Rosendaal, F. R.

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F.R. Rosendaal

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Tijdschrift voor Medisch Onderwijs, maart 2010 | Vol. 29, nr. 1, p. 90-92
Pro-contra topic
Teaching medical students about alterna-
tive and complementary medicine is as
useful as teaching astronomers about the
signs of the zodiac, oil drillers about
dowsing or stock brokers about clairvoy-
ance. After centuries of medicine gov-
erned by magical thinking and witchcraft,
it was only a relatively short time ago that
we embraced the concept of science-
based and evidence-based medicine, and
nothing is to be gained by returning to the
dark ages of superstition and miracle
cures. 
The scientifically inclined reader may
be interested in a definition of alternative
medicine, which is not straightforward,
compare, for example, vitamin therapy
for homocystinaemia (vitamin B) or for
the prevention of the common cold or
ageing (vitamins C and E). A definition
that seems relevant in the present context
is that of therapies and interventions not
taught at medical schools.1 A non-exhaus-
tive list includes magnetism, naturopathy,
chiropractic medicine, herbalism, tradi-
tional Chinese medicine, Unani,
Ayurveda, qi gong, Reiki, aromatherapy,
bio feedback, neuroprogramming, hypno-
sis, homeopathy, acupuncture, acupres-
sure, mental healing, voodoo, interven-
tional prayer, or, in short, everything that
used to be called quackery.
Alternative medicine does not work and
cannot work. If it did, it would be regular
medicine and taught at medical schools.
That does not mean, however, that alter-
native medicine is always harmless, for it
can do harm and likewise including it in
the medical curriculum will have negative
consequences: it will harm the acquisition
of academic thinking, the foremost goal
of an academic education. In order to ex-
plain what academic thinking is and why
alternative medicine is fundamentally
alien to it, we have to look at science and
how it progresses.
Medical school offers an academic envi-
ronment in which students are educated
and trained to become physicians. This is
somewhat different from purely academic
schooling, as in mathematics or medieval
French, or purely vocational training, as
in gardening or plumbing, although one
could easily argue that all practical
schooling, of whatever level, requires
some theoretical framework. ‘Academic’
implies acquiring understanding of how
science moves forward: how theories are
proposed and tested, established when
corroborated by empirical evidence and
sometimes proved wrong by newer theo-
ries or experiments. Isaac Newton’s the-
ory of mechanics was superseded by the
relativity physics of Albert Einstein, three
centuries later. Theories cannot be proven
conclusively, but, as Karl Popper has
taught us, they can only be falsified. The
true scientific mind is critical towards its
own hypotheses and seeks to disprove
them. In so far as serious research is
being done by those who adhere to theo-
ries of alternative medicine, it is to prove
that these theories are right, so that a neg-
ative outcome of such studies is a priori
unacceptable to them. This shows a fun-
damentally unacademic mindset.
Science has often been likened to a
large building, to which each researcher
Should the general curriculum of medical schools 
include teaching in ‘alternative medicine’?
F.R. Rosendaal
91
Ccomplementary and alternative medicine | F.R. Rosendaal 
?
makes some addition or small modifica-
tion and in this way the building at the
same time grows and is remodelled. Or, as
Bernhard de Chartres put it, we are
‘nanos gigantum humeris insidentes’
(dwarves sitting on the shoulders of gi-
ants). Not so with alternative medicine:
the theory of homeopathy is simply the
childish belief that small quantities of a
deleterious substance can cure diseases
that resemble poisoning with that same
substance; a theory which has no footing
in biochemistry and which has not shown
any development or growth since it was
first postulated.2 Acupuncture is based on
a theory of ‘meridians’ that have no basis
in anatomy and defy all logic. In other
worlds, the building was suddenly there,
rather than having been built slowly, and
it has not been improved over time. Those
who believe in alternative medicine, in-
deed only ‘believe’, the word itself indicat-
ing we are not dealing with a rational sci-
ence-based viewpoint. One rarely hears
physicists declare that they ‘believe’ there
might be such a thing as gravity or sur-
geons stating that they ‘believe’ that there
might be some good in repositioning bro-
ken bones (the word ‘believe’ may be used
by scientists, but only to indicate a degree
of uncertainty around a scientific matter,
which is exactly the opposite of the belief
we are discussing here, which rather re-
sembles religious beliefs).
Richard Dawkins gives a beautiful ex-
ample of the academic mindset when he
tells the story of a professor at the Zool-
ogy department in Oxford, who did not
believe the Golgi apparatus existed: “For
years he had passionately believed and
taught that the Golgi apparatus (a micro-
scopic feature of the interior of cells) was
not real: an artifact, an illusion. Every
Monday afternoon it was the custom of
the whole department to listen to a re-
search talk by a visiting lecturer. One
Monday, the visitor was an American cell
biologist who presented completely con-
vincing evidence that the Golgi apparatus
was real. At the end of the lecture, the old
man strode to the front of the hall, shook
the American by the hand and said – with
passion – ‘My dear fellow, I wish to thank
you. I have been wrong these fifteen
years.’”3
Science has two pillars: theory and ex-
perimentation, which are intertwined like
the two strands of DNA: theory leads to
experimentation, which will corroborate
or refute it, and this will lead to new the-
ories. Some theories are very fundamen-
tal and it would require an even more fun-
damental theory and convincing
experimentation to overthrow it, as rela-
tivity did with Newtonian mechanics.
Take for instance homeopathy: to accept
that a substance diluted quadrillion-fold
would exert action because of the way it is
shaken at each dilution, we would need to
reject the most fundamental chemical
theories. Even a well-performed study
showing a clinical effect of homeopathy
in a clinical trial would not be strong
enough evidence to do this.
Should medical students not learn to
have an open mind? Sure. They need to be
critical and they need to question theo-
ries. Uncritical belief in the unfounded
theories of alternative medicine, however,
is the opposite of having an open mind.
Or, as Oberg said: “It is good to have an
open mind, but not so open your brains
fall out.” Medical students need to learn
academic thinking, need to understand
how science is a building of theory strut-
ted by experimentation and none of this
requires teaching of alternative medicine.
As I mentioned above, medical training is
not only academic but also practical.
Medical students need to learn to diag-
nose and treat patients. They need to
Pro-contra topic
92 Pro-contra topic
learn how to communicate with patients
and above all they need to learn empathy.
They will need to know the limitations of
their own skills and of modern medicine.
Perhaps the most difficult lesson will be
that there are patients whom they can
offer very little. Hopefully, they will learn
modesty, humility and tolerance, also
when their patients wish to visit providers
of alternative therapies. And this is the
only reason why some teaching of alter-
native medicine may be included in the
curriculum, for doctors to understand
their patients and to be able to inform
them fully about the dangers inherent in
some ‘therapies’. However, there is no rea-
son at all to teach students about the so-
called underlying principles of alternative
medicine, no reason to teach them about
meridians or endless solutions. Why? Be-
cause there is no scientific basis for these
‘principles.’
That is, of course, if you as a teacher ac-
cept that alternative medicine is non-exis-
tent. If you believe otherwise, you should
go back to your chemistry and biology
books and acquire an academic mindset.
References
1. Eisenberg DM, Kessler RC, Foster C, Norlock FE,
Calkins DR, Delbanco TL. Unconventional medi-
cine in the United States. Prevalence, costs, and
patterns of use. N Engl J Med. 1993;328:246-52.
2. Goldacre B. Bad Science. London: Fourth Estate;
2009 (pp28-63).
3. Richard Dawkins. The God Delusion. London:
Bantam Press; 2006. 
The author
F.R. Rosendaal, MD PhD, is clinical epidemiologist and
professor Department of Clinical Epidemiology, Leiden
University Medical Center Leiden, the Netherlands.
Correspondence
Prof. dr. F.R. Rosendaal, Clinical Epidemiology, C7-P,
Leiden University Medical Center, P.O. Box 9600, 
2300 RC Leiden, the Netherlands. 
E-mail: f.r.rosendaal@lumc.nl
No potential conflict of interest relevant to this article was reported
Ccomplementary and alternative medicine | F.R. Rosendaal 


Should the general curriculum of medical schools include teaching in ‘alternative medicine’?

Rosendaal, FR

German Medical Science

Should the general curriculum of medical schools include teaching in 'alternative medicine'?

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Should the general curriculum of medical schools include teaching in 'alternative medicine'? []

and patterns of use.

The God Delusion. London: Bantam Press;

URN: urn:nbn:de:0183-zma0006580 This article is freely available from http://www.egms.de/en/journals/zma/2010-27/zma000658.shtml Received: 2009-10-08 Revised: 2009-12-10 Accepted:

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Should the general curriculum of medical schools include teaching in 'alternative medicine'?

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