Australasian Science: Australia's authority on science since 1938

Cap, Gown and Wand

By Michael Vagg

Are there any good arguments for teaching complementary medicines in tertiary institutions?

Arguments that complementary and alternative medicines (CAM) should be taught in tertiary institutions collectively assert the following:

  1. Universities should be centres of diverse knowledge, with academic freedom to pursue unconventional ideas. Refusing to teach CAM is a type of censorship – impairing our ability to understand human health and disease.
  2. CAM university students are exposed to “the biomedical sciences, epidemiology and population health, differential diagnosis, safe practice and critical appraisal”.
  3. Not teaching CAM in universities will not reduce public demand for CAM, which will instead be met by poorly trained practitioners.

Academic Freedom

Who could possibly disagree with the first proposition? The stumbling block is that not all unconventional ideas are good – or even possible – in the universe as we know it. Friends of Science in Medicine agrees that any and all plausible treatments are worthy of study, but the grounds for deciding which get precious research dollars should be scientific, not ideological.

CAM advocates have a hard time letting go of their theories when their favourites fail to meet scientific criteria of worthiness. They continue with small pilot studies where larger, better studies would have killed off the theory. Misunderstandings of the past are resurrected as “zombie hypotheses” that never die when they are shown to be wrong.

Criticism is not the same as censorship. Ideas have come and gone in medicine for thousands of years. The best have competed, survived and brought tangible benefits.

The Chief Medical Officer’s current review of CAM interventions is a sign that they are being taken seriously. It’s up to their proponents to convince the rest of us, and to answer fair criticism with better research and refinement of their hypotheses.

Student Exposure to Science

It does seem fair that all students of health care should be exposed to scientific constructs, but they should not then be taught to disregard or disrespect them when they conflict with CAM tenets. Healthcare should be science-based all the way down. It shouldn’t be a top-dressing to cover the rickety foundations of a personality cult or a persuasive delusion. Introducing novice health professionals to an astroturfed version of deeply unscientific disciplines is intellectually dishonest and harms the public understanding of science.

Universities Give Public Credibility

The third argument amounts to a thinly veiled threat. “Let us do what we want or we won’t be responsible for what happens,” they seem to say. The hyper-obvious point they avoid is that teaching CAM in universities gives it public credibility. They can’t admit this because it implies that they are relying on politics and marketing rather than on scientific merit. Leaving CAM training in the hands of non-tertiary providers is clearly likely, over time, to reduce demand as the intellectual prestige and professional standing of its practitioners and defenders erodes.

An unspoken assumption underlying demands for government funding of university CAM training is that a CAM industry is, indeed, worth having. According to the most recent survey of medication consumption in the Medical Journal of Australia, the claimed rate of CAM use was 46.3%. This figure included calcium and vitamin D supplements as well as fish oil, multivitamin and glucosamine supplements. These products, well understood by GPs and the general public, don’t require a separate university-trained health professional to prescribe them. If you account for those five substances, there is almost no CAM use left in the survey!

Furthermore, the survey revealed that very few participants were getting advice about CAM from a source other than their GP, the media or family and friends. What value is left for a university-trained naturopath to add?

Dr Michael Vagg is a Consultant Physician in Pain and Rehabilitation Medicine and a Clinical Senior Lecturer at Deakin University. His Twitter handle is @mickvagg.