Articles

Why would medical schools associate with quackery? Or, How we did it.

Why would medical schools risk association with quackery?

…a question from a Washington Post reporter in 1998.

The following hypothetical answer composed in response was never sent. It awaited a proper forum. Could this be one?

Well, Jeff, quackery is a pejorative term. Some time ago we recognized that words raise emotions and mental pictures. We recognized the cognitive dissonance raised by them, so we tried to eliminate quackery. We recognized the cognitive dissonance raised when one discusses acupuncture, chiropractic, homeopathy, and healing at a distance as if they were quackery when we made claims. For a century, most people just could not allow for the possibility that these things really work.

So over time we recognized that we had to do something about our language. That would be the first step in enabling the thought revolution that is upon us, and changing the paradigm in medicine and science. We simply changed the adjectives, and gave alternate names to the methods, added a few phrases to eliminate negative reactions, and shifted the negative terms to descriptions of the Medical Establishment (and, note the caps in that one.)

And along with that, we took advantage of a shift in perception, to be sure that the public would adopt a non-judgmental attitude. Of course, we had to wait decades for that attitude to mature to the point that they would be willing to give our claims a hearing, whereas just thirty years ago they would have dismissed the claims out of hand. Not only did we get that non-judgmental mind-set, but with it, a strong negative reaction to a description that contained an opinion or one that used any kind of loaded language to describe an underdog – no matter how true or justified that language happened to be. Fortunately for us, a wave of change spread across the intelligentsia, especially in the universities and the literary community, reinforced by the press. This was nicknamed “Political Correctness” or PC by other observers, but it was a new social standard that worked wonders for us. No scientific paper could be published that contained pejorative or negative wording, and almost all popular press reporting became dominated by the same press ethic. The press call it “balance“ or “objective reporting,” and they called reports’ wording of 10-20 years previous to be “biased” or “prejudicial.” And those were sins worse than using four letter words. We were delighted.

We now use words like unorthodox, nonstandard, unconventional, alternative, complementary, and the latest, “integrative.” They produce no emotional reaction. Along with this we invented false dichotomies, which became accepted facts; like holistic vs. reductionist, Western vs. Eastern medicine, linear vs. non-linear thinking. The dichotomies reinforced people’s feelings that these things were opposites, but of equivalent linguistic and scientific value.

Then we had to build a few straw men to show how bad and dangerous medicine was: The Medical Establishment, “cut, burn, and poison,” “cold and impersonal,” Medical Monopoly, Big Pharma, and adopted phrases to use in lobbying like “that‘s just a turf war…” Then we added slogans to replace realistic description like they do in advertising, because they really do work. So we made up Metabolic Therapy, Orthomolecular Medicine, treating the whole person, Treating the cause, not just the symptoms, Medicine for the 21st century, and “complementary and alternative medicine (“CAM”) itself. And how about “changing paradigm” we stole from Tomas Kuhn, “emergent methods” and “emergent technologies” – some of our co-borderliners used that one for cold fusion. [One wealthy foundation just constructed “The New Medicine.”]

So, y’see, what we did was ride a changing social and political scene to construct an entirely new thought system for medicine and health (oh, yeah, we also now use “health” instead of “medicine.”) – a new lens through which all our methods and claims would be seen as “good” or at least neutral. Descriptions such as implausible, unproven, disproven, fraudulent, dubious, would be out. Yet we would be free to use terms to describe medical science as removed, intellectual, unapproachable, elitist, and members of the System would be seen as arrogant, unfeeling, dominating,… well, you get the point. And, quackery, charlatan, irrational, fringe, are no longer linguistically correct (LC.) The cultural relativists, post-modernists, deconstructivists, have paved the way. The educational system, most of the academic, and much of the medical educational system are now etymologically and epistemically correct (ET.)

An example of our success was at the National Library of Medicine a few years ago when a medical author-editor inquired about the recent use of the term, “alternative medicine,” as a subject heading for its reference system. He was told the wording was now part of the common lexicon, and had to be honored, because that was the term the public would use to obtain references. Then just last week, he was asked to moderate a debate on “CAM” for an internet biological science magazine. He suggested the title not be “CAM” or “AM” but “aberrant medical practices.” The editor rejected the change, stating that the last term was prejudicial whereas “alternative” was not. Talk about your success!

We are thankful to the popular media – especially the print media for fifteen years of support. Of course, the press would not consider it support, because its members are blind to the problem. Their system of … ethics is different from that of science. And especially of medicine. They adopted a common theme – actually a template for writing about us. First, they are not interested so much in facts as they are in stories – keeping the attention of readers. So they almost always have a human interest story in an article about us. A leukemia cure by modern drugs by a highly educated and skillful clinician is not a story. Now if an insurance company refuses to pay for the treatment because of its expense, that’s a story. Or if a disgruntled patient didn’t get no satisfaction for a set of symptoms that the physician could not fit into a disease category (often just concern over common bothersome though unimportant symptoms) and then went to a chiropractor or acupuncturist and got relief, however temporary or expected on the basis of waiting and time, that’s a story. Or if a medical school forms a department for using some “alternative” treatment, and teaches the techniques to students, that’s a story. Of course, if the teaching is supported by a large grant from a private foundation run by some of our supporters, that would not likely be mentioned because it could be interpreted as biased. (And between you and me, we would not volunteer that information, would we?.)

And what percent of the readership would read about the structure and function of genes or the physics of heart-lung machines, or of the details of transplant operations? They figure most readers won’t get past paragraph four. It’s so much diagrammatic clutter. We know that in hard times the first sections they sacrifice are the medicine and science pages. There is always a market for sports and entertainment. So your editors will usually go for the first page of the B or the Living Section. And most people don‘t know that those articles don‘t come out of nowhere or just from an editor’s head. We started news releases, writing books and having our agents get us on the radio, and getting reviews of our books. And fortunately, they have lay readers do the reviews; we know what kinds of reviews we would get from real scientists and clinicians. As for the occasional idea you might get for a hit piece, or to tell it like it is, the editors cower – they fear the accusations they will get from us and our attorneys for defamation and interfering with commerce. We sort of have them there.

How about you science writers, who have had background education, special training, and consider yourselves no fools when it comes to so-called scams? With few exceptions, you have already felt the effects of the editors’ marker pens. And the power of that unspoken “balance” thing you were taught as far back as journalism school. And what would you do about getting other points of view anyway? We have seen your formula for articles. A front piece about a happy patient, 15-20 paragraphs about the patient, you, and the method, and two paragraphs by some doubter – a self-described expert skeptic – somewhere between paragraphs 15 and 28; and I thank you for almost always giving the last word, sentences, and paragraphs to us. Besides, you are usually on a deadline, our agents have just about pulverized regulatory agencies through Congress in the name of personal freedom, and most of all, we would never suggest any of those troublemaking skeptics’ names. Count on that.

So with the new postmodern academic teaching in most universities, the slow changes in attitude from language distortion (we call it language capture), and the cooperation of the press, all we needed were two more institutions – a sizable pool of private foundations and a foothold in the government. We got both. We got a powerful senator, chairman of the Health Education and Labor (and Pensions) Committee, egged on by a couple of House members who cajoled the others and the head of the NIH, and got our semi-permanent NIH Institute, now a Center for Complementary and Alternative Medicine and its $120 million per year “awards” to our centers. Those assured the presence and persistence of medical school teaching of our material, special clinics where they are applied, and a an institutional source of employment for us for the first time in more than a century.

And it all mushroomed from there beyond our expectations. We got over 30 of our journals listed and abstracted in Medline/Pubmed of the NLM, and our people and sympathizers have excluded skeptical journals from Pubmed. We got our people to write the descriptions of our methods in government information sources like the NCCAM, the NIH itself (Intellihealth) we got our med school teachers to write the “CAM” sections at the American College of Physicians web pages, and we got essentially all med school website “CAM” sections to describe us in those “neutral” terms, without negative descriptions – even after proof that our methods don’t really work. The entire information establishment has accepted us, has changed its language as we have dictated, and captured hearts and minds of most generators and disseminators of information. [An addition from June, 2008: And now for the real current reason: That $100 million/year from NCCAM, a similar amount from other NIH institutes, and a large dose, perhaps as much as $50 million from private foundations - all into the pool of funding for the medical schools. A subject for 2 prior and yet another post.]

So now watch the straight-thinkers howl. They still don’t realize what hit them or how and why. Neither do you in the press, sticking to your high-minded principles of “balance“ and “fairness“ while feeding the public our intentional restructuring of the language, and not realizing it at all. While the running dogs of righteousness, the straight-laced, long-faced, mind-constricted, conservative, backward-looking, sexist, xenophobic, old men of medicine stomp and holler, and while deans and congressmen are deaf to their pleas…OoooWeeeh. Have we made it or what?

Posted in: Basic Science, Politics and Regulation, Science and the Media

Leave a Comment (27) ↓

27 thoughts on “Why would medical schools associate with quackery? Or, How we did it.

  1. regis2 says:

    I want to thank all of you for the time you take to provide this valuable resource. I have emailed my wife, a health reporter at a mid-sized midwestern newspaper, many stories from your site. She tries hard to do a good job, reporting accurately and skeptically, but is often hampered and constrained by the realities of the modern newspaper business. Again, thanks for your efforts.

  2. V says:

    “We got over 30 of our journals listed and abstracted in Medline/Pubmed of the NLM, and our people and sympathizers have excluded skeptical journals from Pubmed.”

    I’m curious: which skeptical journals were excluded from PubMed? And which altmed journals were included?

  3. Joe says:

    Thanks for this. In my recent experience, librarians (like journalists) often promote quackery in the name of “neutrality,” too, and they rely on incompetent reviewers for collection development. For example, the primary journal for reference librarians (RUSQ) fawns over the opinions of a naturopath.

    Furthermore, a major source for book reviews (“Library Journal”) has reviewers that promote books that look good because they have nice illustrations and cross-references. One book on herbs that received the highest praise was also reviewed by (the late) Varro Tyler- he called it ‘hazardous’ because it presented good and bad information (equally) in the same appealing fashion.

    The same reviewer who raved about the, flawed, book on herbs called Kurt Butler’s masterpiece (“A Consumer’s Guide to ‘Alternative Medicine’” Prometheus, 1992) “biased.” That is like complaining that social workers are biased against child abuse.

    Perhaps a reader can advise me- I am looking for a widely-read library journal that would entertain an adequate critique of sCAM.

  4. My theory is much simpler than Dr. Sampson’s. I think it is the MBAs and mareting geniuses in the dietary supplement/alt. med. industry that are responsible for getting quackery into med schools.

    First, they understood and pandered to the change in the attitude of society, a society in which policy no longer flows from the top down but rather from the bottom up, a society in which people want simple solutions to complex problems, a society that has romantic ideas about a past it knows nothing about, a society that is comparatively wealthy and healthy and that will pay good money for anything that is supposed to be safe and offer “health benefits”, a society in which most, because of lack of education, actually think life can be risk free and that a birth certificate comes with a guarantee of 85 plus healthy, happy, wealthy of life.

    The MBAs and marketers smelled money, lots of money. They knew they could provide products that people with these attitudes would buy. They created a whole, new, unregulated category of products legally called “dietary supplements”. They convinced all kinds of people that they could maintain their health without having to work at it and that they could also make money by selling “health” in bottles and jars to their friends, neighbors, co-workers and families. They enlisted all these customer/salesmen to lobby, market and sell their goods.

    I’ve always suspected that the MBA/marketers knew that a lot of people would be injured and killed by their products but considered it the cost of doing business. I think their business plan has been for every man, woman, child and pet in the industrialized world to take several different colored pills each day along with several different flavors of water from which they believe they will obtain health benefits. The MBA/marketers expect that in a decade or two only a few big, incredibly wealthy international companies will be selling supplements, the fuel that powers the entire alt. med. industry. They expect that most of the little folks who got their movement, aka business or industry, started will fall by the wayside so that only a few major companies selling mislabeled water and sugar pills, most of which will not be labeled “homeopathic”, will be left to pull in billions. But the damage has already been done. The innocent little folks have pressured the mainstream market, doctors, hospitals and scientific institutions to offer them alt med, which more often than not is just another vehicle to sell supplements and make easy money.

    The only solution I see is to go after the money. Expose the industry and enact very strong fraud in advertising laws to protect consumers from quacks. Even the marketing geniuses in the alt. industry find it almost impossible to publicly oppose fraud and laws against it.

  5. LindaRosaRN says:

    Well done, Dr. Sampson.

    All the ground has, indeed, been taken beneath our feet; I see no place from which we can make a last stand.

    This is, alas, a fitting eulogy for “allopathic medicine.”

  6. durvit says:

    V, I may be wrong, but I imagine that Dr Sampson has the inclusion of Medical Hypotheses in mind (for one). There are 2 homeopathy journals; 9 journals dedicated to complementary therapies or alternative and complementary medicine. Dr Sampson has written of the failure to have the Scientific Review of Alternative Medicine accepted for Entrez Pubmed (also contains a full list of altmed journals at that time).

  7. Harriet Hall says:

    Linda,

    All is not lost. We can take a stand for our own “new” kind of medicine that is better than either CAM or conventional evidence-based “allopathic” medicine. It’s called “Science-Based Medicine.” It started here.

    The NACM is an association “of chiropractors who confine their scope of practice to scientific parameters.”
    (http://www.chiromed.org/) Why couldn’t physicians do something similar?

    I think a lot of consumers would rather choose a doctor who is guaranteed not to recommend homeopathy, craniosacral therapy, or any untested treatments.

    I personally know of more than one patient who left his doctor because the doctor suggested something that sounded quacky. I know a woman who refused to ever see her doctor again just because he offered to pray for her.

  8. euthman says:

    I think CAM has made successful inroads into mainstream medical practice, simply because physician reimbursement for clinical services has inexorably gone down, just as practice expenses have continued to rise. This process leaves only two options: 1) develop additional sources of revenue, or 2) go out of business. Doctors’ offices are going the way of movie theaters and convenience stores. The profit margins on the main business (movie tickets, gasoline) are so narrow (or nonexistent) that high-margin supplementary enterprises (candy, drinks, cigarettes) spring up to make up the difference. There is simply too much profit in alt med sales for organized medicine to make any serious effort to stop it. They would be shooting themselves in the foot economically.

    Ed Uthman, MD
    Pathologist, Houston, TX

  9. Joe says:

    Does anyone know why there is a push to call quackery “Integrative” today. Marketing people often speak of the percent of positive opinions on something versus the negatives. “Alternative” was well-established and I am not aware that it has high negatives for the target audience.

    I recall Wallace explaining why “Alternative Med” found its way into the title of SRAM. I thought the publisher was right, that most people are accustomed to AM and would not likely find the journal under some newly-minted terminology.

  10. Linda, I understand your great frustration knowing a little of what you have gone through, but scientific medicine is not dead. The pendulum will swing back in its favor although it will probably take many years for quackery to return to the fringes where it has lived for so long.

    Dr. Hall are the people you speak of Skeptics? The people where I live don’t have a clue that homeo “remedies” are different than the OTCs they stand next to on the shelf in the pharmacy.

    IMO, quackery will be rampant until a large group of consumers realizes that AM, CAM, Integrative and Holistic “medicine” or whatever other term marketers give it is not about science, health, critical thinking or “woo”. It is about money and deceiving the public to make a buck.

    Yes, there are innocent users and practitioners, but the foundation is built on the prospect of making fast, easy money. Even alt practitioners who are not in it for the money use, promote and probably sell supplements. Some do it because they believe their “therapies” and “remedies” offer benefits in spite of the evidence to the contrary. Some do it because it makes them feel wonderful. They can “practice medicine”, be experts and revered as “healers” without having to earn a real degree.

    Remember the cough medicine ads on US TV that said something about “Doctor Mom” knowing which one to choose for her children? Talk about pandering the the public’s desire for “empowerment”, something AM does very well.

  11. Harriet Hall says:

    rjstan,

    You ask if the people I speak of are Skeptics with a capital S. I’m not sure what that means. I know people who are not well educated or informed, who don’t belong to any organization and who wouldn’t identify themselves as skeptics but who have enough common sense to question what they are told and to ask for evidence.

    Some of the people you describe don’t question homeopathic remedies, but I bet they question what the used car salesman tells them. The difference baffles me.

  12. Wallace Sampson says:

    Several questions I can add answers to, but will leave one now and others later…

    V: The thirty altmed journals are listed in my article on the biased resources of the Nat Lib of Med/ Pubmed in Sci Rev Altern Med (SRAM) about 2 years ago. Sorry the publisher has not kept the web page up to date…I can email you a copy, but my desktop is clunking just now. I obtained it with a 30 minute Pubmed search using “alternative medicine”, “acupuncture”, “homeopathy”, and perhaps one more heading, and scrolling through looking for new journal titles. There were probably more.

    How this came about is also in the article…it was demanded (commanded) by Dan Burton (R Ind) in 1999 hearing in which he grilled the head of Heart, lung, Blood Inst. and others. The NLM head dutifully included a nucleus series of “CAM” journals selected by Wayne Jonas of the NCCAM.

    I don’t know if there are other skeptical journals /articles abstracted by Pubmed, but SRAM – which could be the only exclusively skeptical one – was rejected 4 times, Skeptical Inquirer they have not even listed as reviewed despite a number of pertinent articles. TIME, Newsweek, NYTimes and others are ticles are abstracted.

    NLM keeps a list of journals that have published articles – over 100 of them – but I do not have that any more. There are probably more than 30 exclusive “CAM” – “Integrative” journals now. A new search is surely in order.

    WS

  13. Wallace Sampson says:

    Next to last sentence: should be “articles”.

    WS

  14. AntiVax says:

    [2008] Key realities about autism, vaccines, vaccine-injury compensation, Thimerosal, and autism-related research—-Gary S. Goldman, Ph.D & P.G. King PhD.
    http://whale.to/vaccine/king.html

  15. Dr. Hall my short definition of Skeptic with a capital S is person who talks about “woo”, a person usually very well educated and articulate who is very aware of and disturbed by any and all kinds or irrational thought. They spend a lot of time and energy writing logical critiques of all such irrational nonsense often on Internet forums made up of like minded people. They usually read the same books and magazines and often belong to the same skeptic organizations. As far as I can tell for roughly fifteen years now the Skeptics have been a major force in the effort to combat quackery, and the reason that quackery disturbs them so much and that they target it is because it is irrational.

    I don’t relate well to most Skeptics and most of them don’t relate well to me. They find me sarcastic, sharp and nasty. I find many of them humorless and I find that they often give the same weight to everything irrational whereas I find some simply silly and some dangerous. I laugh at the silly and do my best to expose the dangerous. Quackery doesn’t bother me because it is irrational but because it is dangerous. It injures, kills and robs people.

    While I know some people who “ask for evidence” when they are talking to a health care practitioner, aside from MDs, medical scientists, state and federal public health officials I know of very few who can evaluate the quality of the evidence offered. Most simply trust their health care provider or the FDA, just the way that I trust computer professionals since I don’t have the knowledge, time or interest to learn about computers myself.

    Most people are very busy today. Most don’t have the time or the interest to learn enough about scientific medicine to enable them to evaluate evidence. Most people in my area do not know that for all practical purposes the FDA does not regulate supplements or that homeopathic remedies do not contain any active ingredients.

    If their doctor recommends a homeopathic remedy, approved drug or supplement or the druggist sells one and they ask for evidence on safety and efficacy, the doctor or pharmacist can very easily give them references to selectively chosen studies that show that the stuff is safe and efficacious. They can also explain how often they have used the stuff without any bad side effects and with fantastic results. Why heck, they take it themselves and give it to their children.

    Alts use these sales techniques all the time. They do it on this forum. That is one of the reasons that alt med got into scientific institutions and has become a billion $ business gobbled up by the mainstream market. Why they even routinely convince otherwise skeptical reporters that snake oil is safe and beneficial.

    You need knowledge to evaluate evidence. When it comes to medicine, not many people have that knowledge. It is far more complicated than evaluating a used car. Alts know this and and use it to the hilt.

  16. Blue Wode says:

    Joe said “Does anyone know why there is a push to call quackery “Integrative” today.”

    CAMouflage?

    This from Ernst:

    “Integrative medicine is a new concept of healthcare. Confusingly, the term has 2 definitions. The first definition is a healthcare system “that selectively incorporates elements of complementary and alternative medicine (CAM) into comprehensive treatment plans….” The second definition is an approach that emphasizes “health and healing rather than disease and treatment. It views patients as whole people with minds and spirits as well as bodies….”

    -snip-

    The danger of integrative medicine lies in creating a smokescreen behind which dubious practices are pushed into routine healthcare.”

    http://tinyurl.com/67gjnl

    More here:

    “Writing in the British Medical Journal, Rees and Weil wrote: ‘Integrated medicine is not simply a synonym for complementary medicine. Complementary medicine refers to treatments that may be used as adjuncts to conventional treatment and are not usually taught in medical schools. Integrated medicine has a larger meaning and mission, its focus being on health and healing rather than disease and treatment. It views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment.’

    -snip-

    …one gets the impression that integrative medicine is less about integration than about using unproven treatments as alternatives to established treatments.”

    http://tinyurl.com/5ubyjq

  17. Joe says:

    Blue Wode, thanks for those links. I found a book review (behind a pay wall) from 2000 in which the reviewer suggests that “integrative” is used to distinguish between people with real medical credentials (yet, practicing sCAM), and the rest of the quacks.

  18. David Gorski says:

    [2008] Key realities about autism, vaccines, vaccine-injury compensation, Thimerosal, and autism-related research—-Gary S. Goldman, Ph.D & P.G. King PhD.

    Why hello, Mr. Scudamore. Funny, but Dr. Wallace didn’t even mention your quackery-filled website Whale.to in his post. Yet you still feel the need to show up here and push your nonsense.

    You do realize that Medical Veritas is almost as bad a “journal” as the Journal of American Physicians and Surgeons, don’t you? (Perhaps I’ll do an article on it sometime for this blog.) And that the article to which you link is nothing more than the same old disinformation and lies about a mythical link between vaccines and autism?

    In any case, I suggest that you read other offerings by me on this blog:

    Mercury in vaccines as a cause of autism and autism spectrum disorders (ASDs): A failed hypothesis
    Toxic myths about vaccines
    The Hannah Poling case and the rebranding of autism by antivaccinationists as a mitochondrial disorder
    Jenny McCarthy, Jim Carrey, and “Green Our Vaccines”: Anti-vaccine, not “pro-safe vaccine”

Comments are closed.