Should Medical Schools Teach "Integrative Medicine"?

Robert W. Donnell, MD; Nicholas Genes, MD, PhD; Roy M. Poses, MD

Disclosures

December 06, 2007

In This Article

Roy M. Poses, MD: Medical Schools Embrace CAM Uncritically

Unfortunately, Flexner may be rotating all too rapidly. I, too, am concerned that medical schools are teaching and promoting what is often called CAM, despite the lack of logic or evidence supporting many CAM practices. Meanwhile, the same schools seem to give only lip service to the application of logic and evidence to healthcare, as exemplified by the formal processes of EBM. What evidence I could find favors this gloomy assessment.

By 2002, most US medical schools (98 out of 126) were teaching about CAM practices in 1 or more required courses.[15] The material that was being taught was mostly uncritical: Less than one fifth of CAM courses included "critical evaluation of the scientific literature," and almost four fifths were taught by a "CAM practitioner" who was likely to be an enthusiast, not a critic. Many of the modalities being taught had little scientific justification. These included homeopathy (taught in 58% of courses); ethnomedicine, including Ayurveda and Native American medicine (48%); therapeutic touch (38%); naturopathy (36%); and energy medicine, including manipulation of electromagnetic fields and magnet therapy (12%).[6]

In fact, some medical schools have demonstrated major institutional commitments to CAM. For example, the University of Pennsylvania, Philadelphia, Pennsylvania, signed an agreement with the Tai Sophia Institute of the Healing Arts, whose faculty taught, among other things, that people feel better after dislodging "a blockage of qi, or life energy." In the wake of faculty protests and some unfavorable publicity, the university announced that the agreement was "more loosely...a partnership.[16]"

Similarly, West Virginia University, Morgantown, West Virginia, founded the Sydney Banks Institute for Innate Health, which is based on the insights of Canadian welder Sydney Banks, who said he had found "the secret to life," describing his discovery as "what they call God -- the true meaning of God.[17]" The Institute described Banks as a "theosopher," a term best associated with Madame Blavatsky, the Victorian-era spiritualist who conducted seances. (The Institute later dropped "Sydney Banks" from its name, and now goes by the West Virginia Institute for Innate Health.) The Institute's education director, whose highest degree is a master's in English, has described the Institute's work as "profoundly scientific.[17]" However, in 7 years, the faculty apparently have published only 2 peer-reviewed articles, including a pilot study involving only 8 patients.[18]

Medical schools' often uncritical embracement of CAM sadly contrasts with their often lukewarm support of EBM. As Paul Glasziou put it, "evidence-based medicine (EBM) is like safe sex: talked about a lot, preached (taught) a little and practiced infrequently.[19]" In fact, even though more medical schools require instruction in EBM than require courses in CAM,[15] medical graduates continue to perform poorly when tested on EBM skills.[20,21]

In an era of increasingly commercialized healthcare, the managers and bureaucrats may be inclined to favor the popular and attractive CAM approaches over the rigorous and austere EBM approach. Patients, however, may not benefit from the ministrations of doctors better trained about "qi" than about selection bias and the "intention-to-treat" principle.

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