The effort of integrative medicine advocates to co-opt the opioid crisis to claim non-pharmacological treatments for pain as solely theirs continues apace – Science-Based Medicine – David Gorski on January 29, 2018
integrative medicine advocates are co-opting the opioid crisis as a “rationale” for integrating quackery into medicine for the treatment of chronic pain.
What we have here is an example of one of the most powerful forces promoting the “integration” of pseudoscience and quackery into medicine continuing to do so by, yes, taking advantage of the opioid crisis to present its unscientific, pseudoscientific, and mystical prescribed solutions to the crisis.
The Academic Consortium for Integrative Medicine and Health: Promoting quackademic medicine for two decades
Consisting of roughly 70 academic medical centers in North America, the ACIMH declares its mission to be to “advance integrative medicine and health through academic institutions and health systems.”
That’s exactly what it does, too.
Unfortunately, it’s been wildly successful, having started out with eight founding members and expanded its membership many-fold over the last two decades
the ACIMH also likes to promote “partnerships” between quack schools like the naturopathic Bastyr University, and real medical schools, like Georgetown.
Of course, whenever we criticize this infiltration, there are people and forces who are displeased. We very frequently encounter pushback. Often this pushback comes from John Weeks, an early cheerleader for “complementary and alternative medicine” (CAM) and later the rebranding of CAM known as “integrative medicine” who is now editor of the Journal of Alternative and Complementary Medicine, even though at the time he was hired he had no relevant experience editing an academic journal and wasn’t even a physician or a scientist.
Although the ACIMH is not the only force promoting the infiltration of quackery into medical academia, with the Bravewell Consortium and the Samueli Institute both having closed, it is arguably the most influential such organization remaining, along with the University of California, Irvine, where Susan and Henry Samueli donated $200 million to promote integrative medicine.
ACIMH takes advantage of the opioid epidemic
Recently, the ACIMH published its Moving Beyond Medications guidelines.
The express purpose is, as was the National Center for Complementary and Integrative Health’s latest strategic plan, to rebrand “nonpharmacologic treatments for pain” as being all “integrative” or “CAM.”
The other part of this rebranding is that potentially science- and evidence-based interventions for pain, such as exercise, are mixed—or, dare I say it, integrated—with quackery, like chiropractic and acupuncture. This is accomplished through a white paper, a series of guides, and a series of one- or two-page evidence summaries.
For instance, here is the pocket guide.
It lists five steps to treating pain. None of the steps are objectionable on the surface:
- Assess the patient’s pain and well-being
- Set goals jointly with the patient
- Educate the patient about pain management options
- Develop a treatment plan with the patient; address potential challenges
- Followup, troubleshoot, and modify treatment plan as needed
I can’t think of any physician I know who would object to these steps
The devil, of course, is in the details. For instance, under #3, we see:
Describe evidence-informed non-pharmacological and self-care approaches to managing pain and promoting wellness, including but not limited to:
- Chiropractic, Osteopathic and Myofascial Manipulation, Massage Therapy, and
- Physical Therapy
- Cognitive Behavioral Therapy, Stress Management, and other psychological therapies
- Mind-Body Approaches, Meditation, Biofeedback, Guided Imagery
- Yoga, Tai Chi, and other movement therapies
Potentially evidence-based treatments, such a physical therapy, cognitive behavioral therapy, stress management, and the like, are included in a list with
- acupuncture (which is no more than a theatrical placebo),
- chiropractic (chiropractors are, as I like to say, improperly trained physical therapists with delusions of grandeur); and
- osteopathic and myofascial manipulation.
Basically, integrative medicine advocates co-opt the sensible, the science-based, and the potentially science-based lifestyle interventions for pain as being “complementary” or “integrative,” thus claiming them for their own.
They also divide interventions for pain into two categories, “pharmacological” and “non-pharmacological.” Guess which one they claim for their own as being “CAM” or “integrative”? At the same time, they further the stereotype that science- and evidence-based medicine is all about nothing more than drug therapy.
Never forget that the real purpose of integrative medicine, whether acknowledged or not, whether even admitted to themselves by advocates or not, is to integrate quackery with medicine.
Rebranding their nostrums as “nonpharmacologic” treatments for pain serves two purposes.
- First, it allows integrative medicine to claim certain science-based modalities, such as diet, exercise, and evidence-based physical therapy, as solely belonging in their bailiwick.
- Second, it allows them to give a false sense of scientific legitimacy to the pseudoscience, such as acupuncture, energy medicine, and the like into the treatments they’re so desperately trying to “integrate” into medicine.
Finally, these two tactics allow integrative medicine advocates to claim all nonpharmacological treatments of pain as their own, separate from science- and evidence-based medicine, even when such treatments have existed in that realm for a long time.
I feel like you missed the mark, here. Especially in disrespecting some disciplines long shown to be helpful for some people in pain, such as chiropractic and massage. The biggest problems I see with complimentary medicine is that most insurance will not cover it; that it doesn’t help every person and every situation; and often can’t handle pain, on its own accord. Modern medicine is often still needed. (A good chiropractor will be honest if s/he doesn’t think they can help. I know one chiro who has referred patients to a surgeon on occasion.) And it should be complimentary, not “instead of” medication, for people in severe chronic pain. I do agree that “energy medicine” is a bunch of horse manure. Too bad they’re including this in complimentary medicine now, IMO, including it in alt/complimentary medicine causes outrage over the entire group of disciplines. Hence the rant of this article. Please rethink your stance on complimentary medicine as a group and I’ll be on your team arguing against the pseudo science of “energy medicine” and other hoodoo quackery.
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You are right: these alternative treatments *can* work, but they cannot be substituted for pain medication. They can definitely be used to reduce the amount of pain medication needed and many pain patients do exactly that.
It’s when they are used as substitutions for real medical care that problems arise. Just like following a good diet can ease people’s diabetes, such efforts are not a sufficient substitute for insulin, but can certainly lower the amount needed.
Personally, I use all kinds of exercises for my body and eat carefully and make sure to get enough sleep so that I don’t need as high a dose of opioids. If insurance paid for “pool therapy” I’d love to try it or if they’d pay for more than a handful of psychological therapy sessions I’d start that too.
But massage and chiropractic are ineffective or even worsen the pain from my particular condition (EDS) – I learned that the hard way – and after 3 miserable sessions with an old Chinese acupuncturist, he actually told me that acupuncture couldn’t help me. He was a brilliant man, because he was 100% correct in my case even though I hadn’t been diagnosed with EDS yet.
My opinion is just that most “alternative” or “integrative” methods are mostly ineffective on their own and should be used to supplement medical treatment, not replace it.
I gotta see if this group is involved in the Oregon Insanity. Sure do sound like their party line.