Respectful Insolence

Summer school for woo

Imagine you’re a medical student in a dreaded “allopathic” medical school other than Georgetown. Imagine further that you’re finding the grind of learning science- and evidence-based medicine a bit tiresome. After all, there’s so much to learn: principles of biochemistry, physiology, anatomy (and not with acupuncture points), and neuroscience. You’re reading multiple chapters a night, staying up all night cramming your mind full of minutiae of various signaling pathways and eponyms for anatomic structures. All those facts, all that evidence, it’s all so…hard! It’s all so soulless. Where’s the love?

Fortunately, there’s something you can do during the brief vacation you get between the first and second years, or maybe you can turn it into a clinical rotation if you’re in your third or fourth year. Thanks to the infiltration of woo into medical schools, there are options for you. You could, if you like, join up with the American Medical Student Association’s Complementary and Alternative Medicine Leadership and Training Program, for example. You’d better be quick, though, as the deadline’s March 24. If you miss the deadline, you could find yourself on the outside looking in for this:

The CAM Leadership Training Program (LTP) is the experience of a lifetime. 20 medical students from across the country will gather on the campus of the Omega Institute for a five-day, intensive retreat dedicated to complementary and alternative medicine and leadership skills training. Our expectation is that these 20 students will go on to become the future generation of leaders in CAM education in their medical schools and beyond. The 2008 LTP is supported by the Samueli Institute for Information Biology, the Omega Institute for Holistic Studies and individual donors.

Yes, it’s a great idea to get ‘em while they’re young, isn’t it? Indeed, this program seems to be an outgrowth of a grant that AMSA obtained from NCCAM. If you want to see your tax dollars at work influencing the younger generation of physicians while still in their embryonic state to embrace non-evidence-based woo, this program is it:

During the LTP, students will learn from expert facilitators about a number of CAM topics, such as acupuncture, evidence-based research and mind-body medicine. Stress reduction, wellness, and nutrition will also be emphasized throughout the week as students will enjoy healthy meals and will have opportunities to take classes in meditation, yoga, and movement. To enhance leadership skills, LTP facilitators will host sessions on public speaking, teamwork, grant writing and other activities designed to make YOU a more effective advocate for CAM.

That’s right: An advocate for CAM. The explicitly stated purpose is to produce medical students who will go back to their home medical schools after this retreat and agitate for CAM:

In addition, each participant will plan a project to increase CAM awareness at his or her school. The LTP facilitators will host sessions throughout the week to help you make your project a success!

What I want to know is this: Why is AMSA so concerned about bringing woo into medicine and apparently not so concerned about evidence-based medicine? Searching its website for the term “evidence-based medicine” turned up mainly links either to CAM promotion or to its PharmFree Program. This is, of course, ironic given the way that AMSA makes such a big deal of mentioning evidence-based approaches when it comes to dealing with the claims of big pharma while strongly promoting non-evidence-based approaches.

But, you say, you’re not a member of AMSA and the whole touchy-feely, let’s sing “Kumbaya” at the CAM boot camp thing doesn’t float your boat either. That’s OK. that training ground for naturopaths, Bastyr University, has a less intense, more leisurely program just for you: a complementary and alternative medicine program for allopathic medical students. For a mere $1,250 tuition, you can earn three credits while you learn the principles of traditional Chinese medicine, “alternative” nutrition, and naturopathy. You’ll get to explore qi gong and learn to manipulate that undetectable “life force” disorders in the flow of which woo-meisters everywhere like to invoke as the cause of disease and claim to be able to manipulate for therapeutic intent. You’ll get to hang out in the Whole Foods Cooking Lab. (We can only hope that at least there’s some tasty food involved.)

Of course, the students loved it. This is not surprising, because it’s unlikely that students not already predisposed to like woo would pay $1,250 plus travel and living expenses to take a summer course like this. Consequently, we’re treated to glowing testimonials–the stock and trade of so-called “complementary and alternative” medicine.

The more I learn about how woo is infiltrating medical education, the more apparent to me it becomes that there is a serious effort to influence medical students to become more credulous towards modalities that are not based on science. NCCAM is only part of the problem, albeit a large one, given that it funds many of these “educational” (read “indoctination”-al) programs as part of its mission. It’s helped in this by multiple foundations dedicated to the use and promotion of such modalities, as well as the increasing openness or outright surrender to argumentum ad populum. It’s not going away, and it’s getting worse. There are times when I despair, but then I wonder if we’re starting to see a reaction to this phenomenon, given the recent popular book by R. Robert Bausell entitled Snake Oil Science: The Truth About Complementary and Alternative Medicine. I’m also seeing hopeful signs that my colleagues dedicated to science- and evidence-based medicine are starting to wake up, as I do my little part here on this blog and elsewhere.

A guy can always hope, can’t he?

Comments

  1. #1 Rob
    March 18, 2008

    I agree with you that most of CAM is quackery, or at best, little more than an exploitation of the placebo effect. However, I think it’s unfortunate that we dismiss out of hand many therapies that have the potential to be effective and I definitely think that there is a place for CAM in medical training. While CAM tends to fail at exercising rigor, it often approaches medical problems from a fresh perspective- for example, what are the psychological influences of disease, and how can the nervous system be influenced to reduce pain? We get hung up on terminology like ‘energy fields’ and ‘meridians’ but clearly there are strong connections between the brain, the rest of the nervous system and the experience of disease. Consider clinical depression: even the most jaded cynic has to acknowledge that an effective therapy program based on meditation (including, controversially, delusional beliefs in a ‘higher power’) is far more preferable than the dangerous administration of pharmaceuticals that we barely understand and which are ‘regulated’ by a morally bankrupt industry.

    $0.02

  2. #2 T. Bruce McNeely
    March 18, 2008

    These programs sound like a spa vacation with the bonus of being able to add it to your CV. What’s not to like (apart from the content)?
    Rob, considering clinical depression: do you have any evidence that meditation is effective against depression? I know that cognitive therapy is effective for mild clinical depression and probably preferable to antidepressive use (although combining the two is the most effective). I am not aware that meditation is effective against clinical depression (anxiety might be a different matter, of course).

  3. #3 BB
    March 18, 2008

    If CAM becomes part of mainstream medicine, as it looks like it’s headed, will it no longer be “alternative” but de fact mainstream medicine too?
    My other thought, as junior faculty at a state med school, is that med school courses are becoming too market-driven. Students want to dictate the curriculum and the senior faculty in charge are willing to hand over curriculum design to the ones they should be teaching.

  4. #4 The Integral
    March 18, 2008

    first off, stupid question: what exactly is “woo?”

    Is that a generic term to describe any and all kinds of quack medicine that entice doctors, medical schools, and patients alike?

    Ah, I wish I knew a bit more about medicine/medical terms and stuff..I’d get a lot more out of this blog……..but it’s interesting even without all that knowledge. My parents are both doctors…..but they work so hard they don’t even have time to think about quack medicine. I doubt they’ve even really heard of it…….what kinds are out there…..etc.

    So much the better for them…..

    TI

  5. #5 jay
    March 18, 2008

    “but clearly there are strong connections between the brain, the rest of the nervous system and the experience of disease. ”

    Psychology affects pain, but I’m sure that some of Elliot Spitzer’s contacts could do far more for my mental state than a bunch of acupuncture needles.

  6. #6 Phoenix Woman
    March 18, 2008

    Jay: Go with David Vitter’s contacts, they’re cheaper!

  7. #7 Sastra
    March 18, 2008

    While CAM tends to fail at exercising rigor, it often approaches medical problems from a fresh perspective- for example, what are the psychological influences of disease, and how can the nervous system be influenced to reduce pain?

    How is research on the psychological influences of disease and the nervous system’s ability to reduce pain outside of regular medicine? It’s not.

    It’s been noted many times that CAM’s strategy is to appropriate perfectly reasonable and normal parts of mainstream medicine — such as nutrition, herbal remedies, and stress reduction — and claim it for itself, so that the untested and unreasonable extremes can ride to credibility on their backs. This is similar to the modus operandi of many religions: focus on the reasonable morals and guidelines for living and pretend that this makes the miracle and supernatural background just as plausible.

  8. #8 PalMD
    March 18, 2008

    People who go to med school often are geeky (like me) and like to help people (also like me). We like to read and read and read and jump ahead of our studies as much as we can. We want to help people even though are training isn’t complete. Many students volunteer at free clinics and get first-hand exposure to treating patients (while supervised) before they might normally.

    AMSA usually has good intentions: get students motivated early, let them use their altruism and geekiness as soon as possible. But really, they need to be patient.

    One oft-repeated saying is that M1s and M2s don’t even know what they don’t know. This makes them susceptible to woo.

    They need guidance. They need EBM classes.

  9. #9 DrFrank
    March 18, 2008

    @TheIntegral

    See Skepdic’s definition.

    Basically, just imagine any statement where some New Agey type might end it waving their arms around and going “woo-ooo-ooo”

    For example:

    “This treatment works by creating energy resonances in the Qi bio-field of organisms, thus resulting in healing Kabbalah vibrations. Wooo-ooo-oo!”

  10. #10 Dr Aust
    March 18, 2008

    I’m with Pal: more explicit discussion in medical degrees of the basis of scientific and medical evidence, and how that actually underlies a lot of what’s in the books, and should be informing what they are going to be doing as physicians.

    In some ways, one would have thought US med students had more of a head start in “science-based thinking” since they are doing a grad degree having already done 3-4 yrs at college. Contrast our European medical student intake who are usually 18-19 and straight from high school.

    We are actually putting in explicit “EBM” strands in our first 1st and 2nd yr med school curriculum right now.

    Another good way to foster critical thinking, I have found, is to make students write their special study / dissertation projects (which are big in UK medical training) specifically on woo therapies or treatments. I find that setting projects like “Is there any evidence that ANOther CAM remedy can treat XYZ?” is a great way of introducing students to the differences between reliable and unreliable “evidence”.

    I usually ask them to put in a section explicitly side-by-side comparing the consensus from the medico-scientific literature, and the “Internet sales / promotion site verdict”. They usually find the contrast, erm, striking. I like to think I have sown a few seeds of career-long scepticism that way.

  11. #11 The Integral
    March 19, 2008

    Dr Frank: thanks for the skepdic link. it made sense to me in less than 30seconds……that’s rare, for a term I’ve never heard of before….

    What’s up with the New Age and churning out loads of woo?

    I thought we were supposed to get SMARTER as part of the human race……as time went on……….I guess some of us do, and others go in the opposite direction?

    TI

  12. #12 Rob
    March 19, 2008

    Bruce, Sastra: No I don’t have any evidence- but you cite several perfectly valid applications of meditation- my point is that we hear ‘meditation’ or ‘acupuncture’ and immediately say ‘woo’. I think this is especially problematic for Chinese medicine where, without question, there is a lot of superstition, but there is also a long history of observation. Again, my main point is that these things can bring fresh perspective to research, and it seems especially important that doctors understand the range of CAM therapies so they can help their patients distinguish between beneficial and woo.

    Some other good points here about students dictating the curriculum. I think it’s more accurate to say the market is dictating the curriculum- patients want more woo.

  13. #13 Duncan
    March 19, 2008

    I do agree that a statement of fact cannot be insolent.

    However, you rarely make statements of fact. Instead you disgorge your emotional reactions about matters you have already made up your mind to reject.

    That’s fine and dandy but it is not science.

  14. #14 Duncan
    March 19, 2008

    I do agree that a statement of fact cannot be insolent.

    However, you rarely make statements of fact. Instead you disgorge your emotional reactions about matters you have already made up your mind to reject.

    That’s fine and dandy but it is not science.

  15. #15 Doctor J
    March 19, 2008

    Orac,

    Long time reader but I felt the need to speak about this one.

    AMSA is a pretty goofy and out-of-touch group. My classmates (I am a medical student) are a bit embarrassed by the woo-woo aspects of the organization and tend to distance themselves from it as much as possible. I’m a bit ashamed to say I’m a member but I honestly joined for the free Netter’s Anatomy Atlas. Couple their outright support for magic with their rabid opposition to anything having to do with ‘big pharma’ (their “Pharm-free” campaign) and I wonder if AMSA would prefer if we just treated patients with smoking herbs and fragrant balms we brewed in a witches kettle out back.

    We have had ‘exposure’ to CAM in my school simply because we should be knowledgeable about what our patients use without our assent or knowledge. The session was part of our evidence-based curriculum, but as I expected, we were treated to the most mainstream of CAM practitioners who I believe were coached to keep the woo-woo to a minimum. Still, the CAM practitioners were greeted with outright skepticism from most of my classmates, which made me proud.

  16. #16 Doctor J
    March 19, 2008

    Orac,

    Long time reader but I felt the need to speak about this one.

    AMSA is a pretty goofy and out-of-touch group. My classmates (I am a medical student) are a bit embarrassed by the woo-woo aspects of the organization and tend to distance themselves from it as much as possible. I’m a bit ashamed to say I’m a member but I honestly joined for the free Netter’s Anatomy Atlas. Couple their outright support for magic with their rabid opposition to anything having to do with ‘big pharma’ (their “Pharm-free” campaign) and I wonder if AMSA would prefer if we just treated patients with smoking herbs and fragrant balms we brewed in a witches kettle out back.

    We have had ‘exposure’ to CAM in my school simply because we should be knowledgeable about what our patients use without our assent or knowledge. The session was part of our evidence-based curriculum, but as I expected, we were treated to the most mainstream of CAM practitioners who I believe were coached to keep the woo-woo to a minimum. Still, the CAM practitioners were greeted with outright skepticism from most of my classmates, which made me proud.

  17. #17 Zelda
    March 19, 2008

    My school (large, metropolitan allopathic school) has EBM classes for first and second years with required exercises in PubMed searching and critical appraisal of research. We bitch and moan but it’s worth it if two people out of 100 can recognize woo when they see it.

    We also have a mandatory CAM “fair” in the spring (again, first and second years only). We have 15 representatives of various shades of woo coming in with their velvet-lined trunks of gadgets and electrodes and aromatherapeutics. Last year the “compound pharmacist” told us we were being trained to murder patients, a woman told us she cured herself of Stage IV pancreatic cancer with yoga and lavender oil, and some guy tried to get me hooked up to a machine with electrodes (never did find out exactly what he was peddling). What an absurd waste of an afternoon. This year I am bringing some Step 1 materials to read while I’m sitting there so it’s not a complete waste of 5 hours of my life.

  18. #18 Dr. T
    March 20, 2008

    PalMD: One oft-repeated saying is that M1s and M2s don’t even know what they don’t know. This makes them susceptible to woo.

    They need guidance. They need EBM classes.

    I disagree. Even first year medical students should be able to distinguish between evidence-based medicine and bullshit. Those who cannot do not belong in medicine.

    –Dr. T, Associate Professor of Pathology & Laboratory Medicine

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