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New York Times columnist gets it wrong again about integrative and complementary medicine

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| By Dr. Ronald Hoffman

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Once again, I feel compelled to respond to yet another snarky, wrong-headed attack on the medicine I espouse in a column in the New York Times. 

Sometimes, when I share these hit pieces with colleagues, they say: “Don’t give that article additional credence by responding to it.” But the sheer stupidity of this indictment needs to be called out. 

The author, Jen Gunter MD, is a California OB/GYN who has made her journalistic bones with commentaries like “Gwyneth Paltrow and GOOP say the joke is on you if you followed their advice”, “Are homeopathic ‘remedies’ helpful or harmful?” and “14 ways Dr. Oz proves in Trump interview that on TV Oz just plays a doctor”. 

You guessed it. Dr. Gunter is an implacable foe of all things “alternative.” She is a champion of science, and everything rational, in the face of alleged superstitious claptrap.

But the premise of her article is all wrong. She states that the wellness movement represents a regression to a time before science transcended the constraints of religious dogma, with its magical thinking:

“Medicine and religion have long been deeply intertwined, and it’s only relatively recently that they have separated. The wellness-industrial complex seeks to resurrect that connection. It’s like a medical throwback, as if the halcyon days of health were 5,000 years ago. Ancient cleansing rituals with a modern twist—supplements, useless products and scientifically unsupported tests.”

Dr. Gunter implies that modern medicine is a purely rational enterprise, free of ideological and commercial considerations. This is a frequent argument of “quack busters” like Paul Offit, who authored a book critical of unconventional medicine entitled Do You Believe in Magic?

But that view clashes with an astute critique by an MD less enthralled with the intellectual “purity” of the contemporary medical enterprise. Dr. Lissa Rankin writes:

“Physicians were our priests, the war on disease replaced the fight against sin, and pills were my communion. Those who questioned the dogma of my religion were persecuted as “quacks” the way the church persecuted heretics. I was religiously trained to worship the dogma of medicine like the Bible, and it was made very clear to me that I would be excommunicated should I ever turn my back on what I’d been taught.”

In her Times op-ed, Dr. Gunter deploys a variety of rhetorical tricks to impugn natural practices, one of which is conflation, a perennial favorite of propagandists:

“Look closer at most wellness sites and at many of their physician partners, and you’ll find a plethora of medical conspiracy theories: Vaccines and autism. The dangers of water fluoridation. Bras and breast cancer. Cellphones and brain cancer. Heavy metal poisoning. AIDS as a construct of Big Pharma.”

For vaccines, fluoridation, cellphones, heavy metal poisoning, legitimate controversy persists, despite mainstream views that “the science is settled”; these justifiable debates are juxtaposed (conflated) with more way-out, discredited theories about bras and AIDS. 

Wikipedia defines conflation as “when the identities of two or more individuals, concepts, or places, sharing some characteristics of one another, seem to be a single identity, and the differences appear to become lost. In logic, it is the practice of treating two distinct concepts as if they were one, which produces errors or misunderstanding . . .”

I’ve previously weighed in on the medical conspiracy theory that BigPharma—enabled by the “medical Mafia—is intentionally suppressing cheap, natural cures to maintain their sales of expensive drugs, a cabal which I doubt exists. But undeniably, perverse market incentives favor pricey, patentable fixes. Suffering stokes profits, and chronic diseases provide a sinecure for drug companies. 

As the author of a review writes: 

“This study isn’t the first to suggest prescription drugs can pose a health risk. But it is the first to find that the growth of the pharmaceutical industry itself may be associated with worse rather than better health[emphasis added] . . . We found that as the pharmaceutical industry expands, there is a decrease in the beneficial impact of medical specialization on population health.” 

Another favorite device of Dr. Gunter is reductio ad absurdum: “In logic, reductio ad absurdum (Latin for “reduction to absurdity”) is a form of argument which attempts either to disprove a statement by showing it inevitably leads to a ridiculous, absurd, or impractical conclusion, or to prove one by showing that if it were not true, the result would be absurd or impossible.” (Wikipedia)

For example, in her Times article, she exults: 

“Let’s take the trend of adding a pinch of activated charcoal to your food or drink. While the black color is strikingly unexpected and alluring, it’s sold as a supposed ‘detox.’ Guess what? It has the same efficacy as a spell from the local witch.” 

Really? Who does that? In all my years practicing Integrative medicine, I’ve never advocated or even heard of such a marginal practice. 

But is activated charcoal so implausible? Why, then, is it standard practice to administer activated charcoal to every poisoning victim in every emergency room in the world? 

Dr. Gunter goes on to ridicule the preoccupation with “toxins”: 

“I also want to clear up what toxins actually are: harmful substances produced by some plants, animals and bacteria (and, for them, charcoal is no cure). ‘Toxins’, as defined by the peddlers of these dubious cures, are the harmful effluvia of modern life that supposedly roam our bodies . . .” 

But how does that square with an official position taken by the mainstream, orthodox American Academy of Pediatrics: “Effect of environmental toxins on children a growing concern.” Toxicity is a real phenomenon, not a figment of the imagination of alternative healers. 

Then Dr. Gunter employs another rhetorical device: Claiming that wellness advocates all champion “grounding bedsheets” (whatever they are), she is engaging in a classic “straw man” argument.

What is a straw man example? Wikipedia: “A straw man is a common form of argument and is an informal fallacy based on giving the impression of refuting an opponent’s argument, while actually refuting an argument that was not presented by that opponent. One who engages in this fallacy is said to be “attacking a straw man.”

I’m not saying there’s no hype in the wellness movement. Amazing benefits attributed to vaginal steaming, dehydrated veggie/fruit powders, libido-enhancers, hair formulas, and muscle-boosters, are pure bunk. But they’re not representative of the true value of scientifically-validated natural therapies. 

And when Dr. Gunter ridicules “clean” tampons, “clean” food, “clean” makeup, she’s picking the wrong examples of over-reach. Pesticides, herbicides, and endocrine disrupters shouldn’t be in products we consume or apply to our skin. 

Finally, Dr. Gunter invokes studies that purport to show the inefficacy—and alleged harms—of medical alternatives. One is a paper that looked at patients who refused conventional cancer care in lieu of a potpourri of natural approaches. In most instances they fared worse. 

Dr. Gunter is evidently unfamiliar with the details of the study because, had she read it, she would have realized that it’s not a repudiation of integrative or complementary management of cancer where the best of conventional modalities are rationally coordinated with targeted nutrition, as in naturopathic oncology; instead, it’s an indictment of an eccentric choice by a tiny minority of patients with curable cancers who irrationally eschew any kind of surgery, radiation, chemo, or hormone therapy. 

As the authors themselves acknowledge: “It is important to note that complementary and integrative medicine are not the same as alternative medicine as defined in our study. Whereas complementary and integrative medicine incorporate a wide range of therapies that complement conventional medicine, alternative medicine is an unproven therapy that was given in place of conventional treatment.” 

vitamin study that Dr. Gunter asserts demonstrates the inefficacy of supplementation has been widely criticized

“There are numerous problems with many of the included studies. One of the most common problems was that supplementation periods were too short or that supplementation was started too late in an individual’s disease cycle. As important, are issues relating to the forms of nutrients (these often being far from optimal and not including the biologically-active or natural food forms), the combinations of nutrients used (often too limited) or dosages of micronutrients (generally too low, occasionally too high for the wrong type of nutrient e.g. synthetic beta-carotene) . . .” 

Bottom-line, Dr. Gunter is a tourist in the exotic land of integrative medicine. Or worse yet, she hasn’t even bothered to book the trip; it’s as if she’s stayed home and casually browsed an Instagram page to form an opinion without so much as setting foot in a foreign destination. 

If you like this commentary, readers are encouraged to post the URL to the comments section of the original New York Times article. 

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