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
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.