I have long been critical of the World Health Organization’s promotion of dubious treatment methods under the banner of “traditional medicine”. It now has a global strategy to promote what is calls “traditional, complementary and integrative medicine” (TCIM). In my opinion (shared by at least some others) the document is a master class in how to promote medical pseudoscience with the language of evidence-based medicine. It is very similar to RFK’s use of “gold standard science”. Superficially, it sounds fine, but in context, it is a weaponization of the weaknesses and misunderstandings of evidence-based medicine.
The goals sound reasonable, such as this paragraph:
“For the first time, the strategy presented a WHO definition of integrative medicine as “an interdisciplinary and evidence-based approach to health and well-being by using a combination of biomedical and traditional and/or complementary medical knowledge, skills and practices”. The strategy also emphasizes the need for robust scientific evidence and appropriate regulation to support the safe and effective integration of TCIM into health systems and services.”
But the document gives the game away in several critical ways, including what it says and what it doesn’t say. First, if you want to integrate rigorously evidence-based traditional medicine into mainstream medicine, I would argue this has already been done. Of course, this is a process, and I am not arguing that it is complete. Rather, science-based medicine is agnostic toward the origin or modality of any medical intervention. What matters are whether the intervention is scientifically plausible, and how robust the evidence is to indicate safety and efficacy.
Therefore, the unstated major premise of the entire document is that there are safe and effective treatments that are not being used by mainstream medicine systems for some reason. This is unlikely because how would we have rigorous evidence of safety and effectiveness if a modality were not already incorporated into mainstream medicine? Who did this research, and why? Are doctors leaving effective treatments on the table?
At best, there is an argument to be made about inefficiencies and biases in various health care delivery systems, but that is not the approach of the WHO or this document. Supporting research into treatments that are not profitable is fine. Supporting healthcare systems to provide for people who lack effective treatments is also fine.
Further, if you want to integrate science-based medicine into existing traditional health infrastructures, that can also be a way to bring more and more effective health care to many people. But the WHO wants to do the opposite – to integrate unscientific and ineffective treatments into scientific medicine.
One of my biggest concerns with this approach is captured by the frequent use of the phrase “strengthening the evidence base” for TCIM. Whenever the document refers to research, it is to shore up the evidence for TCIM. Never in the document – not once – does it refer to the use of science or evidence to determine “if” a treatment works. Never does it even entertain the notion that one goal of this project might be to eliminate treatments that do not work. It’s as if it assumes there is no such thing as a TCIM intervention that is not safe or effective.
This is consistent with the CAM world in general, and it is clear that CAM promoters have their fingerprints all over this document. First, they equate complementary, alternative and integrative language with “traditional” medicine practices. That was their entry into the WHO. Then they infuse their propaganda into the entire project – essentially hijacking support for traditional health systems to promote CAM pseudoscience and snake oil. Mission accomplished.
The other biggest indication that this is nothing but CAM promotion is their approach to evidence. While they constantly state that this project will only integrate methods that have the highest standards of evidence, they then outline lower standards of evidence (right in line with CAM propaganda).
They refer to “research approaches appropriate to the unique characteristics of TCIM.” This includes “complexity science”, which again is not necessarily a bad thing, but is easily abused. This refers to research within complex systems, where single variables are difficult to isolate. CAM proponents are good at latching onto scientific jargon and then twisting it to their own ends. In this case, they use the term “complexity science” to argue that standard research methods, like double-blind placebo-controlled trials, are not suited to studying their unique methods. You cannot control for variables, so you have to look at the entire system. This is a fancy way of justifying low-quality observational data, the kind that is rife with confounding factors like placebo effects.
Many of the methods they recommend are legitimate in themselves – when used properly. For example, they make many references to “real world” data. All of these observational techniques are helpful to show how treatments operate in practice, or to generate hypotheses. But – they are not a substitute for controlled studies, and they cannot be relied upon to determine safety and efficacy. To someone not steeped in the nuances of science-based medicine, they may sound good. But in reality they are a blaring warning sign, code for – we are not going to do the kind of science that can determine if a treatment works, only the kind that is guaranteed to show that it does work.
There is nothing in this long document to indicate that they understand any of this. They never say that if scientific evidence shows convincingly that a treatment modality is unsafe and/or ineffective they would recommend or take specific steps to eliminate it, or to protect the public from harmful or useless treatments. This is a ratchet of promotion, not a scientific process to separate what works from what doesn’t work.
For those who have been following this saga (the infiltration of medicine with snake oil) over the last half a century, there is one very telling sign – despite the evolving language, and labels, and justifications, and terminology, the modalities that are being promoted never change. It is the same list of dubious treatments – homeopathy, acupuncture, chiropractic, energy medicine, and “natural” remedies. The list never changes, because proponents are not using evidence to determine what works. They are not making genuinely new discoveries. They are just trying to find new ways to market their same-old products.
In short, this is an epic failure on the part of the WHO. They have allowed themselves to be hijacked by an agenda to promote profitable snake oil. This is ultimately entirely about supporting a fraudulent industry projected to be worth $369 billion by 2032. This will likely have a net harm to the health of the people they purport to serve.
This also represents the failure of evidence-based medicine to enforce its own standards, and to police its domain. EBM has become a marketing term. It means whatever people want it to mean, which is often – I can cherry-pick evidence to show that my treatment works; therefore it’s evidence-based, even if the treatment itself makes zero scientific sense.
