Respectful Insolence

If you think Orac’s insolence doesn’t live up to the name of this blog, at least when it comes to lamenting the infiltration of unscientific, non-evidence-based modalities into academic medicine, such as the use of reiki in a top academic trauma hospital, woo finding its way into the mandatory curriculum of a prestigious medical center and becoming more prevalent in the elective curriculum of others (even to the point of credulous acceptance of quackery such as homeopathy), woo being trumpeted by the largest medical student organization in the U.S., and even what I thought to be the most impregnable bastion of scientific medicine in the U.S., the NIH Clinical Center. Sadly, too many medical students and residents presently training seem just to shrug their shoulders at this and seem to look at doctors like Dr. R. W. and myself as old fuddy-duddies or hypocrites for even thinking that this should be a concern, while otherwise prestigious medical centers think nothing of holding a “debate” about homeopathy, as if such quackery is even worthy of being seen anywhere near an academic medical center, other than as a curiosity to be studied under the sociology of medicine. Of course, as I’ve said before, to me it’s clear that this acceptance of woo by academic medical centers is all about marketing, rather than science or improving patient care.

Now, welcome a new voice arguing against this disturbing trend, Panda Bear, MD. Indeed, he’s devoting a whole month worth of posts to the topic, and he’s not nearly as respectful in his insolence as I try to be. For example, check out the first part of his inaugural post:

No one thinks rationally anymore, not even the well-educated. While I don’t necessarily expect critical thinking from the unwashed, higher education, while of no practical value to the legions of college graduates sporting their polyurethane diplomas, should at least teach people to think critically, or there is no point to it and it becomes just a four year interlude where you learned a bunch of trivia and borrowed a lot of money to party with sorority girls. Certainly you should ask for your money back if you graduated without the intellectual skill to distinguish something that you want to be true from something that is. And you should ask for a refund if you have been awarded a diploma in any field without obtaining the fund of knowledge to recognize the difference between something that could be possible and something that can’t possibly be.

Take Homeopathy, a medical therapy which relies on the imaginary property of water to retain the memory of a substance which it has diluted to a point where not a single atom of the substance remains. People often ask me if my experience with Emergency Medicine, the most practical and hard-nosed of the medical specialties, has left me cynical about the possibility of finding some validity in Homeopathy and other equally ridiculous Complementary and Alternative Medicine therapies. Actually, by the time I had finished the eighth grade I had a sufficient background in chemistry and biology to recognize that these things cannot possibly work. How much education do you need, for example, to definitively state that spinal manipulation cannot possibly obviate the need for vaccinations (as many of our chiropractic friends believe) or that spiritual fire cannot possibly, a la Saturday morning cartoons, stream out of the fingers of Reiki healers? It’s not even as if we’re arguing some subtle point about the energy state of an electron shell or an obscure ion channel in yer’ fucking spleen. This is literally third grade stuff and the fact that many prestigious medical centers lack the institutional courage to point it out should make you cringe in shame, either at their gullibility or their venality.

Don’t hold back, Panda, tell us what you really think!

In any case, it ought to be an interesting series worth reading. Come to think of it, I haven’t said much about the infiltration of woo into academic medicine in a while. Maybe Panda Bear, Dr. R.W., and I (maybe with an assist from #1 Dinosaur) can do a bit of a tag-team match…

Comments

  1. #1 Joe
    November 3, 2007

    I look forward to more of this.

    FYI, Wallace Sampson (MD) has a description of a course he teaches (taught?) at Stanford on scientific analysis of CAM Academic Medicine (2001) 76: 248-250.

    I have two questions:
    1) How can the trend be reversed?
    B) Are any schools bucking this trend?

  2. #2 PalMD
    November 3, 2007

    You’ve just given me another reason to go on living…er, I mean more ideas for writing…thanks!

  3. #3 Xerxes1729
    November 3, 2007

    I’ve been surprised at the attitudes of other students at my medical school toward this stuff. What I can’t understand is how you can sit in a EBM class on Tuesday and go on about how you know that woo works because your mother says it does on Wednesday.

    More interesting are the students who are supportive or neutral toward woo without actually understanding how absurd most of it really is. The other day I mentioned that homeopathy was certainly bullshit. Someone I was with objected, and I eventually figured out that he had no idea what homeopathy actually was. Once I explained it he (thankfully) admitted that it was, indeed, bullshit.

    Maybe medical schools should teach about homeopathy, reiki, etc. so that students actually realize how ridiculous it is. My school has electives in CAM and TCM, but both clearly draw the credulous and sympathetic, and, as far as I know, are appropriately skeptical.

  4. #4 PalMD
    November 4, 2007

    Perhaps part of the solution is adding EBM earlier into the curriculum. I love to analyze articles with students, and if you pick one “mainstream” and one “altie” to dissect, even if it’s only once a quarter, I think they’ll get the tools they need.

  5. #5 Graculus
    November 4, 2007

    It’s not even as if we’re arguing some subtle point about the energy state of an electron shell or an obscure ion channel in yer’ fucking spleen.

    *sniff*

    That line is a thing of beauty.

    Xerxes1729: yeah, the label “homeopathy” has been stuck on a bunch of stuff that has nothing to do with homeopathy. It’s a two-way street… some of these things have possiblilities (like potential pharmacological properties of plants), so homeopathy borrows that credibility, plus the other things (naturopathy, etc) borrow the popularity of homeopathy.

    In a way it makes sense… outside of some plants being useful drugs, it’s all the same class of bullshit.

  6. #6 Orac
    November 4, 2007

    Yeah, I like that line, too.

    It’s so appropriate because what the alt-med purveyors want you to believe is that the argument for their woo is something on that level.

  7. #7 PalMD
    November 4, 2007

    I think there should be a law (?Orac’s law) that states “The use of the word ‘quantum’ by anyone other than a physicist or physical chemist raises the probability of woo to 100%.”

  8. #8 JS
    November 4, 2007

    Bronze dog emu’ed you on that one.

    - JS

  9. #9 Doctor J
    November 4, 2007

    Amazing that I’ve never been to your blog before today. I linked here from PandaBear. Incidentally I agree with your take on CAM.

    As a medical student I am also a member of our chapter of AMSA. I joined for the Netters. Still, my chapter is pushing a CAM month, where we will have optional informational sessions hosted by bona fide quacks. I intend to attend, if only to provide a counterpoint to their ridiculous points.

    Keep up the good fight.

  10. #10 ak
    November 5, 2007

    Efforts at prostate cancer prevention do not work. That does not stop everyone from “believing” that certain diets, behaviors matter. We have religion, not medicine.

  11. #11 Genewitch
    November 5, 2007

    Strangely i was duped (maybe) by homeopathic remedies. I bought a bunch of the plant stuff to help me curb my nicotine withdrawl symptoms. Suffice it to say i took the advertising at face value (i was desperate and know that plants work for some things… aloe vera being a big one)…

    I haven’t really tried them yet, but maybe even the placebo properties of them is enough to convince me that they are working. I just wanted to quit. :-)

    so thanks to graculus pointing out that there may be a thread of homeopathy that isn’t just snake oil.

  12. #12 isles
    November 6, 2007

    Good for you, Doctor J! It pisses me off to no end to think that I might someday be treated by a doctor who was taught that water can remember things. How are they supposed to understand the scientific method if they’re simultaneously taught something that flies in its face?

  13. #13 educated consumer
    November 14, 2007

    Are we all aware that the number one cause of death in the United States is medical error?

  14. #14 HCN
    November 14, 2007

    No we are not. How about you give us some evidence of that?

    Try it by age, since accidents are the leading cause of death of those between the ages of 1 to 45, and after age 45 it is heart failure and malignant neoplasms:
    http://www.disastercenter.com/cdc/111riskf.html

  15. #15 Orac
    November 14, 2007

    Are we all aware that the number one cause of death in the United States is medical error?

    No, we aren’t, mainly because it’s not true.

    However, even if it was, please tell us what it has to do with the topic at hand. Also please tell us how permitting even more non-evidence-based medicine would decrease the number of medical errors in the United States.

    Nice try at a red herring, though, as blatantly obvious as it was.

  16. #16 Sally, diploma owner
    November 16, 2007

    Really, Orac. Medical errors sometimes cause human death, but we just try not to concentrate on it. We trying to be sure in our medical system, though, it is not so perfect and requires changes.

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