MD, PhD, FMedSci, FSB, FRCP, FRCPEd

On this blog, I have repeatedly tried to explain why integrative (or integrated) medicine is such a deceptive nonsense; see for instance here, here and here. Today, I have reason to make another attempt: The International Congress on Integrative Medicine & Health.

In 2012, I published an analysis of the ‘3rd European Congress of Integrated Medicine’ which had taken place in December 2010 in Berlin (in Europe they call it ‘integrated’ and in the US ‘integrative’ medicine). For this purpose, I simply read all the 222 abstracts and labelled them according to their contents. The results showed that the vast majority were on unproven alternative therapies and none on conventional treatments.

The abstracts from the International Congress on Integrative Medicine & Health (ICIMH, Green Valley Ranch Resort, Las Vegas, Nevada, USA, May 17–20, 2016) which were just published provide me with the opportunity to check whether this situation has changed. There were around 400 abstracts, and I did essentially the same type of analysis (attributing one subject area to each abstract). And what a tedious task this was! I spotted just two articles of interest, and will report about them shortly.

This time I also assessed whether the conclusions of each paper were positive (expressing something favourable about the subject at hand), negative (expressing something negative about the subject at hand) or neither of the two (surveys, for instance, rarely show positive or negative results).

Here are the results: mind-body therapies were the top subject with 49 papers, followed by acupuncture (44), herbal medicine (37), integrative medicine (36), chiropractic and other manual therapies (26), TCM (19), methodological issues (16), animal and other pre-clinical investigations (15) and Tai Chi (5). The rest of the abstracts were on a diverse array of other subjects. There was not a single paper on a conventional therapy and only 4 focussed on risk assessments.

The 36 articles on integrative medicine deserve perhaps a special mention. The majority of these papers were about using alternative therapies as an add-on to conventional care. They focussed on the alternative therapies used and usually concluded that this ‘integration’ was followed by good results. None of these papers discussed integrative medicine and its assumptions critically, and none of these investigations cast any doubt about the assumption that integrative medicine is a positive thing.

I should also mention that my attributions of the subject areas were not always straight forward. I allowed myself only one subject per paper, but there were, of course, many that could be categorised in more than one subject area ( for instance, a paper on an herbal medicine might be in that category, or in TCM or in pre-clinical). So I tried to attribute the subject that seemed to dominate the abstract in question.

My analysis according to the direction of the conclusions was equally revealing: I categorised 260 papers as positive, 5 as negative and 116 as neither of the two. That means for every negative result there were 52 positive ones. I find this most remarkable.

Essentially, my two analyses of conference abstracts published 6 years apart show the same phenomenon: on the ‘scientific level’, integrative medicine is not about the ‘best of both worlds’ (i. e. the best alternative medicine has to offer integrated with the best conventional medicine offers) – the slogan by which advocates of integrative medicine usually try to ‘sell’ their dubious approach to us. It is almost exclusively about alternative therapies which advocates of integrative medicine aim to smuggle into mainstream healthcare. Critical analysis seems to be unwelcome in this area, and – perhaps worse of all – in the last 6 years, there does not seem to have been any improvement.

And that’s just on the ‘scientific level’, as I said. If you wonder what is happening on the ‘practical level’, you will find that, in the realm of integrative medicine, every quackery under the sun is being promoted at often exorbitant prices to the often gullible and always unsuspecting public. If you don’t believe me, search for ‘integrative medicine clinic’ on the Internet; I promise, you will be surprised!

Personally, I am sometimes amused by the sheer idiocy of all this, but more often I am enraged and ask myself:

  • Why are we allowing quackery to make such a spectacular come-back?
  • Why is hardly anyone voicing strong objections?
  • Is it not our ethical duty to do something about it and try to prevent the worse?

 

11 Responses to Integrative medicine: one of the most colossal deceptions in healthcare today

  • It isn’t even alternative, one of the main marketing articles of this fraud is their almost hysterical condemnation of medicine. Their ranks are filled with anti Vaxxers. They claim that oncology is ineffective. They exaggerate iatrogenic harm.

    In effect, they are anti medicine so they can sell their quackery. How on earth can anyone accept their claims of wanting to integrate with healthcare?

    • good point, I think. it is, of course, difficult to generalise but, for large proportions of ‘integrativists’, this seems to be true.

  • The answer as to why quackery is making a comeback lies with the very significant benefits it brings to camists (who practice camistry – CAM), manufacturers, course organisers and sundry others who are desperate not to lose market share, and seem oblivious to how they secure their advantage in the crowded healthcare market place. Marketing of quackery has got better (in its own terms).

    The Prince of Wales’s Foundation for Integrated Health issued a report on the consumer perspective of CAM in 2001. In its forward, David Peters suggested the findings ‘are of particular interest to anyone concerned with developing integrated health care.’ He did not mean the integration of medical, social, mental and environmental health care (principles which are supported by most conventional healthcare institutions such as the Royal Colleges and BMA), but rather an insurgency so that CAM becomes incorporated with conventional medicine. Pseudo-science with science. He started from the premise that such integration is ‘a good thing’ rather than setting out to discover whether it is. This report failed to distinguish between the therapist and the therapy, practitioner and practice, style and substance.

    The World Health Organization (WHO) defines complementary or alternative medicine as ‘a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.’ This is why many CAM practitioners and supporters are currently keen to use the term ‘integrated’. If CAMs were to be integrated, by definition, they would cease to be complementary or alternative.

    On December 24th 2012, when Prince Charles wrote a guest editorial ‘Integrated health and post modern medicine’ for the Journal of the RSM (yes, the institution which has John McTimoney of McTimoney Chiropractic fame on its ‘Wall of Honour’), only two members responded – Nick Ross (President of HealthWatch UK) and myself. I wrote:

    “Prince Charles’ Editorial is helpful in furthering our understanding of his advocacy, but more clarification is necessary if his wise words are not to result in the antipathy which greeted his speech to the BMA in 1982, and to which he makes reference. He tells us “For many years I have advocated an integrated approach to medicine and health. By integrated medicine, I mean the kind of care that integrates the best of new technology and current knowledge with ancient wisdom. More specifically, perhaps, it is an approach to care of the patient which includes mind, body and spirit and which maximizes the potential of conventional, lifestyle and complementary approaches in the process of healing.” The Prince should be invited to clarify to which ‘ancient wisdom’ he refers. That the sun goes round the earth? That illness is due to imbalance of four humours?

    There is no question clinicians should be caring and demonstrate compassion. That does not require progressive modern medicine to ‘integrate’ in any sense with alternative medical systems. ‘Complementary approaches’ such homeopathy, Reiki and a variety of systems to activate ‘vital forces’ as spoken of by Prince Charles are not needed to complete conventional treatments. They are alternatives to evidence-based modern medicine. The best of ancient wisdom is already incorporated into ‘medicine.’ To integrate medicine with systems for which there is no plausible evidence-base would do a disservice to patients – and to tax-payers expected to foot the bill.”

    No member of the RSM responded to my letter, or to Nick Ross’s. As a magician I know how to deceive and create illusions, but it sticks in my craw that those who promote camistry cannot be more honest, and that they seek to fool patients and the public alike that their ministrations may usefully be integrated with conventional care. Modern scientific medicine has moved away from superstition and metaphysics and should not be dragged back by the devious marketing strategies and glib words of the greedy who prey on the needy.

    More of this in ‘Real Secrets of Alternative Medicine’! (Amazon and Kindle).

    Edzard’s question, “Why is hardly anyone voicing strong objections?” gets to the heart of the problem and should be answered by the Royal Colleges, RSM, RCN, BMA and other conventional medical institutions. All such institutions should be sent a copy of this posting, and asked what their approach to ‘integrated medicine’ is. Urgently. Patients deserve nothing less.

    • At least part of the success of SCAM is, ironically, down tot he very real success of medicine. Back when you were likely to die in childbirth, and if you did survive infancy then you’d likely die of infectious disease or accident by middle age, there was no incentive to look for alternatives – people wanted genuine life-saving treatment. And now ewe have it, so the largest single group of health consumers is probably the worried well.

    • Excellent and accurate comments. This posting and Dr. Rawlins comments should be available to everyone, including all medical institutions, students, physicians and patients. Snake oil salesmen and women are everywhere disguised as Alternative health care. They have even infiltrated respected medical institutions with the assistance of greedy and ignorant law makers as well as influential royals.

  • Yes, it is a complete con. It “integrates” a mix of things that were already integrated, and things which were rejected or discarded as worthless, and claims the former as validation for the latter. The technically correct term is SCAM, in my view, and we should use it.

  • “-Why is hardly anyone voicing strong objections?
    -Is it not our ethical duty to do something about it and try to prevent the worse”

    My answer to these two questions:
    -Job security, promotions, fame and fortune etc. Why involve yourself with the problems in a different field than your own and risk your career? Most, if not all, CAM researchers fully support CAM unconditionally so any objections will have to come from people outside of the CAM field. Catch 22?

    -Most definitely but there is no global initiative, that I know of, to tackle this growing problem. Everyone, or the few who does, is approaching it on their own which is not necessarily a bad thing, but I sometimes feel that it might be a waste of time. In comparison these CAM guys are well organised and speak with a unified voice. What they say is usually crap but apparently good enough to mislead a lot of people. My situation: I am up against a whole University, on my own, which makes me an ankle-biter of sorts. I do enjoy it but I don’t think that my actions will have the desired impact. For example: I did add some factually correct information on their Wikipedia site recently by adding a paragraph to explain their involvement with the CAM industry – industry funding in exchange for the full university support of pseudosciences – and the paragraph is still there even after two weeks! I know it is only biting at their ankles but at least it makes me feel a bit better and you never know what something so small as this might achieve.

    (third paragraph from the top: https://en.wikipedia.org/wiki/Western_Sydney_University)

  • What a sham. Allowing animal and in vitro studies to be presented is inappropriate. The only studies that have any bearing on the topic are human clinical trials, but even those beg the question of what is meant by integrative. Saw palmetto for BPH? OK. But then, that positions the substance as a drug which should therefore be regulated accordingly.

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