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U of T integrative medicine plans spark controversy

University job posting draws criticism from online science community

By Shijie Zhou
Published: 12:43 am, 9 September 2013
Vol CXXXIV, No. 02 under

A recent online job posting for “Director — Centre for Complementary and Integrative Medicine” at the University of Toronto  has drawn criticism from the online science community Science-Based Medicine. These critics are concerned that support of the practice known as integrative medicine is scientifically unfounded and potentially harmful to medical learning at the university.

Integrative medicine is a combination of conventional, “evidence-based” medical treatments and complementary and alternative medicine (CAM); the latter encompases natural products (herbs, probiotics), and mind and body techniques (acupuncture, chiropractic, and energy therapies).

Critics of CAM are strong proponents of evidence-based medicine (EBM). EBM relies on experimental evidence and the scientific method to direct treatment. The difference between the two fields is philosophical: EBM takes on a modernist view, and its theories are rooted in empiricism and objectivity, while CAM uses more cultural, holistic, and spiritual approaches. The latter’s post-modernist basis can be perceived to reject objectivity and
scientific certainty.

U of T alumnus Scott Gavura is a staunch proponent of EBM. In a posting entitled, “The Trojan Horse called Integrative Medicine arrives at another medical school,” published on Science-Based Medicine’s webpage, Gavura slams the U of T job posting, arguing that there should be no alternative to science-driven, research-oriented, evidence-based medicine. He claims that so-called “alternative” methods have no basis in science and that, furthermore, scientific studies even show that some alternative treatments are completely useless. Gavura is also deeply concerned that introducing integrative medicine to both future physicians and pharmacists at U of T will transform the local medical landscape; since both groups would consider integrative medicine a legitimate practice, they could not accuse each other of “quackery.”

U of T currently offers an introductory course in CAM. The new centre, which will be affiliated with the Faculty of Medicine and the Leslie Dan Faculty of Pharmacy, will focus on research and medical training in traditional chinese medicine and natural health products. The job posting states that “the mission of this new Centre is to facilitate, conduct, and obtain support for collaborative basic, clinical, and health services research in complementary and alternative medicine.” The job posting also states that all who apply “must have a md and/or phd degree(s), a strong track record of scholarship and history of peer-reviewed extramural funding.” Gavura does not explicitly address this requirement in his opinion piece.

The controversy surrounding the job posting is rooted in a long debate over the role of research in medicine. In 1910, the American Medical Association commissioned Abraham Flexner to evaluate American and Canadian medical education. Flexner proposed higher standards, including a more rigorous science basis and an enhanced role of research in education. Many universities — such as John Hopkins, McGill, and U of T — were highly rated. Today, Flexner’s vision of medical education has been largely implemented, resulting in the scientific framework within which health professionals currently practice. However, complementary and alternative medicine have been gaining popularity again in the past two decades. Their rise can in part be attributed to some political and cultural reasons. Many EBM proponents believe that the rise in popularity of CAM is the result of a loss of public trust in the big pharmaceutical companies. Many hospitals in the US now offer acupuncture and energy therapies for cancer pain management alongside conventional cancer therapies. The School of Nursing at John Hopkins University encourages its students to embrace alternative medicine, while McGill University offers a new, searchable database for outcome measures designed for CAM researchers.

  • Nick Arrizza

    The Mind Resonance Process

  • Julie

    “However, complementary and alternative medicine have been gaining popularity again in the past two decades. Their rise can in part be attributed to some political and cultural reasons. Many EBM proponents believe that the rise in popularity of CAM is the result of a loss of public trust in the big pharmaceutical companies.”

    This is an example of unfounded statements that underscore the ignorance of the attackers. Firstly, wherever does it state that ‘the rise of popularity’ of CAM therapies is due to political and cultural reasons? There is a large amount of evidence that supports efficacy and positive patient outcomes with the use of CAM therapies, and the policies have done nothing but follow the successes of the population. Secondly, what is it that you define as “CAM” Therapies? Naturopathic Medical programs for example include clinical nutrition. Is there not evidence that an EBM-approach to dietary changes and nutritional supplementation is successful? Consider evaluating the effect on obesity and diabetes type II onset rates with dietary and lifestyle intervention.

    There is evidence that supports acupuncture in pain management. Your statement regarding popularity negates the large amount of evidence that these typically conventional educational institutions are supporting and instead insinuates the increased use of CAM therapies is ‘popular’ due to it being a trend or fad. Traditional Chinese Medicine practitioners and acupuncturists have used acupuncture and herbal treatments for thousands of years before the RCTs showed us that it was effective. Now that 20th century scientific journals are coming on board, I’m sure

    This is not a fad. The use of what you are referring to as CAM therapies (which is still unclear to me) such as diet, lifestyle, herbal medicine, physical medicine and psychological counselling, is a way that we can affect positive change in our patients before (NOT instead of) potentially higher-risk interventions such as intense drug-therapy or surgery. What is the incentive of going through intense suppressive therapy like steroids before trying something that won’t create dependency or make your bones brittle? Wouldn’t we rather try something else first that wouldn’t create such long-term side effects?

  • Elaine

    There is plenty of scientific evidence published in peer reviewed journals supporting the efficacy of a wide variety of these therapies that remain ignored and overlooked by mainstream medical establishment.

  • Edward

    Gavura states, “…furthermore, scientific studies even show that some alternative treatments are completely useless.” Yet many scientific studies show that conventional medicines can be harmful, dangerous, and even deadly – just listen to the disclaimers for the drugs that are advertised on television these days. It seems Gavura and others who strictly support the use “EBM” will dispute the use of CAM because it hasn’t been adequately studied or might be “useless” – better that we harm people instead. Never mind whether or not we can actually help people. It seems to me that some people don’t care what the evidence shows, good or bad, just that there are enough studies to satisfy the FDA which will approve drugs based on their financial backing, despite negative side effects.

  • Len Thomas

    Opposition to any move to accept Complementary and or Alternative from the Scientific community, especially from the online community is always expected.
    Nobody really understands what is and is meant by Complementary Therapies and until they do then many are left with blockages that eventually turn into a physical disease, mind you there are many in the complementary community who have no idea as to what they do or how to use these therapies.
    The call for Clinical trials are maintained by the medical profession only because they do not understand that placebos with complementary energy therapies do not exist because nobody accepts the fact that there are many ways to use these therapies. It will only be when they are understood and their effectiveness will be accepted.