Respectful Insolence

David Colquhoun, eminent scientist and maintainer of the excellent blog DC’s Improbable Science, has recently returned home to the U.K. after a trip across the pond to the U.S. and Canada, where, among other things, he gave a lecture at the University of Toronto, as well as the Riker Memorial Lecture at the Oregon Health and Science University. Now that he’s back, he’s made some observations about the infiltration of quackademic medicine into U.S. medical schools, the same infiltration of woo that I’ve lamented in my Academic Woo Aggregator.

Among his commentary on several “luminaries” of the quackademic medicine programs, programs such as the one at the Integrative Medicine Program at Yale (another one for the Woo Aggregator–how on earth did I miss it?), the Scripps Institute’s Scripps Center for Integrative Medicine, the Oregon Health Sciences University’s Integrative Medicine Service, the University of Arizona’s Program in Integrative Medicine, as well as Columbia University and Cornell. Worse, he’s unearthed a program I failed to find for my Woo Aggregator, namely the Integrative Therapies Program for Children with Cancer at Morgan Stanley Children’s Hospital of NewYork-Presbyterian. The interesting thing is that I could only find press releases about this program; it does not appear to have a webpage or website of its own. Interesting. I may have to investigate further. One thing’s for sure, though: less than one month after the last update, the Academic Woo Aggregator definitely needs another update. I wonder if the number of programs will top 50 when I do update it.

What’s depressing to me, though, about Dr. Colquhoun’s observations is that the situation appears to be worse in the U.S. than in the U.K. because major medical schools are devoting divisions, departments, or services to teaching nonscientific (and in some cases even antiscientific) medicine to students, residents, and fellows and offering it to patients:

It is on the clinical side where the situation is far worse than in the UK. Almost every university hospital, including Harvard, Yale and Stanford, has departments devoted to fairy-tale medicine.

Quacks use a number of euphemisms to make themselves sound more respectable. First they became ‘alternative medicine’, then ‘complementary medicine’. Now the most-used euphemism is ‘integrative medicine’, which is favoured by most US universities (as well as by the Prince of Wales). Raymond Tallis pointed out that this seems to mean integration of treatments that don’t work with treatments that do work.

So, fellow advocates of science- and evidence-based medicine, it appears it’s time to go once more into the breach; this battle will apparently go on for a long time.

Comments

  1. #1 Hank
    February 18, 2008

    What boggles the mind is the fact that hospitals engage in practices without efficacy. Disregarding plausability I can in some way understand, but efficacy?

  2. #2 badchemist
    February 18, 2008

    Orac, if you haven’t heard already the Quackometer’s webhost have proven their spinelessness and pulled the site.

  3. #3 Marshall
    February 18, 2008

    I, for one, am glad that Harvard, Stanford and Yale are incorporating Integrative Medicine. There’s enough problems with “evidence” based-medicine (Poor staffing at FDA, bias by pharmaceutical companies who fund studies and scientists, scientific misconduct, Ionnides’ excellent work on studies deemed “non-operative after a second look) to warrant a few new ideas at our best Universities. Sorry.

  4. #4 PalMD
    February 18, 2008

    Hey, Bad, thanks for the heads up.
    Marshall, the idea behind EBM is that it at least is scientific, whereas cult medicine is akin to religion.

  5. #5 Carl B
    February 18, 2008

    Why would respected pioneers in scientific medicine even have alternative medicine centers, you ask? The answer is real simple:

    Money.

    People rely on their insurance to pay for medical treatments. As soon as any treatment is proven to be effective over placebo and (reasonably) safe, it crosses the divide into “traditional medicine” and is generally covered by insurance, which will pay a certain percentage of what the hospital and doctor charge.

    Alternative medicine, on the other hand, is generally cash only. When you go see a homeopath, you pay the fee that he or she charges (and their full price for their placebo that they’ll try to sell you as the cure for what ails you). No insurance company to speak of. You don’t think allopathic hospitals see this and don’t go “cha-ching?”

  6. #6 Bronze Dog
    February 18, 2008

    Quibble: Allopathy died a century ago. Homeopaths just transfered the label to the emerging, successful competitor. I’m generally more prone to compare homeopathy to allopathy. They’re both quite silly.

  7. #7 Richard Eis
    February 19, 2008

    Can someone please explain to me how the same “medicine” can be alternative, complementary and integrative at the same time? or do they just like the way these happen to roll off the tongue.

    In response to Marshall i have to ask why exactly the same “problems” would not affect “integrative medicine” or why making up “new ideas” would help FDA staffing (or any of your other points quite frankly).
    Actually, if there is a problem with FDA staffing then burying them under a ton of new psuedoscientific claims is hardly going to help. You are only adding to their workload.

  8. #8 Luna_the_cat
    February 19, 2008

    Two problems I see in the US are, first, that many people simply regard medical care as a profit-making business — it’s not about about efficacy so much as it is about generating revenue and keeping customers; and second, there is a strong popular anti-intellectualism, not just in non-professional ranks. It seems like even professionals have been infected by a tendency to value emotionalism and “feelings” over rational analysis.

    Of course, there is to some degree a real danger of losing “customers”. People like my mother, for instance — if she couldn’t find a “western” doctor who allowed her to integrate her herbal supplements, chi-balancing massage and other woo into her treatment schedule, she would abandon “western” medicine entirely in favour of the chi-balancing massage and woo (this isn’t speculation, she did this. Repeatedly. Until we found a woo-friendly “integrative medicine” clinic for her). On the occasions she received criticism from the family for her use of untested supplements, she behaved like an alcoholic; she squirreled them away and took them in secret, because she “knew” they were working for her (even when they were really hurting her badly). At least under the current setup, we know what she is doing, and the doctor has a chance to head off some of the more damaging things. –What else would you do with people like that? Just let them die? Easy enough to say, if it’s not your mother. When it IS your mother, you take what you can get, even when it incorporates nonsense where it shouldn’t be, because you don’t want to see someone you care about damage themselves even more, and you can’t force anyone to be rational if they really don’t want to be.

    No, I don’t have an answer.

  9. #9 Alexis
    February 19, 2008

    Given that the Royal London Homoeopathic Hospital receives NHS funding (although thankfully Primary Care Trusts are cutting back on referrals–you can’t justify paying for homeopathy when there aren’t enough midwives in hospital) I don’t think the Brits can afford to be too smug. The British media is also utterly appalling in reporting health and science stories.

    There is a departmnt of complementary medicine at the Peninsula Medical School, led by Prof. Edzard Ernst, though from his columns in the Guardian I remember him being rather skeptical and using an evidence based perspective to evaluate CAM methods.

  10. #10 london medic
    February 20, 2008

    I’m at one of the big London medical schools, in the first year of an accelerated 4-year medical degree. We have a bit of interprofessional training with nursing students, and one of these consisted of a day spent talking to various alternative therapists, some of whom teach university courses on CAM.

    I was rather pleased to see my coursemates (medics and nurses both) give them a pretty hard time, in particular we were all gobsmacked by a homeopath who gaily informed her group that as her daughter had a ‘strong immune system’, she didn’t need the rubella vaccination!

    I have to say personally, I found that some of the attitudes the CAM practitioners had were pretty reprehensible. One of them talked about how GPs could send their ‘heartsink’ patients to her. That’s great, very ethical, send someone to YOU so they won’t bother US anymore, and then CHARGE them for the privilege! This in a trust that has some of the most deprived areas in the whole of the UK! I was informed that I shouldn’t be ‘closed minded’ about reiki (Hang on mate, you are the one charging 80 quid an hour, you should be able to do better than that!)

    I have resolved to ask the next person who talks about ‘quantum’ and homeopathy to explain plancks constant, the difference between up and down quarks and why finding the higgs boson is important, or shut up and stop trying to blind people with science they know nothing about.

    Having said that, I do agree with what Luna_the_cat says. It is important that doctors don’t transfer any antipathy they may have to CAM onto patients who are using CAM. Indeed I think that CAM can have its place – therapeutic touch and massage for cancer patients for example. I guess one big problem is that some CAM practitioners don’t really seem to know their limits, and wouldn’t refer someone back to their doctor. Perhaps professional registration will help, I just don’t know..

    The homeopaths that spoke to us seemed to regard Ernst as a bit of a trojan horse out to discredit them, so he can’t be all bad!

    Long time reader, first time poster, love the blog.

    londonmedic

  11. #11 David Colquhoun
    February 21, 2008

    Luna_the_cat is right that we have nothing to be smug about. But the point that I was trying to make is that there is that such woo as exists in hospitals in the UK comes under the aegis of the NHS, not of universities. There is no CAM department in Oxford, Cambridge, UCL etc. The heads of those universities have no control at all over what goes on in the teaching hospitals attached to them. In contrast, the woo in the US appears on the university web sites of Harvard, Yale, Stanford etc.

    Of course it is quite likely that that is simply a matter of money. I’d be very interested to see what happened in the UK if the MRC were to provide a billion dollars, as NIH has, for research into CAM. Would Oxford, Cambridge and UCL cave in to the bribe? I don’t know but I wouldn’t put much money on it. It would also be interesting to see whether the money was spent on real research. The billion dollars of US taxpayers’ money has produced next to no useful results.

    I was also very glad to hear that londonmedic spoke out when subjected to nonsense in the name of education (send me some details if you have more -I’ll be happy to give them some publicity). But when you say you have no problem with therapeutic touch for cancer patients, I think that you are neglecting both the lying dilemma and the training dilemma ( http://dcscience.net/?page_id=10 ). Once you allow in that sort of thing, HR zombies start to demand courses -see http://dcscience.net/?p=34 for example, and before you know where you are universities will be laying on courses in magic.

  12. #12 Dr. Jones
    February 23, 2008

    I wonder if health care professionals who subscribe to science-based medicine should participate in a unifying marketing strategy? Just as “Integrative Medicine Specialists” have branded themselves, why not have our own “Science-Based Medicine” brand? Then anyone who comes to us for care will know that we do our utmost to base our decisions on the best evidence to date, we will clearly distinguish between therapies that have been shown to work, versus those that haven’t, and we will not sell or promote placebos for profit. Since quackademic medical centers are succumbing to the lure of grants from wealthy woo-believers, the physicians and providers who work at the centers may yet identify themselves with their scientific values.

    What do you think? Let’s fight marketing with marketing.

  13. #13 Mac
    March 9, 2008

    Well.
    Certainly, the persons such as e.g. notorious Holford must not be Professor, because he is quack.

    However, there is more interesting fact.
    The “proud and mighty” David Colquhoun is not Professor longer. Here is his words from his blog:
    “”5 March 2008. Next Monday there will be a meeting of Academic Board to ‘discuss’ new proposals for professorial pay. Since I’m now a research assistant, I have no vested interest in the outcome. The system so far has been wrapped in mystery, Every year you got a letter to tell you what your pay would be for next year. The proposed system is available here. There are some good things about it. Unlike many of my colleagues, I have always felt that it should be possible for pay to go down in late life for people who cease to be productive. As long, of course, as people who remain productive after 65 can continue to make contributions (UCL has implemented the latter in a manner so stingy that there must be doubts about its legality).”

    (http://dcscience.net/?page_id=179)

    UCL doesn’t consider Colquhoun deserves Professor title and doesn’t think that his present work is the fitting contribution into science.
    Criticism of bad science is useful thing, surely. But critic must not forget that good science is his own MAIN duty. He must be good scientist himself.

  14. #14 Dr Aust
    March 9, 2008

    David Colquhoun is past the official UK University retiring age for PAID employment (compulsory retirement at 65, or in a few places 67)… though it has not slowed him down scientifically. Anyway, being officially “retired” he is not on a “Professorial salary” any more, which is what the post Mac refers to was actually discussing.

    Almost certainly Colquhoun will be an “Emeritus” Professor (formally retired but in fact still active in science). I suspect he pays himself a small salary – research assistant equivalent, hence what he says in the post – out of a research grant.

    Some UK scientists in Colquhoun’s position choose to move at 65/67 to other countries where retiring age does not apply – e.g. Hugh Huxley, one of the doyens of muscle physiology, moved on reaching retirement age from the MRC Laboratory of Molecular Biology in Cambridge to Brandeis. Others, like DC, who have a strong institutional loyalty, choose to stay put under various kinds of ad hoc arrangement.

  15. #15 Mac
    March 10, 2008

    Yes? Will Colquhoun be an Emeritus Professor?!! Indeed?
    If he deserved it, then he would be Emeritus Professor just now! But firstly he doesn’t deserve it, secondly – he will not deserve it, because the only thing which he do now – it is empty talks in blogs. And thirdly, even if he deserve it, the mediocrities, which usurped the power in UCL, will never give him this title.

  16. #16 Mac
    March 10, 2008

    Certainly, Hugh Huxley has come to Brandeis. Because he thinks about Science and his work. And he works, unlike Colquhoun.
    “…who have a strong institutional loyalty…”!
    Indeed?
    Oh, no. He would come to America with his pleasure like Huxley, if somebody invited him to work there! But none of his American friends will invite him.
    Am I wrong? Eh?
    OK! Let his American friends say that I am not right.
    Go ahead!
    Dr. DeCoursey? Prof. Eisenberg? Prof. Auerbach? Who of you could invite Colquhoun to work in your Labs?
    Maybe sirs from Toronto? Gentlemen from California?

  17. #17 Ephistopheles
    March 18, 2008

    Your Colquhoun is old and unproductive in science. He must retire and sit at home.

  18. #18 MartinM
    March 18, 2008

    Can’t help but wonder how many papers Mac or Ephistopheles published last year. Or, for that matter, how many they’ll manage to publish after they pass retirement age.

  19. #19 Mac
    March 18, 2008

    I have received patent last year. The invention in field of biotechnology. Do you have other questions about it? ;)

    And as for retirement age…
    My former chief has received 10 patents last year and has published about 5 papers (one paper – personally, other works together with colleagues). Too much? Not at all. The point is that he is director of research institute, dean of new Faculty and Head of big research project. He is one year senior to “your” Colquhoun.
    Why – “about” 5 papers? Because one of his paper was sent in “Nature”. But “Nature” doesn’t want to publish this paper still. Why? Because “Nature” prefer to publish idiotic talks by the old scientists (such as Colquhoun, for example), unfortunately, but not modern interesting works! :(

    Do you have other questions??… Ask, please, don’t hesitate! :)

  20. #20 Mac
    March 18, 2008

    So the only thing which I can recommend to David Colquhoun – to apply to Mephistopheles :P All the more so – devil is hangs about here anyway… :) ;)

    Anyway – it helped Faust once ;)