More Denial at the 

University of Minnesota

Academic Health Center/Medical School

over Homeopathy

I wrote a piece which appeared on the Brainstorm blog at the Chronicle of Higher Education that apparently caught the attention of someone in the university administration.  For background, please see:

Why Would An Academic Health Center Support Homeopathy?

 Drs. Frank Cerra and Aaron Friedman sent a response that I was happy to post and include below.  Please note that it does not even mention the topic of my original post which was homeopathy.  I've put in some brief comments on a few of the more egregious distortions.

Response: Why Would an Academic Health Center Support Homeopathy?

Guest Post:

Dr. Frank Cerra, former Vice President, University of Minnesota Academic Health Center and Medical School Dean

Dr. Aaron Friedman, Vice President, University of Minesota Academic Health Center and Medical School Dean

In a February 4, 2011 blog post-turned-editorial, University of Minnesota associate professor Bill Gleason openly questions why a University with an evidence-based medical school would dedicate resources to a Center for Spirituality & Healing (CSH).

The post was about homeopathy, gentlemen...

We thought that was an excellent question, so are pleased to have an opportunity to respond.

The Center for Spirituality & Healing was established in 1995 during a period of time when medicine and the health professions in general were coming to terms with the idea that what we don’t know about improving human health is far greater than what we do know within the confines of our traditional, Western-based practice. The original concept was to develop a program that provided faculty, students, and the community with an entry point to what’s now called integrative medicine, or integrative health care.

Since its inception in 1995, the Center for Spirituality & Healing has helped push health care forward.  Students have been and continue to be one of the major drivers for the growth of CSH by crossing disciplines to expand their field of study and adding integrative medicine insight to their scope of study. The Center’s growing number of faculty educates health professionals on new models of care and positions consumers at the center of their health care. Most importantly, the Center helps patients more effectively navigate the health care system, a benefit to any health provider.

Including helpful suggestions on the AHC website about homeopathy and advice about how to select a practioner + employment by the CSH of homeopathy practitioners?

The field of health care is undergoing profound change.  Today, patients more frequently combine a complementary treatment approach to traditional therapies. They’re also taking a more active role in the health care decisions that impact them and to do so, are seeking care from providers who are able to safely and effectively integrate these two types of therapies. Such a shift is an asset – not a threat – as we look to treat the entire patient.

The operating principle of the CSH is to have an evidence-based approach to complementary approaches to health, and also to promote comparative, evidence-based research between complementary and traditional therapies—knowledge that providers need to best serve the patients coming to them for integrative care. So in charging the University with wasting its resources in supporting the CSH, Gleason couldn’t be further from the truth.

Absolutely false, gentlemen. The post was about the CSH wasting its resources on homeopathy.  A fact that all the circumlocution in the world cannot obscure.

In actuality, only a small percentage of the Center’s funding comes from University resources. The rest, it earns through tuition revenue, philanthropic gifts, and extensive research funding.  Integrative medicine is an internationally recognized area of study, including by the National Institutes of Health, and our CSH has been very successful in competing for NIH funding.

And what does the NIH say about homeopathy, gentleman. Please re-read my first post. Have you anything to say about this?

For all of these reasons, the CSH is a great investment with incredible returns. In fact, for every University dollar invested in the CSH, it leverages such funding to generate ten more dollars. If all University Centers, Institutes, and faculty functioned as efficiently or as productively as the CSH, our University would be on very solid footing indeed.

 Wow, the (dubious) claim that since we can "make money" on CSH, this somehow justifies the practice of homeopathy.  I thought universities were supposed to be pursuing truth.  If astrology could bring in the bucks, that would be OK?  Alchemy?  Faith Healing?

The University of Minnesota’s Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers.  In 2011, what we don’t know about improving human health still exceeds that which we do know.  Perhaps this will always be the case.

Homeopathy?

But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.

And who said this?  You are tap dancing around the "H" word, gentleman.

In its short 15 year tenure, the CSH has established a model curriculum, hired faculty, and developed a graduate minor as well as a post-baccalaureate certificate program. And for 15 years, the Center for Spirituality & Healing has enriched health and well-being by providing high-quality interdisciplinary education, conducting rigorous research, and delivering innovative programs that advance integrative health and healing.

We look forward to discovering what the next 15 years holds for not just our Center, but the field of integrative medicine as a whole.

It’s critical to remember that our University is a state-wide resource and its mission is to serve the whole patient, the whole state, and the nation.

This is a pathetic response from the present and former deans of the University of Minnesota Medical School.  Presumably they have taken chemistry courses at some point and are both aware of Avogadro's number.  There is no medicine in homeopathic medicine, gentleman.  And this was a pitiful and evasive answer to my original question: Why would an Academic Health Center support homeopathy?

Comments - so far - on the Chronicle post:

"Maybe the university decided that its financial situation required it to restructure some departments. Did you check to see whether Cultural Studies was merged with pharmacology?"

"Drs. Cerra and Friedman are blowing smoke. Homeopathy has already been studied and found to be without effect. Their response is a perfect example of PR doubletalk."  

"What exactly is “Spirituality”? Do the smoke blowing Drs. actually know?"

A wonderful detailed response: (emphasis mine)

The arguments made in this essay in support of the Center for Spirituality and Healing sound like sleights of hand, and in most cases side-step the issue. Let me comment on a few.

1. “The Center for Spirituality & Healing was established in 1995 during a period of time when medicine and the health professions in general were coming to terms with the idea that what we don’t know about improving human health is far greater than what we do know within the confines of our traditional, Western-based practice.”

I’ll be cynical and point out that the NIH Office of Alternative Medicine was established in 1991, and numerous medical schools around the country established centers or research agendas in CAM in the mid-1990s in order to become eligible for research and development funding from this new NIH office. “…what we don’t know about improving human health is far greater than what we do know…” has always been the case. It’s not about medicine; it’s about the money.

 

2. “The field of health care is undergoing profound change. Today, patients more frequently combine a complementary treatment approach to traditional therapies. They’re also taking a more active role in the health care decisions that impact them and to do so, are seeking care from providers who are able to safely and effectively integrate these two types of therapies.”

Ah yes – a reference to David Eisenberg’s research, which revealed how common it is for U.S. patients to use alternative and complementary medicine unbeknownst to their physicians. We use alternative medicine more often than mainstream allopathic medicine. It’s not a bad thing to understand this, but it does not address the issue: the promotion of worthless therapies under the excuse that patients are going to use them anyway is not ethical.

3, “The operating principle of the CSH is to have an evidence-based approach to complementary approaches to health, and also to promote comparative, evidence-based research between complementary and traditional therapies—knowledge that providers need to best serve the patients coming to them for integrative care.”

Of course it’s evidence-based. Without that guiding principle, it wouldn’t be eligible for NIH research funding. But again it side steps the original point: with no valid, well-designed, replicable studies suggesting that homeopathy is effective beyond its placebo response, how can it be supported?

4. “In actuality, only a small percentage of the Center’s funding comes from University resources. The rest, it earns through tuition revenue, philanthropic gifts, and extensive research funding. Integrative medicine is an internationally recognized area of study, including by the National Institutes of Health, and our CSH has been very successful in competing for NIH funding.”

No comment necessary.

  5. “The University of Minnesota’s Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers. In 2011, what we don’t know about improving human health still exceeds that which we do know. Perhaps this will always be the case. But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.”

Any time a scientist or clinician considers explanations (whether hypotheses or diagnoses or treatment options), those that are most likely to be valid are given priority over those that are less likely to be valid. Allopathic physicians have achieved great success treating cancer as a physical disease, not as a loss of spiritual faith, as Christian Science might urge. If my daughter gets an ear infection, I do not expect her physician to recommend prayer, Reiki massage, or flapping a dead chicken at the aurora borealis. Could those work? Maybe. Should we invest millions in testing them? Not my tax dollars, not when antibiotics seem effective.

Your UMN V-Ps need to acknowledge that it is not the “one line of thinking” that is the issue. It is a way of doing science that is the issue. When science fails to detect any therapeutic benefit from an alternative therapy, it is only ethical to discourage the use of that therapy, not to promote it.

Finally, let me add that there is great benefit in supporting research on many alternative therapies. Chewing willow bark might have seemed bizarre until aspirin was discovered; a vast number of effective drugs are derived from plants, the traditional use of which might look just like those strange primitive medical practices that we want scientized. But when there is not even a way to determine if actions such as “prayer” are effective (we cannot even decide what “it” is, and how to control its use), there is no way to “complete the overall scene.” Homeopathy is junk science; its proposed mechanisms of effectiveness sound like fantasy. Nothing in this Minnesota response offers the first good reason to support such therapies apart from cynical appeals to lots of money that can flow in if we suspend our better judgment and let the feds pay us to study it.

Diane Auer Jones - vice president for external and regulatory affairs for the Career Education Corporation - comments:

Bravo to the University of Minnesota for the very responsible work they are doing to train physicians to consider the patient as a whole person rather than little more than the vessel for the arthritic knee or cancerous prostate. Whether or not homeopathy “works” isn’t the right question to ask. Chemotherapy doesn’t “work” for curing bronchitis in the same way that antibiotics don’t “work” for curing viruses. What we should be asking – and it seems that UofM is – is for what conditions does homeopathic treatment work or work best, and in combination with what other therapies (allopathic, spiritual, etc) does it achieve the best result? It may be that homeopathic remedies work as outstanding stand-alone treatments for some conditions and as complementary (to allopathic) treatments in others. Science has not answered all of the questions about when, how and why alternative (to allopathic) therapies work, but it certainly has not produced any results that would suggest it is a waste of time or money to explore the potential of homeopathic medicine. That homeopathic remedies are inexpensive and have few associated side effects (some remedies make those who are lactose intolerant a bit gassy) should make them the focus of lots of research.

What if homeopathy, acupuncture or spirituality could reduce the cost of health care delivery and produce, for some diseases, equal or better outcomes? Oh, that’s right – it would crumble the hierarchy and challenge the dominance of the current leaders, potentially shifting the power to another. I guess when you can’t show results to prove that your way works best, the best you can do is hack away at the other person’s work. Are the negative commenters afraid that if homeopathy works, you could quickly find yourself out of that job that Harvard medical trained you to do so well? Or are you just worried that the NIH might favor work other than your own when making allocations of scarce resources? Is it just that you don’t want more horses at the tough?

I don’t think anyone is saying that homeopathy, alone, could cure cancer, but perhaps homeopathy could make chemotherapy more effective, or minimize the side effects so that we could use a more aggressive regimen of chemotherapeutic treatment.
Why is it that science is called “junk” science when the findings are counter to mainstream scientific thinking or when one brave soul stands up to challenge his or her peers? Shouldn’t those experts in non-biased empiricism start practicing at least a little of what they preach and hold ALL research findings to an equal level of scrutiny? Have you ever thought about just how much “real” science that is published by mainstream journals turns out to be “junk” science in the end? That, alone, is evidence that peer reviewers are far too lax in criticizing papers that reinforce, rather than challenge, their world view.

Sadly, science has become its own form of religion. In a very odd twist of fate, it is now the scientific community, not the church, that is creating its very own set of modern-day Galileos.

To which, there were of course rejoinders:

Daujones asks: “Have you ever thought about just how much “real” science that is published by mainstream journals turns out to be “junk” science in the end? That, alone, is evidence that peer reviewers are far too lax in criticizing papers that reinforce, rather than challenge, their world view.”

Of course, it’s a serious concern – but that doesn’t make rigorous testing of scientific hypotheses a waste of time, or suggest that those that ROUTINELY FAIL rigorous testing – such as homeopathy’s therapies – should be embraced. There are no discovered conditions in which homeopathy “works” in any way that is different from placebo effects. You may be waiting for that one magical study in which a homeopathic “drug” (which is chemically identical to pure water) actually and unambiguously cures a disease, but you may also be waiting for Santa Claus.

Daujones continues: “What if homeopathy, acupuncture or spirituality could reduce the cost of health care delivery and produce, for some diseases, equal or better outcomes? Oh, that’s right – it would crumble the hierarchy and challenge the dominance of the current leaders, potentially shifting the power to another.”

Very entertaining. Ann Landers used to get letters from people in the 1960s saying that they heard that doctors could cure cancer if they wanted to, but then they’d lose the bulk of their income. It echoed earlier, 19th century concerns – from doctors – that if the “germ” theory of disease turned out to be true, medicine might actually cure disease and doctors would lose the substantial income they derived from treatment of wealthy patient/clients. Medicine persists along its trajectory despite these fantasies.
And the “what if” argument is always a great one. “What if we could find a way to persuade the health fairy to visit whenever we asked, and then those bullying Harvard Med guys that daujones mentioned would be sorry….” What if, instead, we invested our scarce resources in research and development in areas of medical research that have shown real promise?

The “patient as a whole person” is fine. George Engel argued persuasively for that in his famous 1977 article “The Need For a New Medical Model”, and Mack Lipkin wrote his book “The Patient as Person” (also 1977), which became a mainstay of medical education for a while. Nothing wrong with that; clinicians embrace it. But that is a different issue, I’m afraid.

Daujones ends “Sadly, science has become its own form of religion. In a very odd twist of fate, it is now the scientific community, not the church, that is creating its very own set of modern-day Galileos.”

Well, no – religion, as a matter of definition (See Edward Tylor) relies on a belief in a supernatural, which is precisely what has been rejected in science since the Enlightenment. We put people on the moon because our science was good enough, not because we prayed hard enough. Science — like many fields – may embrace its own ideologies, but that doesn’t make science a “religion”, nor does it make those ideologies false. On the contrary – one of the hallmarks of modern medical science is the assumption that revolutions in thinking are just around the corner, as we have moved from simplistic humoral models of disease to anatomical models to cellular pathology to molecular biology, always gaining extraordinary power to diagnose and treat disease. Homeopathy? Not so much.

You want to be treated with a homeopathic “drug” that is chemically indistinguishable from pure water? Fine; go see a homeopath. Just don’t expect a better result than you’d get from a placebo, and don’t expect that responsible allopathic physicians will recommend it. But be very surprised if a major state university medical center offers it.

and

“I guess when you can’t show results to prove that your way works best, the best you can do is hack away at the other person’s work.”

Absolutely right: I guess when you can’t show results to prove that homeopathic remedies work best, the best you can do is hack away at allopathic medicine’s work.

What’s amazing about Diane Auer Jones’s comment on this post is that she was, in the words of her profile on the website of her former employer, The Washington Campus, “trained as a molecular biologist, [and] began her career as a laboratory director and college biology professor.” In other words, someone who was trained in, and practiced, the scientific method now supports a state university offering a scientifically unsupported pseudo-medicine on the grounds that, simply put, since allopathic medicine doesn’t cure absolutely everything all the time, offering any “alternative” medicine must be a good idea.

Not only is Ms. Auer Jones’s comment riddled with the likes of “it may be that,” “what if,” “are negative commenters afraid,” “are [they] afraid,” and “perhaps”–all without one shred of scientific evidence that homeopathic medicine would fare any better than, say, wafting incense and shaking rattles over a patient. It’s up to a medical method to prove it does work; it’s not up to allopathic doctors and scientists to prove that it doesn’t. If there is a bona fide scientific study out there that indicates that a homeopathic remedy works more than a standard deviation better than allopathic medicine in some significant instance, Ms. Auer Jones–who, one would expect, could uncover such data–should cite it.

And while Galileo might have proven the Church wrong on the matter of the Earth being in orbit around the sun, he didn’t prove astrologists, numerologists, alchemists, and tea-leaf readers to be right.

Afterthought: Is the Career Education Corporation looking to add to its roster some schools offering training in “alternative medicine”?

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