Complementary and alternative medicine Quackery Skepticism/critical thinking

Gotta have more woo in my medical school!

Another one has fallen.

Yes, another prestigious medical school has given in. First I lamented the decline in basic science education in medical schools. Then, I lamented even more the infiltration of woo into the curricula of far too many medical schools, spurred on by patient demand, a desire for a nice, high profit cash-on-the-barrelhead set of treatments, and, most depressing of all, the misguided and highly credulous advocacy of the American Medical Student Association (AMSA). Worse, my own alma mater, the University of Michigan, has infiltrated serious woo into its curriculum. But at least U. of M. still leaves its woo as fourth year electives. Not so Georgetown, where woo is being fully integrated into the mandatory curriculum with a disturbing enthusiasm. Not surprisingly much of this infiltration is being funded by the National Center for Complementary and Alternative Medicine (NCCAM).

And Dr. RW informs me that now we have UCSF joining the pack.

Of course, UCSF puts a disclaimer in The UCSF Guide to Integrative Medicine stating:

Inclusion of a therapy, resource, or practitioner in this guide does not imply endorsement by UCSF, the Integrative Medicine Network, or the Osher Center for Integrative Medicine.

Too bad this disclaimer and the frequent mention that there is no good randomized clinical trial data demonstrating the efficacy of most of these treatments is belied by the utterly credulous description of various alt-med modalities found in many of the chapters. For example, check out this description of acupuncture:

Acupuncture relies on the idea of Qi, the energy force that run in regular patterns called meridians through the body. A person’s health is influenced by the flow of Qi in the body, in combination with the universal forces of Yin and Yang. If the flow of Qi is insufficient, unbalanced or interrupted, Yin and Yang become unbalanced, and illness may occur. By inserting fine needles on the body’s surfaces at specific points to connect the meridians, acupuncture is used to regulate or correct the flow of Qi to restore health.

At the initial visit, the practitioner evaluates the patient’s current problems, medical history, available laboratory values and radiological tests, as well as a traditional physical exam of the tongue, reflex points, radial pulse, and external ear. The goal of the evaluation is to link the patient’s problems to a specific imbalance or block of Qi

Note how the description of qi is described as fact, not as an explanation that has no scientific basis for whatever effects (if any) acupuncture has on pain or disease in humans. Even in the section on scientific studies, there is no mention that qi has never been measured or detected, despite many attempts. But the description of acupuncture isn’t that bad compared to some others. At least acupuncture has a potential physiologic mechanism for doing something. (What, I’m not sure.) Not so, homeopathy, but that doesn’t stop the fine folks at UCSF from serving up another heapin’ helpin’ of credulity:

Dr. Hahnemann first formulated his principle of the Law of Similars after testing quinine, a cure for malaria. He found that it produced the symptoms of malaria in a healthy individual. However, when he discontinued the quinine, the symptoms disappeared. After several similar studies, Hahnemann found that very small doses of the substance are nontoxic and yet still work to produce the desired symptoms of the illness in healthy individuals. Homeopathic remedies are therefore diluted to different degrees so that only traces of the original substance are present. Often chemical testing will show no presence of the active ingredient. This, however, is completely consistent with homeopathic philosophy as they believe that the ingredient leaves an imprint on the remedy and it is this ghost print which then acts within the body.

In the discussion of research into homeopathy (now there’s an oxymoron!), not a word is mentioned that homeopathy is chemically and pharmacologically impossible, something that was appreciated by most scientists as far back as the 1840’s.

Worse still are the testimonials, just as good as that of any altie website. Here’s one from a patient:

“By the third day I felt so much better physically I was able for the first time to walk down the stairs, then up the stairs, then I was able to cut my pain medication in half.” –Fibromyalgia patient after having received two months of Ayurvedic cleansing treatment, massage, diet and nutrition consultation and herbal treatments.

Here’s one from a Reiki practitioner:

“I am a Second Degree Reiki Practitioner of the Mikao Usui Tradition. In the 10 years of my Reiki practice I have seen healing transformations in all my clients, on all levels (mental, emotional, spiritual, and physical). One patient that stands out most is a nurse for the U.S. Embassy that had been suffering from Shingles for nearly three years. After several hospitalizations and medical evacuations for treatment, she called me for an appointment. She was on daily doses of morphine painkillers, was exhausted and in pain all the time and had gained a lot of weight. We began weekly Reiki treatments that lasted for about six months. During the six months, she first began sleeping well, feeling more energetic, reducing her morphine and ultimately eliminating all pain medicine, and arriving at full energy balance and recovery.” — Lauretta Agolli, Reiki Practitioner

This, of course, follows a credulous description of what Reiki is, although at least the manual does mention that “Reiki is not recommended as the sole treatment for potentially serious medical conditions, and its use should not delay the time it takes to consult with a health care provider or receive established

Well, that’s a relief after that lovely testimonial and the glowing description of Reiki that preceded this disclaimer.

Of course, no bit of woo would be complete without a bona fide endorsement form a Nobel Laureate. After all, Vitamin C quackery had Linus Pauling, and arginine has Dr. Louis J. Ignarro. And the Alexander Technique, a technique that seems to be ergonomics for which amazingly overblown claims of benefit are made, has this:

“I recommend the Alexander Technique as an extremely sophisticated form of rehabilitation… From personal experience we can already confirm some of the seemingly fantastic claims made by Alexander and his followers– namely, that many types of under-performance and even ailments, both mental and physical, can be alleviated, sometimes to a surprising degree, by teaching the body musculature to function differently. We already notice, with growing amazement, very striking improvements in such diverse things as high blood pressure, breathing, depth of sleep, overall cheerfulness and mental alertness, resilience against outside pressures and in such a refined skill as playing a musical instrument.” — Professor N. Tinbergen, 1907-1988, Nobel Prize for Medicine, 1973

Given that Professor Tinberg also seems to have embraced the now discredited “refrigerator mother” concept of autism, perhaps he isn’t such a great spokesperson for topics outside his area of expertise. (What won him the Nobel Prize was ethology.) Indeed, Prometheus had an amusing take on Dr. Tinbergen’s judgment when it came to embracing dubious hypotheses outside of his field:

In his Nobel lecture, Tinbergen – freshly hung with his Nobel wreath – ventured to explain autism as a response to environmental stress, ala Kanner and Bettleheim.

In doing so, he not only hopped on the “Refrigerator Mother” hypothesis of autism as it was sinking, but he also managed to set a nearly unbeatable record for shortest time between receiving the Nobel Prize and saying something really stupid about a field in which the recipient had little experience. Tinbergen thought that his experience – and it was vast experience – in animal behavior gave him special insight into autism. It might have, but it didn’t.

I could go on, but what’s the point. The UCSF manual has credulous and, in some cases, promotional treatments of a wide variety of woo, including reflexology, Reiki, naturopathy, fasting, spiritual healing, and others, mixed in with the occasional less woo-filled modality, like biofeedback. But what disturbed me even more was some of the descriptions of treatments for specific diseases, for example cancer (of course). Take a look at this schizophrenic passage:

Alternative therapies may be dangerous because they are often unproven and administered in lieu of traditional treatment such as chemotherapy or radiation. Using alternative therapies instead of conventional treatment for highly curable, early-stage cancers is not recommended.

CAM therapies are also considered useful approaches to recurrence, metastatic cancers, and secondary cancers.

In actuality, as far as the cancer goes, alternative therapies are no more useful for curing recurrent or metastatic cancers than for curing early stage curable cancers.

Worse, there are yet more credulous descriptions of all manner of cancer woo, including megavitamins, “colon detoxification’ with coffee enemas (as in the Gerson/Kelley/Gonzalez protocol), antineoplastons, The same is found for all the other diseases discussed individually, all with liberal comparisons between the woo and the dreaded “allopathic” medicine.. Indeed, the only altie woo that, to its credit, the UCSF manual does not mention is chelation therapy. All of this is topped off with an interview with two doctors, Silver Quevedo, MD and Daphne Miller, MD, both of whom give advice on how to integrate woo into conventional medical practices. I think that the best advice came from Dr. Quevedo:

We did not have a very happy experience in San Jose with insurance companies. We actually began to opt-out of managed care and give patients a statement, a super bill with diagnostic codes that they submit as a claim form to their insurance companies, and they pay us directly. So we’ve sort of taken the insurance companies out of the middle, and interestingly the patients seem to be getting paid better by the insurance companies than we were. Basically, the patients have to go out of network if they’re going to see us. Now the ones that have been doing it, they’ve been happy to do it.

And, I’m sure, the doctors integrating such woo into their practices are even more happy to take the money.

Sadly, the infiltration of such non-evidence-based modalities into the medical school curricula of so many universities continues apace. There’s also an enthusiastic subset of medical students who are more than eager to lap it up. Indeed, check out AMSA’s first ICAM newsletter (embarrassingly for me, edited by a University of Michigan medical student), which shows that these students won’t just lap this stuff up, but will actively promote it.

You know, between “intelligent design” advocates like Drs. Cook and Egnor (both of whom teach medical students) and the increasingly uncritical promotion of non-evidence-based “alternative” medicine, I fear for critical thinking skills among my colleagues.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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