Respectful Insolence

CAM in medical schools: A marketing tool?

Fellow ScienceBlogger (I’m not all that enamored of the term “SciBling”) Abel Pharmboy has finally weighed in on the issue of alternative medicine woo finding its way into medical school curricula and its promotion by the American Medical Student Association, which Dr. RW, Joseph, and I have been discussing the last few days.

Besides using his experience in natural products medicine to discuss this issue, Abel asks a very pointed question from a patient’s perspective:

So, someone like me who feels a doctor doesn’t have time for them might approach any one of the growing number of integrative medicine centers within our nation’s top academic medical centers (or a similar practice setting in the community). Will such a person be met by a trained MD or some questionably-credentialled “professional?” This point is the single greatest threat to the use of CAM within conventional medicine. Will they be told that their asthma is the result of unprocessed grief, or problem with the flow of their Qi, or that a simple mindfulness-based meditation program can help resolve their asthma?

That is indeed the question. My argument has been that these programs may be started with the best of intentions and a determination to remain evidence-based, but they tend not to stay that way. The reason is because the development and teaching of these curricula are very prone to be being taken over by true believers, for the simple reason that most conventional doctors devoted to evidence-based medicine do not have that much interest in complementary and alternative medicine (CAM) topics; certainly, most of them don’t have the same passion to apply EBM and science to CAM that the practitioners have to practice and market CAM. Moreover, many of the true believers turn out to be, as Abel informs us, “pseudoexperts.”

I’ll have more to say about this sometime next week (I’ve found a real doozy of an example), but I want to thank Abel for making me aware of an additional resource about which I had previously been unaware, Focus on Alternative and Complementary Therapies (FACT). It’s a tool to add to my armamentarium along with The Scientific Review of Alternative Medicine.

Comments

  1. #1 Joseph j7uy5
    November 18, 2006

    I understand that part of the attraction of these programs is that the services are not covered by most insurance programs. Because patients pay cash, the programs can be lucrative. It is a bit worrisome to me that the profit motive could come into play, because it is so hard to remain objective when there is money to be made.

    I have noticed that the program at UMich is doing a little bit of marketing. Not like McDonald’s or anything, but definitely more than other programs. In fact, I don’t think there are any other individual programs that do any marketing. The Medical Center itself does a fair bit of marketing, but not the programs within the Center.

    By the way, I agree that there is a risk that such a program could become a bit of a loose cannon, once established; this is especially true if administrators (who may not necessarily to able to judge the scientific merits) are influenced by budgetary concerns.

  2. #2 guerillahealer
    November 18, 2006

    HAH!

    Just when things were about to get interesting …

    Fascinating that … challenged to present evidence of CAM’s effectiveness … just at the moment such evidence is presented the discussion disappears.

    CAM has nothing to worry about.

  3. #3 wrg
    November 18, 2006

    Having patients pay cash helps, but I wonder how much overhead a quack experiences. One may (or may not) need an office, may need someone to help with appointments and billing, but someone who’s not offering medicine doesn’t need to pay for any. Why pay for equipment, lab tests, and medications when all you need are marked-up foodstuffs, supplements, magic water or sugar pills, or maybe just some incantations and handwaving?

    Oh, and guerillawoo? I was just about to ask “what evidence?” until I guessed that you were just coming here to crow after some imagined victory on the previous thread. Now I see that you dumped a load of links on it just a couple hours ago and, since blog have not been able to read and to refute over a dozen papers, you now claim victory for “CAM”. I trust you understand that that term embraces everything not yet proven to have medical efficacy, from herbal treatments that might actually do something all the way to such ridiculous notions as the magic, undetectable “vibrations” in water claimed by homeopaths. You’re just claiming that “CAM” as a whole is vindicated by your (no doubt carefully selected) references on all of two topics in hope of convincing the credulous.

    Seriously, that argument reminds me of the creationist (or Chopra) claim that all their beliefs must be true because science doesn’t know everything. That’s the whole idea, though. Scientists test their hypotheses because they acknowledge that they do not know everything, and in so doing they develop the best idea of the natural world we have. In contrast, the faithful supporters of Biblical (or other) creation myths and of mystical, unproven “medicine” have already decided what the truth must be, irrespective of how the real world works. Their pretense that they already do know everything, regardless of evidence, merely exposes how invalid their claims are.

    So, if evidence is presented that some “alternative” methods actually work, they will be recognized as real medicine, and accepted by science. But, no matter how much evidence is presented that some of them could not possibly work, their supporters will deny it. CAM has nothing to worry about so long as the public is credulous to buy into unproven treatments instead of evidence-based medicine. People who want proven therapy certainly do have to worry, though.

  4. #4 Virginia Campbell, MD
    November 18, 2006

    Besides the fact that few medical practioners are really interested in CAM, is the very real phenomena of sincere practioners falling prey to becoming true believers. Once this happens they are no longer open to evidence that their chosen therapy has been shown to be pure placebo.

  5. #5 ERV
    November 18, 2006

    That is indeed the question. My argument has been that these programs may be started with the best of intentions and a determination to remain evidence-based, but they tend not to stay that way. The reason is because the development and teaching of these curricula are very prone to be being taken over by true believers, for the simple reason that most conventional doctors devoted to evidence-based medicine do not have that much interest in complementary and alternative medicine (CAM) topics; certainly, most of them don’t have the same passion to apply EBM and science to CAM that the practitioners have to practice and market CAM. Moreover, many of the true believers turn out to be, as Abel informs us, “pseudoexperts.”

    Yes yes yes! I think that is exactly the problem with AMSA! The only kids drawn to the HuMed group are the ones that support woo anyway– and the rest of AMSA just wants to be ‘nice’.

    btw I have contacted my AMSA friends and urged them to keep an eye on HuMed, and to suggest reforming it back into research-based medicine. Has anyone else contacted AMSA officers?

  6. #6 Orac
    November 19, 2006

    Fascinating that … challenged to present evidence of CAM’s effectiveness … just at the moment such evidence is presented the discussion disappears.

    Don’t be such a putz.

    Believe it or not, I don’t spend every waking minute in front of the computer on by blog, just waiting to rebut trolls like yourself. Quite simply, I wasn’t on the blog much yesterday. You seem to think that I or my readers would be waiting with baited breath for the next pearl to arrive from your keyboard.

    Sorry to disappoint. Also, Saturday is usually the slowest day of the week for traffic to this blog, and yesterday was no exception. Only about half the usual number of people are reading compared to a weekday.

    As for the references that you posted, none of them appear to demonstrate the efficacy of CAM as you claim. Several appear to be about changes in our diet since civilization and industrialization and several other seem to be about dietary magnesium. None of this supports the efficacy of CAM; it’s all merely discussions about modern diets and magnesium, all of which appear to be within the mainstream of “conventional” dietary science.

  7. #7 anonimouse
    November 20, 2006

    The next piece of credible evidence CamQuacks present will be the first, I’m afraid.

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