A little over two years ago, Henry and Susan Samueli, wealthy patrons of medical pseudoscience, gave $200 million to the University of California Irvine (UCI) to establish the eponymous Samueli College of Health Sciences. But the gift came with some troubling strings attached: most of the money goes to so-called “integrative medicine”, including up to 15 faculty chairs and training for medical students. As a part of this package deal, the existing Susan Samueli Center, which offered homeopathy and other alternative treatments, became the Susan Samueli Integrative Health Institute (SSIHI).
The gift’s size and emphasis on “integrative medicine”, coupled with the Samuelis’ penchant for quackery, engendered a sharp response from adherents to science-based medicine and some bad press. SBM’s own Drs. David Gorski and Steve Novella were quoted in several articles criticizing UCI for accepting tainted money. They wrote their own SBM blog posts on the subject as well, appropriately calling it out as “quackademic medicine”.
Steve told the Los Angeles Times that it was “an absolute failure of academia to allow this to happen” and STAT that the gift “puts the imprimatur of a university on things that have been discredited as medical fraud for 50 years”. He pointed out that the term “integrative” makes little sense:
You have to ask what are they integrating? Are they integrating things that don’t work. If it worked, we wouldn’t need to integrate it – it would already be part of the system.
Or, as David put it to STAT, more bluntly:
The only reason “integrative medicine” exists is to integrate quackery into medicine.
It’s been said that what’s good about integrative medicine not unique, and what’s unique about it is not good.
UCI’s medical brass pushed back hard against these criticisms. In addition to the usual appeals to “open-mindedness” and attempts to window dress integrative medicine as “holistic” and being about nutrition and exercise, they swore up and down that unproven treatments would never, ever darken the door of the UC Irvine Susan Samueli Integrative Health Institute.
Dr. Howard Federoff, the university’s vice chancellor for health affairs, told various publications at the time:
The teaching, research, and treatment funded via the Samueli endowment will be rigorously evidence-based.
We are not going to promulgate things that have been established to be ineffective.
There’s nothing I would ever allow in the context of clinical care if I believed the clinical evidence was lacking.
My promise [to the Samuelis] all along is that we will collect the best evidence.
Any non-proven or non-evidence based approach? We will not deploy it.
UCI med school professor Dr. Jay Gargus added that the idea that the med school was going to become a home of “witchcraft” is “just not going to be the case . . . We’re only going to be doing evidenced-based medicine.”
Recently, serendipitously, an internet search just happened to land me on the UCI’s Susan Samueli Integrative Health Institute website. It sounded familiar. A quick search brought me to (where else?) SBM and refreshed my memory. This, I thought, presented the perfect opportunity to have a look around SSIHI and see if UCI stuck to its evidence-based guns.
So, what did I find? Let’s start with the witchcraft.
Mayan abdominal therapy
Under the massage therapy offerings, we find:
Arvigo Techniques or Mayan Abdominal Therapy: This technique addresses the position and health of the pelvic and abdominal organs, and is widely known for its ability to correct prolapsed uterus, fallen uterus, tilted uterus, premenstrual symptom, menopause and the relief of many digestive disorders.
a non-invasive, external, massage technique that gently guides internal abdominal organs into their proper position [from which they have migrated due to activities like running] for optimum health and well-being. The technique works to relieve congestion and blockages by improving The 5 Systems of Flow (arterial, venous, lymphatic, nerve and chi). This results in improved organ function by releasing physical and emotional congestion from the abdomen.
In addition to “correcting” a prolapsed uterus, etc., proponents claim it is beneficial for all sorts of maladies in women, men, and children, ranging from bladder infections to benign prostate hyperplasia to Crohn’s Disease.
Is this, as promised, “rigorously evidence-based”? How about lacking not only evidence, but also scientific plausibility and a basis in human anatomy? If Mayan Abdominal Therapy is “evidence-based”, one can imagine the surprise of general surgeons at UCI Health (“One of America’s Best Hospitals”) who, upon performing a laparotomy, find the abdominal organs have shimmied over to random locations unknown to Gray’s Anatomy. Call the Mayan Abdominal Therapy practitioner!
Also on the SSIHI menu is so-called “functional medicine” (also here), described as an alternative to “providing a prescription for a symptom” (tsk, tsk, you medical doctors!). Functional medicine practitioners, SSIHI claims,
search for the underlying causes of disease, including genetic predisposition, food intolerances, infectious diseases and environmental toxins.
This is all sufficiently vague to obfuscate what functional medicine really is, or does. Real medical specialties, like surgery or oncology, are literally open books, with their scientific underpinnings, diagnostic methods, and treatments all laid out in medical texts and other literature. Functional medicine, on the other hand, keeps its secrets safely locked behind a $15,000 paywall, available only to the “integrative” physicians, naturopaths, chiropractors, acupuncturists, and other health care practitioners who take its courses.
It is only by extrapolation from the paucity of publicly available information that we have been able to surmise its true nature. In David Gorski’s apt summation functional medicine is characterized by reams of useless tests, boatloads of prescribed supplements (often conveniently sold by the practitioner), and a huge invoice, with some quack diagnoses (e.g., “adrenal fatigue“) thrown in for good measure. And, in the estimation of the American Academy of Family Physicians, functional medicine lacks supporting evidence and includes harmful and dangerous treatments.
Despite assurances from Dr. Shaista Malik, SSIHI’s director, that naturopaths on staff would be supervised by MDs and used “for their expertise in nutrition and dietary supplements”, the Medical Director of the functional medicine operation is Afrouz Demehri, a naturopath, whose brief appears to go far beyond nutrition and supplements. In a video on UCI’s website, she depicts herself as an expert in hormonal, GI, thyroid, and mental health issues who wants to substitute her judgment for that of medical specialists or, as she says, be “the umbrella person that puts all those specialties in one area”, presumably functional medicine.
In addition to graduation from a naturopathic school, which is itself chock full of pseudoscience, and being a Doctor of Homeopathic Medicine, Demeri’s alleged expertise comes from several dubious sources. According to her practice’s website (where her name is spelled “Demeri”, not “Dehmeri”, and her connection to UCI is prominently displayed), in addition to her certification in functional medicine, she holds certifications in HeartMath (Steve Novella: “noise-based pseudoscience”), the Bredesen Alzheimer’s Protocol (Harriet Hall: “treatments are based loosely on his hypotheses about causation, with no clear rationale for the combination of interventions”), and platelet-rich plasma injections (Scott Gavura: “lots of hype, no convincing evidence”). She also completed an “Advanced Endocrinology Fellowship” with the American Academy of Anti-Aging Medicine, a fringe medical group criticized by scientists, and naturopath Ben Lynch’s course on MTHFR genetic screenings, which have been thoroughly debunked by real experts in genetics (also here) but are nevertheless used in functional medicine.
SSIHI’s functional medicine operation claims it can treat “any chronic health condition in children or adults” specifically including “leaky gut“, depression, genetic issues (“including autoimmune disorders and mitochondrial dysfunction”), hypothyroidism, and hormonal imbalances with therapies like “detoxification” and herbs and dietary supplements. It also touts bioidentical hormone therapy “to maximize your quality of life and prevent significant illness”, the sort of exaggerated assertion Harvard Women’s Health Watch criticizes as falsely suggesting bioidentical hormones “are a veritable fountain of youth”.
An extraordinary range of diseases and conditions that would, in conventional medicine, be managed by specialty-trained physicians with years-long residencies in, for example, gastroenterology, endocrinology, or rheumatology, appear to fall under functional medicine’s “umbrella”. Given the pseudoscience inherent in functional medicine, as well as its Medical Director’s education, training, and claims of expertise in numerous specialties, UCI would do well to critically evaluate whether its functional medicine operation is keeping the school’s supposed commitment to evidence-based medicine.
Acupuncture and Traditional Chinese Medicine
I guess this is what passes for an “evidence-based approach” at UCI:
A key goal of these therapies is to restore qi (pronounced chee), the “vital energy” that flows through intricate pathways throughout the body. By stimulating acupuncture points, this flow of energy is harmonized and optimal health can be restored.
SSIHI’s director, Dr. Malik, told STAT in 2017 that Chinese herbal treatments “would be used very rarely and, being unproven, would likely be phased out.” They weren’t. From the SSIHI Acupuncture and Traditional Chinese Medicine menu:
Chinese herbal medicine: Traditional Chinese herbal therapy has been practiced safely and effectively for centuries. It offers the greatest potential for beneficial results when prescribed by a trained acupuncturist.
In addition to the “unproven” herbs, which have magically become safe and effective since 2017, SSIHI offers a cornucopia of TCM pseudoscience: acupuncture, cupping, moxibustion, and something called “facial acupuncture renewal”, which
views the face as an extension of the pathways that travel the whole body. By needling the face, blood flow increases and qi (energy) carries nutrients to the cells.
What does TCM treat? For this, SSIHI relies on the WHO’s 1998 list of diseases and conditions “for which acupuncture has been proven, through controlled trials, to be an effective or promising treatment”, a claim that is demonstrably false. Even if it were true at the time, evidence-based medicine would require a reassessment of the evidence twenty-two years later.
In any event, the WHO’s list is extensive, including dysentery, hyper- and hypotension, leukopenia, correction of malpositioned fetuses, and stroke, for which there is no reliable evidence that acupuncture is “an effective or promising treatment”, acupuncture being, in fact, an elaborate placebo.
More “rigorously evidence-based” [sic] stuff
SSIHI also offers:
IV infusion therapy
IV infusions of “micronutrients, such as antioxidants, metabolites, co-factors, vitamins [including high dose vitamin C “if medically indicated”] and minerals” for “mental focus, boosted energy, regained vitality, improved fat loss and sports performance, improved healing and recovery, enhanced immune support against pathogens and detoxification.” Each infusion requires “lab testing prior to infusion and is tailored to the needs of the individual.” Considering the hype about high-dose vitamin C, the lack of evidence for routine vitamin infusions and their abuse in the hands of naturopaths, as well as SSIHI’s use of unvalidated lab tests, while some infusions may be “medically indicated”, one suspects most of them are not.
As with acupuncture, SSIHI is again all in for magical explanations of human functioning, presumably dismissing our vast body of scientific knowledge for no other reason than Ayurvedic “medicine” originated in India “more than 5,000 years ago”, even though none other than the Indian Medical Association has denounced it as “quackery”. Their repertoire of Ayurvedic therapies is limited to the external application of herbal oils which, they claim, defying reality, have some amazing internal effects, including joint lubrication, stimulating digestive enzymes, revitalizing the central nervous system, cleaning and fortifying the blood, and building muscle tissue.
Training in pseudoscience
To ensure that pseudoscience becomes firmly established in the medical profession, the UCI Department of Family Medicine, in collaboration with SSIHI, is developing “a new model of primary care” with a track in integrative medicine, offering education and training in treating primary care patients “using the tools and philosophies of integrative medicine”. I’ll have to give them this: They’ll have plenty of “tools and philosophies” to choose from at SSIHI. There is also a residency program for naturopathic doctors at UCI, apparently a first for U.S. medical schools, and a special integrative medicine program for medical students.
In sum, UCI obviously reneged on its commitment to evidence-based medicine in launching the Susan Samueli Integrative Health Institute. Of course, no one really thought the result would be otherwise because, by definition, integrative medicine requires the inclusion of pseudoscience. Otherwise, it’s just plain old medicine.
Fortunately, it appears that at least some in medicine are waking up to the fact that medical institutions have become infested with nonsense and are urging reform. I’ll end with a quote from an excellent 2018 article in the medical journal Surgeon (abstract here; discussion by Dr. Edzard Ernst here), which, incidentally, called out the Cleveland Clinic’s Center for Functional Medicine, where “patients are unaware of the potential harms and lack of therapeutic effectiveness that come with receiving care from a centre that holds strong non-evidence-based beliefs about medicine.” The authors warn:
Academic medical institutions are supposed to show the highest level of commitment to evidence-based medicine. When they support CAM, it sends the message that practices without a proven therapeutic or safety profile have a place in modern medicine. Indeed, the presentation of proven ineffective therapies alongside high quality, evidence-based medicine in academic medical centres inadvertently legitimizes their usage and is confusing for the public. This is dangerous for patients and damages the reputation of medicine as an evidence-based discipline. More detrimentally, the public may be misguided into thinking that CAM is evidence-based. . . Health care professionals must understand how deep CAM runs in their institutions . . . and advocate against the practice of non-evidence-based medicine. [Emphasis added.]
We’ve been saying the same thing for over a decade at SBM. It is therefore gratifying that the authors cite two SBM posts in their article. Medicine is finally taking notice. Someone should tell UCI.