Jun 07 2016

Integrating Magic and Religion into Health Care

CARE-spoon bendingThe University of Alberta has become the latest battleground between advocates of science-based medicine and proponents of integrating magic and religion into our health care systems. In 2014 the university founded an Integrative Health Institute (IHI), which is headed by Sunita Vorha, who also is the director of their CARE program for integrative health and healing.

The debate has not changed, and it gets to the core foundation of modern health care. The SBM position is quite straightforward – as a profession, health care providers owe it to the public to base their advice and interventions on the best available science and evidence. It is our duty to establish and enforce a standard of care that includes adequate due diligence in determining the safety and effectiveness of interventions. The standard of care also includes giving patients proper informed consent and ethical standards of professionalism. There is also a well-established standard for conducting research on humans.

Essentially, we need to be reasonably sure that our interventions have more benefit than harm, and we need to tell our patients what they need to know so they can make informed decisions about their own health care.

Proponents of complementary and alternative medicine (CAM) want to eliminate the standard of care. They may or may not openly say this, but no matter how they couch their position in flowery misdirection, that is the essence of the CAM movement. The smoking gun evidence that this is the case are health care freedom laws. These are laws, now passed in many states, that essentially eliminate or strongly weaken the standard of care in the name of freedom to practice so-called alternative medicine.

There is a great deal more evidence as well – CAM advocates want to alter the rules of scientific research to allow for weaker and less rigorous methods, they want to count placebo effects as real effects, they want to count anecdotes as solid evidence, they want their own rules for funding research, and they are busy creating their own journals and centers that are friendly to their views.

If you challenge the evidence or their methods, then they accuse you of being closed-minded, elitist, or in bed with industry.

Further still, they want all the respectability of science and academia without adhering to its strict standards. They want funding for research, but then refuse to change their practice based on the results of that research. My open challenge to anyone who disagrees is to point to any CAM method that has been generally rejected by practitioners because of evidence it does not work.

University of Alberta

The latest round of this debate, such as it is, perfectly reflects all of this. It further demonstrates that there are basically three kinds of people supporting CAM in academia. There are the true believers, who want their religious faith to be treated as equal to scientific evidence. There are also con artists and snake oil salesmen who see the CAM phenomenon as an opportunity get rich off the system. Finally there are well-meaning but naive academics who have been fooled by the first two categories, or simply think the whole thing is benign and so don’t really care (so-called shruggies).

The IHI made headlines recently because the Pediatric Integrative Medicine rounds featured a demonstration and workshop on spoon bending. That’s right – cheap magic tricks are now acceptable as medical lectures.

Defenders of the IHI point to the fact that they have an “elite scientific advisory panel” to lend legitimacy to the whole operation. This is where the naive academics or shruggies come in. Proponents of integrating CAM into real medicine use several arguments to make their case, and Vorha makes the same points in defending the IHI against recent criticism. She says:

But she says she’s creating “a safe space” for people to have needed conversations about other ways of practising medicine.

The “safe space” argument is old, the notion is that proponents of CAM are being unfairly criticized and need protecting from those nasty skeptics who want actual evidence to back up claims.

Vohra says 70 per cent of patients already use some form of alternate medicine, and that doctors should learn about those treatments, so that they can provide respectful “patient-centred” care, without alienating those in their care.

The argument from popularity, a circular argument that is not even factually accurate. The 70 percent figure is grossly exaggerated. You can only get to 70% by including things like taking vitamins, exercise, sometimes even prayer. When you consider the true CAM methods, like acupuncture and homeopathy, use is in the single digits. Only things like massage and manipulation for back pain crack double digits.

She also promotes the myth that we have to coddle patients, and that tolerating pseudoscience in medicine is only being respectful to patients. This is nonsense. Yes, we have to be respectful and non-judgmental to our patients, but when patients ask me for my professional advice regarding an alternative treatment, I tell them exactly what I think. Informed consent demands nothing less.

Finally, the fiction that dupes many academics:

She stresses the health institute is about thoughtful scientific research, not advocacy.

That is the Trojan Horse. Once the horse is let inside the walls of academia, always it produces a flood of snake oil and pseudoscience. Virologist Dr. Lorne Tyrrell was on the science advisory committee for the IHI, lending his reputation to the center. He quickly realized that he was duped. He recently resigned, stating:

“I originally agreed to serve on the science advisory board thinking there would be a critical evaluation of many of the forms of alternative medicine that are available to the public,” Tyrrell told me via email Monday. “Unfortunately, rather than critical evaluation, the IHI seemed to give credibility to forms of alternative medicine that I did not agree with. I have resigned … as this has not been an institute of critical scientific evaluation.”

Timothy Caulfield was interviewed about the IHI and pretty well nails the situation:

“It’s a movement that’s growing across North America. You see these ‘integrative institutes’ emerging at universities all over the place. But integrating them into universities creates more tolerance for pseudo-science. It validates it,” says Caulfield. “They never end up being about critical thinking and scientific evidence.

“The idea that there is universal healing energy that we can manipulate with our hands? This is a religious idea. It’s magical thinking. And the problem is that we’re presenting it as science rather than as a religious world view.”

Conclusion

The University of Alberta experience has been replicated at many universities, including Harvard and to a lesser extent Yale. Proponents use the same tired arguments to sell their magic beans, and naive academics buy it. Sometimes large sums of money are donated to make the academics even more receptive.

Once the CAM center is created, it becomes little more than a method for marketing CAM and increasing its penetration into mainstream medicine.

At this point all we can do is to continue to shine a light on the nonsense that follows. The result, in my experience, is brief outrage following by nothing. Proponents of CAM are tireless, because it is a multi-billion dollar industry. Defenders of science and reason have a lot on their plate and no financial incentive.

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