Respectful Insolence

Medical schools going the wrong way

Everyone who reads this blog regularly knows my dismay at the infiltration of the curriculum of American medical schools with increasing amounts of non-evidence-based woo. It’s even gotten to the point where one medical school (Georgetown University) has is integrating alternative medicine into the mandatory curriculum during all four years, even though these modalities are not based in convincing scientific evidence and therefore are not considered standard of care. Well, this distressing trend just gets more and more disturbing. Now, it seems, you can do a residency or fellowship in “integrative medicine,” where you can learn how to “integrate” non-evidence-based modalities right along side scientific evidence-based medicine.

This is “progress”?

What’s most disturbing is looking at the “Licensing, Certifying and Training Standards for Alternate Modalities.” For example, if I ever wanted to be “certified” in homeopathy as a physician, this is all I would need (well, plus $500 to take the “certification exam”):

For MDs (Medical doctors) and DOs (Osteopathic doctors):

  • Certification: The American Board of Homeotherapeutics certifies physicians at two levels:
    1. A Primary Care Certificate in Homeotherapeutics can be obtained at the post-graduate or graduate level. It requires: 60-100 hours of training homeotherapeutics and a written exam;
    2. A “Diplomate in Homeotherapeutics (DHt)” is required for treatment of chronic disease or complex pathology. It requires: proof of comprehensive didactic and clinical traing and 3 years of clinical experience.
  • Licensure: Most physicians practice homeopathic medicine under the licensure provided by their state medical boards. However, Connecticut, Nevada and Arizona have developed separate homeopathic medical state licensing boards and physicians must obtain and additional license in these states. Currently, MDs and DOs are the only professions licensed to practice homeopathy in all of the states.

What the hell is going on in Connecticut, Nevada, and Arizona that they actually license homeopathic woo?

Maybe I’m just wasting my time fighting the intrusion of this woo into medicine. I could just give in and dive in. 60-100 hours? I could take two or three weeks off and do that. Then I, too, could dispense placebos wrapped in ritual and charge money for it.

Yeah, I’m not in a great mood at the moment about the state of medicine.

Comments

  1. #1 planetaryGear
    January 28, 2007

    you should do it! Sign up! What better way to debunk them from the inside. They cant claim you just dont get it if they certified you to do it ;) Put up a paypall donation button and we’ll raise the exam money. A send Orac to woo-school fund! WOO! sounds like fun!

  2. #2 Matt
    January 28, 2007

    You’re forgetting that medicine is regretfully very consumer driven- and homeopathy/alternative therapy is what people want- in addition to botox that is…

    I think that this is fundamentally the same reason why we have the evolution/creationism debate- people don’t know how to recognize and process facts/evidence- but instead like to do what makes them warm and fuzzy inside.

  3. #3 Joe
    January 28, 2007

    This demonstrates what wingnuts the AMSA are. Notice that they refer to naturopathic doctors as if they belong with health professionals.

    It also shows how little the term “certied” means in many cases. For example, Sylvester Stallone’s mother is a certified rumpologist http://www.skepdic.com/rumpology.html who will analyze a picture of your butt for $125. I guess the AMSA missed this specialty.

  4. #4 Marcia
    January 28, 2007

    if you haven’t already seen this, Ayurveda is trying to make a move:

    http://www.financialexpress.com/latest_full_story.php?content_id=150769

    If physicians get a hold of these alternative “therapies”, patients will feel pressured to try what is recommended, so they can maintain a good relationship with their healthcare provider. I’ve talked to many patients who have bought “prostate support” supplements from docs who offer them and who get a cut of the sale when a patient calls an 800 number to make the purchase. These supplements are far more expensive when compared to those you can purchase at a local vitamin shop. The patients would invariably tell me that they didn’t really want to buy them, but since it was their doc who told them, they felt they should, for not only did it have the doc’s backing, but at the next visit he or she might ask them about it. Virtually all of them said they were uncomfortable with the physician recommending the supplement, but they almost always bought it.

    What happens when they recommend a Deepak Chopra energy- supporting Indian botanical?

    My hope is that all of the placebo-like results coming from NCCAM will nip this garbage in the bud.

  5. #5 impatientpatient
    January 28, 2007

    Frustrating and embarrassing. And that is as a non medical person.

    I just wrote about this at Pharyngula, regarding the spirituality quiz. I flipped because there are too many woo based programs that purport to treat the WHOLE person ( as opposed to the problem, I guess) with alternative crap.

    Keep fighting

  6. #6 Ali
    January 28, 2007

    I was thinking the same thing as planetaryGear. Lure in the alties and then sow the seeds of rational thought.

  7. #7 bones
    January 28, 2007

    I have started a MD Licensing, Certifying, and Trining Program for use of the Force in the practice of medicine. it requires 100hours of viewing the various Star Wars movies and practicing the following phrase, “You do not have (name of suspected disease)” until people believe you. We have perfect evidence for Jedi Medicine, look it works in the movie, what more proof do you need? I anticipate the total cost for certification would be $500 and total loss of self respect. Hey, it’s as intelligent as an MD believing in homeopathy.

  8. #8 PhysioProf
    January 28, 2007

    If the administration at the medical school where I teach ever tells me to “integrate” nonsense into the curriculum, I will refuse (if I have tenure by then)!

  9. #9 Andy
    January 28, 2007

    Wait wait, couldn’t this have positive outcomes as well? If real doctors are licensed in alternative medicine and the public is made aware of this, then they would go to their MD/DO for primary care instead of going to some quack, since the MD/DO will be certified to do the same things anyway. The MD/DO would be better able to spot real problems that may present themselves and provide appropriate treatment, whereas the patient runs a greater risk by seeing the quack with no real medical training.

  10. #10 Joe
    January 28, 2007

    @Andy, I agree that is a nice scenario, and when I think of MDs practicing IntMed I hope the quackery only comes in after adequate medical care has been rendered. To the extent it keeps the “worried-well” from obtaining inferior care, it is a good thing.

    The downside is the apparent legitimization of the quackery- and the lure of (for example) pure homeopaths who say “Your doctor only dabbles in homeo; whereas I am better at it because I have more thoroughly studied it and it is all I do. And, I cost less.”

    There is, also, a problem of developing and reinforcing uncritical thinking in the medical community. That could lead to inferior medical care.

  11. #11 bernarda
    January 28, 2007

    You might be interested in this “medical” point of view coming from England.

    http://www.timesonline.co.uk/article/0,,2087-2570067,00.html

    “A MUSLIM doctors’ leader has provoked an outcry by urging British Muslims not to vaccinate their children against diseases such as measles, mumps and rubella because it is “un-Islamic”.

    Dr Abdul Majid Katme, head of the Islamic Medical Association, is telling Muslims that almost all vaccines contain products derived from animal and human tissue, which make them “haram”, or unlawful for Muslims to take.
    Islam permits only the consumption of halal products, where the animal has had its throat cut and bled to death while God’s name is invoked.

    Islam also forbids the eating of any pig meat, which Katme says is another reason why vaccines should be avoided, as some contain or have been made using pork-based gelatine.

    His warning has been criticised by the Department of Health and the British Medical Association, who said Katme risked increasing infections ranging from flu and measles to polio and diphtheria in Muslim communities.

    Katme, a psychiatrist who has worked in the National Health Service for 15 years, wields influence as the head of one of only two national Islamic medical organisations as well as being a member of the Muslim Council of Britain. Moderate Muslims are concerned at the potential impact because other Islamic doctors will have to confirm vaccines are derived from animal and human products.”

    I thought you would be interested, regardless of what you think of me, which is unimportant.

  12. #12 anonimouse
    January 28, 2007

    The AMSA is truly disturbing, and not just because they’re fans of the woo. There’s some other rather creepy things they pursue on the down low.

  13. #13 M
    January 29, 2007

    In the UK the NHS funds this bullshit. Disintegrating left right and centre, no money for anything, but money enough for state-funded woo.

    grrrrrrr

  14. #14 Orac
    January 29, 2007

    The AMSA is truly disturbing, and not just because they’re fans of the woo. There’s some other rather creepy things they pursue on the down low.

    Do tell. Can you tell us more?

  15. #15 anonimouse
    January 29, 2007

    I can’t really. Let’s just say that there’s some serious woo (not just medical woo, either) that permeates portions of the AMSA.

  16. #16 Sid Schwab
    January 29, 2007

    It’s inarguably highly disturbing. What’s not clear is why med schools, most of which, you’d think, had a least enough real scientists on the faculty to raise a stink, are doing this. Is it because the applicant level is sinking? Do the feel the need to accept people who lack any understanding of evidence-based medicine? Is it a cynical view that they should help their graduates make money in a stupid world? It’s truly hard to fathom, and it’s really, really depressing. We are, once again, seen to be a nation of idiots.

    In my area I’ve already seen ads by young MDs touting their “integrative” approach, and listing their use of naturopathy, homeopathy, etc. My plan is to not get sick. Hope I can stick with it.

  17. #17 Robert W. Donnell
    January 29, 2007

    Orac,
    Concerning AMSA, try poking around their web site. Most of the “good” stuff (buried deep, deep deep in the site!) concerns medical woo but their’s also a broad cultural agenda of extremist activism on issues like single payer health, tort reform and end of life. You can also lurk on some of the Google discussion groups and med student forums to see how deep into woo they really are. They have an interesting way of luring unsuspecting med students into their agenda.

    AMSA is big, well organized and surprisingly influential. They’re grooming the next generation of doctors to launch a postmodern revolution in medicine that’ll make Abe Flexner turn over in his grave.

    This whole medschool woo thing needs exposure, so I’m always glad to see you hammer away at it. I’ve given it a rest the last couple of weeks, so I’ll probably put up a link to your post to keep the discussion going.

  18. #18 anonimouse
    January 30, 2007

    Concerning AMSA, try poking around their web site. Most of the “good” stuff (buried deep, deep deep in the site!) concerns medical woo but their’s also a broad cultural agenda of extremist activism on issues like single payer health, tort reform and end of life. You can also lurk on some of the Google discussion groups and med student forums to see how deep into woo they really are. They have an interesting way of luring unsuspecting med students into their agenda.

    That’s just what’s publicly available, too.

  19. #19 kimberly
    January 30, 2007

    You “real” doctors (this endearing term made up by medical doctors simply shows your god-like complex)are so caught up in complimenting your egos by showing other’s fallacies, and with using “Scientific Evidence” as your only validity. A person doesn’t need to be a doctor to read the medical journals out there showing how DANGEROUS you medical doctors and the drugs you push really are!! You might be a self-proclaimed “real” doctor, but apparently you can’t read that well. For if you could, you would consider bringing your ego down to Earth’s level (you know down here with the rest of us idiots) and start really caring about the patients. But then again, you would remember that you pledged to “First do no harm”. Don’t forget, you become a doctor because you want to help people, not because you need to stroke your ego. Actually, that was probably giving too much credit to your ethics and morals.

    The real problem isn’t the fact that other medical doctors want to learn alternatives (again, another term from your group), it is in fact that you guys change your practices like a mother changes a baby’s diaper. If something comes out that could make you money, you start to justify and validate it’s nature and then you try to take it over. Did these alternatives not work thousands of years ago? Of course they did, there just wasn’t a pot of gold attached to it like there is now. You should maybe believe in something and stick with it. The last conference I attended had “how to integrate nutrition into your medical practice” next door. Why don’t you guys stick to pushing drugs like you’re supposed to. You don’t and won’t see the “fake quack ” doctors next door to your conferences learning how to integrate drugs into our practices. Oh yeah, next time you can scientifically prove what kinds of reactions patients will have when taking a drug, then you’ll have an argument with scientific validity. Trust me, we DON’T want your profession anywhere near us!! And we definitely DON’T want you practicing alternative therapies, because then they won’t be safe and we will be lumped into the fact that medicine is the third leading cause of death in this country. OUCH!!

    A “Fake” Doctor
    And since my malpractice insurance proves the safety of what I do in contrast with any medical doctor, I will proudly use the title “Fake Doctor” so as not to be grouped in with your practices.

  20. #20 anonimouse
    January 30, 2007

    Kimberly,

    Couldn’t get into medical school, huh?

  21. #21 Brad Jacobs
    January 31, 2007

    It’s too bad that when you think of ‘alternative medicine’ you think of quackery. There are an increasing number of rigorous clinical trials conducted on a multitude of therapies that show great promise and, of course, an equal number that show some therapies are no better than placebo. But why throw the baby out with the baby basket? What lump different therapies from different disciplines and technologies together? Why not engage in a more refined and precise dialogue on specific therapies and issues e.g. use of ephedra for weight-loss, use of chaparral, chelation therapy etc.

    By combining disparate modalities/therapies/technologies together and calling them ‘alternative medicine’ you deny patients/consumers a proper education on the risks, benefits of specific treatment options that they are considering or discussing with you and their friends. This is the reason why only 30% of patients tell their physician they use dietary supplements (Mayo clinic pre-op survey) and when prompted (in this population) 60% were taking a dietary supplement!— your perspective will only enforce further silence and increase risks to the patient who no longer has access to someone with an open, and discriminating mind.

    In addition you deny them access to therapies that may encourage self-care, self-efficacy, reduce healthcare utilization, and reliance on health professionals (e.g. tai chi, and yoga as an example of ‘exercise’)? In a climate of increasing health costs, lack of funding for prevention, increased burden on the consumer to cover their medical costs, it is negligent for the medical community to turn their backs on viable treatment options that may have surprising results. While 500K people per year die of tobacco related illness (#1 Killer), 400K die per year from poor diet/lack of exercise (#2 killer)- Mokdad et al JAMA 2004.

    Specific therapies include stress management(meditation, breathing techniques etc.), exercise, healthy eating for starters which are the mainstay of MD scope of practice but (frequently) not given the time needed to encourage behavioral change.

    Examples of less self-care oriented but clearly less expensive/invasive treatment options include, #1) omega-3 fatty acids (fish oil, flax seed, fatty fish) has clearly demonstrated a 30% mortality benefit, and 50% sudden death mortality benefit amongst those with documented CAD. #2)glucosamine sulfate (note NEJM multi-center trial used a different formulation and, nonetheless, showed benefit among mod-severe subgroup) or #3)acupuncture for knee osteoarthritis. Of course, the nay-sayers will point out negative trials but when you look at the overall compilation of studies…they are effective. Also, consider #4) acupuncture for nausea and vomiting during chemotherapy, pregnancy, or post-surgically.

    So why all the fuss? I think it is important that our young physicians learn the full spectrum of treatment options available to the patient, as well as learn about Integrative Medicine which includes not only ‘more tools in the tool box’ and the benefits/risks and evidence associated with each but the importance of patient-centred care, of self-care, of building self-efficacy, of enhancing the ‘placebo response’/’healing potential’ through engaging the mind.

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