BMJ: the scam of integrative medicine

Here. (I will take down the text once have toll free link from bmj.)

There’s been a shift in the world of alternative NHS medicine. I know, I know, alternative so called medicine is only medicine that doesn’t work: so how come it’s still chumming up with our evidence aware NHS? It’s not, you see, called “alternative” or even the giveaway “homoeopathic” medicine any more. Keep up: it’s now called “integrative medicine,” which is the most insulting, misleading, and nonsensical rebranding yet.

So the Royal London Homoeopathic Hospital is now the Royal London Hospital for Integrated Medicine. In Glasgow, it has become the Centre for Integrative Care. Bristol calls one of its clinics the Integrated Centre for Health. You get the idea. As we have come to realise, homoeopathy is placebo, and rather than closing the places down they have tried to corner what does work—listening and spending time with patients—as their new specialism. The new moniker, said Dr David Reilly, clinical director at the Glasgow centre, is “reflecting its development work in creating new models of care especially in long term conditions, with an emphasis on person centred, individualised therapeutic relationships aimed at helping people enable their own strength and self care.”

Does this mean that doctors listen to patients; try to work out what would help and what would be acceptable to them; and encourage, support, and plan for the future? Instead of these being core attributes of normal good care, integrative care is attempting to lift these essentials away from the norm and into their special realm, spiced with placebo pills and acupuncture, which inject the consultation with inherent untruths.

It isn’t fair that professional, compassionate care is seen as something of a specialist competency to be available only to those who consort with non-evidenced based medicine. Interest in the whole person is what good doctors have always had. Creating a new brand of integrated care almost accuses those of us in normal medicine of aiming for something different. If only we had the resources to spend more time with patients and we were allowed to treat people’s concerns with professionalism and evidence rather than the will of the government’s general practice contract. Then everyone might have a chance to benefit from professional medical care, not just a few willing to suspend their disbelief.

Real integrated care can only be provided by evidence based doctors. Anything less is a grave disservice. But I’m a forgiving sort. Integrative doctors, come on. Ditch the homoeopathy; get rid of your reiki. Come back to discover the necessity, richness, and vitality of evidence. Find fulfilment in the honest human values shared in the relationship between doctor and patient. Help us get rid of politics in the consulting room, abet us in ripping up the general practice contract, and let’s all help all of our patients.

12 Responses to “BMJ: the scam of integrative medicine”

  1. Guy Chapman July 14, 2011 at 10:27 pm #

    The only way these people can stop being quacks and take a proper place in the health service is by dropping the quackery. Unfortunately they seem to be so wedded tot he quackery that they are going the other way and doing whatever they can to fly it in under the radar.

    I have no problem with empathic individuals setting up shop as counsellors. I have no problem with the idea that massage might help lower back pain. I do have a serious problem when in order to get your counselling you have to buy into pseudoscientific sugar pills which are also sold by out and out charlatans who claim to cure cancer and malaria, and I have a problem when your masseur wants to twist your neck with a risk of fatal stroke in the name of curing some “subluxation” that has no objectively verifiable existence.

    If we want to learn from the alternative-to-medicine crowd then let’s learn from them, not let them in the door with crank theories that most people lack the knowledge to identify for the bullshit they truly are.

  2. EDZARD ERNST July 15, 2011 at 8:44 am #

    very good comment!it’s the old bait and switch technique and nothing else.the new college of medicine seems to bring this trick to a new level of perfection/deception.it’s trick and not treatment!

  3. Luke Scientiae July 15, 2011 at 8:51 am #

    That it is left up to bloggers, however excellent, to implore doctors to return to evidence-based treatment is a disgrace.

    Why isn’t it simply illegal for doctors to direct patients towards the quacks and charlatans? Shouldn’t it being illegal come naturally out of the government legislating to protect the public from harm?

    In fact, why isn’t it illegal for reiki and homeopathy to make any claims at all about affecting human health one way or the other if they can’t provide adequate evidence to support what they are saying?

  4. domenica July 15, 2011 at 10:34 pm #

    I can’t believe people like you still exist. You sound like a half-wit from the 1950’s. there is a lot more evidence for naturopathic, homeopathic and eastern medicine than anything you practice I’m sure. About 3000 years worth of practice. You should be ashamed of your ignorance and blatant misuse of that degree someone was irresponsible enough to give you.

  5. David Colquhoun July 16, 2011 at 9:33 am #

    Margaret McCartney has hit the nail on the head. She usually does.
    Dr Neaves, comment in the BMJ, on the other hand, sounds as though she’s beginning to panic. She says

    "You might not agree with homeopathy, but acupuncture you include too, which is offered by NHS physiotherapists and pain clinics across the country? Might this extend to osteopathy too? Or was NICE wrong in the guidelines on chronic back pain."

    The simple answer is that NICE was most certainly wrong. The advice has been widely ignored because it is "controversial".
    Acupuncture is now, according to the evidence, seen as being essentially a theatrical placebo. It is based on "principles" that are sheer nonsense and its placebo effect is barely big enough to be useful in real life.
    Osteopathy was, like the utterly discredited chiropractic, the invention of a Victorian crank. To make matters worse, many osteopaths offer "cranio-sacral osteopathy", a form of laying on of hands that is no better than black magic. We are awaiting the judgement of the Advertising Standards Authority concerning some utterly unjustified claims made in a leaflet issued by the Royal London Hospital for Integrated Medicine. Judging by the ASA’s previous judgement on this topic, the hospital will be in trouble.
    The evidence is pretty clear now that osteopathy and chiropractic are no more effective than any other manipulation therapy, even for low back pain, so they are both entirely redundant. You can get the same effect without all the mumbo jumbo that accompanies the alternative treatments. The mumbo jumbo is insulting to patients, and unethical because it’s either untrue or it’s meaning less.
    The more interesting question now is whether any manipulative therapy is useful for low back pain. There is some reason [1] to think they may not be. If so, it’s sad, but it does not justify lying to patients
    1. Artus et al. Rheumatology 2010;49(12):2346-56.

  6. phayes July 16, 2011 at 1:28 pm #

    I feel the same way about all this as Luke Scientiae. The apparent general tolerance for even the looniest quackery is puzzling and depressing enough but its infiltration into the NHS and Universities etc. is surreal and disturbing. Scary even:

    😉

  7. HJohnston July 16, 2011 at 8:58 pm #

    A few thoughts . . . Mr. Chapman “I have a problem when your masseur wants to twist your neck with a risk of fatal stroke” in over 100 years of history of massage therapy has this ever happened? Even once? If we want to go by the evidence rather that hyperbole I think we need to demonstrate that this has actually happened. Considering the tens of millions of massages that have been given world wide if this was a true risk there would be documentation of it occuring. There is however, plenty of evidence of patients expiring while prescribed polypharmacy due to drug interactions. Each drug of course is tested and considered safe by the government agency; however, these drugs have never been tested together eventhough they are regularly prescribed together. Can we say that evidence based medicine was used on a patient when there is no evidence that the multiple drugs that are prescribed to the patient have ever been tested together, in the way they are likely to be prescribed to a randomized group, over the length of time that the prescription would likely be used for? Did we use evidence based medicine? Or did we just assume it would work and assume it was safe because it was convenient to do so and it reinforced the practices that were already being used?

    Concerning some other comments, remember in the 70’s the fringe group that was recommending fish oil, flax seed oil, probiotics & vitamins were considered quacks, charlatains, etc. What is happening now? The drug companies have fish oil composites that doctors are prescribing. There are also doctors world wide that are suggesting to their patients to take fish oil, flax seed oil, probiotics & vitamins. The “quacks” in the 70’s were just 40 years ahead of “traditional medicine”. Sometimes we forget that those that were selling fish oil etc in the 70’s had low margins and could not afford to do the studies big pharmacutical companies can do. The suppliments worked just as well in the 70’s as they do now, they just didn’t have the high cost studies behind them. Now the drug companies can charge many times more for essentially the same effect on the patient and doctors can be assured that they now have “evidence” behind what they are prescribing. Too bad for the last 40 years of patients. They could have had the positive effects of the suppliments and no side effects. Sometimes I think we forget that the entities providing the “evidence” often have a financial benefit for proving that their products work and that the doctor should prescribe them. We forget, at least in the US, that the pharmacutical companies can do multiple studies and only have to have 1 show that there is a statistically significant effect. ie, they can do 19 studies that show the drug doesn’t work and 1 that shows it does and the drug is approved. Is that really evidenced based medicine? Patients have no such agenda. They just want to get better. If you have a patient that says I did xxxx and I felt better and my pain went away and I was able to function better I would find them much more believable, and more valid “evidence” than a drug company that shows positive results for 1 double blind study for a drug that they will be making a significant profit on. Maybe in the health care field we should use the same standard for judging evidence as the criminal courts. If a witness as an ulterior motive (ie profit) for providing evidence they are judged as less reliable than the witnesses that provides evidence and have no ulterior motives.

  8. bikeclips August 10, 2011 at 1:36 pm #

    Sorry to bump a slightly older post but HJohnston needed an answer!

    Vertebral arterial dissection (a cause of stroke) is well described following minor trauma including massage (as has carotid and – more rarely – subclavian arterial dissection). I haven’t the time to do a literature search so can’t tell you if fatal strokes have been reported, but that seems a moot point. The Canadian Chiropractic Association (stop quacking at the back) include a mention of it in their “clinical” guidelines, going so far as to put a value on the risk (One in a million – I’m sure they didn’t make it up).

    I’m not sure I agree that the opinions of “fringe groups” on dietary supplement use, have been vindicated by modern evidence or practice but – in any case – shouldn’t a responsible position be one of open-mindedness. I’m happy to accept the benefits of any given intervention provided there is robust evidence supporting them. Obtaining funding to prove the efficacy of an unprofitable agent might be difficult and I can’t pretend that the system is perfect but that doesn’t mean we should accept treatments based on anecdote. The approach to pharma companies binning their negative results should be to implement a properly and universally enforced system of trials registration so that everybody knows what the proposed aims of a study are before it starts. I’m afraid that if we resort to your system: “A patient says…” then we’re stumbling in the dark.

  9. Margaret McCartney
    margaretmccartney August 10, 2011 at 8:14 pm #

    sorry I missed this
    Edzard Ernst has a v good thing in the BJGP on this. but it’s behind a paywall. instead here is this

    http://www.guardian.co.uk/science/blog/2011/jul/12/chiropractors-ethical-duty-patients-risks

    I honestly don’t care if something starts off ‘alternative’ or ‘orthodox’ – it’s the evidence that counts. so I will happily stop prescribing things that we have no evidence for and will want to use things that do work. I really don’t care what they might have been once categorised as, what’s important is whether or not they work.

    I also think that any industry – pharmacological, vitamin supplements, etc – is at risk of overhyping their claims. That’s why we need independent assessments and open transparent research asking useful questions. We should have the same standards for all research, no matter the provenance of the therapy.

    • Jane Giakoumakis June 8, 2015 at 5:08 pm #

      Wish i had found your blog in 2011 Margaret! I agree with what you have said. I was a nurse specialist and had to ill-health retire due to M.E which was triggered by 2 viruses, one being EBV. Myself and many others were on the cross party group for M.E for years and before it’s collapse (due to a labour MSP) we were fighting against this nonsense. I have been taking calls from patients diagnosed with M.E for 15yrs and this clinic is one where many are referred to (thank goodness NHS Lanarkshire will not be funding any more patients to attend there) The stories I hear appall me and this Glasgow clinic is not cost effective and more importantly fails to get people better as Reilly promises them! Alternative therapies , well some, are a way of making people feel nice but they are NOT the answer. I was involved in helping NHS Lanarkshire draw up a M.E Guideline yrs ago for their Director of Public Health Report and i said it all then. Nothing has changed. I am thankful for my GP practice which who fully understand my illness, accept their limitations and rely on evidence based medicine. I do go for massage on my neck and shoulder area re some of the muscle spasm I have with this illness but it is no way a cure . Best M.E Guideline in the World at present can be read at the following link. If you would like a hard copy please send me your address and I will have one posted. http://investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf
      Unable to type for any longer but thanks again for your sensible blog.

      sincerely Jane

  10. alayah August 29, 2011 at 5:01 pm #

    i agree with Luke Scientiae

  11. Leo Lyons August 30, 2011 at 2:44 pm #

    If we agree that rebranding institutions using the term Integrative is merely PR and an attempt to disassociate oneself from increasingly discredited practices – whilst still actually prescribing those practices – why do we so readily comply and start using the new names? Snake oil is still Snake Oil whatever you call it – so lets keep calling it snake oil.

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