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.