Toronto is once again at the center of a pseudoscience scandal. This time, it involves medical quackery being taught in a prestigious university.
The University of Toronto has been offering a course for undergraduates called "Alternative Health: Practice and Theory." The teacher is a devotee of homeopathy, a practice that defies the basic laws of science and has no good evidence of efficacy. The readings include anti-vaccine materials and an article glorifying Andrew Wakefield, a discredited physician-researcher who used fraudulent research to fabricate a link between measles vaccines and autism.
But what’s even more incredible is the fact that a senior university official investigated the course and determined there was no cause for concern.
In a three-page review, Dr. Vivek Goel, a vice president at the University of Toronto, argued that students would have already taken science-based courses by the time they were exposed to the alternative health class. He then offered this conclusion:
I do not find that the instructor’s approach in this class has been, or would have reasonably been perceived to be unbalanced, in the sense that it deviated from a presentation of material that, in context, would enable critical analysis, and inquiry. Thus, from an academic pedagogy perspective, I do not find that there has been sufficient deviation from the range of normal approaches to warrant concerns.
Not everyone agreed with his assessment. Jen Gunter, an OB-GYN in San Francisco, offered this outraged take:
No medical, nursing, or basic biology/immunology textbooks or articles are referenced in the required reading nor is any information from Health Canada or the World Health Organization. Instead, the required reading/viewing and additional information for the students (meaning what they will learn and thus take away from the course) includes Andrew Wakefield (who lost his medical license for falsifying data in a now beyond infamous study with falsified data) and anti-vaccine propaganda sites.
At least 90 percent of US medical schools now teach alternative medicine
This scandal is emblematic of a challenge that all universities, particularly those with medical schools, now face: how to deal with alternative medicine. After all, many patients are now requesting services like homeopathy and acupuncture, so there's a good case that health professionals should at least be familiar with them. Some practices, like forms of herbal medicine or yoga, even have compelling evidence of benefit. But these practices too often aren't science-based — and universities have to be careful not to teach outright quackery.
The University of Toronto isn’t the first university to struggle with this. Georgetown has a "mind-body" medicine program for med students. The University of Michigan has a similar course. Dr. Mehmet Oz, of TV fame, helped bring alternative therapies, from reiki energy healing to homeopathy, into Columbia University’s operating rooms. The University of Arizona started a medical fellowship in alternative medicine under the leadership of famed holistic healer and physician Andrew Weil.
All told, according to the Association of American Medical Colleges, of the 132 medical schools across the United States that answered a survey question last year about whether they offered classes in alternative medicine, 126 said they did so in required courses. There are about 140 MD-granting universities in the US, so this means the vast majority of medical schools are now in the business of teaching alternative medicine.
What's the best way for universities to teach alternative medicine?
Considering that, I asked a few people who have dealt with this conundrum to weigh in on the best path forward.
Brian Deer, an investigative reporter who uncovered Andrew Wakefield's fraud, wrote in an email that courses like the one at University of Toronto need to be balanced and properly sourced:
Does the university expect students to read the UK General Medical Council's statutory tribunal findings against Wakefield of (1) financial fraud, (2) research fraud, and (3) two counts of common lying to doctors and scientists, or the British Medical Journal's judgment that his work was ‘an elaborate fraud,’ or The Lancet editor's retraction comments on Wakefield's research, in which the editor said the journal was ‘deceived.’
Edzard Ernst, an expert on the science of alternative medicine and professor emeritus at Exeter University, said that students should be taught the evidence both for and against alternative therapies. In order to present that kind of fair and balanced view, he added, it helps not to have evangelists and practitioners as course leaders:
Alternative medicine needs to be taught dispassionately on the basis of the existing evidence which is positive in a few cases and negative in the majority of instances. The trouble is that currently most medical schools delegate this task to enthusiasts of the respective therapies. Thus a homeopath, might instruct med students and tell them a lot of nonsense about homeopathy. I have seen this happening all too often.
David Gorski, a cancer surgeon at Wayne State University School of Medicine who wrote about this issue in the journal Nature, felt that so-called alternative practices that are proven to work — from yoga to particular diets or meditation — shouldn't be part of a special program, but rather integrated into the regular health or medical curriculum.
"There's no reason education on lifestyle practices or diet should be taught in alternative medicine. They should just be taught in medicine," he said over the phone, adding: "There's medicine that’s been proven to work and medicine that hasn't been proven. When something alternative has been proven to work, it becomes medicine."