Assaulting alternative medicine: worthwhile or witch hunt?BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1075 (Published 15 February 2012) Cite this as: BMJ 2012;344:e1075
- Ray Moynihan, author, journalist, and conjoint lecturer, University of Newcastle, Australia
Fresh from its successes in the United Kingdom, the campaign to close down complementary and alternative medicine courses at universities is moving down under. A new group called the Friends of Science in Medicine wants to stop what it calls “pseudoscience” on campus, and vice chancellors at many of Australia’s universities are in its sights. So is this a reasonable reassertion of scientific principles or a bellicose, tribal attack on the competition?
The campaign is targeting many modalities, from acupuncture, naturopathy, and chiropractic to energy medicine, homeopathy, and tactile healing. While saying that it supports research, Friends of Science in Medicine argues that “universities involved in teaching pseudoscience give such ideologies undeserved credibility, damage their academic standing, and put the public at risk.” Vice chancellors are being urged to discuss with science faculties the “withdrawal of these courses,” and further campaigns aimed at insurers are being flagged.
“It’s a witch hunt,” says Southern Cross University’s Stephen Myers, a leading complementary medicine researcher and trained naturopath, a medical doctor, and author of government funded reports urging the integration of traditional Chinese medicine and naturopathy into the mainstream. “All health professions are currently under a call to increase the evidence base. Complementary medicine is in a similar situation, yet what this new group is calling for will remove individuals from academic positions that have capacity to contribute to that evidence base.” These professions need high standards of education, says Professor Myers, students need to understand the limits of their practice, and mechanisms to prevent inappropriate practice are required. “If all the courses close, standards of education fall and public health is detrimentally affected.” He’s backed by his vice chancellor, Peter Lee, who is “very comfortable with the rigour and strength of the science” at his university. The organisation representing vice chancellors has responded by saying that course content is a matter for individual universities.
A key campaign figure in the UK is the University College London professor David Colquhoun, who is helping his Australian colleagues—suggesting, for example, the use of freedom of information legislation to discover course content. Asked about concerns from academics that a witch hunt might be under way, he said, “Good, that’s the intention. I’ve got no mercy for vice chancellors and senior medics. I don’t mind going for the jugular, because it’s a betrayal of what universities are for, it’s going back to pre-enlightenment.” Professor Colquhoun dismisses the field as nonsense, its advocates as quacks, and ancient wisdom as “mostly wrong.” The massive research effort of the US National Center for Complementary and Alternative Medicine had found, he said, “not a single useful treatment.” Asked about evidence on the centre’s website suggesting that some treatments might be useful, he said there was only “a handful.”
Although much of the scientific effort referenced on the website finds treatments failing to beat placebo, other studies are more positive, such as a recent systematic review of almost 270 randomised controlled trials indicating potential benefits of acupuncture, massage, and spinal manipulation for some forms of back and neck pain.1 The complex treatment approaches of naturopathy, says the US centre, “are challenging to study, and little scientific evidence is currently available on overall effectiveness.” For homeopathy, most analyses find little evidence to support it, though some randomised placebo controlled trials report positive effects, the centre says.
At the same time it’s no secret that much conventional medicine is unsupported by good evidence. As with many complementary therapies, the BMJ Group’s Clinical Evidence currently classifies many surgical and medical interventions as being of “unknown effectiveness.”2 In Australia it is estimated that most of Medicare’s 5000 items “have never been comprehensively assessed for their safety, effectiveness and/or cost-effectiveness.”3 Disinvesting from ineffective and potentially dangerous mainstream treatments can also prove difficult.4 And much of so called scientific evidence is debased through the systematic bias that tends to flow with commercial funding.5
Any “friend of science” would surely be horrified by much of what happens inside conventional medicine, yet the campaign in Australia is aimed solely at the complementary sector. One of the founders of the Australian campaign, the University of New South Wales emeritus professor John Dwyer, says that it is not a witch hunt and not about attacking practitioners or researchers: it is about ending the teaching of “pseudoscience.” More than 400 people have signed up to the campaign, but one person who has withdrawn his initial support is the president of the Australian Medical Association, Steve Hambleton, who believes that the issue has become “much fuzzier and less clear.” Rather than calling for a widespread shutdown he says that courses should be judged case by case. “It’s too big a sledgehammer,” he says, agreeing that there is a danger of giving scientific imprimatur to “less than scientific” activities but emphasising the need for an open mind. Alan Bensoussan, a complementary medicine researcher at the University of Western Sydney, says that although the Friends of Science in Medicine sounds innocuous enough, he fears it is an attempt to purge universities of learning about areas such as Chinese medicine, approaches that could produce new ways of dealing with some chronic diseases.
In any mode of medicine over-promoting what may do more harm than good is as bad as building markets by making healthy people feel broken and in need of fixing. No doubt academic standards in some complementary medicine courses could be tightened and materials improved or removed. But wielding the sledgehammer may well undermine campus conversations that could ultimately enrich our scientific methods and our capacity to face the complex health challenges of the future.
Cite this as: BMJ 2012;344:e1075