCF will embrace a prescientific system of medicine that is rooted in what is, in essence, the Asian variant of the humoral theory of medicine in which disease is attributed to imbalances in the five elements rather than the four humors, whose treatments are based on a rationale of somehow channeling or redirecting the flow of a nonexistent “life energy” that has yet to be detected by science and whose medicines are impure mixtures of natural products with nothing resembling what we could consider rigorous evidence of efficacy and safety.

The infiltration of quackademic medicine into medical academia continues apace, to our shame as a profession.

Posted in: Herbs & Supplements, Medical Academia

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39 thoughts on “Traditional Chinese herbalism at the Cleveland Clinic? What happened to science-based medicine?

  1. brewandferment says:

    I usually don’t cross post, but since Dr. Gorski’s “friend” wrote the same article the other day, am repeating my question in case Angora Rabbit doesn’t go over to his “friend’s” site that often if at all:

    Could one of the RDs or other true nutrition researchers please help clear up one area of confusion for me:

    I regularly see comments to the effect of “get vitamins from food because supplements don’t work as well (if at all)” and indeed the synergy argument is usually made in conjunction with this statement. How does this differ? This is an earnest question and NOT a defense of [one of "friend's" post] comments.

    As a (barely) related aside, I did the math on trying to get the RDA of potassium and it would require vast caloric overload due to the sheer number of sweet potatoes and bananas that would need to be consumed. Even half the RDA would require the intake of at least one sweet potato (the richest source of potassium) daily just to get enough. I like them, I really do–but not daily!!!

    So: please explain why food and not supplements? (or some combo??) What am I missing in this seemingly contradictory example?

    1. Andrey Pavlov says:

      I’d also be curious as to this answer B&F.

      My understanding is that it isn’t so much that supplements are “bad” or don’t give you the necessary micronutrients (though in some specific cases they are less bioavailable; e.g. iron vs heme) but that they aren’t necessary since the average developed diet is more than sufficient to meet those needs. The money spent on supplements is thus better spent just purchasing fresh foodstuffs since that will meet your requirements.

      Your discussion about the RDA for potassium is interesting though and I do not know the answer off the top of my head. I would venture to guess that it is likely some combination of neglecting your other sources of potassium that are already built into your diet (you get potassium from everything so you wouldn’t need to add an entire sweet potato every day to meet the requirements) coupled with the RDA not being fully scientifically validated in some manner*. But I am certainly curious if my intuition on the matter is correct.

      *I think it is much more the former than the latter.

      1. Andrey Pavlov says:

        derp: “average developed nation diet”

      2. Harriet Hall says:

        I have read the argument that the body handles a nutrient differently if it gets small amounts at intervals compared to a large dose all at once. Could large amounts overwhelm a physiologic process or turn genes on or off? Could an imbalance between two nutrients upset a symbiosis? I don’t know, but it seems plausible. We do know that almost every vitamin is toxic in large enough doses, and there is some evidence of harm from multivitamins.

      3. brewandferment says:

        The amount of potassium RDA rather recently went up by a large amount to 4700mg. A cup of cooked white beans from one website source is listed as providing 1004 mg. So in other words, if you ate nothing else ( bear with me, it’s just for the sake of illustrating my question) that day, you would need to eat more than 4 and a half cups of cooked white beans! That’s a lot of beans and I bet a lot of calories too.

        Obviously, a good varied diet wouldn’t be just those–but my point is that everything else you eat that is lower in potassium would require you to eat even more of it to achieve the desired amount of potassium for the day. From one site that gave a list of the top 10 sources of potassium and starting with the white beans, to get the RDA would be: 1 cup of cooked white beans, 1 cup of cooked spinach (there’s a whole $3 bag right there!), one average baked potato (with skin), 1/2 cup dried apricots, one cup cubed baked acorn squash, and one average banana–that comes out to about 4850 mg, a little over but close enough. That’s a lot of food and calories–and the farther down the sourcing list you go, the more you have to eat to get there. I dunno whether a day eating this list would leave gaps in other key nutrients. And my head starts to hurt thinking about how to optimize my diet for each key ingredient individually–and thats even if I were actually willing to use my Ops Analysis degree from 20 years ago…

        Not that I pay this much attention regularly, let alone get my family to eat like this–too hard! But the reason I brought the question up on this topic is because it’s a case where it seems to be that in regard to nutrition, “nature is best” applies, but that is contrary to the argument against “nature is best” that’s well answered in regard to herbal “medicine.”

        1. WilliamLawrenceUtridge says:

          Don’t forget that RDAs are deliberately set hi to cover the most people. So that 4,000+ mg is designed to ensure that 95% of all people get enough potassium. If you’re anything less than the 95th percentile, chances are you’re getting enough from a regular diet with adequate fruits and vegetables.

          1. brewandferment says:

            Ok, I get the general concept, but the point is if I analyzed my diet for specific nutrients and come out low, let’s say most days, then I must not be in the 95%. And in this case, I did count up sources and I promise you, for potassium anyhow, I’m nowhere near the RDA (or even 50% of it) through diet alone, ever. So how can one say “if you eat adequate fruits and vegetables” when despite the fact that I regularly DO eat adequate quantities of various plants, there’s no way I can accomplish that RDA for potassium from food if my analysis and understanding is correct. Haven’t bothered to do for other nutrients, just this one which is so hard to get through diet as far as I can understand.

            And the other issue is the “synergy from food (ie nature better)” vs “supplementing diet (ie science better)” dilemma.

            Unless a major portion comes from black coffee in which case I should definitely be fine! But none of my family drinks any significant quantities of coffee–eldest calls it “devil’s juice” and middle drinks coffee-tinged milk once or twice a month. Youngest won’t even try “coffee milk” and husband gets grumpy about corrupting the kids with my “habit/addiction”–his choice of words!

    2. mouse says:

      Sounds like a good question to me BrewandFerment. I’m not a scientist, so I can’t add much as an answer, but I will be interested to see answers.

      I would clarify though, that the preference for food based nutrients is usually in absence of a deficient. I think some, maybe most, vitamin/mineral deficiencies require supplementation to correct.

  2. MTDoc says:

    Your mention of digitalis brought back a memory from my med school days. In the 1950′s, we actually did use the “leaf”, a bunch of foxglove leaf ground up and put in a capsule. We learned a lot about dig toxicity that way. Lanoxin then came along and it was much easier to manage digitalization , though in retrospect we used rather heavy doses. Some of the early generic digoxin was just as bad (hence my reference to the brand name) but hopefully generic manufacturers have better quality control now days,especially for drugs with such narrow therapeutic ranges.

    Your last statement is regrettably true, even here in pristine Montana.

  3. StuckInTheMiddle says:

    I am a patient at the Cleveland Clinic. I can’t read this whole article. I’m too sick to comprehend it all. I have just been referred to their Integrative Medicine Center for herbal and other therapies, and I see that it requires that one have their pulse read. I’ve tried all of these so-called therapies in the past, elsewhere. They don’t work to cure disease. Herbs might, but they should first be tested and fully evaluated for safety and efficacy and purity.

    Cleveland Clinic offers Reiki and other stuff that I think is nothing more than feel good talk and touch. I’d rather do other stuff to make myself feel good, and none of it works for me anymore anyway.

    Some of my neck muscles feel like they are swelling or bulging and now a red rash has appeared around my neck and upper back. I’ve been complaining about extreme and progressive neck tightness for a couple of years, and now this rash has recently appeared. I’m told the rash is coincidental. The drenching sweats are coincidental too, I suppose. The rash is worst after a night of drenching sweats. I sleep alone, and so the doctors don’t see this happening. It’s all anecdotes to them. Some don’t even seem to believe me. My blood work is fine, and so they won’t test me for infections. Many of them can feel the swelling, enlargement or fullness in my neck, but my MRI and CT is clear.

    My doctors tell me it would be unethical to test me for infections, because they do not believe that I have one since my condition is chronic. Doing those tests would mislead me, and that would be unethical, they say. They tell me it would be unethical to do a biopsy on the enlarged/swollen/dense muscles because they can’t go poking around in my neck. They can’t do a simple muscle biopsy, because that would be unethical. A PET scan to study the soft tissue is out of the question because I don’t have cancer and they don’t want to have to deal with my insurance company and fight for the coverage. It is unethical to do an unnecessary test like a PET scan, since I don’t have cancer, they say.

    There is Type 1 bone marrow edema in this same area, but I am told that it would be unethical to treat me for this condition until further studies have shown that this type of bone marrow edema is indeed caused by infection. Antibiotics are very dangerous, and it would be very unethical to treat me with them long-term based on just a few studies, and for a chronic condition.

    I am in extreme, unbearable pain. My neck hurts so bad. I’ve lost all quality of my life. All things which I think would be science-based to diagnose are not being done. No biopsy, no cultures, no PET scans. All those things are unethical, I’m told. It is also unethical for them to continue giving me medication for pain, so that is being cut off. But, it is ethical for physicians to refer me for a pulse reading, Reiki and untested herbs.

    Call me confused.

    1. MTDoc says:

      Yes, you have every right to be confused. Really hard to see where ethics fit into the picture, since your consultants appear willing to through you to the wolves. I do not mean to judge, as I have no direct knowledge of your situation. However, we who practice in small communities, and have often seen patients returning from the “ivory towers” with equivalent dissatisfaction, kind of understand what happens. I can’t believe that a good FP or internist, who is willing and able to spend time with you can’t help you find the answers to your problems. That is, when he isn’t searching the ICD 9 (soon to be the ICD 10) for the proper billing code. I truly wish you well in your quest.

      1. StuckInTheMiddle says:

        MTDoc, I can’t find a good internist who is both willing and able to spend the time and accepts Medicare. Cleveland Clinic’s solution is to help ease my symptoms by sending me to have my pulse read for $100 a pop. I can’t work and don’t have an income. I’d rather spend my money on something that will actually help treat this rash and swelling in my neck. Why is it so hard to find a good doctor who is willing and able to spend the time to offer real treatments?

  4. Andrey Pavlov says:

    So this jumped out at me:

    “For something like acute pneumonia, Western antibiotics may be faster and more cost-effective,” says Roofener. “But if someone has antibiotic resistance, we can strengthen their immune system.”

    “Western antibiotics”? As opposed to… Eastern ones? They may be faster and more cost effective?

    I get that this is probably just random ramblings off-the-cuff from someone who is as pure a quack as Daffy himself, but it belies some very deep seated and dangerous ideas about medicine. Besides the obvious fundamental misunderstandings about what antibiotics are and how they are not region-coded liked DVDs, the (barely) implicit assumption here is that her quackery can cure acute pneumonia just not as quickly and at more cost. In other words, opening the door to the idea that should the patient be fine with the idea of spending a little extra cash and time, that these nostrums are a reasonable alternative. I won’t belabor how dangerous that is beyond mentioning that I’ve seen a number of otherwise healthy people with a very standard, straightforward, non-resistant S. pneumoniae pneumonia on a vent with acute right sided heart failure*.

    Next the idea that someone has resistance, rather than the bacteria having resistance. Besides the obvious “immune boosting” BS, assume it to be true. The idea then is that somehow boosting the immune system can help with resistance.

    The point is that her discussion of the topic in just those two sentences lends deep insight into how incredibly and profoundly she not just misunderstands how human physiology and medicine work, but what she genuinely thinks is the way it works. And now for PMoran, an illustration of why those “true believers” are actually more dangerous than the actual shysters – she has every cause and reason to push her agenda and get her nostrums and herbs and “immune boosting” pneumonia treatments into the hospital because she genuinely believes they will help people. And when you have shruggies like Rizsk around, and obviously CCF itself has little compunction about bringing such rank quackery under its umbrella and referring patients to it, what is in place to prevent that from happening? Where is that bright line in the sand that says “Quackery here is OK, but quackery there is not?”

    *for the non-medicos: S. pneumoniae is the most common pathogen causing pneumonia in adults. It is not usually antibiotics resistant, typically very easily treatable with many antibiotics, and typically has a low mortality associated with it. But even it can be extremely rapidly progressing and be very life threatening, going from a mild pneumonia that could be treated on an outpatient basis to ICU in as little (or even less than) a day.

  5. Howard Wallach says:

    Thank God you rigid would-be totalitarians are losing the battle (in the US and Canada, anyway) to keep useful natural treatments and cures out of the hands
    of the general population! If you want to spend the hundreds of millions of dollars
    to perform studies that meet your satisfaction on hundreds of natural medicinals
    which have been used for millennia, go ahead and do it. You know darn well that
    few people are going to do so when there’s no huge financial gains to be made from
    non-patentable natural substances. I, personally, have had excellent, I would say tremendously successful results from Chinese and Tibetan medicine as well as Western neutriceuticals for a variety of conditions with nary a side effect. On the other hand I suffer permanent shoulder tendon damage from a fluoroquinolone
    and chronic gastritis from a prescription NSAID. I wish you every failure in your despicable cause.

    1. Chris says:

      “hundreds of natural medicinals which have been used for millennia, ”

      Cool.

      Can you please give how well those “medicinals” have worked for:

      epilepsy
      type 1 diabetes
      leukemia
      strep infections
      pneumonia
      measles
      tetanus
      diphtheria

      1. David Gorski says:

        Well, there is digitalis (derived from foxglove) for heart failure and taxol (derived from the bark of the Pacific Yew) for cancer. Oh, wait. We don’t give the raw plants for the very reasons I mentioned in my post. :-)

        1. Chris says:

          Of course, insulin was originally derived from the pancreases obtained from slaughter houses. Now it is made with yeast. That is also “natural.”

          It is just that it has to be purified and made safely in a rigidly controlled environment.

      2. mouse says:

        The antimalarials like Hydroxychloroquine (used for malaria and rheumatic diseases) are based on quinine which was made from cinchona bark.

        Nature is great inspiration, but lacks quality control.

        1. Sean Duggan says:

          Nature is great inspiration, but lacks quality control.

          Heh… reminds me of the old joke about how the problem with nudist colonies is that there’s just no quality control.

          We do also have quinine to thank for the gin and tonic. The tonic water had the quinine in it and the British added gin to make it more palatable.

          1. n brownlee says:

            And it worked! Thank god for science based medicine.

          2. mouse says:

            Now I add ginger syrup, lime and mint to make the gin more palatable. It’s a cure-all tonic (well at least you feel like you’ve been cured for a little while).

            1. n brownlee says:

              That sounds really, really good. REALLY good. Mmmmm…

              1. mouse says:

                This recipe is similar to mine. http://leitesculinaria.com/80734/recipes-southside-cocktail.html

                But replace the simple syrup with ginger syrup. Recipe here
                http://imbibemagazine.com/Ginger-Syrup-Recipe

                I shake it with ice, then strain it into a glass. I garnish with slices of crystalized ginger on a toothpick, that you can intermittently stir in the drink. Making the ginger syrup is a bit of a project, but the finished product is yummy.

              2. mouse says:

                I wasn’t clear, add the splash of club soda after straining, if you shake with club soda it will sorta explode (probably obvious, but it didn’t stop me from trying it).

    2. MTDoc says:

      The latest here is “aqua-sooth colon hydrotherapy” along with all the usual ND crap. If I’d only known that was available sooner, I would not have had my GI man remove the three adenomatous polyps from my cecum using that colonoscope. I’m afraid my medicine can beat your medicine any day. But to each his/her own.

  6. Kultakutri says:

    Let me digress a bit first.

    My grandma was diagnosed with breast cancer (ohai, Dr Gorski) and before she got actually treated, there were things to be done. Various checkups and whatnot. My mother took charge of everything because she lives nearby and she’s a bit of action girl, and although Gran got the best standard of care, there was time when nothing was happening. And mom needed that Something-should-be-done. That precious time is being wasted before the oncology dept. meets tomorrow to discuss and organize what to do with various patients, for example. And then well-meaning people go and do something not because it’s needed for the patient but because they need it to deal with their stress.

    I reckon that not all people observe themselves when thinking and use an imaginary red pencil to mark the wrong bits. Many just do their thinking without being aware of reality, their own biases and the bits of universe that don’t revolve around their heads… and they thus go and do something without being aware that it’s not done for the purported goal of treating whatever the issue but it’s a stress reaction and coping strategy. I guess that at least some MDs are aware of this and address it in some way that wouldn’t hurt anyone but would make them feel better – something like, say, scented candles or an apple a day or some vitamins if the folks like pills can always be found without sending the patient to the nearest charlatan… right?

    1. Andrey Pavlov says:

      And then well-meaning people go and do something not because it’s needed for the patient but because they need it to deal with their stress.

      Indeed. One of my attendings said that one of the most difficult things to do is what he calls “MICO” – Masterful Inactivity and Cat-like Observation.

      I guess that at least some MDs are aware of this and address it in some way that wouldn’t hurt anyone but would make them feel better – something like, say, scented candles or an apple a day or some vitamins if the folks like pills can always be found without sending the patient to the nearest charlatan… right?

      Yes, absolutely. Perhaps not enough of us? I don’t know. But most everyone I have worked with seems to fit at least somewhat into that. I have said before that I am a proponent of things like day-spa settings for chemotherapy administration. Why not be able to get your mani-pedi or a light massage whilst waiting for your chemo to infuse? But clearly labeled as what it is – not as some way to “rejuvenate your healing powers” or some other nonsense.

  7. Ellana Livermore says:

    MD Anderson currently has posters claiming that using their Integrative Medicine department offerings ” can optimize your quality of life and clinical outcomes.” Really? I am a patient at MDA and every time I encounter this nonsense I question MDA’s commitment to SBM and the institutional ethics of the organization, I figure it is a matter of time until they follow Cleveland Clinic.

    1. StuckInTheMiddle says:

      Taking money from ill patients to do TCM pulse readings is patient exploitation. It should be illegal. It should be considered medical fraud and medical negligence.

      1. Flower says:

        Taking pulse readings is what doctors used to do not so long ago…..

        1. Windriven says:

          No, what doctors did was take your heart rate. TCM pulse readings are rather different as I understand it.

          1. Andrey Pavlov says:

            TCM pulse readings are very different indeed. However, we do take note of the character of the pulse. This can provide insight into a small set of cardiovascular problems. A “waterhammer” pulse as it is called could indicate aortic regurgitation. A strong pulse on the right and weak on the left could indicate coarctation of the aorta or aortic dissection. And so on. But these qualities are tried directly with the mechanic function of the heart and vessels, not magically to other organ systems as in TCM

  8. Flower says:

    “The reason physicians moved away from herbal medicine to pharmaceutical drugs is for predictability. ”

    The unpredictable element in this scenario is the patient and his or her diet, lifestyle, genetics, etc.

    Life is not a science experiment, moreover, when you begin to practice polypharmacy even the supposed predictability of drug-based medicine goes by the wayside.

    Lastly, medicine moved away from herbal medicine because drugs are patentable and hugely profitable!

    1. Andrey Pavlov says:

      Let’s see now troll. Three sentences. And every. Single. One. Is. Wrong.

      The unpredictable element in this scenario is the patient and his or her diet, lifestyle, genetics, etc.

      That unpredictability remains whether using herbs or purified drugs. We can remove unpredictability from one of those two systems, and it ain’t people.

      Life is not a science experiment, moreover, when you begin to practice polypharmacy even the supposed predictability of drug-based medicine goes by the wayside.

      Life sure is a science experiment. How else can we possibly figure it out? You say “science experiment” like it was a bad thing. One of my little joys in life is coming home a couple times a year and seeing my nephews, 6 and 10, and the first thing the ask me, with wide eyes and jumping up and down, is “What experiment are we doing today?” And poly-pharmacy is still better than poly-herbalism.

      Lastly, medicine moved away from herbal medicine because drugs are patentable and hugely profitable!

      False. Herbs can indeed be patented and sold, as can just about anything. A proprietary blend, extraction method, or even just a brand name can offer copious amounts of money. Which is part of why the herb/supplement industry is $30 billion dollars in the US alone.

  9. Peter S says:

    Brigham and Women’s in Boston has had a similar center for a few years. I suspect a big part of it is just economics — they are meeting patient demand and market accordingly with some tropes you guys would have fun with. And I also suspect a lot of people are in fact helped via the placebo effect, maybe even enhanced by the ‘legitimacy” of the setting. I don’t think Brigham and Women’s has gone so far as to offer Chinese herbs yet, although I may be wrong about that.

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