I’ve spent a lot of time in Cleveland. Indeed, I lived there for eight years in the late 1980s and early 1990s, during which time I completed my surgery residency training, completed my PhD, and, even more importantly, met and married my wife. Even though I haven’t lived there for nearly 20 years—I can’t believe it’s been that long—I still have an affinity for the city, which is perhaps why I’ve had a tendency to come down hard on venerable Cleveland medical institutions that turn to quackademic medicine, one where I trained (I’m talking to you, University Hospitals of Cleveland) and one where I did not (you, too, Cleveland Clinic foundation). Both are hip-deep in quackademic medicine, but of the two, the Cleveland Clinic appears to have embraced woo far more tightly. For instance, it achieved notoriety for opening a traditional Chinese medicine clinic staffed by a naturopath who uses homeopathy (but I repeat myself) and then followed up that bold foray into quackification by hiring Dr. Mark Hyman, arguably the foremost proponent of the “holistic” specialty dubbed “functional medicine.” Add to that the CCF’s enthusiastic promotion of “complementary and alternative medicine” (CAM) including acupuncture, in pediatrics, and truly you have a paradise of quackademia. Clearly, pseudoscience is now “baked in” to the CCF’s DNA.
Unfortunately, it goes beyond just the CCF and UH. Indeed, I was annoyed to see an article yesterday in a publication I routinely used to read when I lived in Cleveland, The Cleveland Scene, where Brandy Schillace, the public engagement fellow at the Dittrick Medical History Center and Museum and the managing editor of Culture, Medicine and Psychiatry. wrote a credulous fluff piece entitled On ‘Alternative Medicine’ in Cleveland, Where ‘Hospital Medicine’ is the Prescription of the Day. Starting out by tracing the history of hospital medicine in Cleveland back to the founding of the City Hospital in 1837 to the evolution of medical powerhouses like the CCF and UH, Schillace tries to put alternative practitioners smack in the center of things:
These days, Cleveland medicine brings to mind the Cleveland Clinic, University Hospital or Metro, but the history of Cleveland—once a wild and wooly western town—includes far more mavericks and bold independents than many realize. And while these institutions get a larger share of the press, alternative and independent practice continues to thrive.
How does this enclave support the Cleveland community? And in what ways has it captured the enterprising spirit that brought Cleveland from swampy Cuyahoga backwater to thriving medical center?
I have little doubt that some of these “alternative medicine” practitioners have an “enterprising spirit.” So did Kevin Trudeau. The question is not the go-get-’em entrepreneurial spirit, but rather what they do, which ranges from the benign (yoga and Pilates) to the quacky (acupuncture and myoskeletal alignment):
Tom Ockler, an alternative physical therapist, hails from Buffalo but has been practicing in the Cleveland area for 37 years (Alternative Healthcare Solutions).
Anne Kinchen of Cleveland Acupuncture began her practice in 1999 as one of the first 10 acupuncturists in Ohio. They represent those working longest in our community, but they are joined by some relative newcomers.
Marque Garaux, a climber and former Marine, practices, teaches and leads Mysore Ashtanga yoga at Harmony Studios in Willoughby (Yoga Marque). He has studied at the K. Patthbi Jois Ashtanga Yoga Institute in India, where yoga is understood as a whole body health practice.
Newest to Cleveland are Joseph Watts (Watts Integrative Manual Therapy) and Kari Watts, relocated from Lexington, Kentucky. Joe practices a unique form of manual therapy; more than massage, he uses techniques from lymphatic drainage to myoskeletal alignment. Kari works as a small-class Pilates instructor.
For example, Anne Kinchen is an acupuncturist who uses acupuncture and traditional Chinese medicine to treat infertility, claiming, “Traditional Oriental medicine offers infertility patients much more than just adjunctive before and after acupuncture treatments” and that “TOM has a long and established history for the regulation of the woman’s menstrual cycle, as well as treatment for various male infertility issues.” Neither of these are, of course true. Acupuncture does not improve, for instance, in vitro fertilization (IVF) success rates. No matter how much acupuncturists claim that acupuncture assists IVF, the very studies they cite do not support the hypothesis, nor does acupuncture help for polycystic ovary syndrome, one of the most common causes of female factor infertility. Yet, thanks to anecdotes and bad science, acupuncture is frequently offered not just at CAM and “integrative medicine” clinics but at actual fertility clinics. It doesn’t work.
Then there’s Joseph Watts. One thing that a quick Google search revealed was something that wasn’t revealed in the article. Watts is Schillace’s brother:
— Brandy Schillace (@bschillace) September 7, 2015
She’s also not shy about promoting her brother’s business on Twitter:
— Brandy Schillace (@bschillace) September 8, 2015
She also re-Tweets a fair number of his Tweets.
Personally, I think that disclosing that two of the people interviewed in the article are your brother and sister-in-law would not be just appropriate, but mandatory, but nowhere in the article does Schillace state that Watts is her brother. In any case, Watts offers everything from lymphatic drainage (which can be a legitimate technique to treat lymphedema but is often infused with serious woo) to myofascial release, the latter of which which is quackery. In any case, these “alternative” practitioners are presented as brave maverick practitioners. Naturally, they were quick to expound on the “individualization” of their treatments:
So what is this unique difference? As soon as I asked the question, I felt the energy of the room shift. Leaning forward in their chairs, the five practitioners eagerly shared: “Individualized attention.” “Getting to know the patient.” “Treating them as they need to be treated, not as time or insurance companies dictate.” Joe considered the difference to be threefold: Individual Orthopedic Testing, Time, and Self-Care.
Of course, without a sound scientific basis to “individualize” treatments, what “individualization” of therapies in alternative medicine usually means, more than anything else, is making it up as you go along.
They also expressed concern about the large hospital systems (such as the Cleveland Clinic and University Hospitals) offering alternative therapies now. What do you think their concern was? Basically, it was a fear of rules telling them what they can and cannot do:
Anne and Tom were quick to point out that alternative practices have been thriving elsewhere, as well. “Clearly, there are more people interested in medical alternatives,” Anne said—but the hospital systems have taken up that cause, too, which is a kind of double-edged sword. Physical therapists and acupuncturists who work within the system necessarily have to abide by the rules of that system, and that means potentially compromising on a patient’s needs.
In other words, medical centers, whose leaders delude themselves into thinking that the quackery they are “integrating” into their “integrative medicine” clinics and centers, is evidence-based, use what they perceive that evidence base to be to limit the true alt-med practitioners from making it up as they go along unfettered by concerns about evidence. I know, I know, that’s not what they say, but it is what they very likely mean—other than the delusion about the quackery being evidence-based given that it’s a delusion they share. This idea pops up again in a different form here:
Today, with the advent of Cleveland Clinic’s Center for Integrative Medicine, “alternative” therapies have become better accepted by the mainstream, and yet by mainstreaming the therapies such centers have overshadowed what was originally “alternative” about them. The received narrative becomes potentially one-dimensional, and, after all, a practice that evolves in the hospital system will necessarily take on the character of that system. Moving out of that system provides freedom, but can be isolating. “I miss sharing with colleagues,” Tom explains—adding “I also miss days off!” We laugh. But it’s true. These independents work long hours to make what they do transparent, translatable, and understood. And yet, they are the unheard voices.
It depends on what you mean by “unheard.” Personally, I think such voices are, unfortunately, heard all too well. For instance, I once looked at how many alternative medical practices are just within a mile or so of my house. There are at least four chiropractors, one of which is a one-stop shop for quackery that offers everything from chiropractic, to infrared saunas, to “detox foot baths,” to “energy healing.” Then there are at least three or four other alternative medicine practices, including a reiki practitioner; a practitioner who offers naturopathy, traditional Chinese medicine, DNA activation (yes, DNA activation), homeopathic drainage, and cranial sacral therapy; and a practitioner within walking distance of my house who advertises her reiki and TCM services on cable TV. I’m sure I’ve probably missed one or two, and I also know that if I expand the search radius to five miles from my house there are probably a dozen such practitioners. Count the run-of-the-mill chiropractors, and the number is probably at least double that.
Quackery is everywhere. From the standpoint of economics and competition, I can understand why quacks might be afraid that the big guns are moving in on their action. For example, if I want to drive 25 miles or so, I could be treated with anthroposophic medicine at the University of Michigan. It’s in Cleveland as well, big-time. Just the other day, Mark Hyman posted a picture of himself in a shelled out office space, exulting in the 18,000 sq. ft. space that will be the new home he Cleveland Clinic Center for Functional Medicine:
Yes, the highly dubious “integrative” medicine known as functional medicine is a centerpiece of the Cleveland Clinic’s integrative medicine center, which already offers reiki, acupuncture, craniosacral therapy, traditional Chinese medicine, and more.
Not surprisingly, Schillace concludes with what I like to call the “they thought this was quackery, but now it’s becoming accepted” appeal to popularity:
As Cleveland continues its rise as a medical city, some of its most foundational and hardest working members have been strangely overlooked. Some people likely don’t even consider massage—or yoga and Pilates—as therapies. Others might think acupuncture and physical therapy only work for the “believers.” And still others view independent practice with suspicion: surely “real” medicine belongs in a hospital…
History tells a different story. Looking back at the bizarre and brilliant tales that built our city—on doctors who took chances, who knew their patients as they knew their neighbors, and who sometimes went against the grain—I see Cleveland’s finest moments. Looking at this room of alternative practitioners, men and women working to heal the human at the center of medicine, I see our greatest inheritance.
I also can’t help but point out that she also sees her brother.
When I see a room of such practitioners, I do not see the best Cleveland has to offer I see a part of medicine that is not supported by science and is thus far from the “greatest inheritance” of Cleveland medicine.