One of the most frequent claims of supporters of so-called "complementary and alternative medicine" (CAM), which goes by the Orwellian name "integrative medicine," is that it represents "integrating" alternative medicine with science-based medicine to produce the "best of both worlds." Of course, when I think of the best of both worlds, I usually think of The Best of Both Worlds, which might well be appropriate, except that, unlike the case when the Borg assimilate a species, when science-based medicine is forced to assimilate quackery, the quackery changes it, making it weaker, not stronger, and degrading its scientific basis. As I like to say, "integrative medicine" involves "integrating" pseudoscience and quackery with real medicine, to the detriment of the latter. When integrative medicine isn't incorporating outright quackery like naturopathy, homeopathy, and traditional Chinese medicine into medicine, it's busy rebranding certain science-based modalities like exercise and diet as somehow being "alternative" or "integrative," usually while adding just enough pseudoscience make them less science-based.

Unfortunately, unlike the old days when doctors were willing to call quackery quackery, the whole concept of "integrative medicine" has been wildly successful over the last 20 years in breaking down resistance to incorporating pseudoscience like naturopathy into medicine. This has led to the rise of what I like to refer to as "quackademic medicine," in which quackery has infiltrated the walls of academic medicine, where integrative medicine programs have popped up like so much kudzu, and the National Center for Complementary and Integrative Health (NCCIH), which was formerly known as the National Center for Complementary and Alternative Medicine (NCCAM), center in the NIH dedicated to funding studies of pseudoscience. Politically, this drip, drip, drip of legitimization of quackery has, not surprisingly, led to efforts to legitimize it completely. Indeed, Jann Bellamy just described how a new bill introduced by the supplement industry's lapdog Senator Orrin Hatch (R-UT) could lead to taxpayer subsidization of health savings accounts that can be used to purchase homeopathy. Meanwhile, a provision was slipped into the Affordable Care Act that mandates insurance coverage for the services of any state-licensed health care professional, which means that in states where chiropractic is licensed, insurance policies sold through ACA exchanges have to cover chiropractic. Ditto naturopathy.

What I was disturbed to learn is that apparently (at least if John Weeks is to be believed), on the Democratic side both Hillary Clinton and Bernie Sanders are sympathetic to CAM:

A colleague recently sent me a photo of presidential hopeful Bernie Sanders at a 2010 integrative medicine conference. His right ear is full of acupuncture needles. They looked like the five needle NADA protocol that, given its value in stress reduction, should likely be a regular treatment of any candidate on the campaign trail. The picture didn't surprise me. In 1996, I was invited to speak on insurance issues associated with what was then called "complementary and alternative medicine" at an unusual conference in Vermont. Then Congressman Sanders had convened a statewide gathering of all healthcare stakeholders to examine the potential in these new approaches and practitioners. Massage therapists rubbed shoulders with insurance executives, acupuncturists with hospital administrators. Relationship building began.

And Hillary:

I was working in Seattle with the American Association of Naturopathic Physicians in early 1993 when a call came through from the Clinton White House. Say what? I was even more stunned than you likely are on reading this. This was early in the movement for integration. News had just broken that a third of adults in the United States were using some kind of "unconventional medicine." Billions were being spent. Stakeholders of all kinds, such as those Sanders would soon be organizing, were awakening. The call came smack in the middle of the healthcare reform effort Hillary led. Everyone was wondering how to get into a process that was haunted and ultimately undone by a chosen strategy of exclusion and secrecy. Who's in? Who's out? The caller, from Hillary Clinton's personal staff, said the meeting in the West Wing would include only a couple dozen people. Clinton would share a process for how alternative medicine could give input to the reform team. Could we send someone?

Whoa. None of this is good. Of course, when it comes to Hillary Clinton, it's not exactly a surprise. Readers who've been around more than a couple of years will remember my reaction when I discovered just how close the Clintons had become to Dr. Mark Hyman, the king of "functional medicine" quackery, who's so prominent that the Cleveland Clinic basically built him a functional medicine center to run. Functional medicine, as you will recall, is a form of highly dubious medicine that involves measuring all sorts of lab values and trying to correct them, whether it makes a difference or not. There's actually a lot more to it than that, although maybe it's more correct to say that there's a lot less to it from a scientific standpoint. It's beyond the scope of this post to do a detailed deconstruction of functional medicine, but I have done it before. The point is that Clinton has shown herself to be susceptible to woo.

And apparently so has Bernie Sanders. Get a load of this speech he gave in 2010 to the Vermont conference mentioned in Weeks' article:

To me, the increasing integration of CAM and conventional care just makes sense. Research shows that more people are demanding and turning to integrative care because it parallels their personal values and desire to be treated as a whole person. For a wide variety of reasons, more and more people are not simply content to go to a doctor’s office, get a diagnosis and take a pill. They want to know what the cause of their medical problem is and how, when possible, it can be best alleviated through natural, non-invasive or non-pharmaceutical means.

And a little later in his remarks:

I believe integrative health care offers an excellent opportunity to address these and many other issues and improve our too-expensive and not always-effective “sick-care” system. Clearly, we need to put much more emphasis on disease prevention and wellness, and on care that links physical and mental well-being.

Oh, dear. No.

Sure, it's possible that Sanders was just being polite to his hosts, but I doubt it was just that. You don't say stuff like this if you don't believe it to some extent. It sounds as though Sanders buys into the false dichotomy between "natural" and pharmaceutical and the CAM propaganda that paints medicine as not promoting prevention.

Ah, you say. That was nearly six years ago. Maybe Sanders has wised up. Sadly, if this story from November is any indication, he hasn't:

Sen. Bernie Sanders praised holistic and alternative health care Monday as he introduced a Veterans Health Administration official to doctors and nurses in Burlington. Sanders described the increasing integration of Chinese medicine and yoga, for example, as bright spots in a largely dysfunctional American health care system.

Apparently Sanders has a different definition of "bright spot" than those who think medicine should be science-based do. While you'd be hard-pressed to find any of us who are opposed to yoga (stripped of its mystical mumbo-jumbo, it is, after all, nothing more than a form of exercise), but traditional Chines medicine is a prescientific medical system rooted in primitive vitalism that has no place in scientific medicine. That such mystical unscientific quackery is rapidly being "integrated" into medicine is hardly what I would call a "bright spot." He's also the one who is credited (if you can call it that) with inserting the provision requiring licensed CAM professions to be included as part of the health care workforce into the ACA.

Worse, Sanders appears to be pushing to "integrate" this quackery with the medical care being provided in the VA system. Isn't auricular acupuncture bad enough? Don't our vets deserve nothing but the very best medical care, science-based medicine? Why would we subject our vets to prescientific quackery. Apparently Sanders supports doing just this. He also co-sponsored a bill, the Veterans’ Health Promotion Act of 2013, to set up pilot programs in CAM in the VA, with the intent of introducing CAM more widely in the VA system. Fortunately, it failed to pass.

Basically, Sanders has a long history of supporting quackery that can be documented through sources other than John Weeks. Hillary Clinton also has dodgy history; obviously being close to Mark Hyman, who, besides his functional medicine quackery, has published an antivaccine book with Robert F. Kennedy, Jr. There's even a report that she got Hyman face time with Secretary of Health and Human Services Kathleen Sebelius. It's from Breitbart.com, though; so I take the report with a grain of salt the size of the salt mines under Detroit. Still, there's no doubt that on the Democratic side, both major candidates have a problem when it comes to supporting science-based medicine. It's part of the reason why I'm not particularly enthusiastic about either of them.

Obviously, though, I'm even less enthusiastic about the Republican field, for reasons that go beyond medicine. After all, of the remaining Republican contenders, Donald Trump, besides truly scary with his other ridiculous ideas, is rabidly antivaccine and has been at least a decade, having on many occasions repeated the myth that vaccines cause autism, while Ben Carson panders to antivaccinationists and has a decade-long history of shilling for the supplement company Mannatech with his very own dubious cancer cure testimonial. Ted Cruz doesn't appear to embrace medical pseudoscience, at least not that I can find, but he embraces plenty of other pseudoscience and hangs out with his own objectionable doctors.

Sadly, this looks to be another election that will be a choice between the lesser of two evils, which will force those of us who support science-based medicine to weigh just how important that is to us compared to other policy positions. If, for instance, Donald Trump is the Republican nominee, the choice will be easy, because in addition to his antivaccine views his other views are noxious beyond belief, which would make it easier to hold my nose and support the Democratic nominee. If Ted Cruz is the nominee, his views are sufficiently noxious and his support for anthropogenic global warming denialism so flagrant that, again, it will be easy for me to hold my nose and vote for the Democrat. If the nominee is an establishment candidate like Marco Rubio, Jeb Bush, or John Kasich is nominated, it will be a bit harder to hold my nose and vote for the Democrat, but other issues might win the day.

The bottom line is that, from the standpoint of science, this current crop of Presidential candidates leaves much to be desired, and that's an understatement.