Sunday, July 09, 2006

Retired Doc's suggestion for med school curriculum Part 13

Had I been aware of the degree to which CAM (complementary and alternative medicine) has been accepted, taught,and practiced in at least some medical schools, I would have made this suggestion as Part 1 of the suggested curriculum series. Logically it should be Part 1 because to learn the science and art of medicine,which is supposed to be what medical schools teach, one should be able to know how to distinguish between science and pseudo-science.

I would have thought that college graduates entering med school would know well the distinction between the two and I suspect most do on entry. However, after learning their med school has a CAM clinic, CAM instructors and practitioners and that the NIH funds CAM research and that the FDA uses less stringent standards of evidence in evaluating alternative therapies,their understanding of the distinction may become blurred.

To mitigate that potential blurring, here is some material (not intended to be comprehensive) to include in the "what is science, anyway?" lecture.

The discussion might well begin with Einstein's comment regarding the development of western science which he said to be based on two things' The invention of the formal logic system by the Greeks and the discovery of the possibility of finding causal relationship by systematic experiments.

A discussion of Karl Popper's treatment of the problem of "demarcation" should be included. To Popper this was the basic issue of what is the difference between science and psuedo-science.
He said:

"...the criterion of the scientific status of a theory is its falsifiability,or refutability, or testability."

If a theory cannot be stated in such a way as to allow for its refutation, it is not science.

Edward O.Wilson is his book ,"Consilience, the Unity of Knowledge" says this about the difference between science and pseudo-science;

Science... is the organized systematic enterprise that gathers knowledge about the world and condenses the knowledge into testable laws and principles.

Wilson's diagnostic features of science are ( I paraphrase a bit)

1.repeatability
2.economy-abstract the information into its simplest form
3.mensuration-measure it
4.heuristics-the best science stimulates further discovery
5.consilience about which Dr. Wilson says that the explanation most likely to survive are those that can :

"be connected and proven consistent with one another."

Mention needs to made of the importance of reductionism wherein that which is thought relevant to the problem at hand is walled off and for the time being the rest ignored.This is a major difference between western scientific thinking and eastern holistic thought which is prevalent in the fables of some forms of alternative medicine. The few folks who read this on their computers can do so because of the accomplishments of western scientific thought and not the efforts of those who believe that everything is related to everything and the methods of western scientific thought are no more valid than say the undetectable "lifeforces" of reiki.

I became more convinced that a lecture or lectures on what is science and how well it has worked needs to be part of the curriculum when I read this June 18, 2006 posting by Dr. RW on the activities of the SAMA.Based on their statements they seem to believe that it is not clear what "type of science" is needed to evaluate CAM.It is hard to believe that medical educators have failed so badly .

The above suggestions are not intended to be all inclusive but the main point is that the powers that be in medical education need to make sure that their students know the difference between science and pseudo-science, teach them about the former and stop promoting the latter.

2 comments:

Aubrey Blumsohn said...

I agree completely with your rant, but I think the failure goes much deeper.

It is completely true that medical educators who have attempted to redefine the meaning of science have "failed badly".

However, addressing this failure is impossible because we also fail to address the parts of "our" science that are frankly dubious and even fraudulent.

It is hardly surprising that quacks and charlatans laugh when we make the distinction between our "science" and "their" nonsense.

We live in a world where other charlatans (commonly from industry) are allowed to get away with breaching all of the rules of science. The current sagas of Vioxx and SSRI’s are essentially cases of commercial research misconduct. In Sheffield we were denied access to randomization codes by a pharmaceutical "patron", then had "findings" ghost-analyzed and ghostwritten in out names. These findings turned out to be fallacious. The company stated in their defense that this is “standard practice”.

I propose that the freedom of medical scientists to act and speak scientifically has to be addressed before we can criticize others effectively.

My rant at http://www.cafas.org.uk/update51.pdf

Aubrey Blumsohn
Blog: www.scientific-misconduct.blogspot.com

james gaulte said...

Thanks for your comments-they are well taken.Proponents and fellow travelers of CAM seem to brazenly operate outside of the boundaries of science often with denials of its validity and those-often in industry- guilty of fraud and deception use the trappings of science and statistics and EBM to mislead the medical readers.I hope there are physicians and other scientists who can continue to speak out against both.