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Should medical students be taught alternative medicine?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2417 (Published 28 March 2014) Cite this as: BMJ 2014;348:g2417

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Re: Should medical students be taught alternative medicine?

Dear Sir

Medical education aims to give students not only knowledge and skills, but mainly scientific wisdom and criticism, to prepare them for the difficulties of diagnosis and to make good treatment evaluations, to help patients make good informed choices that are possible only with trustworthy information. When patients choose treatments based on untruthful information, they only have an illusion of autonomy, and worse, they remain starved of the benefits of proven therapies.

The inclusion of ATs disciplines in medical curricula has been advocated to improve physician’s communication with patients that have also chosen treatment by Alternative Therapies (ATs), but, it is very difficult for universities to teach Evidence Based Medicine, and at the same time explain some matters with very low level of evidence like ATs, based only on their traditional use as plain guarantee for efficacy and a justification for rescind peer scrutiny. Yet, the History of Medicine demonstrates that many traditional treatments were pernicious like purges and bloodlettings base on the “humors theory” of Hippocrates.

In this era of explosive scientific growth, with the rise of many valuable disciplines overcrowding the undergraduate medical curricula, is it wise to waste time and resources to teach unproven theories of ATs? It seems more useful to teach Philosophy of Science, to develop students' critical minds to recognize the difference between pseudoscience (that occult errors, refuses to test their theories, and cultivates myths), and Science that submit data and theories to peer auditing, and as Karl Popper said, achieves the progress by correction of errors that are transparently disclosed on medical review.

ATs invoking its traditional use usually refuse peer scrutiny of their therapies, and when submitted to the same rigorous test, they reveal an efficacy similar to placebo. Cork and Williams [1] report that of 685 alternative therapies investigated through adequate clinical trials and meta-analyses, only 7% showed any evidence of efficacy, and many cases of adverse effects (including deaths) were reported, even with Homeopathy. Homeopathic medicines involve so many serial dilutions that in the final product there remains only water, which has led many scientists to consider homoeopathic remedies as “aqueous placebos”, which was confirmed on several pathologies by many placebo-controlled trials [2]. But, perhaps the most expressive proof of homeopathy’s inefficacy, is the lobby suppression of the report produced by “NHS Choices” referred to by Torjesen [3], which concluded that the majority of independent experts agreed that “Homeopathy is no more successful than placebo”.

A prominent Portuguese homeopath has recently declared to a newspaper reportage [4], that homeopathic products act by a process involving the emission of photons. After a lesson about Evidence Based Medicine, how is it possible to speak about luminescent medicines like fireflies?

How is it possible to teach medical students about the “miraculous medicines” like the product Slackstone that dissolves kidney and gallbladder stones (with very different biochemical pathogenesis) by the action of “dialytic water”, which is obtained by the modification of “atoms of water” (fig-1) referred several times on the electronic link of this product ( http://www.slackstone.com/ ).

It is worthy to remember that in the eighteenth century, the King of France appointed the great figure of the enlightenment Benjamin Franklin to lead a commission for evaluation of Mesmer’s therapeutics with magnetic iron rods [5]. Franklin pioneered the first blinded study design when he asked Mesmer to divide patients in two groups, and then blindfolded them before the application of the iron or wood rods. With this study design Franklin demonstrated to French society that Mesmer’s therapy was ineffective.

With some lax European legislation for ATs (like the Portuguese Law 45/2003 that gives plain technical and deontological autonomy to ATs practitioners), are we going backwards? I hope not, but surely we are forgetting the experimental science of Francis Bacon, and the lessons of many others like René Descartes, that gave huge contributions to de progress of science, mainly by modifying its behavior, by the Cartesian doubt and experimentalism. As Karl Popper said, the progress of Science is made by the correction of errors, which implies the fundamental testing of theories and data, and as he said, transparent disclosure on the way the data were obtained is critical, so that they can be reproduced for scrutiny by peers. It is useless to cultivate therapeutic myths, as happened over centuries with “humor theories and bloodlettings”.

Science is not free from bias, errors and fraud, but what is important for its progress is their mitigation by its transparent diagnoses and disclosure, like medical reviews have done. Many ATs practitioners invoke these errors to relativize the worth of Medicine, but that is not our weakness: it is our strongest way to reach the progress and avoid quackery.

It is necessary to develop scientific criticism not only in medical schools but also in society, to test and analyze ATs that may be useful. But it is necessary to select those that have proved their worth by the same rigorous tests applied to medical therapies, so that our patients could use its autonomy choosing them based on reliable information. We must avoid illusions of autonomy based on myths.

Bibliography.
1- Cork, N and Williams, G. Should medical students be taught alternative medicine? BMJ 2014;348:g2417
2-Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Sterne JAC, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. The Lancet 2005; 366: 726–32.
3-Ingrid Torjesen. Civil servants suppress evidence on homeopathy on NHS website after lobbying from prince’s charity. BMJ 2013;346:f1071.
4- Homeopatia cura ou fraude. Visão 2011; 937:74-82.
5- John Oates “The Science of drug therapy” Chapter 5 of Goodman & Guilman’s The Pharmacological basis of Therapeutics. 11th ed. McGraw-Hill New York 2006: 117-137.

Competing interests: No competing interests

14 April 2014
Fernando Martins do Vale
Professor of Pharmacology and Clinical Pharmacologist
Inst. Pharmacology/Neurosciences, IMM, Bioethics Department, and CFCUL Faculty of Medicine-University of Lisbon.
Faculty of Medicine-University of Lisbon. 1649-028 Lisboa, Portugal