promoted by 52% more of the cancer centers. In
terms of absolute numbers, 17 centers promoted
information on guided imagery in the most recent
analysis (a very slight decline from 18), while dietary
supplements were promoted most recently by 42 of
the 45 centers, up from only 17 in 2010.
All 20 integrative oncology therapies were pro-
vided at the centers to some degree. Only 3 centers of-
fered Ayurveda,^14 while “healing touch” was included
at 13 (29%), Reiki at 18 (40%), and Qigong at 16
(36%). Nutritional services were provided at 41 of the
centers (91%).
Soon after, one of the leading cancer professional
organizations—the American Society of Clinical On-
cology (ASCO)—reviewed and supported a number of
the recommendations made by the Society of Integra-
tive Oncology.^15 Thus, the SIO now has the support of
ASCO. This association will clearly be used as a “mar-
keting” tool, with integrative oncology practitioners
promoting the position that integrative therapy now
has the endorsement of the oncology community. It
may be likely that the number of major cancer centers
promoting integrative therapies on their websites and
utilizing resources to provide integrative oncology serv-
ices will continue to grow.
It appears that we have a significant increase in
major cancer centers promoting integrative therapies
on their websites, a significant number of major cancer
centers providing integrative oncology services, and a
major cancer organization endorsing guidelines pro-
moted by the Society of Integrative Oncology.So What’s the Problem?
At first glance, this may not appear to be a problem. An
organization defining itself as “evidence-based” in the
fight against cancer now has many of the therapies it
has promoted endorsed by a major cancer organiza-
tion. Moreover, the acceptance of the therapies is in-
creasing in major cancer centers. What is there to be
concerned about?
The first consideration is whether the magnitude
of the increase in the use of integrative oncology prac-
tices is accurately presented over the 7-year period be-
tween the completed studies. The lack of precise
definitions of categories and the over-inclusion of in-
terventions that are counted as integrative—that is,
therapies that purportedly need to be “integrated” into
mainstream medicine—is problematic. For example,
nutritional consultations were commonly used even
when I (MS) was practicing at Johns Hopkins several
decades ago. These consultations were not viewed as
“integrative,” “alternative,” or “complementary” thera-
pies. As a function of the disease or treatment, manypatients were challenged to take in enough nutrition to
maximize their health. Nutritionists were not huddled
away in an “integrative” clinic, but were already clearly
part of mainstream medicine.
The same could be said for labeling “dietary sup-
plements” as integrative. Many patients may suffer
from vitamin or mineral deficiencies from the disease
or treatment and receive such supplements. This is not
“evidence” for the use of integrative therapy in cancer
centers. It is not clear if information provided on can-
cer center websites indicates that such services are part
of mainstream medicine. If so, its inclusion in the
analysis as “integrative” is suspect. There is no mention
of how much of the information on the websites or
services provided is drawn from real science as part of
already accepted mainstream medicine vs. the quack-
ery that often comes with alternative nutritional ap-
proaches. This holds especially true for the inclusion of
exercise, given that physical activity has been clearly
demonstrated to provide benefit in terms of cancer
prevention, recurrence, and quality of life.^16 Exercise is
clearly part of mainstream medical practice.
In sum, several integrative oncology interventions
do not fit the definition at all. They are clearly already
part of mainstream cancer care. This artificially inflates
the results of the analysis, particularly given these in-
terventions (nutritional consultations, dietary supple-
ments, exercise) are by far the services most often
provided and most widely promoted by the cancer cen-
ters reviewed.
First, it is unclear whether the two analyses (2010
and 2017) are comparing “apples to apples.” In the
2010 study,^13 the category of “supportive care” was uti-
lized (the title of the article was “complementary and
alternative medicine and supportive care”) as well as a
listing for “support groups,” which again would be seen
by most professionals and patients as mainstream.
There was no such category in the most recent analysis
and one wonders how “support groups” were catego-
rized. In addition, the analysis of websites was con-
ducted by two researchers “after initial training.” In
addition to not describing how such training occurred,
the “researchers” were in fact the two primary authors
of the study—clearly leading to a strong possibility that
the analyses were biased in favor of “finding” integra-
tive oncology practices.
Second,there is little evidence for many of the in-
terventions noted. There are a number of reviews17,18,19
that question the effectiveness of many of the “integra-
tive therapy” practices reported in the study. Practices
such as healing touch, massage, acupuncture, Qigong,
and Tai Chi do not have quality research to support their
use. Most often, when results have shown benefit, the36 SKEPTIC MAGAZINE volume 25 number 1 2020