The Biopolitics of Quackademic Medicine in Iran

For ordinary people – or patients – who have been overwhelmed by the mixture of valid and invalid health information they receive from the mass or social media and wonder which one to trust, one helpful piece of advice would be to ask a healthcare professional or look at academic sources. A healthcare professional is a person with a degree and license in healthcare, such as a doctor, who can always be trusted and relied upon to tell apart valid health information from misinformation. The disaster happens when those degree and license-holder physicians become the purveyors of health pseudoscience. The worst happens when they hold academic positions in well-reputed medical institutes. As a result, academic sources also turn into the suppliers of misinformation. That is what has been happening in Iran for more than two decades.

Quackademic is a term coined to identify the infiltration of pseudoscientific institutions in the academic community. Biopolitics has been used with various meanings. However, this paper adopts the definition that describes it as the interference of politics and political powers in life sciences and the way people live. In many countries, religious and political ideologies support various branches of health pseudoscience or antiscience. When they are in power, they exploit public resources to promote those pseudo- or antiscientific ideas in different ways, including nestling them in academic institutions. This is an obvious instance of biopolitics. This article depicts Iran’s ongoing experience with quackademic medicine promoted by biopolitics.

A Brief History of a Politically Supported Medicine

The School of Persian Medicine, the birthplace of the first academic group and Ph.D. program of Traditional Iranian Medicine (TIM), was established in 2007 as a new part of the Tehran University of Medical Sciences, Iran’s oldest and most prestigious medical school. Its establishment was not a mere academic endeavor but a political one, with both the Supreme Leader, Ayatollah Ali Khamenei, and the President, Mahmoud Ahmadinejad, staunchly advocating for TIM. This political support, which has endured under subsequent presidents and their administrations, is deeply entrenched in the political ideology of the Islamic Republic, which is characterized by anti-Western sentiments and a commitment to self-reliance.

Mahmoud Ahmadinejad, the Islamic Republic’s President from 2005 to 2013, was pivotal in establishing and expanding the academic institutions dedicated to TIM. His fervent belief in medical pseudoscience was no secret, recurrently expressed in his presidential speeches. For instance, he once proclaimed:

“I know individuals who, by simply examining your pulse, can diagnose your body more accurately than the most advanced digital machines, such as C.T. Scan, and identify all the issues and malfunctions in your bodily systems. These are not hearsay; I have personally had my pulse examined twice, and they diagnosed all the problems and diseases in my body and their causes [!].”

For thee, but not for me

The Supreme Leader, Ayatollah Khamenei, has never shied away from supporting TIM. In addition to many sayings, he included a solid mandate to promote and establish TIM in the “General Health Policies,” a document that the Ministry of Health and other governmental stakeholders in the health sector must follow.

It is worth mentioning that the Supreme Leader has always used the most advanced medical technologies and Western-educated physicians for himself and his family. He has never risked his health by trusting the providers of TIM or other quackeries such as Islamic Medicine. However, when it comes to advising people, while he has never banned or disparaged scientific medicine as a whole, he promotes TIM.

Despite some scattered resistance in the governing bodies of the health system, the continuous support of the top leaders, including the Ministers of Health, has led to the near-full implementation of the abovementioned General Policies in the country. So far, tens of TIM schools, departments, research centers, clinics, and other academic institutions have been established within medical universities. Hundreds of Ph.D. students who hold an M.D. degree and are licensed to practice TIM have graduated. The integration of TIM into the primary healthcare system, along with insurance coverage for TIM treatments, is being pursued.

TIM is Pseudoscience

The main feature that differentiates TIM from other (valid or invalid) branches of medicine is not its reliance on herbal remedies, ancient treatments, or medieval manuscripts but its reliance on the theory of four humors and temperaments. TIM is pseudoscience because (1) in the realm of basic sciences (the understanding of health, disease, and treatment), it relies on obsolete and wrong identity-making theories, and (2) in the realm of clinical medicine, it refuses to follow the standards of evidence-based medicine (EBM).

The humoral theory is the core theory that forms TIM’s identity. To preserve this identity, the practitioners and purveyors of TIM need to safeguard this theory from falsification. In other words, they need to keep the humoral theory as a sacred dogma that should be preserved at any cost! This is their exit from the highway of science to the wrong way of pseudoscience and quackery.

Ancient Origins

The version of the humoral theory adopted by TIM was first developed in ancient Greece by physicians and philosophers such as Hippocrates (460-370 BC) and Aristotle (384-322 BC). It was then further developed and expanded in ancient Rome by Galen (129-216 CE). Galen’s books were translated into Arabic during the translation movement by great translators of the House of Translation in Baghdad, including Hunayn ibn Ishaq al-Ibadi (808–873 CE), who translated almost all of Galen’s books into Arabic. Those books were studied all over the Muslim-majority world then, from Cordoba in today’s Spain to Samarqand and Bukhara in today’s Uzbekistan. Some great physicians and philosophers, such as Al-Razi (865–925 CE) and Ibn Sina (080-1037 CE), significantly contributed to this branch of medicine and authored encyclopedic books such as The Canon of Medicine by Ibn Sina.

Their accounts of anatomy, physiology, and pathophysiology are now obsolete. For example, according to them, the liver digests the ingested food into four humors: phlegm, blood, yellow bile, and black bile. These fluids are circulated in the veins. All the veins originate from the liver. The concentration of these humors forms the organs, while their more diluted and refined form, the Pneuma (or Rowh), is circulated in the arteries. Health is the status of balance among the humors and temperaments (wet, dry, hot, and cold), and disease is the status of imbalance among them because of excess or deficiency. Therefore, treatment aimed to correct the imbalance by remedies or treatments such as blood-letting, cupping, purging, or enema. These theories were invented centuries before the development of modern theories such as the cell theory, the germ theory, the genes theory, and others that help us understand human health and disease today. Today, even a high school student knows that those humoral theories are wrong and have been rejected.

Appeal to Tradition Fallacy

The departments of TIM try to smuggle all those obsolete theories and practices into medical universities. They teach them as “alternative medicine” to medical students and their Ph.D. students, who will be licensed to practice accordingly.

In clinical medicine, the academic centers of TIM, after nearly two decades of consuming a large portion of the health sector’s budget, have yet to introduce a remedy derived from their old manuscripts that is more effective than scientific medicine medications in treating a serious disease. They have long publication lists because their students need to publish articles to graduate, and their faculty members need to publish to get promotions. Also, they publish in a wide array of journals dedicated to medical pseudoscience, some of which have been established in their own institutions. Most of these articles are historical papers exploring old manuscripts. In addition, there are numerous published clinical trials among them with lots of methodological faults and shortcomings. At the end of the day, as mentioned above, they have been embarrassingly unsuccessful in conducting well-designed clinical trials and achieving any noteworthy results.

Quackademic Medicine at Work

Today, major medical universities in Iran host tens of academic centers of TIM. Many of them offer master’s and PhD degrees. The Iranian Ministry of Health and Medical Education has an office dedicated to promoting TIM. Numerous clinics called “Salamatkadeh,” meaning the House of Health, have been established under the umbrella of medical universities and even within major university hospitals. According to law, TIM medications are exempted from many conditions and steps for obtaining marketing approval from Iran’s Food and Drug Organization. A number of medicines have already received such approval without having clear supporting evidence.

Hundreds of M.D.s have obtained their Ph.D. degrees in TIM. They are licensed to practice TIM. The professors and practitioners of TIM are frequently invited by the government TV (the only formally permitted TV in Iran) as health experts. They publish on websites and social media pages of the Ministry of Health and medical universities. Therefore, their audience finds them approved by and a part of medical academia and has no reason not to trust them. The number of TIM visits is claimed to be ever-increasing in a way that there is a shortage of practitioners with a TIM degree.

It is separate from various other branches of quackery medicine, such as Islamic medicine, homeopathy, energy therapy, magnetic therapy, and countless other branches of pseudoscience and antiscience that exploit the scientific illiteracy of the public in contemporary Iran. What makes TIM different, and more dangerous and harmful, is mainly their being “quackademic.”

The Role of Bioethics

The institution of bioethics has a crucial role in defending society against the harmful intrusion of biopolitically motivated pseudoscience. Certain widely accepted bioethical principles, including nonmaleficence and scientific validity, can be relied upon to create a theoretical model for addressing such problems.

Some ethical and professional guidelines in Iran emphasize the importance of evidence-based methodology in clinical medicine. However, in the absence of a robust civil society, the government controls almost all the professional bodies, such as the Medical Council of the Islamic Republic of Iran, and the regulatory institutions, such as the national and regional Research Ethics Committees. Therefore, when infesting academia with pseudoscience is a government-supported project, none of them shows any motivation to stand against it.

The burden of educating the public and even health professionals about the pseudoscientific aspects of TIM and the danger of medical pseudoscience is on the shoulders of a number of intellectuals who feel a personal responsibility to do this job and accept its burden and risks.

Purveyors of Pseudoscience

Around the globe, biopolitics plays a crucial role in promoting various types of health pseudoscience and antiscience. Religious and political powers have their perspectives on health, disease, and medicine and advocate for branches of medicine that concord with those perspectives. When in power, they help their supported branches of pseudoscience to infiltrate governmental bodies, health systems, and academic institutions.

If it happens, as has already been in progress in Iran, the worst and most harmful type of health pseudoscience emerges because the institution people should trust to distinguish science from pseudoscience, namely the professionals and academic bodies, turn into the purveyors of pseudoscience. That is what has happened in Iran over the past two decades, and it is still in progress.

Escaping the Dungeon of Medical Pseudoscience

Medical traditions and traditional medicines all over the world, including in rich and old civilizations like Iran, are sources for considerable therapeutic hypotheses, such as traditional herbal remedies and other treatments. Nobody argues that they are entirely useless and ineffective. There is a reasonable possibility that some of them are truly safe and effective. However, their safety and effectiveness must be assessed by well-designed and conducted clinical trials before being marketed or prescribed.

The TIM departments in Iran, at the very beginning, were supposed to accomplish this mission. However, the difficulty of scientific research and the lucrative business of practicing pseudoscience, in addition to the political support, directed them toward their current path. It was a bad idea, even at the beginning, to establish TIM departments for such a purpose because when they are named TIM, they adopt a mission to defend their identity as a separate and valid branch of medicine, that is, the entrance of the dungeon of pseudoscience.

Instead, the best way to explore the potential of traditional remedies is by conducting research with the collaboration of pharmacognosy or ethnopharmacology departments. That is the only exit from the dungeon of medical pseudoscience. Right now, however, it looks like nobody in the Iranian Ministry of Health or TIM departments is looking for such an exit.