CAM In Medical Schools

A recent US News and World Report article on the incorporation of complementary and alternative medicine (CAM) into US medical schools credulously repeats the pro-CAM marketing hype. There is no evidence that the author, Meryl Davids Landau, spoke to a single critic of CAM, or is even aware that such criticism exists. The result looks more like marketing copy than serious journalism.

She begins:

Now that nearly 40 percent of American adults swear by some form of complementary and alternative medicine, or CAM—from nutrition and mental relaxation to acupuncture, magnet therapy, and foreign healing systems like traditional Chinese medicine and Indian ayurveda—a growing number of medical schools, too, are supplementing medication with meditation.

There is much to deconstruct just in this first paragraph. The entire article in an argument from popularity. This is a game the pro-CAM community has been playing for years. People are using CAM because it’s popular; medical schools should teach it because people are using it; the government should research it because of all the interest in it; and CAM should be popular because it’s being researched and taught in medical schools. CAM is like Paris Hilton – famous for being famous.

What’s missing from this circular argument for popularity is evidence that any particular CAM modality actually works, or even has scientific plausibility or the potential to teach us something new about the human body and healing.

The argument is not only fallacious – it’s wrong, or at least highly deceptive. This stems from the core fallacy of CAM, and that’s the very concept of CAM itself. It is a false category, which does not describe any cohesive philosophy or approach to medicine but rather exists solely as a marketing ploy to carve out a double standard – to exempt certain modalities from the rigors of science, evidence, and logic. This false dichotomy results in lumping a wide variety of treatments under one umbrella, and then claiming that the entire category is popular.

When we look a little closer at the numbers we find that the vast majority of so-called CAM use in the US is either massage (16%), chiropractic or osteopathic manipulation (21.9%), and yoga (9.5%). (There is overlap in use so you can’t simply add these percentages, but the vast majority of the mythical “40%” figure comes from these categories.) So some form of exercise, stretching, or muscle manipulation accounts for the vast majority of CAM use. Throw in some other modalities that are not really CAM, like relaxation and nutrition (since when has the science of nutrition been alternative to science) and that accounts for even more.

What’s left for the real hardcore CAM modalities like homeopathy and acupuncture? Not much. These modalities have been languishing in the single digits and not significantly increasing. But by lumping them in which relaxation and massage you can generate the false impression that the whole category is popular. The entire exercise is intellectually sloppy and deceptive – by design. And this deception is being used to convince medical schools that “CAM” deserves access to the limited resources of the school, which is then used to convince patients that it’s legitimate (more circular reasoning).

And we’re just at the first paragraph. She continues:

Interest in teaching alternative approaches “has exploded, especially this last year,” says Laurie Hofmann, executive director of the Institute for Functional Medicine, which is based in Gig Harbor, Wash. The nonprofit institute educates healthcare professionals to look for underlying systemic imbalances as a cause of illness rather than focus on treating symptoms and, when possible, to correct with lifestyle changes and mind-body techniques.

No evidence is offered for this alleged “explosion” in interest. What’s missing from the article is any mention of the Bravewell Collaboration – a funding organization that pays medical schools to open up CAM centers. This is part of a very deliberate “quiet revolution” that Wally Sampson has written extensively about, an attempt to change the practice of medicine by influencing medical education (rather than through compelling evidence).

Landau then repeats, without the slightest hint of journalistic skepticism, the claim that “integrative” medicine looks for underlying causes of illness, while mainstream medicine simply treats the symptoms. This is pure CAM marketing mythology, having no basis in reality. Science-based medicine is built upon a systematic attempt to understand the underlying cause of illness. Of course, when scientific medicine searches for underlying causes this is denigrated by CAM proponents are “reductionist.” When they do it, it’s “holistic.”

The difference between the scientific approach and the typical CAM approach is that science is based in reality. It slowly builds a knowledge base that is internally consistent. Whereas most CAM modalities are philosophy-based – they are based on pre-scientific superstitious notions of health and illness that have not been subjected to any kind of systematic study, or that have been left behind by scientific advance (such as the notion of life energy). These philosophies are often mutually exclusive, which doesn’t seem to bother the “big tent” CAM movement. In the end, the alleged underlying “imbalances” sought for by CAM practitioners are illusory and not based in reality. That doesn’t stop them from being smug in their dismissal of scientific medicine.

What follows is a long list of medical schools integrating nonsense into their curriculum – as if this is a good thing. Landau admits that many medical schools find it difficult to find time in their busy curriculum for CAM teaching. This is because there is a large body of medical knowledge that needs to be crammed into four years of medical school. At Yale where I teach every department is clamoring for one more hour here or there to teach their material. There just isn’t enough time, and we have to be creative in maximizing classroom time for the students. This just highlights the importance of not wasting this limited resource teaching the fads of the day.

This gets to the deeper question that is not even addressed in the article – what is the responsibility of academic medicine in determining the standards that should be followed in medical education? Medical schools are being offered what are essentially bribes, and are being told that CAM is popular as reasons to spend precious time teaching (often really promoting) CAM. This is often accomplished without open debate and discussion, and many faculty members are shocked to find out what is going on in their own institution (quiet revolution indeed). But isn’t it the responsibility of medical schools to maintain high standards of science and academia, to resist the forces of pseudoscience, sectarian beliefs, and popular culture? Perhaps I am being too idealistic.

In the end Landau’s article was devoid of any serious discussion of the actual issues. The result was a propaganda piece (intentional or not) for the sectarian beliefs and economic agenda of CAM, at the expense of academic integrity.

Posted in: Medical Academia, Science and the Media

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