MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I was alerted to an article in which some US doctors, including the famous Andrew Weil, promote the idea that so-called alternative medicine (SCAM) has a lot to offer for people recovering from Covid-19 infections. There would be a lot to argue about their recommendations, but today I will not go into this (I find it just too predictable how SCAM proponents try to promote SCAM on the basis of flimsy evidence; perhaps I am suffering from ‘BS for Covid fatigue’?). What did, however, strike me in their paper was a definition of INTEGRATIVE MEDICINE (IM) that I had not yet come across:

Integrative medicine is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.

Ever since the term IM became fashionable, there have been dozens of definitions of the term (almost as though IM proponents were not quite sure themselves what they were promoting). And ever since I first heard about IM, I felt it was a thinly disguised attempt to smuggle unproven treatments into the routine of evidence-based medicine (EBM). In 2002, I published my 1st comment on the subject. In it, I warned that IM must not become an excuse for using every conceivable untested treatment under the banner of holism. Nineteen years on, this is exactly what has happened, and one definition of IM after the next is soaked in platitudes, falsehoods and misunderstandings.

So, let’s see how reasonable this new definition is. I will try to do this by briefly discussing each element of the two sentences.

  1. IM is healing-oriented medicine: this is a transparently daft platitude. Does anyone know a medicine that is not oriented towards healing? Healing is the process of becoming well again, especially after a cut or other injury, or of making someone well again. Healing is what medicine has always been and always be aimed at. In other words, it is not something that differentiates IM from other forms of healthcare.
  2. IM takes account of the whole person: This is the little holistic trick that IM proponents like to adopt. It implies that normal medicine or EBM is not holistic. This implication is wrong. Any good medicine is holistic, and if a sector of healthcare fails to account for the whole person, we need to reform it. (Here are the conclusions of an editorial I published in 2007 entitled ‘Holistic heath care?‘: good health care is likely to be holistic but holistic health care, as it is marketed at present, is not necessarily good. The term ‘holistic’ may even be a ‘red herring’ which misleads patients. What matters most is whether or not any given approach optimally benefits the patient. This goal is best achieved with effective and safe interventions administered humanely — regardless of what label we put on them.) Creating a branch of medicine that, like IM, pretends to have a monopoly on holism can only hinder this process.
  3. IM includes all aspects of lifestyle: really, all of them? This is nonsense! Good physicians take into account the RELEVANT lifestyles of their patients. If, for instance, my patient with intermittent claudication is a postman, his condition would affect him differently from a patient who is a secretary. But all lifestyles? No! I fear this ‘over the top’ statement merely indicates that those who have conceived it have difficulties differentiating the important from the trivial.
  4. IM emphasizes the therapeutic relationship: that’s nice! But so do all other physicians (except perhaps pathologists). As medical students, we were taught how to do it, some physicians wrote books about it (remember Balint?), and many of us ran courses on the subject. Some conventional clinicians might even feel insulted by the implication that they do not emphasize the therapeutic relationship. Again, the IM brigade take an essential element of good healthcare as their monopoly. It almost seems to be a nasty habit of theirs to highjack a core element of healthcare and declare it as their invention.
  5. IM is informed by evidence: that is brilliant, finally there emerges a real difference between IM and EBM! While proper medicine is BASED on evidence, IM is merely INFORMED by it. The difference is fundamental, because it allows IM clinicians to use any un- or disproven SCAM. The evidence for homeopathy fails to show that it is effective? Never mind, IM is not evidence-based, it is evidence-informed. IM physiciance know homeopathy is a placebo therapy (if not they would be ill-informed which would make them unethical), but they nevertheless use homeopathy (try to find an IM clinic that does not offer homeopathy!), because IM is not EBM. IM is evidence-informed!
  6. IM makes use of all appropriate therapies: and the last point takes the biscuit. Are the IM fanatics honestly suggesting that conventional doctors use inappropriate therapies? Does anyone know a branch of health care where clinicians systematically employ therapies that are not appropriate? Appropriate means suitable or right for a particular situation or occasion. Are IM practitioners the only ones who use therapies that are suitable for a particular situation? This last point really does count on anyone falling for IM not to have the slightest ability to think analytically.

This short analysis confirms yet again that IM is little more than a smokescreen behind which IM advocates try to smuggle nonsense into routine healthcare. The fact that, during the last two decades, the definition constantly changed, while no half decent definition emerged suggests that they themselves don’t quite know what it is. They like moving the goal post but seem unsure in which direction. And their latest attempt to define IM indicates to me that IM advocates might not be the brightest buttons in the drawer.

53 Responses to A new definition of ‘INTEGRATED MEDICINE’

  • I find it necessary to suggest a correction to your post dear professor. You wrote “famous” where you should have written “infamous”, regarding the clown MD who invented (not discovered) so called “integrative medicine”.
    I hope you do not mind me quoting a very informative chapter about him in arepository of essays on American loonatics:

    One of the Four Horsemen of the Woo-pocalypse, Andrew Weil is a certified medical doctor and one of the most influential promoters of woo in the States (partially since he has an actual medical background). Being a medical doctor does not entail that you know how science works, however, a point that Weil demonstrates to brilliant effect. Upon discovering evidence-based medicine, Weil immediately decided in advance that if a study doesn’t give him the results he wants, then it must be flawed, thus flaunting his conviction that motivated reasoning is a truth-preserving inference rule. It isn’t.

  • Does anyone know a medicine that is not oriented towards healing?

    Strictly speaking, preventative medicine is not orientated towards healing. This includes vaccines, adjuvant cancer treatment, treatment of hypertension and hyperlipidaemia, recommendations regarding lifestyle and much of the work of community physicians and epidemiologists. It is always better to prevent a problem than to heal it.

  • This analysis is unlikely ever to be bettered.
    All medical and other healthcare students, in all parts of the world, should receive a copy, and all practitioners of medicine, camists as well as ‘conventional’ (i.e., honest), practitioners should have a copy to hand.

    We really must stop all this ‘Integrative/integrated’ nonsense or conspiracy theorists will storm the capital of intellectual integrity.
    They can say what they like, but should not kid folks they are in touch with reality.

    “If you mix cow pie with apple pie, it does not make the cow pie taste better, it makes the apple pie worse.” Mark Crislip (2012), quoted by https://scienceblogs.com/insolence/2012/02/28/boiling-integrative-medicine-down-to-its-essence-in-34-words.

  • What this IM definition is seeking to address is the failures of Evidently Baseless Medicine (EBM) since it is not holistic and there is so much specialization and lack of communication between specialists on any particular patient. And many specialties use treatments that are focused on short term localized results that lead to long term negative consequences.

    I will give an example of someone who is a family member. They had acne in their teens and were given an internal medicine that knocked out their acne (while they took it) but also damaged their microbiome which led to serious candidiasis, evidenced by athlete’s foot, itching, sugar craving, etc etc. The candidiasis got so severe eventually that it led to severe depression. After years of suffering from depression they went to a psychiatrist who prescribed anti-depressants without even stopping to inquire about or consider the possibility of the candidiasis. The anti-depressants palliated but of ccourse didnt cure. They had to step away from CON-Med doctors and cure their candidiasis using alternative treatments in order to address both the depression and the athlete’s foot, etc.

    If this IM manifesto inspires some CON(ventional)-Med doctors to get out of their specialty silos and integrate their work with other doctors in other specialties in the care of patients, its worthwhile.

    • “Evidently Baseless Medicine (EBM) … is not holistic”
      but you are mistaken my friend!

      • Listen to podcasts (“Doctors Farmacy”) by Dr Mark Hyman, a Functional Medical doctor, if you want to hear what a truly holistic medical practice is like. A typical allopathic diagnosis is not the beginning of treatment, its the beginning of the investigation for them. He and his colleagues are incredible and follow the latest science. Had I known such a thing was possible when I was school age I would have gone that route.

      • I do not agree that all conventional EBM is ‘baseless’. But Roger is right about it being non-holistic, in practice. See my comments below.

    • Roger, can you hear the pantomime chorus of “Oh yes it is!”?
      Of course ‘medicine’ is ‘holistic’.
      Please do not be silly and pervert the use of a perfectly simple English word in a vain attempt to claim some form of imaginary intellectual ascendency.

      If you want to change conventional EBM based medical practice, more quickly than it is changing, become a doctor.
      Shouting from the sidelines is no substitute for rational discourse.

    • Roger,

      I will give an example of someone who is a family member. They had acne in their teens and were given an internal medicine that knocked out their acne (while they took it) but also damaged their microbiome which led to serious candidiasis, evidenced by athlete’s foot, itching, sugar craving, etc etc. The candidiasis got so severe eventually that it led to severe depression. After years of suffering from depression they went to a psychiatrist who prescribed anti-depressants without even stopping to inquire about or consider the possibility of the candidiasis. The anti-depressants palliated but of ccourse didnt cure. They had to step away from CON-Med doctors and cure their candidiasis using alternative treatments in order to address both the depression and the athlete’s foot, etc.

      1. The symptoms you describe are not serious candidiasis, which is something generally only seen in individuals who are profoundly immunosuppressed and which is an emergency requiring life-saving treatment, usually on an intensive care unit.

      2. Athlete’s foot is usually caused by various species of tinea, not candida, though Staphylococcus aureus can also cause chonic foot infections with a similar clinical picture. Was the diagnosis of athlete’s foot confirmed microbiologically, or was it a self-diagnosis? Is there microbiological evidence that he has ever had a candida infection?

      3. Itching can be caused by a great many things. Itching where? What made it better or worse? Was it accompanied by a rash, and if so what sort? Were there any other associated signs such as excoriation or lichenification?

      4. What has sugar craving got to do with candidiasis? It is true that diabetes is a risk factor for topical candida infection, particularly if the control is poor, but other than the fact that sugar craving and diabetes both involve sugar I can’t see the connection here. Most people who crave sugar do so as a result of bad eating habits.

      5. What exactly do you mean when you say that the candidiasis became severe enough to cause depression? I have not come across depression as a feature of candida infection, so I assume that you are referring to intractable symptoms of some kind.

      6. I would normally expect a psychiatrist to take a full history before prescribing anything, including life events and precipitating factors. Are you sure that he didn’t ask about such things, or that your relative didn’t tell him that he was being driven mad (literally) by chronic symptoms? I can see that the psychiatrist might not have ascribed them to candidiasis, though.

      7. Do you have evidence that the drugs given for acne altered your relative’s microbiome, and if so that the alteration was persistent? Gut flora may take months to return to normal after a course of antibiotics, but general they do so eventually.

      8. Why have you concluded that the symptoms you describe (of athlete’s foot, itching, sugar craving and depression) are related to the acne treatment? and not coincidental? There are a great many changes in the body during adolescence, and of course they will all be correlated with one another because they occur over the same time period. That doesn’t make them cause and effect, however.

      9. Are you sure that you haven’t started with a narrative and picked the features of your relative’s medical history as you perceive them which happen to fit, bolstered by some untested assumptions, and used that as evidence of Western medicine’s shortcomings?

      10. The two things that you have told us about your relative’s experience with conventional doctors is that the prescribed treatment helped his acne and the antidepressants helped his depression, which is what they were supposed to do. Have you considered that your expectations here might be a bit unrealistic?

      11. I would be interested to know whether he consulted a conventional doctor about his other symptoms, and what transpired.

      • @Dr J M-K

        The diagnosis of candidiasis Roger discusses is the quack diagnosis of a clinically unproven condition which bears no relation to proper systemic candidiasis. A different quack would probably have diagnosed chronic Lyme disease. Or mercury toxicity from his fillings.

        A quack diagnosis was made and quack treatments used whilst a self-limiting problem resolved on its own. Meanwhile Roger engages in the ongoing expression of the Post Hoc Ergo Propter Hoc fallacy that is his life.

      • I asked and he told me he was given high dose tetracycline for a couple months which led to all the symptoms mentioned and many more that lasted for many years. He had significant dysbiosis following this. He did not go to conventional doctors for those symptoms. The psychiatrist only asked about the current psychological symptoms during the very short office visits and prescribed a different anti-depressant each time. This happened over about a 6 month period before he stopped going to him.

        • “He did not go to conventional doctors for those symptoms.”

          If you’re sick, it really helps to tell people that.

          Presumably there was a referral made by the GP to the psychiatrist. Busy psychiatrist probably (and not unreasonably) assumes the referring GP has addressed any physical ailments, although it’s a bit odd they wouldn’t ask questions about general health and lifestyle. Also suspect that they should switch medications so quickly. Very suspect that they wouldn’t recommend other first-line therapies such as psychotherapy.

          Perhaps they were hectically busy and stressed. Quite possibly they were not very good. Maybe they did do all these things, and between you and your cousin the narrative has evolved in the retelling. Certainly, we all know your own versatile relationship with the truth, and altie conversion stories are nothing if not self-servingly selective. This is why anecdotes are the lowest form of evidence—a starting point for enquiry and improvement, nothing more.

          Sucks for your cousin, and I’m sure folks here will feel sympathy for his ills and can cite their own instances where conventional medical care has fallen short, whether due to substandard care, the limitations of medical science, and/or the complexities and unpredictabilities of human biology throwing extra spanners in the works.

          To quote Dara O’Briain: “Science knows it doesn’t know everything; otherwise, it’d stop. But just because science doesn’t know everything doesn’t mean you can fill in the gaps with whatever fairy tale most appeals to you.”

          Medicine knows it isn’t perfect, which is why it works to improve over time. It’s slow and messy and sometimes really screws up, but that’s true of all human endeavors (outside of religions, natch).

          And still, the fact that the best justification you can bring for AltMed is “well CON-med [sic] makes mistakes” screams from the rooftops as to the intellectual, ethical, and evidentiary desert that your beloved AltMed is; for if you had compelling evidence to support AltMed you bring that; not these sorry wastrel tu quoques.

          You damn your own cause by your arguments, Roger. Sad, though unsuprising, you cannot not see that.

          But anyway, hope your cousin is well now. (Skin and digestive conditions are both pigs.)

          “Flaws in aircraft design do not prove the existence of magic carpets.” Dr Ben Goldacre

      • The tetracycline only helped the acne during the time period that he took it i.e. a short term locally focused treatment that had long term negative effects, which which was one of my original points about allopathic medicine. The anti-depressants had marginal benefits he said and had significant side-effects. Palliative and not holistic which was my second point. Only by finally addressing the dysbiosis did he eventually recover both from the depression and the “candida” or whatever label you want to give it. Neither doctor was able to look outside of the silo of their specialty, apparently.

        • How was the dysbiosis diagnosed, and what reason do you have to suppose that it was responsible for his symptoms or that it was caused by the tetracycline? How was it treated, and how was the change in his microbiome confirmed? Or are you simply making assumptions without evidence to support them?

  • Excellent!!! When I read the definition of IM it seemed perfectly reasonable. I still think it is reasonable but now I see the sly wording to justify slipping SCAM into patient care.

  • This is yet more evidence that the loose alliance of anti-CAM sceptics, which includes professor Ernst, HealthwatchUK, Ben Goldacre, Richard Dawkins, Dr Christian Jessen, and professor David Colquhoun, has failed.

    Over the last decade the mainstream public, and Conservative politicians, have increasingly ignored them, because their double standards have become more and more evident. The sceptics have paid lip service to addressing the inflated claims of Pharma-medicine, and its near-silence about direct harms, while their criticisms of CAM employ offensive language and oppressive behaviour.

    One recent example (readers can search my Tweets and website for ‘Goldacre’ and ‘Jessen’ for others): a few weeks ago I pointed out that professor Colquhoun’s calling Nadine Dorries MP ‘loony’ and ‘Mad Nad’ was offensive. It must be obvious that this has become actively counterproductive given that she is now minister for mental health and patient safety in the UK government https://twitter.com/NMacFa/status/1329828163065704451?s=20 .

    I was unable to directly point that out to professor Colquhoun because he had already censored my objection to his use of four-letter words https://twitter.com/david_colquhoun/status/137292135291551744?s=20 . I use ‘censored’ rather than ‘blocked’, because he is a professor at a publicly funded university, and therefore has an obligation to allow public scrutiny.

    The Chair of HealthwatchUK (which awarded professor Colquhoun its 2015 prize, and regularly engages with him), professor Susan Bewley, declined to take the offensive language seriously, and even offered the feeble excuse that professor Colquhoun had not ‘had the benefit of medical training to learn professional politeness’: https://twitter.com/susan_bewley/status/1329118846725337096?s=20 .

    For CAM-sceptic voices to reverse the decline in their influence, they need to change their behaviour, especially as it appears likely that there will be a Conservative government until at least 2029.

    • Nice to see that you have no substantial arguments agains the contents of my post. Thanks!

      • I have provided a substantial argument, against your assertion that conventional medicine is ‘likely to be holistic’. Abusing people who have a tendency to believe in CAM as ‘mad’ or stupid is certainly not holistic, is it? The NHS is a public service for everyone, not just for people who have a narrowly rationalistic outlook.

        Roger, above, wrote about a case in which a serious side effect from a prescribed drug led to a patient being alienated from what he calls ‘CON-med’. You ignored his point. Not holistic.

        You write (summarising a piece you pubished in 2007): ‘if a sector of healthcare fails to account for the whole person, we need to reform it.’ But you did/do not. As another Conservative (ex-)minister of health wrote in the 2020 Cumberlege Report: ‘It became all too clear that [patients] who have been affected have been dismissed, overlooked, and ignored for far too long. The issue here is not one of a single or a few rogue medical practitioners…’ https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf

        But there is no mention of this major government-funded Report, which concluded that CON-med’s overpromotion of prescribed drugs and devices is so out of control that a new ‘Patient Safety Commissioner’ is needed, in your Tweets or Blog. Not holistic.

        • I have provided a substantial argument, against your assertion that conventional medicine is ‘likely to be holistic’.
          NO YOU HAVEN’T
          Abusing people who have a tendency to believe in CAM as ‘mad’ or stupid is certainly not holistic, is it?
          I NEVER DID THAT IN CLINICAL PRACTICE
          The NHS is a public service for everyone, not just for people who have a narrowly rationalistic outlook.
          WHO SAID OTHERWISE?
          Roger, above, wrote about a case in which a serious side effect from a prescribed drug led to a patient being alienated from what he calls ‘CON-med’. You ignored his point.
          ON THIS BLOG, I GET SOME 50 000 COMMENTS, I HAVE NO AMBITION TO COMMENT ON ALL, PARTICULARLY NOT ON ANECDOTES.
          Not holistic.
          YOU SEEM TO HAVE A WEIRD UNDERSTANDING OF THIS TERM
          You write (summarising a piece you pubished in 2007): ‘if a sector of healthcare fails to account for the whole person, we need to reform it.’ But you did/do not.
          IT’S NOT MY REMIT NOR MY COMPETENCE.
          As another Conservative (ex-)minister of health wrote in the 2020 Cumberlege Report: ‘It became all too clear that [patients] who have been affected have been dismissed, overlooked, and ignored for far too long. The issue here is not one of a single or a few rogue medical practitioners…’ https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf
          WHAT HAS THAT TO DO WITH ME OR MY POST?
          But there is no mention of this major government-funded Report, which concluded that CON-med’s overpromotion of prescribed drugs and devices is so out of control that a new ‘Patient Safety Commissioner’ is needed, in your Tweets or Blog.
          SEE ABOVE
          Not holistic.
          SEE ABOVE

          • I have provided a substantial argument, against your assertion that conventional medicine is ‘likely to be holistic’.

            NO YOU HAVEN’T

            Indeed Mr MacFarlane has not. But he knows it’s substantial. And would his own brain lie to him?

            See also: fixed belief.

          • Just a few brief further responses:

            I NEVER DID THAT IN CLINICAL PRACTICE
            OK, but I am criticising your current campaigning, 90% of which I agree with. You are allowing your supporters to post abusive comments (‘rabid’, for example), and have sometimes been extremely offensive yourself (many would argue that ‘moron’ is abusive): https://twitter.com/EdzardErnst/status/1274611436392722432?s=20

            The NHS is a public service for everyone, not just for people who have a narrowly rationalistic outlook.
            WHO SAID OTHERWISE?
            The repeated criticism of CAM adherents as stupid, is closely parallel to the ‘God Delusion’ arguments of Richard Dawkins and others, which are widely seen as narrowly rationalistic.

            ON THIS BLOG, I GET SOME 50 000 COMMENTS, I HAVE NO AMBITION TO COMMENT ON ALL, PARTICULARLY NOT ON ANECDOTES.
            But you responded to part of Roger’s comment, and ignored the part about the prescribed drug adverse effect. That appears typical of your responses generally. You also appear to have a double standard about ‘anecdotes’: I have not seen you criticise the anecdotes of your supporters.

            Not holistic.
            YOU SEEM TO HAVE A WEIRD UNDERSTANDING OF THIS TERM
            Collins dictionary currently states that ‘holistic’ refers to the ‘complete person, physically and psychologically’. Clearly, patient experience of prescribed drug adverse effects falls within this. https://www.collinsdictionary.com/dictionary/english/holistic

            IT’S NOT MY REMIT NOR MY COMPETENCE.
            I disagree that it is outside your competence to start reversing the ‘double standards’ I complain of.

            WHAT HAS THAT TO DO WITH ME OR MY POST?
            The Cumberlege Report is very relevant to the context of the rise of ‘Integrated Medicine’, because it is clear that CAM adherents and practitioners lobby their MPs, and have found that Conservative MPs have been more receptive than Labour MPs. Baroness Cumberlege has set up an APPG with Jeremy Hunt, the former health secretary, and current chair of the Commons Health Committee: http://firstdonoharmappg.org.uk/

            Jeremy Hunt has appeared in several of your Blog pieces: https://edzardernst.com/?s=jeremy+hunt

          • @Neil MacFarlane: So are you just here to tone-troll, or is there a substantive point you intend to make?

          • has,

            @Neil MacFarlane: So are you just here to tone-troll, or is there a substantive point you intend to make?

            As as I understand it Dr MacFarlane is a psychiatrist who is actively campaigning to improve mental health services in the NHS by lobbying to increase funding and by calling out rogue practitioners and instances where pharmaceutical companies have exerted undue influence. He believes that there is an over-reliance on the use of psychoactive drugs (as a cheap and quick solution) rather than examining psychosocial causes of mental illness. His views here seem to extend more widely to the practice of doctors reaching for the prescription pad rather than considering alternative approaches (alternative to drugs, that is).

            As such, I think he is making the point that Roger’s concerns about long-term effects of conventional drugs, and the poor experience that his relative has had with a psychiatrist, are being dismissed out of hand rather than listened to. He is also making the point that many of the comments here are ill-mannered and inappropriate, and more importantly that you are never going to convince anybody of anything by being rude.

            He is also making the point that he is concerned about how effective supporters of alternative medicine are in lobbying their MP’s.

            I knew Neil a long time ago when we were part of a small group of medical students at Trinity College, Cambridge, within the wider class studying medicine at the university. We went our separate ways after we graduated, Neil to Guy’s Hospital and eventually into psychiatry and I to Westminster Medical School and ultimately into oncology. Nevertheless I don’t think he is the sort of person who would troll a site such as this one. I do agree that some of what he is saying is outside the remit of this blog, which is, of course, limited to the subject of alternative medicine. However, I don’t think that is a reason to be quite so dismissive.

            Over the time I have been reading and posting to the blog I have seen a tendency for commentators to divide other contributers into “them” and “us”, depending on which side of the SCAM fence they come down on. As a result it is too easy to rubbish anything the other side says, rather than to listen to it and accept that they may sometimes have a point (it is quite unusually for someone to be wrong about everything, though a couple of names spring to mind…). Then if you do disagree with something it is more effective to refute it with evidence rather than just to assume that they are wrong.

          • @JMK: “As as I understand it Dr MacFarlane is a psychiatrist who is actively campaigning to improve mental health services in the NHS by lobbying to increase funding and by calling out rogue practitioners and instances where pharmaceutical companies have exerted undue influence. He believes that there is an over-reliance on the use of psychoactive drugs (as a cheap and quick solution) rather than examining psychosocial causes of mental illness.”

            All of which is laudable, but that’s not what he’s doing here.

            “As such, I think he is making the point that Roger’s concerns about long-term effects of conventional drugs, and the poor experience that his relative has had with a psychiatrist, are being dismissed out of hand rather than listened to.”

            I’m sure everyone here can list both good and bad experiences with mainstream medicine; I know I can. That can explain why some patients fall for CAM, but not all; and certainly not the peddlers of CAM. More importantly, none of real medicines’ failings justify or excuse CAM’s own practices, which should build its case on its own merits—and by choosing not to do so reveals the even greater fraud at its own core. That is the topic that Prof Ernst chooses to discuss on his forum, which is understandable as that is his area of expertise. Those who wish to discuss different topics are free to start their own.

            In attempting to take over narrative here, CAMists are employing the sort of manipulative controlling behavior common to [domestic] abusers and cults; most recently seen on Capitol Hill, but also documented in the likes of r/raisedbynarcissists and Crash Override, not to mention professional works such as DSM-5.

            “He is also making the point that many of the comments here are ill-mannered and inappropriate, and more importantly that you are never going to convince anybody of anything by being rude.”

            I’m rude in my language, but only to those that invite it. Alties are rude because (in addition to unspeakably cruel language when it suits them) they lie, smear, manipulate, distort, lie again, evade, sh-t on the rug, poison the well, firehose, gaslight, and resort to argumentum ad populum, ad hominem, argument from incredulity, argument from antiquity, tu quoque, blame the victim, and (Roger’s personal favorite) Reductio ad Hitlerum when all else fails. And that’s even when they are sincerely and politely offered every opportunity to make their case using logic, honesty, and evidence. So who is insulting who here?

            You can argue the efficacy or otherwise of rude words, and whether or not it’s an effective response to their constant calculated trolling, but let’s not pretend the opprobrium isn’t earned. The AltMed regulars not here for any constructive purpose, only to roll around in their own reeking egotism and smear their critics’ faces with it at every opportunity they can too.

            Therefore I would urge Dr Neil MacFarlane MRCPsych to think very carefully about who he chooses to lie with lest he end up stenching too, because “Oh now look what you made me do!” is not the language of a victim; it is the language of the abusers.

          • @JMK: “Over the time I have been reading and posting to the blog I have seen a tendency for commentators to divide other contributers into “them” and “us”, depending on which side of the SCAM fence they come down on.”

            The CAMists are the ones ultimately enforcing that “them” vs “us” distinction, because they require it to fuel their narcissism—that ravening insatiable need to feel more special and better than everyone else. Even their paranoias (whether justified or not) are only there to service that demand.

            While we can choose to “walk in their shoes”, they must spit on ours. For them to do anything else is an admission that they are fundamentally no different to us, and while we may feel embarrassment at being so little different to Them, they are enraged at even the thought they are anything like Us.

            Now, there might be some pro-science advocates here who have never screwed up in their own lives, and a bit arrogant for that. But I’ve intimated often enough the harms that my own self-deceiving Need to Believe has caused to myself and those around me, and I’m willing to bet most science folk here are of similar “There but for the grace…” self-awareness.

            I mean, I always worry that I’m overreading other people, projecting my tiny awareness of Type 2 Cluster B personality types onto people I just don’t like. But, at the same time, I’m trying to form hypotheses that explain why these other people speak and behave as they do and, inexpert as they are, I’m hard pushed to find a better explanation of observed facts than: CAM cheerleaders do not think as we do, and do not hold the same priorities that we have. Which, as empathetic individuals, brings us to the other mistake we can easily make: automatically assuming others have the same empathy and insight that we do.

            As I recently noted in an exchange with Herr Hümmer:

            We are here because we hold concern for other people’s health and wellbeing, not just our own, and find ourselves ethically outraged by those whose lies endanger that.

            They are here because they want to win Debate Club.

            ..

            Of course, these are just some words I’ve written on a screen, and I can tell you for free that I’m wrong all the time. So everyone here should look to their own and each other’s behaviors to determine the veracity or otherwise of that particular opinion. But I am entirely confident that if you were to stack up all the gaslighting and firehosing performed by each “team” on this forum, the resulting evidence would be overwhelmingly one-sided.

            You and I may regard our personal “mea culpas” as an essential requirement of self-integrity. But understand: others will view admissions of error as a symbol of weakness, and will weaponize our own honesty against us—if we allow them. So while we should indeed hold out our hand, because that is in Our nature, we should feel no shame nor fear in holding it up for everyone to see every single time that They bite it.

            Abusers don’t win by being abusive. They win by convincing the rest of us to apologise.

        • Hi Neil,

          It is nice to hear from you after all this time. Is it really 40 years since we were room-mates?

          Roger, above, wrote about a case in which a serious side effect from a prescribed drug led to a patient being alienated from what he calls ‘CON-med’.

          I don’t know if you have been following this blog for a while or have just recently come across it. This is one of Roger’s more reasonable contributions. On the basis of his previous posts many of us regular readers have trouble taking him seriously.

          I am skeptical about his unsupported contention that the symptoms he describes are actually side-effects from a prescribed drug. I would be interested to know your reasons for accepting his beliefs as true.

          You ignored his point. Not holistic.

          Roger is a participant in a discussion, not a patient. Do you think it is relevant to take a holistic approach to challenging his arguments? I’m not even clear what that would mean in this context.

          But there is no mention of this major government-funded Report, which concluded that CON-med’s overpromotion of prescribed drugs and devices is so out of control that a new ‘Patient Safety Commissioner’ is needed, in your Tweets or Blog. Not holistic.

          There are many shortcomings of conventional medicine, including the ones that you allude to. However, they are outside the scope of this particular blog, which is concerned with alternative medicine.

          • “Roger is a participant in a discussion”

            I believe the medical term is “frequent flier”.

          • Hi Julian

            Thanks for your supportive comment of 21.49 yesterday. I am responding here (again – see below for my initial response to you which was ‘out of synch’) because it is no longer possible to do so in that thread.

            Three further points on the relevance of psychiatry to CAM:

            1. The recent removal of accreditation from the Society of Homeopaths, in which so-called CEASE was clearly a major factor, shows that children with autism and other ‘neurodevelopmental disorders’ are among the groups most vulnerable to CAM. https://edzardernst.com/2021/01/the-accreditation-of-the-uk-society-of-homeopaths-has-been-suspended/#comment-129622

            2. Fatigue is the second commonest symptom presenting to GPs, and many people have chronic fatigue, with no biomedical cause found on investigation. Given that theories of ‘energy’ are a common component of CAM modalities, those theories are likely to be partly a response to a need for which Conventional Medicine provides inadequate answers.

            What I would call ‘Conventional Psychiatry’ has claimed that it has shown both ‘graded exercise therapy’ (GET) and a modified form of CBT to be effective and safe for ‘Chronic Fatigue Syndrome’. NICE accepted the claim, but its current draft revision largely reverses that. If, as seems likely, NICE sticks to its decision, it will be a major setback for Conventional Psychiatry. https://www.bmj.com/content/371/bmj.m4356

            I predict that CAM proponents will see this as a further opportunity. https://edzardernst.com/2020/05/homeopathy-is-not-effective-for-psychiatric-disorders-a-new-systematic-review-and-meta-analysis/

            3. I agree that CAM is sometimes a ‘scam’. But I am not convinced, as professor Ernst seems to be, that most CAM practitioners are ‘fraudsters’, which would mean that they routinely employ conscious and deliberate deception. https://edzardernst.com/2019/08/so-called-alternative-medicine-scam-for-disease-prevention-please-dont-believe-the-fraudsters/

            Some psychiatrists specialise in ‘forensic’ mental health, part of which often includes the assessment of whether patients are lying. I was not such a specialist, but I worked in several forensic units (including a ‘psychopathic disorder’ service), and as an NHS consultant I had some ‘offender’ patients, detained under the ‘forensic’ sections of the Mental Health Act.

            It seems to me that if CAM opponents overstate the ‘fraud’ element of CAM, for example by blanket use of such terms as ‘SCAM’, that is another way to alienate patients who may have only mild or moderate CAM leanings.

          • “I am not convinced, as professor Ernst seems to be, that most CAM practitioners are ‘fraudsters’”
            where did I claim this?

          • @Dr MacFarlane: “But I am not convinced, as professor Ernst seems to be, that most CAM practitioners are ‘fraudsters’, which would mean that they routinely employ conscious and deliberate deception.”

            The first person that most CAM practitioners deceive is themselves. And if it was only themselves they deceived then no-one else would care but—as in all good religions/addictions/pyramid schemes—their need to feed their need demands growth, which means dragging in others beneath them.

            But perhaps there are other words in psychiatry or law for someone who goes on to deceive others having willfully deceived himself first? If you have any you think more appropriate, please share.

    • do you have anything of any actual substance to say?

      if you think having Nadine Dorries as Health Minister is a good thing your judgement must be suspect for one thing. It is highly doubtful she knows much about it – or anything else for that matter.

    • “[Mad Nads] is now minister for mental health and patient safety”

      Oh goodie, I feel so much saner and safer already. No wait… the other thing.

      “Dr Neil MacFarlane MRCPsych”

      I would say “physician heal thyself” but it looks like that boat has flown.

    • Is there any evidence that CAM is increasing?

      I am rather proud of the short tweet where I said “Not my job to negotiate your relationships” as it isnt. You Neil feel you have been ‘censored’ by lots and lots of people and then drag bystanders like me in.
      “I was taught it’s wicked to mock the afflicted. It’s an insult to people with MH problems to compare them to the venal, stupid or corrupt.” If that’s not condemnation, what is
      “DC hasn’t had the benefit of medical training to learn professional politeness” was an obscure reference to the licence regulated professionals do NOT have to be rude.
      I copied DC in.

      And still you return to attack a ‘loose group’ as if we were some conspiratorial cabal, or you are insatiable in the desire to knock everybody else but not look in the mirror.

      • “And still you return to attack a ‘loose group’ as if we were some conspiratorial cabal, or you are insatiable in the desire to knock everybody else but not look in the mirror.”

        Sympathies. IANAD, but when someone’s sincerely convinced that s/he is Right (but can’t coherently explain how) and the rest of the world is conspiring against him, I do wonder if it might be something neurological. In which case he’s lost the capacity for introspection and self-correction—so don’t waste your time appealing to those faculties—because it’s his own brain that’s lying to him: telling him he’s perfectly well, therefore everyone else must be ill. Horrifying and awful, and no fun for those around him either.

        But unless you’re family I’m guessing all you can do here is send a letter of concern to his medical regulator, and get others he’s targeting to do likewise, so that a clear paper trail of concerning behavior is established; and then maybe some action will be taken (although I wouldn’t hold my breath: foxes, henhouses, etc).

      • Hi Professor Bewley

        Professor Ernst Tweeted a piece in 2013 giving a 1.5% figure for CAM growth in 2012. https://twitter.com/EdzardErnst/status/414033719934996480?s=20

        This recent market research piece projects 16.8% annual growth: https://www.pharmiweb.com/press-release/2020-08-10/complementary-and-alternative-medicine-market-to-grow-at-about-168-cagr-during-forecast-period#:~:text=As%20per%20the%20report%2C%20the,CAGR%20between%202019%20and%202025.

        Clearly, the methodologies were not the same, but they do seem to support my impression that CAM growth is not merely present, but is accelerating.

        Professor Ernst’s CAM ‘Hall of Fame’ continues to grow. Inevitably, it has a UK focus, but the fact that six of its sixteen members are UK-based suggests that the ‘loose alliance’ is failing here. https://edzardernst.com/2021/01/a-homeopath-becomes-the-16th-member-of-my-the-alternative-medicine-hall-of-fame/

        I have Tweeted to you the fact of measles re-emergence in the UK, and you have not offered any argument against that being a valid indirect metric of CAM growth. When I talk with patients and families who have been harmed by conventional medicine, it is clear that CAM (and vaccine scepticism) are primarily fuelled by the double standards of the ‘CON-Med’ establishment.

        A piece in the Guardian this week cites 72% vaccine hesitancy (having read the research, I would use the stronger ‘scepticism’) among black people: https://twitter.com/NMacFa/status/1350855359045492742?s=20

        Regarding abusive Tweets and censorship by professor Colquhoun and others, yes you have given some acknowledgement of the validity of my concerns, but you need to go much further and be properly proactive.

        Do I look in the mirror? Of course! My reflection tells me ‘You chump! You should have started holding the self-interested and incompetent medical establishment to account much earlier!’

        • The distinct whiff of conventional medicine neither justifies nor excuses the reeking stench of SCAM. Anyone who borrows Roger’s idiot “CON-Med” tu quoques in performing AltMed apologetics is not doing himself any favors, least of all if he expects to effect substantive reform. Perhaps you need a new mirror? Because you look like a particularly sad Don Quixote from here. Carry on down your current path, even the windmills will regard you as a joke.

  • Integrative medicine is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle.

    Three weeks ago, I had a video-appointment with my rehab doctor. Besides making sure that I was alive she discussed my progress and my exercise plans, admonished me on my diet, and discussed how I was psychologically holding up under the pandemic.

    Gee, I guess she practices Integrative Medicine without anyone telling her.

  • Hi Julian

    Yes it is 40 years since we worked together as licensed (student) vivisectionists at Cambridge University! I have seen several of your contributions here, and consider them to be of high quality.

    However, I do not agree that it is ‘out of scope’ to provide evidence contrary to professor Ernst’s assertion (which is also widely implied elsewhere on his blog), that conventional medicine is ‘likely’ to be ‘holistic’. I take his assertion to mean that NHS medicine ‘is usually holistic’. It is not. It may well be that most ordinary specialists (including professor Ernst, when he was practising, and yourself) and GPs, do their best to be holistic, with limited resources. But that is not the same thing.

    I do not support CAM modalities such as homeopathy, but it seems to me that the gains made by Singh, Goldacre, Ernst & others 10-20 years ago have been thrown away, substantially due to the double standards I outlined.

    CAM has regrouped, and ‘Integrated Medicine’ is one expression of that. CAM is quite capable of promoting itself without recourse to libel litigation, just as Pharma-medicine does.

    When you write that Roger is not, strictly speaking, a patient in this context, that seems to me to be an overly narrow view. He was putting forward a patient’s experience. You may be correct in outlining how ‘candidiasis’ has taken on a life of its own in the CAM world, which departs from EBM orthodoxy. But in my experience of talking with CAM adherents who complain of adverse effects from prescribed drugs, there is usually some basis for their complaints. It seems likely that the drug prescribed was an antibiotic, and one only has to look at patient information leaflets to see a wide range of adverse effects described: https://www.medicines.org.uk/emc/files/pil.5923.pdf .

    • “CAM is quite capable of promoting itself without recourse to libel litigation”

      And yet, litigating critics is a favorite pastime of CAM’s most enthusiastic peddlers.

      As for Roger, you should know yourself that anecdotes are the lowest form of evidence. That gut flora disruption resulting from hard antibiotic use was not addressed in followup appointments screams all kinds of suspicious. And indeed, Roger himself notes that his cousin did not tell his doctors about it.

      Which is not to discount the possibility of suboptimal/substandard medical practice, as we all know that can and does happen. But as a qualified psychiatrist yourself you should know better than anyone the troubles of dealing with uncommunicative, uncooperative, noncompliant patients. And this is all, of course, assuming that a third-hand tale, communicated by a party who is known to have a highly prejudiced relationship to truth and disclosure, isn’t just another self-servingly manipulated AltMed steamer.

      Faults in real medicine neither validate nor justify CAM. If CAMmers honestly gave a crap about real medicine’s failings, the first thing they’d do would be to discard CAM entirely so that everyone can devote full and undivided attention to engaging and improving real medicine going forward. But that’s not their goal; their goal is to smear medicine with excrement so that patients who don’t know the details will be fooled into buying their heavily perfumed steamer instead. And if you can find a bigger, more cut-n-dried, abuse of patients’ trust than that, you let us know, m’kay. ’Cos right now you are part of the problem, and we are not nearly so blind as you take us for.

      • @ has

        hear hear!

        I think that is indeed the danger.
        I don’t believe anyone is arguing that conventional medicine is anywhere near perfect – but the remedy for that is certainly NOT SCAM!

        SCAMmers are duplicitous, are peddling pseudoscience and have a totally different agenda.

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