I know that various unusual therapies work for some people some of the time (myself included), but they are truly a hit and miss proposition.
They’re among the nation’s premier medical centers, at the leading edge of scientific research.
Yet hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing.
They offer “energy healing” to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida’s hospital even promises to explain how herbal therapy can reverse Alzheimer’s. (It can’t.)
This embrace of alternative medicine has been building for years. But a STAT examination of 15 academic research centers across the US underscores just how deeply these therapies have become embedded in prestigious hospitals and medical schools.
Some hospitals have built luxurious, spa-like wellness centers to draw patients for spiritual healing, homeopathy, and more. And they’re promoting such treatments for a wide array of conditions, including depression, heart disease, cancer, and chronic pain.
Duke even markets a pediatric program that suggests on its website that alternative medicine, including “detoxification programs” and “botanical medicines,” can help children with conditions ranging from autism to asthma to ADHD.
“We’ve become witch doctors”
– Dr. Steven Novella, a professor of neurology at the Yale School of Medicine and a longtime critic of alternative medicine
STAT’s examination found a booming market for such therapies: The clinic at the University of California, San Francisco, is growing so fast, it’s bursting out of its space.
Even as they count on these programs to bring in patients and revenue, several hospitals were reluctant to talk to STAT about why they’re lending their distinguished names to unproven therapies.
Duke Health declined repeated requests for interviews about its rapidly growing integrative medicine center, which charges patients $1,800 a year just for a basic membership, with acupuncture and other treatments billed separately.
By promoting such therapies, Novella said, physicians are forfeiting “any claim that we had to being a science-based profession.”
As for patients? They’re “being snookered,” he said.
Modern medicine clearly can’t cure everyone.
It fails a great many patients.
Despite the amazing advances in scientific research, the increasing numbers of studies, and ever more complex molecular and biological medications, our general health has not improved – it may even be worsening.
We perform heroic interventions to prevent death but
do little to prevent a lifetime of suffering.
So why not encourage them to try an ancient Indian remedy or a spiritual healing technique that’s unlikely to cause harm — and may provide some relief, if only from the placebo effect?
“Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what’s best for a patient. Who am I to say that’s hogwash?” said Dr. Linda Lee.
A gastroenterologist, Lee runs the Johns Hopkins Integrative Medicine and Digestive Center, which offers acupuncture, massage therapy, and reiki — a therapy that the center’s website describes as laying on hands “to transmit Universal Life Energy” to the patient.
Lee and others who promote alternative therapies are careful to say that they can supplement — but can’t replace — conventional treatments.
Duke’s Integrative Medicine store, for instance, sells “Po Chai Pills” that are touted on the hospital’s website as a cure for everything from belching to hangovers to headaches.
The site explains that taking a pill “harmonizes the stomach, stems counterflow ascent of stomach qi, dispels damp, dispels pathogenic factors, subdues yang, relieves pain.”
None of that makes sense in modern biomedical terms.
Asked about the therapy, Dr. Daniel Monti, who directs the integrative health center, acknowledged that the data is “largely anecdotal,” and said the hospital offers the treatment only rarely, “when there are few other options.” But those caveats don’t come through on the website.
“Patients only want [alternative medicine] because they’re being told they should want it. They see a prestigious hospital is offering it, so they think it’s legitimate,” said Novella.
“The perpetuation of these practices is
a victory of marketing over truth”
-Steven Salzberg, a biomedical engineer at Johns Hopkins who lectures in the medical school.
If a hospital is “offering treatment that’s based on fantasy, it undermines the credibility of the institution.”
Cleveland Clinic’s chief executive, Dr. Toby Cosgrove has stood up for the general principle of offering alternative treatments.
“The old way of combating chronic disease hasn’t worked,”
This is also very true.
Healthcare used to appreciate ambiguity, uncertainty, and doubt but, in its culture of absolute certainty and reliance on evidence from biased studies, it has failed us.
Cosgrove wrote in a column posted on the hospital’s website. “… We have heard from our patients that they want more than conventional medicine can offer.”
A booming market for ‘natural’ therapies
There’s no question that patients want alternative medicine. It’s a $37 billion-a-year business.
In most cases, insurers won’t cover alternative therapies — there’s simply not enough evidence that they actually work — so patients pay out of pocket: $85 for acupuncture, $100 for reiki, $38 for pills made from thyme and oregano oils that promise to “harmonize digestive and respiratory function.”
If they failed to offer “natural” therapies, some hospital executives fear they would lose a chance to attract patients who need more lucrative care, such as orthopedic surgeries or cancer treatments.
“The people running the hospitals are doctors, but they also have MBAs. They talk of patients as customers. Customers have demands. Your job is to sell them what they want,” said Arthur Caplan, a bioethicist at New York University’s medical school. Too often, he said, the attitude is, “We’re damn well going to do it if the guys down the street are doing it.”
While most hospitals declined to give specific revenue figures, STAT found indications of rapid growth.
Duke University’s integrative medicine clinic, a stunning space with arching wood ceilings and an indoor garden, has seen strong growth: Total visits jumped 50 percent in 2015, to more than 14,000, Dr. Adam Perlman, the executive director, told IntegrativePractitioner.com. (He declined to talk to STAT.)
Many hospitals have also expanded into more general “wellness” offerings, with classes in healthy cooking, tai chi, meditation, and art therapy. UCSF offers a $375 class on “cultivating emotional balance” (and a free class on “laughter yoga”). Mayo Clinic sells a $2,900 “signature experience,” which includes consultations with a wellness coach.
“[Hospital executives] talk of patients as customers. Customers have demands. Your job is to sell them what they want.” -Arthur Caplan, bioethicist at New York University
Academic medical centers often boast that they’re more rigorous in evaluating alternative therapies — and weeding out scams — than a for-profit wellness center might be.
“The important thing about practicing in an academic center is that we must hold ourselves to certain standards,” said Estores, the medical director at the University of Florida’s integrative medicine clinic.
Standards of profit, that is.
The University of Florida, for instance, is using Facebook to advertise an herbal medicine workshop for providers and the public that promises to answer questions including, “How can we stabilize or reverse Alzheimer’s disease?”
…the site then goes on to promote dozens of treatments for everything from ADHD to whiplash, saying they have “appeared to be beneficial in this and other complementary medicine clinics.”
‘It’s not black and white’
Perhaps the most prevalent alternative treatment STAT found on offer is acupuncture. It’s promoted for more than a dozen conditions, including high blood pressure, sinus problems, infertility, migraines, and digestive irregularities.
Several major insurers, including Aetna, Anthem, and regional Blue Cross Blue Shield affiliates, cover acupuncture as a treatment for chronic pain and nausea.
But the Centers for Medicare and Medicaid Services won’t pay for acupuncture, dismissing the scientific evidence as insufficient.
Still, it’s important for physicians to keep an open mind, said Lang, the interim director of the Cleveland Clinic Wellness Institute.
On this, I absolutely agree. Too many arrogant know-it-all doctors have harmed patients by ignoring patient feedback. When presented with a very unusual symptom or side-effect reported by a patient, they simply say, “That’s impossible!”
Many pain patients have suffered at their hands. Only after years of further scientific progress or an accurate diagnosis does it become clear that the patient was often correct.
He said, for example, that he used to avoid referring patients for acupuncture, until he saw the benefit it provided to some of them. “I have seen it work in some chronic pain situations,” said Lang. “It can be very helpful. If it doesn’t work, I don’t know that you’ve lost anything. If it does, you do get to a better place.”
And while the evidence of its efficacy is not ironclad, neither is the evidence for various pharmaceutical therapies that are routinely provided by hospitals and covered by insurance.
Advocates of alternative medicine say it’s difficult to test some alternative therapies through rigorous clinical trials, primarily because treatment techniques vary from patient to patient. (The federal government does, however, spend roughly $120 million a year to fund research through the NIH National Center for Complementary and Integrative Health.)
They note, too, that traditional doctors sometimes stray from proven treatments, for instance when they prescribe medicines off-label for conditions the drugs have not been approved to treat.
“We do use things that aren’t necessarily 100 percent evidence-based, but I would argue that’s also true within all of medicine,” said Dr. Jill Schneiderhan, co-director of the University of Michigan’s integrative family medicine program.
Here we clearly see the problems of practicing medicine for the benefit of the patient in the environment of a seeking profit for the benefit of the corporation.
Right now, and for the foreseeable future, our society is giving free rein to corporations while the true practice of medicine is relegated a far, far lower priority.
We can only hope this disaster will become obvious soon so that we can reprioritize healing over profit before healthcare becomes completely routine: standardized and ruled by impersonal algorithms.