Another example of why I fear for the future of medicine

It’s been a while since I wrote about this topic, but I fear for the future of medicine.

Regular readers know what I’m talking about. The infiltration of various unscientific, pseudoscientific, and even anti-scientific “complementary and alternative medicine” (CAM) modalities into academic medicine seems increasingly to be endangering science-based medicine. Worse, this infiltration of quackery seems at least as bad, if not worse, in academic medicine, so much so that Dr. R.W. coined a most exquisite term for the increasing prevalence of pseudoscience in medical academia: Quackademic medicine. Whether it is the American Medical Student Association promoting quackery, the National Center for Complementary and Alternative Medicine (NCCAM) funding studies of homeopathy, medical schools adopting pseudoscience wholesale in their medical curriculum, or hospitals using it to attract woo-friendly paying patients, there is ample reason to fear for the scientific basis of medicine. It’s not just the U.S., either. All you have to do is to peruse David Colquhoun’s DC’s Improbable Science to know that this is a phenomenon that transcends national boundaries and has made its way into virtually every industrialized nation, particularly in the U.K. and Europe.

The result, it would appear, is a generation of medical students with far too many students like Jonny Martell. Jonny Martell is a third year medical student at Kings College London, and he has apparently found sufficient time away from his studies to write paeans to woo like The magic of alternative medicine. Sadly, he doesn’t see the irony of his chosen title. Alternative medicine is magic, all right. For what is homeopathy, if not magic? What is the idea that a healer can manipulate some sort of “life force” that is undetectable by modern scientific instruments in order to heal people but magic? What are psychics but people who either lie about being able to do magic or have deluded themselves into thinking they can do it? Yet, Mr. Martell feels inadquate around psychics:

I was working next to a world renowned psychic and spiritual healer in the healing sanctuary of a music festival. This made me nervous: my own training in complementary medicine before medical school gave me no such special powers. Many of the people I treated had the customary battle wounds of a sedentary office bound existence. Others came in just to feel better. These people were clearly treating themselves. Who else uses complementary and alternative medicine (CAM) and why?

Why indeed? I’ll give Mr. Martell credit for a modicum–but just a modicum–of awareness about CAM. He does realize that many patients seek it out for chronic conditions for which science-based medicine doesn’t have a lot of good treatments, although I would point out that I’ve come across my share of patients who have conditions that are perfectly treatable for potential cure using modern scientific medicine. Martell’s answer appears to be that if symptoms aren’t explained well through scientific medicine, then we should try magic to treat it.

And people wonder why I fear for the future of medicine.

Martell gives me even more reason to fear. Although he shows an admirable concern for patients with chronic diseases, his answer is anything but a service to them, as he launches into an essay that shows no sign of recognizing what is and is not science. Worse, he even seems to equate what CAM practitioners do with what the “best” science-based practitioners do:

Several approaches in CAM employ language and metaphors redolent of Eastern concepts of balance and energy flow. These are strikingly at odds with the reductionist technical lexicon of allopathic orthodoxy. This perhaps appeals to patients interested more in the “why” as opposed to the “what.” If stripped of its more esoteric overtures, this is of course no different to the best practice offered by general practitioners. A crucial difference, however, is the luxury of time.

Here’s a hint: Whenever you see someone refer to science-based medicine as “allopathic” medicine, you know you’re dealing with a historically ignorant git. The term “allopath” was invented by the creator of homeopathy, Samuel Hahnemann, ot describe anyone who was not a homeopath. In essence, it was used to describe the physicians of the era, who used harsh treatments like toxic metals, purgatives, and bleeding based on the ancient Greek idea of imbalances in the four humors being the cause of disease. Basically, allopathy is the opposite of homeopathy in that it isn’t like curing like, but the opposite curing opposite. The bottom line is that “allopath” is an intentionally derisive term that misrepresents what modern, science-based medicine is, and, in fact, science-based physicians do not practice “allopathy. In fact, the term is rarely, if ever, used by anyone other than practitioners of “alternative” medicine practices rooted in vitalism, like naturopathy, homeopathy, or chiropractic. I weep to see a medical student in his clinical rotations referring to his future profession as “allopathy” because it betrays an ignorance of and contempt for his own future professoin that is breathtaking to behold. Remember, “allopath” is virtually always intended as a derogatory term. Using “allopath” to describe a science-based MD is just like using the term “Darwinist” to describe an evolutionary biologist or a modern-day defender of evolutionary theory. As evolution has progressed far beyond Darwin, “allopathy” has progressed far beyond what it was in Hahnemann’s day.

Proving himself irony-proof, Martell continues by pointing out that the doctor-patient relationship in many instances has become too impersonal. He points out a deficiency of touch. Of course, too much touch puts a physician at risk for being accused of improprieties; so I’d be careful there. Unfortunately, Martell describes placebo medicine perfectly but seems utterly oblivious to the fact that that is what he is describing:

Working at the festival brought home to me how the tensions that exist between CAM and allopathic medicine can illuminate each other’s blind spots. Where primary care’s 10 minute consultation, spot of reassurance, and some tablets fail to hit the spot, I suspect that in some cases the holistic principles underpinning some CAM approaches are as instrumental in making the patient feel better as the intervention itself.

In other words, it’s placebo medicine. Most CAM modalities don’t do anything active against a disease process, but they do involve showing a lot of attention to the patient, which is perfect to maximize placebo effects. Unfortunately, poor Jonny gets it wrong when he concludes from this that in such instances “the therapy is unlikely to perform too well in randomised controlled trials, focusing as they do on an illusory magic bullet.”

Or maybe the reason why such therapies fail to do well in randomized controlled trials is because they are placebos and therefore perform roughly equal to placebos.

If I weeped for the future of medicine before over seeing a medical student deride his own future profession as nothing more than “allopathy,” I weep even more at the concluding paragraph of this revealing little post:

A willingness to develop an understanding of the appeal of CAM, despite its shortcomings, might be more likely among doctors if they had a better understanding of the fallible foundations on which their own pedestal of evidence based medicine is built. At the very least, it might make for a bit more humility and less flippant mockery when confronted with the popularity of the clairvoyant shop next door.

It’s truly depressing to think that a young man who will soon be a physician apparently thinks that the foundation of evidence-based medicine is so fallable that it is comparable to the “magic” and “mystery” that is alternative medicine and rationalizes the failures of CAM to measure up in randomized clinical trials to its allegedly “holistic principles.” By doing so, he profoundly devalues his own future profession. For instnace, if he were to become a primary care physician, he could be a holistic doctor without the need for scare quotation marks. He could be, as PalMD might put it, a real holistic doctor, wielding only the most kick-ass science-based medicine. As for who is the most arrogant, it is not necessarily science-based practioners mocking quackery. Rather, it is the pseudoexperts who think that they can bypass the hard work of showing that their therapies actually work through science and clinical trials in favor of testimonials and magical thinking.

Of Jonny Martell, I’m afraid that I have to conclude by saying that the woo is strong in this one. Sadly, because of the infiltration of quackademic medicine into medical academia, there are more and more Jonny Martell’s out there, and they will be taking care of you and me as we age and inevitably begin to suffer the diseases of aging.

It’s a thought that scares me.