Many thanks to my oncology colleague and ScienceBlogs.com SciBling, Orac, for his repeated referrals to my posts as of late. He's been one of my blogging mentors from the genesis of my blogosphere presence and generally ranks #1 or #2 as the source of my referral traffic.
So, in return, let me direct Terra Sig readers to two of Orac's best posts this past week, one of which I consider among his best of the year.
First, is Orac's discussion of Institutional Review Boards, or IRBs, the entities convened to ensure human subjects protection in clinical research trials. Orac points our that, as is wont with any institutionalized committee structure, a well-intended idea often stands in the way of legitimate research. This post is top-notch, award-winning medical blogging.
Second is an area I've been thinking of for quite some time: the shortcomings of including alternative medicine services and education in conventional academic medical center services and health sciences curricula.
The discussion stems from the fact that embattled 16-year-old, non-Hodgkins lymphoma patient, Starchild Abraham Cherrix, sought conventional chemotherapy at a Mississippi medical center that also offers alternative therapies. We've spoken as of late about the financial reasons for conventional medicine jumping on the alt med bandwagon, even at places like Harvard and Memorial Sloan-Kettering, but Orac raises some serious concerns over how to reconcile teaching about these modalities in evidence-based medical curricula.
- Log in to post comments
I've spoken with some medical students about their experience on the receiving end of the UMich complimentary and alternative medicine curriculum. (CAM)
I get the impression that they think too much time is spent on it, and that the lecturers diminish the credibility of CAM by being defensive about it while they teach.
One of the things I worry about is that they are exposed to so many different things, all on a superficial level, that they tend to lump everything together and not think about it critically.
If they are going to have CAM in the curriculum, it would be better for them to focus on just a few selected modalities.
There is an excellent article by Wallace Sampson in Academic Medicine (2001) 76: 248-250. I believe anyone can get the full text online. Dr. Sampson (now emeritus) taught a course on critical thinking and "AM" at Stanford. "Academic Medicine" seems to have a few articles on the subject.
I blame the lack of rigor among recent med graduates on the NCCAM's pushing unthinking acceptance of AM. But I also blame science "education" for not adequately "educating" people in the sciences. We expect students to learn the "facts" of science rather than the system of developing those facts.
Then, when someone presents the "facts" of AM, the students assume they were properly obtained. If I offer a different view, they assume that mine is only an opinion, and there may be some scientific disagreement.
Joseph, the UMich program you cite is actually one of the better and more comprehensive educational experiences offered in CAM at US medical schools. Still, for the reasons you point out, it is viewed as uncritical and devoid of the necessary detail because of attempts to cover too much material, and often in a defensive or advocacy manner.
Trying to cram good coverage of CAM into an already stretched medical curriculum is just like, as Joe points out, the problems with NCCAM trying to cover extramural grants for all modalities for all diseases. When stretched too thin, the level of detailed coverage and infusion of critical thinking skills get such short schrift, that it might be better not to include it at all.
Both Dr. RW and Orac have great posts this week on the dichotomy of critical thinking skills espoused by the American Medical Students Association, as even they seem to hold CAM to a different (i.e., lesser) standard than conventional pharmacotherapy.