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Pseudoscience in Our Universities

The Science of Medicine

Steven Novella

Volume 36.3, May/June 2012

The group Friends of Science in Medicine has recently formed in Australia, and they now have over 400 professional members. They felt the need to come together over a disturbing trend—the infiltration of rank pseudoscience into once respected universities.

It is a sign of our times that we have to defend having standards of good science in the practice of medicine and the teaching of a science-based curriculum in universities. High standards of science in medicine are necessary in order to ensure, as best as we can, that treatments and interventions are safe, effective, and ethical. It is extremely complicated and tricky to determine safety and efficacy. Humans suffer from numerous mechanisms of self-deception, cognitive flaws and biases, poor grasp of statistics, and perceptual failings that are likely to lead us astray. In fact our biases tend to systematically lead us to false conclusions that we wish to be true, rather than to the truth.

These flaws, biases, and cognitive errors make it difficult to come to reliable conclusions in any area of exploration, but perhaps particularly so in the applied science of medicine. This field is further plagued by placebo effects, which represent the above effects in addition to a complex emotional and physical response to the nonspecific aspects of getting attention from an attentive practitioner.

Science is the only system that we have developed that systematically controls for all of these biases and flaws to see through to reliable information. Science endeavors to be transparent, thorough, and rigorous. The application of scientific principles has demonstrably transformed medicine (and human knowledge in general) for the better. As a society we should not lightly abandon the principles of science or try to change them to meet the needs of the current fads.

Universities in particular are supposed to be the exemplars of scholarship and intellectual legitimacy. People believe universities are intellectual leaders, not followers, and they are correct (or at least, they should be). Teach­ing a topic in a university is absolutely an endorsement of the legitimacy of that topic. We can distinguish between teaching about something and teaching the thing itself. It is okay to teach about so-called complementary and alternative medicine (CAM) as a sociological phenomenon or even as an example of pseudoscience. Practi­tioners also need to learn about any method their patients may be using or about which they are curious. Credu­lously teaching CAM, however, is an endorsement, the granting of the imprimatur of the university.

It is tempting to cater to prevailing fads, to acquiesce to the vocal advocates and give them what they want, especially when there isn’t much protest. That is exactly what intellectual integrity is about, however—doing the right thing because it is right, not because it is popular or expedient.

I will acknowledge perhaps the only legitimate argument on the other side: that of academic freedom and diversity of opinion. I agree with the principle that a university should also be a place for the free exchange of ideas and should not easily impose censorship. Proponents of nonsense, however, have taken this principle too far. Academic freedom needs to be tempered with quality control. Professors should not be allowed to teach absolutely anything they want without limit. The university has a duty to ensure that the minimal standards of academic legitimacy are met.

This duty includes ensuring that science is taught in science classes. This debate has come up with reference to teaching creationism as science as a matter of academic freedom. Such freedom does not extend to the point of teaching demonstrable pseudoscience as if it were a legitimate science. The exact same thing can be said about teaching homeopathy, for example, as if it were legitimate science-based medicine.

The argument above should not be difficult to make and should resonate with academics. It has worked well in the United Kingdom, spearheaded mostly by David Colquhoun, who has used freedom of information requests to obtain the CAM curricula at universities teaching CAM, and then simply sent them to the dean and/or board of trustees of the university. This one act has led to the removal of CAM courses from universities in the United King­dom. Simply shining a light on what was happening was enough.

In the United States we are having a harder time, although we have had some successes also. The American Medical Student Association (AMSA) has been infiltrated by CAM proponents who have managed to get requirements for CAM to be taught in American medical schools. Of course, we can still teach about CAM (which I actually advocate) rather than promote pseudoscience—something that is not a subtle distinction but is often difficult for some to make.

Australia is perhaps having the most difficult time with this issue, leading to the formation of the Friends of Science in Medicine. Their request is simple: no pseudoscience in universities. They have helped bring the debate to the forefront. CAM’s greatest ally in infiltrating universities is stealth. I have seen this infiltration occur deliberately under the radar with the stated goal of avoiding too much attention, which might draw criticism. This violates the principle of transparency, and it illustrates why focusing attention on this trend is so useful.

Of course, CAM proponents are not going to just lie down and go away. There have been many responses to the criticism of teaching CAM in medical schools, none of which is valid. In Australia, the most frequently quoted defender of teaching on nonsense in universities is Iain Graham, professor at Southern Cross University’s School of Health. He is quoted in several articles, but this quote responding to criticism from John Dwyer, emeritus professor of medicine at the University of New South Wales, is representative:

Professor Dwyer’s sweeping discussion about the issue are to do with quackery really, and the rooting out of poor practise. But if we look historically at the evolution of health care and the health professions, there are many similarities with where things started.

He mentioned homeopathy for ex­ample, well homeopathy is as old as Greek Hypocrates in terms of practising medicine. (Australian Broad­casting Company 2011)

Here we have a blatant misstatement of fact combined with a logical fallacy. Graham probably (if I am being generous) did not mean to state that homeopathy can be traced back to ancient Greece, just that some CAM therapies can. Homeopathy was in­vented by Samuel Hahnemann about 200 years ago (Novella 2009).

But I wonder what CAM modalities he had in mind. Chiropractic? About 100 years ago. Therapeutic touch? A few decades ago. Acupunc­ture is a complex question, but what passes for acupuncture today is less than 100 years old. Perhaps he was thinking about bloodletting or trepanation.

However, it is true that some basic concepts, like the notion of “life energy,” can trace their roots to ancient Greece and other ancient cultures. However, such notions are pre-scientific nonsense. Scientists abandoned the notion of life energy over a century ago because there was no evidence that such a force exists (and there still isn’t). After figuring out all the basic processes of life, there was essentially nothing left for the alleged life force to do.

For some reason, however, Graham believes that antiquity in science is a virtue—the “argument from antiquity” logical fallacy. The unstated assumption is that if an idea has survived for hundreds or thousands of years it must be legitimate. This is demonstrably false. Galenic medicine (bloodletting, purging, etc., based on the notion of the four humors) survived for thousands of years, and yet it was based on complete and utter primitive nonsense. In fact its tendrils still exist. There is still bloodletting, cupping (which is just another form of bloodletting), and similar practices going on in the world. It was replaced in the West because of the advent of science in medicine—a trend that Graham apparently wants to reverse.

Graham’s second swing and a miss: “Eighty per cent of Australians seek alternative therapies,” Graham is quoted as saying by Australian newspaper the Northern Star. “Obviously orthodox medicine is not working for everyone” (www.northernstar.com.au/story/2011/12/12/alternative-therapy-course-not-magic/). I highly doubt that the 80 percent figure is correct. Most such figures are highly inflated by including all sorts of practices in the CAM category, such as exercising and eating organic food—and sometimes prayer is included. U.S. surveys show the percentage of CAM use is around 33 percent (NIH 2008), but this is mostly things like massage and chiropractic manipulations. Home­o­­pathy use is around 3–4 percent, and acu­punc­ture 6–7 percent. In fact, only manipulation and massage were in the double digits.

This is all marketing deception. Create a false category (CAM), pad it out with commonly used methods, and then claim that the extreme fringes are therefore getting more popular. I don’t know how Graham got to 80 percent (I doubt such methods are that much more popular in Australia than in the United States) but it is close to one survey from 2007 that found that 69 percent of Australians used one of the seventeen most popular forms of CAM in the last year (Xue et al. 2007). However, that study included in its list martial arts, yoga, massage, meditation, and taking multivitamins. I am not sure what taking multi­vitamins says about the popularity of homeopathy, but apparently Graham thinks it is significant.

In any case, I will grant that CAM as a marketing concept has been somewhat successful—and even that it has gained popularity recently (although not as much as advocates would have you think). That is entirely irrelevant, however, to the question of whether or not any particular CAM modality is science-based and appropriate for a university curriculum (which is the question at hand).

Universities are supposed to be thought leaders with intellectual standards that rise above the mere notion of popularity. They are supposed to uphold academic standards of scholarship, especially in scientific disciplines with high standards in science. It is therefore very odd and disturbing to defend a university policy based upon popularity. Should we allow surveys of public opinion to determine whether or not we teach creationism or astrology in our universities?

It is good to see some organized backlash against the infiltration of pseudoscience and nonsense into the very institutions that should be teaching against such things. It is good to see more and more articles written about this topic—we want attention for the issue. We want a discussion of the merits of our position verses the pro-CAM position. Let’s have a very public debate about the facts, about what is science, and how we as a society should determine what medical interventions are worth our public support.

We will confidently stand by our position. CAM proponents, like crea­tionists, have nothing but weak and fallacious—and long discredited—arguments on their side.


References

Australian Broadcasting Company. 2011. Uni criticised for teaching alternative therapies (De­cem­ber 9). Available online at www.abc.net.au/local/stories/2011/12/09/3387574.htm.

NIH. 2008. 2007 National Health Interview Survey (NHIS) Adult Alternative Medicine Public Use File (althealt) IDN Variables Wednesday, June 4, 2008. Available online at ftp://ftp.cdc.gov/pub/health_statistics/NCHS/dataset_documentation/NHIS/2007/althealt_freq.pdf.

Novella, S. 2009. Homeopathy awareness week (blog entry). NeuroLogica (June 15). Avail­able online at http://theness.com/neurologicablog/index.php/homeopathy-awareness-week/.

Xue, C.C., A.L. Zhang, V. Lin, et al. 2007. Com­plementary and alternative medicine use in Australia: A national population-based survey. Journal of Alternative and Comple­mentary Medicine 13(6) (July/August): 643–50.

Steven Novella

Steven Novella, MD, is an assistant professor of neurology at Yale University School of Medicine. He is 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.