Does $200 Million Quack?

A $200 million gift is turning into a $200 million headache for the University of California, Irvine, as critics argue it is indulging the wishes of wealthy donors who advocate for junk science.

The university announced the gift last week, tagging it as the largest in its history and the seventh largest ever made to a single public university. Longtime UCI donors Susan and Henry Samueli are giving the money to name a “first of its kind” College of Health Sciences focusing on “interdisciplinary integrative health,” the announcement read. The renamed Susan and Henry Samueli College of Health Sciences will be the first “university-based health sciences enterprise to incorporate integrative health research, teaching and patient care” across schools and programs, it continued.

Many medical researchers have pounced on the donation, which they saw as rich donors influencing academic and scientific decisions that should be reserved for academics. They called integrative medicine a rebranding of alternative medicine -- a collection of practices not supported by science, like homeopathy, and of ideas stolen from mainstream medicine, like nutrition. Those stolen ideas do not need to be integrated into mainstream medicine because they are already part of it, wrote one critic, Steven Novella, on the blog Science-Based Medicine.

“What is clearly happening here is an attempt to put a giant thumb of the scale of science and medicine through money,” wrote Novella, who is an academic clinical neurologist at the Yale University School of Medicine and the executive editor of Science-Based Medicine. “That is essentially what has been happening with so-called alternative medicine for the last four decades.”

University leaders have rejected the idea that the College of Health Sciences will be advocating for practices proven to be ineffective. The college’s Academic Senate chair was involved early in the process of securing the Samuelis’ donation and said nothing indicated academic freedom would be violated. He was, however, surprised at the way the donation was portrayed to the public.

If nothing else, the controversy shows how delicate the relationship between donor dollars and academic freedom has become in a time when state funding for higher education is severely restricted. The fundamental tensions are nothing new, experts said. But the UCI situation serves as a reminder that colleges and universities should be thinking hard about just how much influence they might be giving big-name donors and how they will be viewed for taking money from controversial figures.

The Samuelis’ gift stands out for its size, what it will do, the way it was announced and who is giving it. Henry Samueli co-founded a semiconductor maker, Broadcom, and the couple owns the Anaheim Ducks professional hockey team.

They are also longtime backers of integrative medicine. They founded the Susan Samueli Center for Integrative Medicine at UCI with a $5.7 million donation in 2001. Also in 2001, they started a freestanding Virginia-based institute to study alternative medicine that operated for 15 years before saying it would shut down its research and programs in 2017.

Susan Samueli has attracted media attention for telling the story of how she became an advocate for alternative medicine. More than 30 years ago, she came down with a cold while visiting France, according to an account in the Los Angeles Times. A friend suggested she try the homeopathic remedy aconite, and she was cured. The Samuelis believe the methods allowed them to keep their children healthy without using antibiotics.

The couple made clear their allegiance to alternative medicine at an announcement of their UCI gift.

“I firmly believe that health and well-being is achieved when conventional medicine is supplemented with evidence-based, complementary and alternative medicine,” Susan Samueli said.

“So now, with evidence in hand, the timing is right to shift our system toward integrative health,” she said. “Many clinicians are already using complementary practices as part of mainstream medicine. Medical students are demanding integrative health courses and experiences. The public is not only interested, but they are clamoring for it.”

Henry Samueli reiterated that he is a believer in integrative health. His personal physician is Shaista Malik, the director of the Susan Samueli Center for Integrative Medicine at UCI -- which he called “Susan’s center.” Malik monitors Henry Samueli's blood chemistry, adjusts his supplements and cholesterol medication, and makes sure he maintains a healthy lifestyle, he said. He credited his wife for his conversion to the health practices.

“Susan has completely converted me into an advocate for integrative health,” he said. “When I feel a cold or flu coming on, rather than run to the doctor, I run to Susan to figure out which homeopathic remedy or Chinese herb I should be taking.”

UCI’s official press release announcing the gift makes no mention of homeopathy or Chinese herbs. It defines integrative health as redefining the relationship between practitioner and patient “by focusing on the whole person and the whole community.” Integrated health is informed by scientific evidence and includes preventative measures, therapeutic approaches, lifestyle approaches and health-care professionals, according to the release.

The Susan and Henry Samueli College of Health Sciences will include the UCI School of Medicine and School of Nursing, School of Pharmacy and School of Population Health (the current Department of Pharmaceutical Sciences and Program in Public Health are both expected to become schools). It will also include the existing Susan Samueli Center for Integrative Medicine, which will be renamed the Susan Samueli Integrative Health Institute and is slated to cover multidisciplinary research, education, clinical service and community programs.

A quarter of the $200 million gift will go toward a new building for the College of Health Sciences. Another $5 million is earmarked for laboratories and technology.

The remainder will go toward an endowment. It will fund as many as 15 faculty chairs in various disciplines for faculty with integrative health expertise and integrative health training for medical school students. It will also fund scholarships and fellowships, interdisciplinary research projects, curricular development and clinical services in the Integrative Health Institute.

Critics called many of the practices in question quackery and asked what practices the university is integrating.

“If mainstream medicine, by its own standards, uses interventions which have been shown to be safe and effective, the only things left to integrate are treatments that have not been shown to be safe and effective,” Novella wrote. “Some of these unproven treatments are also highly implausible, sometimes to the point that they are essentially magic potions and witchcraft.”

Good science-based primary care doctors take care of the whole patient already, argued David H. Gorski, a professor of surgery and oncology at Wayne State University, on the blog Respectful Insolence. The Samuelis’ gift could do plenty of good, wrote Los Angeles Times columnist Michael Hiltzik. But its source will bring scrutiny into whether the university is committed to scientific rigor.

Malik, the director of the Susan Samueli Center, is being promoted to associate vice chancellor of UCI to collaborate with other medical schools, Hiltzik reported. The Samuelis will not have a say in recruiting or choosing faculty members to hold endowed chairs.

However, they will both serve on advisory boards. The Samuelis or their representative are invited to serve on both an advisory board for the college and one for the institute, a university spokesman, Tom Vasich, said in an email Monday. The advisory boards will counsel the university on the mission and vision of the college and institute.

A College of Health Sciences campus has been part of UCI expansion plans for years, Vasich added. The intention has always been for the four schools to share a focus on comprehensive care for individuals and communities, he said.

UCI was unable to schedule an administrator for interview with Inside Higher Ed Monday. The university’s vice chancellor for health affairs, Howard Federoff, told Hiltzik of the Los Angeles Times that teaching, research and treatment funded by the Samuelis' gift will be evidence based.

“We’re not going to promulgate things that have been established to be ineffective,” he said. “There’s nothing I would ever allow in the context of clinical care if I believed the clinical evidence was lacking.”

Federoff went on to label critics too skeptical, saying physician scientists need to keep a broadly open mind when finding ways to deliver care or make diagnoses. He pointed out that some treatments once dismissed were later found to be effective in some applications.

The Samuelis have been supportive of learning about the most effective ways to address prevention, health and wellness, according to Gerald Solomon, executive director for the Samueli Foundation. Solomon does not see the current medical system paying for health and wellness on a large scale. Research can be valuable, he said.

“One of the greatest aspects of what UCI offers is that it is a leading institution around research,” Solomon said. “And when you engage in good, high-level, evidence-based research, you learn. You learn things that work and things that don’t work. And isn’t it good to know both?”

UCI made clear up front that it would have control over what it chooses to do with the gift, Solomon said.

The gift is scheduled to be disbursed in $50 million increments over time, according to the university. The first $50 million comes in 2017, followed by disbursals in 2020, 2023 and 2025.

Jay Gargus is a professor of physiology and biophysics, a professor of pediatrics, and the director for the UCI School of Medicine’s Center for Autism Research and Translation. He is also the chair of the College of Health Sciences Academic Senate and was involved in early development meetings regarding the Samuelis’ gift, although he was not present for the signing of a gift agreement.

Gargus has seen nothing that makes him believe the gift violated ordinary standards.

“The idea that UCI College of Health Sciences is going to become a home of homeopathy or witchcraft or call it whatever you want, that’s just not going to be the case,” he said. “We’re only going to be doing evidence-based medicine. And it’s going to be rigorously reviewed, programmatically, by the Academic Senate.”

The plan was for the Samuelis’ gift to be the lead gift of a broader fund-raising effort, Gargus said. He was surprised by some of the content at the gift’s announcement but believes it was likely aimed at the donor base.

“What you see on the surface of that infomercial launch that we had would be troubling if you didn’t know more about the whole process,” Gargus said. “I could see why anxiety could be raised about what this is going to be. But once you know how the UC system operates, you know that’s not what this is going to be.”

Tension between donors who want to exert influence or pursue specific goals and universities that need to maintain their academic integrity is nothing new. But what is changing now is the amount of fund-raising taking place and the universities doing it, according to Noah Drezner, an associate professor of higher education at Columbia University Teachers College (who has contributed opinion pieces to Inside Higher Ed in the past).

For many years, only private universities were raising large amounts of money, he said. But as state funding has shriveled, public colleges and universities are trying to raise more and more from donors.

More fund-raising has led to more scrutiny -- both within universities and in broader society about how much influence mega-donors have.

“I think seeing it outside of higher education has just made higher ed fund-raisers and administrators a little bit more interested in that conversation and these larger questions,” he said. “How much are you willing to, potentially, bend mission in order to progress on other things?

“It’s complicated, and these are those difficult questions of ethics that institutions need to grapple with.”