Being an avid reader of SBM and a cancer patient, I have come to deeply appreciate the writing and respect the various contributors for their expertise and attention to detail on a topic as important as cancer treatment. I have unfortunately found SBM lacking when it comes to a patient’ or lay-person’s’ perspective. This is understandable, as the average person is typically not well versed in science, medicine, or logical fallacies, all important when examining medical claims and practices. Nonetheless, this is a general problem because lack of patient and public involvement in healthcare is partly responsible for the spectacular growth of the integrative medicine industry. Under the integrative and CAM umbrella there is an almost-endless list of topics (as readers are well aware) to write on but there is only so much space in one article. To address this gap, I would like to focus on the general harm caused to patients by the presence of integrative medicine in healthcare (hence the creative title).
How I encountered integrative medicine
As a result of becoming ill I have had the great pleasure of touring most of the major hospital networks in Manhattan, specifically the hematology/oncology services, as I had a blood condition that eventually turned out to be a rare cancer. At every initial visit I was recommended to schedule an appointment with the integrative medical service by most nurses and the occasional doctor. I was already aware that alternative medicine was at best a collective delusion but I wasn’t’ familiar with “integrative medicine” (IM). Upon inquiring, I was met every time with a different yet equally-nebulous and ambiguous definition that typically included the words “balance,” “harmony,” “holistic,” and “wellness.” I was curious. After some quick research on my own I was a bit confused; it seemed to be nothing but alternative health approaches being marketed as part of real medicine. After seeing articles with titles like “The effects of Reiki therapy and companionship on quality of life, mood, and symptom distress during chemotherapy“, I realized that IM was just the continuation of a scam I thought was relegated to the fringes. However, it was back, and no longer peddled solely by the familiar (and laughable) flower children, but by mainstream healthcare workers and highly respected healthcare institutions. Among the myriad surface dangers posed by this “new” field are its appeal, ease of access, and most of all, faulty science. More on the resulting harm later.
Integrative medicine preys on a patient’s desire for hope and control
Anyone that has ever faced a serious illness, or been close to someone who has, should be able to easily understand the initial appeal of integrative medicine. There seems to be limited options to treat the primary condition, symptoms, medication side effects, and even psychological effects. In any (other) field of medicine, you get sick and the doctor will recommend a treatment. Out-of-office information truly accessible to the average person is usually not very specific, normally providing only a brief description and listing general treatments a doctor may provide, such as medications or surgery. These sources use general terms, not out of secrecy or malevolence, but simply out of the desire to not overload an already-overwhelmed patients with complex information.
However, when a patient looks at an integrative medicine website, hospital pamphlet, flyer, or any other means of promotion they are met with a plethora of options with “detailed” descriptions to pick from, all offering the possibility to help in some way. The majority of these descriptions are filled with catchy, enticing, and non-specific terms that could apply to nearly everyone and any condition. Take, for example, these quotes from the’ Center for Comprehensive Wellness at the Columbia University Medical Center, a part of the New York Presbyterian Hospital that utilizes CAM therapies on pediatric patients:
Reiki is an ancient, gentle hands-on healing technique originating in Japan. Reiki promotes relaxation, eases pain, and reduces anxiety and stress. It also assists the body in cleansing toxins and balances the flow of subtle energy.
Acupuncture and acupressure, both forms of Traditional Chinese Medicine (TCM), stimulate specific points on the body known as acupoints in order to reduce tension, help the body relax deeply, and strengthen resistance to disease. These approaches relax the muscle fibers, resulting in increased blood flow and release of toxins.
Reading these, it is easy to see how a person could be misled, since this is information coming from a reputable source and sounds very convincing if not read with a skeptical lens. No well-conducted study has shown that either of the above treatments will heal or prevent disease, aid in removing toxins (always unspecified) from the body, or manipulate a non-existent energy field. They may cause an improvement in mood and/or relaxation through (very real) placebo effects and a simple human connection, but both a positive mood and relaxation can be brought about through far less mystical ways. Indeed, acupuncture actually carries an actual risk of infection with no actual benefit.
Upon personally reading such pamphlets and information, I was led through a gamut of feelings, the first of which being confusion. One pamphlet listed several of these “modalities” in a chart on one axis and symptoms or problems on the other. At the intersection of each were circles ranging from empty to fully shaded, similar to Consumer Reports reviews, which represented the evidence behind each technique. Unsurprisingly, the majority were in support of even the most bizarre CAM therapies. When I questioned my oncologist about these claims he had (in his professional opinion) no clue why they would endorse remedies that were known not to work. This seemed contradictory to me but I trusted my oncologist even though all the information about integrative care was presented in a medical fashion. The trust was not blind, all CAM therapies seemed disconcertingly like medical advice given by Dr. Oz to me and as a result felt the need to do a little digging. Though fortunately I was able to recognize the faulty science by consulting medical textbooks and journals, I understand that most people are unable to do that, which is how’ they are lured in. Despite discovering the truth, I am still left with the nagging feeling that I was misled and/or lied to by a hospital and medical professionals, which is something that no one should ever have to feel or be concerned about when ill.
Access to these options provides a false sense of control to someone who felt that they had little or none. Appeal is also generated by the way these “treatments” are presented. As above, they are often portrayed as ancient, natural, indigenous, or spiritual. In fact, reiki originated in 1922, a year not considered ancient by anyone I know. In addition, the terms “Western medicine” and “conventional medicine” are frequently used to create a false dichotomy that implies those outside of integrative medicine are shut off from the rest of the world and society, that other incarnations of medicine are of equal or more value.
An evolution, or regression, of medicine?
From Mount Sinai’s website:
Integrative Medicine represents an evolution in healthcare that combines conventional medical practices with other indigenous and western healing approaches, using scientific evidence as the rationale for incorporating these modalities into patient care. The integrative approach emphasizes patient empowerment and encourages patients to take an active role in their health.
If Integrative medicine is truly an evolution of healthcare and not a step backwards, then one would expect to see results in research, research that meets the most stringent requirements inherit to the scientific process. Yet, very rarely are proper placebo-controlled studies done, and when they are, there is absolutely no benefit to any alternative “treatment” now part of integrative medicine. Studies are then pursued with less rigor and so many confounding factors that make success almost certain (this is without accounting for possible data manipulation). These studies allow “practitioners” to make dubious claims about unscientific “modalities” that are backed up by such “pseudo-research”. If an intelligent person decides not to take things at face value and do some basic (but not intensive) investigation, they could be met with comments such as the following from the Memorial Sloan Kettering Cancer Center, one of the world’s most respected cancer research institutions:
We know that a therapy works only when it has been scientifically tested and found to be effective and safe. Anecdotal reports may provide research ideas, but they are not proof that a therapy works. Patients and the public have a right to know whether therapies of all kinds fulfill the claims they make.
Coming from such a prestigious institution, these comments make it seem as if there is no question that integrative medicine is legitimate. If doubt still persists and a search of a medical database such as PubMed is done, there is what seems to be overwhelming support for these CAM practices, with many studies producing positive results. Only when these studies are closely examined can it be seen they are of terribly poor quality and that properly conducted studies do not reveal any positive effects beyond that of a placebo. I will not belabor the faulty science aspect of integrative medicine as it can take an entire article or more to properly examine just one bad study. I will say that twenty bad studies are not worth one well-designed and properly conducted study, and that the CAM industry has done a wonderful job of making people of all educational levels think otherwise.
The harms of integrative medicine
Finally, we are left with the harms occurring as a result of integrative medicine. The most dangerous result is the same that has always been a part of alternative medicine, that patients will not seek appropriate medical care in a timely manner or at all. As demonstrated recently in a study on CAM use and chemotherapy (covered by Dr. Gorski), this is, as we know, not an imaginary occurrence, fear mongering, or hyperbole. People are less likely to use real medicine when CAM is a factor. A defining factor of integrative medicine is that “practitioners” claim they advise all patients to use other “modalities” only in addition to “Western medicine”. This does not mean that patients will listen to that advice. When the idea is put into a patient’s head that not only do medicine and science not have all the answers, but that other “options” exist that will never turn someone away, always claim to be effective, never admit that hope is lost, and are always presented warmly, there will undoubtedly be some inclination not to go back to a long office wait for a 10 minute visit to get medications with unpleasant side-effects, and instead get a relaxing session of reiki. This will obviously not occur with all patients, but some will likely stray from proper treatment even if only a bit. Others may move completely away and into the arms of a genuinely alternative provider where they certainly won’t get proper medical care, lose a lot of money in the process, and possibly their lives.
As frightening as all the dangers above are to us adults, we also have to realize that there has been a massive proliferation of services offered to pediatric patients. When truly ill children are receiving inappropriate medical care it is a clear warning bell that something needs to change. If just one child dies as a result that is one too many (and there has already been one).
Economics is another factor to be concerned about when it comes to integrative medicine. Costs are rarely covered by insurance but seem affordable at first glance. The patient is soon caught in the web and paying for multiple sessions in multiple forms, sometimes by the same provider. Even without a serious illness these costs can put a drain on a person financially. Those unfortunate enough to have a serious illness typically don’t have much money to play around with. The risk of running out of money is very real for many people, and not a penny should be spent on ineffective care in such cases. Further, society bears an economic burden, as well as individuals; some hospitals will claim to provide some CAM services free of charge but there is always an opportunity cost, as everything must be funded in one way or another and every dollar that goes towards providing integrative care or researching a treatment that has been disproved multiple times takes that money away from truly valuable medicine. There are still studies being conducted on the widely-discredited practice of therapeutic touch when cancer immunology researchers are producing real results.
Though not as personally imaginable to the general person, there is also the psychologically destructive occurrence of patient victimization that I have personally been subjected to. In this article, victimization refers not to that done by the public but more specifically by other patients, practitioners, and even family members of the sick. This may be difficult to comprehend to those who have not experienced it, and I’m sure there will be outright deniers (mostly by those responsible), but it is very real. Integrative medicine has reached the point where it is shoved down our collective throats in hospitals, doctor’s’ offices, television, and especially the internet, making it difficult for people not to have it in their minds.
My own experiences with integrative medicine
Even without a study we know the above to be true; not only can the editors of SBM speak to this as medical professionals but so can I as a patient. Until very recently I had attended several support groups for those with cancer in New York City, some weekly, some monthly. The focus of each varied, one was general, two were for young adults, two were for those with advanced cancer, and one was for blood cancers. I did not stop because I got better, but because I was tired of losing members of the group to their disease. Yes, that’s partly to be expected but not exactly. Some of those deaths I can say could have been prevented, or at least put off for a while, most of them in the young-adult and advanced cancer groups. If there were 10 people, on average, three of them were using CAM therapies either exclusively or almost exclusively. That was not the case when I met them though; they adhered strictly to their doctors’ directions and recommendations but were being treated by integrative practitioners as well. The story was always the same when that day of the week or month came when they announced their departure from standard care, different words but same content. They were tired of feeling the side effects of their medications, searching for better combinations of anti-emetics or seeing their doctor for a brief visit once a month or so. They had the option of CAM where the doctors seemed to care more, spent more time with them, and rarely said “some side effects can’t be avoided.” There was the common delusion among them that if something made them feel better it had to be better, that it had to be doing more. I met one gentleman that had completely renounced modern medicine for a “health coach” that told him the only thing he needed to do was ejaculate more often. Don’t get me wrong, I see that this would make any guy feel better, but hardly find it useful in combating the metastatic anal cancer he had. I do want to stress again that these were not people already entrenched in an alternative medicine mindset, but were pulled and pushed towards it.
At this point I must ashamedly admit I have tried a few integrative therapies (mind you, not because I felt they were worth a try but for the same reason most men do things they don’t want to, an attractive woman). I have had the displeasure of participating in a “restorative” yoga session that included reiki, aromatherapy, and Tibetan singing bowls, and separately I also utilized “essential oil therapy”. The yoga class was a two-hour ordeal in a room of mostly very fit women. I wore jeans and a sweater (There wasn’t a chance in hell I was putting spandex shorts on) that made me stand out right away to everyone. Scents were burned for our “pleasure” and then we were informed of what we were in for. We were told that “Restorative yoga helps the body to drop into the parasympathetic nervous system and restore balance.” I honestly can’t even begin to tell you how that makes no sense as I was unaware that I was separated from my parasympathetic nervous system. The Tibetan singing bowls were meant to “restore balance and harmony in a person’s whole being.” Once again, I have no idea. I was told afterward (by that pretty girl) I also received reiki. I was questioned as to whether I felt the heating of her hands and the tingling. I said “no” and was met with a “you’ll feel it soon” and that was it. I never felt whatever “it” was and that was my last class. In addition to all of that I also tried “essential oil therapy” on several occasions at the bequest of, you guessed it, a pretty girl. I tried rubbing ginger oil on the soles of my feet to help with nausea. I knew it made no sense but it did accomplish something – I had to change my sheets. On another occasion I rubbed lavender oil in my hair to help me sleep. It didn’t work. I blame it on the overwhelming smell of lavender, myself. Overall, I found all of the above to be useless but can personally see the attraction of having a human connection and will admit that parts of the class were relaxing (but punctuated by spirituality-based pseudoscience that sounds sensible to the uninformed individual).
If you think that you’re seeing a pattern in the last paragraph or in the field of integrative medicine it’s because you are. As I stated before regarding the false dichotomy presented in the form of Western vs. Eastern medicine, there is an inexplicable obsession with anything even remotely Eastern in the field (Reiki-Japanese, Acupuncture-Chinese, Yoga-Hindu). I suspect that is because they carry a mystical, ancient, and mysterious aspect, making them easier to sell to Westerners. That is just a guess though; I will leave that to sociologists to figure out. This obsession with another culture above your own has been termed xenocentrism. Though this attitude may be exciting and sometimes advantageous when you are an interior designer, it is a disadvantage in the field of medicine. Not only is it harmful because it convinces patients that unscientific ideas are equal to those that are actually beneficial, but it also has the unintended consequence of portraying every medical doctor in the East as a quack. It implies they wouldn’t know hepatosplenomegaly (swollen spleen and liver) could be caused by bone marrow failure but instead believe it was caused by a blocked energy channel, an idea often seen in “traditional Chinese medicine”.
I have seen this in discussions in waiting rooms with other patients, sometimes off-topic, sometimes about our diagnosis and treatment. A large number mentioned some form of CAM therapy or another, often overseen or provided by the integrative service at that hospital. When I was asked about which of those “treatments” I took advantage of, I gave the simple and reasonable answer that they had no benefit and I didn’t use any. That answer was not only met by most with a refusal to believe in their lack of efficacy, but also probed as to why I didn’t care about my health or my family. In addition, I was advised to switch oncologists several times to one that was more “open” or “knowledgeable”. These ideas were most likely planted in their heads by their integrative care team. Far worse, I have heard similar remarks from family and various friends; “If you don’t feel well, see a chiropractor,” “I’ve heard gluten-free diets are good for cancer,” and my personal favorite, “you can’t trust medicine to help.” In multiple conversations with an integrative medicine advocate and “practitioner” I know personally, multiple “points” were made in the same vein. Upon refusing to try reiki and “essential oil therapy” again, I was told that I could never expect to get better if I didn’t use the “solutions at hand.” When I explained the science behind such refusal and wanting truthful, reliable treatment, I was met with, “Only your truth and that of science” (At that point I obviously had to leave the room). The message of all of these incidents to me was that it is our own fault, as patients that prefer science-based treatments, for not getting better, our fault for not using CAM approaches.
We all need to ask ourselves: is the slight mood boost and relaxation worth all of the above effort when the same can be accomplished with some smooth jazz and a hug?