White Coat Underground

This war taking place in our nation’s medical schools and academic medical centers. Orac at Respectful Insolence has been tracking this trend, as have those of us writing at Science-Based Medicine. It is a war between those who feel that medicine should continue to be based on science and those who want to integrate faith-based practices. The model for this war is not that of pedagogical disputes or funding scuffles. More than anything else, it resembles a religious war.

The basic story goes like this: medical schools are in charge of educating future doctors. Individual hospitals are in charge of educating recent medical school graduates in their specialty of choice. Once they are out and practicing, very little stands in the way of doctors practicing medicine however they see fit. While the standard is that we should all be practicing science-based medicine, this practice is not universal. There are plenty of physicians who fail to follow evidence-based guidelines, such as following blood pressure and blood sugar goals for diabetics. Mechanisms are slowly developing to bring physicians into the fold, as it were. There are more and more incentive programs that reward or punish physicians financially based on how well they follow established evidence-based guidelines.

But there are also plenty of physicians who not only don’t follow current guidelines but who don’t even follow the basic scientific principles on which modern medicine is based. As we have discussed many times before, they follow faith-based practices which have no plausible mechanisms of action and have been disproved. They adhere to homeopathy, chiropractic, acupuncture, and reiki despite all the evidence to the contrary. They are, in other words, practicing religion rather than medicine.

Like all the good religions, they are trying to spread the word, and where better to start than in our nation’s medical schools? Medical students are anxious to help and anxious to learn. During the first two years of med school, they have fewer opportunities to help people, but the desire is there. Since the basic science classes can be boring, they may do things like volunteer at a homeless clinic or get involved in student groups—and they are often “tempted” by the song of woo. They get lectures—sanctioned or otherwise—on faith-based practices in a setting that makes them seem endorsed by the school. These practices are easy to latch onto before you learn real medicine—students can easily learn reiki and since they have few other outlets for their altruistic urges, this is a ripe time to “educate” them on “healing”.

I have been fortunate to hear many stories of these conversion attempts. Because of my internet presence, I get emails from doctors, med students, and others, many of them with stories that sound more like a visit from the Jehovah’s Witnesses than a med school experience. Students hear speakers who evangelize for altie practices, and if they raise objections, they are often accused of being “closed-minded” or worse. I’ve heard stories of students being harassed for daring to identify quackery for what it is, of threats to “report” them to their dean if they don’t leave the poor alties alone.

And this threat may be real. Many schools actually incorporate faith-based practices into their curricula, making it mandatory learning. To put, say, reiki on the same level as abdominal surgery (that is, as a legitimate approach to an illness) is to lie to students. To force them to learn from credulous teachers and CAM advocates without any opportunity to fight back is academic abuse.

This war is real. It is a war for the future of medicine and so affects every one of us. This is not a fight we can step away from.

Comments

#1 Whitecoat Tales
March 30, 2009

I’m a med student at a Woo-Friendly school. Does this make me a foot soldier or an innocent bystander?
In a recent didactic a professor-of-woo spent 2 hours peddling her dastardly goods to us en mass.

I asked her why she was talking to us about homeopathy’s benefits the same week a large multicentre randomized trial showed accupuncture to be not significantly different from sham-accupuncture. Another student followed that up by questioning the scientific basis of homeopathy. The response was a lecture on how different names mean different things and demand different kinds of evidence.
Sadly, many students bought that utter non-answer.

If the war is taking place in our med schools, we may be losing – maybe not in terms of gross numbers, but by the mere fact that this is considered worth more than a lecture saying “this is what your patients might believe, educate them as to the truth”.
#2 PalMD
March 30, 2009

The response was a lecture on how different names mean different things and demand different kinds of evidence.

The stupid truly does burn.
#3 Whitecoat Tales
March 30, 2009

Actually we’ve periodically had lectures from Woo practioners. Once or twice it was a good skeptical “this is the evidence, and you need to know it because your patients will use it.” Generally its pro woo, because of our “center for integrative medicine”.

Whats disappointing is that the med students (anecdotally, I have no evidence) most likely to be pro-woo are those planning on going into practice as family med, or general internists – the people who have the biggest opportunity to educate about faith based medicine.
#4 Steve S
March 30, 2009

When I was in my periodontics program, the program director would let any warm body with a tray of slides (I’m dating myself, aren’t I?) come and lecture to the residents. We were a pretty tight group (only 6 of us) and could tell the wheat from the chaff.

When I later became the department chairman I had a pretty firm rule against that kind of thing. It’s an abuse.
#5 DrBadger
March 30, 2009

Whats disappointing is that the med students (anecdotally, I have no evidence) most likely to be pro-woo are those planning on going into practice as family med, or general internists – the people who have the biggest opportunity to educate about faith based medicine.

Although I have no evidence either, I have a suspicion that this is the case also. I’m bracing myself for the pro-woo “education” when I get back to med school next summer. I’m afraid I won’t be able to hold myself back from a confrontation.
#6 A patient
March 31, 2009

No flames please!

In the past decade, there has been several highly publicized cases where fast-tracked drugs and led to unnecessary drug induced illness and even death. This has led to an unfortunate, but very real mistrust of “science-based” medicine. The failure of the medical profession to address regulatory reform has led to repeated cases where drug compounds harm rather than heal and reinforce this perception of the general public.

Rather than attacking patients and the practitioners who reassure them for being ignorant (that doesn’t work, but drives patients away). I suggest that “science-based” practitioners would be more effective in introducing “science-based” reform into the drug approval process, which the general public perceives as tainted by the a political process where money influences regulatory policy to allow unsafe drugs to enter the market.

As for “science-based” practitioners, I have had a traditionally trained physician, spout statistics from “scientific studies” at me, claiming that since 80% of all patients respond to the drug treatment he prescibed, I “should” be okay. He simply ignored that I had lost 25% of my weight on his treatment plan, justifying the treatment based on his statistics. I would propose to you that a 5′ 10″ individual losing 30 pounds in three months and coming in weighing 120 pounds, should have gotten his attention. It did not, because of his interpretation of the “science of statistics” which said to him that his drug therapy should work in 80% of all cases.

Ha! There was some lesson in the misapplication of statistics to the individual patient that was missing from this doctor’s training.

There’s plenty of woo to go around.
#7 Donna B.
March 31, 2009

“I suggest that “science-based” practitioners would be more effective in introducing “science-based” reform into the drug approval process, which the general public perceives as tainted by the a political process where money influences regulatory policy to allow unsafe drugs to enter the market.” –A patient

Being a patient myself, I find it meaningless to base any opinion on public perception.

That said, as a patient I find it difficult to work with doctors who can’t “think outside the guidelines”. It would seem that if all one had to do was follow a set of printed guidelines, a nurse practitioner or a physician’s assistant would be capable of doing that just fine. Why do we need doctors?

I also worry that the guidelines are being set more on a scientific review of the cost rather than what a physician thinks an individual patient needs. Even if cost is not a factor, to be useful the guidelines must be based on averages and I’d bet there are few average patients.

I’m all for a war on woo, but I’m leery of fighting it with guidelines.
#8 Dr Benway
March 31, 2009

Hi studs.

Job 1 for you is survival. Don’t be an hero. You’re life is tough enough without being labeled a trouble-maker.

But you can pass on hard evidence of woo to us. Handouts, fliers, photos of slides filled with woo, name of speaker, date of talk, etc. Anything that might help prove that proper evidential standards are not being respected.
#9 The Blind Watchmaker
March 31, 2009

“I would propose to you that a 5′ 10″ individual losing 30 pounds in three months and coming in weighing 120 pounds, should have gotten his attention. It did not, because of his interpretation of the “science of statistics” which said to him that his drug therapy should work in 80% of all cases.”

There always will be bad doctors, bad accountants, bad plumbers and others that cannot see the forest through the trees.

Science should be the guide. Clinical judgement is obviously important.

The issue is not whether there are a few bad doctors out there. The issue is the concerning rise in “doctors” practicing nonsence and the community accepting this out of political/social “correctness”.
#10 antipodean
March 31, 2009

A Patient said “In the past decade, there has been several highly publicized cases where fast-tracked drugs and led to unnecessary drug induced illness and even death. This has led to an unfortunate, but very real mistrust of “science-based” medicine.”

Science-based medicine is the mechanism by which these problems were detected and publicized. Science-based medicine didn’t cause the problem, it’s the cure. Note that this doesn’t happen in woo. There is no self-correcting mechanism in quackery.

Your physician was clearly correct in playing the 80% odds on the treatment plan initially. The problem is not then applying his clinical judgement when it’s clear you are part of the 20%. This is the inherent difficulty in medicine balancing the science of medicine with the art of medicine.

Please remember that a woo practitioner will either flail around trying every modality they learnt at the holiday inn meeting last weekend to your problem or will doggedly stick to one modality. Both of these ‘treatment plans’ will of course have a 0% chance of working better than placebo. They will never ever learn from their mistakes.
#11 Whitecoat Tales
March 31, 2009

Re: A patient
Lets be clear.
Evidence based medicine is NOT cookbook medicine. Treatment plans should be dynamic, and when it is clear something isn’t working, something new must be tried.

An anecdote of badly practiced evidence based medicine is not a license for faith based medicine.
#12 Denice Walter
March 31, 2009

The woo-propagandizers who sow the seeds of mistrust of science-based medecine often have no background in science themselves.For the past year, I’ve commented about all manner of *dreck* I’ve encountered at “Woo Central”(i.e. NaturalNews) or that “Festival of Involutional Idiocy” (a/k/a the Gary Null Show).Concerning the latter,I have a question for followers:should you take medical advice from someone who has no medical training whatsoever,who has a mail order doctorate,who mispronounces terms from physiology,who creates neologisms and malapropizes constantly,who can’t accurately report what he saw on “60 Minutes” the night before,who has a paucity of general knowledge( getting information about vaccines from HBO’s”John Adams”,ECT from a 1970′s movie,food processing from a 100 year old account:”The Jungle”), who profits from people’s mistrust of medecine(see his product list),who, since the economic crisis began, suddenly became an *expert*,predicting future trends,playing on fears, giving unsound advice(“Take your money out of the banks”)and grandiously, creating his own alternative “Stimulus Plan” (see website).If someone can’t get simple information (and the English language) straight, should you trust their advice for your health( or wealth)?
#13 DLC
April 6, 2009

Keep the blasted crap out of medical school.
Med school students have enough to do as it is without having to be bothered with woo-woos.
#14 John H.
April 6, 2009

I’m starting to view the general mistrust of science as a kind of faith (or perhaps religion). The mistrust is not based on rational thinking, and the conclusion (that it’s “bad”) flies in the face of reality. Both are characteristics of many religious faiths.

I may be oversimplifying, but at least this hypothesis explains why the rational, reasonable approach to fighting the (re)surgence of woo isn’t working terribly well. For example, once a person can equate acupuncture to science-based medicine (that both are faith-based–i.e., not subject to independent verification) then both are equally viable. Equally non-viable, as well.

If one then wants to dismiss the science-based approach, there’s no cognitive dissonance. This “science is a religion” bent is consonant with all kinds of science denials, from creationism to anti-vaccination.