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FRIENDS of Science in Medicine have refuted claims in two MJA articles that the group is trying to get rid of all complementary and alternative medicine courses from universities.
FSM president Professor John Dwyer, of the University of NSW, told MJA InSight that his organisation “clearly” supports CAM research where there is evidence for potential benefit.
“It will be a great pity if parallel health care still exists in 10 years, for science has the ability to see a convergence of CAM and orthodox medicine”, he said.
The two articles published in this week’s issue of the MJA were in response to an editorial written by members of FSM published earlier this year in the Journal. (1)
In an editorial published this week in the MJA, the authors, led by Professor Stephen Myers, professor of complementary medicine at Southern Cross University in NSW, wrote that the call by FSM to remove complementary medicine from universities raised deep issues. (2)
“The debate on whether complementary medicine should be a university discipline, when seen from sociological perspective, says much less about good science and much more about control and power”, the authors wrote.
“Indeed, it is not melodramatic to point out that if the 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. This controversy is simply the latest episode in a long-contested battle between orthodox and divergent views.
“[CAM] courses clearly develop critical thinking and fulfil the criteria for legitimate university disciplines”, they wrote.
In a Perspectives article, the authors, led by Professor Paul Komesaroff, of the department of medicine at Monash University, called on members of FSM to “revise their tactics and instead support open, respectful dialogue in the great spirit and tradition of science itself”. (3)
The authors said that they believed the views promoted by FSM in the earlier MJA editorial, “exceed the boundaries of reasoned debate and risk compromising the values that FSM claims to support”.
Professor Dwyer said the FSM had been “swamped with media enquiries” since the latest MJA articles were released to the media.
He said it was hard to discuss in detail the factual errors in the two articles, “let alone the questions around the nature of science” in a media interview.
The current controversy was initially sparked by a letter sent by the FSM earlier this year to vice-chancellors of universities offering CAM courses. It asked that the universities review their teaching of health sciences “to ensure that primacy is given to scientific principles based on experimental evidence”.
“We ask that your university confirm the principle that all health-related courses should be taught according to scientific principles based on experimental evidence,” the letter said.
Professor Dwyer said the articles published in the latest MJA misrepresented the FSM’s point of view and seemed to misrepresent what was understood by the scientific process itself.
“It is pointless to argue about who is right and who is wrong, who should be believed and who should not. That is the whole point of FSM’s approach; to subject claims to proper scientific scrutiny, as science excels in determining impartially whether these supposed treatments are effective or not”, Professor Dwyer said in his response to the articles.
He said a full response to the claims in the MJA articles would be included on the FSM’s website.
– Kath Ryan
1. MJA 2012; 196: 225-226
2. MJA 2012; 197:69-70
3. MJA 2012: 197: 82-83
Posted 16 July 2012
The response by Mia and other comments nicely encapsulate some of the fallacies used in defence of CAM. Firstly, the plural of anecdotes is not data. Secondly, arguing that modern medicine should clean up it’s own backyard is irrelevant to the argument that CAM is unscientific quackery. No one is arguing that medicine is perfect, and as a medical practitioner I will be the first to admit that there are significant problems, but using this as a justification or defence for CAM is irrational. Arguing that CAM has been around for thousands of years is also unpersuasive. Just because it has always been done that way doesn’t mean that it isn’t stupid. Or ineffective. It is ironically CAM that is close minded, as the scientific basis of medicine is happy to discard therapies when credible evidence showing ineffectiveness comes to light. CAM in many cases is not just unproven, it is disproven.
There’s no such thing as alternative medicine. There are only medical treatments that can be shown to be effective and those for which there is no scientific basis. If “alternative” treatments do work, then they should be incorporated into usual practice. I’ve nothing against “herbal” treatments. Morphine and metformin are herbal.
http://theconversation.edu.au/modern-chiropractic-therapy-is-based-on-ev…
Sue, would you mind explaining what university the student is from and how they are currently being taught the subluxation? Which parts of the subluxation complex are not science based. Tone is a hard thing to get across in an email, but I am genuinely interested to know what you are being told and what this university may be teaching.
Thanks.
Anonymous – my information about “subluxation” being taught in chiropractic training comes from a current student. How is it not science-based? Because it is not consistent with directly observable and measurable mechanisms of pathophysiology. (Many modern chiros also agree with this). My comment that some GPs refer to chiros is a statement of known fact – it has nothing to do with my views of FSM’s views. Anything else?
I suspect that arguments about CAM are not likely to go away any time soon. However, I think that the marginal benefit of more CAM, based upon meta-analyses, seems to be quite small, and it only diverts attention from potentially more useful things. Nonetheless, I am not saying that prescribing more pharmaceuticals is necessrily the answer either.
The biggest marginal benefit in clinical medicine is likely to come from lifestyle medicine, that is convincing people to stop smoking, eat healthier, reduce excessive alcohol consumption, lose weight and exercise more.
The irony is that it is sometimes the alternative medicine practitioners rather than conventional practitioners who recommend these things.
Sue,
Perhaps you could explain how the subluxation is taught at universities in Australia and which part of the subluxation is not science based.
May I also say that your views about GPs referring to chiropractors puts them at odds with FSM’s view that GPs should not be referring to chiropractors nor should GPs have a professional association with them (ie: GP and chiro sharing the same premises).
Teaching about complementary medicine in 1980.
I support the work of Quackwatch, and Medical Skeptics and am regarded by my complementary medicine taking patients as a disbeliever. But I support the stance taken by Paul A Komesaroff and his co-authors, that medicine and science must oppose intolerance and censorship. (Med J Aust 2012; 197 (2): 82-83). The following story shows that, in the last 30 years, not much has changed in the bullying intolerance and desire for censorship of some of the dominant educational cultures within medicine.
In the early 1980s, one in four of our patients were also attending alternative practitioners and using complementary medical remedies. So my Department of General Practice started a teaching module on these two topics. This included fifth-year medical students sitting in with alternative health practitioners. The students’ tasks were to understand the historical antecedents of the alternative practitioner’s belief system, to see what they actually did and who went to see them.
My medical faculty Dean informed me that the Medical Board had received a complaint about my teaching of alternative medicine. I replied that I was not teaching alternative medicine but teaching about alternative medicine. “Whatever it is” he ordered, “Stop it, forthwith!”.
I suggested he tell the Medical Board to communicate directly with me. They sent me a stern warning to desist from the further teaching of Alternative Medicine.
I wrote back arguing that: “If the Medical Board wishes medical students to be ignorant, rather than knowledgeable, about the beliefs and practices of their future patients, then they had a fight on their hands and one that they could not possibly win.
I received no further communication from the Medical Board or from the Dean.
Chiropractic manipulation for low back pain is the one area where there is strong evidence for chiropractic treatment – but no better than conventional therapy. It is based on the physical manipulation – not the discredited theory of “adjusting the subluxation”. Physiotherapy is also effective manipulative therapy, but science-based. Many modern chiropractors simply perform physical therapy without claiming to correct all illness with manipulation, and most people have no problem with them – many doctors refer to them as they do to physios. IF they can help someone lose weight and keep it off – so much the better. None of that proves that the non-science-based therapies offer anything beyond placebo.
It has been well said that the plural of anecdote is not evidence. People do lose weight and their back pain can suddenly improve. Moreover, the placebo effect is real. One reason that alternative practitioners garner support is the conviction with which they believe in their therapies. This can strongly influence the placebo effect.
One woman, Helen Chryssides, writing for the Reader’s Digest in 2000, visited 25 different naturopaths around Australia complaining of fatigue, and received 25 different diagnoses and treatments. I do not doubt, however, that many people visiting these naturopaths felt better afterwards. This, however, does not demonstrate a specific treatment effect of the therapy.
If Alternative Medicine presents a treatment that survives scientific scrutiny, it changes from Alternative Medicine into Scientific or Conventional Medicine. The rest of Alternavie Medicine achieves market success by it’s placebo effect on suggestible people. That this appeal to the suggestible works so well is what Sciientific Medicine should be studying and teaching. Otherwise these alternative philosophies should be kept apart. Mixing real and”magic” medicine in the same practitioner and “school”, undermines the effectiveness of both. Everyone is likely to benefit more if we live in parallel with the quacks.
Yes, the key word in this debate is ‘amateurs’. Meaning those not initiated into the ART. The fact is that there are medical professionals with a conventional… medical degree also learning techniques that complement the repertoire of the medical professional, who might have witnessed the limitations of modern medicine. Possible?! If his experience would not support it and show that there is some benefit, surely he would not practice for example acupuncture… Would he?! “Made-up model”? It survived few thousands years so it is a well-established practice. There is also evidence to show that it works in controlling pain.
Another example: a friend who had a pinched nerve (and was in bad pain) went to see the old GP, who ordered blood tests. Many blood tests. Prescribed Panadol and sent my friend on her way. She walked right into the chiropractor’s office on the next level, had an adjustment and 10 minutes later (and no blood loss involved) she emerged pain free and smiling. So the question is: would you want to see the ‘conventional’ GP if you are in similar condition/situation or a chiropractor?
PS: My friend did not have another pinched nerve since that incident. Another chiropractor/naturopath treated her for overeating and excess weight. She lost weight and kept it off. In her view it was the best investment she made in a long time and it reduced her stress levels considerably. (Try it, maybe it will do the same for you.)
Conventional medicine has a very compartmentalized view of he human body and the whole system. Perhaps it knows more about ion fluxes, but it still does not know the ‘why’.
Is this in defense of the conventional medicine: “IF the cream of students spend years studying, apprenticing and then studying, and still get things wrong, how on earth can amateurs, using a made-up model, do better?” Does it work in your view?
We must always be cautious of any single “remedy” that purports to treat everything from low back pain to infertility to migraine to earache. Such is the case for modalities like acupuncture and homeopathy. We know the pathophysiological basis for so much of disease – from the directly observed macro level to the subcellular level of electron microscopy. We know how nerve transmission works. We know about ion fluxes across cell membranes. We know that potasssium is mostly intracellular and sodium extracellular. We know what magnesium does in high doses. We know how renal tubules work. How, then, can we justify teaching “therapies” based on unexplained models, or contrary to directly observed pathophysiology? Would the community tolerate alternative engineering? Perhaps not if they thought the bridges might fall, or computers might stop. COmplaints like Mia’s about the medical system don’t lend any credibility at all to any “alterntive”. IF the cream of students spend years studying, apprenticing and then studying, and still get things wrong, how on earth can amateurs, using a made-up model, do better?
As science hero Neil deGrasse Tyson says “Q: What do you call Alternative Medicine that survives double-blind laboratory tests? A: Regular Medicine.”
Even if you feel double-blind trials are too big a demand, should we be teaching students unproved anything?
Teach students about the existence of whatever; teach students how to research whatever; but don’t teach them unproven whatever.
A surfeit of Cochranes that just don’t disprove is insufficient for education.
I can not help but to agree with Professor Stephen Myers. To remove CAM from universities is the first step to marginalize, and discredit and then question the right to exist… If it is removed form universities, it will be hard to ‘research’ or prove effectiveness as no-one will be willing to fund ‘snake-oil’ studies…
Yes, the push to have CAM eliminated and marginalized is about power and authority. It would be so much more helpful if ‘FSM’ would be looking for enemies within first and deal with those if the desire to protect the pubic and to provide ONLY evidence based treatments.
If only medical practice would be science based!!! But readers of this and other medical publications are confronted with articles in almost every issue that shows that:
“Doctors tend to confuse what they believe with what they know,”
“The reasons why doctors traditionally take so long to question dogma are complex”
or
“the medical profession is so trusted that its activities are rarely questioned”
or
“Healthcare is still plagued by statistical deception and bad science”
or my favourite from MJA InSight:
“most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform”
go on, google…
So, I believe there is enough there FSM to get busy.
Oh dear…
It is of course not possible to defend pseudoscience except by distorting science or simply arguing fallaciously. FSM raised concerns about the unscientific and credulous claims that were being spouted unopposed by some academics. They have been answered by the usual melange of hand-waving post-modernist claptrap which really boils down to saying “Don’t be mean to our cherished delusions”.
I am told that natural medicine was recorded in Egypt about 3000 years ago- perhaps even before that – now it is 2000AD – total of 5000 years. Only recently – last hundred years has the life span by disease modification been increased.
Scientific medicine has only arisen in the latter period coinciding with the advances that actually benefit.
Therefore something that has not worked for 4900 years should be studied for historical purposes and the course should be offered in the Arts faculty of a University. Perhaps as an elective in the history & philosophy of science.
There is no legitimacy to offer historical medicine as a modern stand alone pseudodegree.
– but then again some universities – actually the same one as offers complementary medicine course offers a university degree in Surfing.
The evidence speaks for itself
I think that there are two problems here. One is definitional and one relates to the nature and level of evidence which is considered acceptable.
Ideally the concept of alternative medicine should not exist as all medicine should be based upon acceptable evidence in order to be declared medicine at all.
Nobody would, I suspect, wish to take their car to an “alternative” mechanic who followed completely unorthodox and unsubstantiated theories about automobiles.
When one looks at the evidence for alternative medicine in terms of meta-analyses of randomised trials, the results are very interesting and are the subject of the book, Trick or Treatment, by Ernst and Singh (2008).
Meta-analyses which included trials with a score of less than 3 out of 5 on the Oxford Quality Scale (Jadad Scale), for randomisation, blinding and follow up, showed positive results for all alternative therapies including homeopathy, acupuncture and chiropractic. When one restricted the results to trials scoring 3 out of 5 or more, then most of the support disappeared, in many cases entirely.
It seems that there is evidence and evidence.
When I hear supporters of Supplementary, Complementary and Alternative Medicine (SCAM) defending the teaching of pseudoscience in universities I’m reminded of creationists calling out “Teach the controversy”.
There is a place for it, however, and it’s analogous to the couple of semesters I spend studying fraud in an accountancy course. Teach this stuff in courses about the history of medicine, critical thinking, research methods, statistics and other areas where it is useful to demonstrate how not to do things and how to detect what happens when the rules of the universe are ignored.
How can you give legitimacy to alleged “disciplines” that have as basic beliefs the idea that ALL disease is caused by misalignment of the vertebrae, or that diluting “natural medicines” makes them more potent.
It sounds to me like Professor Dwyer is trying to resolve 2 paradigms of health care, medical care and CAM/allied care for patient needs. Why bother? Services using both CAM/allied and medical resources are needed according to the current debates. There are no absolutes with developing evidence in clinical settings, only first do no harm. The goals and leaders of FSM are critically and eloquently dissected in this new blog by systems culture analyst Steve Jenkins. http://stevej-on-mbesi.blogspot.com.au/2012/02/friends-of-science-in-med… . Patient safety with all therapies should be the common standard. Right now medical care doesn’t match up to airline safety standards….Why? Let’s focus on fixing this problem first.
I wonder if Prof Myers and colleagues, who wrote the MJA Editorial “The legitimacy of academic complementary medicine”, believe that the practice of homeopathy should be taught to university students of health sciences (as distinct from its critical appraisal)?
Also, do they agree with the awarding of degree courses in homeopathy practice as currently offered by the Endeavour College of Natural Health?
Could they please explain how such a course can, “develop critical thinking and fulfill the criteria for legitimate university disciplines”?
Prove the value/efficacy then teach the course
I agree with Chris. Complementary medicine fulfills all of the criteria for pseudoscience and is based on grossly fallacious reasoning. Similar to FSM I support reasearch into CAM to determine if it is effective but I do not accept that CAM is in any way scientific and should not be considered a science based discipline.
“[CAM] courses clearly develop critical thinking and fulfil the criteria for legitimate university disciplines” — Anyone who’s attended these lectures will know what a joke this statement is. Let’s stop legitimising so-called complementary medicine – if it doesn’t fulfil the criteria for legitimate medicine then remove it from our institutions of knowledge and take steps to minimise its harm to those who know no better.