- Email: [email protected]
Alternative Medicine
Archives of Medical Research 31 (2000) 537–538
EDITORIAL
Alternative Medicine: To Teach or Not to Teach Luis Benítez-Bribiesca
Health care services around the world can be roughly classified into two groups according to their medical orientation: scientific medicine and “traditional medicine.” The first is based on sound biomedical research and has been in use in developed countries for a bit more than a century. The latter, however, encompasses healing practices compiled over the centuries through trial and error or merely by cultural and religious beliefs. Although most developed nations use scientific medicine for health care, almost 80% of the world’s health care services are provided only with traditional medicine. But in countries where scientific medicine predominates, traditional and unconventional medical practices have been rediscovered and are being sought by the public with growing interest (1). However, aside from the traditional remedies imported from ancient cultures there has been an explosion of newly developed practices that are clearly aimed at hoodwinking the public and making a quick profit. This contemporary quackery that has emerged—in developed nations, not surprisingly—is due mainly to commercial interest, and usually combines traditional with pseudoscientific remedies that offer miraculous cures. It is, therefore, regrettable that all these unconventional practices have been assembled indiscriminately under the general title of alternative and complementary medicine (ACM), which encompasses those practices used for prevention and treatment of disease that are neither widely taught in medical schools nor generally available in the hospitals of developed nations. Under this heading, the U.S. Congress created the Office of Alternative Medicine (OAM) in 1992, appointing it to the National Institutes of Health and assigning to it a substantial budget that this year reached almost 70 million dollars (U.S. currency) (2). Grouping all these unconventional practices under one heading, one institute, and one budget poses a great problem for the proper orientation of scientific research in this area. Although traditional medicine has proven to be a source of valuable pharmacological agents such as quinine, digitalis,
Address reprint requests to: Luis Benítez-Bribiesca, MD, Unidad de Investigaciones Oncológicas, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Av. Cuauhtémoc 330, Col. Doctores, 06725 Mexico City, Mexico. FAX:(⫹525) 578-6174; E-mail: [email protected]
aspirin, opioids, vinca alkaloids, and taxol and has disclosed the benefits of some practices such as acupuncture or hypnotic suggestion, modern quackery such as laetrile, krebiozen, the Gonzalez treatment for colon cancer, the Aslan GH-2 treatment for aging, and shark’s cartilage for cancer has rendered no proven benefit even by anecdotal account. Other absurd methods such as color and crystal healing, aromatherapy, and scientology have been introduced and have captured the public interest despite the lack of proof of any therapeutic effect. This field has grown so enormously popular that nearly 42% of Americans have tried some sort of unproven remedy, and spent 27 billion dollars in 1997 on these unorthodox practices. In many other developed countries, this trend is also gaining adepts at an alarming pace. There is, nevertheless, a common denominator among most patients seeking any of these alternative treatments: they feel well and not infrequently claim to be cured. There are, therefore, two main reasons to embark on scientific research in the broad field of ACM: first, to look for novel compounds with therapeutic effects in the complex and poorly explored field of traditional medicine. The second is to investigate the psychosomatic mechanisms underlying the curative feeling that the gurus of modern quackery or the clever marketing of products evoke among the general public (3). There is little doubt that careful and meticulous scientific investigation of these alternative therapies would provide sound scientific bases to allow some of them to be incorporated into the standard medical armamentarium. The ancient wisdom of herbalism can be developed into a modern approach to phytotherapy by applying stringent scientific pharmacological methods. But more challenging questions can be pursued. For instance, a most intriguing and less studied effect is conditioning, be it by means of religiouslike belief, suggestion, marketing, or magic-like practices. Psychoneuroimmunology, a new emerging field of research, is beginning to provide evidence that conditioning plays an important role in the pathogenesis of disease and in the pharmacological effects of drugs (4). It is likely that many of the most scientifically weird therapies, such as color healing, aromatherapy, reflexology, meditation, homeopathy, and even the placebo effect might work through poorly understood networks of conditioning. If this were the
0188-4409/00 $–see front matter. Copyright © 2001 IMSS. Published by Elsevier Science Inc. PII S0188-4409(00)00 2 3 7 - X
538
Benítez-Bribiesca/ Archives of Medical Research 31 (2000) 537–538
case, the conventional physician could learn more about conditioning and improve the doctor–patient relationship, which many patients feel has deteriorated so greatly nowadays, and which constitutes an indispensable ingredient for healing. The importance of basic research to study unconventional medical practices cannot be overstressed. But incorporating or teaching any of these unorthodox practices in medical schools without solid scientific evidence of their value is another matter. During the last few years, medical schools in many countries have brought alternative medicine into their hallowed halls. In the U.S., more than 70 schools offer some type of alternative medicine program (5,6). There is no doubt that social and political pressure exists in medical schools to incorporate ACM into the curriculum. This trend is fueled mainly by the popular interest of a public disenchanted with the increasing complexity and staggering costs of conventional medicine, not by genuine scientific interest. Medical students seek out these courses to learn some of the most appealing ACM methods for use in their private practice regardless of their having been scientifically proven. This constitutes a paradox and a serious threat to scientific medicine, because it is only a little over a century ago that medicine departed from unproved practices and evolved progressively into a scientifically based profession. The teaching of medicine changed dramatically after Abraham Flexner, who insisted, in his classic report, that medical schools ground their medical curricula in the basic sciences taught by full-time investigators (7). Because most medical schools adhere to this general scheme, adding alternative medicine courses developed and driven by their advocates will inevitably pose serious conflicting ideas in the minds of students. Developing a scientific attitude for the understanding and practicing of modern medicine in medical students is an arduous task for medical schools. Dividing
medicine into scientific and alternative is useless and artificial. Introducing ACM courses may create a schizoid environment. Should medical students adhere to the teachings of molecular biology, pathophysiology, and pharmacology or instead go for homeopathy, acupuncture, “coyote medicine,” or transcendental meditation? The latter easy way is more appealing and certainly more profitable, as unorthodox healing practices can be learned without much effort and certainly without questioning. Investigating and teaching traditional as well as unorthodox medical practices as ways to encourage new ideas for research within the context of the basic sciences could stimulate students and faculty members to develop other routes of research, and perhaps to discover and understand different forms of healing. Anything useful for the treatment of disease, provided it is scientifically proven, should be incorporated sooner or later into mainstream medical practice. But introducing ACM courses alternating with scientifically based medical subjects represents a serious threat to proper medical education that could bring back the rule-of-thumb medical practice that Flexner dreamed of abolishing.
References 1. Katzenstein L. Does Sampson see any alternative? Nat Med 1997;3:1306. 2. Stokstad E. Stephen Straus’s impossible job. Science 2000;288:1568. 3. Benítez Bribiesca L. Alternative medicine (Letter to the Editor). Science 2000;289:246. 4. Black PH. Psychoneuroimmunology: brain and immunity. Sci Med 1995;2:16. 5. Jonas WB. Researching alternative medicine. Nat Med 1997;3:824. 6. Marshall E. Bastions of tradition adapt to alternative medicine. Science 2000;288:1571. 7. Chapman CB. The Flexner report. By Abraham Flexner. Daedalus 1974;103:105.
EDITORIAL
Alternative Medicine: To Teach or Not to Teach Luis Benítez-Bribiesca
Health care services around the world can be roughly classified into two groups according to their medical orientation: scientific medicine and “traditional medicine.” The first is based on sound biomedical research and has been in use in developed countries for a bit more than a century. The latter, however, encompasses healing practices compiled over the centuries through trial and error or merely by cultural and religious beliefs. Although most developed nations use scientific medicine for health care, almost 80% of the world’s health care services are provided only with traditional medicine. But in countries where scientific medicine predominates, traditional and unconventional medical practices have been rediscovered and are being sought by the public with growing interest (1). However, aside from the traditional remedies imported from ancient cultures there has been an explosion of newly developed practices that are clearly aimed at hoodwinking the public and making a quick profit. This contemporary quackery that has emerged—in developed nations, not surprisingly—is due mainly to commercial interest, and usually combines traditional with pseudoscientific remedies that offer miraculous cures. It is, therefore, regrettable that all these unconventional practices have been assembled indiscriminately under the general title of alternative and complementary medicine (ACM), which encompasses those practices used for prevention and treatment of disease that are neither widely taught in medical schools nor generally available in the hospitals of developed nations. Under this heading, the U.S. Congress created the Office of Alternative Medicine (OAM) in 1992, appointing it to the National Institutes of Health and assigning to it a substantial budget that this year reached almost 70 million dollars (U.S. currency) (2). Grouping all these unconventional practices under one heading, one institute, and one budget poses a great problem for the proper orientation of scientific research in this area. Although traditional medicine has proven to be a source of valuable pharmacological agents such as quinine, digitalis,
Address reprint requests to: Luis Benítez-Bribiesca, MD, Unidad de Investigaciones Oncológicas, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Av. Cuauhtémoc 330, Col. Doctores, 06725 Mexico City, Mexico. FAX:(⫹525) 578-6174; E-mail: [email protected]
aspirin, opioids, vinca alkaloids, and taxol and has disclosed the benefits of some practices such as acupuncture or hypnotic suggestion, modern quackery such as laetrile, krebiozen, the Gonzalez treatment for colon cancer, the Aslan GH-2 treatment for aging, and shark’s cartilage for cancer has rendered no proven benefit even by anecdotal account. Other absurd methods such as color and crystal healing, aromatherapy, and scientology have been introduced and have captured the public interest despite the lack of proof of any therapeutic effect. This field has grown so enormously popular that nearly 42% of Americans have tried some sort of unproven remedy, and spent 27 billion dollars in 1997 on these unorthodox practices. In many other developed countries, this trend is also gaining adepts at an alarming pace. There is, nevertheless, a common denominator among most patients seeking any of these alternative treatments: they feel well and not infrequently claim to be cured. There are, therefore, two main reasons to embark on scientific research in the broad field of ACM: first, to look for novel compounds with therapeutic effects in the complex and poorly explored field of traditional medicine. The second is to investigate the psychosomatic mechanisms underlying the curative feeling that the gurus of modern quackery or the clever marketing of products evoke among the general public (3). There is little doubt that careful and meticulous scientific investigation of these alternative therapies would provide sound scientific bases to allow some of them to be incorporated into the standard medical armamentarium. The ancient wisdom of herbalism can be developed into a modern approach to phytotherapy by applying stringent scientific pharmacological methods. But more challenging questions can be pursued. For instance, a most intriguing and less studied effect is conditioning, be it by means of religiouslike belief, suggestion, marketing, or magic-like practices. Psychoneuroimmunology, a new emerging field of research, is beginning to provide evidence that conditioning plays an important role in the pathogenesis of disease and in the pharmacological effects of drugs (4). It is likely that many of the most scientifically weird therapies, such as color healing, aromatherapy, reflexology, meditation, homeopathy, and even the placebo effect might work through poorly understood networks of conditioning. If this were the
0188-4409/00 $–see front matter. Copyright © 2001 IMSS. Published by Elsevier Science Inc. PII S0188-4409(00)00 2 3 7 - X
538
Benítez-Bribiesca/ Archives of Medical Research 31 (2000) 537–538
case, the conventional physician could learn more about conditioning and improve the doctor–patient relationship, which many patients feel has deteriorated so greatly nowadays, and which constitutes an indispensable ingredient for healing. The importance of basic research to study unconventional medical practices cannot be overstressed. But incorporating or teaching any of these unorthodox practices in medical schools without solid scientific evidence of their value is another matter. During the last few years, medical schools in many countries have brought alternative medicine into their hallowed halls. In the U.S., more than 70 schools offer some type of alternative medicine program (5,6). There is no doubt that social and political pressure exists in medical schools to incorporate ACM into the curriculum. This trend is fueled mainly by the popular interest of a public disenchanted with the increasing complexity and staggering costs of conventional medicine, not by genuine scientific interest. Medical students seek out these courses to learn some of the most appealing ACM methods for use in their private practice regardless of their having been scientifically proven. This constitutes a paradox and a serious threat to scientific medicine, because it is only a little over a century ago that medicine departed from unproved practices and evolved progressively into a scientifically based profession. The teaching of medicine changed dramatically after Abraham Flexner, who insisted, in his classic report, that medical schools ground their medical curricula in the basic sciences taught by full-time investigators (7). Because most medical schools adhere to this general scheme, adding alternative medicine courses developed and driven by their advocates will inevitably pose serious conflicting ideas in the minds of students. Developing a scientific attitude for the understanding and practicing of modern medicine in medical students is an arduous task for medical schools. Dividing
medicine into scientific and alternative is useless and artificial. Introducing ACM courses may create a schizoid environment. Should medical students adhere to the teachings of molecular biology, pathophysiology, and pharmacology or instead go for homeopathy, acupuncture, “coyote medicine,” or transcendental meditation? The latter easy way is more appealing and certainly more profitable, as unorthodox healing practices can be learned without much effort and certainly without questioning. Investigating and teaching traditional as well as unorthodox medical practices as ways to encourage new ideas for research within the context of the basic sciences could stimulate students and faculty members to develop other routes of research, and perhaps to discover and understand different forms of healing. Anything useful for the treatment of disease, provided it is scientifically proven, should be incorporated sooner or later into mainstream medical practice. But introducing ACM courses alternating with scientifically based medical subjects represents a serious threat to proper medical education that could bring back the rule-of-thumb medical practice that Flexner dreamed of abolishing.
References 1. Katzenstein L. Does Sampson see any alternative? Nat Med 1997;3:1306. 2. Stokstad E. Stephen Straus’s impossible job. Science 2000;288:1568. 3. Benítez Bribiesca L. Alternative medicine (Letter to the Editor). Science 2000;289:246. 4. Black PH. Psychoneuroimmunology: brain and immunity. Sci Med 1995;2:16. 5. Jonas WB. Researching alternative medicine. Nat Med 1997;3:824. 6. Marshall E. Bastions of tradition adapt to alternative medicine. Science 2000;288:1571. 7. Chapman CB. The Flexner report. By Abraham Flexner. Daedalus 1974;103:105.