Sep 24 2013

Misinformation from Mayo Clinic

The Mayo Clinic is a recognized center for excellence in both clinical medicine and research. They also maintain one of the best medical information websites on the net. I often find myself there when searching for information on a topic with which I am not familiar.

The Mayo Clinic also represents the current problem with academic medicine and the current fad of so-called complementary and alternative medicine (CAM) – they just don’t get it. They do not seem to understand what CAM really is, its history,  its current practice, and the state of the evidence. But they know it’s out there and people are interested in it (because they are told they should be) and so they feel the need to address it.

When they do address CAM, however, they have apparently done what most academic centers have done in my experience – they turn it over to “CAM experts,” which ends up being CAM proponents. The result is that CAM propaganda and shameless promotion becomes endorsed by an academic institution (what my colleagues and I have come to call “quackademic medicine”).

The Mayo Clinic Consumer Health entry on CAM is the perfect representation of this failure on the part of many academics. This web page is supposed to provide useful information to health consumers to help them understand CAM and make informed decisions – important decisions for their own health. In that goal it is a complete failure. The web page spreads misinformation and would serve to confuse and misinform anyone who relies on it as a definitive reference.

The problems start right in the first paragraph:

“Nearly 40 percent of adults report using complementary and alternative medicine, also called CAM for short. Doctors are embracing CAM therapies, too, often combining them with mainstream medical therapies — spawning the new term “integrative medicine.” “

The 40 percent figure is simply wrong – a bit of CAM propaganda that Mayo regurgitates apparently without fact checking. They do give the NCCAM as a reference, but in doing so they are referencing a secondary source that itself is the king of quackademia.

Surveys about CAM use are problematic because the category is a contrived marketing scheme and not a real entity. What, for example, does the popularity of massage have to do with the popularity of homeopathy? By including things like vitamins and massage, CAM surveys pad the numbers to make the hard core modalities (like energy medicine) seem more popular, when in fact they are in the small single digits. 

They also make the claim that “doctors are embracing CAM” but there is no evidence to support such a claim. It is clearly meant, however, to make CAM seem legitimate and cutting edge (when neither is true).

They do acknowledge that the category is a moving target but explain it this way:

“Exactly what’s considered complementary and alternative medicine changes constantly as treatments undergo testing and move into the mainstream. “

Really? Can they give one example of a CAM treatment that moved into the mainstream because of evidence? There are mainstream treatments that CAM proponents have tried to “steal” by claim it for themselves, like nutrition, but this is just more deception. The list of CAM treatments today is pretty much the same as it was 50 years ago.

The fun really starts when they describe individual CAM treatments. For example:

Homeopathy. This approach uses minute doses of a substance that causes symptoms to stimulate the body’s self-healing response.

Everything in this sentence is wrong. Homeopathic remedies generally do not contain minute doses, they contain non-existent doses. Further, there is no evidence that any homeopathic potion stimulate “the body’s self-healing response” – whatever that is.

Naturopathy. This approach focuses on noninvasive treatments to help your body do its own healing and uses a variety of practices, such as massage, acupuncture, herbal remedies, exercise and lifestyle counseling.

At least some of the information here is accurate – naturopaths do use acupuncture and a variety of other practices. But the entry does not really capture the essence of what naturopathy is – a combination of unscientific, implausible, and often disproved therapies.

Most galling is their “explanation” for why some doctors are cautious about CAM:

Many conventional doctors practicing today didn’t receive training in CAM therapies, so they may not feel comfortable making recommendations or addressing questions in this area. However, as the evidence for certain therapies increases, doctors are increasingly open to complementary and alternative medicine. At the same time, doctors also have good reason to be cautious when it comes to complementary and alternative medicine. Conventional medicine values therapies that have been demonstrated through research and testing to be safe and effective. While scientific evidence exists for some CAM therapies, for many there are key questions that are yet to be answered.

In addition, some practitioners of complementary and alternative medicine make exaggerated claims about curing diseases, and some ask you to forgo treatment from your conventional doctor. For these reasons, many doctors are conservative about recommending CAM therapies.

Clearly none of the Mayo staff who wrote this entry has any familiarity with why doctors actually reject CAM.  They are making an explicit claim here – that rejection is due to unfamiliarity, and familiarity leads to acceptance. The truth, in my experience, is the opposite. The more most physicians are familiar with CAM the more they realize that it is a collection of implausible and nonsensical claims and they reject it.

They also are claiming that the evidence for certain therapies is increasing. Really? Which therapies? In the last 20 years the evidence has gone significantly against straight chiropractic, homeopathy, acupuncture, and energy medicine. The evidence is going in the opposite direction than they claim.

The paragraph does raise the issue of evidence, but look how carefully they dance around the reality. For some CAM treatments there are “key questions that remain to be answered.” This is sales copy, not a respected academic reference.

In fact, many CAM treatments are highly scientifically implausible. Many physicians reject them because they are scientifically literate. And for many CAM modalities the clinical evidence shows that they do not work. We’re not just waiting for better evidence – these treatments should not work, and they don’t work.

The last paragraph again is masterful politics, trying not to offend anyone. All CAM claims are exaggerated, by definition, if they were backed by evidence they would not be CAM. The only feature, in fact, that is universal among treatments that can be genuinely called CAM is that their claims at best exceed the evidence and at worst are against the evidence.

Conclusion

The Mayo Clinic entry on CAM is a massive failure. It misinforms the public about the true nature of CAM, the state of the evidence, and the true nature and extent of criticism against CAM. It is, unfortunately, typical of a general failure on the part of academic medicine to properly address the CAM phenomenon, to understand what it is, why it is a threat to our patients, to the public, and to the institution of medicine, and why it should be opposed.

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22 responses so far

22 Responses to “Misinformation from Mayo Clinic”

  1. etatroon 24 Sep 2013 at 11:13 am

    About six months ago, NBC Nightly News ran a story which Brian Williams introduced this way: “After many years, researchers have finally confirmed what millions of Americans already knew: that ACUPUNCTURE WORKS.” … and went on to the describe the review that concluded that acupuncture works. Meanwhile, Steve Novella was writing about why the article was propaganda. I wrote into NBC Nightly News, asking them to run a correction, but they (obviously) neither did nor responded to my request. For a while, they were running lots of CAM stories, and each time, I wrote in, and told them why they were wrong. They eventually stopped, but I don’t think it was because of me. I think it was because their medical correspondent couldn’t say these things with a straight face any more or maybe the producers realized they were repeated propaganda. But I don’t think I’ll ever forget walking my dog and listening to NBC Nightly News podcast and Brian Williams proclaiming for all the world with definitiveness and authority that acupuncture works. His broadcast probably packed the most damage-per-word-count to US medicine for a long time. This, and stories like it, is why CAM is creeping into medical schools. They are run by business people, people with “health system management” MBA’s, not MD’s, and certainly not academics. My own institution and my alma mater both have centers for “integrative” medicine. They get NIH funding, and they aggressively market their “research” via institutional press releases.

  2. clgoodon 24 Sep 2013 at 2:09 pm

    I ran into some CAM nonsense on the Mayo Clinic web site a few months ago. My heart sank. I no longer consider them a reliable source for health information. Anything I find there has to be backed up by two or three other, actual medical sites now.

    Very sad.

  3. ivr4on 24 Sep 2013 at 4:57 pm

    Clearly the Mayo clinic is run by a bunch of quacks and charlatans that have no interest in the health and well being of the public. How dare they even consider something other than surgery or prescription medication to help people heal. More and more I am getting the feeling that articles like this are by fronts for the pharmaceutical companies. This article is clearly written out of fear; fear that there are ideas and practices out there that you don’t understand and your only resort is to lash out against those ideas. In this case you are attacking one of the most respected medical institutions in the world. Do you, mr. author, perhaps think that maybe you are the one that doesn’t get it?
    As far as I can tell the premiss being put forth by the author is that doctors should be the ones that tell their patients how to feel. Ms X has had back problems for years, gets some acupuncture then feels better. According to this article an act of fraud as been committed and her doctor should tell her so. Why? By the way Ms.X your pain didn’t go away you just think it did!
    My daughter and I suffer from ‘hay fever’ allergies in the spring. I give her those little white sugar pills knowing full well there is no ‘real’ medicine in them. 15 minutes later symptoms gone she feels better. The over the counter solution has terrible side effects that effectively ruin her day. Why choose the poison? What is your point? People should only feel better if YOU say it is ok.
    So what is your point? Why publish articles like this when they serve no real purpose. Is it preaching to the choir so that you get a enough hits on your blog so you keep your job? Many people die every year at the hands of incompetent doctors, and the latest big pharm fad.
    How many die from acupuncture or sugar pills? I understand meditation helps clear the mind. Maybe you could try it and come up with a helpful article. Get a doctor to prescribe it for you if makes you feel better.

  4. ConspicuousCarlon 24 Sep 2013 at 7:19 pm

    “key questions that remain to be answered.”

    And now for a brief lesson in deception which will be taught by examples. Don’t bother writing this down, it’s dead-simple amateur level stuff.

    If you want the Russians to believe that you have a secret military base, don’t announce that you have it. Instead, start up a fake political controversy about how much it is costing to operate; its existence will be assumed.

    If you want your fraud victim to think you own a hotel, don’t tell him you own a hotel. Instead, sit around griping about the employment taxes you have to pay for hiring an extra bellboy. People will just assume that you run a hotel.

    And if you want everyone to think your product actually contains anything at all, warn people that its usage is “controversial” or “mysterious” or that it isn’t “fully understood”. If everyone is arguing and wondering about how something works, the victim is naturally going to assume that the stuff actually exists. Because if it were 100% transparent BS, why would anyone who looked into it be confused or bother arguing the finer details?

  5. Davdoodleson 25 Sep 2013 at 1:13 am

    “The Mayo Clinic is a… center for excellence in both clinical medicine and research”

    “Homeopathy. This approach uses minute doses of a substance that causes symptoms to stimulate the body’s self-healing response.”

    The latter statement belies the former.
    .

  6. ChrisHon 25 Sep 2013 at 1:55 am

    Fortunately, that bit of dalliance does not affect the real surgical and medical staff. They are awesome, as we know from personal experience.

    When our son had heart surgery there last year the only evidence of “alternative medicine” was a teeny tiny card on the wall in the post-surgical ward, plus a music CD (apparently only certain heart patients get it, we don’t know we never put in a machine).

    Do not mistake press releases as actual hospital policy.

    Still, Rochester, MN is a very strange place. Though the Barnes and Noble is awesome. It is in a former movie theater that looks like a medieval village. It includes store fronts and very nice night time sky. It looks quite lovely.

  7. Hosson 25 Sep 2013 at 9:08 am

    I sent a message to the Mayo customer service staff explaining my concern about the information on their webpage about CAM. Below is their response.

    “Thank you for your email.

    http://www.mayo.edu/research/centers-programs/complementary-integrative-medicine/complementary-integrative-medicine-program/overview

    To quote our own Complementary and Alternative Medicine center:

    Complementary and alternative medicine (CAM) is the popular term for health and wellness therapies that have typically not been part of conventional Western medicine. “Complementary” means treatments that are used along with conventional medicine. “Alternative” means treatments used in place of conventional medicine.

    Mayo Clinic doctors are committed to providing evidence-based care and use only the complementary and integrative therapies that have been tested for effectiveness and safety. They can provide you with information about the risks and benefits of alternative medicine treatments. Mayo researchers conduct studies to improve complementary and integrative medicine treatments.

    Sincerely;
    Stacey
    Mayo Clinic Online Services”

  8. ccbowerson 25 Sep 2013 at 9:36 am

    “Do not mistake press releases as actual hospital policy.”

    I don’t think that anyone is mistaken in that way, but the mismatch between what they say as an institution and what they do is not a small problem. Not only does it reflect poorly on the institution for those who care about science based medicine, it also adds to the widespread misinformation regarding CAM and medicine. Misleading the public about CAM is a big deal for an institution like the Mayo Clinic, and perhaps even worse is that they don’t seem to understand that they are doing just that

  9. SteveAon 25 Sep 2013 at 9:47 am

    “Mayo Clinic doctors are committed to providing evidence-based care and use only the complementary and integrative therapies that have been tested for effectiveness and safety.”

    What does ‘intergrative’ mean?

    Sounds like an invitation to pick a therapy and ask to see their evidence for it…

  10. tmac57on 25 Sep 2013 at 10:49 am

    It’s a little jarring to come across this kind of thing on the Mayo Clinic site. Sort of like finding out that Berkshire Hathaway is including an investment in a Nigerian Prince as part of it’s portfolio.

  11. tmac57on 25 Sep 2013 at 11:00 am

    On a related tangent,What do you make of Dr. Paul Offit’s seeming acceptance of placebo medicine as a legitimate tool for doctors to use for their patients. He seems particularly enamored with acupuncture as a useful placebo.
    Maybe Mayo is of the same mind.

  12. DevoutCatalyston 25 Sep 2013 at 11:38 am

    Yep, Offit’s an acupuncture guy. Wish he would explain himself here.

  13. Hosson 25 Sep 2013 at 11:42 am

    http://www.mayo.edu/research/centers-programs/complementary-integrative-medicine/complementary-integrative-medicine-program/practice

    ‘Each year, more than 5,000 patients receive treatment in the Complementary and Integrative Medicine Program. Patients utilize our physician consultation service provided by physicians trained in Integrative Medicine, Massage Therapy provided by certified massage therapists, and Acupuncture provided by both physicans trained in acupuncture and licensed acpuncturists.’

    http://www.mayoclinic.org/acupuncture/
    http://www.mayoclinic.org/hypnosis/
    http://www.mayoclinic.org/resilience-training/

    Mayo Clinic Book of Alternative Medicine, 2nd Edition
    http://store.mayoclinic.com/products/bookDetails.cfm?mpid=61

    I’m very disappointed. I just wished more people(or the right people) cared about shit like this.

  14. ccbowerson 25 Sep 2013 at 2:57 pm

    “What do you make of Dr. Paul Offit’s seeming acceptance of placebo medicine as a legitimate tool for doctors to use for their patients. He seems particularly enamored with acupuncture as a useful placebo.”

    I’ve heard him say this on more than one occasion, but the most recent time he seemed a bit more careful in his wording. I wouldn’t say he is an acupuncture guy, as much as he is not sufficiently considering the potential downside to embracing the use of deception and approaching a “what’s the harm?” mentality. He seemed to have the ‘facts’ correct about acupuncture when I heard him most recently, but I questioned his conclusions. That may be because I think he is underinformed regarding placebo effects. It would be nice to hear someone challenge him in a friendly way about these things. That wasn’t going to happen on NPR, as he was the primary skeptic in that setting.

  15. Hosson 25 Sep 2013 at 3:25 pm

    http://www.csicop.org/specialarticles/show/do_you_believe_in_magic/

    Below is a excerpt taken from CSI’s website of an interview of Dr. Paul Offit by Kylie Sturgess.
    The part about placebo and acupuncture is near the end of the interview.

    ‘Kylie: What would you suggest if you had friends, family, loved ones who were using alternative medicine, risking their lives? What’s the best advice you could give to them?

    Paul: Just so I’m not setting myself up as having a completely negative view of the industry: I think there is something to be said for the placebo response, which is unfortunately named. I think when people hear the word “placebo,” they assume that it’s dismissive, trivializing, that it’s just all in my head and that it’s not real.

    I think that in fact, the placebo response can be a physiological response. I think believing that you are about to be helped in some way goes a long way to being helped in some way. Clearly there are studies. There are five books published on the placebo response, each of which has several hundred articles referenced.’

    Using a placebo as treatment seems to be highly unethical. Although I’m just guessing as I haven’t done any research on the subject.

  16. BillyJoe7on 25 Sep 2013 at 5:26 pm

    Paul Offit: “the placebo response can be a physiological response”

    The placebo response IS a physiological response, otherwise it couldn’t exist.
    Even if it was just “all in the head”, it would still be a physiological response but, of course, nothing remains “all in the head” because the brain has secondary effects on the rest of the body.

  17. Bruceon 26 Sep 2013 at 6:41 am

    I have had some very logical and scientifically minded colleagues through joint working with the NHS state outright that they know Homeopathy doesn’t work, but that they supported the use of it in the NHS because of the Placebo Effect…

    I was too shocked to respond coherently. Once I have a more secure platform this is definitely an area I would like to tackle out in the “sticks” where I live.

  18. denisexon 28 Sep 2013 at 12:11 am

    Are the people at the medical centers responsible for embracing CAM doctors, business people, or both?

  19. GaelanClarkon 01 Oct 2013 at 6:45 am

    “”When they do address CAM, however, they have apparently done what most academic centers have done in my experience – they turn it over to “CAM experts”"…….

    Okay……exchange CAM for……Climate change………exchange CAM for GMO’s……exchange CAM for medical experts.

    I capped the FDA and the CDC to ask how many drugs have been taken off of the market because they are worse than using nothing……wait for it……..wait……….wait……………THEY DONT KEEP A LIST OF THAT!!!!!!!!!!!!!

    WHY NOT?

    WOW WOW WOW…….everyone wants their own “experts” talking about their own “expertise”.

    You have really, really jumped the shark on that brilliant expose. WOW…

  20. GaelanClarkon 01 Oct 2013 at 6:55 am

    And so what is this…… http://www.eurekalert.org/pub_releases/2013-09/cu-cca092713.php

    Oh, it’s just those damned communist Chinese working in cahoots with those damned tea taxing Brits on ways to reprove what has been known for over 3000 years amongst TCM practitioners……that cancer can be blocked and cured…..oh b-b-b-but BIG PHARMA did not synthesize that!!!!! POOOOOH ON YOU anyway, so says Novella…..yoyr just shills in the system…..of misinformation?

    WOW AGAIN

  21. Bruceon 01 Oct 2013 at 8:07 am

    “”The formula has been shown to be beneficial to patients with certain solid tumours, when used alone and in conventional therapies, such as Chemotherapy.

    “It suggests that combining the formula with conventional as well as new therapies could hold the key to developing new treatments for cancer patients.

    “We are already looking to clinical trials in treatment of lung and other cancer types.”"

    Please post again when they have done some clinical trials. But from what I can see that looks like scientists doing science. They notice something seems to work, and now they are doing trials on it.

    If that does turn out to be a useful treatment for a form of cancer then great, but I don’t see how it supports your argument.

    Not sure I can understand your argument to be honest.

    Have a read through:

    http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/

  22. GaelanClarkon 01 Oct 2013 at 8:51 am

    Yeah, so Bruce, what is the definition of “empirical”?

    Yes, rhetorical question AND thank you for knowing the answer.

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