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Christina Chase, MS, RD Heather S Oliff, PhD Mariann Garner-Wizard Risa N Schulman, PhD Diane Graves, MPH, RD Densie Webb, PhD Executive Editor – Mark Blumenthal Consulting Editor – Don Brown, N.D. Managing Editor – Lori Glenn Funding/Administration – Wayne Silverman, PhD Production – George Solis/Kathleen Coyne
File: § Alternative Medicine § Integrative Medicine § Medical Curricula HC 052315 - 221 Date: November 27, 2002 RE: Alternative Medicine in Medical School Curricula
Marcus DM. How should alternative medicine be taught to medical students and physicians? Academic Medicine 2001;76:224-229. Criticism of conventional medicine and medical education by proponents of alternative therapies, in particular Andrew Weil, M.D., occasion this response. While admitting that "medical educators have been slow to recognize the need for... curricula in alternative medicine...", Donald M. Marcus, M.D., professor of medicine and immunology at Baylor College of Medicine in Houston, finds that such criticisms "misrepresent medicine and the medical curriculum and obscure the basic differences between traditional [i.e., conventional] and alternative medicine." While critics allege that conventional medicine (referred to as "traditional" medicine in this article) ignores mind-body interactions, an "[a]wareness of the profound influence of temperament and emotions on body functions has always been prominent in Western medicine," such as the reassurance afforded by physicians who offered little else but purging and bleeding. The biopsychosocial model is central to modern medical education. The Association of Medical Colleges' learning objectives include "knowledge of the important nonbiological determinants of poor health." Humanistic qualities are important both in doctors' professional evaluations and to accrediting agencies. The allegation that conventional medicine does not seek to understand the cause of illness, but suppresses symptoms, ignoring the body's ability to heal itself, receives similar short shrift. Marcus says that "courses in the pathophysiology of disease have been taught... for decades" and cites Hippocrates' dictum, "First, do no harm," as an acknowledgement of the recuperative powers of the body. Similarly, he disposes of the criticism that conventional medicine ignores disease prevention and health maintenance by pointing out that preventive medicine has been taught in medical schools for decades. While acknowledging that life-style approaches may not have been emphasized enough in the past, he adds that they receive much attention today. Marcus states that criticisms of medical education are based on "undocumented anecdotes" about the shortcomings of particular physicians, for which the system of medical education is hardly responsible. As to alternative medicine, "Truly alternative practices differ from traditional [i.e., conventional] medicine in their concepts of the causes and treatment of diseases, and in their attitude toward evidence." While
conventional medicine has come to realize "the power of the placebo," developed sophisticated methods for controlled clinical trials, and embraced evidence-based interventions, Marcus states that alternative therapies are "belief-based." Citing traditional Chinese and Ayurvedic medicine, homeopathy and "healing touch," he says, "Although these healing traditions differ in their specific formulations..., they share a belief in a vital energy... whose disruption or imbalance causes disease." In addition, some proponents of alternative therapies doubt that they can be proven or disproven through clinical trials. He quotes Larry Dossey, M.D., executive editor of Alternative Therapies in Health and Medicine: "To subject alternative therapies to sterile, impersonal double-blind conditions strips them of intrinsic qualities that are part of their power." "A more subtle problem" is the citation of studies supporting the efficacy of acupuncture, chiropractic, and herbal medications "without considering the quality of those studies." Marcus acknowledges that "some investigators" of alternative treatments apply rigorous standards and that "many therapies used by traditional medicine are not supported by the highest quality of evidence." However, he firmly contrasts alternative medicine's reliance on tradition and belief with conventional medicine's willingness to consider new evidence. Marcus advocates educating physicians about the conceptual basis, efficacy and safety of alternative therapies, in order to help patients make "informed choices." "Physicians should be especially sensitive to... patients with intractable medical conditions;" in other words, show compassion to those to whom they can offer no hope. Due to the self-prescribing nature of many herbal treatments and dietary supplements, and their relative freedom from government oversight (compared to conventional drugs), he advocates a public education campaign about their "uncertain benefits and potential hazards," to be carried out by health care practitioners. (He does not include the relatively certain benefits of some of the more well-researched products.) More research into alternative treatments is urged in order to better evaluate their safety and usefulness. In particular, "[B]otanicals remain a promising source of new therapeutic agents," and acupuncture may prove useful in treating chronic pain. Marcus is confident that, "Treatments whose efficacy is demonstrated... will inevitably be incorporated into medical practice." However, he states that teaching unproven alternative practices or remedies in medical schools would be a mistake, conferring undeserved legitimacy on such treatments and compromising "the scientific and scholarly foundations of medical education." At the end of the article, a Cover Note, "The Never-ending Search," by Addeane S. Caelleigh, compares the current horror at formerly common practices based on "amazing mixtures of accurate information, ignorance, the misdirected weight of tradition, wishful thinking, and superstition," with what may well be current people's descendants' scorn for interventions such as chemotherapy. Correspondingly, fields such as chronopharmacology, which seem rather far-fetched today, may, with more study, "open a window into deeper understanding of human physiology." In any event, "The importance lies in the process of science — an openness to new ideas that is always linked to a rigorous research method and the logic at its heart." — Mariann Garner-Wizard
Enclosure: Referenced article is reprinted with permission from Academic Medicine, journal of the AAMC.
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