Clinical trials Complementary and alternative medicine Medicine Pseudoscience Quackery Science Skepticism/critical thinking

Woo infiltrates the very heart of scientific medicine in the U.S.

I’ve complained on multiple occasions about the infiltration of non-evidence-based “medicine” (a.k.a. woo) into every level of medicine in the U.S.. Worst of all, it’s infiltrating medical education in a big way, starting with the pro-woo activism of the American Medical Student Association (AMSA), to various educational programs in various medical schools, to even the mandatory medical curriculum in at least one prestigious medical school. This is more than just teaching what various “alternative medical” therapies are, so that new physicians know what their patients are referring to or about various potential interactions between herbs and pharmaceutical medications, something that I wouldn’t have any objections to. However, it goes far beyond that, to encompass uncritical teaching of woo as though it had a scientific basis.

Of course, it doesn’t help that there’s now a $120+ million/year bureaucracy ensconced in the very heart of the bastion of scientific medicine, the NIH. This is, of course the National Center for Alternative and Complementary Medicine, whose support for the study of utter woo I have bemoaned. After hundreds of millions of dollars over a decade and a half of its existence, NCCAM has been utterly unable to demonstrate the efficacy or lack of efficacy of a single “alternative” therapy. Despite that, I had always thought that there remained one beacon of scientific medicine, one place where woo did not hold sway, and that place is the NIH Clinical Center, the hospital on the NIH campus where many cutting edge experimental therapies are first tried in patients.

Dr. R. W. has shown me that I was wrong. Woo has now widely infiltrated the NIH Clinical Center:

The National Center for Complementary and Alternative Medicine (NCCAM) has established an Integrative Medicine Consult Service at the National Institutes of Health (NIH) Clinical Center, the world’s largest hospital devoted to research. This service will provide physicians, nurses, and other members of the Clinical Center health care team the ability to discuss complementary and alternative medicine (CAM) therapies with knowledgeable medical staff from the consult service and learn how various CAM practices might complement or interact with a patient’s care as a research participant at the Clinical Center.

Lovely. After the usual boilerplate about how supposedly more than one-third of American adults use some form of CAM, the press release tries to justify this decision:

Since patients at the Clinical Center are participating in research studies, it is important to know what CAM therapies are being used and how they might affect the treatments being studied.

“Volunteers who participate in clinical research at the NIH Clinical Center are partners in medical discovery. We are committed to providing excellent care for them,” said John I. Gallin, M.D., Director of the Clinical Center. “This new consult service will help enhance the care they receive and the research conducted here.”

While I agree that it is absolutely essential to know what CAM treatments are being used by patients participating in clinical trials, I don’t see how it follows from that that providing woo to them at the clinical center as a consult service will improve their care. I suppose if all such a service did was to advise researchers and physicians on CAM treatments that patients may already be taking, it might be reasonable, but no consult service could ever limit itself to that. The very purpose of a consult service is to recommend treatments to the primary physicians. Worse, this new service is not a new phenomenon. Apparently woo has been entrenched in parts of the Clinical Center for a while now:

CAM is not a new concept at the NIH Clinical Center. The Clinical Center’s Pain and Palliative Care Service and the Rehabilitation Medicine Department offer acupuncture, Reiki, hypnosis, guided imagery, massage therapy, acupuncture, tai chi, and qi gong training. The Pharmacy Department consults on herbals and herb/drug interactions and has conducted research in these areas. The Integrative Medicine Consult Service will coordinate the resources of these existing services to meet the needs of the Clinical Center staff and its patients. In addition to offering clinical consultation regarding CAM therapies, the service will establish a research program embedded in NIH”s clinical and translational research structure and provide CAM education for NIH staff, patients, and their families.

Reiki? Qi gong? I had no idea that life energy woo is being offered to patients as if it had a basis in science in the hospital that is at the very heart of scientific medicine in the U.S. Truly, evidence-based medicine is doomed. Consider the background of the new director of this consult service:

The director of the consult service will be Patrick J. Mansky, M.D., a clinical oncologist and researcher at NCCAM. Dr. Mansky received his medical degree from Witten/Herdecke University Medical School in Germany, where he also gained experience and received instruction in Anthroposophical Medicine including herbal therapies, art therapies, and physical applications. After a postdoctoral research fellowship in immunogenetics at Memorial Sloan-Kettering Cancer Center, New York, NY, he completed clinical residency training in pediatrics and internal medicine at Case Western Reserve University in Cleveland, OH. Dr. Mansky joined NIH in 1997 as a clinical and research fellow in pediatric hematology/oncology and medical oncology at the National Cancer Institute.

Anthroposophical medicine? Rudolf Steiner‘s woo? You know, the guy whose philosophy was responsible for the concepts behind biodynamic farming, where various parts of dead animals are buried on the farm to “strengthen its life force”? Sure, Dr. Mansky apparently has experience in “conventional” medicine, but if he accepts Anthroposophical medicine as anything other than spiritual woo I have serious doubts about his critical thinking skills. After all, Steiner’s medicine postulates the causes of illness are not primarily physical but spiritual; that good health is achieved when the physical organism is properly ‘aligned’ with three nonphysical bodies that manifest during a human’s lifetime, the ‘etheric body,’ the ‘astral body,’ and the “I,” a spark of divine selfhood or ego that separates true humans from animals and subhumans. Bad health, on the other hand, comes from this;

Bad health, on the other hand, often reflects the working out of one’s “karmic destiny.” If one enters this world carrying spiritual impurities resulting from sins and errors committed in previous lives, disease can serve as a rite of passage, purging evils from one’s bodily/spiritual system. Thus, medical intervention is often a bad idea: A doctor who cures a patient with drugs, etc., may be blocking the patient’s karmic self-healing process.

How is this different from religion?

Moreover, Anthroposophical medicine has a distinctly antivaccination cast to it. Perhaps I’m being unfair to Dr. Mansky, and perhaps his later training at, among other places, the institution at which I did my general surgery residency, purged the woo that is Anthroposophy. Perhaps. Or perhaps it doesn’t even really matter who’s in charge of this new consult service at the NIH Clinical Center. Given the mentality of CAM advocates, no matter who’s in charge this new initiative will be, as Dr. R. W. put it, “taking woo to a whole new level.”

In retrospect, I suppose that this further infiltration of woo into the NIH was inevitable once NCCAM had been established. After all, NCCAM is a full Center in the NIH. Given that, in the eyes of the NIH bureaucracy there is no logical reason that NCCAM shouldn’t be allowed into the NIH Clinical Center and no reason there shouldn’t be a CAM Consult Service there. Moreover, it doesn’t matter that the real purpose of NCCAM is, more than anything else, to promote the use of CAM by giving it a veneer of scientific respectability. Remember, the NIH did not take the initiative in forming NCCAM. Rather, it was woo-loving legislators such as Senator Tom Harkin (D-Iowa) who foisted NCCAM upon the NIH and resist all attempts to cut its funding. I used to be of the opinion that NCCAM served a useful purpose, but no more. In recent years, it has become abundantly clear to me that it wastes money studying therapies with no scientific plausibility or basis in science such as Reiki or homeopathy as though they worked.

How long can evidence-based medicine endure in the face of this relentless assault? I used to think that EBM was the wave of the future. Now I fear that woo is the future of American medicine.

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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