Regular readers will not be surprised that the MJA articles on CAM teaching in universities have not gone unnoticed by this column. Ian Musgrave has done a typically thorough job highlighting one of the most misleading aspects of the arguments presented in the 2 pieces, I feel there are a few more that need pointing out.
With a hat tip to Sean Rintel’s excellent piece on Olympic memes and also recognising that these debates can easily degenerate into namecalling and unhelpful discussion, I thought adding some memes might help lighten the tone a bit. For ease of reference to the group of authors who contributed to the editorial, I will refer to them collectively as the Apologists.
CAM in Universities
The Apologists begin by making a number of justifications for their support of ongoing teaching of aspiring CAM health practitioners in higher education. They assert that
the real benefit of an appropriately mentored and approved university education is the exposure of students to the biomedical sciences, epidemiology and population health, differential diagnosis, safe practice and critical appraisal
They leave out the bit about students then being taught about herbs that don’t work, treatments such as Bowen Therapy, iridology and applied kinesiology which have never been subjected to any serious research and subluxations that don’t exist. There is no point asking students to begin by respecting biomedical science only to have them ditch it when it disagrees with the ideology of the treatment you want them to provide. Intellectual integrity demands that health professions have a consistent approach to science. Either disregard it, or embrace it. Don’t make up ‘sciencey’ jargon just to sound clever or serious.
They also try to justify the need for university level education in such areas because removing these programs will not diminish clinical demand but may decrease the educational rigour of these courses, to the detriment of patients. This reads like a barely veiled threat. I don’t agree that there is no way to reduce public demand for quackery. A better educated public and appropriately enforced regulations for the industry would go a long way towards reducing a demand that is not as high as CAM proponents would like to think (there will be more about this in another post to come). They seem to argue that the general public should be hostage to practitioners who want to do things their way regardless of whether they are actually helping their patients or not. Fund us to do what we want, or we won’t be held responsible for what we do seems to be the implied threat.
The Apologists go on to hail universities as institutions which
conserve the diversity of ideas in the community, and that this is as important to the survival of knowledge as genetic diversity is to the survival of species
I see. We do seem to be getting along OK without university departments of phrenology, bloodletting, miasmas, leeching and mesmerism. There was a time when they were taken very seriously but their extinction is entirely appropriate within universities. Better stuff came along which more closely approximated reality. Maybe they are sometimes used as examples of historical and sociological curiosity but this is not essential to the survival of medical knowledge. Neither is the persistence of such outmoded belief systems such as herbalism, homeopathy, chiropractic and similar vitalistic approaches.
They go on to opine that Authoritarianism, supernaturalism, corporatism, irrationalism and political correctness have been identified as the enemies of ideas and considered to be synonymous with enemies of universities. I wouldn’t disagree, but in what parallel universe do they propose that scientific healthcare is more authoritarian, mystical, corporatist, irrational and politically correct than CAM? Followers of chiropractic, homeopathy, TCM and nutritionism are famously authoritarian. If you don’t believe me, try lurking on a forum where they are discussed, and then make a polite and well-reasoned criticism of the founder of the movement in a thread. Try explaining to a naturopath in your local pharmacy or health-food shop that although a decade ago we thought glucosamine might have been good for joint pain, we now don’t think so because large, well-conducted studies showed it wasn’t. Do I really need to provide examples of CAM being irrational? Or supernaturalist? An entire branch of CAM is called Energy Medicine and this purports to provide healing by manipulating an unseen ‘biofield’ which is undetectable by physics. Mind you, physics can detect the tiny electromagnetic energy from Voyager 1 which is only about 17 billion kilometers away from us putting out information from a transmitter that is not much more powerful than an average light bulb. So it’s not as if we wouldn’t find it if it was there. Similarly for the supposed ‘meridians’ of acupuncture. Despite all the efforts of proponents, there has never been a clear demonstration of what meridians actually are, or indeed whether they exist. Supernatural? Irrational? Is it just me who can’t figure this line out?
The Relationship of CAM to Science
The Apologists then head off into a vaguely postmodern exegesis about sociology and science. See what you make of this argument… _Indeed, it is not melodramatic to point out that if Friends of Science in Medicine were to succeed in their stated aims, they would achieve a dystopia - a medical ‘1984’ where only one way of knowing the body in health and illness is permitted in public discourse. Well, for starters, it IS melodramatic to call FSM dystopian. Allow me to also point out that FSM are not talking about public discourse, they are talking about university training of health professionals. The logic of this argument rests on an assumption that scientific knowledge is not special. If you want to accept this argument, you must also conclude that knowledge obtained by the scientific method is just culturally determined opinion. Karl Popper and other philosophers have made a convincing case that scientific truths are more trustworthy than mere opinion because they can be verified by anyone with the means to do so, regardless of culture. Importantly, scientific beliefs can be disproven by anyone who can show that the chain of reasoning and experimental verification is flawed. FSM are calling for the removal of taxpayer funding for the training or health professionals in improbable or disproven treatments. They continue to support the investigation of any and all potentially useful treatments. If research suggests it works, then it should be taught. Doesn’t sound much like 1984 to me.
I would suggest that readers of a delicate disposition who are easily offended by the egregiously illogical should look away now.
The Apologists then go on to demand a truly remarkable and bizarre concession. Citing biological plausibility as an explanation for accepting a lack of evidence in conventional medicine over complementary medicine is flawed. Biological plausibility depends on contemporary biological knowledge and we should not dismiss an association because it may be new to science or medicine.
It appears we are being asked to abandon what is nothing less than a fundamental tenet of science here. Science proceeds from the known to the unknown. If you want to introduce new knowledge it has to be explained in terms of what is already known. You can go on to expand, demolish or reinterpret the current knowledge as you please but you must first master what we already know and be able to explain it. You can’t just hand in a note from your mum asking to be excused from this. You can’t just sit there like Canute and wave away the ocean of biological science that exists. The onus of proof is on the scientist making the claim to new knowledge. It’s not the obligation of everybody else to believe it because someone thinks it may be true.
Having already treated logic like the unfortunate cop in Reservoir Dogs, the Apologists then quote Voltaire in the conclusion.
Voltaire of course, being famously a champion of sceptical rationality and a scourge of those who would fool themselves and others. As the wreckage and debris of the irony meter begins to float down from the atmosphere, they make the stunning assertion that These courses clearly develop critical thinking. With the greatest of respect I submit that if that is their goal, they are failing miserably. It is university-trained chiropractors who are the largest professional group supporting the antivaccine movement, and who espouse belief in imaginary causes of disease. It is university-trained naturopaths who fail to be critical of the welter of disproven treatments such as applied kinesiology, herbal remedies, iridology and Bach flower remedies they are trained to dole out. It is university-trained TCM practitioners who continue to do small, poorly-powered pilot studies of acupuncture in areas where large, well-conducted studies have shown it doesn’t work. It is their professors who are asking for the conventions of science to be dispensed with so their papers will have ‘better’ results.
These, then, appear to be the best and most compelling arguments that can be put in defence of the current position of CAM in academia. A dog’s breakfast of post-modernism, paranoid futurism and pathological science. It is disappointingly likely that these arguments will simply continue to be trotted out without much development every time this issue is raised from now on. The MJA has given the Apologists an elevated platform to make their case, and I can’t help but think they have fumbled the opportunity.