Big name bloggers like Orac and Dr. RW and KevinMD are all up in arms about how “medical schools are going the wrong way” and asking “Does anyone in academic medicine care about the integrity of medical education?” They like to talk about the fluffy “woo” of medical school, as if we’re all hippies out in our commune who have sacrilegiously sacrificed our Evidence and Data to a golden cow.
Give. Me. A. Break.
They’re whining as if this is the most scandalous thing to have happened to American Medicine. Are you kidding me?
This is the same American Medicine (and academic medicine) that has played a part in the Vioxx scandal, who often have so many industry ties to their work that it’s hard to know if anyone is objective anymore. This is the same medical system where doctors at prestigious medical centers install medical devices and get a kickback, where doctors (academic and non) get paid big bucks to sign their patients up for clinical trials, and get flown to lavish vacations for industry-sponsored “education.” (I could dig up more examples if you really want.)
I’d ask these bloggers: Does anyone in medicine care about the integrity of medicine? If they don’t do any of these unethical things, great, but if you’re that upset about “integrity,” why not take a stand and try to change the system?
First off, do I believe in “Complimentary” or “Alternative” medicine (CAM)? I can’t say. It hasn’t been studied enough. Does this mean it doesn’t work? No. (I also realize this means that we can’t say it does work, either.) My own experience with acupuncture was that it helped my back. But I think some parts of CAM make sense: eating healthy, local foods, more produce, less processed foods. It’s extremely granola, but the American diet is so far from that, that a little overcompensation is fine in my book.
Either way, many patients use CAM, whether I think it’s a good idea or not–and honestly, I’d much rather have some sort of idea about what CAM is and what I need to know about it than be ignorant of it completely. Some herbs affect medication dosages, for instance. While I’m not ready to go advocate for my patients to take Chinese herbs for their liver failure, I unfortunately don’t get to control what they do in their own free time. I’d prefer to meet the patient where he or she is at than write them off or be ignorant when they ask me a CAM question. (And yes, Western Medicine is still lacking in the “cures” department–if a placebo effect helps someone, should we honestly ruin it for them if we don’t have anything better to offer?)
You know, it often comes back to the Almighty Dollar in many of these cases. And while I don’t think that most CAM people are in it for the money, the money is clearly there–people spend billions on CAM and vitamins and supplements that probably aren’t doing anything for them.
But if the CAM folks are in it for the money, who can blame them? What has American medicine (and by that, I mean doctors) focused on? Money, money, money. Specialists now try to do more procedures. Why? We put stents and devices into people all day long, sometimes without evidence or data of better outcomes. Why? Money.
There are many things in American medicine that disturb me. Is teaching a future doctor about treatments that aren’t proven bad? I’d say yes. But is that the worst of our problems? Hell no.
(PS: Did no one in medical school learn anything that turned out to be totally wrong, or totally bad for a patient? I know I already have.)