Saturday, November 12, 2005

What is happening to our medical schools?

Abraham Flexner is turning over in his grave.Almost a century ago Abraham Flexner, a secondary school educator, was commissioned by the Carnage Foundation to study medical education in the United States and Canada. The conclusion of the Flexner Report was scathing. Medical education was a sorry state of affairs. (Download the original report here ---large pdf file).

As a result of the report medical schools closed, others merged, and those that survived instituted major reforms. Medical education for the twentieth century and beyond was to have scientific underpinnings. The Flexner Report has since been celebrated as a pivotal document in medical education.

But what would Abraham Flexner think of medical education at the dawn of the twenty first century? Have medical schools backslidden? Sadly, medical education has forgotten some of Flexner’s warnings, as evidenced over the past decade by the increasing uncritical acceptance of unscientific teaching in the medical curriculum. This conclusion is supported both by systematic research and examples such as this uncritical homeopathy promotion by the University of Maryland Medical Center. (Thanks to the Health Fraud List for this link).

I do not oppose the right to teach or practice alternative medicine, or patients’ rights to choose it. The problem is that much of alternative medicine is a separate realm, outside the biological model. Thus it can not “complement” science based practice nor can it be “integrated” with it. Yes, it’s a free market place of ideas. The homeopath, the colonic irrigator and the herbalist have every right to compete in this market and patients have a right to choose. I would submit, however, that their practices cannot be integrated with mine. And, although medical students need to be made aware that such practices exist, medical schools should not be promoting them.

Flexner asserts precisely this notion. Let’s examine a portion of the Flexner Report concerning science based medicine. (The portion of the Flexner Report discussed here has been reproduced on this page from Homeowatch). Referring to homeopathy and other unscientific methods as “dogma” the report notes “The ebbing vitality of homeopathic schools is a striking demonstration of the incompatibility of science and dogma. One may begin with science and work through the entire medical curriculum consistently, exposing everything to the same sort of test; or one may begin with a dogmatic assertion and resolutely refuse to entertain anything at variance with it. But one cannot do both. One cannot simultaneously assert science and dogma;”. So, from this passage in Chapter X of the report comes a strong message: institutions of medical education must decide what they’re all about. Choose science or choose another path. One or the other please, not both. Clearly Flexner’s mandate left no room for “complementary” or “integrative” solutions.

Another offering from the University of Maryland School of Medicine Center for Integrative Medicine is Reiki. The course description for Reiki level II says the student will learn to “send distant healing to others as well as to past or future events.” Maybe Harry Potter should apply. In the Advanced Reiki training course the student will “learn how to use crystals and stones with Reiki and create a Reiki grid that will continue to send Reiki to yourself and others after it is charged.”

This sort of thing is going on to an increasing degree at numerous medical schools. Here’s a sampling from the University of New Mexico Health Science Center. Or, just Google up any medical school and combine a search term for your favorite alternative modality.

I hope our medical schools don’t devolve into institutes for the eclectic healing arts. In 1910 Abraham Flexner cleaned house in American medical education. By 2010 we may need him back.

15 comments:

james gaulte said...

Your post is eye opening and frightening.The establishment of alternative medicine clinics by some medical schools clearly promotes and legitimizes activites that are outside of the realm of science and rational analysis.How did this happen?

howard_coward said...

We must be at a Kansas med school

Anonymous said...

Kansas? Maryland is as "Blue State" as they get!

Anonymous said...

As a "recipient" of some alternative healing therapies, I believe the main reason the medical schools don't want to teach alternatives is because the schools are probably beholden to the pharm companies, and would probably stand to lost lots of bucks if future-docs knew they could *sometimes* tell their patients about alternatives that could treat their conditions MUCH cheaper than the drugs offered by the big pharms.

R. W. Donnell said...

To "anonymous" who said "I believe the main reason the medical schools don't want to teach alternatives is because the schools are probably beholden to the pharm..." My point is that med schools *do* teach alternatives. Not all of them, but certainly in increasing numbers! And yes, the money from pharma is influential but it works both ways. There's a lot of consumer pressure driving the market in favor of CAM and the med schools have noticed. Add to that the enormous infusion of *public* money and the result is considerable financial interest on the part of medical institutions in the promotion of CAM.

Anonymous said...

There is no such thing as alternative medicine. There is medicine and there are untested hypotheses (or disproven ones). If you think that holding your hands over someone's head and moving their energy around can cure something put it in a randomized double blind study and publish in a peer reviewed journal. If it works I'll refer patients to you. If not, I won't. I don't care if it's a drug, surgery, or reiki. If it's not reproducible and testable, it's not medicine.

BladeDoc

Sara said...

Hey, Hey. We don't endorse alternative medicine in Kansas medical schools! (Alternative science with regard to other issues and one of our wayward researchers aside.)

R. W. Donnell said...

Anonymous said "There is no such thing as alternative medicine. There is medicine and there are untested hypotheses (or disproven ones)." Perhaps "alternative" is a misnomer. I agree that there is medicine that has been proven to work, and that which has not. There is no "alternative" to treatment that works.

Anonymous (speaking of *Therapeutic Touch*) also said "If you think that holding your hands over someone's head and moving their energy around can cure something put it in a randomized double blind study and publish in a peer reviewed journal. If it works I'll refer patients to you." Not so fast---Therapeutic Touch has no biologic plausibility. It fails the first test. It has already been debunked empirically, but if someone "studies" it enough times sooner or later chance variation will produce "positive" results. So, if a RCT shows a positive outcome at a p value of 0.04 what would it mean? Chance variation would produce the desired result 4% of the time. On the other hand negative empiric studies never convince a true adherent. That's the kind of trouble you get into when you try to study baseless implausible methods. Yet big bucks are coming out of our pockets to attempt just that.

angry doc said...

Glad to see I am not the only one who feels this way!

We had a discussion about integrating the concepts of 'alternative' medicine with 'western' medicine on my blog recently.

http://angrydr.blogspot.com/2005/11/clues-for-clueless-chapter-2.html

Thank you.

Anonymous said...

I don't understand why so many physicians feel so threatened by CAM. True, CAM is often not testable by the methods used to "prove" other treatments. But as any good doc will tell you, evidence based medicine is not the end all of helping patients. There are always alternatives to any treatment, and by refusing to acknowledge the utility of these, we sell ourselves and our patients short.

R. W. Donnell said...

Anonymous said...
"I don't understand why so many physicians feel so threatened by CAM."

I can't speak for other physicians, but I am not threatenet by CAM in the least. The boosters of CAM have every right to compete with "mainstream" in the market place of ideas. In fact, I don't criticize CAM as much as I do mainstream medical schools if they promote pseudoscience while claiming to have scientific underpinnings. It's just intellectually dishonest.

R. W. Donnell said...

To Angry Doc---
Yes, that's an interesting thread you've got going. I'll post a link.

angry doc said...

Thank you, Dr RW.

I think 'intellectually dishonest' sums it all up.

jasmine said...

These days most of the medical schools are being hold by pharmaceutical companies .Schools do whatever those people tell them to do and teach them whatever they say.

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Anna

Holistic Rehab

Anonymous said...

This is very sad and pathetic article, but than again it was published in 2005. Glad to see more people have their eyes open now, and see that all modern medicine does is teach "established truth" based on outright lies (the Dr. Reuben scandal, anyone?). And then attack any doctor's character or intellect for asking uncomfortable questions or exploring natural healing.