Consider the following fundamental principles: First, billionaires should be allowed to donate their money however they wish, short of financing criminal enterprises. Second, it's almost impossible for a university to turn down a nine-figure donation.
That brings us to the announcement on Sept. 18 of a $200-million gift by Henry and Susan Samueli to UC Irvine. The donation, the seventh-largest ever to a single public university, will be used for a new building on campus to house the Samueli College of Health Sciences, which will incorporate UCI's medical and nursing schools and planned schools of pharmacy and "population health" (that is, public health). But most of the money will be devoted to an endowment for up to 15 chairs for world-class faculty with "expertise in integrative health" and for the training of students in that curriculum.
And that's where UCI is stepping into a minefield.
The very terms "integrative health" and "integrative medicine" raise hackles among physicians who say they're code for introducing unproven and debunked nostrums into a curriculum that should be based exclusively on scientific evidence. Among the approaches with little or no scientific support that get "integrated" are acupuncture, herbal concoctions, and homeopathy and naturopathy.
Several major institutions, including Stanford and Johns Hopkins, have added elements of integrative medicine to their curricula — prompted at least in part by demand from patients and the backing of wealthy adherents.
"Universities shouldn't fall for this," says Steven Novella, a neurologist at Yale and executive editor of the Science-Based Medicine blog. "They're buying the spin. It's an absolute failure of academia to allow this sort of thing to happen." In a blog post, Novella flayed UCI's establishment of an integrative medicine curriculum as "quackademic medicine."
UCI seems sensitive to the peril of becoming associated with that trend. Howard Federoff, the university's vice chancellor for health affairs, insists that the teaching, research and treatment funded via the Samueli endowment will be rigorously evidence-based.
"We're not going to promulgate things that have been established to be ineffective," he told me. "There's nothing I would ever allow in the context of clinical care if I believed the clinical evidence was lacking."
But he says that Gorski and Novella are too skeptical. "As physician scientists, we need to keep the broadest open mind to to new ways to deliver care or monitor care or diagnose diseases," he says.
It isn't unusual for treatments that once were dismissed out of hand to be discovered later to have effective applications, Federoff says. Even some skeptics agree that some therapies commonly marketed as "alternative" or "complementary" treatments may warrant well-designed studies to establish whether they actually work.
"I'm not sure there's a lot of promise, but there's room to do some things with unexplored herbal substances and room for a good study of chiropractic," says Stephen Barrett, a retired North Carolina psychiatrist who runs the skeptical blog Quackwatch.
Integrative health, however, is vulnerable to being dismissed as a brand name with an exaggerated marketing pitch. Typically, it's described as a holistic approach to treat "the whole person, not just the disease," to cite the definition found on the home page of UCI's Susan Samueli Center for Integrative Medicine, which was founded in 2001 with a $5.7-million donation from the couple.
Yet that merely sets up "traditional" medical practice as a straw man. Many treatments claimed as special by integrative medicine promoters — including massage, exercise, nutritional counseling and lifestyle advice — long have been part of routine medical consultations without being adorned with the term "holistic."
Federoff, an expert in gene therapy and neurodegenerative disorders who became head of UCI's medical institutions in 2015, maintains that doctors haven't incorporated those approaches into their practices systematically enough. "I've recommended to patients many times that they should eat better, drink alcohol in moderation, should not smoke," he says, "but most clinicians do not capture fully how to measure the impact of those recommendations." UCI's vision of integrative health, he says, will include research into how exercise works to change the body's resistance to disease.
But promoters of alternative and integrative medicine often go further to embrace approaches with no established scientific basis. "It's been said that what's good about integrative medicine is not unique, and what's unique about it is not good," says Gorski. "You don't need to embrace quackery to treat the whole patient."
The biggest problem UCI may have with the Samuelis' donation is the couple themselves. The family's fortune, which is estimated by Forbes at more than $3 billion, derives from Broadcom, a chip manufacturer co-founded by Henry Samueli in 1991. The couple also own the Anaheim Ducks of the National Hockey League. Their philanthropic generosity is a byword, including a $30-million gift to UCLA to support what is now the Samueli School of Engineering and Applied Science.
They also have a long history as promoters of unproven or disproven medical approaches. Susan Samueli traces her interest in homeopathy back to a trip to Paris some three decades ago during which she caught a cold, or felt one coming on. As she told my colleague Teresa Watanabe, a friend plied her with a homeopathic remedy she says cured her.
As the basis for a lifelong commitment to homeopathy, the story strikes physicians as absurd: Colds are a self-limiting ailment not known to respond to any treatment but the passage of time. Yet Susan Samueli soon turned her husband into an adherent. Susan Samueli was not available to comment for this column.
"Susan was a huge believer and had many friends who were doing various things in homeopathy and Chinese herbs and nutrition and diet," Henry Samueli related in an April 2016 podcast with Wayne Jonas, then the head of the Virginia-based Samueli Institute, which purported to study alternative medicine but has been wound down this year. "Every time I felt a little runny nose or a sore throat I said, 'Susan, give me a remedy.' So I'm totally bought in now … I'm a complete believer that these alternative therapies have a lot of efficacy." He said the couple's goal became to "try to develop some scientific evidence behind it, because it's all anecdotal, and it would be nice to have a little firmer scientific basis."
As it happens, homeopathy is one "alternative" medical approach that is conclusively regarded as useless, even by experts who encourage study of other nontraditional therapies. Its idea, which dates back to the 18th century, is to treat diseases with substances that create the same symptoms, but at such a diluted level that no trace of the substance remains in a dose chemically indistinguishable from water. The concept has been thoroughly tested and thoroughly debunked.
Federoff says UCI's medical program will be insulated effectively from the Samuelis' personal beliefs, and the donors accept that. "Notwithstanding that Susan has been a persistent proponent of these approaches, they know that it is up to us to really prove out what will work and not work," he says. "I don't think their history will in any way negatively impact what we do. My promise to them all along is that we will collect the best evidence."
Yet that independence may not be so easy to maintain. As part of the new funding, the Susan Samueli Center will be elevated into the Susan Samueli Integrative Health Institute and absorbed into the new medical complex. The center's director, Shaista Malik, will be promoted to associate vice chancellor of UCI to "collaborate" with the other medical schools, Federoff says. But he says she'll have no jurisdiction over the other institutions.
The Samuelis will have no voice in recruiting or choosing occupants of the endowed chairs, Federoff says, but at least one of them is likely to be on an advisory board for the Integrative Health Institute.
UCI's own record in this vein isn't encouraging. The Susan Samueli Center offers treatments that combine common, well-understood therapies, such as exercise, with known quackery, including homeopathy. In April 2011, Susan Samueli delivered a guest lecture to a campus group called Students for Integrative Medicine, at which she bemoaned on behalf of homeopathic practitioners that "it's tough to get the respect we deserve," according to a report in a campus newspaper.
There's no question that the Samuelis' gift could do a tremendous amount of good — $200 million will go far to jump UCI up into the front ranks of academic medical institutions. But its pedigree also will bring a lot of scrutiny into whether the university is maintaining its explicit commitment to scientific rigor.
Some people doubt it can.
"Probably there are some people at UCI who think, 'We'll accept the money, and just do the science-based stuff like nutrition and massage,'" Novella says. "But you can't promote homeopathy and naturopathy and also say you're going to have high standards of science and evidence. They're mutually incompatible."