Thursday, December 18, 2008

How to bring woo to an academic medical center

This paper, which could have come straight out of the Quackademic Medicine playbook, tells how it was done at two institutions in Canada. To successfully integrate woo into an academic medical center you need a promoter and a Trojan horse.

The promoter, aka the champion:

Our results suggest that a highly respected champion is necessary for the development of a new integrative medicine program. Both these programs were highly dependent on the efforts of champions with visions who were able to mobilize a wide range of individuals at many different levels within the health care system in order to facilitate the actualization of these integrative medicine programs..... What is most important is that the champion has credibility within the host institution, as well as with patients and clinicians who will work together in the integrative medicine program.

The Trojan horse (italics mine):

CARE began with only a consult service and to date does not include a chiropractor among the team members despite the high use of chiropractic among children. Similarly, the chiropractors in the SMH clinic began by explicitly limiting their legally-defined wide scope of practice to musculoskeletal conditions. However, as referrals and comfort levels increased over time, the SMH chiropractors have seen a wider range of referrals and increasingly have been asked to provide 'second opinion' level service when their physicians are unsure of the diagnosis (ie, because of diagnostic uncertainty, they will defer the diagnostic opinion to the chiropractors). This suggests an evolution in the physicians' level of trust and confidence towards the chiropractors. In both settings, the CAM providers were being integrated into conventional medicine contexts and as such, there was a degree of conventional medicine dominance created by the existing structures as has been described previously. In both clinics, the CAM providers were required to initially limit the scope of their activities in order to gain access to the integrative setting.

“Trojan horse” is a figure of speech I borrowed from Orac, who invoked the concept about a year ago to describe how pseudoscience gets its foot in the door of the academic medical center:

In reality, what bothers me about the whole concept of CAM is that it's basically a Trojan horse through which some therapies that might be evidence-based and could easily be integrated into our standard armamentarium of medical therapies are the "foot in the door" behind which hardcore woo lumped together as CAM follow, woo such as homeopathy, craniosacral therapy, reiki, and even reflexology, all of which I have encountered on wepages for academic centers devoted to CAM.

1 comment:

Anonymous said...

I live near one of these fin medical centers and am absolutely APPALLED by this foray into stupid. I have been for about three years, when I first found out about it and the Hope Foundation which is another nutty institution that promotes woo. This was all brought in during the realm of a health minister who put their name and face on an essentially CAM practice advertising booklet.... and who is now finance minister. You can just imagine how we are doing financially these days!