From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link).  Oy.

I was looking over a recent class catalog from my alma mater, University of Oregon. I see the Astronomy Department is having a day devoted to astrology, inviting astrologers to talk about their profession. And the Chemistry department is having alchemists give an overview on how to change base metals into gold. And, to green our energy, the Physics Department, where I acquired my undergraduate degree, is having a symposium on perpetual motion machines. I am so proud.

I kid.

But not when it comes to SCAM (Supplements, Complementary and Alternative Medicine). Medicine is strange in that has no issues embracing pseudo-science. My medical school, OHSU, had an afternoon devoted to Integrative Medicine for the third year medical students, with lectures by a chiropractor, a traditional Chinese pseudomedicine practitioner, a naturopath and an integrative medicine practitioner. They also had a small group discussion of a case of irritable bowel syndrome where one of the discussion leaders was a……Qi……….Gong………..master. Really. I would be so pissed if I was going $166,000 in medical school debt and I was being taught about the approach to ANYTHING by a Qi Gong Master. It was a day to ignore that whole ‘science’ thing in the name of the school.

I have no issue with medical schools teaching about SCAMs. SCAMs should be taught as part of the medical school curriculum. But not proselytizing propaganda by proponents of pseudo-medicine. Can I alliterate or what?

Unfortunately I was unable to attend to lectures so I do not know what the spoken content of the lectures were, but I did receive from a former resident a copy of the slides used. The slides are interesting not only for what they say, but what they do not say. Lies of omission as it were.

So, for the sake of OHSU students who might wander into this post, here is a deconstruction of the slides. I do not cover all the nonsense on these slides, but this site can fill that lack for those who want to explore the topics further. For those of you who are regular readers, there is little new in what follows, so you might want to go read something else.

Traditional Chinese pseudomedicine

Their slide set had only 5 slides, which is 4 more than needed to cover the reality-based aspects of TCPM. Evidently they covered Chinese acupuncture (ignoring all the other forms of the acupuncture, especially the one true form, Tong Ren. The rest are posers) and have slides showing acupuncture (No gloves used. Of course. That is why there are some many reports of infection from acupuncture) and moxibustion).

The two lecturers have a website for their practice that contains all the usual nonsense about acupuncture, well-covered on this website for you OHSU students who have wandered this way for the first time.

I wonder if they mentioned that there is no qi and no meridians.

I wonder if the lecturers mentioned that acupuncture has never been found to be effective for ANY process in any high quality study. It is but a theatrical placebo. But there are 2,208 references searching PubMed for ‘acupuncture complications’, quite a price to pay an intervention that does nothing.

But at least, as noted on the cover letter with the slides, the students learned how to capture the qi of a tree in the forest to cleanse the liver.

Chiropractic

Two chiropractors from the University of Western States, the local Chiropractic trade school, gave this lecture.

They start with the guiding principles of chiropractic:

  • The body has the ability to heal itself through natural means
  • Balance is created by fostering the structural integrity of the spine allowing for continued movement and decreased stress on the nervous system
  • Treating the cause of the patient’s symptoms

The first always sounds appealing, the appeal to nature fallacy. Western States teaches the myth of the subluxation complex, and for chiropractors that is the cause of almost all symptoms. When all you have is manipulation, everything is subluxation.

I wonder if they mentioned that the fundamental precepts of chiropractic, that of subluxation, innate energy, and their interventions of spinal manipulation are completely based in fantasy? Doubt it.

They mention it was founded by DD Palmer in 1895. Founded? You mean how he pulled it out of, er, well, thin air, after allegedly restoring hearing by adjusting the spine? You are a medical student. Is the 8th nerve anywhere near the spine? That make any sense to you? Does chiropractic? I thought not.

They mention chiropractic education as having more hours than medical school. But really, if the hours of education are spent reinforcing the fundamental fiction of chiropractic subluxation and manipulation, are those quality education hours? Nope.

And they mention no residency. Has there ever been an MD who was competent to take care of patients right out of medical school? Are you? Nope. Chiropractic education is qualitatively inferior to an MD and their training is minimal. Not a good background for diagnosing and treating the ill.

There is a slide for:

  • Conditions we have Strong evidence for treating with manipulation
  • Acute, sub-acute & chronic low back pain
  • Acute, sub-acute & chronic neck pain
  • Migraine & Cervicogenic Headaches
  • Cervicogenic Dizziness
  • Extremity conditions- knee OA, patellofemoral pain syndrome, plantar fasciosis

The reference, by chiropractors, for chiropractors (no bias there) shows that only chronic low back pain is considered to have high quality evidence, which I would consider strong evidence, the rest are moderate quality evidence at best.

The actual abstract says:

Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet.

I little, well, disingenuous don’t you think? And for low back pain? The independent Cochrane review, who make no money from spinal manipulation therapy, says:

Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.

By that definition, Bud Light would be a strong beer.

By the way, did they mention the risk of stroke that is the tradeoff for an intervention that likely has no clinically-meaningful difference when compared to other interventions with less risk?

Although current biomechanics evidence is insufficient to establish the claim that CMT [cervical manipulation therapy] causes CD [cervical artery dissection], clinical reports suggest that mechanical forces play a role in a considerable number of CDs and most population controlled studies have found an association between CMT and [vertebral artery dissection] stroke in young patients. Although the incidence of CMT-associated CD in patients who have previously received CMT is not well established, and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine.

Did they also mention that Oregon chiropractors oppose immunization? Maybe if they spent more time on public health and less on the subluxation complex, they might learn something useful for patient care.

It was a nice piece of chiropractic propaganda.

Naturopathy

The lecturer was from the National College of Naturopathic Medicine. The first slide mentions education. If you want to know the truth about naturopathy from a former naturopath, go to Naturopathic Diaries.

They mention a 4 year medical school. Did they mention that much of that is spent learning the pseudo-sciences of homeopathy, energy therapies, hydrotherapy, colonics and more? I doubt it. Oddly, homeopathy, one of the main pseudo-sciences of naturopathy, is not mentioned on the slides. Time spent in edumcation in pseudoscience is not time spent in real medicine.

They mention 1,200 clinical hours? That is 150 eight hour days. Half a year. NDs education is a fraction of what it takes to be a family practitioner, 5,000 hours for NDs vs 21,000 hours for Family Practitioners, and FPs are trained in reality based medicine. Not to mention some of those clinical hours don’t involve actually having contact with a patient.

They mention they are trained for primary care. Did they mention that Oregon naturopaths object to vaccination, that they do an inferior job at vaccinating their patients, who are then more likely to have a vaccine preventable disease? Did they mention they also do a poor job at cancer screening? None of which should come as a surprise if you understand their training and edumacation.

Then they go through a series of slides discussing the naturopathic approach to patients, and the slides are remarkably vague. They mention none of the widespread pseudo-medicines that are the bread and butter of naturopathy. See “Disingenuous: Deconstruction of a naturopathic white paper” and others on this site for the truth THEY do not want you to know, about the reality of naturopathic practice. The devil is, as is always the case, in the details, and the details of ND practice should scare the hell out of any doctor.

And please.

Whole system approach. That is what we do, real doctors, based on years of education and training in reality based medicine. Do not let the frauds of SCAM, whose whole systems are based in fantasy, have you believing otherwise.

Naturopathy, chiropractic and acupuncture are to real medicine what guitar hero is to Jimmy Page. They play at medicine, but the result of playing at medicine is dead people, as demonstrated in Canada with Ezekiel Stephan, a 19 month old boy whose naturopath treated meningitis with tincture of echinacea. The first patient I took care of paid with their life thanks to naturopathic care, taking alkaline therapy for their cancer and dying of progressive untreated malignancy

Don’t think a naturopath has even the vaguest sense of real disease and treatment.

Integrative medicine

What is integrative medicine? It:

combines treatments from conventional medicine and complementary and alternative medicine (CAM) for which there is some high quality evidence of safety and effectiveness (NCCAM)

What are the CAMs suggested?

  • Natural products: herbal, vitamins, minerals and other natural products
  • Mind body medicine: deep breathing, meditation, yoga, acupuncture, guided imagery, tai chi, hypnotism, progressive relaxation, qi gong
  • Manipulative and body based practices: massage, manipulation
  • Energy medicine: Reiki, healing touch, qi gong
  • Chinese medicine
  • Ayurvedic medicine
  • Functional medicine
  • Homeopathy
  • Naturopathy
  • Traditional healers
  • Environmental medicine
  • Group Visits

This is a list of all the pseudo-medicines that do not work, cannot work if known reality is to be understood, and only have toxicities and side effects. None of the above have high quality evidence for effectiveness. Many (homeopathy, reiki) are literally nothing. The basis of therapeutic touch was disproven by a 6th grader and published in JAMA. Chinese and Ayurvedic products might have well been made using Portland air and Flint water, they are so often filled with toxins – real toxins, like lead, arsenic and mercury.

So integrative medicine is taking rank pseudo-scientific nonsense and combining it real medicine. That is why I say, when you integrate cow pie with apple pie, the cow pie is not made better, the apple pie is made worse.

And then the usual mea culpa as to why these modalities cannot be or are not studied:

The double-blind placebo-controlled trial is not ideal for studying interventions which individualize care, such as homeopathy and acupuncture.

“Either homeopathy works or controlled trials don’t!” said Scottish homeopath David Reilly. The reason that double-blind placebo-controlled trial is not ideal is that homeopathy and acupuncture are cow pies.

The healing interaction may be dismissed by many researchers as “placebo” effect, whereas we acknowledge this is often more important than any other treatments we apply.

If you are relying on placebo, you are relying on nothing. And it is considered unethical to give placebo outside of clinical trials, not that SCAM practitioners worry about the ethics of their practice.

Meta-analysis, often set as the gold standard, is problematic because it often pools reasonable studies with poorly-designed studies which may have used an inferior botanical extract, used inadequate dosing or had other serious methodological flaws, so that a truly effective intervention may be discounted based on such pooling of good and bad studies.

Or maybe it is because the aforementioned modalities are based on nonsense and as such do not have efficacy? 50 years of research into SCAM and they still can’t find efficacy for any of the above interventions. Rather than admit they are not effective, they rationalize away their failure. It is why no SCAM is ever abandoned or altered. Ever. SCAM is immune to data.

As best I can tell, there are no lectures from a reality/science-based medicine perspective on SCAM. If that is the introduction to integrative medicine, the students at OHSU are in a world of hurt. If one of you have made it this far, please send the link for this blog to all your classmates.

In the real world, the curse scam:

This scam involves convincing the mark that she and her valuables, including cash, are cursed and that the con artist, posing as a psychic, Tarot card reader, Gypsy, clairvoyant or the like has the power to cleanse the person and her money and jewelry, thereby lifting the curse. Modern con artists sometimes claim the problem is “negative energy” rather than a curse, which might appear too old-fashioned a term for people hip to the New Age.

is punished with jail. In, what is in my opinion (as is this entire post, although opinion better supported by reality) the medical equivalent:

This SCAM involves convincing the patient that she has an imbalance or toxins and that the provider, posing as a real doctor or the like has the power to cleanse the person of toxins or restore balance thereby treating the illness. Modern providers sometimes claim the problem is found by identifying the real cause of disease and open Integrative Medicine clinics, to appear modern for people hip to the New Age.

and is rewarded with tenure track academic positions.

If I were a medical student at OHSU, I would ask for a prorated tuition refund for the four plus hours devoted to pseudo-scientific propaganda.

And any student at OHSU who would like free, yes free, pdfs of the complete set of Science-Based Medicine ebooks, including books on acupuncture, chiropractic and naturopathy, send an email to admin[at]sfsbm.org and I will send you a link.

The final irony, and perhaps of source of true perpetual energy, is that at one time science-based medicine was important in US medical schools thanks to the Flexner Report. That is no longer the case. Now Flexner must be spinning in his grave at such a ferocious rate if we could just wrap him in copper wire we could generate enough electricity for the whole state.

 

 

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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