Respectful Insolence

Steve Salzberg is a man after my own heart. You’ll see why in a minute.

I’ve frequently written about the pseudoscientific nonsense that goes on at the University of Maryland. Indeed, the University of Maryland School of Medicine is a hotbed of quackademic medicine, including the use of reiki at its world-renowned trauma center along with other forms of quackery. Steve Salzberg is on the faculty at the University of Maryland, and he’s not happy:

So what’s going on at Maryland’s medical school? UMM is home to one of the nation’s premier “integrative medicine” programs, which promotes a wide range of questionable practices. Its clinical services include:

  • Acupuncture
  • Homeopathy
  • Reflexology
  • Reiki
  • Qi Gong

Although each of these has a different history, all of them are, well, nonsense. Let’s take a closer look homeopathy, which is perhaps the most ridiculous pseudoscience on the list. Homeopathy is based on two ideas: that “like cures like”, and that vanishingly small quantities of medicine are stronger than larger quantities. Both ideas were invented by Samuel Hahnemann in the late 1700s, back when most medicine was pretty bad for you. Unfortunately for Hahnemann, his ideas were no better.

The University of Maryland teaches homeopathy. Yes, homeopathy. It’s also the source of that scientifically weak acupuncture review article that found its way into the NEJM last summer.

It’s even worse than that. Apparently the integrative medicine elective has become one of the top choices for fourth year medical students:

The popularity of the Integrative Medicine elective is skyrocketing. When they were third year medical students, Kenez and Sahan rushed to register for the class because they were worried it would close quickly. More students than ever before are putting the elective on the top of their elective wish list and queuing up early to get into the class.

Of course, this is a “chicken or the egg” problem. Is the IM elective popular because the University of Maryland has become so woo-infused that its reputation attracts credulous medical students interested in quackademic medicine? Or is the IM elective so popular because the infusion of woo into the University of Maryland corrupted the students who are there and convinced them that IM is the wave of the future? Either way, perhaps we should rename the University of Maryland School of Medicine to the Hogwarts School of Medical Witchcraft and Wizardry.

Comments

  1. #1 Anglachel the Common Sense Pagan
    April 22, 2011

    I have said it once, I can say it a billion times more. Religion has no place in the practice of medicine!! I want my doctors to focus on the science. That is their job. To treat the body. It is my job to take care of my own soul, not my doctor’s. I hope that someday the world will realize this. I hate to think that we are going backwards towards medieval medicine.

  2. #2 sliperslap
    April 22, 2011

    As a medical student myself, I hate the idea of integrative medicine diluting what we here in the real world refer to as science. That being said, I know the 4th years tend to gravitate towards the easier electives so they have more time in applying for residencies. Perhaps the trend seen in Maryland is due to the fact that they all know it is quack and is therefore easier, rather than being deluded to believe in this nonsense. I certainly hope that’s the reason behind it.

  3. #3 Sam C
    April 22, 2011

    Might the students be opting for it as an easy option? A little bit of relaxation in a busy schedule.

    Of course, it is absurd that UMM teaches this rubbish as a valid discipline, although it probably should be part of a medic’s education to learn about these things so they can talk knowledgeably to any of their patients who are contemplaing the Dark Side.

  4. #4 Scott Cunningham
    April 22, 2011

    @Sam C
    Yeah, I used to take the odd science-ethics type elective because they’re lighter than organic chemistry. I’ve had to stop it. I always fail for having insufficient faith in the Force. Also, I got tired of the Godwinisms.

    I hope they’re taking the CAM electives for a break and/or flame war, too, but hey, we’re all empiricists here, right? We should get some hard data on that.

    In my town, I’m seeing both woo-infusion of our premed biology curriculum (via IM electives crosslisted with anthropology,) and woo-infusion of our new private practice doctor’s clinics. So here in Northern Ontario, I’m leaning no, no they’re mostly swallowing IM hook line and sinker.

  5. #5 augustine
    April 22, 2011

    Steve Salzberg is a man after my own heart. You’ll see why in a minute.

    I see why, now. You are God and he is your David.

  6. #6 cervantes
    April 22, 2011

    Or is the IM elective so popular because it’s an easy course, and medical school is mostly very demanding?

  7. #7 Rose
    April 22, 2011

    Don’t mess with my Qi gong!!! Assholes…

  8. #8 stripey_cat
    April 22, 2011

    I would imagine that by their final year, the students are pretty stressed. Also, they will have had time to come to realise that while medicine can do a lot, it is very difficult and complex, and there are things it cannot do; but they haven’t had the years of actual practice and experience to reconcile themselves to those facts. So, emotionally, they’ll be very vulnerable to any teaching that promises to treat patients more effectively. Possibly this could be ameliorated with discussions of ethics and fallibility earlier in the course, but making room for philosophy at the expense of clinical science would be itself difficult to achieve.♦

  9. #9 Ben W
    April 22, 2011

    This is unfair! There’s no comparison between Hogwarts and the University of Maryland School of Medicine. At Hogwarts, magic actually works – so it’s not “woo”.

  10. #10 David Tyler
    April 22, 2011

    A good reason for the interest in Woo could be that in these days of falling insurance reimbursements, having a cash only profit center is very compelling. With the non-sense pre-sold by the likes of Dr. Oz it is a clear winner that can help finance the delivery of real care. Just another side effect of our fragmented health care system.

  11. #11 Nomen Nescio
    April 22, 2011

    I would imagine that by their final year, the students are pretty stressed.

    there’s no good reason they should need to be stressed, there’s feng shui for that… (/rimshot)

  12. #12 Sam a
    April 22, 2011

    As a med student at UMSOM, I was embarrassed that I paid money for that class. In second year, we had a few short classes on “Integrative Medicine.” I walked out of the first one and didn’t attend any of the others.
    It’s sad. I chose to attend UMSOM because of its reputation for producing physicians with strong clinical skills. I believe it still has that reputation. I’m worried, however, that it might become more known for this.
    I would say (granted, totally unscientifically) that people taking that elective were split fifty-fifty into two categories: taking it easy or drinking the kool-aid.

  13. #13 Nomen Nescio
    April 22, 2011

    I would imagine that by their final year, the students are pretty stressed.

    there’s no good reason they should need to be stressed, there’s feng shui for that… (/rimshot)

  14. #14 Prometheus
    April 22, 2011

    The argument that “Integrative Medicine” is an easy course taken for a “break” makes some sense. After all, most of the IM “experts” can’t define what they do, so how hard can the end-of-term test be?

    Homeopathy is ______ ?

    [a] …treatment of like with like.
    [b] …increasing potency with increasing dilution.
    [c] …highly profitable
    [d] …utter nonsense.
    [e] all of the above

    Answer [c] brings up a salient point. The reason that many hospitals (and medical schools usually run hospitals) are going over to the Dark Side (i.e. “CAM”) is because it is highly profitable.

    Most insurance policies won’t cover “CAM” (except in those states that mandate insurance coverage of magic-based medicine), so it is largely paid for out-of-pocket. And since the hospital administrators know that “CAM” won’t positively affect a patient’s treatment (and pray that it won’t negatively affect it), they don’t feel morally obligated to provide it to patients who can’t pay for it.

    The cost of most “CAM” supplies is essentially nil. Water (for homeopathy) is available at a nominal cost, the “herbs” for naturopathy can either be grown on the hospital grounds or purchased locally for a minimal cost (or, if you want to minimise risk and maximise profits, you can dry and grind grass clippings “harvested” by the grounds-keepers).

    Since most “CAM” practitioners aren’t licensed, there is nothing preventing the hospital from hiring a high-school drop-out at minimum wage and billing for their services correcting “Chi flow” or “adjusting auras” or whatever nonsense.

    For that matter, although homeopaths and naturopaths are licensed in some states, there is nothing preventing the patient or their family members from popping down to the hospital gift shop and buying the herbs or homepathic water that they or their family member needs. None of it requires a prescription, so why would the hospital need to hire a homeopath or naturopath? Give the patient a simple check-list or computer programme and let them decide for themselves what they need. What could be more “empowering”?

    It’s well past time that some scrutiny was applied to the profit motive in “CAM”; for far too long, people have assumed (wrongly) that the folks promoting these…..therapies are motivated solely by love for their fellow human. These folks are out to make a buck (or pound, euro, franc, yen, etc.) just like everyone else. It’s high time we gave that some consideration and stopped treating them like self-sacrificing martyrs.

    Prometheus

  15. #15 Lawrence
    April 22, 2011

    Prometheus – I’ve made the same argument in the past. Today’s harried medical practices feel hamstrung by the insurance companies as to what they can and can’t charge for their various treatments, etc. “Alternative” practices are low or no overhead & aren’t subject to insurance scrutiny or oversight, and many patience will pay cash.

    So, definitely an incentive to cash in on the current “woo” craze.

  16. #16 lunchstealer
    April 22, 2011

    The placebo effect is a thing, and my wife (who suffers from lupus, and thus has lots of general discomfort) once had a doctor ask her if she thought that acupuncture or other alternative medicine might help. As soon as she said, “Well, I don’t think there’s much scientific basis for those treatments, is there?”, his response was, “OK, it won’t help you.”

    It was clear that he was checking to see if she believed they’d help. When she said they wouldn’t he decided that they’d be of no use because they’d provide no placebo effect.

  17. #17 Nico
    April 22, 2011

    This should be illegal. Students enroll in med schools with so many loans and financial problems, expecting to get real education and they get just pure BS. This a sickening scam.

    Thank you Orac, if I ever apply to med school i’ll be making a huge black list, starting from institutions which have been flagged for BS here.

  18. #18 Val
    April 22, 2011

    > Is the IM elective popular because
    > the University of Maryland has become
    > so woo-infused that its reputation attracts
    > credulous medical students interested in
    > quackademic medicine?

    There is a third alternative: it’s an easy A. Say you’re a cynical med student in need of a GPA boost. Why not take advantage of a course where the boundaries delimiting the right answers are wide and fuzzy?

    Here’s a link to the elective: http://medschool.umaryland.edu/osa/electives/faph544.asp

    Compare to the descriptions for say, the electives for Advanced Clinical Neurology, the ICU, or the ER (links on the left). Those electives require students to spend a lot of time with real patients while they do real stuff. I didn’t look at all the other electives, but the ones I checked all followed the ICU/ER/Neurology pattern.

    Which might seem easier to the less-than-stellar student? “Cultivat[ing] an increased awareness about the therapies in an objective and open minded way” or dealing with a dying guy with a crushed chest and massive internal bleeding at 3 am?

  19. #19 Sam a
    April 22, 2011

    @ those who argue taking this class is an easy A
    By the time you roll around to fourth year, you’re already applying for residencies. The grades in fourth year don’t really matter, and in some electives there are no grades at all.
    Generally, electives are taken in your fields of interest so you have something to talk about during interviews.

  20. #20 daedalus2u
    April 22, 2011

    If it is an elective, it is a good way to tell if someone is a crap doctor. They will have that course on their transcript.

    If the word got out that serious places wouldn’t tolerate crap like that on a transcript, the popularity of the courses might change. It would be rough on the students who got fooled by it, but better to be rough on them than to defraud their future patients.

  21. #21 mxh
    April 22, 2011

    If it is an elective, it is a good way to tell if someone is a crap doctor. They will have that course on their transcript.

    Yep, no way I’d consider a med student for residency if they’re wasting their elective time taking pseudoscience (I’d rather have them do nothing). For you non-medical types, after the first few months, 4th year medical school grades essentially don’t matter, so it’s not a matter of easy A. Easy course, maybe. But, having just completed med school, I can tell you that most med students are in the habit of just accepting whatever they are told, no matter how little it makes sense. If some faculty member touts the power of woo, whether to kiss ass or because they’re genuinely stupid, 75% of med students will buy into it, another 24% will object but will stay silent for fear of getting a bad grade, the one percent that does express their concern about being taught crap will be called unprofessional and will get a bad grade.

  22. #22 Dangerous Bacon
    April 22, 2011

    Prometheus: “The reason that many hospitals (and medical schools usually run hospitals) are going over to the Dark Side (i.e. “CAM”) is because it is highly profitable.”

    Certainly that’s a compelling reason. Perhaps just as important to hospitals and med schools is the perceived need to appear “relevant” as well as warm and fuzzy. There’s been so much publicity given to woo (partly by self-made woomeisters like Drs. Weil and Oz) that many institutions fear being perceived as cold/intolerant/backward by the general public if they don’t at least make some effort towards being woo-friendly.

    As for med students, one hopes that at least a few of those attending “integrative medicine” courses are motivated by wanting to understand what is being preached, so that they can hold forth intelligibly on the subject, and talk their patients out of potentially harmful woo and into getting evidence-based care.

  23. #23 Abby
    April 23, 2011

    I wonder what is the minimum GPA and MCAT they require…..
    I would go there if its my last and only choice
    Gosh! I hope I get a good MCAT score so I dont have to go to extremes! LoL
    Quackery sounds like a fun hobby though

  24. #24 harrync
    April 23, 2011

    Some people go into medicine to help people; some go into medicine to make money. Is there an easier way for an M.D. to make money than selling woo? If your object is to make money, of course you are going to sign up for Woo 101 -I mean, Alternative Medicine 101.

  25. #25 ZDoggMD
    April 23, 2011

    Ha! The “Alternative Medicine Dark Arts!” : http://zdoggmd.com/2010/12/a-muggles-guide-to-med-school/

  26. #26 Turnkey
    April 23, 2011

    I’m sort of wondering if students might go for IM just to improve job prospects (and profits!) after graduation. You could do it along the side and charge exorbitant fees to order relatively useless tests. Maybe prescribe “gluten/casein free Mediterranean diet” for a few extra ducats as well.

    There is a definite market demand for IM physicians. Financially, going into it to skin a few suckers might be a good idea. (and you can tell yourself, at least your not sending them to someone doing directly harmful stuff).

  27. #27 ms4
    April 23, 2011

    mxh, sam a:

    Both of you correctly point out that fourth year courses don’t matter after residency interviews (unless of course, you fail them).

    However, after February, there’s a rush to light-load the last few months of medical school, especially after the waves of audition rotations, brutalizing rounds of interviews (I went on 40, prelim + advanced) and the stress of the match.

    The most popular four courses for March/April electives at my school are two online courses (ethics, multiculturalism) and light clinical rotations such as dermatology and rehabilitation medicine.

    My guess is that most of these students who take it are enjoying a cushy end of year exit rotation. Some of them are probably mild curious. Most are sitting in the back playing online poker. While I would never take a course like that if there was an alternative, I wouldn’t read much into integrative medicine’s popularity based on the enrollment patterns of checked-out fourth years.

  28. #28 Laura
    April 23, 2011

    Maybe prescribe “gluten/casein free Mediterranean diet” for a few extra ducats as well.

    Doesn’t belong in a lump with homeopathy etc. People who have celiac disease (gluten intolerance) often have similar reactions to other foods besides gluten grains, and especially often sensitive to the casein in dairy products. The casein cross-reacts with gluten.
    If you look up “gluten sensitivity” on Medline, you see a lot of research recently on other kinds of gluten sensitivity besides celiac disease , so people who don’t have celiac disease may also benefit from a gluten/dairy free diet.

    A long time ago I saw a paper on a trial of gluten/casein free diet with schizophrenics (or maybe just gluten free, I don’t remember). It didn’t work with most of them but they said one person made a dramatic recovery on the diet. And the author commented that they’d tried the gluten/casein free diet and found it “very relaxing”. The *author* was gluten sensitive!
    For me, avoiding gluten and some other foods had huge psychological and physical effects.

  29. #29 Kausik Datta
    April 23, 2011

    Thank you Orac, if I ever apply to med school i’ll be making a huge black list, starting from institutions which have been flagged for BS here.

    Well, Nico, you better keep your pencil and reams and reams of sheets handy, so that you don’t run out. Even Hopkins – yes, the Johns Hopkins University School of Medicine – has a Center for Complimentary and Alternative Medicine. From their website,

    For individuals who may be interested in pursuing complementary and alternative medicine therapies, the Johns Hopkins Integrative Medicine & Digestive Center bridges modern medicine and other healing modalities to help anyone with chronic symptoms achieve a better quality of life…

    The Doctor’s office at the comprehensive health care facility has a cabinet in the waiting room that contains Oscillococcinum – Oscillococcinum for heaven’s sake! – (although, to be honest, I don’t know if that is ever prescribed to anyone).

  30. #30 Harbo
    April 24, 2011

    Woo is my ultimate retirement scheme…..
    (or if the powers that be, catch up, and deregister me)
    The “Worried Well” are legion, and will pay handsomely, and there is no bother with college or government regulation.
    (also a way into the cash economy free of tax!)
    I have had years of jargon speak to spice the “up sell” so no worries mate!!
    The ultimate is that if I happen across an actual sick person, I can flick them back to the dark side for real medicine.

  31. #31 Rongeur
    April 24, 2011

    Eeek. I’ve been considering UMBC for undergrad, but this is giving me some second thoughts…. Do you think the woo’s contained to UMM, or has it metastasized?

  32. #32 mxh
    April 24, 2011

    @Rongeur, It’s usually the health sciences that are susceptible to woo, the rest of the university usually has real scientists that know better.

  33. #33 prn
    April 25, 2011

    I don’t have any use for Orac’s examples listed.

    But I can see the problems, and benefits, that creat some pro and con. For example contemporaneous to homeopathy was Fowler’s solution, an arsenate. Without anything else, an oxidative poison might be necessary, but the misuses could easily outnumber the successes. Fowler’s solution lasted into the 1950s, and more interesting “mainstream” successors have appeared since.

    “Modern” medicine is in a crisis that seems to be missing the forest for the trees in a number of areas. Special interest groups within the medical industry are damaging efficacy and credibility, greatly.

    The implications of systematic thyroid errors for 40-50 years are pretty large. Statin survival games, with peak benefit for the unwashed(out) in 3 years and then net zero at 7-8 years (at least in the first few versions with a long history), faster even hideous problems with the washouts, were good for how many billions?

    I suspect it is the nutrition wars where the system will break. I know RD that have repeatedly failed on course, MD that know nothing, and yet the subject is being hijacked by its failures, and outright criminals. The FDA is encroaching nutrition in ways that will be more detrimental to many, for price and performance.

  34. #34 coldhope
    April 25, 2011

    I was intensely pleased to see this published. My position doesn’t allow me to complain about this kind of rubbish at UM; that an actual UMCP professor stepped forward and said what needed to be said is a wonderfully affirming surprise.

    Of course the comments are your typical ZOMG UR CLOSE MINDED BIG PHARMA, but at least his words are out there.

  35. #35 mikmik
    April 29, 2011

    this is an outrage! Is ‘perpetual motion mechanics’ taught in physics? Is there such a course as ‘post alien abduction stress disorder diagnosis’ offered in psychiatry? Or ‘spiritual systems admin.’ in I.T.? Bigfoot anatomy? NO!
    Why should only the MDs get taught the easy(and highly profitable) stuff?
    There’s more than enough complimentary science to go around, wouldn’t you say, even esoteric subjects like philosophy and logic could offer plausable deniability electives… Or was that law?
    In any event, it is time to dismantle the monopoly big medicine has over our constitutional right to freedom of facts and deregulate all faculties over what constitutes information!
    Everyone has the right to study alternative knowledge.
    Fight big Medica and their stranglehold on big money. We all have the right of fraudulen..I mean freedom of income. FREEDOM ;*[]

    Wilfred Wallace

  36. #36 mikmik
    April 29, 2011

    this is an outrage! Is ‘perpetual motion mechanics’ taught in physics? Is there such a course as ‘post alien abduction stress disorder diagnosis’ offered in psychiatry? Or ‘spiritual systems admin.’ in I.T.? Bigfoot anatomy? NO!
    Why should only the MDs get taught the easy(and highly profitable) stuff?
    There’s more than enough complimentary science to go around, wouldn’t you say, even esoteric subjects like philosophy and logic could offer plausable deniability electives… Or was that law?
    In any event, it is time to dismantle the monopoly big medicine has over our constitutional right to freedom of facts and deregulate all faculties over what constitutes information!
    Everyone has the right to study alternative knowledge.
    Fight big Medica and their stranglehold on big money. We all have the right of fraudulen..I mean freedom of income. FREEDOM ;*[]

    Wilfred Wallace

  37. #37 FilipinoMDstudent
    May 7, 2011

    I was shocked to find Integrative Medicine and homeopathy books in the library of my medical school. Thankfully, they only seemed like donated books. Furthermore, it seems like nobody borrows them: this is an indication that alternative medicine will not be taught to us during the clinical years. I just hope the Philippine Medical schools (especially the one I go to) and hospitals will not fall into the same trap as the ones mentioned here.