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.