Quackery infiltrates The BMJ – Science-Based Medicine – David Gorski – May 22, 2017
Is LACK of EVIDENCE the same as/equate to QUAKERY?
We here have long lamented the creeping infiltration of quackery into medical academia in which modalities once considered quackery, such as
- reiki, naturopathy,
- homeopathy, and
- various other dubious treatments,
have found their way into what should be bastions of science-based medicine (SBM).
Over the years, we have noted the proliferation of “integrative medicine” programs and residencies in medical academia, and professional conferences, the credulous teaching of CAM modalities as part of the normal medical school curriculum. (Georgetown University even had a program where acupuncture meridians and points were taught during gross anatomy.)
Basically, CAM has been a Trojan horse for quackery in which appeals to more “humanistic” medicine and emphasis on diet and exercise have lured medical schools to bring the giant horse in, after the doors on the bellies of the Trojan horses opened to disgorge quackery such as naturopathy, homeopathy, acupuncture, reiki, and even anthroposophy.
Besides the enthusiastic embrace of quackery by large, respected academic institutions like the Cleveland Clinic and Memorial Sloan-Kettering Cancer Center, this “integration” of quackery with medicine has manifested itself in medical journals.
Once hard-nosed, science-based medical journals have, unfortunately, started publishing what can only be described as credulous endorsements of quackery.
We’ve documented many examples of this shameful phenomena over the years, but I’m about to document a whopper of an example now in, of all places, The BMJ, which has now published two “state of the art reviews” on “integrative medicine” that can only be described as fully buying into the false paradigm that quackery needs to be “integrated” with medicine.
- The first “state of the art review is about the management of chronic pain using complementary and integrative medicine by Lucy Chen from the Massachusetts General Hospital Center for Translational Pain Research and Andreas Michalsen from the Institute for Social Medicine, Epidemiology and Health Economics and Immanuel Hospital in Berlin.
- The second is about complementary and integrative medicine in the management of headache by Denise Millstine, Christina Y Chen, and Brent Bauer, all from the Mayo Clinic. Sadly, both Harvard and the Mayo Clinic have become bastions of quackademic medicine.
The evolving language of “integrative medicine”—or whatever they’re calling it this week
I’ve been noticing a new step in the evolution of language about CAM, and this is another part of it.
It first struck me when the National Center for Complementary and Alternative Medicine (NCCAM) first proposed renaming itself to the National Center for Research on Complementary and Integrative Health.
The actual name NCCAM took, as we all know now, was the National Center for Complementary and Integrative Health (NCCIH).
This is just the latest iteration of rebranding quackery to try to make it respectable by calling it something else, and the BMJ articles contribute to this rebranding.
Around a quarter century or so ago, as part of a conscious effort to make quackery respectable, the term alternative medicine morphed into “complementary and alternative medicine” (CAM).
The process continued, such that around 15 years or so ago, the term “CAM” then “evolved” into “integrative medicine.”
Thus, back in the mists of time (say around the late 1990s to early 2000s) was born a new term: “integrative medicine.” No longer were CAM practitioners content to have their favorite quackery be “complementary” to real medicine.
The term “integrative medicine” (IM) served their purpose perfectly. No longer were their treatments merely “complementary” to real medicine.
The very intentional implication, was that alternative medicine was now co-equal to science- and evidence-based medicine, an equal partner in the “integrating,” and that “integrative medicine” combined the “best of both worlds”
Of course, I like to refer to such “integration” of pseudoscience into medical academia as “quackademic” medicine.
Then came the NCCIH, which broadened the term to gauzy near-meaninglessness.
“Integrative health”? Just what the heck is that?
Why get rid of the word “medicine”?
Obviously, the intent was to expand the meaning to encompass nearly anything health-related and to further blunt any concerns that pseudoscience is being used
I’ve started noticing the term “integrative health” popping up more and more, supplanting “integrative medicine.”
As part of that messaging and rebranding, CAM has positioned itself as a means of “nonpharmacologically managing” pain and a large part of any potential solution to the opioid addiction epidemic, messaging that’s been going on at least five years, is part of the NCCIH’s strategic plan, and has been so successful that even the FDA is buying into it.
One thing that struck me about this review is that it was weighted very heavily towards either rheumatoid arthritis or studies of back or neck pain, which is not entirely unreasonable given that back and neck pain are very common. Another thing that struck me about this article right away is that it is how heavily weighted towards acupuncture it appears, with a large table of studies that supposedly establish efficacy of acupuncture for pain
Basically, the larger and better designed the clinical trial, the less likely it is to show an effect of acupuncture above placebo. Acupuncture is theatrical placebo.
It also encompasses biodynamic farming, which involves actions like stuffing cow manure into the horn of a cow and burying it in the autumn, leaving it to decompose during the winter, and taking crushed powdered quartz and stuffing it into a horn of a cow to bury in the spring until autumn, supposedly to control fungal diseases.
Any review that takes anthroposophic medicine seriously is not a serious review.
The evidence base for CIM strategies for migraine is low quality, but providers should recommend it because they “empower” patients and help them take an active role in their care?
What a false dichotomy!
Empowering patients and getting them to take a more active role in their own care do not require prescribing unscientific treatments with no compelling evidence for their efficacy.
Count The BMJ among the fallen
With the increasing infiltration of quackery into medicine in the form of CAM, or “integrative medicine,” or “CIM,” or whatever you want to call it, we are seeing more and more journals succumb to the temptation to publish nonsense like these two review articles that appeared in The BMJ.
In this case, it’s particularly puzzling, given how The BMJ has a history of publishing articles
- decrying the overhyping of acupuncture and
- warning about acupuncture-transmitted infections and
- potentially serious adverse events.
It’s also published articles with titles like
- “The scam of integrative medicine“,
- “Integrative medicine and the point of credulity“, and
- “Doctors warn of dangers of complementary medicine for children.”
It has also published credulous articles as well, but seldom, as far as I can tell, as “systematic reviews” as obviously biased as these two are.
What is happening? Sadly, I think I know.
The tide of pseudoscience that has been rising over the last quarter century has simply engulfed The BMJ too.