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“CAM” Education in Medical Schools—A Critical Opportunity Missed

Mea culpa to the max. I completely forgot that today is my day to post on SBM, so I’m going to have to cheat a little. Here is a link to a recent article by yours truly that appeared on Virtual Mentor, an online ethics journal published by the AMA with major input from medical students. Note that I didn’t write the initial scenario; that was provided to me for my comments. The contents for the entire issue, titled “Complementary and Alternative Therapies—Medicine’s Response,” are here. Check out some of the other contributors (I was unaware of who they would be when I agreed to write my piece).

Posted in: Acupuncture, Basic Science, Chiropractic, Energy Medicine, Herbs & Supplements, History, Homeopathy, Medical Academia, Medical Ethics, Science and Medicine

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10 thoughts on ““CAM” Education in Medical Schools—A Critical Opportunity Missed

  1. daijiyobu says:

    It is interesting — from the issue you’ve link to — to see the AMA reiterate a central ethical stricture its members must abide by:

    “it is unethical to engage in or to aid and abet in treatment which has no scientific basis and is dangerous, is calculated to deceive the patient by giving false hope, or which may cause the patient to delay in seeking proper care.”

    This sums up SO MUCH alt-med / whatever-else-they’re-marketing-it-as.

    When I search the web with the terms “homeopathy powerful electromagnetic naturopathic” outside quotes removed, at least now the nonsense ND sites are mixed with the scientific skepticism sites.

    I constantly wonder why there isn’t any pressure to force naturopathy to clean up its act.

    For how long with the false advertizing go on?

    Looking at the current New York State legislative session, actually, it looks like instead the medical interests have shook hands with them in mutual self-admiration and there will be licensure.

    Conclusion: nobody is serious anymore, ethical strictures are just words.

    -r.c.

  2. TimonT says:

    I hope one of the SBM writers will respond to the Deepak Chopra article in that issue of Virtual Mentor.

  3. pmoran says:

    I hope one of the SBM writers will respond to the Deepak Chopra article in that issue of Virtual Mentor.

    Another interesting read, from a reasonaby moderate voice.

    There are no outlandish claims, and it is clear that Chopra mainly has in mind icing the cake of clinical medicine with a CAM flourish, rather than changing core ingredients.

    His comments as to the arbitrariness of the scientific basis of some aspects of mainstream medicine need checking, but he admits that this is of no relevance to the worth of CAM, anyway.

    He asks for further reconciliation of the mianstream with CAM partly because of the latter’s supposed preventive medicinel credentials. This is based upon three unfounded assumptions

    1. that CAM practitioners offer a cost-effective way of teaching beneficial lifestyles — an untenable proposition.. They can be taught in schools, in homes and on TV. Compliance is the problem..

    2. that CAM practitioners have more certain knowledge concerning the factors that contribute ot preventable illnesses. This is also untenale, since they lack any means of acquiring such knowledge outside of published scientific research that is available to all.

    3. that CAm practitioners will be better at inducing compliance. It is very doubtful that this would apply beyond their present clientele, who are likely to be already better motivated, and to have already superior lifestyles.

    So what else is there? A likely inflated perception as to the place of mind-body influences within medicine, with reference to preliminary studies that I have not examined but which presumably have yet to undergo the decline effect that Chopra accuses the mainstream of ignoring..

    So, are we left with anything other than the “non-specific influences of medical interactions including placebo-related influences” that we regularly refer to here? It does not appear so.

    Ethical objections to the use of purely ritualistic treatments (placebo) are neatly dispatched by referring to something called the “mystery of healing”.

    I don’t think there is much of a mystery. We know for certain that no form of mind-body medicine will affect the progress of most diseases, although it may help some patients to suffer less.

    We don’t know for certain how useful this (euphemistic?) form of medicine actually is with responsive conditions. We need to know this before we can react in a rational manner to the overtures of CAM, even if we choose to confine ourselves to a “working better than placebo” model of medicine..

  4. woo-fu says:

    I appreciate the manner in which you confront the issues without becoming confrontational in general. I also liked your analysis and deconstruction of CAM arguments. You managed to cover medical ethics, CAM educational/marketing strategies, and the basics of logic in one nice primer.

  5. nobodyyouknow says:

    That was an excellent article, along with the Michael Shermer article cited at the bottom. Really hits the high points of this critical issue that faces medicine and patients.

    I was once in ND school, for about a month, before I realized the entire thing was an elaborate scam. Well, maybe not a scam, but definitely a for-profit business disguised as a medical school charging outrageous sums just to market to “students” how great naturopathy is compared to conventional medicine. The application process was made to appear grueling and competitive but I’m assuming pretty much anyone with good grades from undergrad who is willing to pay (read: for profit school getting it’s hands on government subsidized loans) was admitted. They required no MCAT or GRE scores. The orientation and initial intensive first week, an 8 hour “psychology” course, was mostly propaganda about holistic medicine and patient/doctor relationships.

    It has all the ingredients that allows it to look like a school. Lecture rooms, labs, lab coats, a teaching clinic, professors who are either PhDs or NDs, a course naming/numbering system that looks like college, textbooks, a library, etc. There were two items in particular that made realize I was wasting my money. 1) I mailed my biochem notes to a friend who was in regular medical school to compare. The ND notes were not just overly simplistic but also made huge leaps into clinical inappropriate for a first year med student. 2) Conventional medical schools do not accept transfer credits from “basic science courses” taken at an ND school, but ND school accepts MD school credits. Hmm.

    I was initially attracted to naturopathy because I thought it was a new approach to treating disease. Once I explored the rhetoric a bit deeper, it seemed to me to be a lot of anecdotal thinking, unconvincing studies, science-like talk, and more or less the same exact philosophical approach to treating disease as regular MDs, but using “natural” substances, diets, and goofy vitalist modalities in place of pharmaceutical drugs that incidentally worked less well and less predictably. I did not see how naturopathy was hugely different or hugely ahead of the game in understanding how disease comes to be and how to effectively treat it, although they certainly spent a great deal of time patting themselves on the back as though they have.

    NDs as practitioners were more touchy feely and listened to me more, but as a patient of naturopathy for several years, they never helped me. And, when I did not improve using their wooish modalities, they blamed me for not following through. Compliance is not the issue. The issue is that the stuff mostly doesn’t work. They have no better understanding of medicine and human physiology than the hippie biology major who works at your local health food store.

    I eventually went with surgery to correct my illness and feel fortunate that there was a surgery available to allow me to break out of the hell that is being a sick person trying to find relief in either realm of medicine. Change in medicine certainly is in order, but alt-med as we currently know it certainly isn’t the agent of change I had in mind.

    Thanks to this blog, I now finally have something medical and science oriented to read that doesn’t anger and sadden me at every turn. If anyone has the foggiest clue how to advance medicine into something usable and satisfying, it would be the people who contribute to this blog.

  6. daijiyobu says:

    @nobodyyouknow regarding:

    “conventional medical schools do not accept transfer credits from ‘basic science courses’ taken at an ND school but ND school accepts MD school credits.”

    Yeah, lived it. Left ND school out of disgust and realized even many of my undergrad. sciences were, by that time, actually TOO OLD for most graduate programs.

    Meanwhile, in Naturopathyland, their schools’ consortia the AANMC states TO THIS DAY that ND schools

    [disregard their false labeling of modern medicine as 'allopathic', that ONLY speaks to naturopathy's own sectarian nature, not to pun]:

    “require more hours of basic and clinical science than many top allopathic medical schools [the naturopathy-as-superscience claim!]. Students of naturopathic medicine use the Western medical sciences as a foundation [the claim is science subset naturopathy!...and] are educated in the same biomedical sciences as allopathic physicians.”

    I’ve been formulating naturopathic inanity this way, most recently:

    science subset
    medical science subset
    naturopathy subset
    science-refuted or -unsupported.

    Where is “the same” actually ‘hugely different’? Where is something ACTUALLY what it is not?

    Naturopathyland, wherein academic bait-and-switch is labeled rigor and professional!

    -r.c.

  7. nobodyyouknow says:

    daijiyobu –

    I feel your pain. Plus I just clicked on your blog! I’ve been wondering if other people out there have done any whistle blowing about the ND scam! Glad to know someone has. I’ll be reading your blog shortly.

    How long did you stay in the program? I was in for a month. Funny, I recently did a post in my own blog about my experiences there and my assessment of it.

    As far as your comment on how “naturopathic doctors receive the same training as MDs…etc etc” All I can say to that is…YES. RIDICULOUSLY UNTRUE. There is an insane amount of rhetoric in that world, which I’m starting to realize is another hallmark of cultish medical subsets. Their proponents repeat a lot of the same phrases, kind of like a lot of religious groups.

    I’ll leave you a link to my blog on yours so you can read about my experiences with alternative medicine. I’ll post a link to yours on mine as well. =)

    G

  8. daijiyobu says:

    Re: “how long did you stay in the program?”

    Four years. It was the homeopathy I kept particularly avoiding, like poison actually [ironically]. I’m proud to say I included a note on my homeopathy final exam, leaving the exam answers themselves blank, that caused the instructor to flip out in front of the class in rage.

    And that particularly undid the whole deal. Homeopathy is DEAR to naturopathy, along with the colonics, alcohol-based herbal tincture blends of mystery content, applied kinesiology, supplement junk, and simply a HUGE basis of junk thought.

    As a discontented student unwilling to follow cultic marching orders, I was basically banned from seeing patients in clinic and therein would never be able to reach my clinic numbers even if I’d stayed there for ten years worth of tuition.

    So cult, yes. This was years ago. Turns out though that the university had no interest in my point of view or my own rights and dignity. Can’t forget that, for sure. And definitely had / has no interest in the truth of their contents in terms of labeling.

    What I realize now is that ND schools are in licensed states, and State licensure of falsehoods such as naturopathy leads to NO EDUCATION CONSUMER RIGHTS and a Teflon coating upon their falsely labeled apparatus. They get to regulate themselves.

    Meanwhile, I still read ND / NMD sites and index their science claims and their nonscience essential beliefs and methods.

    I’ve read more ND web pages than probably anyone living. The collision / contradiction / absurdity interests me.

    Part of my project is to easily provide data for anyone in the future who may need ammunition. I’m particularly sickened by the fact that the college guides misguide hugely these days.

    -r.c.

  9. DrEdBeck says:

    Seems to me that since the United States currently ranks 50th on the world Longevity chart, they would be open to learning something new. Of course CAM is harder to fit into a test tube and control pathways with patents, so maybe it is not as attractive to the Medical Industrial Complex that we are experiencing here. Excellent and well thought out articles, even if they are heavily biased.

    Dr. Ed Beck
    http://www.AdvancedChiropracticCenter.com

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