The story of the Trojan horse is well known: the Greeks allegedly delivered to the city of Troy a massive wooden horse, which the Trojans mistook for a gift and pulled inside their city. At night, this hollow horse released a band of Greek men who had been hiding inside of it, and they opened the city gates so that their army could strike the final blow in the Trojan War.
The concept of “integrative medicine” has gained in popularity since it was coined by Dr. Andrew Weil in 1994 and it is important to recognize it as the Trojan horse that it is. Although the metaphor usually implies deception, many fans of integrative medicine promote this gift horse without misleading intentions, but the damage may well be the same.
A horse designed by a committee
The claim at the heart of integrative medicine is that conventional medicine is not enough and that so-called complementary and alternative medicine (CAM) is also insufficient, but that by integrating the two, patients get the best of both worlds. Medicine is accused of being hyper-focused on disease and on the use of pharmaceuticals, failing patients with chronic illnesses. CAM is positioned as the answer to this, the yang to conventional medicine’s yin to yield a complete, holistic perspective.
On its surface, the CAM half of integrative medicine looks wonderful. We are usually told it involves nutrition and exercise. Similarly, proponents of integrative medicine claim its added value is in holism, meaning focusing on the whole person. Strangely though, as has been argued by many people, conventional medicine at its best is focused on the whole person. But integrative medicine’s seductive, superficial messaging does not end there.
This Trojan horse has been making major in-roads inside of academic hospitals, and it moves on four wheels: the appeals to nature, antiquity, authority, and popularity. Hospital directors and patients alike are told that integrative medicine prioritizes natural treatments... without mentioning that synthesized products are not necessarily harmful and natural ones, not necessarily harmless (or useful). They are told that many of these interventions, like acupuncture, have been used for a long time... just like bloodletting was in ye olden days. They are told that many serious university hospitals, like Johns Hopkins, Duke, and Yale, are already offering integrative medicine... but keeping up with the Joneses is no substitute for a critical appraisal of the body of evidence. And they are told that many, many people are clamouring for these therapies. Market forces being what they are, the Trojan horse rolls into town and we may wonder what pours out of it.
The two towers
Inside the Trojan horse of integrative medicine, painted in the colours of nutrition and exercise, we find unproven and disproven remedies like homeopathy, the 200-year-old philosophy that claims that the more a substance is diluted, the stronger it becomes. We find Reiki and other energy healing interventions, which pretend that hands-off massages of an undiscovered force field around the body can provide healing. We find poorly regulated herbal remedies, problematic therapies like acupuncture, and things like reflexology, where a foot massage can somehow help your stomach heal itself. The horse also contains more benign interventions, like art therapy and massages, but the majority of CAM’s contribution puzzles the mind. These often pre-scientific folkloric therapies often lack plausible mechanisms. Given our extensive knowledge of biology, it makes no sense for the entire human body to be represented on the sole of our feet (see reflexology). Given our extensive knowledge of chemistry, it makes no sense for vast dilutions that leave behind no trace of the ingredient to work (see homeopathy). Yet proponents often throw their hands up when confronted with this and simply claim that it works, how ever it may work.
Universities can easily fall under the spell of integrative medicine because of what I would call “the two towers.” Imagine two towers that visually represent the evidence we have for conventional medicine and for complementary and alternative medicine, things like homeopathy and Reiki. The conventional medicine tower has an old foundation and is continually being extended and repaired with better materials. By comparison, the CAM tower’s foundation is made of cheap, imitation material, and while there’s a shell that gives it its full height, the bricks have not been laid yet. But the structure is draped in a banner that illustrates what the tower will look like when finished. From a distance, both towers appear similar. Same height, same look. But when you get closer to the CAM tower, you notice how grossly incomplete it is. “Don’t worry,” you are told, “what we have so far is very promising and we will keep building it.” This slogan never goes away. The CAM tower will always be sold as promising, year after year, convincing many people to invest in it.
Always look a gift horse in the mouth
Studies of ear acupuncture, craniosacral therapy, homeopathy and many other complementary interventions are usually small, poorly done, and encouraging. When rigorous trials are completed, they fail to demonstrate efficacy, which leads CAM proponents to return to smaller studies and extract hopeful results from those. This tower of promising results can then be presented to academic health centres by philanthropists who believe acupuncture or homeopathy cured them, and their generous donations can lead to the creation of integrative medical centres within these hospitals. Impressive consortia are created to advocate for integrative medicine and to put pressure on medical school curricula to pull the Trojan horse in.
There are clear harms to this. Obviously, if I were to argue that because astronomy is insufficient, it needs to hold hands with astrology in university faculties, it would be easier to see the potential for intellectual harm. Similarly, I have seen Canadians elevating Indigenous ancestral knowledge to the same level as science and asking for its integration into medicine, without testing these claims with the most rigorous tools we have, and I find this equally troublesome
There’s also the financial harm to selling invalid therapies to patients, but perhaps an even bigger eye-opener on the subject of harm is vaccination. Integrative medicine frequently does not embrace immunization, one of the most important public health interventions we have. Dr. Daniel Neides, former director of the Cleveland Clinic Wellness Institute, infamously wrote a furious anti-vaccination screed in 2017 on the website Cleveland.com. Meanwhile, a survey completed by 290 members of the American Board of Integrative and Holistic Medicine revealed them to be more likely than their conventional counterparts to believe misinformation about vaccines (e.g. alternative schedules, toxicities, link to autism). Chiropractors, whose practice is often rolled into integrative medicine, are notorious for harbouring a significant percentage of antivaxxers; ditto for naturopaths. Given how many CAM disciples worship at the altar of Mother Nature and see toxins everywhere, a vote for integrative medicine often risks bolstering unnecessary vaccine hesitancy.
If you are caught looking this Trojan horse in the mouth, the most likely retort you will hear is that conventional medicine has problems. Yes, it does. It is true that medicine does not offer great solutions to many chronic conditions, chief among them chronic pain. Some of its solutions, like opioids, have also caused significant harm because of misplaced economic interests. But the medicine tower gets fixed. Moldy parts are extruded and replaced. Meanwhile, the CAM tower remains deeply flawed and mostly illusory. The bricks are coming, we are told, and soon we will have the proof we need.
If I may bring one more metaphor to this crowded landscape, it would be Dr. Ben Goldacre’s pearl of wisdom. “Problems in aircraft design,” he says, “do not mean that magic carpets can actually fly.” As the Trojan horse of integrative medicine knocks on the doors of our institutions, we must remember that what we need is not a hollow prize with a corrupting cargo; we need to keep fixing the real tower.
Take-home message:
- Integrative medicine is a philosophy that advocates for the integration of conventional medical care with numerous complementary and alternative therapies, like Reiki and homeopathy
- The evidence for these complementary therapies is often lacking but they keep being sold as a promising solution to the problems of real medicine
- It’s important to remember that just because there are problems with airplanes, the solution is not to switch to flying carpets
