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Reporting back on my Grand Rounds experience at FSU

Last Thursday, I had the distinct privilege and honor to be invited to speak at Grand Rounds at the Florida State University College of Medicine in Tallahassee. Ray Bellamy, who is on the faculty there and is also the husband of our very own Jann Bellamy (who is herself is the founder of the Campaign for Science-based Health Care), invited me down to give a talk on “complementary and alternative medicine” (CAM) and “integrative medicine” (IM). Although I’ve spoken to skeptics’ groups, such as local groups or even to workshops at The Amazing Meeting, and to medical students’ groups, this represented the first time I had been invited to speak in front of a large group of medical professionals, not all of whom necessarily agreed with our viewpoint here at SBM. So it was with some trepidation that last Wednesday I braved the trip to Tallahassee, with the unfortunately requisite connection in Atlanta that necessitated my practically running from one end of that massive airport to the other in order to make my connection to the little puddle jumper of a jet that took me to Tallahassee. Whether or not my talk was a success or not, readers can judge for themselves, as it’s been posted online on the FSU Grand Rounds page. (Just scroll down to November 10 and then hit the link. Unfortunately, it appears that you’ll need Microsoft Silverlight to get the video to work.) I haven’t watched the whole thing yet, but I encourage you to do so and tell me how good (or bad) I was and why. I want to get better, and I won’t rest until I’m as good at communicating medicine as Neil deGrasse Tyson or Richard Wiseman, for instance, is at communicating science.

Ray and Jann were, of course, consummate hosts and did their best to make me feel right at home. No surprise there. What did somewhat surprise me (a little) was the dinner they had arranged for Wednesday night. No, it didn’t surprise me that there was a dinner the night before, but rather how it was arranged. Invited were several members of the local Center For Inquiry affiliate, some faculty from FSU, one reporter, and two members of the FSU medical student interest group in CAM. The reporter, Mark Hohmeister, ended up interviewing me for an article that was published on Friday in the local newspaper entitled No shortage of snake oil in alternative medicine, but what intrigued me most was the presence of the two medical students. I truly have to give them credit for bravery, given that the attendance was largely stacked to the skeptical side and that unfortunately their faculty advisor was away at another meeting and unable to attend. I don’t know that I could have done something like what they did when I was a medical student. Back then, I was a lot less outspoken than I am now. Also, there was a faculty member there who, I was told, thought that homeopathy might work and was fairly heavily into CAM/IM. Actually, strike the word “fairly.” He made arguments that made me think of Deepak Chopra, complete with the invocation of quantum effects as a possible explanation for how homeopathy “works.” One exchange that stands out in my mind was his telling me that my conclusion that homeopathy is about as close to impossible as a hypothesis can be is based on “Newtonian thinking.” When I informed him that it’s not just Newtonian physics that proclaims homeopathy to be impossible, he seemed relatively unfazed.

Don’t get the wrong idea, though. The dinner was quite congenial, with excellent food and drink, but the conversation was not without disagreement. Of course, that was its very purpose, to bring together students and one faculty member to encounter a viewpoint that they perhaps had never really encountered up close and personal before. Don’t worry, we weren’t too hard on the students. In fact, they won my admiration, even though it saddened me how much their thought processes had become tainted with the sorts of arguments that CAM practitioners make. One of them even made the argument that various CAM modalities are so “individualized” and complex that they can’t really be studied using randomized clinical trials. They also appeared fairly impressed by a recent talk by a chiropractor to their group.

All of this led me to wonder why these bright, enthusiastic, driven students were so attracted to CAM. Even after asking them that question, I’m still not sure I understand why, but I want to. Certainly part of it has to do with their desire to be closer and more empathetic to their patients, although I did try to point out that it doesn’t require pseudoscience to be more empathetic to one’s patients. The attraction also seemed to derive from an understandable desire to be a more “holistic” doctor, although I pointed out that one doesn’t need to “supplement” science-based medicine with modalities not supported by science in order to be holistic. In the end, I really liked these kids (if you can call 23-year-olds “kids”; I suppose you can when you’re almost 50) and couldn’t help but hope that my talk would have some effect on them. They did attend the talk, but unfortunately I wasn’t able to talk to them afterward. I don’t know if I was too “strident” or “dismissive” in my talk, but on the other hand speaking bluntly is sometimes necessary to drive a point home.

Certainly, it’s a good thing that FSU was open enough to Dr. Bellamy’s desire to counter some of the CAM messages that medical students are receiving, both in their curriculum and from the medical world at large. Quackademic medicine has infiltrated deeply into medical academia, risking turning it into medical quackademia. I only hope that, in my own little way, I might have planted a seed in some minds, and not just the students from the CAM interest group, that will later blossom.

Posted in: Medical Academia

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19 thoughts on “Reporting back on my Grand Rounds experience at FSU

  1. DugganSC says:

    “Actually, strike the word “heavily.””
    ^_^ Do you mean “Actually, strike the word “fairly””? That would seem to make more sense with his hidebound stance.

    As regards the adherence to CAM, I think part of it’s the limitless potential, same reason a lot of people want to believe in magic. We do some pretty amazing things with conventional medicine, but the better the state of the art gets, the more frustrating it can be to see things we can’t fix, e.g. autism and much cancer. Whereas CAM promises the moon, limitless potential and the possibility that right around the corner, there’s a miracle cure that will spring full-fledged when we find the right energy point/combination of herbs/waved dead chicken. Contrast that against years of trials on medications showing that Medicine A has a 3% better cure rate but a 53% increase in sudden heart failure. To some degree, one might ask why people are so thrilled with watching fictional movies when there are so many good non-fictional ones out there.

  2. Bthyer says:

    Your talk was very much enjoyed. Thanks for coming to FSU. Keep up the good work!

    Bruce

  3. cervantes says:

    I think one reason the wooitude may appeal to students is that it feels vaguely emancipatory. Most of the faculty are committed to science based medicine, at least in principle; they are authority figures and also vaguely parental; they are elites within an elite institution. Young people have a natural and commendable proclivity to challenge authority. There are, in my view, plenty of ways in which the medical institution, medical practice, and medical authority could legitimately be challenged, but the CAM jive is readily available, has various forms of superficial appeal, and is promoted by kindly-seeming fellows like Andrew Weill. As much as you may be committed to holistic and humane practice, fully within the context of science based medicine, they may legitimately feel that it is in short supply in the real world, and the claim of “integrative” medicine to be the way to supply it is probably seductive to them.

    Medical eduction (as a generalization, happy to hear you tout how exceptional your school is) very much emphasizes biomedical science over clinical practice and patients as people, particularly in the first two years, and they are being made to stay up till all hours in rote memorization to pass the anatomy final. It’s not surprising they feel as though something is missing.

  4. lilady says:

    I was able to view your presentation in its entirety and it was excellent. However, I was unable to hear the questions (four, I believe), that were posed to you by attendees.

    You asked for suggestions so…might I suggest that you repeat the question for the benefit of the other attendees and of course for SBM readers and “posterity”.

    I was only able to read the newspaper interview by “Googling” “No Shortage of Snake Oil Salesmen” because the link leads to the newspaper’s pay wall. When I tried to view the 19 comments that the article generated it led me back to the pay wall.

    Congratulations Dr. Gorski on an informative presentation.

  5. pmoran says:

    One of them even made the argument that various CAM modalities are so “individualized” and complex that they can’t really be studied using randomized clinical trials.

    In theory anything with a measurable outcome can be tested. However there are enormous problems in practice if as is probable it is the psychological environment that produces any benefits from CAM.

    How, for example, do you you control for the patient self-selection upon which all CAM use is based?

    How do you control for the stressed patient being able to obtain support from more readily accessible, less busy highly empathic CAM practitioners, than from MDs who may be necessarily preoccupied with other matters?

    On another point, I would have asked the CAM supporting students “what do you think CAM methods can do?”. The vague answers would reveal that it is really this type of thing that they have in mind, and the point that CAM has no effect on any serious illness can be emphasised.

    Cervantes has a point. There are deeper factors determining who is sceptical and who is not. I don’t believe that in most cases it comes from any in-depth consideration of all the evidence.

  6. wertys says:

    Based on my own journey, those CAM boosting students may well mature into solid skeptics once they have experienced the chicanery and distasteful ethics of the proponents of sCAM for themselves. They are interested in engaging, and as you correctly point out, they had some chutzpah in even showing up!

  7. Quill says:

    I had a chance to see the presentation today. Well done! I enjoyed your calm demeanor and clear explanations. Including the explanatory video on homeopathy with all the drops in the ocean was an especially nice touch.

    I think what impressed me most is that always sounded like you knew what you were talking about and were there to present factual information. This may sound like faint praise but it is quite the opposite, especially after viewing an “alternative medical” presentation. They usually have all the sweaty vigor of a revival, are short on basic science and always have that feeling of sales pressure being applied in ways that call used car salespeople to mind.

    I did find one thing about your presentation lacking, even bordering on offensive, though. As a Mac fan boy, why were you using Powerpoint instead of Keynote? ;-)

  8. nybgrus says:

    Excellent talk overall Dr. Gorski. Hopefully you will get the chance to do many more of these. I would love to see a write up of any “fallout” (good or bad) from the talk, especially from the university and its IM department. Maybe I can find a way to arrange for and persuade you to do a talk over at my clinical school sometime next year :-D Though in doing a google search I find very little in the way of quackademia in my parts, though they do offer some acupuncture and a little bit of IM in the neighboring universities.

    If I had to make a critique though (and only since you asked in the post) I would say just two things.

    The first is not to pause so much when you get to the parts of the talk that may piss people off. Obviously I can understand your trepidation there but, IMO, it would be better received if it were stated smoothly, easily, and matter of factly.

    The second falls in line with the first – perhaps a bit more practice of delivering the talk to smooth over the rough points and pauses. In my experience and research, the winner of a debate is the one who sounds the best, not necessarily the one who has the best data. The same goes for the sCAMsters – they always sound so confident. Science should and does make us humble, but it is my opinion that talks like these should be given very confidently – why not have both the evidence and the confidence?

    In any event, they were relatively minor points – the content of the talk was great and certainly helped hone in on the central issue of the SBM/EBM distinction and why it matters.

  9. David Gorski says:

    That’s easy. Time. I got so used to PowerPoint a long time ago that I’ve found it difficult to change over. In other words, it’s sheer inertia. Every time I need to put together a talk, it almost always ends up being on a fairly tight deadline or I’m so busy with other things that I don’t get started on the talk until soon before (which ends up being indistinguishable from a tight deadline). This all means that I don’t perceive that I can afford to take the time to learn Keynote or to spend the time it takes to convert my huge library of existing PowerPoint slides over and reformatting them to look good in Keynote. Maybe my next talk. Of course, I keep saying that every time I’m invited to give a talk. Inertia wins again. Damn you, PowerPoint.

  10. kathy says:

    Why do people insist that facts are hard and cold, I wonder? They are wonderful. You say, “… it doesn’t require pseudoscience to be more empathetic to one’s patients” … true … you don’t have to believe in the stork to be empathetic to your children. You know how they came into existence, and it didn’t involve any magic potions, but there’s nothing cold or uncaring about that!

  11. Jann Bellamy says:

    I had the privilege of viewing Dr. Gorski “live” and it was a great talk. Two practicing MDs from the community commented to us how much they enjoyed the talk but thought you could have hit “CAM” even harder!

    I came away thinking . . . how could anyone ever defend “CAM” after hearing this talk?

    As for the med students, they are an unfortunate example of what one just one faculty member friendly to “woo” can do in a medical school. Had they been presented information about “CAM” in an objective manner, with a view toward helping them understand what they might run across in practice and how to effectively counsel patients about “CAM” use, this would not have happened. They are obviously bright, personable and very excited about medicine. It is most disturbing they have been presented with such an expurgated view of “CAM.”

  12. David Gorski says:

    I had the privilege of viewing Dr. Gorski “live” and it was a great talk. Two practicing MDs from the community commented to us how much they enjoyed the talk but thought you could have hit “CAM” even harder!

    Geez, I likened “integrative medicine” to “integrating magic into science-based medicine and illustrated the point with pictures of Doctor Strange (the Sorcerer Supreme of the Marvel Comics universe, for those of you who unfamiliar with the character), Harry Potter, Bellatrix Lestrange, and Lord Voldemort, few cryin’ out loud! How much harder could I have hit CAM? :-)

  13. Quill says:

    Geez, I likened “integrative medicine” to “integrating magic into science-based medicine and illustrated the point with pictures of…Harry Potter, Bellatrix Lestrange, and Lord Voldemort, few cryin’ out loud! How much harder could I have hit CAM?

    Well, possibly by pointing out, CAM-style, that the self-cognizing, internal world-system of the Harry Potter books is actually more plausible (and definitely more interesting entertaining) than many of the CAM “modalities” and “post-Cartesian” systems currently on offer.

    A few examples:

    –There was herb and chemistry Professor Snape who insisted on verifiable, repeatable results in laboratory experiments before you could legally practice potions.
    –There was no One True Cure for anything much less everything.
    –Even the Death Eaters didn’t go in for therapeutic touch but insisted on grabbing their victims by the throat whenever possible.
    –Voldemort didn’t have the ability to just “move his Chi” around but had to extract it from other living people.
    –The wizardly medical people admitted right away that not everything is curable, fixable or amenable to current remedies.
    –And finally, not once do you see acupuncture needles, chiropractor benches, stones or crystals floating around in the Hogwarts infirmary. ;-)

  14. hairyape68 says:

    “kids”
    You are about the same age as I was when my daughter was 23. Now, 29 years later, she is still a “kid” in my world.
    Nothing wrong with being a kid, in my view, except they are almost always a lot younger than us. Some of them are very thin skinned about it, so discretion is indicated when talking about them. Good for them being kids, they’ve got more future left than we do. They may go on to do great things.

  15. David Gorski says:

    Well, possibly by pointing out, CAM-style, that the self-cognizing, internal world-system of the Harry Potter books is actually more plausible (and definitely more interesting entertaining) than many of the CAM “modalities” and “post-Cartesian” systems currently on offer.

    Or, as I like to say in my talks, the difference between CAM and Harry Potter is that in the Harry Potter novels and movies magic works. :-)

  16. WilliamLawrenceUtridge says:

    I think the big reason why the young tend to be interested in CAM is the same reason the ignorant tend to be – they’re such superficially convincing talking points, like an extended, generation-long Gish Gallop. It takes a fairly substantial investment of time to understand enough of the basics to realize that there’s no room for acupuncture points in the anatomy, that Brownian motion would blot out any “memory” of water, that the body’s digestive processes break down herbs and collagen into substrates that are recycled. Ben Goldacre has made this point – you can learn the biochemical processes the body uses to manage blood levels of vitamins and minerals, proteins, fats and carbohydrates, and figure out that it doesn’t matter how much vitamin C you take, your blood levels won’t exceed a certain point. You can learn it, but it takes years.

    CAM sounds so glib and easy, while exposing the lies requires you to learn a lot more about how the world actually works – and it turns out the world is pretty complicated.

  17. Quill says:

    “Or, as I like to say in my talks, the difference between CAM and Harry Potter is that in the Harry Potter novels and movies magic works.”

    heh! Exactly. Isn’t it interesting, too, that CAM practitioners and the movie makers rely on the same thing for us to see it working, namely the willing suspension of disbelief, just as Coleridge described it?

  18. ConspicuousCarl says:

    For people who don’t use silverlight, the “other formats” tab will flip over and give you a windows media stream. So you can use the “other” microsoft video format.

  19. GLaDOS says:

    The CAM proponents are masters of the art of agreement. They read the wishes and fears of their audience and make a few statements that everyone agrees with. Then they build upon that foundation with other assertions that seem reasonable to accept until the moment when the hook is set and the fish can’t wriggle off without suffering a fair amount of pain.

    Example thematic arc:

    1. Sad story of brave young soldier in Iraq killed by IED.
    2. Tearful family at funeral.
    3. You, the audience, identify strongly with the grieving parents.
    4. Enter Fred Phelps and the “God Hates Fags” asshol_s.
    5. Family troubled and upset.
    6. Group of veterans on motorcycles stand as a shield around the graveside service.
    7. Bikers compared to platoon buddies going back for one of their own.
    8. F_ck those haters protesting.
    9. There ought to be a law.
    10. Law.
    11. Nice people going to church faced with disruptive protesters.
    12. F_ck those intolerant bigots.
    13. And to set the hook: Anonymous standing outside the CoS protesting.

    Another similar arc used by those deathly afraid of criticism:

    1. Gay teen beaten to death by bullies at his school.
    2. Intolerance killed that poor boy.
    3. You probably see where I’m going with this.

    The pro-CAM tribe use a couple story arcs depending upon their audience:

    1. Libertarian “health freedom” aka “nobody is the boss of me”.
    2. Nature verses the machine.
    3. A mystery sandwich awaits you.

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