Hold the Mayo

I did my residency in Minneapolis at the county hospital. Occasionally a patient would go the Mayo Clinic in Rochester for a second opinion, get all their tests repeated and more, then came back with the same diagnosis and treatment plan. We would say if you want a Rochester Sandwich, hold the mayo.

That started my skepticism about big name clinics and famous hospitals. There are good and bad doctors everywhere. Judging from the metastasis of pseudo-medicine into many of the prominent medical institutions in the US, I suspect my bias that these institutions are more interested in income than science-based medicine.

Which brings me to Complementary and alternative medicine from the Mayo Clinic, with the subtitle

You've heard the hype about complementary and alternative medicine. Now get the facts.

Given that they have an Integrative Medicine Department, I was wondering how they would spin 'the facts.' As always in a CAM article, they start with the disingenuous:

Nearly 40 percent of adults report using complementary and alternative medicine

It's actually 38.3%  When I was in grade school I would have been told to round to 38. I am surprised they did not round it up to almost 50%. And you only get to that number by including interventions that are not alternative like diet and exercise.

They use the National Center for Complementary and Alternative Medicine (NCCAM) classification of pseudo-medicines, dividing them into

  • Whole medical systems
  • Mind-body medicine
  • Biologically based practices
  • Manipulative and body-based practices
  • Energy medicine

What all these have in common, with the exception of Biologically based which includes herbs, is a complete disconnect from reality as it is understood by the sciences. You would not know that from the Mayo.

Homeopathy is described as using

minute doses of a substance that causes symptoms to stimulate the body's self-healing response.

Most homeopathic nostrums have no active substance in them and the ideas behind homeopathy is totally nonsensical.

Energy medicine is an

Invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. The goal of these therapies is to unblock or re-balance your energy force.

No such energy has ever been measured and none of these interventions have been shown to have efficacy beyond bias. Credulity is the order of the day at the Mayo.

They continue:

Many conventional doctors practicing today didn't receive training in CAM therapies, so they may not feel comfortable making recommendations or addressing questions in this area.

Could it be that conventional doctors, based in reality and science, know it would be unethical and fraudulent to recommend therapies that are fanciful delusions with no efficacy?

However, as the evidence for certain therapies increases, doctors are increasingly open to complementary and alternative medicine...While scientific evidence exists for some CAM therapies, for many there are key questions that are yet to be answered

What these 'certain therapies' are goes unmentioned, since the NCCAM has yet to support a study that demonstrates any benefit from the pseudo-medicines mentioned in the article. And there is the old saying, what do you call alternative medicine that has been proven to work? Medicine. BTW, I am not a conventional doctor, I am a doctor. I do not need the adjective.

They continue with the question

Why is there so little evidence about complementary and alternative medicine?

One reason for the lack of research in complementary and alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional therapies are often funded by big companies that develop and sell drugs. Fewer resources are available to support trials of complementary and alternative medicine. That's why NCCAM was established — to foster research into complementary and alternative medicine and make the findings available to the public.

Perhaps there is a paucity of funding for these modalities because prior plausibility would suggest that since they are based on fantasy, not reality, it would be unethical and a waste or resources to study them? Not that the numerous well done studies that show a lack of efficacy prevent the expansion of integrative medicine programs.

That's in-depth consumer health at the Mayo. I can't see that they have done much to improve since I was a resident. I would still hold the Mayo on my Rochester sandwich.

Research shows research doesn't matter
Points of Interest 7/5/2014

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