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“Trust me, have I got a deal for you!”

As a young mother comforts her feverish and uncomfortable infant, a doctor enters the dimly-lit exam room. The child’s mother and the bedside nurse look at him expectantly.

“I’ve got the results. There is an infection in your son’s spinal fluid, which was one of the things we discussed as a possible cause of his high fever and irritability,” the physician explains to the now-crying mother. “We need to start treatment right away and admit him to the hospital.”

After answering the distraught mother’s questions and discussing her child’s treatment plan, the doctor leaves the room and begins to write orders in the patient’s chart. The nurse, eager to begin appropriate therapy looks over his shoulder with a confused look on his face.

“Excuse me doc, but you’ve got to be a little more clear on that order don’t you think?”

Written in barely-legible doctor scribble, next to the date and time of the encounter and above his signature and hospital number, is the lone word “antibiotics”.

“What do you mean? This child is sick and he needs antibiotics stat!”

“Sure doc, but which one, how much and how often? Where did you go to medical school again?”

“Clearly you aren’t current on the literature. Antibiotics have been around for decades and have been proven time and time again to treat infections. Millions of people take them every day and are pleased with the results. Now you are wasting precious time that could be spent caring for this sick child!”

The nurse, unhappy with the response, storms off to find assistance from his supervisor. The doctor, confident that he is providing competent medical are for his patient, expresses dismay at how closed-minded some of his colleagues are.

Naturally, the above situation is absurd, and the nurse is completely correct in questioning the physician on his order for “antibiotics”. What antibiotic, or antibiotics, are appropriate and at what dose? Through what route, oral or parenteral (e.g. intravenously or intramuscularly), should the antibiotic be administered? How often should it be given and for what duration? Five days? Two weeks? To condense the large number of antibiotics available in a hospital pharmacy into one all-encompassing term makes no sense. Antibiotics are drugs, often consisting of completely different chemical structures with significantly-different side effect profiles. There are varying degrees of safety and effectiveness with each individual antibiotic depending on the bacteria/virus/fungus being treated, the location of the infection, the age of the patient, and the presence of co-morbid conditions such as renal or liver disease. Calling for “antibiotics” in this fashion would never happen outside of a poorly written (is there any other kind?) medical drama on Lifetime.

As new antibiotics have been developed over the years, they are studied scientifically on an individual basis. Sure there are classes of antibiotics that work via similar mechanisms, such as breaking down a bacterial cell wall, or that might be effective in killing or delaying the growth of the same types of bacteria, but nobody would make a blanket statement, let alone write an order, like the one written by our fictional physician. Unfortunately, this kind of thinking is rampant in the world of so-called complementary and alternative medicine.

The “It’s All Good!” fallacy is employed by individual practitioners, lobbying organizations and even government agencies sympathetic to alternative medicine as a means of deceptively gaining a foothold for their favorite implausible and unproven therapies. Their targets are the hearts and minds of consumers as well as a growing number of practicing medical professionals. Buoyed by media-fueled public awareness that lacks appropriate context, the growing popularity of a variety of bogus therapies, funding from the National Center for Complementary and Alternative Medicine (NCCAM) and clever marketing, the most ridiculous of ideas are now masquerading as medicine in even our most hallowed academic institutions.

A common saying among advocates of science-based medicine and skeptics who choose to tackle the unfortunate and undeserved incursion of quackery into healthcare is that there is really no such thing as alternative medicine. I agree with this completely and would add that there is no such thing as complementary or integrative medicine either, regardless of what NCCAM puts on its website. These are marketing terms meant to distract from the reality that these therapies have either not been subjected to proper scientific study or that they have failed that study and are held aloft only by a foundation of tenacious anecdote-fueled belief, cultural momentum and supporters with deep pockets.

When proponents of alternative medicine, far too many of which being influential lawmakers with little to no knowledge of science or medicine, call for financial support in the form of taxpayer money, they tend to use a similar tactic. They hold up a small group of therapies that have been shown to be effective, typically entities involving stress reduction, positive lifestyle changes like increased exercise and smoking cessation, improved nutrition, or various herbal remedies, as symbols of how wonderful alternative medicine is. This ignores two important facts.

These proposed symbols of the success of alternative medicine have been co-opted from the science-based medicine which discovered them and established their benefit. More importantly, these alt med proponents are ignoring the fact that the overwhelming majority of what is considered CAM is absolute quackery. In other words, just because a good massage helps your migraines or decreases your fatigue it does not mean that non-existent molecules of homeopathic poison ivy will cure your itchy rash. The use by proponents of terminology like alternative medicine is just as preposterous as the above emergency room physician writing an order for antibiotics. Which alternative therapy? Acupuncture? Homeopathy? Quantum Reiki? And for what indication? And what is it an alternative to? A proven therapy? Each individual treatment must be investigated for efficacy and safety with the tools of science, not the machinations of politicians and ideologues.

In the not too distant past, implausible treatments supported only by sloppy anecdotal evidence or poorly-designed studies had an accepted name. Rational-minded folk were unapologetic when describing a bogus cancer cure or an implausible and disproven treatment for depression as quackery. But over the past couple of decades the quack has become the alternative medicine provider and the bogus treatment has morphed into alternative medicine, CAM, or integrative medicine. This was no accident. The change in terminology has served proponents of quackery quite well by successfully leading the public to think that these therapies are just another way of achieving health, another narrative in the marketplace of ideas. But only science can determine what works and what doesn’t. In the meantime, no therapy should be allowed to circumvent appropriate investigation because of semantics and double standards.

I wrote this post originally in January of 2009 and unfortunately things have only gotten worse. The NCCAM still wastes millions of taxpayer dollars. More respected medical institutions have succumbed to the siren song of quackademic medicine. More medical schools have incorporated alternative medicine courses into their curriculum without appropriate context and skepticism. And the public continues to be victimized by misinformation with the imprimatur of institutions such as Mayo Clinic, Yale and many, many more.

A study published this month in Medical Acupuncture serves as an excellent example of this trend towards obfuscation and seemingly-blind acceptance of nonsense. The paper, titled “Acupuncture Helps Reduce Need for Sedative Medications in Neonates and Infants Undergoing Treatment in the Intensive Care Unit: A Prospective Case Series” demonstrates that even critically ill children are not protected from quackery at the hands of bamboozled believers and the more prevalent shruggie. It boggles the mind that this uncontrolled and nonblinded train wreck of a study was approved by an IRB at Stanford’s children’s hospital. At least they probably wore gloves.

 

 

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician practicing at Newton-Wellesley Hospital in Newton, MA, and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @skepticpedi and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey.