Five issues I have with integrative medicine
| By Dr. Ronald Hoffman
I spend a lot of time criticizing the excesses of conventional medicine here on Intelligent Medicine. It’s expensive, depersonalized, can deliver devastating side effects, and doesn’t get to root causes of most disease.
On the other hand, the very term “Intelligent Medicine” conjures a balanced approach to health, blending the best of high-tech medicine with the best of natural modalities.
As President and Medical Director of the Alliance for Natural Health, and a longtime integrative physician, my professional bias favors lifestyle modification and innovative deployment of nutraceuticals and low-tech/high-touch therapies often considered offbeat by mainstream medicine. But that doesn’t blind me to the potential for allopathic medicine to deliver remarkable cures, where appropriate.
At times the battle lines seem to be drawn between orthodox and alternative. Many standard doctors are reflexively skeptical of anything other than “evidence-based” therapies. They’re just cherry-picking the data, confirming the old adage: “If you’re not up on it, you’re down on it.”
But that doesn’t give some of my integrative medicine colleagues license to uncritically shun all drugs and surgery as “unnatural”. They’re practicing a form of narrow-thinking.
Here are some examples of where I think the natural medicine movement has gone off the rails:
The reification of “Functional Medicine”: This is going to be a difficult one, because I have enormous respect for the Institute of Functional Medicine (IFM), which has developed a magnificent, detailed curriculum for addressing fundamental causes of disease rather than just placing band-aids on symptoms.
The Oxford Dictionary defines “reification” as “The treatment of a relatively abstract signified (e.g. technology, mind, or self) as if it were a single, bounded, undifferentiated, fixed, and unchanging thing, the essential nature of which could be taken for granted.”
In an effort to standardize the sometimes chaotic thought streams of alternative medicine, Functional Medicine has inadvertently substituted what amounts to its own orthodoxy. How-to courses teach would-be practitioners to see health problems as a concatenation of microbiome imbalances, leaky gut, food intolerances, nutrient deficiencies, environmental toxicity, and genetic susceptibilities.
Which is all well and good, but without a proper medical framework, it’s an incomplete way of looking at the body. Missing is an understanding how conventional therapies work—or don’t—and when they should be employed or withheld.
Emulating conventional continuing medical education—whose cost is a burden even to non-holistic medical practitioners—IFM offers turn-key courses like “Restoring Gastrointestinal Equilibrium: Practical Applications for Understanding, Assessing, and Treating Gut Dysfunction for $1,715.00 – $2,125.00; typically, from start to finish, their certification program costs between $13,000-$17,000.
Another outfit, Functional Medicine Fast Track, boasts:
“Register for our Free Training: Why Adding an Online Functional Medicine Program to Your Practice is the Key to Escape the Office, Scale Your Income, and Reach Millions (While getting even better outcomes for your patients than you are now!)” Hundreds of graduates are emerging with a limited understanding of all the medical options available.
Sure, there need to be standards for practicing natural and alternative medicine—you can’t just make it up as you go along. But I can’t resist thinking this might lead to “cookie cutter medicine” as constraining as the algorithms that bind regular docs.
Herbs over drugs: There’s good reason for using, for example, CBD as a natural non-addictive alternative to pain meds, or curcumin as a safer alternative to stomach-rending NSAIDS for inflammation. But I frequently get questions like “What supplement should I use to lower my cholesterol?” I invariably reply that it’s important to establish whether you really need to lower your cholesterol. Not everybody does, in spite of the propaganda we’re bombarded with in the media. If you don’t think statins are a good idea, why would you buy in to take a red yeast rice supplement—which, after all, is a weak natural statin of uncertain potency? It’s an example of ideology trumping practicality.
Alternatively, if you’re stricken with shortness of breath and chest pain, it might be advisable to pop an aspirin as you dial 911, rather than search for a white willow tree whose bark you can brew to yield salicylic acid. Or treat pneumonia with an appropriate antibiotic instead of olive leaf extract.
Stem cell fervor: The idea is appealing—return pluripotent cells to the body, which can differentiate into building blocks for your failing organs, be it eyes, brain, joints, liver etc. But spinning down some blood or bone marrow and then reinjecting it without the right prep doesn’t guarantee the cells are going to find their way to the trouble area.
Stem cells are the Holy Grail of regenerative medicine. Intensive research is underway to discover how best to harness their potential. But obstacles bedevil scientists as they try to develop methods to coax them to “take” and effect repair. Early results suggest some benefits for stem cells injected into joints—but even that is iffy. Docs offering stem cells as expensive panaceas for all manner of devastating ills are jumping the gun.
Shoddy research: We in the integrative medicine community need to up our game when it comes to the studies used to substantiate our claims. Not all companies are culpable; many invest considerable sums to underwrite credible research. But examples of exaggerated claims abound.
For example, I was once approached to endorse a popular memory product. The makers claimed studies proved it worked: one was in test tubes, another was in dogs, and a third was in humans, with only 22 subjects, and on closer inspection showed no statistically-significant difference between consumers of the supplements and controls. Moreover, all three studies were performed by the supplement manufacturer, introducing the potential for bias, or even outright fraud.
I demurred. They were indignant. The promoters thought it was simply a matter of offering me sponsorship dollars. I stuck to my guns. To this day, they continue to mount extensive ad campaigns on radio and TV.
Unfortunately, sketchy products, highly-advertised and often targeting the vulnerable elderly, tarnish the reputation of the natural products industry.
Weak research supporting dubious nostrums is not the exclusive province of alternative therapies; the updated fall Covid boosters the CDC is encouraging all of us to take are substantiated only by studies showing the enhancement of neutralizing antibodies in mice, monkeys and a handful of human subjects, not by real-world trials showing protection from infection, hospitalization or death.
Orthorexia: Orthorexia nervosa is a term coined over 25 years ago by one of my colleagues, Dr. Steve Bratman. It refers to an inordinate fixation with healthy eating. Too many acolytes of natural medicine develop an obsession with food; Bratman aptly described it as:
“ . . . obsessive focus on food choice, planning, purchase, preparation, and consumption; food regarded primarily as source of health rather than pleasure; distress or disgust when in proximity to prohibited foods; exaggerated faith that inclusion or elimination of particular kinds of food can prevent or cure disease or affect daily well-being; periodic shifts in dietary beliefs while other processes persist unchanged; moral judgment of others based on dietary choices; body image distortion around sense of physical ‘impurity’ rather than weight; persistent belief that dietary practices are health-promoting despite evidence of malnutrition.”
Paradoxically, most people don’t care what they shove into their pie-holes. But we stalwarts of natural medicine struggle to convince folks that diet matters—sometimes with the unintended consequence that we turn our patients and clients into orthorexics!
Perversely, a holistic approach runs the risk of heightened concern over pervasive environmental insults—which we surely all should minimize—but to an extent that civilized life becomes oppressive. Other patients become convinced they themselves are beset with internal toxins that must be relentlessly purged, or that they may be afflicted with ineradicable viruses, bacteria or parasites. This may lead to an unhealthy pursuit of increasingly radical alternative treatments—which some natural practitioners may be all too willing to enable, to patients’ detriment.
If this seems like I’m biting the hand that feeds me, well, so be it. This column is likely to stir up a hornet’s nest, so I’d enjoy hearing your comments, agree or not. Send to questions@drhoffman.net and we’ll air some on future podcasts.
