10 February 9, 2018

An Integrative Education: Georgetown’s Complementary and Program Sparks Debate

By Alex Lewontin

Dr. David Gorski has quite a bit to say about “quackademic The CAM program was founded in 2001 by Hakima Haramati prefers the term integrative medicine to describe medicine.” Amri, who holds a doctorate in biochemistry and reproductive the curriculum of the CAM program, which covers subjects like “Quackademic,” a portmanteau of quack and academic, physiology, and Aviad Haramati, who holds a doctorate in , homeopathy, chiropractic medicine, , means exactly that. “It’s the infiltration of into physiology. The program was based on a National Institutes , yoga, mindfulness, and other systems of non-conventional academic medicine,” Gorski said. “I wish I had coined [the of Health grant to develop a curriculum to expose graduate medicine. term], but I didn’t.” students to the field of complementary and alternative medicine As one of the leading names in integrative medicine Gorski is a surgical oncologist, a professor at the Wayne in a critical and evidence based way. education, Georgetown has been in Gorski’s crosshairs. On July State University School of Medicine, and the managing editor What exactly is “complementary and alternative 27, 2015, Gorski published an entry on Science-Based Medicine of the blog Science-Based Medicine. Gorski himself has been medicine”? Technically, there are three similar but distinct titled “Bastions of Quackademic Medicine: Georgetown accused of quackery and has developed a degree of internet terms for the field: alternative, complementary, and integrative. University.” Specifically, the post addressed the Spring/Summer infamy among anti-vaccination advocates for his staunch and “Alternative medicine is essentially anything outside the issue of Georgetown Medicine, which was dedicated to the CAM public criticism of their movements. He has been the subject of mainstream of medicine. The term complementary medicine program and associated research. “Georgetown is telling its several smear campaigns which have, without evidence, accused came into being in the U.K., because what they found was that medical students: Forget all that boring old reductionist ‘Western’ him of everything from being a paid shill for the pharmaceutical people weren’t using [these practices] instead of conventional science you’ve learned all these years,” Gorski wrote. “Open your industry to having associations with pedophiles. What Dr. medicine, which is what the term alternative connotes, but mind to the sympathetic magic that is homeopathy. Never mind Gorski sees as “quackademics” is not the anti-vaccination rather to complement treatments in conventional medicine,” that it has no basis in science and its precepts violate multiple movements, however, but something else, something that can Haramati said. “Integrative medicine is really the blending of well-established laws of physics and chemistry.” be found much closer to the Hilltop: the Georgetown University both conventional and nonconventional, bringing the best The CAM faculty doesn’t see it that way, however. “As Medical Center M.S. of Physiology in Complementary and evidence from both to improve patient wellbeing and the scientists and academicians, as long as we have the evidence, Alternative Medicine (CAM) program. health of the public.” and our statements are evidence-based, then that’s what we’re THE GEORGETOWN VOICE 11 going to teach our students,” Amri said. “I want [our critics] invasive and less deleterious form of treatment that can help If history is any indication though, each side could find to show me what they have read that is really a good study, the patient, I can’t imagine why we would not want to do that.” affirmation for some of its ideas as evidence builds. and shows negative effects. If there are negative effects, I want Placebo or not, it is hard to dismiss all those interested in Gorski cites laetrile, also erroneously known as vitamin to know also. I want to show that to the students. We are not integrative medicine as quacks. The Department of Defense, B-17, a substance extracted from stone fruit pits. “In the teaching the students to become advocates of the field. That’s in response to the opioid epidemic, has been investigating ’70s, it was touted as a magical mystery cancer cure,” Gorski not our focus. Our focus is to teach them how to separate the acupuncture, mindfulness, and other integrative treatments to said. “We eventually did clinical trials on it in the early ’80s good from the bad.” help veterans with chronic pain. “This is the military,” Haramati and showed it doesn’t work.” Actor Steve McQueen died of Haramati, a self-described skeptic, sees this as in line said. “They’re not exactly San Francisco hippies.” The CAM pleural mesothelioma in Mexico, having travelled there to seek with Georgetown’s Jesuit philosophy. When he started the program itself uses the same scientific standards as any other treatment with laetrile. program, he met with university President DeGioia, and program in the Medical Center. “We’re not going to be teaching For Haramati, mindfulness demonstrates just the opposite. warned him that there could be pushback. “I told him, ‘We students about crystals. We are careful about what subjects “The Buddhists have promoted the practice of mindfulness for are going to explore areas with objectivity, and with rigor, and we bring to the table. There is something called ‘biological a very long time. In the ’70s, John Kabat-Zinn at the University isn’t that the Jesuit way?’” plausibility,’ where we start with practices that are common and of Massachusetts brings this practice, secularizes it, and teaches which there is an evidence base for.” it to patients with chronic pain as a way to become present in Haramati does understand the tendency for conventional the moment,” Haramati said. Today, mindfulness has become a medicine to reject some alternative practices. In 2010, he led mainstream practice for dealing with physical pain, as well as a a delegation to India to gather data on Ayurveda, a system host of mental illnesses. of Indian traditional medicine. He was disappointed with the The next decade of data will shed more light on the very state of research in the country. “If you want to make a dent debates that swirl around the Hilltop today. But until then, don’t “This is the military. in the Western scientific world, you’re going to have to use the expect people like Gorski, Amri, and Haramati to stop speaking They’re not exactly scientific method.” their minds. San Francisco hippies.”

Gorski also believes that students should be taught about complementary and alternative practices, but he sees far less gray area. “I’ve always said that physicians should know about alternative medicine, but that isn’t the problem. The problem is that it’s taught in a credulous fashion, as though it were accepted, as though it deserves to be ‘integrated’ into regular science-based medicine,” Gorski said. “These programs are not taught by skeptics or critical thinkers who are familiar with the evidence and know why the evidence doesn’t show that these things work. They’re taught by believers.” Still, Gorski doesn’t believe that everything taught under the umbrella of integrative medicine is pure fiction. “There are parts of integrative medicine that potentially work, but they’re the parts any primary care physician will already recommend, things like diet modifications, exercise, et cetera,” he said. “The good parts of integrative medicine are not unique to integrative medicine, but what is unique is not good.” The truly alternative fields have already been discredited for Gorski. For example, he describes acupuncture, which has gained popularity and acceptance in recent years, as “a theatrical placebo,” where the location of the needles, or whether or not they penetrate the skin, doesn’t make a difference in the result. “The problem with giving a placebo with no effect is that you’re basically forced to lie,” Gorski said.

Haramati doesn’t see it that way. “The body has the intrinsic Jaster Emily ability to heal itself. If our mind perceives that a treatment is helping us, and we can leverage that through engagement and treatment, isn’t that what we’re after?” he said. “If this is a less