Feb 08 2012
Teaching Pseudoscience In Universities
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34 Responses to “Teaching Pseudoscience In Universities”
As far as I know, there is no advocacy group in the U. S. that works to resist the infiltration of CAM into medicine and medical schools that is similar to the National Center for Science Education that works against creationists and (beginning recently) global warming deniers. I would be happy to support such an organization. If there IS such an organization, please let me know what it is. If there is none, what are the chances that one will form? Do you think there is any chance of getting an organization such as the NCSE or the Union of Concerned Scientists to add this issue to their agenda?
This is an opportune time to mention that, this semester, my colleague and I are leading a seminar course on Critical Thinking for senior Dietetics majors. Although the course itself is required by the ADA, we are using the course to teach these future clinicians to recognize bogus claims including those of CAM. Bausell’s “Snake Oil Science” is a foundation textbook. Students select a peer reviewed paper on a topic that interests them and we lead them through the process of how to think critically about the paper’s claims. They will then give two oral presentations of the paper and are graded on their understanding and critical thinking. The overarching goal is to give students the confidence and experience to research and develop new good practices in the presence of ambiguity, something that clinicians need to do daily.
We’d like to think this is exactly the type of course needed by preclinical and clinical students. It could be easily adapted to a range of clinical programs – or to any of the sciences. We’ll be posting the materials (lectures, syllabus, etc) to Michael Shermer’s website on Skeptical Teaching after the semester ends.
Let me point out that, the reason this course exists, is that ADA has the foresight to mandate training in Critical Thinking. I don’t know how this will happen in other fields if the curriculum does not mandate it. Too often curricula are driven by what is on the Certifying Exam. If critical thinking skills are not actively required and then rewarded in some manner (such as being on the Boards), then the status quo will continue.
“O Medical Science…”
http://www.youtube.com/watch?feature=player_detailpage&v=R0lgNLiHlag#t=515s
I applaud the efforts described by Agora Rabbit to instill critical thinking in the ADA. I would like to see such a policy spread far and wide and to start much earlier in the educational process, however. My own children (now in 20’s and 30’s) are good skeptics, but mostly because I heavily supplemented their public and private school educations. They got a smattering of skepticism on the subject of advertising, but never directly related to the scientific method. Most of their friends are extremely gullible and “pro-woo”. They consider their “health freedom” to be the end of the argument. It is difficult to attempt to reason with someone who is committed to the cult of “positive energy”. Whatever you say is rejected as “negative energy” or “science doesn’t know everything”, and in typical cult-like fashion, you are cut off as bringing harmful “negativity” into the “circle”.
Journalism comes into this as well. Reporters should be the first line of defense of reason, but they are much prone to the false equivalency meme that leaves the comment sections of even the NY Times filled with unchallenged nonsense. I often spend a couple of hours just posting “replies” to the non-stop attacks on MSM, BigPharma, GMO, and the like–to say nothing of diet and nutrition nonsense.
I, too, would like to know if there is one particular group that is taking this on in a comprehensive manner?
Thanks for the kind thoughts, Janet. I agree with you about education. Insert here long boring discussion how science education emphasizes education instead of science. Many teachers are not taught science properly and are not comfortable teaching the scientific method, even if they could describe it accurately.
One thing I repeatedly tell my students is that “science is not a democracy.” And maybe this is why Americans are so susceptible to all sorts of nonsense information? It is in our cultural DNA that all can “make it” if only enough effort is given. Alas, this is not so for science (and other areas).
My institution has an annual adjunct position for a science journalist. It is competitive and gives them the opportunity to have full campus access, visit labs, and attend class. Over the years I’ve had several in my courses. This sort of program would be nice to expand to other institutions.
Great post! Thanks.
My favorite part is that it’s a trauma surgeon who basically says that obviously trauma surgery is a million times better than CAM, but of course everything else in medicine is clearly vastly inferior. Funny, I’m a psychiatrist, and I think psychiatry is a lot better than CAM. I wonder if there’s a pattern here?
I looked at the AMSA’s website and it’s pretty disturbing. I often wonder what makes medical education and the health sciences in general so susceptible to infiltration by quackery. Why do so many MDs (even one is too many as far as I’m concerned), with all their education and training, support this stuff?
We have an “evidence-based-medicine” class at our school that every student is required to take and we recently spent a few lectures discussing the fundamental tenets of critical thinking in our ethics class yet I still come across students saying stuff along the lines of “there’s a cure for cancer but the FDA is suppressing it” or “even if you believe acupuncture doesn’t work what’s the harm in recommending it if it makes patients feel better?.”
Do physicists and chemists have this same problem? How often do they have to deal with the descent of their own colleagues into woo?
@mdstudent:
http://virtualmentor.ama-assn.org/2011/06/ccas2-1106.html
Of course there’s no place for pseudoscience in universities! However, I do believe there is a place for CAM.
I would support something like a 15 point paper (single semester, quarter time or less) that uses CAM to teach the use of scientific investigation and critical thinking in medicine. The emphasis of the paper would be on science and critical thinking rather than the CAM.
In reality, that’s all it would take to demonstrate that most of CAM has no base in science and that CAM is almost entirely magical thinking.
How many universities are prepared to provide such a science paper?
Dile E. Tanteon wrote: “As far as I know, there is no advocacy group in the U. S. that works to resist the infiltration of CAM into medicine and medical schools…”
A number of other people also noticed the need for such an organization which led to the formation of the *Institute for Science in Medicine.*
http://www.scienceinmedicine.org/
ISM is a policy institute, with nearly 60 fellows; it is affiliated with Pew’s Campaign for Dental Health and Australia’s Friends of Science in Medicine.
@mdstudent: I think the issue is that MDs and other health care professionals, as a group, have minimal training in the methods of science. I went through an MD/PhD program not that many years ago, and I still remember it pretty well. MDs generally learn a bunch of “science,” i.e. knowledge that scientists figured out, but they don’t learn much “science,” i.e. the process used to gain that knowledge. And they shouldn’t – the goal of general medical training is not to train researchers, it’s to train people who will apply that knowledge competently. Doctors are to biologists as engineers are to physicists. Back in medical school, this used to bother me because I felt that my coursework wasn’t rigorous enough. Now, looking back on it after having had actual clinical experience, I appreciate the reasons why medical school doesn’t try to train scientists, but I still think the training should be more rigorous.
I once argued with a CAM proponent (we need a good all-encompassing term, like what the creationists use for evolutionary biologists…evilutionist) and said that they sound just like a creationist. Offended, she said that creationism is a belief, but CAM uses evidence. My irony meter blew up.
Maybe I’m old or something, but when I was in grad school in biochemistry, pseudoscience was nowhere to be found at my school. I remember fractionating urine to prove to someone that taking excess vitamins just made a vitamin rich urine.
@ Dr. Atwood, thank you for the link. I also found this article by Dr. Gorski (http://www.sciencebasedmedicine.org/index.php/hard-science-and-medical-school/) that helped answer my questions.
@ Evilrobot, thank you for your input. I’m starting to understand and accept the difference between a clinician’s training and that of a chemist. Even though it doesn’t make me feel better, I’m sure I’ll quickly gain a deep appreciation for my basic sciences training once I’m faced with an actual patient as opposed to a multiple choice exam.
Sorry, but I meant to link this article by Tim Kreider: http://www.sciencebasedmedicine.org/index.php/medical-training-versus-scientific-training/
The article by Dr. Gorski is still pertinent though.
As usual excellent post and comments. To add my own experience:
I genuinely believed this to be the case before I finished my undergrad. This is because ALL of my medical anthropology courses drilled that into my head. I mean almost verbatim. Couple that with the fact that US med schools don’t require a degree in science (any Bachelor’s will do, so long as a few science pre-req’s and a good MCAT score are present) and you can very easily have somoene with only a degree in med anthro and an ability to regurtitate a few scientific facts in med school.
It is also my experience that many of my classmates memorize the facts of medicine without any appreciation for what it actually means. To them it is all just names + numbers = diagnosis without realizing that there is a fundamental basis for why that is. Besides making med school harder that allows for pseudoscience to wend its way easily into their minds. A clinical trial becomes just another “name + number” and the “treatment” just “works.” After all, they never learned why the “name + number” actually equals the diagnosis, so the treatment is just another “name” to add to the equation.
I’ve said it before, but I’ll say it again: I had some colleagues post up a rather bad article. I read it genuinely curious and absolutely destroyed it. Rather than accept the conclusion was wrong, it caused a massive uproar which led to one student commenting that it sounded like my analysis was spot on, she couldn’t argue with my statistical knowledge or critical analysis, but that I shouldn’t be so strident and “mean” (I used completely neutral language, of course) and that “medicine is more an art than a science” and thus justified accepting the conclusion of the paper despite the fact that she had just agreed my analysis was beyond reproach!
A few months later, after a few more such skirmishes, I was approached by another student representative and told that many students did not like me because they felt “afraid” to post anything up. I responded that they shouldn’t be afraid if their reasoning was sound. After much discussion this student finally said, “Don’t you think in 300 years, everything we know about science will be completely different?” My jaw dropped and I said no. Unequivocally no.
There is indeed something to be said for training undergrads in the scientific process not just to be able to regurgitate a bunch of scientific facts. I know for a fact this is not done particularly well, because while believing the garbage my med anthro degree taught me, I did well in my biological sciences degree from a school highly ranked and very prideful of its science curriculum (I was actually lectured to by Nobel laureates in buildings named after them – I believe we had 8 on faculty at the time of my undergrad). Something like Angorra Rabit’s class would have been invaluable.
@mdstudent, nybgrus: take comfort in the fact that your critical thinking and basic science training will be an important asset in the clinical world. Not for the easy cases, but for the tough ones. Also, keep in mind that you will encounter excellent clinicians who think critically and rigorously in certain domains but not others.
Nybgrus — It’s news to me that medical anthropology takes the position that the various healing systems it studies are effective. Anthropologists study human culture, not medical outcomes. No doubt there are examples of some who have “gone native,” as it were, and started to believe in the stuff they study, but that’s certainly not inherent to the field. On the contrary, actually. You might want to check out a seminal work, Kleinman’s Patients and healers in the context of culture. An explorationof the borderland between anthropology, medicine, and psychiatry. It is hardly credulous.
It gets murky:
http://www.smh.com.au/technology/technology-news/alternative-health-poll-exposes-malaise-20120210-1sg9v.html
@evilroboto:
Yes, and I have met them. I have also met many like myself and that is indeed glorious. Also, thank you for the kind words. My current track is taking me towards critical care pulm, and I reckon that my critical thinking and application of knowledge will come in handy there.
@cervantes:
I completely agree with you. And I had many wonderful anthropology courses throughout my degree. However, all of my medical anthropology courses were taught in the same credulous manner. In fact, pretty much all of my professors in those classes were quite literally angry at “Western medicine” and how blind it was to the utility of “other ways of healing.”
You may claim that this is unusual or at least not the foundational premise, and I would sort of agree. But the fact that Kaptchuk and Moerman exist and write in and work for venerable journals and institutions makes me hedge that notion. What flows forth from them is extremely remeniscent of my professors. Honestly, reading them transports me back instantly to the lecture hall as their rhetoric is often word-for-word what was (many times angrily) lectured to me as an undergrad. Perhaps my experience was unusual and indeed a bastardization of what was supposed to be, but it certainly is in line with what SBM is seeing come out of venerable sources which gives us all so much angst.
—-
I’ll add a brief addendum to my previous post – I was tutoring a classmate who has yet to take the USMLE Step 1 last night. She could not understand the alpha-a/Gs interactions and why cAMP led to vasodilation. In fact, she had no idea what cAMP even was! When I explained to her briefly what it was, and that it was a reflection of the energy state of a cell (i.e. when she made the link from ATP—>AMP—> cAMP) a giant lightbulb went off in her head. Which is wonderful, but my point was made – many people just memorize a name or acronym that means nothing to them beyond a flow chart of names and acronyms. They can memorize it well enough to reguritate on a test, but completely lack any ability to actually apply that knowledge in any other context.
check out Johnson State University in Vermont. This is sort of a vo-tech style program for CAM.
http://www.jsc.edu/Academics/BehavioralSciences/WellnessAndAlternativeMedicine/default.aspx
here’s a class schedule and a few other links about them.
http://vermontmedicineshow.blogspot.com/2012/02/meet-original-team-in-johnson-vt.html
http://vermontmedicineshow.blogspot.com/2011/04/chiro-cures-dog-let-training-and.html
http://vermontmedicineshow.blogspot.com/2011/04/johnson-states-alternative-medicine-vo.html
@nybgrus: your story about G protein signaling reminds me of an interaction I had once with one of the medicine chiefs when I was an intern. At the time, I was one of the few md/phds around, and it was a running joke that people would “call a basic science consult” and have me explain things to them. Anyway, this medicine chief explained some aspect of a mechanism, and I made a minor correction to what he said, and he told me that at the end of the day, the main reason that clinicians care about mechanisms of action is as a mnemonic device to help them organize and remember all of the necessary information. I think that’s partially true, if you’re dealing with situations where there is a clear evidence base and practice guidelines, but once you’re “out of book,” dealing with complicated combinations of medications/comorbidities/whatever where there isn’t a clear evidence base, then that understanding becomes very important.
@evilroboto:
Obviously my error was picked up – that should be alpha-1, not alpha-a. lol.
But yes, I can agree with that as well. Understanding that basic mechanism can help make sense of a lot of drug effects so you in essence only learn one thing instead of many. In cases where the evidence base and guidelines are well established and straightforward, this does indeed become superfluous. I reckon a family practice physician would have much less use for such detailed mechanism knowledge since anything complicated enough to warrant that deeper level of knowledge would be referred anyways. However, having a basic appreciation for and understanding of mechanisms should act as a “vaccine,” if you will, against completely implausibly claims. Understanding that everything we do actually does have a molecular basis of action should (emphasis on should) preclude people from thinking that energy chelation, homeopathy, or Reiki can possibly do anything.
oops. didn’t mean to put the A-team link up there. Although she is part o the Johnson State WAM crew. Here’s a link to the Johnson State student newspaper about graduates of the program and what they are doing today.
http://www.jsc.edu/basementmedicine/currentissue/backPage.aspx
In general, like most religious education institutions, the key to the successful passage of pseudoscience across generations is isolaton. Removing doubt creators helps with belief.
Yeah, f’cryin’ outloud. I noticed their website a few years ago. BTW, you guys are great. Who are you? Please send me an email if you don’t want to reveal yours here.
KA
@nybgrus: I didn’t point out the alpha1 thing because I knew it was a typo, but I wasn’t 100% sure whether you were referring to alpha adrenergic receptors or Galphas. However, I don’t think your explanation of mechanisms of vasodilation was 100% correct. First, I don’t think any of the alpha adrenergic receptors are Gs-coupled. The alpha1s are primarily Gq/11-coupled, while the alpha2s are Gi/o-coupled. That’s why alpha1 agonists are pressors and alpha1 antagonists cause orthostasis (probably the main reason why thorazine is rarely used any more). The role of cAMP would be relevant for alpha2 agents like clonidine, which is an alpha2 agonist that used to be used commonly for hypertension but is now used primarily as a second-line agent for ADHD. But in that case, it’s actually decreased cAMP causing vasodilation.
But yes, I agree, mechanistic knowledge should protect physicians against CAM sympathizing, and I would argue that to a large extent, it does. To play devil’s advocate to some extent, it is true that there are many effective treatments that were validated empirically and still aren’t fully mechanistically understood (e.g. lithium for bipolar d/o), there are treatments that work at least in part by different mechanisms than what was originally postulated (e.g. statins), and there are treatments based on sophisticated basic science work that ultimately fail to pan out like they’re supposed to (e.g. celebrex/vioxx). I can understand why many clinicians don’t consider basic science to be the be-all and end-all, and why they might be sympathetic to reiki or whatever based on crappy clinical data. They’re wrong, of course, but I think it’s a somewhat understandable error.
DoH, my pedantry tags were deleted from the last post. Oh, well, it should be obvious from context.
@evilroboto:
you are, of course, absolutely correct.
Apparently I typoed and then went off the wrong path of my typo! To be honest I was just mixing up all the stuff in my head and typing way too fast. I was thinking in my head of cAMP vasodilation effects from beta adrenergic stim of Gs. I just wrote down the wrong receptor, made a typo, and then just quickly changed my typo without realizing I’d written down the wrong receptor! Mea culpa and thanks for the teaching point! I was focused on the point of my friend not knowing what cAMP was at all and the rest is history.
Interesting point in playing devil’s advocate there. I can understand where you are coming from. I suppose though it really stems from a lack of understanding (belief?) that indeed there simply is no ethereal or spiritual world to influence physical processes. I mean, not knowing a mechanism for something that genuinely works, or knowing a mechanism that is elegant but for some reason doesn’t work shouldn’t allow for the insertion of supernatural causation as the explanation. But often it is. I guess the whole of it boils down to this common reaction for those without enough knowledge or not entirely sold on the notion that there simply is no supernatural realm to use those gray areas and small gaps in knowledge to maintain their belief. That and just plain ol’ lazy thinking.
76 percent of health care workers use complementary and alternative medicine (CAM), compared to 63 percent of the general population, according to research in the journal Health Services Research.
In addition, health care providers, such as doctors and nurses, were more than twice as likely to have used practitioner-based CAM, and nearly three times as likely to use self-treatment with CAM than support workers.
Apparently, health care professionals, especially doctors and nurses, believe in CAM even more than the public does! What does this mean?
Personal Use of Complementary and Alternative Medicine (CAM) by U.S. Health Care Workers
http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01304.x/abstract
100% of people named Stan Mrak don’t understand how to read scientific literature nor use statistics properly
vermontmedicineshow@yahoo.com
[...] Teaching Pseudoscience In Universities (sciencebasedmedicine.org) [...]
When teaching Therapeutic Touch in the U of Colorado’s School of Nursing was challenged in the 1990s, the regents formed a blue ribbon panel. After the panel reported back to the regents about the state of TT research, the regents told the nursing school that it had ten years to show TT was a valid practice and after that, if there was no good evidence for TT, the subject could no longer be taught. After the ten years had passed, I checked the course catalog a few times and didn’t see anything overtly TT in the offerings. The school’s TT treatment center had closed, and it’s major TT proponents had moved on. As accountability goes in universities these days, that was something.
I find it quite sad when a story like that is considered progress.