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Your Daily Posterous subscriptions September 10th, 2011 The growth of

integrative medicine in academic

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The growth of integrative medicine in academic institutions

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MD<http://www.kevinmd.com/blog/post-author/robert-donnell>| in

Education <http://www.kevinmd.com/blog/category/education> | no responses

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*The Atlantic* published an article about the growth of quackademic medicine

in our teaching

institutions<http://www.theatlantic.com/magazine/archive/2011/07/the-triumph-of-\

new-age-medicine/8554/>and

it’s celebratory more than critical. It profiles the integrative

medicine clinic of Dr. Berman. That’s right, this Dr.

Berman<http://doctorrw.blogspot.com/2007/10/meet-newest-member-of-trauma-team-re\

iki.html>.

I blogged about him four years ago and it seems his clinic at the University

of land is still going strong. Stronger, apparently.

The article, like integrative medicine itself, is a mixture of quackery and

general distortion with a little science and pseudo skepticism thrown in. A

central premise is that no matter how nutty the idea, you can’t call it

quackery if it carries the imprimatur of a respected academic institution:

“Concerns of outright malpractice or naked hucksterism seem grossly

misplaced when applied to a clinic like Berman’s.”

Below are a few more of the distortions contained in the article:

The false dichotomy between the conventional medicine approach and

“healing.”

The claim that conventional medicine ignores prevention.

The notion that the principles of conventional medical science are obsolete

because they originated in the era when acute infectious diseases were the

leading killers.

The idea that medical science has failed to make significant advances in the

care of chronic diseases. (Tom

Sullivan<http://www.policymed.com/2011/08/modern-medicine-vs-alternative-medicin\

e-different-levels-of-evidence.html>debunks

that popular canard.)

By and large the purported benefits of integrative medicine, as illustrated

by the numerous testimonials in the article, are the result of the placebo

effect and the generous time and personal attention lavished on the patients

who attend. So, some might ask, what’s the problem? Aren’t those reasons

enough to justify integrative medicine?

Not when those benefits are attributed to a quacky intervention. It’s just

unethical. As Steve Novella, interviewed for the piece, said:

Novella is a highly respected Yale neurologist, and the editor of

Science-Based Medicine, an influential blog that has tirelessly gone after

alternative medicine. I met with him in his home outside New Haven,

Connecticut, where he argued that claims about the practitioner-patient

relationship are only intended to draw attention away from the fact that

randomized trials have by and large failed to show that alternative

treatments work better than placebos. And while he concedes that sham

treatments can give patients a more positive attitude, which can confer real

health benefits, he is adamant that providing sham treatments at

all—essentially fooling patients into believing they’re being helped—is

highly unethical. “Alternative practitioners have a big advantage,” says

Novella. “They can lie to patients. I can’t.”

Aside from the ethical considerations cited by Novella the argument raises

another false dichotomy: that spending lots of time with patients and

approaching them as whole persons is somehow uniquely inherent to

integrative medicine and foreign to conventional medicine. For many

counter-examples to that argument just read DB’s many

posts<http://www.medrants.com/> on

the true nature of mainstream *internal* medicine or my

post<http://doctorrw.blogspot.com/2011/01/what-is-internist-anyway.html>where

I cite the example of the late

Brittingham<http://medicine.mc.vanderbilt.edu/brittingham/brittinghamTribute.pdf\

>as

the exemplar.

No, it’s not the pure notion of the whole person or spending time with

patients that’s unique to integrative medicine. So what *is* integrative

medicine’s uniqueness? I would submit that, in part, it’s the fact that it

makes quacky claims that are so appealing and sensational to the uncritical

public that patients are willing to pay handsomely for it out of pocket.

That eliminates some of the time pressure that exists under the

reimbursement system for conventional medicine.

The article additionally points out the alarming degree to which

quackademics are infiltrating the renowned Mayo Clinic, to a greater degree

than even I was aware. Even the dean of the medical school is on board.

Some of the Mayo doctors quoted in the article are in favor of integrative

medicine but their arguments are mainly sophistry. Though superficially

appealing the defects and half-truths in their statements become apparent

once a little critical thought is applied.

via

kevinmd.com<http://www.kevinmd.com/blog/2011/09/growth-integrative-medicine-acad\

emic-institutions.html>

Modern Medicine vs. Alternative Medicine: Different Levels of Evidence

- Policy and

Medicine<http://ptmanagerblog.com/modern-medicine-vs-alternative-medicine-diffe>

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Modern Medicine vs. Alternative Medicine: Different Levels of Evidence

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6970c-pi>

Prescription medicines and advances in medical treatment have helped people

avoid disability and death caused by disease, lowered overall treatment

costs, and has lowered death rates for heart disease, stroke, cancer, and

other deadly diseases for several decades.

Since 1970, the death rate from heart disease has dropped nearly 60% and

deaths from stroke are down 70%. The death rate from cancer has dropped 16%

since 1990 and the death rate from HIV/AIDS has dropped more than 75% from

its highest point in 1995. In addition, the average life span of Americans

increased from 69.7 years in 1960 to approximately 80 years in 2007.

In addition, the 5-year survival rates for cancer have risen by 26% just

since 1984. And while HIV/AIDS was the 8th leading cause of death in the US

in 1996, today, it’s not even ranked in the top 15.

Moreover, for every $1 spent on statin therapy for heart attack survivors,

as much as $9.44 is produced in health gains. For every $1 spent on routine

use of beta-blockers for acute heart attack sufferers, as high as $38.44 is

produced in health gains. And for every $1 spent on intensive glycemic

control in newly diagnosed type 2 diabetes patients, as much as $3.77 is

produced in health gains.

The use of newer inhaled corticosteroids for patients (including children)

for one year has also reduced the risk of hospitalization by 50%, the number

of outpatient visits by 26%, and monthly health care costs by 24% per

patient. Additionally, because of the treatments and medicine researched and

developed by the pharmaceutical industry, early detection and better

treatments have increased overall 5-year cancer survival rates by 36% since

the late 1970s. Moreover, life expectancy for people with cancer increased 3

years between 1980 and 2000, and 86% of that gain is attributed to better

treatment, including medicines.

Despite the significant gains in health care and quality of living

individuals have experienced over the past several decades because of the

treatments and drugs created by industry (in collaboration with academia and

government), a recent article in The

Atlantic<http://www.theatlantic.com/magazine/archive/2011/07/the-triumph-of-new-\

age-medicine/8554/>conveniently

disregards the above data in favor of the “triumph of new-age

medicine,” also known as “alternative medicine.”

Specifically, the article asserts that the medical community is growing more

open to alternative medicine’s possibilities in large part because

“mainstream medicine is failing.” But is it failing? Based on the

statistics above, this point is extremely misguided and problematic.

*New-Age Medicine** *

The article focuses on Berman, a physician who is in charge of The

Center for Integrative Medicine at the University of land Medical Center

in downtown Baltimore. His clinic is focused on alternative medicine,

sometimes known as “complementary” or “holistic” medicine.

While there is no official list of what alternative medicine actually

comprises, treatments falling under the umbrella typically include

acupuncture, homeopathy (the administration of a glass of water supposedly

containing the undetectable remnants of various semi-toxic substances),

chiropractic, herbal medicine, Reiki (“laying on of hands,” or “energy

therapy”), meditation (now often called “mindfulness”), massage,

aromatherapy, hypnosis, Ayurveda (a traditional medical practice originating

in India), and several other treatments not normally prescribed by

mainstream doctors.

The term *integrative medicine *refers to the conjunction of these practices

with mainstream medical care. Interestingly, Berman’s clinic is “hardly

unique,” and in recent years, the U.S. has seen about 43 clinics spring up

at major academic medical institutions including Harvard, Yale, Duke, the

University of California at San Francisco, and the Mayo Clinic.

Alternative-medicine experiences can vary widely. It can include a long

initial meeting covering many details of the patient’s history; a calming

atmosphere; an extensive discussion of how to improve diet and exercise; a

strong focus on reducing everyday stress; an explanation of how the

treatment will unleash the body’s ability to heal itself; assurance that

over time the treatment will help both the problem that prompted the visit

and also general health; gentle physical contact; and the establishment of

frequent follow-up visits.

To some however, such as Salzberg, a prominent biology researcher at

the University of land at College Park, alternative medicine is merely

“cleverly marketed, dangerous quackery.” He asserted that, “these clinics

throw together a little homeopathy, a little meditation, a little voodoo,

and then they add in a little accepted medicine and call it integrative

medicine, so there’s less criticism.”

Contrary to this approach, Salzberg asserted that there is only “one type of

medicine, and that’s medicine whose treatments have been proven to work.”

And he pointed out that alternative medicine has not been proven to work,

and proponents of the practice will not admit it because “they are making

too much money on it.”

Accordingly, Salzberg believes that funding for alternative medicine, such

as that received by Berman’s clinic, should be removed. Instead, however,

he asserted that alternative medicine keeps being propelled by a handful of

members of Congress who are determined to see their faith in alternative

medicine validated.

In addition, medical centers are lining up to establish research clinics so

that they can take NIH funding for alternative-medicine studies. Aggressive

marketing of these clinics can also generate substantial patient demand

(even a small integrative clinic can take in several million dollars a

year).

Salzberg also pointed out that the successful claims of alternative medicine

are misguided because subjective symptoms like pain and discomfort are

susceptible to the power of suggestion. These same symptoms also tend to be

cyclical, meaning that people who see a practitioner when their symptoms

flare up are likely to see the symptoms moderate, no matter what the

practitioner does or doesn’t do. Patients simply misattribute the

improvement to the treatment.

Consequently, Salzberg noted that the biggest danger of alternative medicine

is that patients who see alternative practitioners will stop getting

mainstream care altogether. He noted that, “the more time they spend getting

fraudulent treatments, the less time they’ll spend getting treatments that

work and that could save their lives.”

*Alternative Medicine vs. Modern Medicine** *

About 40 percent of Americans have tried some form of alternative medicine

at some point, and some $35 billion a year is spent on it. A certain amount

of abuse seems like a given. Nonetheless, says Salzberg, the bottom line is

that studies clearly show alternative medicine simply does not work. And at

first glance, that contention seems nearly incontrovertible.

The scientific literature is replete with careful studies that show, again

and again, that virtually all of the core treatments plied by alternative

practitioners, including homeopathy, acupuncture, chiropractic, and others,

help patients no more than do “sham” treatments designed to fool patients

into thinking they’re getting the treatment when they’re really not.

In contrast to alternative medicine, “modern medicine was formed around

successes in fighting infectious disease,” says Blackburn, a

biologist at the University of California at San Francisco and a Nobel

laureate. “Infectious agents were the big sources of disease and mortality,

up until the last century. We could find out what the agent was in a sick

patient and attack the agent medically.”

The medical infrastructure we have today was designed with infectious agents

in mind. Physician training and practices, hospitals, the pharmaceutical

industry, and health insurance all were built around the model of running

tests on sick patients to determine which drug or surgical procedure would

best deal with some discrete offending agent. The system works very well for

that original purpose, against even the most challenging of these agents—as

the taming of the AIDS virus attests.

Yet, medicine’s triumph over infectious disease brought to the fore the

so-called chronic, complex diseases—heart disease, cancer, diabetes,

Alzheimer’s, and other illnesses without a clear causal agent. Now that we

live longer, these typically late-developing diseases have become by far our

biggest killers. Heart disease, prostate cancer, breast cancer, diabetes,

obesity, and other chronic diseases now account for three-quarters of our

health-care spending. “We face an entirely different set of big medical

challenges today,” says Blackburn.

“But we haven’t rethought the way we fight illness.” That is, the medical

establishment still waits for us to develop some sign of one of these

illnesses, then seeks to treat us with drugs and surgery. Instead, the

author asserts that the drugs created to treat these chronic diseases have

been largely inadequate or worse, pointing to examples such as Avastin and

Avandia. As a result, the author tries to draw the connection between a few

shortcomings to the fact that America spends “vastly more on health as a

percentage of gross domestic product than every other country—40 percent

more than France, the fourth-biggest payer.” But what the author fails to

realize is that of the percentage we are spending on health care, only 10%

or 10 cents out of every dollar is coming from prescription drugs or

treatments.

Nevertheless, the author asserts that what is needed is a system that

focuses on lowering the risk that these diseases will take hold in the first

place. “We need to prevent and slow the onset of these diseases,” according

to Blackburn. For those proponents of alternative medicine, they espouse

getting doctors to speak to patients about healthy diets, encouragement of

more exercise, and measures to reduce stress.

The author goes on to cite evidence that “lifestyle and attitude changes

have enormous impact on health is now overwhelming.” For example, the

article points out Dean

Ornish, a physician-researcher at the University of California at San

Francisco and the founder of the independent Preventive Medicine Research

Institute, who has been showing in studies for more than three decades that

diet, exercise, and stress reduction can do a better job of preventing,

slowing, and even reversing heart disease than most drugs and surgical

procedures.

To get patients to follow this “alternative regiment,” physicians have to

give patients more attention, meaning longer, more frequent visits that

focus on what is going on in a patient’s lives; more effort spent easing

anxieties, instilling healthy attitudes, and getting patients to take

responsibility for their well-being; and concerted attempts to provide hope.

In other words, conveying to patients that a physician’s commitment to

caring for them will endure over time, and to imbue patients with “trust,

hope, and a sense of being known.”

Of course, given the current status of payments, reimbursement, and other

medical practice issues, it is difficult for doctors to have visits with

patients lasting more than 20 minutes. Moreover, studies show that visits

average about 20 minutes, that doctors change the subject back to technical

talk when patients mention their emotions, that they interrupt patients’

initial statements after 23 seconds on average, that they spend a single

minute providing information, and that they bring up weight issues with

fewer than half their overweight patients.

*Is Alternative Medicine Effective*

Novella calls the notion that alternative care’s benefits are rooted

in closer practitioner-patient interactions the “touchy feely defense.”

Novella, a highly respected Yale neurologist, argued that claims about the

practitioner-patient relationship are only intended to draw attention away

from the fact that randomized trials have by and large failed to show that

alternative treatments work better than placebos.

In response to this argument, Ted Kaptchuk, a Harvard researcher who studies

the impact of placebos, noted that, “mainstream medicine uses the placebo

effect all the time.” To be approved by the FDA, a drug has to do better

than a placebo in studies.” Consequently, the author points to a recent

study, which concluded that 85 percent of new prescription drugs hitting the

market are of little or no benefit to patients. But what does that mean?

There are very few “new prescription drugs.” More to the point however, the

propaganda about lifestyle changes being better than drugs and devices would

be believable if lifestyle changes happened. But Americans are getting

fatter and lazier all the time, yet, according to economist

Lichtenberg, we’re living longer and better.

With systemic costs in mind, it does not even really make sense to ask

physicians—who, after all, spend hundreds of thousands of dollars and a

decade of their lives becoming trained in anatomy, biochemistry, high-tech

diagnosis, pharmacology, and more—to spend long blocks of time bonding with

patients. Other sorts of professionals could be better at the healing,

bonding, and placebo-selling part, and for less money.

These might include behavioral-medicine therapists, social workers, nurse

practitioners, or even some entirely new sort of practitioner specially

trained for the task—and working alongside or under the direction of a

conventional physician, who could continue to focus on quickly prescribing

conventional tests, drugs, and surgeries when they were specifically called

for.* *

Interestingly, the author pointed out that randomized clinical trials are

not needed to prove the effectiveness of alternative medicine. Why? Because

physicians are able to prescribe products off-label for indications that

also do not have good randomized-trial data. Accordingly, the author

asserted that while “we may not have great evidence that alternative

medicine works, that’s very different from saying it *doesn’t *work.”

The problem with this assertion is that if you promote a product off label,

you are sued by the Department of Justice for billions of dollars, but if

you promote alternative medicine without evidence there are little or no

consequences.

*Conclusion*

There is no question that physicians who spend more time with patients and

listen more carefully will see benefits. Novella agreed that a caring,

bonding practitioner is more likely to get patients to adopt healthier

lifestyles, and that these changes lead to better health. And he agrees that

many patients do feel better when practitioners actively try to help them

deal with vague, hard-to-diagnose complaints such as pain and fatigue,

instead of telling them that there’s no diagnosis or effective treatment.

But these aspects of a better patient-practitioner relationship should not

be uniquely associated with alternative medicine, and such principles should

not attempt to discredit the breakthroughs and innovations from the drug and

device industry. Instead, we should look to our doctors to be the nurturing

caregivers who take the time to listen to us, bond with us, and guide us

toward healthier lifestyles and lower levels of stress. But for doctors

outside of academia, this kind of time is hard to come by. Why?

The current system makes it nearly impossible for most doctors to have the

sort of relationship with patients that would best promote health. The

biggest culprit, is the way doctors are reimbursed. “Doctors are paid for

providing treatments, not for spending time talking to patients,” says

Victor Montori, an endocrinologist at the Mayo Clinic.

As pharmaceutical companies begin to take more and more of their business to

other countries, along with tax revenues, jobs, and discoveries, journalists

should be more careful with how they portray the significant breakthroughs

and innovations the pharmaceutical and medical device industry have created

for Americans. Mainstream medicine is nowhere close to failing. The

American health care system is what is failing Americans, while industry is

continuing to put more and more money into research and development to find

new cures and treatments for chronic diseases and serious illnesses.

If it were not for the discoveries of these companies, many of the people

reading the Atlantic as well as this blog would not be here today. The

efforts of the industry should not be sacrificed for the ideals of better

care from physicians. As noted above, changes in care are more about the

reimbursement system, and less about the 10 cents of every dollar spent on

health care in America.

Ultimately, if it were not for the declines in death

rates<http://www.policymed.com/2010/10/the-value-of-medicine.html>from

heart disease and stroke, created by the drug device industry, we

would

lose 1 million more Americans every year. Just ask yourself, what are the

chances that you or someone you loved would be in that 1 million, this year

or the next.

via

policymed.com<http://www.policymed.com/2011/08/modern-medicine-vs-alternative-me\

dicine-different-levels-of-evidence.html>

Do you know these top 10 Michigan Medicare fraud fugitives? | Detroit

Free Press |

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Zoom

A Medicare fraud fugitive hot line started in February wants leads on 170

people believed to have fled the country to avoid jail or prosecution. Ten

of those fugitives are from Detroit and are accused of fraud in receiving

more than $42 million. To report a tip, call the Office of Inspector

General, part of the U.S. Department of Health and Human Services, at

1-, or 1-800-HHS-TIPS or go to www.oig.hhs.gov/fraud/fugitives

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