I am an underling at a large, academic hospital, in an oncology unit. Recently, our hospital added a department of “Integrative Medicine.” Space, already at a premium, is being taken up in our department by a pair of acupuncturists. I have been forced to help handle their patients, including asking them for payment for services rendered. I know many of these patients well, care about them on a personal level, and have earned their trust. And yet, I am helping my corporate masters and a couple of woo practitioners fleece them. I feel helpless. Even the MDs here are afraid to say a word (they are not permitted to discourage patients from pursuing “alternative” treatments, they can only encourage patients to get actual treatment). The hospital itself sees only dollar signs. I don’t know what else to do. Any suggestions?
Thank you for writing in and thank you for being concerned with this. You are part of the future of medicine and of the medical establishment and we need people like you who care about these things.
I recently had a sort of similar situation where I was at my local doctor’s office and I heard my physician recommending another patient in the hall go see a chiropractor. I was shocked. I trusted this doctor to give good honest advice in terms of science-based health care. When he came into my room I asked him if he believed in the efficacy of chiropractic. He shrugged his shoulders and said essentially that it was like massage therapy and that while it won’t cure any specific ailment, it can make a patient feel better so they offer out of office referrals.
We will touch on the topic of “shruggies” again below.
I wouldn’t have a problem with doctors referring patients to chiropractors if chiropractors changed their shop signs to read something more along the lines of this:
“Sorta Like a Massage Therapist!– Hey, we won’t cure you – but we might make ya feel better”.
I’m just saying that a tad bit more honesty in the profession would be nice. And I would prefer the chiropractic industry based their practices more on muscular therapy or injury rehabilitation and maybe that silly little thing we call the scientific method and not so much on mysterious subluxations and eastern philosophy.
If I need to adjust my outlook I’ll consider having coffee with a philosopher. If I need to fix my neck or my back, I want an actual science literate MD.
I have since found another primary care physician.
But this post isn’t about chiropractic. This post is more about chiropractic’s buddy, the Edward Scissorhands of alt-med known as acupuncture and its attempt at wedging itself into the science-based medical establishment.
And as we all know, I am not a doctor so my experience in working in a doctor’s office or hospital is limited to me sitting in the waiting room reading a magazine. Therefore, I thought I should go find an actual science-based doctor and skeptic. I did just that. And I didn’t find just any doctor, I found one of the superheroes of medicine and skepticism to lend his advice to this column.
Dr. David Gorski is the managing editor of Science-Based Medicine and a breast cancer surgeon and researcher as well as an associate professor of surgery at the Barbara Ann Karmanos Cancer Institute and Wayne State University.
Here is what Dr. Gorski had to say:
This is a difficult problem, even for the most skeptical among us. The infiltration of non-science-based treatments into academic medical centers is something I like to call “quackademic medicine,” because the term describes what is going on perfectly. In any case, there is no convincing evidence that acupuncture functions any better than placebo, and the better designed the study the less likely it is to show an apparent effect. (Just search the Science-Based Medicine blog for “acupuncture” and you’ll find numerous articles supporting this contention.) Unfortunately, a number of medical centers have decided that there’s gold in that thar woo, and you are unlikely to change their mind, although you might want to show them this report, which indicates that CAM programs aren’t as lucrative as commonly believed.
If you do want to try to make a difference, you will have to be prepared to get in trouble or even to walk away from your job. If you’re not willing to do that, then you’ll have little choice but to grin and bear it, perhaps with as much passive aggressive obstruction as you feel you can safely get away with. You might be forced to go along with this, but there’s no reason you have to be enthusiastic about it. If, on the other hand, you’re willing to take a risk, then the way to go is to build alliances. You state that even the doctors are afraid to speak up. Is that because they are “shruggies” or because they’re genuinely fearful of repercussions? Either way, before acting, you need to discuss with doctors and other personnel who have expressed misgivings about this program and try to build a group to go to management and express its concerns. Point out that the evidence doesn’t support acupuncture, that it’s unethical to offer a treatment for which there is no evidence of efficacy, and that it is not as lucrative as commonly believed. If that doesn’t work, you’re going to have to figure out whether you can live with yourself participating in this latest foray of quackademic medicine into academia.
I hope this was helpful for you Bethany and I hope that, if not at this particular moment in time, you eventually find yourself in a position to chance things for the better.
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