Gotta have more woo in my medical school, 2011 edition

Four years ago, I wrote a post that I called Gotta have more woo in my medical school! In it, I discussed how UCSF had put out a woo-ful, non-science-based booklet about “complementary and alternative medicine” (CAM), full of references to qi, acupuncture, and all manner of woo. Since then I’ve been sounding the alarm bells about the creeping infiltration of pseudoscience into medical school, even so much that it’s becoming part of the mandatory medical school curriculum. Now, four years later, I see that the creeping infiltration has ceased to creep. Rather, it’s turned into a torrent of woo pouring into medical school curricula. that’s now being recognized by the U.S. News and World Report in a disturbingly entitled article Medical Schools Embrace Alternative Medicine. Its contents are even more disturbing, and, unfortunately, it’s written chock full of alt-med tropes that concede the language war to the side of pseudoscience. That much is obvious right from the beginning when the article is subtitled “Patients’ desire for alternative therapies is driving changes in medical education,” which leads right into this:

Now that nearly 40 percent of American adults swear by some form of complementary and alternative medicine, or CAM–from nutrition and mental relaxation to acupuncture, magnet therapy, and foreign healing systems like traditional Chinese medicine and Indian ayurveda–a growing number of medical schools, too, are supplementing medication with meditation.

Interest in teaching alternative approaches “has exploded, especially this last year,” says Laurie Hofmann, executive director of the Institute for Functional Medicine, which is based in Gig Harbor, Wash. The nonprofit institute educates healthcare professionals to look for underlying systemic imbalances as a cause of illness rather than focus on treating symptoms and, when possible, to correct with lifestyle changes and mind-body techniques.

As you can see, the journalist who wrote this, Meryl Davids Landau, falls prey to common CAM framing mechanisms, beginning with the claim that CAM is so popular. Of course, that 40% figure so beloved of CAMsters and woo-meisters of all stripes is deceptive, as it includes massage, chiropractic, and yoga. If you look at the “hard” woo, such as homeopathy and energy healing, the numbers are much lower. Then there are exercise, diet, and other modalities that aren’t really “alternative” at all, but rightly should be included as part of science-based medicine. These are often subsumed into the “CAM” brand, even though they don’t really belong there. Whittle that stuff out, and the very same surveys support a figure more on the order of 5% of people using truly “alternative” medical modalities, such as homeopathy, acupuncture, reiki, and others.

Also, as I’ve pointed out before in my criticisms of its most famous practitioner Mark Hyman, Functional medicine, as we have seen before, is a collection of various quackeries that represents itself as somehow having greater insight into human physiology when in reality it’s based largely on the extrapolation of early science beyond any scientific justification and the misinterpretation of existing science. And apparently this woo is finding its way into a medical school near you.

As an academic surgeon, this does not give me a lot of confidence in our next generation of medical students. For example, we have a first year resident who is quoted in the article named Carson Brown:

“I could already see the limitations of Western medicine, especially when treating recurrent pain or other chronic conditions. I thought other healing traditions could fill in some gaps,” says Carson Brown, a first year resident at San Mateo Medical Center in California. Spurred in part by the relief that acupuncture had offered her for hip pain induced by a sports injury, she took a two-week elective offered to fourth-year UCSF students last year that covered topics from acupuncture to mind-body medicine to herbs.

Once again, whenever you see someone use the term “Western medicine” as a synonym for science-based medicine, you should know you’re dealing with someone who has at the very minimum taken a sip of the Kool Aid of CAM quackery and at the very maximum drunk deeply to the point of wanting to be a homeopath. As far as I’m concerned, it can’t be emphasized enough. There is no such thing as “Western” medicine. There is no such thing as “Eastern” medicine. There is only medicine that is science based versus medicine that is not. The East/West dichotomy beloved of CAMsters is a false one. In fact, not only is it a false dichotomy, but it contains within it a bit of racism as well.

One also can’t help but notice the irony as well that, while the CAM advocates are claiming that they are all about the science, the best they can come up with to support going into CAM is anecdotes and feelings. Well, not quite. Landau mostly uncritically parrots favorite CAM tropes like the “growing body of evidence” that allegedly supports CAM. Of course, what they mention is not really CAM, like nutrition. The “bait and switch” of CAM is alive and well and being bought into by credulous reporters. Well, not completely. I will give Landau credit for citing a 2009 review that

found a bias “in favor of CAM,” noting recommendations of acupuncture for conditions like asthma where there is “no credible evidence” and instances of ignoring research–for example, studies associating chiropractic neck manipulation with stroke.

I’ll also give him credit for noting a major problem with all this insinuation of CAM into the medical school curriculum, namely that something’s got to give. Time is limited, and the medical school curriculum is in essence a zero-sum game. If time is made for CAM, then something else has to go. What will it be? Maybe anatomy won’t be covered in as much detail so that medical students have some time to study the fantastical anatomy that is, for example, the meridian system in acupuncture through which qi is claimed to flow. Or maybe histology won’t be covered in as much detail so that students can learn a bit of faith healing in the form of reiki?. Who knows. What I do know is that every minute of pseudoscience that insinuates its way into the medical school curriculm means that some bit of real science will have to be pushed aside. It’s that simple, and that stark.

Even here, the bait and switch is alive and well. Once again, nutrition is co-opted and represented as being part of CAM, leading to a frame in which it is lamented that medical students aren’t getting enough education in nutrition–as though CAM education could remedy that situation or CAM is equated with nutrition:

Medical schools that can’t find the resources or the space in their packed curricula to add CAM–a recent Institute for Functional Medicine (IFM) survey indicated that time, not lack of interest, is the prime impediment–may find that online education can fill the gap. Next year, the University of Arizona will launch a 16-hour Internet-based holistic course on prevention and wellness, open to medical students from other schools.

The IFM will debut Web-based modules later this year on gastrointestinal health, the principles of functional medicine, and nutrition. (Time constraints are no doubt the reason a recent study in Academic Medicine found that only 27 percent of medical schools currently meet the minimum target, set by the National Academy of Sciences, of 25 hours for class time about nutrition.)

Note the framing. Gastrointestinal health, functional medicine, and nutrition are treated as a module, and then it is pointed out that most medical schools don’t reach the currently recommended minimum class time teaching about nutrition, as if science-based nutrition has anything to do with the woo that is functional medicine! This is the sort of thing that irritates the crap out of me time and time again. Unfortunately, physicians should really know better. Equally unfortunately, these same physicians uncritically buy into the “bait and switch,” whereby nutrition and other modalities that should be science-based are co-opted as somehow “alternative” and then used as a means of implying that all the other baggage that comes with CAM is just as reasonable and effective as nutritional interventions for some chronic health disorders.

It’s depressing to see an article like this for a couple of reasons. First, it shows just how thoroughly the terminology of CAM has embedded itself into medicine and, from there, has metastasized into the language used to report on CAM. Worse, the woo in medical school is not just proliferating, but becoming more intense. Gotta have more woo in my medical school, indeed.

And here I am, rapidly approaching the age where I’m likely to need more medical care. These medical students will be the ones to give it to me. All I can say is that when I’m 80+ years old and in the hospital, if some young punk comes into my room offering to realign my flow of qi or adjust my chakras I just hope I have enough strength and presence of mind left to show him how really to rearrange the flow of qi.

Either that, or I at least want to be that cantankerous old man who selectively makes the lives of any hospital physician, nurse, or staff member proposing to treat him with quackery miserable.