Time heals. Those alternative therapies that the medical establishment for so many years dismissed as unscientific and of little or no value to the well-being of patients are being discussed at some of the most prestigious medical schools in the nation. Courses on alternative practices are on the rise at medical schools, and some of the schools now require their students to have some knowledge of alternative therapies before they graduate.
Those are just some of the conclusions reached from a study on the nation's medical schools. The report, "Courses Involving Complementary and Alternative Medicine at U.S. Medical Schools," appeared in the September 2nd issue of the Journal of the American Medical Association.1
The study's lead author was Miriam Wetzel, PhD, of the Center for Alternative Medicine Research at Boston's Beth Israel Deaconess Medical Center and Harvard Medical School. "This is a very good trend, because ultimately I'm hoping that (alternative medicine) will not be a fringe area of medicine," said Dr. Wetzel. "It really needs to be integrated throughout medicine."2
Co-authors of the report included Drs. Ted Kaptchuk and David Eisenberg. Dr. Eisenberg, it should be noted, authored a landmark study3 on the use of "unconventional medicine in the United States" in 1993 which determined that nearly one out of every three Americans used some form of alternative therapy, such as chiropractic, acupuncture, homeopathy.
Survey Methods and Results
Dr. Wetzel and her colleagues implemented a mail-in survey in January of 1997, contacted each of the nation's 125 medical schools in an effort to document the prevalence and diversity of medical school education with regards to complementary and alternative medicine. The researchers defined complementary and alternative medicine as "treatment modalities not traditionally taught in Western medical schools."
In September 1997, a second letter was sent to the schools that had not responded to the initial January letter. In all, Wetzel and her colleagues received responses from 117 schools. The results of the survey showed just how much of an impact alternative forms of treatment are beginning to have on otherwise "traditional" forms of patient care.
Among the highlights of the study:
- 117 of the 75 schools reported offering "one or more courses in complementary and alternative medicine, or including these topics in required courses." Among the most popular courses offered are those that informed students about chiropractic, acupuncture, massage, therapeutic touch, homeopathy, nutrition and mind-body techniques.
- 123 courses in alternative and complementary therapies are offered by the schools. The majority of courses offered (68%) are stand-alone elective courses, but 31% of the courses reported are required courses.
- The number of medical schools covering alternative therapies as part of a required course "increased to 63 (from 46 in 1996-97); medical schools offering a separate elective course increased to 54 (from 47 in 1996-97)."
"That's an extraordinary rise for a very traditional and conservative area," said Dr. Wetzel. "Now, these things are being taught in Western medical schools, not necessarily the techniques of how to do them, but certainly about them."
- Only 29 medical schools provided curriculum materials describing the alternative medicine courses they offer, but of those that supply such materials, "most include acupuncture, chiropractic, massage, therapeutic touch, homeopathy, nutrition, herbal medicine and mind-body techniques." Several courses also offered a spiritual or faith-based perspective, and some courses were taught by faculty with a background in Asian or Native American folklore.
- The amount of time scheduled for elective courses differs greatly at the various medical schools, ranging from as little as nine contact hours to as much as 160. Nine schools reported courses of more than 100 contact hours.
Table I: Number of complementary and alternative courses offered at the nation's 125 medical schools.
| Number of Courses Reported | |
| Complementary and alternative medicine topics as stand-alone courses: | 84 |
| Complementary and alternative medicine topics as part of required courses: | 38 |
| Complementary and alternative medicine topics as part of elective courses: | 1 |
| Total: | 123 |
[Table II: Complementary and alternative therapy courses as assigned by department affiliation.]
| Predominant Departmental Affiliations | |
| Family practice/community medicine: | 38 |
| Medicine/internal medicine: | 14 |
| Psychiatry: | 4 |
| Office of medical education/dean's office: | 11 |
| Affiliated institutes or centers: | 9 |
| Humanities/medical humanities: | 5 |
| Interdepartmental/integrated: | 5 |
| Other: | 21 |
| No departmental affiliation: | 16 |
| Total: | 123 |
[Table III: Academic credit for complementary and alternative courses.]
| Yes -- 97 (79.7%) |
| No -- 8 (6.5%) |
| Not reported -- 18 (13.8 |
"Many of these practices have been around for thousands of years and would not have endured if they weren't of some benefit," said Dr. Wetzel. "Doctors need to know what they can reliably recommend, what might do harm, and what's simply ineffective among alternative therapies."4
Differing Opinions
Of course, some in the medical profession remain skeptical about the benefits that alternative therapies can offer. Well-known critic Dr. Wallace Sampson, who has taught a class debunking alternative medicine at Stanford since the 1970s, described many of the courses on alternative medicine as "indoctrination" and "politically correct propaganda."5
In their report, Dr. Wetzel and her colleagues note that it will be up to those who teach the future doctors of America to "respond to this relentless challenge to evolve."
Some educators, such as Dr. Sampson, simply refuse to evolve, but clearly the medical teaching institutions now have a more open mind about alternative care. As third-year medical student Raja Abusharr said, "I don't buy everything that is labeled as alternative medicine. It can be really dangerous for a lot of people. But the same thing is true for conventional medicine. I think there's a way to use the best of both worlds."
Impact on the Chiropractic Profession
In their conclusion, the study's author's noted that:
"... patients are increasingly seeking to identify a physician who is solidly grounded on conventional, orthodox medicine and is also knowledgeable about the value and limitations of alternative treatments. The discussion about how best to prepare future physicians for this role is only beginning ..."As a profession, physicians will increasingly be expected to responsibly advise patients who use seek, or demand complementary and alternative therapies. We believe the development of a more consistent educational approach to this provocative area is essential."
The authors suggest that students interested in alternative and complementary therapies should experience the treatments themselves. "Experiencing acupuncture or therapeutic massage or tasting a macrobiotic meal," the scientists remarked, "adds a dimension to the learning experience that a lecture or simple demonstration cannot. The deeper understanding that results should provide a better basis for responsibly advising patients."
A new generation of medical doctors is learning something about chiropractic, not seeking to discredit or destroy the profession as many of their forefathers did. With this understanding comes the opening of communication between the medical and chiropractic professions, leading to a more cooperative spirit and sharing of information for better patient care.
References
- Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at U.S. medical schools. JAMA, Sept. 2, 1998;280:784-787.
- Schulte B. Many schools adding courses in alternative medicine. Mercury News September 2, 1998 (www.mercurycenter.com).
- Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs and patters of use. N Engl J Med, 1993;328:246ª252.
- Bowman L. Med. schools now offer courses in alternative medicine. Scripps-Howard News Service, September 2, 1998.
- Schulte B.
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