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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