Should medical students be taught alternative medicine?

Should medical students be taught alternative medicine?

The BMJ has a point-counterpoint essay in the March 28 issue called Should medical students be taught alternative medicine?.

The "yes" vote argues that patients are going to use alternative medicine and that some alternative interventions are effective:

ginger and acupressure for reducing morning sickness in pregnancy, and acupuncture and massage for persistent low back pain.

Not. He evidently is not a regular reader at Science-Based Medicine and he also succumbs to the propaganda that includes diet and exercise as "alternative." He also a what's-the-harm shruggie in promoting pseudo-medicines:

We may not require a randomized controlled trial to know that aromatherapy makes some patients feel better or that yoga has benefits. Learning to work well in partnership with patients is an essential skill for all of us and not only medical students.

The "No" vote argues that there is no science to support alternative therapies and that

In medicine, there are few concepts as seductive yet utterly devoid of scientific merit as alternative therapies. Doctors must be aware that these exist, and that they have limitations and contraindications, to help patients to make informed decisions about using them or not. Beyond this, we argue that teaching alternative medicine to medical students is illogical and a waste of time. It is unethical to indoctrinate students when they might not yet have acquired the critical skills to decide for themselves whether a particular therapy is effective, safe, and affordable. Moreover, it takes a great deal of courage for medical students—especially in their junior years—to challenge or contradict their teachers.

I think the answer is yes, but more importantly, it is how CAM is taught that is important. The key phase was in the 'No' argument:

when they might not yet have acquired the critical skills.

As far as I can tell, never gonna happen. Critical thinking is not part of medical education where the sheer volume of information that has to be absorbed often precludes learning how to think.

I wish I had the time to develop a CAM curricula, as there is more to be learned about how to evaluate reality-based medicine by carefully dissecting a pseudo-medical paper than will ever be learned from a journal club concerning the latest angina treatment trail. Because CAM is different from reality-based medicine, and because of those differences you cannot apply the typical teaching modalities used in medical training. Those differences are

1) CAM is a spectrum of propaganda definitions. Diet and exercise are not CAM, but called such. It is rarely mentioned that CAM is a marketing tool that covers everything from the well established diet to the totally wackaloon of homeopathy.

2) Unlike real medicine, much of CAM is not based on known reality. Homeopathy, reiki, acupuncture, applied kinesiology, chiropractic etc etc are based on fiction. It serves as an excellent starting point for understanding Bayes theorm and statistics.

3) Most of CAM exists because of the failure of clinicians, CAM practitioners, researchers and patients to recognize and apply all the cognitive biases that make it easy to decide that internal mammary artery ligation is an effective treatment for angina or that acupuncture relieves pain.

4) The most important difference between CAM an reality-based medicine is that reality based medicine changes with the data. The "Yes" writer notes

Good doctors have always had the flexibility to change their practice in the light of new evidence and patients have benefitted.

Which begs the questions: has there ever been a CAM therapy that has changed in light of new evidence? Are there any quality improvement studies in the world of CAM? I have asked this before and I am still waiting for an example.

CAM should absolutely be taught in medical school, but not as part of an

undergraduate curriculum for promoting treatments that are not underpinned by hard evidence that they work and are acceptably safe.

but as object lessons on critical thinking, the medical equivalent of Scared Straight. Students learn valuable critical thinking skills by the examining the examples where it was applied so horribly wrong.

Points of Interest: 4/02/2014
Points of Interest 4/1/2014