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LEVELAND — 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. 

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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.

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.

  • Cleveland Clinic made a decision to offer healthy food and add alternative treatments along with conventional, including pain relief through acupuncture, and their business is so strong that they have bought up many of the other hospitals in the region. They are known for their successful outcomes, and many of my friends owe their lives to doctors at the Clinic. The column should not make us throw the baby out with the vaccine prescription. Cleveland Clinic rocks and Wellness is a big part of that success!

    • The claims Cleveland Clinic is making about reiki, acupuncture, and other modalities are fraudulent. Even if what they are doing might be popular, it does not justify the grave ethical lapses that selling fake medicine requires.

      Here is a 2.5 year-old article that explains with respect to reiki:
      https://sciencebasedmedicine.org/reiki-fraudulent-misrepresentation/

      Can you believe that a mainstream health center would advertise this nonsense?:

      “When we experience good health, [qi] energy flows unobstructed along pathways in the body called meridians. Each meridian is believed to be connected to a specific organ system, and when an energy flow is disrupted by a disease or an injury, illness or pain occurs. Acupuncture is then used to balance the flow of Qi and stimulate our body’s natural ability to heal.”

      Healthcare workers are among the most trusted professionals. They should maintain high ethical standards to maintain that trust.

    • Cleveland Clinic’s Wellness Institute is but one of 24 of Cleveland Clinic Institutes and Departments (http://my.clevelandclinic.org/departments). And within the Wellness Institute, the “woo” such as “Energy Medicine” and a $35.99 “Homeopathic Medicine” product are offered along with evidence-based prophylactics and treatments and such as Dr. Caldwell Esselstyn’s nutrition-based heart-health program.

  • Linda, I fully acknowledge that the Institute of Medicine and almost all US based institutions support the unrestricted use of mercury dental amalgam, and its undisclosed mercury content to patients and parents.

    It helps to ask questions. Why were the Scandinavian countries, which have some of the best dental researchers and journals in the world, the first to phase down and ban dental amalgam? Why were the four retractions of amalgam safety published by toxicologist James S. Woods et al, after they found neurological deficits and kidney function changes in boys with a half dozen gene types that are not rare, not published by the same journal that published dental amalgam was safe? Why is mercury dental amalgam a hazardous waste before installed in the mouth, and after it is removed, but not when in the mouth, even though mercury off-gases in tiny amounts with heat and abrasion? Why are other nations restricting, phasing out, or banning dental amalgam, and not the United States? Is the science different over here, or the institutions which decide what is good science, and safest for patients?

    Here is the International Academy of Medicine and Toxicology’s Position Statement on Dental Amalgam: https://iaomt.org/wp-content/uploads/IAOMT-Position-Statement-Update-2016-6.16.16.pdf. Here is James S Woods et al’s fourth article 2011-2014 in PubMed retracting the findings of amalgam safety from the Children’s Amalgam Trial: https://www.ncbi.nlm.nih.gov/pubmed/25109824.

  • Linda, I acknowledge the Institute of Medicine and almost all US institutions fully support the use of dental amalgam. They need to update their homework, become familiar with newer scientific and medical research, and read outside the US to broaden perspective and knowledge. It also helps to ask interesting questions. For example, why were the Scandinavian countries, with some of the best dental researchers and journals in the world, the first to phase down and end use of dental amalgam? Apparently some of the gene types that do not methylate – clear heavy metals and toxins – well are more prevalent in those nations. Why were the four retractions of amalgam safety in children by Children’s Amalgam Trial toxicologist James S. Woods et al not published in the same US journal that initially published the articles on its safety, after they found boys with a half dozen relatively common gene types had neurobehavioral deficits and kidney function changes compared to the control group? Why would a material that is hazardous waste before installation, and after removal, be completely safe in the human body, in contact with mucosal tissue, in the airway and mouth, gateway to the lungs, blood system, gut, immune system, neurological system and brain, as mercury from amalgams off-gases in small amounts with heat and abrasion? Why would a growing number of other nations take action to protect their more vulnerable citizens, future generations, and the environment? Why would the ADA fight the amalgam phasedown provisions in the Minamata International Treaty on Mercury? Why does the FDA warn consumers to do a patch test 24 hours before using hair color, but not recommend patients be prescreened for immune reactivity to dental and medical device materials before they are permanently installed?

    Here is the position statement of the International Academy of Medicine and Toxicology: https://iaomt.org/wp-content/uploads/IAOMT-Position-Statement-Update-2016-6.16.16.pdf. Here is the fourth article, a summary article, published by James S. Woods et al in Neurotoxicoloy, available in PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176692/. This is a topic on which readers should conduct their own research, because conflicts of interest cloud the field in the United States.

    • International Academy of Medicine and Toxicology? That’s the Holistic Dentists. These are the guys who don’t like fluoridation, one of the greatest advances in public health ever.

      Woods mentions two studies that specifically looked at amalgams:

      “…(DeRouen et al., 2006; Bellinger et al, 2006) conducted between 1996-2006 compared the performance of children with and without Hg-containing dental amalgam fillings on a extensive battery of neurobehavioral tests over a period of 5 to 7 years following dental treatment beginning at a mean age of 10 years. Neither study found significant differences in neurobehavioral performance over the course of the trial when comparing children with and without dental amalgam fillings.”

      Wood’s study lumped dietary mercury with amalgams.

  • I’m a retired Acupuncture Physician/Physical Therapist and this is a very controversial area! Unfortunately, Corporation America has entered the Natural Med Arena for profit! Natural medicine clearly has its place in the treatment of many diseases and pathology, both acute and Chronic! However, in an acute, severe trauma episode, the patient should be rushed to the nearest E R for appropriate care; however, there r some amazing Homeopathic remedies that could be administered ,as adjunctive care, in concert with essential E R Tx, with excellent results! I’ve seen this! Western & Natural medicine both have their place; I’m trained in both and am acutely aware of this! For many chronic pathology, issues, natural medicine is the preferred tx, or augmented tx! I’ve seen this many times, both as a practitioner and patient!
    Most natural medicine Docs r not nearly as affluent, as mainstream Docs; myself, a case in point!
    Much of this really depends on the individual practitioner, in terms of quality of care, etc.
    I’m very happy to see that companies like Cancer Centers of America have a Naturopathic Doc on staff! It’s purely augmentive and I’m certain, efficacious!

    • So a quack is happy to see that other quacks are starting to invade mainstream health centers. Homeopathy and acupuncture work for zero conditions.

  • Regarding vaccinations, there is no controversy regarding their safety and benefits. We should not tolerate vaccine fear-mongers; they are a public health menace. It is unfair and a waste of time to make ethical professionals “work harder” to pitch the safety of vaccines to a frightened public.

    What need to do hospitals have of these “alternative medicine” centers other than to trade vague notions of “natural” and “whole-person” nonsense for financial gain. Anything they offer of actual therapeutic value is better provided by science-based professionals, such as dietitians and physical therapists. And by the way, that worthless homeopathic detoxing is an example of “integrative medicine” practitioners’ idea of getting to the “root cause.”

    “Integrating” non-science-based practices with modern medicine is not possible. It presents an oil vs. water situation. For one thing, there is a problem in not speaking the same language. As a nurse, what am I to make of “blocked chakras” (Therapeutic Touch/Reiki/Healing Touch) or “rising damp from the liver” (acupuncture, Traditional Chinese Medicine)? These are fanciful notions with no basis in reality. I can only scratch my head.

    Alas, insurance companies used to draw the line at unvalidated practices. Now it is up to hospitals to recognize they have an ethical responsibility to patients to only offer science-based treatment that have a demonstrated benefit and safety. At a minimum, they should never use these fringe practices on children. But if they do, I suggest the Reiki practitioners should use a wand when they wave their hands above patients, so the kids get the message that this is really just Hogwarts make-believe.

  • Vaccination still has many pitfalls. Everyday 5 people visit the emergency room for vaccination related injury. 3 of those 5 will have a life changing incident, ie; permanent paralysis or death. Vaccination injury during development is a cause of autism, a small percentage though. The benefits of vaccination still outweigh the potential negatives, unless you are one of the 5.

  • If the medical profession and STAT wants to delve further into the problems inherent in mixing professional and commercial/trade roles in patient care, it should turn its attention to dentistry. Unlike the AMA, the ADA mixes such roles. The ADA was founded in 1859 to promote the use of dental amalgam, a mix of about 50% mercury and other metals. A patent search on dental amalgam shows a shift over time from patents to improve amalgam and the safety of its mixing and delivery system, to patents to contain its harm to dental workers, patients and the environment. ADA affiliates have held patents on dental amalgam. The last one expired mid-1990s.

    When 60 Minutes ran a program in 1990 questioning dental amalgam’s safety, everyone who worked on it except Morley Safer was fired. The ADA added a gag clause to its Code of Ethics. State dental boards expelled dentists who spoke out, until the Supreme Court put a stop to that on the grounds of free speech. Dental amalgam is the product of choice for dental insurers, Indian Health Service, Medicaid, the Military, and the VA. While about half of US dentists no longer use dental amalgam, it is still required teaching in US dental schools. A growing number of other nations are restricting its use, phasing it out, or have banned its use.

    The FDA’s Class II approval of dental amalgam has a curious history: a 40 year delay in classification, creation of a new element in the periodic table (later withdrawn), a new Commissioner who sat on the board of a dental products distributor and still held stock options after taking office who then recused herself under pressure. The 2009 Class II ruling required manufacturers’ Materials Safety Data Sheets (MSDS) to list contraindications and side effects, but no requirement for patients to get information such as they get for prescription drugs, OTC products, or personal care products. No right of written informed consent for patients or parents before it is permanently installed, and no information on the health risks of its removal unless done with special precautions and safety equipment. The transcripts of FDA’s Dental Products Panel Meetings in 2006 and 2010 – which did not support the FDA position of amalgam safety based on new scientific evidence – were archived on its website, so are difficult to find. Litigation has been underway for years.

    Follow the science and follow the money to understand what is going on in healthcare. Leave no stones unturned if you want to promote better health, and less costly, more effective healthcare.

    • That is well constructed arguement, and full of truth. Medicine changes dramatically every hundred years. Things being done today will look medievil tomorrow.

  • The medical system l believe had its grass roots in actual patient care. Today corporate greed has infiltrated the system. In fact the CEO who made the hugest $in 2016 was that of Pharmaceutical company.
    In today’s world one can find reported “evidence” to support a varience of health outcomes. I worked in Gov’t health and shook my head when l realized the reality of “non” health care. Is it not likely that those who will make huge amounts of money by a medical intervention will also willingly provide much financial support to get the evidence needed to keep certain interventions going?
    Many of today’s medical interventions fix the symptom but not the root cause.
    I wish real patient “care” would be supported from both medical and natural resources. I believe both have a place in today’s world. But l am truly frightened how corporate greed is killing the world and it’s inhabitants increasingly. Science and data can support much but my sense is that it may not always tell the whole picture of what it knows.

    • Thanks to Congress, well over $1 billion has been spent funding research on “alternative” practices. It has proved to be throwing money down a rat hole. One Congressman recently chided NIH’s National Center for Complementary and Integrative Health for not finding anything that works.

  • The STAT appears to be using this unfortunate example from the Cleveland Clinic to reinforce its blatant dislike of complementary medicine and an integrative approach to wellness. The issue of vaccine effectiveness has little or nothing to do with a more effective approach to health and wellness. Vaccines are critical to health; so is a more integrated approach to medical practice. I am beginning to have second thoughts about STAT, especially since it appears more and more to be biased. What funding from pharmaceutical companies and other “big medicine” is supporting STAT?

    • What percentage of centers and health professionals advertising themselves as “complementary”, “integrative”, “alternative”, “holistic”, or “functional” are committing health fraud by selling treatments with little to no scientific evidence for safety and efficacy? Surely it is almost all of them, at least from a review of their web sites and what comes out of their mouths.

      And typically, those who believe in fake medicine like the Chinese medicine treatments, energy medicine, or homeopathic detox kits sold by the Cleveland Clinic distrust real medicine like vaccines. This is a well known phenomenon known as “crank magnetism” where people become attracted to multiple crank ideas at the same time.

      As Dr. Mark Crislip says, “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.”

  • Thank you for mentioning, near the end paragraphs, that STAT has a connection to Benson-Henry Institute, affiliated with Mass Gen, and “a resource in the areas of mind body and integrative medicine”.

    Disclosure is important, important enough that it might be mentioned in the contributor links at the bottom.

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