If there’s one aspect of medical education that I consider to be paramount, at least when it comes to understanding how to analyze and apply all the evidence, both basic science and clinical, it’s a firm grounding in the scientific method. I advocate science-based medicine (SBM), which is what evidence-based medicine (EBM) should be. SBM tries to overcome the shortcomings of EBM by taking into account all the evidence, both scientific and clinical, in deciding what therapies work, what therapies don’t work, and why. To recap, a major part of our thesis is that EBM, although a step forward over prior dogma-based medical models, ultimately falls short of making medicine as effective as it can be. As currently practiced, EBM appears to worship clinical trial evidence above all else and nearly completely ignores basic science considerations, relegating them to the lowest form of evidence, lower than even small case series. This blind spot has directly contributed to the infiltration of quackery into academic medicine and so-called EBM because in the cases of ridiculously improbable modalities like homeopathy and reiki, deficiencies in how clinical trials are conducted and analyzed can make it appear that these modalities might actually have efficacy.
Unfortunately, in medical school there is very little, if any, concentration on the scientific method. In fact, one thing that shocked me when I first entered what is one of the best medical schools in the U.S., the University of Michigan, was just how “practical” the science taught to us as students was. It was very much a “just the facts, ma’am,” sort of presentation, with little, if any, emphasis on how those scientific facts were discovered. Indeed, before I entered medical school, I had taken graduate level biochemistry courses for a whole year. This was some truly hard core stuff. Unfortunately, I couldn’t get out of taking medical school biochemistry my first year, but taking the course was illuminating when I contrasted it with my graduate level biochemistry course, the same introductory biochemistry course that the first year biochemistry graduate students had to take. The key difference was that in medical school there was very little in the way of mechanistic detail taught, but there was a whole lot of memorization. The same was true in nearly all the other classes we took in the first two years. Admittedly, for anatomy it’s pretty hard not to have to engage in a whole lot of rote memorization to master the material. It’s the nature of the beast. However, the same shouldn’t necessarily be true of physiology and pharmacology, for example. Unfortunately, all too often it was.
Over time, I came to realize that there was no easy answer to correcting this problem, because medical school is far more akin to a trade school than a science training school. How much science and in what form it should be taught remain difficult questions that go to the heart of medical education and what it means to be a good physician. Clearly, I believe that, among other things, a good physician must use science-based practice, but how does medical education achieve that? That’s one reason why I’m both appalled and intrigued by a program at the Mt. Sinai School of Medicine for humanities majors to enter medical school without all the hard sciences. It’s a program that was written up in the New York Times about a week ago in an article entitled Getting Into Med School Without Hard Sciences. This NYT article used the results of a recent article published in Medical Academia under the title Challenging Traditional Premedical Requirements as Predictors of Success in Medical School: The Mount Sinai School of Medicine Humanities and Medicine Program as a jumping off point to do a story about a rather radical program in medical humanities offered by the Mt. Sinai School of Medicine.
Humanities in medicine
Let’s first take a look at how the NYT described the program:
For generations of pre-med students, three things have been as certain as death and taxes: organic chemistry, physics and the Medical College Admission Test, known by its dread-inducing acronym, the MCAT.
So it came as a total shock to Elizabeth Adler when she discovered, through a singer in her favorite a cappella group at Brown University, that one of the nation’s top medical schools admits a small number of students every year who have skipped all three requirements.
Until then, despite being the daughter of a physician, she said, “I was kind of thinking medical school was not the right track for me.”
Ms. Adler became one of the lucky few in one of the best kept secrets in the cutthroat world of medical school admissions, the Humanities and Medicine Program at the Mount Sinai medical school on the Upper East Side of Manhattan.
The program promises slots to about 35 undergraduates a year if they study humanities or social sciences instead of the traditional pre-medical school curriculum and maintain a 3.5 grade-point average.
I actually first became aware of this program four years ago, when the NYT ran a story about how art appreciation was being taught as part of the curriculum at Mt. Sinai. I even mentioned it in a blog post, linking to the article, which was about the appalling lack of knowledge of anatomy among medical students being reported by surgeons in Australia. At the time, I was puzzled why such courses were being offered in medical school when there is so little time and so much to teach. Don’t get me wrong. I wish I had taken more humanities and arts classes during my undergraduate years. My not having done so is one of the great regrets of my life, truly a missed opportunity. However, in medical school, unless one is going into medical illustration, my thought at the time was that such a program was all very well and good, but medical school is not a liberal arts school; it is, as I have pointed out, more or less a specialized school, an advanced program of education designed to inculcate into students the basic knowledge and skills that all physicians should have.
Let’s look at the study itself. Basically, it’s pretty thin gruel whose only findings the authors, Dr. David Muller and Dr. Nathan Kase (the latter of whom is the founder of Mount Sinai’s Humanities in Medicine Program), extrapolate far beyond what is justified. It amazes me, in fact, that Academic Medicine would allow so much data-free speculation and pontification in the discussion section of this study. Let’s put it this way. There are really only three findings in this study regarding the Humanities in Medicine (HuMed) students. Basically, Muller and Kase looked at the outcomes of HuMed students from 2004 to 2009 and compared them to the outcomes of medical students on the “traditional” track and found that:
- There was a trend among HuMed students toward residencies in primary care and psychiatry and away from surgical subspecialties and anesthesiology.
- There were no statistically significant differences between the groups in clerkship honors other than psychiatry (HuMed students outperformed their peers, P < .0001) or in commencement distinctions or honors. Although HuMed students were significantly more likely to secure a scholarly-year mentored project (P = .001), there was no difference in graduating with distinction in research (P = .281).
- HuMed students were more likely to have lower United States Medical Licensing Examination Step 1 scores (221 ± 20 versus 227 ± 19, P = .0039) and to take a nonscholarly leave of absence (P = .0001).
The wag in me can’t resist wondering whether the way HuMed students apparently excelled in psychology says anything about the scientific basis of psychiatry, but that’s just the nasty, reductionistic cancer researcher in me. The most important point of this study is that, for the most part, the HuMed students don’t appear to do significantly differently than students in the traditional medical education track other than a tendency towards more “touchy-feely” specialties. This result doesn’t actually surprise me much, given that it is the mission of medical schools to teach the common knowledge and skills that all doctors require. One would expect that, if the medical school curriculum is constructed to provide adequate “catch up” instruction to students whose background in the basic sciences is somewhat … lacking, then most students, particularly students who are highly motivated, as medical students tend to be, should be able to keep up. And HuMed students do get a bit of a catch up course in the form of a “summer boot camp,” described thusly by the NYT:
The students apply in their sophomore or junior years in college and agree to major in humanities or social science, rather than the hard sciences. If they are admitted, they are required to take only basic biology and chemistry, at a level many students accomplish through Advanced Placement courses in high school.
They forgo organic chemistry, physics and calculus — though they get abbreviated organic chemistry and physics courses during a summer boot camp run by Mount Sinai. They are exempt from the MCAT. Instead, they are admitted into the program based on their high school SAT scores, two personal essays, their high school and early college grades and interviews.
I must admit that I’m a bit disturbed by some of this, and here’s why. The reason we know that, for example, homeopathy is incredibly — nay, monumentally — implausible is based primarily on basic science, specifically very basic physics and chemistry. It is chemistry and Avogadro’s number that tell us that a 30C homeopathic dilution almost certainly has not a single molecule of original remedy left. It is basic physics and chemistry that tell us that water doesn’t have “memory,” at least not the way that homeopaths tell us. It is basic chemistry that tells us that, even if water did have “memory,” there’s no known mechanism by which such “memory” could be transmitted to cells for therapeutic effect. In other words, I worry that science-based medicine is in danger if future generations of physicians eschew the hard sciences and elect to “get by” on the bare minimum that they can get by with. Worse, the attitude that seems to be underlying the entire HuMed program is that science is an obstacle to becoming a physician.
Science: An “obstacle” rather than a prerequisite?
From my perspective, science and medicine should go hand in hand. Science informs what is good medicine, and physicians should have a sufficient grounding in the scientific method to be able to recognize what is and is not good scientific and clinical evidence for a therapy. EBM only goes part of the way to reaching that goal. SBM, properly applied, is what EBM could and should be were it not for its devaluation of basic science. Now that devaluation appears to be evident in medical education. Witness some of the quotes from the NYT story and Muller and Kase’s article. For example, from the NYT:
“You have to have the proper amount of moral courage to say ‘O.K., we’re going to skip over a lot of the huge barriers to a lot of our students,’ ” said Dr. David Battinelli, senior associate dean for education at Hofstra University School of Medicine.
And, from Muller and Kase’s study:
The HuMed program at Mount Sinai was designed to determine the extent to which the MCAT and traditional premed courses in organic chemistry, physics, and calculus are necessary for successful completion of a medical school curriculum. It was also designed to encourage students interested in the humanistic elements of medicine to seriously consider pursuing a medical career. Many of these students are initially reluctant to pursue medicine because they are uncertain about their interest in science, they are concerned about their ability to meet the high scholastic expectations of admissions committees, or they are unwilling to divert the time and effort required to meet standard medical school admission requirements.
And, from Dr. Kase himself, as quoted in the NYT:
“There’s no question,” Dr. Kase said. “The default pathway is: Well, how did they do on the MCAT? How did they do on organic chemistry? What was their grade-point average?”
“That excludes a lot of kids,” said Dr. Kase, who founded the Mount Sinai program in 1987 when he was dean of the medical school, and who is now dean emeritus and a professor of obstetrics and gynecology. “But it also diminishes; it makes science into an obstacle rather than something that is an insight into the biology of human disease.”
While it’s a fair question to ask just how much basic science is necessary as a prerequisite for medical school in order to produce the best physicians possible, is anyone else disturbed at how, for example, Dr. Battinelli characterizes the basic sciences as “barriers” to medical students, rather than reasonable prerequisites that try to ensure a knowledge base necessary to succeed in medical school? Or how Muller and Kase seem to dismiss science as relatively unimportant in medicine to the point that they seriously argue that, just because some students are discouraged from a medical career because they fear the science medical schools should decrease the amount of science required of premeds? Or how Kase seems to think of basic science as more of an “obstacle” than anything else? Or how Muller and Kase seem want to bend over backwards to admit students who apparently can’t be bothered to “divert the time and effort required to meet standard medical school admissions requirements”? If such students are not sufficiently interested in medicine to do what it takes when what it takes is not an unreasonable expectation, I worry about their commitment to medicine. I really do. After all, as physicians, we deal with people’s lives and health.
In fact, I would counter that pretty much every prerequisite and requirement to be admitted to medical school and then complete its curriculum are “barriers” and “obstacles” — yes, even any new set of prerequisites that Muller and Kase might come up with to replace the currently existing paradigm. They’re supposed to be barriers! That’s what maintaining standards is all about: excluding those who can’t make the cut and making sure that the educational curriculum gives those who do make the cut the knowledge and skill base to be at least competent physicians, preferably excellent physicians. What should be argued is what is the proper nature and difficulty of these barriers, not whether there should be such barriers. Should there be more basic science? Are we demanding too much basic science? Is it enough to have a humanities degree and “fill in” later the science? Certainly this study doesn’t answer any of these questions. Even Dr. Batinelli points out that the more important question is how graduates of Mt. Sinai’s HuMed program do 5 and 10 years down the road, after they’ve completed their residency training and entered practice. What I do not like to see are students who voice attitudes like one of the featured students in the NYT article:
Among the current crop is Ms. Adler, 21, a senior at Brown studying global political economy and majoring in development studies.
Ms. Adler said she was inspired by her freshman study abroad in Africa. “I didn’t want to waste a class on physics, or waste a class on orgo,” she said. “The social determinants of health are so much more pervasive than the immediate biology of it.”
My suggestion to Ms. Adler is that if she doesn’t want to “waste” time on prerequisites currently considered necessary for medical school, then perhaps she shouldn’t become a physician. Social determinants of health are indeed very important, but in actually treating a patient you still need to understand the biology of disease and the treatment used to combat the disease. I suppose I’ll be labeled “arrogant” for being so blunt in saying that, but I don’t care. As a future patient, I can only hope that Ms. Adler figures out that being a physician is about more than the social determinants of health. In fact, you don’t even need an MD to study the social determinants of health. I work with some very talented epidemiologists and MPHs who do just that. Perhaps Ms. Adler should consider that or a similar career path if that’s what she’s passionate about.
What is the proper role of science in medical education?
Proving once again that everything old is new again, this study and entire discussion remind me that this sort of debate has been going on over 100 years, since before Abraham Flexner published the Flexner Report in 1910. Even now, on the 100th year since the release of that report, it is not a debate that is likely to go away. For one thing, as Muller and Kase point out, there has been opposition to the ideas embodied in the Flexner Report that medical schools require at least two years of college- or university-level basic science education grounded in basic sciences like physics, chemistry, and biology, characterizing as such opposition as falling into three categories, as they describe in their study:
According to Gross and colleagues,9 critics of premed requirements fall into three categories: those who would eliminate all requirements,10 those who advocate for continuously updating the premed science curriculum,5-7 and those who believe that the premed curriculum must broadened to reflect a richer liberal arts education.5,6,8
Personally, my view would probably fall between the last two categories: I believe that the pre-med science curriculum should be continuously updated based on the latest science but see room for a richer liberal arts educations. The two are not necessarily incompatible. However, such a fusion is not what I see happening in Mt. Sinai’s HuMed program. Rather, what I see is a fusion of numbers one and three, meeting halfway, so to speak, between eliminating all requirements and requiring a richer liberal arts education.
In fact, I would go further than that. What bothers me about Muller and Kase’s thesis is, as I have said before, the way that it seems to view science as an obstacle to getting into medical school and becoming a doctor, as opposed to being a necessary prerequisite to being able to put the flood of information taught in medical school into context. The humanistic part of medicine is very important to being an effective, but if those humanistic elements are not also wedded to a firm understanding of the science of clinical practice, we risk producing a generation of physicians who are very good at holding their patients’ hands and offering encouragement to them but not so good at actually treating their medical problems.
In other words, I fear a generation of physicians perfectly suited to “integrate” so-called “complementary and alternative” medicine (CAM) into their practices.
I understand that much of the basic science that we learn in prerequisites for medical school (i.e., the “pre-med” curriculum) is not strictly necessary to be a good physician. However, I would argue that learning the scientific method and, even better, internalizing it as part of one’s being, is critical to being a good physician. Consider, for example, EBM. In EBM, science matters almost not at all. Basic science considerations are in fact relegated to the lowest form of evidence for or against a treatment, even below small case series (i.e., anecdotes). Under normal circumstances, such a ranking of basic science considerations may not seem particularly unreasonable. After all, many are the treatment modalities that seem as though they should work on the basis of science alone but turn out not to work when tested in clinical trials, thus showing us either that our understanding of the science of disease is not as strong as we think or that there are other considerations that we have not taken into account. Either way, it’s not unreasonable in general not to rely on basic science alone — with one exception. That exception, as regular readers of this blog no doubt can guess, is when a treatment proposes a mechanism that is not just implausible based on basic science but so implausible that for all intents and purposes it can be considered impossible because for it to work large swaths of well-established science would have to be not just in error but spectacularly and outrageously wrong.
Think homeopathy. Think reiki. Think “therapeutic touch.”
Even leaving aside the question of distinguishing quackery from science, science is important in medicine, as Dr. RW pointed out four years ago:
It’s probably a waste for most of us to memorize the chemical structure of amino acids, but it may be important to know enough about their structure and properties to understand that some are hydrophobic and comprise membrane lipid bilayers while others are hydrophilic and form hydrogen bonds, the basis for the secondary structure of proteins. Memorizing all the steps in the glycolytic sequence and the Krebs cycle won’t make you a better doctor but it could be important to understand how those reactions yield energy, why a molecule of glucose yields only a couple of ATPs in the glycolytic sequence, but an additional 30 some odd in the Krebs cycle, a fact that explains the difference between aerobic and anaerobic metabolism and why folks have to breathe. It’s all about the how and why of health and disease.
Or, as I would put it, physicians need to have a firm grounding in basic science for two reasons. First, as my professors used to reiterate almost ad nauseam, a significant fraction of what we learn in medical school and residency will be obsolete in a decade, and one of the main purposes of medical school is to give us sufficient background knowledge and understanding to be able to keep up with new developments, understand them, and incorporate them into our practices. A strong basic science background makes it easier for physicians to adapt to changes in knowledge leading to changes in recommended therapy and provides the conceptual framework against which to evaluate new scientific and medical findings. As Mark Crislip put it in his usual inimitable sarcastic fashion, if you want job that requires no constant reevaluation of what we do for patients based on new science, perhaps you should be a naturopath or homeopath. Physicians must be constantly learning, from training all the way to retirement, and that learning is much easier if we have a firm background the physiological, biochemical, and anatomical principles involved, even if we quickly forget details like the structures of various amino acids or where Rotter’s nodes are (although as a breast surgeon, I’ll never forget this; that’s why I chose Rotter’s nodes as an example). Second, as I have argued before, a firm grounding in science helps us to recognize pseudoscience when we see it. A poor scientific understanding of one area that leads to credulity towards a pseudoscience is all too often a marker for or harbinger of a tendency to accept other pseudoscience uncritically.
I would agree with Dr. RW that no one knows for sure what the optimal amount of basic science education should be a prerequisite to be admitted to medical school. Similarly, no one knows what the optimal mix between basic science and clinical instruction is to produce the best possible physicians. Certainly I don’t. These are questions for legitimate debate. What worries me is that the role of science in medicine has, ever since I finished medical school, appeared to be continually under siege. The science that is taught in medical school appears to be purely practical in nature. Memorize this. Memorize that. Apply that equation. Don’t think too deeply about it; a superficial knowledge is fine. A survey course in organic chemistry over the summer is just fine. Never mind that one of the key aspects of organic chemistry that most challenged me and made me understand is that you can’t just memorize things. You have to understand reaction mechanisms and how to apply them. You have to be able to use that understanding to design plans to synthesize chemicals. It’s really cool and fun stuff. And I say this even though the lowest grade I ever got in an undergraduate science class was in my second term honors organic chemistry class.
The ideas being pushed by academics like Muller and Kase also strike me as a false dichotomy. Either we require a ridiculous amount of science as prerequisites or we in essence require almost no basic science, supplemented with survey courses that can’t convey the richness of science or emphasize the scientific method at the heart of the sciences that underlie medical knowledge. As Dr. RW also pointed out, it’s perfectly possible to major in the humanities and take sufficient prerequisite science courses to be accepted into medical school. Students have been doing it for generations.
Perhaps what concerns me the most is not so much the deemphasis of science in medicine but rather the deemphasis of the scientific method and the critical thinking that underlies the scientific method. Teaching science to pre-med and medical students isn’t necessarily going to innoculate them against pseudoscientific ideas, such as many of the aspects of CAM that have infiltrated medicine over the last 20 years. A broader approach is needed. Teaching critical thinking skills, a subset of which is the scientific method, would represent a powerful strategy to keep medicine science- and evidence-based. If we could wed a strong understanding of the scientific method with a broader understanding of critical thinking, the latter of which could certainly be taught as part of a humanities curriculum, it would be a powerful weapon against quackademic medicine. Unfortunately, I fear we’re going in exactly the wrong direction, wedding a watered down science curriculum with a whole lot of postmodernist nonsense.
132 replies on “Basic science: An “obstacle” to students who want to study medicine?”
It’s not just an issue with med students. I’ve had some incredibly disturbing discussions with nurses and mid-levels who really do believe some of the stuff they’ve heard. From the nurse who convinced a patient to take up reiki instead of going through with chemo to the NP who would not vaccinate her children because they’re home-schooled (so, in her mind, they would not be exposed to other kids, never mind that they all go to wal-mart together). It’s just scary to have someone receive a degree in science or a science-related field and then have that same person throw away all the evidence in the world and go on their merry way to wooville.
I think this quote from the article cannot be stressed enough: “[The] more important question is how graduates of Mt. Sinai’s HuMed program do 5 and 10 years down the road, after they’ve completed their residency training and entered practice.”
If you want to make it easier to complete med school, allow cheating, or abolish exams altogether. You will then find that practically everybody does equally well.
But will they be good doctors?
One more note: Woolly-minded quack supporters have a tendency to appropriate terms like “evidence”, “research”, “patient care” and especially “critical thinking”.
The latter, to them, means cursing at science and facts and promoting whatever quackery they’ve bought into instead.
I actually have to get some work today so I didn’t make my way through this entire even-more-Oracian-than-usual post 😉 but I just wanted to add a quick comment about my experience going to school for engineering: Similar problem. The physics was fairly comprehensive, though like you say it was fairly “Just the fact ma’am”-ish. There was basically no other science, except for a chemistry 101 course that I think was weaker tea than the class I took in high school.
I think there’s a lot of analogous issues here, in that you don’t really need a strong backing in basic science and the scientific method for either engineering or medicine, but it provides some relevant context that can come in really handy — and in any case, studying the scientific method is great for everybody, just for critical thinking’s sake.
BTW, I suspect this may be why you see so many engineers popping up as creationists, AGW denialists, etc. We have just enough scientific training to make us think we know what we are talking about, but not enough to actually have a deep understanding of how science works. Furthermore, the way we go about our day-to-day business is “science-y” but not science — we make hypothesis, do experiments, but our standards of proof are far less rigorous, and we don’t tend to worry about things like post-hypothesizing, lack of blinding, etc. In fact, heh, in one sense of the word, you could even say that the practice of engineering is a form of “pseudoscience”, if you sort of get what I’m saying… 😉 No surprise that so many engineers go on to delve in actual pseudoscience!
I read the Times story with interest and skepticism.
The best doctors need a really, really strong foundation in science and in math – the kind of education we’re not providing most public school students in the U.S. Otherwise, they won’t be able to do good research or even read critically about new scientific and medical reports published by their colleagues. They also need to be literate – verbally skilled and culturally aware – so that they can explain things to people who are not doctors.
My experience has been that most of the doctors that learnt the minutiae of basic sciences end up being the most average of clinicians, and many of those who learnt by broad strokes have become fantastic and extremely knowledgable practitioners.
The reason I raise this is I feel that courses that focus heavily on science to exclusion of other topics select for the first group.
Broader based education still allows that group to excel academically, but also provides access to the people who have huge potential, but don’t excel in such a formalised setting.
It takes a whole range of people to fill as broad a field as medicine. Even psychiatrists. Certainly the vast majority of those who practice surgery don’t have that aptitude (to be polite). Imagine if they had no-one to refer to!
Perhaps my experience is biased by the fact hard ‘science’ medical education always has been more didactic in my country though.
I certainly support science and scientific thinking in medicine, but not at the expense of training those who are often the most skilled and inspired doctors.
My experience has been that most of the doctors that learnt the minutiae of basic sciences end up being the most average of clinicians, and many of those who learnt by broad strokes have become fantastic and extremely knowledgable practitioners.
The reason I raise this is I feel that courses that focus heavily on science to exclusion of other topics select for the first group.
Broader based education still allows that group to excel academically, but also provides access to the people who have huge potential, but don’t excel in such a formalised setting.
It takes a whole range of people to fill as broad a field as medicine. Even psychiatrists. Certainly the vast majority of those who practice surgery don’t have that aptitude (to be polite). Imagine if they had no-one to refer to!
Perhaps my experience is biased by the fact hard ‘science’ medical education always has been more didactic in my country though.
I certainly support science and scientific thinking in medicine, but not at the expense of training those who are often the most skilled and inspired doctors.
A lot of undergraduate chemistry is nothing but brute force memorization anyway, something med school students have to be exceedingly good at. So I’d be surprised if it’s a prerequisite that actually would give future MDs trouble. And from that blog entry you linked to the Harvard med school student who uses strong base and acid to wash her hair, it’s not like a lot is being retained long time.
Nevertheless, as pointed out above, it might be enough to recognize the worst of the woo as unlikely if you’d heard of Avogadro’s number and that there are four forces holding the universe together, and that the list does not include qi.
My experience has been that most of the doctors that learnt the minutiae of basic sciences end up being the most average of clinicians, and many of those who learnt by broad strokes have become fantastic and extremely knowledgable practitioners.
The reason I raise this is I feel that courses that focus heavily on science to exclusion of other topics select for the first group.
Broader based education still allows that group to excel academically, but also provides access to the people who have huge potential, but don’t excel in such a formalised setting.
It takes a whole range of people to fill as broad a field as medicine. Even psychiatrists. Certainly the vast majority of those who practice surgery don’t have that aptitude (to be polite). Imagine if they had no-one to refer to!
Perhaps my experience is biased by the fact hard ‘science’ medical education always has been more didactic in my country though.
I certainly support science and scientific thinking in medicine, but not at the expense of training those who are often the most skilled and inspired doctors.
The question of whether organic chemistry, physics, and basic biology are important for medicine or not really boils down to whether you think of medical school as a professional school or a trade school. If it is a professional school then expecting doctors to know the basic biology, chemistry, and physics behind what they’re doing makes sense. If it is simply a trade school where you are only expected to memorize the insulin sliding scale and learn how to read the NCCN guidelines, no big deal if you don’t know the backgound.
My experience has been that most of the doctors that learnt the minutiae of basic sciences end up being the most average of clinicians, and many of those who learnt by broad strokes have become fantastic and extremely knowledgable practitioners.
The reason I raise this is I feel that courses that focus heavily on science to exclusion of other topics select for the first group.
Broader based education still allows that group to excel academically, but also provides access to the people who have huge potential, but don’t excel in such a formalised setting.
It takes a whole range of people to fill as broad a field as medicine. Even psychiatrists. Certainly the vast majority of those who practice surgery don’t have that aptitude (to be polite). Imagine if they had no-one to refer to!
Perhaps my experience is biased by the fact hard ‘science’ medical education always has been more didactic in my country though.
I certainly support science and scientific thinking in medicine, but not at the expense of training those who are often the most skilled and inspired doctors.
It certainly would not be fair to say that softer science med graduates would be more likelyto swallow pseudoscience, those practitioners are burnouts and parasites. That’s ethics, not science.
Sorry for that orac. It said it wasn’t posting. Please delete all but the last one!
Holy quadruple post, Batman!
It’s precisely the broad strokes that are being argued for here – in particular, the scientific method and critical thinking. I don’t believe Orac’s referring to finer details like memorizing the chemical structures of the enzymes in the Krebs cycle, or anything like that.
How much science are we talking about at undergrad level, anyhow? There ought to be room in a four-year college curriculum for the necessary biology, chemistry, math, and physics plus a good amount of liberal arts stuff. For example, Columbia College (which was easy to find quickly) notes that a person can take the necessary premed courses along with a major in art history. (I assume the same is true of other liberal arts majors.) They also note that most medical schools don’t care what your undergrad major was, if you got good grades in the necessary science prereqs, and that they are likely to want variety in their classes. “Your choice of major should be guided solely by your own intellectual interests and aptitudes.”
This suggests that someone with the science aptitude, who is the only French literature major applying to a medical school from her college, might have an advantage over the seventeenth biology major.
What we don’t need is more doctors, nurses, pharmacists, and other medical professionals who are scornful of science or scientists. But it’s possible to study literature or French or history or pure mathematics and still think well of science; it also seems possible to major in chemistry, thinking that will look good to med school admissions offices, without any real comprehension of science as a process rather than a bundle of facts.
Maybe I’m a bit jaded, but I don’t think its going to make much of a difference to the end product… my impression of the medical profession is that as a result of the training regimen they go through, they largely lose much of their critical thinking and questioning skills and instead adopt a sponge-like ability to memorize details. In mixed classes of medical and science students I experienced in grad school, the science grad students asked the questions, debated the papers, and were interested in the theories – the medical students just wanted the facts and weren’t interested (or capable) of discussing the theories behind them. In my post-science career, I’ve been similarly unimpressed by medical scientists who have entered the field as MDs or surgeons… the journals are filled with badly conducted studies, poor conclusions, and an overreliance on clinical trials or statistical analysis without a deeper understanding of their data and the processes they are attempting to model.
Lack of critical thing is ubiquitous throughout the systems.
I think if we attempt to continue down this path if idiocy we are SCREWED…
I posted this comment on a completely different subject on another site:
http://www.theoildrum.com/node/6819#comment-695737
I think it goes to the heart of the matter with regards the dire consequences of a scientifically illiterate society that is wielding immensely powerful technologies. We might as well give loaded weapons to 5 year olds.
I , most fortunately, was able to complete a BA which nearly equally balanced the art/lit with life sciences/social sciences ( please don’t ask how)- in grad school, while other students moaned in physio, stat courses, and experimental courses, I was fine ( although I had to field many frantic phone requests for assistance from fellow students – as well as offers of monetary renumeration for writing papers ). Cutting back on science requirements for med school?- Perish the thought! But I have the sneaking suspicion that this idea possibly reflects a general shift away from scientific values and thought across the entire population over the past few decades – and in education, from grade school on.( One of the root causes of Woo-philia?)
There is a lot of talk about reducing the chemistry pre-requisites for med school. As you note, a lot of it is brute memorization, and right up med student alley, but then again, some of the current proposals are bothersome. For example, the big idea right now is to reduce the amount of organic chemistry, so that they can get more biochem. But this is just silly, because biochem is basically applied organic chem. We are supposed to reduce their organic knowledge, and this is supposed to help them in biochem?
Of course, the problem is that I am thinking about it in terms of _understanding_. I haven’t had a lick of biochemistry in my life. Never took a bio class since my sophomore year of high school, and never took biochem in college. However, I understand a lot of biochem because I understand organic chemistry. So while I might not be able to write the Krebs cycle, when I see the reagents of the Krebs cycle, I can actually do a pretty good job of predicting what’s going to happen.
Med schools think that “knowing biochemistry” means you have memorized the important pathways and can list the 20 amino acids (whether you can distinguish hexoses and pentoses is a different question (ZING!)) That doesn’t mean you understand the chemistry.
And it is important. When my wife was taking pharmacology in vet school, she would sometime ask me about some drug and how it worked. I didn’t know anything about the drug, but I could look at it and say, “You’ve got an epoxide here, and so that is going to be primed for nucleophilic attack. I would figure that there is going to something like that in the mechanism.” Meanwhile, their approach was just to memorize some details about when and where the drug should be used. So in the end, sure, they can follow a checklist of “here’s the symptoms, match it up with the drug,” and that can work, but without any understanding of what you are doing, and why. Is that what we want our doctors to be? Merely the algorithm that matches symptoms with meds? Or do we want them to say, “This is what’s happening in your cell. What I want to do is to make X happen instead, and so I am going to give you a medication that has Z, which causes X to occur”? That’s what I think of when I think of a “skilled and inspired” doctor.
I want doctors who understand basic science, i.e. the science that forms the basis for understanding. Sure, they need to know the Krebs cycle, but they also need to know why it does what it does.
In my view, science and scientific thinking is what makes doctors skilled in the first place. If you aren’t doing that, you are just a robotatron. We could just was well write a computer program.
Re your commentary that med school emphasized a “trade school” approach at the expense of scientific theory, interesting that I found almost exactly the opposite problem when I went to law school. It was all very intellectual and academic regarding how to read cases and construe them in your favor, or at worst distinguish a particular case from your own situation if it was unfavorable. (In practice there tend to be relatively few cases of first impression. There is usually case law directly on point, and judges get rather cross if you try to argue around the obvious controlling precedent.)
There was nothing about how to file a lawsuit, interview a client and witnesses to make sure there weren’t holes or surprises later, how to conduct effective direct and cross-examination, how to object to a question another lawyer asked or some piece of evidence he proposed to submit (no, that wasn’t even discussed from a practical perspective in Evidence class), how to preserve issues for appeal, and certainly nothing about conducting effective settlement negotiations. For non-litigators, there was nothing about the nuts-and-bolts of perfecting a lien or security interest, buying or selling land (though we did spend an inordinate amount of time on the various pitfalls associated with the Rule Against Perpetuities and various connected concepts such as the Fertile Octogenarian Rule), conducting mergers and acquisitions, etc., etc., etc.
I think popular demand may now have forced more clinical practice at the law school level, rather than leaving this to the catch-as-catch-can method of students obtaining various types of legal clerkships on their own during school.
I’m a medical student that loves psychiatry and wants to go into psychiatric research. The fact that they did better in psychiatry made me wince. Unfortunately, there are quite a few people that give psychiatry a bad name with their ‘softness’ (to put it politely), but it can be a science! I swear!
Not to be mean, but I’ve noticed that medical school selects for people who can memorize. And not people who can think creatively.
I see this a lot in my wife’s lab. They get medical students on rotation. Occasionally they find one who can think, so they try to recruit him/her into science.
Mostly though, they say “Medical school is a good fit for you…”
They never realize they’ve just been failed. I generally don’t bring that up. But seeing as how you broached the subject.
I’ve been similarly unimpressed by medical scientists who have entered the field as MDs or surgeons
MDs OR surgeons? You are aware that surgeons are either MDs or DOs, right?
I found the article intriguing in part because I was an English major in college and took only the minimum amount of science and math necessary to graduate. Several years later, I entered an MPH program that doesn’t have science prerequisites (at least not for the health policy track). As far as learning the scientific method, I feel like my MPH epidemiology and biostats classes have given me enough of a grounding that I know the importance of study design, weight of the evidence, etc. (Though some of my knowledge comes from my work experience as well as MPH coursework.)
In short, my education, while short on actual biology, chemistry, and physics, has given me enough training to be skeptical of interventions until I see some well-designed RCTs showing them to be effective and a plausible explanation of mechanisms (i.e., I don’t buy homeopathy). It doesn’t seem to me that it’s necessary to have physics and calculus to get to the point of knowing what kind of evidence should guide clinical decisions and having a sufficient understanding of evidence that’s out there.
As far as actual scientific knowledge, though, I definitely want my doctors to have a solid grounding in chemistry and biology. If the boot camp to get HuMed students caught up on these is really rigorous, it might suffice, but I’d want to see a demonstration that students who do this catch-up rather than getting it in college have a sufficient understanding that lasts beyond the boot camp final exams.
The point in the article that made me think this kind of program is worth considering is HuMed students’ trend toward residencies in primary care. We desperately need more primary care doctors, and anything that might increase their number is worth investigating. But we do need to see how HuMed grads perform as doctors before this program gets ramped up or spread.
I’d like to add my voice to those that see the major problem in pre-med training as a lack of critical thinking. My university has separated biomed and biology departments into two colleges, and the biomed dept. pushes premeds into their program. Unfortunately, the biomed dept has a reputation as “biology for creationists”, because, like the med schools Orac is talking about, these students are pushed to “learn the facts” without understanding how to connect those facts with an idea as basic as evolution. I see this “just the facts” mentality while TAing comparative vertebrate anatomy as well as in my side job with MCAT test prep. I worry what this lack of critical thinking will do in those years in practice, when physicians have no idea of what they don’t understand.
Sorry Diane, that should be GPs or surgeons.
I really wish I could say that science prerequisites would provide pre-med students with a basic understanding of the scientific method and an ability to apply critical thinking. Unfortunately, I find most undergraduate programs wholly lacking in such instruction. Some philosophy programs probably provide much better practice in critical thinking -if not necessarily in science. Asking an applicant to evaluate a medical treatment in a test or essay type form may provide a better indication of future doctors able to separate woo from justified treatments.
My university has separated biomed and biology departments into two colleges, and the biomed dept. pushes premeds into their program. Unfortunately, the biomed dept has a reputation as “biology for creationists”, because, like the med schools Orac is talking about, these students are pushed to “learn the facts” without understanding how to connect those facts with an idea as basic as evolution.
So maybe this study, if it means anything at all, is not a recommendation for the humed program but rather a condemnation of how poor current pre-med education is. Given that a lot of the facts do have to be relearned in medical school, it seems that college is the ideal place for potential medical students to learn basics such as how science works (it is NOT just a set of facts…not that everyone here couldn’t give that rant already), how to write well and quickly (yes, that’s a “humanities” skill, but it’s important in medicine as well), and other such foundation skills. I’d certainly not argue that the current premed system is perfect. But deleting the sciences from it doesn’t seem the best approach.
Instead of begging for more specific type of education how about teaching our scientist honesty, integrity, and morality.
But who will teach them?
ORAC? Pharmaceutical Scientists?
“The foundation of science is honesty. The present granting method is so much at variance with the basic ideas of science that it has to breed dishonesty, forcing scientists into devious ways. One of the widely applied practices is to do work and then present results as a project and report later that all predictions were verified.”
“The unknown is the unknown because one does not know what is there. If one knows what one will do and find in it, then it is not research any more and is not worth doing. The NIH wants detailed projects, wants the applicants to tell exactly what they will do and find during the tenure of their grants, which excludes unexpected discoveries on which progress depends. No doubt there are important problems which can be outlined in advance, as, for instance, the establishment of the sequence of amino acids in a protein, but the understanding of degenerative diseases, like cancer, muscular dystrophy, or schizophrenia, which is stagnant, waits for unexpected discoveries.”
“Of the four major discoveries I made myself, two were immediately rejected by leading scientists of the field. It is natural that this should be so, because a discovery is a discovery because it is at variance with accepted knowledge.”
– Albert Szent-Gyorgyi
What I find inane about the viewpoints brought up by the NYT article – and AFAICT, it’s been present in medical school admissions logic since the mid-90’s – is the assumption that humanities students are automatically more empathetic, social, better listeners, etc than those who chose physical science majors. It’s almost implicitly accepted without comment, and the conversation usually instead runs into the question of whether doctors need to be “better scientists” or “better listeners”, etc.
It’s so pervasive that most of the premeds I knew in the mid-90s who were all science-focused deliberately took liberal arts majors and did all of the pre-med requirements anyway in order to boost their attractiveness as applicants. (As well as did additional community service and charity work, etc.) If they’d had a free choice, they would have just been biochemistry, chemistry, biology, etc majors, but they knew that there was a strong bias against that, and so they just played along with the biases present in the system. I’m sure that some of these HuMed students (who probably would have done regular premed programs anyway) just see this as another avenue to game the system and get it without competing via MCATs, etc.
As I said to Orac, I would much rather have a doctor that knows biology and pharmacology than one that is sensitive and holds my hand.
A lady in my MCAT course tried to argue this point with me. She said that people that were kinder and sympathetic got sued less. I told her that a judge would be less likely to throw out the case if she didn’t know her biology and pharmacology.
In my undergrad biology courses, we would be shown videos, and then the rest of the class would be spent debunking the videos and pointing out logical and experimental flaws. In addition to the material, which was substantial, we got our first basic logic lessons.
I think that doctors need a firm grasp of problem-solving. The MCATs are kind of swayed in this fashion: the ability to understand and synthesize a lot of material very quickly is definitely an asset.
But problem solving is tied up with the ability to understand what is science and what isn’t. Ways to think around a medical problem are intimately connected with the full and deep grasp of biology, Ochem, biochem, and physiology. Lack of understanding results in a practitioner that robotically prescribes one medication after another in the hopes that something might work.
I was already leaning toward research in med school. Perhaps I’ll investigate it further.
What I find hilarious is that the NYT is talking about this program like it’s the most revolutionary thing since sliced bread. Up here in Canada we’ve had medical schools that have no course requirements for many years, most notably the med school at McMaster University (no science prereqs, up until recently no MCAT requirement, now only looking at the Verbal from the MCAT), and also the University of Calgary (which requires the MCAT, but only looks at the Bio and Verbal sections and has no science prereqs).
See:
http://fhs.mcmaster.ca/mdprog/admissions.html
http://www.ucalgary.ca/mdprogram/prospective/admissions/applicants1011
At least for McMaster, they tend to have a higher percentage of students entering family medicine (~40% per year, compared to 20-30% for most other Canadian schools). So the “more primary care” trend holds there as well (match statistics for the Canadian match: http://www.carms.ca/eng/operations_R1reports_10_e.shtml ). I remember also hearing their pass rates on the MCCQE (the Canadian version of the USMLE) tended to be slightly lower than average. But what’s also interesting is that because there aren’t any requirements, both science and non-science students apply, so in that sense it is more selective because there’s a larger pool of applicants fighting for the same spots.
On another note, I must say as a med student, the lack of emphasis on critical thinking / sciencey thinking freaks me out. While everyone is taught biostats, I feel very few people retain it, and that’s part of the problem. I remember while studying for the USMLE and doing practice questions, the %s of students who got questions about basic epidemiology or EBM concepts right was scarily low (like 50-70% – the Kaplan QBank statistics are sometimes rather interesting). Given that this is one of the few times people should know or cram these things, it suggests that the level of EBM literacy is probably pretty poor overall, and I find that unfortunate. OTOH, I feel that it’s really hard to get people to employ critical thinking if they don’t want to (which is why there are always tons of complaints any time there’s a question on a preclerkship exam that involves thinking and problem solving rather than memorizing facts).
@#21
Nope, you’re not mean. The fact that med school is taught in a way that encourages memorization without actually learning any concepts behind them and the general acceptance of CAM on med school campuses is a deadly combination that is quickly bringing out MDs that see no problem with referring their patients to chiropractors, acupuncturists, homeopaths and natrupaths. I’m nearly done with med school and many of my classmates (and even some attendings) have gotten upset at me for questioning the validity of quackery… a science-based argument is useless to them (“you’re not open-minded enough” is the typical response).
Dr. RW may find it important that doctors understand the basic functions of amino acids (in proteins), but I get the idea it’s been a while since he studied them:
Um, two very fundamental errors there.
As an engineer-turned-medical student, I thought this was an interesting post. I agree that both engineering and medicine are fields in applied sciences. But my (anectdotal) experience conflicts with the idea that engineers are somehow more susceptible to magical thinking and woo. I would agree that engineers have less of an excuse when they’re caught promoting some woo (they should know better), but it was AMSA, the FM practicioners, and my classmates who introduced me to reiki, homeopathy and all the rest. Many of my classmates from engineering school were very number-driven, “what does the data say” sort of folks. Certainly none of them ever talked about woo.
Changing gears, the sciences should stay in the premedical curriculum. We need that background in order to understand the concepts taught in medical school. Secondarily, it helps maintain a level of excellence. That excellence is required because we give drugs and do procedures that, if done incorrectly, kill people. Lastly, the premedical curriculum should be difficult, because medicine is difficult. We should not spend limited training resources on people who are not dedicated to the field.
Clarification: I meant my *medical school* classmates introduced me to woo.
Originally posted by RxnMan:
I agree that both engineering and medicine are fields in applied sciences. But my (anectdotal) experience conflicts with the idea that engineers are somehow more susceptible to magical thinking and woo. I would agree that engineers have less of an excuse when they’re caught promoting some woo (they should know better), but it was AMSA, the FM practicioners, and my classmates who introduced me to reiki, homeopathy and all the rest. Many of my classmates from engineering school were very number-driven, “what does the data say” sort of folks. Certainly none of them ever talked about woo.
My experience in engineering has pretty much matched yours – and I think that’s because engineering, as practiced, doesn’t really leave much room for quackery. When we design a building, or system, etc., we have certain equations that we have to use – and we’ve got to be able to back ourselves up with that later on, if need be. Physical structures don’t generally respond to the placebo effect – it either works or it doesn’t. And if it doesn’t work, we’re gonna hear about it, and so will the licensing board. Just doesn’t leave a lot of room open for, “Let’s keep an open mind about how big those girders need to be”.
Leaving aside the differences in how medical education and training is conducted in the UK, Finland and the US, I would like to know that – which I visit my general medical practitioner – s/he has enough scientific knowledge and understanding to know how to do his/her job properly. I find it alarming that the arts and humanities are taking priority over the sort of scientific background that makes it possible for a medical practitioner to keep apace with things in the world of medicine.
I trained in the psychology of teaching, learning and development; we were told to keep in mind the interactions of many factors involved in how learning happens, how teaching should be done to maximise its effectiveness, and how development – for some – may not always go the way it does for most people. The influences were in part socio-cultural, but they also went hand in hand with biological factors. The importance of keeping in touch with the sciences (both social and biological) cannot be under-estimated, even in psychology. They should not be left aside in medicine, either.
Regarding scientific method, even if a medical practitioner has no intention of conducting research on a large scale, the ability to conduct an n=1 study or ten (and then meeta-analyse them) is a bloody good thing to have. Because, if the need arises, the practitioner should be in a position to monitor clusters of anomalous responses to treatment, because this may be useful information to feed back into the health-care system at some point.
Even within the reflective practitioner or practitioner-researcher model, there is a lot of information that can be gained. This is what we were taught where I trained. I think it’s just as important for medical practitioners as it is for anyone else who is involved in work with people – whether in education, social care or medical/health care.
sowellfan: “My experience in engineering has pretty much matched yours – and I think that’s because engineering, as practiced, doesn’t really leave much room for quackery.”
An architect can use Euclidean geometry to lay a foundation for a home. Euclidean geometry is based on the world being flat. Is the world flat? No. Just because something works doesn’t mean it’s true.
sowelfan: “Physical structures don’t generally respond to the placebo effect – it either works or it doesn’t.”
Well an engineer would have a difficult time understanding medical science. Because sometimes it works and sometimes it doesn’t. It’s funny that way.
An engineer may be less susceptible to medical woo, but then again, they it seems more likely, even, to be creationists.
It is the whole, “Everything is designed and therefore needs a creator” problem, I think.
The problem of creationist engineers is pretty-well recognized.
Little Augie:
Still showing the depths of your ignorance. Did you ever hear of bioengineering? Or of the things that were created by engineers and medical researchers like dialysis machines, sonograms, defibrillators, ventilators, and on and on.
I will say that I switched from mechanical engineering to aerospace engineering because ME was more rote learning, where the aero department went more in depth on the mathematics, material science and basic mechanics of the subjects. I found it easier to remember if I knew how they got to the methods of structural behavior (I even have a copy History of the Strength of Materials).
Though, that is a bit specialized… and I only did have a year of each of chemistry and physics. I do know my limits, unlike some trolls on this blog (like Little Augie and Mr. “Associate of Applied Science in Electronics Technology” from a community college who claims to cure lots of things with herbs and the like, but has no clue what persons lack a Y-chromosome).
Pablo:
I don’t know. Andrew Cutler is a chemical engineer (he runs the Autism/Mercury Yahoo group, Trevor Marshall is an electrical engineer (Marshall protocol to avoid Vitamin D), and let us not forget that Andy Schlafly was an electrical engineer before becoming a lawyer for the very woo American Association of Physicians and Surgeons (where abortion causes cancers and vaccines are bad).
I don’t think any discipline is immune to cranks. Just look at a list of prominent AIDS denialists who should have the requisite education and background: Peter Duesberg, Kerry Mullis, and Harvey Bialy (plus a couple more).
Interesting to contrast statements about knowledge of basic sciences, and the scientific method, as a “barrier” to med school that should be removed, with this:
http://www.usmle.org/general_information/cru/Post-AAMC-USMLE-update.pdf
“Foundational science will be reflected in all three Steps. Whereas currently Step 1 is the primary examination in which science knowledge is assessed within USMLE, efforts are underway to incorporate assessment of the science at the core of medical practice into all Steps Test materials which draw on application of fundamental science and scientific reasoning will be included in all components of the USMLE. These changes will be incremental, but comparison across several years will demonstrate substantial change as content migrates to fulfill CRU recommendations.”
Mount Sinai might think that med students don’t need to be interested in science when they enter medical school, but with the upcoming revisions to USMLE, they’ll have to demonstrate more of it to show minimum competency and be granted a license to practice in the future.
Dear augustine @ 38; Euclidean geometry has nothing to do with the earth being flat. It is a set of axioms designed to describe a general geometric space. While it turns out that Euclidean geometry is bad for describing the universe as a whole, our best description of the geometry of space still includes the idea that the universe is locally Euclidean (thanks Einstein!). Also, I suppose it would be possible to use the synthetic geometry beloved by the Greeks to lay out the foundation of a house, but I hear all the cool kids have started using coordinate systems in imitation of that radical iconoclast Descartes. Thanks for your time.
Sincerely,
Perhaps you are able to distinguish your argument from that made by naturalized US citizens who argue against amnesty for persons who entered the US illegally. “We went through it, we saved our money, they should too.” I can’t.
Are you in a contradictory argument about medicine, maintaining that it is a mystery to laymen who have not had certain courses (and experience), but they are to choose your mystery over other “mysteries” such as chakras?
Of the scientific method(s) you seem to have something in mind like Koch’s, not sure. If the core of your objection distills down to Lib Majors not knowing the method as you say, that would be simple to fix by a course, or a quiz against their reading. Huxley’s “Method and Results” would be good, wouldn’t it? Somehow, despite, I don’t think that is your objection.
One has to wonder, “Why the agony?” Is all this part of a fermentation from the new ready availability of knowledge via the internet? Are the Harrison and Cecil or similar now not on line for all the world to read, just be able to understand them, however slowly? Oh, and bother to look at them. I know, people can’t read.
Analysis of blood tests, drugs from Big Pharma (explained by salesmen), seminars to stay “up to date”. Surgery if your hand is steady. There’s a lot of surgery; when the doctor is out, his nurse says often, “He is in surgery.” Then you see him eating lunch or on the golf course. I guess the surgery was canceled. That’s what we see doctors doing. Not you, we don’t see you.
Can the lib art majors not do these same things after a hospital residency? No reason why not.
Arrogance no doubt helps in decision-making and in keeping things out of the hands of nurses. I don’t mind arrogance, for long, but does it mean that the doctor knows best how to educate doctors in a world turning upside down? The doctor can’t see the turning? Is old fogey always a virtue?
My doctor, PCP, put up a big sign, saying “God Bless America” and a big American flag on his office door. I know what that means, checked him on fundrace. Where’s the scientific method in that reasoning?
Your post seems to me a writing down as if talking. Well, okay. You can consider this comment in the same vein, just ideas. As to the attention given you in opposing you on certain matters in certain ways, you should be unhackled, perhaps complimented. You haven’t had much counterpoint above, out of excessive respect I guess.
Here’s a conundrum. The author claims to embrace the scientific method. The scientific method shows no difference between the end results at graduation between Humanities students and hard core science students.
So why doesn’t the author accept the answer? Because science types, despite all the huffing and puffing about scientific method only really accept the results when they agree with their preconceived notions.
My god, the irony is delicious.
Maybe it is just me but I am having a really hard time figuring out just what gould1865 is trying to get at.
The first part about maintaining mystery in medicine seems to be reading into Orac’s post things that are not there. There are a few sentences I think I might understand but others I cannot. It is all just so random and all over the place and has so many little issues it can hardly be replied to.
Ian, the problem is that the correct outcomes haven’t been measured. How they did on test scores or clinical evaluations (which tests ass-kissing more than any actual medicine) has very little bearing on what kind of physicians they’ll be. We won’t know the effect of this until the students who skipped out on science become practicing physicians.
When I was in Organic (a long, long time ago, in a galaxy far, far away) the professor himself complained to us that he wished for two different organic chemistry tracks: one that would be more biochem-oriented and one for “real chemists” by which he meant, people mightily interested in Diels-Alder cyclization and singing The Grignard Song (to the tune of America The Beautiful). Now a minion of Big Pharma, I don’t disagree; I frequently wish my own physicians had a more thorough knowledge of biochemistry and pharmacology than they got in formal schooling. Instead, we all have that fucking Grignard song embedded in our brains, where we could have learned something more useful.
Dammit, now I have an earworm.
The caaarbonyl is pooooolarized
the carbon end is plus,
a nuuuuucleophile can thus attack
the carbon nu-cle-uuuuuus.
A Griiiiiignard yields an allllcohol
of types there are but three.
It stiiiicks like glue to Ceeee-oh-two
From C to shining C!
Big Blue, that’s just beautiful!
I have long thought we university professors better do the best we can to educate premeds at the BS level; because we can’t count on medical schools to educate rather than train.
Errrr….. I’d hate to tell you this but that isn’t what the results show. Its essentially showing that these people are going into a field of medicine most divorced from science.
I’m frankly astonished that medical school doesn’t include courses on critical thinking and the scientific method, but given the overall sorry state of our educational system I suppose I shouldn’t be.
In regards to engineering, another data point: The engineering program at Harvey Mudd College had required courses in both, as well as requiring at least two years of chemistry, ditto for physics and math. And these weren’t watered down courses either – p-chem was the same as what the chemists took, E&M the same as what the physicists took, etc. Biology coursework wasn’t required when I was there, but it probably is now that there’s a biology department.
Harvey Mudd is also interesting in that there’s also a big humanities component to the curriculum. Every student has to pick a specific area in the humanities and social sciences and complete a substantial number of courses in that area. There is also a requirement for a certain number of courses in various general areas: History, psych, lit, etc. And since Harvey Mudd doesn’t offer a lot of these courses itself, students are forced to take them at one of the other Claremont colleges, meaning they’re taking lit along with the Pomona lit majors, economics along with the CMC economics majors, and so on.
One of the interesting side effects this had was it made double majors with engineering as one of the components almost impossible to complete in four years – too many required courses and not enough time to take them all. In fact the only double major you used to see with any regularity was math-physics because that’s the one with the most course overlap.
Amusingly enough, the only courses I now feel were a waste of my time were some of the required engineering courses. I’m sorry, but dynamics was little more than a rehash of first year physics, and the introductory lab course overlapped far too much with physics lab. Those course slots are precious, especially for someone like me who was trying to cram in what amounted to a minor in mathematics.
I’ll translate Orac’s post into real life terms and distill it down what really it matters…”Everyone must be exactly like me or they are all wrong.”
This, by the way, is the fundamentalists creed and therefore you all seem to be what it is you profess to hate the most…a bunch of fundamentalists. Still very entertaining reading all your stuff though. Peace out.
@ Ian Shaw (#45):
Your claim:
Evidence, please. Pray tell what preconceived notions that, say, special/general relativity and quantum mechanics agreed with when they emerged as principles of physics.
@ gould (#44):
To become an expert in most disciplines, one needs a wide body of subject matter knowledge and critical thinking skills to correctly apply the subject matter knowledge to bear on problems. In medicine, the subject matter knowledge happens to relate to biology & chemistry: anatomy, physiology, epidemiology, organic and biochemistry, microbiology, and the like.
If you think that such expertise can somehow be readily acquired through the Internet… well, only if Jenny McCarthy is an ‘expert’. One might as well be Charlie Bartlett, going to psychologists, presenting fake symptoms, getting perscriptions and giving them to fellow students – copy-catting the process with no real understanding behind it.
@53
BINGO!
Comoser: “Evidence, please. Pray tell what preconceived notions that, say, special/general relativity and quantum mechanics agreed with when they emerged as principles of physics.”
—————
You can’t be that retarded. More is expected from an SBMer. Look back at history. Please read Thomas Kuhn.
You’ve asked the wrong question. You first need to ask what was the prevailing wisdom of the day. All great scientists were opposed by other established scientists.
The problem here is we don’t really have enough data to decide. We don’t know whether HuMed students really make better or worse doctors than their peers or what kind of training is best than a doctor. Most of the comments above basically represent personal prejudice either for or against – they’re all just untested hypotheses. Please, let’s get us some data here, then we can figger out.
And as for the whole CAM infiltrating the medical schools business – yeah, that’s pretty scary. Maybe we need to add a question to the MCAT about homeopathy, something like, “For what conditions or disorders would it be appropriate to suggest homeopathic treatment?” and if the applicant’s answer is anything other than “NONE”, they should be automatically disqualified.
re: engineers and woo. I don’t think engineers are more prone to woofull thinking than normal people but they do tend to be much more sure of themselves when they do get into the woo.
@DrWonderful: It’s really bad form to comment on a post you haven’t even skimmed let alone read.
but given the overall sorry state of our educational system
Have you actually read how they used to educate people? It’s true that higher education works at a less exalted plane, but then how much use is Latin anyhow? For all the complaints above about the memorisation of facts compared to thinking, the importance of rote memorisation has fallen over the decades in education.
Of all the stupid “it was better in the past” fallacies, the idea that education is much worse than it was is one of the most trotted out, and least supportable.
Maybe the average 16 year old in school reads worse than they used to. But forty years ago the average 16 year old wasn’t in school.
@augustine:
Are you a Poe? Because… wow.
I remember reading Mathematical Cranks that there seemed to be a high representation of engineers as math cranks. As a former structural dynamics engineer I was appalled that some were offended by imaginary numbers!
My God, are you kidding? Who actually reads that?
A lot of med schools in australia do try to teach critical thinking, but some people dig it, and most don’t.
My impression of med graduates its people are who they are, and some are keyed towards science, others not. You should see how hard most radiology trainees find physics.
But I stand by what I said. Not being keyed to science and accepting pseudoscience are very different things. I have met very few med students who believe in homeopathy. I know many doctors who believe in it and promote it. My take is that there will always be a large group of graduates who get burnt out by the hours and difficulty of the work. Some go into research, some into pharm repping, some into management, and some into woo. It is burn out rather than knowledge.
You cannot prevent this with education.
That’s my take anyway.
The thing is that we already have classes of medical personnel who are given a trade school education and taught how to respond to a broad variety of problems by applying effective techniques. They are, in our state, called physicians assistants and nurses of various categories. They are completely invaluable as healers.
We also have a category of medical personnel who are expected to understand what is going on and what can be done about it, applying best practice science based medical principles. New evidence is coming in constantly, and we need people who can digest it and apply it, whether it be a new paper on prostate cancer, clinical reports on treating MRSA or what have you. The people who do this are called doctors of various categories.
If one is serious about becoming a doctor, one needs to understand how the science of medicine is built. That means the scientific method, statistics, and a working background in the underlying sciences. Medicine isn’t static, and it is the doctors who have to translate our changing understanding into effective clinical practice. Medicine’s increased effectiveness has been based on reason and the scientific method, but this has been under attack from the touchy feely left and the anti-factual right, a sad alliance.
Technically Euclidean geometry *would* only work on a flat world, as it assumes parallel lines never converge. On Earth, parallel lines of longitude *do* converge at the poles. Of course, given the size of the world, in practice you can generally ignore this, but that’s just like using Newtonian physics in daily life.
DrWonderful:
Well, I read about the book from a Dr. Mark Crislip podcast (it turns out his undergraduate degree is in physics). Since I also read books by Paul Nahin, and other books on the history of mathematics, engineering, medicine and science (like the The Immortal Life of Henrietta Lacks and The Poisoner’s Handbook), along with biographies of people like Paul Dirac (disclaimer, I have actually used the Dirac Delta Function), Oliver Sacks, Lillian Moller Gilbreth, and Rosalind Franklin,… it is part of stuff I like. Today I picked up History of the World in Six Glasses by Tom Standage.
Once upon a time I read science fiction, but now I prefer science and math reality. I never really read romance stuff and other crap some people expect of those without a Y-chromosome (possibly because I have been married to the most wonderful man for over thirty years).
Do you have a problem with that?
Oh, crud… I meant I heard about the book from a Crislip podcast!
@DrWonderful: “I’ll translate Orac’s post into real life terms and distill it down what really it matters…’Everyone must be exactly like me or they are all wrong.'”
Tell me you’re just kidding, right? I mean it … you’re joking… you can’t really believe that shit, can you?
“This, by the way, is the fundamentalists creed and therefore you all seem to be what it is you profess to hate the most…a bunch of fundamentalists. Still very entertaining reading all your stuff though. Peace out.”
Ahhhhhh….
Evidently you do believe it. Obviously, you have no understanding of how science works.
You may not have been joking but you are still talking shit.
Deal with it.
I saw the headline in the times but didn’t read the article but did think that it sounded more akin to the medical education my father and his colleagues got fifty years ago.
My father (his background is typical of the other six or seven doctors in their practice) was a chemistry undergrad at a small liberal arts college. He always said he was grateful that he was able to go to school before getting into med school was so competitve. He took music appreciation, poetry, history and writing classes every semester. He pitched farm league ball for the Baltimore Orioles for a couple of seasons before going to med school at Penn State. He was a solid primary care physician who enjoyed his patients and his colleagues. My PCP has a PhD in music and taught at a couple of Ivies before realizing that he liked medicine more than mazurkas. Anecdotes not evidence, I know. I also agree with what I think is your basic premise: a strong science based background and the ability to think scientifically is key to being a good physician. Medicine is much more fragmented than it was when my father was practicing.
If a student has been taught to think critically – whether in the humanities or the sciences – then they probably have the ability to learn the skills to be a physician.
Yes I am serious. Your self righteous fundamentalism is getting the best of you. The idea that someone would lower in value your fundamentalist belief system, especially in your own domain, is not only insulting to you but clearly threatens you as well. The irony is that this is what you all do here on a daily basis, almost pathologically, to everyone else. Orac’s post shows he is insulted and threatened by a new and evolving medicine.
Let’s face an undeniable fact and try to deal with it instead of thinking we can roll right over reality by being smarter and more “right” than everyone…patients absolutely do not want to be treated by, and do not respond as well to, snarky “scientists.” So what are we going to do about it? Oh, looks like one school is trying to figure that out….
I wouldn’t mind having a snarky scientist for a doctor.
In my experience, you only need an intro to organic chem to understand biochem – if you can figure out the nomenclature and most basic reactions, you’re good to go. More advanced organic chem is about stuff that is not meaningfully relenvant to a biochemist – reactions that make use of palladium, Diels-Alder reactions, NMR identification of compounds and HOMO-LUMO theory to predict major products are not very useful to somebody who deals with enzymes.
We already have a system here in which humanities students can enter med school – instead of standardized tests, we have a scoring system which ascribes a score to your file according to your results and to a difficulty modifier according to whichever program you are in.
That makes it possible for humanities student to enter med school or pharmacy, provided they satisfy the basic science requirements.
As I have helped one of those students complete the science requirements in organic chem, I can tell you that I am genuinely scared. Humanities studies are generally extremely easy, compared with any science program, and students who complete them, even with shockingly high scores (which they need to enter med school), would score below the worst science students. I have had a fellow PhD student tell me, as she completed a law degree to become a patent lawyer, that this was so easy compared with her chemistry degree that she could have made it in her sleep. I cannot help but think humanities to med school is a way for mediocre students to get admitted.
And I am not exactly rassured that humanities students tend to go to psychiatry. We have a well-known psychiatrist here who will likely have his licence pulled for giving “medical” advice to people over the radio – people who in all probability were very sick, and didn’t need an idiotic fluffy-headed “doctor” expounding his “theory” about how all their present problems are due to their relationships with their mothers. And who likes to cite “studies” which “prove” that dark-skinned people have lower intelligence than white people. Somehow I don’t think this individual has a very strong science background.
#57 – Nice strawman you have going there. Nowhere did I assert, or even imply, that the way things were taught in the past was any better. My comment was only concerned with our present situation. Things being worse (or better) in the past is irrelevant.
AS for learning Latin, I took Latin for two years and have no regrets for having done so – it’s actually quite useful thing to know. I would happily trade the five years of French I took for five years of Spanish though.
Finally, 1970 was 40 years ago. I think you need to go a bit further back than that to find a period where the average 16 year old wasn’t in school in the US. The so-called high school movement began around 1910 and was largely complete by 1940, at which point high school enrollment was around 75%.
As a patient, I want my doc’s medical school — and its prerequisites — to be hard. Not challenging, hard. I don’t want someone who got C’s throughout undemanding coursework to be in charge of my medical care, and certainly not to be performing surgery!
@ ugh troll:
That’s some serious comprehension fail.
The poster I replied to claimed that scientists only accept hypotheses that reinforce or adhere to their preconceived notions. So I noted that at least two major new concepts in physics most certainly did not.
At any rate, the important lesson is that scientists, if they are any good, will adapt to a changing understanding of the world if that is where the evidence directs (such as was the case with the theories of relativity and quantum theory) – as compared to cranks like yourself, who cling to unreality no matter how much evidence you are presented with.
Suggestion: why don’t you read the comments and undestand what is actually being said, instead of what you imagine is going being said?
composer: “At any rate, the important lesson is that scientists, if they are any good, will adapt to a changing understanding of the world if that is where the evidence directs (such as was the case with the theories of relativity and quantum theory) – as compared to cranks like yourself, who cling to unreality no matter how much evidence you are presented with.”
——————————————————
Individual scientists do NOT change their worldview because of evidence my friend. You’re in naivete land if you believe that is what happens in real life.
In the real world creativity is stifled, stamped out, ridiculed by skeptics. It’s the nature of the skeptic mind.
SBMers are killing true science and discovery in favor of an algorithmic based brand of science.
But since most of the posters here aren’t real scientists, but instead ideologues, that makes since.
What the hell? How the hell does the one field in which imaginary numbers are used ad nasuem does one have people who hate imaginary numbers. Phasors (Phase vectors) plays an important part in electrical engineering.
Adam_Y, exactly my point, and why they are cranks. I will note many of them were more mechanical design type engineers who really had used only enough math to get by. Though I cannot tell you how many times I had to explain the concept of frequency distribution, resonant frequency and some other random vibration like why the mass was important to other structural engineers (the ones who mostly seemed concerned with static forces).
what scares, confuses and confounds me is that some of the examples of basic science knowledge that leads people AWAY from woo, like Avogadro’s number were things that I learned in regular science classes in public high school. Avogadro = grade 10 science. Kreb’s cycle = biology 11 & 12. Rudimentary stuff on cell structures, anatomy…
I never went beyond high school biology or chemistry, or past grade 10 physics, none of them AP courses (we didn’t have such a thing) so it is beyond my understanding how ANYONE falls prey to woo – was my ordinary suburban Canadian education so unusual?
And yeah, I’d like a snarky scientist as my doctor. I have a spouse to hold my hand – I want a doctor who can explain my condition and treatment effectively
I remember seeing some anti-imaginary number cranks over at PZs place (I think it was there). They were a hoot, completely ignorant of mathematics.
@CanadianChick- you seem to make the assumption that your doctors grades from his undergraduate basic science courses would actually impact the outcome of your treatment. I would argue that likely would not be the case. I also would argue that your bias toward wanting a fundamentalist culture where science reigns supreme over all other factors in life has lead to your assumption.
So what you are telling me is that I have a better background of frequency dynamics and vibrations with my electrical engineering degree than a lot of structural engineers who build buildings that are exposed to vibrations and resonance. This sounds just as bad the liberal arts doctors.
Unfortunately yes, it seems to be lots of cookbook methods unless they do mechanical systems and earthquake. Which is why my son is opting for electrical engineering instead of mechanical engineering, he likes the more math.
He was happy when I told him of the books by Nahin (An Imaginary Tale, the story of the square root of -1 and Euler’s Fabulous Formula).
Adam_Y, this was a large vehicle design and manufacturing company, so lots of engineers doing small scopes of work. I worked with mechanical systems engineers who used an analog computer to model hydralics… as electrical components have direct corollaries to mass/spring/damper systems.
Travis, in the last few years I have driven son and friends to various places (the best place to talk to teenagers). I remember having conversations with one friend who dropped pre-calculus because of the imaginary number. I tried to explain to him it was not mysterious and very useful. I failed. He has just graduated from high school and is going to major in business.
Shorter DrWonderful:
You’re all fundamentalists because…because…I SAY SO!!!
OMG, you actually read books about mathematics!!!! Typical fundamentalist!
Besides, you’re all fundamentalists!
Fundamentalist, fundamentalist, fundamentalist!
@38
You are correct in saying that spacetime is not perfectly flat, even on the scale of the earth, but this is not what (current) engineers claim. They only claim that the curvature is well within engineering tolerance and is therefore not worth considering.
I find this frightening. There’s already a joke – Q: What do you call the guy who graduated at the bottom of his class from medical school? A: “Doctor.” There are already a ton of people out there practicing medicine badly (most of them are on my insurance plan. . .) Do we really want to add to that number? I certainly don’t.
I disagree with those who hold that medical education produces physicians without the ability to think critically. One of the major educational activities in residency is “journal club” where a small group get together and pull apart the methodology of a clinical trial. Also, every residency program in Canada requires the completion of a scholarly project – a requirement that is actually a relatively recent development. Although basic science is very important to understanding the underlying mechanisms of disease, it is not the only way that critical thinking skills are taught.
Dear Jonathon Badger @65:
You are correct that the surface of the sphere is not Euclidean. But that has nothing to do with whether the world we live in is Euclidean—reason being that you can think of the Earth as a sphere in a three-dimensional Euclidean space. This doesn’t work as a model of the universe because of relativistic considerations, not because the earth isn’t flat (something the ancient Greeks apparently knew pretty well).
This “thread” has been going on for years, and long before threads.
I rarely read past .Post# 66. because the trolls and poes appear to reach critical mass about there: but this one is a delight. Thanks to all, esp. Orac (trolls and poes included)
I decry the “loss” of critical thinking at all levels of education, and fear the rise of woo not just in medicine, but in law, politics, sociology,…………..and even fishing.
I seem to recall my parents and grandparents with similar portents of doom.
I remain hopeful “we” will prevail, and threads such as this will help. I hope the weapons can be taken back from the 5yo’s (thanks Fred the Hun # 16)
I would like to leave you with a quote from p165 of “The Mathematical Universe” William Dunham:(this book should be compulsory for ALL courses)
“If a mathematician bragged about never having read a lick of poetry, she or he would be branded as an ignorant lout. Yet the poet who admits to being mathematically illiterate often wears this illiteracy as a badge of pride. Somehow this seems unfair.”
Hardcore science basics should be part and parcel of ALL higher education/undergrad coursework. I am perplexed at the continued antiquated practice of American public school year that is limited to ~ 8 months (5 weeks off during the regular year), instead of 10 months. Four weeks off in summer would be more than enough to ‘refresh young minds’, but not long enough that they loose touch with sensible study habits.
US schools need those extra 2 months to pound physics, math and chemistry into kids – starting early on in primary school – rather than waiting to introduce it in a wrote memorization format in grades 9-12. This is fundamentally necessary to produce a globally competitive workforce.
There are secondary benefits: Science-literate folks tend to learning-adaptable throughout life and are less stressed by a rapid pace of necessary technological change.
A mindful populace is also likely to be brainwashed by woo and hand-waving consumerism and politics, because they are taught the art of critical reasoning. Science basics knowledge makes for good citizenship, because it removes the mystery of How Things Work; consumer-voter-citizen reasoning – or lack of it – directly effect the quality of their lives and their community through their decisions and actions. It leads to responsible behavior because one is able to match present action to future consequences and weigh risks accordingly.
Kids should learn the periodic chart alongside their ABCs, and should be familiarized with common principles of physics and chemistry because practical science examples emphasize and underscore common sense behaviors in preparation for adult role training.
While you may decry the absence of hardcore science basis for teaching medicine, the insult and damage is compounded a thousand-fold, when our public school educators lack science basics instruction themselves, rendering them incompetent in basic and applied science principles, and fostering either fear, disdain or dislike of science by their basic skills deficiency.
The easiest degree to obtain in college, beyond Phys-Ed, is an Education degree.
This is one of the many reasons I’m not sure whether to consider anyone with an IQ under, say, 110 human anymore. To see that there are people in colleges who sort of reasoning is to see the generation of weapons-grade derp.
Er, to see that there are people in colleges who generate this sort of reasoning, rather.
Passerby:
Cool! How will you fund those changes?
Drug companies may need to support this type MD for future marketing purposes, especially as old generics with off label uses and specialized “nutrients” are shown to be more cost effective, or outright more effective. e.g compare a COX2 and CD15s/CD19-9 expressing stage III or mCRC patient’s treatment options – tegafur-uracil + cimetidine + PSK + aspirin against Xelox + 1-2 “biologicals”. Some conventional data suggests that 90-95% of the cheaply treated ones, will be alive in 10 years, at average 70 yrs age, when most of the “Xelots” will be broke and dead for 6-8 yrs….
Nutrigenomics and metabalomics are showing that molecular medicine and prevention are often, unpatentable and, gasp, orthomolecular in nature e.g. L-5MTHF, D3, K2-MK4/7, R-lipoate, when correctly applied in combination and quantity.
Honest, balanced EBM with publicly funded research (dumped my AHA, ACS contributions) would eventually show this, but SBM combined with historical papers, metabalomics and nutrigenomics are the primary avenues right now. EBM, vs SBM, could be considered a denial tactic and barrier to market entry to keep the cheap stuff out, delay what gets through, and raise competitors’ costs hence less overcompetitive pricing.
One of the common failings of new drug tests are placebo tests without competitive drug test arms, nominally that the new drug works at all rather than best. Old science stuff often works better, if you know where and how to look or what to test for, especially with identified molecular target groups.
Big profits depend on weak science.
WTF?! Sheesh, premed science requirements are often no barrier to earning a degree in humanities then earning an MD. Even back when I was in high school (and receiving mail from colleges that sometimes included course catalogs and lists of which major requires what) I figured out that at many schools the B.A. degree requires so many credits that even after one fulfills the major requirements for English or history or whatever one still has enough credits left over to complete all the premed requirements (especially when biology, chemistry, physics, and calculus courses can also be counted as fulfilling some distribution requirements for someone who doesn’t major in hard sciences).
“Hardcore science basics should be part and parcel of ALL higher education/undergrad coursework.”
I’m going to echo the same sentiment about the UK systems (E&W, S and NI).
“I am perplexed at the continued antiquated practice of American public school year that is limited to ~ 8 months (5 weeks off during the regular year), instead of 10 months.”
In the UK, universities and other HEIs have traditionally had different term lengths: 8 weeks for the Oxbridge lot, and 10 weeks for the civics and red-bricks; the old polytechnics had a 12 week term. Three terms made an academic year, before the semester structure became the norm.
The thing that suffers in shorter term-lengths is the time available for learning. Only quick learners (mostly rote-memorists) will do well in that sort of situation, generally. 12 weeks gives adequate time for the student to get a good handle on the material covered during the term.
“Four weeks off in summer would be more than enough to ‘refresh young minds’, but not long enough that they loose touch with sensible study habits.”
Couldn’t agree more.
“US schools need those extra 2 months to pound physics, math and chemistry into kids – starting early on in primary school – rather than waiting to introduce it in a wrote memorization format in grades 9-12.”
I’m thinking that the UK systems could benefit from the same remedy.
“This is fundamentally necessary to produce a globally competitive workforce.”
Yep.
‘Dr’ Wonderful:
“Yes I am serious. Your self righteous fundamentalism is getting the best of you.”
What? Because we want proper science in medicine instead of bullshit woo?
“The idea that someone would lower in value your fundamentalist belief system, especially in your own domain, is not only insulting to you but clearly threatens you as well.”
No. It’s saddening and sickening. Because this letting go of scientific knowledge and understanding is what makes it so easy for people we trust to make and keep us well to introduce bullshit ideas like chelation for autism and other crap like that.
“The irony is that this is what you all do here on a daily basis, almost pathologically, to everyone else. Orac’s post shows he is insulted and threatened by a new and evolving medicine.”
Get a brain! Orac isn’t insulted or threatened by a new and evolving medicine: he’s pissed off that not enough emphasis is placed on the sciences and scientific method in medical education and training. As am I, and a bloody good number of people reading this blog. If it doesn’t piss you off, I have to assume that you called yourself DrWonderful as a self-style honorific. I doubt that anyone else would want to call you Doctor. I’d not, for sure.
“Let’s face an undeniable fact and try to deal with it instead of thinking we can roll right over reality by being smarter and more ‘right’ than everyone…patients absolutely do not want to be treated by, and do not respond as well to, snarky ‘scientists’.”
Let’s face an undeniable fact that the scientifically illiterate make arguments against science. As with most other people, I’d rather my medical practitioner was good with science instead of behaving like a sodding technician with no clue about testing hypotheses in his/her general medical practice.
“So what are we going to do about it? Oh, looks like one school is trying to figure that out….”
No. Looks like one school is trying to make things even worse.
Go get a brain.
I prefer to have a snarky scientist for a doctor. I am currently undergoing testing for a weird problem I have, and I really don’t give a rat’s ass about my internist’s bedside manner – I just want to know why the “/$%?” I can’t do any phyical activity anymore without feeling extreme tiredness or why my heartbeat sometimes peaks to 100-120 bpm without reason when I’m lying down.
Having somebody pat me on the head saying “there, there” won’t help me at all.
@100: Have your physician do a tilt-table test.
See: Dysautonomia, Postural orthostatic hypotension.
after 101:
Then ask what causes it and what pill corrects it.
No snarky scientist doctor will ever “fix” your problem. I promise.
I know that primairly because I took a control theory class. The entire modeling aspect was done using mechanical devices since most electrical engineers were all ready proficient with circuits. I’m just really surprised mechanical and structural engineers don’t have that background.
Well in their defense even I had that problem in high school. Hell even the way my college structured their classes it was a problem when I was getting my electrical engineering degree. They dumped so much math that was necessary to do engineering and only told you why it worked two years after the fact.
“Look back at history. Please read Thomas Kuhn.”
BWAHAHAHAHAHAHAHAHA!!!!
(Because that which is supported by name-dropping can be dismissed with a hearty gut-laugh.)
“I’m just really surprised mechanical and structural engineers don’t have that background.”
Remember, it is not all of them. It is more of a case if you don’t use it you lose it. The math cranks were a small subset of engineers, not all of them.
some ignorant arsehole: “No snarky scientist doctor will ever ‘fix’ your problem. I promise.”
A scientist doctor (and she deserves the title Dr since she completed a doctoral degree in medicine) was the person who fixed a long term skin problem for me. And her approach was scientific, not woo. We tried something and if it didn’t work, she reviewed the situation. Then she’d use any feedback I gave her to make a new decision with me about what we could do.
She got me cleared of a long term painful skin problem inside 5 weeks. And don’t say it could have been self-limiting: had it been that, it would not have gone on for 4 yrs.
Augie, do us all a favour and go stick your arrogance up your arse – as far away from here as you can possibly get.
I wish I could say I’m shocked by this, but sadly I am not. Even in some science programs themselves this is happening. There are a number of Geoscience departments that have decided that the best way to increase enrollments and ingratiate themselves to the powers that be is to reduce the number of foundational geology courses. To make matters worse they often decrease the required semesters of chemistry, physics and math required for the degree. They also no longer require anything more than a single 100 level, introductory survey class as a prerequisite for 300 level courses for subjects such as mineralogy, hydrogeology, and petrology. I once taught a mineralogy course where many of the students had not taken a chemistry class since high school. I could go on about that particular horror story, but I don’t want to hijack the thread (involves violations of FERPA among other things).
What it all means I’m afraid is that we have many universities that need increased enrollment and tuition to feed a metastasizing administration. In my unfortunate experience some faculty are happily complicit.
And we wonder how purveyors of woo and denialism find someone with a degree to back up their BS.
“And we wonder how purveyors of woo and denialism find someone with a degree to back up their BS.”
The system is creating their idiot for them.
And all in the name of increasing profits.
>An engineer may be less susceptible to medical woo, but then again, they it seems more likely, even, to be creationists.
No, absolutely not. Engineers have to have both feet on the ground. If they have religion they restrict it to Sundays. If a doctor gets it wrong and people die, he might go to their funeral. If I got it wrong and people died, I would certainly lose my job and probably go to prison.
Speaking of flat earth geometry; I do ballistics. The damned earth is not flat and it’s not even round, the stupid thing. It is an irregular ellipsoid and the bane of my life.
“If they have religion they restrict it to Sundays.”
Probably to just one hour on Sundays.
“Probably to just one hour on Sundays.”
You see, Augie, old bean…. I’m an atheist. I think that even one hour on Sundays is too much. Not that I’d have a problem if a medic or engineer or anything else (in terms of brand of professional) had a religious practice. If they let it get in the way of doing the best that they could in their professional practice by letting it by-pass their professional training, then I would.
Augie, do us all a favour and go stick your arrogance up your arse – as far away from here as you can possibly get.
Well? Was she snarky?
I hope you didn’t think your anecdote somehow demonstrated scientific prowess only practiced by snarky scientist doctors therefore proving some type of point.
HMM. let’s try this. Doesn’t work? let’s try this then. ad infinitum. I know but she’s smart with degrees ‘n everything hence “scientist doctor”. I guess every doctor is a scientist doctor.
Let me guess. Anti-inflammatory?
“If they let it get in the way of doing the best that they could in their professional practice by letting it by-pass their professional training, then I would.”
Why would they?
“Well? Was she snarky?”
Actually, no. But you fucking are.
“I hope you didn’t think your anecdote somehow demonstrated scientific prowess only practiced by snarky scientist doctors therefore proving some type of point.”
Says the person whose only real armoury in blogs like this is anecdote (if we’re lucky, because mostly it’s misinterpretations of the statistics).
I’m just making the point that she used scientific method to arrive at the cause of the problem, the name of the problem and the correct treatment for the problem. Basically: getting information, forming a hypothesis, testing the hypothesis, revising the hypothesis based on the results of the first test, testing the new hypothesis, and so on. What is so hard for you to understand about that? That was my point, as any of the regulars here could be able to tell you.
“HMM. let’s try this. Doesn’t work? let’s try this then. ad infinitum. I know but she’s smart with degrees ‘n everything hence ‘scientist doctor’. I guess every doctor is a scientist doctor.”
Wrong, for the reasons stated previously. Not every doctor is a scientist doctor. Most don’t know how to do the sort of application of science that is needed to converge on a solution very fast. Your ‘let’s try this ad infinitum’ thing is what most medics do. The one I’m talking about converged on the right treatment on the second iteration. Faster than most do in dermatology.
“Let me guess. Anti-inflammatory?”
Heh. How fucking wrong can you be? Why would she prescribe an anti-inflammatory for seborrheic dermatitis brought about by stress? Symptomatic relief might come from that but no lasting benefit would. She used a treatment modality that she did her doctorate on: moisturiser after light treatment on the skin. Did the job. And rather quickly compared to other medical practitioners’ treatment regimes based on guessing.
“If they let it get in the way of doing the best that they could in their professional practice by letting it by-pass their professional training, then I would.”
“Why would they?”
Dunno, and I’d hope they wouldn’t. But, if they did, I’d have a serious problem with it.
Hmmm, using football terms while teaching boys football hinders them from learning the game..What a ridiculous premise. The last place I want things ‘dumbed down’, is science.
I have two nieces who are sisters. Both are now family doctors in the Toronto area.
The older one got a bachelor’s degree without hard sciences and got admitted to McMaster University in Hamilton which does not require hard sciences.
The other got a bachelor’s degree with the normal pre-med courses and went to the University of Toronto for her medical studies.
Fortunately, both of them seem to have successfully avoided any wooness. One of them even made some public appearances on behalf of HPV vaccination.
David N. Andrews M.D. PhD. M. Ed., C. P. S. E..L.N.O.P.: “Why would she prescribe an anti-inflammatory for seborrheic dermatitis brought about by stress?
A psychosomatic disease? In your head is it?
“She used a treatment modality that she did her doctorate on: moisturiser after light treatment on the skin. Did the job. And rather quickly compared to other medical practitioners’ treatment regimes based on guessing.”
Tell us more about this anecdotal treatment. Since your illness is mental in origin how do you not know the placebo effect was in play here? Was the moisturiser or the light treatment that was the active “ingredient”. What was in this moisturiser?
You do know that it doesn’t count because your doctor used the placebo on you right? That’s not “real” medicine like the doctors on here.
You’re not so different. Skeptic my ass!
“What I find inane about the viewpoints brought up by the NYT article – and AFAICT, it’s been present in medical school admissions logic since the mid-90’s – is the assumption that humanities students are automatically more empathetic, social, better listeners, etc than those who chose physical science majors. It’s almost implicitly accepted without comment, and the conversation usually instead runs into the question of whether doctors need to be “better scientists” or “better listeners”, etc…”
I think that’s because people who are less empathetic, are anti-social, are worse listeners, etc. get encouraged by the stereotype believers to go major in the hard sciences instead of the humanities (and then the people who major in the hard sciences because they actually like the hard sciences then get told by the stereotype believers “they asked for it” when the anti-social ones harass them in the labs).
“I am currently undergoing testing for a weird problem I have, and I really don’t give a rat’s ass about my internist’s bedside manner”
I know someone else who is all “I don’t care about my doctor’s social skills, I just care about my doctor’s technical skills!!!” On another occasion she told me “when I told my gyno I didn’t want his entire class watching my pelvic exam he was so rude, he argued with me instead of accepting that I said no!!!” as if that wasn’t an example of poor social skills despite good technical skills.
“David N. Andrews M.D. PhD. M. Ed., C. P. S. E..L.N.O.P.”
How’s about you go play marbles on a motorway and do the whole world a huge favour?
“A psychosomatic disease? In your head is it?”
If you’re such a thick piece of shit that you don’t know what ‘psychosomatic’ actually means, why ask questions with answers too complicated for your comprehension, you thick little shit.
“Tell us more about this anecdotal treatment. Since your illness is mental in origin how do you not know the placebo effect was in play here? Was the moisturiser or the light treatment that was the active ‘ingredient’. What was in this moisturiser?”
Standard moisturiser. The light treatment was UV light. Tell me about your anecdotal intelligence, Augie.
“You do know that it doesn’t count because your doctor used the placebo on you right? That’s not ‘real’ medicine like the doctors on here.”
It was fucking good dermatology, you dozey piece of shit.
“You’re not so different. Skeptic my ass!”
Hah. Go fuck yourself.
“The social determinants of health are so much more pervasive than the immediate biology of it.”
Pardon me while I retrieve my eyeballs from the back of my head. I don’t want a physician who is so flippant about the necessity for knowledge of biology!
But Orac, GPs only write perscriptions. They do not need no stinkin’ basic science to write a script.
I wonder if this is the prevailing attitude.
@102 and you think some woo-peddler can ?
I don’t need a stupid placebo. I need to know if my heart will crap out on me. If I waste time and money pursuing wishful thinking I have a very real risk of becoming one very dead kemist.
I am not a “worried well”. I used to be able to run for 2 hours, now I get out of breath after one flight of stairs. My internist has dectected a heart murmur.
Woomeisters can’t do shit for real, serious problems like cardiac insufficiency.
I am a grad student in cognitive psychology, though cognitive neuroscience might be a better way to describe my field. This blog is great, but I feel the need to defend my field for a moment. Just as naturopathy is the woo of medicine, psychoanalysis (still taught despite there being not one shred of evidence for it!) and some other schools persist as the woo of psychology.
My personal research informs the type of resections performed in TLE patients, among other things. Psychology is slowly pushing the bullshit out, just like medicine had to and still is.
I will extend my own bias and say I have never been in a sociology or education course that even pretended to have empirical based theories :-/
David N. Andrews M.D. PhD. M. Ed., C. P. S. E. L.M.N.O.P.: “It was fucking good dermatology, you dozey piece of shit.”
Says the woo consumer. Whatever you say good doctor. Your letters speak for themselves. Just don’t have a meltdown and destroy your computer. You should get out in the sun more. You know, UV light.
augustine… i found an excellent poem for you. it echoes the sentiments of everyone here.
Like a Night Club in the morning, you’re the bitter end.
Like a recently disinfected shit-house, you’re clean round the bend.
You give me the horrors
too bad to be true
All of my tomorrow’s
are lousy coz of you.
You put the Shat in Shatter
Put the Pain in Spain
Your germs are splattered about
Your face is just a stain
You’re certainly no raver, commonly known as a drag.
Do us all a favour, here… wear this polythene bag.
You’re like a dose of scabies,
I’ve got you under my skin.
You make life a fairy tale… Grimm!
People mention murder, the moment you arrive.
I’d consider killing you if I thought you were alive.
You’ve got this slippery quality,
it makes me think of phlegm,
and a dual personality
I hate both of them.
Your bad breath, vamps disease, destruction, and decay.
Please, please, please, please, take yourself away.
Like a death a birthday party,
you ruin all the fun.
Like a sucked and spat our smartie,
you’re no use to anyone.
Like the shadow of the guillotine
on a dead consumptive’s face.
Speaking as an outsider,
what do you think of the human race
You went to a progressive psychiatrist.
He recommended suicide…
before scratching your bad name off his list,
and pointing the way outside.
You hear laughter breaking through, it makes you want to fart.
You’re heading for a breakdown,
better pull yourself apart.
Your dirty name gets passed about when something goes amiss.
Your attitudes are platitudes,
just make me wanna piss.
What kind of creature bore you
Was is some kind of bat
They can’t find a good word for you,
but I can…
TWAT.
LYRICS © JOHN COOPER CLARKE
I hope Orac doesn’t mind (I think he’d certainly agree with the sentiment).
I suspect that a key reason that science isn’t taught well in medical school is closely related to a key reason it isn’t taught in elementary or secondary school: Namely, the fear of offending Fundies.
The great medical advances of the past hundred years rely, directly or indirectly, on the same biological science that upholds the concept of evolution. Yet if these advances are shorn of the context in which they were developed, and then presented without context to students, it makes it quite possible for someone to learn how to use these advances and still believe in creationism.
So true. Think Dr. Egnor.
Think:
https://www.respectfulinsolence.com/2006/04/medicine_and_evolution_part_4_1.php
https://www.respectfulinsolence.com/2006/04/evolution_and_medicine_part_4a.php
psychosomatic:
adj.
1. Of or relating to a disorder having physical symptoms but originating from mental or emotional causes.
2. Relating to or concerned with the influence of the mind on the body, and the body on the mind, especially with respect to disease: psychosomatic medicine.
Re: Augie’s intellectual ability:
– can obviously seek out a definition
– can obviously cut and paste said definition
– can manage to locate target website upon which to post said definition
– cannot understand definition in part 2, regarding influence of mind on body, especially in relation to stress and its effects on the body.
Never mind. That’s why we have people like Robert Sapolsky and David Gorski and others. Not that they’re any good to Augie and his/her ilk… just goes to show – you can’t educate pig-shit.
Considering that psychology is still considered a liberal arts major, despite classes like psychstats (basically biostatistics with different word problems), psychobiology, neuroscience, and psychopharmacology being required in the good programs… It doesn’t surprise me that psychiatry winds up with a lot of people with liberal arts degrees. Most psychiatrists I’ve met, however excellent (including one who would fit in well here with his anti-woo, pro-science stance) either did or wished they had taken psychology for an undergraduate program, because psychology is rarely discussed in med school and they felt unprepared. That says less about psychiatry being a “soft” science and more about the issue with psychology, even research psychology, being lumped in with history and English lit.
Seriously, I have never understood why the psychobiology professor at my university, who performed rigorous experimentation on the long-term behavioral and cognitive effects of chronic sleep deprivation, was a “liberal arts” professor while the behavioral science professor, who studied the behavioral and cognitive effects of food abundance vs. scarcity, was hard science.
“Considering that psychology is still considered a liberal arts major, despite classes like psychstats (basically biostatistics with different word problems), psychobiology, neuroscience, and psychopharmacology being required in the good programs…”
Doesn’t “liberal arts” actually include biology, chemistry, physics, and math? Boston University sure had those departments in its College of Liberal Arts long before they changed its name to College of Arts and Sciences.
“I prefer to have a snarky scientist for a doctor. I am currently undergoing testing for a weird problem I have, and I really don’t give a rat’s ass about my internist’s bedside manner…”
Not even when your doctor’s bedside manner violates your dignity? I know someone who has that same “I don’t care about my doctors’ social skills!!!” attitude *and* complained about her OB/GYN belittling her objections to inviting a whole damn class in to watch her pelvic eexam, as if her ESL teacher taught her the wrong definition of “social skills” and so she doesn’t realize that what that OB/GYN did to her was an example of poor social skills…