Thursday, October 09, 2014

Faculty of Medicine at the University of Toronto supports quackery

Our Dean of Medicine, Catharine Whiteside, announced recently that the Faculty of Medicine and the Faculty of Pharmacy are entering into a joint program for
Evaluating Complementary and Alternative Medicine
. They will collaborate with a new Centre for Integrative Medicine (CIM) run by Lynda Balneaves.

It's not clear what form of "Complementary Medicine" (i.e. non-evidence based medicine) she (Lynda Balneaves) supports but it seems to include "natural health products (e.g., vitamins and herbal therapies), manipulative physical treatments (e.g., massage), and mindbody therapies (e.g., meditation)" [CAMEO]. Other websites mention acupuncture.1

"Alternative Medicine" is also another word for medical care that has not been proven effective by standard clinical trials. Otherwise it wouldn't be "alternative." What this means is that the Faculties of Medicine and Pharmacy have abandoned the ideal of evidenced-based medicine.2 You may want to take that into account next time you are choosing a physician.

Here's the announcment by Dean Whiteside ...
Complementary and alternative medicine (CAM) is widespread, but not very well understood. According to one study, almost three-quarters of Canadians — 74 per cent — have used some form of CAM in their lifetime. This can include chiropractic treatment, acupuncture, herbal remedies, or traditional Chinese medicine. Patients often opt to use these therapies without consulting a conventional medical professional and without understanding how these CAM therapies might interact with other drugs or therapies they may be using. Both patients and health care providers require better information so they can make informed choices about CAM therapies. Research in CAM to provide evidence for best practice is necessary.

This is why a new academic partnership has formed among our Faculty of Medicine, the Leslie Dan Faculty of Pharmacy and The Scarborough Hospital — a long time community-affiliate of the University of Toronto. The Centre for Integrative Medicine (CIM) will focus on CAM research and education. This will be achieved through an interprofessional approach — led by the Centre’s Director, Professor Lynda Balneaves — that brings together scientists, physicians, pharmacists, nurses, CAM practitioners and others who work in the health care field. Our Faculties of Pharmacy and Medicine will support the scientific research that will ground the Centre’s evidence-based approach, while a Clinical Hub will be established at The Scarborough Hospital’s Birchmount campus to help patients manage their day-to-day health. The result will be a living laboratory that allows us to study ways to safely and effectively integrate evidence-informed CAM therapies, including traditional Chinese medicine, with conventional medical care.

On September 29, our Faculty Council approved CIM’s creation as an EDU-C and on October 17, we will celebrate the official launch of the Centre. Professor Balneaves, working with colleagues across U of T and The Scarborough Hospital, has already been overseeing the first phase of the Centre’s launch, which is focused on consulting and identifying the needs of the community. She is also laying strong foundations for the effective clinical care and research to follow. By spring 2015, the Centre will launch a series of pilot projects designed to address the clinical needs of the TSH community integrated with education and applied clinical research, and it will be ready to announce long-term plans.

CIM is another example of how we are working closely with our colleagues at U of T and throughout our expanded network of affiliated hospitals to address important health challenges and opportunities. It also strengthens our academic partnership with The Scarborough Hospital to ensure we help support their vision of providing the best health care for a global community.

Many people have supported the Centre, but KY and Betty Ho have been particularly engaged. They have endowed a chair — to be known as the KY and Betty Ho Chair in Integrative Medicine — held by the Centre Director. Their generosity and leadership in supporting this Centre has been catalytic and greatly appreciated.

We could not hope to have a more distinguished leader than Professor Balneaves. She joins us from the University of British Columbia, where she has led a UBC-BC Cancer Agency initiative called the Complementary Medicine Education and Outcomes (CAMEO) Research Program, which provides evidence-based education and decision support for cancer patients and cancer health professionals. She has been investigating complementary and alternative medicine for 20 years, and her groundbreaking work has been frequently cited in media across Canada. I am very proud that the Centre is starting out in the capable hands of such a talented research leader.

Catharine Whiteside
Dean, Faculty of Medicine

UPDATE: A little birdie reminds me that if you want to understand how institutions work you should remember the old adage, "follow the money." There might be some very wealthy people who would like to promote Chinese herbal medicine and acupuncture. I wonder who they might be?


1. She supports medical marijuana but that's not "complimentary medicine" or "alternative medicine."

2. Of course that's not how the university spins it. They claim that the collaboration will investigate whether these alternative medicines are effective. I wonder how long it will take to discover that most of them don't work? Don't we know that already? Isn't that why they're called CAM?

22 comments :

  1. The name includes the word "evaluating". If their goal is to objectively evaluate and understand these then it doesn't sound like a bad idea. Also, there have been some interesting connections between meditation and attention found recently - not all "alternative" medicine is the same.

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    Replies
    1. There is already too much money and time spent on such alternate medicine evaluations. We already know from many years and millions of dollars spent on this that it vary rarely has any benefit beyond placebo effects.

      Delete
    2. Biological plausibility be considered when we are deciding how to spend our already limited resources. Also, the claim that we are simply "evaluating" these treatments is typically a trojan horse to get CAM into med schools.

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    3. Some Chinese herbal medicines consists of actual molecules, the same kind of molecules (like taxol and artemisinin) that have been isolated from plants and turned into billion dollar drugs. So I think "follow the money" may actually apply in this case in a different way.

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    4. The means already exist to isolate and study the efficacy of such molecules thru "conventional" medicine. So what is the purpose of setting up a centre specifically study things like Chinese herbal medicine?

      The National Institute of Health in the US actually has a project specifically set up to evaluate CAM. As of 2011 it has consumed $1.4 billion in precious research fundings, without producing a single worthwhile positive discovery (though it did confirm that coffee enemas do not cure pancreatic cancer):

      http://www.hillmanfoundation.org/blog/coffee-enemas-aromatherapy-and-intercessory-prayer-your-tax-dollars-work

      "Complementary" medicine should compete on a level playing field against other experimental treatments that actually have a valid scientific basis and likelihood of being effective. It should not be given an avenue for preferential treatment.

      Delete
  2. "Alternative Medicine" is also another word for medical care that has not been proven effective by standard clinical trials. Otherwise it wouldn't be "alternative."

    Exactly. It isn't that no folk remedies have ever been shown to be effective, it's that they have to go through the same evaluation as treatments developed by pharmaceutical companies. The argument that (for example) the native people of Tibet have treated cancer with a local herb for centuries is a *starting* point for medical trials. Typically the alternative medicine types think such anecdotal evidence is sufficient for something to be used in practice.

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  3. “You know what they call alternative medicine that's been proved to work? - Medicine.” ― Tim Minchin

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  4. Do you know what they call alternative medicine that's been proven to work?



    Medicine.

    -- Tim Minchin

    ReplyDelete
    Replies
    1. It's either great minds think alike or fools seldom differ.

      Delete
  5. Larry,
    What are your "credits" in this area of medicine...? You must be fully certified to criticize the medical establishment...?

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    Replies
    1. A biochemist wouldn't need to be accredited in alternative medicine to recognize claims that go against basic biology and science.

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    2. Only in the sense that you must be a certified theologian to criticize religion, or a certified idiot to criticize comments by Quest.

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    3. "What are your "credits" in this area of medicine...? You must be fully certified to criticize the medical establishment...?"

      Larry is a biochemist, but I'm both an MD and PhD, and I agree with Larry. If it's credentials that you want, I might not be as well-published as Edzard Ernst on the issue of CAM, but I'm not without a couple of publications myself:

      http://www.cell.com/trends/molecular-medicine/fulltext/S1471-4914(14)00103-8

      http://www.nature.com/nrc/journal/v14/n10/abs/nrc3822.html

      Not to mention that I'm editor of the Science-Based Medicine blog:

      http://www.sciencebasedmedicine.org

      For example:

      http://www.sciencebasedmedicine.org/quackademia-update-2014/

      Enjoy! :-)

      Delete
    4. Does this make you qualified to criticize a drug, that... let's say has mixed reviews... and opinions, especially in certain age groups of patients....?
      Well... Dr. Gorski... what would happen to you if you publicly criticized a drug that is a big seller... say Paxil...? You wouldn't lose your license because you are a doctor and PHD which makes it perfect...

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    5. Quest lacks the intelligence to carry Dr. Gorski's briefcase.

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    6. Yeah,,, Dr. Gorkski knows what would happen to his ass if he criticized a shitty drug but you don't... yeah.. I lack intelligence and what do you lack shit head...? Change your nickname and you are going to be fine...

      Delete
    7. Re Quest

      Change your nickname and you are going to be fine.

      What's the matter with my nickname? For the information of Quest, the Colnago manufacturing company, founded by Ernesto Colnago, has been making racing bicycling frames in Italy for 60 years and is one of the premier such enterprises in the world. I happen to own a 1980 model Colnago Superissimo.

      http://en.wikipedia.org/wiki/Colnago

      Delete
  6. According to one study, almost three-quarters of Canadians — 74 per cent — have used some form of CAM in their lifetime. This can include chiropractic treatment, acupuncture, herbal remedies, or traditional Chinese medicine. Patients often opt to use these therapies without consulting a conventional medical professional and without understanding how these CAM therapies might interact with other drugs or therapies they may be using. Both patients and health care providers require better information so they can make informed choices about CAM therapies. Research in CAM to provide evidence for best practice is necessary.

    As an MD, I often hear this rationale offered to justify the study of CAM: That our patients are using "alternative treatments" anyway, so rather than just dismissing them we should learn how to "integrate" them into our practice.

    I wonder why the same approach is not taken for other treatments that have been found to be ineffective or unsafe. For instance, rather than educating practitioners and the public on why not to prescribe antibiotics for viral infections, why don't we just "integrate" this practice into standard care?

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    1. I wish that more MDs had this opinion. I've heard the "what's the harm" argument from MDs as well as patients. Apart from being a waste of time and money, don't they realize that some of this stuff can also cause harm?

      It scares me that this stuff is making it into med schools!

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    2. One thing CAM can teach real medicine: The importance of marketing.

      Unfortunately, it is more difficult to convince people to accept a treatment when you are restricted to telling the truth about it. CAM practitioners do not work under such a constraint.

      Delete
  7. If they accept alternative medicine then they must accept alternative conclusions in origin subjects.
    Creationism is a science, or as much as our opponents, subject and so if acupuncture and spells is allowed then no more denying us

    It does seem to not be worthy of a university. However healing is a special matter for people and so any chance for it by any means makes a more liberal attitude about methodology.
    Also will help revive the medical support industries who provide leeches.
    HMMM> Something is wrong with universities these days.

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    ReplyDelete