East meets West at Beth Israel—Cage Match!

When those of us who practice real medicine write about implausible medical claims, we are often accused of lacking compassion, as if offering false hope is the same as compassion. We are also accused of turning away from therapies that “couldn’t hurt”. After all, if someone wants to use aromatherapy, what’s the harm?

The truth is that improbable medical claims are dangerous, and not just for the obvious reasons (i.e. dangerous practices such as chelation therapy). They also turn people away from real therapy. I’ve previously introduced you to the concept that there is no such thing as “alternative medicine”. When the Chinese herb artemisin was found to cure malaria and became widely used by modern doctors, it became by definition not alternative. If something “altie” like massage makes someone feel better, it’s neither altie nor “mainstream”—it’s just nice; go and do it. Yoga probably falls into the latter category, of a practice that may give comfort to some people, but is unlikely to affect objective measures of health and disease.

As reported (quite well) by the Times:

A foundation run by Donna Karan, creator of…the much-imitated DKNY line of clothing, has donated $850,000 for a yearlong experiment combining Eastern and Western healing methods at Beth Israel Medical Center. Instead of just letting a celebrated donor adopt a hospital wing, renovate it and have her name embossed on a plaque, the Karan-Beth Israel project will have a celebrated donor turn a hospital into a testing ground for a trendy, medically controversial notion: that yoga, meditation and aromatherapy can enhance regimens of chemotherapy and radiation.

I’ll stipulate that by “Eastern and Western healing methods” they mean credulous Americans’ impression of what is done in “the East” vs. science-based medicine as it is practiced around the world (the Eastern and Western bits).

Why invest so much in bringing relaxation techniques to the hospital? According to Beth Israel’s CEO:

“While we are giving patients traditional medicine, we are not going to exclude patients’ values and beliefs,” said Dr. David Shulkin, the chief executive of Beth Israel, noting that a third of Americans seek alternative treatments. “To make care accessible to these third of Americans, we’re trying to embrace care that makes them more comfortable.”

What is 15% of cancer patients were seeking euthanasia? What if they wanted methamphetamine? Should we integrate these practices into our modern cancer centers? I suspect the motives are both financial and compassionate, but the compassion is misguided. Providing cancer patients undergoing treatments with relaxation techniques, treatment of pain and anxiety, spiritual care, and other comforts is hardly alternative. To claim that they help people with cancer get better is the big leap. (And let’s set aside the possibility that an “Eastern” outfitted cancer center may not groove with everyone’s sense of spirituality).

Some of Ms. Karan’s stated goals are worthy:

Ms. Karan hopes to prove that the Urban Zen regime can reduce classic symptoms of cancer and its treatment, like pain, nausea and anxiety (thereby cutting hospital stays and costs) and serve as a model for replication elsewhere.

Like many patients, she has turned toward dubious practices because of previous bad experiences with real medicine:

Ms. Karan longed for the help of a Marcus Welby, the kind of friendly, wise doctor who seemed possible only on television, and even then in a more innocent era. “Today everybody’s a specialist,” she lamented in an interview. “We’re only one person, even though we have a lot of parts, but everybody takes a piece of us.”

Despite all his high-tech medical treatment, her husband could not breathe, she recalled, until a yoga teacher taught him to “open his lungs.” “He went from ah-ah-ah,” she said, mimicking his gasping for breath, “to aaaaahh.”

“Everybody was dealing with his disease,” she said of the doctors. “Nobody was looking at him holistically as a patient. How do you treat the patient at the mind-body level? Not only the patient but the loved one?”

The above anecdote has an identifiable problem, which can be partly ameliorated via better selection and training of physicians, but one fact of science-based medicine is that experts are required, and not every one of these experts can get to know “the whole patient” and still serve everyone. Karan’s cure may suffer from some of the same problems as mainstream medicine—it’s a “one size fits all” solution. I’m not so sure an Orthodox Jew or Evangelical Christian would feel all that comfortable in her Zen center.

But there are some real problems here that go deeper than just debating the merits of having a Zen cancer center. The sad truth is that behind every so-called compassionate altmed healer is a charlatan. In this case, the fox is already in the hen house. Beth Israel has a “Center for Integrative Medicine” and the docs from this program are closely tied to Karan’s experiment. The two doctors named in the article have rather interesting histories. (They are both “real” doctors. They just seem to have a “different” view on health and disease.)

Take Dr. Woodson Merrell, the head of BI’s Integrative Med department. Among his publications is an apologetic for homeopathy (W . Merrell, E.Shalts. Homeopathy. Medical Clinics of North America, Volume 86, Issue 1, Pages 47 – 62.). If you read here regularly, you may recall my disdain for homeopathy. Here, just a taste from his paper:

Homeopathy essentially rests on two scientific tenets: the principle of similars and a claim concerning the biologic effects of high dilutions. Despite the principles’ apparent contradictions of common sense in medicine and a clear mechanism of action in physics, careful examination shows that they actually are compatible with many current common biomedical observations.

If we took everyone to task on one piece of misguided writing, we’d all be in trouble. Let’s see what else he’s written:

    The Arginine Solution, The First Guide to America’s New Cardio-Enhancing
    Supplement By Robert Fried, Ph.D., Woodson C. Merrell, MD and James Thornton
    The Impact of Acupuncture and Craniosacral Therapy Interventions on Clinical Outcomes in Adults With Asthma. L .Mehl-Madrona, B. Kligler , S. Silverman, H. Lynton, W. Merrell. The Journal of Science and Healing. Volume 3, Issue 1, January 2007, Pages 28-36. “Our study showed that the two complementary therapies studied–craniosacral therapy and acupuncture–could be expected to reduce medication use and improve asthma-related quality of life in adults with asthma.”

Other than his standard medical qualifications, I’m not sure why this guy has anything special to offer a cancer center. If it’s pushing strange supplements, homeopathy, or cranial-sacral therapy, well, perhaps the cancer center isn’t interested in being modern any longer.

His collaborator, Dr. Benjamin Kligler (yes, like Merrell, a real doctor), has a few more publications than does Merrell, but these are hardly rigorous:

    Lynton H, Kligler B, Shiflett S. Yoga in stroke rehabilitation: a systematic review and results of a pilot study. Top Stroke Rehabil. 2007 Jul-Aug;14(4):1-8.
    Kligler B, Koithan M, Maizes V, Hayes M, Schneider C, Lebensohn P, Hadley S.
    Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study.
    BMC Med Educ. 2007 Apr 18;7:7.
    Erickson K, Shalts E, Kligler B.Case study in integrative medicine: Jared C, a child with recurrent otitis media and upper respiratory illness. Explore (NY). 2006 May;2(3):235-7.

Neither of these doc’s publications gives me great confidence. And then there’s the complementary health center they run. Surprise, surprise…they offer a zoo of woo. And they offer a focus on “functional medicine“, a whole new kind of woo.

Hey, I don’t doubt the competence or compassion of either of these docs—I just think that they’re heading down a dead-end.

Perhaps this sounds overly harsh, too critical. But let me sum this up for you, dear reader.

A major urban medical center is letting a fashion icon redo part of their cancer center in Zen style to focus on yoga. The “scientific” end of the deal is being run by a couple of docs who believe in a non-science-based approach to health and disease. And a ton of money is pouring into this effort.

Look, we are obviously doing something wrong here. There is a perception among some patients that their doctors are not compassionate or holistic enough. The good news is that it’s rather easy to provide compassionate care that is science-based. All it takes is a good ear and a human touch. It doesn’t have to involve adding questionable modalities to our armamentarium.