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?
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.
1st class article about IM: http://www.chadhayesmd.com/integrative/
Wow! It’s a substantial read, but it sparkles from start to finish with Chad Hayes’s light touch and wit. Like you say: a first-class article. An ironical tribute to the desperately batty people who genuinely imagine they are working for the benefit of mankind (and who often charge a high fee for doing so, of course).
Not for the first time, I found myself slack-jawed at the extent to which even people with MD qualifications seem to have learned absolutely nothing about the way the body works in health and disease. I recommend everyone to follow the link and choose their own candidate for the prize of the most ridiculous parody of biomedical science.
My personal award goes to Jerry Tennant, because he’s found a previously ignored association (to my knowledge) of links between a small, countable part of the body and other organs, viz. the teeth! Dr. Tennant told the audience: “The teeth enable one’s emotions to directly affect organ function and health because “emotions are stored in magnetic fields. Magnetic fields like to reside in crystals. Teeth are the body’s crystals.”” Those last two sentences are a masterpiece of novel discovery.
I came here because I have recently begun working with an FNP-C at an integrative medicine practice in an effort to lose weight. I am morbidly obese and I feel like I need as much help as I can get. All my spidey senses are on full alert though. The FNP seems competent, but she has put me on what I would consider a crazy amount of supplements after getting blood and stool samples. According to the blood work, I am deficient in Potassium, Vitamin D, and Vitamin B6. So I am taking all those along with a multivitamin, blood pressure pills, allergy pills, two kinds of digestive/probiotic pills, and three different kinds of powder: Inulin and Inflammacore for gut health and Inositol to help keep me from becoming diabetic. Oh, and I’m supposed to be taking iron too. I also supposedly have sleep apnea, but I hate the CPAP and almost never use it.
I asked the FNP straight up if she felt like all this was crazy. I didn’t really expect her to be honest, of course. I just felt like I needed to clear the air a bit. Man, I truly don’t know where to go from here. I do feel like I am being scammed, but blood work doesn’t lie either. I am not sure what to think!
Thank you for sharing your story. I have extended professional experience with this problem but I am NOT giving you individualised advice here, just offering my opinion on the advice you have been given and some general information based on your story.
It sounds like you need to find a less gullible health care worker to mentor you in your efforts. This one seems to have swallowed the integrative bait, hook, line and sinker.
Morbid obesity calls for an enormous efforts from the patient if conservative measures are to have lasting results. Proper coaching and guidance are a key to success, which is unfortunately rare with conservative measures alone, only around 5% can maintain a clinically significant weight loss for more than 5 years. But there are those who succeed and it is very important to make an extended and genuine effort before deciding on surgery.
Paradoxically, many obese suffer from micronutrient malnutrition. Poor food choices and constant “dieting” are to blame. B12, Iron and vitD are the most common problems needing substitution. It is sensible to take multivitamins with minerals as well but you can chuck the other nonsense you mention (Inulin, Inflammacore and Inositol) they re useless and will certainly not prevent diabetes. There is no medicine or herb or remedy that will independently help with weight loss, apart from dangerous substances that are of course banned.
My opinion on the gut flora issue is that it is most probably a secondary phenomenon. The differnce in gut flora is caused by the dietary habits, not vice versa. Theories about microbe transplant causing weight loss are just that, unproven and unlikely theories so far.
Staying away from carbs and loosing weight are the keys to DM prevention and many cases of type 2 DM will remit to proper dietary management.
Sleep apnoe will in most cases improve and even disappear with weight loss. Iron substitution is commonly needed in menstruating women and is a must after bypass surgery.
Surgery is very popular for a very good reason, it helps those who can manage the permanent life style change necessary. Those who are not prepared to make radical, permanent changes in your diet and lifestyle are usually better off without surgery.
The most important preparation for surgery is to find a surgeon who has a lot of experience and does a lot of such cases with a good track record.
Inositol and inulin will simply give you diarrhoea and dehydrate you. You will lose weight by losing water which your body needs to function normally.
There is quite a lot of research into the role of gut bacteria in obesity but it is a long way from producing any sort of useful treatment; perhaps in another decade or two.
I would suggest getting your doctor to refer you to a proper medical specialist. Unfortunately, though, the only way to lose weight effectively is diet, and it takes a long time (though you will start to feel the benefits fairly quickly). Exercise helps to turn fat into muscle but won’t get the weight off. Nevertheless it is important for the normal functioning of the body.
Baryatric surgery helps some people (but many cheat – think liquidised Mars bars), but this is very specialist and completely outside my area of expertise.
As a doctor who suffers from sleep apnoea, I can tell you that my life was transformed by CPAP and it is well worth pursuing it. I would contact your local sleep disorder clinic and see if they can find something that suits you better. There are many different designs of mask, some of which suit particular individuals better than others. If you are not a mouth breather, a nasal mask might be much easier. It is important that the pressure settings are right, and personally I find the more sophisticated self-titrating variable-pressure devices don’t suit me at all, as they keep turning the pressure up until the mask leaks. I don’t know whether you live in a low-humidity area – if so, having a humidifier on your CPAP can prevent the dry throat that some people get; generally in the UK the air is damp enough for it not to be necessary.
My experience of CPAP is that it immediately made me feel fifteen years younger, though in all fairness my sleep apnoea was pretty bad. Think about how your body functions with low oxygen levels all night and no proper sleep ever! There is also evidence that it can help with weight loss.
Finally, if you are a driver with sleep apnoea it is illegal to drive unless you use it for at least four hours every night, and if you are involved in an accident then you will find that your insurance will not be valid unless you can prove that you have been using your CPAP correctly.
A few of thoughts to follow Dr Julian Money-Kyrle’s correct comments.
It is true that many patients cheat, or rather, they do not make the permanent adjustments to their diet and lifestyle that are necessary for a durable result. You can “cheat” in the way Julian describes if you have a gastric band or a sleeve but not so easily with a gastric bypass because you will have lots of problems if you drink/eat high carb diet. A bypass is still the gold standard treatment. In the UK, gastric banding has been a very popular, perhaps the best known procedure. It should have been abandoned completely about ten years ago as it did in many other parts of the world where experts realised it is only a good procedure for the surgeon, not the patient.
As to sleep apnoe, most[sic] of our patients were able to return their machine some months after surgery.
A CPAP machine will not cause weight loss on its own but better sleep facilitates life style improvements, whch are always beneficial.
If we get back on this blog’s topic, it is a well established fact that no so called alternative medical measures are worthwhile for weight loss. Any results will easily be surpassed by simple lifestyle adjustments and are usually caused by concomitant changes in diet and exercise anyway.
This was quite well substantiated in the congressional hearing where Dr. Mehmet “Dr. Oz” Öz had to admit that none of the wonder-supplements he had promoted for weight loss really worked.
But obese people, just like cancer patients, athletes and new parents are always easy marks for charlatans promising easy results for their goods and services.
Integrative medicine revolves around legitimising factitious health care means and methods by intermixing them with genuine measures and shrouding them in a veil of false significance.
Inulin is a complex carbohydrate not metabolised by us but by gut bacteria so, yes, it does nourish the microbiome but it is also the active ingredient in alliums, pulses and the like which gives them the fearsome reputation they have for making you fart like a herd of buffalo. Inulin supplements may well lead to happy gut bugs but you’d be best advised to leave the windows open.
I share your feelings of rage about this assault on reason and science.
I would like to share some thoughts as to offering some small suggestions in relation to your 2nd question “Why is hardly anyone voicing strong objections?”
Not too long ago I was speaking to the staff of an NHS department. They were all extremely stressed and openly complained that their department was offering sub-standard services that were not fit for purpose. Some appeared sleep deprived and one was tearful. They also described a frightening situation in which a person could lose their job if they made comment that could be interpreted as offensive or made a complaint against a senior member of staff. They were all very anxious about austerity and job security.
It seemed to me that people were working in a frightening, dysfunctional work environment. They did not feel valued, they did not feel supported and they did not feel able to offer the high quality service that they had been able to offer in the past.
The next time I saw them they all seemed much happier and quite content, however they also seemed uninterested in and disengaged from the concerns they had expressed to me on previous occasions.
I asked what had happened since I had last seen them. They replied that they had received “mindfulness training” and that it helped them to live “in the moment” and to not worry about things they were powerless to change.
One of them told me that it felt very strange initially and that she had to put her trust in the mindfulness trainer, which was not easy, but that once she had “surrendered to the process” that she started to feel much calmer and happier straight away.
I should say at this point that I meditate every day. I do not chant or sit cross legged with my eyes closed, I simply go for a walk in nature and allow myself to replenish my mind and body with calm, deep breathing, an appreciation of nature and gentle exercise. I am not opposed to meditation, on the contrary, I feel that taking time out to rest, reflect and re-boot the mind is essential for everyone.
I am however extremely concerned about the vast amounts of money that are being spend on mindfulness consultants and the effects on NHS staff of mindfulness training.
If one is offering a sub-standard unfit for purpose, service then it seems entirely proper that one should feel enraged and concerned about this.
If one works in an environment where bullying is rampant and whistle-blowers are punished then it is appropriate to feel angry and concerned about this.
I am extremely concerned that some of the senior managers in the NHS and other institutions have embraced mindfulness uncritically and with no proper examination of the qualifications and alliances of the consultants providing such training.
It seems to me that mindfulness can be the thin end of the wedge by which all kinds of quackery and woo are introduced into NHS services.
There is more to write about this and also about leadership coaching within the NHS and other institutions, but this is all I have time for for the moment, except to say that the previously tearful clinician was quite adamant that I should undertake mindfulness training and persisted in her attempts to persuade me to try it despite my repeated statements that I was not interested.
This experience was reminiscent of the film Invasion of the Body Snatchers. Maybe a new film should be made about mindfulness within the NHS? Maybe Invasion of the Bodhi Snatchers?
I have worked in a number of NHS departments, some of them very dysfunctional and indeed some where concerns over losing private patients to other consultants led to open hostility within teams and even attempts to discredit colleagues. I was lucky enough to work as a consultant in a hospital where none of that was the case (not entirely luck as I had had some of my specialist training there and knew what it was like). The ethos was to put the patient above all else, and everybody was very supportive of colleagues at all levels. There were certainly no barriers to speaking out about specific concerns, and there were regular meetings to review deaths and unexpected morbidity so that lessons could be learned from them (although this is a mandatory requirement, I think in some places it can degenerate into a box-ticking exercise).
The oncology department was a particularly special place to work, although we were very busy and the sheer pressure of getting through the number of patients was quite challenging. This regularly meant that staff would have to work late (beyond their paid hours), and although most people weren’t happy about this, they did it because they wanted to give the best care they could to the patients.
However, over the years it became apparent just how much the NHS relied on the goodwill of its staff, and demanded more and more from them, giving back less in terms of respect and recognition of their skills. In particular, pay rises never kept up with inflation. Meanwhile, of course, the cost of medical care was steadily rising. Every time there was a new Government, the whole system would be reorganised, and it would take several years to settle back down to something that worked properly. Targets were introduced, which meant that priority was given to what could be easily measured, and creative ways were found of meeting the targets without necessarily improving the service. Certainly there are many things which have improved, and I still believe that as a whole the NHS is able to deliver care which is unmatched elsewhere in the world. However, the goodwill is running out, and knee-jerk Government policies imposed from above don’t help.
I don’t pretend to know what the answer is, though better funding would help, and policies which involve valuing everybody for their contribution, and listening to what they have to say. I don’t think mindfulness training really has a big role here.