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Regular readers know that I’m a proud graduate of the University of Michigan Medical School. Part of the reason for my pride is that, back in the late 1980s when I attended, U. of M. Medical School was really hardcore about science, so much so that it was viewed by prospective students and many other medical schools as seriously old school. No new (at the time, at least) organ system approach to the curriculum of the first two years for us! No getting us seeing patients from the first week! No, we had to earn seeing patients with a year of biochemistry, anatomy, physiology, etc. I also walked a mile uphill to attend classes and a mile uphill on my way home every evening. (Actually, the walking a mile part was not entirely inaccurate; on nice days I’d skip the shuttle bus from the Ann Arbor VA, which was right across the street from my apartment building and ran from the VA to the U. of M. Medical Center.) In any event, during the first two years, every four weeks, like clockwork, we’d have what was called a concurrent examination, which basically meant that we were tested (with multiple choice tests chock full of Type K questions, of course!) on every subject on the same morning.

At the time I studied there, the medical curriculum for the first two years had been fairly constant for quite some time, with a heaping helpin’ of anatomy, histology, biochemistry, and physiology in the first year and the second year packed full of pharmacology, pathology, and neurosciences, plus physical examination skills. Nowhere to be found in the curriculum was anything resembling “energy medicine” or anything that wasn’t science-based! Of course, back in the 1980s, the infiltration of quackademic medicine (the mingling of quackery with academic medicine) into medical schools and academic medical centers hadn’t really begun in earnest yet, although the rumblings of what is now called “complementary and alternative medicine” ( CAM ) and, more frequently these days, “integrative medicine” (IM) were starting to be detected in East Coast and West Coast schools. In flyover country, though, it was all very stodgy and scientific, which was fantastic.

Unfortunately, it didn’t last, at least not in the whole medical school. Although for the most part U. of M. is still pretty hardcore about science, there is one department, the Department of Family Medicine, that is becoming a wretched hive of scum and quackery. That particular department first came to my attention when I learned several years ago that there was a program in anthroposophic medicine, the mysticism-based, homeopathy-loving form of medicine founded by Rudolf Steiner, who also invented “biodynamic farming.” Although some of the links to the program have disappeared, you can still find the the purportedly multidisciplinary “Integrative Family Medicine” program that boasts of a “team of family physicians with advanced training in holistic medicine, anthroposophic medicine, and acupuncture,” along with Ricardo Roberto Bartelme, MD, emeritus faculty of Family Practice who lists anthroposophic medicine as one of his specialties. Sure, it appears that the anthroposophic medicine footprint in the department isn’t what it once was, but the fact that it is still in a department of a major medical school and academic medical center is inexcusable.

It goes deeper than that. U. of M.’s department of family medicine now sports a naturopath on its faculty, Suzanna Zick. Not-A-Doctor Zick is even co-director of the integrative medicine program in the department. She was also part of the team who developed the clinical care guidelines for breast cancer patients published by the Society of Integrative Oncology (SIO) in 2014 and updated last year and was even president of the organization from 2015-2016. She’s also published a dubious study on acupressure. Again, given that naturopathy is quackery and that you can’t have naturopathy without homeopathy or antivaccine beliefs, it is profoundly distressing to me to see a naturopath on the faculty of my alma mater.

The quackademic medicine situation at the University of Michigan appears to be getting worse, at least in the Department of Family Medicine. Not only does the department have anthroposophic medicine, but it has a credulous approach to The One Quackery To Rule Them All, homeopathy, and wait until you see what it’s teaching its residents about acupuncture!

Enter the Queen’s homeopath

My favorite term to describe homeopathy is The One Quackery To Rule Them All. (Yes, I’m a massive J.R.R. Tolkien fan.) The reason for that, of course, is obvious to anyone who knows anything about homeopathy. Basically, homeopathy is based on two principles, neither of which is rooted in science, but rather vitalism and magic: The Law of Similars, which states that you treat a symptom by using a substance that causes that symptom; and the Law of Infinitesimals, which states that diluting a remedy makes it stronger. The consequences that flow from these two “Laws” can get really bizarre, such as homeopathic saliva from a rabid dog. That is why I was quite shocked to see this Tweet the other day about talks about homeopathy given by Peter Fisher and Iris Bell at my alma mater, the University of Michigan:

Homeopathy research presented at University of Michigan: https://t.co/BCv9XABmWL — Kathleen Slonager (@Homeopath_Kat) July 24, 2018

Which led me to this Facebook post:

I must pause to note here that Peter Fisher was recently killed when he was hit by a truck riding his bicycle to work in London. The talk in this video was from May.

I also love how this post includes a stock photo of a scientist in a lab in front of a large instrument, all in order to imply that homeopathy is scientific. It’s not. I also wonder how the American Institute of Homeopathy came to host Peter Fisher, the Queen’s physician and homeopath and very prominent in British homeopathy. The talk was a two-fer, as well. Included in the session was Iris Bell, a believer in homeopathy based at Andrew Weil’s integrative medicine program at the University of Arizona. I also have to wonder what, exactly, it was that the American Institute of Homeopathy hosted, given that the YouTube video shows both Peter Fisher and Iris Bell giving their talks by teleconference. Clearly, there was no travel expense. Maybe there were honoraria. Maybe the American Institute of Homeopathy paid for lunch, given that this sounded like a lunchtime lecture. (Near the end of the talks, both of which ran long, it’s mentioned that a lot of the physicians attending had to leave to get to their afternoon clinics by 1 PM.) Who knows?

First up, the Queen’s homeopath

It didn’t take long for Peter Fisher to get right into things. Indeed, a funny thing is that in his talk Peter Fisher describes these two laws in detail and admits quite freely that, thanks to Avogadro’s number, a homeopathic dilution greater than 12C (or 23X) is highly unlikely to contain even a single molecule of starting material left. Then, however, he goes on to say on more than one occasion variations of, “The fact that there is no starting substance present doesn’t mean there is nothing present” or “Do not confuse that [the lack of starting material after serial dilutions]” with ‘nothing is present.'” When I heard that, I had a feeling I knew where the talks were going to go, but I’m getting a head of myself here. First, let’s link to the video, which you are welcome to watch in its one hour, one minute quack glory if you so desire, but I do have to discuss its “high”—or should I say “low”—points.

So here’s the video:

The first 36 minutes or so of this woo-fest at the University of Michigan is Peter Fisher, and the remainder of the video is Iris Bell. Let’s dig in.

Since I already mentioned that Fisher described the invention of homeopathy by Samuel Hahnemann and how homeopathic remedies are made; so I’ll skip over those. He did, however, start by listing the topics he wanted to address:

Homeopathy is much misunderstood

Who uses homeopathy?

Comparative and cost effectiveness research

Systematic reviews and meta-analyses

Biological models of high dilutions response

Physical chemistry research

That’s a heck of a lot to pack into what presumably was supposed to be a 30 minute talk! Of course, given that the talk is about homeopathy, I was seriously tempted to make any of a number of homeopathy jokes about the brevity of the talks. I restrained myself. I will give him credit for defending vaccination, but will also point out that he’s deluding himself if he thinks that homeopathy is not antivaccine or that homeopaths don’t claim that homeopathy can substitute for vaccinations. Homeopathic nosodes, anyone?

Hormesis abused

Given the utter implausibility of homeopathy based on chemistry, physics, and biology, Fisher spent an awful lot of time on topics #2 and #3, who uses homeopathy and comparative and cost effectiveness research. This allowed him to cherry pick multiple uncontrolled studies. Before he does that, though, he invokes hormesis as the principle that allows “ultralow” concentrations of molecules to have biological effects. Basically, hormesis is a term to describe how some compounds can have nonlinear dose-response curves. He used examples of chlordane against crickets, showing graphs where very low concentrations of this pesticide induce greater weight gain in young crickets before the curve turns south and increasing doses cause slower weight gain and ultimately weight loss and death.

I once discussed hormesis in the context of radiation after the Fukushima nuclear spill after an earthquake and tsunami that devastated northern Japan. Basically, Ann Coulter and the usual suspects who try to downplay environmental catastrophes were trying to argue that Fukushima wasn’t a big deal because a little (or even more than a little) radiation is actually good for you based on—you guessed it—hormesis. Let’s just say that she cherry picked her studies and exaggerated hormesis, while misrepresenting the reasons for the linear no-threshold (LNT) model used by regulatory agencies. The name is relatively self-explanatory, and the model states that any radiation is a hazard in a linear fashion. As I pointed out, at very low doses, it’s hard to distinguish between an LNT model and hormesis, and the radiation levels at Fukushima were above any reasonable estimate where hormesis might be possible. (As an aside, not too long ago, I watched the episode of the Netflix series Dark Tourist in which David Farrier visits Fukushima, which is now deserted because of radiation, and is forced to cut his tour short because radiation readings were much higher than advertised and higher than what was deemed safe.) Let’s just say that Fisher, like Coulter, oversold hormesis as being a near-universal phenomenon (it’s not). Let’s also just say that, given that there is no starting material left in most homeopathic remedies, invoking hormesis as a basis of homeopathy is—shall we say?—completely irrelevant.

Observational studies and bad systematic reviews and meta-analyses

As for the observational papers, holy hell! Fisher started going through several observational, uncontrolled studies. One showed that homeopathy use is most prevalent in France (10% of the population) and might be higher in India. Given what I’ve learned recently about the popularity of homeopathy in France, I was not surprised. He also noted that in the US, only 2.1% of the population has used homeopathy in the last year, but that homeopathy use was associated with high levels of education, female sex, a “healthy lifestyle”, and multiple complementary therapies. He noted a study from France, which compared conventional family practices versus homeopathic family practitioners, versus “mixed” (practices where homeopathy was integrated). The claimed finding was that homeopathy use was associated with less use of nonsteroidal anti-inflammatory drugs, less use of antibiotics, less use of psychotropic drugs, and that it cost 20% less. He cited another study from Germany that claimed better results with homeopathy for the same cost. Another study cited by Fisher of “homeopathy in the real world” claimed to show that the use of homeopathy could avert the use of antibiotics for acute otitis media. Of course, given that antibiotics are not always necessary for acute otitis media and in some cases “watchful waiting” plus treatment of symptoms are appropriate, it would take a randomized controlled trial to tell whether homeopathy is doing anything, and this wasn’t it. The same could be said of a study cited by Fisher that purported to show that homeopathy could decrease antibiotic use in acute upper respiratory infection. (Most URIs don’t require antibiotics.) I also couldn’t help but note that a lot of these studies were old, too. The otitis media study is from 2001, for instance.

Interestingly, Fisher also cited the Swiss Health Technology Assessment from 2012. This is, as Jan Willem Nienhuys put it, a case of “homeopathic optimism” and, as Edzard Ernst puts it, a report that only homeopaths take seriously any more. Fisher also cites a database supposedly at this URL: https://www.carstens-stiftung.de/core-hom, where, he claims, as of May 2018 there were 1,210 clinical trials of homeopathy. I clicked on that link and got a 404 page not found error. Whatever’s going on, I can’t help but point out that Edzard Ernst had a look at this database three years ago and was less than impressed, because some trials weren’t randomized; some weren’t even clinical trials; the list includes reanalyses of already published studies; a lot weren’t peer-reviewed or even placebo-controlled (it’s hard not to make jokes here); and the majority are of terrible methodological quality.

Fisher also cites a meta-analysis by Mathie et al from 2014 that claimed (hilariously) that not only is homeopathy effective, but the effect size increases with better-designed studies, which is the exact opposite of what we would expect for any treatment, conventional or alternative, because that’s how it goes. Initial, less rigorous trials often yield more impressive results, which often “decline” in later, more rigorous trials. That raised my eyebrow right away. Fortunately, again, Edzard Ernst is familiar with this nonsense and has discussed the Mathie meta-analysis in detail. Basically, he’s noted that this meta-analysis somehow managed to omit “the two most rigorous studies which happen to be negative.” Let’s just say that misleading by meta-analysis is a common tactic of homeopaths. Sadly, faculty at the University of Michigan were unable to pick up on this.

Fisher finished rushing through a bunch of the usual suspect studies for mechanisms. I couldn’t help but laugh uproariously when he spent some time claiming that the studies in mast cell degranulation by Jacques Benveniste were good evidence of a biological effect of homeopathic remedies. Benveniste’s work was fatally flawed and shown to be nonsense by James Randi himself. Basically, Randi and the team of referees asked Benveniste to repeat the experiment, but went to extraordinary lengths to make sure that the people carrying out the experiments didn’t know what groups were the control groups and which groups were the ultradilute samples. Under these conditions, Benveniste’s results were not replicable. This showed how critical proper blinding was to experiments involving homeopathy. Fisher also blew through a few other papers, which I might have to look into if I get the time, but they all looked to suffer from similar issues.

Iris Bell: Nanoparticles prove homeopathy!

Last up was Iris Bell. Bell, as you might know, is a physician and homeopath (and emeritus professor at the University of Arizona) whom I first noticed ten years ago after she had gotten a grant to study homeopathy from the National Center for Complementary and Alternative Medicine ( NCCAM ), now known as the National Center for Complementary and Integrative Health ( NCCIH ) and from her debate appearance in 2007 at the University of Connecticut. She’s clearly unhappy with skeptics, because she declares right at the outset, “Skeptics keep saying, “There’s nothing there, so this is ridiculous.'” Why, yes. Yes we do. Then she goes to a straw man, claiming we say, “If you have a positive finding, so what? It’s an accident.” Actually, our arguments about Bayesian considerations are quite a bit more nuanced than that. But whatever.

Her response is a striking set of data that “allow you to put together a potential model for how this all works. The emphasis is that you’re going to find, truly, structures in the material that generate signals that have been demonstrated that will then trigger nonlinear responses in the organism, a complex adaptive system that is self-organized and actually has self-similarity (?) at certain levels.” Her overview of the “healing process” is as follows: Pick correct remedy for diseased organism and organ, which leads to a self-amplified adaptive response across the networks, which leads to healing and a healthier organism. She emphasizes that skeptics misunderstand homeopathy because homeopathic remedies are “not acting like a drug,” but are rather “acting like a signal that tells the body that it can heal” (whatever that means).

Here’s where Bell gets into what I knew was coming from the beginning, when Fisher said that just because homeopathic remedies don’t contain any original remedy doesn’t mean that there isn’t something there. Yes, we’re talking nanoparticles, baby! Not only are nanoparticles the One True Cause Of Disease in some alternative medicine, they’re also the cure because they make homeopathy work! It’s one of the favorite “explanations” for homeopathy out there other than the “memory of water” and it’s just as plausible and convincing (as in not at all plausible). I remember when I first heard of this gambit back in 2010, upon encountering a paper published by homeopaths in India that confused what were almost certainly heavy metal nanoparticle contaminants from the manufacturing process for particles arising de novo as a result of the succussion (shaking) between each dilution step. I later heard about how homeopaths were invoking silica nanoparticles as “proof” that homeopathic remedies were not just water. Of course, can’t help but wonder where silica nanoparticles come could possibly come from, if in fact they have actually been detected in homeopathic remedies. It couldn’t have anything to do with the fact that most homeopathic dilutions are made in glass (which is to say silica) vials, could it? Perish the thought! Basically, Bell’s been peddling this same line for quite some time.

According to Bell, all that grinding and succussion generate nanoparticles, and these nanoparticles do things. All sorts of things. Magical things. Like homeopathy things. They can even emit electrical signals! Oh, wait. The paper Bell cites to justify that claim is the infamous paper by Nobel Laureate Luc Montagnier, who, unfortunately, appears to have fallen prey to the Nobel Disease and become a crank. Indeed, that particular paper was roundly criticized by skeptics for its poor methodology and conclusions not supported by its data. These days Montagnier is subjecting autistic children to long term antibiotic treatment and appearing at quack conferences like Autism One, along with women who think that giving autistic children bleach enemas is a good way to treat autism. In other words, as sad as it makes me to say it, Montagnier is no longer a good scientist, and I wouldn’t trust anything he publishes these days any more than I trust what Dana Ullman publishes—or, for that matter, Iris Bell.

Of course, in this talk, it’s not just silicates from the glass, but she even mentions how homeopaths use natural cork stoppers and speculates how cork might adsorb to the nanoparticles. Her explanation for how nanoparticles “get there” is epically hilarious:



Basically, it’s a whole lot of handwaving involving the lactose that is sometimes in ground up homeopathic remedies before they are placed in a water/ethanol solution to be diluted, combined with shaking, nanobubbles, interactions between nanobubbles on the surface of the glass with entrapped air bubbles and the formation of a layer of nanoparticles on the surface of the remedy. It’s all utter nonsense, as I’m sure any physicist, chemist, or materials scientist will be happy to back me up about. She also cites Luc Montagnier’s claim of electrical signals from homeopathically-prepared E. coli. That’s when she jumped the shark, even for a homeopath, although she did also invoke quantum entanglement, as all good defenders of quackery do.

Bell, too, had to rush through her last few slides, which left a couple of minutes for questions. To be honest, I was very disappointed. Not a single skeptical question was asked—not one!—and the last question basically set Bell up to go on about how she wants to find collaborators who have model systems she’s interested in and ultimately use “big data” to answer how homeopathy works.

Because of course she does.

Teaching integrative medicine in the Department of Family Medicine

You might ask, given the leadership role in resident education held by a naturopath, the lack of skepticism towards homeopathy, and the presence of an anthroposophic medicine advocate in the department, what the U. of M. Department of Family Medicine is teaching its residents and the medical students rotating through its clinics. The answer, it turns out, was on the U. of M. website, where the Department of Family Medicine provides a helpful webpage entitled Family Medicine Education Modules, which are:

Our education modules are made available through a partnership with Open.Michigan, a University of Michigan initiative committed to open content licensing and supporting the use, redistribution, and remixing of educational materials. Open.Michigan has reviewed this material in accordance with U.S. Copyright Law and has tried to maximize your ability to use, share, and adapt.

There are three integrative medicine modules:

Integrative Medicine Based Approach to Care Asthma

Depression

Diabetes Type 2

Gastroesophageal Reflux Disease (GERD)

Headache

Menopause

Obesity and Weight Loss

Prenatal Care

Upper Respiratory Infection (URI) Integrative Medicine: Body-Based Therapies Acupuncture

Manual Medicine

Massage Therapy Integrative Medicine: Mind-Body Therapies Overview

Guided Imagery

Hypertension

I perused the list, and zeroed in on the most pseudoscientific treatment there, acupuncture. I was somewhat surprised there wasn’t anything on naturopathy in the modules, but I predicted that a lot of what naturopaths do would just be “integrated” into the education. I also realized that I really wish I had a U. of M. login, because there were pre- and post-tests that I could have looked at but didn’t have access to. In any event, the acupuncture module is listed has having been developed by “U-M Department of Family Medicine integrative medicine fellow, Andrew H. Heyman, MD, MPH, in 2007” and is currently being “maintained by faculty member, Tarannum A. Master-Hunter, MD,” with the last review being in February 2018. Her clinical interests are listed as family medicine, sports medicine, and clinical acupuncture. Great! We have a physician administering what I consider to be quackery at my alma mater!

What about the module? Ever the optimist, I was hoping for better, but what I got was typical misinformation about acupuncture. For instance, we get the narrative that acupuncture is ancient:

“The superior physician controls disease before any illness has declared itself;

the average physician practices acupuncture before the disease has come to crisis; the inferior practitioner treats the patient when illness is already dying away.”

– Zhen Jiu Jia Yi Jing

( Comprehensive Manual of Acupuncture and Moxibustion , 282 AD) Chinese medicine has evolved from a theoretically and clinically heterogeneous heritage that includes ancestor healing, demon exorcism, magic correspondences and herbal medicine. Its history is well documented in more than 10,000 medical treatises.

The first European reports on Chinese medicine came from 16th and 17th century Jesuits.

Missionaries to Asia brought back the theory and practice of Traditional Chinese Medicine to Europe (see Acupuncture – European history). Today, Chinese medicine embraces a complex, internally consistent and comprehensive medical tradition that includes acupuncture, herbology, nutrition, meditation, exercise, and manual therapy. Aside from treating disease, Chinese medicine has maintained a vigilant position on health prevention.

Of course, there are wildly varying estimates for how old acupuncture is that depend on how reliable one considers ancient texts and what, exactly, one counts as acupuncture. I like to think of it by asking a simple question: Did the technology exist to make fine needles 2,000 years ago? The answer, of course, is no. So if acupuncture existed, it must have been very different then than it is now, given that the technology to produce such thin needles didn’t exist until much, much later. Indeed, it is very likely that acupuncture started out as no more than an Asian variety of the bloodletting practiced in Europe, with acupuncture points and meridians being near veins to be opened. There was also a strong connection between ancient acupuncture and astrology, such that one of our guest bloggers, Ben Kavoussi, once referred to it as “astrology with needles.” Indeed, it’s pretty clear that acupuncture was likely an offshoot of bloodletting.

Kavoussi also noted a lot of other things about the history of acupuncture that acupuncture advocates forget. For instance, although needling is often cited in the Yellow Emperor’s Canon of Medicine , relatively little has been written about it elsewhere and that, reportedly, by the middle of the second millennium, the practice had been largely abandoned, with Chinese and other Asian societies actually taking steps to eliminate it, even by outlawing it. Indeed, by 1757 a book documenting the history of Chinese medicine called acupuncture a “lost art.” For example, in 1822 an edict banned its practice and teaching from the Imperial Medical Institute in China, and the practice was banned in Japan in 1876 and finally outlawed in China in 1929. Then in the 1930s a Chinese pediatrician named Cheng Dan’an proposed that needling therapy be resurrected because now its actions could be explained through neurology. He also replaced the previously used coarse needles with the fine filiform needles in use today.

If you want to read what acupuncture was like over 100 years ago, read Harriet Hall’s review of a book by a Scottish surgeon Dugald Christie, who was stationed in China from 1883 to 1913. The descriptions feature children with needles left plunged deep in their bodies for days, including one who died. Of course, I’ve picked up the history of acupuncture beginning with the era of Chairman Mao Zedong, who basically retconned the history of traditional Chinese medicine (TCM) and acupuncture and promoted it to the world, a promotion that is still going on today. This retconned version of the history of TCM, in which it is presented as a unified whole philosophy of medicine and acupuncture uses very fine needles, is what U. of M. is teaching. Never mind that acupuncture as we know it has existed for probably less than 100 years. No wonder there are so many varieties of acupuncture.

Let’s just say that if the module gets the history so wrong, opting for propaganda over actual history, I have grave doubts about the rest of it. I was not wrong to have them. For instance, qi is described pretty much as “energy” or the “vivifying force contained in (and circulating through) all natural phenomena and life forms” and as flowing “through these meridians in an organized fashion to provide nourishment and protection to the organism,” with acupuncture points described as “nodes” along the meridians that “serve as access gates or switches that send information and can influence internal physiologic processes.” There are also a lot of hand-waving “explanations” for how acupuncture “works” like this:

Since nerve conduction alone does not explain all biologically-related phenomena induced by acupuncture, new explanatory theories are emerging. One set of explanations include the cell to cell depolarization of electro-ionic shifts in sodium, potassium and calcium causing the stimulus to pass along tissue planes such as fascia. Additionally, small shifts in electro-magnetic potentials occur during acupuncture treatment that can accumulate to cause larger organ system responses once thought unlikely.

This is, of course, nonsense, as is the claim that acupuncture is good for a large number of conditions, such as those listed here. Apparently, the Department of Family Medicine doesn’t understand that acupuncture is nothing more than a theatrical placebo. It has no specific effects for anything or that “pulse diagnosis” is bogus—or that whenever you hear a quack make a statement like this, it’s nonsense:

Symptoms may worsen 24 hours after a treatment, followed by marked improvements, which usually signals a positive response.

Ugh.

Basically, there is no skepticism in the entire module. It’s taught the way that an acupuncturist would teach acupuncture. There isn’t even anything resembling a serious acknowledgement that science doesn’t support acupuncture. It’s just assumed that it works, and presumably that’s what family practice residents and medical students are learning.

I’ll have to go through the rest of the modules when I get a chance.

Quackademic medicine at the University of Michigan

It saddens me that even one department in the medical school that trained me has drunk deeply from the quackademic medicine firehose. I only reassure myself by telling myself that the department of surgery there is relatively free of this nonsense, as is (most) of the rest of the medical center. I only hope it doesn’t metastasize from the Department of Family Medicine.

Of course, it’s not just Michigan. I’ve been documenting for nearly 14 years the infiltration of quackademic medicine pseudoscience into some of the most prestigious medical schools and academic medical centers in the world, institutions as storied as Memorial Sloan-Kettering Cancer Center, M.D. Anderson Cancer Center, Georgetown, Harvard, Yale, and the University of Arizona. I’d be naïve indeed to think that my alma mater couldn’t fall prey to the same sort of pseudoscience. I reassure myself by noting that, as far as I can tell, it’s just one department and that my current institution, although not completely free of “integrative oncology” and “integrative medicine,” has a far smaller amount of it than a lot of the most prestigious medical schools in the country. I aim to do what I can as faculty to keep it that way.