Opening photo from the Atlantic feature

Integrator columnist Taylor Walsh alerted me via email to a feature in the July-August 2011 Atlantic Monthly by David H. Freedman entitled "The Triumph of New Age Medicine." Walsh mentioned that the writer was he same fellow who had explore John Ioannidis' deconstruction of the claims of medical researchers. Before reading Freedman's piece I urged him to write up something. He did. Before I read Walsh's remarks, I read Freedman's piece, then wrote a separate column. Walsh's comments are below. Mine will be linked here when posted.

Walsh, a regular Integrator contributor, is a consultant, entrepreneur and writer on digital media and integrative health. His own blog is at Getting to Integrative Health and Wellness. Walsh tweets on related topics via @taylorw.

Comments on "The Triumph of New Age Medicine"

- Taylor Walsh

Taylor Walsh

This article is an important appraisal of the view of the future that the integrative medicine and practice communities can now see before them; even as integrative medicine itself has in recent weeks come under some conservative media skepticism from Forbes magazine and The Economist.

It is important because once you pass through the expected but decreasingly dense tangle of skepticism, writer David H. Freedman is able to highlight and describe in comprehensible fashion the aspects of integrative medicine and practice that have sustained their advancement and will continue to do so. 

As a journalist, Freedman is interested in burrowing into the general assumptions of professional cultures whose work has great reach and great consequence. He wrote the book, "Wrong: Why Experts Keep Failing Us-And How to Know When Not to Trust Them."  Last November Atlantic published his eye-opening account on the work of meta researcher John Ioannides, MD, whose examinations of medical research in the 1990's exposed a dysfunctional system and unreliable results (conditions that inspired in part the program for Comparative Effectiveness Research managed through Institute of Medicine in 2009 as part of the American Recovery Act).

Freedman's starting premise appears to be the question, "How come alternative medicine is still here?"

" Freedman highlights in comprehensible fashion the aspects of integrative medicine and practice that have sustained their advancement and will continue to do so."

From an integrative practice point of view the article has a number of problems and for the general reader includes several unnecessary distractions, starting with the title phrase "New Age Medicine." That phrase still retains its powerful connotation for things way out of the mainstream: tie-dyes, a perpetual daze, the 60s, and now marijuana clinics lining California strip malls.

Freedman also makes the decision to use "alternative medicine" throughout. "Alternative" is an "instead of" term, which immediately sets the integrative and "real" medical communities on opposite sides of the room. Had he used "complementary" the story would be more easily digested by the general reader and it would more accurately describe the current state of integrative and conventional relations. (Thus another vote for complementary and integrative?)

It isn't helpful, for instance, to suggest that a representative example of current integrative treatment might include "hologrammed silicone bracelets."  But there it is, to capture the mind's eye of the general reader.

So his story rolls out a little unevenly.  It is not unlike following a mosaic stretching through a gallery of 30 rooms, the walls of each revealing a little more of an unfolding theme.  

Which means, as is most often the case for this topic, the gallery trip must stop in the obligatory Quackaderium, where skeptics rain down aspersions on the intention and motivation of CAIM professions and on the "gullible" public to whom they are "marketing." (Freedman eventually sets these assertions against the prevailing realities, but I wondered how many readers would reach this passage on page 3 and think "just more of the same," and go back to email.)

	"As is most often the case for this topic, the gallery trip must stop in the obligatory Quackaderium, where skeptics rain down aspersions on the intention and motivation of CAIM professions.

But on balance, the trip through Freedman's gallery, reveals a collection of fairly drawn portraits: on the questions of evidence and the apparent omnipresence of the placebo; the inadequacy of RCTs; the loss of healing sensibilities among physicians; real patients he observes in treatment; and the depth of integrative acceptance in the most well known conventional care institutions. You'll have your own highlights; here are a few:

• "To focus on alternative medicine's placebo effect ignores what may be its largest benefit-its adherence to a ‘healing' model of patient care."

• "The medical community knows perfectly well what sort of patient-care model would work better against complex diseases... the promotion of a healthy diet, encouragement of more exercise, and measures to reduce stress."

• "Every single physician I spoke with agreed: the current system makes it nearly impossible for most doctors to have the sort of relationship with patients that would best promote health."

•  "A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically."

• "Other sorts of professionals could be better at the healing, bonding ... and for less money. These might include behavioral-medicine therapists, social workers, nurse practitioners, or even some entirely new sort of practitioner specially trained for the task." 

• "But what's the sham treatment for being a caring practitioner, focused on getting a patient to adopt healthier attitudes and behaviors?"  Citing UC Davis neuroscientist Clifford Saron: ‘...Science has to learn to listen in a sophisticated way to what individuals report to us.'"

• "Ultimately, what today's medical students think about alternative medicine will be more important to the future of medicine than what anyone else thinks of it."

Eventually the trip through the Freedman gallery takes him into the Mayo Clinic (literally), where his account of observations, conversations, and commentary reaches a kind of reality crescendo.  He writes: "This notion that alternative medicine is a legitimate response to mainstream medicine's real shortcomings is one I heard, in variations, from everyone I spoke with at the Mayo Clinic."  

"Freedman's assessment presents for general readers a view of a future in which medicine has been changed substantially, through integrative practices and attitudes."

While all of the above may draw knowing nods among Integrator readers, Freedman's assessment presents for general readers a view of a future in which medicine has been changed substantially, through integrative practices and attitudes that have been experienced and accepted by patients for the last generation.  

While he did not address the growth and maturation of the CAM disciplines, whose work outside the conventional care establishment established the value of their approaches for that gullible public in the first place, he senses that the forthcoming era might require "...even some entirely new sort of practitioner specially trained..." Nodding at that suggestion will be the educators at Tai Sophia Institute's Wellness Coach program, as well as at Duke Integrative Coaching.

A Berman Effect?

For some reason, this article includes the second appearance in a big time publication in as many months for Brian Berman, director of the U of Maryland Medical School's Center for Integrative Medicine in Baltimore. Freedman begins his story in the CIM offices talking to Berman and a few of his patients and colleagues. That makes for an easy transition across campus, where another U of Maryland prof, Steven Salzberg, PhD has set up shop as one of the fiercest critics of all things CAIM.

Last month Salzberg, from his position as a columnist for Forbes.com (also printed in Forbes magazine), began his summary blast at integrative medicine with a barrage aimed at Berman  before moving on to the rest of the academic health center community.

Freedman's conversation with Salzberg about the evidence base for CAIM includes a rather poignant reflection on its comparison to the evidence for psychotherapy. It is a coda to the article worth the wait.