Articles

Posts Tagged complementary and alternative medicine

Milestones on the path to integrating quackery with medicine

Integrative medicine

It’s been a long time since I’ve encountered Glenn Sabin. You might remember him, though. He runs a consulting firm, FON Therapeutics, which is dedicated to the promotion of “integrative” health, or, as I like to put it, the “integration of pseudoscience and quackery with science-based medicine. What I remember most about Sabin is how he once proclaimed that “integrative medicine” was a brand, not a specialty. Unfortunately, he was correct in his assessment. Basically, he declared, “CAM [complementary and alternative medicine] is dead. The evolution of evidence-based, personalized integrative medicine, and its implementation in clinic, lives on.” The reason CAM was being killed by its advocates was, of course, because the term CAM contains the word “alternative” in it, and that was a barrier to mainstream acceptance. It didn’t bother Sabin one whit that there’s a lot of unscientific and unproven quackery in the CAM that has mostly become integrative medicine:

It’s true that not all stress reduction techniques, say, Reiki, boast a solid evidence base. But many clinicians who offer services like Reiki do so because they’ve observed it helping many of their patients to relax, thus lessening their need for certain medications. They rationalize that since the intervention is not potentially harmful and their patient is more relaxed and reporting beneficial value, then what difference does it really make if we don’t yet know exactly how it works?

To him, “integrative” health and medicine were the future, mainly because the connotation is much more favorable. To paraphrase how I put it at the time, no longer were CAM practitioners content to have their favorite quackery be “complementary” to real medicine. After all, “complementary” implied a subsidiary position. Medicine was the cake, and their nostrums were just the icing, and that wasn’t anywhere good enough. Those promoting CAM craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine. The term “integrative medicine” served their purpose perfectly. No longer were their treatments merely “complementary” to real medicine. Oh, no. Now they were “integrating” their treatments with those of science- and evidence-based medicine! The implication, the very, very, very intentional implication, was that alternative medicine was co-equal to science- and evidence-based medicine, an equal partner in the “integrating.”
(more…)

Posted in: Acupuncture, Critical Thinking, Medical Academia, Traditional Chinese Medicine

Leave a Comment (0) →

Dr. Richard Rawlins Reveals the Real Secrets of Alternative Medicine

Dr. Richard Rawlins reveals the secrets of alternative medicine in a new book

Dr. Richard Rawlins

Dr. Richard Rawlins, an orthopedic surgeon in the UK who is also a magician and member of the Magic Circle, has written an exhaustive review of alternative medicine, Real Secrets of Alternative Medicine: An Exposé.

“A conversation with Mrs. Smith”

A conversation with Mrs. Smith bookends the text. She comes to Dr. Rawlins for hip replacement surgery and asks if there is any alternative medicine she could try first. He tells her some patients say they have benefited, but personal experience is no substitute for critical analysis of evidence. He explains that there is no evidence to support those alternatives but that if she wants to try them, she can go ahead and try. Then she asks which one is most likely to help her. He tells her he can’t recommend one because he has not studied them in any detail. She says perhaps he should study them, and then write a book. So he does.

At the end of the book, he tells Mrs. Smith what he has learned: that complementary and alternative medicine (CAM) “works” but only as a placebo; it does not affect disease outcomes and can sometimes do harm. He quotes cancer researcher David Grimes:

By clinging to delusion, belief in alternative medicine denigrates the very wonder of science and medicine and the massive strides we as a species have made over the last century or so in understanding the world around us, and how our bodies work.

Rawlins ends the book by telling Mrs. Smith “Conventional practitioners care more than you may think. That is the real secret.”

In between those conversations is a 370-page tour de force that covers the entire history of medicine and CAM, stresses the importance of scientific evidence, reviews how good the brain is at deluding itself, explains the placebo effect and the attractions of CAM, and argues that society should not pay for it. (more…)

Posted in: Book & movie reviews

Leave a Comment (0) →

“Non-pharmacological treatments for pain” ≠ CAM, no matter how much NCCIH wishes it so

NCCIH #TalkPain

I’ve had the Monday spot on this blog for quite a long time now. While there are many advantages to posting on Monday, not the least of which is having more time to put a post together (although that is also a disadvantage because it incentivizes my taking more time than I sometimes should), one distinct disadvantage is that all the Monday holidays are mine. That leaves me a choice on, for example, Memorial Day and Labor Day every year. It’s a choice with three options: The first is: Don’t post. (Do stop laughing, please. I know it’s me.) The second is: Use a guest post. I thought about this, and there are guest posts in the pipeline, but I don’t like to use a guest post just because I’m feeling lazy. It strikes me as an abuse of being the managing editor. Finally, I could post, which is what I decided to do.

I mainly decided to do a post because late last week there was something to blog about that was pretty important and interesting, courtesy of the National Center for Complementary and Integrative Health (NCCIH), which was formerly known as the National Center for Complementary and Alternative Medicine (NCCAM). Basically, on September 1, the NCCIH published a press release, “Review Examines Clinical Trial Evidence on Complementary Approaches for Five Painful Conditions.” Elsewhere, NCCIH Lead Epidemiologist and first author of the review, Richard Nahin, PhD, MPH, bragged on the NCCIH blog, “New Review Offers Providers and Researchers Evidence-Based Information on Complementary Health Approaches for Pain.” It didn’t take long for headlines to start appearing that said things like:
(more…)

Posted in: Acupuncture, Clinical Trials, Medical Academia, Politics and Regulation

Leave a Comment (0) →

Building a Case for CAM

[Editor’s note: Mark Crislip is taking a well deserved vacation from blogging, and James Thomas has kindly agreed to provide another guest post to fill the gaping need left in all of your lives. Enjoy!]

Building a case for complementary and alternative medicine. This shouldn't be hard!

Building a case for complementary and alternative medicine. This shouldn’t be hard!

According to the Orwellian-named National Center for Complementary and Integrative Health, roughly 33% of adults aged 18-44 and about 37% aged 45-64 use some form of CAM. More disturbing is that 12% of children aged 4-17 used some form of CAM in the last 12 months. If there is good news, it is that the NCCIH takes a broad view of “complementary health approaches” including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy healing therapy, special diets (including vegetarian and vegan, macrobiotic, Atkins, Pritikin, and Ornish), folk medicine or traditional healers, guided imagery, homeopathic treatment, hypnosis, naturopathy, non-vitamin, non-mineral dietary supplements, massage, meditation, progressive relaxation, qi gong, tai chi, and yoga. In fact these approaches range from the wacky (energy healing therapy, homeopathy) to the mainstream (massage, yoga) with nothing alternative about them. With more than 60 million Americans using some form of CAM, it is fair to ask if we can build a case for truly integrating CAM into mainstream medical practice.

So who are these people using CAM and just what are they using it for? CAM users can be found in almost every demographic but the largest cohort is white, female, and fairly well educated. A good deal of CAM is used for common and often vague conditions with back pain being the most commonly cited. But it is also used by cancer patients, for cardiovascular disease, and even for Alzheimer’s disease. The problem is that none of the CAM approaches are useful for any of these conditions; strike that, none of the CAM approaches are useful for anything at all much beyond placebo.

I’m going to keep this essay down to a more reasonable length than my earlier offerings (pauses here for the applause to fade) so I’m not going to talk much about most CAM “modalities.” Reiki is deconstructed here and here, or for those who just want a Crislipian good time, here. Homeopathy is eviscerated here. For the deeper dive go here, or for the full monte, here. If after that you still have questions about homeopathy you should probably get a hobby.

But wait, there’s more!

Chiropractic, and acupuncture, and hypnosis, and chelation, and, and…go to the masthead and enter the CAM of your choice in the box with the little magnifying glass. If some charlatan has offered it as a medical treatment, this is your gateway to good information about it. But (and that ‘but’ was your spoiler alert), none of it has much impact on any measurable medical condition. CAM does not shrink tumors, CAM does not dilate bronchi, CAM does not strip pounds of icky toxins out of your colon. Those claims and most others are easily dismissed by anyone with basic reasoning skills and the URL for Pubmed (here it is: http://www.ncbi.nlm.nih.gov/pubmed).

There are however, two arguments in favor of CAM that deserve a bit more careful consideration: electro-acupuncture for pain relief through the mechanism of stimulating endorphin release, and the more general argument that many patients have needs unmet by the medical mainstream, often psycho-social needs that do not have an ICD-10 (a type of diagnostic code) and for which no treatment infrastructure exists within the mainstream health care delivery system. These are the cases I’ll try to build today. (more…)

Posted in: Critical Thinking, Science and Medicine

Leave a Comment (0) →

If You Think Doctors Don’t Do Prevention, Think Again

Prevention has long been a priority of conventional medicine

Prevention has long been a priority of conventional medicine

One of the common criticisms we hear from alternative and integrative medicine proponents is that doctors don’t do anything to prevent illnesses and have no interest in prevention. They claim that doctors are only trained to hand out pills to treat existing illnesses. Sometimes they even accuse them of deliberately covering up cures and wanting to perpetuate illnesses like cancer so they can make more money by treating patients. Nothing could be more absurd. Every reputable doctor would rather prevent illnesses than treat them. In his book Heart 411, cardiologist Steven Nissen even said he would be glad to see his specialty become obsolete: “Don’t worry about us; we will gladly hang up our scalpel and stethoscope if we can find a better way to lead you to a heart-healthy life.”

Doctors own prevention. They invented it, from vaccines to clean water to preventive screening tests. Mainstream medicine was responsible for the greatest preventive achievement in history: the smallpox vaccine campaign succeeded in preventing anyone from ever getting smallpox again. I defy you to comb through historical records and find any doctor who ever said “Let’s stop vaccinating for smallpox so we can make more money treating its victims.”

Prevention is one of the six fundamental principles of naturopathy. Alternative practitioners pride themselves on prevention, but they don’t actually do a very good job of it. In fact, there is evidence that their patients are less likely to get immunizations and some of the standard preventive screening tests recommended by the USPSTF. Instead of rigorously implementing evidence-based preventive strategies, they tend to offer other speculative, untested recommendations.
(more…)

Posted in: Naturopathy, Public Health, Vaccines

Leave a Comment (0) →

“Complementary and Integrative Health” at the VA: Integrating pseudoscience into the care of veterans

BattlefieldAcupuncture

I was originally going to write this post for the 4th of July, given the subject matter. However, as regular readers know, I am not unlike Dug the Dog in the movie Up, with new topics that float past me in my social media and blog reading rounds serving as the squirrel. Then I got a copy of the movie VAXXED to review last week, and before I knew it this post had been delayed two weeks. Never let it be said, though, that I don’t circle back to topics that interest med. (Wait, strike that. Sometimes, that actually does happen. It just didn’t happen this time.) This time around, I will be using documents forwarded to me by a reader as a means of revisiting a discussion that dates back to the early days of this blog, before discussing the broader problem, which is the infiltration of pseudoscientific “complementary and alternative medicine” (CAM) into VA medical centers.

The return of the revenge of “battlefield acupuncture”

Today’s topic is the Veterans Health Administration (VHA) and its embrace of pseudoscience. VA Medical Centers (VAMCs) provide care for over 8 million veterans, ranging from the dwindling number of World War II and Korean War veterans to soldiers coming home now from our wars in Iraq and Afghanistan. Although there have been problems over the years with VAMCs and the quality of care they provide, including a recent scandal over hiding veterans’ inability to get timely doctor’s appointments at VAMCs, a concerted effort to improve that quality of care over the last couple of decades has yielded fruit so that today the quality of care in VA facilities compares favorably to the private sector. Unfortunately, like the private sector, the VA is also embracing alternative medicine in the form of CAM, or, as its proponents like to call it these days, “integrative medicine,” in order to put a happy label on the “integration” of pseudoscience and quackery with conventional medicine.
(more…)

Posted in: Acupuncture, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

Leave a Comment (0) →

About Herbs: an app to avoid

Pictured: A better source of health information than "About Herbs".

Pictured: A better source of health information than “About Herbs”.

Medicine has an intellectual hierarchy. Supposedly the best and the brightest are in the academic medical centers and are the thought leaders in their field.

Those of us lower in the hierarchy are well aware of some of the warts present on our betters, but I would expect those at the top would adhere to the highest intellectual and ethical standards. People being, well, people, expecting exceptional standards is admittedly an unrealistic expectation.

It would appear that many academic centers are doing their best to avoid meeting my expectations, attempting to abandon all standards.

I mentioned over at SfSBM that Dana-Farber is spending 2 million dollars on a renovation to, in part, offer the unmitigated steer manure that is reiki and reflexology to their cancer patients. Yes. Reiki. Reflexology.

Those are not fracking earthquakes in Kentucky, those tremors are the result of the tremendous kinetic energy of Flexner spinning in his grave as his life’s work becomes a farce.

Dana-Farber is just one of many academic medical centers who are putting their imprimatur on nonsense.

Memorial Sloan Kettering Cancer Integrative has released “About Herbs”, an iPad/iPhone guide to Botanicals, Supplements, Complementary Therapies and More. Spoiler alert: the ‘More’ does not include critical thinking. This guide is not anywhere as ludicrous as offering reeky, sorry, reiki, but at times it comes close. (more…)

Posted in: Acupuncture, Commentary, Critical Thinking, Herbs & Supplements, Homeopathy, Traditional Chinese Medicine

Leave a Comment (0) →

Tai Chi versus physical therapy for osteoarthritis of the knee: How CAM “rebranding” works

Tai Chi versus physical therapy for osteoarthritis of the knee: How CAM “rebranding” works

“Complementary and alternative medicine” (CAM), now more frequently referred to as “integrative medicine” by its proponents, consists of a hodge-podge of largely unrelated treatments that range from seemingly reasonable (e.g., diet and exercise) to pure quackery (e.g., acupuncture, reiki and other “energy medicine”) that CAM proponents are trying furiously to “integrate” as coequals into science-based medicine. They do this because they have fallen under the sway of an ideology that posits a false dichotomy: To practice true “holistic” and “preventative” medicine, physicians and other health care professionals must embrace the pre-scientific, pseudoscientific, or anti-scientific ideas about medicine that underlie much of the “alternative medicine” being “integrated.”

Unfortunately, they’ve been largely successful over the last 25 years or so. From my perspective, the strategy that has been the most effective in mainstreaming quack practices as part of “integrative medicine” has been what I like to call the “rebranding” of practices that could and should be part of standard, science-based medicine. I’m referring, of course, to nutrition and dietary interventions, as well as lifestyle interventions, specifically exercise. To the extent that standard medicine might have undervalued such interventions over the past few decades, we practitioners of science-based medicine might be said, to some extent at least, to have brought this on ourselves. On the other hand, it is not as though doctors haven’t been advising our patients to quit smoking and moderate their drinking and to lose weight through altering their diet and exercising more for many decades. We do this because we know it works. For instance, when some naturopathic quack touts “curing” type II diabetes with a vegan diet plus exercise, we know that can work because we know that losing weight can normalize blood sugar values in many cases of type II diabetes. Heck, the Endocrine Society itself even says so, declaring “lifestyle optimization” as “essential for all patients with diabetes” and recommending that all patients with type II diabetes “strive to attain and maintain an optimal weight through a primarily plant-based diet high in polyunsaturated and monounsaturated fatty acids, with limited intake of saturated fatty acids and avoidance of trans fats,” that they lose weight through physical activity, and get enough rest. A vegan diet just takes that dietary advice to an unnecessary extreme, and any supplements recommended are almost always unnecessary.
(more…)

Posted in: Clinical Trials, Traditional Chinese Medicine

Leave a Comment (0) →

CAM use and chemotherapy: A negative correlation

It turns out that the use of certain forms of CAM makes it less likely that breast cancer patients will receive the chemotherapy they need.

It turns out that the use of certain forms of CAM makes it less likely that breast cancer patients will receive the chemotherapy they need.

So-called “alternative” medicine is made up of a hodge-podge of health care practices and treatments based on beliefs that are unscientific, pre-scientific, and pseudoscientific. These modalities include practices as diverse as homeopathy, traditional Chinese medicine, reflexology, reiki and other forms of “energy medicine” based on vitalism, chiropractic, and naturopathy, and that’s a short list of the quackery that falls under the rubric of the term “alternative medicine.” Unfortunately, this unscientific, pre-scientific, and pseudoscientific hodge-podge of treatments rooted in nonsense is rapidly being “integrated” into real medicine, thanks to an unfortunately influential movement in medicine whose members have been seduced into thinking that there might be something to them and view “integrating” them into medicine as means of practicing more “holistic” and “humanistic” medicine. This “integration” started out by being called “complementary and alternative medicine” (CAM) but now among believers the preferred term is usually “integrative medicine,” largely because it eliminates the word “alternative,” which implies (correctly) that the modality is not real medicine, and “complementary,” which implies a subsidiary status, a status of being nice to have but not essential.

Particularly harmful is the hostility towards conventional medicine that often strongly correlates with use of alternative medicine. Indeed, some people even choose to rely on alternative medicine instead of real medicine to treat cancer. Unsurprisingly, the results of such a decision are generally not very good. Actually, they are almost always terrible. Very, very terrible indeed. Not surprisingly, the use of alternative medicine is associated with bad outcomes. Cancer patients who might have survived die because of it. It’s not as though it hasn’t been studied either, although the main studies I’m aware of tend to look at the bad outcomes in patients who choose alternative medicine. There is another question, and it’s one that a new study published in JAMA Oncology last week seeks to answer. It’s a study that briefly made the news, producing headlines like:
(more…)

Posted in: Cancer, Herbs & Supplements

Leave a Comment (0) →

A Harris Poll on “Alternative Medicine”

One can only imagine how annoyed Twain would have been had he known about opinion polls.

One can only imagine how annoyed Twain would have been had he known about opinion polls.

Mark Twain popularized the phrase, “There are three kinds of lies: lies, damned lies, and polls and surveys.” (He may have said “statistics” at the end, but I think this version works as well.)

A new Harris Poll on “alternative medicine” nicely demonstrates some of the problems with polls. The biggest problem is how you frame the questions. You can dramatically affect the results of the poll by exactly how a question is phrased, which other questions come before or after the question, and the overall context of the poll.

In essence a poll is a two-way form of communication. While it is meant to derive information from the subjects of the poll, those subjects are also receiving information from the poll itself. That is the very reason for “push polling” – which is the practice of disguising campaigning messages as a poll. (“On a scale from 1-5, how much are you bothered by the fact that candidate X is a misogynist?”). Yes, Prime Minister has an amusing example of this practice in action.

Interpreting the results of a poll is also not straightforward. You have to know how the subjects of the poll interpreted the questions, and what factors might affect their response. (more…)

Posted in: Commentary

Leave a Comment (0) →
Page 1 of 9 12345...»