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When Woo Enters the Science Classroom

June 3, 2011

Slowly but surely a trend of woo entering science classrooms on university campuses continues to develop. This is an issue that has been written about by concerned proponents of science-based medicine who have pointed to it occurring in both undergraduate science programs and medical schools all over Canada, the U.S. and the world(1, 2, 3, 4). As a Canadian undergraduate I am aware of this issue having reared its ugly head in many Canadian undergraduate programs and have even read about entire courses described in some curriculums, most often as a class about Complementary and Alternative Medicine (CAM) or Integrative Medicine (IM). Still, no matter how much I have heard about this ridiculosity I was not quite prepared the first time I experienced it myself. Particularly given that it came in the form of a fallacy laden lecture delivered by an MD. To set the stage, this was a second year introductory class in human health and disease. We had gone over the basics of the human immune system, pathogenicity, and microbiology, along with some of the social issues around human health and a little about history of medicine, generally an interesting course. Near the end of the course a guest lecturer was scheduled to come speak. Our guest speaker that day was to be an MD who works based out of a well-respected local hospital and is also a some-time lecturer with the university’s faculty of medicine. Any hope I may have initially had that this talk on Integrative Medicine would take an even remotely skeptical look at the bag o’ woo dragged around by those on Integrative Medicine bandwagon was quickly extinguished when I read the assigned papers prior to the lecture. There was some interesting, and objective stuff included but so were some advertisements for quackery disguised as serious scientific research. So it was with low expectations that I set off to attend my first ever lecture on Integrative Medicine.

As I alluded to already, what shocked me most about my experience in this lecture was the extent to which this guest lecturer relied on obviously fallacious reasoning and absolutely no actual evidence while promulgating his thesis that integrative medicine is a good thing, necessary even, to fix the broken Western medical establishment.

As an aside, I have already noted on this blog an issue I experience often during conversations about medical quackery, particularly with fellow science students. I often find that there are gaps in the way terms are defined from one person to the next. Although this is a topic that could easily fill its own post I was to lay out the basic issue with integrative medicine for those who have not read any of the great stuff written on this subject that I have already linked to. Complementary and Alternative Medicine is a catch all phrase to describe all forms of quackery and nonsense that either have not been proven to be safe and effective, or have already been proven to be either unsafe, ineffective, or both, yet are continuing to be offered by alternative practitioners. When treatments are shown to be safe and effective through rigorous scientific research and trials, they are adopted as medicine and cease to be referred to as complimentary or alternative. This is the one common thread running through all forms of CAM. If we can agree that this is the case then integrative medicine, a term used describe efforts to offer patients CAM treatments alongside, in addition to, or in place of, accepted science-based medicine, cannot be considered anything other than an attempt to integrate unproven, unscientific medical treatments with science-based medicine. This is not an issue of culture, acceptance of differing value systems or a way to integrate potentially beneficial CAM treatments with science-based medicine. Any treatments currently considered CAM that are shown to be beneficial and safe will at that time cease to be CAM, will be considered science-based, and will be offered to patients appropriately without the need of any special agenda called Integrative Medicine. This is why the very notion of Integrative Medicine is an issue from the word go.

Now back to our enlightening science lecture.

As I mentioned, what most surprised me about this lecture was just how devoid of any rational thought processes and actual information it was. Of course, anyone who approaches CAM with even the slightest bit of skepticism is aware that in most cases there is very little, if any, good scientific data to support the use of any given CAM modality. That being said, I would expect someone who has had time to formulate his thoughts and put together a PowerPoint presentation pushing the integrative medicine agenda to at least cherry pick some positive clinical trials, muddy the water with some distorted statistics, or at make some kind of argument to support his position that there is something real to be gained from integrating quackery with science-based medicine. To my surprise, this lecturer did not even bother with enough effort to do that much. Let’s have a look at the highlights.

First, our Integrative Medicine promoting MD weaved back and forth down a winding forest trail of random quotes from and/or about mind-body medicine, Taoist philosophy, traditional Chinese medicine (TCM) and yin and yang, Hippocrates, Aesculapius, Voltaire, and Descartes. Not feeling entirely like a science lecture yet? At this point the well…point of it all was still a little unclear. There was a mixture here of appeals to antiquity and ancient wisdom, random quotes about mind-body connections, and some false dichotomy about Western Medicine vs. Eastern Medicine thrown in for good measure. As another aside, the false dichotomy here is the allusion to science-based medicine as being Western as though people cannot practice good rigorous science in the East, or that facts in the West are somehow not facts when geography changes. There are a lot of good scientists and doctors practicing science-based medicine in the East that may not agree with our lecturer on this point.

From here our professor moved to what just may have been the piece de resistance of this talk. A three-point description of what integrative medicine is. First, integrative medicine promotes health and well-being. Why we need quackery integrated with science-based medicine to to promote health and well-being was not thoroughly explained but I think it’s clear…well…maybe not. Then again, my close-minded “Western” doctor doesn’t promote health and well-being at all, we all know that diet and exercise is solely the realm of CAM and vaccines are toxic and clearly do not promote health and well-being, maybe our lecturer was on to something here. Second, integrative medicine promotes individuals and communities taking more responsibility for their own health. We all know how those dastardly science-based doctors tell us not to take any responsibility for our own health, in fact if we’re being honest those evil reductionists are actively preventing us from doing so with all of their drugs and technology. If only they would tell us to eat right, exercise, get good rest, and avoid risky and unhealthy behaviours like smoking maybe we could take some responsibility for our own health. Last but not least, integrative medicine promotes health professionals collaborating and sharing information. If only we could get science-based doctors and health professionals to communicate with one another without integrative medicine. Really, this was the focal definition of IM offered to a group of wide-eyed university students. See what he did there? What’s not to like, these all sound like admirable goals right, who could argue with IM in the face of this definition. The important fact that’s left out of the explanation is that all of these things already happen and the extent to which one could argue that science-based practitioners need to improve on these worthy goals has nothing to do with integrative medicine. You heard it here first, no not really, many have said it before but I will say it again, we do not need to integrate science-based medicine with quackery in order to improve on aspects of patient care and health that have nothing to do with the quackery in question. The fact that science-based medicine is not perfect and there are things about the way it is practice that could be improved does not support the Grand Canyon sized logical leap necessary to get from there to IM.

We then went on to learn about iatrogenic illnesses and including some fantastic statistics about how many people die or are harmed due to iatrogenic illnesses and how many people in hospitals are harmed by receiving incorrect meds. Of course all of this information was presented with no context whatsoever, no discussion of risk vs. benefit analysis, not to mention zero explanation of how the use of CAM in any of these instances would result in better outcomes or what any of it had to do with integrative medicine.

Another highlight was a discussion of the importance of evidence-based medicine and the contributions of the Cochrane Collaboration and their systematic reviews, unfortunately somewhat foreign concepts for many undergraduates early in their science education. This slide included information about the number of systematic reviews of CAM modalities done by the fine Cochrane folks. Our lecturer was calling for more research into CAM, more money to be poured into the black hole of researching scientifically implausible treatments. There was some discussion of the limited number of reviews that have been done on CAM treatments. Unfortunately none of this discussion revolved around the outcome of any of those reviews or the lack of scientific plausibility to call for more studies. You see, evidence is important, reviews are valuable ways of weighing evidence, and there have been over 50 reviews of CAM done by Cochrane. What’s that you’re asking, what were the outcomes of those more than 50 reviews? What do those reviews tell us about whether more research is actually needed? Well you just never mind that, all you need to know is that there have been reviews completed but we need more, all of this research would not be invested into CAM if it didn’t work now would it?

At this point the discussion of evidence-based medicine turned to what the lecturer, without context called, other valid forms of evidence. This list included a variety of types of evidence with usefulness of application ranging from very limited to non-existent including N of 1 studies, patient preference studies, and observational data. That’s right, without context, in front of a class of a couple hundred green science students eager to learn about how science is done, and all too eager put their trust in the MD standing before them to tell it like it is, our lecturer suggested that randomized, double-blind, placebo controlled trials are great but we shouldn’t forget about the value of anecdotes. Of course he used sciency sounding words to say it but he basically equated anecdote and patient preference with RCTs.
From here our lecture closed with a flurry of the greatest hits of CAM apologetics:

– CAM is not studied enough because “Big pharma” can’t make money on CAM and therefore isn’t interested (with so little money to be made in CAM it’s a wonder how all of these CAM practitioners keep their businesses open, for the love of patients I guess).
– Special pleading about how many benefits of CAM cannot be measured and quantified. The classic ‘your Western science cannot study my CAM’.
– Western medicine is resistant to CAM primarily because doctors are scared of the loss of business.
– Western medicine does not work in cases of chronic illness but CAM does.
– Western medicine is not able to meet the needs of a post-modernist society (What the heck does that even mean!).
– Western medicine is too costly, therefore we should integrate CAM.
– Western Medicine is all about illness and integrative medicine is about wellness and self-healing.
– Patients are already using CAM, therefore we should pursue the integrative medicine agenda.
– Western medicine and its ‘reductionist’ approach cannot help with chronic illness.
– Western medicine needs to take a more ‘holistic’ approach to care.
– Western medicine is too close-minded to other world views.
– Western medicine needs to be less rigid with the standards of evidence-based medicine when it comes to CAM.

I will resist the temptation to play a game of name that fallacy here, feel free to do so yourself if you like, think of it like an exercise to practice your critical thinking skills.

Now came the time for questions and answers, I must admit, looking back on the experience I feel I may have failed in my responsibility at this point as I only managed to get one biting question out in an effort to call the lecturer on his frequent appeals to antiquity. My excuse involves a combination of being completely stunned by what I had just witnessed and a more pragmatic, if wimpy, desire not to damage my mark in the class by being overly confrontational with the lecturer who it seemed to me could sfely count my professor as a supporter of the IM agenda. What did surprise me is that I felt relatively lonely in my utter astonishment at what I had just witnessed. That being said, I have to give due credit to the girl who, after much discussion of acupuncture as a great example of CAM during both the lecture and question period, asked (with tongue planted firmly in cheek) if our lecturer “could…um…give us a scientific explanation for the basis for acupuncture”. Sadly, I do not lie when I tell you the answer included both the words qi and meridians. I won’t dive into the discussion during the question period about homeopathy except to say that it included a very confident pronouncement that Physicists have found that water in fact does have a memory.

Although enduring this kind of lecture in what was supposed to be a science class, and by an MD/Professor no less, was disappointing enough. Almost equally disappointing was the response I witnessed from so many of my fellow students, responses that ran the gamut from utter apathy, to shruggie-type oh well responses, all the way to full-on support and surprise at my discomfort with what we had just experienced. Yes, there were some who seemed to share my concern over the experience but I must say we seemed to me to be in a significant minority. In fact, the experience is one of the things that lead me to start thinking about this blog project.

While this was my first official personal experience with woo in the classroom, the fact is that quackademic medicine is on the rise and it likely won’t be my last. As an undergraduate continuing on the path toward science degree and hopefully medical school in the not-too-distant future, I am resigned to the fact that it is not only possible, but probably that I will experience the stench of quackademic medicine many more times in my education and in my professional career. If this particular lecturer’s closing remarks are any indication, he will be working hard to ensure it happens, that the integrative medicine agenda is followed through. ‘Western medicine’ is broken don’t you know, and of course the only way to fix it is to sprinkle in a little woo and mix it around to create a wonderful cocktail of science and quackery. Only then will medical professionals be doing their best to really treat patients, the whole patient, not just the disease.

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From → Quackademia

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