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Unwelcome complements

Scientists say degree courses in complementary therapies and alternative medicine are 'baloney' and 'mumbo-jumbo'. CAM academics disagree passionately. Zoe Corbyn checks out the fray

It is the start of term and the teaching clinic for complementary therapies at the University of Westminster in central London is gearing up for another busy year.

The so-called "polyclinic" offers inexpensive treatments in 11 therapies to the public. For £20 a session you can choose from a menu ranging from homoeopathy to acupuncture to craniosacral therapy.

It will soon be humming with life as students of all years begin observing or administering the therapies under the tuition of the 70 or so practising academic staff and tutors.

The clinical experience - students must clock up 500 hours - is a major component of all the BSc honours degrees in complementary and alternative medicine (CAM) offered by the university. Westminster offers the largest number of science degrees among the 40 BSc and BSc (honours) in complementary medicine available at 14 UK universities.

Some other universities also have teaching clinics, but the size of Westminster's ten-room facility, currently in its tenth year of operation, is truly impressive.

It is overseen by David Peters, clinical director of the School of Integrated Health, which runs the degrees out of its department of complementary therapies. The courses are flourishing, he says, despite recent controversy about CAM, which included a staff rebellion at the University of Central Lancashire over plans to introduce new science degrees in acupuncture and Chinese herbal medicine.

Books published this year aimed at exposing "bogus" therapies have also received wide publicity. They include Trick or Treatment? Alternative Medicine on Trial co-written by Edzard Ernst, who holds the Laing Chair in Complementary Medicine at the Peninsula Medical School at the University of Exeter, and who describes himself as an "evaluator" of CAM. Ben Goldacre, national newspaper columnist and author of the recently published book Bad Science, who also runs a website of the same name, has addressed the issue in similarly negative terms. But the critics do not seem to put students off.

Student numbers
YearStudents studying CAMStudents studying chemistry
2002-032,98519,015
2003-044,00018,525
2004-055,68518,520
2005-066,80518,375
2006-076,76519,585
Source: Higher Education Statistics Agency

"We thought with all the publicity we would not do so well, but it has been a very good year. We are over target with 180 first-year students, and we have the second-highest employability rate in the university," Peters says.

Meanwhile, less than a mile down the road - but a world away from CAM - is an academic unlikely to pay a visit to the polyclinic. David Colquhoun, professor of pharmacology at University College London, is among those at the forefront of a growing campaign of opposition to what critics call "pseudo-science degrees" on the grounds that the vast majority are not based on empirical evidence.

Colquhoun calls it "quite incredible" that the subjects are being taught in universities, and the labels of BSc and MSc for such degrees are, he says, "particularly offensive".

With the focus on training CAM practitioners rather than producing critical thinkers, students are also being taught "gobbledegook" mechanisms to explain their therapies that have "no plausible scientific basis", he says. Colquhoun campaigns, he says, because he believes it is "worth it" to defend what universities should be doing, and adds that many scientists share his view.

"No respectable university should provide a course that preaches the mumbo-jumbo of meridians, energy flows and Qi (the principles on which acupuncture is based) as though they were science," he argues.

Colquhoun is shortly expecting a ruling from the Information Commissioner on whether he can have access to teaching materials used by one institution. If he is successful, they will doubtless appear on the blog he runs, which aims both to expose the degrees to public ridicule and enlighten vice-chancellors, who he believes are so busy seeing the courses as cash cows that they are not aware of the content of the degrees being taught at their institutions.

Colquhoun suggests that the rise of the therapies and the courses is a wider problem for society in general: the "denial of rationality" and "betrayal" of 18th-century Enlightenment values. It is a controversial argument articulated in a number of books and is based on the belief that society is witnessing a retreat from the rationalist legacy bequeathed by the Enlightenment.

Whether or not this is true, it is certainly the case that since the 1980s CAM - the collection of therapies emphasising a holistic approach to healthcare that are not presently considered part of conventional diagnosis and treatment - has been growing in popularity.

Cam course student acceptance
YearNumber
2002-03353
2003-04384
2004-05487
2005-06612
2006-07846
2007-08960
Source: Universities and Colleges Admissions Service
It is estimated that 20 per cent of people in the UK access CAM regularly, spending about £1.6 billion annually. As use has grown, so too have student numbers, more than doubling over the past five years. In 2006-07 about 7,000 students were enrolled on CAM courses at university level. In the past academic year, 960 students accepted places on CAM degree courses through the UK Universities and Colleges Admissions Service.


Around the time his book was launched, Ernst gave a demonstration on homoeopathic medicine to the media during which he showed how a homoeopathic remedy for insomnia was made. Following the homoeopathic principle of "like cures like" and "small doses", he pipetted a drop of coffee into water and diluted it again and again. His point: that "the plausibility of homoeopathy is zero".

Ernst says the debate is characterised by beliefs held with an almost religious conviction, with "believers" in both alternative and anti-alternative medicine camps. He stresses that although he is seen by CAM supporters as the latter, he is neither, and wants only to talk facts.

He does not object to vocational training in the subjects to ensure that patients come to no harm, but his view is that the degrees have no place in universities. "(Their) basis is not academic, the mode of action is almost certainly wrong ... (and) if there is the evidence I think it belongs in medicine," he explains.

It is understandable, given the adverse publicity, that academics delivering the subjects feel under siege, although vitriolic and personal attacks, along with speculation about financial motives, come from both sides in the wider debate on CAM.

Peters, along with Brian Isbell, head of Westminster's department of complementary therapies, explains that they have spent the past 25 and 15 years, respectively, building up their school.

The recent history of CAM in universities begins in the mid-1980s, with a centre at the University of Exeter. This, however, folded in the early 1990s, with Westminster taking up the mantle in 1993 and others following suit.

Peters does not see complementary medicine - at least in the context Westminster is looking at it - as part of the "great tsunami of irrationalism about to sweep the world".

"There is bound to be a bit of a turning point (after years of positive publicity), but I think we have felt very unfairly criticised. It is a bit of nerve that those who have never touched a patient in their life think they can comment on what clinical practice is and isn't OK."

Tim Duerden, co-programme leader of complementary medicine and health sciences at the University of Salford, is another CAM academic who feels that the debate is steeped in double standards. He questions why CAM degrees are being attacked when science degrees are also available in sociology, psychology and economics. "If CAM is not appropriate for a BSc then so many other areas aren't appropriate," he points out.

Duerden sees the situation as "very much a rehearsal" of arguments those subjects went through decades ago before it was concluded that a BSc could be about phenomena that were "socially or psychologically measurable" rather than just "physically measurable".

The point, say the CAM academics, is that they are producing quality practitioners conversant in both conventional and alternative models of healthcare at a time when health services - inundated with people with chronic conditions - need it most, and more people than ever are accessing CAM. Courses, they say, aim to ensure a high quality of care in the National Health Service and by private practitioners. How can you improve scientific research into CAM if therapists aren't being educated?

Compared with a purely vocational education, universities offering courses in CAM produce graduates that are "research-aware" and "research-minded", they argue. Strikingly, most of the courses are taught at post-1992 universities, which have traditionally been less research-focused.

The arguments for teaching CAM resonate with Michael Pittilo, vice-chancellor of The Robert Gordon University and a trustee of The Prince's Foundation for Integrated Health.

Pittilo argues that the "significant body of knowledge" that surrounds CAM makes it appropriate for study at degree level. "It could be argued that some of that is mythical, that the body of knowledge is wrong in its relationship to science but ... that does not mean it is not worthy of study."

He believes that the amount of science on offer in the degrees should determine their label. "If there is a significant amount of science - 60 per cent of CAM is hard science - then I have no problems. I cannot see why that and more traditional systems could not be taught side by side."

Pittilo believes that the anti-CAM campaign is preventing the development of valuable programmes. As chair of a Department of Health steering group on statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems, he called for an honours bachelors degree to be the threshold entry for inclusion on the register of therapists.

The Government had indicated earlier that it wanted to regulate the fields to make them safer, as it does for osteopathy and chiropractic. Science degrees would thereby be at the heart of the professions.

To see CAM acquire a veneer of respectability by means of state endorsement is a sensitive issue for those who oppose the degrees. The controversy seems set to ignite again with the Government announcement that it is reconsidering whether or not to press ahead with statutory regulation.

Ultimately, however, the debate comes down to whether CAM works. And here the believers and non-believers seem irreconcilably divided (see below).

Peters and Isbell say that there are "clinical phenomena" that seem to be "useful in real practice", even if effects do not show up in conventional scientific trials. "Something is certainly going on, and we think universities are the place to find out (what)," Peters says.

He agrees that if, indeed, CAM turned out to be "pure placebo - and there is a debate about what placebo is" - the subjects would not be fit to be taught as science degrees.

In their favour, the courses do seem to contain a large amount of science. For example, in addition to their training as practitioners, students on Westminster's three-year BSc honours courses undertake a minimum of five health science subjects, including anatomy and physiology, as well as a research project.

Duerden says Salford's courses also contain a large science component. He argues that the "very variable" evidence base for CAM makes it ideal to really test students' critical thinking. He adds that sociology and the philosophy of science are also included, which means that students are more able to function as "critical advocates" of the scientific model.

But, critics argue, it is when the courses start to stray into the teaching of practice that the "mumbo-jumbo" sets in. Science and the practice of the therapies collide.

"You cannot have degrees in things unless you have some evidence that they work. The evidence has to come before degrees, not afterwards," Colquhoun says.

Colquhoun points to teaching material he has obtained to make his case against CAM being on the curriculum. The PowerPoint slides for a University of Westminster lecture on "energy/vibrational medicine" set out how to diagnose using "energy testing", a "pendulum or dowsing rod" and even "intuition".

Slides used in a homoeopathy lecture also at Westminster, obtained by Times Higher Education, cover the subject of "spider remedies", where extracts derived from different types of spider appear to be used to treat different temperaments and conditions.

Isbell says it is "invalid" to sample one lecture from a course and draw conclusions. He says that several homoeopathic remedies are derived from spiders and may be prescribed for patients displaying a range of different symptoms. But, as with all CAM taught at Westminster, training is also given so that practitioners recognise symptoms they cannot treat and can refer a patient to a doctor.

Of the "energy/vibrational medicine" presentation, he says that the content is designed to "introduce" the students to some of the models that come up in CAM. "It would be an injustice to our students if they graduated and didn't know the vocabulary that could be used by a patient."

Duerden describes the explanations of CAM modes of action using energy flows as "metaphorical". Peters believes that practitioners do feel something "which sometimes feels tingly and energetic" but that it would be "absolutely wrong" to teach that this was "concrete reality". "Qi and healing energy are a way of short-handing certain kinds of experience," he says.

So how do students reconcile the conflicting models they are taught? Lisa Sherman is a graduate of Westminster's BSc in acupuncture. Completing her studies in 2006, she now has a CAM practice in Islington, north London, with two other graduates from her year; she also works at Hammersmith Hospital. She has a degree in molecular biology from King's College London.

She says sometimes her work is about integrating the different models of conventional and complementary medicine and at others it is about holding paradoxical beliefs. She likens it to the behaviour of light that, according to physics, can act as both waves and particles. "One works better sometimes and the other works better at other times," she says, arguing that both are "internally logical" and can be used to diagnose and successfully treat illness.

But concerns persist about the content of courses, even from those inside the CAM discipline. One lecturer, speaking on condition of anonymity, says he has seen practices such as the "tasting" of herbal medicine to determine whether it can treat illness, the use of pendulums to diagnose symptoms and even students being encouraged to treat cancer by using CAMs - despite it being illegal to claim CAM can treat cancer under the terms of the Cancer Act 1939.

He explains that the basic problem is that although students may be taught a core of medical science in the early years, it is then separated from the teaching of the CAM therapies and clinical work by a "massive damp-proof course".

"Once it has been studied and passed it is effectively dropped. There is almost nothing scientific in the teaching beyond the core modules. Lecturers in the complementary therapies rarely refer back to them and, students say, actively block discussion.

"And you can see why. It puts the mumbo-jumbo into total contradiction ... They get into clinic and they can do whatever they like. Diagnosing and treating are often based on pure fancy."

He says many students, like their practising lecturers, are also quick to shrug off their science. "It is the easiest thing to do when the subject is not only hard intellectual work but also challenges your own prejudices.

"Most students come into the courses thinking they are 'healers' and want to get into the clinic ... This is romantic medicine for people who don't want to do the hard work of learning how to think critically."

So why, then, do the courses persist? Colquhoun believes there is almost certainly a "bums-on-seats" financial interest, which is undoubtedly a factor, although it also seems to be driven by those keen to develop the specialism.

He is also critical of the "utterly vacuous" validation processes courses go through. The quality of all UK university courses is regulated by the Quality Assurance Agency, but it does not judge content, he explains. Rather, universities' committees of experts who "believe the same baloney" approve them. He agrees that the QAA should not dictate what is taught, but the "badges of respectability" it gives make a mockery of the situation.

Others, including Pittilo, disagree. He says: "Provided that there is a proper system of bringing in vigorous peer review - and that should not just include people from the discipline - then I think (the system) works very well."

As to the way forward, perhaps there is some middle ground. Although Ernst believes homoeopathy has had its day, he advocates more research into CAM to identify worthwhile interventions. The problem, he says, is that CAM research is not a priority for major funders.

A professor of nursing at the University of Sheffield could perhaps have an answer. Roger Watson describes how his views on CAM have "changed over the years". At one time, he considered all CAM to be "nonsense", but now sees a "growing body of evidence for a very few, selected, therapies".

He does not think that there should be stand-alone degrees in CAM, but he supports a general science degree in complementary therapies that would take in acupuncture but cast out homoeopathy.

Meanwhile, back at Westminster, Peters is contemplating the future. The new vice-chancellor has announced that the School of Integrated Health is to merge with the School of Biosciences as part of a streamlining plan.

Rumour has it that there has been a near-riot among Biosciences School staff, who want no association with the "unscientific" subjects. Peters admits it will be a challenging time. "It is going to mean we get into closer conversations than maybe we have had so far," he says.

Course providers
The 14 UK universities that offer BSc or BSc (honours) degrees in CAM
UniversityNo of BSc/BSc honours degreesSubjects
Anglia Ruskin2Complementary medicine (aromatherapy); complementary medicine (reflexology)
University of Wales Institute, Cardiff1Complementary therapies
Central Lancashire4Acupuncture; complementary medicine; herbal medicine; homoeopathic medicine
East London2Complementary therapy; complementary therapy (extended)
Greenwich2Complementary therapies; health sciences for complementary therapies
Leeds Metropolitan1Complementary therapies
Lincoln2Acupuncture; herbal medicine
Middlesex 4Complementary health sciences; complementary health sciences (Ayurveda); herbal medicine; traditional Chinese medicine
Napier University, Edinburgh3 (see notes)Complementary healthcare (aromatherapy); complementary healthcare (reflexology); herbal medicine
Glyndwr2Chinese medicine; complementary medicine practice
Salford4Complementary medicine and health sciences; complementary therapy in practice (top up); counselling and complementary medicine; traditional Chinese medicine (acupuncture)
Thames Valley 1Complementary medicine in healthcare
Westminster11Chinese medicine: acupuncture (with foundation degree); health sciences (either with or without a foundation degree) in complementary therapies, herbal medicine, homoeopathy, naturopathy and nutritional therapy
Wolverhampton1Complementary therapies
TOTAL40 
Source: Ucas list of 63 courses for “complementary medicine” including 40 BSc or BSc (honours) degrees offered by 14 universities
All degrees are BSc (honours) except in the case of Napier University, which offers all degrees at ordinary level and only herbal medicine at honours level.
The University of Derby offers a BA (honours) in complementary therapies.
Many universities also offer foundation degrees in complementary therapies, which are not listed in this table.

CAN CAM CONVINCE THE SCEPTICS? LEADING THERAPIES AND THEIR KNOWN EFFICACY

Aromatherapy: Plant essences used for therapeutic purposes, usually with massage. May improve quality of life for cancer patients and is likely to have a positive effect on anxiety and back pain, but no compelling evidence for use on any other medical complaint.

Acupuncture: Insertion of needles into the skin at special sites, known as points, for therapeutic or preventative purposes. Beneficial for nausea and vomiting, neck pain and osteoarthritis of the knee.

Herbal medicine: Medicinal use of preparations made from mixtures of plant material. Different from phytomedicine practised in many European countries, which is integrated into conventional medicine and where a doctor or pharmacist prescribes a single herb known to be effective for a particular condition. A number of herbal extracts are thought to be effective for various conditions, although traditional herbalists' practice of using individualised mixtures is not supported by good evidence. The risk-benefit balance has to be assessed individually for each herbal preparation, and many are untested.

Homoeopathy: Therapeutic method using highly diluted preparations of substances. Its two main axioms are the "like cures like" principle - a remedy that causes a certain symptom in healthy people can be used to treat such symptoms in patients - and the notion that, by serial dilution, a remedy does not get less but more effective. The evidence of effectiveness is encouraging for chronic fatigue syndrome only. For all other conditions, it is either ineffective, unlikely to be beneficial or has unknown effectiveness.

Reflexology: Treatment employing manual pressure to specific areas of the body, usually feet, which are thought to correspond to internal organs. The effectiveness remains unproven for any indication.

Traditional Chinese medicine: Based on complex philosophical theories, where disease is regarded as a result of blockage of vital energy. It is an umbrella term for approaches developed in ancient China, including acupuncture and Chinese herbal medicine. As a whole system, TCM has not been adequately tested for efficacy and may involve serious risks.

Source: Oxford Handbook of Complementary Medicine by Edzard Ernst and others, 2008

ON THE EVIDENCE: CAM DEFENDERS FIGHT BACK

Critics of complementary and alternative medicine (CAM) argue that based on randomised controlled trials (RCTs) - the gold standard of evidence-based conventional medicine - much CAM simply does not work for almost all the conditions it claims to treat.

Defenders of the degrees fight back. Firstly, they say that some CAM does show positive effects, over and above placebo effects, and the criteria for meta-analyses (when results of several RCTs are combined) can be biased.

But they also argue that it is utterly inappropriate to use the "lens" of conventional medicine to test CAM because it does not capture the way the therapy is practised.

Homoeopathic remedies, for example, are prescribed on an individual basis so conventional clinical trials cannot test them. Added to this are arguments that science is only one way of looking at the world and that the conventional model still has much to learn.

Those defending CAM also claim that the mechanisms ascribed to particular therapies have scientifically observable effects. Traditional acupuncture points have lower skin resistance, auras can be related to electromagnetic fields around the body and homoeopathy can be explained in terms of the "memory" of water, they say.

Scientists argue that there is no evidence for these claims, and that RCTs can easily be designed to take account of CAM's idiosyncrasies.

Readers' comments (61)

  • Zoë Corbyn is to be complimented for producing an article that really does try to examine both sides of the Complementary and Alternative Medicines (CAM) debate, although it is interesting to note that, as the article progresses, the emphasis on the furore caused by the fact that 14 UK universities have degrees in CAM appears to drop, resulting in the focus being almost entirely on the merits and demerits of each kind of therapy without paying too much attention to where these therapies are being practised.

    Given that this is essentially a journalistic article rather than an academic treatise, it is, however, noticeable that Corbyn does not pay too much attention to analysis of the debate, rather she is content to include opinions from both sides of the debate without making any real effort to give the readers her own judgement on the matter. Consequently, it could be argued that the article remains somewhat inconclusive, notwithstanding the fact that the degree programmes in CAM are apparently not in danger of dying out, even if, as Corbyn points out, the “real” medical science part appears to have little or no importance whatsoever attached to it after a certain point in the programme.

    I must admit, though, to being surprised as to the claim that “500” hours of CAM “experience” are required of would-be graduates from the Westminster programme. That would amount to an average of 167 hours (the equivalent of practically a whole week non-stop) per year of being in clinics and “either observing or administering” the therapies. However, one must wonder at exactly how much of “the clinical experience”, as Corbyn puts it, involves actual practical application of the therapies after observation of qualified practitioners. Corbyn does not make it clear as to how much practical experience these would-be practitioners get.

    Colquhoun is cited as saying that the accolade (if such a word can be used) of the illustrious titles of BSc and MSc to degrees in CAM is “particularly offensive”, presumably because of his views regarding the glaring lack of empirical evidence in CAM, something which presumably flies in the metaphorical face of those descendants of the Enlightenment who allegedly do not rely on “intuition” to come up with something supposedly convincing. However, if scientists care to cast their minds back (and not necessarily to the era of antiquity), a lot of what is accepted as science now was undoubtedly based on so-called “intuition” and speculation. One could even take quantum mechanics as a 20th century example. How well received was Einstein’s idea that gravity from a large body could actually bend (i.e., refract) light? The chances are that this former patents bureau clerk was derided by many scientists until Eddington’s expedition in 1919 proved the theory correct. Physics and CAM are not the same as each other, of course, yet both subjects do contain a degree of uncertainty (as Heisenberg pointed out with some clarity).

    Based on what it says in Corbyn’s article (and I have read no other material on this), it would appear that the argument is less to do with what title should be accorded to a university-level qualification in CAM but more to do with whether one should only study something intellectual if it “works”, since Western Modern Science (WMS) is based on the premise of (almost) anything being ultimately subject to scrutiny and being “proven”. Codification of theory is one of the bedrocks on which WMS is based, yet that should not be any excuse to denigrate the lack of codification in anything concerning what might oppositely be called “non-WMS” as being equated with a lack of “hard” knowledge.

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  • ADDITIONAL COMMENT

    As part of my (second) master’s degree in education, I studied a course called “Contemporary issues in science learning”. Part of that course was on inclusive education, and it partly dealt with “science” in a non-WMS sense. It is fair to say that much of modern Western pharmacology is based on a history of preparations for medicines by tribal elders in native peoples such as the First Nations in Canada, where CAM is still practised. The fact that, in almost all instances, these medicines have been known to work, irrespective of the lack of codification of the kind that is required (nay, demanded) by WMS, is no reason to devalue CAM as such, notwithstanding the fact that the idea of getting a degree in it is a thorn in the metaphorical side of certain academics.

    After all, many moons ago, the idea of getting a degree in a “trendy” subject (or so it seemed at the time) like media studies was also heavily derided and dismissed as an attempt to dilute the concept of a university degree as encompassing the teaching and application of thinking and analytical skills. While Corbyn does points out that the “post-1992” universities are primarily involved in offering degree programmes in CAM, it does not mean that the focus for research in CAM might be any less than that for physics or chemistry or biology or related conventional sciences. “The evidence has to come before degrees, not afterwards,” Colquhoun is alleged to have said on this matter, but, in my opinion, “evidence” is such a subjective word! “Evidence” appears to be acceptable only to those who have an idea (and probably a prejudiced one at that) as to what it is supposed to be, and anything that conflicts with their ideas may be subject to summary rejection. Does one have to see air physically in order to know it is there? Does one have to see God physically in order to know He is (possibly) there?

    From the readings I did during that aforementioned course, it appears that WMS adherents have become somewhat too set in their ways. Physicists accepted the idea that matter was made out of particles long before the technology existed for them to be detected. J. J. Thomson’s “plum-pudding” model of the atom from 1897 is now known to be way off the mark, yet it was a start since it was based on known physical phenomena, notwithstanding the fact that it took the likes of Bohr, Einstein, Dirac, Fermi, Feynman and Heisenberg to go ever deeper into the structure and behaviour of particles. Indeed, the wave-particle duality of light is pointed out in this article by CAM graduate Lisa Sherman. “One works better sometimes and the other works better at other times,” Corbyn cites her as saying. It would have been of interest had Corbyn or some commentator made reference to the possible existence of the “duality” of therapies!

    However, the main debate is whether CAM ought (not) to be accepted as a university subject on equal terms with the traditional (Western) sciences and medicine. Acceptance of anything considered to be alien has always been problematic, with the traditional purists clamouring for its instant rejection along with its advocates and with the champions clamouring for recognition.

    Considering that acupuncture has been around for centuries, it seems strange that it appears to be somewhat challenging to convey to sceptics the idea that one can reasonably employ analytical skills to it as well as other allied CAM disciplines and practices. Psychology is an accepted discipline now yet it was only in the last century that studying “the mind” in an analytical way paved the way for such acceptance, even if it is physically impossible to “get inside” the mind. The explanations for how it works come through in terms of human behaviour.

    The same could be said for CAM. Explaining how CAM works exactly, notwithstanding the idea that, for some, it might be nothing more than a placebo, could be as much of an intellectual challenge as psychology in terms of the challenges involved in providing an explanation for physical (and even mental) healing. That does not mean that there is no explanation at all or no reason for why CAM works (or does not work). Finding them is an intellectual challenge in itself, and such challenges are what universities are supposed to be about.

    CHRISTOPHER CROSSLEY is a Lecturer in English for Academic Purposes at a private education training centre in Wuhan City in the People’s Republic of China

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  • The CAM advocates arguments do seem very close to those employed by the religious: CAM and the real world are two non-overlapping magesteria, and you have to have faith if you want to be blessed by the healing power of CAM.

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  • BSc though? If they were graduating with a BWoo that would be more appropriate.

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  • I think Christopher Crossley has confused the study of CAM as a form of anthropology, which is probably a legitimate field of endeavour, with study of the peculiar rules of individual therapies based on a false assumption that they have specific therapeutic power beyond a placebo effect. The whole problem is that the junk science BSc degrees about which David Colquhoun complains are taught by believers to believers with not a shred of the analytical skill that Christopher Crossley implies should be applied.

    Of course CAM therapies can be analysed. Most have been. Most are useless, or at least only have the same therapeutic power as a cup of tea and a chat.

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  • "Ultimately, however, the debate comes down to whether CAM works. And here the believers and non-believers seem irreconcilably divided"

    Whether CAM works is not an issue of belief. It can (despite protestations of CAM advocates) be robustly tested in controlled trials and whern this happens it falls short. It should fall short. The basis of CAM is almost universally absurdist. CAM advocates would be more than happy with the trial paradigm if it offered support but since it doesn't they feel it is inappropriate.

    CAM itself is an issue of belief. As such it cannot be considered a science. Occasionally giving nods to biomedical science (often woefully misinterpreting it to fit the therapy fad of the day) is not science. It is pseudoscience. In CAM there is no systematic and logical basis to the underpinning rationale. Thus nothing is right or wrong and there can be no quality control. Pity the patients at the end of such a chaotic therapeutic philosophy.

    And be careful how you present the evidence. For example acupuncture is "beneficial for nausea and vomiting, neck pain and osteoarthritis of the knee." When reviewers accounted for methodological weaknesses of trials and interpretive limitations a recent major review concluded that no robust evidence could be found that acupuncture is effective for any indication (Derry et al.2006).

    Not all knowledge is created equal. Not all belief systems qualify as knowledge.

    I'm off to enrol in a BSc(Hons) in flower fairies and nasty goblins.

    Reference: Derry, C.J., Derry, S., McQuay, H.J., & Moore, R.A. (2006). Systematic review of systematic reviews of acupuncture published 1996-2005. Clinical Medicine, Journal of the Royal College of Physicians of London, 6(4), 381-386.


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  • Teaching CAM as science is like teaching that the Moon landings were faked in a history degree.

    Yes, lots of people believe it. But there is no evidence that it's true and overwhelming evidence that it's not.

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  • '....'it is utterly inappropriate to use the "lens" of conventional medicine to test CAM because it does not capture the way the therapy is practised'.

    Presumably it is the scientific 'lens' of conventional medicine to which proponents of CAM allude. How then can it ever be approriate in their terms, never mind on a scientific level, to have BScs and MScs in their 'therapies'?

    University degrees, whether in science or arts subjects, should surely be designed to teach critical thinking and equip students to argue coherently and logically, looking at the facts and learning from mistakes. Anything less debases the institution in question. The appearance of degrees in these alternative realities are alarming not least in their lack of rigour,because even when there are science modules included, these do seem to be balanced - or would negated be an appropriate word - by ideas such as the memory of water or of an elusive thing called vitalism.

    Scientists are generally good at recognising that they do not have all the answers and that new facts often emerge: this is one of the things that make it exciting and stimulating. Preachers of CAM do not seem generally to have developed such self-criticism and reflection.

    Let's have CAM practitioners who are properly trained, who examine the facts and recognise the palliative nature of their placebos, who do not claim success when the person was not really ill in the first place or who had symptoms which always clear up on their own, who do not pretend their therapies are better than, say, immunisation and who are really integrated in the real world, not their own parallel one. But above all, don't call it science. Because it just isn't.

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  • So, where are all the “critically thinking”, “research-minded” graduates from 40 CAM degrees offered by UK universities? For 15 years I have been looking for them mostly in vain. What I do see, however, are CAM practitioners, students and graduates who have little interest in science and even less understanding of it. Many even seem to be systematically led to develop a deep-rooted anti-scientific attitude. And their knowledge about anatomy physiology? Forget it! Critical thinking is usually a totally foreign concept to them. The trouble is I cannot even blame them – after all, their university tutors are often utterly devoid of this quality themselves.

    In order to teach any subject at an academic level, one needs firstly a more or less straight forward body of knowledge and secondly tutors who are capable of critically evaluating it. In CAM, we often have neither.

    Imagine a BSc course in complementary medicine where, on Monday, students are told that ill health is due to an imbalance of yin and yang (acupuncture), on Tuesday that it depends on the flow of the “innate” through the spine (chiropractic), on Wednesday that is governed by the self-healing forces of the body (naturopathy), on Thursday that it must be healed with ultra molecular dilutions according to the like cures like principle (homeopathy) and on Friday that it can detected through finding impurities on the iris (Iridology). Considering this monumental confusion, the graduates are perhaps not that bad after all.

    One of the most obvious signs for a lamentable lack of critical thinking must be the terminology employed by proponents. When I came to Exeter 15 years ago, I (thankfully only briefly) became the director of 'The Centre for Complementary Health Studies'. When I asked what “complementary health” is and how it differs from any other form of health, I only saw blank faces. A little later ‘The Prince’s Foundation for Integrated Health’ was created. Whenever I inquire whether “integrated health” supposes that health can also be unintegrated or non-integrated, people give me a pitiful smile. Long gone seems the notion that health can only be good or poor or sometimes in between. It is surprising how often one can recognise pseudo-science and pseudo-education merely by their pseudo-language.

    Peters and Isabell may be right when they state that “something is certainly going on, and we think universities are the place to find out”. In plain language, that means conducting research. If we follow this path, one day, we might have “found out” - then and only then, I suggest, we can teach it to students.

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  • Universities have been teaching and awarding degrees in Theology for a lot longer than Science so it's hardly as though belief-based higher education is a new thing.

    Perhaps shifting CAM courses away from Science and placing them closer to the Theology and Philosophy courses might be the best way out.

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