Bravewell Collaborative
This is yet another response to the recent “Integrative Medicine in America” report published by the Bravewell Collaborative. Drs. Novella and Gorski have already given that report its due, so I won’t repeat the background information. Inevitably, I’ll cover some of the same points, but I’ll also try to emphasize a few that stand out to me. Most of these have been discussed on SBM over the years, but bear repeating from time to time. Let’s begin with:

If it ducks like a quack…

Misleading language is the sine qua non of ‘integrative medicine’ (IM) and its various synonyms. The term itself is a euphemism, intended to distract the reader from first noticing the quackery that is its distinguishing characteristic. As previously explained, Bravewell darlings Andrew Weil and Ralph Snyderman, quack pitchmen extraordinaires, recognized nearly 10 years ago that if you really want to sell the product, you should dress it up in ways that appeal to a broad market.

Let’s see how this is done in the latest report. Here is the very first sentence:

The impetus for developing and implementing integrative medicine strategies is rooted in the desire to improve patient care.

Who would disagree with improving patient care? (Try not to notice the begged question). Here’s the next paragraph (emphasis added):

The Bravewell Collaborative, a philanthropic organization that works to improve healthcare, defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.”

Who would dare to disagree with those points? Other than biting off more than it can chew (see below), the definition applies to modern medicine, which tries to be patient-centered, holistic (in the honest sense of the term), “personalized,” scientific, etc. You have to be pretty savvy to recognize the misleading hype in that paragraph:

  • “The Bravewell Collaborative…works to improve healthcare.” That would require that highly implausible medical claims—the only things that distinguish IM from real medicine—actually do what their proponents claim. They don’t, as we at SBM have been explaining for years.
  • “…puts the patient at the center.” That implies “patient-centered care,” which requires that practitioners provide honest, comprehensive information about the methods in question. IM practitioners are universally dishonest about such matters. They have to be, because otherwise they’d have to tell patients the truth: that the methods are worthless. In a subsequent post I’ll provide examples pertinent to this report.
  • “…an array of scientific disciplines.” This is standard quackspeak for “an array of pseudoscientific disciplines.” Here’s an example from that Mother of All IM centers, Andrew Weil’s Arizona Center for Integrative Medicine:

[Iris Bell, MD, PhD] is a clinical researcher with an emphasis on systems theory as a conceptual framework and the use of psychophysiological methodologies (EEG, cardiovascular) to study the linear and nonlinear effects of homeopathic remedies and low level environmental chemicals.

  • “…to heal illness and disease.” The standard muddling of everything that might bother anyone, whether medical or not, other than being strapped for cash. This effortlessly leads to offering anything that might make someone feel better, whether medical or not, other than money. See how easy IM is?
  • “…maintain optimum health.” Another standard IM gambit: its special and specious claim to preventive medicine.

Making promises they can’t keep

A recurrent theme is that IM can do, well, everything. We saw evidence of that above:

…an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health.

In the very next paragraph, the Bravewell Report makes it explicit (emphasis added):

…very little information had been collected regarding the actual practice of integrative medicine, which by definition treats the whole person.

It may not immediately occur to many readers, in this Era of Hype, but such a claim is ridiculous. Philosophers Clark Glymour and Douglas Stalker recognized this nearly 30 years ago in their essay about ‘holistic medicine,’ previously discussed on SBM here and here:

Another doctrine said to be holistic is that one’s state of health is affected by everything. Whatever this means, it has nothing to do with any possible practice of medicine, for no one can attend to everything. If physicians cannot distinguish relevant from irrelevant factors, important from unimportant causes, then they can do nothing.

Glymour and Stalker’s next few sentences, by the way, were these:

A variation of this doctrine is not vacuous but merely vapid: ‘Fundamental to holistic medicine is the recognition that each state of health and disease requires a consideration of all contributing factors: psychological, psychosocial, environmental, and spiritual.’ [Pelletier 1979] This is not a new revelation about medicine. Insofar as such multiple factors are known and believed to be important, they are routinely addressed in conventional medicine practice.

It would seem not to be a new revelation about ‘integrative medicine,’ either; just a repackaging of the same old stuff by a different label. Even the authors are the same.

An established part of healthcare?

From the Bravewell report’s conclusion:

The strong affiliations to hospitals, healthcare systems, and medical and nursing schools as well as the centers’ collaborative work with and growing referrals from their own health systems reveal that integrative medicine is now an established part of healthcare in the United States.

Being “an established part of healthcare” is not the same as being accepted as valid in any important medical sense. I suppose one would be technically correct to write, “chiropractic is now an established part of healthcare,” but that would ignore the only interesting question about chiropractic.

There is no question that some of the centers looked at in this report are affiliated with hospitals and healthcare systems. Some that claim to be so affiliated are not, however. The Marino Center for Integrative Health in Cambridge and Wellesley, Massachusetts, is identified in the report as having a “hospital affiliation” with the Newton-Wellesley Hospital, which is where I work. In fact, some but not all of the Marino Center physicians have been granted staff privileges at my hospital—a mistake, in my opinion—but there is no institutional affiliation whatsoever. In two weeks I’ll look at the Marino Center in some detail.

More from the Bravewell conclusions:

…high levels of concordance of interventions for specific conditions suggests that integrative medicine practice is informed by a common knowledge base.

The naive reader might assume that a “common knowledge base” suggests something about medical validity. It does not. It suggests something about faddism.

The data from the survey reveals that integrative medicine centers embrace a group of core values that inform and radiate through their practice and interactions with their patients.

Ah, ’embrace,’ ‘inform and radiate’: you don’t need a baloney detection kit to notice that such metaphors inform and radiate through quack treatises everywhere.

Ultimately, Bravewell quacks

Here’s the final paragraph of the conclusion in the Executive Summary:

One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with nonconventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community.

Don’t you just love how spin doctors occasionally slip, and admit to what you knew was the case all along? I’ve been referring to what Bravewell calls “nonconventional or non-Western therapies; ancient healing wisdom” by the useful and accurate shorthand, “quackery.” For a somewhat broader treatment, let’s go to Glymour and Stalker:

The therapies described and recommended in a typical book of the genre include biofeedback, hypnosis, psychic healing, chiropractic, tai chi, iridology, homeopathy, acupuncture, clairvoyant diagnosis, human auras, and Rolfing. One of the larger books of this kind was even subsidized by the National Institute of Mental Health.
What ties together the diverse practices…? In part, a banal rhetoric about the physician as consoler… In part, familiar and rather useless admonitions about not overlooking the abundance of circumstances that may contribute to one condition or another. Such banalities are often true and no doubt sometimes ignored, with disastrous consequences, but they scarcely amount to a distinctive conception of medicine. Holist therapies can be divided into those that are adaptations of traditional medical practices in other societies—Chinese, Navajo, and so forth—and those that were invented, so to speak, the week before last by some relatively successful crank.
Insofar as it extends beyond banality, the holistic medical movement constitutes both a deliberate attempt to substitute a magical for an engineering conception of the physician and an attack on scientific understanding and reasoning. Although the holistic movement does not contain a conception of medicine distinct from those we have discussed, it does contain a reactionary impetus to return the practice of medicine to the practice of magic and to replace logic and method with occultism and obfuscation.

“Welfare for the rich”

The two philosophers warned of what Bravewell calls “integrative medicine” becoming “an established part of healthcare”:

If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason. Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign. At times, physicians may find themselves in sympathy with the holistic movement, because some fragment of the rhetoric rings true, because of certain practices and attitudes they encounter in their daily work with colleagues and patients, or because of dissatisfaction with the economic and social organization of medicine. One hopes they will speak bluntly, but it does no good to join forces with cranks and quacks, magicians and madmen.

Bravewell is what can happen when ditzy rich people who know little about medicine or science get it into their heads that they know something—some crucial secret or secrets, little known to most in medicine except for a few cranks who themselves have found the secret to easy money. That would be maddening enough, although we must expect it as part of living in a free, democratic society. What we shouldn’t have to accept is that those rich people haven’t been using their own money. They’ve been using ours.



Posted by Kimball Atwood