Editor's Note: This is an update of an article originally published on Medscape on January 13, 2017.

Introduction

In the age of fake news, illicit Internet pharmacies, and proposed rollbacks to healthcare regulations, it is perhaps not surprising that clinics offering unsubstantiated or poorly administered medical treatments seem to be on the rise.

Medscape reached out to experts to get their thoughts on nine clinics with questionable practices that may be worth further scrutiny.

Integrative Medicine Storms Academia's Ivory Tower

For many of the physician contributors to the blog Science-Based Medicine (SBM), which takes aim at unfounded medical practices and beliefs, the continued rise of integrative medicine (IM) represents one of the most exasperating trends in contemporary healthcare. IM is roughly defined as the combining of conventional and what used to be called "complementary and alternative medicine" (CAM), though there is wide variability in that definition.

From this relatively straightforward foundation, IM incorporates a host of other therapies of decidedly unclear scientific value, such as reiki, homeopathy, and reflexology.

"Some clinics just offer acupuncture, for example, and others offer the complete buffet dinner of nonsense," said SBM contributor Mark A. Crislip, MD, an infectious disease specialist in Portland, Oregon. "Their defining characteristic is pseudomedicine and pseudoscience."

SBM's managing editor, David H. Gorski, professor of surgery and oncology at Wayne State University School of Medicine in Detroit, Michigan, suggested that IM misleads by building upon established health practices.

"Integrative medicine is very good at coopting certain science-based modalities, such as nutrition, exercise, and lifestyle changes, which they identify as somehow being alternative or integrative, when in reality it's just medicine," he said.

From this relatively straightforward foundation, IM incorporates a host of other therapies of decidedly unclear scientific value, such as reiki, homeopathy, and reflexology. Because these unproven therapies are placed alongside established health interventions, critics argue, patients are led to believe that the entirety of what IM offers is valid.

IM is now taught in more than half of US and Canadian medical schools and delivered in several of the most esteemed academic health centers.[1] The cohabitation of evidence-based medicine and unproven fringe treatments under the same institutional roof can produce predictably awkward results. This was on full display in early 2017 when Daniel Neides, MD, director and CEO of the Cleveland Clinic's Wellness Institute, wrote a piece for the website Cleveland.com, in which he implied that preservatives and adjuvants in vaccines, as well as following the recommended vaccine schedule in infants, may contribute to autism. The resulting backlash caused Neides to step down from his post, and he is now in private practice.

When you offer worthless therapies for money, that's fraud in the real world.

Critics of IM see its embrace by institutional academic health as purely economically motivated. Estimates from a decade ago were that US adults spent nearly $34 billion annually out of pocket on CAM[2]—numbers that are surely higher in today's environment, where these practices have become even more mainstream.

To IM proponents who state that even if these therapies haven't shown overwhelming efficacy in randomized trials, patients nonetheless physically benefit via a sort of placebo effect that enhances relaxation and improves state of mind, Crislip offers a stiff rejoinder.

"When you offer worthless therapies for money, that's fraud in the real world," he said. "Fortune-tellers convicted of defrauding people of their money because they're possessed by evil demons just have to open an integrative medicine clinic and cruise. They'll never get punished."