ActivismSkepticism

Ask Surly Amy and Dr. Gorski: In the Workplace Skeptical Activism

Greetings Amy!

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?

~Bethany

Dear Bethany,

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.

Photo by Surly Amy

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.

Photo by Surly Amy

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.

David

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.

Got a question you would like some Surly-Skepchick advice on? Send it in! We won’t publish your real name, unless you want us to and creative pseudonyms get bonus points! Just use the contact link on the top left of the page.

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Amy Roth

Amy Davis Roth (aka Surly Amy) is a multimedia artist who resides in Los Angeles, California. She makes Surly-Ramics. She is the fearless leader of Mad Art Lab. Support her on Patreon. Follow her on twitter: @SurlyAmy or on Google+. Tip Jar is here.

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34 Comments

  1. And I thought we lay people had it bad trying to decide whether to speak up when a friend tells us about a great homeopathic medicine she’s been using. To be in a position of trust and authority and not be able to say anything must be agony! I don’t blame Bethany for not wanting to jeopardize her job, especially in this economy, but I hope she can find a way to at least pass on a complaint.

  2. Amy (and Dr. Gorski),

    Terrific answer overall, but I think your choice of movie as metaphor is a bit off.

    Edward Scissorhands did indeed involve sharp instruments and dangerous situations but I would argue that Edward was a gentle soul who was simply misunderstood, a description I don’t think you would extend to you’re not-so-friendly neighborhood acupuncturist.

    I believe a better choice would be A Nightmare on Elm Street because although Freddy did everything within his (and his writers’) power to make himself lovable he was after all is said and done still the same killer underneath.

    So maybe Dr. Wang’s Nightmare and Relaxation Clinic might be more in order.

  3. So is there a way to integrate the “let’s educate people about what acupuncture actually does” with the actual “acupuncture in a hospital WTF” problem?

    It seems like acupuncture may be right in the middle of the woo spectrum; yes, it can help drain your sinuses; no, it does not cure terminal illnesses.

    So if people want to house all of their medical and “medical-adjacent” needs in one building, just like I want to have my weight training and my esthetician in the same gym/spa because it saves me money/makes them money, can this happen within a hospital setting and can it go hand-in-hand with patient education about what acupuncture/massage/etc. actually does?

    1. How does it help drain sinuses? Like if you stick a needle all the way through your nose? My understanding is the only studies that has shown any efficacy of acupuncture are with knee pain and it was no better than sham therapy unless electrical stimulation is used which then in turn is no longer traditional acupuncture.

      http://www.sciencebasedmedicine.org/index.php/emdr-and-acupuncture-selling-non-specific-effects/

      For more info on acupuncture do a search on Pub Med or for analysis do a search on science based medicine:

      http://www.sciencebasedmedicine.org/?s=acupuncture

      1. it was no better than sham therapy unless electrical stimulation is used which then in turn is no longer traditional acupuncture.

        So, is the acupuncture offered at the writer’s medical center “traditional” in the sense that there is no electrical stimulation? I’ve never seen that (acupuncture but no e-stim) offered in a hospital-attached “complementary medicine” center–that would surprise me and I would indeed be suspicious.

  4. Hi! Just wanted to thank you for recommending coffee with a philosopher for outlook adjustment. Not enough people consider the coffee with a philosopher option. Do remember that philosophers are poor, so it’s greatly appreciated if you buy us coffee. :)

  5. Amanda Palmer linked to her acupuncturist in a blog post she put up this weekend. I took a look at the website and was disturbed to see the practitioner claiming that the World Health Organization validated her claims that acupuncture was an effective treatment for a whole range of disorders.

    So, I visited the WHO website and was even more disturbed to see that she wasn’t lying: http://apps.who.int/medicinedocs/en/d/Js4926e/5.html

    “This publication reviews selected studies on controlled clinical trials. Some of these studies have provided incontrovertible scientific evidence that acupuncture is more successful than placebo treatments in certain conditions.”

    At least they admit that it’s pretty difficult to conduct controlled trials of acupuncture: http://apps.who.int/medicinedocs/en/d/Js4926e/3.3.html

  6. I watched part of this video recently on UCTV’s feed to our local cable TV company (I missed the beginning):

    http://www.ucsd.tv/search-details.aspx?showID=23045

    Typically UCTV carries pretty hard science and speakers from the UCSF School of Medicine seems to be no exception. The Osher Center for Integrative Medicine where Dr. Newmark resides seems to be independent of school of medicine, however.

    I must say that I found his talk to be pretty interesting (and at first pretty convincing), but toward the end when he started talking about homeopathy and acupuncture I got a little suscpicious (IIRC he did say that these tools only seem to have limited benefit). This leaves me with the question as to how much this should undermine the credibility of Dr. Newmark’s seemingly more scientific claims?

    \BCT

  7. I don’t have any experience of acupuncture and certainly never plan to. However, I do have personal experience with chiropractic. When I was about 14, my upper back started hurting. My mom took me to a chiropractor who made me watch a video on how chiropractic is like a miracle that fixes everything. Needless to say I didn’t go back. However, the pain continued, especially after I was rear-ended in a car accident. A friend said to try a chiropractor they’d been to, so I went. This one was different. No fluff or mysticism involved, just that my spinal column was out of alignment and he adjusted it and took measurements of the degree of movement my neck could make to each side. After about 4 visits I’d regained about 30 degrees of rotation in my neck and the pain went away.

    After reading this post, I wanted to offer my experience with chiropractic, as I’ve found that there are both incredibly silly ones out there with a load of lies, and also people who are highly trained at manipulating the spinal column to relieve pulled muscles and pain without claiming to be any sort of substitute for internal medicine or fixing anything else.

  8. I am a veterinarian employed in a 3 veterinarian practice in which one of the veterinarians practices a mixture of real medicine mixed with woo. Different week/different woo. He’s tried them all. His rationale is that “you gotta give ’em something,” even if that something is bullshit. He thinks by offering them what they think they want, he is providing some kind of service. I think he believes it works. He tends to have his own clientele, but If he is not in the office, his clients sometimes ask me follow up questions on his services. Generally, I state that I do my best to practice science based medicine and that they should speak to him. But if they press me, I try to answer honestly without directly calling my boss an idiot. I mention that lack of scientific studies showing any benefit whatsoever. I mention potential side effects. I had a client a couple of weeks ago that was stunned to hear that the herbs he had prescribed would cost almost $100. We discussed it, and she decided against the purchase. Honestly, with some of his devotees, I know that my words are wasted and I just don’t press it. My employer has never confronted me about this. I know it is half assed and I should get a new job. Lots of reasons…blah, blah blah. Woo has permeated veterinary medicine, and it is hard for me to admit that I continue at a job that has any association with this crap. Don’t hate me.

    1. Just saving even one pet owner from wasting $100 tells me you’re right where you need to be. If it comes down to it and you’re fired for calling him out, then that’s great for your resume, when you find a clinic that only practices science-based veterinary.

  9. Thanks for writing this post. Integrative medicine (the infiltration of quackery into academia and other areas of the medical mainstream) is my pet peave. It scares the hell out of me. I hope that the skepchicks will keep on this topic and that individual skeptics will do what they can.

  10. Does your state have a “conscientious objector” provision that health care workers can’t be fired if they refuse to participate in procedures they find morally unacceptable?

    Participating in the defrauding of patients being against your “religion”?

  11. I was rear-ended earlier this year, which resulted in some serious spinal issues. I’ve had one operation on my neck, and am probably due for another at the base of my spine in the near future.

    A friend at work referred me to a physical therapist a few weeks after the accident when my aches and pains began increasing. When he e-mailed me the business card I saw that the practitioner was, in fact, a DC. When I called to make my first appointment I asked the receptionist “I’m a science-based medicine sort of guy, so I have to ask—does think he can cure asthma by adjusting people’s backs?”

    “Oh hell no” she replied.

    “OK, we’re good. How soon can we get started?” This chiro is very good friends with the neurosurgeon who’s become my new BFF, and referred me when it became clear that there was structural damage that needed surgical intervention.

    Side note: I work at a Big Science company, and regularly have lunch with more PhDs than most people meet in a year. I have lost count of how many people have asked me if I’ve tried acupuncture and offered to give me a referral.

  12. Hello all. Just registered.
    What i find sad is that many people confuse chiropractics and acupuncture with those natural cure methods that actually are scientifically proven. Like herbs.
    Here many call themselves “natural healers”, but their practice has little to do with nature, more like chakras and magnetic fields, pendulums and many other things from whats scientific explanations they dont have a clue about.

    1. What herbs are you referring to? Something like willow bark that was made into aspirin?

      Most herbs marketed as alt med cures are unregulated and are not proven to work and the ones that are regulated and proven to work become actual drugs, like the aforementioned aspirin.

      Natural does not equal safe and effective so do be cautious.

  13. Word. Tried a nat. supplement once and it did the job it said it would do (in spades actually) but, after a couple of beers face went flush, eyes went bloodshot and head felt like it was about to bust.

    As for the subject topic, I don’t see anything wrong with folks trying alternative medicine but, when it’s endorsed and housed within a hospital there’s something unethical about that….unless the patients are given literature and disclaimer notices to read and sign off on, then it’s on them.

  14. Okay, as much as I think most CAM (Complementary and Alternative Medicine) is a bunch of crap, I see this as a parallel situation to religious people objecting to working in a hospital that performs abortions or a drugstore that sells the “morning after” pill.

    No matter how you feel about their choice, your employer has chosen to sell these products or services. You should not protest that decision to the customers (patients).

    Make your case to your management and if that fails, either tolerate the CRAP (I mean CAM) with a straight face or find a position somewhere else away from it.

    It sucks when there is a conflict between your moral compass (in this case, selling services which don’t work) and your job, but you also have an obligation to your employer.

    1. There’s also the Hippocratic Oath. And while at this point in time no one seems to be pursuing these frauds legally 9and applying that label), fraud is also illegal. So yes, there needs to be some pushback against the employer. How much will vary from case to case.

  15. As a massage therapist, I prickle slightly at the parallel. Yes, the concept is correct: I won’t cure you, and I can probably make you feel better. But I’m also far less likely to HURT you than some life-force moving kook who snaps your neck around.

  16. I am the inquiring Bethany :). Yes, the new department is offering “traditional acupuncture” as well as reiki. Good times. As I am a parent and the breadwinner in my home, losing my job is not an option (though storming out in the midst of a righteous speech and some dramatic desk overturning has been a recurring fantasy). At the moment, passive aggression reigns. So far, I’ve been “forgetting” Science Based Medicine posts and articles debunking acupuncture and reiki. Oops, did I leave those among the magazines in the waiting room? Silly me.

  17. Hello, I have 2 comments.

    1st, some healthcare professionals, under some circumstances, have a legal right to refuse to perform certain job duties if they morally object. http://www.aafcp.org/cplm/files/10.pdf

    2nd, I recently found myself in a similar situation. I was able to eliminate the CAM service in my facility entirely, simply by honestly analyzing the pros and cons and bringing the facts to the decision-maker. While YMMV, it’s worth a try. :)

  18. I lied. I have a 3rd comment. ;)

    It’s misleading to the general public to house CAM with EBM. I’ve come up with numerous anecdotes from my own experience. Before I understood evidence/science/etc., I thought b/c something was sold in a pharmacy it was known to work (PSI bands) and I thought b/c chiropractic had doctors and offices, it was the same as any other type of doctor.

    The reality is the general public is scientifically illiterate and/or does not research the facts about everything they encounter.

    IMO if, for example, oncology units want to offer Reiki/massage/meditation/other CAM non-invasive stuff, they ought to be handing out fact sheets from NIH and telling patients the facts–it might make you feel more relaxed, for example.

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