SHANDS ARTS IN MEDICINE

MARKET ANALYSIS

FEBRUARY 2003 UPDATE

Bob Allston


TABLE OF CONTENTS

  1. INTRODUCTION
  2. HISTORY
  3. FACULTY AND ORGANIZATION
  4. RESEARCH
  5. EDUCATION
  6. WEB PAGE SURVEY
  7. UPDATE SUMMARY

    INTRODUCTION

  1. It is now almost three years since this page originally appeared on line. And all the evidence suggests that the program continues on the same path with little change for the better. It still apparently enjoys the generous sponsorship and protection of the Shands Hospital administration from which position it generates ever more layers of self aggrandizing hype; always portraying itself as the dynamic center of the arts/medicine universe when in fact even after 12 years it remains a very insignificant marginalized segment of it.

  2. An April 2000, overview of the problems with the program may be found at Summary of AIM's Competitive Shortcomings The same problems remain today.

  3. Note: In some of the links that follow on this page, you will note that there is a second link immediately following the first one entitled "backup". This backup link goes to a copy of the page as it existed when this was written, so it will be available in the event the referenced page should be removed or modified by its author. In some instances, I have only provided a link to the backup page when I have provided a link to the source page elsewhere.

  4. Shortly after my original page appeared, the Center for the Arts in Healthcare Research and Education (CAHRE), the education and research arm for AIM, introduced its own Web site, backup providing an overview of how AIM presents itself to the world.

  5. I shall discuss each of the links in the menu on the left side of the page.

    HISTORY

  6. The history page repeats the often heard hype that the Shands Artist in Residence program is a national model for other programs. This claim appears particularly dubious in light of the fact that artist in residence programs were a fixture in many venues such as summer retreats, camps, and educational institutions long before AIM came into existence; some of which are undoubtedly the source of inspiration for various hospital programs.

  7. As well, the major arts therapy professions have been around much longer than Shands Arts in Medicine, the number of people in these professions collectively outnumber Arts in Medicine people something like 100 to 1 and they have undoubtedly furnished the inspiration for many hospital programs.

  8. For example, the history page also claims "In 1996, UF became the first university in the nation to offer a Dance in Medicine course including both classroom and clinical experiences." However, in referencing the American Dance Therapy Association Web site it may be noted that the organization was established in 1966, a full 24 years before Shands Arts in Medicine even came into existence. We are thus asked to believe that none of the member organizations had classroom and clinical instruction for this 24 years.

    FACULTY AND ORGANIZATION

  9. This page states that CAHRE has three faculty members. Dr. Rusti Brandman is on the UF dance faculty and Jill Sonke-Henderson is a dancer with about two years of university education. Dr. Graham-Pole is a medical doctor and founder of the program. However, having two dance faculty and no faculty for art or music begs explanation, for art and music are both better established and far more highly employed in the world of arts/medicine than dance.

  10. Outside of three faculty members, we aren't given any information about who the directors, executive board, and advisory board members are, which would of course be helpful in understanding the nature of the organization. However, Dr. Graham Pole's UF AIM site, backup, lists him as a director and Dr. Brandman's UF faculty site, backup, lists her as a co-director and Ms. Sonke-Henderson's UF AIM site, backup, lists her as a co-director. Dr. Glen Turner is listed on the CAHRE research page as executive board member of CAHRE. In a UF search, I don't find any faculty bio page or other pages on him other than his email and address. The only other person I happen to know of is Mr. Don Lutz who is listed as a member of the advisory board on his own site, backup, (see The Weaning of America- About the Author.) As indicated in a number of sites other than just his own, A, backup, B, backup, C, D, he is controversial.

    RESEARCH

  11. The research page is also long on hype and short on details; appearing designed to create the illusion of an organization involved with useful research while avoiding specifics. The most glaring deficiency of this page is that there is not a single reference to published results, or indeed any other documented results of any nature. Research people always reference their publications when discussing their research, particularly in their own Web pages. For, how is anyone going to be able to use their research results if they don't publish them and make references available where people expect to find them?

    The research for each person is addressed below:

    1. Dr. Brandman's study is termed a "qualitative descriptive study". The project has been going on for several years and no published (or unpublished) results are offered. But more importantly, we need to know how dance as a modality of healing stacks up against all others, alternative modalities or conventional medicine, and this (if I understand "qualitative descriptive study" correctly) wouldn't appear to do it. For instance, we need to know whether under some circumstances watching someone dance (or dancing yourself) is as good or better than taking a tranquilizer pill. Her UF faculty page, backup, contains no references to publications, or research findings otherwise, either.

    2. The paragraph on Dr. Graham-Pole's research is far too vague to evaluate; saying only that he is involved in "several" research projects; giving no references to published (or unpublished) results (on either previous or present research). However a Pub Med Web site (search on "Graham-Pole") references 89 publications since 1971, some of which are on conventional medicine and some on arts/medicine; and many of which are from well respected publications. At the same time, Arts in Medicine is primarily operated by him, and it has been a primary factor in building his stature as a doctor.

    3. This poses some obvious questions. For example, do they accept the same hype he employs at UF? I doubt it, at least in the case where he is co-author with I would presume respectable co-authors. Possibly he builds his reputation on hype at UF, where he knows he won't be challenged, but is more circumspect when writing for the journals. Or possibly he has been around long enough that the journals simply don't critically examine what he submits. Whatever the case, considering his proclivity for hype over substance at Shands, any research he has authored and presented in these journal articles or otherwise, might benefit from objective examination particularly in the arts/medicine field. Unfortunately past experience suggests any undertaking of this nature is most unlikely.

    4. Jill Sonke-henderson is a professional dancer with about two years of college. At least in her case we have a reference to her research, a hospital survey where we are furnished the survey questions, backup, and a summary of the survey responses, backup. The stated purpose of the survey is to determine the demand for artists, or artist in residence positions in hospitals. An examination of the survey follows:

      1. First off, we aren't furnished any information about how many institutions were invited to respond to the survey or how many of those invited to respond declined to do so and for what reason. Sixty is a very small number out of the total number of hospitals in the southeast. Were some of these hospitals solicited based on some kind of indication of a positive attitude toward Shands Arts in Medicine? Were they solicited based on size? And what is the average size of the institutions actually surveyed? Without knowing the details of the selection process, of course we have no way of assessing the accuracy, utility or bias in the responses.

      2. However, ignoring the above issues and just examining the survey itself, it appears to be all but useless. Does the first survey question "We have an arts related program" mean hanging pictures on the wall? Does it mean a single volunteer going into a large hospital once a week and telling stories to children? Does it mean maintaining a collection of music CDs and CD players for use by patients? The question is so vague that it would be difficult to imagine any hospital that didn't have an "arts related program" of some nature; which of course is the answer they want, suggesting a demand for their students.

      3. The second question "We would like to have an arts related program" only shares the same fault. It is difficult to envision a hospital that wouldn't like to have an "arts related program"; the phrase being so broad and vague it encompasses just about anything.

      4. The third question "We have original works of art in our facility" shares the same problem as well. Again, it is difficult to envision a hospital that can't claim to have at least one "original work of art" of some nature. Paintings and other art are often donated, staff will bring their favorite paintings to their offices or reception areas, patients will make art of various kinds which gets displayed somewhere. Is this what the survey wants? -Who knows. A large institution that has a single original work of art would have to answer yes but clearly such a response would be very misleading in the context of the purpose of the survey.

      5. We have to say the same thing about the fourth question, "We have paid artists in our facility". A large hospital that has one paid artist of some nature would satisfy this question but again yield a very misleading result. It is common for hospitals to hire artists to paint murals or furnish other forms of art to hospitals. Does this qualify?

      6. Question seven, "We would like our patients to participate in creative activities", was obviously designed to guarantee a positive response; for again, it would be difficult to imagine a hospital that wouldn't like their patients to" participate in creative activities". Is rehab exercise a "creative activity"? Is speech therapy a "creative activity"? Is telling jokes a "creative activity"? Most surprisingly, 11 percent of the respondents did actually answer in the negative.

      7. Question nine is, "We recognize the value of art in a healing environment". Answering no to this would be equivalent to saying that your hospital saw no benefit in having nice pictures on the wall. Indeed, I don't ever recollect being in a hospital that didn't have at least some pictures, so one might anticipate that all respondents would answer in the affirmative; which they did. Again, of what benefit to anyone is such a question other than hype and public relations?

      8. If these problems aren't critical enough, the problems of the survey are further compounded by a total lack of any survey questions as to the education, degrees, or certifications the respondent hospitals require (or would require) of their artists. Simply knowing that a hospital wants artists without knowing what artists they are willing to hire, is of little value. Hospitals everywhere hire art, music and other types of art therapists, requiring them to have degrees and various other qualifications in their fields for which Shands arts in medicine trained students would not qualify. Indeed, as discussed below, the evidence suggests that Arts therapy trained artists in hospitals may outnumber Arts in Medicine trained artists in hospitals something like 100 to 1. Factoring in this information would further drastically alter the picture of the demand for Shands trained Arts in Medicine students. (A major distinction between the two is that arts therapy training includes psychology and Arts in Medicine doesn't; and most of the arts therapy professions have much more extensive educational requirements otherwise, as well.)

      9. Indeed, the survey suffers from a complete lack of sufficient specificity, discrimination or completeness from which to derive any meaningful information. It is simply a public relations ploy directed toward funding sources and others AIM wishes to convince there is substantial demand for Arts in Medicine trained people.

    5. Cathy DeWitt has a UF bachelor's degree in journalism but no degrees in music; although she took music courses while studying journalism. To my knowledge she has no background in research and I would doubt that she is doing any credible research. Although here again due to a lack of information, it is impossible to evaluate any research she may be doing; no published results or references otherwise being offered.

    6. Dr. Glen Turner has been involved in this project for many years. When I was with AIM, I requested to talk to him about his research and I was forbidden to do so. Again the discussion is too vague to evaluate anything and there are no publications or references otherwise offered. As mentioned above I was unable to locate a University Web site for him to see if there might be any further information.

  12. Another glaring deficiency in this description of research concerns clinical trials. Clinical trials are the standard for comparing the value of one modality of healing to another as well as establishing the effectiveness of a modality of healing in absolute terms (without comparing it to others.) They are thus top priority for unproven or controversial modalities of healing as well as improving established modalities. They are simply a basic component of virtually any research program. However, not one such project is even mentioned.

  13. Many of the researchers named in the research page lack sufficient credentials to design and carry out research that would be credible in the research community. When people lack research experience, it is common for them to associate with others who have such experience. However, no mention is made of joint research between AIM researchers and those in related academic areas or other institutions with the necessary experience.

  14. It is customary to mention the size of research grants. However no such information is supplied.

  15. No mention is made of any kind of relationship or joint projects between AIM research and any other arts/medicine research organizations including the established therapy professions such as art therapy, music therapy, dance therapy, or recreation therapy, where there is a vast and growing amount of research being carried out.

  16. In summary, I think many AIM people like to view themselves as just nice artsy people doing nice things for patients; certainly a view that has merit. However, the AIM leaders that authored this research page clearly wish to present AIM as an academic discipline with an active research program. However, as such, this page raises far more questions than it answers about the amount, quality and purposes of AIM research. And considering all the deficiencies, I find it difficult to find any reason for the existence of the page other than to mislead the unwary into thinking that AIM is a credible academic discipline with a credible research program on par with other disciplines such as the arts therapy professions and medical professions engaged in credible research.

    EDUCATION

  17. I will go down the curriculum list.

  18. I am unable to locate the course DAA 1020 on the Santa Fe Web site.

  19. DAN 3775 is currently offered at UF with an enrolment of 8 students according to the Theater and Dance office.

  20. I am unable to locate the Honors course IDH 2931, sec. 2554 although there is an Honors course IDH 2931 section 4824X entitled Spirituality and Health.

  21. The Honors course Music and Health IDH 3931, sec. 0924 is offered.

  22. There is a certificate (see page 26) offered in Dance in Healing.

  23. I don't find any reference to a certificate in Arts in Medicine at Santa Fe.

  24. There is a course in Dance in Clinical Practice DAA 4930 referenced in the above mentioned certificate with a current enrolment of 3 students.

  25. There is a course in individual study, DAN 4905 relating to Dance in Medicine with an enrolment of 2 students.

  26. As far as I can determine these are all the courses and certificates offered at either UF or Santa Fe sponsored by Shands Arts in Medicine. The honors courses are not open to the general student body, being available only to a very limited number of incoming freshmen with a high school GPA of 3.9 or better along with other requirements. Thus for the general student body there appears to be a total of three Arts in Medicine related courses with a total enrolment of 8 + 2 + 3 = 13, and all of the courses as well as the certificate are restricted to the area of dance.

  27. Thus it appears that education suffers from three critical deficiencies for a program that claims to be a model for the world. The number of students is far below what one would expect to see. The number of arts/medicine courses offered is far below what one would expect to find. And the variety of arts/medicine courses, all restricted to dance, is far too limited; particularly in view of the fact (discussed below) that art and music are both far more extensively employed in the world of art/healing than dance.

  28. The remainder of the subjects on the CAHRE web page side bar are of less importance so this completes my review of the CAHRE site.

    WEB PAGE SURVEY

  29. In this original document of April 2000, I did a survey to determine the number of times a particular phrase such as "arts in medicine" or "dance therapy" appeared in the title of web pages. This would give a rough estimate, for example, of how popular Arts in Medicine was compared to Dance Therapy. I have repeated the survey in this update to determine if there appears to be any appreciable change over the past three years. The results are set forth below.

  30. The total for Arts in Medicine (including Arts in Healing and Arts in Healthcare) was 9 sites in the original survey. For the Feb. 03 update the total number of returns is now 33 sites, for an increase of 3.66 times the original number.

  31. The total for Dance Therapy was 39 sites in the original survey. For the Feb. 2003 update, the number is now 184 sites, for an increase of 4.72 times the original number.

  32. The total for Recreation Therapy was 40 sites, and the total for Therapeutic Recreation was 148 sites. These are two names for essentially the same discipline thus the two results may be added, making a total of 188 sites for the original survey. For the Feb. 2003, update the number of "recreation therapy" sites is now 274, and the number for "therapeutic recreation" is now 1409, for a total of 1683, or an increase of 8.95 times the original number.

  33. The total for Art Therapy was 650 sites in the original survey. For the Feb. 2003 update the number is now 1973 sites for an increase of 3.03 times the original number.

  34. The movie Patch Adams, about a doctor who clowns around to cheer up hospital patients relates to AIM; and the total for Patch Adams was 807 sites in the original survey. For the Feb. 2003, update the number is now 827 for an increase of 1.02 times the original number. The fact that there is virtually no increase here for the past three years is probably due to the fact that the movie would have been more popular closer to the time it was first introduced.

  35. The total for Music Therapy was 1,039 sites in the original survey. For the Feb. 2003, update the number is now 3,720 sites for an increase of 3.58 times the original number.

  36. The total for acupuncture was 6,654 sites in the original survey. For the Feb. 2003, update, the number is now19,200 sites, for an increase of 2.88 times the original number.

  37. The total for meditation was 16,166 sites in the original survey. For the Feb. 2003, update, the number is now 54,284 sites for an increase of 3.36 times the original number.

  38. The total for medicine was 156,222 sites in the original survey. For the Feb. 2003, update the number is now 435,501 sites for an increase of 2.79 times the original number.

  39. The total for arts was 352,489 sites for the original survey. For the Feb. 2003, update the number is now 1,511,485 sites for an increase of 4.29 times the original number.

  40. If we examine the change in the number of sites for words such as "medicine" or "arts" we note it is rather large, being 2.79 and 4.29 respectively; certainly much larger than any actual growth by any measure that might be anticipated in either art or medicine. Thus it appears that the bulk of the increase is due to the increased popularity of the Web over these three years rather than growth in these disciplines.

  41. However the relative differences between the different disciplines would appear to yield about the same relative popularity of the different disciplines as it did three years ago. Thus if we compare the 33 sites for "arts in medicine" (including "arts in healing" and "arts in healthcare") with the 184 sites for "dance therapy", the 1683 sites for "recreation therapy", the 1973 sites for art therapy, and the 3,720 sites for "music therapy", it is clear that "arts in medicine" remains extremely small compared to all of the therapy professions and it is less than one percent of "music therapy" alone.

  42. Shands Arts in Medicine's concentration on dance, with its only academic certificate and all generally available courses in the area of dance, is all the more curious in light of the fact that among the therapy professions, dance therapy is one of the least popular. For dance therapy enjoys only 5 percent of the popularity of music therapy, 9 percent of the popularity of art therapy, and 11 percent of the popularity of recreation therapy, the latter of which UF has degree programs through the Ph.D.

  43. Thus Shands Arts in Medicine is concentrating its scarce education resources, taxpayer's money, and grant funds, to train students seeking a useful education, to be proficient to work or volunteer within what appears to be less than one percent of the arts/medicine world; an infinitesimally small fraction by any measure.

    UPDATE SUMMARY

  44. Shands Arts in Medicine has been a major element in building the reputation of a Shands doctor, Dr. Graham-Pole, who distinguishes his program from that of all the much older and better established therapy professions by leaving out education in psychology; which over time they have all unanimously adopted as essential. This is probably because, for the arts, the human mind is always a direct element of the treatment, unlike for instance, pills or surgery where the mind is not a primary element in administering treatment (except perhaps for brain surgery or drugs that affect the brain.) Thus one might argue he has an uphill battle to gain market share; thus the hype and deception.

  45. Now, three years after my first page on this subject, the Shands Arts in Medicine program continues to beg the same questions found three years ago. Specifically, in this update, the program is found to be what has to be described as grosely deficient in research, education, enrolment, curriculum, and plain honesty, among other things, for a program that claims to be a world leader. Why, after almost three years, hasn't Shands or the University critically investigated Shands Arts in Medicine (whether or not anyone has seen this original Web page?) Or if it has been investigated, why hasn't it changed? Has the Arts in Medicine program ever been objectively compared with what is available from the Recreation Therapy profession at UF? How about the program at FSU? Or indeed, numerous other available programs? More fundamentally, have the merits of the core character of the program -not having a base in psychology- ever been objectively scrutinized in comparison to the merits of the therapy professions?

  46. It should not take a relative outsider such as myself to examine the issue; for there is no question that many doctors, staff, students and volunteers know of AIM's shortcomings. The fact is that Shands engenders a climate of fear and suppression; or to be a little more politically correct --a climate of live and let live. Or if you like, a climate of mind your own business. Or it might be called a code of honor not to attack fellow doctors. By whatever name, I have heard this sentiment voiced more than once and the long living less than ideal character of Arts in Medicine is stark testimony to the fact that it may have pervaded the hospital professional community for a long time. And being so deeply entrenched at Shands it may be a long time before it gets a proper examination.

  47. The causes of such repressive academic environments can be complex but in other universities, pressures of funding, competition, commercialization and globalization have been found to be major elements. And characteristic of such academic climates, anyone breaching this code could find themselves accused of having "personality problems" and find their reputations and jobs in serious difficulty, as was the case at another Florida university (go to end of Web page). My own experience at Shands was not so serious since I was only a volunteer; however, had I been a student, staff or faculty, it might have been much worse.

  48. How many other dubious medical programs at Shands hospital enjoy such support? How safe are they for patients? To what extent are patients being denied better treatment in favor of inferior programs? How many better research or clinical programs are being suppressed by such inferior but favored programs? How many patients have been unnecessarily injured then the injury covered up? How many doctors at Shands have built their reputations on hype, money and connections at the expense of doctors, staff, or students, with better ideas but without the hype, money and connections? It seems nobody is going to know very soon.

    Return to Shands Arts in Medicine Market Analysis


    Contact me at boballston@yahoo.com.

    Copyright © 2003, Robert Allston. All rights reserved.