Jan 23 2012

Science, Medicine, and Academia

Proponents of so-called complementary and alternative medicine (CAM) are forcing us to answer a question no one has explicitly asked – should there be a scientific basis to medicine? Proponents are generally very coy about this topic, and in most venues want to pretend that they are being scientific, while really promoting “other” forms of evidence and “other” ways of knowing. They promote health care freedom laws designed to weaken the scientific standards of medicine, while simultaneously infiltrating academia with assurances that they are science-based.

Unfortunately most academics and health care professionals are simply naive to the situation (so-called “shruggies”) and too easily accept these assurances without checking out the facts themselves. Their initial reaction to those of us who are calmly but insistently pointing out that the CAM emperor has no clothes is to assume that we must be overreacting, because CAM can’t truly be as bad as we say. Homeopathy can’t really be made of nothing, can it? But it’s a large industry, with entire hospitals in the UK. How can it be as nonsensical as the skeptics are saying?

This naivete extends, unfortunately, to many university administrators, who are used to being egalitarian and accommodating. Proponents of CAM are sincere, and know how to play the game, so they put their best academic foot forward (often lubricated with grants from ideologically dedicated organizations like the Bravewell collaboration) and work their way into academia. They are persistent, and good at dismissing their critics as closed-minded, unfair, or having an axe to grind.

Perhaps the best tool we have in countering this infiltration of abject nonsense into the halls of academia is to simply point out exactly what they are buying. This strategy has had a great deal of success in the UK, and some limited success in the US. Now, defenders of science and reason in Australia are gearing up for their own fight. A new group called the Friends of Science in Medicine has formed to oppose the watering-down of science in academic medicine and the practice of medicine in Australia. A recent article about the group states:

 A new group called “Friends of Science in Medicine” comprising of more than 350 of Australias top scientists, including basic and clinical scientists, medical practitioners, clinical academics and consumer advocates have formed to address what they consider the “diminishing of the standards applied to the teaching of science in our universities”. The group is concerned about the increased teaching of, what they call, “pseudoscience” in Australian universities and its application within our health care system.

Their aims are in line with other groups, like the Institute for Science in Medicine (an international group of which I am Chairman). And of course we tackle this issue frequently at Science-Based Medicine.

Our collective strategy is basically two-fold. The first is to establish what the scientific standard should be. The second is to shine light onto the claims and practices of so-called CAM, to expose the fact that they do not meet this standard. Proponents are coy on the first question, and deceptive (either naively self-deceptive or deliberately so) on the second.

We need to affirm the necessity of having a transparent objective scientific standard for medicine. Otherwise, there is no standard of care. There would be no way of determining which treatments were legitimate and which were not. This question has many practical implications – which professions should be licensed, which treatments covered by insurance, which practices allowed under the scope of practice of each profession, what should be taught in medical, nursing, and other health-related curricula, and which practices constitute malpractice. Without a science-based standard, there are no answers to these questions.

That, of course, is what CAM proponents want. How else can you practice homeopathy, get covered for it, have it be included within your scope of practice, and not be sued blind.

Further – we can’t have a double-standard. Within medicine there is a pretty clear consensus as to what the scientific standard is. It is slowly evolving, if anything becoming more stringent as we root out more and more subtle ways of subverting best scientific practice. CAM as a category exists to weaken this standard, or to create a double standard for themselves so that practices that are not science-based can be taught, used, and covered. But (I hope) CAM is starting to be the victim of their own success, in that as they have successfully promoted CAM it is necessarily coming more and more into the light. As it does it is getting easier to expose CAM for the utter nonsense that most of it is.

Groups like those mentioned above are starting to form – comprised of health care professionals who have bothered to look and see what is happening.

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