Collingewheel

Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not improve the apple pie. Yet that is what’s going on in medical academia these days—with a vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”

In fact, it was my two recent publications bemoaning the infiltration of quackademic medicine into medical academia, one in Nature Reviews Cancer and one with Steve Novella in Trends in Molecular Medicine, that got me thinking again about this phenomenon. Actually, it was more my learning of yet another step deeper into quackademia by a once well-respected academic medical institution, occurring so soon after having just published two articles bemoaning that very tendency, that served as a harsh reminder of just what we’re up against. So I decided to greatly expand a post that I did for my not-so-super-secret other blog recently beyond a focus on just one institution, in order to try to demonstrate for you a bit more how and why quackery has found a comfortable place in medical academia and how, just when I thought things can’t get worse, they do. There is also room for hope in that I also found evidence that our criticisms are at least starting to be noticed. I begin with the sad tale of the Cleveland Clinic Foundation, which has gone one step beyond its previous embrace of traditional Chinese medicine. I’ll then discuss another unfortunate example, after which I’ll look a bit at the pushback and marketing of “integrative” medicine.

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The Cleveland Clinic Foundation: Quackademia now reigns supreme

Quackademic medicine has been infiltrating many formerly science-based academic medical centers. Such centers have a seemingly-amazing ability to compartmentalize, insisting on rigorous science for most treatments but possessing an amazing blind spot when it comes to anything having to do with “integrative medicine.” Unfortunately, in few places is this tendency as intense as it is at the Cleveland Clinic Foundation (CCF). It’s an institution with which I have more than a passing familiarity. After all, I lived in Cleveland for eight years from the late-1980s to the mid-1990s when I did my surgery residency at the University Hospitals of Cleveland (now known as University Hospitals Case Medical Center) and my PhD at the Department of Physiology and Biophysics at Case Western Reserve University (CWRU), both of which were just down Carnegie Avenue from the CCF. I also worked part time as a flight physician for Metro Life Flight, for which a frequent destination for cardiac patients that we picked up from outlying hospitals was—you guessed it—the Cleveland Clinic. Twenty years ago, the CCF was Case’s chief rival in terms of medicine, science, and competition for patients. These days, their relationship is no longer as acrimonious as it was when I was at Case, but unfortunately the two institutions appear to have become rivals in quackademic medicine.

It’s a rivalry the CCF appears to be winning. Sure, Case has a big integrative medicine program and sponsored a meeting of the Society for Integrative Oncology and has been caught recommending reflexology, but that’s nothing compared to the CCF’s promotion of “energy healing’ (in particular reiki), acupuncture for children, and, most recently, the opening of a traditional Chinese medicine clinic run by a naturopath.

So what can CCF do to top that foray into quackademia? I really wish I hadn’t asked. The reason is that I just learned last week that the CCF has ratcheted up the pseudoscience to 11 and beyond. How? Simple. See this article in the Cleveland Plain Dealer:

In its ongoing focus on wellness and disease prevention, the Cleveland Clinic is opening a new Center for Functional Medicine. In doing so, the Clinic is the first academic medical center in the United States to embrace functional medicine, the focus of which is more on identifying underlying causes of illness and less on symptom management.

The center will work together with Clinic specialists to study the impact functional medicine has on certain chronic diseases.

Within the next few weeks, screening will begin for the first of up to 300 patients for one of four clinical trials comparing the standard treatment for asthma, inflammatory bowel disease, type 2 diabetes and migraines with that of functional medicine approaches.

The new center at the Clinic’s main campus is a collaboration between the Clinic and The Institute for Functional Medicine. Dr. Mark Hyman, chairman of The Institute for Functional Medicine, whose offices are in Washington state and New Mexico, and founder of The UltraWellness Center in Massachusetts, will serve as director of the new Center for Functional Medicine.

That’s right. The CCF has embraced the medical pseudoscience that is “functional medicine” and even hired its most famous practitioner, Dr. Mark Hyman. We’ve met Dr. Hyman before many times. For instance, he has argued for turning back the clock and relying on anecdotal medicine instead of scientific medicine and has mangled cancer research and systems biology to justify “functional medicine.” He’s also twisted autism science beyond recognition. Most recently, it’s been reported that Bill and Hillary Clinton have fallen under Dr. Hyman’s spell.

So what does this mean for CCF? Highly dubious medicine. Quackery, even. That’s what it means. Don’t believe me? Go back and read my recent description of functional medicine. Look at Wally Sampson’s multi-part analysis of what functional medicine is claimed to be here, here, here, here, and here. Basically, it’s a vaguely defined “discipline” in which it is claimed that measuring a whole bunch of metabolic factors and other lab values will lead to a “holistic” approach to disease, a situation well demonstrated by a “subspecialty” of functional medicine known as “functional endocrinology,” which involves running a number of expensive and generally unnecessary tests in order to “diagnose” various endocrine disorders and is often invoked by alternative medicine practitioners. Never mind that just what “functional medicine” actually entails is kept quite vague. That vagueness is the very thing that allows Dr. Hyman to claim:

“Functional Medicine looks at the underlying causes of disease, while focusing on the whole person rather than an isolated set of symptoms,” Hyman said in the news release. “We look at a patient’s history and the personalized interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease.”

The new center is a collaboration with The Institute for Functional Medicine, an organization also led by Hyman.

Or, as the press release describes:

Functional Medicine is a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease. The primary drivers of the chronic disease epidemic are the daily interactions among an individual’s genetics, environment, and lifestyle choices. Functional medicine addresses these underlying causes of disease and equips healthcare practitioners to help their patients manage this complex, interconnected web.

Of course, “functional medicine” does nothing of the sort, at least not any better than conventional medicine. According to news reports, Hyman will only sully his shoes by setting foot in Cleveland three days a month (sorry, having lived in Cleveland, I know just how much those East Coast types like Hyman look down on it), which makes me wonder how he can be the director of anything there, much less a center at a large institution like the CCF. Not surprisingly, the CCF has hired a physician to do the day-to-day grunt work of running this new center: Dr. Patrick Hanaway, who was the chief medical officer of Genova Diagnostics from 2002-2012, a laboratory that offers all sorts of tests of, in my opinion, questionable medical value seemingly custom-made for functional medicine assessments, including a saliva adrenal stress profile, comprehensive diagnostic stool analysis, and toxic effects CORE, among others. Of course, Dr. Hanaway is an integrative “holistic” practitioner. After that, he apparently became the director of medical education for Dr. Hyman’s Institute for Functional Medicine. Frighteningly, the practice where Dr. Hanaway works offers “holistic newborn and pediatric care,” including what is characterized as “grounded discussions” on vaccines:

Each talk is facilitated by Dr. Susan Bradt or Dr. Lisa Lichtig, board certified family physicians who practice holistic medicine. We cover the hot topics of controversy including links made to autism and asthma, the ingredient thimerosal (mercury), individualizing schedules and current outbreaks of vaccine preventable disease in our community. We review each disease and its associated vaccine and discuss vaccine ingredients, school requirements and legal issues. An extensive handout is provided to supplement the class and serve as a future reference. This class is essential for all families so they can be more informed about vaccinations. It is especially helpful for parents feeling concerned or hesitant about vaccinating their children according to the standard schedule. It provides a grounded explanation of the issues and helps remove fear surrounding the topic thus helping parents navigate decision making from a more balanced and educated starting place. You will walk away with a great foundation on the topic of childhood vaccines and be able to confidently make choices that feel safe for your family.

I recognize the code words, as, I’m sure, do many of you who follow the vaccine manufactroversy from a science-based perspective. The big giveaway is that the website doesn’t dismiss the “links made to autism and asthma” (hint: there are no such links, at least none that are evidence-based) and claims to discuss “ingredients,” a sure sign that the class involves the “toxins gambit,” a fallacious gambit designed to cause fear, uncertainty, and doubt about vaccines. It’s of a piece with Dr. Hanaway’s boss Dr. Hyman’s recent foray into anti vaccine fear mongering with antivaccine crank Robert F. Kennedy, Jr.. This antivaccine effort even included an appearance on The Dr. Oz Show a mere week before the announcement of the functional medicine center at the CCF. One wonders why the CCF would hire someone who spreads such blatant antivaccine propaganda as Dr. Hyman does and who even teams up with someone who is as vociferously antivaccine as RFK, Jr. (I know antivaccine when I see it, or at least pandering to antivaccine views.)

Then there’s this:

For uncomplicated pregnancies we encourage laboring at home as long as possible with the support of a birth partner and/or doula. Once at the hospital we help create an intimate and encouraging atmosphere utilizing low lighting, freedom of movement, homeopathy, vocalization, massage, water, birthing ball and stool to support women in labor as it intensifies. Medications and epidurals are available upon request. Woman birth in a variety of positions including in the water and squatting.

Homeopathy? Water birthing? Yep, Dr. Hanaway’s partners practice “natural childbirth” woo. One wonders if the CCF will “integrate” such services into its obstetrics unit or stop being so certain about recommending vaccines to children in its pediatrics clinics. Perhaps CCF will now try to help recreate the Los Angeles experience with respect to vaccines in the Midwest.

So how on earth was someone like Dr. Hyman or Dr. Hanaway offered a job at an institution as prestigious as the CCF? Listen to the CEO of the CCF, Dr. Toby Cosgrove. He’ll tell you:

In the release, Clinic CEO Dr. Toby Cosgrove said the new center is “not a departure for Cleveland Clinic, but a continuation of the innovative, holistic approach that we have embraced.” Cosgrove cited the Clinic’s wellness institute, Center for Integrative Medicine, its Chinese herbal therapy clinic and the Center for Personalized Healthcare.

I can’t argue with this. The CCF has been traveling down the road of quackademic medicine for a long time. This new initiative is nothing more than a continuation of the “integration” of quackery into medical practice at the CCF. Cosgrove also demonstrates an attitude all too common among CAM advocates:

“What we really want is validation of what we believe to be true,” Cosgrove said.

Not: “We want to find out if this works or not.” Rather: “We want to prove this is true.” It reminds me of Tom Harkin’s famous remarks.

In any case, there’s nothing “innovative” about what CCF is doing. It’s just embracing ancient, pre-scientific medicine on the one hand (the traditional Chinese medicine clinic) and taking the worst “shotgun” testing modern medicine has to offer, cranking it up to 11 and beyond, and calling it “functional medicine.” The idea seems to be to check as many lab values as possible until something is found to be wrong (as it will be with virtually everyone if you check enough lab values) and then to “treat it,” labeling the “treatment” as somehow “holistic.”

I can’t argue that CCF isn’t a “trailblazer,” though. Unfortunately, it’s a trailblazer in introducing quackery into conventional medicine. Cosgrove ought to rename the CCF to the Cleveland Quackademic Clinic. Former rival of my surgical and doctoral alma mater the CCF might be, but it is sad for me to contemplate the decline of this once-great institution. It has fallen for the fallacious argument, beloved of proponents of “integrative medicine” that, because current medicine has problems with providing the “human touch” and in some cases dealing with chronic disease, “integrating” quackery into science-based medicine is the only answer. No wonder John Weeks (you remember John Weeks, don’t you?) is busily declaring this new center at the CCF a “tipping point” for integrative medicine.

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George Washington University does the CCF one better

From my vantage point it’s depressingly true that the CCF has gotten very, very bad indeed with respect to its promotion of medical pseudoscience. Besides its traditional Chinese medicine clinic and its Center for Functional Medicine, just take a look at its Center for Integrative Medicine, which offers chiropractic, acupuncture, and the magical faith healing that is reiki. If you really want to see how far gone the CCF is, just read its Reiki Factsheet.)

Then look at the Center for Integrative Medicine at the George Washington University Medical Center (GWCIM). Compared to the GWCIM, the CCF’s integrative medicine program looks like a bastion of science-based medicine. 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. Perhaps even the GWCIM is a bit embarrassed, because it can’t even provide a correct description of reiki:

Reiki describes both a harmonizing energy and a non-invasive therapy which involves the placing of hands in a sequence of locations on or near the body. It is not massage, as the hands remain stationary at each position.

The purpose of Reiki is to promote the client’s own natural healing process by providing deep relaxation, abatement of signs or symptoms of distress, or instilling a sense of harmony and balance. Reiki can be used in conjunction with any other treatment to enhance and accelerate its effectiveness.

No, reiki is faith healing that substitutes Eastern mystical beliefs for Christian beliefs, as I like to point out any time a discussion of reiki comes up. At least the CCF describes the magic that is the channeling of “healing energy” from the “universal source” more or less correctly.

I perused what GWCIM writes about a few other modalities, and 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.” They are not. Their training is inadequate and usually consists of as little as 20 days of primary care practice during their third or fourth years of naturopathy school. Meanwhile naturopaths embrace the four humors and tend to be staunchly antivaccine with rare “sort of” exceptions. Doesn’t GWCIM know that? Or doesn’t it care? Apparently not.

Indeed, look at what GWCIM says about high-dose intravenous vitamin C therapy for cancer. After citing in vitro and animal studies that are not particularly compelling and then claiming that there are “several case reports published in peer-reviewed medical journals that meet quality standards set by the National Cancer Institute” that “demonstrate that a small number of patients have responded to a high dose IV Vit-C infusion treatment after all other treatments have failed” (which is patently incorrect, as these cases are as unconvincing as Stanislaw Burzynski cases), all the while admitting that there aren’t any compelling randomized clinical trials, GWCIM writes that in practice:

Based on a vast pool of clinical experience, IV administration of high dose Vit-C has been shown to essentially have no side effects, unlike chemotherapy drugs and radiation therapy. Since IV Vit-C works just like chemotherapy and radiation therapy by releasing free radicals, there are no contraindications for their simultaneous use. In fact, Vit-C may work synergistically with chemotherapy and potentiate its effect.

However, there are some disadvantages. The course of therapy is long and intense, two to three times per week (2 hours each) and for the duration of about a year. It can cost over $20,000 for a year-long course of treatment if it is not covered by an insurance.

When evaluating new innovative cancer treatments we need to ensure that three basic requirements are met:

One: There is a clinical plausibility, i.e., credible case reports exist.

Two: There is a biological plausibility, i.e., the mechanism of action is clear.

Three: Proven clinical effectiveness, i.e., a randomized controlled trial has been conducted.

High dose IV Vit-C therapy has met the first two requirements. It is unfortunate that it would take many years before the last step can be accomplished.

We feel compelled to offer this treatment to patients when there are no other choices even though the definitive clinical evidence of its effectiveness is not yet available.

Clinical plausibility? Intravenous vitamin C might not be homeopathy-grade implausible, but it’s not particularly plausible either. As I like to say frequently, vitamin C, even if it worked, would be a really long run for a short slide, given the incredibly high concentration of ascorbate that’s ever been shown to have in vitro anticancer activity. If vitamin C were anything other than “natural,” doctors would have abandoned it a very long time ago as far more trouble than its minimal-to-nonexistent promise warrants. Achieving such concentrations is difficult, and it is not without side effects, contrary to GWCIM’s claims. I therefore call nonsense on number one. As for biological plausibility, the mechanism is anything but clear. It could be generation of free radicals, but there are also studies suggesting that ascorbate could interfere with chemotherapy, as the Memorial Sloan-Kettering Cancer Center integrative medicine web page acknowledges as it says that high dose vitamin C shouldn’t be used outside of a clinical trial. I call nonsense on number two. Finally, while it’s true that there hasn’t been a large randomized clinical trial for vitamin C for cancer, there has been a phase I/II clinical trial that was basically negative, as I described earlier this year. So I call nonsense on number three as well.

In other words, there is no reason for oncologists at GWCIM to “feel compelled” to offer this treatment, especially given that GWCIM admits that there is no definitive clinical evidence of its effectiveness, particularly considering that, contrary to what GWCIM claims, high dose ascorbate is not without the potential for adverse events. None of this stops GWCIM from recommending high dose vitamin C for the treatment of “a variety of infections as an adjunctive modality.” I fear that GWCIM interprets the science of alternative medicines in the same way it interprets the evidence on vitamin C as a cancer treatment: Through wishful thinking and the most positive spin possible on a body of evidence that does not support their efficacy. Oh, and you can detox, possibly get chelation therapy, and help study reiki at GWCIM, too!

See why I’m depressed?

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Integrative medicine advocates strike back

Three years ago, I wrote a post in which I characterized integrative medicine as a “brand, not a specialty.” In it, I described how in the 1990s “alternative medicine” was rebranded as “complementary and alternative medicine” (CAM) and, over the last few years, has been further rebranded as “integrative medicine,” which is frequently portrayed by advocates as the “best of both worlds.” It’s not that kind of “best of both worlds,” but rather this kind, with integrative medicine “assimilating” what should be—and usually is—science-based medicine, such as nutrition, exercise, and natural products into itself and fusing it with a purpose inimical to science-based medicine.

Glenn Sabin apparently doesn’t like such arguments. And, to be fair, there could be counterarguments based on sound reasoning and evidence. Unfortunately, Sabin appears incapable of offering them. Instead, he proclaims that there are “dwindling skeptics,” using what I like to call the logical fallacy known as the bandwagon fallacy. It’s a fallacy Sabin embraces with gusto:

This phenomenon is fueled by growing patient demand and an emerging cadre of integrative-trained clinicians. Patients across the spectrum of conditions and pathologies consistently experience quality outcomes vis-à-vis these services delivered by a wide range of licensed integrative health disciplines.

I like to respond to this sort of argument thusly: You know what else and who else were enormously popular? Yep, Nazi-ism and Hitler. No, I’m not claiming that integrative medicine is in any way like Nazi-ism. It is simply a suitably and intentionally overblown comparison designed to demonstrate the ridiculousness of appeals to popularity like Sabin’s as an argument. Just because something is popular does not mean it is evidence-based or good. It might be, but it also very well might not be. To take another example, half the people in the US do not believe in evolution. Does that mean evolution is not valid science? Of course not. All an appeal to popularity means is that something is popular, and often that popularity in such appeals is exaggerated.

As happy as Sabin is about the seeming “popularity” of integrative medicine, he’s equally ticked off about criticisms that it’s nothing more than a “rebranding” of quackery:

These skeptics darkly describe a continuous ‘rebranding’ of the field: from alternative medicine, to complementary alternative medicine (CAM) to the integrative health and medicine field of today. It’s not a rebranding. It’s an evolution. Some view it more like a revolution. This is about patient-centered health creation and self-efficacy. It’s the natural progression towards greater population health.

That’s right! New Coke wasn’t a rebranding! It was an evolution! Actually, the rationale for recent proposal by that the National Center for Complementary and Alternative Medicine (NCCAM) be renamed the “National Center for Research on Complementary and Integrative Health” sure sounds like a rebranding:

We see the growth of integrative health care within communities across the US, including hospitals, hospices, and military health facilities. With these changes in the research and practice landscape, we believe that our current name no longer accurately reflects our Congressional mandate, which is, in part, to study the integration of these practices as a complement to conventional care.

We also recognize that our current name is not explicit about our research mission, and that it may be misconstrued as advocacy or promotion of unproven practices.

As I pointed out at the time, this is the very same rationale that’s been used since time immemorial (or at least over the last 30 years or so that has seen the rise of CAM and quackademic medicine) every time a name change for “alternative” medicine has been proposed. As I’ve also pointed out, the reason for this continual rebranding of quackery is that words have power.

Sabin is also off base when he writes:

Naysayers declare that nutrition and exercise are neither “alternative” nor “integrative”; that they’ve always been part and parcel of “plain medicine”; that integrative and lifestyle medicine physicians are “coopting conventional medicine!” The truth is that a mere fifty years ago our food was largely unadulterated, grown in fertile soil and much more nutritious. People were generally more active and doctors were teachers (”teacher” actually comes from the Latin word for doctor”). Unfortunately “the teaching” aspect is largely missing today and nutrition, exercise and psycho-social counseling play no central role in the practice of conventional medicine.

Food fifty years ago was unadulterated? What about the concerns about pollution and pesticide use back then that led, in part, to the dawn of the environmental movement and stricter laws and regulations? Wonder Bread was more nutritious? Nutrition, exercise, and psycho-social counseling play “no central role in the practice of conventional medicine”? Whatever Sabin is smoking, I’d want some were it not that I can’t inhale. If psychosocial counseling plays “no central role” in, for instance, oncology, then why is it that the American College of Surgeons Commission on Cancer’s (ACS CoC’s) requirements for cancer program certification now include standards for psychosocial distress screening, survivorship care plans including addressing patients’ psychosocial needs, risk assessment, nutrition services, and physical activity and weight loss programs? Why does the ACS CoC also require education programs regarding cancer awareness and prevention to meet the needs of the community? Why is it, as I mentioned in my NRC paper, that the standard of care for prediabetes and recently diagnosed type II diabetes includes dietary interventions and encouragement of exercise? Sabin is just plain incorrect.

I can’t help but wonder if at some level Sabin knows that we “skeptics” (or, as he calls us, “cynics”) have a point, given that he writes this about us:

Perhaps they’ll refocus their energies on the real perpetuators of medical quackery: those unprincipled charlatans who often rob their patients of life and treasure with ineffective or dangerous products, agents, interventions or ideology in lieu of proven curative and often life-saving standard of care interventions.

One wonders if he means Stanislaw Burzynski. Or perhaps he means treatments like Nicholas Gonzalez’s treatments. Probably not. He does, however, castigate us for this:

I would like to see better attention paid to the contraindications between natural and formulated pharma agents, or a deeper scientific dive into the controversy surrounding antioxidant adjuvant chemotherapy and radiation therapy, and, um, less on whether acupuncture works or if Reiki’s really helpful with reducing stress and anxiety. Clearly, if patients benefit and there are no significant safety concerns, who really cares exactly how they work? (I’m not implying that scientists should stop investigating these matters. I’m emphasizing the primacy of favorable patient outcomes.)

One wonders whether Sabin doesn’t want us paying so much attention to reiki and acupuncture because, deep in his heart, he knows almost as well as skeptics do that they are quackery based on prescientific mystical belief systems. Unfortunately, as I pointed out above and can be found on SBM in other discussions of reiki quackery at the CCF, University of Arizona, and elsewhere, acupuncture and reiki are some of the most commonly-offered alternative medical modality in quackademic medicine. Notice how he also seems to be admitting that these modalities are placebo modalities, asking “Just because some health creation programs, processes and interventions (especially those based on whole systems) do not perfectly align with the traditional random controlled, double-blinded pharma model of reductionist scientific discovery, does it cancel out the patient’s positive outcome?”

The problem is that the positive outcomes touted have not been demonstrated to be due to these modalities, and, as Steve Novella, Harriet Hall, Mark Crislip, and I have discussed repeatedly, placebo effects are subjective effects, require deception, and are simply being “rebranded” as “self-healing” and the “power of positive thinking.” It’s a narrative being sold by people like Sabin.

Finally, I can’t help but note that Sabin himself has admitted that the name “integrative medicine” is a “rebranding of CAM in an article entitled “CAM Is Dead“:

Today several integrative centers across the country still contain the words CAM in their name. This is both confusing to health consumers and damaging for these centers’ brand. Most clinics and centers launched during the last decade have evolved with their branding to include today’s more appropriate terminology of “integrative medicine”, “integrative services” or “integrative therapies”.

The bold text is Sabin’s not mine. As I pointed out at the time, Sabin basically admitted that the term “integrative medicine” is about the marketing of quackery. This is not surprising, given that Sabin is the founder of FON Therapeutics, a company that exists for this purpose:

FON is dedicated to positioning integrative health organizations for long term growth while advancing evidence-based integrative medicine as the standard of care.

A leading business development consulting firm, FON specializes in customized solutions—focused on growing patient volume, program and product sales—driven by innovative marketing, messaging and branded storytelling, all rooted in fiscally viable business models that work.

FON offers an e-book by Sabin entitled Grow Your Integrative Medicine Business by Telling Bigger Stories (wow, I wonder if Sabin knows what that sounds like) and a white paper on ‘How to Increase Clinic Utilization of Integrative Medicine Services in 60 Days“, while expressing admiration for the Cancer Treatment Centers of America as the 800-pound marketing gorilla. FON is a marketing company, offering all sorts of marketing services to integrative medical centers, pointing out the economic potential of integrative medicine as being projected to reach $50 billion annually. Indeed, in Weeks’ article on the Hyman-CCF partnership, Sabin worries:

Sabin then raised some questions about the intersection of typical functional medicine business practices with the Cleveland Clinic culture. He noted that in Hyman’s private clinic an office visit with the doctor to the Clintons can run pretty steep. It’s $1,500 for 80 minutes with Hyman. Fifty minutes with a nutritionist will set you back $240. Hyman’s clinic does not accept insurance. Hyman’s business model also includes profiting from supplement sales, from which he donates a portion for functional medicine research.

Sabin adds a further question: “How deep will Cleveland Clinic go in terms of embracing a model of comprehensive functional labs looking at biochemical milieu to inform recommendations of well-placed nutraceuticals.” Such lab work-ups can also be quite expensive for patients even as are the bags of natural medicines that are typically part of functional medicine therapeutic regimes.

Although ideology and a misguided view that to become more “holistic” one must embrace quackery seem to be driving the infiltration of quackery into medical academia, we must never forget that there is a clever and sophisticated marketing campaign behind it as well. Does anyone think that the CCF would have embraced Mark Hyman if it didn’t think he can make the hospital significant money? I doubt it, Mark Hyman’s anecdote about how he told the CCF’s Cosgrove that it “probably didn’t want him there” notwithstanding, and I bet Sabin would agree with this point at least. As much as advocates claim that it’s not just about the money, it’s also about the money.

 

 

Posted by David Gorski

Dr. Gorski’s full information can be found here, along with information for patients.

David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski’s biographical information, disclaimers regarding his writings, and notice to patients here.