From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)
In May, the International Research Congress on Integrative Medicine and Health (IRCIMH) conference was held in Miami. In the words of its website, the conference was “convened by” the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), “in association with” the International Society for Complementary Medicine Research. As CAHCIM chirped in this tweet: “Three days, 22 countries, 100 academic medical institutions, [and] 900 researchers, physicians, educators, and trainees…” Interestingly, despite the fact that “use of all appropriate … healthcare professionals and disciplines to achieve optimal health and healing” is part of CAHCIM’s definition of integrative medicine, actual CAM providers were barely visible among the conference committee bigwigs.
Emmeline Edwards, Ph.D., Director, Division of Extramural Research at the National Center for Complementary and Alternative Medicine (NCCAM), herself on the conference’s Program Committee, was decidedly underwhelmed. (NCCAM helped fund the conference. Additional funding information here.) After offering rather tepid congratulations to the organizers and participants, Dr. Edwards launched into a pointed, but very politely delivered, criticism of the research presented (emphasis mine):
The poster sessions offered a great opportunity to meet many new investigators engaged in exciting research in the field of integrative health. Reflecting on some highlights of these sessions, I was brought to the realization that we could strive for better balance in the science featured in the IRCIMH poster presentations. The clinical research posters outnumbered the basic research presentations 3:1, and research on mind and body strategies dominated the research landscape. One concern is that many clinical research projects were not developed from adequate mechanistic studies and, hence, the outcomes from these projects may not be very informative, provide a well-defined path for the next study, or give direction for future research programs.
How right you are, Dr. Edwards! We’ve been saying some of the same things here at SBM for years. We’ve noticed these very same problems in the organization you work for. Recently, as a matter of fact.
Perhaps I can help Dr. Edwards understand the deficiencies she noted. Integrative medicine proponents prefer clinical research over basic research and don’t particularly care for “adequate mechanistic studies” because having to demonstrate a plausible mechanism of action would eliminate their use of too many of the tools of IM, such as acupuncture, homeopathy, therapeutic touch and reiki. They much prefer tooth fairy science, where prior plausibility is considered unnecessary and plunging right into clinical research allows them to skip the hard stuff.
It doesn’t matter that the outcomes may not be “informative” or provide a “well defined path” or guide future research. Outcomes aren’t that important. You will find an array of “alternative” therapies employed by IM practitioners (also here and here, among many others) where there is no good evidence of effectiveness. Nor is a “well defined path” to the next study necessary when research continues willy-nilly on all sorts of implausible and unpromising treatments. (Just look at the list of abstracts at the very conference you discuss.) How many times have you seen the statement “more research is needed” at the end of a study of some wholly implausible treatment that shows no evidence of effectiveness? As long as “more research is needed” and researchers can find the money to fund it from, say, NCCAM, or other taxpayer funded or private source, research will continue, whether we need it or not.
And why is there so much emphasis on “mind and body interventions?” That’s where the money is. Your agency, NCCAM, has lumped just about all of CAM into one massive category called “mind and body medicine.”
As used in this plan, mind and body encompasses interventions from the three domains of mind/body medicine, manipulative and body-based practices, and energy medicine.
In the ever-shifting definition of CAM, a category called “mind and body medicine” includes “mind/body” as one subset and “body” as another subset. Clear on that? Me neither. Thus, now practically all of CAM is “mind and body medicine,” including such diverse practices as acupuncture, yoga, spinal manipulation, Pilates, reiki, craniosacral therapy and reflexology.
An independent review
The Journal of Alternative and Complementary Medicine has granted open access to the abstracts of poster presentations from the conference. Let’s take a look and see why Dr. Edwards might be concerned that the poster presentations weren’t up to snuff. And let’s see if these presentations measure up to the CAHCIM’s mission of “disseminating information on rigorous scientific research.”
The existence of a Scientific Review Committee for the conference indicates there were some sort of criteria these poster presentations had to meet, but there is no information I could find as to what those criteria might be. Evidently, the bar was extremely low, as we shall see. The Committee was headed by Chairs David Eisenberg, MD, of Harvard, who has a position at the Samueli Institute as well, and Peter Wayne, PhD, also of Harvard. Dr. Eisenberg’s colleague at the Samueli Institute, Wayne Jonas, M.D., was on the Committee too, in charge of Research Methods.
Tooth fairy science
We’ll start with a few examples of tooth fairy science, or as Dr. Edwards put it, clinical research “not developed from adequate mechanistic studies,” and begin with a real jaw-dropper. Six pediatric patients who presented with appendicitis at the Children’s Hospital in Los Angeles emergency room were recruited for a trial of Japanese acupuncture for pain and inflammation. The rationale?
Acupuncture has been shown to treat various medical conditions including acute and chronic pain, and there is speculation that it has anti-inflammatory effects.
Since when is “speculation” a sufficient basis for pediatric human subjects research?
Many iterations of acupuncture were the subject of poster presentations: Japanese acupuncture, “regular” acupuncture, electro-acupuncture, group acupuncture, bee venom acupuncture, and music electro-acupuncture. Had to look that last one up.
[Researchers] suggested that sound waves converted to electric currents may be used to stimulate acupuncture needles to get better results. An apparatus has been devised . . . to convert music into electric waves suitable for use in electro-acupuncture by which the frequency is changed in accordance with the music.
Researchers at the School of Acupuncture-Moxibustion and Tuina in Beijing tested this on rats to see if it might improve mild depression and concluded that it “could have a positive effect.” I wonder if the type of music matters? Is punk rock better or worse than classical? How about jazz versus country music? Obviously, more research is needed.
In addition to many studies of acupuncture, there were studies of wet cupping on depression and anxiety as well as on markers of inflammation and Hsp proteins in patients with metabolic syndrome. You’ll not be surprised to learn that wet cupping didn’t work.
It seems TCM practitioners are dissatisfied with their “theories,” so much so that they feel the need to correlate them with “Western” tests and diagnoses. One study of TCM diagnoses opined that “liver housing blood” could be concluded from lab tests showing, for example, reduced potassium levels. Another found that “the changes of tongue picture can reflect the severity of hepatic cirrhosis in a certain extent.”
Apparently, in kinesiology “theory,” one muscle will weaken after the practitioner speaks a lie and stay strong if he speaks the truth. According to this series of studies, kinesiology practitioners correctly distinguished lies from the truth more often than by chance alone or by guessing. Sense About Science take note: the researchers are from the University of Oxford and City University London.
Researchers concluded that therapeutic touch had significant effects on immune responses by down-regulating serum cytokines, macrophages, and modulated lymphocyte subsets in mice. It also significantly reduced metastasis but not primary tumor size in a mouse breast cancer model. Per another study, Bach Flower Remedies, whose intent is to “harmonize the ethereal, emotional and metal body”, decreased anxiety.
One study employed The Reiki Client Quality Monitoring Tool (who knew?) and found that a decrease in pain and stress and an increase in “happiness” for both in- and out-patient oncology patients. (No control, no blinding.) Brennan Healing Science is another energy healing modality. (This was the first I’d heard of “BHS.”) A “survey development and pilot testing” for a BHS study to see “which conditions may be amenable to energy healing” was presented. If you ask the healers, a lot of conditions are amenable, according to the abstract. The healers reported that 25.4% of physical symptoms and 27.8% of psychosocial symptoms improved completely. (I‘m not sure what “improved completely” means.) “Spiritual factors” (whatever they are) improved the most. This small survey of healers will now be “administered to hundreds of others worldwide.”
Integrative medicine research can make for strange bedfellows. The Upper Cervical Research Foundation, which posits that “when a small but measurable spinal misalignment known as the Atlas Subluxation Complex (ASC) is detected and corrected, a return toward good health and normal activity can be realized,” partnered with the University of Calgary and Alberta Health Services to conduct research on the effect of upper cervical manipulation on migraine headaches. They determined that this intervention was indeed beneficial.
And here are some stunning statistics regarding “unconventional” lab tests. Researchers from Yale, Georgetown and Ohio State conducted a survey of 638 licensed healthcare professionals who were “associated with” CAM/integrative medicine organizations. The most frequently used lab tests included, among others, stool analyses, salivary hormone assays and urine heavy metal tests, all biggies in the alt med field. The results showed that about a third of adults and up to a whopping 46% of pediatric patients were subjected to these unconventional tests. 61% of practitioners used unconventional tests for children and adolescents. 40-53% of adult tests were reimbursed by third parties, such as Medicare and private insurance.
So what were the researchers’ recommendations? Investigate why taxpayers are footing the bill for nonsensical tests? Outrage that children were being subjected to these tests? A call for tighter regulations on lab testing? Nope. None of these. They want “further study” of their validity, apparently based on the nonsensical rationale that “unconventional tests are often utilized in chronic conditions without reliable mainstream treatments.” So, since there isn’t a science-based treatment, we need to study how CAM providers determine the need for bogus treatments with bogus tests.
Rebranding
Apparently, the quest to rebrand is never ending in integrative medicine. Here we have an example from the University of Kansas. The victim is the discipline of Dietetics and Nutrition. As the abstract points out,
Integrative Medicine is an expanding field of healthcare that emphasizes nutrition as a key component.
Yes, expanding by rebranding. Dietetic interns were placed in the IM program and a new subspecialty was created, Dietetics in Integrative Medicine (“DIM”), which includes a new Master of Science degree for a Graduate Certificate in DIM. As budding dieticians, perhaps the DIM students could perform an actual demonstration of Crislip’s Theorem:
If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.
Rebranding in integrative medicine includes not only poaching from science-based medicine, but also recasting negative results as positive. Two examples:
In a Norwegian study, two medical doctors reviewed complaints of adverse reactions to homeopathy. These reactions were then evaluated independently by two homeopaths. The homeopaths rebranded about two-thirds of the adverse effects as “homeopathic aggravations,” which actually “indicates an improved health status after an initial aggravation.”
Good evidence has been rebranded as bad attitude. In a survey of 750 CAM providers, 47.6% reported feeling pressure to demonstrate practice effectiveness. Cranial sacral therapists reported the least pressure, which is good for them, considering there is no evidence whatsoever that cranial sacral therapy is effective. Chiropractors, naturopaths and reiki practitioners (of all people) reported more pressure. I would think this increased perception of the importance of evidence-based practice would be viewed as a positive development, but research begs to differ. Why? Because, according to Self-Determination Theory, healthcare providers who feel pressure to demonstrate effectiveness “will adopt a controlling rather than an autonomy-supportive motivational orientation.” So now evidence-based practice is bad? (Which would sure be a good thing for CAM.) And is the hegemony of reductionist conventional medicine applying the screws? Nope. They are the least mentioned source. Most common source? The general public. Good for them.
Physics
No discussion of CAM research would be complete without a look into what we’ll call “alternative physics.”
One presentation from two researchers at the University of Maryland and its medical school purported to test the hypothesis that “human bioenergy fields consist of a form of energy that can push against physical objects, as in psychokinesis.” (James Randi, are you listening?) They claim to have discovered, by using a torsion pendulum balance, not only that “effects were dramatic” but also that “the pendulum oscillated with many new frequencies.” They found “intriguing” the fact that “effects exerted by the subject on the pendulum persist for 30-60 minutes after the subjects departs from the pendulum” suggesting to them that “the effects are somehow retained within the molecular/atomic structure of the steel mesh or coco fiber hemisphere” which were the aforesaid physical objects in this research project.
William Tiller and Nisha Manek of the Tiller Institute had a poster presentation on “Information Medicine: Emergence of a New Medical Paradigm.” Tiller is the founder of the Institute for Psychoenergetic Science, an outfit showcasing, well, basically, him. Here’s the abstract’s word salad, I mean, conclusion:
Information (intention) is a source of free energy and can change whole living systems in a specific and beneficial direction and robustly expands the normal molecular theories of bio-information. Crucially, human consciousness as the source of free energy is capable of driving chemical processes and opens the door to INFOMED. Modern physics concepts of information theory suggest a higher level of therapeutic intervention that go beyond the traditional mental, emotional and physical approaches to treating diseases.
In another strange bedfellows combination, the Tiller Institute teamed up with the Biostatistics Department at the University of Iowa to conduct a study of an “Intention Host Device [IHD] imprinted with intention to assist autistic individuals [n=39], located around the globe, to integrate into the physical bodies and experience.”
The researchers concluded that “intention broadcast by an IHD resulted in significant gains” for the test subjects in sociability, communication and other improvements.
There were four poster presentations on two related products, the BioPower Bioceramics Pad and the BioPower Bioceramics shirt. What are they? BioPower products are a combination of two “technologies.” From the company’s (Multiple Energy Technologies, LLC) website:
BIO Power technology is based in part on bioceramics, ultrafine mineral particles with photothermal properties that are extracted from the Amazon rainforest. When heated by the human body or another source, the minerals embedded in the product emit long infrared radiation that increases cellular metabolism, induces analgesia, promotes muscle relaxation, and decreases inflammation and oxidative stress.
The other half of BIO Power’s dual technology is vibrational therapy, the practice of
manipulating energy fields to affect health. The human biofield is a network of complex electromagnetic fields engendered by the movement of sub-atomic particles. BIO Power products are imprinted with signature frequencies that transmit to the user upon contact, rebalancing the energy fields that help to regulate cellular physiology.
Apparently these studies did not test the claim that the “energy fields” of mice or men (or women) could be manipulated to “rebalance” them. It is not clear from the website whether the shirts include the vibrational therapy feature. In any event, according to these researchers, the bioceramics pad was beneficial to mice pain, paw strength and stamina. The shirts were beneficial to judo practitioners’ and basketball players’ performance.
Why bother?
All in all, I think you’d have to agree that CAHCIM certainly met its goal of “disseminating information on rigorous scientific research” with these outstanding presentations. Excellent job, Scientific Review Committee!
Dr. Edwards ended her comments by reminding integrative medicine researchers of NCCAM’s goals for its research portfolio (emphasis mine):
research that is conducted at the appropriate stage based on current evidence; research that is statistically powered to assess clinically meaningful outcomes (when the evidence base is sufficient to support an efficacy trial); and research that proposes realistic timeframes and budgets and test hypotheses that will guide future research. We want to encourage our investigators to give strong consideration to the strength and quality of their preliminary data, the appropriateness of the proposed methods to answer their stated hypotheses, the feasibility of a clinical trial as designed, and the potential impact of trial outcome to shape future studies.
The most likely result of following these rules, of course, is that even more studies will demonstrate a lack of benefit for CAM practices. And since evidence doesn’t seem to matter to integrative medicine practitioners, why bother?
