Last week the Director of the Cleveland Clinic Wellness Center, Daniel Neides, wrote a crank anti-vaccine screed in a column for a local news outlet. This prompted an immediate backlash of criticism from professionals who care about the integrity of science in medicine. It also prompted some immediate damage control by the Cleveland Clinic, who released the following statement:
Cleveland Clinic is fully committed to evidence-based medicine. Harmful myths and untruths about vaccinations have been scientifically debunked in rigorous ways. We completely support vaccinations to protect people, especially children who are particularly vulnerable. Our physician published his statement without authorization from Cleveland Clinic. His views do not reflect the position of Cleveland Clinic and appropriate disciplinary action will be taken.
That was a reasonable immediate response, but of course does not address the underlying problem – the Cleveland Clinic has increasingly embraced unscientific “alternative” medicine in recent years, and their Wellness Center is a primary example, being a hotbed of pseudoscience. It’s interesting to note that when mainstream medical practitioners or institutions embrace so-called alternative medicine they often draw the line at anti-vaccine quackery. There is no real scientific reason for making that the line in the sand (the CAM services they do offer are just as unscientific as anti-vaccine nonsense), but there is a very real PR reason.
CAM is often sold to academics and hospitals as offering more choices to their customers (Uh, I mean patients), but anti-vaccine claims don’t do that. Further, vaccines (which are a clear home run for science-based medicine) remain very popular, and it is still common to view anti-vaccine claims as conspiracy quackery. That is why it is always amusing when centers like the Cleveland Clinic get burned by the anti-vaccine pseudoscience that flows into their institutions along with the CAM quackery they knowingly let in.
The immediate response of the Cleveland Clinic led us to speculate whether or not this episode might cause some at the Cleveland Clinic to engage in genuine soul-searching and substantive change, or would they just do damage-control, sweep it under the rug, and go on embracing pseudoscience.
Well, our speculation is now over. Toby Cosgrove, MD, President and CEO of the Cleveland Clinic (I think it’s fair to say he speaks with some authority regarding the Cleveland Clinic) published an article on the Cleveland Clinic website in which he indicates that the Cleveland Clinic will continue to fully embrace pseudoscience and quackery in medicine (as long as it is called “alternative”).
The article is very useful in that is presents an excellent example of the propaganda and misdirection that leads to what we call “quackademic medicine” – the embrace by otherwise mainstream or science-based institutions of popular quackery.
Cosgrove begins with one of the biggest myths of CAM, that scientific medicine does not adequately address wellness, or preventive medicine, and that we need to embrace CAM in order to do so. He writes:
Smoking, poor diet, and lack of exercise were the leading factors that placed patients under my scalpel.
That’s why we established the Cleveland Clinic’s Wellness Institute in 2007 and placed its leader in the C-suite with the title of Chief Wellness Officer. From its inception, the goal of the Wellness Institute is to focus on “health care,” not just “sick care.”
Historically, healthcare has not done a good job of promoting disease prevention. Our Wellness Institute has built a framework to guide patients to healthier lifestyle choices.
It is disturbing when the propaganda of the enemy is internalized and accepted. It is uncontroversial that much of the disease in our society is the product of lifestyle factors (that and aging). I also fully endorse hospitals and medical centers having resources dedicated to health promotion and disease prevention.
However, it is simply not true that mainstream medicine focuses only on “sick care” and not on “health care” or preventive medicine. All of the principles of preventive medicine, including the risks of smoking, the benefits of exercise, and the relationship of nutrition and diet to health and disease, were discovered and promoted within the paradigm of mainstream scientific medicine. CAM proponents simply rewrote history and took credit for anything preventive.
Primary care physicians would likely be surprised to discover from Cosgrove, a cardiothoracic surgeon, that they do not engage in preventive medicine. This is simply a myth, as big as any of the anti-vaccine myths that Cosgrove condemns.
What about the claim that healthcare has not done a good job of promoting disease prevention? This claim is vague – does he mean that healthcare providers don’t try, or that their attempts are not successful? The former interpretation is simply not true. The latter is a complex question. It is very difficult to change lifestyle behaviors of patients. There is, in fact, a robust program of research investigating how better to do just that. Simply telling patients that a certain behavior is a risk factor for disease has little (but non-zero) effect. Educating them about healthy lifestyles also has a real but small effect.
Researchers have investigated new techniques, such as motivational interviewing, in which the patient is encouraged to express their health goals so that the provider can help them achieve those goals. This works better than the older “scared straight” method but still has a modest effect. There is also research into society-level interventions, to nudge patients to better choices, or make them easier to make and maintain.
The bottom line is that changing behavior is extremely difficult, but there is a robust and active effort to prevent diseases by promoting healthy lifestyles. So what, exactly, is Cosgrove saying? Does he or the Cleveland Clinic have any magical new techniques for promoting healthy behavior they would like to share with the rest of us? I would encourage them to simply publish their results in the peer-reviewed scientific literature. Do they really think they are just trying harder than the rest of us? We can brush that off as a bit of self-serving marketing.
Unfortunately, what Cosgrove is doing is using the trope that mainstream medicine does not do preventive medicine as justification for embracing quackery. If the Cleveland Clinic Wellness Center were simply a center of preventive medicine, trying to push forward the science of health promotion, I would be all for it. Alas, that is not what it is.
The Link to Anti-Vaccine Claims
Cosgrove, after posturing about preventive medicine, responds to recent critics (presumably including SBM):
Harmful myths, untruths and junk science about vaccinations have been scientifically debunked. Serious adverse effects are incredibly rare. And there is no demonstrated link between autism and vaccination.
Still, critics have used the column to disparage the Wellness Institute as a whole and the concept of wellness in general.
We have not criticized the concept of promoting wellness. That is an unfair straw man. We have criticized the Wellness Institute, and Cosgrove fails to acknowledge or address that criticism. Our criticism is that when you lower the standards of science in medicine, when you embrace dubious health claims and treatments that have historically been considered fraudulent quackery (until they were rebranded as alternative), then you open the door for all sorts of nonsense, including anti-vaccine quackery.
Cosgrove and the Cleveland Clinic can spend as much time as they want praising the virtues of vaccines, and condemning anti-vaccine myths, but that does not address the core criticism. Cosgrove does not even mention how the Director of their Wellness Center could embrace and promote, “Harmful myths, untruths and junk science about vaccinations.”
By his silence I can only infer that he thinks that the philosophy of the Wellness Center and Dr. Neides anti-vaccine quackery are somehow unrelated. This view is supported by Cosgrove’s statement that:
However, in a recent online column, the Wellness Institute’s medical director shared his personal views about vaccination – views that do not represent Cleveland Clinic in any way.
He is trying to distance himself and the Cleveland Clinic from Dr. Neides by dismissing his article as his “personal views.” I’m sorry, but that does not work. Dr. Neides is a doctor and the director of a clinic. His views on vaccines are not just his “personal views,” they are his professional views, and dictate his professional behavior, which includes teaching students and treating patients at the Cleveland Clinic.
Further, they do, in fact, represent the Cleveland Clinic, because the clinic endorses Neides by hiring him as the director of their Wellness Center (which Cosgrove believes is an extremely important center), and because the very philosophy of the Cleveland Clinic Wellness Center is perfectly aligned with anti-vaccine quackery.
Cosgrove pretends this conflict does not exist, and does not address at all. Any hope that the Cleveland Clinic would have an epiphany and realize that their embrace of CAM quackery may not be a good thing has evaporated.
Still, with what I have quoted so far one might think, hopefully, that Cosgrove is defending his institution while planning to quietly back away from the quackery that, until now, has characterized their Wellness Center. Let me dash those hopes.
Some approaches may be considered unconventional, but most – acupuncture, yoga, Chinese herbal medicine, guided imagery and relaxation techniques – have scientific backing. We have heard from our patients that they want more than conventional medicine can offer and we believe it is best that they undertake these alternative therapies under the guidance of their Cleveland Clinic physician.
I wonder which approaches Cosgrove considers “unconventional,” and what, exactly he means by “unconventional”? The use of vague and slippery terminology is a hallmark of pseudoscience, and it is discouraging to see Cosgrove slip into that form so easily. On their website they promote energy medicine:
A method of healing that involves balancing and restoring the body’s natural energies for the purposes of increasing vitality, balancing emotions, and improving health.
This is pure vitalism, which is a prescientific notion that was discarded 150 years ago. Their website also claims that the treatments “patients find most helpful” include things like Reiki (which is just Eastern faith-healing). Notice how they carefully avoid saying that these treatments actually work, or that they are demonstrated by scientific evidence, but patients find them helpful. So I guess by “unconventional” Cosgrove means that they are pseudoscientific quackery.
What about the treatments that Cosgrove claims “have scientific backing?” We have discussed acupuncture at length here. Systematic reviews of the evidence show that acupuncture does not work for any indication. Acupuncture does not have better scientific evidence supporting it, just better marketing. Yoga is exercise, and it has the benefits of exercise. This is not alternative. Relaxation techniques also, in my careful reading of the scientific literature, cause relaxation. I know that may come as a shock, but it’s true. Relaxation, it turns out, is relaxing which reduces stress (which is pretty much the opposite of relaxation). Again – there is nothing alternative about any of this, unless you make “healing” claims that go beyond the evidence.
Chinese herbal medicine is more of a complex topic. Herbs are drugs, which can have real effects. There is nothing magical about herbs (unless you believe that they are, in fact, magical). But there are two big problems with Chinese herbal medicine. The first is that it is embedded in Traditional Chinese Medicine, which is mostly ancient superstition, no different than Galenic medicine and bloodletting.
The second is that herbal medicine is just sloppy. The herbal drugs used are poorly characterized, not standardized, insufficiently studied and the claims made for them are not adequately evidence-based. It’s just messy pharmaceutical treatment based mostly on tradition and anecdote, rather than careful scientific evidence.
Elsewhere in the article Cosgrove praises their Functional Medicine center. We have discussed functional medicine at length before, and I won’t repeat it here. Suffice to say this is just another flavor of CAM pseudoscience in medicine, sprinkled with more lab tests and a more deliberate appearance of science, without actually being science-based.
Cosgrove justifies embracing “unconventional” and pseudoscientific treatments, at least in this article, in two ways. As quoted above, patients want these treatments, so Cleveland Clinic might as well make money off of them (I mean, guide their patients to proper use, whatever that is). This is misguided (if sincere). Patients still look to experts and professionals to give them proper advice and guidance. They assume that large venerable institutions of medicine base their recommendations on science and evidence. When you embrace pseudoscience you don’t control it – it controls you. That is what this recent episode with Neides should have taught Cosgrove, but apparently didn’t.
He concludes with an appeal to need:
Cleveland Clinic is the first major academic medical center to embrace many of these alternative strategies. We believe that doing so is justified by the magnitude of the disease challenge. By making healthier choices, people can avoid medications and procedures. And that truly is the best medicine.
This is just poor logic. Needing to prevent disease does not justify embracing pseudoscience. In fact, the opposite is true. Yes, the disease burden facing our aging population is enormous. Also, as we solve the simpler medical problems we are left with more and more complex problems. As technology advances, our choices get more complex. This requires an increased dedication to medicine that works. We know what is safe and effective because of careful, rigorous, thorough and unbiased assessment of all available evidence.
Watering down the rigor of evidence in medicine will not move us toward greater health. It will not solve the problems faced by the growing demands for health care. It will worsen them.
The Cleveland Clinic had an opportunity to reassess their approach, and to make a much needed course correction. Instead they have reaffirmed their dedication to embracing pseudoscience and quackery under the umbrella of marketing terms that are meant to deceive and distract. They have made themselves into a powerful force for pseudoscience in medicine.
Cleveland Clinic Fully Embraces Pseudoscience Steven Novella