A “distinction track” in quackademic medicine is born

The infiltration of quackademic medicine continues apace.

I know, I know. I say that a lot, but it’s only because it is, alas, so very, very true and so very, very distressing to supporters of science-based medicine. It’s not as though I haven’t written about it many, many times over the last six and a half years; indeed, it’s become a major theme of this blog and at least one other blog that regular readers here might be familiar with. Whether it be the American Medical Students Association (AMSA) pitching woo, Georgetown going beyond electives in “complementary and alternative medicine” (CAM) or “integrative medicine” (IM) and “integrating” quackery into its mandatory medical school curriculum, or the National Center for Complementary and Alternative Medicine (NCCAM) funding pseudoscience, I’ve done my best to bring these issues to the attention of my readers, hoping that education will lead to action.

Of course, arguably the epicenter of the woonami currently engulfing medical education in the U.S. is a kindly-appearing, rotund, bearded man who looks much like a desert Santa Claus. This man is clearly one of the “thought leaders” (if you can call it that) of the CAM/IM movement, not to mention a pioneer in bringing quackery into the medical school curriculum. He currently makes his home in Arizona and has built up a bastion of CAM/IM at the University of Arizona, from which it has metastasized to medical schools all over this great nation of ours, having had his CAM/IM program designated a “center of excellence,” an oxymoron when applied to CAM/IM if ever I’ve heard one.

I am referring, of course, to Dr. Andrew Weil.

This time around, he’s gone beyond having his Arizona Center for Integrative Medicine designated a “center of excellence.” Now, the University of Arizona College of Medicine-Tucson has partnered with the Arizona Center for Integrative Medicine to reward medical students for pursuing a career in quackery:

Medical students in the new Distinction Track in Integrative Medicine will learn healing-oriented and preventive medicine techniques during an intensive four-year program.

The Arizona Center for Integrative Medicine and the University of Arizona College of Medicine-Tucson have announced a new Distinction Track in Integrative Medicine for UA medical students.

The track is an intensive four-year study program, in addition to the standard curriculum. Students who complete the requirements will graduate with distinction, as recognized by the college’s dean.

That’s right. Students who pursue extra study in this Distinction Track in IM will get a nice notch on their CV regarding what a great student they were. Given that there are only three other such Distinction Tracks, for example, Global Health and Research. Does IM rate being among the very few such areas of focus that include medical areas of focus as important as global health and research? I think not. It’s like including shamanism and witch doctoring as an area of focus co-equal to research. Come to think of it, that’s just what Dr. Weil is doing, and somehow he’s snookered the board at UA to think that it’s a good idea to make its medical school such a magnet for pseudoscience. It’s a depressing sight to see, but not unexpected.

What makes this development so depressing and disturbing is that Weil is an expert at the “bait and switch” of alternative–excuse me, “integrative”–medicine. Much of his health advice is unobjectionable–science-based, even–but he sprinkles it with woo, appeals to “open-mindedness,” and highly dubious medicines, all while recommending and selling various supplements, his books, and, above all, himself, as in the Andrew Weil brand. Not surprisingly, coverage of the announcement of the Distinction Track in IM is no different:

Preventive medicine is a crucial part of a medical professionals’ training and is often minimalized in conventional medical training,” said Dr. Andrew Weil, center founder and director. “Receiving this additional training early in their career will give UA College of Medicine students an advantage in their residency and practice and a more comprehensive set of skills for treating and communicating with their patients.”

I really hate it when Weil or other promoters of “integrating” quackery into medicine pull this gambit. It’s so common that I’m surprised no one that I know of has given it a name before; so I’ll dub it the “prevention gambit,” you know, to go along with the “pharma shill gambit” or the “toxin gambit.” Basically, CAM/IM promoters use the prevention gambit to try to convince people that only CAM or IM deals with prevention. Never mind that at least half or more of what a family practitioner or internist who practices primary care does every day is prevention. For example, what is the point of trying to control hypertension if not the prevention of atherosclerotic cardiovascular disease leading to stroke, heart attack, or peripheral vascular disease? True, practitioners of science-based medicine might all too often fail to emphasize prevention and wellness as much as they should or would like, but that is mainly a function of a reimbursement system that doesn’t reward time spent with patients, leading to very short patient visits. The answer to that problem is not to “integrate” woo with medicine because quacks are allegedly better at spending time with patients and making them feel better. Rather, it’s to fix medicine to align reimbursement incentives to encourage spending more time with patients and emphasizing preventive care more strongly. In contrast, Andrew Weil promotes the tired old CAM/IM false dichotomy that implies that the only way to practice preventative care is to “integrate” CAM into standard medical practice.

The problem, of course, is that, in the name of prevention or fixing medicine to make it more “humanistic,” CAM/IM advocates “integrating” into the medical school curriculum (and then later into medical practice) pseudoscience like:

Introductory sessions and workshops will be presented by community preceptors focusing on different modalities of integrative medicine: botanicals, homeopathy, mind/body, naturopathy, nutrition, traditional Chinese medicine, osteopathy, and energy medicine.

How many times does it have to be repeated? Homeopathy is quackery. It’s water that a homeopath has cast a magic spell on. Naturopathy is mostly quackery, a potpourri of pseudoscientific, prescientific, mystical, and vitalistic practices, anything that naturopaths can represent as being more “natural” than science-based medicine. Traditional Chinese medicine is based on a prescientific understanding of disease rooted in vitalism. There is no reason that practices like this should be taught in a medical school in 2011, except to make sure that medical students know what they are, in case any of their patients is using them and know potential interactions with real medicine. That’s it. Medicine has moved on from the days when TCM seemed reasonable. CAM/IM has not, and it appears that it never will.

So what does the woo-minded medical student have to do if he or she is admitted to the Distinction Track? This:

It will require participation in the center’s month-long integrative medicine elective rotation, attendance at grand rounds presentations and patient conferences, monthly special-topics lectures, facilitation of a “healer’s art” course, completion of more than 30 hours of online courses, a capstone paper suitable for publication and an oral exam.

Oh, goody. I wonder if there will be questions about homeopathy on that oral examination. Thinking back to my oral board exam for surgery, which was one of the most intimidating, nerve-wracking examinations I’ve ever had to take. Think of it this way. You fly out to a strange city, where the gods (or at least the demigods) of surgery were there to determine whether you are sufficiently knowledgeable and therefore worthy to be admitted to the club of board certified surgeons. These are the surgeons who literally wrote the textbooks I studied as a medical student and resident. They would be paired with local surgeons, so that there were two examiners for each session, each sitting in one hotel room, and candidates would go from room to room for a total of three half-hour sessions.

The thing is, the oral boards made sense, as intimidating as they were at the time. Each pair of surgeons would present two or three cases and the candidate would have to tell them how he or she would take care of the patient. The examiners would try to throw some curveballs in there, and if you waited too long to act or did something wrong they’d make sure the patient started getting sicker and sicker. However, the answers expected were science-based and had to fall within the realm of safe, science-based practice. The answers or courses of action that would flunk a candidate had to fall well outside of of safe surgical practice.

Why am I telling you this? Simple. It’s because I wonder how on earth you can have an oral examination, which, I’m guessing, includes patient cases? I mean, seriously. How does a medical student choose whether to use acupuncture, homeopathy, or TCM, for instance, on a given position? In a world where all manner of pseudoscience is considered “integrative,” how can one have any standards based on any sort of objective evidence that allows a practitioner to decide among different varieties of magic? In such a world, how can there be such a thing as a wrong answer?

Sadly, UA is completely behind this effort:

“This endorsement by the UA College of Medicine acknowledges the impact and acceptance of integrative medicine as an important field of study, and recognizes our center’s role as a leader in medical education,” said Dr. Victoria Maizes, executive director of the Arizona Center for Integrative Medicine. “Creation of this track expands our educational opportunities to virtually every level of medical education, from student to seasoned practitioner.”

Well, it all depends on what you consider an “educational opportunity.” There’s no doubt that adding CAM/IM to the curriculum–or any curriculum–would “expand educational opportunities,” but is that a good thing? I would argue that it is not, at least not when those additional educational opportunities involve mixing pseudoscience with science and shaking vigorously until it’s hard to tell one from the other.

Yet that is exactly the path that medical education is taking here in 2011, with Andrew Weil and UA leading the way.