Respectful Insolence

There’s no woo like Harvard woo

I’d start out by saying that here’s another one for my (in)famous Academic Woo Aggregator, except that this institution is already a part of the Woo Aggregator. The only thing I can say is that Steve Novella (who’s from Yale and has had to manage an influx of woo at his home institution) might get to feel a bit of schadenfreude over this, because the institution in question is Harvard University.

And boy is this a doozy. In fact, it’s a $6,500 dose of continuing medical education doozy! Check out Structural Acupuncture for Physicians:

Date: 10/2/2008 — 6/7/2009
Course #: 00292317
Areas of Interest: psychiatry, physical medicine & rehabilitation, pediatrics, pain management, internist, family practice, neurology, obstetrics, anesthesiology
Tuition:
Physicians $6,500.00
Location: The Joseph B. Martin Conference Center at Harvard Medical School, 60 Avenue Louis Pasteur, Boston, M
Director(s): Joseph Audette, MD|David Euler, Lic. Ac.|Kiiko Matsumoto, Lic. Ac.
Offered by: Spaulding Rehabilitation Hospital, Department of Physical Medicine & Rehab.

Now that’s some serious tuition for continuing medical education (CME). How on earth could this class cost so much? A couple of years ago, I took a course for surgical educators that was nearly a week long and included hotel and meals for only around $3,500. Even the Harvard name isn’t enough for such tuition for a course of this nature. Well, maybe it is, but it wouldn’t be enough for me. Let’s take a look at the brochure for the course to see what woo-trainees get for their money:

This unique course provides practical, hands-on training in acupuncture. The training program is designed to bring together Eastern and Western views of health and disease into a result-oriented acupuncture style. You will learn to evaluate and treat patients using modern Japanese acupuncture techniques that link classical Chinese theory to concrete, understandable clinical diagnostic and treatment techniques. Strong emphasis is also placed on developing a neuroanatomical understanding of pain modulation with acupuncture.

“Neuroanatomical understanding of pain modulation with acupuncture”? Are they serious? Remember what the supposed basis of acupuncture is. It has nothing to do with neuroanatomy. It has everything to do with prescientific notions of “life energy” or qi, and how sticking needles in into various “meridians” is able to “unblock” the flow of qi. It has nothing to do with science or scientific medicine. Don’t believe me? Take a look at the course objectives:

  • Integrate acupuncture diagnostic and therapeutic techniques for managing pain and other medical conditions into your clinical practice.
  • Apply neuroanatomical approaches to pain modulation with dry needling as an adjunctive treatment technique.
  • Understand the methodological problems with current clinical research in acupuncture.
  • Advance your clinical research skills with a solid grounding in both the practice and science of acupuncture.

Understand the methodological problems with current clinical research in acupuncture? I don’t need, nor does any clinical researcher who takes the time to pay attention and learn, what the methodological problems with current clinical research in acupuncture are. I’ve written about them extensively, for example, here. Inadequate blinding, inappropriate placebo controls (or, all too often, no placebo controls at all, and bad design are rampant in trials of acupuncture, and the more poorly-designed the trial, the more likely it is to be positive. And, again, I ask: What on earth is the “neuroanatomic” basis of acupuncture? Even if acupuncture were effective above and beyond placebo effect, you could scratch the “anatomical” part and just call it neurological. That’s because sham acupuncture in which the needles are placed in areas that are not “meridians” through which qi flows. Worse than that, neither sham acupuncture or “real” acupuncture are any more effective than placebo acupuncture, in which special retractable needles are used that fool the patient into thinking he’s having acupuncture but don’t actually penetrate the skin.

That it refers to the “science” of acupuncture is perhaps the most irritating part of this brochure. There is nothing that I can see that’s the least bit scientific as far as the concepts underlying acupuncture. It’s possible that it may have some effect as a counterirritant or through causing the release of endorphins, but the evidence supporting such concepts are fairly weak. Not that that stops Harvard:

This course will include an introduction to traditional Chinese medicine with special emphasis on developing an understanding of its practical application to clinical care from a Western perspective. Emphasis is given to “hands-on” point location and needling techniques based upon palpatory feedback, familiarization with the meridian pathways and organ pathology. The topics of this course will include the following:

  • Pain Control
  • Hormonal Imbalances
  • OB/GYN Problems
  • GI Disorders
  • Scar Treatments
  • Structural and Orthopedic
  • Problems
  • Cardiac and Vascular Disorders
  • Autoimmune and Autonomic
  • Disorders
  • Mood Disorders
  • Auricular Acupuncture
  • Myofascial and Neuroanatomic Treatment

Yep, that’s right. Even though there’s no scientific basis or suggestion that meridians even exist, Harvard’s going to teach about them.

If this course actually taught a skeptical, scientific, and critical approach to complementary and alternative medicine (CAM) modalities such as acupuncture, I’d have no problem with them. That would be great. Unfortunately, what this course is is yet another in a line of courses taught by practitioners and credulous believers. No critical thinking towards acupuncture appears likely to be taught. After all, no one’s going to spend $6,500 for a course, even if he can write it off on his taxes, to learn skepticism for woo. No, people taking this course want to learn how to practice woo, so that they can “integrate” scientifically highly implausible modalities for which there is little or no data to support them with scientific medicine.

Actually, even though I’m not at a hoity-toity, Ivy League university and medical school, I can feel a bit of schadenfreude too. While it’s true that I may be at a mid-level to upper-mid-level medical school, I can now proudly say that my university has it over both Harvard and Yale in one thing.

I’ve yet to be able to find anywhere near as much quackademic medicine here.

Comments

  1. #1 ekchung
    July 11, 2008

    I received a brochure for this very program last week. Went immediately into the recycle bin. I hope it won’t ruin the rest of the recycling batch. Although my schadenfreude is severely limited having come from a Harvard-affiliated residency (and having worked with one of the guest speakers), I can at least get some pleasure from my MIT undergrad roots.

    Seriously, though – they’re offering CME credits for this crap!

  2. #2 NickG
    July 11, 2008

    The screwy part is that assuming you were either evil or credulous enough to take this course, what do you bet you’d make your $6,500 back quickly by peddling woo to your crunchy patients?

  3. #3 Confused
    July 11, 2008

    I’ve yet to be able to find anywhere near as much quackademic medicine here.

    Erk! Don’t let Murphy hear you!

  4. #4 Aaron Golas
    July 11, 2008

    Days like these, it feels good to be a Dartmouth alum. ;-)

  5. #5 SteveWH
    July 11, 2008

    It looks like the course runs for a whole academic year. That might explain why tuition is so high.

  6. #6 qetzal
    July 11, 2008

    @NickG

    No kidding! Think how impressive it will be when you tell your patient that you were trained in acupuncture by Harvard Medical School! I bet you could make back your $6.5K in a month.

    Next thing you know, Harvard will be selling endorsements:

    “Official Accupuncturist of the Harvard Medical School”

    I bet people would easily pay them $10K per year to be able to say that.

    Disgusting.

  7. #7 curlyfries
    July 11, 2008

    While I agree that this course is going to be teaching some shaky pseudoscience dressed up as science, it hardly seems fair to indict the entire institution on the basis of one continuing education class.

  8. #8 Joe
    July 11, 2008

    curlyfries,

    Look at the background cited in the body of the post, Harvard is already a haven for woo.

    As for me, I still don’t understand how such a course could be accepted for CME. I have noted elsewhere that the American Chemical Society exercises more control over accreditation.

  9. #9 Sophist FCD
    July 11, 2008

    No, people taking this course want to learn how to practice woo, so that they can “integrate” scientifically highly implausible modalities for which there is little or no data to support them with scientific medicine.

    People taking this course want to learn how to practice woo so that they can integrate their patient’s money with their bank accounts.

  10. #10 Dr. T
    July 11, 2008

    Your article inspired me to check out my medical school, SUNY Downstate Medical Center in Brooklyn. I was please to find no references favorable to woo. I am happy to report that in 2007, SUNY Downstate faculty published two anti-woo articles:

    Adverse effects of phytoestrogens on reproductive health: a report of three cases.

    CAM (complementary and alternative medicine) use in kidney transplant recipients (KTR’s) is associated with non-adherence (NA) to medication and unhappiness with the transplant experience.

  11. #11 Dr. T
    July 11, 2008

    Response to curlyfries:

    Chemists don’t need licenses, so the ACS can be strict and stringent without denying jobs to mediocre chemists. Unfortunately, the hard sciences have more than their share of quacks and woo-meisters. The ones I recall are physicists claiming to have developed cold fusion, toxicologists claiming devastating health consequences from nearly every chemical known to mankind, biologists claiming zillions of new species of animals (and then promptly listing them as endangered since they only found two), and climatologists claiming the planet is cooking due to CO2.

    Medical quackery and woo gets more attention because it is personal: the quackery and woo is supposed to help you. (That’s my rhyming quota for the month.)

  12. #12 Joe
    July 12, 2008

    Dr. T,

    You were responding to my question, and I find your suggestion a bit confusing. You wrote “Chemists don’t need licenses, so the ACS can be strict and stringent without denying jobs to mediocre chemists.”

    It seems you are arguing that the AMA/med schools cannot be strict because that would keep inferior doctors from being licensed. If you don’t set (and enforce) high standards, the license means very little.

    You also seem to say that denying CME for acupuncture is unduly strict. As I understand it, it is unethical for a doctor to prescribe a placebo. The best evidence is that acupuncture is purely a placebo; so a doctor providing it is acting unethically.

  13. #13 Dr. R
    July 12, 2008

    The cost of this course is $21.67 per CME hour. Is that expensive?
    If you can’t beat them, join them.

  14. #14 Tercel
    July 13, 2008

    I’d also point out that Dr. T tries to lump climate science into his list of quack science. This reveals a lack of objectivity. You don’t get to deny the conclusions of an entire field of legitimate scientists, mountains of empirical data, replicated results, and theoretical founding, on the sole grounds that you personally don’t understand or don’t like the conclusions.

    I always find it ironic when people present themselves as anti-anti-science, and then in the same breath attack valid science. This is similar to the way the Discovery institute will claim that we should teach creationism is grade school in the name of “academic freedom.”

  15. #15 DavidCT
    July 14, 2008

    The Harvard woomeisters at least have their psychology right. This is just like buying a forged art masterpiece. The more you pay the less likely you are to doubt the authenticity.

  16. #16 Peter Bowditch
    July 20, 2008

    I’ve already seen an acupuncturist using “taught at Harvard Medical School” as evidence of how quackupuncture is now fully accepted as a valid medical treatment for, umm, well for whatever it treats.

    Disclaimer: Macquarie University has the dual distinction of being the place that awarded me a couple of qualifications and of being the first real university to offer courses in chiropractic. I turn my testamurs to the wall every Friday as a form of penance and to hide my shame.

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