Monday, December 10, 2007

Medical Schools Struggle to Integrate "Integrative Medicine"

Medscape posted a thought-provoking essay on how medical schools are integrating "integrative medicine" into their curriculae. Its take home message: bad idea.

I agree. Find our why here.
Medscape posted a thought-provoking essay on how medical schools are integrating "integrative medicine" into their curriculae. Its take home message: bad idea.

I agree.

The article discusses the Flexner Report which was indeed a remarkable document in its day. The authors make the point that it is no less relevant now. 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. Traditional western medicine is increasingly being viewed as dogmatic, uncreative, and narrow-minded. Alternative modes of healing are seen as more holistic and somehow more natural.

I don't object to anyone following the call of their own belief system. But it is becoming less politically correct to argue against the incorporation of nonwestern therapies in modern medical practice.

Don't get me wrong. I would whole-heartedly embrace the most bizarre witchcraft imaginable...if it made people better and alleviated suffering. I wouldn't even demand that such therapies actually cured anyone. Unfortunately, so many of these treatments (herbology, accupuncture, magnets, crystals, magical incantations, channeling through my neighbor's beagle, etc.) have not been proven effective.

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.

I remember a committee meeting of one of the two major private hospitals in a community where I used to practice (a highly regarded institution with a solid medical staff). A family practitioner on staff outlined a marketing push to promote our institution's support of alternative medicine (it wasn't called integrative medicine at the time). Some of us on staff were stunned that this hospital would risk its reputation on something so obviously non-evidence-based.

When she was asked about this, her response was simply, "Well, everyone is doing it and if we don't get on the train now, we'll be left behind." What an inadequate, wishy-washy excuse. Ultimately, the hospital caved.
It's disturbing to read that (as documented in the article) these same changes are happening in our nation's medical schools as well.

And now, a personal anecdote. I once tried to learn accupuncture. I signed up for a very sophisticated, very rigorous course (that involved many hours of training). I read the textbooks, memorized the meridians and the accupuncture points (it was harder than gross anatomy). 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". I just couldn't get away from the ludicrous silliness. It was like watching a movie where the characters were so poorly drawn, the storyline so utterly absurd that I couldn't achieve the suspension of belief needed to enjoy it.

I am an integrative medicine failure. I am a philistine.

Update: Read this post by Orac.

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Blogger mark's tails said...

Sad but true CMM, as I am sure you know from Orac's recent posts over at respectful insolence. It is becoming more pervasive at my institution as well. Last year as I was leaving for the evening I noticed a big sign for those participating in the 'Reiki study', no word on the results or a publication which makes me even more nervous. Are they going to publish negative results?

December 11, 2007 6:40 AM  
Anonymous Anonymous said...

My hope is that market forces will drive us towards therapies that are proven effective. When budget crunches worsen, we won't be able to afford wasting resources on magic. Evidence based therapies have to win out in the end because they work - though there has always been, and will always be, a market for snake oil. Physicians have been passive about CAM because they don't understand it - or erroneously believe that it's harmless enough, so it can be ignored. But when they realize that their medical oncology grants are being denied because resources are being allocated to the study of homeopathy - then they will take a stand. Sadly, money may speak louder than scientists themselves.

December 11, 2007 8:34 PM  
Anonymous Anonymous said...

I respectfully disagree, and as somebody who actually was on several medications that almost killed me and got better when a doctor merely guided my immune system to do what it was intended to do, well, I'm glad that my med school teaches integrative medicine.

Oh wait, I see a Michelle Malkin link on the side. I guess I shouldn't be surprised by your take. Unfortunate.

December 18, 2007 10:40 PM  

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