CLEVELAND — In the span of a few days, the anti-vaccine screed of a Cleveland Clinic doctor prompted a social media firestorm, an apparent retraction from the physician, and promises of disciplinary action by administrators of his prestigious hospital system.
But those reactions will not entirely contain the damage caused by the rant, which has already been picked up by anti-vaccine organizations, or address a more fundamental question: Why do hospitals that espouse evidence-based medical care operate alternative medicine institutes that offer treatments with little foundation in science?
The anti-vaccine column that triggered the weekend’s outcry was written by Dr. Daniel Neides, director and CEO of the Cleveland Clinic’s Wellness Institute, which advertises homeopathic remedies and alternative weight loss and pain management treatments with little basis in science.
The clinic, which strongly disavowed Neides’s statements, is far from alone among major US medical centers in operating a wellness institute. Seeking to broaden their appeal and increase revenue, a flurry of US hospitals have opened alternative and complementary medicine centers in recent years. Top hospitals and academic medical centers, including the Mayo Clinic, University of California, San Francisco, the University of Iowa, and Duke University Medical Center, participate in what has become a multibillion-dollar industry.
“It’s infuriating,” said Tim Caulfield, a lawyer and health policy professor at the University of Alberta in Canada who often exposes fraudulent health advice. Hospitals “are providing therapies that don’t have good evidence behind them, and it absolutely opens the door to this kind of nonsense.”
Some medical centers refer to the practice as integrative care — the weaving together of traditional and alternative medicine. There’s even an academic consortium for integrated care that brings together more than 60 academic medical centers and affiliated clinics with complementary health branches. The board of directors includes medical doctors from Boston University, MD Anderson Cancer Center, Mayo, and Vanderbilt. Its mission: “Advance the principles and practices of integrative healthcare within academic institutions.”
Dr. Michael S. Sinha, a physician-attorney and research fellow at Brigham and Women’s Hospital in Boston, said such institutes can be lucrative because of high patient demand for their services. Many patients are willing to pay out of pocket for services such as acupuncture, cupping, moxibustion, and reiki. Many of the services offered by such institutes can be billed to insurance companies, even if not supported by rigorous clinical studies.
In some cases, Sinha said, emphasis on naturopathic or holistic remedies, rather than conventional medical treatments, can be problematic, especially for conditions that have evidence-based treatments.
“Damage to reputation can be significant, as the Cleveland Clinic fallout demonstrates,” Sinha said.
Some doctors took to social media, however, to caution against throwing stones because many prestigious medical centers promote testing and treatments, such as robot surgery and proton beam therapy, for purposes that aren’t necessarily grounded in science.
Same reason robots in prostatectomy & proton beam radiation therapy took off: patient demand fueled by self-interested pre-evidence hype. https://t.co/3AmxmImNyN
— Timothy Gilligan (@GilliganTimothy) January 8, 2017
In his commentary posted on Cleveland.com, Neides, who is a family doctor, said that preservatives and other ingredients in vaccines are dangerous and are likely behind the increase in diagnosed cases of neurological diseases such as autism — a claim that has long been discredited by researchers.
“Does the vaccine burden — as has been debated for years — cause autism? I don’t know and will not debate that here. What I will stand up and scream is that newborns without intact immune systems and detoxification systems are being over-burdened with PRESERVATIVES AND ADJUVANTS IN THE VACCINES,” he wrote. Adjuvants are added to vaccines to prompt a stronger immune response.
Neides issued an apology and apparent retraction on Sunday, saying in a statement released by the Cleveland Clinic: “I fully support vaccinations and my concern was meant to be positive around the safety of them.” A clinic spokeswoman said Saturday that “he will not be doing an interview.”
As an undergraduate, Neides studied psychology at Ohio State University, graduating in 1988. He went on to pursue a medical degree there as well, doing his residency in family medicine at the Riverside Methodist Hospital in Columbus.
He hasn’t always promoted anti-vaccination ideas.
Two years ago, around the time he began contributing to Cleveland.com, he wrote, “Having survived the nightmare of the 2009 flu epidemic, you can bet I am the first in line with my sleeve rolled up. I hope many of you will take advantage of the many flu vaccine clinics that Cleveland Clinic has to offer. With a nod to Benjamin Franklin, ‘an ounce of prevention is worth a pound of cure.’”
His articles for Cleveland.com included the Cleveland Clinic’s official logo next to his name, but the hospital said that it does not approve of that use of its logo. Cleveland.com removed his column from its site on Sunday, after the Cleveland Clinic asked it to do so on Neides’s behalf, a spokeswoman for the health system said. But it was re-posted Sunday evening.
His statements about vaccines prompted some in the medical community to question why Neides was allowed to work as a medical educator. He has won a number of awards for his role in shaping curricula and teaching at the Cleveland Clinic Lerner College of Medicine, where he worked as the associate director of clinical education. Clinic spokeswoman Eileen Sheil said by email that Neides’s medical education role “ended a few years ago.”
The Cleveland Clinic Wellness Institute mixes more conventional health advice with ideas you might not associate with a top research hospital. The institute offers psychotherapy and healthier cooking tips — but its website says it also provides “Eden Energy Medicine, Reiki, and other energy healing techniques to promote balance and flow in your body’s energy systems” through “pressure touching” and “tracing and circling over certain areas of the body.”
The institute has a Wellness Store, accessible both online and in-person. Online, you can order everything from “stress-free” coloring books to homeopathic detox kits, which are sold for $36.
That was troubling for Dr. Adam Gaffney, a pulmonary and critical care specialist, who teaches at Harvard Medical School.
“With the wellness movement more generally, what I find troubling is how much of a business it can be,” he told STAT. “If you look for instance at the Cleveland Clinic Wellness Institute website, they have a shop where you can purchase a homeopathic cleansing regimen of some sort. That’s clear pseudoscience. We don’t believe in homeopathy. It bothers me that products are being sold in that fashion to patients.”
He added that this is symptomatic of an entrepreneurial model instead of a professional one: “We see time and time again how the corporatization of medicine produces unfortunate results, when health care becomes a commodity. … There is a huge difference between prescribing medicines and selling products.”
While Gaffney believes in freedom of speech for physicians, he thinks that they need to use that responsibly so that their statements don’t conflict with their role as doctors. “Promoting discredited ideas about the lack of safety of vaccines is not a controversial idea, it’s a wrong idea,” Gaffney said. “It’s been clearly disproven by the science.”
Dr. Paul Offit, a professor of pediatrics and director of the vaccination education center at the Children’s Hospital of Philadelphia, said doctors in integrative medicine institutes sometimes “cross the line into this fuzzy, metaphysical thinking, which is what [Neides] did.”
He said Neides displayed a total lack of knowledge about the preservatives and activating agents used in vaccines, and did not even properly distinguish between them in his column. “It’s the usual bull[expletive],” he said, “which is to say that everything with a chemical name is bad for you.”
Offit noted that his own hospital has a division of integrative and holistic medicine. “I too fight this fight internally,” he said. “We all do. Harvard does. Yale does. It’s not uncommon to have this, and the reason is that hospitals cater to a marketplace, and there is a market out there for this kind of medicine.”
Plenty of physicians in the integrative medicine community disagree vehemently with Neides’ questionable views on vaccines.
“There’s no one that I know in integrative medicine who would say you should use an alternative approach to preventing communicable diseases in children,” said Dr. Greg Fricchione, the director of Massachusetts General Hospital’s Benson-Henry Institute for Mind-Body Medicine, who added that his daughter is the medical director for immunizations for the city of Chicago.
The Cleveland Clinic Wellness Institute is well-regarded, he said, but he did not worry that Neides’s comments will affect the credibility of integrative medicine as a whole.
“This is one guy, and I’m not sure of what his motivation was,” Fricchione told STAT. “I don’t think it will impair our ability to continue to provide integrated approaches, whole-person approaches, to health care … and I don’t think it will impair our ability to do the best basic and clinical research in integrative medicine.”
John Henry, the owner of STAT, has contributed funding to the Benson-Henry Institute.
In some instances, questionable arguments and treatments pitched by alternative medicine doctors force their colleagues to work harder to convince patients that vaccines and other evidence-based treatments are necessary.
Dr. Benjamin Mazer, a resident physician in pathology at Yale New Haven Hospital, sees Neides’s statements on vaccines as an example of a dangerous trend in which doctors promote conspiracy theories that try to undermine proven practices.
“Vaccines really are one of the best representations of modern medicine, so to attack that is to attack the pillar of what physicians have to offer to patients,” he said.
Megan Thielking contributed to this article.