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Quackademic medicine.

I love that term, because it succinctly describes the infiltration of pseudoscientific medicine into medical academia. As I’ve said many times, I wish I had been the one to coin the phrase, but I wasn’t. To the best of my ability to determine, I first picked it up from Dr. R. W. Donnell back in 2008 and haven’t been able to find an earlier use of the term. As much as I try to give credit where credit is due, I have, however, appropriated the term “quackademic medicine” (not to mention its variants, like “quackademia”), used it, and tried my best to popularize it among supporters of science-based medicine. Indeed, one of my earliest posts on this blog was about how quackery has infiltrated the hallowed halls of medical academia, complete with links to medical schools that have “integrative medicine” programs and even medical schools that promoted the purely magic-based medical modalities known as reiki and homeopathy. It’s been a recurrent topic on this blog ever since, leading to a number posts on the unethical clinical trials of treatments with zero or minimal pre-trial plausibility, the degradation of the scientific basis of medicine, and the acceptance of magical thinking as a means of treating patients in all too many medical centers.

One strong candidate for quackademic ground zero, if there can be such a thing for the phenomenon like quackademic medicine, which is creeping up like so much kudzu in the cracks of the edifice of science-based medicine ( SBM ), is the University of Arizona. U. of A. is, of course, the home of one of the originators of the concept of quackademic medicine and one of its most famous and tireless promoters, Dr. Andrew Weil. Dr. Weil, as you might recall, has even been the driving force for creating a highly dubious “board certification” in integrative medicine. Sadly, apparently this new board certification has been so popular among physicians wanting to “integrate” a little quackery into their practices, that its first examination has been delayed from May to November 2014, so that the American Board of Physician Specialties can figure out how to accommodate the unexpectedly large number of applicants.

So what happens when a patient arrives at U. of A. for treatment? I found out last week when I received an e-mail, which led to a fairly long e-mail exchange, with a man whose son was diagnosed with leukemia and is being treated at the University of Arizona Cancer Center (UACC). Although this man gave me permission to use his name, I am going to decline to do so because there is a child involved, although anyone involved in his case at U. of A. will likely quickly be able to identify who the man is. It turns out that he is a professor at U. of A. in a humanities department (which is why I’ll refer to him henceforth as the Professor), and, even though he is not a scientist, he clearly knows how to think (which would not be surprising if you knew what department he was in). In his e-mail, he told me how appalled he was at the sorts of treatments being offered to his son:



I was appalled to discover that the center offers treatments like Reiki, Reflexology, Acupuncture, Cranial massage, etc. These treatments are advertised as “healing”–including boosting one’s immune system, complementing conventional chemotherapy etc. I wrote the the [sic] director of the center who at first expressed concern and thanked me for calling these things to her attention. She said she would convene a board of physicians to look into it. After three months went by, I wrote to her asking for an update. She told me the board was still working on it and that she was “confident they would take care of it”. I have been asking her for a timeline and she is not returning my emails. At first I thought this was probably the pernicious influence of Andrew Weil, but I have since discovered that cancer centers around the country are offering these “treatments” including places like Sloan-Kettering. Because of this, I’ve concluded there is no point in going to the media to try to expose what’s going on.

Of course, blogs are the media. The new media, but media nonetheless. At least I like to think so.

The Professor is probably correct about going to the traditional media, though. There probably is little point in going to the press, although we can always hope. Most of the time, when the press looks into the infiltration of quackademic medicine into medical academia, the result is a story like this appalling one from a year and a half ago in which NBC News chief medical correspondent Nancy Snyderman strongly embraced quackademic medicine to the point that she even said that if a doctor “doesn’t know” about integrative medicine, “I think it’s time to ask for a referral to someone who does.” It made me sad to see a woman who normally stands up for science, at least with respect to vaccines and combatting the antivaccine movement, to fall so hard for pseudoscience when it exists at Memorial Sloan-Kettering Cancer Center. Even I have had to hang my head in shame when I discovered that my alma mater both for medical and undergraduate school, the University of Michigan, actually has a program in anthroposophic medicine.

Unfortunately, although I hoped that the Professor would make as much of a stink as he could, I felt compelled to warn him that I doubted he would be successful because this sort of “integration” of quackery with academic medicine is very much entrenched at the University of Arizona. It started with the pernicious influence of Andrew Weil, but if Dr. Weil were to drop dead or retire today I doubt that it would change much, if at all, because quackademic medicine has had years to become embedded in the culture there. To put it bluntly, U. of A. is one of the centers of quackademic medicine in the US, if not the world, and I don’t see that changing any time soon. I also looked up UACC’s director, Dr. Ann E. Cress, and noted that she’s an interim director, which makes it highly unlikely that, even if she were so inclined, she could do much of anything. An interim cancer center director isn’t going to be able to take on Andrew Weil. It also doesn’t help that there are researchers at U. of A. like Dr. Myra Muramoto, who recently scored a $3.1 million from the National Cancer Institute (NCI)—not the National Center for Complementary and Alternative Medicine, mind you, the NCI—to do this:

Dr. Myra Muramoto, Arizona Cancer Center member and associate professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine, has received $3.1 million from the National Cancer Institute to develop and evaluate a new program to train chiropractors, acupuncturists and massage therapists in effective ways to help their patients and clients quit tobacco. The grant will fund “Project Reach,” which will partner over the next five years with Pima County chiropractors, acupuncturists, massage therapists and their office staff to evaluate ways they can best help their patients quit tobacco.

That’s a big chunk of change of the sort that cancer centers value above all, money from NCI grants. When cancer centers are being considered for NCI-designated comprehensive cancer center status (NCI-CCC)—or trying to renew their status—one huge consideration is the level of NCI funding its investigators have. Basically, for this purpose NIH grants are good, but NCI grants are the best. That’s why any investigator with a $3.1 million NCI grant will have outsized influence and an NCI-CCC or any cancer center seeking NCI designation. Of course, because chiropractors, acupuncturists, and massage therapists often claim, without valid scientific evidence, to be able to help people quit smoking with their woo, such a grant would almost certainly have the effect of encouraging referrals of smokers to these practitioners, to make sure enough patients accrue to the study funded by the grant.

Quackademic medicine at UACC

It turns out that U. of A. does indeed offer its patients tons of “supportive” care therapies not rooted in science. A quick look at its Survivorship Care page reveals:

In collaboration with the medical and psychosocial services at The University of Arizona Cancer Center, we will work with patients to: Reduce physical symptoms associated with cancer and its treatment (e.g., pain, fatigue, insomnia, etc.)

Manage side effects of chemotherapy and radiation with therapies such as acupuncture, botanicals, and mind-body medicine

Examine lifestyle factors and situations (e.g., diet, risk for undernutrition, physical activity, emotional coping skills, support network, and spirituality) that may affect symptoms and/or course of disease

Develop and work toward goals for health, wellness, and what is most meaningful and valuable after diagnosis, as well as during and after treatment

Actively participate in their health care

Regain a sense of control and well-being despite the diagnosis

Notice the quackademic medicine “integrated” with potentially science-based modalities for supportive care: acupuncture, botanicals, “mind-body” medicine. Note how such useless modalities like acupuncture are listed as being, in essence, co-equal with various dietary, lifestyle, and coping modalities. This is basically how quackademic medicine “rebrands” what should be science-based modalities as somehow being “alternative” or outside the mainstream. It then lumps them together with modalities that are pure quackery (acupuncture, reiki, therapeutic touch, etc.), the implication being that it’s all part of a lovely “complementary and alternative medicine” ( CAM ) package that represents the “best of both worlds.” Of course, we at SBM reject the idea that there are “two worlds,” citing the oft-repeated adage that there is no such thing as “alternative medicine.” Rather, there is medicine that has been scientifically demonstrated to work. There is medicine that has not been scientifically shown to work. There is medicine that has been shown not to work. The reason “alternative medicine” is alternative is because it falls into one of the latter two categories. What do you call alternative medicine that’s been shown scientifically to work?

Medicine.

I know, I know. We say this a lot here, but it’s true. Also true is Mark Crislip’s almost famous adage, which I like to use in almost all of the talks I give about “integrative” medicine these days:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

As I’ve said many times before, I wish I had thought of this quote.

Trying to hide the stench of cow pie in the apple pie

Make no mistake about it, UACC is “integrating” fantasy with reality by offering reflexology (or, as I like to call it, a nice foot and hand massage with delusions of grandeur), reiki (or, as I like to call it, faith healing substituting Eastern mysticism for Judeo-Christian beliefs), craniosacral massage (or, as I like to call it, a nice scalp massage with delusions of grandeur), healing touch (also known as therapeutic touch, which I like to call reiki without the foreign name), and many others. At least, I wasn’t able to find anywhere that the UACC offers homeopathy to patients, although one of the most famous of the “magical grants” awarded by NCCAM was to a University of Arizona researcher in Dr. Weil’s department to study homeopathy.

It didn’t take too long for it to become clear to the Professor that UACC was not dealing with him in good faith. At least, that’s what he told me in a subsequent e-mail. What led him to believe this was a combination of not getting his e-mails answered and then what happened after he complained about perhaps the most egregious example that he found at UACC. He first brought this issue up back in December, and, after several requests to have a meeting, the Professor became frustrated and basically sent a threat to go to the media. Shortly after that, the web page on the UACC site that had so disturbed the Professor became this:

Yes, that’s a big “Access Denied” message. One wonders whether UACC deleted the page or just hid it so that you need a University of Arizona login to see it. Maybe one of our readers from U. of A. could check and report back here.

Thankfully, due to the magic of Google Cache, we can see what was there until as recently as a week ago:

One wonders if the administration of UACC, out of concern that the Professor might actually do what he said he would do (shop his story around to newspapers), got rid of the web page for Frank Schuster. Of course, it’s not so easy, as I showed above, and, in case anyone’s interested, I’ve saved a web archive of the page for permanent archival purposes (for me, that is).

I can see why the UACC administration would be embarrassed enough to act like this. On the now defunct page, potential patients for UACC were treated to incredible claims like:

Very simply, Reiki is energy that flows through the body of the practitioner, and conveyed through the hands into the body of the recipient. It is subtle energy, but it can be felt – usually as a warmth, tingles or slight pressure.

And, perhaps the most ridiculous claim of all:

Any particular effects cannot be predicted. The energy is intelligent and it will do whatever is best. What can be stated is that it will help any condition.

That’s right. Apparently this “healing energy” from the “universal source” is so intelligent that it will do whatever is needed or best. That totally must be why it can’t be studied! Its effects are so darned unpredictable! It’s also hard not to note that on the old web page about Mr. Schuster there was a link to his practice’s web page Energy-Therapy.net, where there’s also a link to his blog Energy Therapies, which appears not to have been updated since 2005 but is quite revealing nonetheless. Indeed, in one post on Mr. Schuster’s web page, we see a claim that speaks for itself:

ALL illness and disease are indications of an unbalanced or depleted energetic condition. The resulting manifestation as pain or anxiety is the body’s way of letting you know that something in your life is out of balance.

But don’t worry, Mr. Schuster can help. You don’t even have to come to his practice or UACC! That’s because, you see, Mr. Schuster offers distance healing:

Distant Healing is defined as a “mental intention on behalf of one person, to benefit another at a distance.” In this context, prayer is a mental act of intercession in which the believer (pray-er) puts himself “between” God and the recipient. God then uses the prayer (pray-er) as the conduit for the request – be it healing, therapy, or another type of petition. God’s healing power is directed through the healer to the person in need. If that person is present, the power can be conveyed through touch. In the event that person cannot be present, God’s healing power is effectively conveyed by mental intention through the thought process. In this realm distance is not a consideration. One might not believe any of this, nor have faith that this kind of healing can occur. Actually, that is irrelevant. The only faith that really matters is that of the healer or pray-er. The single requirement of the recipient is to be in a receptive mode, open to healing possibilities. It is not necessary to believe that the acts of prayer, distant healing or touch healing are effective.

This is, of course, completely unscientific. It’s religion, pure and simple. In fact, I would argue that it’s just another form of faith healing, given how Mr. Schuster invokes God as the source of the “healing power.” And it’s only $25 for four 15 minute sessions! (More if you want to donate more.) What a bargain! At least there’s a quack Miranda warning at the bottom of the page, and one notes that Mr. Schuster also includes a plug for NCCAM .

I don’t know whether Mr. Schuster actually offers distance healing to UACC patients, although it’s clear from his web page that he offers it. Regardless of whether he offers it to UACC patients or not, I hope that I would not be alone in arguing that mystical nonsense like reiki (which Mr. Schuster appears to implicitly admit to be faith healing) has no place in an academic medical center, much less an NCI-CCC like UACC. There are only 41 NCI-CCCs in the entire country. I’m faculty at one and am proud of having been on the faculty of two different NCI-CCC’s. The NCI designation is supposed to mean that these cancer centers are the best of the best, adhering to only the highest standards of patient care, research, and community engagement. To see an NCI-CCC offering faith healing, distance healing, and treatments based far more on magical thinking, religious and mystical ideas, and prescientific concepts of disease, such as reiki, reflexology, and acupuncture, embarrasses me almost as it would to learn these modalities were being promoted for patients by my own cancer center as though they were legitimate treatment modalities. Fortunately, they are not, which is one reason I’m proud of my cancer center, but I nonetheless fear this occurrence. After all, if M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center can fall so deep into the rabbit hole of woo, I’m under no illusion that it can’t happen where I work too. All it would take is a new cancer center director, a new director of supportive services who is more “open” to these sorts of treatments, or maybe a new member of the board of directors who is woo-friendly. SBM is fragile these days.

Perhaps Dr. Cress feels the same way, along with many of the other excellent science-based clinicians and researchers based at UACC. I doubt it’s a coincidence that there isn’t a single mention of CAM or “integrative medicine” in a recent history of UACC published on the UACC blog last fall. In a way, I feel a bit sorry for Dr. Cress in that, as an interim director, she probably has neither the authority nor inclination to deal with this issue definitively. She probably wants to let whoever is appointed the next permanent director deal with it. Whatever the case, the Professor still doesn’t know whether Mr. Schuster is still affiliated with UACC or not, the removal of his web page from public view notwithstanding. I’m not sure that even the minimal action of removing from the UACC website a webpage that links to a website offering distance healing would have happened if the Professor hadn’t been faculty at the University of Arizona and threatened to go to the press.

Maybe they were concerned that people would also notice that Mr. Schuster’s other website, Paths-Mind-Is-It.com, offers a veritable cornucopia of dubious products, such as Increased Synchronicity, which claims to be able to:

Increase in awareness of the present moment. Fully appreciating the here and now

Have future self send information back through time to current moment. This is specific for the following periods of time…1 minute, 1 day, 1 week, 1 month and 3 months

Have current self send current information back through time to past self. This is also specific for the following periods of time…1 minute, 1 day, 1 week, 1 month and 3 months

Increasing unity/harmony between past, present and future self

Hey, if Mr. Schuster can send healing messages over distances, why not forward or backward in time, too? Yes, basically, his PATHS “utilize proprietary breakthrough technology” that claims this:

Rapid Data Transfer (RDT) GENERATION II embodies a quantum leap in Mind Technology. RDT Gen. II is a unique technology that helps you use the potential of your own mind without any drugs or medications. It can help you to improve in almost every area of your life including, health (physical, mental, emotional & spiritual), enlightenment, productivity, success, communication, finances, relationships, fitness and sports – even improve your memory! RDT has been helping thousands of individuals, like you, improve their lives in many ways (click here to read success stories) in as little as 3 minutes a week.

RDT or Rapid Data Transfer facilitates high-speed communication between an on-line Theater Presentation and the human subconscious.

As best I can figure, PATHS are multimedia computer presentations that claim to be able to do all sorts of things for you, including improving your stem cell health, strengthening your connective tissue, and doing quantum meditation. Note that the word “quantum” features prominently in this “technology,” and regular readers know what the use of that word almost always indicates in this context.

What remains of the cow pie

Even if Mr. Schuster is indeed gone from UACC, there’s a lot of woo that remains there, as the Professor mentioned in his e-mails. Specifically, he pointed out something called The Seven Levels of Healing, a program created and offered by Dr. Jeremy Geffen, MD, FACP, who is described as a “board certified medical oncologist and leading expert in integrative medicine and oncology and is the author of the book The Journey Through Cancer: Healing and Transforming the Whole Person .” I think I’ll quote the Professor about why he found this so objectionable, because, really, without letting myself go, I’d have a hard time putting it better myself. In his criticism, the Professor also cites examples from Dr. Geffen’s website:

Today I’m in the cancer center and I’ve noticed something else. You offer here something called “The Seven Levels of Healing”. I looked up this program. Level 7 is about the nature of spirit. Here’s one thing they say: Spirit is our true nature: timeless, eternal, and dimensionless, the source from which all awareness, all creativity and, ultimately, all healing flows. As you know, this claim is scientific nonsense. One may have religious faith in such a claim, but is it appropriate for this claim to be made by the cancer center? The description continues: The goal of “The Nature of Spirit” is to assist each person to discover this spiritual aspect of themselves, and to bring this into full, ongoing awareness. When what we experience as physical reality is threatened, it is more important than ever before to remember that another part of us is timeless and eternal, and remains strong, healthy, and powerful, no matter what our physical circumstances may be. In recognizing the nature of our spiritual selves, and the incredible mystery of awareness itself, we uncover the source of ultimate love and freedom — an infinite ocean from which healing can be drawn. Again, completely unscientific claims about healing. As far as I know, the “Seven Levels of Healing” program is free. This makes it less objectionable, although in my mind, it is still objectionable for the cancer center, a supposedly scientific, evidence-based institution, to be pushing what is essentially religion. Moreover, in the description of level 3: “The Body as Garden”, they say the following: Here we explore the full spectrum of complementary approaches to healing: nutrition; exercise; massage; yoga; herbal therapies; Ayurvedic, Tibetan and Chinese medicine; acupuncture; homeopathy: chiropractic; and visualization. We do not offer or promote these approaches as cancer treatments per se, and we do not believe that they should be viewed in this manner. However, we do believe that they can supplement conventional care by cleansing, toning, relaxing, and strengthening the body, thus giving health and well-being the greatest chance to emerge. Although these claims are vague, it would be quite natural for someone to interpret them as meaning that these treatments, some of which are offered at the center for a fee, can aid in one’s recovery from cancer. I know of no evidence to support this claim. And do you have any idea what they mean by ‘cleansing’ and ‘toning’ the body? Do these terms have any scientific meaning in this context?

Likely, the Professor learned of this program through a fliers or pamphlet like this one. He is quite correct, too. By offering this particular program, UACC has irresponsibly placed its imprimatur and thus the assumed imprimatur of science on pseudoscience and mystical, religious mumbo-jumbo. There is no excuse for this.

This “Seven Levels of Healing” represents a program by a physician who is not UACC faculty but is promoted by UACC to its patients. It offers homeopathy, which, no matter how much homeopaths try to deny it, is pure quackery, as we’ve described many, many times here. Ayurveda and traditional Chinese medicine are modalities based on prescientific ideas of how diseases work not unlike the four humors in prescientific European medical traditions. Worse, according to the biography on the website, Dr. Geffen is apparently “focused on implementing ‘The Seven Levels of Healing’ program in cancer centers throughout the United States, along with writing, speaking, and consulting with hospitals, cancer centers, and professional organizations in developing leading-edge integrative programs for medicine, wellness, and life.” Although several cancer centers appear to have adopted the “Seven Levels of Healing” woo, from what I can tell, UACC is the only NCI-CCC that is involved, making it by far the most prominent cancer center to be using Dr. Geffen’s program. I really hope that I don’t learn of any more.

Given the infiltration of quackademic medicine into even the most respectable medical centers, it’s hard to know whether UACC is merely the cancer center that’s gone the farthest down the rabbit hole of pseudoscience or whether I just don’t know of ones that are even worse. Given the large shadow that Andrew Weil casts over the medical school there, it might well be so that, when it comes to quackademic medicine in oncology, UACC reigns supreme. As prominent as M.D. Anderson and Memorial Sloan-Kettering Cancer Centers are, as far as I can tell, neither of them has yet offered distance healing to their patients, although many are the academic medical centers that offer a quackery only slightly removed from distance healing, namely reiki. After all, what’s the difference between saying you can channel “healing energy” from the “universal source” into a patient if you’re in the room with him or if you’re thousands of miles away? In my mind, not much. At least one academic medical center offers homeopathy. (Actually, I wish it were only one.)

Can anything be done?

Often, I’m asked something like, “What’s the harm?” After all, UACC and the other cancer centers that offer up “integrative oncology” don’t deny patients science-based treatments for their cancer. True enough. However, as the Professor demonstrates, the existence of “integrative oncology” programs has a profoundly confusing effect on patients and their families, who, quite reasonably, assume that an NCI-CCC would not offer any treatments that were not science-based. Consequently, the line between science and pseudoscience is becoming increasingly blurred, to the point where even a lot of physicians have a hard time telling the difference when it comes to modalities like acupuncture, which has been the most successful at projecting a facade of science over prescientific mystical origins and a mid-20th century resurrection based on political need in China, thanks to low quality studies and random noise in clinical trials. Worse, this infiltration has led to grossly unethical clinical trials, such as the Gonzalez trial, in which patients undergoing a “natural” therapy for cancer did much worse than conventional therapy, even for a disease with as grim a prognosis as pancreatic cancer. Perhaps an even more pernicious effect (actually, there’s no “perhaps” about it) is that this blurring of the lines between science and pseudoscience so badly batters the filters against pseudoscience that a cancer center like UACC can allow practitioners like Frank Schuster and Dr. Jeremy Geffen to be associated with its programs, and even hire them to provide unscientific medicine.

My first wish is that more patients like the Professor would so vigorously protest the infiltration of quackery into academic medical centers like UACC. My second wish is that it would take more than the potential embarrassment of publicity about a practitioner that even the quackiest of quackademics can’t defend to push a cancer center to act to protect the scientific basis of cancer care. Maybe the Professor can serve as an example of the first wish, but I fear I will not live to see the second ever fulfilled.