The Thin, Fuzzy Line between Medical Science and “Alternative” or “Complementary” Medicine

As physicians we try to draw a clear line when we make recommendations to our patients. Is the treatment choice based on strict, evidence-based medical science, is it based on the doctor’s years of experience, or is there really nothing factual to support a recommendation? Is it just an opinion, or worse, part of the darker side of health care, a profit-driven option?  By explaining these differences, we help our patients to make informed choices. Recently one of the U.S.’s most prestigious medical research and teaching hospitals, the Cleveland Clinic, promised disciplinary action against the Medical Director of its own Wellness Institute, Dr. Daniel Neides..

In a statement to the press, Dr. Neides rants against flu shots, childhood immunization, and a long list of what he calls “toxic exposures.” Worst of all, he takes advantage of the public’s anxiety about vaccine safety including supposed links to autism. Dr. Neides innocently asks “Does the vaccine burden – as has been debated for years – cause autism?” Thus, he carefully sidesteps the claim that vaccines cause autism, a growing concern in the general public following research published in Britain in 1998. That research was found to be fraudulent and its author‘s medical license revoked. The autism connection has been repeatedly discredited by large-scale, multi-national studies.

Since Dr. Neides has now apologized for his statements, I assume that his motives involved publicity-seeking for his alternative-medicine programs. The Clinic has fiercely disclaimed Dr. Neides’ article (which carried the Cleveland Clinic logo). The bigger question here is why a research-based institution like the Cleveland Clinic includes “integrative medicine” as part of its wellness programs. Its webpage states: “Integrative Medicine uses modalities such as acupuncture, chiropractic manipulation and relaxation techniques to reduce pain; dietary and herbal approaches to manage diseases…”  The Clinic is not alone in embracing alternative therapies. Many of the country’s premier research and teaching hospitals now offer similar programs to satisfy growing patient demand in this multi-billion dollar industry. In doing so, however, our trusted healthcare institutions must walk a careful line to honestly counsel patients about which therapies have good evidence to support their use and which may be nothing more than pseudo-science. This is especially true when the institution profits from its recommendation. The Clinic’s Online Wellness Store, for example, offers “…Hundreds of wellness products to purchase, with a Wellness Rewards program that allows you to earn discounts over time to use against future purchases.”

And how do we at Sparks & Favor advise our patients? We remain absolutely committed to the safety and effectiveness of vaccines that have largely eliminated diseases like small pox, polio, diphtheria, measles, and many others that terrified families very few generations ago. If you have followed our patient education forums, blog posts, and newsletters, you know that we are generally skeptical of the supplement industry, especially involving weight-loss products. I am comfortable that there is a place for many of the non-conventional therapies described above, including exercise therapy, comfort measures, relaxation techniques, and some vitamin/mineral supplements, botanicals, and pro-biotics so long as they are offered to patients with full disclosure about the evidence (or lack of evidence) to support their use. If you are shopping for these products, the National Center for Complementary and Integrative Health (part of the National Institutes of Health) is a good place to start. Its Health Topics from a to Z provides research-based information on alternative therapies and products.  And a word about placebos—we have long known that some things make us feel better simply because we believe in them. As long as they do no harm, and no one misleads us medically or financially, this is acceptable.

I agree with Dr. Adam Gaffney, a pulmonary and critical care specialist on faculty at Harvard Medical School, who criticized Dr. Neides’ statement.  About our professional responsibility as physicians he says, “There is a huge difference between prescribing medicines and selling products.”