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.