Friday, May 06, 2005

University of Pennsylvania Allies with Tai Sophia Institute

The Philadelphia Inquirer reports that the prestigious University of Pennsylvania Medical School has announced a partnership with a local center for complementary and alternative medicine (CAM), the Tai Sophia Institute, and in parternship will begin to offer a masters degree in CAM.
The article quotes 86 year old Arnold Fishman, a pulmonologist, who has "enjoyed a long, achievement filled career in evidence-based medicine," advocating for the alliance, "my interest is: what are the new frontiers?" He further noted, "The message from consumers is quite clear." "Medicine cannot supply all that consumers feel they want."
But Robert Baratz, a skeptic about CAM, challenged this, saying the University is "attempting to capitalize on the so-called dynamics of the marketplace."
The Tai Institute's Institutional Values include
  • "Operate from a declaration of oneness, a unity with all creation."
  • "Make all judgments and decisions in the context and light of the seven (past 3, future 3, and present) generations."
The Tai Institute offers acupuncture and herbalist services. Its web-site states
  • "Individuals using traditional acupuncture treatments often find relief from concerns including headaches, chronic fatigue, depression, allergies, back pain, digestive disorders, joint pain, sleeping problems, infertility, menstrual disorders and other symptoms."
  • "Acupuncture is helpful for many concerns from headaches to joint pain. It has also been found effective for severe chronic conditions where pinpointing the cause has been difficult to determine. Those who receive ongoing treatment for maintenance and the promotion of good health have told us that they: • Tend to get sick less often and recover more quickly• Have improved stamina and vitality• Are better managers of their own health• See reductions in long-term health care costs and tend to visit physicians less often• Enjoy deepened more harmonious relationships with others "
The web-site presents no evidence to support these claims. I doubt they are well supported by data from well-designed randomized controlled trials. For a more skeptical view of acupuncture, see this page from Quackwatch.
Regarding herbal therapies, the Tai Sophia web-site states:
  • "Botanical healing, used for thousands of years, is used specifically to support the healthy structure and function of the body. It works to promote vitality, balance, and longevity. "
Again, The Institute does not present evidence that, in particular, using herbs causes people to live longer. Although I will allow that some CAM remedies may turn out to have benefits that outweigh their harms, I see no reason to believe that this is true for any particular such remedy until it has been tested in well-designed controlled studies. I can see value in medical schools teaching students about patients' use of CAM, and performing well-designed research on CAM. However, the University of Pennsylvania's alliance with an Institute that seems to be a fervent, uncritical promoter of CAM seems at odds with the the scientific basis of medicine that medical schools, of all institutions, should uphold. I hope the University will come up with a clearer explanation for what it is doing than the purely consumerist approach described in the Inquirer's article.
[Full disclosure: I did a Kaiser Fellowship in General Internal Medicine at the University of Pennsylvania, where I got training in, among other subjects, clinical epidemiology.]


james gaulte said...

I also certainly hope that an institute with the prestige of University of Penn.can offer a decent explanation for partnering with an institute whose values include "Make all judgments and decisions in the context and light of the seven generations".At first blush,it just seems ridiculous.One institution based on science and one based on word of mouth and unproven claims.

InformaticsMD said...

The debunking of "therapeutic touch" in JAMA should be remembered (hey, perhaps those of us in Medical Informatics can learn how to diagnose malfunctioing computers via a waving of the hands over the CPU!)

A close look at therapeutic touch. JAMA. 1998 Apr 1;279(13):1005-10.

Rosa L, Rosa E, Sarner L, Barrett S.

CONTEXT: Therapeutic Touch (TT) is a widely used nursing practice rooted in mysticism but alleged to have a scientific basis. Practitioners of TT claim to treat many medical conditions by using their hands to manipulate a "human energy field" perceptible above the patient's skin. OBJECTIVE: To investigate whether TT practitioners can actually perceive a "human energy field." DESIGN: Twenty-one practitioners with TT experience for from 1 to 27 years were tested under blinded conditions to determine whether they could correctly identify which of their hands was closest to the investigator's hand. Placement of the investigator's hand was determined by flipping a coin. Fourteen practitioners were tested 10 times each, and 7 practitioners were tested 20 times each. MAIN OUTCOME MEASURE: Practitioners of TT were asked to state whether the investigator's unseen hand hovered above their right hand or their left hand. To show the validity of TT theory, the practitioners should have been able to locate the investigator's hand 100% of the time. A score of 50% would be expected through chance alone. RESULTS: Practitioners of TT identified the correct hand in only 123 (44%) of 280 trials, which is close to what would be expected for random chance. There was no significant correlation between the practitioner's score and length of experience (r=0.23). The statistical power of this experiment was sufficient to conclude that if TT practitioners could reliably detect a human energy field, the study would have demonstrated this. CONCLUSIONS: Twenty-one experienced TT practitioners were unable to detect the investigator's "energy field." Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.

Tim Gorski MD said...

We could easily max out the available storage here for why CAM doesn't fit with the mission of a medical school. But just look at the justification that's being given: "The message from consumers is quite clear." "Medicine cannot supply all that consumers feel they want."

Since when is it medicine's mission to "supply all that consumers feel they want?" Patients want all sorts of things that it is not the place of the physician to supply. Patients may want spiritual/theological counseling, for example. They may want financial advice or "downline distributors" in their MLM ventures. They may even want sex (the prevalence of doctor-patient sex despite the taboo is not a simple measure of the proportion of rapists among doctors).

Ultimately, the drive to "integrate" "CAM" is really a drive to **medicalize** aspects of the human condition in which medical science and physicians have no special expertise and therefore no legitimate right to meddle in. Pyschiatry and sociology have fallen down on the job (or are not being listened to) when it comes to the reasons for the "demand" for "CAM," which may be related to forces that foster and maintain increasing distance and alienation between people and their communities. These forces include the onslaught of fraudulent marketing unleashed by the 1993 DSHEA law.

Anonymous said...

I am sure that the University is responding to the growing number of patients who want to be treated as a whole person, not just an accumulation of anatomical parts. It is refreshing to see a University offering medical students the opportunity to learn both the art and science of healing. Obviously, integrated health care is not something everyone supports; but thousands of individuals are disappointed by allopathic medicine and/or traditional medical providers. This transition to an integrated approach of traditional western medicine and holistic complimentary or alternative therapies is long overdue! Bravo, University of Pennsylvania!!