Beautiful Cascadia, where science goes to die.

Beautiful Cascadia, where science goes to die.

When the Pacific NW secedes from the Union it is to be part of a new country, Cascadia. The capital would be Portlandia, I suppose. Somehow, I think not. But when I watch the devolution of health care in Oregon, I think back to The Onion (?) when they reported that the United Kingdom was to be sold to Disney, being renamed as “The United Magic Kingdom.”

That is health care in Oregon due the steady insinuation of naturopathy and other pseudomedicine into real health care.

Oregon Health and Pseudoscience University

Growing up my alma mater was the University of Oregon Medical School. Since then it has undergone two name changes, first to Oregon Health Sciences University and then to the current Oregon Health & Sciences University (OHSU)—with, it should be noted, an ampersand. Not an ‘and’.

Perhaps they need one more name change, since they are not always that interested in the “Science” part of their name.

Some background is needed.

Portland has a trifecta of pseudoscience schools: Naturopathic (National College of Natural Medicine), Chiropractic (University of Western States) and ‘Oriental’ (Oregon College of Oriental Medicine).

Lucky us.

As an aside my kids let me know that the word ‘Oriental’ as used to describe people from the East, the term I grew up using, is persona non grata. I understand the reasoning. The proper term, they tell me, is Asian. So I have a mental cringe every time I see the name “Oregon College of Oriental Medicine”.

All three schools are steeped in pseudoscience and pseudomedicine, removed from known reality. As examples, the naturopathic school teaches homeopathy (and more), the chiropractic school teaches the subluxation complex, and the ‘Oriental’ (cringe) school teaches acupuncture. Reading the curricula of the schools suggests that there is no pseudomedical stone left unturned.

In the 1980s, OHSU received a grant to study low back pain in conjunction with the chiropractic school. As Cyndi Lauper noted, Money changes everything.

Why worry about standards, reality, plausibility, and science when there are Benjamins to be had? The Oregon Collaborative for Integrative Medicine was born, the OCIM:

The Collaborative was formally established in 2003 as the Oregon Collaborative for Complementary and Alternative Medicine as the result of a National Institutes of Health R25 CAM Education grant awarded to OHSU. UWS, OCOM and NCNM were all subsequently awarded follow-up R25 education grants.

With OHSU and Pacific University joining up with the troika to, among other plans, develop the Medical Education version of the Island of Doctor Moreau, with grotesque and unnatural hybrids, far worse than any hyena-swine or sloth-creature:

Standing beside the traditional MD/PhD or MD/MPH will be the ND/ MD, the MD/DAOM, the ND/DC, the ND/PhD, the DAOM/MPH and countless other combinations to build new vanguards of cross trained clinicians focused on inclusivity and collaboration

It is like the chemistry department at the University of Oregon having an alchemy degree, the astronomy department having an astrology degree, and the physics department a degree in the Time Cube (I may need a new example soon). But for millions of dollars, why not?

Their website mentions that:

In 2003, OHSU was awarded a $1.5 million dollar grant to develop, implement, and evaluate a new four-year curriculum for medical students in complementary and alternative medicine.

$1,500,000 is a lot of money. As best I can tell from talking with medical students, there is no four-year SCAM curriculum. There is one rotation in an Integrative Medicine Clinic [PDF] that I would fail, being unable to “establish and maintain a climate of mutual respect, dignity, diversity, integrity, honesty, and trust” with any pseudomedical provider. But that’s me. They have maybe a half-dozen publications as a result.

I just think about what we could do with 1.5 million dollars. I could create an amazing SCAM course with that kind of money. I wonder, could we apply for an NICCH education grant?

For support to develop and/or implement a program as it relates to a category in one or more of the areas of education, information, training, technical assistance, coordination, or evaluation.

We do that.

That is all I can find so far, but I have more digging to do. I have yet to figure out how to find the results of an NIH grant and how the money was spent. For that kind of money I would expect one hell of a curriculum, unless they wasted at least 1.5 million dollars in NIH money and have nothing to show for it. Nah.

At least they have other research to show for their efforts, for as it says on their web page:

OCIM and our members have a wealth of past and current research.

And they proudly list, what, oh well…

This section of our website is in development, please check back soon to learn about the enormous breadth of research that has been done and continues to be done in integrative medicine and health…

I would love to see this wealth of research, although I suspect it may be as comprehensive as the medical school curriculum they have developed, implemented and evaluated.

It is true, there has been and continues to be an enormous breadth of research in pseudomedicine. Most of the SCAM research, as we know from this website, is poorly done and the high-quality studies demonstrate no utility for most the pseudomedicines promulgated by the OCIM.

And now they are proud to announce a Fellowship in Integrative Medicine.

My motto: when you integrate cow pie into apple pie, the cow pie is not improved, the apple pie is made worse.

For $31,000 over two years virtually anyone (MD, ND, DC) can participate in an virtual classroom of topics that, at least to look at their titles, appear to contain nothing that anyone really needs to know to practice medicine.

But perhaps the content-free titles in the curriculum are hiding a deep and meaningful substantive medical education.

Given that NDs, DCs, dietitians, social workers and psychologists are among those eligible for the program, a comprehensive understanding of modern science-based medicine would appear not to be a requirement.

I also wonder how the Accreditation Council for Graduate Medical Education (ACGME) and Accreditation Council for Continuing Medical Education (ACCME) approved this program.

So OHSU continues down the road to becoming OHPSU.

Spit take

This was in the local paper: “Naturopathic clinic designated as top tier primary care facility.” Good thing I was not drinking when I read the headline.

It has, by the way, my favorite picture of acupuncture technique, because not only are there no gloves on the hands of the acupuncturist as her fingers are next to the needle, there is a box of (unused) gloves behind her on the shelf. I use this photo in every acupuncture talk and the audience always responds with disgusted laughter.

But how could a naturopathic clinic be a top tier primary care facility?

Remember, in Oregon, naturopaths are designated in the statutes as primary care providers. This is like designating pi as equal to 3.14, but it is the law of the land here in the Magic Kingdom of Cascadia. It does not matter that their education and training in real medicine are about the same as buying a Fisher-Price Medical Kit Playset and declaring you are a doctor. According to the state, playing doctor makes you a doctor.

So what then are the requirements to become a top tier clinic?

Core Attributes

– Access to care: Patients get the care they need, when they need it.
– Accountability: Recognized clinics are responsible for making sure patients receive the best possible care.
– Comprehensive: Clinics provide patients all the care, information and services they need.
– Continuity: Clinics work with patients and their community to improve patient and population health over time.
– Coordination and integration: Clinics help patients navigate the system to meet their needs in a safe and timely way.
– Patient and family-centered: Clinics recognize that patients are the most important members of the health care team and that they are ultimately responsible for their overall health and wellness.

If you go through the standards, there is almost nothing about adhering to science-based medical care and standards. Use homeopathy, acupuncture, energy and water therapy and other fantastical interventions? Not even relevant to the designation. And so not only can the naturopathic college get a designation, so can A Natural Path, an ND clinic in Seaside Oregon. Get it? Naturopath, Natural Path? So clever. There is nothing in the core attributes concerning the actual appropriate diagnosis and treatment of diseases. It is all about service and coordination of care, the infrastructure for providing care, not the actual medical care itself. This is something that medicine has not always been all that good at in the past.

No good deed ever goes unpunished. Just as evidence-based medicine can be misused to make pseudomedicine appear effective, the goal to provide better medical care can be misused by those with no medical training at all.

As I read the standard, for something as fundamental as childhood vaccinations clinics do not actually have to give vaccines – they just need to:

offer(s) or coordinate(s) recommended age and gender appropriate preventive services based on best available evidence.

Not actually give the vaccine, just offer and coordinate. Although they do have metrics for meeting minimal vaccination standards for children and adults. I will have to investigate this further as well as determine if I can access the submission forms used by the state to qualify the ND clinics. I have not heard back from the state as I write this.

As far as the designation as a top tier primary care facility, it does not matter in the least, as in the case of naturopaths, that the providers have no education or training in real medicine and that their entire paradigm of medical care is rooted in pseudoscience and fantasy. It is almost all about the service provided, not the quality of medicine practiced.

The designation is like restaurant sanitation grades [PDF]. Important information about the infrastructure of the facility but says nothing about the quality of the food. And in the case of an ND clinic, it is like getting the Just Like Home Dinner Play Food.


Addendum

I did not want to hijack the thread on Jann’s post yesterday, but my main response?

Batman would win. Period.

Hijack away.

 

 

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.

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