Wednesday, July 18, 2007

CAM and higher education

A tragedy in the making?
During the course of clinical practice, veterinarians (and physicians) often encounter a variety of circumstances that affect the daily course of administrating care to a patient. They can either be a hindrance or a help towards the goal of attaining the most appropriate medical treatment for a given individual.

For example, refusing a blood transfusion or declining blood work can greatly impede ones ability to treat or diagnose whereas people jumping in line to donate an organ opens the doors to previously impossible therapies. Such is the way of clinical practice as the doctor blends his or her experience, current available science based knowledge, and the patients (or owners) perspectives in order to come up with a “do-able” strategy. These approaches vary depending upon the balance between these spheres of influence and often translate into unique therapeutic approaches. The ultimate goal is to find an effective balance that is heavily tempered with the hammer of scientific methodology.

In other words, even though an elected therapy may vary in some way depending upon a given situation, it needs to “pass muster” so to speak. It needs to demonstrate a level of effectiveness, plausibility, and repeatability that results from steady and rigorous inquiry from a serious- admittedly imperfect- community of humans involved in an intense endeavor; the search for reality based solutions.

This has been the responsibility society has given to the medical community, especially in the last century. Though the nature of healing may have a seemingly infinite set of variable influences and built in uncertainties, it has been wisely placed under the guiding light of methodologies that allows for consistent and tangible results.

Herein lays the growing concern when faced with a set of practices that walk away from these hard won lessons regarding healing. Though science is not a cult, religion, or some particular “post-modern” version of reality there are those who think that it is one or all of these things. Due either to misunderstandings, misrepresentations, and mostly, a lack of adequate science education many people falsely compare the hard won knowledge of modern medicine equally with archaic and implausible modalities such as homeopathy, the five elements, and most of chiropractic theory.

The alarms of reason and truth should be sounding all around the halls of higher education as these types of belief based and unreasonable systems gain a foothold within the realm of hard won legitimacy- without having any!

Dr RW discusses this very concern regarding the uncritical teaching of alternative therapies in US medical schools noting the alarming trend towards incorporating Complementary and Alternative Medicine (CAM) courses into their regular curricula. Are these courses being critically examined for plausibility and efficacy? The unfortunate answer is no! Sampson (University School of Medicine, California) cites in a 2001 study:

“Advocacy and non-critical assessment are the approaches currently taken by most U.S. medical schools in their courses covering what is commonly called "complementary and alternative medicine" (CAM). CAM therapies are anomalous practices for which claims of efficacy are either unproved or disproved. The author's research indicates that most medical schools do not present CAM material in a form that encourages critiques and analyses of these claims. He presents the reasons for the unwarranted acceptance of CAM. These include the CAM movement's attempt to alter standards of evaluating therapies. A survey of CAM curricula in U.S. medical schools in 1995-1997 showed that of 56 course offerings related to CAM, only four were oriented to criticism. The author's course at Stanford University School of Medicine approaches CAM with the skepticism and critical thinking appropriate for unproven therapies. The author concludes by calling on all medical schools to include in their curricula methods to analyze and assess critically the content validity of CAM claims.”

Another recent 2007 survey reviewing preclinical students at Georgetown University School of Medicine reflects a possible receptivity to CAM and illustrates that science based education and critical thinking skills may be lacking in earlier formal education:

Interest in and enthusiasm about CAM modalities was high in this sample; personal experience was much less prevalent. Students were in favor of CAM training in the curriculum to the extent that they could provide advice to patients; the largest proportions of the sample planned to endorse, refer patients for, or provide 8 of the 15 modalities surveyed in their future practice.”

This 2002 survey explored the apparent lack of familiarity in US medical schools of CAM and the disconcerting assumption that these modalities are effective therapies:

“A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.”

Another eye-opening reason to be concerned about the infiltration of uncritical thinking and associated CAM modalities into medical education is the example of the insidious growth of CAM in the nursing profession as described by Sandy Szwarc.

“…it is also important that the public understand what is happening and that we hear the voices of nurses who are concerned about the growing adoption into nursing practice of alternative modalities that have no scientifically valid theoretical underpinnings or proven medical efficacy.”

Together, these observations reflect important warning signs the medical community needs to take seriously if the foundation of a reality based/critical thinking education is to continue to hold its proper role as the gateway to effective modern medicine.

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