Complementary and alternative medicine Medicine Quackery

The infiltration of woo into medical academia continues apace

Here we go again.

As regular readers know, I’ve lamented long and loud the infiltration of unscientific “complementary and alternative medicine” (CAM, or what Dr. RW dubbed “quackademic medicine, a term I very much like) into medical school curricula, academic medical centers, and postgraduate medical education. A while back, in particular, I got rather worked up over how the University of Maryland’s respected Shock Trauma Center. But it wasn’t just any woo. Rather, it was one of the absolute woo-iest of woos, namely reiki, which is nothing more than magical faith healing based on Eastern mysticism rather than Christianity.

Yesterday, thanks to an AP story making the rounds, I got an update:

BALTIMORE – At one of the nation’s top trauma hospitals, a nurse circles a patient’s bed, humming and waving her arms as if shooing evil spirits. Another woman rubs a quartz bowl with a wand, making tunes that mix with the beeping monitors and hissing respirator keeping the man alive.

They are doing Reiki therapy, which claims to heal through invisible energy fields. The anesthesia chief, Dr. Richard Dutton, calls it “mystical mumbo jumbo.” Still, he’s a fan.

“It’s self-hypnosis” that can help patients relax, he said. “If you tell yourself you have less pain, you actually do have less pain.”

Alternative medicine has become mainstream. It is finding wider acceptance by doctors, insurers and hospitals like the shock trauma center at the University of Maryland Medical Center.

Well, it’s obvious to see that an attack of rationality and science hasn’t struck the University of Maryland in the year and a half since I last paid attention to this. Why not bring in the witch doctors while they’re at it? After all, reiki may not be “shooing away evil spirits,” but it’s not far removed from such superstitions. Wait. Strike that. it’s not removed from that at all, as it is faith healing, patterned after stories about Jesus in the Bible and fused with a heapin’ helpin’ of Eastern woo. It’s magic. Indeed, it even has chanting and spell casting that go with it, as reiki masters inscribe mystical symbols in the air and hold their hands over their patients, either not touching or only barely touching the patient in order to direct “healing energy” or qi into the patient to an allegedly therapeutic effect.

Everybody dumps on the big, bad health insurance companies. Certainly, I’ve done my share of it and on occasion gone to war to try to get a treatment covered for a patient, usually successfully. However if there was one thing I had always thought the insurance companies were good for, it was to put a brake on the infiltration of pseudoscientific quackery into medicine by refusing to pay for modalities that have no good science or clinical evidence to support their use. True, the refusal of insurance companies to pay for woo in a perverse way made it more attractive, mainly because woo then became all cash on the barrelhead without all that mucking about with any paperwork other than perhaps credit card receipts. At least, there was no bothering with preapprovals and the copious documentation insurance companies require. Despite that advantage, though, insurance company reimbursement is a critical step for CAM, because it signifies treatments that are truly mainstream, and refusal of third party payers to reimburse for CAM has been a major stumbling block in its never ending quest to enter the mainstream.

Perhaps not any more:

Health insurers are cutting deals to let alternative medicine providers market supplements and services directly to members. Some insurers steer patients to Internet sellers of supplements, even though patients must pay for these out of pocket.

This is depressing. Cracks are forming in one of the last lines of defense. The reason, of course, is that insurance companies are businesses. Although they are mainly hired by employers and are thus mainly responsive to them, if enough of their potential customers want woo, this desire will eventually make itself felt through by insurance companies through employers, particularly when more than one plan are offered by a single insurer. In that case, woo sells, and insurance companies may feel compelled to offer it in order to avoid losing customers to other insurance companies that do offer it.

The bummer news about insurance companies, aside, this article does get a fair amount right:

Government actions and powerful interest groups have left consumers vulnerable to flawed products and misleading marketing.

Dietary supplements do not have to be proved safe or effective before they can be sold. Some contain natural things you might not want, such as lead and arsenic. Some interfere with other things you may be taking, such as birth control pills.

“Herbals are medicines,” with good and bad effects, said Bruce Silverglade of the consumer group Center for Science in the Public Interest.

Contrary to their little-guy image, many of these products are made by big businesses. Ingredients and their countries of origin are a mystery to consumers. They are marketed in ways that manipulate emotions, just like ads for hot cars and cool clothes.

Even therapies that may help certain conditions, such as acupuncture, are being touted for uses beyond their evidence.

An Associated Press review of dozens of studies and interviews with more than 100 sources found an underground medical system operating in plain sight, with a different standard than the rest of medical care, and millions of people using it on blind faith.

That’s exactly right (except for the part about acupuncture possibly helping with some conditions, a claim for which the evidence is dubious at best). Herbs, if they do anything, are drugs (or contain drugs). Sometimes they’re adulterated on purpose with drugs. Often, supplements are made by subsidiaries of big pharma, operating under a different name so as not to risk the reputation of the parent company and, more importantly, not to disillusion the credulous looking for “natural” cures untouched by big pharma. What amazed me about this article is that it points out things I’ve been talking about for a long time, particularly how the Dietary Supplement and Health Education Act of 1994 declared that supplements are food, not drugs, and therefore do not have to be shown to be safe and effective. It even cited an expert who points out that one in four supplements has a problem when actually tested. This is a good thing, and something that needs to be reemphasized again and again and again.

The article even points out other things that I’ve been saying here:

  • Big hospitals and clinics increasingly offer alternative therapies. Many just offer stress reducers like meditation, yoga and massage. But some offer treatments with little or no scientific basis, to patients who are emotionally vulnerable and gravely ill.
  • Some medical schools are teaching future doctors about alternative medicine, sometimes with federal grants. The goal is to educate them about what patients are using so they can give evidence-based, nonjudgmental care. But some schools have ties to alternative medicine practitioners and advocates.

Add to that pointing out that alternative medicine can lead to cancer patients’ blowing their best shot at beating their disease and how little regulation and self-policing there is in the alternative medicine and supplement industry. If you’ve been reading this blog for a while, you know just how bad it is. If you haven’t, either hit the archives or hang around a while, and you soon will. Still, no article is perfect, and I really hate it when I see quotes like this from Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine (NCCAM):

“Most patients are not treated very satisfactorily,” Briggs said. “If we had highly effective, satisfactory conventional treatment we probably wouldn’t have as much need for these other strategies and as much public interest in them.”

While there is a grain of truth to this, it ignores one huge side of the equation, namely the massively overblown claims based on no evidence that many CAM practitioners make for “natural cures” with no side effects for a wide variety of diseases. Yes, science-based practitioners often do not meet the emotional needs of their patients. In fact, it was always very hard, but it’s getting harder and harder as Medicare and third party payers relentlessly keep ratcheting reimbursement down, necessitating higher volumes just to keep incomes from plummeting. Higher volumes, unfortunately, mean less time with each patient. I don’t claim that that’s the main reason. Surely, we physicians do bear part of the blame, as often we aren’t interested enough in doing better on that score. However, CAM practitioners have a huge advantage, namely that of time coupled with little or now accountability if things go wrong.

Perhaps the best part of this article came near the end, when it reiterated something I’ve said time and time again: Just how meaningless the term “natural” is and, especially, that just because something is “natural” does not make it safe or effective. As I like to say, strychnine is “natural.” Tetrodotoxin is “natural.” Curare is “natural.” They’ll all kill you quite naturally.

Unfortunately, the growth of quackademic medicine continues apace. Fortunately, I’m seeing a bit more skepticism–at least at times–in the mainstream press. I’ve been wondering whether any pushback would occur against the unrelenting infiltration of pseudoscience would. Certainly it exists in the blogosphere; unfortunately, very little appears to be occurring in the mainstream press. I’m happy to say that this article, despite its flaws, is better than at least 90% of what I read out there.

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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