Creeping quackery: “Integrative” cancer care spreading in NIH-supported centers

Enlarge/ Various homeopathic remedies.Wikidudeman

More than 60 percent of NIH-supported comprehensive cancer centers in the US include “integrative medicine” in their services and patient information. And in recent years, the centers’ inclusion of dubious treatments has only grown, according to a new article in the Journal of the National Cancer Institute Monographs.

For instance, the number of centers providing patients with information on “healing touch”—a type of “energy medicine”—increased nearly 30 percent between 2009 and 2016. Cancer patients at 26 of the 45 government-designated comprehensive centers around the country can now learn about that hocus-pocus along with actual cancer therapies. Likewise, inclusion of Ayurveda—a pseudoscience involving herbal, mineral, and metal treatments—increased by 10 percent in the same timeframe. Now, 18 of 45 cancer centers supported by the National Cancer Institute provide patients with information on that sorcery.

While the data may alarm evidence-based physicians and health experts, an accompanying article on the semantics of “integrative medicine” may be of more concern. In it, advocates of “integrative medicine” try to define what “integrative medicine” is, exactly. But rather than a clear definition, they create a vague and broad one that includes “mind and body practices.” It involves everything from the “medicalized” components of a healthy lifestyle (such as simple exercise) to what can charitably be described as magic.

Such a large range of treatments—some reasonable, some not—may add legitimacy to the idea of integrative medicine while concealing quackery. As critic David Gorski, a blogger and oncology professor and surgeon at Wayne State University, puts it:

Basically, if you’ve ever had a massage or done art or music while being treated for cancer, by definition you’ve used integrative medicine. If you’ve ever meditated or prayed while being treated for cancer, you’ve used integrative medicine. If you’ve done Tai Chi, yoga, or Qi Gong (or even just exercise) while being treated for cancer, you’ve used integrative medicine.

But, as Dr. Gorski continues, advocates of integrative medicine aren’t just into harmless endeavors like art, meditation, and exercise. They’re also into outright unproven and disproven mumbo-jumbo, including homeopathy.

The senior author on both the cancer center article and the semantics article is Dr. Jun Mao, a family physician and chief of the Integrative Medicine Service at Memorial Sloan Kettering. He’s also the past president of the Society for Integrative Oncology (SIO), which embraces naturopaths and, by extension, homeopaths. The SIO also advocates for the inclusion of “alternative” or “complementary” treatments in cancer care, alongside conventional methods.

An easier pill to swallow

Dr. Mao and his colleagues argue that as conventional treatments get better and better at keeping cancer patients alive, there’s more need for “natural” approaches to improve quality of life—particularly when dealing with the side effects of potent cancer drugs. This is an “unmet” need, they write.

As Gorski points out, this is a common argument made by peddlers of unproven notions and potions. Essentially, the argument is “that, to treat the ‘whole patient’ and to address ‘unmet needs,’ doctors must embrace the quackery in integrative medicine,” he writes.

While neither of the articles co-authored by Mao even mention the terms “naturopathy” or “homeopathy,” the SIO considers naturopaths on equal footing with trained and licensed physicians. Naturopaths can be members of SIO, and several past presidents of the organization have been licensed naturopaths. Naturopaths rely on a variety of “alternative” medicines and debunked pseudosciences while eschewing evidence-based medicine. Many naturopaths oppose vaccination, for instance. They also embrace homeopathy, which is based on the erroneous idea that “like cures like.” That is, heavy dilutions of a substance that creates symptoms similar to a particular disease can cure that disease. Most homeopathic remedies are simply water, which has led many to consider homeopaths charlatans over the years.

To earn a license in naturopathy from the North American Board of Naturopathic Examiners (NABNE), naturopaths must be trained in homeopathy and pass the Naturopathic Physicians Licensing Examinations (NPLEX), which tests knowledge of homeopathic remedies.

Yet, a reader might not pick up on the connection between homeopathy and naturopathy from the SIO’s description and discussion of “integrative oncology.” This, Dr. Gorski speculates, is on purpose. He writes:

I really can’t help but suspect that, in its effort to persuade medical academia that integrative oncology is rigorously science- and evidence-based, whether intentionally or not, the SIO leadership is focusing all its attention on promoting the evidence-based modalities that have been “rebranded” as “integrative,” such as diet, exercise, and the like, and the patient-support modalities that have been medicalized into “integrative medicine,” such as massage, art therapy, music therapy, and the like. Pay no attention to the quackery that integrative oncology and medicine lump together with the diet, exercise, and the like, the SIO seems to be saying by the absence of focus on naturopathy (and the homeopathy that nearly all naturopaths practice).

Whether on purpose or not, the pitch for integrative medicine seems to be working. As Mao and colleagues report in their article of NCI-designated comprehensive cancer centers, more doctors seem to be including alternative therapies.

Meanwhile, Mao and his colleagues have their sights set on expanding integrative medicine’s use further. The authors conclude:

As these centers lead the way in cancer research and clinical innovation, we need to ensure that integrative medicine can be cohesively incorporated into the continuum of cancer treatment and survivorship care using a financially sustainable structure. In addition, evidence-informed integrative medicine needs to expand beyond the walls of academic medical centers into community cancer centers and clinics to benefit patients from diverse socio-economic backgrounds.

JNCI Monographs, 2017. DOI: 10.1093/jncimonographs/lgx004.

JNCI Monographs, 2017. DOI: 10.1093/jncimonographs/lgx012 (About DOIs).

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