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CAM Qualifications: Or Are They sCAM?

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There are many thousands of considerate, generous people who want to develop a career in caring for people, alleviating suffering, providing some form of treatment. Many enter the medical professions studying to be doctors, nurses, physiotherapists, radiologists, and a host of other specialties.

If you look at the courses on offer, though, you will see not only the medical and scientific ones, but also some that provide qualifications in Complementary and Alternative Medicine, CAM for short. These often stress words like holistic, energy-based, non-invasive, and integrative, and claim to provide forms of medical care not addressed by conventional medicine. The institutions offering such qualifications now include many mainstream universities.

One would think, since mainstream universities are validating these courses, that there is some serious established basis for their contents, that they were determined to be factual and meet a high intellectual standard, that the skills imparted are genuine, evidence-based, and reliable. That's what you would expect if you went to university to study say, engineering, or chemistry, or architecture. Your qualification from a university would indicate that you had met certain demanding academic and professional standards, and that the courses you had studied were rigorously assessed as to the factual basis of their content.  Unfortunately, we can no longer assume that is the case.

As the CAM movement sought mainstream acceptance, it generated its own institutions, produced its own teaching materials, issued its own qualifications, published its own journals, produced its own trainers and lecturers, and largely side-stepped the usual arbiters of academic and professional competence. Alongside the traditional academic institutions – the universities – there arose many different colleges offering qualifications in everything from crystal healing to Ayurvedic medicine, from homeopathy to light therapy, from reiki to magnets, and they operate with very different standards.

Some universities in the UK have, until recently, been issuing Bachelor of Science degrees in homeopathy alongside degrees in physics and biochemistry. Although there are strict scientific criteria for the inclusion of subjects into university academic curricula, the CAM courses slipped through the net. Those homeopathy B.Sc. courses have now been closed down – it's difficult to award a science degree based on a non-science for which there is absolutely no evidence. Nevertheless, there remain many pseudoscience courses mixed in with genuine science courses. Some universities are rebranding these pseudoscience courses as arts degrees, to avoid scientific scrutiny, and are issuing B.A. degrees instead.

Dr David Colquhoun has been tireless in trying to obtain the course materials used by students in these pseudoscience courses. Despite the universities' refusal to release them, even under the Freedom of Information Act, he has been able to get access to some remarkable details.

So what is going on with these institutions, acting so cavalier with academic standards, undermining the value of those who have worked for genuine science degrees, and misleading those students who are studying pseudoscience into thinking that they are getting valuable qualifications?

Well, there are obviously the commercial interests of an industry trying to establish itself as mainstream. Getting institutional acceptance is important to any new field. But this particular industry is based on belief in the therapies they promote, and not on the evidence of efficacy. Still, they are a strong commercial lobby who can exert influence on financially strapped bureaucratic administrations in academia, and they have cash that universities want.

When universities have to put bums on seats to get adequate funding, then a lucrative source of cash is available in validating qualifications from courses which are actually delivered by other institutions. And in many cases, they are the private institutions already awarding their own CAM qualifications: they can now also buy validation from a university.

About Bob Lloyd

  • http://www.skepticat.com Skepticat

    Nice piece. DC is a hero. I really wonder whether one of the BSc homeopaths will try to sue once they realise they’ve wasted their time and money on a worthles qualification. Or, having invested so much in it, are they destined to defend it to their dying day? Probably.

  • http://www.leavingthelandofwoo.com Bob Lloyd

    Homeopathy courses are something of an enigma since basing them on the principle that dilution increases strength, an apparent absence of content might actually make them more valuable :)

    I think many people interested in CAM are attracted to the Reiki pyramid selling business. For around $1200 and around a year of partial employment, they can buy into the Reiki business and make money training others. Since you have to be enrolled by an existing Reiki expert, that protects your investment since you can recover your outlay by enrolling others in turn. And of course, since the Reiki energy is undetectable, whether you believe you have those skills or not doesn’t matter – the customer can’t tell anyway.

    But for those going to a university course expecting real education, these courses are pretty awful. It would be reassuring if science departments in all universities were prepared to question the content of these courses though that would expose individuals to the wrath of the administrators. Maybe we need a system of whistleblowers in academia able to report the contents of these courses to the media?

  • http://www.subtlebodydynamics.com Daniel

    Sir,

    Your appeal for high standards is commendable. However, you say; practitioners of pseudoscience are convinced that they are qualified, that their skills are real, and that they are genuinely offering effective treatment, because they have a piece of paper stamped by an academic institution.

    Do you speak from a place of absolute certainty that you know for certain that these pseudoscience are in fact ineffective? I wonder, what degree/study of science imparts the understandings of the all pervasive subtleties of spirit and life energy?…

    Science is grand. In it’s majesty, we have gone to the moon and much, much more. We see into the depths of the physical world with astonishing detail. Yet, the greatest mysteries of life, science can’t even begin to explain. This article say’s little about any actual results that these practitioners experiance. Mayhaps, the students of these pseudoscience’s are convinced that they are qualified because they have gained experiential understandings. The type of subjective truth that science can not quantify.

    The Dalai Lama wrote in his book “The Universe in a Single Atom” that our current definition of science must be expanded if we are going to peer deeper into what we are.

    We are much more than simple matter and flesh. We are alive with spirit, spirit that is not found in the raw materials that science tells us we are made from. This missing animated awareness is not subject to physical science as we currently understand it. The phenomena under examination is entirely subjective, but the process which the more mature of these modalities (pseudosciences) used to validate, is identical to that of traditional science. The scientific method still applies, (collection of data through observation and experimentation, and the formulation and testing of hypotheses).

    Yogis, Sages and Masters have experimentally worked the theorems for thousands of years. Yet the truth of their findings is such that every individual must experience it for themselves, to know it’s truth. Don’t you find it striking that hundreds, thousands, millions of practitioners, yogis, sages and masters all come to the same conclusions? Spirit and life energy may not be tangible to the unskilled, but everyone can, with practice, experience the same aspects and qualities, IF they apply the proven methods!

    Call this study of phenomenon anything you like, Metaphysics is sorta catchy. However try to not stand in the way of progress. Articles with spin such as this one, only hinder the advancement of the ‘study’, and it’s acceptance as a possible means for relieving the suffering of millions. Just ask millions of Chinese!

  • http://www.leavingthelandofwoo.com Bob Lloyd

    [the understandings of the all pervasive subtleties of spirit and life energy?...]
    You see, that empty metaphysics is precisely the way to disguise the fact that there is no content to these supposed understandings. Anyone, literally anyone, can postulate that there is spirit or life energy but that’s only the beginning of the enquiry.

    Next you need to demonstrate that it is there and not simply an idea, we need to show the evidence and let someone else examine it. The evidence has to be more than simply someone’s idea that it exists, because we all have mistaken ideas. How do you tell that your own ideas are not mistaken? Just by believing you are right? Surely not? You have to use them to make testable predictions.

    [Yet, the greatest mysteries of life, science can't even begin to explain.]
    And what exactly are these greatest mysteries of life that science can’t explain? Very often people say that when they don’t understand something themselves and assume that the subject itself is not understood. Even the origin of life is adequately explained by the chemical properties of biological molecules in the primitive world environment. There are still unanswered questions of course, but that’s not the same as saying science has nothing to say about them.

    [Mayhaps, the students of these pseudoscience's are convinced that they are qualified because they have gained experiential understandings. The type of subjective truth that science can not quantify.]
    That experiential understanding has to relate to the physical reality of human bodies if they are offering therapies and treatments. That’s where the burden of proof becomes essential. They can study any sort of ideas and theories about how the world is, how the body works, but at the point where they start to offer treatment and therapy, they need to be able to show it works. For example in the case of Reiki, they need to be able to demonstrate the existence of their energy, show its effects, and demonstrate a real consequence. Crucially, this has to be evidenced independent of the anecdotal evidence from satisfied customers. They can’t and don’t.

    [We are much more than simple matter and flesh. We are alive with spirit, spirit that is not found in the raw materials that science tells us we are made from.]
    That’s fine as a story, or even a theory if you can use it to predict something. But taking it as true without investigating it is no basis for claiming knowledge. One could equally claim that we are actually made up of invisible sticky blobby stuff which is also invisible. It’s no less credible than spirit. Where do we go to test the ideas?

    [the process which the more mature of these modalities (pseudosciences) used to validate, is identical to that of traditional science.]
    Quite simply untrue. The pseudoscience taught on CAM courses is not subjected to trial, to test, to scientific evaluation. Try to find the least bit of evidence to support homeopathy for example, or Reiki energy healing, or crystal therapy. These are taught on the basis that the student needs to believe rather than investigate. On a physics course, students are expected to criticise, to question, to experiment, to observe, to theorise and test. That approach is totally alien CAM.

    [Spirit and life energy may not be tangible to the unskilled, but everyone can, with practice, experience the same aspects and qualities, IF they apply the proven methods!]
    In other words, if you believe then you will believe. Science produces reliable knowledge precisely because it doesn’t depend on belief. It doesn’t matter what the individual scientist believes: if the science is right, the result stands regardless of the beliefs of the experimenters. Whether you believe it or not, the speed of light is constant. That result was produced using proven methods which led to testable predictions. Let’s see some testable predictions from say magnet therapy, or crystal healing, or iridology, or acupuncture. Acupuncturists can’t even agree amongst themselves as to where the meridians are supposed to be, and patients given fake acupuncture react in exactly the same way – it’s the placebo effect and it can be generated even using coloured sugar pills (just as in homeopathy).

    But that old pretence that you have to be skilled to know about the mystical just doesn’t cut it. Being spiritual is just a fancy word for a bit of introspection, a bit of contemplation, self-evaluation. You can get all the benefits of that without any of the mystical vocabulary. And you can get to higher levels of consciousness by slightly increasing your serotonin levels through relaxation. No need for mysticism, and certainly no place for it in the treatment of people with illnesses.

    The mystics who are attracted to CAM should really question the actual content of the courses, check the evidentiary basis, and be very careful before shelling out lots of money on wishful thinking.

  • http://www.leavingthelandofwoo.com Bob Lloyd

    An article explaining how the placebo effect works:
    Placebo effect

    And a more clinical evaluation of how it functions in the case of pain reduction, but with useful explanations of the methodology of testing placebo effects too:
    Article on PubMed
    You might need to register (free) for PubMed to get access but it is an invaluable source of information about the evidentiary basis of medicine.

  • http://www.whalertly.com Robert M. Barga

    These sort of classes not only undermine my and my fellow student’s degrees, but they undermine science in the entirety.

    Furthermore, they serve only to harm the trusting students. These kids want to help others; however, in reality, they are simply learning how to hide the occurance.

  • James Pannozzi

    Well, the Homeopathic medical colleges in the U.S., in their heyday 100 years ago, pretty much mirrored the curriculum of standard medical colleges, with additional Homeopathy courses added. In Arizona, the first American Homeopathic medical college is scheduled to open with a full 4 year program in 2010. From the looks of their web site, the program is comphrehensive.
    The key to evaluating CAM is to understand that, for example, Chinese medicine is typical, evolved from an inductive and synthetic basis, over the course of centuries, and over the course of the rise and fall of various schools of thought as empires rose and fell, textbooks were written commented on, lost and rediscovered, rather than deducted from laboratory science as much of our standard medicine is supposed to be.

    There is no reason why Homeopathic and other CAM colleges cannot include both rigorous western science as well as coverage of the CAM aspect. If they fail in either one, the student and the public is being shortchanged.

    As regards Homeopathy, the problem is that it is far younger than Chinese medicine, the scientific research has barely begun but has already shown anomalies in high dilution behaviours (yes, even when ALL the molecules are diluted away!) and there is active opposition and attempts to kill off the research based on the sceptics own personal opinions, 1930′s mental ball and stick models of moleculess and other completely unscientific prejudice.
    Such an attitude is completely anti-scientific – since when does the feeling that something is “impossible” have any weight at all in scientific research? And with a huge body of clinical evidence and case history, the evidence is overwhelming that at the very least some sort of curative effct, well beyond mere placebo, is operative. This needs to be investigated by REAL DOCTORS and genuine scientists, not put down by a bunch of armchair sceptics…even well educated ones, who have never been near a patient.

  • http://www.leavingthelandofwoo.com Bob Lloyd

    [The key to evaluating CAM is to understand that, for example, Chinese medicine is typical, evolved from an inductive and synthetic basis, over the course of centuries, and over the course of the rise and fall of various schools of thought as empires rose and fell, textbooks were written commented on, lost and rediscovered, rather than deducted from laboratory science as much of our standard medicine is supposed to be.]

    That’s quite wrong. The key to evaluating them is to test whether or not they work, and that means subjecting them to controlled, double-blind, randomised trials, collecting the data and analysing the evidence. When that’s done, far from showing they are effective, they are shown not to work. Where there is any effect shown, it is indistinguishable from the placebo. That’s what evaluating these approaches really means. If they worked, no-one would object.

    The fact that for thousands of years some people have believed in them is absolutely no recommendation. People used to believe in bleeding patients by cutting veins as a way of relieving fever. Beliefs can, and often are, wrong – that’s why we need to test these therapies. And they have been tested, very thoroughly, and they don’t work.

    [there is active opposition and attempts to kill off the research ]
    That too is untrue. What there has been is an insistence that anecdotal evidence is hopelessly inadequate as it is. Anecdotal evidence is nothing more than a biased account, which is why clinical researchers insist of double-blind, controlled trials. The opposition has been from CAM practitioners who keep refusing to submit their claims to the test.

    [And with a huge body of clinical evidence and case history, the evidence is overwhelming that at the very least some sort of curative effct, well beyond mere placebo, is operative.]
    Again, a repetition of something why is actually untrue. The evidence offered by CAM is a collection of anecdotal accounts – which is inadequate as evidence of medical efficacy. It is the lack of understanding of the necessary rigorous nature of testing, that leads CAM practitioners to think they have evidence when they don’t. Take away the biased anecdotal accounts and the cupboard is bare. That’s no basis on which to make claims of treatment and therapy.

    Whenever the question of CAM is raised, someone always claims that it hasn’t been investigated. But in fact, there have been very many studies and even meta-studies of the studies (so high is their number). The Cochrane Collaboration summarises these results as does Dr Edzard Ernst (a one-time CAM practitioner and professor of alternative medicine at Essex University).

    It’s a sad fact that despite exhaustive studies, these so-called therapies are without substance. Find the evidence, present it, subject it to peer review, get others to reproduce the evidence, and then… only then, will it have any credible scientific claim to be offering something beyond placebo.

    There’s no conspiracy against CAM, far from it. If we could cure illnesses by wiggling toes, GPs would flock to it. It’s cheap, easy, non-invasive, fantastic. Alas, it doesn’t work.

  • http://constantinacrystal.wordpress.com Constantina Crystal

    I have been a skeptic for many years. I believed only in what could be scientifically proven. However, when science failed me bitterly, I came to the conclusion that there must be something beyond the physical body. The spiritual aspect that is not taught by western medicine but (unfortunately) by gurus, or therapists or priests.
    You mentioned in your article that alternative or complementary therapies are based on beliefs. Well, you are wrong. They are based on EXPERIENCE that spans across several millenia. They may not be able to analyse scientifically how they work but they certainly produce results. And, let us not forget that the basis of every science is observation. Analysis and proof comes only later.

  • http://www.leavingthelandofwoo.com Bob Lloyd

    [You mentioned in your article that alternative or complementary therapies are based on beliefs. Well, you are wrong. They are based on EXPERIENCE that spans across several millenia. They may not be able to analyse scientifically how they work but they certainly produce results.]

    I understand that when medicine doesn’t provide an answer, there is a natural tendency to look for something else. The question is whether or not it works. The eastern mystical therapies argue that these have worked for thousands of years but unfortunately, there is no evidence to support that except for anecdotal accounts. These are notoriously fickle accounts because they rely on the subjective impressions of believers.

    As an example, Reiki argues that there is some universal healing energy called Qi which has in fact been detected by no-one, and not even Reiki practitioners can demonstrate any tangible effect. It is based entirely on belief. No-one can show that it even exists.

    It’s the problem of the unreliability of anecdotal accounts that makes clinical researcher demand high standards of evidence, such as the controlled double-blind trial. They have to remove that anecdotal bias before the evidence is reliable.

    The anecdotal account is infused with the placebo effect and that means that, just because lots of people believed something was true, it isn’t necessarily true – it needs independent verification to remove the bias. Clinical history is full of certain beliefs that turned out to be quite wrong.

    When these eastern mystical therapies have been tested, they fall apart. Likewise trials of Reiki, healing energy, homeopathy, acupuncture, and so on. Take away the anecdotal accounts and the cupboard is bare. No matter what people believe about their experience, we need to remove the bias and get independent verification. In the case of eastern spiritual therapies, they just don’t come through.

    You might like to have a look at this article that explains the placebo effect in a bit more detail.

  • http://www.whalertly.com Robert M. Barga

    Just wondering, but if medicine is science (it is) then why should there be a spiritual aspect?