Posts Tagged integrative medicine

On “integrative medicine” and walking and chewing gum at the same time

Walk and chew gum at the same time

I didn’t think I’d be discussing Dr. David Katz again so soon. In fact, when Mark Crislip (who clearly hates me, given how often he sends me links to articles like this) sent me a link to Dr. Katz’s latest article, “Cleaning the House of Medicine“, published—where else?—in The Huffington Post, that home for “reputable” quack-friendly bloviation since 2005, when I first read the article, my first reaction was that Katz must surely be trolling us here at SBM. At first, I wasn’t going to respond to him again. However, Katz’s article represents a very common misconception about science-based medicine that is worth refuting. It is not my intention to be arguing back and forth with Dr. Katz every couple of weeks, but I did think it worth one more round. I think you’ll understand why by the end of this post.

First, however, a brief recap is in order for readers who might not have been following the discussion over the last month or so. It all started a couple of weeks ago, when Jann Bellamy, in response to a special issue of the American Journal of Preventative Medicine edited by Katz and dedicated to making the case for integrative medicine in preventive medicine training, quite correctly discussed how “integrative medicine” is always all about the “potential.” Indeed, after having spent considerable sums of federal grant money studying the “integration” of pseudoscience into medicine with respect to preventive care, the journal couldn’t come up with any concrete examples how integrative medicine adds anything (other than quackery) to medicine. Dr. Katz, who is well-known in the world of quackademic medicine for his infamous 2008 speech in which he asserted that physicians need to use a “more fluid concept of evidence” in evaluating treatments, particularly “complementary and alternative medicine” (CAM), responded with another HuffPo article entitled “Science and Medicine, Fools and Fanatics: The ‘Fluidity’ of Woo“. In lieu of reasonable, science-based arguments, Dr. Katz’ article was little more than a rant that consisted mainly of outrage that mere mortals lacking his awesome academic credentials had had the temerity to question his awesomeness and dedication to science coupled with an accusation that we are just too rigid and simplistic in our thinking to understand the subtle complexities of how different standards of evidence must be applied to complex patients. Steve Novella and I both responded that we understand just fine, explained how doctors do this all the time without using quackery like naturopathy and homeopathy (both of which Katz has advocated), and pointed out his argumentum ad ignorantiam with respect to energy medicine.

There’s where I thought it would end. Unfortunately, I was mistaken. On Friday, Katz launched another broadside at us, couched in the form of an argument that medicine must “clean its own house” before worrying about his quackademic medicine. It’s something I hear often enough that I thought it would be worth responding to, even if Dr. Katz was indeed trolling us.

Posted in: Critical Thinking, Medical Academia, Science and Medicine, Surgical Procedures

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To debate or not to debate: The strange bedfellows of Andrew Weil

Andrew Weil

To debate or not to debate, that is the question.
Whether it is nobler in the mind to suffer
The slings and arrows of outrageous quackery
Or to take arms against a sea of quackademia,
And, by opposing end them.

Hamlet, Act III, Scene 1, paraphrased badly.


The question of whether it is worthwhile to debate cranks, quacks, and advocates of pseudoscience has long been a contentious issue in the skeptic community. Those of you who’ve been reading my posts for a while know that I’ve always come down on the side that it is not a good idea One thing I’ve learned in my more than a decade of blogging, both here and at my not-so-super-secret other blog, is that advocates of pseudoscience love public debates. Indeed, whenever you see a skeptic agree to a public debate with an advocate of pseudoscience, it’s a damned sure bet that it wasn’t the skeptic who proposed it. I suppose it’s possible that there have been such instances that I’m unaware of, but I do know of a lot of instances where it was the other way around. I’ve even witnessed one myself, when our fearless founder Steve Novella debated antivaccine quack Julian Whitaker about vaccine safety at FreedomFest in Las Vegas while we were at TAM three years ago. Steve mopped the floor with Dr. Whitaker so dramatically that it almost changed my mind about the value of debates with quacks because, witnessing the debate, I saw that the arguments Dr. Whitaker marshaled were such hackneyed antivaccine talking points that I knew I could also have demolished them. Still, in the end, no minds were likely to be changed, and the question of vaccine safety was clearly being used as a tool to oppose school vaccine mandates or, as antivaccinationists like to call them deceptively, “forced vaccination.” Whether vaccines are safe and effective or not is a separate question from whether the government should mandate certain vaccines as a precondition for attending school or being in day care.

Over the years, I myself have been “challenged” to similar debates myself. Perhaps the most bizarre example occurred when someone claiming to represent HIV/AIDS denialist Christine Maggiore contacted me claiming that she wanted to arrange a debate between us. Maggiore, unfortunately, died a mere two years later of—you guessed it—AIDS-related complications. Although occasionally the ego gratification of being asked to participate in such events vied with my longstanding belief that debating cranks doesn’t sway anyone, sharing the stage with a real scientist does unduly elevate the crank in the eyes of the public. Besides, whatever the seeming outcome of the debate, you can count on the crank to declare victory and his believers to agree. In any event, science isn’t decided by the metrics used to judge who “wins” a public debate, which rely more on rhetoric and cleverness rather than science to decide the outcome. Finally, such debates are not without risks. Although Julian Whitaker, for example, was terrible at it, other cranks are adept at the Gish Gallop, and an unprepared skeptic or scientist can be made to appear clueless in front of a crowd that is almost always packed with supporters of the crank, not the skeptic.

Just last week, there was another “debate” challenge that led me to question my resolve not to debate cranks. It came from a most unexpected source.

Posted in: Medical Academia, Medical Ethics, Science and the Media

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The elusive “potential” of integrative medicine

The Integrative Medicine Wheel

The Integrative Medicine Wheel


UPDATE: Dr. Katz has responded to this post in his usual venue, The Huffington Post.

Alternative medicine was all about “potential” from the get go:

In 1991, the Senate Appropriations Committee responsible for funding the National Institutes of Health (NIH) declared itself “not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices.”

Thus, the Committee, led by chair Sen. Tom Harkin, directed the NIH to create an advisory panel that would “fully test the most promising unconventional medical practices.”

The advisory panel became the Office of Alternative Medicine, which became the National Center for Complementary and Alternative Medicine, which became the National Center for Complementary and Integrative Medicine, its current iteration.

This effort to unlock the “potential” of unconventional (renamed alternative, renamed complementary and alternative, renamed integrative) medicine forced an uncomfortable alliance between science and pseudoscience from the beginning. Advocates like Harkin, and his two quackery-promoting constituents, Berkeley Bedell (colostrum and something called “714-X,” derived from camphor) and Frank Wiewel (immuno-augmenative therapy for cancer), were all for “fully testing” until they realized what “fully testing” meant to a scientist: double-blind, placebo controlled trials. It was thus that the true believers discovered the value of special pleading: they “favored quick field studies that would validate alternative treatments.”

Taxpayer monies flowed into legitimate medical and scientific research institutions to conduct alternative medicine research: the Maryland School of Medicine, Harvard Medical School, University of California at Davis, and the Texas Health Science Center, among others, received funds for the study of antineoplastons, cartilage products, magnets, mind-body control, and even Bedell and Wiewel’s beloved “714-X” and immuno-augmentative therapy. (more…)

Posted in: Clinical Trials, Medical Academia, Public Health

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Here be Dragons: Caring for Children in a Dangerous Sea of sCAM

Here be dragons large map

As a pediatrician working in a relatively sCAM-inclined region, it is not uncommon to find myself taking care of patients who are also being followed by so-called alternative medicine practitioners. This often creates a major obstacle to providing appropriate care and establishing an atmosphere of mutual trust in the provider-patient/parent relationship. It usually makes me feel like I’m battling invisible serpents in a sea of sCAM.

While these double-dipping parents utilize a variety of sCAM providers, including naturopaths, homeopaths, chiropractors, and a smattering of “holistic healers”, most are taking their children to one of a few “wellness” centers near my practice where they are seen by actual medical doctors practicing so-called “integrative medicine”. Many of these children have vague, chronic, usually non-specific complaints that are difficult to explain and thus to treat. Some have behavioral and mental health problems, or neurodevelopmental conditions such as autism for which parents are seeking explanations and treatments.

What I find to be a common theme with these patients is that they and their parents are summarily taken advantage of by their alternative care providers when they are given a fictitious diagnosis and treated with a variety of useless potions, elixers, and false hopes. Often, parents bring their children to these providers because they are frustrated by their child’s chronic complaints of fatigue, pain, or other somatic issues that have eluded a satisfactory diagnosis or treatment. Invariably, the diagnosis that has remained so elusive to me is quickly found and treated by these much more “holistic” and open-minded providers. In fact, I have never seen a consultation note from one of these providers indicating any uncertainty as to diagnosis or treatment regimen. Typically a large battery of expensive, inappropriate, and sometimes outright fraudulent lab tests is ordered, often from equally questionable laboratories. Again, there are invariably interesting findings prompting tailored and bizarre treatments. In typical red-flag sCAM fashion, some of these providers have their own supplement store, available online only to their patients, prominently displayed on their website. These providers are perceived as being more holistically informed about health and wellness then “conventional” doctors like myself, as if there are two distinct ways of treating illness and maintaining health…as if there is truly such a thing as alternative medicine.

It can be very difficult to manage patients who are being simultaneously “treated” by such providers. Sometimes the treatments complicate or confuse the picture, but it always indicates a failure of trust in the “conventional” method of practice, which is science and evidence based, and in science itself.

Below are a few examples of patients cared for by my practice and simultaneously followed by alternative medicine practitioners. They provide a good picture of just how problematic these co-practitioners can be. No names or identifying information are revealed. (more…)

Posted in: Diagnostic tests & procedures, Herbs & Supplements, Naturopathy, Pharmaceuticals, Science and Medicine

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Bastions of quackademic medicine: Georgetown University

The cover of Georgetown Medicine Spring/Summer 2015 issue. This image will drive Mark Crislip crazy, as it features yet another acupuncturist not using gloves while sticking needles into people. Dr. Gorski loves watching Dr. Crislip's reactions to such photos.

The cover of Georgetown Medicine Spring/Summer 2015 issue. This image will drive Mark Crislip crazy, as it features yet another acupuncturist not using gloves while sticking needles into people. Dr. Gorski loves watching Dr. Crislip’s reactions to such photos.

We frequently discuss a disturbing phenomenon known as quackademic medicine. Basically, quackademic medicine is a phenomenon that has taken hold over the last two decades in medical academia in which once ostensibly science-based medical schools and academic medical centers embrace quackery. This embrace was once called “complementary and alternative medicine” (CAM) but among quackademics the preferred term is now “integrative medicine.” Of course, when looked at objectively, integrative medicine is far more a brand than a specialty. Specifically, it’s a combination of rebranding some science-based modalities, such as nutrition and exercise, as somehow being “alternative” or “integrative” with the integration of outright quackery, such as reiki and “energy healing,” acupuncture, and naturopathy, into conventional medicine. As my good bud and fellow Science-Based Medicine (SBM) blogger Mark Crislip put it, mixing cow pie with apple pie does not make the cow pie better, but we seem to be “integrating” the cow pie of quackery with the apple pie of science-based medicine thinking that somehow it will improve the smell, taste, and texture of the cow pie.

I remember how, when I first discovered how prevalent outright pseudoscience and quackery had become in medical academia (which was before I became one of the founding SBM bloggers), I was in denial. I couldn’t believe it. Then I tracked this phenomenon with something I called the Academic Woo Aggregator. It turned out to be a hopeless endeavor because, as I soon discovered, the phenomenon was so pervasive that it was really hard to keep the Aggregator up to date. Since then, I’ve generally only focused on particularly egregious examples, naming names when institutions like my alma mater embrace anthroposophic medicine; “respectable” journals publish “integrative medicine” guidelines for breast cancer patients; cancer organizations include “integrative oncology” in their professional meetings; NCI-designated comprehensive cancer centers promote reiki to pediatric cancer patients or offer high dose unproven vitamin C treatment to patients; or respected academic institutions embrace traditional Chinese medicine (TCM) and the quackery that is function medicine. You get the idea. It’s depressing just how far medical academia has fallen in terms of being “open-minded” to the point of brains falling out when it comes to medical pseudoscience.

Posted in: Acupuncture, Basic Science, Energy Medicine, Homeopathy, Medical Academia

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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.


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

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A journey to alternative and integrative medicine apostasy

Julian the Apostate presiding at a conference of sectarians, by Edward Armitage, 1875

Julian the Apostate presiding at a conference of sectarians, by Edward Armitage, 1875

I’ve been blogging for over a decade now, a fact that I find really hard to believe looking back on it right now. I’ve told the story before, but it’s worth briefly recounting again because doing so will explain why the story I’m about to discuss caught my attention. My “gateway drug,” if you will, into skepticism was discovering Holocaust denial in the late 1990s on Usenet, a vast and sprawling conglomeration of thousands of discussion forums that began to fade away at the turn of the century with the rise of web-based forums and Google providing an interface to it to make it Google Groups. The forum where I first discovered Holocaust denial and learned to combat it, alt.revisionism, still exists, but long ago degenerated into a cesspool of racism, spam, and trolling. A couple of years later, around 2000 or so, I discovered quackery and the antivaccine movement, thanks to a Usenet newsgroup known as, which is where I honed my early skills applying science to medical claims. It’s also where I first encountered Peter Moran, a regular commenter here who greatly inspired me back then with his full-throated criticism of cancer quackery and his website that taught me reasons why cancer quackery could appear to work even when it did nothing to impact the progression of the cancer.

In December 2004, intrigued by all the news stories about blogging and having discovered a number of good blogs, I decided on one dark, gray Saturday afternoon to dip my toe in the blogosphere. On the spur of the moment I created the first iteration of my not-so-super-secret other blog on—what else?—Blogger. Much to my own amazement, over the course of a year I got my little hobby noticed, to the point where I was invited to join a blog collective; by late 2007 I had become prominent enough to be invited by Steve Novella to join this very blog at its founding, where I have remained for seven years, with no plans to move on any time soon. During my early days, though, there was one person who also inspired me, helping me to learn about the pseudoscience that undergirds the antivaccine movement and, in particular, the quackery making up what is known these days as the “autism biomed” movement. His name is James Laidler, and he was one of the ones who introduced me to this topic which I’ve written about many times both at my not-so-super-secret other blog and, of course, right here on SBM. In doing so, over the years I’ve catalogued why “autism biomed” seems compelling to many parents with children with autism, how antivaccine groups use fake “medical conferences” to sell autism biomed by giving a patina of medical respectability to rank quackery like bleach enemas, and providing a place where those selling unscientific treatments can find willing customers and where disreputable discredited “scientists” like Andrew Wakefield and Mark Geier can find adoring fans who believe their quackery.

I bring this up because last week WIRED published an excellent article about Jim Laidler, “An Alternative-Medicine Believer’s Journey Back to Science.” Appropriately enough, it’s by Alan Levinovitz, an assistant professor of religion at James Madison University. I say “appropriately enough” because, as has been noted here on a number of occasions, there are many religion-like aspects to alternative medicine in general but to the autism biomed movement in particular. Indeed, the two are often tied together, with the motivation for some alt-med being explicitly religious and belief in alt-med sharing some major characteristics with religion, particularly belief in miracles against evidence, charismatic leaders (like Andrew Wakefield) who can do no wrong, and mutually-supportive communities of believers who reinforce each others’ beliefs and ward off skepticism. Add to that the magical thinking, and it’s not for nothing that I’ve referred to the central dogma of alternative medicine as being that wishing makes it so. Indeed, it’s for good reason that I frequently point out that most “energy medicine” (particularly reiki) is basically faith healing that substitutes Eastern mysticism for Judeo-Christian religious beliefs.

In Levinovitz’s profile of Jim Laidler, we see a lot of this, and I learned some details that I didn’t know about Laidler before. Levinovitz also grasps the religion-like nature of alt-med by starting the article bluntly saying:

Jim and Louise Laidler lost their faith on a trip to Disneyland in 2002, while having breakfast in Goofy’s Kitchen.


Posted in: Health Fraud, Neuroscience/Mental Health, Vaccines

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The false dichotomies of CAM and “integrative medicine”


A lot of medical specialties have throwaway newspapers/magazines that are supported by advertising and somehow mysteriously managed to show up for free in the mailboxes of practitioners. In my case, I’ve found myself on the subscription list for such papers about oncology, but also general surgery (I’m Board-certified as a general surgeon). When I have to recertify in about three years, it will be as a general surgeon, which was really fun to try to do last time after having specialized as a breast cancer surgeon, and will likely be even more fun next time, when I will be 10 years further out from my general surgery and surgical oncology training. In any case, that must be why, no matter where I end up working, sooner or later I end up receiving General Surgery News (GSN).

As throwaway professional newspapers go, GSN is not bad. However, occasionally it publishes op-ed articles that make me scratch my head or even tick me off with their obtuseness. Lately, apparently, it’s started some blogs. The one in particular that is the center of attention for this post is by Victoria Stern, is called “The Scope” and is billed as “exploring the lesser known sides of surgery.” Of course, it’s a bit odd that some of the first posts on this blog are about work hour restrictions and whether they leave new surgeons unprepared to practice surgery, the debate over breast screening, and what it takes to train expert surgeons, none of which are exactly “lesser known sides of surgery.” Work hour restrictions, in particular, have been discussed in surgery journals, at conferences, and among surgeons ad nauseam, particularly whether we are training a generation of surgeons unable to deal with the rigors of practicing surgery in the real world.

Posted in: Critical Thinking, Medical Ethics

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What’s in a name?: NCCAM tries to polish a turd


What’s in a name? that which we call a rose
By any other name would smell as sweet;
So Romeo would, were he not Romeo call’d,
Retain that dear perfection which he owes
Without that title. Romeo, doff thy name,
And for that name which is no part of thee
Take all myself.

William Shakespeare, Romeo and Juliet, Act II, Scene 2

You can clean up a pig, put a ribbon on its tail, spray it with perfume, but it is still a pig.

You can paint a turd red, but it’s still a turd.

There’s a colloquial phrase commonly used to describe an effort to sell or promote something that is so inherently awful or at least so flawed as to be unsalvageable without either a radical rethinking or such a major overhaul that it would be impractical or impossible to do: Polishing a turd. In this, advocates of so-called “complementary and alternative medicine” (CAM) have been very successful. Mark Crislip, in his usual inimitable fashion, just reminded us why CAM is a turd that needs polishing. Unfortunately, on Friday, I learned that the National Center for Complementary and Alternative Medicine unveiled a proposal to help it be more efficient in polishing the turd that is CAM through the clever use of language, and it wants your feedback. There were lots of other things that happened over the last few days that tempted me to write about them that will likely have to appear over at my not-so-secret other blog, but this one caught my attention and held it, given that it goes to the very heart of the deceptive use of language that is at the heart of giving CAM the appearance of legitimacy. In this specific case, NCCAM wants a new name. Dr. Briggs wants to rename NCCAM the National Center for Research on Complementary and Integrative Health (NCRCI). (I have no idea why the abbreviation of the proposed new center name isn’t NCRCIH.) Here’s Dr. Briggs explaining the rationale for the proposal and urging feedback by June 6 at I urge you to watch the whole video, or at least read the transcript:

Thus does Dr. Briggs propose polishing the turd that is NCCAM.

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

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Has science-based medicine already lost to pseudoscience?

After writing Saturday’s 5,000-word magnum opus about misguided “right to try” bills that are proliferating in state legislatures like so much kudzu, I thought I’d try something a bit different—and more concise. Fear not. This doesn’t mean that I’m going to become Harriet Hall as a writer, because no one does concise and insightful as well as she does, but I do on occasion want to try my hand being less logorrheic. I’ll probably fail, but at least I can pat myself on the back for trying. If I succeed, though, it’ll only make me better. I hope. I also realize that I just made it harder by blathering on for a whole paragraph before getting to the point, a habit of mine that infuriates some readers and amuses others who find my way of winding towards the point at least somewhat entertaining.

Thus endeth the nauseatingly—but briefer than usual!—self-deprecating navel gazing and beginneth the post.

The opportunity appeared to me in the form of an article that popped up in my feed on Medscape entitled, Do Clinicians Base CAM Recommendations to Patients on Evidence of Efficacy? Since “complementary and alternative medicine” (CAM) is, by and large, mostly made up of a collection of modalities either based on prescientific thinking and possessing little, if any, plausibility on a scientific basis, my first reaction was to note that health care practitioners do recommend CAM to some patients, meaning that the answer must be, “No,” and then to move on. However, I wanted to see what Dr. Désirée A. Lie, the author, said and to see what the reasons are for whatever answer she came up with. So I read on.

The article starts with a case study:

Posted in: Science and the Media

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