On teaching pseudoscientific controversies in universities…

About a month ago, a number of news stories were published reporting that the University of Toronto had offered a course in alternative medicine taught by a homeopath named Beth Laundau-Halpern that presented a segment that was clearly highly biased towards antivaccine pseudoscience. It was worse than that, though, because this homeopathy just happened to be married to a dean at the university named Rick Halpern. The whole thing blew up into an embarrassing fiasco that demanded a response from the University. Unfortunately, this came in the form of a weaselly report, in which Vivek Goel, Vice-President Research and Innovation, was charged with investigating. He actually looked at the course’s syllabus, interviewed Landau-Halpern and various other people involved, and, incredibly, concluded that this alternative medicine course was “not unbalanced.” Not surprisingly, those of us who devote significant proportions of our free time promoting science- and evidence-based medicine were—shall we say?—less than pleased. Blogospheric volleys against the University of Toronto’s class and its attempt to claim it wasn’t “unbalanced” started with Jen Gunter, who sarcastically noted that the University of Toronto apparently thought that Andrew Wakefield is a legitimate source of vaccine information, and then proceeded to the likes of Steve Novella, a heavy hitter in this area, and, of course, little ol’ me, a somewhat less heavy hitter. As I noted at the time, the University of Toronto’s course was yet another example of what I like to call quackademia or quackademic medicine; i.e., the infiltration of pseudoscience taught and even practiced uncritically in academic medical centers.

Of course, it was pointed out, even right here in the comment section of this very blog, that this was not a course offered by the University of Toronto Faculty of Medicine, and indeed this was true. The course was in fact offered as part of the Health Studies Program and fell under the auspices of the Department of Anthropology. As such, this course wasn’t teaching medical students the quackery that is homeopathy, although, as I couldn’t help but note at the time, the Leslie Dan Faculty of Pharmacy at the University of Toronto has on its faculty a true believer in homeopathy named Heather Boon, who’s carrying out a clinical trial of homeopathy for attention deficit hyperactivity disorder (ADHD). In fact, Heather Boon is more than just faculty; she’s the dean of the Leslie Dan Faculty of Pharmacy! (Also not surprisingly, she doesn’t like Dr. Novella or myself.) So, naturally, it was hard for skeptics not to see Landau-Halpern’s course, apparently offered more because her husband was a dean than because of any merit the course had, through the lense of other even more disturbing infiltrations of quackademic medicine at the University of Toronto.

In any case, it was ultimately reported that Landau-Halpern is no longer U. of T. faculty and the university will no longer offer the course, and, as I learned recently, Rick Halpern resigned as dean to return to teaching history. It’s hard not to link the embarrassment his university suffered in the wake of the news reports about his wife’s course to Halpern’s rather sudden resignation as dean. Although it was messy, and the university’s report made the risible statement that Landau-Halpern’s course was “not unbalanced,” all’s corrected, right?

Sort of. At best.

The campus of the University of Toronto these days?

The campus of the University of Toronto these days?

This ugly incident and the university’s unsatisfactory response notwithstanding, the other day I was disappointed to see a senior faculty member at U. of T. not only defending the university but defending its having offered the course in the first place. Because it is someone who is usually soundly in the science-based camp, I had to take his viewpoint seriously. Unfortunately, I find his arguments unpersuasive. Equally unfortunately, this defense of the university included an unjustified swipe at medical skeptics like myself that I personally found downright insulting.

I’m referring to Larry Moran, a Professor of Biochemistry at U. of T., who wrote a post on his blog, On teaching alternative medicine at the University of Toronto. First, let me deal with the insulting part, so that I don’t have to deal with it again and can proceed from areas where there is more common ground and hopefully finish on a high (or at least not on a nasty) note. Near the end of his post, Moran dismissively and condescendingly attacks a massive straw man, one so massive that, were it set on fire, it could probably be seen from space and I could probably see its glow in the east at night even though Toronto is well over 200 miles away from where I live:

From an academic pedagogical perspective, there’s nothing wrong with a course that has a reading list emphasizing quack medicine. This is the view that people outside of the university don’t understand. They appear to want to prevent students from ever learning about, or discussing, the anti-vax movement and how to deal with it.

They are wrong.2

Those of you who read the articles and have seen talks by supporters of science-based medicine like Steve Novella and myself will recognize this for the straw man that it is. We never say anything like this, that we want to prevent students from learning about or discussing the antivaccine movement. That is an assertion that is unsupported and, quite frankly, downright risible. So you should understand that I was more than a little pissed off when I read this part of Moran’s post. We never say that we don’t want alternative medicine to be taught or antivaccine views taught. (Indeed, I really wish that pediatrics residency programs, for instance, would do a better job of teaching antivaccine views, so that they don’t catch pediatricians by surprise when parents start expressing them.) What we complain about is the uncritical teaching of these topics, the teaching, for example, of alternative medicine modalities as though they had scientific merit. This is a massive problem in medical academia. I’ve lost track of how many times I’ve reiterated this very point going back at least a decade.

Indeed, in the very post about Landau-Halpern’s course, I wrote:

Don’t get me wrong. I don’t object in concept to a course that looks at the antivaccine movement and its arguments, but such a course must be rooted in science and critical thinking, so that it helps students understand why antivaccine misinformation is not supported by science. Ditto quantum quackery.

And in his post on the topic, Steve Novella wrote:

Optimally, courses promoting pseudoscience would not be taught at any university. If a university wants to teach about alternative medicine, or creationism, or astrology, they should teach it from a critical point of view. This should not be confused with promoting pseudoscientific propaganda, however.

And that is exactly the issue with Landau-Halpern’s course, as I will discuss in a moment. Its syllabus reviewed it to be far more about propaganda for alternative medicine than a critical evaluation of various alternative medicine topics.

Now let’s see what Moran also said after his footnote:

2. If any of these people respond to this post, you can be certain that they are going to move the goalposts. They are now going to say that they were never opposed to exposing students to anti-vaccine material but only opposed to the way it would have been taught in this particular course.

Bullshit, Professor Moran. Bullshit. I don’t know what posts you’ve been reading, but I, at least, have been utterly consistent in this position since I was first shocked out of my shruggie complacency by learning of the existence of quackademic medicine, lo nearly a decade ago (for Steve Novella and other skeptics who were among my inspirations, even longer). I became involved with my not-so-super-secret other blog in order to combat the uncritical teaching of alternative medicine pseudoscience and quackery in medical schools and academia.

There, now that I’ve gotten that off my chest, I can calm down and discuss the rest of Profesor Moran’s arguments a bit more dispassionately, albeit not much less snarkily. This is, after all, the Respectful Insolence blog, and what better form of Insolence is there than snark? But, first, because there is a fair amount of common ground between Prof. Moran an myself, an olive branch of sorts.

Moran writes:

From my perspective, the main problem was not the content of the course but the qualifications of the instructor and the reason she got her job. The instructor was not qualified to teach a university course, although I would have no problem with her giving some of the lectures in a course run by a qualified university instructor. I think the university has done a fine job of resolving that issue.

Oy, that last sentence. So close, and yet so far. I’ll ignore it for the moment because I do, actually, agree with the bulk of this passage. Certainly, there was at least the the appearance of impropriety, if not actual impropriety, in way that a dean’s wife got to teach this course even though, by virtue of being a homeopath, she was utterly unqualified to teach such a course. Why was she unqualified? For one thing, she is biased in favor of pseudoscience. Indeed, homeopathy as a “profession” (my fingers seized up as I typed that word and it took two or three attempts to get them to work) is generally very much antivaccine. But wait! you say. Just because Landau-Halpern is a homeopath doesn’t necessarily mean she is antivaccine herself. True enough! I suppose it’s possible that there are rare unicorns homeopaths who aren’t antivaccine. However, if these unicorns homeopaths exist, they are so rare that I can’t remember having encountered one in my 15+ years of examining pseudoscientific medical claims. Indeed, the closest thing I ever came to a homeopath who isn’t antivaccine was a naturopath who claimed not to be antivaccine (remember, you can’t have naturopathy without homeopathy), and it turns out that she spouted plenty of antivaccine pseudoscience.

So let’s look at Landau-Halpern herself, whose history provides copious evidence that she is antivaccine. For instance, as I documented, Halpern was busted by CBC Marketplace advising a reporter posing as a young mother not to vaccinate and promoted the quackery of homeopathic nosodes as an alternative to vaccines. Not only that, but she treats ADHD (she ought to get along with Prof. Boon quite famously) and autism with homeopathy as well, which tells me her understanding of science is incredibly lacking. On her very own website, she writes:

My interest in autism was sparked by my experiences with the detoxification of children who were damaged by the administration of vaccines. Many behavioral problems soon disappeared when vaccines were detoxified, even when many of these children came to me for completely different reasons. In my practice it turned out that mood swings, aggression, restlessness, attention deficit disorder (ADD) and ADHD often are correlated to the many and early vaccinations in children. When some of my autistic patients greatly improved after the detoxification of their vaccines, my interest was aroused, and I became increasingly convinced that autism must at least partially tie in with the administration of vaccines. At the Chicago congress on autism in May of 2003 I presented 30 cases of behavioral disorders that had significantly improved with the detoxification of the vaccines (among these were three autistic children). Nowadays it has become clear that vaccines are not the only culprit, although the most important, other toxic substances can also play an important role.

So, yes, Halpern is antivaccine and was utterly unqualified to teach a course about alternative medicine. However, as a homeopath, she was very much qualified to teach an overview course in alternative medicine.

I note that there’s a big difference between teaching a course about a subject like alternative medicine and teaching a course in such a subject. I like to make an analogy, albeit an imperfect one, to religion dating back to my days attending a Catholic school. Think of this difference as the difference between teaching a course about world religions and the courses offered on Catholic religion. In the former case, we were taught in an amazingly dispassionate fashion about the various world religions, their doctrines, and their histories. In our Catholic religion class, however, we were taught Catholic doctrine as Truth. In other words, I’m referring to the difference between education and indoctrination.

Of course, there is nothing in a world religion class to let students figure out which religions have more validity than others. An atheist might say they are all equally invalid while a believer would simply say that his religion is valid and all those others are not. In science, however, we can determine what is and isn’t scientific, and in medicine we can determine what is and isn’t quackery. Moran makes an analogy:

Lots of people are getting their knickers in a twist because the university offers a course on “Alternative Health.” That’s mostly because they don’t understand how universities are supposed to work. As most Sandwalk readers know, I advocate dealing directly with controversies and, to that end, I think it’s a good idea to teach a course where students can examine the main creationist arguments. It’s a good way to practice critical thinking. For many years I taught a course where the main reading was Jonathan Wells’ book Icons of Evolution.

It’s not a bad analogy. But see where it falls down. Prof. Moran, not a creationist, taught the course and led the discussions. He is a biochemist and very much a defender of evolution. Depending on how good a teacher he is and what his style of teaching this particular course was, he could guide the students to see the flaws in creationist arguments or tweak them so that they found them on their own. That’s not at all what was going on with the alternative medicine course that caused the controversy, as the course’s syllabus (dissected in detail by Jen Gunter, Steve Novella, and myself) inarguably indicates, containing nothing but credulous takes on quantum quackery and antivaccine views, among others. Basically, U. of T. had a quack teaching a course in quackery in a manner that would be akin to having a creationist teach Prof. Moran’s course in creationist arguments. You can bet that the students would likely come away from such a course with a different take on creationist arguments than they did from his version of the course! You can also bet that Prof. Moran wouldn’t be happy to find out that a course about “controversies” in evolution was being taught by, say, Ken Ham or a flack from the Discovery Institute. So why doesn’t he understand why we are unhappy about an antivaccinationist and quack teaching a course that included a module on “controversies in vaccination” and issues in alternative medicine?

A lot of his other objections seem to boil down to a rather condescending dismissal of concerns as being due to critics allegedly not understanding how universities work. I understand how universities, at least medical schools, work just fine, having spent my entire career in medical academia, and so does Steve Novella, having spent his entire career in medical academia. Now, to be fair, medical academia is a specialized beast and not run quite the way other schools in the university tend to be run. For one thing, medical schools have to produce a curriculum that is approved by the Liaison Committee on Medical Education (LCME); there is less freedom, at least in clinical departments, over what courses can be offered. The rest of medical school departments tend to train primarily graduate students, necessitating graduate-level classes. On the other hand, that very lack of freedom also causes one of our biggest headaches with respect to quackademic medicine, and that’s the LCME’s requirement that “complementary and alternative medicine” be taught in the curriculum. There are, of course, two ways of doing that: from a critical and science-based viewpoint, or from a more credulous viewpoint. Sadly, all too many medical schools choose the latter or methods that lean towards the latter, with actual alternative medicine practitioners teaching the courses, and that is what science-based medicine battles against.

Be that as it may, yes, it’s a good thing that U. of T. apparently brought the offending program under tighter departmental control, apparently declined to re-sign the offending homeopath as adjunct faculty, and—this is just my guess but a plausible one, I think—probably encouraged Rick Halpern to resign as dean. It really is. In contrast, it’s not a good thing that Vivek Goel, Vice-President Research and Innovation, could look at the curriculum for Halpern-Landau’s course and conclude that it was “not unbalanced.” I would have been far more impressed if U. of T. had simply said, “Hey, we screwed up. We somehow let a homeopath slip an unbalanced class past our usual checks and balances. We shouldn’t be teaching quackery as though it were medicine any more than we should be teaching creationism as though it were evolution.”

Moran also asks readers to put this course in context, to look at the rest of the curriculum. I argue that in this case that’s a red herring. There’s nothing wrong with offering a course that examines pseudoscience and even invites advocates of pseudoscience to give guest lectures, but when the person running the course is herself the practitioner of a pseudoscientific form of medicine, there’s a real problem. I don’t care what the prerequisites to the class were or what other courses are taught in the program. Moran goes on and on about a university’s responsibility to expose students to controversies in a field of study. True enough. However, a university also has a responsibility to teach such controversies from the perspective of what can be demonstrated with evidence. Putting a purveyor of magic water in charge of a course on magic treatments fails that test.

Finally, Moran also goes wrong here:

It’s important to understand that we are not dealing with children. These are mature university students taking a course in their final year of study. They do not need to be “protected” from the evil bogeyman of quack medicine. Most of the outsiders complaining about this course seem to think that these naive students are going to be swayed to the dark side by being exposed to the real world of quackery. If that were true (it is not true) then we would have a much more serious problem on our hands than just this course.

Here’s where, I suspect, Moran’s own background betrays him and he doesn’t see the broader picture, at least not in medicine. Remember, he is a professor in a hard core basic science department (biochemistry) that accepts and teaches evolution. There is little or no danger that its students, by the time they reach upper levels, would not be well-equipped to deal with creationist fallacies, particularly with him on the faculty. His confidence in them is understandable. Contrast that to this program, the Health Studies Program at UTSC, which is a lot less hard core, combining “courses from a range of disciplines to examine this critical area from a biological, social and policy perspective.” It’s also an undergraduate program, which virtually by definition means that the students won’t be receiving as deep a background in the issues relevant to alternative medicine as medical and graduate students do.

In the end, my little fit of pique over Prof. Moran’s condescending and dismissive attitude towards those of us who were so outraged by this course being offered by U. of T. aside, we actually (mostly agree). Moran supports “teaching the controversy” with respect to evolution and with respect to alternative medicine. So do I. Where we disagree is over what “teaching the controversy” actually entails. Can Prof. Moran can honestly say that he wouldn’t be the least bit upset if his own department were to offer an entire course on “controversies in evolution” taught by Ken Ham, Casey Luskin, and a Discovery Institute fellow to be named later? That he would approve of such a class as a great way to “teach the controversy”? If he can, I’d say there’s a problem. If he can’t say that, I congratulate him. That’s the correct reaction. In that case, I also point out that he has no business being so contemptuous of our anger over a homeopath teaching a course in alternative medicine as a way of “teaching the controversy.”