I have previously discussed the problem with so-called “integrative medicine.” It is ultimately a Trojan Horse intended to gain acceptance for alternative therapies without the bother of demonstrating they actually work through rigorous scientific research. Proponents of integrative medicine want to generate the impression that there is no meaningful difference between cardiology and acupuncture, oncology and chiropractic, surgery and homeopathy. All of these are just equivalent areas of specialization within medicine. The problem is that this is a lie.
Most alternative therapies are either unproven or already disproven, which is why they are in that category to begin with. And while some do deserve serious research to determine whether or not they are safe and effective, proponents aren’t interested in doing this, because they already “know” these methods are effective based on personal experience and faith. They only wish to convince their mainstream colleagues, and they view science as a marketing tool rather than a way to find out the truth about these practices.
I have also previously written about the integrative medicine program at the University of Tennessee veterinary school as an example of this problem. It is funded in part by the American Holistic Veterinary Medical Foundation (AHVMF), whose leaders have repeatedly demonstrated their commitment to pseudoscience and their fundamental rejection of basic scientific principles. The center also receives funding from the Mercola Healthy Pets, a branch of the web site founded by Dr. Joseph Mercola, one of the most effective promoters of quackery and opponents of science-based medicine out there. Of course, accepting funding from these sources does not automatically mean the program shares their goals and methods, but it is reason to look closely at the program itself.
A recent interview with Dr. Raditic, founder of the UT integrative medicine program, and Dr. Danielle Conway, the inaugural fellow in integrative medicine at UT, published on the Mercola veterinary web site, provides examples of the CAM marketing strategy embedded in the notion of integrative medicine (Part 1, Part 2).
Dr. Conway, in a previous interview, explained that her faith in alternative therapies is founded on her personal experience as a child. She recounts her parents’ decision to turn to a naturopath for help with a serious illness she experienced. According to the interview, “After a few rounds of herbs, homeopathy and acupuncture, she was able to be a normal kid again.” Given the evidence that homeopathy is a useless placebo, most herbal therapies remain unproven and have significant risks, and acupuncture is almost certainly a placebo as well, this anecdote-driven faith seems misplaced. Yet Dr. Conway has already received training in the pseudoscience that is Traditional Chinese Veterinary Medicine, and it seems likely that she comes to this fellowship with her mind pretty well made up. This is not a perspective conducive to rigorous, open-minded scientific work.
This attitude seems to underlie an anecdote from the interview which is clearly intended to imply alternative therapies can be not only equal but superior to conventional medicine. Dr. Conway relates seeing a patient that had already been seen by numerous veterinary specialists “who hadn’t been able to help.” Despite being a brand-new veterinarian, Dr. Conway claims to have been able to properly identify the problem these experts missed thanks to her alternative training.
She was at that moment very grateful for the complementary medicine training she had already received in acupuncture and chiropractic, because it added a new dimension to her physical examination of the dog.
Dr. Conway began to do some basic chiropractic manipulations on the dog, paying attention to little subtleties that veterinary students don’t learn about in conventional vet medicine training. She realized there was something going on with the dog’s larynx. She thought to herself, “It’s stuck. It’s just not right.”
Shockingly, Dr. Conway turns out to have been right when conventional veterinarians were wrong, as the dog reportedly had an abscess of the larynx. The story goes on to suggest that the dog was successfully treated by alternative medicine alone, though I suspect some details of the diagnosis and therapy have been left out in the interest of creating a narrative that serves the purposes of CAM promotion:
Not only was Danielle able to accurately diagnose the dog, she was also able to treat him successfully with aromatics.
The article goes on to strongly imply that alternative practitioners are more skilled at physical examination and that conventional medicine relies too heavily on technology. Just as exercise, nutrition, and other completely conventional and mainstream health practices are often labeled “alternative” to suggest that CAM practitioners employ them and conventional doctors do not, so the universal expectation that veterinarians should learn and perform an effective physical exam as a routine part of clinical practice is twisted to suggest that this technique is somehow a feature of alternative medicine that mainstream doctors often don’t understand or apply.
In addition to such disingenuous spin, the story also ignores the overwhelming evidence against the theory and most clinical applications of chiropractic, which relies on a vitalistic understanding of health and disease completely incompatible with the real science both Drs. Conway and Raditic claim to also value.
The article reinforces in several other ways the role of programs such as this as advertising vehicles rather than true efforts to discovery the real value of alternative therapies. Dr. Raditic, for example, implies that preventative health care, like a good physical exam, is an alternative, rather than mainstream practice:
Seeing patients as puppies and kittens and embarking on a proactive approach to their lifelong health care is the goal. To do that, integrative programs must be available in every veterinary school.
And she once again identifies the goal of research as not discovery of the truth but marketing and promoting alternative medicine:
And good-quality research needs to be done. Danielle says, “That’s how I think we’re really going to change hearts and minds, and convince veterinarians to incorporate complementary medicine into everyday practice.”
To be fair, both Dr. Raditic and Dr. Conway acknowledge the importance of basic science and conventional veterinary medicine, and I don’t doubt they are sincere. Like most CAM vets I have met, they are most likely nice people and competent conventional clinicians. However, despite their genuine belief that they are working in the best interests of patients and veterinary medicine and in a way consistent with the principles of science, the reality is that their statements and actions are deeply inconsistent with the principles of scientific medicine. A deep, unshakeable faith in therapies that have not yet been proven or, in many cases, have already been demonstrated to be ineffective is not compatible with an open or scientific mindset.
The purpose of integrative medicine programs like the one at UT is clearly to promote therapies despite the lack of evidence for them or the evidence against them. By making such therapies familiar, by implying they are equivalent to scientific medical specialties, by mischaracterizing science-based medicine and appropriate as “alternative” aspects of conventional care, such as nutrition and physical exam skills, these advocates hope to spread their faith in alternative therapies regardless of the scientific evidence for or against them.
This is not, despite all the best intentions, truly what is best interests of patients. More homeopathy, chiropractic, acupuncture, aromatherapy, and the like will not bring better health to our patients. Rigorous scientific evaluation of plausible therapies will. The right way to handle alternative therapies is to discard the category itself and simply treat them like any other kind of medicine. Those that show plausibility through basic science and pre-clinical study should be subjected to high-quality clinical trials. If they demonstrate consistent, meaningful benefit and acceptable risks, they should simply become “medicine,” not “alternative medicine.” Those that fail this test should be abandoned. An honest, fair, science-based approach will separate the worthwhile from the worthless, rather than merely making the unproven or worthless seem more scientifically legitimate, as integrative medicine programs like this currently do.
The dog diagnosis story is interesting: it seems quite possible that some people are better diagnosticians than others – having digested technical information in a more fruitful way, better reading of body language, unconscious processing of comparisons with healthy subjects’ behaviour etc. I surprise myself frequently by diagnosing horse malaises – with subsequent veterinary confirmation, but I think it’s more down to information processing and not imposing pre-set ideas than chanelling any extra-scientific paradigm. But humans are all too prone to think that the products of their brains are wonderfully special and enlightening, putting them on the high ground and leading them to think that anecdotes involving themselves and their own theories/specialities are definitive. Science is supposed to provide guard rails against people falling off these dizzy heights!
The real problem with the story, of course, is not whether it is accurate or not since we have no way to know. The problem is that its purpose is purely propaganda. If Dr. Conway had been wrong in this case, do you think she would have reported the story in this interview or concluded that her chiropractic and acupuncture training made her less capable at performing physical exams than conventionally trained vets? Of course not. The anecdote only matters if it supports what CAM advocate already believe. If not, it is ignored.