In February 2003, the Institute of Medicine (IOM) announced that it was assembling a committee to identify major scientific and policy issues in “complementary and alternative medicine” (“CAM”) research, regulation, training, credentialing and “integration with conventional medicine.” As part of this process, it posted the names of 15 appointees and asked for public comment about their suitability. Here are IOM’s biographical sketch of Dr. Fishman and the comments I submitted. Despite some of his questionable “CAM”-related activities I believed his background was adequate to do a good job as a “CAM” Committee member provided that the committee was balanced by people who understand the dark side of the “CAM” marketplace. His was retained on the proposed committee, but no knowledgeable critics were added.
|IOM Description (February 2003): Alfred P. Fishman is the William Maul Measey Professor of Medicine and Senior Associate Dean for Program Development at the University of Pennsylvania School of Medicine. He is Director of the Office of Complementary Therapies at the University of Pennsylvania and serves as representative of the University to the Consortium of Academic Health Centers for Integrative Medicine. In 1966, he became Professor of Medicine at the University of Chicago and Director of the Cardiovascular Institute at Michael Reese Hospital and Medical Center. In 1969, he joined the faculty of the University of Pennsylvania as Professor of Medicine and Associate Dean of Research. He currently serves as Chair of the Health Promotion and Disease Prevention Council, Chair of the Steering Committee on Complementary and Alternative Medicine and is also on the Board of Directors of the Metanexus Institute. Dr. Fishman has been a consultant to the executive office of the President of the United States; a member of the Council of the National Heart, Lung and Blood Institute and Chairman of the Health Sciences Policy Board of the Institute of Medicine, NAS. He has served on numerous editorial boards and as a member of the Board of Directors of the American Heart Association. Dr. Fishman was President of the American Physiological Society, and is or has been a member of several national honor societies and serves on a number of Boards of Directors, including the National Space Biomedical Research Institute (NSBRI). He is a past President of the College of Physicians of Philadelphia. He has edited nine books and published over 250 scientific articles.|
My Comments (Posted on February 23, 2003)
- Fishman is principal investigator in a grant that the University of Pennsylvania received to “develop and implement an integrative program in complementary and alternative medicine at an academic medical center.” A summary on the Josiah Macy Foundation Web site states:
Medical students need this information, participants concluded, so that they will be able to inform their patients about the potential benefits and risks of different CAM practices, to refer interested patients to practices where benefit has been established and harm is not an issue, and to understand potential interactions between western medicine and CAM interventions.
This issue has been explored in depth at the University of Pennsylvania where a multidisciplinary faculty group has been developing an approach that would meet this goal for their students and could serve as a model for other medical schools. The program they envision would integrate CAM into western scientific medicine without undermining the principles or practices of evidence-based medicine.
- The University of Pennsylvania’s PennCAM Web site gives a detailed overview of its program but does not indicate whether or not students receive reliable information on CAM topics. The steering committee’s Web site provides “CAM Content in the Medical School Curriculum,” which outlines the topics being covered but does not indicate the details of what is conveyed. For example, it describes a course in which homeopathy is covered but does not say whether or not students are encouraged to believe that homeopathy has validity.
- If I were evaluating the program, I would investigate whether methods that are part of standard practice are being mislabeled as “CAM” and whether students are informed about any of the vast number of quack practices that have been relabeled as “CAM.”
- CAMatPenn, a newsletter that Fishman edits, has greatly exaggerated “CAM” utilization by citing the dubious statistics of David Eisenberg, M.D.
- Despite my concerns, I believe that Fishman’s experience in developing university-based programs makes him an appropriate IOM committee member provided that the committee is balanced by people who understand the quackery and deception that are rampant in the “CAM” marketplace. At present, there does not seem to be a single committee member who fits this description.
This article was revised on January 15, 2005.