[Editor’s note: This post might seem familiar to some because it appeared on my not-so-secret other blog in other forms. I apologize, as I pride myself on producing new material for SBM every week, but I do have a good excuse. I’m currently in Manchester, England, having just finished attending QEDCon, where I gave a talk on integrative medicine. There just wasn’t time to do more material.]
John Weeks has long been an activist for what is now known as “integrative medicine,” earlier known as “complementary and alternative medicine”(CAM). Basically, for many years Mr. Weeks has been at the forefront of encouraging the “integration” of quackery with real medicine and promoting what I like to refer to as “quackademic medicine,” a perfect term to describe the increasing encroachment of pseudoscience and quackery in medical academia in the form of—you guessed it—integrative medicine. For some bizarre reason in May 2016 he was appointed editor of the Journal of Alternative and Complementary Medicine (JACM), even though he has zero background in science or medicine of a type that one would expect in a journal editor. Once there, he wasted little time comparing doctors advocating science-based medicine and opposing pseudoscience in medicine to Donald Trump.
Fast forward a year and a half, when the University of California, Irvine (UCI) accepted a $200 million gift from Susan and Henry Samueli to vastly expand the integrative medicine offerings at UCI (which were already quite extensive) in the form of establishing the Susan and Henry Samueli College of Health Sciences, with the current Susan Samueli Center for Integrative Medicine becoming the Susan Samueli Integrative Health Institute. Amazingly, it wasn’t just skeptics like Steve Novella writing negative articles about this development. Michael Hiltzik of the LA Times wrote an article in which Dr. Novella and I were quoted with a lovely headline, “A $200-million donation threatens to tar UC Irvine’s medical school as a haven for quacks.” Elsewhere, Usha Lee McFarling over at STAT News chimed in with a story with a somewhat less critical but still quite unflattering headline, “A $200 million gift promotes alternative therapies at a California medical school — and critics recoil.” Both articles contrasted the claims by Dr. Howard Federoff, CEO of UC Irvine’s health system that the new institute and college will be rigorously evidence-based with the reality of the homeopathy offered by UCI. Hiltzik, amusingly, pointed out how UCI was trying to send references to homeopathy on its website down the memory hole and failing miserably. Meanwhile, Rick Seltzer at Inside Higher Ed quoted Steve Novella as he asked, “Does $200 million quack?” (My answer: Yes. Very loudly. And, yes, I used that line in my talk at QEDCon.)
Steven, of course, used this story to point out that UCI has long embraced homeopathy. Also, because all naturopaths are trained in homeopathy, you can’t have naturopathy without homeopathy. Those of us who know how deeply “integrated” (couldn’t resist) quackery is in naturopathy couldn’t help but point out that Dr. Federoff’s claim that UCI’s new integrative medicine effort will be rigorously evidence-based is complete and utter bullshit unless UCI gets rid of naturopaths, at least as a start. Also, given that the Samuelis are very much believers in homeopathy, so much so that they mentioned support for research into homeopathy in one of their gift agreements with UCI in 2004, I highly doubt that UCI could dump homeopathy very easily even if Dr. Federoff wanted to. Indeed, given Dr. Federoff’s long history of integrating quackery into medicine at Georgetown, which was his gig before he moved to UCI, I doubt that Dr. Federoff is particularly serious about getting rid of the quackery, anyway. It’s now too entrenched.
This sort of coverage clearly enraged poor Mr. Weeks, who goes to great lengths to project a facade of civility in comparison to all the “anger” he portrays on “our” side. Indeed, his facade slipped so much that he misspelled Mr. Hiltzik’s name alternatively as “Hitzig” and “Tiltzig” in a post published—where else?—that original wretched hive of scum and quackery, The Huffington Post, in the form of an article entitled “Shameful Media Response to the Samueli’s Visionary $200-Million Integrative Health Investment at UC Irvine,” in which he refers to critics of integrative medicine as “antiscience” and as “having blood on our hands.” You can get a taste from the introduction:
The response of the LA Times, STAT, Medpage, and most media to the visionary $200-million integrative health investment of Susan and Henry Samueli at UC Irvine has been a shameful display of media descent into Trump-like, polarizing tweets. Worse yet, the coverage has been a profoundly anti-science. These media, and others, have chosen to provide platforms to a small handful of individuals who for decades have denied the evidence of acupuncture, chiropractic, mind-body and multiple other integrative approaches.
Mr. Weeks is nothing if not predictable. These days, to him any criticism of integrative medicine is “Trump-like” and “polarizing.” This is the schtick he came up with last year, before the election and continuing after it. To this recent but now familiar trope, Mr. Weeks adds a new epithet: “Anti-science.” In essence, he is doing exactly what climate science denialisms and antivaxers do: Try to flip the narrative and portray themselves as the true defenders of scientific inquiry and their critics as close-minded dogmatic skeptics who will not consider all the evidence. This is, of course, nonsense when antivaxers and climate science denialists do it, and it’s no less ridiculous when Mr. Weeks does it. Also, note how Mr. Weeks also tries to minimize the criticism by minimizing the critics, referring to us dismissively as a “small handful of individuals,” in order to portray us as being a tiny minority who can safely be ignored. Elsewhere in his article, he refers to Medscape “bleating” out a link to McFarling’s article in STAT. (Get it? We’re sheeple.) Sadly, Mr. Weeks’ tactics are all mind-numbingly obvious, but at this point in his jeremiad, Mr. Weeks turns out to be just getting started. It doesn’t take him long to work himself into a fine lather:
From his LA Times podium, Michael Hiltzig first gives voice to David Gorski and then to Steven Novella, long-time colleagues and back-slapping companions as anti-integrative medicine vigilantes. Hiltzig quotes Gorski first, shaping the Samueli’s investment this way: “The only reason ‘integrative medicine’ exists is to integrate quackery into medicine.” Tiltzig immediately turns to Novella to use the Trumpish, name-calling term that Gorski himself favors: “In a blog post, Novella flayed UCI’s establishment of an integrative medicine curriculum as ’quackademic medicine.’”
“Back-slapping companions as anti-integrative medicine vigilantes”? I laughed out loud when I read that line. Maybe we should change the name of the blog from Science-Based Medicine to Vigilante-Based Medicine. On second thought, SBM is such a nice abbreviation. The whole “vigilante” charge, though, is meant to further demonize Steve and me, who slap each other on the back like dudebros after each new takedown of integrative medicine. Maybe next he’ll portray us as bumping chests and shouting, like football fans. (Seriously, could Mr. Weeks be any more obvious?)
The answer, apparently, is no:
It would be one thing if this were just journalistic laziness. Sure, go ahead and run polarizing copy based on a tweetish view of the universe that makes a story fit for afternoon TV. In fact, however, these media have chosen to trumpet fake news. They promote this polarizing grandstanding rather than honor the emerging scientific consensus that is yet poorly integrated into health professional education and practice – and that utterly backs the Samuelis’ investment and direction at UC Irvine:
He then cites four references that actually show how deeply embedded quackery has become in medicine, thanks to the efforts of people like Mr. Weeks. For instance, he mentions the Joint Commission’s 2015 revision of its pain management standard that recommends nonpharmacologic approaches to pain, and mentions acupuncture, chiropractic, and osteopathic manipulation. Now, I’ve discussed many times before how integrative medicine mavens have latched on to the opioid crisis as an opportunity to expand their influence by rebranding CAM/integrative medicine as “nonpharmacologic approaches to pain.” Indeed, the National Center for Complementary and Integrative Medicine (NCCIH) enshrined this in its 2016-2021 strategic plan. Ever since the opioid crisis inserted itself into the national consciousness, proponents of integrative medicine have seen a golden opportunity to use it to further the integration of quackery into medicine. Only they want to be seen as science-based; so when programs like the one at UCI are caught advertising The One Quackery To Rule Them All, homeopathy, they scramble to hide the evidence of it.
Mr. Weeks makes a great show of mentioning guidelines published by the Mayo Clinic, which, if anything, showed that the “complementary” approaches to pain examined do not have an effect greater than placebo. Truly, it was an awful review article. Predictably, he also mentioned the American College of Physicians guidelines for low back pain. I can’t help but note that those recommendations characterized evidence base for acupuncture, for example, as low quality evidence, moderate at best, and cited the GERAC Study, which basically showed that acupuncture does not work. Another mixed “electroacupuncture” (which is basically TENS) with acupuncture. Truly this was thin gruel for the ACP. Finally, he referred to the National Academy of Medicine’s review on nonpharmacological approaches to pain. I perused it. It misrepresents the evidence base for acupuncture in a far too favorable a fashion, for instance claiming that recent “reviews and meta-analyses examining the effect of acupuncture on musculoskeletal pain (neck and back pain, osteoarthritis, chronic headache and shoulder pain, fibromyalgia) have found that overall, acupuncture is superior to sham and no acupuncture, but with relatively modest differences between true and sham acupuncture.” Yes, the NAM cited the Vickers meta-analysis, which showed that acupuncture doesn’t work, with no clinically significant effect on pain, although the conclusion was spun to be the exact opposite. Yes, Mr. Weeks is doing what any “thought leader” in integrative medicine has to do: Exaggerate or even misrepresent the evidence base supporting the quackery that integrative medicine is seeking to add to medicine.
Up until now, Mr. Weeks didn’t actually anger me. Rather, he amused me, as he recycled the same tired, dubious arguments that he’s always used, complete with his dismissive comparison of critics of integrative medicine to Donald Trump, which he’s now done so often that to me it’s a cliché. Indeed, I’m half tempted to make a drinking game out of Mr. Weeks’ references to Donald Trump as a means of denigrating his opponents: Take a drink each time he compares our writing to Trump or to Tweets. The only problem is that playing the game would probably put me at risk for alcohol poisoning.
Here’s where Mr. Weeks actually managed to anger me. It’s hard for an apologist for quackery to do, but Mr. Weeks managed it:
The roundhouse, condemnatory, “quackademic” perspectives of Gorski, Novella, Caulfield and their like toward complementary and integrative health and medicine need to be treated and dismissed by the LA Times and others as the anti-science that they are. Sure, discussion can be engaged over specific approaches or therapies. Yet giving a platform to this broad dismissal of the Sameulis’ investment is no different than repeatedly quoting non-believers in climate change at the top of an article about a massive, exciting effort to correct human environmental degradation.
And while the scale is different, both forms of science denial have blood on their hands. The residual, reactive, medical ideology of these anti-integrative careerists to which the LA Times and others give a platform is a barrier to potentially lifesaving directions toward which the Joint Commission-Mayo/NIH-American College of Physicians-NAM-Attorneys General jointly urge us – and the Samueli investment would propel us.
What utter cluelessness.
We’re doctors. Mr. Weeks is not. We save lives. Mr. Weeks does not. I’m a medical researcher. Mr. Weeks is not. I can deal with his unwarranted attacks on us as “antiscience.” I can laugh at them, even. I know we have the data, the science, and reason on our side. Also, contrary to how we are portrayed, we do not dismiss massage, mindfulness, exercise, diet, or other lifestyle aspects of integrative medicine. We merely point out that they are more appropriately a part of science-based medicine and that integrative medicine is “rebranding” them as somehow being “alternative” or “integrative” and then throwing in quackery like acupuncture, reiki, naturopathy, and the like. The purpose, of course, is to legitimize quackery. That’s why I say that there is no reason for integrative medicine to exist other than to provide a vessel through which quackery can be integrated into medicine.
As for being an “anti-integrative medicine careerist,” I view this as a thinly disguised variant of the “pharma shill” gambit, in which Mr. Weeks insinuates that we must be biased because we’ve made a career out of being “anti-integrative medicine.” Would this sort of thing were even possible! Seriously, though, Mr. Weeks should look at my publication record. Only two of my publications indexed on PubMed can be characterized as even being about integrative medicine. However, Mr. Weeks’ little tirade has med me think that maybe I should try much harder to publish more of this in the peer-reviewed scientific literature. The reason I haven’t is because I’m not an “anti-integrative medicine careerist.” Maybe I should become one, except that I’d call it being a pro-science careerist.
To get an idea of where Mr. Weeks comes from, he repeats a number of anti-medicine tropes. For instance, he does his best to paint critics of integrative medicine as a discipline as not caring about prevention. That’s an old chestnut, because integrative medicine proponents have tried very hard to rebrand any sort of interventions to prevent disease as their bailiwick. He also cites a BMJ paper concluding that medical errors result in 251,000 deaths per year and are the third largest cause of death in the US, clearly having selected that particular paper because it has one of the largest numbers of deaths estimated anywhere in the literature. (Über-quacks Mike Adams, Gary Null, and Joe Mercola would be proud.) As I pointed out when this study was published in 2016, the methodology used to calculate this number was highly questionable, at best, and basically custom-designed to inflate the number of deaths due to medical error, particularly through misattribution of the cause; i.e., mischaracterization of complications that had nothing to do with medical error as being due to error.
Mr. Weeks then defends the poor, put-upon Samuelis as being philanthropists of the highest order, listing their charitable donations over the last two decades. No one is denying that the Samuelis have made worthwhile charitable donations over the last 25 years. It is not those particular donations that I and people like Steve Novella and Tim Caulfield have a problem with. Rather, it is the Samuelis’ repeated donations in the cause of furthering integrative medicine that we criticize. Remember, as has been pointed out in multiple articles, the Samuelis are true believers in The One Quackery To Rule Them All, homeopathy. Does Mr. Weeks think that homeopathy is science-based? I’m sorry, but you cannot credibly claim the mantle of science if you believe in homeopathy. Period. You just can’t. You can try, but you will be called out, even laughed at—and deservedly so. Homeopathy is quackery based on concepts of vitalism and sympathetic magic.
Mr. Weeks concludes:
Reporters: stop giving a platform to anti-science. Do us all a favor and get serious, and scientific, about your reporting of an investment of the Samuelis at UC Irvine that – despite this apparently necessary stone throwing – may prove to be the most influential philanthropic investment in the substantial course correction that US academic medicine and medical industry need.
Actually, that’s what I’m afraid of, that the Samueli investment will be the most influential philanthropic donation in medicine. I’ll show you what I mean.
Quackery in medical education
One aspect of quackademic medicine that I probably don’t write about as much as I should is the “integration” of quackery into the curricula of medical schools. Part of the reason for that, I suspect, is that I am fortunate enough to be faculty at a medical school and cancer center that remain relatively untouched by the pseudoscience of integrative medicine. True, our medical school does have at least one credulous lecture about “complementary and alternative medicine” (CAM) that the medical students have to imbibe, but it really is pretty close to the bare minimum required by the accrediting agencies. Oh, yes. Proponents of integrative medicine have been so successful that one requirement for accreditation by the Liaison Committee on Medical Education (LCME) is that there be adequate instruction about CAM. Actually, that’s not quite true. Among the educational objectives in the LCME requirements is ED-10: “The curriculum of a medical education program must include behavioral and socioeconomic subjects in addition to basic science and clinical disciplines.” This is where CAM and integrative medicine are slipped in. That’s because the Academic Consortium for Integrative Medicine and Health successfully lobbied the LCME to include CAM in its list of topics addressed in the LCME Medical Education Database relative to accreditation standard ED-10. Unfortunately, how that is done in practice is often in the form of entirely credulous teaching of CAM.
Here’s where the Samueli donation comes in. The purpose of the Samuelis’ $200 million donation is to create a college of health sciences that will encompass several UCI schools, including its school of medicine and nursing school, dedicated to “integrating” quackery at all levels into medicine thusly:
The Samuelis’ gift will provide $50 million toward construction of a facility to house the college and $5 million for state-of-the-art technology and labs – forming the foundation of a national showcase for integrative health. It also earmarks $145 million to create an endowment for:
- Up to 15 faculty chairs across the medicine, nursing, pharmacy and population health disciplines for senior, midcareer and junior faculty with expertise in integrative health
- Integrative health training and mentoring for interested medical school students
- Scholarships and fellowships for undergraduate and graduate students planning careers in related fields
- Innovative curricular development and campuswide interdisciplinary research projects
- Ongoing clinical services, research and education in the Susan Samueli Integrative Health Institute, including investigations of nonconventional interventions as part of medical treatment and educating medical and lay communities about benefits and risks associated with new healthcare approaches
Here’s the one that should concern all physicians and advocates interested in promoting science in medicine, number 3: “innovative curricular development.” That’s CAM-speak for teaching CAM alongside real medicine as though homeopathy has scientific validity. This brings us to an article by noted cheerleader for “integrative medicine” Glenn Sabin, “Integrative health’s place in the medical school curriculum.” If you want to know where Sabin’s coming from, consider my previous discussions related to his promotion of alternative medicine, such as his “history” of the integration of quackery with medicine and his advocacy for anecdotal evidence disguised as “N-of-1 trials” over clinical trials in determining if various alternative medicines “work.” He also first got my attention for openly admitting that integrative medicine is a brand, not a specialty. Also consider this paragraph from his latest:
My colleague, John Weeks, wrote a terrific response in Huffington Post to the media’s shameful coverage of the visionary and game-changing Samueli gift to UCI. He cogently supports his position with actual research, facts, and developments that illustrate just how out-of-touch these dwindling skeptics are—and how a few media outlets took the bait that led them down a narrow-minded narrative centering on one controversial therapy: homeopathy.
For me, though, the back-and-forth with the cynics is not worth the expended energy. This is not just about acupuncture or chiropractic or massage or dietary supplements. It’s much bigger.
The Samueli gift is about the future of health, led by the doctors of tomorrow, like my nephew, Max, who is in his first year of medical school at George Washington University.
Homeopathy is not “controversial.” It is rank pseudoscience. This is not even in dispute. Just look at the way UCI started furiously scrubbing its websites of references to homeopathy as soon as critics started looking at the Samuelis’ gift in detail. Clearly, the administration was embarrassed. I also note that one earlier gift agreement between the Samuelis to UCI explicitly mentioned that it was to be used to promote research into homeopathy, among other pseudoscientific modalities and that until recently UCI advertised the services of a naturopath and homeopath on its website. Even proponents of integrating quackery into medicine are embarrassed by homeopathy.
When discussing the “integration” of quackery into medical school, I like to discuss another “George” university namely Georgetown. In many ways, it was a “trailblazer” in “integrating” quackery into medicine. I recounted its history just a couple of years ago, citing a 2003 Georgetown brochure:
One of the reasons CAM is usually offered as an elective is that there’s just no time or room in U.S. medical schools to fit in one more massive subject,” says Michael Lumpkin, Ph.D., professor and chair of the department of physiology and biophysics at Georgetown. “When the course is an elective, a self-selected group – maybe 10 or 20 students in a class of 180 medical students – will take it,” Lumpkin says. “What we’ve tried at Georgetown is rather than create all new courses, we take relevant CAM issues and modalities and weave them seamlessly into existing courses.
The “seamless” weaving of CAM into existing classes includes, for instance, a presentation by an acupuncturist on the “anatomy of acupuncture” in the gross anatomy course for first-year students. The same lecturer explores acupuncture’s application in pain relief in the neuroscience course…
Haramati and Lumpkin say Georgetown’s program is distinct from CAM initiatives in other medical schools in two ways: The school is integrating CAM education into existing course work across all four years of each student’s medical education, and the initiative includes a mind-body class to help students use techniques to manage their own health and improve self-care.
Yes, fourteen years ago, Georgetown was “integrating” pseudoscience into its medical school curriculum at every level, starting from day one. Twelve years later, it was celebrating pseudoscience on the cover of the medical school’s magazine. That’s not all, though. Reflexology is taught as fact, along with prescientific medical systems, such as traditional Chinese medicine (TCM), “energy healing” like reiki and therapeutic touch, and pretty much every “integrative” quackery you can think of. In 2007, Georgetown partnered with the naturopathy school Bastyr University to train the next generation of integrative medicine practitioners.
This is the sort of future of medicine that Weeks and Sabin so strongly desire.
It’s also not as though George Washington University isn’t itself a bastion of quackademic medicine. Three years ago, I wrote about all the quackery advertised on its website. GWCIM’s list of services includes acupuncture (of course!), chiropractic, craniosacral therapy, infrared light therapies, glutathione infusions, Myers’ Cocktail, naturopathy (again, of course!), reiki, intravenous high dose vitamin C, and genetic profile results that include “customized interpretation of 23andme.com genetic profile results with specific accent on methylation and detoxification profiles.” It’s a truly horrifying website to contemplate, given how little of it has any resemblance to science-based medicine and how much of it includes outright quackery like reiki. In addition, its website’s descriptions of various alternative medicine modalities are depressingly and similarly credulous. Acupuncture is described as being used for “for treatment of respiratory, digestive, urinary and reproductive systems, as well as the disorders of muscle tone, hormone production, circulation, and allergic responses” plus “pain relief, gynecological conditions and symptoms, insomnia, anxiety, and to enhance wellness.” Naturopathy is described as a “comprehensive approach to health and healing that combines modern scientific knowledge with traditional and natural forms of medicine,” with naturopaths addressing “the mental, emotional and physical aspects of an individual, and aim to treat the root causes as well as the symptoms of illness.” According to GWCIM, naturopaths are “trained as primary care doctors at accredited four-year naturopathic medical schools.”
I also can’t help but note that John Weeks’ article is the very same one I started this post discussing, in which Weeks accused us of having “blood on our hands.” Apparently, Sabin approves of such rhetoric, as long as it’s directed against his opponents.
Sabin’s article is yet another example of how “integrative medicine” rebrands science-based modalities, such as nutrition, exercise, and lifestyle modification as somehow “alternative” or “integrative” and then uses them as the vehicle in which quackery is also “integrated” into medicine, while trying to dismiss anyone who points out the pseudoscience as the “old guard—the few out-of-touch, aging critics pushing back.” (I note that Sabin and Weeks aren’t exactly spring chickens themselves.) Naturally, he tries to push back against the critics’ narrative:
These same integrative health and medicine naysayers essentially conflate quackery—which ought to be called out and confronted—with the larger, progressive, and impactful, integrative health and medicine movement.
Critics also purport that nutrition, physical activity, and stress reduction are already consistently applied (or taught) clinically—that it’s already ‘part of medicine’. These few critics are wrong. Their view is incorrect. Their statements are patently false. We know this because, if these truly preventative measures were applied—if this was remotely the case—our healthcare delivery system would be consistently delivering ‘health care’, not ‘chronic disease care’.
Proponents of integrative medicine always try to sweep all the quackery their specialty embraces under the rug. Pay no attention to that quackery behind the curtain, they say. We’re all about nutrition, lifestyle, and stress reduction. They somehow never manage to address the question: Why is quackery so associated with integrative medicine? If integrative medicine really were about “nutrition, lifestyle, and stress reduction” and nothing else, the quackery would be unnecessary. Homeopathy, naturopathy, acupuncture, “energy healing,” functional medicine, bogus allergy testing, and more forms of pseudoscience and quackery than I can list here (but have discussed over the years on this very blog) would not find such a comfortable home in “integrative medicine.” That they do fit so nicely in “integrative medicine” is by design, not accident.
Nutrition and lifestyle, the Trojan horse of integrative medicine
Consider this. Let’s, for the sake of argument, concede that Sabin has a point. Perhaps nutrition, physical activity, and stress reduction are not sufficiently consistently applied in clinical medicine. If that is indeed the case, the answer is to develop strategies to change this shortcoming in medicine. Those strategies, assuming they’re science based (as they should be), will not involve embracing pseudoscience and quackery. Sabin and Weeks go on and on and on about promoting the “nutrition, physical activity, and stress reduction” aspect of medicine, but fail to explain why a separate specialty is needed to emphasize these health promotion activities more. That’s because they can’t. The entire unspoken rationale that they cannot admit is that “nutrition, physical activity, and stress reduction” function, in essence, as a Trojan horse for hardcore quackery. Integrative medicine shows up at the gates of academic medicine looking like “nutrition, physical activity, and stress reduction,” but once the horse is pulled into the ivory tower of academia, out jumps the real quackery, like naturopathy, homeopathy, acupuncture, functional medicine, and the like.
Also unspoken is that the reason integrative medicine proponents want so badly to insinuate their specialty and thinking into medical school is because they want “nutrition, physical activity, and stress reduction” forever linked with the quackery that they also champion. At schools like GWU and Georgetown, it’s working, too. I fear, however, that UCI will soon far surpass both GWU and Georgetown as bastions of quackademic medicine.