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Medical students actively recruited for CAM

Here at Science-Based Medicine we’ve been getting a lot of letters from medical students.  This is a good thing and a bad thing.   I’m glad people see us a a resource for SBM, but I’m unhappy that medical students: 1) need us; 2) don’t have someone to approach on campus.  Let’s explore some of the more subtle ways cult medical practices infiltrate medical education.

Outpatient Rotations

In order to give all of their students experience in outpatient medicine, most med schools must reach out to the community.  Sure, some med schools have big enough clinics to support an experience for all of their students, but that’s the minority.  For their internal medicine, pediatrics, and family medicine rotations, med students often spend time at private doctors’ offices.  These offices are minimally vetted, and I’d venture to guess that the vetting does not include checking for non-standard practices.   In fact, schools are so desperate for spots, that almost any office will do.  It’s good for students to see how medicine is practiced in the “real world” but that real world often involves cult medicine practices.  Along the same lines, many practitioners are not up to date on the most recent best practices.  I remember a family doc I worked with who used to give huge doses of intramuscular steroids to people for seasonal allergies.  This isn’t the best idea, but I was a student. Who was I to tell him how to practice medicine?

We don’t police our colleagues very effectively—we have surrendered that duty largely to the courts.  However, if doctors want a medical school affiliation, it seems a small price to allow the school to come in and see if the office practices medicine  according to the standard of care.  In addition to checking for the most minimal quality standards, it would rule out docs who are offering voodoo in place of medicine.

Sponsored Groups

There are dozens of medical student groups out there—some supporting peoples’ choice of specialty, some with religious or cultural affiliations, and other simply for fun.  It’s not unusual for these groups to bring in speakers.  There is generally a collegial atmosphere at medical schools—for example, I am staunchly pro-choice, and a friend and fellow student was staunchly anti-abortion, and belonged to a Christian medical student group.  We sparred frequently, including having dueling letters to the editor in the Chicago Tribune, but we also often had a beer together and hung out.  We understood that we would not agree on this issue and that we would each fight hard for our position.

What happens when this collegiality breaks down?   I’ve heard of instances where medical students have spoken out and been slapped down by their fellow students.  This is a very common tactic of cult medicine groups—since they can’t win on facts, they cannot tolerate dissent.  If a student is harassed for speaking out against CAM on campus, who is she to turn to for support?  Will she receive support from her dean?  Will she be asked to make nice with the people promoting harmful practices?

At a recent meeting of the American Medical Student Association, a bill was introduced to officially recognize naturopathic students as “medical students”.   Medical students are just starting their journey to become doctors are are vulnerable to this “inclusiveness” message.  The bill was thankfully voted down, but this helps illustrate how deeply the alties are working.

Ethical Crisis

We are at a crossroads in medical education.  Proponents of made-up medical practices are infiltrating the academy at every level, and trying to convert medical students at a vulnerable time.  When they are called out, they cry foul.  The tactics are quasi-religious.  Those of us in medical education have a grave responsibility.  We must train doctors who are compassionate and who understand the difference between science-based medicine and everything else.  It’s time to be less inclusive in our curricula.  It’s time to have coursework that specifically addresses made-up medical practices, explains why they are wrong, dangerous, and unethical.  It is time to take the offensive.  It both delights and saddens me that this blog is one of the centers for the defense of medicine.  It shouldn’t have to be that way.  That being said, we will continue to be a resource for those interested in keeping the science in medicine, and will hopefully help birth some additional resources in the near future.

If you are a student or educator and are concerned about made-up medicine in your institution, feel free to email us.  We share emails among ourselves but with no one else, and we will not write about your situation without your explicit permission.  It’s time we all joined the battle.

Posted in: Medical Academia, Medical Ethics, Science and Medicine

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8 thoughts on “Medical students actively recruited for CAM

  1. daijiyobu says:

    Dr. L. wrote: “students actively recruited for CAM.”

    Well, if I really wanted to further my sCAM agenda, I’d get myself into the Peterson’s College Guide and state false things about science and make it a B.S. [no pun intended]

    (see http://www.petersons.com/collegeprofiles/Profile.aspx?inunid=6936 ):

    “an undergraduate education at Bastyr University is the first step on a path leading to a richly rewarding future in the dynamic field of science-based natural health. Bastyr’s unparalleled programs are based on a mind-body-spirit approach to wellness [...per] a degree in the natural health sciences [...] Bastyr University offers several two-year, upper-division programs that lead to bachelor of science degrees.”

    See, within science is the supernatural…by decree.

    And now I will pun [groan first!!!]…by degree.

    -r.c.

  2. The Blind Watchmaker says:

    It seems reasonable to introduce the notion of SCAM ‘treatments’ to medical students so that they get an understanding of what their future patients are going to be asking about. There will be many strange substances that their patients will write in on their medication lists that are not in their pharmacology classes. The available data evaluating SCAM treatments should be presented so that they can see for themselves their objective lack of efficacy. In this way, they will learn critical thinking.

    Real medicines come attached to actual data and this data has to show efficacy for said medicines to be accepted. In these “Integrated Medicine” curriculums, SCAM treatments get a pass that real medicines do not. They have to, because if held to the same standards, SCAM treatments are exposed as bunk.

    I agree. Questioning SCAM seems politically incorrect. This attitude seems even present with the accademic medical teachers (who would otherwise apply a very critical eye to the studies of real medicines). This is disturbing.

  3. pmoran says:

    I agree medical schools have no business encouraging students to tolerate the “this is how it works” pseudoscience of CAM or to afford its methods equal status in disease treatment.

    But may I point out that we have not been very effective in molding the milieu that present medical students have inherited? How, then, do we ensure that medical students are well-equipped to deal with all the challenges that CAM poses, including the likelihood that it can actually help some patients through the non-specific/placebo influences that pervade all medical activity, and that it is mainly resorted to when CM has already run its dash or has nothing obviously better to offer — so why do we care, so long as the methods employed are reasonably safe?

    A crucial question: Is it rational to use placebo influences to explain away many apparent (mainly subjective) benefits of “alternative” methods and then to baldly pronounce, almost in the same breath, that “they don’t work”. In other words, is the divide between SBM and CAM really between treatments that work and those that don’t, or does it lie rather in HOW they work and the EXTENT to which they can work? We seem to be saying that we will condone treatments that work via mechanisms that include these systems of neurotransmitters but not ones that trigger this other system.

    I have drawn attention here on a couple of occasions to the recently published Cochane reviews (Linde et Al) of acupuncture and sham acupuncture vs no additional treatment for headache but find that no one here seems to want to discuss their significance or that of other evidence that such placebo medicines may have worthwhile uses in medicine. Medical students opposing CAM will certainly find those studies being quoted at them as ishowing the limitations of the classic “working better than placebo” model used by SBM.

    There remain good arguments as to why mainstream doctors should have minimal truck with CAM and why they should try to draw clear distinctions with their patients. Discussions on the placebo are invariably instantly hijacked by thos question of placebo use by doctors, whereas I am mainly concerned with why our usual approaches to CAM don’t seem to have much impact and whether that is because they are not quite reflective of medical reality, and even repellent, when they seem to be putting arcane scientific considerations above patient welfare.

  4. Dr Benway says:

    pmoran,

    In my opinion, we ought to leave the placebo effect as a specific intervention to the dramatists.

    I’m not a doctor on TV, because I’m an actual doctor.

  5. @pmoran

    I’m merely a third year med student but your post made me uncomfortable.

    … evidence that such placebo medicines may have worthwhile uses in medicine.

    Placebo medicine seems to fly in the face of Autonomy.
    But there’s a practical concern – we now practice medicine in the age of google. It is a reality that anything you placebo onto a patient can be easily researched by anyone who wants too.

    Now don’t get me wrong, I was on the neuro inpatient service last month. When a variety of measures failed to fix intractable headache, and we’ve ruled out all the scary stuff, our attending hyped up Topamax as an amazing headache med. I found that somewhat questionable ethically. Even then, at least my attending drew a line.

    This is just my opinion, but we’re doctors, we aren’t actors. Noone does normal saline flushes for pseudoseizures anymore, and I don’t think anyone should give patients with URI’s a homeopathic medicine just to “send them home with something” or “placebo effect” either.

    From my perspective, I don’t think you can justify placebo meds -cam or otherwise – unless you’re willing to say “Well autonomy is a myth -we steer patients to what the ‘right’ treatment is anyway. When we can’t, they’re autonomous and do what they want.” If you’re willing to throw that out, I can buy placebo meds as an intervention.

  6. pmoran says:

    whitecoattales, I understand your position, and agree you should not use placebos if you are not wholly comfortable with them. But every day of your medical life you are going to be confronted with patients using, or wanting to use “alternatives” or sending cues such as “I don’t like taking drugs”. Some will swear that CAM treatments are helping them. You will have other patients that you will be unable to help much even after much scouring your evidence-based treatment cupboard. How will you relate to all this?

    I am hoping to find a way through the all the paradoxes, dilemmas, anthropological, public health and contextual considerations posed by the apparent effectiveness of placebo medicines and certain shortfalls in present medical capabilities, so as to retain any public benefits, preserve patient autonomy , maintain respect and compassion for the human condition, and avoid the patient alienation that some versions of medical skepticism clearly provoke. And all this while being consistent with ALL the scientific evidence

    Perhaps the task is impossible. Perhaps some can see it all more clearly than I. I do think I have a solid appreciation of what the evidence shows.

  7. Dr Benway says:

    pmoran, I think we need a rule: we don’t lie to patients. I also think that rules should be broken in certain situations. Life is complicated and it’s difficult to predict exactly what those situations might look like.

    If you’re going to steal or lie or kill for a higher purpose, it’s a good idea to have clear in your mind who may judge you, and how you might persuade them that anyone else would have done the same, given the circumstances.

    It’s painful, failing a patient who needs help when you’ve no solution. At those times, I think feeling sad without being overwhelmed by sadness and simply listening to the patient’s experience can be helpful.

  8. But every day of your medical life you are going to be confronted with patients using, or wanting to use “alternatives” or sending cues such as “I don’t like taking drugs”. Some will swear that CAM treatments are helping them. You will have other patients that you will be unable to help much even after much scouring your evidence-based treatment cupboard. How will you relate to all this?

    I won’t offer them false hope.
    As for their swearing CAM treatments are helping, people are poor judges of what’s helping, it’s often a case of post hoc, ergo propter hoc.

    Part of respecting a patient, is being honest with a patient. If a patient is swearing by some CAM therapy, it’s my responsibility to give them the truth about that therapy, not to blow smoke up their rear and say “why yes, that oscillo realy might have helped your flu!”

    I think our advice is only credible so long as we’re telling the truth.

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