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Science, Medicine, and Academia

by Steven Novella, Jan 23 2012

Proponents of so-called complementary and alternative medicine (CAM) are forcing us to answer a question no one has explicitly asked – should there be a scientific basis to medicine? Proponents are generally very coy about this topic, and in most venues want to pretend that they are being scientific, while really promoting “other” forms of evidence and “other” ways of knowing. They promote health care freedom laws designed to weaken the scientific standards of medicine, while simultaneously infiltrating academia with assurances that they are science-based.

Unfortunately most academics and health care professionals are simply naive to the situation (so-called “shruggies”) and too easily accept these assurances without checking out the facts themselves. Their initial reaction to those of us who are calmly but insistently pointing out that the CAM emperor has no clothes is to assume that we must be overreacting, because CAM can’t truly be as bad as we say. Homeopathy can’t really be made of nothing, can it? But it’s a large industry, with entire hospitals in the UK. How can it be as nonsensical as the skeptics are saying?

This naivete extends, unfortunately, to many university administrators, who are used to being egalitarian and accommodating. Proponents of CAM are sincere, and know how to play the game, so they put their best academic foot forward (often lubricated with grants from ideologically dedicated organizations like the Bravewell collaboration) and work their way into academia. They are persistent, and good at dismissing their critics as closed-minded, unfair, or having an axe to grind.

Perhaps the best tool we have in countering this infiltration of abject nonsense into the halls of academia is to simply point out exactly what they are buying. This strategy has had a great deal of success in the UK, and some limited success in the US. Now, defenders of science and reason in Australia are gearing up for their own fight. A new group called the Friends of Science in Medicine has formed to oppose the watering-down of science in academic medicine and the practice of medicine in Australia. A recent article about the group states:

 A new group called “Friends of Science in Medicine” comprising of more than 350 of Australias top scientists, including basic and clinical scientists, medical practitioners, clinical academics and consumer advocates have formed to address what they consider the “diminishing of the standards applied to the teaching of science in our universities”. The group is concerned about the increased teaching of, what they call, ”pseudoscience” in Australian universities and its application within our health care system.

Their aims are in line with other groups, like the Institute for Science in Medicine (an international group of which I am Chairman). And of course we tackle this issue frequently at Science-Based Medicine.

Our collective strategy is basically two-fold. The first is to establish what the scientific standard should be. The second is to shine light onto the claims and practices of so-called CAM, to expose the fact that they do not meet this standard. Proponents are coy on the first question, and deceptive (either naively self-deceptive or deliberately so) on the second.

We need to affirm the necessity of having a transparent objective scientific standard for medicine. Otherwise, there is no standard of care. There would be no way of determining which treatments were legitimate and which were not. This question has many practical implications – which professions should be licensed, which treatments covered by insurance, which practices allowed under the scope of practice of each profession, what should be taught in medical, nursing, and other health-related curricula, and which practices constitute malpractice. Without a science-based standard, there are no answers to these questions.

That, of course, is what CAM proponents want. How else can you practice homeopathy, get covered for it, have it be included within your scope of practice, and not be sued blind.

Further – we can’t have a double-standard. Within medicine there is a pretty clear consensus as to what the scientific standard is. It is slowly evolving, if anything becoming more stringent as we root out more and more subtle ways of subverting best scientific practice. CAM as a category exists to weaken this standard, or to create a double standard for themselves so that practices that are not science-based can be taught, used, and covered. But (I hope) CAM is starting to be the victim of their own success, in that as they have successfully promoted CAM it is necessarily coming more and more into the light. As it does it is getting easier to expose CAM for the utter nonsense that most of it is.

Groups like those mentioned above are starting to form – comprised of health care professionals who have bothered to look and see what is happening.

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9 Responses to “Science, Medicine, and Academia”

  1. Janet Camp says:

    This is good news, but as I was (passively, as I am not a sports fan) watching a football game with family, I heard the announcer state that a player’s chiropractor had evaluated his possible head injury and allowed him to return to the game.

    I think there is much work ahead.

  2. Max says:

    News just in
    http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=502&action=detail&ref=1012&start=3&issueref=225
    “UCLA Health System is the first medical system on the West Coast to adopt Urban Zen Integrative Therapy, a program that delivers yoga therapy, mindfulness meditation, nutrition, Reiki and aromatherapy to the bedside of interested patients.”

    “How much scientific evidence is there about the effectiveness of these techniques?
    There is some, but it is preliminary. We are approaching this in the typical UCLA way, in that we want strong data to prove that this does or doesn’t work. From the start, we will hold randomized clinical trials in which we will compare patients who get this treatment with patients who don’t on a host of measures.”

  3. Disappointed med student says:

    Thanks for this post. I’m a student at an American medical school. I continue to be shocked by the degree to which CAM is indulged by my institution, including offering these kinds of “services” at our no-pay community clinic. On the one occasion when I expressed my skepticism, diplomatically, to one of my mentors (an MD!) I was told unambiguously that I wasn’t to rock the boat. Easily the most disappointing moment of my education so far.

  4. Mendelation says:

    I am a professor at a medical school. In recently applying for a new position with another school I discussed with one of the faculty my concerns with CAM and the need for all teaching to be science based. I didn’t get the position because they didn’t think I would be able to “effectively teach within their curriculum”. I think, though I lack the evidence to prove, that my views on CAM were a major part of why I didn’t get the position. Sad when adherence to the principles of evidence and science make you undesirable.

  5. Victor Carulei says:

    All the evidence that you need to show that CAM is an absolute sham is already in the scientific domain

    The worlds expert on CAM is Prof Ezart Ernst at the University of Exeter. If i remember correctly, some facts are as follows:

    He has published 40 books on the subject and 1000 papers.

    His conclusion?

    CAM is no better than placebo in 95% of cases.
    So in 5% of cases it is better than placebo.
    Now that is good treatment.

    The gullible public for the most part absolutely scientifically illiterate, don’t realize that they are victims of their own stupidity. After reading a few words of wisdom on CAM websites, they are now empowered ( how nice) done the due diligence from reading the introductory trash posed as science on all CAM websites and now armed with this disinformation they are about to embark on a self empowering tour de force to take care au naturelle of all their ailments. Including no vaccinations because it “weakens” the immune system. Sure! That is why polio and smallpox are gone.

    I have patients that are routinely told the following tripe by these imbeciles (complement)

    Stop all your allopathic treatment it is toxic to your health. You need detox and colonics and treatment for adrenal fatigue. The cost is usually $300+. This includes people with brittle Diabetes, Asthma, CCF some of whom are living from week to week on a truckload of drugs and when the CAM artiste tampers with this treatment I have usually seen these people in Emerg- dying – because the idiot told them to stop diuretics, Ace inhibitors or b blockers. Now if I had to do that the regulatory authorities would say to me: “Sorry Doc you have lost your way and need to re attend medical school” or worse, depending on outcome, pull my license. And the CAM artiste? Why they live another day peddling their nonsense to gullible fools and get off scott free as there is no regulation of these clowns.

    So you can see the double standard here. If I were to embrace CAM treatment for acute appendicitis and give the patient a colonic and herbs and he dies, (with 100 % certain) I am charged with malpractice and a million dollar law suite. And the CAM artiste? Well if he treated the fellow and he died and he does not even know that, because the person does not die in the CAM’s office but in the ICU with septic shock. What then? Liability? Zippo.

    What a farce.

    I am mad, not at CAM but at the SPINELESS politicians and administrators who are embarking on this road of junk science. Regarding the training of medical students. How is it possible that anybody who has done physics, chemistry and biology 101, believes in such BS. They have to reject the scientific method to embrace this nonsense, and that is really frightening. Ditch the science and go off and embrace junk. Suggest to me that they were not taught properly in the first place. Or is it the lure of money mixed up with a complex system of beliefs, cultural or otherwise?

    These CAM folk cant possibly believe that the nonsense they are selling is scientific at all. Pseudo science mumbo jumbo? Yes! Junk science? Most definitely. But is it Science, real science? Please don’t annoy me. Could the majority be fraudsters or deluded What other conclusion can you come to, apart from delusional thinking aka psychosis or fraud. Thats it. Unless you would like to invoke a third possibility i..e a belief system akin to religion? Now we we are really slipping down the slippery slope to
    nowhere.

    Note the lexicon for CAM use to be snake oil salesman and quackery . Now we are no longer talking about Chiropractic, Naturopathy or Homeopathy – but twin LIES embodied in the term CAM.

    1) Complementary – add some reflexology i.e. foot massage after a coronary stent was placed. Sure that should help.
    2) Alternative – really ! Treat a persons fracture with herbs and spices? Treat a person with a fractured skull and intracranial bleeding with Tai Chi +some chiropractic neck manipulation + iridology and a whiff of reflexology. Sure why not. Open your mind to the wonderful world of CAM.

    And the end result anybody? – Stone DEAD patient.

    Cheers

    VC