So, Integrative Medicine?

[Patassa]

Recently while cruising the interwebs and looking at dream places for medical school, residency and/or fellowship training I ran across the fact that places like Duke, Scripps, Mayo, Cleveland Clinic etc. are all offering integrative medicine in some way, shape or form.

What is the general feeling out there in the non-trad world on integrative medicine?

I personally am very interested in these developments. The scathing criticisms that I've read so far come off more to me as the old guard fighting a losing battle. That and some strange wholesale world view buy in called "science". As in you either "believe" in science or you don't and you're a quack/nut/etc etc ad nausium degrading name calling childish nonsense. This old guard (at least in my mind they are the old guard) seem to be shouting from the roof tops that academic scientific medical institutions have sold out or lost their rigor. Is that it? Or are they providing a service that is in demand? Or are they offering new/old techniques that help people regardless if the current scientific method can "prove" it. How could the scientific method "prove" meditation helped someone manage their pain anyways? Why would anyone even look to science for that answer in the first place?


Don't get me wrong, I love science and it clearly has much to offer us. But science is limited in what it can and can't tell us. And, science is always right...right up until it's wrong. Which doesn't offer me much in terms of an all encompassing world view. So most of the criticisms I've read so far don't persuade me against integrative medicine.

Also, through some of the documentaries I've watched recently, it seems many of the people who come looking for integrative medicine techniques are the ones who have already tried "scientific medicine" and it's either failed them or they didn't like the effects.

Thoughts? Feelings? Interpretive dances?

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[QofQuimica]

Or are they providing a service that is in demand?

Bingo.

Why would you be surprised that these private institutions you mentioned and others like them are going to offer integrative medicine? It's not illegal; their customers want it; and a lot of said customers are willing to pay for it out of pocket. This is America. What self-respecting hospital system wouldn't want to jump on that kind of gravy train given the chance?

 

[mspeedwagon]

Welcome to America! There is on opportunity to make a lot of money and schools are taking advantage of that. Reminds me of MBAs back in the day. There were only a few reputable programs back in the day and now you can get an MBA without getting off the couch. Of course, you have to be willing to send a check once in a while, but even that you can send online to the school (no reason to even leave the house).

If there is demand and an opportunity to make money, supply follows.

 

[Patassa]

Bingo.

Why would you be surprised that these private institutions you mentioned and others like them are going to offer integrative medicine? It's not illegal; their customers want it; and a lot of said customers are willing to pay for it out of pocket. This is America. What self-respecting hospital system wouldn't want to jump on that kind of gravy train given the chance?

I'm surprised because aren't academic and/or elite type hospitals supposed to be the bastions of good science, among other things? Wouldn't there be a risk of their reputations being harmed which could result in a decrease of grants from the .gov world and loss of credibility in the academia world resulting in loss of funds and loss of talent?

If this stuff was all voodoo and magic tricks, what "self-respecting" hospital system would want to jump on it?

For instance: Let's say I was diagnosed with some strange and rare cancer, because of my geographical location, I'd be at M.D. Anderson asap. Why? Because they are the pinnacle of research and treatment options, at least that is there reputation in the south. But if they are selling me voodoo and magic tricks, I think I might reassess my options. I think this is more complicated than a simple market demand.

 

[Patassa]

Welcome to America! There is on opportunity to make a lot of money and schools are taking advantage of that. Reminds me of MBAs back in the day. There were only a few reputable programs back in the day and now you can get an MBA without getting off the couch. Of course, you have to be willing to send a check once in a while, but even that you can send online to the school (no reason to even leave the house).

If there is demand and an opportunity to make money, supply follows.

I'm not following your parallel, at all. But I think I follow your conclusion, however I'm not sure that applies absolutely in medicine. Seems there are some ethics boards and lawyers that might get in involved.

 

[QofQuimica]

I'm surprised because aren't academic and/or elite type hospitals supposed to be the bastions of good science, among other things? Wouldn't there be a risk of their reputations being harmed which could result in a decrease of grants from the .gov world and loss of credibility in the academia world resulting in loss of funds and loss of talent?

If this stuff was all voodoo and magic tricks, what "self-respecting" hospital system would want to jump on it?

For instance: Let's say I was diagnosed with some strange and rare cancer, because of my geographical location, I'd be at M.D. Anderson asap. Why? Because they are the pinnacle of research and treatment options, at least that is there reputation in the south. But if they are selling me voodoo and magic tricks, I think I might reassess my options. I think this is more complicated than a simple market demand.

You're only surprised because you haven't actually practiced medicine yet. Coming from a hard science background (I was a chemist for ten years before med school), one of the things that most shocked me during my third year of medical school was that so much of our "best practice" rests on....absolutely nothing. You hear buzz words like "evidence based medicine" all the time. Well, a lot of what we do has no evidence, or bad evidence, or is just based on expert opinion. And that's why it's so common for patients to get frustrated about not knowing what to do, or for the medical community to do a complete 180 with various treatments.

If you're interested, read up on the controversy on beta blockers. A few decades ago, giving a congestive heart failure (CHF) patient a beta blocker would have been akin to malpractice. Everyone *knew* giving beta blockers to CHF patients would kill them. Then someone actually did the studies, and guess what? CHF patients did better on beta blockers. Nowadays, *not* giving a beta blocker to a CHF patient would be akin to malpractice.

I also think that premeds greatly underestimate the extent to which medicine is a Big Business. Yes, the most prestigious hospital systems can jump on popularity bandwagons. And yes, they do. There's not really any risk to offering integrative medicine. I mean, what are the odds of hurting someone with meditation, homeopathy, or reiki? Except for maybe emptying their wallets, people won't be complaining too much about any side effects.

FWIW, I would be surprised if MD Anderson didn't offer integrative therapies. Cancer patients and others with potentially fatal diseases are some of the most likely to be interested in alternative therapies, especially when they're told that modern medicine has nothing to offer them. Not at all saying that I blame them, though I do think that some alternative practitioners are predatory on desperate people. But that's a conversation for another time.

 

[Patassa]

You're only surprised because you haven't actually practiced medicine yet. Coming from a hard science background (I was a chemist for ten years before med school), one of the things that most shocked me during my third year of medical school was that so much of our "best practice" rests on....absolutely nothing. You hear buzz words like "evidence based medicine" all the time. Well, a lot of what we do has no evidence, or bad evidence, or is just based on expert opinion. And that's why it's so common for patients to get frustrated about not knowing what to do, or for the medical community to do a complete 180 with various treatments.

If you're interested, read up on the controversy on beta blockers. A few decades ago, giving a congestive heart failure (CHF) patient a beta blocker would have been akin to malpractice. Everyone *knew* giving beta blockers to CHF patients would kill them. Then someone actually did the studies, and guess what? CHF patients did better on beta blockers. Nowadays, *not* giving a beta blocker to a CHF patient would be akin to malpractice.

I also think that premeds greatly underestimate the extent to which medicine is a Big Business. Yes, the most prestigious hospital systems can jump on popularity bandwagons. And yes, they do. There's not really any risk to offering integrative medicine. I mean, what are the odds of hurting someone with meditation, homeopathy, or reiki? Except for maybe emptying their wallets, people won't be complaining too much about any side effects.

FWIW, I would be surprised if MD Anderson didn't offer integrative therapies. Cancer patients and others with potentially fatal diseases are some of the most likely to be interested in alternative therapies, especially when they're told that modern medicine has nothing to offer them. Not at all saying that I blame them, though I do think that some alternative practitioners are predatory on desperate people. But that's a conversation for another time.

Ok so everything you're saying here makes sense to me. And the way you've described medicine in relation to science is the way that we had engineering described to us in relation to physics. We take what the physics can tell us, but we can't stop there, we have to go further and apply it and fix things even if we don't have the correct understanding of the physics behind it yet. Esp. in Metallurgy, that stuff was total hocus pocus.

So let me ask you, when I search on the interwebs about integrative medicine, there are some serious weighty sticks being used to beat it down and now to beat on the hospitals that are utilizing it. A former editor of a scientific journal wrote a pretty scathing review in the mid 90s, for example. Why all the vitriol if Doctors like yourself already know that the medicine you practice does not have 100% basis in infallible scientific findings?

 

[QofQuimica]

Ok so everything you're saying here makes sense to me. And the way you've described medicine in relation to science is the way that we had engineering described to us in relation to physics. We take what the physics can tell us, but we can't stop there, we have to go further and apply it and fix things even if we don't have the correct understanding of the physics behind it yet. Esp. in Metallurgy, that stuff was total hocus pocus.

So let me ask you, when I search on the interwebs about integrative medicine, there are some serious weighty sticks being used to beat it down and now to beat on the hospitals that are utilizing it. A former editor of a scientific journal wrote a pretty scathing review in the mid 90s, for example. Why all the vitriol if Doctors like yourself already know that the medicine you practice does not have 100% basis in infallible scientific findings?

Because as bad as conventional practitioners are at obtaining evidence (or following the evidence even when we have it), we do recognize that our practice *should* be evidence based. And as bad as the evidence is for many things in conventional medicine, it's a zillion times worse for alternative medicine therapies, most of which are found to have no effect at all when studied with any semblance of rigor. Then there's the human nature aspect, where it's much easier to see the mote in your neighbor's eye than it is to see the beam in your own.