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Acupuncture Meets Aspirin
Thursday, November 17, at 2 p.m., U.S. Eastern time
Since the early 1990s, acupuncture, herbs, massage, and meditation have found their way into traditional medical schools, and now more than half the nation's accredited schools require at least some study of alternative or complementary medicine.
Proponents say future doctors need to know about treatments that are increasingly entering the mainstream. They should know, for example, if an herbal remedy a patient is using might interfere with his chemotherapy. But many medical-school professors and students go further: They see no reason why they shouldn't refer a patient to an acupuncturist or chiropractor if other methods have failed.
Is it irresponsible to teach remedies that many doctors consider flaky or even dangerous? If medical students should not be trained in those methods, should they at least be taught to evaluate them, given that more than one-third of Americans now turn to alternative remedies? Or is incorporating those methods into the curriculum merely pandering to popular tastes?
» Take 2 Herbal Remedies and Call Me in the Morning (11/18/2005)
Michael J. Baime is a clinical assistant professor of medicine at the University of Pennsylvania and the founder and director of the Penn Program for Stress Management. He has practiced meditation since 1969 and directs nontraditional courses, including "Spirituality and Medicine" and "Mind/Body Medicine." His current research projects include investigations into the use of meditation as a treatment for multiple sclerosis and obesity.
Piper Fogg (Moderator):
I'm Piper Fogg, a reporter here, and I'd like to welcome Dr. Baime. Thanks for taking some time with us today. Let's get started.
Question from Dr. Mary Tranquillo, Strayer University:
What medical schools require the study of non-Western healing methods? Where can I find what non-Western methods are taught at each school?
Michael J. Baime:
That's an interesting question, because although there have been surveys of classes that concentrate on CAM, the extent to which material about non-Western, complementary, or alternative modalities is embedded in standard curriculum is unknown. For instance, at the University of Pennsylvania School of Medicine, I teach a lecture that is included in the required Brain and Behavior (neuroscience) course. Some of the material in that course is about meditation and mind-body healing techniques. But the focus of most of the course is conventional neuroscience. So my material would not show up on a standard survey of CAM in medical schools.
Question from Terry Polevoy, MD - HealthWatcher.net:
Hospitals and nursing schools all over North America are allowing numerous quacks into their institutions to teach nonsense like therapeutic touch, while others have welcomed other alternative practitioners who masquerade as health professionals, i.e. they use Doctor in front of their names, or use unrecognized initials after their names. How in the world are medical students supposed to recognize a quack when their own training programs and institutions do not provide them with the knowledge and critical skills necessary?
Are the institution of higher education who are promoting this nonsense receiving money from CAM proponents to do this?
Has your institution taken a stance for or against this? If so, what are those positions?
Michael J. Baime:
I will assume that you're not stating that all practitioners of what we are calling CAM, or complementary and alternative medicine, are quacks. If you are, it's a different question, and I'm happy to talk about that.
I agree that some proponents of alternative medicine are taking advantage of patients. This is, unfortunately, true of licensed medical doctors as well.
It is the role of the School of Medicine to provide guidance and to set standards in this area. There is a substantial body of evidence to suggest that some CAM modalities offer meaningful benefits, for instance, acupuncture for some types of chronic pain. Other modalities seem to be ineffective, such as some nutritional supplements in preventing heart disease. Others are, as of yet, unproven one way or the other. So the array of modalities that have been subject to rigorous evidence-based appraoches is much like the rest of medicine. Some of our treatments are validated and some are not.
AS far as the liklihood of institutions of higher education accepting money from CAM proponents, I haven't heard of that happening. And we don't have a stance against it because it seems so unlikley that it wouldn't occur. It would hardly seem to be worth the trouble. We would all agree that we wouldn't be accepted. I wonder more about the ethics of the support of traditional medical education education, especially CME, by pharmaceutical companies. But that, too, is a different discussion.
Question from Scott Smallwood, Chronicle:
Have you seen any generational shift in how receptive people are to alternative medicine? Do current students seem more or less open to the ideas than older alums?
Michael J. Baime:
I have absolutely no question that there is a generational shift. The interesting question is whether the acceptance of CAM by younger practitioners is gong to endure as those physicians enter practice and become older and more established. It may be that the acceptance of what is not traditional is simply a part of being younger. Or it may be that cultural attitudes toward these modalities is actually changing. It seems to me that it is some of both.
Question from Andrew Mytelka, Chronicle of Higher Ed:
Do health-insurance companies provide coverage for alternative and complementary medical treatments? If so, should that factor play a decisive role in what medical students are taught?
Michael J. Baime:
Insurance companies provide coverage when it is necessary. It is, for better or worse, a business decision. When there is a compelling body of evidence that a CAM treatment provides a meaninful clinical benefit then it usually becomes a covered service eventually. At that point an interesting question is whether it can really be considered "alternative" in any way. If it works, and we provide in our system, it seems to have corssed the boundary into the mainstream. I would not like to use insurance coverage as a factor in determining what students are taught about anything. Even if a treatment or modality is of no benefit, but is widely used, our clinicians need to know about it. If there is evidence that it is of benefit, then they also need to know about it.
Question from Stacy Gomes, Pacific College of Oriental Medicine:
Don't you think that is an "informational" shift vs. "generational"? There is so much 'hard science' data avaialble now on physiological changes happening with "alternative" medicine - how can that be ignored if you really care about your patients?
Michael J. Baime:
I wish that I could truly believe that information alone would change attitudes. But you are right, as the available information becomes more compelling, it becomes more difficult to deny the effectiveness of all CAM treatments. That doesn't keep some of us from continuing to believe that all CAM is equally useless. It is also true that proponents of these modalities sometimes can have unjustified enthusiasm. Somewhere in between is a truth that we are working towards. The respect for that truth, whether or not it fits with our prejudices, is what we would like to instill in our students.
Question from John Gravois, The Chronicle of Higher Education:
I've noticed that many of the scientists who have done the most high-profile research on the neurophysiological effects of meditation are practitioners of meditation themselves. Is the same true for scientists who research other alternative therapies? Does this pose a problem for the credibility of their findings?
Michael J. Baime:
That's a very good question. In general, scientists do choose to study topics that they believe in, or at least have an interest in. These areas are no different. I would like to think that the scientific method, and in particular, the prospective double-blind randomized clinical trial, is an adequate safeguard against unintentional bias. And I don't believe that intentional distortion of results occurs commonly. The NIH has an entire institute that is devoted to guaranteeing the validity of CAM research. I believe that they do a very good job.
So there may be some question about the credibility of these findings. But I don't think there is a better way to do the research.
Question from Stacy Gomes, Pacific College of Oriental Medicine:
We have provided faculty to the UC Irvine school of medicine for several years to help with their elective class on integrative medicine. What I hear form the students who have taken that class is that the material is very superfical and is only providing awareness. My question to medical schools: Is "awareness" of alternative modalities the goal? It is a starting point but may need to be revised.
Michael J. Baime:
No area that is taught in a school of medicine is covered adequately to allow for the development of real expertise. No medical student who takes an elective in a medical school can hope to do much more than have awareness of that topic. This is as true for obstetrics as it is for CAM. If a student wants to deeply understand a system of CAM, or to gain proficiency in its practice, they are in the wrong school, or it is the wrong time of their career.
In some places it is possible to get more advanced training in a specific alternative medicine modality during medical school. That is the goal of the relationship between the University of Pennsylvania School of Medicine and Tai Sophia Institute in Baltimore. If a student wants to learn more about acupuncture or botanical medicine while they are at Penn,, they can study at Tai Sophia during their medical school training. That seems like a reasonable compromise. Penn is unlikely to provide extensive training in acupuncture in the near future. But (in my opinion) it is clearly a modality that provides a benefit, and students with a particular interest
Question from Jennifer K. Ruark, Chronicle of Higher Ed:
Since, on the whole, American doctors and medical schools still view alternative medicine skeptically, I assume they find research on the benefits of those treatments unconvincing. Why is that? Or has there been too little research?
Michael J. Baime:
It is a moving target. The culture of medicine, and its world view, changes every generation. Evidence about CAM is coming, but it is still early. There is some very convincing research, but not enough. And some American doctors and medical schools will be hard to convince even with overwhelming evidence.
It is interesting to discover how much variability there is, even among the members of a single department. Some doctors are extremely open to the possiblity that some CAM treatments will be more effective than what is currently available. Others discount that possibility completely.
And it will be like that for a long time. A belief system, like the belief system of medicine, is a large and ponderous object with a lot of momentum. It only changes its direction when a lot of force is applied for a long time. That process is underway, but it will always be incomplete. Some individuals will push for what is untested, untraditional, and uncertain. Others want guarantees.
Question from JA Campbell, Florida University:
Not all CAM is effective, nor is all Western medicine effective or scientifically proven. However, how can we ignore a body of knowledge such as Traditional Chinese Medicine (TCM) that has been refined by the experience of hundreds of thousands of Chinese doctors over 5000 years?
Acupuncture works. I am a scientist, and was a skeptic of acupuncture until nothing else could be done by Western doctors. I tried acupuncture by a certified practitioner, and experienced immediate pain relief.
Years later, after vision problems that could not be fixed by Western doctors, I returned to a Chinese doctor who practices acupuncture and traditional herbal medicine. My retinal edema disappears after each treatment, and my overall health is significantly improved.
We should open our minds, and our insurance system, to therapies that really work. Traditional Chinese Medicine works.
I hope all medical schools will at least provide one course from a Chinese acupuncturist, trained in TCM in China, to introduce future doctors to a system proven over 5000 years. We westerners can't claim even a tenth of that time of experience.
Michael J. Baime:
I think that you're speaking to the choir! There is extensive evidence that acupuncure works. There is less evidence about TCM, but there is much work in progress.
For better or worse, our belief system requires that experience like yours be validated with scientific study. The truth of thousands of years of experience is not adequate. There are many other systems with similar histories. Some will be found to be effective. Some will not.
Nor is an individual's experience adequate. It worked for you, but there are many others for whom it hasn't worked. It is hard to be certain that, on the average, it is better for most people simply based on what happened to you. We need more information.
The best advocacy that anyone can provide is to support unbiased research into these forms of healing. Whatever is actually true can withstand the scrutiny of science. Hopefully the debate about CAM will become a discussion of what we find to be true, not what we believe.
Question from Scott Smallwood, Chronicle:
Do you envision Penn continuing to find ways to collaborate with alternative-medicine practioners or do you think the Tai Sophia experience has made that less likely?
Michael J. Baime:
My suspicion is that increased information and exposure will make collaboration more likely. In my own practice as a primary care internist, I have seen some striking results from acupuncture. That isn't the same as the knowledge of the scientific results that I've been championing, but it made a big impact on me personally. So I don't just believe that acupuncture works based on the literature. I also found that it works based on my clinical experience.
I run a meditation-based stress management program at Penn. What I have found is that the presence of that program has increased interest in meditation in many areas at my University. Because of the presence of the program, I've taught meditation in the Department of Psychology, in the Graduate School of Education, and in Wharton, the business school. Familiarity breeds interest, at least in this case. So I would expect it to breed collaboration as well.
Piper Fogg (Moderator):
OK, that wraps up our session. Thanks very much to Dr. Baime.
Michael J. Baime:
Thank you all for taking the time to think about this topic and submit questions. It is fascinating to see how our approach to CAM is changing as new research brings new information into the system. The introduction of this information into medical education is bound to be slow and sometimes halting. This kind of change always is. Hopefully we can teach our students to value curiosity about what they don't know as much as they value certainty.