Alternative medicine

Most medical schools offer courses in alternative medicine. Here’s how to avoid quackery.

Toronto is once again at the center of a pseudoscience scandal. This time it’s medical quackery taught at a prestigious university.

The University of Toronto offers a course for undergraduate students called “Alternative Health: Practice and Theory”. The teacher is a follower of homeopathy, a practice that defies the fundamental laws of science and whose effectiveness is not proven. Readings include anti-vaccine docs and a glorifying article Andrew Wakefielda discredited medical researcher who used fraudulent research to fabricate a link between measles vaccines and autism.

But what’s even more incredible is that a senior university official investigated the course and determined that there was no reason to worry.

In one three page review, Dr. Vivek Goel, vice-president of the University of Toronto, argued that the students would have already taken science courses by the time they were exposed to the alternative medicine course. He then offered this conclusion:

I do not find that the instructor’s approach in this course has been, or reasonably would have been seen to be, unbalanced in that it deviates from a presentation of material which, in the context, would permit an analysis review and investigation. Thus, from the point of view of university pedagogy, I do not find that there has been enough deviation from the range of normal approaches to warrant concern.

Not everyone agreed with his assessment. Jen Gunter, OB-GYN in San Francisco, offered this outraged hold:

No medical, nursing, or basic biology/immunology textbooks or articles are referenced in the required reading, nor is any information from Health Canada or the World Health Organization. Instead, required reading/viewing and additional information for students (i.e. what they will learn and therefore take away from the course) includes Andrew Wakefield (who lost his medical license for falsifying data in a now infamous study with falsified data) and anti-vaccine propaganda sites.

At least 90% of US medical schools now teach alternative medicine

This scandal is emblematic of a challenge that all universities, especially those with medical schools, now face: how to deal with alternative medicine. After all, many patients are now requesting services like homeopathy and acupuncture, so there are good reasons medical professionals should at least know about them. Some practices, such as forms of herbal medicine or yoga, even have compelling evidence of benefits. But too often these practices are not based on science – and universities must be careful not to teach outright quackery.

The University of Toronto is not the first university to struggle with this. georgetown has a “mind-body” medicine program for medical students. the University of Michigan has a similar course. TV fame Dr. Mehmet Oz helped bring alternative therapies, from reiki energy healing to homeopathy, to the operating rooms of Columbia University. The University of Arizona has launched a medical scholarship in alternative medicine under the guidance of renowned physician and holistic healer Andrew Weil.

In total, according to the Association of American Medical Colleges, of the 132 medical schools across the United States that responded to a survey question last year about whether they offered courses in alternative medicine, 126 declared having done so in the compulsory courses. There are approximately 140 universities granting MD degrees in the United States, which means that the vast majority of medical schools are now dedicated to teaching alternative medicine.

What is the best way for universities to teach alternative medicine?

Considering this, I asked a few people who have faced this conundrum to comment on the best way forward.

Brian Deer, an investigative journalist who uncovered Andrew Wakefield’s fraud, wrote in an email that courses like the one at the University of Toronto need to be balanced and properly funded:

Does the university expect students to read the findings of the Statutory Tribunal of the General Medical Council of the United Kingdom against Wakefield regarding (1) financial fraud, (2) research fraud and (3) two counts of lies common to doctors and scientists, or the judgment of the British Medical Journal that his work was “an elaborate fraud”, or the Lancet editor’s retracting comments on Wakefield’s research, in which the editor has said the newspaper had been “cheated”.

Edzard Ernst, an expert in the science of alternative medicine and emeritus professor at the University of Exeter, said students should learn the evidence for and against alternative therapies. In order to present this kind of fair and balanced point of view, he added, it is helpful not to have evangelists and practitioners as course leaders:

Alternative medicine should be taught dispassionately based on existing evidence which is positive in a few cases and negative in the majority of cases. The problem is that currently most medical schools delegate this task to enthusiasts of the respective therapies. So a homeopath could instruct medical students and tell them a lot of nonsense about homeopathy. I’ve seen this happen too often.

David Gorski, a cancer surgeon at Wayne State University School of Medicine, who wrote about the issue in the journal Naturebelieved that proven alternative practices – from yoga to special diets or meditation – should not be part of a special program, but rather be incorporated into the regular health or medical program.

“There is no reason education about lifestyle practices or diet should be taught in alternative medicine. They should just be taught in medicine,” he said over the phone, adding: “There are proven drugs and unproven drugs. When something alternative has been proven to work, it becomes a drug.”