Feb 08 2012
The debate about teaching so-called complementary and alternative medicine (CAM) in universities and medical schools rages on. Attention has turned recently to Australia, where the infiltration of CAM into universities is a growing problem. A new group has formed called the Friends of Science in Medicine to advocate for maintaining high standards of science in medical academia. They have been successful in at least invigorating the debate, leading to a slew of articles on the topic, many of which are reasonable. They have also forced CAM proponents to defend their position, which they do with the usual bad logic and invalid arguments.
It is a sign of our times that we even have to defend having standards of good science in the practice of medicine and the teaching of a science-based curriculum in universities. This is an issue we have discussed at length on SBM often. The core philosophy of SBM is that high standards of science in medicine are necessary in order to ensure, as best as we can, that treatments and interventions are safe and effective. It is extremely complicated and tricky to determine safety and efficacy. Humans suffer from numerous mechanisms of self-deception, cognitive flaws and biases, poor grasp of statistics, and perceptual failings that are likely to lead us astray. In fact our biases tend to systematically lead us to false conclusions that we wish to be true, rather than the truth.
Science is the only system that we have developed that systematically controls for all of these biases and flaws to see through to reliable information. Science endeavors to be transparent, thorough, and rigorous. The applications of scientific principles has demonstrably transformed medicine (and human knowledge in general) for the better. As a society we should not lightly abandon the principles of science nor try to change them to meet the needs of the current fads.
Further, universities are supposed to be the exemplars of scholarship and intellectual legitimacy. They believe themselves to be intellectual leaders, not followers, and they are correct (or at least, they should be). Teaching a topic in a university is absolutely an endorsement of the legitimacy of that topic. We can distinguish between teaching about something and teaching the thing itself. It is OK to teach about CAM as a sociological phenomenon or even as an example of pseudoscience. Credulously teaching CAM, however, is an endorsement, the granting of the imprimatur of the university.
It is tempting to cater to prevailing fads, to acquiesce to the vocal advocates and give them what they want, especially when there isn’t much protest. That is exactly what intellectual integrity is about, however – doing the right thing because it is right, not because it is popular or expedient.
I will acknowledge perhaps the only legitimate argument on the other side – that of academic freedom and diversity of opinion. I agree with the principle that a university should also be a place for the free exchange of ideas and should not easily impose censorship. Proponents of nonsense, however, have taken this principle too far. Academic freedom needs to be tempered with quality control. Professors should not be allowed to teach absolutely anything they want without limit. The university has a duty to ensure that the minimal standards of academic legitimacy are met.
This duty includes ensuring that science is taught in science classes. This debate has come up with reference to teaching creationism as science as a matter of academic freedom. Such freedom does not extend to the point of teaching demonstrable pseudoscience as if it were a legitimate science. The exact same thing can be said about teaching homeopathy, for example, as if it were legitimate science-based medicine.
The argument above should not be difficult to make and should resonate with academics. It has worked well in the UK, spearheaded mostly by our colleague David Colquhoun, who has used freedom of information requests to obtain the CAM curricula and universities teaching CAM, and then simply sent them to the Dean and/or board of trustees of the university. This one act has led to the removal of CAM courses from universities in the UK. Simply shining a light on what was happening was enough.
In the US we are having a harder time, although we have had some successes also. The American Medical Student Association (AMSA) has been infiltrated by CAM proponents and they have managed to get requirements for CAM to be taught in American medical schools. Of course, we can still teach about CAM (which I actually advocate) rather than promote pseudoscience – something that should not be a subtle distinction but is often difficult to make.
Australia is perhaps having the most difficult time with this issue, leading to the formation of the Friends of Science in Medicine. They already have over 300 individual supporters. Also, the Institute for Science in Medicine, with over 50 fellows, has officially joined FOSM in their protest. Their request is simple – no pseudoscience in universities. They have helped bring the debate to the forefront. CAM’s greatest ally in infiltrating universities is stealth. I have seen this infiltration occur under the radar, deliberately, with the stated goal of avoiding too much attention which might draw criticism. This violates the principle of transparency, and why focusing attention on this trend is so useful.
Of course, CAM proponents are not going to just lie down and go away. I have seen many responses to the criticism of teaching CAM in medical schools, none valid. They trot out the same tired fallacies (another thing they share in common with creationists). I could choose any of dozens of examples, but here is one from a discussion forum on the Australian CAM debate:
There is no better than modern medicine when it comes to surgery, emergency and trauma, but for almost everything else, traditional, natural or alternative medicine is far more effective – particularly for chronic illness which modern medicine is completely unable to treat or cure. These therapies, unlike modern medicine which focuses on symptom control, work to treat the entire person, recognising and stimulating the body’s innate capability to heal the root cause of illness. Modern medicine actually suppresses and thwarts that innate healing mechanism by unbalancing the complex human organism and its systems, particularly the immune system, with the liberal use of drugs and ignorance of the importance of diet and lifestyle.
With conventional medicine’s birth came the slow and deliberate move by the medical profession to discredit what became labelled ”alternative medicine”. I can only presume that what lies at the heart of it is the threat to conventional medicine’s power base and the unhealthy relationship it has long enjoyed with the trillion-dollar pharmaceutical industry.
It is about time the Australian medical profession started educating rather than medicating. It is unfortunate that it is the public’s disillusionment with modern medicine and its inability to treat many diseases, as well as the dreadful side-effects of any treatment offered, that have increased the popularity of complementary and alternative medicine. It should have been due to the interest, enthusiasm and reason of doctors, scientists, researchers and politicians.
As a qualified medical specialist and surgeon, I am ashamed of the medical profession when it so blatantly displays its ignorance and persists in attacking a profession from which we have much to learn.
Dr Valerie Malka is a surgeon and former director of trauma services at Westmead Hospital.
We have deconstructed all of these arguments before, many times, but we will have to keep doing it. The historical revisionism and logical fallacies in this argument are rampant. First comes the claim that “natural” or “alternative” medicine is more effective than science-based medicine for chronic ailments. Dr. Malka makes this claim without evidence and without even a good working definition of what “natural” or “alternative” is. This blog is full of articles and analysis showing that so-called CAM is ineffective. If CAM proponents could demonstrate with solid science that any particular modality is effective for any particular indication, then it would become part of science-based medicine.
Notice also the counter claim that modern medicine is completely unable to treat or cure chronic illness. This is a bold and demonstrably absurd claim. We may not be able to cure chronic illnesses – by definition, that’s why they are chronic – but we can certainly treat most of them to improve quality of life, minimize complications, and extend life expectancy. We have very effective treatments for diabetes, migraine, heart disease, any many other common chronic illnesses. I defy any CAM proponent to name one CAM modality that has been shown to be effective in significantly treating any chronic illness (and not the science-based modalities, like nutrition and physical therapy, that they have tried to relabel as CAM).
She then invokes a conspiracy by mainstream medicine to suppress CAM, which she attributes to nothing but turf protection. This is also demonstrably incorrect – while science-based medicine is not perfect, the treatments that have survived over the decades are those that are supported by the best evidence. It’s a complex and sloppy process, but it is science-based. To reduce the modern institution of medicine to mere professional protectionism is nothing but a malicious lie.
Here again we see an insightful comparison to creationism. Creationists try to simultaneously elevate their religious beliefs to that of a legitimate science, while trying to drag down evolution to that of a mere belief system. I guess their hope is that they will meet somewhere in the middle and at least have equivalence. Likewise CAM proponents are constantly trying to exaggerate the problems with science-based medicine, deny the evidence base for it, and argue that it is all blind, corrupt, and unscientific. They try to drag down SBM because they are the ones engaged in a turf war – trying to promote a trade that cannot compete on the science.
She concludes by assuming that CAM popularity, such as it is, is due to the failings of modern medicine. But the evidence is against this assumption. The evidence shows that it is philosophy and wishful thinking, not dissatisfaction with mainstream medicine, that drives use of CAM.
It is good to see some organized backlash against the infiltration of pseudoscience and nonsense into the very institutions that should be teaching against such things. It is good to see more and more articles written about this topic – we want attention to the issue. We want a discussion of the merits of our position vs the pro-CAM position. Let’s have a very public debate about the facts, about what is science, and how we as a society should determine what medical interventions are worth our public support.
We will confidently stand by our position. CAM proponents, like creationists, have nothing but weak and fallacious arguments, long discredited, on their side.
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