In 1910 Abraham Flexner wrote a report regarding the state of medical education. The aftermath was stricter standards for admission, fewer medical schools, and an immediate, although, sadly, not long-lasting, impact on alternative medicine.
A number of medical schools prior to the Flexner report offered courses in eclectic medicine, naturopathy, homeopathy, and other “alternative” approaches. Flexner believed in the scientific approach, and was appalled at those who promoted non-vaccination. The medical schools that offered such “alternative” approaches were either closed, or they changed their curriculum to drop them.
The one alternative set of schools that did change were the osteopathic schools, which adopted the scientific method, but continued to offer “manipulation” in their curriculum. Today, the osteopathic physicians have equivalent training to medical physicians.
Sadly, we have now seen a reversal of science based thought as states sanction non-scientific approaches to illness? Are we entering a new dark age in science and medicine? Have we left the renaissance period where science and engineering brought us so much, to go backward to the era of treatments that have no proven benefit or efficacy?
Listening to a recent podcast from Skeptics Guide to The Universe, and learned that homeopathy advocates using heat to treat burns. You can find confirmation of this dangerous practice on-line. Homeopaths, as well as other “alternative” approaches to medicine, have state-sanctioned practice. Which means, in Arizona, if you become burned and go to a homeopath- they might give you a treatment that would kill you, but the state is sanctioning it.
The state of Arizona has a State appointed board of homeopathic physicians. The purpose is to “protect the health, safety and welfare of Arizona citizens by examining, licensing and regulating homeopathic physicians.” If the state was really interested in protecting health and safety of Arizona then get rid of this board, and let the world know that homeopathy has no basis in science, will not add to your health, and there will be no licensed homeopathic physicians in Arizona.
In almost every state, there are boards to regulate homeopathic practice as well as, chiropractic boards, naturopathic boards- state sanctioned and licensed treatments that have little or no proven efficacy.
While that cost to the states is “a drop in the bucket” the cost to individuals is not. Many states mandate that chiropractic treatment be a covered benefit of insurance policies. When there is mandated treatment, insurance costs increase. If insurance companies could exclude chiropractic, homeopathic, and naturopathic treatments- the cost of policies would decrease. There is now a push for other “Complementary and Alternative Medicine” to be mandated by insurance companies, based on the premise that they mandate chiropractic.
But the costs do not end with your insurance policy. In our state we have chiropractors that team with ambulance-chasing lawyers. Here is the scheme – you get in a car accident, and call the lawyer. The lawyer has a group of people who will examine you, including chiropractors. Once the case has settled, those bills are paid at a higher rate than customary fee. There is more money to be made by chiropractors that follow these lawyers than in practice (in practice if they are paid by insurance companies they have an adjusted fee, with the legal system, if a settlement is performed they can charge whatever they like). Because the state sanctions “chiropractic” it is an allowed bill in settlement of automobile accidents, even though there is no evidence that chiropractic treatment has any benefit beyond massage therapy.
In Arizona, citizens pay for non-science based treatment not only through taxes that regulate their boards, but with increased insurance costs because the state mandates it cover a treatment that does not have any proven scientific benefit. Increased automobile insurance costs because the chiropractic treatment is ultimately passed on to all drivers.
Perhaps the most dangerous chiropractic trend is the desire to certify some chiropractors to treat concussions. Some chiropractors are advertising on their web sites – to quote: “If your child has suffered a head injury with or without loss of consciousness get them checked asap by your medical doctor or sports chiropractor.” The treatment of concussions is a highly specialized neurologic diagnosis, that involves neuro-radiologists (radiologists that specialize in reading films of the nervous system), neurologists, and neurosurgeons. There is no evidence that chiropractic manipulation of the cervical spine or any spine helps with concussion. In fact, there have been 26 deaths attributed to chiropractic manipulation of the spine (and many non-published deaths- we have two). There is no role for chiropractors in the treatment of concussions, and yet having a state board gives them a false status among the general public.
In Australia, top scientists have asked the universities to reverse “the trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by convincing scientific evidence.” By providing a degree in a “complementary medicine” one gives even more credibility to pseudoscience. To counter this Nick Klomp, the dean of science faculty at Charles Sturt University in Wagga Wagga, New South Wales agreed that there was an issue and states that his training is “all abut evidence based, science based,” – of course, that is like saying we give a degree in Santa Claus studies, and teach them to think critically.
On a recent show by Dr. Oz, he asked people to ask their physicians why they don’t offer complementary treatments — the answer is obvious: we offer treatments that have are proven to help- it is a part of our medical ethics. In our pillars of medical ethics we have beneficence – and that means we cannot offer a patient a treatment that will not benefit the patient. While conventional medicine has that as a pillar, apparently homeopaths, chiropractors, naturopaths, and others do not. Their treatment is “belief based” with lots of confirmation bias from their patients.
The disconnect between politicians and science is quite old. In 1851 in Michigan a group of citizens successfully petitioned the state to fund a homeopathy school. This led to a major fight between the Board of Regents of The University of Michigan and the state legislature. Ultimately the state did fund one. Science ultimately prevailed and the homeopathy school was closed. I leave you with this quote from Dr. Zina Pitcher at the time on the Board of Regents at The University of Michigan in 1851:
…shall the accumulated results of three thousand years of experience be laid aside, because there has arisen in the world a sect which, by engrafting a medical dogma upon a spurious theology, have built up a system (so-called) and baptized it Homœopathy? Shall the High Priests of this spiritual school be specially commissioned by the Regents of the University of Michigan, to teach the grown up men of this age that the decillionth of a grain of sulphur will, if administered homœopathically, cure seven-tenths of their diseases, whilst in every mouthful of albuminous food they swallow, every hair upon their heads, and every drop of urine distilled from the kidneys, carries into or out of their system as much of that article as would make a body, if incorporated with the required amount of sugar, as large as the planet Saturn?
In an era when states want to save money, and cut programs- perhaps the first programs that need to be cut are those that have no proven efficacy. It would save a small amount of money in the state’s revenue- and its citizens would save much more when treatments of no value become of historical interest.
Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.