MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Many experts have argued that the growing popularity of alternative medicine (AM) mandates their implementation into formal undergraduate medical education. Most medical students seem to feel a need to learn about AM. Yet little is known about the student-specific need for AM education. The objective of this paper was address this issue, specifically the authors wanted to assess the self-reported need for AM education among Australian medical students.

Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse the data.

The results show that these medical students generally held favourable attitudes toward AM but had knowledge deficits and did not feel adept at counselling patients about AMs. All students were supportive of integrating AM into education, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. Students recognised the need to be able to effectively communicate about AMs and advise patients regarding safe and effective AM use.

The authors of this survey concluded that Australian medical students expressed interest in, and the need for, AM education in medical education regardless of their opinion of it, and were supportive of evidence-based AMs being part of their armamentarium. However, current levels of AM education in medical schools do not adequately enable this. This level of receptivity suggests the need for AM education with firm recommendations and competencies to assist AM education development required. Identifying this need may help medical educators to respond more effectively.

One might object to such wide-reaching conclusions based on a sample size of just 30. However, there are several similar surveys from other parts of the world which seem to paint a similar picture: most medical students clearly do want to learn about AM. But this issue raises several important questions:

  • How can this be squeezed into the already over-full curriculum?
  • Should students learn about AM or should they learn how to practice AM?
  • Who should teach this subject?

In my view, students should learn the essentials about AM but not how to do this or that therapy. Most deans of medical schools seem to agree with me on that particular point.

The question as to who should teach students about AM is, however, much more contentious. Most conventional medical instructors have no interest in and/or no knowledge of the subject. Consequently, there is a tendency for medical schools to delegate AM by hiring a few alternative practitioners to cover AM. Thus we see homeopaths teaching medical students all (well, almost all) about homeopathy, acupuncturists teaching acupuncture, herbalists teaching herbal medicine etc. To many observers, this might sound right and reasonable – but I beg to differ resolutely.

Most alternative practitioners who I have met (and these were many over the last 20 years) are clearly not capable of teaching their own subject in a way that befits a medical school. They have little or no idea about the nature of scientific evidence and usually lack the slightest hint of critical analysis. Thus a homeopaths might teach homeopathy such that students get the impression that it is well grounded in evidence, for instance. Students who have been taught in this fashion are not likely to advise their future patients responsibly on the subject in question: THE TEACHING OF NONSENSE IS BOUND TO RESULT IN NONSENSICAL PRACTICE!

In my view, AM is an ideal subject to acquaint medical students with the concepts of critical thinking. In this respect, it offers an almost opportunity for medical schools to develop much-needed skills in their students. Sadly, however, this is not what is currently happening. All too often, medical school deans find themselves caught between the devil and the deep blue sea. In the end, they tend to delegate the subject of AM to people who are not competent and should not be let loose on impressionable students.

I fear that progress and care of future patients are bound to suffer.

 

21 Responses to What should medical students learn about alternative medicine?

  • Acupuncture can be easily explained scientifically. It seems everybody is on the wrong track, even the people in the East, but nobody wants to listen. Maybe the answer is to simple, the claim about endorphins being released by the brain to eliminate pain might be 5% correct if any. Stiff neck muscles and lower back pain for a start can be relieved within a few minutes if the working of acupuncture is understood in the way I see it. All other stress related diseases can be treated the same way.

  • There would be some point in teaching med students about the main branches of quackery in terms like “This is what practitioners say, this is the evidence”, so that they can have informed conversations with their patients. A doctor who knows what a particular woo-ology is supposed to be about stands a better chance of persuading patients of its wooness than if she has to say “Sorry, don’t know anything about it”.

  • And to continue a theme from your book, AM should also feature centrally in any courses or teaching about medical ethics.

  • I have found when working with doctors that its the young ones who are the most evangelical and anti-chiro. The older GP’s tend to send me the most referrals, while the specialists I talk to have the attitude “we don’t have all the answers, so if you can help thats great”. They have a confident laid back attitude! Interestingly, I have found that if I present a good critical argument to the most vocal anti-chiro doctors they switch to the other extreme and become strong supporters, though only to me and not the chiropractic profession in general. Communicating with doctors is a challenge. Reports I send to GP’s contain a lot of detail on history, examination, diagnosis, care plan and prognosis. While a report to a referring specialist is 1 paragraph, short and to the point. Its a case of “don’t teach me how to suck eggs, I’m fine, just get on with the job and keep me updated!”

    • @”Thinking”-Chiro (sorry, to me that is an oxymoron),
      I’m always fascinated that doctors would send patients to you for a placebo rather than dispense it themselves. Maybe it shifts the burden of responsibility from them.

      • “Maybe it shifts the burden of responsibility from them.”
        I have thought this many times when assisting chronic pain patients.
        I never underestimate the power of placebo and nocebo! I am spending more and more of my time advising patients on exercise, rehab, explaining pain, what they can do etc!

  • I agree whole heartedly.

    The same applies to the studies of any science. The studying of any science should not take into account all the esoterical movements that might be out there. It should empower the students with the tools and the critical thinking that lets them be able to see for themselves what’s real and what’s not.

    Teaching AM to medical students would be the same as doing a course on, say, earth rays to physics students.

    Students should be tought the things that (are proven to) do work. When they are proven to work they are simply called M, not AM (any more).

  • Of course medical students should learn about alternative ‘medicine’. They should be taught what a load of nonsense it is, and how to counter the claims of its proponents. After all, the AM crowd teach their students and practitioners how to deal with the arguments put forward by real medical practitioners. It is unfair on doctors, nurses and other medical personnel to expect them to have all the answers to the questions and comments which patients will bring in.

    And it should go further than medical students. Every GP must get dozens of patients every week who say they have seen an article in a magazine which says that a particular treatment is the certain cure for something. It is part of CPD to be able to deal with this sort of query, and those responsible for CPD should be taking it on board. I know my own GP surgery gets a number of people who read a certain national newspaper and actually take it into the surgery to prove that the doctor/nurse doesn’t know what they are talking about because the paper says some wacky treatment will cure whatever they have (or think they have).

    Who should do the teaching? Obviously not alternative practitioners. Any medical school who invites in any such practitioners to teach students is in my opinion guilty of malpractice. I don’t believe there are so few authoritative sceptics around that they couldn’t do the rounds of the medical schools with time to spare.

  • It’s a bit like teaching religion in schools, dare I say. By all means inform students of the practices, culture and history of the CAMS, but always from the scientific and evidence based perspective. It took me many years to truly appreciate the difference between anecdote and evidence, and I wasn’t really taught this in med school (but we are talking 30 years ago). I am an “older” specialist and I have to say my skepticism of CAM only gets stronger with time!

  • If, as you suggest, medical students lack critical thinking, I am not worried about them becoming homeopaths. I am worried about them becoming crap doctors.

  • Embedded in my medical practice are students in their penultimate undergraduate year for the entire academic year.
    I shall put the above question to them and report back with their responses.
    Conversely I wonder what alternative medicine students should learn about, well, medicine?

    • @Dr grog
      “Conversely I wonder what alternative medicine students should learn about, well, medicine?”
      Seriously, what a silly question. According to the alt-meds who frequent this blog, they know it all.
      (Oh, if only they could see the irony?)
      ~
      I, for one, am very interested in the responses. I know an anaesthetist who I thought was intelligent but I have real doubts about her capacity for critical thinking (about many things).

    • “Conversely I wonder what alternative medicine students should learn about, well, medicine?”
      The most important thing of all, when to refer to a doctor! I pick up on average 2-3 spinal secondary cancers per year. To treat every patient is easy and requires little critical thinking! Knowing when not to treat is infinitely more important!

      • Speaking of irony;
        “The most important thing of all, when to refer to a doctor! I pick up on average 2-3 spinal secondary cancers per year. To treat every patient is easy and requires little critical thinking! Knowing when not to treat is infinitely more important!”.
        Is it only me who sees the absurdity of this situation? If you weren’t involved, that is, if people sought medical care from a doctor, their cancer may have been detected earlier and their chances of recovery were be enhanced. Your involvement has only delayed a diagnosis and proper medical care.
        ~
        I know you are proud of yourself, however, your involvement is not only extraneous but, potentially, life threatening. Or, are you suggesting that your skills at diagnosis are superior to most medical doctors?

        • The substance of homeopathy

          The substance of homeopathy, which the researchers are still looking for, is part of each matter. People have known the essence of matter for several millennia since the first pyramid was built. On the Golan Heights there were 8000 megalithic structures built, mainly dolmens, some had the top cover plate of a different type of rock. On one of the dolmens I will try to indicate the essence of homeopathy and more. All megalithic structures were built in energetic places where the energy source is a water flow, underground springs or other features. Four previously unknown properties of static electricity have emerged from our research. These allow to guide research in another direction (for details on http://www.miroslavprovod.com).

          The matter of dolmens interacts with the source and obtains energy from it. Different kinds of rocks create different “zoning codes” that characterise the properties of each dolmen. The mutual contact of auras, or zones of both charges is to balance their energy potential while moving chemical properties. People could spontaneously transfer chemically modified energy from the dolmens. It follows that different health problems were cured with different energy and chemical values.

          The above text can deduce the nature of homeopathy. Its secret is not hidden in a dilution of the molecules, but in water treatment. Simple experiment can be done with a plastic soda bottle – shaking the water augments the aura and the water charge. Static electricity of water creates something unknown and tempts to wonder if the same feature transfers something from the megalithic structures to organisms and materials. The hundreds of menhirs and dolmens that were built on the Earth tempt us to wonder if the builders did not use more energy for other purposes.

          I believe it is important to note that a similar phenomenon in which there are changes in the original code matter described in the bible EX 20.25. “And when you build a sacrificial altar, do not build it from blocks (ie. The hewn stones), because you have him raised his (iron) and desecrated the tool you are (ie. The stones).” It is inconceivable, but it can be demonstrated experimentally,
          Today, homeopathy treats 400 million patients around the world and it is practiced by around 300,000 physicians. Homeopathy is used for this purpose in approximately 100 countries. Patients do not know the nature of homeopathy, but it is sufficient for them that it works.
          It is not easy to understand the high level science of the megalithic culture, but “Caucasian antigravity” clearly indicates that we missed something in history. That text presents another line of research, from which some further information can emerge.

          Miroslav Provod

          • @Miroslav Provod
            Good grief! You are copy-and-pasting your nonsense word for word in diferent threads. This is antisocial behaviour.

  • In reply to Frank Collins:
    I work in a medical centre with doctors! I have a referral network of GP’s, physio’s and specialists who I communicate with constantly. They refer to me and I refer to them. This interdiciplinary approach is the foundation of medicine!
    Are you saying that prompt appropriate referral up the medical food chain and collaboration with doctors is inappropriate?

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