Robert W. Donnell, MD: Abraham Flexner May Be Turning Over in His Grave
A century ago, medical education lacked standardization and scientific discipline. To address the problem, the American Medical Association formed the Council on Medical Education (CME), tasked with restructuring the curricula of American medical schools. At the CME's request, the Carnegie Foundation commissioned Abraham Flexner to survey and report on the quality of medical schools in the United States and Canada. The Flexner Report that followed in 1910 was severely critical of medical education. In its aftermath, many medical schools closed or merged. Those that survived instituted major reforms.
The Flexner Report was revolutionary and even today is widely celebrated as a defining document for medical education. However, the last decade has seen a disturbing trend away from Flexner's warnings. Medical schools are reverting to pre-Flexnerian standards by adding pseudoscientific health claims to their course materials under the rubric of "integrative medicine."
Flexner condemned such claims, writing in Chapter X of the Report that they should have no place in medical education. Modern medicine, he said, "wants not dogma, but facts. It countenances no presupposition that is not common to it with all the natural sciences, with all logical thinking." Unfortunately, medical schools today not only countenance but teach and promote such presuppositions, many of which would require us to abandon basic science textbooks.
Let's make a distinction. Doctors need to know about the alternative treatments that patients are seeking so that they can recognize herb-drug interactions, engage patients in discussions about alternative treatments, and appreciate cultural differences that may lead patients to seek such treatments. Medical schools should equip students in these areas. However, they should teach an appropriately critical and scientific view of alternative theories.
For many medical schools today, that's the rub. Academic leaders, in fact, are suggesting that alternative modalities should be presented "in the context of their own philosophies and models of health and illness." Survey data from both MD- and DO-granting schools confirm this trend.[5,6,7] In other words, dubious claims are being promoted to students in an unscientific, uncritical manner. If you need more evidence, browse the Web sites of academic medical centers to see what's going on and note their promotions of therapeutic touch, homeopathy, Ayurvedic medicine, shamanism, chakras, and more.
So, you may say, what's wrong with combining other healing traditions with scientific methods? Plenty, because it results in an eclectic mix of diverse theories with no common basis. It leaves medicine without a consistent scientific framework upon which to evaluate treatments.
The Flexner Report came down strongly against integrative medicine. In Chapter X, Flexner posed this question about the compatibility of scientific medicine with pseudoscientific claims, which he termed dogma: "Is it essential that we should now conclude a treaty of peace, by which the reduced number of medical schools should be pro-rated as to recognize dissenters on an equitable basis?" His emphatic answer was "no." He later continued: "The ebbing vitality of homeopathic schools is a striking demonstration of the incompatibility of science and dogma."
Unfortunately, academic medicine is now turning its back on Flexner's mandate. Our medical schools are devolving into Hogwarts-like institutions of eclectic healing arts. Reforms are urgently needed so that medical education will once again be rooted in science.
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Cite this: Should Medical Schools Teach "Integrative Medicine"? - Medscape - Dec 06, 2007.