Drs. Frank Cerra and Aaron Friedman have asked for an opportunity to respond to my original post: Why Would An Academic Health Center Support Homeopathy. I am pleased to do this.
Guest Post:
Dr. Frank Cerra, former Vice President, University of Minnesota Academic Health Center and Medical School Dean
Dr. Aaron Friedman, Vice President, University of Minesota Academic Health Center and Medical School Dean
In a February 4, 2011 blog post-turned-editorial, University of Minnesota associate professor Bill Gleason openly questions why a University with an evidence-based medical school would dedicate resources to a Center for Spirituality & Healing (CSH).
We thought that was an excellent question, so are pleased to have an opportunity to respond.
The Center for Spirituality & Healing was established in 1995 during a period of time when medicine and the health professions in general were coming to terms with the idea that what we don’t know about improving human health is far greater than what we do know within the confines of our traditional, Western-based practice. The original concept was to develop a program that provided faculty, students, and the community with an entry point to what’s now called integrative medicine, or integrative health care.
Since its inception in 1995, the Center for Spirituality & Healing has helped push health care forward. Students have been and continue to be one of the major drivers for the growth of CSH by crossing disciplines to expand their field of study and adding integrative medicine insight to their scope of study. The Center’s growing number of faculty educates health professionals on new models of care and positions consumers at the center of their health care. Most importantly, the Center helps patients more effectively navigate the health care system, a benefit to any health provider.
The field of health care is undergoing profound change. Today, patients more frequently combine a complementary treatment approach to traditional therapies. They’re also taking a more active role in the health care decisions that impact them and to do so, are seeking care from providers who are able to safely and effectively integrate these two types of therapies. Such a shift is an asset – not a threat – as we look to treat the entire patient.
The operating principle of the CSH is to have an evidence-based approach to complementary approaches to health, and also to promote comparative, evidence-based research between complementary and traditional therapies—knowledge that providers need to best serve the patients coming to them for integrative care. So in charging the University with wasting its resources in supporting the CSH, Gleason couldn’t be further from the truth.
In actuality, only a small percentage of the Center’s funding comes from University resources. The rest, it earns through tuition revenue, philanthropic gifts, and extensive research funding. Integrative medicine is an internationally recognized area of study, including by the National Institutes of Health, and our CSH has been very successful in competing for NIH funding.
For all of these reasons, the CSH is a great investment with incredible returns. In fact, for every University dollar invested in the CSH, it leverages such funding to generate ten more dollars. If all University Centers, Institutes, and faculty functioned as efficiently or as productively as the CSH, our University would be on very solid footing indeed.
The University of Minnesota’s Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers. In 2011, what we don’t know about improving human health still exceeds that which we do know. Perhaps this will always be the case.
But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.
In its short 15 year tenure, the CSH has established a model curriculum, hired faculty, and developed a graduate minor as well as a post-baccalaureate certificate program. And for 15 years, the Center for Spirituality & Healing has enriched health and well-being by providing high-quality interdisciplinary education, conducting rigorous research, and delivering innovative programs that advance integrative health and healing.
We look forward to discovering what the next 15 years holds for not just our Center, but the field of integrative medicine as a whole.
It’s critical to remember that our University is a state-wide resource and its mission is to serve the whole patient, the whole state, and the nation.
27 Responses to Response: Why Would an Academic Health Center Support Homeopathy?
pocvecem - February 11, 2011 at 6:17 pm
Same snark as last time:
Maybe the university decided that its financial situation required it to restructure some departments. Did you check to see whether Cultural Studies was merged with pharmacology?
hemlocktree - February 11, 2011 at 8:01 pm
Drs. Cerra and Friedman are blowing smoke. Homeopathy has already been studied and found to be without effect. Their response is a perfect example of PR doubletalk. There certainly are complementary medicine therapies that are effective (for example, yoga is effective in treating stress and depression), so why not mention the ones that have a research backing, instead of making vague statements.
jffoster - February 12, 2011 at 7:44 am
What exactly is “Spirituality”? Do the smoke blowing Drs. actually know? Why do they need that term in the title of their program at all?
wbgleason - February 12, 2011 at 8:10 am
Please note that this response does not even mention the topic of my original post which was homeopathy. I think this says about all that needs to be said by me.
Bill Gleason, University of Minnesota alum and med school faculty
barbarapiper - February 12, 2011 at 9:39 am
The arguments made in this essay in support of the Center for Spirituality and Healing sound like sleights of hand, and in most cases side-step the issue. Let me comment on a few.
1.
“The Center for Spirituality & Healing was established in 1995 during a period of time when medicine and the health professions in general were coming to terms with the idea that what we don’t know about improving human health is far greater than what we do know within the confines of our traditional, Western-based practice.”
I’ll be cynical and point out that the NIH Office of Alternative Medicine was established in 1991, and numerous medical schools around the country established centers or research agendas in CAM in the mid-1990s in order to become eligible for research and development funding from this new NIH office. “…what we don’t know about improving human health is far greater than what we do know…” has always been the case. It’s not about medicine; it’s about the money.
2.
“The field of health care is undergoing profound change. Today, patients more frequently combine a complementary treatment approach to traditional therapies. They’re also taking a more active role in the health care decisions that impact them and to do so, are seeking care from providers who are able to safely and effectively integrate these two types of therapies.”
Ah yes – a reference to David Eisenberg’s research, which revealed how common it is for U.S. patients to use alternative and complementary medicine unbeknownst to their physicians. We use alternative medicine more often than mainstream allopathic medicine. It’s not a bad thing to understand this, but it does not address the issue: the promotion of worthless therapies under the excuse that patients are going to use them anyway is not ethical.
3.
“The operating principle of the CSH is to have an evidence-based approach to complementary approaches to health, and also to promote comparative, evidence-based research between complementary and traditional therapies—knowledge that providers need to best serve the patients coming to them for integrative care.”
Of course it’s evidence-based. Without that guiding principle, it wouldn’t be eligible for NIH research funding. But again it side steps the original point: with no valid, well-designed, replicable studies suggesting that homeopathy is effective beyond its placebo response, how can it be supported?
4.
“In actuality, only a small percentage of the Center’s funding comes from University resources. The rest, it earns through tuition revenue, philanthropic gifts, and extensive research funding. Integrative medicine is an internationally recognized area of study, including by the National Institutes of Health, and our CSH has been very successful in competing for NIH funding.”
No comment necessary.
5.
“The University of Minnesota’s Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers. In 2011, what we don’t know about improving human health still exceeds that which we do know. Perhaps this will always be the case. But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.”
Any time a scientist or clinician considers explanations (whether hypotheses or diagnoses or treatment options), those that are most likely to be valid are given priority over those that are less likely to be valid. Allopathic physicians have achieved great success treating cancer as a physical disease, not as a lost of spiritual faith, as Christian Science might urge. If my daughter gets an ear infection, I do not expect her physician to recommend prayer, Reiki massage, or flapping a dead chicken at the aurora borealis. Could those work? Maybe. Should we invest millions in testing them? Not my tax dollars, not when antibiotics seem effective.
Your UMN V-Ps need to acknowledge that it is not the “one line of thinking” that is the issue. It is a way of doing science that is the issue. When science fails to detect any therapeutic benefit from an alternative therapy, it is only ethical to discourage the use of that therapy, not to promote it.
Finally, let me add that there is great benefit in supporting research on many alternative therapies. Chewing willow bark might have seemed bizarre until aspirin was discovered; a vast number of effective drugs are derived from plants, the traditional use of which might look just like those strange primitive medical practices that we want scientized. But when there is not even a way to determine if actions such as “prayer” are effective (we cannot even decide what “it” is, and how to control its use), there is no way to “complete the overall scene.” Homeopathy is junk science; its proposed mechanisms of effectiveness sound like fantasy. Nothing in this Minnesota response offers the first good reason to support such therapies apart from cynical appeals to lots of money that can flow in if we suspend our better judgment and let the feds pay us to study it.
daujones - February 12, 2011 at 4:25 pm
Bravo to the University of Minnesota for the very responsible work they are doing to train physicians to consider the patient as a whole person rather than little more than the vessel for the arthritic knee or cancerous prostate. Whether or not homeopathy “works” isn’t the right question to ask. Chemotherapy doesn’t “work” for curing bronchitis in the same way that antibiotics don’t “work” for curing viruses. What we should be asking – and it seems that UofM is – is for what conditions does homeopathic treatment work or work best, and in combination with what other therapies (allopathic, spiritual, etc) does it achieve the best result? It may be that homeopathic remedies work as outstanding stand-alone treatments for some conditions and as complementary (to allopathic) treatments in others. Science has not answered all of the questions about when, how and why alternative (to allopathic) therapies work, but it certainly has not produced any results that would suggest it is a waste of time or money to explore the potential of homeopathic medicine. That homeopathic remedies are inexpensive and have few associated side effects (some remedies make those who are lactose intolerant a bit gassy) should make them the focus of lots of research.
What if homeopathy, acupuncture or spirituality could reduce the cost of health care delivery and produce, for some diseases, equal or better outcomes? Oh, that’s right – it would crumble the hierarchy and challenge the dominance of the current leaders, potentially shifting the power to another. I guess when you can’t show results to prove that your way works best, the best you can do is hack away at the other person’s work. Are the negative commenters afraid that if homeopathy works, you could quickly find yourself out of that job that Harvard medical trained you to do so well? Or are you just worried that the NIH might favor work other than your own when making allocations of scarce resources? Is it just that you don’t want more horses at the tough?
I don’t think anyone is saying that homeopathy, alone, could cure cancer, but perhaps homeopathy could make chemotherapy more effective, or minimize the side effects so that we could use a more aggressive regimen of chemotherapeutic treatment.
Why is it that science is called “junk” science when the findings are counter to mainstream scientific thinking or when one brave soul stands up to challenge his or her peers? Shouldn’t those experts in non-biased empiricism start practicing at least a little of what they preach and hold ALL research findings to an equal level of scrutiny? Have you ever thought about just how much “real” science that is published by mainstream journals turns out to be “junk” science in the end? That, alone, is evidence that peer reviewers are far too lax in criticizing papers that reinforce, rather than challenge, their world view.
Sadly, science has become its own form of religion. In a very odd twist of fate, it is now the scientific community, not the church, that is creating its very own set of modern-day Galileos.
barbarapiper - February 12, 2011 at 5:26 pm
Daujones asks: “Have you ever thought about just how much “real” science that is published by mainstream journals turns out to be “junk” science in the end? That, alone, is evidence that peer reviewers are far too lax in criticizing papers that reinforce, rather than challenge, their world view.”
Of course, it’s a serious concern – but that doesn’t make rigorous testing of scientific hypotheses a waste of time, or suggest that those that ROUTINELY FAIL rigorous testing – such as homeopathy’s therapies – should be embraced. There are no discovered conditions in which homeopathy “works” in any way that is different from placebo effects. You may be waiting for that one magical study in which a homeopathic “drug” (which is chemically identical to pure water) actually and unambiguously cures a disease, but you may also be waiting for Santa Claus.
Daujones continues: “What if homeopathy, acupuncture or spirituality could reduce the cost of health care delivery and produce, for some diseases, equal or better outcomes? Oh, that’s right – it would crumble the hierarchy and challenge the dominance of the current leaders, potentially shifting the power to another.”
Very entertaining. Ann Landers used to get letters from people in the 1960s saying that they heard that doctors could cure cancer if they wanted to, but then they’d lose the bulk of their income. It echoed earlier, 19th century concerns – from doctors – that if the “germ” theory of disease turned out to be true, medicine might actually cure disease and doctors would lose the substantial income they derived from treatment of wealthy patient/clients. Medicine persists along its trajectory despite these fantasies.
And the “what if” argument is always a great one. “What if we could find a way to persuade the health fairy to visit whenever we asked, and then those bullying Harvard Med guys that daujones mentioned would be sorry….” What if, instead, we invested our scarce resources in research and development in areas of medical research that have shown real promise?
The “patient as a whole person” is fine. George Engel argued persuasively for that in his famous 1977 article “The New For a New Medical Model”, and Mack Lipkin wrote his book “The Patient as Person” (also 1977), which became a mainstay of medical education for a while. Nothing wrong with that; clinicians embrace it. But that is a different issue, I’m afraid.
Daujones ends “Sadly, science has become its own form of religion. In a very odd twist of fate, it is now the scientific community, not the church, that is creating its very own set of modern-day Galileos.”
Well, no – religion, as a matter of definition (See Edward Tylor) relies on a belief in a supernatural, which is precisely what has been rejected in science since the Enlightenment. We put people on the moon because our science was good enough, not because we prayed hard enough. Science — like many fields – may embrace its own ideologies, but that doesn’t make science a “religion”, nor does it make those ideologies false. On the contrary – one of the hallmarks of modern medical science is the assumption that revolutions in thinking are just around the corner, as we have moved from simplistic humoral models of disease to anatomical models to cellular pathology to molecular biology, always gaining extraordinary power to diagnose and treat disease. Homeopathy? Not so much.
You want to be treated with a homeopathic “drug” that is chemically indistinguishable from pure water? Fine; go see a homeopath. Just don’t expect a better result than you’d get from a placebo, and don’t expect that responsible allopathic physicians will recommend it. But be very surprised if a major state university medical center offers it.
goxewu - February 12, 2011 at 7:21 pm
“I guess when you can’t show results to prove that your way works best, the best you can do is hack away at the other person’s work.”
Absolutely right: I guess when you can’t show results to prove that homeopathic remedies work best, the best you can do is hack away at allopathic medicine’s work.
What’s amazing about Diane Auer Jones’s comment on this post is that she was, in the words of her profile on the website of her former employer, The Washington Campus, “trained as a molecular biologist, [and] began her career as a laboratory director and college biology professor.” In other words, someone who was trained in, and practiced, the scientific method now supports a state university offering a scientifically unsupported pseudo-medicine on the grounds that, simply put, since allopathic medicine doesn’t cure absolutely everything all the time, offering any “alternative” medicine must be a good idea.
Not only is Ms. Auer Jones’s comment riddled with the likes of “it may be that,” “what if,” “are negative commenters afraid,” “are [they] afraid,” and “perhaps”–all without one shred of scientific evidence that homeopathic medicine would fare any better than, say, wafting incense and shaking rattles over a patient. It’s up to a medical method to prove it does work; it’s not up to allopathic doctors and scientists to prove that it doesn’t. If there is a bona fide scientific study out there that indicates that a homeopathic remedy works more than a standard deviation better than allopathic medicine in some significant instance, Ms. Auer Jones–who, one would expect, could uncover such data–should cite it.
And while Galileo might have proven the Church wrong on the matter of the Earth being in orbit around the sun, he didn’t prove astrologists, numerologists, alchemists, and tea-leaf readers to be right.
Afterthought: Is the Career Education Corporation looking to add to its roster some schools offering training in “alternative medicine”?
Juan2X - June 29, 2011 at 10:21 pm
Can we say “antithetical” ?
arrive2__net - June 30, 2011 at 1:54 am
The way the Carnegie-Mellon software is described here it seems to me that it is more likely to take the place of a textbook than of the professor.
It seems as if the C-M software plays a role as equalizer among students, so the less prepared students are able to complete the course along with the more prepared students. With tuition as high as it is, failing to complete a course is a significant loss of money for the student, as well as a loss of time, so having this kind of resource available to the student could make a big difference. It seems obvious that the student who needs to make extensive use of the C-M software will have to invest a lot of extra study time to complete the regular course work requirements plus the remedial parts of the software, but the article did not address that. Perhaps the software is so individualized (or adaptive) that the student is able to limit his or her software use the truly needed components.
I don’t think its unusual for regular college students who feel unprepared for a course to seek additional help through tutoring, self-directed extra studying, consulting with other students, etc. The C-M software could be a major improvement on leaving the individual students to struggle with being under prepared. Improving completion rates from 41 to 99 percent is major.
Where student potential problem areas are predictable and well-defined it seems like that the
C-M type of software could provide the well-focused help some students may need.
Bart Schuster
Arrive2.net
Twitter.com/arrive2_net
kathden - June 30, 2011 at 7:28 am
The project director’s saying the software will allow professors to “teach different things” in the classroom betrays a lack of thought about how one progresses through this kind of technical course (notice: statistics, math, logic, and the like) and the curriculum it’s part of.
I have occasionally expressed out loud in my department that logic courses could be made far more philosophical if everyone took a course in propositional logic beforehand (I could then do a single course beginning with the more sophisticated predicate logic, move on to a little modal logic, and present some issues about the limits of logic at the end–and all along have a little more time to discuss “philosophical implications”). But whatever course you are teaching, the major pedagogical problem is that students make progress at different rates. Suppose propositional logic (PropL) is what the software is helping them with, and the slower students are spending (say) three times the total clock-hours working on PropL as the better students. If I introduce different kinds of material in the classroom while they are still in the PropL phase of the course the slower students will feel even more overburdened (because at every moment of that early phase they will be at least a little bit behind the better students, with a lot more work).
The source of this “problem” is that there is an entire curriculum that you have to work through step by step. That’s why we have earlier courses that are prerequisites for later courses, and why we cover basic materials before we move on to more sophisticated topics.
It is one thing to give students resources to succeed in what is, for the average student, a well designed course with a reasonable amount of material to be learned. It is another to believe that we can ask them to use those extra resources while taking the course and at the same time packing more material into the course.
dirigo1 - June 30, 2011 at 8:10 am
Online courses are the inflatable dolls of academia. They may look nice at a distance, but no matter how much kids contribute, they won’t take much of lasting value away. They are sterile-minded bureaucrats’ euphemasia instruments, a for-profit cultural execution chamber.
educationfrontlines - June 30, 2011 at 8:34 am
Again, the Chronicle HE title does not reflect the content of the article.
“College”…singular.
acorn - June 30, 2011 at 9:18 am
Agreed. But we’re always telling our teenage kids to get off the phone. We don’t encourage them to spend yet more time talking on the phone precisely because we do want them to interact face-to-face with people and their surroundings.
rlgwau - June 30, 2011 at 9:21 am
One college–Bryn Mawr–is the primary example given, but Paragraph 5 mentions that BW is just one of 36 colleges that will be using the new software.
cb_10 - June 30, 2011 at 9:39 am
A lot of bad analogies here. Let’s just put it this way: How much lasting value did you think anyone would take away from your post here? For that matter, how much lasting value does someone take from dissertations or journals or writing in general. (And of course the Web consists of far more that that)
I’m very skeptical of people who make revolutionary claims about online learning replacing the bricks and mortar classroom, but one thing I dearly hope to see the death of soon is this magical idea that academia only works in a face to face courses. Research doesn’t support it, practice doesn’t support it. Certainly there are types of learning that require physical interaction (painting, chem labs,etc.) but not all learning and not all aspects of learning.
And to compare online classes with inflatable dolls (and a “cultural execution chamber” whatever that would be)? The analogy, like the doll, is full of hot air.
The real world that students are going to enter is now full of digital resources (including many firmly grounded in the liberal arts – checked your local museum’s Web site lately?). Schools that ignore that reality are not doing their students any favors. Indeed, they are grounding them in a social and professional paradigm that perished well over a decade ago.
education4access - June 30, 2011 at 10:18 am
I am pleased to see this decision that is being made by Bryn Mawr.
E-learning that works well often uses the concept of mastery learning. This sort of learning is designed to help 100% or the students master 70% or more of a course’s instructional material. Print-based mastery learning, combined with interactive discussion oriented tutorial sessions, has proven to be very successful in non-traditional higher education among adults around the world.
Electronic-based mastery learning combined with face-to-face discussion oriented tutorial sessions also promises to be quite successful. This sort of instruction will achieve the best results when the professor adopts principles of adult education as s/he leads the tutorial discussion.
chriskox - June 30, 2011 at 10:52 am
Will anyone discuss the real issue here, the basic skills void for many high school grads?
Terry Powell - June 30, 2011 at 11:20 am
I disagree with you. It does not appear as though you have experience with the online learning environment. Online learning is harder, more intense and more compact than one semester within a classroom. My associates was done in a classroom. My bachelors, masters and doctorate degree programs have all been done online. With my working two jobs (teaching at two universities), I would not have been able to complete my degree programs. Also, as a professor for two art universities, I also teach online courses. With one school, I provide live lecture to my students twice a week. Our interaction is live and lectures/demonstrations are all recorded for those who could not attend the live sessions. An on-ground class is at least 10 weeks. Most online courses are condensed into five weeks. The expectations, curriculum and objectives are much higher than either a blended learning environment or that of an on-ground classroom.
mmcferrin1616 - June 30, 2011 at 11:20 am
Agreed. And this is where the online courses have value. For a generation raised on a constant diet of technology, a dusty textbook full of remedial math and basic grammar is not a source of motivation. Online developmental courses, especially those that are asynchronous and even self-paced, can provide an engaging way to build those missing skill-sets and retain an otherwise frustrated student. Online education is a tool like so many other educational innovations and should be used with and by professors, not in place of them.
Terry Powell - June 30, 2011 at 11:26 am
Juan,
“What” is not ethical?
idixon - June 30, 2011 at 12:53 pm
Denying reality will not change it. I read the continued dialog about online learning while the demand for educational access continues to grow. Students that are well prepared will flourish in either environment frankly. I have had the good fortune to teach in both settings and the nature of the course, instructor preparation and the tools they have to work with make the difference.
Online learning is a tool whose time is here and if we continue to resist using it (appropriately) we will continue to seem out of touch to our students and the world. Open our minds and hearts, continue to learn that should be our message.
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davidfalcone - July 1, 2011 at 7:04 am
There is another issue here that concerns me. Take a statistics class. A university class in statistics does more than pass on skills involving z-scores and regression coefficients and F tests. It is part of a larger socialization process that results, hopefully, in the honing of a students capacity to get on in a world that is filled with differences, and public struggle and citizenship. If this sounds misplaced, then consider the students in class who openly take text messages or are totally insensitive to the others close by when they fail to consider their choice of words when talking in public. And these are the little things. I wouldn’t be worried if I thought that there would always be a balance of in-class and on-line experiences for our students. But, unfortunately, there is big money in on-line courses and big savings for most universities in using them. Unless something changes, we will let the market decide on how we educate our students. If the market decides … there won’t be much use for the brick and mortar and this, I fear, will come at a great cost.
johnakline - July 1, 2011 at 1:08 pm
I see nothing wrong with a computer “taking over some of the basics” as he said. And agree with the poster above that a website or web app or computer application can do a lot more than a text book when it comes to self paced learning and assessment (the non-lecture part of the course). Seems this would be particularly true for Math – which is after all the native tongue of a computer. I know some colleagues who make extensive use of online materials for a traditional face to face class (usually through LMS). For example – using the online platform for testing, threaded discussions, homework, accessing media elements and readings, etc. These are often things we do not have enough time to do in class. If we can use the online space for some of this stuff – we can use the lecture for more exciting stuff. This does not do much for the fact that most people are actually not great lecturers. Should not be a surprise as most of us are not trained in public speaking (or teaching for that matter). And sitting in front of a not-so-great lecturer is probably not the best learning experience. But I digress…
ychumanities - July 1, 2011 at 1:44 pm
Most parents tell their kids to get off the phone because they want to use that phone themselves!
bigyaz - July 14, 2011 at 4:19 pm
Sounds like someone did not actually read — or at least comprehend — said article:
“… that Bryn Mawr and 35 other colleges will be using.”