Why would medical schools risk association with quackery?

…a question from a Washington Post reporter in 1998.

The following hypothetical answer composed in response was never sent. It awaited a proper forum. Could this be one?

Well, Jeff, quackery is a pejorative term. Some time ago we recognized that words raise emotions and mental pictures. We recognized the cognitive dissonance raised by them, so we tried to eliminate quackery. We recognized the cognitive dissonance raised when one discusses acupuncture, chiropractic, homeopathy, and healing at a distance as if they were quackery when we made claims. For a century, most people just could not allow for the possibility that these things really work.

So over time we recognized that we had to do something about our language. That would be the first step in enabling the thought revolution that is upon us, and changing the paradigm in medicine and science. We simply changed the adjectives, and gave alternate names to the methods, added a few phrases to eliminate negative reactions, and shifted the negative terms to descriptions of the Medical Establishment (and, note the caps in that one.)

And along with that, we took advantage of a shift in perception, to be sure that the public would adopt a non-judgmental attitude. Of course, we had to wait decades for that attitude to mature to the point that they would be willing to give our claims a hearing, whereas just thirty years ago they would have dismissed the claims out of hand. Not only did we get that non-judgmental mind-set, but with it, a strong negative reaction to a description that contained an opinion or one that used any kind of loaded language to describe an underdog – no matter how true or justified that language happened to be. Fortunately for us, a wave of change spread across the intelligentsia, especially in the universities and the literary community, reinforced by the press. This was nicknamed “Political Correctness” or PC by other observers, but it was a new social standard that worked wonders for us. No scientific paper could be published that contained pejorative or negative wording, and almost all popular press reporting became dominated by the same press ethic. The press call it “balance“ or “objective reporting,” and they called reports’ wording of 10-20 years previous to be “biased” or “prejudicial.” And those were sins worse than using four letter words. We were delighted.

We now use words like unorthodox, nonstandard, unconventional, alternative, complementary, and the latest, “integrative.” They produce no emotional reaction. Along with this we invented false dichotomies, which became accepted facts; like holistic vs. reductionist, Western vs. Eastern medicine, linear vs. non-linear thinking. The dichotomies reinforced people’s feelings that these things were opposites, but of equivalent linguistic and scientific value.

Then we had to build a few straw men to show how bad and dangerous medicine was: The Medical Establishment, “cut, burn, and poison,” “cold and impersonal,” Medical Monopoly, Big Pharma, and adopted phrases to use in lobbying like “that‘s just a turf war…” Then we added slogans to replace realistic description like they do in advertising, because they really do work. So we made up Metabolic Therapy, Orthomolecular Medicine, treating the whole person, Treating the cause, not just the symptoms, Medicine for the 21st century, and “complementary and alternative medicine (“CAM”) itself. And how about “changing paradigm” we stole from Tomas Kuhn, “emergent methods” and “emergent technologies” – some of our co-borderliners used that one for cold fusion. [One wealthy foundation just constructed “The New Medicine.”]

So, y’see, what we did was ride a changing social and political scene to construct an entirely new thought system for medicine and health (oh, yeah, we also now use “health” instead of “medicine.”) – a new lens through which all our methods and claims would be seen as “good” or at least neutral. Descriptions such as implausible, unproven, disproven, fraudulent, dubious, would be out. Yet we would be free to use terms to describe medical science as removed, intellectual, unapproachable, elitist, and members of the System would be seen as arrogant, unfeeling, dominating,… well, you get the point. And, quackery, charlatan, irrational, fringe, are no longer linguistically correct (LC.) The cultural relativists, post-modernists, deconstructivists, have paved the way. The educational system, most of the academic, and much of the medical educational system are now etymologically and epistemically correct (ET.)

An example of our success was at the National Library of Medicine a few years ago when a medical author-editor inquired about the recent use of the term, “alternative medicine,” as a subject heading for its reference system. He was told the wording was now part of the common lexicon, and had to be honored, because that was the term the public would use to obtain references. Then just last week, he was asked to moderate a debate on “CAM” for an internet biological science magazine. He suggested the title not be “CAM” or “AM” but “aberrant medical practices.” The editor rejected the change, stating that the last term was prejudicial whereas “alternative” was not. Talk about your success!

We are thankful to the popular media – especially the print media for fifteen years of support. Of course, the press would not consider it support, because its members are blind to the problem. Their system of … ethics is different from that of science. And especially of medicine. They adopted a common theme – actually a template for writing about us. First, they are not interested so much in facts as they are in stories – keeping the attention of readers. So they almost always have a human interest story in an article about us. A leukemia cure by modern drugs by a highly educated and skillful clinician is not a story. Now if an insurance company refuses to pay for the treatment because of its expense, that’s a story. Or if a disgruntled patient didn’t get no satisfaction for a set of symptoms that the physician could not fit into a disease category (often just concern over common bothersome though unimportant symptoms) and then went to a chiropractor or acupuncturist and got relief, however temporary or expected on the basis of waiting and time, that’s a story. Or if a medical school forms a department for using some “alternative” treatment, and teaches the techniques to students, that’s a story. Of course, if the teaching is supported by a large grant from a private foundation run by some of our supporters, that would not likely be mentioned because it could be interpreted as biased. (And between you and me, we would not volunteer that information, would we?.)

And what percent of the readership would read about the structure and function of genes or the physics of heart-lung machines, or of the details of transplant operations? They figure most readers won’t get past paragraph four. It’s so much diagrammatic clutter. We know that in hard times the first sections they sacrifice are the medicine and science pages. There is always a market for sports and entertainment. So your editors will usually go for the first page of the B or the Living Section. And most people don‘t know that those articles don‘t come out of nowhere or just from an editor’s head. We started news releases, writing books and having our agents get us on the radio, and getting reviews of our books. And fortunately, they have lay readers do the reviews; we know what kinds of reviews we would get from real scientists and clinicians. As for the occasional idea you might get for a hit piece, or to tell it like it is, the editors cower – they fear the accusations they will get from us and our attorneys for defamation and interfering with commerce. We sort of have them there.

How about you science writers, who have had background education, special training, and consider yourselves no fools when it comes to so-called scams? With few exceptions, you have already felt the effects of the editors’ marker pens. And the power of that unspoken “balance” thing you were taught as far back as journalism school. And what would you do about getting other points of view anyway? We have seen your formula for articles. A front piece about a happy patient, 15-20 paragraphs about the patient, you, and the method, and two paragraphs by some doubter – a self-described expert skeptic – somewhere between paragraphs 15 and 28; and I thank you for almost always giving the last word, sentences, and paragraphs to us. Besides, you are usually on a deadline, our agents have just about pulverized regulatory agencies through Congress in the name of personal freedom, and most of all, we would never suggest any of those troublemaking skeptics’ names. Count on that.

So with the new postmodern academic teaching in most universities, the slow changes in attitude from language distortion (we call it language capture), and the cooperation of the press, all we needed were two more institutions – a sizable pool of private foundations and a foothold in the government. We got both. We got a powerful senator, chairman of the Health Education and Labor (and Pensions) Committee, egged on by a couple of House members who cajoled the others and the head of the NIH, and got our semi-permanent NIH Institute, now a Center for Complementary and Alternative Medicine and its $120 million per year “awards” to our centers. Those assured the presence and persistence of medical school teaching of our material, special clinics where they are applied, and a an institutional source of employment for us for the first time in more than a century.

And it all mushroomed from there beyond our expectations. We got over 30 of our journals listed and abstracted in Medline/Pubmed of the NLM, and our people and sympathizers have excluded skeptical journals from Pubmed. We got our people to write the descriptions of our methods in government information sources like the NCCAM, the NIH itself (Intellihealth) we got our med school teachers to write the “CAM” sections at the American College of Physicians web pages, and we got essentially all med school website “CAM” sections to describe us in those “neutral” terms, without negative descriptions – even after proof that our methods don’t really work. The entire information establishment has accepted us, has changed its language as we have dictated, and captured hearts and minds of most generators and disseminators of information. [An addition from June, 2008: And now for the real current reason: That $100 million/year from NCCAM, a similar amount from other NIH institutes, and a large dose, perhaps as much as $50 million from private foundations – all into the pool of funding for the medical schools. A subject for 2 prior and yet another post.]

So now watch the straight-thinkers howl. They still don’t realize what hit them or how and why. Neither do you in the press, sticking to your high-minded principles of “balance“ and “fairness“ while feeding the public our intentional restructuring of the language, and not realizing it at all. While the running dogs of righteousness, the straight-laced, long-faced, mind-constricted, conservative, backward-looking, sexist, xenophobic, old men of medicine stomp and holler, and while deans and congressmen are deaf to their pleas…OoooWeeeh. Have we made it or what?

Posted by Wallace Sampson

Retired hematologist/oncologist, presumptive analyzer of ideological and fraudulent medical claims, claimant to being founding editor of the Scientific Review of Alternative Medicine, and to detecting quackery by smell.