Jun 29 2015

Drinking the “Integrative” Kool-Aid at the Atlantic

A recent article at the Atlantic by Jennie Rothenberg Gritzi demonstrates just how thoroughly the alternative medicine movement (I will refer to this as CAM) has been able to influence the cultural conversation over the practice of medicine.  This is great evidence of how successful a persistent marketing campaign can be.

Gritzi relates early on in the article that she was predisposed to CAM from a young age, which might explain her journalistic failures in this piece.  She writes:

After visiting the NIH center and talking to leading integrative physicians, I can say pretty definitively that integrative health is not just another name for alternative medicine.

The only evidence she gives that she spoke to critics of CAM is a couple quotes from Paul Offit, her “token skeptic.”  In the end there is nothing new in the piece. She recycles the CAM marketing talking points quite faithfully, without any real analysis or journalistic skepticism.

She spends some time talking about the limitations of modern medicine, as if that is justification for incorporating nonsense into medicine. She buys the CAM propaganda that they somehow invented things like nutrition and stress reduction .

There was one new bit in the revisionist history that makes up CAM marketing.  She writes:

As the Institute of Medicine report put it, pain flouts “the long-standing belief regarding the strict separation between mind and body, often attributed to the early 17th-century French philosopher René Descartes.”

This may be why so many chronic pain sufferers are drawn to traditional medicine: The Cartesian idea of mind-body duality never found its way into these ancient systems.

She actually claims that scientific medicine is somehow dualist while CAM rejects dualism and understands that the mind and body are one.  This is, of course, the exact opposite of the truth. She doesn’t appear to pick up how muddied and confused her characterization is when she later writes:

It’s hard to talk about integrative health without using abstract terms likewellnessvitality, and healing. Most traditional medicine systems are built around these ideas. They start with the assumption that there’s some kind of life force that wards off disease. Then they treat specific illnesses by balancing elements or unblocking energy flow—whatever it takes to get the body back to its natural state of equilibrium.

The scientific view is that the mind is what the brain does, and therefore mind and body are the same thing.  It is scientific medicine that worked out things like the ways the brain influences the function of other systems through the neuroendocrine axis, for example.

Modern medicine also operates by the biopsychosocial model, in which we consider the entire patient, their biological processes as well as their psychological and cultural factors.

CAM (which is, by the way, the exact same thing as “integrative” medicine) is inherently dualist. The entire idea of a life force is dualist – that there is a force that is somehow separate from material biology. Many CAM treatments start with the assumption of a life force, and idea that was rejected by science over a century ago because of a total lack of evidence and such a notion is entirely unnecessary.

Of course Gritzi spends a lot of time talking about pain management. This is one of CAMs favorite areas because pain is subjective and highly amenable to psychological factors. Our perception of pain, emotional response to it, and ability to tolerate it are all capable of being manipulated by a host of factors. No one doubts this, and these ideas are already part of science-based medicine.

CAM proponents, however, like to point to the pain research and then say, essentially, “Aha, my magic is real.”

Gritzi also accepts the CAM interpretation of the state of current research with respect to things like acupuncture. She concludes that acupuncture works for pain, and then cites only the infamous Vickers meta-analysis as evidence.

A more scientific view of the evidence, in my opinion, clearly leads to the conclusion that acupuncture doesn’t work. The evidence for acupuncture is about as convincing as the evidence for ESP or free energy. You never get what we actually need to conclude that a new phenomenon is real – a rigorous study design that shows significant results with a meaningful effect size that can be independently replicated. Instead you get marginal and ephemeral results out of which a motivated researcher can squeeze a sliver of significance.

Gritzi concludes with another marketing point of CAM propaganda – the science-based medicine treats only acute illness, while CAM is better suited to managing chronic illness. This is utter nonsense, a narrative construct of CAM revisionist history.

First, all of the interventions that actually work for prevention and health promotion were discovered by scientific medicine and have already been incorporated into practice. Yes, we can criticize how quickly and thoroughly new knowledge makes its way to the practitioner in the field, but this is a separate point entirely.

CAM proponents incorporate science-based prevention methods, like nutrition, exercise, and stress reduction, and call it CAM to give their loose collection of nonsense a patina of legitimacy. Of course if you peek under the hood, the same load of CAM pseudoscience is still there.

I do notice a trend of rejecting homeopathy as evidence that the CAM practitioner is discriminating. This is perhaps a new development, but I wonder if it will last. Gritzi relates that some practitioners she spoke to won’t prescribe homeopathy, but won’t dissuade their patients from using it either. If it doesn’t work, then why won’t they say so, and counsel not to use it?

Some practitioners are distancing themselves from homeopathy, because it is so heavily under criticism, but they still can’t bring themselves to criticize it also, because once they start criticizing a treatment for being unscientific, the entire house of cards will collapse.


Despite all of the careful rhetoric, the constant name changes, and the “evolving” marketing strategies – at the end of the day the CAM/integrative movement is about one thing, rejecting a single science-based standard of care.

Proponents make elaborate excuses for using magic, and sophisticated arguments for using poor scientific evidence, for ignoring inconvenient evidence, and for essentially being pseudoscientists.

Gritzi’s piece is essentially an advertisement for a marketing brand. Her article utterly lack any true investigative journalism or skepticism. As a result she entirely missed the reality of the subject she allegedly investigated, and therefore misinformed her readers.

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