My desire to be the firstest with the mostest when it comes to blogging about new articles notwithstanding, as I perused the table of contents of the NEJM this week, I was shocked to see an article that made me wonder whether the editors at NEJM might just be starting to “get it”—just a little bit—regarding “integrative” medicine. As our very own Mark Crislip put it a little more than a week ago:
If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.
Lately, though, I’ve been more fond of a version that doesn’t use fancy words like “instantiate”:
If you integrate fantasy with reality, you don’t make the fantasy more real. You temporarily make your reality seem more fantasy-based, but reality always wins out in the end.
The part about the cow pie needs no change, although I think ice cream works a bit better than apple pie. Your mileage may vary. Feel free to make up your own metaphor inspired by Mark’s.
In any case, in the Perspective section, I saw three articles about “patient-centered” care:
Goal-Oriented Patient Care — An Alternative Health Outcomes by David B. Reuben, M.D., and Mary E. Tinetti, M.D.
Shared Decision Making — The Pinnacle of Patient-Centered Care by Michael J. Barry, M.D., and Susan Edgman-Levitan, P.A.
Defining “Patient-Centered Medicine” by Charles L. Bardes, M.D.
As I and several of my fellow SBM bloggers have pointed out, the whole concept of “patient-centered” care, as worthy as it is in theory, is all too often in practice co-opted by promoters of unscientific, pseusocientific, and faith-based health care modalities to justify quackery. That’s why the fourth article on the list surprised me:
What’s the Alternative? The Worldwide Web of Integrative Medicine by Ranjana Srivastava, F.R.A.C.P.
When I saw this title, I was rather expecting apologetics about “integrative” medicine. What I got instead was an article that would have been appropriate right here on this very blog, a post about a woman who had fallen prey to a dubious test promoted at an “integrative” health fair and the devastating results of that test. That’s why I was suprised.
After all, let’s look at the record of the NEJM over the last couple of years. What is still considered to be one of the best medical journals in the world, if not the best, appears to be the victim of a conscious effort on the behalf of its editors to dethrone itself as king of medical journals through its increasing acceptance of the spin placed on medical science by those who would integrate fantasy with reality in medicine in the hope of improving medicine. Unfortunately for them reality has a way of always winning out in the end, just as the cow pie wins out in Mark’s metaphor.