May June pages BOX_SI new design masters 3/29/12 9:01 AM Page 24 [ THE SCIENCE OF MEDICINE S T E V E N NO V E L L A Steven Novella, MD, is assistant professor of neurology at Yale School of Medicine, the host of the Skeptics’ Guide to the Universe podcast, author of the NeuroLogica blog, executive editor of the Science-Based Medicine blog, and president of the New England Skeptical Society. Pseudoscience in Our Universities he group Friends of Science in Universities in particular are supposed demonstrable pseudoscience as if it were Medicine has recently formed in to be the exemplars of scholarship and a legitimate science. The exact same TAustralia, and they now have over intellectual legitimacy. People believe thing can be said about teaching home- 400 professional members. They felt the universities are intellectual leaders, not opathy, for example, as if it were legiti- need to come together over a disturbing followers, and they are correct (or at least, mate science-based medicine. trend—the infiltration of rank pseudo- they should be). Teach ing a topic in a The argument above should not be science into once respected universities. university is absolutely an endorsement difficult to make and should resonate It is a sign of our times that we have of the legitimacy of that topic. We can with academics. It has worked well in to defend having standards of good sci- distinguish between teaching about the United Kingdom, spearheaded ence in the practice of medicine and the something and teaching the thing itself. mostly by David Colquhoun, who has teaching of a science-based curriculum It is okay to teach about so-called com- used freedom of information requests in universities. High standards of sci- plementary and alternative medicine to obtain the CAM curricula at univer- ence in medicine are necessary in order (CAM) as a sociological phenomenon or sities teaching CAM, and then simply to ensure, as best as we can, that treat- even as an example of pseudoscience. sent them to the dean and/or board of ments and interventions are safe, effec- Practi tioners also need to learn about any trustees of the university. This one act tive, and ethical. It is extremely compli- method their patients may be using or has led to the removal of CAM courses cated and tricky to determine safety and about which they are curious. Credu - from universities in the United King - efficacy. Humans suffer from numerous lously teaching CAM, however, is an en- dom. Simply shining a light on what mechanisms of self-deception, cognitive dorsement, the granting of the impri- was happening was enough. flaws and biases, poor grasp of statistics, matur of the university. In the United States we are having and perceptual failings that are likely to It is tempting to cater to prevailing a harder time, although we have had lead us astray. In fact our biases tend to fads, to acquiesce to the vocal advocates some successes also. The American systematically lead us to false conclu- and give them what they want, espe- Medical Student Association (AMSA) sions that we wish to be true, rather cially when there isn’t much protest. has been infiltrated by CAM propo- than to the truth. That is exactly what intellectual in- nents who have managed to get re- These flaws, biases, and cognitive er- tegrity is about, however—doing the quirements for CAM to be taught in rors make it difficult to come to reliable right thing because it is right, not be- American medical schools. Of course, conclusions in any area of exploration, cause it is popular or expedient. we can still teach about CAM (which I but perhaps particularly so in the ap- I will acknowledge perhaps the only actually advocate) rather than promote plied science of medicine. This field is legitimate argument on the other side: pseudoscience—something that is not further plagued by placebo effects, that of academic freedom and diversity a subtle distinction but is often difficult which represent the above effects in ad- of opinion. I agree with the principle that for some to make. dition to a complex emotional and a university should also be a place for the Australia is perhaps having the most physical response to the nonspecific as- free exchange of ideas and should not difficult time with this issue, leading to pects of getting attention from an at- easily impose censorship. Proponents of the formation of the Friends of Science tentive practitioner. nonsense, however, have taken this prin- in Medicine. Their request is simple: no Science is the only system that we ciple too far. Academic freedom needs to pseudoscience in universities. They have developed that systematically con- be tempered with quality control. Profes- have helped bring the debate to the trols for all of these biases and flaws to sors should not be allowed to teach ab- forefront. CAM’s greatest ally in infil- see through to reliable information. solutely anything they want without trating universities is stealth. I have Science endeavors to be transparent, limit. The university has a duty to ensure seen this infiltration occur deliberately thorough, and rigorous. The application that the minimal standards of academic under the radar with the stated goal of of scientific principles has demonstra- legitimacy are met. avoiding too much attention, which bly transformed medicine (and human This duty includes ensuring that sci- might draw criticism. This violates the knowledge in general) for the better. As ence is taught in science classes. This de- principle of transparency, and it illus- a society we should not lightly abandon bate has come up with reference to trates why focusing attention on this the principles of science or try to teaching creationism as science as a mat- trend is so useful. change them to meet the needs of the ter of academic freedom. Such freedom Of course, CAM proponents are not current fads. does not extend to the point of teaching going to just lie down and go away. 24 Volume 36 Issue 3 | Skeptical Inquirer May June pages BOX_SI new design masters 3/29/12 9:01 AM Page 25 There have been many responses to the is that if an idea has survived for hun- a marketing concept has been somewhat criticism of teaching CAM in medical dreds or thousands of years it must be le- successful—and even that it has gained schools, none of which is valid. In Aus- gitimate. This is demonstrably false. popularity recently (although not as much tralia, the most frequently quoted de- Galenic medicine (bloodletting, purging, as advocates would have you think). That fender of teaching on nonsense in uni- etc., based on the notion of the four hu- is entirely irrelevant, however, to the ques- versities is Iain Graham, professor at mors) survived for thousands of years, tion of whether or not any particular Southern Cross University’s School of and yet it was based on complete and CAM modality is science-based and ap- Health. He is quoted in several articles, utter primitive nonsense. In fact its ten- propriate for a university curriculum but this quote responding to criticism drils still exist. There is still bloodletting, (which is the question at hand). from John Dwyer, emeritus professor of cupping (which is just another form of Universities are supposed to be medicine at the University of New bloodletting), and similar practices going thought leaders with intellectual stan- South Wales, is representative: on in the world. It was replaced in the dards that rise above the mere notion of Professor Dwyer’s sweeping discus- West because of the advent of science in popularity. They are supposed to uphold sion about the issue are to do with medicine—a trend that Graham appar- academic standards of scholarship, espe- quackery really, and the rooting out ently wants to reverse. cially in scientific disciplines with high of poor practise. But if we look his- Graham’s second swing and a miss: standards in science. It is therefore very torically at the evolution of health “Eighty per cent of Australians seek al- care and the health professions, there odd and disturbing to defend a university are many similarities with where ternative therapies,” Graham is quoted as policy based upon popularity. Should we things started. saying by Australian newspaper the allow surveys of public opinion to deter- He mentioned homeopathy for Northern Star. “Obviously orthodox mine whether or not we teach creation- ex ample, well homeopathy is as old as medicine is not working for everyone” ism or astrology in our universities? Greek Hypocrates in terms of prac- (www.northernstar.com.au/story/2011/ It is good to see some organized tising medicine. (Australian Broad - 12/12/alternative-therapy-course-not- casting Company 2011) backlash against the infiltration of pseu- magic/). I highly doubt that the 80 per- doscience and nonsense into the very Here we have a blatant misstate- cent figure is correct. Most such figures institutions that should be teaching ment of fact combined with a logical are highly inflated by including all sorts against such things. It is good to see fallacy. Graham probably (if I am being of practices in the CAM category, such more and more articles written about generous) did not mean to state that as exercising and eating organic food— this topic—we want attention for the homeopathy can be traced back to an- and sometimes prayer is included. U.S. issue. We want a discussion of the mer- cient Greece, just that some CAM surveys show the percentage of CAM its of our position verses the pro-CAM therapies can.