Terra Sigillata

Both Dr. RW and Orac have great posts this week on the dichotomy of critical thinking skills espoused by the American Medical Students Association (AMSA), a US national medical student association. Most interesting is their support this week of a PharmFree Day on 16 November whose nobel goal is to minimize the influence of the pharmaceutical industry on medical students, residents, and fellows.

However, Dr. RW points out the hypocrisy of one segment of the organization that states; “we [The AMSA Humanistic Medicine Action Committee] advocate for Complementary and Alternative Medicine Education.” I am a strong proponent that medical and other health sciences students be offered some course material that provides critical, evidence-based evaluations of modalities patients may be pursuing on their own. However, I am very uncomfortable with the “advocacy” position taken by this arm of AMSA.

Dr. RW notes that AMSA seems to hold complementary and alternative medicine to a different (i.e., lesser) standard than conventional pharmacotherapy. Orac holds forth in a lengthy and persuasive fashion of his concern for the future of medicine if students do not apply the same skepticism to CAM modalities that they are and should with pharmaceutical remedies.

I have some familiarity with this organization (AMSA) and similar movements within US medical schools that allow the promotion of CAM without 1) adequate revisitation of critical-thinking skills and 2) oversight by appropriate medical school faculty. Most US med school CAM programs operate as some offshoot from the main department of medicine and there is little incentive for critical-thinking faculty to be involved with development and implementation of the course material.

As a result, non-evidence-based education and clinical service programs proliferate on even the most prestigious medical school campuses because 1) they sometimes bring in actual clinical earnings, 2) faculty who oppose the programs are either too busy to get involved or think that association will stigmatize them, or 3) combatting non-rigorous CAM teaching falls low on the list of priorities of most medical school faculty members. I also fault members of some curriculum committees for not being as forcefully critical as they should be of what gets taught and who does the teaching.

Even when I teach about herbal medicines, one of the more conceptually-acceptable and sometimes fact-based of the alt med practices, I am amazed by how many students just want me to talk about doses without even getting into a detailed of evaluation of whether the stuff works in the first place. Some are very disappointed when I tell them how few herbal medicines are actually supported by double-blind, placebo-controlled efficacy trials.

However, facts are facts, and facts are not often what advocates want to know.

If an organization wants to combat the abuses of the pharmaceutical industry in medical education, they must hold equally under the magnifying glass questionable medical practices.

Comments

  1. #1 Joe
    November 14, 2006

    APB, have you realized that naturopathy is quackery? If they have a central tenet, it relates to imaginary toxins. Homeopathy is not the only nonsense they endorse. They subscribe to just about every form of woo.

    Most of the herbs and acupuncture they prescribe have no clinical foundation. They advocate against vaccination (except, they have homeopathic vaccines). They have all manner of forms of “water therapy,” from enemas to “drawing toxins” out through the skin with a sitz-bath.

    I’ll stop here. What do you think?

  2. #2 Zuska
    November 15, 2006

    Hmmm, this worries me. My neurologist recently prescribed petodolux (butterbur) for me to prevent migraine. (I haven’t actually started taking it yet.) I thought it was cool that he was accepting of alternative medicine but maybe it isn’t after all. Where does one go to look up whether or not there’s really any evidence for efficacy of a given herbal medicine?

  3. #3 Abel Pharmboy
    November 15, 2006

    Zuska, your neurologist must be a well-read one because she/he made one of the few sound recommendations in herbal medicine. A specific extract of Petasites hybridus manufactured by Weber & Weber in Germany, called Petadolex, recently showed efficacy in a placebo-controlled RCT for migraine prophylaxis led by a major migraine expert at Albert Einstein COM (Dr Richard Lipton).

    At present, I could caution against buying any Petasites product except for the Weber & Weber brand of Petadolex (disclaimer: I have no financial ties) – Petasites contains potentially hepatotoxic pyrrolizidine alkaloids that are removed by W&W’s patented procedure; overcoming this problem was the major reason this herbal remedy was only recently given the attention it deserves.

  4. #4 Robin Peters
    November 16, 2006

    I made a similar comment on Orac’s blog, but it bears repeating. These alternatives are accepted because they do bring in clinical revenue, at least in part; they bring in clinical revenue, in part, because patients get a wonderful feeling of being treated as individuals. My acupuncture points might be different from yours, even varying from illness to illness in me, so they’re impossible to standardize and test to see if a certain type of acupuncture is effective in general. A homeopathic remedy might vary, depending on which body part is affected; you might get a different remedy if the right hand is affected from the one which worked when you had that pain in your left hand. Needless to say, such unproven nostrums are tailored to each individual and practitioners are unwilling to standardize them in order to get them tested properly.

    Patients just love the individual attention this produces. If my remedies are going to be different from yours, the practitioner has to spend time – plenty of time – determing what works for me. There is no way a protocol can be developed to make it easy for interns and residents to treat patients. It’s a very labor-intensive process, and one which brings in all that revenue because it’s so popular with the patients. They feel cared for as individuals, rather than as just another insurance card or bunch of stitches or staples.

    That’s my theory, at any rate.

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