Time to Cut Funding For CAM Education in Medical Schools

It is difficult to determine the number of people who use Complementary and Alternative treatments. CAM practitioners and supporters do their best to make the numbers as high as possible so they can make the argument that the public demands their services. One of the methods they use to inflate the numbers is to include lifestyle changes such as increasing exercise and improving diet alongside the more ridiculous treatments such as Reiki and Homoeopathy. A recent study conducted in the USA looked at the issue.

In December 2008, the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention) released new findings on Americans’ use of complementary and alternative medicine (CAM). The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under. A similar CAM section was included in the 2002 NHIS, providing the opportunity to examine trends in CAM use, too.

The details of this study are discussed in depth by Brennen McKenzie at Science Based Medicine  where he digs into the article and explains how the NCCAM report overstates the uptake of most types of CAM. Despite this, supporters have used this supposedly to insinuate themselves into medical schools to an alarming degree. Four researchers from the Indiana University School of Medicine looked at the amount of CAM being taught.

The topics most often being taught were acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%).

Again, the inclusion of relaxation and nutrition are not necessarily indicative of CAM, although there is much diet advice based upon non-scientific principles.  These courses are also mostly taught by CAM practitioners, and do not emphasize critical evaluations of the practices.

On the other hand, in the UK, enrolment in university programs in CAM have been decreasing over the past few years. In 1992, John Major’s administration created 66 universities which were able to award complementary medicine degree, however lately improvements have been seen.

The number of bachelor and masters degrees in subjects such as reflexology, aromatherapy, acupuncture and homoeopathy has halved since 2007, from more than 40 to 21. Many of the surviving courses are under review.

The closures are partly the result of a campaign led by Dr David Colquhoun, professor of pharmacology at University College London, and the rationalist pressure group Sense about Science. In 2007, when alternative medicine was highly popular, 16 state-funded degree-awarding institutions were offering 42 fully accredited BSc/BA courses in 12 non-evidence-based forms of medicine. These included ayurveda, naturopathy, therapeutic massage and homoeopathy.
Dr Colquhoun said: “Universities are using shocking teaching, like suggesting that amethysts emit high ‘yin energy’.”

We cannot underestimate the effect of the loss in court of the British Chiropractic Association in their libel suit against Simon Singh, who challenged their grandiose claims of medical cures. As a result of that case, 25% of chiropractors were investigated for making unsubstituted claims for their procedures. The end result of these campaigns is that funding bodies, particularly the British government, have dropped support for CAM education.

Enrolment in acupuncture and other ‘complementary medicine’ programs has fallen in Britain. A University College London pharmacology professor has led the charge to drop public funding for teaching ‘quackery.’
Starting this year, it will no longer be possible to receive a degree from a publicly-funded British university in areas of “alternative medicine,” including homeopathy, naturopathy, and reflexology.
Derby University, in the Midlands of the United Kingdom, said that as of 2012 it was shutting down its complementary medicine department. Meanwhile, the University of Westminster, in central London, which used to be the country’s leader of alternative medicine degrees, is no longer taking on new students in this area of study for the fall 2012 semester.
Until last year, students at Salford University in Manchester could take a bachelor of science degree in homeopathy, Chinese medicine or acupuncture – all disciplines regarded as non-scientific in the wider science community.

Here in Canada, we are not as advanced as Britain in the removal of such non-science based medicine from our medical schools. There is an organization called Complementary and Alternative Medicine Issues in Undergraduate Medical Education (CAM in UME), whose stated goal is to increase knowledge of CAM modalities in Medical Schools. While they make the claim on their website that they are not actively promoting CAM, some of their largest funding organizations are CAM related.

Whether this group is behind the examples below or not, the following courses at Canadian medical schools are a blight upon the medical education and practice in this country. This is not meant to be any sort of an inclusive list; merely a sampling of some Canadian schools, and what I found disturbed me greatly.

McMaster University has an Acupuncture Program  that according to their website meets the accreditation standards of the College of Physicians and Surgeons of Canada, the The Royal College of Family Physicians of Canada, and the Worker Safety and Insurance (WSIB) of Ontario.

At McGill University, one of the elective courses is Acupuncture: Theory and Practice.

This program is offered to the senior student who already has some clinical experience with patients in Medicine, Surgery, or Psychiatry. The acupuncture theory would be introduced to the student, and practical application to patients in a clinical setting (private clinic). The literature on the relationship of endorphins and acupuncture would be reviewed.

The University of Manitoba Association of Medical Students has a list of groups, one of which is the
Integrative Medicine Interest Group (IMIGATUM)

Called IMIGATUM (Integrative Medicine Interest Group at the University of Manitoba). We will be hosting events such as acupuncture clinics, pre- and post-exam stress relief, yogadance instruction (yes, YOGADANCE), and many more.

Memorial University has a clinical elective titled Urban Family Medicine  available for 3rd and 4th year students and is taught at the Shea Heights Health Care Centre. More information here and here.

Shea Heights Health Care Centre is a unique clinical experience on the periphery of St. John’s. The community has a well defined “rural” atmosphere and the health centre demonstrates a multidisciplinary aproach to health care. Working with public health, social workers and community health nurses gives residents a true experience of teamwork. Intra partum obstetrics, house calls and acupuncture are a few more features. The practice accomodates two residents for each rotations.

At Dalhousie University in the chronic pain management clinic acupuncture is a regular part of treatment.

The Queen’s University practice guidelines for arthritis  include electroacupuncture for moderate to severe osteoarthritis of the knee.

University of British Columbia also has an elective that places students in a setting to learn from CAM practitioners.

This elective places students in clinics with preceptors who are not only medical doctors but also practitioners of complementary therapies. Each student is rotated between a few doctors – with one per doctor at a time – in order to maximize a close-up, first-hand exposure to special interests, skills or healing modalities that are not generally taught in medical school. The preceptors have appropriate training in their fields of special interest that have been incorporated into their scope of medical practice. Most are general practitioners or family physicians practising integrative medicine.

The student is afforded the opportunity to observe, first-hand, physicians practising complementary therapies, including some of the following: acupuncture, traditional Chinese medicine, Ayurveda, homeopathy, psycho-spiritual medicine, Shen therapy, neural therapy, orthomolecular medicine. There will not be any promotion of one therapy or system over another; furthermore, this elective is not a training course that enables the student to immediately use any of the therapies. However, this elective will serve to broaden the student’s mind and horizon.

Finally, the University of Saskatchewan has an integrative medicine centre where the centre’s faculty have expertise in:

medical acupuncture, Traditional Chinese Medicine, medical anthropology, nutritional medicine, natural health products, mind-body practices, integrative pain medicine, massage and bodywork, health education, decision sciences, research methods and multivariate statistics.

They also sponsor a twice monthly seminar

The Integrative Health Seminar is intended to promote innovation in health care by building bridges between research, education, practice, and public policy across a wide spectrum of medical specialities and health-related disciplines.

I readily admit that I have no personal experience with the education at medical schools, and the list I have accumulated here was developed via a number of searches on the med school sites.

Universities in Canada receive a large amount of their funding from governments, with the amount being even larger if you consider government student bursaries and subsidized loans. I also have no figures on the number or amount of government grants that are offered to university research institutes to study some of these modalities that have already been totally discredited.

We depend upon our physicians to give us advice based upon evidence and science based medicine.  We expect them to be well educated and taught to critically evaluate the treatments they recommend to us. Teaching CAM in medical schools is exactly the opposite of how we need to train our doctors.

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Very shortly after I posted this, I came upon this post by Steve Novella at SBM.

 

9 Responses to “Time to Cut Funding For CAM Education in Medical Schools”

  1. I think there’s a difference between being informed about CAM and being taught CAM. Med students should be informed about it (how else can you explain to someone why homeopathy doesn’t work but statins will?) in a skeptical way so they can identify what their patients are telling them. However, I totally agree – we’re supposed to be taught medical science. Obviously there is also a lot of art to medicine, but clinical judgement needs to be founded on rational thought and a scientific knowledge base.

  2. jrkrideau says:

    Woo in the med schools Argh!

    I thought there was a new Evidenced Base Medicine wave. Obviiously I missed something in the last few years.

    Links problem — The McGill and UBC links don’t seem to be working.

    Re the
    Re: Univ of Manitoba Integrative Medicine Interest Group

    This appears to be a student group. It may not say much for the critical thinking skills the university is teaching its students but, at first blush,I am not sure that it means that UM’s medical school is teaching CAM. Let’s hope not.

    The blurb reads more like a social club :)

    Re: the Queen’s University practice guidelines for arthritis

    I notice that this is not actually a Queen’s publication but rather one from the Arthritis Society. I wonder how it got in there?

    What appears to be the latest Cochrane Review “Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis” does not particularly support the use of electro-acupuncture but does not completely dismiss it but that’s based on only one study.

    One would hope that Queen’s professors have noticed this and point it out.

    What also got me in the guidelines was “injectable gold” but it apparently is a legitimate drug.

    • Thanks for the heads up about the links. I think I have them fixed now. At least they work for me.

      I know that the Manitoba group is a student group, but its existence speaks to the school attitude towards TCM.

      On the guidelines from the Arthritis society, I found it off the Queen’s University site, so I assume the school endorses the document.

      Cochrane Reviews have a history of being more friendly to CAM than they should be. As has been discussed at SBM, they follow evidence based rather than science based medicine approach. The difference is that SBM includes prior plausibility, EBM does not. There are enough studies comparing ‘real’ acupuncture to ‘sham’ acupuncture that have shown that there is nothing to suggest that acupuncture has any impact whatsoever.

  3. jrkrideau says:

    Links seem fine now. Thanks.

    I had not realised that there was that distinction between SBM and EBM. I just thought that the E in EBM would imply scientific evidence. I’ll have to do some reading.

    “On the guidelines from the Arthritis society, I found it off the Queen’s University site, so I assume the school endorses the document. ”

    I see your point. To be honest, it is such a small thing in relationship to the courses at UBC or McGill that I think it’s trivial.

    Still, I’d to hear from the Queen’s med school. I’m just down the road so maybe I’ll give them a call or drop in.

  4. neurochick says:

    Check out the University of Lethbridge’s new endowed professorship in Health Sciences for Alternative and Complementary Medicine or whatever the title is. Most of the professors are so ashamed that they want to find a rock to crawl under. Students are desperately trying to dissociate themselves from the school of health sciences. Some of the best of the best scientists in various disciplines burst into tears when the announcement was made. So yep, give it to the masses, and the whole concept of a university is eroded once again. If they were going to hire a person to thoroughly test these claims (as the press release said it would be an “evidence-based program” that would be great regardless of the outcome, but NO… the dean of nursing welcomes the use of all sorts of stuff from chiropractic to homeopathy as being used by modern nurses. HELP!!!!

  5. Robyn Safarian says:

    I’m afraid dismissing alternative medicine is a bit arrogant. As a medical doctor I would have liked to learn more about a holistic approach, which at the time I did my studies wasn’t even in the curriculum.

    The problem is that the current trend in medicine calls for ‘treat the symptoms’, until the next one pokes out. It is a very disjointed and dismissive approach to health, one that doesn’t consider the full complexity of our system.

    Admittedly, one should take many of the alternative options with great caution, as they have no scientific evidence behind them. However, if we shut the door on them we will never get the scientific evidence that may support their use.

    Let’s be cautious but have an open mind on the subject.

    • I don’t see any arrogance in dismissing treatments that have no science behind them. I am sorry that as a medical doctor you see a trend towards treating the symptoms. That, I believe, is a problem in your own approach to medicine. I have had the same family doctor for 20 years, and he has always used a ‘holistic’ approach. He knows my children and asks about them, my relationships and my other life circumstances. Holistic does not mean the use of CAM.

      Since virtually all of the evidence points to the uselessness of CAM, dismissing those treatments is the only reasonable approach.

    • I’m not sure which medical school you attended, but at mine I am yet to see any philosophy that reduces medicine to “treat the symptoms.” They teach us to work backwards from the symptoms to the underlying causes and pathology, and treat from there. There are times and places where treating the symptoms is actually appropriate and humane – palliation is an incredibly important aspect of the health care system, and I wouldn’t want to be part of a system that ignored symptom treatment when pathology treatment was not possible.

      It’s not about shutting the door on alternative medicine, it’s shutting the door on teaching medical students about things which have no supporting evidence. Physiologically plausible and poorly studied “alternative” medicines should be studied, but by the time they’ve been scientifically validated as useful in clinical practice, they’re suddenly no longer alternative, now are they? There is no time to get into the nuances of alt med and the scientific evidence for and against it in medical schools. This is an undergraduate degree where we are supposed to be information sponges, not graduate-level data analysts. I don’t spend a lot of time questioning every treatment professors recommend because there is simply no time to do so. If professors present claims about acupuncture and homeopathy as being beneficial, how many students are going to bring that forward into their practices without ever being given the chance to question it? Medicine without a scientific basis, alternative or not, has no place being taught in medical schools.

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  • John Underhay

    John Underhay, also known as Peicurmudgeon, is just your average atheist, left leaning, SCUBA diving, snorkeling, biker. He lives on PEI and spends some of his time attempting to point out the flaws and or dangers in promoting ideas that run contrary to the laws of physics, chemistry, or biology. He has a BSc (Biology) and an MSc (Pharmacology) from the University of Prince Edward Island, and is currently retired. You can read more of his posts at http://peicurmudgeon.wordpress.com/