Wednesday, December 12, 2007

Confessions of an integrative medicine failure

A favorable blog reaction to our Medscape Roundtable on integrative medicine taught in medical school was posted by California Medicine Man. Concerning the Flexner Report, the focus of our article, he notes:

The original report published in 1910 covered a lot of ground but a central point was that medical education needed to be based on data-driven scientific knowledge. Flexner eschewed hokey, unproven, unquestioned dogma and established that modern medical education needed to do better than that.While I have not studied the extent to which medical schools of today are getting away from that paradigm, it seems that we are to some degree. Integrative medicine is the new big thing.

California Medicine Man works in academic medicine. He sees the woo invasion first hand. He asks:

So why give these treatments the prestige that explicit support by allopathic medical schools engenders? It would be one thing if the principles of integrative medicine were being presented simply as information med students need to be aware of. It can be argued that such knowledge will facilitate communication with their patients (many of whom are using or considering such therapies). But that's only part of it. As the article discusses, fewer and fewer judgments are being made as to their validity and they're being presented as legitimate alternatives to standard treatments.

In other words, medical schools are putting their good names and scientific reputations behind pseudoscience. As was pointed out in the Roundtable article, non-evidence based and implausible health claims are being promoted rather than critically examined.

Naturally I like California Medicine Man’s post because he agrees with me, but what’s most interesting is his personal anecdote about an intense, sophisticated acupuncture course (there are a number of CAM courses offered by mainstream academic institutions). He writes:

I read the textbooks, memorized the meridians and the accupuncture points (it was harder than gross anatomy).

Sure it was, especially given the lack of any consistent definition of the points let alone any rational basis for their locations.

He goes on:

I learned the different diagnostic protocols, the personality types, etc. I practiced "feeling the Qi" when placing the needles in my classmates. I failed miserably. I simply couldn't do it. I've asked myself many times why this discipline so thoroughly eluded me. The bottom line was that I just couldn't "let go".

Evidently in this, one of the more sophisticated and rigorous courses available, the learning was experiential and subjective, requiring the student to suspend critical thinking. But the California Medicine Man just couldn’t do it. That’s why he describes himself as an “integrative medicine failure.”

I have read the CAM web pages of numerous medical schools and the extensive promotions by the American Medical Student Association. In most cases the subjective, experiential and promotional approaches to CAM seem to dominate their educational efforts. Not a healthy trend in my view.

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