"Integrative" Medicine

Change it had to come

We knew it all along

We were liberated from the fall that's all

But the world looks just the same

And history ain't changed

'Cause the banners, they all flown in the last war

I'll tip my hat to the new constitution

Take a bow for the new revolution

Smile and grin at the change all around me

Pick up my guitar and play

Just like yesterday

Then I'll get on my knees and pray

We don't get fooled again

Don't get fooled again

Meet the new boss

Same as the old boss

(Pete Townsend, 1971)

in·te·grateverb \ˈin-tə-ˌgrāt\

1 to form, coordinate, or blend into a functioning or unified whole

2 to unite with something else : to incorporate into a larger unit

3 to end the segregation of and bring into equal membership in society or an organization

in·teg·ri·ty

noun \in-ˈte-grə-tē\

1 firm adherence to a code of especially moral or artistic values

2 an unimpaired condition

3 the quality or state of being complete or undivided

The words “integrate” and “integrity” derive from the common Latin root integer (“complete, perfect”).

“A value system's abstraction depth and range of applicable interaction may also function as significant factors in identifying integrity due to their congruence or lack of congruence with observation.

A value system may evolve over time while retaining integrity if those who espouse the values account for and resolve inconsistencies.”

http://en.wikipedia.org/wiki/Integrity

Introduction

The practice of medicine has come a long way. Only by rejecting dogma and replacing it with science has medical science and education been able to make significant and rapid advancements. Over the last century, American medical schools have earned top rankings among the world’s universities.

Scientific medicine is humble. It fully admits what it does not know. As such, scientific medicine achieves integrity.

Recently, it has become fashionable to ‘integrate’ dogmatic practices back into mainstream medicine. As we shall see, what we have taken about a century to achieve, is in danger of backsliding into an era characterized by a priori beliefs, magical thinking and dogma.

Institutions and educators who, in recent history, achieved high recognition as champions of academic and scientific medicine, have begun to allow dogmatic, unscientific practices to infiltrate (“integrate”) back into their institutions. This lapse in critical thinking and integrity is defended by fallacies such as appeals to popularity, antiquity and personal testimony. Academically esteemed institutions such as Harvard, Stanford, Columbia, Cornell, as well as smaller medical systems (such as Henry Ford and Beaumont Health Systems here in Michigan) have begun to integrate dogma at the expense of integrity.

Before we look at the claims being made in these departments of “Integrative Medicine”, we should consider the recent hard road to reform that the American medical education system took to achieve integrity.

Skeptical Medicine is indebted to Mark Crislip, M.D. for pointing out the contributions of Abraham Flexner’s report on medical education at the turn of the twentieth century. This survey revealed the chaotic, unstandardized, sectarian and unscientific ‘anything goes’ state of affairs that was the American medical education system. The changes that followed resulted in strict standardization of teaching medicine with a foundation in objective science.

Dr. Crislip then compared and contrasted this manifesto with a recent survey of U.S. academic medical institutions referred to as The Bravewell Report which observed that,

“One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with non conventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community “

So, integrative medicine is integrative. The Bravewell conclusion begs the question by unstated premise: Does science-based medicine not concern itself with “the whole person”? It would seem that many confuse science with a lack of compassion. This is a false dichotomy. It also ignores the incoherence of combining unscientific beliefs with scientific knowledge as if they could possibly be on equal footing. This incoherence is disguised by the fact that several of the ‘alternative’ services provided in such departments are not alternative at all, thus giving supporters a false appearance of legitimacy.

Dr. Crislip then points out in his excellent article that,

“If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

The reforms that followed Flexner’s report were revolutionary. Most U.S. medical students have never heard Flexner or his call for a standardized, science-based medical curriculum. It is very relevant in today’s discussion of the infiltration of “quackademic” medicine in our academic institutions. Pseudoscience has wedged itself back into mainstream medicine under the clever name of Integrative Medicine with surprisingly little resistance from our academic leaders. Little by little, this “integration” is eroding our integrity.

This section contains parts of Flexner’s report from the section entitled The Medical Sects. Please do not be put off by the lengths of the quoted paragraphs. In fact, all students of medicine should go back and read his entire report, just as students of U.S. History should read the Declaration of Independence.

We may have had a revolution, but are getting fooled again.

Change It Had To Come

Since the early twentieth century, the practice of medicine has made unprecedented progress. There have been startling advances in the basic sciences, clinical sciences and technology. However, the fundamental paradigm shift in medicine has been the standardization of medical education and practice based on the scientific method.

At the turn of the century, medical education in North America was chaotic. Uniformity in the teaching of medical students varied not only in approach and curriculum, but in beliefs. Many were what we would today call “diploma mills”.

In 1905, the newly formed Council on Medical Education (CME) established that medical education in America should consist of 4 years training: 2 years of classroom and laboratory work devoted to anatomy, physiology and pathology, and 2 years of clinical work in a hospital setting under the instruction of clinicians. To assess the state of affairs as it was in 1908, CME commissioned the Carnegie Foundation for the Advancement of Teaching to survey North American medical schools. Abraham Flexner, an educator and reformer, conducted the survey by visiting 150 medical schools. His report (referred to as “The Flexner Report”) is often credited for sparking the wave of reform and standardization of medical education that quickly followed.

In addition to finding a disturbing lack of physical needs, such as proper classrooms, laboratories and equipment, Flexner also found a lack of science as a foundation in medical education. Instead, he found education divided among medical “sects”, such as so-called allopathy, homeopathy, osteopathy, “eclectics” and chiropractic.Allopathy was a pejorative name coined by Hahnemann (of homeopathy fame) that refers to doctors who use drugs counter to the teaching of homeopathy. Osteopathy at the time was based on ideas by A.T.Still, in which healing is facilitated by physical manipulations. It is distinguished from D.D. Palmer’s chiropractic as Still’s teachings did not claim to be directing the life-energy “innate intelligence” through undetectable “subluxations”. Eclectic medicine was promoted by Constantine Samuel Rafinesque and referred to a mix of practices involving herbs and other botanicals, inspired by practices of Native Americans. These systems were similar in that they held a priori (preconceived) notions about how the body and healing works. Flexner would make any modern day skeptic proud. He firmly pointed out the hazards of relying on preconceived notions to inform our decisions.

(note - highlights were added by Skeptical Medicine)

“The proposition raises at once the question as to whether in this era of scientific medicine, sectarian medicine is logically defensible; as to whether , while it exists, separate standards, fixed by the conditions under which it can survive, are justifiable. Prior to the placing of medicine on a scientific basis, sectarianism was, of course, inevitable. Every one started with some sort of preconceived notion; and from a logical point of view, one preconception is as good as another.”

“The modern point of view may be restated as follows: medicine is a discipline, in which the effort is made to use knowledge procured in various ways in order to effect certain practical ends. With abstract general propositions it has nothing to do. It harbors no preconceptions as to diseases or their cure. Instead of starting with a finished and supposedly adequate dogma or principle, it has progressively become less cock-sure and more modest. It distrusts general propositions, a priori explanations, grandiose and comforting generalizations. It needs theories only as convenient summaries in which a number of ascertained facts may be used tentatively to define a course of action. It makes no effort to use its discoveries to substantiate a principle formulated before the facts were even suspected. For it has learned from the previous history of human thought that men possessed of vague preconceived ideas are strongly disposed to force facts to fit, defend, or explain them. And this tendency both interferes with the free search for truth and limits the good which can be extracted from such truth as in its despite attained.

Modern medicine has therefore as little sympathy for allopathy as for homeopathy. It simply denies outright the relevance or value of either doctrine. It wants not dogma, but facts. It countenances no presupposition that is not common to it with all the natural sciences, with all logical thinking.The sectarian, on the other hand, begins with his mind made up. He possesses in advance a general formula, which the particular instance is going to illustrate, verify, reaffirm, even though he may not know just how. One may be sure that facts so read will make good what is expected of them; that only that will be seen which will sustain its expected function; that every aspect noted will be dutifully loyal to the revelation in whose favor the observer is predisposed: the human mind is so constituted.” (page 157, Flexner Report)Flexner illustrates here one of the basic differences between science and pseudoscience. Science does not start with a foregone conclusion (a priori), and then seek only confirmatory evidence for it. Science begins with an idea inferred from observations, then tests the idea. Conclusions only tentatively follow such process. Scientific conclusions follow the evidence (a posteriori). A priori conclusions are a hallmark of pseudoscience.

We Knew It All Along

We learned in the Critical Thinking in Medicine section that the art of medicine is informed by the science of medicine. Skeptical doctors take this as our a priori conviction; i.e. - we knew it all along.

Flexner agreed. Science should be the basis for medical knowledge, not dogma.

“It is precisely the function of scientific method -- in social life, politics, engineering, medicine -- to get rid of such hindrances to clear thought and effective action. For it, comprehensive summaries are situate in the future, not in the past; we shall attain them, if at all, at the end of great travail; they are not lightly to be assumed prior to the beginning. Science believes slowly; in the absence of crucial demonstration its mien is humble, its hold is light.”

“Scientific medicine therefore brushes aside all historic dogma. It gets down to details immediately. No man is asked in whose name he comes -- whether that of Hahnemann, Rush, or of some more recent prophet. But all are required to undergo rigorous cross-examination. Whatsoever makes good is accepted, becomes insofar part, and organic part, of the permanent structure. To plead in advance a principle couched in pseudo-scientific language or of extra-scientific character is to violate scientific quality. There is no need, just as there is no logical justification, for the invocation of names or creeds, for the segregation from the larger body of established truth of any particular set of truths or supposed truths as especially precious. Such segregation may easily invest error with the sanctity of truth; it will certainly result in conferring disproportionate importance upon the fact or procedure marked out as of pivotal significance. The tendency to build a system out of a few partially apprehended facts, deductive inference filling in the rest, has not indeed been limited to medicine, but it has nowhere else had more calamitous consequences.” (page 157, Flexner Report)

We Were Liberated From the Fall

After the Flexner Report was published, sweeping changes were made in American medical schools. Schools had to be affiliated with recognized, academic universities. Students had to have a minimum of undergraduate requirements. The four year medical school structure was standardized; 2 years of basic science and 2 years of clinical work. Since then, the clinical years have become guided by science. The number of schools shrunk and the quality of schools grew. The so-called “allopathy” and osteopathy schools embraced scientific medicine. They thrived and today are all but indistinguishable. Medical students in such schools graduated with the recognition from external governing bodies that they were trained according to such standards.

Dogmatic schools and practices did not, on the other hand, receive such recognition. According to Flexner, this was a good thing. Science presumes that there is only one reality. Practices with mutually conflicting a priori beliefs cannot all be correct. We can only justify support for institutions that follow a posteriori conclusions.

On page 157 and 158, Flexner wrote,

“The logical position of medical sectarians today is self-contradictory. They have practically accepted the curriculum as it has been worked out on the scientific basis. They teach pathology, bacteriology, clinical microscopy. They are thereby committed to the scientific method; for they aim to train the student to ascertain and interpret facts in the accepted scientific manner. He may even learn his sciences in the same laboratory as the non-sectarian. But scientific method cannot be limited to the first half of medical education. The same method, the same attitude of mind, must consistently permeate the entire process. The sectarian therefore in effect contradicts himself when, having pursued or having agreed to pursue the normal scientific curriculum with his student for two years, he at the beginning of the third year produces a novel principle and requires that thenceforth the student effect a compromise between science and revelation.

Once granted the possibility of the medical dogma, there can be no limit to the number of dissenting sects. As a matter of fact, only three or four are entitled to serious notice in an educational discussion. The chiropractics, them mechano-therapists, and several others are not medical sectarians, though exceedingly desirous of masquerading as such; they are unconscionable quacks, whose printed advertisements are tissues of exaggeration, pretense, and misrepresentation of the most unqualifiedly mercenary character. The public prosecutor and the grand jury are the proper agencies for dealing with them.”

Flexner noted a declining trend in homeopathic schools from 1900 through 1910. He predicted further declines if standards and integrity would increase. In the next paragraph, Flexner writes the spirit of one of Skeptical Medicine’s main themes: It is logically contradictory - and therefore forbidden - to embrace science and logic when they support an idea, but then to reject them when they do not.

“Logically, no other outcome is possible. The ebbing vitality of homeopathic schools is a striking demonstration of the incompatibility of science and dogma. One may begin with science and work through the entire medical curriculum consistently, exposing everything to the same sort of test; or one may begin with a dogmatic assertion and resolutely refuse to entertain anything at variance with it. But one cannot do both. One cannot simultaneously assert science and dogma; one cannot travel half the road under the former banner, in the hope of taking up the latter, too, at the middle of the march. Science, once embraced, will conquer the whole.”

(page 161, Flexner Report)

Flexner also emphasised one of the main points of the Alternative Medicine section. Medical treatments that have been scientifically proven to work become part of scientific medicine. They are no longer part of the alternative canon. For if a homeopathic remedy would somehow be proven to work, it would be, well...medicine.

“It will be clear, then, why when outlining a system of schools for the training of physicians on scientific lines, no specific provision is made for homeopathy. For everything of proved value in homeopathy belongs of right to scientific medicine and is at this moment incorporate in it; nothing else has any footing at all, whether it be of allopathic or homeopathic lineage.”

(page 161-162, Flexner Report)

Don’t Get Fooled Again

Regulations and emphasis on meeting scientific standards can only do so much. Ultimately, the market of medical treatments is subject to market forces. Through reforms in medical education, scientific medicine has brought the American system to enviable heights. (Health care delivery is a different issue. Here we are discussing scientific integrity of medical education). Regulations can put science-based practitioners in public light, but can only hope to curtail the practice of dogma. Again, we turn to the Flexner’s words at the end of his section on medical sectarianism.

“In dealing with the medical sectary, society can employ no special device. Certain profound characteristics in one way or another support the medical dissenter: now the primitive belief in magic crops up in his credulous respect for an impotent drug; again, all other procedure having failed, what is there to lose by flinging one’s self upon the mercy of chance? Instincts so profound cannot be abolished by statute. But the limits within which they can play may be so regulated as to forbid alike their commercial and their crudely ignorant exploitation. The law may require that all practitioners of the healing art comply with a rigidly enforced preliminary educational standard; that every school possess the requisite facilities; that every licensed physician demonstrate a practical knowledge of the body and its affections. To these terms no reasonable person can object; the good sense of society can enforce them upon reasonable and unreasonable alike. From medical sects that can live on these conditions, the public will suffer little more harm than it is destined to suffer anyhow from the necessary incompleteness of human knowledge and the necessary defects of human skill.”

(page 166, Flexner Report)

Meet the New Boss, Same as the Old Boss

However, the specter of sectarian dogmatism was not extinguished by regulations.

In today’s commercial world, public demand for such practices has risen (for possible reasons why, see the sections on Alternative Medicine and Skeptical and Compassionate). Academic institutions have been feeling the economic pressure.

It has become trendy to teach and offer alternative medicine at our medical schools and other academic medical institutions again. After all that reformation, our esteemed scientific establishments are “integrating” dogmatic beliefs with science-based practices. In today’s America, health care systems have been in an economic battle with each other to maintain market share. Through television, radio, billboards and the internet, each healthcare institution is eager to tell us why choosing their particular care “could be the most important decision you’ll ever make”.

In the 2000’s, advertisements for departments of “Integrative Medicine” and “Wellness” began cropping up among hospital adds. Practices such as homeopathy, Reiki, acupuncture, herbal medicine, and “naturopathy” were added to the services provided at academic medical centers.

The perceived demand for such services undoubtedly fuels the competitive drive for other centers to ‘integrate’ such dogmatic practices into their own programs. One wonders what the academic physicians at these centers are thinking when they stand by, smile and nod as they allow their institutions to promote these pseudosciences. However, as we learned in the section on Cognitive Dissonance, people do not often simply adopt an unscientific or irrational concept whole cloth. They get there in small steps. Each step may produce some dissonance, which leads to rationalization and reinforcement. Through each successive, small dissonance-reducing step, they get deeper and deeper into the concept.

CAM supporters often point out that skeptics may have never personally tried their services. That may or may not be true, but it is irrelevant. The whole point of science is to come to objective conclusions after evidence has been properly weighed. Personal experience, anecdotes and preconceived conclusions bias one's critical thinking. When skeptics ask for evidence, they are not asking for personal experience. They are asking for unbiased data that is strong enough to overcome the prior plausibility (or implausibility) of the claim.

Without the unifying consistency of science-based knowledge and practice, 'integrating' the wide variety of claims of CAM leads to inconsistency.

U.S.News reports,

"Each center has its own notion of CAM and how best to fit it into the medical mix, which can be challenging. "There is rarely a consensus among CAM experts on the optimal product, dose, or intended users," states a report from the National Center for Complementary and Alternative Medicine, an arm of the National Institutes of Health charged with doling out research funds and tidying the thicket of therapies deemed to fall within CAM's broad reach.

At one extreme are found techniques such as yoga and massage, acknowledged by the most hard-line skeptics to have some benefit, if only to lower stress and anxiety. At the other are therapies that even many who applaud CAM's newfound academic popularity call "woo-woo medicine" because of the sheer implausibility of their rationale. Homeopathy, which involves remedies often lacking a single molecule of active substance, is the poster child; some would add energy therapies such as healing touch. The broad middle takes in acupuncture, herbal medicine, and other CAM approaches that seem to benefit some people with certain conditions."

Let’s look at some of the claims being made at a few of our otherwise esteemed, academic medical institutions. Note that they all pay lip-service to science, even though many of the claims have been either falsified by science or are actually unfalsifiable. Also note that they include massage, nutrition and counselling in the same category as truly pseudoscientific services. Thus, they can claim to produce real outcomes. Again, there is nothing alternative about massage, nutrition and counselling. They do just what one would expect.

- Stanford University

“Integrative Medicine combines the best of "alternative" and complementary treatments with mainstream modern medicine and psychology to provide care for the whole person: mind and body. We are here to help you live more fully, cope better with your medical condition, control symptoms, and participate more fully in your medical care. Started in 1998, the Stanford Center for Integrative Medicine (SCIM) is committed to evidence-based practices.”

Stanford’s department strongly promotes its acupuncture services. The website states,

“In acupuncture, fine disposable needles are inserted at critical points in the body that connect nerves, muscles and organs. Acupuncture can affect respiratory, digestive, urinary and reproductive systems, as well as muscle tone, hormone production, circulation and allergic responses. We offer acupuncture to treat chronic pain, musculoskeletal and joint pain, headache, cancer treatment side effects, gastrointestinal conditions, and women's health issues including urinary problems, infertility, nausea and vomiting in pregnancy and menopause. Our acupuncture staff includes anesthesiologists, a naturopath and a Chinese-trained licensed acupuncturist.”

We have learned that evidence does not support most, if any, of these claims. To maintain that acupuncture is “evidence-based” is disingenuous.

- Columbia University (New York-Presbyterian Hospital)

“Complementary, alternative, and integrative medicine is the use of treatments, such as homeopathic medicine, ayurveda, botanical dietary supplements, and massage, that are not necessarily considered part of "conventional" medicine.”

Botanical pharmacology and supplements were covered in the Natural Products section.

Homeopathy? Really? We would do well by remembering Flexner’s assessment:

“The ebbing vitality of homeopathic schools is a striking demonstration of the incompatibility of science and dogma. One may begin with science and work through the entire medical curriculum consistently, exposing everything to the same sort of test; or one may begin with a dogmatic assertion and resolutely refuse to entertain anything at variance with it. But one cannot do both. One cannot simultaneously assert science and dogma; one cannot travel half the road under the former banner, in the hope of taking up the latter, too, at the middle of the march. Science, once embraced, will conquer the whole.”

NYPH’s website continues...

“The Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center was created to facilitate and conduct rigorous scientific investigation to evaluate the effectiveness, safety, and mechanisms of action of alternative and complementary practices.”

As we learned in the Alternative Medicine section, no credible research in Alternative Medicine to date has ever been positive in the scientific sense. One wonders what standards of evidence they are using in their research.

“By blending the best of complementary and academic medicine, the Center treats the entire person, emphasizing healing in a way that acknowledges the complex nature of chronic illness.”

Again, we see the telling false dichotomy implying that science-based medicine somehow doesn’t consider the “whole patient”.

- Cornell University

“The Weill Cornell Center for Complementary and Integrative Medicine, however, will introduce the results of clinical and basic research to provide the latest, best-documented treatment programs in complementary medicine. In the end, this kind of synergy between medical practice and scientific research will help the Center provide patients with the best care, while building an exceptional multi-specialty clinical practice in complementary and integrative medicine.”

Again, if they have any positive trials, the world is waiting to hear it. The Bayesian “prior probability” is very small, given the history of research in these areas. The evidence required to overcome this would need to be ‘extraordinary’. This point lies at the very heart of the EBM vs. SBM problem.

- Harvard University (Brigham and Women’s Hospital)

“Comprehensive services available at the Osher Clinical Center For Complementary and Integrative Medical Therapies for patients include:

Acupuncture – traditional Chinese and Japanese;
Chiropractic care;
Cranial Sacral therapy;
Therapeutic Massage;
Mindfulness-based Stress Reduction;
Occupational Therapy;
Therapeutic Tai Chi/Yoga.”

Here we see the typical mixing of pseudoscience (Acupuncture, Chiropractic, Cranial Sacral therapy) with uncontested, “is-what-it-is” therapies such as massage, occupational therapy and stress reduction techniques.

Recall from the Flexner report,

“The chiropractics, them mechano-therapists, and several others are not medical sectarians, though exceedingly desirous of masquerading as such; they are unconscionable quacks, whose printed advertisements are tissues of exaggeration, pretense, and misrepresentation of the most unqualifiedly mercenary character. The public prosecutor and the grand jury are the proper agencies for dealing with them.”

Harvard is lending its world-renowned academic status to dogmatic pseudosciences. This gives pseudoscience a false legitimacy that it has not (and cannot) earn.

- The University of Michigan

Michigan was one of the few schools, along with Johns Hopkins and Harvard, that received commendations from Flexner for providing a quality medical education. However, like Harvard, they too have succumbed to ‘integrative’ forces. Their website advertises two subsections: “Anthroposophic Medicine” and “Holistic Family Medicine”

“Anthroposophic Medicine [V]iews health as a matter of mind-body-spirit balance and is centered on the idea that humans are not independent organisms but, instead, beings composed of the interactions of physical body, inner life body, soul (mind and emotions), and spiritual ego (self-awareness).”

and,

“Whereas conventional medicine focuses on "fixing" the part of the physical body that is "broken," anthroposophic medicine prescribes treatment for the whole being through conventional methods in combination with holistic methods. As such, anthroposophic medicine integrates theories and practices of modern medicine with alternative, nature-based treatments and a spiritual-scientific understanding of the human being. The practice is based on Austrian philosopher Rudolf Steiner’s concept of anthroposophy, a scientific and philosophical worldview that connects the spiritual within the human being to the spiritual in nature, the world and the cosmos."

So again we see the false dichotomy that views science-based medicine as somehow not caring about the “whole” person while the alternative belief system does. Anthroposophy, as described above, is a belief system. Belief systems are never science, nor should they claim to be. People may believe-in whatever world view makes them happy, so long as their believe-in doesn’t get mistaken for a believe-that. A belief-in a “worldview that connects the spiritual within the human being to the spiritual in nature, the world and the cosmos” is not a claim at all. It is fine, but it is not science.

Michigan extrapolates this belief system to claim,

“The human being is intrinsically connected to nature’s mineral, plant and animal kingdoms through physical and spiritual forces and anthroposophic medicine must therefore consider natural elements during times of treatment.”

Here, we cross the line from ‘believe-in’ to ‘believe-that’ as they are making empirical claims. At least the therapeutic modalities that somehow come out of this belief system are fairly harmless. They include...”natural remedies (herbs, plant extracts, essential oils, potentized metals, etc.), medicinal baths, external compresses or ointments, artistic therapies (clay modeling, painting, music therapy and therapeutic speech formation), therapeutic Eurythmy (movement therapy), rhythmical massage (a form of light-touch massage), psychological and biographical counseling”

Again, we see different rationale for the same mix of pseudoscience and aesthetics. And (again!), feel-good, aesthetic therapies such as massage, oil rubs and music therapy are not “alternative”. They simply feel nice and are fine. No claims need to be made beyond this. It is also disingenuous to include psychological counselling as alternative (that is unless they are using counselling methods that have never been proven to be effective).

The other “remedies” (botanicals and “potentized metals” - i.e. homeopathic metal dilution) are clearly in the CAM category. Extraordinary claims demand extraordinary evidence. The Univ. of Michigan would likely reject flimsy science from any other academic department. But here, they embrace it. Why?

Michigan also promotes “Holistic Family Medicine”. In this department, they focus on promoting love, prevention, healthy lifestyles, treating causes rather than just symptoms, healthy physician-patient relationships and other common-sense things that primary care physicians should already be promoting in their conventional practices. However, Holistic Family Medicine uncritically embraces the usual variety of CAM treatments along with science-based care. It is basically normal primary care with a weasel word name and an uncritical ‘integration’ of CAM.

- Beaumont Health System

This academic medical center, now formally part of the OUWB School of Medicine, is very familiar (and dear) to Skeptical Medicine’s author.

Sadly, the competitive fight for local market share has been palpable. Larger hospital systems buy out smaller ones. New facilities are built with consumers in mind. Luxurious rooms, food courts and coffee chains seem to be considered as standard as emergency rooms and laboratory services.

This is all perfectly understandable in a free market society and should not be considered a bad thing necessarily. Hotel chains and auto companies, for instance, are forced to increase the level of services they provide to stay competitive. Features that were once considered luxurious extras are now standard.

However, science has never been a popularity contest.

Conclusions about empiric claims come only after the rigorous science is performed. This concept is fundamental in distinguishing science from pseudoscience. Our academic medical centers, especially those that are part of a medical school, are supposed to make medical decisions that are informed by science and not by popularity contests. It would seem that competitive market forces are allowing academic physicians to turn a blind eye to the fact that we are allowing pseudoscience to be practiced alongside science-based care.

Such seems to be the case between competing health care systems such as Beaumont and Henry Ford Hospital . Each seem to be trying to keep up and outpace the other by offering services that are perceived as popular.

It has to be stressed again and again that services such as nutrition, fitness, exercise/ yoga, counselling and massage are not the issue. They should not be considered ‘alternative’ (unless false claims are made by the individual practitioners).

What is at hand are the unscientific claims that are being made (often mutually contradictory claims) in these departments to support the use of botanicals, ‘energy’ and ‘mind-body medicine’.

Beaumont’s website advertises:

“...integrative medicine combines conventional and alternative approaches to address the biological, psychological, social and spiritual aspects of health and illness.

Beaumont's Integrative Medicine Program focuses on healing the whole person, with the goal of improving quality of life for patients, their families and others close to them.

We offer clinical massage, acupuncture, naturopathy, guided imagery, reflexology, energy balancing with Reiki, scar therapy, lymphatic wellness massage, Indian Head Massage, hydrotherapy, Cranial Sacral Therapy, neuromuscular therapy, meditation and yoga which combine the best of Eastern traditions while complementing traditional Western medical practice.

The goal of any successful integrative medicine program is to truly "integrate" allopathic medicine with mind-body-spirit modalities with the ultimate goal of helping patients adapt to traditional medical treatments. Our modalities directly affect the body's physiological healing process while gently awakening the mind-body-spirit connection needed to enhance the healing process.”

Here, as with the examples above, ‘integrative’ medicine justifies its own need by implying a dichotomy. On one hand we have the cold, reductionist “allopaths”. We therefore need, on the other hand, the alternative practitioners to address the patient’s psychological and spiritual needs.

However, psychological needs should be dealt with through psychology. Spiritual needs are highly dependent on a person’s preconceived beliefs and have been dealt with through chaplain services selected according to those beliefs. It is not the duty of any hospital or academic center to push a belief system onto patients to address ‘spiritual needs’. If you will recall, acupuncture and other culturally driven healing practices are belief systems. Medical practitioners must respect an individual’s previously established beliefs insofar as they don’t lead to scientifically known harms. However, we must not try to establish new beliefs without evidence.

Beaumont’s department seems to value so-called ‘energy medicine’ practices. These include acupuncture and Reiki. These belief systems do not belong in academic settings. When practiced in such settings, they become pseudoscience through and through.

Not only is Reiki presented as if it is real, classes are offered to the public for hundreds of dollars.

And let's not get started on 'Craniosacral Therapy'

-International "Integration"

The inconsistency of mixing medical science and pseudoscience is an international problem.

Examples are the United Kingdom and Australia. Each has a different history, and each has its skeptics who are active in the fight to remove pseudoscience from their academic institutions.

Friends of Science in Medicine is an Australian organization but has global outreach in its mission. Their website states,

"Friends of Science in Medicine (FSM) is an association of concerned scientists, clinicians and members of the public who support a rigorous application of the best science to any health-related profession and oppose health education and practice not based on convincing scientific evidence.

We are currently campaigning:

"to reverse the current trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by sound scientific evidence".

Conclusion: Fooled Again

Flexner outlined a new constitution. We saw a new revolution. We smiled and grinned at the change all around us.

But, how quickly we forget the hard lessons. The medical sectarians that Flexner denounced are back.

By falsely giving pseudoscience legitimacy, the average person can no longer distinguish reality from fantasy.

Our once trusted, scientific, academic establishments are losing their integrity. Integration and integrity come from the same root, but have obviously taken on different meanings.

As stated above,

“[A] value system may evolve over time while retaining integrity if those who espouse the values account for and resolve inconsistencies”. Our ‘integration’ with pseudoscience presents us with grave inconsistencies."

We hold strong standards of evidence for medical doctors and medical scientists. We are turning a blind eye to the lack of (or contradiction of) scientific evidence in our “Integrative Medicine” departments. Conclusions must follow from evidence, not precede it.

The world looks just the same.

History has not changed.

We have met the new boss.

Same as the old boss.

We have been fooled again.

John Byrne, M.D.