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NCCIH and the true evolution of integrative medicine

NCCIH and the true evolution of integrative medicine

There can be no doubt that, when it comes to medicine, The Atlantic has an enormous blind spot. Under the guise of being seemingly “skeptical,” the magazine has, over the last few years, published some truly atrocious articles about medicine. I first noticed this during the H1N1 pandemic, when The Atlantic published an article lionizing flu vaccine “skeptic” Tom Jefferson, who, unfortunately, happens to be head of the Vaccines Field at the Cochrane Collaboration, entitled “Does the Vaccine Matter?” It was so bad that Mark Crislip did a paragraph-by-paragraph fisking of the article, while Revere also explained just where the article went so very, very wrong. Over at a blog known to many here, the question was asked whether The Atlantic (among other things) matters. It didn’t take The Atlantic long to cement its lack of judgment over medical stories by publishing, for example, a misguided defense of chelation therapy, a rather poor article by Megan McArdle on the relationship between health insurance status and mortality, and an article in which John Ioannidis’ work was represented as meaning we can’t believe anything in science-based medicine. Topping it all off was the most notorious article of all, the most blatant apologetics for alternative medicine in general and quackademic medicine in particular that Steve Novella or I have seen in a long time. The article was even entitled “The Triumph of New Age Medicine.”

Now The Atlantic has published an article that is, in essence, The Triumph of New Age Medicine, Part Deux. In this case, the article is by Jennie Rothenberg Gritz, a senior editor at The Atlantic, and entitled “The Evolution of Alternative Medicine.” It is, in essence, pure propaganda for the paired phenomena of “integrative” medicine and quackademic medicine, without which integrative medicine would likely not exist. The central message? It’s the same central (and false) message that advocates of quackademic medicine have been promoting for at least 25 years: “Hey, this stuff isn’t quackery any more! We’re scientific, ma-an!” You can even tell that’s going to be the central message from the tag line under the title:

When it comes to treating pain and chronic disease, many doctors are turning to treatments like acupuncture and meditation—but using them as part of a larger, integrative approach to health.

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Posted in: Acupuncture, History, Medical Academia, Naturopathy, Science and the Media

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Attitudes Predict CAM Use

 From the US Food and Drug Association article "6 Tip-offs to Rip-offs: Don’t Fall for Health Fraud Scams

CAM: More branding than medicine.

One of the persistent themes of SBM is that CAM (complementary and alternative medicine, or integrative medicine) is nothing more than a marketing brand. Its recent popularity is not based upon new evidence or a changing paradigm of medicine as its proponents claim. Its popularity is increasing despite the lack of evidence for specific CAM treatments and despite a dedication to evidence-based medicine within the medical profession.

CAM is also modern mythology, which I guess all really effective advertising and branding is. It floats atop a number of demonstrably false marketing claims. One is that the popularity and use of CAM is surging. This is partly a self-fulfilling prophesy, and no doubt it is increasing, but the degree to which CAM is popular has been consistently exaggerated by proponents (largely as a way to justify its existence).

This myth is largely perpetuated by redefining CAM as needed, including things like prayer, massage, and taking vitamins. I suspect that praying for a sick loved-one has always been popular and doesn’t represent a trend toward CAM. When unequivocal alternative modalities are considered, their use is still tiny and not increasing. The most recent NIH survey found:

Use of acupuncture (1.1%), homeopathic treatment (1.7%) naturopathy (0.2%), and energy healing (0.5%) was miniscule.

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Posted in: Medical Academia, Science and Medicine

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What Should We Do in the Absence of Evidence?

Pictured: Smarter than you.

Pictured: Smarter than you.

For every complex problem, there is an answer that is clear, simple—and wrong.

– H.L. Mencken

Despite my multiple personalities, it seems that only the OCD doctor gets anything done. The Goth cowgirl persona? Lazy. And the NBA playoffs are sucking up an inordinate amount of time. Go Blazers. Just not very far. Sigh. But what are you going to do. Work needs doing and someone has to do it.

This week was one of deadlines. In June I am giving a series of talks at the SMACC conference in Chicago and I have to have all my talks ready to go today. So sometimes to meet all my deadlines I need to re-purpose other material.

Spoiler alert: if you are going to be at SMACC and hear my lectures, stop reading here. Everything I am going say in 6 weeks will follow. And really even if you are going to SMACC, it is a content-free post. You might be better off spending your time elsewhere. (more…)

Posted in: Critical Thinking, Humor, Medical Academia, Science and Medicine

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Integrative medicine, naturopathy, and David Katz’s “more fluid concept of evidence”

The Integrative Medicine Wheel

The Integrative Medicine Wheel

Dr. David Katz is undoubtedly a heavy hitter in the brave new world of “integrative medicine,” a specialty that seeks to “integrate” pseudoscience with science, nonsense, with sense, and quackery with real medicine. In fairness, that’s not the way physicians like Dr. Katz see it. Rather, they see it as “integrating” the “best of both worlds” to the benefit of patients. However, as we’ve documented extensively here, on our personal blogs, and even in the biomedical literature (plug, plug), what “integrative” medicine means in practice is indeed what I characterized, the infiltration of woo into medicine. This infiltration seems to have started mainly in academia—hence the term “quackademic medicine” and “quackademia”—with the steady infiltration of nonsense into medical schools and academic medical centers, but has since metastasized to the world of community hospitals. This “integration” (or, as I like to refer to it, “infiltration”) has become so pronounced that a few years ago The Atlantic published an article entitled “The Triumph of New Age Medicine“, and just last December the Journal of the National Cancer Institute (JNCI) published a monograph full of articles touting “integrative oncology,” including guidelines recommended by the Society of Integrative Oncology (SIO) for the “integrative” treatment of breast cancer symptoms.

I mention Dr. Katz for two reasons. First, he’s taken another broadside at us at Science-Based Medicine in blog entry at The Huffington Postwhere else?—entitled “Holism, Holes and Poles” that I’ve been meaning to address for a while. But before I address Dr. Katz’s most recent complaint against science-based medicine (SBM), it’s necessary to step back and look at some history.
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Posted in: Clinical Trials, Homeopathy, Medical Academia, Naturopathy

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Pseudoscience North: What’s happening to the University of Toronto?

Trojan Rabbit

 

Today’s post is a reluctant challenge. I’m nominating my own alma mater, the University of Toronto, as the new pseudoscience leader among large universities – not just in Canada, but all of North America. If you can identify a large university promoting or embracing more scientifically questionable activities, I’ll happily buy you a coffee. Yes, it’s personal to me, as I have two degrees from U of T. But I’m more concerned about the precedent. If Canada’s largest university is making decisions that appear to lack a careful consideration of the scientific evidence, then what does that suggest about the scientific standards for universities in Canada? (more…)

Posted in: Chiropractic, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Traditional Chinese Medicine, Vaccines

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Communicating Health Science News

From the Wikimedia Commons.

Pictured: Test subjects probably not worth a press release.

A recent study addresses the problem of sensationalism in the communication of science news, an issue we deal with on a regular basis. The study was titled “The association between exaggeration in health related science news and academic press releases: retrospective observational study“. The results show two interesting things – that university press releases frequently overhype the results of studies, and that this has a dramatic effect on overall reporting about the research.

The authors reviewed “Press releases (n=462) on biomedical and health related science issued by 20 leading UK universities in 2011, alongside their associated peer reviewed research papers and news stories (n=668).” They found that 40% of the press releases contained exaggerated health advice, 33% overemphasized the causal connection, and 36% exaggerated the ability to extrapolate animal and cell data to humans.”

Further:

When press releases contained such exaggeration, 58%, 81%, and 86% of news stories, respectively, contained similar exaggeration, compared with exaggeration rates of 17%, 18%, and 10% in news when the press releases were not exaggerated.

This study points a finger directly at academic press offices as a significant source of bad science news reporting. This does not let other links in the news chain off the hook, however. (more…)

Posted in: Medical Academia, Science and the Media

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Selling “integrative oncology” as a monograph in JNCI

pancreatic-cancer-diagnostics-l

Sometimes, it’s hard not to get the feeling that my fellow bloggers at Science-Based Medicine and I are trying to hold back the tide in terms the infiltration of pseudoscience and quackery into conventional medicine, a term I like to refer to as quackademic medicine. In most cases, this infiltration occurs under the rubric of “complementary and alternative medicine” (CAM), which these days is increasingly referred to as “integrative medicine,” the better to banish any impression of inferior status implied by the name “CAM” and replace it with the implication of a happy, harmonious “integration” of the “best of both worlds.” (As I like to point out, analogies to another “best of both worlds” are hard to resist.) Of course, as my good buddy Mark Crislip has put it, the passionate protestations of CAM advocates otherwise notwithstanding, integrating cow pie with apple pie doesn’t make the cow pie better. Rather, it makes the apple pie worse.

In any case, over the last three months, Steve Novella and I published a solid commentary in Trends in Molecular Medicine decrying the testing in randomized clinical trials of, in essence, magic, while I managed to score a commentary in Nature Reviews Cancer criticizing “integrative oncology.” Pretty good, right? What do I see this month in the Journal of the National Cancer Institute (or JNCI, as we like to call it)? An entire monograph devoted to a the topic, “The Role of Integrative Oncology for Cancer Survivorship”, touting integrative oncology, of course. And where did I find out about this monograph? I found out about it from Josephine Briggs, the director of the National Center for Complementary and Alternative Medicine (NCCAM) herself, on the NCCAM blog in a post entitled “The Evidence Base for Integrative Approaches to Cancer Care“, in which she touts her perspective piece in the JNCI issue entitled “Building the Evidence Base for Integrative Approaches to Care of Cancer Survivors.” In an introductory article, Jun J. Mao and Lorenzo Cohen of the Department of Family Medicine and Community Health, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania and the University of Texas M.D. Anderson Cancer Center, respectively, line up this monograph thusly:
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Posted in: Cancer, Clinical Trials, Medical Academia

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Retconning the story of traditional Chinese medicine

Retcon

Retcon (shortened form of RETroactive CONtinuity; first made popular in the comic book world):

  1. (original meaning) Adding information to the back story of a fictional character or world, without invalidating that which had gone before.
  2. (more common usage) Adding or altering information regarding the back story of a fictional character or world, regardless of whether the change contradicts what was said before.

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Posted in: Clinical Trials, History, Medical Academia, Traditional Chinese Medicine

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Quackademia update: The Cleveland Clinic, George Washington University, and the continued infiltration of quackery into medical academia

Collingewheel

Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not improve the apple pie. Yet that is what’s going on in medical academia these days—with a vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”

In fact, it was my two recent publications bemoaning the infiltration of quackademic medicine into medical academia, one in Nature Reviews Cancer and one with Steve Novella in Trends in Molecular Medicine, that got me thinking again about this phenomenon. Actually, it was more my learning of yet another step deeper into quackademia by a once well-respected academic medical institution, occurring so soon after having just published two articles bemoaning that very tendency, that served as a harsh reminder of just what we’re up against. So I decided to greatly expand a post that I did for my not-so-super-secret other blog recently beyond a focus on just one institution, in order to try to demonstrate for you a bit more how and why quackery has found a comfortable place in medical academia and how, just when I thought things can’t get worse, they do. There is also room for hope in that I also found evidence that our criticisms are at least starting to be noticed. I begin with the sad tale of the Cleveland Clinic Foundation, which has gone one step beyond its previous embrace of traditional Chinese medicine. I’ll then discuss another unfortunate example, after which I’ll look a bit at the pushback and marketing of “integrative” medicine.
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Posted in: Acupuncture, Energy Medicine, Medical Academia, Science and the Media

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Tens of millions for CAM research — and it’s all on your dime

George-Washington-dollar-bill-480x384

The Federal Funding Accountability and Transparency Act (FFATA) was signed on September 26, 2006. The intent is to empower every American with the ability to hold the government accountable for each spending decision. The end result is to reduce wasteful spending in the government. The FFATA legislation requires information on federal awards (federal financial assistance and expenditures) be made available to the public via a single, searchable website, which is www.USASpending.gov.

And what subject is more deserving of being held accountable by the American people than complementary/alternative/integrative medicine? After all, in what other area of government spending does scientific implausibility – indeed, even scientific impossibility – offer no impediment to spending millions of taxpayer dollars in research funds? We’ve complained about the NCCAM’s wasteful spending on pseudomedicine here on SBM several times: here, here, here and here, among others. As you shall see, the problem doesn’t stop at that particular $2.5 billion. (more…)

Posted in: Acupuncture, Chiropractic, Clinical Trials, Energy Medicine, Homeopathy, Medical Academia, Naturopathy, Politics and Regulation

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