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Sunday, August 02, 2015

On teaching alternative medicine at the University of Toronto

There's been a recent kerfluffle about a course called "Alternative Health: Practive and Theory" taught as part of a program in Health Studies at the University of Toronto's Scarborough campus (Toronto, Ontario, Canada).

Most of the readings in the course emphasized non-evidence-based medicine and health. The instructor was Beth Landau-Halpern, a homeopath who warns her patients about the dangers of vaccines [see Beth Landau-Halpern]. She's also the wife of Rick Halpern, the Dean and Vice-Principle of University of Toronto, Scarborough (UTSC). Ms. Landau-Halpern will no longer be teaching and the Dean has resigned [Rick Halpern Resigns].

From my perspective, the main problem was not the content of the course but the qualifications of the instructor and the reason she got her job. The instructor was not qualified to teach a university course, although I would have no problem with her giving some of the lectures in a course run by a qualified university instructor. I think the university has done a fine job of resolving that issue.

Lots of people are getting their knickers in a twist because the university offers a course on "Alternative Health." That's mostly because they don't understand how universities are supposed to work. As most Sandwalk readers know, I advocate dealing directly with controversies and, to that end, I think it's a good idea to teach a course where students can examine the main creationist arguments. It's a good way to practice critical thinking. For many years I taught a course where the main reading was Jonathan Wells' book Icons of Evolution.

What applies to creationism in a biology program also applies to quack medicine in a program that emphasizes health sciences.

Apparently I'm not alone in thinking that we need to teach the controversy. The university provost asked Vivek Goel, Vice-President Research and Innovation, to comment on the syllabus of the course. Vivek is a very smart man and a very fair man who understands universities better than most administrators. His area of expertise is Public Health. (Disclaimer: I know Vivek Goel.)

Let's look at the report he wrote for the Provost. There's a lot of good stuff in there [Review of HLTHD04H3-S: Special Topics in Health (Alternative Health: Practice and Theory)].
The Vice-President and Provost received a variety of complaints regarding the assigned readings in a posted version of the syllabus for a class on immunization in this course, alleging that the class would not be taught in a manner consistent with reasonable academic expectations for balance and rigor.

Although the Provost has indicated, and I agree, that it is not the role of senior administration of the University to examine the appropriateness of content within individual courses, she asked that I provide her with comments from the pedagogical process perspective (in particular, whether the processes used to approve and develop the course, at a departmental level, are consistent with best practice), to assist her in responding to the concerns that have been raised.

I have conducted this review in close collaboration with the Chair of the Department of Anthropology at UTSC, Professor Michael Lambek and the Health Studies Program Director, Professor John Scherk. The UTSC Department of Anthropology is the administrative unit responsible for the Health Studies Program.
This is an important point. Senior university administrators should not meddle with the content of university courses. That's the prerogative of departments. If academic freedom is ever going to mean anything significant, then it's up to individual departments and programs to determine what's appropriate for courses in their discipline. Yes, it's true that there might be times when an entire department makes poor judgements but that's the price you pay to ensure academic freedom. You certainly can't allow outside pressure on senior administrators to influence what's taught and what's not.

In most cases, the individual instructors in a course should decide on specific content within the parameters chosen by the department. This is not a right that's written in stone because there will often be cases where an individual instructor makes poor decisions. In such cases, the department can "meddle" or assign another instructor to teach the course. Instructors with tenure should not be dismissed or punished for what they choose to teach. They can be re-assigned.

I'm glad to see a senior administrator (Vivek Goel) who recognizes this point.
As part of my review I examined the curriculum for the Health Studies Program, the 2015 syllabus for the course, and student evaluations from the 2014 session for the course. I interviewed Professors Lambek and Scherk, and the instructor, Ms Beth Landau-Halpern.

At the outset I must be clear that evaluations of content and pedagogical approach ought to be done at the level of the program and department, by academic colleagues who have the appropriate expertise to conduct such examinations. Accordingly, my review has focused primarily on the processes that were followed in this case. However, given that the topic of concern regarding immunization is within my academic area of expertise, I do offer some observations for future consideration by the department.
While recognizing, correctly, that the department has the ultimate authority, Goel thinks that the process can be reviewed by senior administrators. This is dangerous territory, in my opinion, but this is a special case because the instructor is the wife of the Dean. It's possible that the department was unduly influenced.
The Health Studies Program at UTSC combines courses from a range of disciplines to examine this critical area from a biological, social and policy perspective. The program enrols 640 students a year in two Major areas: Population Health, leading to a BSc, and Health Policy, leading to a BA. Each Major can also be taken with a co-op option. All students take a full year two course sequence entitled Foundations of Health Studies. Most students combine the Major with another area, often another science Major. All students take a statistics course and many take a course in health research methods.

The Program Director notes that the majority of courses that students take are firmly rooted in biomedical sciences and students have exposure to issues regarding vaccines and immunization throughout the program. The evidentiary basis for these interventions is presented within these earlier courses. Several of the courses also examine the controversies regarding specific vaccines.
This is important. University courses don't exist in a vacuum. They are usually part of a program and they have specific co-requisites and pre-requisites. Outsiders looking at the content of a single course don't appreciate this.
The course offered by Ms Landau-Halpern is a final year option limited to 30 students. The program aims to have several courses under the title Special Topics in Health each year. Students may also take Directed Readings or Directed Research, among other options in this category. Students taking any of these options are in their final year of study and are expected to approach controversial topics with a critical lens.
The department knew what it was doing by exposing their majors to controversial topics in the field. That's exactly what they should be doing. It's all about critical thinking.
The program is constantly looking for ways to provide new and emerging topics of interest to students. Health practitioners are often asked to conduct such courses. It is within this context that this specific course was developed as an elective for interested final year students. The course aims to present alternative medicine and to explore the controversies around these modalities. The instructor reports that as the students start with a strong biomedicine background, they approach the topics presented quite critically.
If you don't understand this then you don't understand how universities are supposed to behave. The pedagogical principle is sound and correct. Whether it was carried out correctly in practice is another matter but those who think that mention of alternative medicine should be banned from the campus are wrong. That's how ostriches behave when they stick their head in the sand.1 It doesn't make the controversy go away.

It's important to understand that we are not dealing with children. These are mature university students taking a course in their final year of study. They do not need to be "protected" from the evil bogeyman of quack medicine. Most of the outsiders complaining about this course seem to think that these naive students are going to be swayed to the dark side by being exposed to the real world of quackery. If that were true (it is not true) then we would have a much more serious problem on our hands than just this course.
The student evaluations from 2014 reveal that students do understand the purpose of the course and appreciated the opportunity to critically think about these alternative modalities. The course is rated very positively by the students who took it 2014. Many students commented that they felt that the topics covered in the course should be introduced into the curriculum in earlier years. There were no complaints from the students in 2014 regarding the content of the course, and I am not aware of any student complaints so far in 2015.
The students get it, even if people outside the university don't.
The session which generated the bulk of the concerns which were brought to the attention of the Provost is one dealing with immunization. Ms Landau-Halpern reports that she revised the curriculum in mid-February in light of the ongoing measles outbreaks. Thus, she had already voluntary removed the session for which the greatest degree of concerns were subsequently expressed.

I did explore with her how she approached this topic in 2014 and how she would have done so if it had remained on the curriculum this year. She reports that she approaches this issue from a nuanced perspective and encourages students to think critically about vaccine effectiveness and safety.

The syllabus for the course contains a reading list for the immunization class which gives emphasis to materials that primarily focus on risks for vaccines. The instructor reports that she provides these readings as the students have already seen the other side in previous courses. In class they are then able to have a discussion from all perspectives.

As a result, I do not find that the instructor’s approach in this class has been, or would have reasonably been perceived to be unbalanced, in the sense that it deviated from a presentation of material that, in context, would enable critical analysis, and inquiry. Thus, from an academic pedagogy perspective, I do not find that there has been sufficient deviation from the range of normal approaches to warrant concerns.
From an academic pedagogical perspective, there's nothing wrong with a course that has a reading list emphasizing quack medicine. This is the view that people outside of the university don't understand. They appear to want to prevent students from ever learning about, or discussing, the anti-vax movement and how to deal with it.

They are wrong.2
Notwithstanding the foregoing, and based on my own experience as a faculty member working in this area, I would suggest that the syllabus for such a course could explain better the approach that is being taken so that students could better understand the context for their assigned readings. I also note that many of the readings in the course are from secondary sources on the internet. The course could be
enhanced by a greater reliance on the scholarly literature, both biomedical as well as social sciences.
I disagree with Vivek on this point. The course should be about the perception of controversy that the general public is exposed to. The average person is more likely to get their information from the internet so that's the source that students should be examining. They should be prepared to deal with that kind of misinformation when they leave the university and enter the real world.
In any case, courses such as Special Topics in Health are already approved to cover a broad range of areas. Faculty normally offer courses under such a rubric in areas that they are interested in exploring with students and in conjunction with discussion with colleagues in their department. This is often a route by which new courses get developed. Special Topics are also a means by which new ideas are introduced into the curriculum.

In the case where individuals offering such courses are sessional instructors, the Anthropology Department’s position posting asks for a current CV, a proposed course outline, a statement of teaching and evidence of teaching effectiveness and 2 letters of reference. These materials are reviewed by the department and instructors are selected in accordance with the processes in place for appointment of sessional instructors.

On review of the process it does not appear that there was adequate consideration or comment by the department and colleagues on the proposed course outline developed in 2013 for the Spring 2014 session, nor for the Spring 2015 session. While I do not find that the course is unbalanced, in the sense of the term used above, I do believe it could be strengthened by greater engagement of academic colleagues through such a review process. The Department Chair and Program Director will continue to work closely with the instructor through the balance of the term. If the course is to be offered again in the future it should be developed as a regular course and taken through the usual governance reviews.

Such a process, including the selection of the course instructor, would also facilitate the identification of appropriately qualified people to present the broad area of content that is intended to be covered. When combined with the initiation of a curriculum committee, there is every reason to believe that there will be enhancement of the department’s ability to offer a range of relevant, rigorously prepared and well-delivered courses to support the degrees granted.
This was the real problem. There's nothing wrong with teaching a course on alternative medicine and the anti-vaccine controversy as long as students have the background to be able to think about it critically. There's nothing wrong with an upper-level course syllabus that has lots of readings and videos on quack medicine. That was not the problem. Trying to force the university to remove such material from a course reveals a profound lack of understanding on how universities are supposed to work. Universities must resist such pressure.

However, in this case, the mechanism of choosing an instructor and ensuring academic rigor in the course was not ideal.

1. I'm aware of the fact that ostriches don't really bury their heads in the sand.

2. If any of these people respond to this post, you can be certain that they are going to move the goalposts. They are now going to say that they were never opposed to exposing students to anti-vaccine material but only opposed to the way it would have been taught in this particular course.


Argon said...

But to be sure, being an unqualified idiot (with a homeopathic practice) didn't help things. I'm OK with the "students aren't special flowers thing" but how well is an informed student going to do when demonstrating that the instructor doesn't know their ass from a hole in the ground with regard to quantum mechanics?

The University (and the Anthropology (?) Dept.) deservedly lost respect with regard to its commitment to academic rigor and instructor selection. And the Dean husband should've staying miles away from the whole thing.

Jmac said...

A lot of people are into "alternative medicine" these days. Most information people get on "alternative medicine" is via Google. Unfortunately the majority of information on the subject online is simply false and it requires a very well trained eye to distinguish what could be true or false.

Recently, my wife and I desperately tried to discourage our good friends from applying the "raw food diet". We are not experts in the field, but after doing a little bit of research and seeing the symptoms they were experiencing by being on the diet, we were very desperate to help them out. It didn't work.

I'm not sure where the solution to the problem is. Who should educate the public and who should monitor the internet for quackery. I think that the true education on alternative medicine should start at universities and doctors and nurses should be taught first what is true and what is false. Unfortunately this is unlikely as long as what's being taught is influenced by the pharmaceutical companies and their corrupt friends.

Robert Byers said...

Whose universities are these? They belong to the Canadian people. So its up to the people to decide what is taught if there is a contention. It seems to me its not this practice but instead its these paid administrators , whatever department, who decide.
Yes everyone believes the kids are easily influenced and not sharp enough to decide things anmd yes everybody whats THEIR university to reflect their belief systems.
It seems to me this university and all Canadian ones fall short of the vision or dream of a successful nation.
That is that they reflect the people , and reflect their intelligence regarding anything of interest in academic circles.
These days its just a finishing school for high school and doesn't get the best people to actually make a contribution that should be better then the rest of the world except America.
Yes creationism should be taught by creationists in some classes and yes the whole contention by anyone. I don't think critical thinking exists in human nature.
All there is is weighing more then one side on a issue.

Unknown said...

"There's nothing wrong with teaching a course on alternative medicine and the anti-vaccine controversy as long as students have the background to be able to think about it critically."

Bingo. Although that's one big caveat. The other thing, these aren't really "science" classes. Debunking Quackery 401 could be a very interesting class though.

Alex SL said...

They should be prepared to deal with that kind of misinformation when they leave the university and enter the real world.

There is little to disagree with this sentence as such, or with the idea that the administration should leave course design to the lecturers.

The problem with the above sentence, however, is that there is a difference between a lecturer saying "this here is horrible misinformation that you will encounter in real life, and here is how to deal with it", and a lecturer actively spreading the misinformation themselves through the trust and authority they have in the teacher - student relationship which is by design and necessity different from a fully mature, critically thinking adult - fully mature, critically thinking adult relationship.

(If the latter was what is going on at universities then one could do without any lecturers and professors, which would save a lot of money. It so happens that we have places of learning that work like that, but they are called public libraries.)

Without any additional information, the students' course evaluation excerpted above could also be read as at least some of them (there might be self-selection going on, as not everybody has to take that course) fully agreeing with homoeopathy and anti-vaccination views and suggesting they should already be integrated into earlier years. At least it does not specify that what they learned was critical thinking and how to rebut those.

Larry Moran said...

Wouldn't it be nice if there were no university instructors who spread misinformation? It would certainly eliminate a lot of my blog posts.

The best we can hope for is that all instructors buy into the concept that we are trying to create critical thinkers. They also have to accept the fact that some students will challenge their ideas in class. This should be encouraged.

In such an ideal world, we probably wouldn't have instructors who teach incorrect versions of evolutionary theory for very long. We also wouldn't have instructors who teach incorrect versions of the Central Dogma.

Uncivilized Elk said...

As a undergrad I got taught the incorrect version of the Central Dogma twice. Also had 1 prof (who was generally not that great) state how he can't "imagine" more than 50% of the genome being junk (pffft).

But I do think there is a difference between instructors being misinformed or teaching incorrect things on a (relatively) minor scale, while their general class outline is for the most part filled with correct information, opposed to the entire class outline being flawed and BS from the ground-up - which is more like the example you provide in your blog post.

Piotr Gąsiorowski said...

If one follows Argon's link, the course description is quoted there:

We will delve into a quantum physics’ understanding of disease and alternative medicine to provide a scientific hypothesis of how these modalities may work. Quantum physics is a branch of physics that understands the interrelationship between matter and energy. This science offers clear explanations as to why homeopathic remedies with seemingly no chemical trace of the original substance are able to resolve chronic diseases, why acupuncture can offer patients enough pain relief to undergo surgery without anesthesia, why meditation alone can, in some instances, reduce the size of cancerous tumors.

The quantum-mechanical understanding of the healing effect of sweetened water -- there's not even a homeopathic dose of sense in this quack jargon. If Mrs Landau-Halpern is not a charlatan and a fraud, who is?

SRM said...

The quantum-mechanical understanding of the healing effect of sweetened water -- there's not even a homeopathic dose of sense in this quack jargon.

That's a damning course description. In what department could that have passed unchallenged through the normal curriculum committee review process? I guess the answer is evident in this case.

Konrad said...

Wow, what a quote. This description is even worse than just quoting Lewis Carroll:

"The time has come," the Walrus said,
"To talk of many things:
Of shoes--and ships--and sealing-wax--
Of cabbages--and kings--
And why the sea is boiling hot--
And whether pigs have wings."

At least, on the pigs-have-wings issue, Carroll said "whether" rather than "why".

Can this really be the same description Vivek Goel was commenting on? There must have been some mistake.

John Harshman said...

I think it's a problem that the instructor herself was a quack. And that's not just a problem with the process for choosing instructors. If there's to be a class about quackery, it would be reasonable to have it team taught by a quack and an expert in quackery. That would insure that students had access to all sources of information and that the instructor's authority wouldn't act to discourage critical thinking. I don't find lack of student complaints compelling here either; you need actual questioning of students to know what went on.

And discouragement of critical thinking is exactly what I think would happen if (switching subjects to my favorite) your department got a creationist to teach a course on creationism. But if you taught the course and were able to persuade Ken Ham to give some lectures and lead some discussions, that would be cool. But a course about creationism is different from a course in creationism, which is what you would get if Ken Ham taught the whole thing. Best case scenario, it would result in huge arguments between teacher and students, every class, all the time, with the students doing their own, self-directed literature research to refute his claims. I doubt, however, that the students would generally be willing to hijack the class that way or that Ken would be willing to put up with it for long. Worst case scenario, a one-sided presentation and lack of expertise on the part of the students results in objections being shut down, maybe even a conversion or two.

colnago80 said...

Apparently Helpern is not the only quack at UT, there is also a miscreant named Heather Boon who seems to be a devotee of homeopathy

Jmac said...

There are parts of "alternative medicine" that are scientifically sound and often work better than conventional medicine or by applying both-prophylaxis and conventional medicine. I don't think prevention is emphasized enough mainly because of the pharmaceutical industry paying and influencing the studies that seem to contradict the data that shows positive effects of preventative, or healthy measures.

Faizal Ali said...

Prevention is part of conventional medicine. Nothing "alternative" about it.

Jmac said...

So, one being treated by an MD has a choice or an alternative treatment options say for high blood sugar: medication, restrictive calorie diabetic diet, or both, right?

Larry Moran said...

There are parts of "alternative medicine" that are scientifically sound.

No there aren't. If it's scientifically sound it's just called "medicine."

Faizal Ali said...

So, one being treated by an MD has a choice or an alternative treatment options say for high blood sugar: medication, restrictive calorie diabetic diet, or both, right?

Yes, among other options. That's correct. Thanks for admitting you're wrong.

Jmac said...

So if I go to an "alternative medicine" specialist and I get recommendations that are scientifically sound, would this specialist be considered to be practicing medicine without a license or just practicing "alternative medicine" that is scientifically sound?

Faizal Ali said...

So if I go to an "alternative medicine" specialist and I get recommendations that are scientifically sound, would this specialist be considered to be practicing medicine without a license or just practicing "alternative medicine" that is scientifically sound?

Neither. He would be practicing scientifically sound medicine, which means he is not practicing "alternative medicine."

Unknown said...

I think there is some miscommunication there. To me - and I guess lutesuite and Larry - the key to medicine is that treatments are evidence based. I.e. that the effectiveness of a treatment has been shown in properly done double blind, randomized trials using a control group (preferably two, one with a placebo and one without).
There is another use of the term, which defines it by how the treatment was developed. So all kinds of traditional medicines fall into that camp. Some of the treatments that fall under the "alternative medicine" label by the second definition work. But those that do don't fall under it by the first definition.

Faizal Ali said...

I agree, the terms can sometimes be confusing. But the main reason for the confusion is that there exists a group of people who insist on separating a group of "treatments", which may or may not be effective, and calling them "alternative". Academic and clinical medicine already has a method of assessing the efficacy of treatments, as you describe yourself, so on what basis are some segregated into the category of "alternative"? In practice, the basis is that they have yet to be subjected to the process of scientific evaluation, or have been subjected to this testing and found to be ineffective. Apart from that, there is no rigorous objective criteria by whch a treatment is considered "alternative."

Jmac said...

I agree, the terms can sometimes be confusing

So now you've just confirmed what I have been claiming since the beginning on this thread.

Faizal Ali said...

That you're confused? When was there ever any doubt of that?

Piotr Gąsiorowski said...

In this case, it's not only the treatment that is labelled "alternative". The speak of a "wide range of modalities other than conventional western biomedicine". So, for example, traditional Chinese medicine, mesmerism, reiki, shaman healing, etc. are not merely unconventional methods whose effectiveness could be studied with "western" scientific methods and tested in clinical tests. They transport us to an alternative universe whose inhabitants have chakras and meridians, and where diseases are caused by a quantum imbalance between the yin and yang charges in bioenergy fields (possibly as a result of MMR vaccination). You can't test them if you don't know how to harness qi energy and if you are a backward muggle who doesn't even use telepathy in everyday life.

Jass said...

Does anybody here know the meaning of the word alternative?

I doubt that.

Alex SL said...


Unfortunately I do not understand your reply. Of course we don't have an ideal world, but I thought the point of contention was whether people are allowed to try getting closer to an ideal world by criticising a university for teaching pseudoscience or whether we should not make that attempt because academic freedom.

Your newest post seems to suggest that you are also against courses teaching pseudoscience as true and factual and merely want to allow for courses that teach good science while mentioning that pseudoscience exists. However, if that understanding is correct, then I am suddenly confused what the above post was about, because I can't imagine that there is anybody who would disagree with that or ever has. The criticism of the course in question was, as far as I can tell as an uninvolved outsider, always about it promoting anti-vaccine views, never about it mentioning anti-vaccine views.

Larry Moran said...

@Alex SL

Most of the criticism came from people who opposed the idea that anti-vaccine views were being discussed in a university course. They did not consider the possibility that this could be part of a legitimate course in a health program.

There nothing wrong with having lecturers who PROMOTE minority views in university courses as long as there's plenty of opportunity for students to debate and discuss both sides of a controversy. Those who restrict their criticism to the idea that only defenders (promotors) of minority controversial opinions should be banned are stll wrong, as long as there's an appropriate balance in the course.

Alex SL said...

Thanks for clarifying. It means, however, that I still find myself disagreeing with you. Where you see the slippery slope towards banning a scientifically sound minority view, I see the reductio ad absurdum of a university telling its students that bloodletting is good medicinal practice, or geocentrism, in the name of academic freedom.

I just understand that latter term in a completely different way than you do - not as "professors can teach whatever they want" but as "professors cannot be sanctioned for expressing unpopular political or religious views, as long as they do the job they are being paid for, i.e. teaching good science".

Larry Moran said...

@Alex SL

Here's how I interpret your statement. "Professors cannot be sanctioned for anything they say as long as, while they're in the classroom, they teach what I think they should be paid to teach." Is that an accurate representation of your view?

Alex SL said...

Not really "I", because I have no idea what good fluid physics would look like at the moment for example, but otherwise pretty much yes. I am paid to do research; if I start spending my paid work hours writing poems instead I fully expect to lose my job. Somebody else might be paid to paint walls; if they start covering the walls with pig entrails instead one would expect there to be consequences.

I fail to understand why professors should not be required to do the job they are being paid for.

pkelly2505 said...

So I guess Professor Moran would not oppose a course in "alternative" biochemistry, even if the instructor gave different chemical formulas for every known compound found in "traditional" biochem texts. The students can just use their critical thinking skills to determine that they are being taught nonsense.