The Integrative Medicine Wheel: False hope and lies
There are a number of things about so-called “integrative medicine” (or, “IM”) we don’t know, such as
- Whether IM really offers the best of conventional medicine and CAM.
- Whether IM produces better outcomes.
- Whether IM is effective in the area of prevention, including obesity and cardiovascular risk.
- Whether IM has anything to offer preventive medicine.
- Whether future IM research will yield beneficial results.
- Whether IM has a positive impact on utilization clinical preventive services, smoking cessation, diet, and physical activity.
- Whether IM is cost effective.
We don’t even have a working definition of “integrative medicine,” although experience tells us that incorporating diagnoses and treatments with insufficient evidence of safety and effectiveness is an acceptable element of integrative practice, as is rebranding “conventional” practices as “integrative.”
Normally, these substantial deficiencies would get in the way of declaring that IM is anything like a real specialty in medicine. Indeed, as David Gorski has pointed out, IM is more of a brand than a specialty. Yet, as we do know, integrative medicine considers itself exempt from the rules. Thus, a few years ago, Andrew Weil, MD, an early adopter in incorporating pseudoscience into medical practice, announced his desire to create of a board certification in integrative medicine. No doubt aware that IM couldn’t fulfill the requirements of the American Board of Medical Specialties (ABMS), he turned to the American Board of Physician Specialties (ABPS), whose requirements for Board recognition are more forgiving. For example, the ABPS is willing to credit work experience as a prerequisite to board certification, as opposed to residency and fellowship training. Sure enough, a few years ago, the ABPS formally accepted board-certification in IM via the ABPS’s recognition of the American Board of Integrative Medicine (ABOIM). (more…)
A new PEW survey does a deep exploration of public attitudes toward genetically modified organisms (GMOs), organic food, and scientific consensus. While the numbers are better than I thought they would be, perhaps indicating some progress, they still indicate a large disconnect between scientific and public opinion on food matters.
GMOs are safe
It is reasonable to take as a premise for understanding this survey that there is a strong scientific consensus that GMOs are safe for human and animal consumption. Every major scientific and medical organization that has systematically reviewed the published data (most of which, by the way, is independent from industry) have come to the same conclusion, that current GMOs on the market are safe and that there are no inherent risks to current technologies used to create GMOs. The latest such report, a 2016 review conducted by the National Academy of Sciences and discussed here on SBM in May, also concluded GMOs are safe.
In a 2015 Pew survey, 88% of scientists surveyed reported they felt GMOs were safe. That was higher than the 87% who reported they believed in man-made global warming. So arguably there is a stronger scientific consensus that GMOs are safe than there is for anthropogenic global warming.
At the same time there is no convincing evidence, after 50 years of research, that organic food is more healthful than conventional produce.
I have bad news to announce to our readers. While traveling in Australia, SBM stalwart and founding editor Harriet Hall suffered a fall and significant injury. Australian skeptic and friend of the blog Eren Segev has the news, and this is all I know other than what Steve Novella told me the other day in an e-mail. It wasn’t any more than this:
We here at SBM are saddened and are hopeful that Harriet will soon be able to return to her home and ultimately make a full recovery. I haven’t yet had any direct communication with Harriet or her husband.
For purposes of her blogging here at SBM, there is one more post that she wrote before this that will be published next Tuesday. After that, her regular Tuesday posting time will be filled with guest posts and a series of “Best of Harriet Hall” reposts until she is able to resume her regular contributions to SBM, however long that takes.
I and the rest of the editors and regulars at SBM wish Harriet a swift recovery. I hope that regular SBM readers will do the same. We will post updates as they become available.
What is it with causes like alternative medicine and getting naked except for body paint?
Old fart that I am, I’ve been a fan of The Rolling Stones since the mid-1970s, when I was in junior high school. Over the years, I’ve accumulated pretty close to all of their studio albums—and even bought multiple remastered versions of classics like Exile on Main Street and Beggar’s Banquet—and got access to the rest when I discovered the joy of streaming through Apple Music. Granted, the Stones went through a rough patch, creatively speaking, in the 1980s (the less said about Under Cover and Dirty Work, for instance, the better) and nothing they’ve done since the late 1970s has lived up to their glory days, but, damn, if I wasn’t surprised that their latest album of blues covers Blue & Lonesome released on Friday is really good.
Ed. Note: After the prolonged comment thread in Harriet Hall’s review of this book in July, given the controversy, we were willing to consider a guest post offering another perspective. In this case, the perspective is very similar to Harriet’s, the main difference being primarily in emphasis.
As a dietitian working in the area of vegan nutrition, I see no shortage of outrageous claims about vegan diets. They come from both sides of the debate. Advocates for veganism sometimes ascribe unsubstantiated benefits to vegan diets while downplaying concerns about meeting nutrient needs.
On the other side of the debate are bloggers and authors who insist that a vegan diet is a dangerous choice and that it can’t support health over the long term. Prominent voices for this perspective include those whose health failed on a vegan diet and who eventually returned to eating meat, dairy and eggs. They are now on a mission to prove that humans require animal foods.
Mara J. Kahn is the latest author to try to capitalize on that story. Her book Vegan Betrayal has already been reviewed on Science Based Medicine and the nutrition information was deemed evidence-based. I came away with a different impression when I read the book.
I don’t feel any particular need to prove that a vegan diet is the only healthful way to eat; that’s not the point of veganism. The term was coined in 1944 by the founders of England’s Vegan Society and was defined as:
a philosophy and way of living which seeks to exclude — as far as is possible and practical — all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose.
A young child opening a CAMCrate for Kids! box, hoping for relief from her Childhood-Onset Qi Deficiency (COQD)
Cleveland, OH- Cleveland native Kelly Anderson is looking forward to the end of the month like a young child anxiously awaiting Christmas morning. That’s because on a day between the 20th and the 28th of December, she will receive the gift of hope. Anderson, a 43-year-old mother of five who was diagnosed with chronic Lyme disease and numerous nutritional imbalances earlier this year by a Naturopathic doctor during a visit to discuss her unexplained fatigue, is part of a growing number of people interested in an alternative path to wellness.
CAMCrate, a new monthly subscription box service developed by the experts at Cleveland Clinic’s Center for Integrative and Lifestyle Medicine, will deliver boxes of high quality and thoroughly tested alternative medical experiences right to customer’s doorstep starting this month. Anderson, who learned about the new service during a routine check-up at the office of her Cleveland Clinic affiliated primary care doctor, is quick to point out that she loves her conventional medical doctor. “I’m not against Western scientific medicine, I’m just looking to augment it with something different, something special. Who doesn’t want a little magic and mystery in their lives?” (more…)
No drug is free of risks, or the potential for causing harm. Every decision to take a drug needs to consider expected benefits and known risks. One of the ways we can reduce harms is by studying drug use rigorously. Only by understanding the “real world” effects of drugs can we understand the true risks (and benefits) and design strategies to reduce the risk of iatrogenic harm — that is, harms caused by the intervention itself. Adverse events related to drug treatments are common. Some lead to hospitalization. Studies suggest 28% of events are avoidable in the community setting, and 42% are avoidable in long-term care settings. That’s a tremendous amount of possible harm from something prescribed to help. A new study published this week shows that adverse drug events (ADEs) continue to cause significant problems, sending over a million Americans to the emergency room every year.
In vitro fertilization (IVF) is the only option for many couples who want to have their own genetic child. This is an expensive procedure – it can cost up to $20,000 per attempt, with about a 40% success rate overall.
Couples going for IVF are often desperate to have their own child, and the uncertainty of success can be emotionally and financially draining. For this reason they are an especially vulnerable population when it comes to optional services (“add-on services”) that promise to increase the chances of success.
A recent BMJ article reviewed the evidence for 38 IVF add-on services typically offered in the UK: “Lack of evidence for interventions offered in UK fertility centres.” The title gives away the punch line – of the 38 services they reviewed, only one had any compelling published evidence of efficacy, endometrial scratch (causing minor trauma to the uterine wall to enhance the probability of embryo implantation). Even then the evidence was only “moderate.” The authors write:
Our appraisal of the evidence shows only one intervention, endometrial scratching, for which the review evidence robustly supports an increase in live birth rate, yet even this evidence is of only moderate quality, and the observed benefit is only in women with more than two previous embryo transfers.
That could easily be just random noise in the research. If you look at 38 different treatments, what are the odds that at random one of them will have an excess of false positive studies, and only in one subgroup (which is a red flag)?
BrainPlus IQ: If it turns your brain blue, consult a doctor.
I got an email urging me to check out a wonderful new product that boosts brain performance: it “doubles IQ, skyrockets energy levels, and connects areas of the brain not previously connected.” It is BrainPlus IQ, a dietary supplement that falls into the category of nootropics, substances that enhance cognition and memory. After looking into it, my first thought was that if it doubles your IQ you might become smart enough to realize you have been scammed. The advertising for this product is as reprehensible as anything I have seen (and I have seen a lot).
The link in the email was to a “Discovery” website article titled “Anderson Cooper: Stephen Hawking Predicts, “This Pill Will Change Humanity” and It’s What I Credit My $20 Million Net Worth To.” According to the article, Stephen Hawking said his brain is sharper than ever because he uses BrainPlus IQ. It quotes Denzel Washington, saying he gave a speech at a science convention (unnamed) in New York City, saying BrainPlus IQ enabled him to memorize movie lines after reading them just once. He brought to the stage MIT scientist Peter Molnar, who said he had tested BrainPlus IQ against Adderall in 1,000 patients and found it was 600% more effective and subjects doubled their IQ in 10 days. It has “absolutely no harmful ingredients, it’s non-addictive, and 79% of participants double their IQ within 24 hours.” It was supposedly described as “Viagra for the brain” in Forbes magazine. (more…)
Functional Medicine practitioners like to make patients think that this diagram actually means something.
I’ve frequently written about a form of medicine often practiced by those who bill themselves as practicing “complementary and alternative medicine” (CAM) or “integrative medicine” (or, as I like to refer to it, “integrating” quackery with medicine). I’m referring to something called “functional medicine” or, sometimes, “functional wellness,” which Wally Sampson first introduced to readers of this blog way back in 2008, and continued to educate our readers over multiple posts. Over the years, I’ve tried to explain why the term “functional medicine” (FM) is really a misnomer, how in reality it is a form of “personalized medicine” gone haywire, or, as I like to refer to it, as “making it up as you go along.” Unfortunately, thanks largely to its greatest popularizer, Dr. Mark Hyman, FM is popular, so much so that Bill and Hillary Clinton count Hyman as one of their medical advisors and the Cleveland Clinic, not satisfied with embracing prescientific traditional Chinese medicine, has gone “all in” for FM by hiring Dr. Hyman two years ago to set up a functional medicine clinic. Unfortunately, it’s been “wildly successful” there.
Unfortunately its success is not deserved, at least from a scientific standpoint.