Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Bravo!
- Sri S Varman (9 July 2004)
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A Princely Riposte
- Lesley J Fallowfield (9 July 2004)
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Where may I send fan mail?
- Luke Devey (9 July 2004)
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We always knew he wasn't listening
- Norman J Vetter (9 July 2004)
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A response to my predecessor the Prince of Wales
- Brian Jarman (9 July 2004)
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Someone belled the cat
- Mangesh A Thorat (9 July 2004)
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open mind
- Brian F Walker (9 July 2004)
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Well done
- Harold Jacobs (9 July 2004)
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Excellent!
- Roger Eeckels (9 July 2004)
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Response to Michael Baum
- Mark R. Lipsman (9 July 2004)
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In Full Agreement
- Moises Gorodezky (9 July 2004)
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Re: Open Letter to the Prince of Wales
- Laurie A Forbes (9 July 2004)
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My E-Mail to Prof. Baum: With Respect Prince Charles is not so Wrong!
- Bobby K. Potter (9 July 2004)
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Partial and Parallel Truths:}}}:::::::>
- Dr.Bhalendu S Vaishnav, Dr. Smruti B. Vaishnav ,Addl. Professor, Department of Obstretics And Gynecology, P.S.Medical College. (9 July 2004)
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Prince of Wales Chastised
- Abram Hoffer (9 July 2004)
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In Defence Of HRH Prince Charles : An Open Invitation To Join ACAM
- Joseph . C . Obi (10 July 2004)
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Bigotry
- John P Heptonstall (10 July 2004)
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Challenging Baum on the scope of his methodology
- G.A. Bates (10 July 2004)
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In the soup together
- M C Feliciello (10 July 2004)
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With respect, Professor, you haven't got it.
- Dr. Herbert H. Nehrlich (10 July 2004)
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Baum's misdirected criticism: blames the drowning for clutching at straws.
- Steve A Hawkins (10 July 2004)
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Perhaps we should shoot the messenger
- Andrew N Bamji (10 July 2004)
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plus ca change
- Geoffrey C Rivett (10 July 2004)
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Which emporer is naked?
- John P Briffa (10 July 2004)
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Science is worth the effort.
- Luke Devey (10 July 2004)
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Doing good or just feeling better.
- Carl Thomson (10 July 2004)
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Gwyneth Paltrow will have more influence
- Neville W Goodman (10 July 2004)
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Prince of Wales and CAM!
- Dr. Naseem A. Qureshi MD, IMAPA, LMIPS (10 July 2004)
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Objective science?
- Paul A Taylor (10 July 2004)
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FIRE YOUR DOCTOR
- Rev Dr Michael Ellner (10 July 2004)
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A Letter to Royalty: a sardonic view
- Robert I. Rudolph, M.D., FACP (10 July 2004)
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Prince Open letter to the Prince of Wales
- Croft Woodruff (10 July 2004)
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Cancer Complacency
- Alan S. Meltzer (11 July 2004)
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Pardon me, Dr Baum. Exactly WHO,... has got it wrong?
- Hilary Butler (11 July 2004)
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Who do you call "Alternative"?
- Patrick P L Quanten (11 July 2004)
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Dear Richard Smith
- David Potterton ND MRN MNIMH (11 July 2004)
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Re: Science is worth the effort.
- Eddie Vos (11 July 2004)
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Dear Prince Charles,
- Caroline Richmond (12 July 2004)
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Re: FIRE YOUR DOCTOR
- Dr. Anne H Spencer, Royal Oak, MI 48073 USA (12 July 2004)
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Gerson Therapy Hardly Unproven
- Howard D. Straus (12 July 2004)
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Common medical politics.
- William G. Pickering (12 July 2004)
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Re: Science is worth the effort.
- John P Heptonstall (12 July 2004)
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Alternative Cancer Cures
- Louise Mclean (12 July 2004)
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Yes to more Research
- Simon C Ottman (12 July 2004)
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Re: A Letter to Royalty: a sardonic view
- Mark Struthers (12 July 2004)
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unproven need not mean untrue
- krishna g. badami (12 July 2004)
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Alternative healing is New Age spirituality, functionally distinct from medicine and science
- Bruce G Charlton (12 July 2004)
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Re: Re: Science is worth the effort.
- Ellen C G Grant (12 July 2004)
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The bully’s cloak for bigotry
- Steve Hickey PhD (12 July 2004)
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The obvious answer
- Adam Jacobs (12 July 2004)
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Everybody is entitled to speak - whether titled or not.
- susanne mccabe (12 July 2004)
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Re: Excellent!
- Eddie vos (13 July 2004)
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Thanks for trying to get sense into the public discourse
- Gerald Beuchelt (13 July 2004)
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An open letter to Professor Baum
- Heather M. Goodare (13 July 2004)
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Open your mind Professor!
- Sandra H Rowles (13 July 2004)
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Prince Charles: Anecdotes?Perhaps worth listening to
- Wolfgang H Furste (13 July 2004)
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Science is What the Scientists Do.
- BM Hegde (13 July 2004)
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Tall stories of alternative cancer cures
- Trisha Greenhalgh (13 July 2004)
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Why don't you get rid of the Royals?
- Joseph C Watine (13 July 2004)
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Misinterpreting the message?
- Dai Roberts, Alison McNulty, Christine Waterman (14 July 2004)
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Re: Tall stories of alternative cancer cures
- John P Heptonstall (14 July 2004)
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Re: TALL STORIES
- Dr. Herbert H. Nehrlich (14 July 2004)
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Re: Tall stories of alternative cancer cures
- Ellen C G Grant (14 July 2004)
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True scientists should have open minds.
- Jacqui Gath MBCS C Eng (15 July 2004)
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A Challenge to Professor Baum
- G Robert N Jones (15 July 2004)
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Re: Pardon me, Dr Baum. Exactly WHO,... has got it wrong?
- Neville D Yeomans (15 July 2004)
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Prince Chalres lecture best resonse to Prof Baum
- Abram Hoffer (15 July 2004)
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Possible link to homeopathy and genetics
- Joao N Bento (15 July 2004)
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'The need to stay open-minded'
- Margaret C Anderson (16 July 2004)
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The Fallacy of a Single Medical Science Envisaged by Professor Michael Baum - The Reality of a Division into Mechanistic and Holistic Medicine
- Erich K. Ledermann, Allan Withnell (16 July 2004)
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One consequence of a 100% mortality rate
- Robert A. Da Prato (17 July 2004)
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Pritikin was motivated - but did he have any answers?
- Dr. Herbert H. Nehrlich (19 July 2004)
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The Prince and the Professor: Who's got it wrong?
- Earl Baldwin of Bewdley (19 July 2004)
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The need for integration of qualitative and quantitative approaches.
- Hazel Thornton (20 July 2004)
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Friends in low places
- Michael O'Donnell (21 July 2004)
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What matters is what works
- John Hopkins (23 July 2004)
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Inductive logic is not to blame
- Darren J Bradley (23 July 2004)
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Re: Friends in low places - where are they?
- Hazel Thornton (23 July 2004)
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With respect your highness
- Richard Carlos (23 July 2004)
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With respect, Professor Baum, you've got it wrong
- Alexander Molassiotis (27 July 2004)
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Who needs to be pressured?
- P J Moran (27 July 2004)
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Re: Who needs to be pressured?
- Howard D. Straus (29 July 2004)
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Re: Re: Who needs to be pressured?
- Peter J Moran (30 July 2004)
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Re: Re: Re: Who needs to be pressured?
- Howard D. Straus (1 August 2004)
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Re: Pritikin was motivated - but did he have any answers?
- Erich K. Ledermann (3 August 2004)
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Please Share Their Agony - Your Royal Highness
- Michael D Innis (5 August 2004)
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Re: "An Open Letter to Prince Charles*.
- Dr. Sankar. K. Das (8 September 2004)
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HRH The Prince of Wales's Speech
- Michael Fox (22 September 2004)
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Wonder
- John Y Davenport (24 September 2004)
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CONGRATULATIONS
- CELIO LEVYMAN,MD,MSc (27 September 2004)
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Royal Patronage
- Andrew D LAWSON (10 October 2004)
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Explosions of CAM?
- Allan J Sweeney (30 December 2004)
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Sri S Varman, Director of Surgery Redland Hospital, Cleveland, Australia 4163
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Congratulations for having the courage to say that the Emperor is naked. Competing interests: None declared |
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Lesley J Fallowfield, Professor of Psycho-oncology Brighton & Sussex Medical School, BN1 9QG
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Well done Michael Baum, you deserve a Knighthood at the very least for putting your head on the block yet again and having the courage to say what most of us believe, but usually feel to cowardly to express in the presence of the Royals. See you in the Tower ! Lesley Fallowfield your fellow heretic Competing interests: Lesley Fallowfield is a known collaborator of Michael Baum |
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Luke Devey, Research Fellow University of Edinburgh
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I am delighted that Professor Baum has spoken for all of us who object to the excessive exposure given to the ill-informed opinions peddled by our future Monarch. I am grateful indeed to anyone with sufficient integrity to abandon all hope of a knighthood to speak out in this way. Thank you!! Competing interests: None declared |
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Norman J Vetter, Reader, Department of Epidemiology, Statistics and Public Health University of Wales College of Medicine, CF14 4XN
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Archie Cochrane, Professor here, in the University of Wales College of Medicine, spent much of his life promoting the use of scientific methods in medicine. Wales therefore, likes to think of itself as a centre for evidence-based medicine. Perhaps the next time the Prince visits we could bring him up to date. Competing interests: None declared |
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Brian Jarman, Immediate Past President of the BMA Imperial College Faculty of Medicine
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On 4 Nov 1970, while I was working as a resident in medicine at one of the Harvard teaching hospitals in Boston, my wife noted that our 5 year old son had a small lump at the back of his head. I noticed that he was pale and had bruises on his legs, so I said to her that I thought he had leukaemia. The diagnosis of acute lymphoblastic leukaemia (ALL) was confirmed by a blood test next day and a bone marrow the day after. At the time I and my medical friends knew of no effective treatment for ALL and so we decided to bring him back home to the UK to die. Several friends and relatives suggested various forms of alternative medicine treatment. Luckily, when we arrived in London Dr Humphrey Kay at the Royal Marsden Hospital suggested that our son should be entered into the UK ALL trial based on the treatment devised by Professor Donald Pinkel at St Jude’s Hospital, Memphis, Tennessee which had been shown to be effective in a recent trial in the USA. Our son went into remission, has not relapsed and is now well aged 39. The pressure from well-meaning friends to try alternative treatment was quite difficult to resist. I have had patients who have felt similar pressure to which they have, at times, succumbed when effective conventional treatment was available. Competing interests: None declared |
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Mangesh A Thorat, Senior Registrar Dept. of Surgical Oncology, TATA MEMORIAL HOSPITAL, Dr. E.Borges Marg, Parel, Mumbai - 400012
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It required someone of Professor Baum’s stature to come out courageously in open to put the things straight. Alternative medicine has always been common topic for debate, and I suppose that this letter has answered most of the questions. Remedies (???) from alternative medicine definitely need to be explored in the most scientific manner. And such medicines cannot be blindly accepted till these pass the rigorous scientific testing by most modern methods. Thank you professor for standing firmly for medical scientific community. Competing interests: None declared |
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Brian F Walker, GP Hong Kong
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Bravo the Price of Wales! I have long admired his open minded approach to current problems of the world. It is surely unreasonable to expect the medical profession to ask for even-handed approaches to health care when it is doctors who are the cause of the 4th most common cause of death - properly prescribed medication which is properly administered. Taken together with blunders, errors and happenstance, doctors are the number one cause of death. When it comes to health (and cancer) we as a profession have failed to take adequate reconizance of the fact that correct nutrition and correct exercise are the foundations of properly maiantained health. How many doctors can properly claim to know more than their grandmothers about nutrition? And yet we feel able to recommend treatments for cancer that have in the last 10 years brought not one more day of life to patients, but at horrendously increased costs. Having successfully treated cancers with foods, and seen reversal of widespread bony metastases (primary adenocarcnoma lung) with increased body mass, reversed persisting thrombocytopaenia of 2, and seen healthy brain tissue regrow into the site of a glioblastoma (no residual tumour) - to name but a few - I find the arrogance of the medical profession with respect to CAM an unbearable slight on the intelligence of our patients. In the atmosphere of blatant data manipulation by drug companies for corporate gain, falsification or bias of results for personal glory, and the proven inability to discern truth from the morass of unluckily applied statistics, I would far rather question the results of current pseudo- research than the documented successes of ethical and caring observers of facts. Competing interests: None declared |
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Harold Jacobs, Consultant Neurologist 14115-96 Ave, Edmonton, AB, T5N 0B9, Canada
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I wish to commend the author, Michael Baum, for his frank, reasoned and polite rebuke to the irresposible medical advice offered to the public by someone not versed in medicine nor in science. Such advice does far more harm than good. Flawed advice raises false hopes adding to human suffering. Competing interests: None declared |
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Roger Eeckels, emeritus professor of paediatrics University of Leuven, Belgium
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How could one not fully agree? Should not the considerable amounts of money spent on alternative medicine better be used to alleviate the suffering of mothers and children in poor countries? Roger Eeckels, MD, DTM&H Competing interests: None declared |
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Mark R. Lipsman, Nonmedical 01460
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The colossal arrogance of Michael Baum's message to Prince Charles that he shouldn't speak up about alternative health methods--unfortunately all too characteristic of the medical profession--is one of the main reasons people are turning to alternative techniques in such record numbers, aside from the fact that they work. As one who has cured himself of cancer using holistic methods, without going to a doctor, I know whereof I speak. Conventional medicine has nothing to offer for cancer except surgery, radiation, and chemotherapy--otherwise known as slash, burn, and poison--and more and more people are catching on that the mutilation, burning, and toxic chemicals are completely unnecessary. Modern medicine, in thrall to the pharmaceutical industry, fails utterly to understand that cancer itself arises from toxicity and that a cure depends on righting the body's internal energy balance. Gerson's diet works well, and so do many other techniques. The fact that large numbers of people are trying them and succeeding is a reproach to medicine's many failures. The holistic way typically offers superior results with fewer or no side effects and much lower cost--not to mention that patients aren't sent through an assembly line and get a practitioner who actually has the time to listen and respond. Competing interests: None declared |
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Moises Gorodezky, Retired Chief of Service Inst. Nac. Cardiol. Mexico Explanada 920, Mexico, D.F. 11000 Mexico
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I fully agree with the letter of Prof. Baum and I admire his courage. I think that is very important to denounce all the quackery and supperstition when it appears, no matter where and by whom. Well said and well done Professor Baum !! Moises Gorodezky M.D. Competing interests: None declared |
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Laurie A Forbes, None Retired
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I have just read with great satisfaction your letter on the subject of alternative medicine and Prince Charles. In a world seeming more and more steeped in irrationality, the last thing needed is someone of his position and influence promoting quack medical treatments. May I respectively encourage further efforts on your behalf. In my experience, as a medical lay person, the battle against quackery is, for the most part, fruitless and futile (and not assisted at all by generally science illiterate law makers) but if even a few are influenced the efforts are worthwhile. Best regards, Laurie Forbes Calgary, Canada Competing interests: None declared |
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Bobby K. Potter, student Asda Hulme, M15
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Dear Prof. Baum, I am Robert Potter a young student at Nottingham Uni and have a few questions about your view on Cancer treatments. Firstly I would like to say that I am a student of Politics not Pharmacy so please excuse any ignorance or stupidity I may portray. My father is Prof. Gerry Potter, also a cancer expert at Leicester De Monfort, and he has found and can prove the link between diet and cancer. The letter you published in British Medical Journal on Friday openly criticised the unproven alternative therapies Prince Charles was endorsing. The point of my e.mail is I want to know why is food seen as alternative. And although 13 glasses of carrot juice and coffee enemas may be yet scientifically unproven the link of food as a remedy to chronic disease is not. My father is woking on a product revolving round his own theories of carcinogenesis, which involves Fruit. But of course he can't claim that they kill cancer cells because this is a food supplement and cannot be seen as medicinal by interpretation. You think it is not helpful when high profile figures make sweeping statements on matters they are not qualified in but on the other hand these are DYING people here, so isn't the sharing of thoughts benefitial however unfounded. You yourself have criticised orthodox medicines, here I refer to your paper entitled 'Has Tamoxifen Had Its Day?', so wouldn't you agree that these so-called alternative therapies working in conjuction with so-called orthodox treatments should be given a chance? The body is evolved to metabolise natural compounds not sythesised drugs, so my point is shouldn't nature have a turn, at the very least to work in a complementary manner. I know very little on the matter but it seems to me that a) the pharmaceutical industry - chemotherapists and surgeons etc have a vested interest in preventing the spread of ideas and other cures and b) you've got one hell of a gripe with Charlie Boy! Being a youth I agree with you on the latter. But I probably know as much as you on the royal family and I wouldn't go as far as say that just because he made an opinion on medical science that he is patronised by the sycophants who surround him. Perhaps it is you who "may have overstepped the mark." (There's my politics coming out again) Also, you can't knock him because I really believe he wants to help. He's the president of the Foundation for intergrated Health and a campaigner for remedies for christ sake. At the end of the day he's looking forward and embraces change and chances in the hope of saving lives. I understand thats what you want to do as well, you probably get hundreds of desperate and heart-braking e.mails from victims of the 'Big Casino' wanting a shred of information just to inspire that bit of hope, God knows my Dad gets them. I only hope if his product works he again realises the miraculous nature of the job you have in common. Your in a very previliged position, the cancer sufferers hang on to your every statement, please don't rubbish my fathers work because he can prove it. Kindest Regards Robert Potter Competing interests: None declared |
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Dr.Bhalendu S Vaishnav, Addl. Professor,Department of Medicine P.S.Medical College, Karamsad,Gujarat, India.Pin 388325, Dr. Smruti B. Vaishnav ,Addl. Professor, Department of Obstretics And Gynecology, P.S.Medical College.
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The raison d'eitre of all medical sciences throughout the history of the mankind has always been the same i.e. to relieve the human suffering and to bring about a positive state of well-being. Their approach, however, has been influenced by the then prevailing belief systems,amenities and the methodology of assessment of human disease states. Synthesis between allopathic medicine and alternative therapies can be arrived at, atleast fundamentally to begin with, by comparing 'em with different roads going atop the mountain.While no two roads may ever cross each other, they still share the journey upwards. Each medical science adderesses some aspect of human disease and in that particular field the others are not equal contendors.Allopathy is adept in handelling the physical dimensions.Many of the alternative therapeutic sciences adderss the psychosomatic,'sub-clinical',or 'subtle physical' dimansions of health and disease.Their measures of measurements are different and therefore cannot satisfy the criteria of modern medicine. The need is to identify a common denominator or an integrating principle of human health. Obviously this principle lies beyond all sciences. It encompasses all but is bound by none. Competing interests: None declared |
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Abram Hoffer, Psychiatrist Victoria BC
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The National Post, Friday, July 9, 2004 under the Headline " Prince scolded over coffee enema 'cure' wrote " A prestigious British medical journal has blasted Prince Charles over his support for controversial cancer treatments that include coffee enemas and copious amounts of carrot juice". More accurately it should have stated that it was Professor Michael Baum who blasted Prince Charles while your journal labeled it a Personal View thus publicly dissociating yourself from his views. Professor Baum is disturbed because he thinks that Prince Charles was "not exercising his power with extreme caution when advising patients with life threatening disease to embrace unproven therapies". He writes "I have always advocated the scientific evaluation of CAM? Using controlled trials". It puzzled me why he was so unhappy with Prince Charles's comments. According to the Sunday Observer, Prince Charles told the health care audience he knew of one patient who had been treated successfully and added that "rather than dismissing such experience, we should further investigate the beneficial nature of these treatments. If Prince Charles is correctly quoted he and Professor Baum are in perfect agreement that alternative cancer therapies should be properly tested with good controlled clinical trials. Prince Charles did not recommend that patients seek out the Gerson treatment. He said we should further investigate such experiences. The main different appears to be that Prince Charles would like to see these trials conducted sooner rather than later and Professor Baum is content never to do them for he expects the alternative practitioners to conduct them even though they have no resources, no institutes, no research grants, and no time to conduct these trials. I think Professor Baum would be in a much stronger position if he were to use his influence to initiate these trials. Is this a this another case of Royalty to the rescue. Sir Thomas Sydenham Md(1), (1624 to 1689) was confronted with small pox. In 1667 1196 died and 1468 the following year in London with a population of only 500,000. Dr Sydenham observed that the death rate from small pox was much higher when the patients fever was increased. This was the standard treatment of that day. He wrote "By such means greater slaughters are committed and more havocke made of mankinde every yeare than hath bin made in any age by the sword of the fiercest and most bloody tyrant that the world ever produced". Dr Sydenham allowed his patients to stay out of bed for four days after the onset of the fever, allowed them liberal fluids, particularly small beer, a few bedclothes and in a few cases of youths, bleeding. His treatment was designed to keep the fever down. This was a new idea in medicine. The medical profession did not particularly like what Dr Sydenham was doing since it went against theory and practice going back nearly 1500 years. He was challenged to a duel. He had been Lieutenant in Oliver Cromwell's army. The medical association threatened him with loss of his licence. Had the double blind randomized prospective methods been known they would have demanded that. Dr Sydenham appealed to the first Earl of Shaftesbury in 1669 where he described the controversy, his data and the results he was getting. I like his sentence" It fares not always soe well with Truth and Right as not to need a patronage, new truths especially such as stand in the way of received maxims and general practice, and like trees sprouting up in the middle of the beaten road. which however useful or pleasant is not fenced while they are young and defended till they are growne too sturdy for common injury, are sure to be tramped on in the bud and to be trod into dust and forgetfulness". (1) Dewhurst, K. Dr. Thomas Sydenham (1624 - 1689) Jarold & Sons Ltd. Norwich, 1966 Competing interests: None declared |
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Joseph . C . Obi, Professor Of Complementary and Alternative Medicine (CAM) Research ; School Of Natural Medicine , Larnarca , Cyprus , European Union .
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I hereby fully support the highly outstanding efforts of HRH Prince Charles to publicly raise the basic profile of Complementary and Alternative Medicine (CAM) in the United Kingdom. However, it is my personal opinion that the Prince Of Wales may not actually be highlighting those exceedingly successful aspects of Complementary and Alternative Medicine which have consistently been scientifically proven to be almost as beneficial as their Orthodox Counterparts. I therefore warmly invite Prince Charles (at his own Royal Leisure) to humbly visit the website of the American College for Advancement in Medicine (ACAM) at http://www.acam.org , to get up-to-date information about our various Academic Conferences and Workshops; as these would certainly assist him (and many others) to do much more good for 'Holistic Specialties' at large. Our Future King may also wish to humbly appoint one or two ACAM Members to constantly advise him from time to time , on precisely what NOT to say about certain exceedingly explosive issues relating to Complementary and Alternative Medicine. I for one, can gleefully provide him with free tuition and guidance via e-mail , without any ostentatious charges , 24 hours a day : All he just needs to do is simply make contact. May I finally (respectfully) call upon Professor Baum to henceforth 'Pick On Someone His Own Clinical Size' ; and duly channel much more of his 'Academic Energies' into the 'Miraculous Use' of Simple 'Non- Prescription' CAM Therapies ...like Lycopene in Advanced Metastatic Prostate Cancer....and Padma in Occlusive Peripheral Vascular Disease. There is (most certainly) much more to Complementary and Alternative Medicine than 'Carrot Juice' and 'Coffee Enemas'. Competing interests: Professor Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants . He humbly invented the 'Omnipill'. |
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre LS27 8EG
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Sir I think Prof. Baum's intolerance of the deliberations and opinions of the Prince of Wales are testament to the bigotry Prof Baum has exhibited for many years where alternative and complementary methods are concerned. It came as no suprise that he should be the one chosen to express said outrage, or that there would be any number of a vocal minority of medics who would support his display of outrageous bigotry. Regards John H. Competing interests: I am a practitioner of Traditional Chinese Medicine - acupuncture & moxibustion |
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G.A. Bates, ex-social worker and retired teacher Leicester, England, UK
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Michael Baum's "chastisement" of Prince Charles needs to be challenged for no other reason than he is wrong to suggest alternative medicine is the result of inferior thought and lacking in scientific credentials. Laying the groundwork for his argument Baum puts great play on the 'new skills' learnt by doctors in the last 20 years including "epistemology .. the nature of proof.". Baum then goes on to give a very brief account of modern scientific method (what is in fact Popperian falsificationism) which is at the root of so-called 'null hypothesis methodology' the cornerstone of modern statistics employed by scientific research. OK. So far so good. Then he states: " You [Prince Charles] promote the Gerson diet whose only support comes from inductive logic-that is, anecdote. .. " and .. ".. I do beg you to exercise your power with extreme caution when advising patients with life threatening diseases to embrace unproven therapies. " Braun then proceeds to differentiate between the more simplistic inductive process, and falsificationism (or refutation) on which modern research is built. It is textbook stuff alright. Just one thing Michael Baum forgets - all primary knowledge is based on anecdotal experience. We naturally 'associate the positive' in our experience. To characteristically or habitually 'deny the negative' (this would be 'refutation of the null hypothesis' in Popperian terms) is virtually impossible because we are 'creatures of contact' and not abstract entities. The schemata of formal reasoning arrive much later in life and even then we communicate our experience in terms of affirmation, rather than denial. This is quite evident in the syntax of language: even the language that Baum uses: " If their [CAM] proponents lack the courage of their convictions to have their pet remedies subjected to the hazards of refutation then they are the bigots who will forever be condemned to practise on the fringe. " The juxtaposition of positives: IF <conditional statement / cause> THEN <conclusion / effect> makes intuitive sense to all regardless of mathematical ability or inherent truth - there is no better way to express an IDEA, but this is not refutation - it is affirmation. How then, does this phenomenology of experience and communication relate to medicine and epistemology? Simply this: Our knowledge, intuition and feeling about the world from the moment we begin to experience it is based on a substrate of proof by association, not denial by refutation. In this way, the 'methodology of the anecdote' serves as a vital link between the solipsism of the womb (extreme relativism) and the archaic world paradigms that have survived the vicissitudes of time and modern science to give us a great wealth of viable alternative and traditional medicines. Popper himself went to great lengths to make the point that falsificationism has a limited context and to apply the notion incorrectly leads to a fragmentation of knowledge [1]. I hope this brief exposition will stimulate Michael Baum and others in the mainstream of medicine to consider the merits of alternative medical paradigms per se, rather than attempting a transplant into the unnatural surroundings of a controlled trial that is bound to suffer either rejection or total suppression. This does not imply a return to witchcraft or spiritism (indeed traditional chinese medicine - TCM - rejected that path thousands of years ago in the Nei Jing, a famous text of antiquity). Rather we should understand the 'methodology of the anecdote' as a kind of time-conditioned (dare I say dialectic-historic) filtering of evidence that the laboratory is incapable of reproducing. I'd say respectfully to Michael Baum that "A little knowledge is a dangerous thing" and ask him not to forget where Popper's falsificationism originates - in a sound scepticism of the pretentious, both ancient and modern [2]. Let us applaud Prince Charles for fighting the corner for CAM. Thank you Sir! We owe you a great debt for helping to keep alive these ancient treasures in a throwaway world. Yours faithfully, Mr. G.A. "Sammy" Bates www.prostateman.org 1. "The fact that most of the sources of our knowledge are traditional condemns anti-traditionalism as futile. ..... without tradition, knowledge would be impossible" Karl R. Popper: Conjectures and Refutations. Routledge 1963. ISBN 0-415-28594-1. p. 28 2. "For the simple truth is that truth is very often hard to come by, and that once found it may easily be lost again. Erroneous beliefs may have an astonishing power to survive, for thousands of years, in defiance of experience, with or without the aid of conspiracy. The history of science, and especially of medicine, could furnish us with a number of good examples." Karl R. Popper, from his lecture "On the Sources of Knowledge and Ignorance" first delivered before the British Academy in 1960. Proc Br Ac 46. Competing interests: None declared |
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M C Feliciello, n/a Leeds
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I’d like to focus on the word “Complementary” here, not the phrase “Mutually Exclusive” I don't believe the Prince of Wales to advocate the abandonment of reason? Adequate and balanced nutrition is an acknowledged prerequisite of good health, but dietary elements have a role in healing too.We know relatively little about the active phytochemical components in our diet, even the humble carrot (1) Are we so ready to dismiss potentially untapped and abundant resources? Good research can be conducted on CAM (2)and will hopefully meet the territorial requirements of the most entrenched sceptic, but who will rush to fund THAT kind of research? Has anyone applied for the patent (3) on Carrots yet? (1) Health promoting chemicals in vegetables and fruit Lars P Christensen, Dept of Food Science, Danish Institute of Agricultural Sciences http://www.bioteamsouth.dk/download/Bioactives_DJF.pdf (2)Complementary and Alternative Medicine, When Rigorous, can be Science Edwin L. Cooper eCAM 2004 1(1):1-4; doi:10.1093/ecam/neh002 http://www.ecam.oupjournals.org/ (3)Associated Press GlaxoSmithKline Settles Augmentin Suit http://www.forbes.com/home/feeds/ap/2004/07/08/ap1448595.html Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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"....I was the only one of my colleagues unequivocally to register dissent....", methinks is hardly an accomplishment. Scolding Prince Charles for "promoting unproven cures for cancer" doesn't appear to be very constructive either. "The paper invited me to respond " . Well, Professor Baum, your comments invited me to respond to you, so you may, if you wish, consider this an open letter to you. Your response appears to me somewhat of a tirade, with just a judicious amount of arrogant confidence mixed in to stop short of offending.Your response does little to help the situation about which you are so concerned . "Over the past 20 years I have treated thousands of patients with cancer and lost some dear friends and relatives ....to this dreaded disease." This, semi-subliminally, gives the impression that you treated thousands and lost a few. The reality, however, would be that you most certainly lost thousands. You state that Prince Charles's "power and authority rest on an accident of birth ". This is a strange comment as I would have thought that the Prince, by now, is standing on his own feet, royal or not. You warn of the dangerous advice the Prince gives to patients with life- threatening diseases and you urge people not to "embrace unproven therapies". Well, what is a patient to do? Does (s)he 'embrace' conventional cancer therapy even at the risk that the embrace might turn into a lethal one? The undercurrent of your letter is, to me, bordering on insulting Prince Charles although you will probably be given the royal benefit of a doubt. About coffee enemas and carrot juice. This has such a hilarious ring to it but that is undoubtedly the intent. "Slash, burn and poison" would be an answer for the tabloids to consider. More seriously, the 30% alleged fall in breast cancer mortality since 1984 reminds me of the recent statement (also from Great Britain) of a significant decrease in overall cancer mortality and of the American Heart Association's oft-repeated propaganda for a drastic improvement on that front. Both were proven false and both had agendas. No, Professor, if you are trying to give the impression that the "WAR ON CANCER" is being won I am afraid that very few people would take you seriously. You challenge Alternative Medicine to present scientific evaluation but the tone of your letter clearly conveys that you would be the last person to move a finger to bring this about. Should a thorough testing of alternative methods not be MANDATORY ? After all, if this eventuated it could prove you right. The words of condemnation for Alternative Medicine come easy to you. You predict that "these bigots will be condemned to practise on the fringe". After a good look at the numbers I wouldn't be so sure about that. When you talk about SCIENCE and MEDICINE you may not be thinking about your track record concerning cancer but, as you must know, I am not alone in the conviction that there is little difference in cancer outcomes between 1974 and 2004; in fact the record is dismal! Dr. Max Gerson was no quack. Coffee enemas were not his invention, they were part of the "science of medicine". Yet you manage to make it sound as if Gerson were a member of the lunatic fringe. Issels, Livingstone-Wheeler, Cilento, even Hoxsey and many others were hounded, ridiculed and jailed, not because they were asking or coercing their patients to 'embrace unproven therapies', but because they were a threat. Pardon me for not taking the altruistic concern of the Medical Establishment for the welfare of their patients seriously in this context. There is far too much evidence to the contrary. Rather than castigating His Royal Highness for openly supporting alternative therapies it would have been significantly more productive if you had praised his efforts and asked him to join you in a no-holds- barred expedition into the innermost depths of Alternative Medicine. That, if you are not afraid of it (and as a loyal subject) would be the only logical road to march on. Condemnation without investigation - how does that fit in with your epistemology? You dismiss cures by Alternative Methods out of hand. Never happened, you say. But you may want to consider that even small untruths will eventually erode your credibility. Dr. Albert Schweitzer called Dr. Max Gerson a 'medical genius'. He praised him for his work and for his cures in hopeless cancer patients. I, for one wish to applaud Prince Charles for coming to the aid of the commoners by pointing out alternative roads that may be fit to travel on and may even be a better option at times. Rather than scold and lecture the Prince it would have been much better had you supported him for the good of mankind. But you wouldn't think of that, would you? That would take another Albert Schweitzer. Competing interests: None declared |
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Steve A Hawkins, none none
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(Ed: I first read an account of Prof Baum's letter via the NetDoctor' newsletter and tried to e-mail the comment below to him at UCL, but as the mail was 'bounced' and he does not seem to be listed on their server or the college directory, I wonder if you could either include it in your feedback, or pass it on for me. Thank you, SteveH) Dear Prof Baum, I have just read an account - via the NetDoctor service - of your castigation of Prince Charles' support for 'alternative therapy'. Whilst I hold no brief for the quacks in any branch of medicine, and have lost friends who followed 'alternative' therapies, I feel that, though I agree with much of what you say when it comes to the special case of cancer treatment, you are in many cases, wrong about the reasons people 'choose' the 'alternative'. You are quoted as saying: "There is this peculiar idea of a conspiracy in orthodox medicine that doctors want to deny their patients effective treatment. I don't know of any doctor who would not use a treatment that worked." This statement itself goes some way to explaining the 'peculiar idea': 'orthodox medicine' is only interested in 'orthodox' illnesses and diseases - which are, those from which drug companies can make the most profit from 'treatment' (There is a wealth of evidence of which I am sure you are aware.). As a result of this bias the word 'cure' has all but vanished from the medical literature, and those of us who have the misfortune to: suffer from 'unorthodox' illnesses; live in an 'unorthodox' part of the world - from which no profit is to be made; or who actually want to be cured rather than turned into life long addicts and cash cows for the drug companies, have NO alternative but to do nothing, or take the lesser, but, very expensive risk, of entrusting ourselves to the 'alternative' quacks. As someone who has been robbed of the enjoyment and productiveness of my middle years and sees little prospect of any positive change in the future, and who has never had any money to spend on 'treatments' of either kind, I am well placed to see the shortcomings on both sides of the Curate's Egg that is modern medicine, orthodox or alternative: both are 'good in parts'; both are effectively emasculated as a result of the very real conspiracy that is the profit motive. The result of this is that, for vast numbers of suffering people, doctors simply do not and cannot 'use a treatment that works', because under this system there is not and cannot be one, and their desperate charges are left to fend for themselves among the shark infested waters of 'alternative medicine'. Apparently it is not within the powers or inclinations of governments to insist on proper medical research that leads to cures rather than patents and profits, but, until this happens, there will always be a huge market for any would be 'alternative' manufacturer to exploit. It is a shame that you chose to apply your critical eloquence to an unfortunate effect rather than the cause that drives people to the 'alternatives'. Sincerely, Steve Hawkins Competing interests: None declared |
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Andrew N Bamji, Consultant (rheumatology/rehabilitation) Queen Mary's Hospital, Sidcup, Kent DA14 6LT
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Bravo, Professor, for saying what others do not even dare to think! However, the media have their part to play in this, for if they reported responsibly it is you who would get the four pages and the Prince of Wales less than one. I note that a number of Rapid Responses have commented that the Prince was calling for research to be done on some of these things - and that is vital if we are not always to be embroiled in arguments setting science against anecdote (as, indeed, a number of respondents have done). However the Royal Family does itself no favours by espousing offbeat causes. One could, of course, argue that the Prime Minister's family may not be so far behind... Personally I would like all columns about “alternative” remedies (that in the “Sunday Times” supplement particularly incenses me with its hearsay and flim-flam) to have a health warning prominently displayed at the top. There is abundant evidence (apparently, to be fair, reasonably well reported) that some "alternative" remedies may interact to fatal effect with drugs; there is good evidence also that some herbal preparations are heavily contaminated with steroids, paracetamol and other substances; and evidence also of direct harm (for example, the substitution of Aristolochia for another herb of similar Chinese name, resulting in an epidemic of renal failure, and renal cancer, in Belgium). Competing interests: My son has recently completed a course of chemotherapy for cancer |
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Geoffrey C Rivett, historian, retired medical civil servant 173 Shakespeare Tower, Barbican, London EC2Y 8DR
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In the archives of the King's Fund (A/KE/569/8) reposes the "Lister Letter" written in 1897. Lister was asked to give his views on how the money of the Prince of Wales' Fund, now the King's Fund, should be distributed. He wrote that a great problem would be to decide which hospitals were run on a sound professional basis. He referred to hospitals that prescribed red electricity or green electricity. He thought that an authoritative group of advisers was necessary - but that was not what Edward, the then Prince of Wales had in mind. Nevertheless the Fund did behave with probity and took heed of its visitors remarks. Perhaps it is time that the Lister letter was disinterred. author: The development of the London Hospital System, 1823-1982 (King's Fund, 1986) Competing interests: None declared |
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John P Briffa, Doctor and Writer London
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Professor Baum pulls no punches in his criticism of the Prince of Wales’ support of complementary cancer treatments. The crux of his argument seems to be that the Prince of Wales should not be advising individuals to embrace ‘unproven’ therapies. The Profressor seems to take particular exception to the Prince of Wales’ recent show of support for the so-called Gerson therapy - a cancer treatment based on vegetable juices and coffee enemas. The Gerson therapy is unproven, in that it has not been subjected to systematic study. Whether it is of broad benefit to cancer patients is simply not known. Was it so wrong for the The Prince of Wales to call for more study in this area? But, even before the evidence is in, Profressor Baum seems to dismisses nutritional therapy out-of-hand, and describes the experience of cancer sufferers who are apparently cured by it as an ‘urban myth’. I respectfully remind Profressor Baum that that, as far as the potential benefits of a treatment are concerned, absence of evidence does not necessarily mean evidence of absence. It appears as though Professor’s Baum’s views on naturally-oriented cancer therapies are based not on scientific objectivity (as he seems to assert), but prejudice. It is perhaps somewhat ironic that, in his letter, he indirectly cautions the Prince of Wales about letting his personal beliefs prejudice his advice. A strong subtext in Profressor Baum’s letter is the notion that conventional cancer treatments are based on sound scientific ground. But is this really so? Chemotherapy is often recommended for several types of cancer for which there is no clear evidence of benefit. Currently, cancer affects about one in three of the population, and kills one in four. These bald statistics mean that the great majority of individuals diagnosed will cancer will die from it. This is hardly a ringing endorsement of conventional cancer therapy. In a television interview Professor Baum expressed the opionion that natural treatments for cancer are potentially harmful and may reduce the quality of life. Of course this is true, but one wonders how the risks of drinking vegetable juice and having coffee enemas compare to those of conventional therapies. Profressor Baum, of all people, should know that treatment with chemotherapy is generally no stroll in the park. Surgery and radiotherapy are not without real hazard either. Conventional cancer therapies may have important detrimental effects on morbidity and mortality. The dawn of the information age and a rising desire for self- empowerment means thatm like it or not, individuals are becoming increasingly knowledgeable about the principles, practice and politics of medicine. And more and more, it seems, they are growing cautious of conventional medicine and ‘expert’ opinion. I suspect Professor Baum’s views will do little to restore people’s faith in these things. Sri Varman congratulates the Professor on having the courage to point out that the Emperor has no clothes. Perhaps Mr Varman might like to clarify which Emperor he is referring to? Competing interests: None declared |
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Luke Devey, Research Fellow University of Edinburgh
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Writing as a doctor struggling to learn the art of molecular biology (through which doctors and scientists seek to understand illnesses and develop new treatments), I can attest to the huge complexity of the subject. Science is difficult. Science requires great effort on the part of those who wish to understand it. Because it is so difficult, I fully understand the human temptation to seek understanding of the world's mysteries in a more intuitive, simpler way. Alas, such oversimplifications only reveal mirages. Medical science, like all technologies relies on the cold analysis of hard data: would we have mobile phones and spaceships if our physicists had ignored the facts in front of them? In contrast with professional scientists, most of us, the prince and his defenders included, do not have the ability, training, skills or years of effort to fully understand the complexities of science. Contradiction of scientific research, without the foundation of extensive scientific education is prejudiced folly. Arrogant are those, whoever they are, who discount the lengthy application of powerful scientific brains, because they are unable to understand the complexities of the subject. Facts are facts, however hard to grasp. Competing interests: None declared |
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Carl Thomson, Retired NHS Consultant Formerly West Cumberland Hospital, CA28 8JG
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We should, as a profession, be behind Prof. Baum's sentiments. If conventional medicine is to be disciplined by sound, statistical evidence of cost benefit, then complimentary measures, I refuse at present to call them medicine, should be similarly validated. Those who wish to make a living selling it should be licensed and reqired to furnish the evidence of effectiveness before public money is used to provide the complimentary measures. Certainly, soothing sick patients to make them feel generally better or less anxious is a full part of orthodox medicine we should all continue to apply, but we need to differentiate between what is curative and what is simply soothing. Even if I have nothing more wrong with me than an unexpected tax bill, I reckon that a gentle massage by an attractive attendant in a warm, pleasant-smelling environment with relaxing music is going to make me tick the 'feel better' box - at least for a while. We need to be clear about this aspect to decide how our tax dollars are spent, otherwise, it is like asking who is for free beer for the workers. Competing interests: None declared |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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Many of the newspapers reported Professor Baum's open letter, with which I completely agree. But in the same issues of many of those newspapers there appeared photographs of Gwyneth Paltrow, freshly sporting evidence of a recent moxibustion session. Just as Prince Charles had more space in the newspapers than did Professor Baum, so Gwyneth Paltrow did also. As another e-correspondent has commented, we have an uphill struggle if the media report uncritically on unproven but fashionable therapies. Competing interests: None declared |
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Dr. Naseem A. Qureshi MD, IMAPA, LMIPS, Locum Psychiatrist Postcode:64399, SBAHC, Riyadh, KSA
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Sir: His highness, Prince Charles is a well known campaigner for the advancement of Complementary and Alternative Medicine [CAM], which has currently received international back-up for scientific research and practice. Indeed, WHO is supportive of CAM. Consequently, even other international medical organizations have earmarked substantial funds for testing the value of alternative medicines in various medical diseases, treatable and untreatable. Prof. Baum's letter openly criticizes not only the ever increasing research interest of medical personnel in alternative medications but also supporters of CAM campaign including Prince of Wales, which does n't do any justice. Dr.Baum must disclose his competing interests, which might have guided him to write such a skeptical letter to Prince of Wales and about CAM in particular. It is strongly hoped that CAM will flourish in future and take the major, leading role in alleviating the pains of those patients with (in)curable diseases without developing any untowards complications, which are most common with modern medicines. Reference: Michael Baum. An open letter to the Prince of Wales: with respect, your highness, you've got it wrong.BMJ 2004; 329: 118. Competing interests: CAM Campaigner |
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Paul A Taylor, Health campaigner Darlington DL3 7SX
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In fact there is plenty of evidence that natural therapies, or Orthomolecular Medicine as it is more properly known, are effective in the treatment of cancer. Indeed, the Journal of Orthomolecular Medicine http://www.orthomed.org/jom/jom.htm publishes peer-reviewed research of this kind on a regular basis, and has been doing so continually for 36 years now. Either science is objective, in which case it considers ALL of the available research, or it is not, in which case it considers only that research which the likes of Prof. Baum consider to fall into his own particular belief-systems. I proffer therefore that some science is not considered politically correct, and that our healthcare systems and scientific establishments are therefore clearly in need of a radical overhall. Competing interests: None declared |
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Rev Dr Michael Ellner, President HEAL, (Health Education AIDS Liaison-NYC) New York, 10113
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Prince Charles is right to exercise his basic human right and responsibility to question, challenge and, when necessary, FIRE his doctor. Take heed England, the Journal of the American Medical Association acknowledged that modern medicine is the third leading cause of death in America. Most conventional medical treatments are not helping the majority of people taking them most of the time. Many Americans are seriously harmed by Dr. Baum’s "proven treatments”, and over 200,000 a year are outright killed by them! (JAMA. 2000; 284: 483-485). The good news is that millions of people around the world are waking up and smelling the herbal teas; many are doing their own research, firing their doctors and taking charge of their lives and health. It is obviously long past time to hold the practice of medicine to the same scientific standards that Professor Baum insists is lacking for alternative health care. Rev. Dr. Competing interests: None declared |
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Robert I. Rudolph, M.D., FACP, Clinical Professor of Dermatology, University of Pennsylvania, Philadelphia, PA, USA 1134 Penn Avenue, Wyomissing, PA19610 USA
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At the risk of having myself eviscerated (since I am an American and have no experience with "Royals") I must admit that the letter to Prince Charles, and the retorts anent it, make for entertaining reading and theater. I won't detail my own views regarding the medical science (or lack thereof) expressed in the original letter, or the Prince's statements which prompted it, or the numerous rebuttals, but will simply ask: "Who cares at all - or should care at all- what he said about this matter"? The Prince should have, in my opinion and in this context, been given the same reception as Sean Penn (a very prominent US actor) received when expressing his political views here in the USA. Both nabobs are certainly entitled to speak their piece, but their comments are, to my mind, utterly meaningless and irrelevant, and should carry no weight. Their amateurish statements should not have been exalted or elevated with great whoopings and shoutings by anyone, much less us professionals. I would hope that the intelligent citizen of each country has been able to recognize the comments for what they were, and has not clutched them to their bosoms as gospel. If not, then these acolytes deserve whatever they get. Competing interests: None declared |
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Croft Woodruff, health researcher, journalist, broadcaster 6262A Fraser Street, Vancouver BC, V5W 3A1 [604] 327 3889
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Prince Charles' recognition of the Gerson Therapy as having value as a cancer treatmentc certainly has the U.K. cancer establishment setting its hair on fire while personally attacking the prince. What is laughable is the fact Dr. Nicholas Gonzales of New York recently received a grant from the U.S. National Institutes of Health [NIH] to fund a large clinical trial using nutritional therapy to treat cancer. The grant was given in light of the fact that Dr. Gonzales has a demonstrably successful track record in the nutritional management of cancer. Of course the old boy network (or is it nitwits?) in the cancer establishment attacked NIH for giving the grant. What are they afraid of? They are always demanding proof until there is the likely hood of a study -then they try anything to shut it down. Same thing with chelation therapy - there was to be a chelation study set up at Washington State University in Seattle - jointly funded by the Office of Alternative Medicine [NIH] and the American College form Advancement in Medicine until the Quackbusters got wind of it and went so far as to approach the Governor of Washington to shut it down before it even got started. I had the privilege of spending a whole day with Dr. Albert Schatz, , co-discover of streptomycin, in Montreal in the early 1980's as guests in the home of a mutual friend, Dr. Jean Marc Brunet of L'Naturiste and who is a well known Le Journal de Montreal columnist. We talked of many things. Max Gerson was the personal physician and friend of Albert Einstein and the philanthropist and missionary, Albert Schweitzer. Dr. Gerson cured Schweitzer and his wife of various health problems including adult onset diabetes. Albert Schatz was also a friend of Dr. Gerson, Dr. Einstein and the the Schweitzers. Croft Woodruff Competing interests: None declared |
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Alan S. Meltzer, Previously Senior Medical Advisor, Laboratory Centre for Disease Control, Health Canada 350 Wellington St. (Apt. 402), Kingston, Ontario, Canada K7K 7J7
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Professor Baum is to be congratulated for his brave initiative. Thinking that there is always a "cure around the corner" we tend to become complacent about cancer. Any vigorous debate on the topic is to be welcomed. It is hard to reconcile the intermittent optimism which swirls around the cancer scene with our frequent sad farewells to friends who die prematurely because of the disease. For despite some major gains in diagnosis and therapy, cancers of the breast, ovaries, lungs and prostate remain horrendous captains of death for millions of people worldwide. In the 1960s I did a short spell in chemotherapy in the NHS. Now I have the feeling that we are not as far along the cancer road as we should be. When assessing our current progress we need to humbly remember that the early Egyptians used surgery to remove growths and chemotherapy is a spin-off from the deadly mustard gas of World War one. New approaches are needed ! Now is the time for increased support; new ideas and initiatives. Professor Baum's action has the potential to spur vigorous debate on the topic. Now we should all be asking the question "could we be doing better?" Competing interests: None declared |
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Hilary Butler, freelance journalist home 1892, NZ
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Dear Sir You no doubt have read a book, by Dr Fisher called "Statistical Methods for Research Workers." This 1925 book, as no doubt you know, forms the foundation for all statistical analysis now used by scientists. Critical to this method, as you also will know, is the so-called P- value, defined as the chances of getting at least as impressive evidence as that actually seen as if a simple fluke was at work. Correct? These P-values are worked out mathematically from the raw experimental data. According to Dr Fisher, if the resulting P-value is below 0.05, then it is safe to label the finding as "significant". Open any leading medical journals and you will see the phrqase "P<0.05" in every conceivable areas of research. Especially in cancer research. Correct? Well, see, I have a problem with the whole concept of the P-values, and do you know why? Imagine my surprise when I read that apparently, there is ***no ****scientific ****rationale ***** for the figure 0.05 whatsoever??!!!!! Apparently, Dr Fisher chose that figure because he said it was "convenient". As you might see, the implications for this are far reaching. Not least of which is this question: Could it be that this standard "scientific" baseline is a load of hogswash decided by an arbitrary standard chosen from the crystal ball from the er.. um... well... "I don't know" domain? Could it be that the results of any research using this arbitrary standard is thereby subject to critical flaws? Flaws which have been written about in great detail in the 80's by Professor James Berger of Purdue University, who published an entire series of papers alerting researchers to the tendency of the standard tests to be very wrong. Oh and Professor Leonard Savage, who said that P-values were able to boost the apparents significant of implausible results by a factor of 10 or more. Both warned that P-values were very prone to attribute significance to fluke results. Both were ignored. But then, such is the way of medical history. If the above is corrent, then how is it that Professor Baum would have us believe, that THIS WORK, vests in him the power and authority... and the audacity to criticise Prince Charles's suggestions? Actually, I don't think much of Prince Charles's call either, if it means the studies he wants done are to be done using what appear to be happenstancely conceived P-values. As seen elsewhere, medical icons in the late 1800's were prescribing either red electricity or green electricity. On what basis? Fashion maybe? Could it be that the "fashion" of what Professor Baum has to offer, is about as valid as green or red electricity? Or maybe, the use of blood letting? Or perhaps mercury purges and a whole raft of medieval certainties of back then in them there days? What needs to happen is that someone needs to take these issues head on, to expose and abandon any unscientific basis for much of the research medicine now considered "valid". If the above is true then many of the medical claims would be seen to be a flurry of words, for the benefit of the researcher's CV. And medical libraries might, of necessity have to eliminate at least 90% of that which is now considered statistically significant. Then, which emperor would have no clothes? Hilary Butler Competing interests: None declared |
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Patrick P L Quanten, Indepedent Health Adviser Alderney GY9 3XL
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Dr Baum bases his authority on 40 years of intense study and 25 years of experience. The study he refers to is one of a medical system which is no more than 200 years old. Traditional Chinese Medicine, Ayurveda and every other traditional medical system around the world are several thousands years old. All these systems have a serious scientific background, which one can study and comprehend. These systems have survived all this time virtually unaltered because of their effectiveness and solid basic philosophy, unlike the Modern Western Medical System, which changes its advice so rapidly that even doctors very often are not aware of the "advances" made. The "alternative" medicine - alternative to what people have always used - is our Western model, not the traditional medicine of the world. Competing interests: None declared |
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David Potterton ND MRN MNIMH, Medical journalist, Naturopath, Medical Herbalist Reading, Berks RG31 5EB
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Dear Richard Smith, As a medical editor(i) may I first congratulate you on a good piece of circulating-building journalism. Orthodox versus unorthodox always makes a good read. And always too good to reject on the grounds of inaccuracy. As a number of Rapid Responses point out Michael Baum did not check the accuracy of his sources before going to war. It’s so easy to read what Prince Charles actually said. I have it in front of me now (try Google… Prince Charles). Cancer is a serious subject – and therefore all serious attempts at improving the treatment of people with cancer should be properly examined. It is getting on for 50 years since Max Gerson MD wrote his book(ii) (432 pages) – detailing with case histories, photographs and x-rays – his success with 50 terminally ill patients, thus giving accounts of a wide spectrum of invasive tumours. It is a book that should be read by every oncologist. I wonder whether Michael Baum has read it? Have you? In the preface Gerson writes: “The history of medicine reveals that reformers who bring new ideas into the general thinking and practice of physicians have a difficult time. “Very few physicians like to change their medical approaches. “Right from the beginning the physician wants most of all to help the patient. He hesitates to take risks for his patients by applying a not- recognised treatment.” This is why people with cancer may decide, for example, to try an alternative; why they may go to the Bristol Cancer Help Centre (BCHC), try the Gerson therapy, or some other therapy, which may or may not be helpful. Has Michael Baum ever visited the Bristol Cancer Help Centre? Have you? I certainly advise people with cancer to go there. I do recall that the BMJ published a Personal View on the BCHC in September 1990 by Jeffrey Tobias (based on the belief that a study performed by respected conventional researchers couldn’t possibly be wrong) It was entitled: “Surely a natural cancer remedy can’t be dangerous – can it? (iii). Have you forgotten that the BCHC had to close its doors for a time until the research was shown to be flawed? Incidentally, Prince Charles officially opened the BCHC and many of its methods have since been incorporated into conventional care. Michael Baum uses the term Gerson proponents? The only real “proponents” in the UK are the people who are following the Gerson regime and who belong to a self-help organisation. They help one another because the oncologists are not interested. I am not a “proponent”, but I would like someone to take a serious interest in what this group of people are doing for themselves. Until recently osteopathy and chiropractic were branded as quackery, but are now statutory regulated and part of the “system”. It may be news to you, but in about two years’ time acupuncturists and medical herbalists will also start to become statutory regulated and will also become part of the system – and doctors will refer their patients to them. This is quite good progress as the National Institute of Medical Herbalists wasn’t founded until 1864. Won’t leave many “quacks” left to pillory then will it? Although, there’s always the homeopaths, I suppose. As herbalist Nicholas Culpeper said in the 17th Century: “Please God give the physicians some wisdom. They have more than their share of ignorance already.” (i) British Naturopathic Journal. (ii) A Cancer Therapy: Results of Fifty Cases, Totality Books, California, 1958. (iii)BMJ, 1990, 301, 613 Competing interests: None declared |
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Eddie Vos, maintains health-heart.org Sutton Qc Canada J0E 2K0
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In response to researcher Dr. Devey: science is indeed complex and much research leads to confusion since the basic nutritional confounders are ignored. Prince Charles proposed to deal with some of the nutritional approaches first and to do more research in this field.
Quoting from Dr. A.W. Saul's editorial in the current J. of Orthomolecular Medicine (2004 V19(2):67): "[M]edicine" may well be called the study of what happens when poisonous chemicals are placed in malnourished human bodies." No researcher would do animal studies in sub-optimally fed animals but most human disease studies, and diseases, operate in this context. Sub-optimal nutrition equals illness and medical uncertainty, and as sure as one can kill a rabbit with cat food, so can one kill a cat with rabbit food. Human diets [deep fried and folate depleted] are where on this scale? A most often ignored dictum in the study of any illness [first scurvy and now heart disease and cancer]: "It's the micronutrients. Stupid!" It seems in this context that the Prince called for more effort. For example, it makes more sense to supply adequate folate to help prevent Alzheimer's and cancer [DNA damage by uracil replacing thymine -(Blount, Ames et al (1)] than to reach for anti-folate drugs like methotrexate to kill growing cancer cells from DNA damage. Back to the basics of Nutrition First, otherwise the science will never make sense. Bravo Prince. (1) BC Blount et al. Folate deficiency causes uracil misincorporation into human DNA and chromosome breakage: implications for cancer and neuronal damage. Proc Natl Acad Sci U S A. 1997 Apr 1;94(7):3290-5 PMID 9096386. Competing interests: None declared |
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Caroline Richmond, Obituary writer SW3 5AQ
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In December 2002, 9 years after being diagnosed with a low-grade lymphoma – that’s a slow-growing cancer of the immune system – I developed a high-grade lymphoma. That’s a very aggressive cancer. Jackie Kennedy and PRince Husein of Jordan died of it. Within a fortnight I had a lymph node the size of a cow pat and couldn’t breathe because of fluid round my lungs. Things were looking bad. I asked my oncologist what my chances were of lasting another 12 months. He said, about 50% with a stem cell transplant and 25% without. I had the stem cell transplant (preceded by standard and then high dose chemotherapy) and, as even you may have gathered, I am still alive. Incidentally, I haven’t tried Gerson therapy. The Canadian physician and medical writer Dr Rob Buckman says those coffee enemas ruin the taste of the coffee. Competing interests: None declared |
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Dr. Anne H Spencer, Founder IMDHA IMDHDA 4110 Edgealnd #800, Royal Oak, MI 48073 USA
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FYI - Michael Ellner is a Fellow of the International Medical and Dental Hypnotherapy Association® and has helped thousands to heal using Hypnosis alone and/or combined with traditional western medicine. Dr. Ellner is one of the most sought after professional speakers in relation to catastrophic illness and ways to help individuals heal - body, mind and spirit. We thank him for contributing to this e-publication. Dr. Anne, Founder IMDHA - www.infinityinst.com Competing interests: None declared |
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Howard D. Straus, President, Cancer Research Wellness Inst Carmel, CA 93923
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Dr. Baum's response to Prince Charles' address deliberately misstated the Prince's position. Where the statement was perfectly reasonable, "More research is needed," he made it sound like the Prince was recommending that people drop their chemotherapy (a really good idea, anyway). Dr. Baum repeats a completely false piece of propaganda that has been used for years: the Gerson Therapy is "unproven". Quite the contrary. The Gerson Therapy has been published for over 70 years in the world's leading peer-reviewed medical journals, and confirmed by hundreds of serious medical scientists. This is a perfectly adequate definition of scientific proof, Dr. Baum, and ignoring it shows your incompetence as a researcher in the literature. And speaking of incompetence, your bragging of a twenty-year record of failure as a cancer "expert" who can't even cure his own family and dear friends hardly bestows upon you the "power" you claim. Even one cured patient would be worthy of instant attention from a profession that has few enough of those, and there are far more patients than that ready, willing and able to testify to their total recoveries, ten, twenty, fifty years after the Gerson Therapy. Conventional medicine insists on "randomized, double blind" studies, yet the studies that it does on chemotherapeutic agents ALWAYS compare the agent under research with another chemotherapeutic agent, NEVER against no agent at all, a placebo, or a natural therapy. The end result only is a comparison between two ineffective treatments, the lesser of two evils, so to speak. What are the researchers afraid of? Is it possible that a placebo, or no treatment at all would be better than any chemotherapy? If not, let them do that research. Desperate patients in the United States and around the world are turning increasingly to alternative therapies because of the manifest failure of conventional approaches to cancer that produce benefit mostly to pharmaceutical giants and the oncologists. Do they not deserve the medical profession's honest evaluation of alternative therapies? If Dr. Baum is so confident that holistic, nutritional therapy is useless, wouldn't he encourage an unbiased and careful test to demonstrate his point immediately and conclusively? Then he would not have to pretend to know something that he clearly does not, resorting to bluster and innuendo. Wasn't it Dr. Baum himself who stated that bolstering the immune system would be a prime goal in avoiding or curing cancer? That is exactly what the Gerson Therapy does! If Dr. Baum knew anything at all about the therapy he is so roundly condemning, he would see that it was in total agreement with his own recommendations. What are you afraid of, Dr. Baum? We are not afraid of an honest trial, we would welcome it. Our records and centers are open for inspection by any competent authority; none has ever come to evaluate us. If you, or any other researcher would like a bibliography of the Gerson Therapy and the hundreds of published confirmations in the literature, I would be happy to send it. Sadly, I do not expect any inquiries from Dr. Baum. (The bibliography is also published on the web, on the website www.doctoryourself.com). Finally, I imagine it must take a lot of courage to so frankly and bluntly insult the future King of England, especially when you are so very wrong. Competing interests: I am Dr. Gerson's grandson, and the author of his biography, Dr. Max Gerson: Healing the Hopeless |
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William G. Pickering, Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne NE3 4AL
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Common medical politics. "We probably share many opinions about art and architecture" conjectures the commoner Baum to the Prince of Wales. This seems presumptuous, anecdotal and without "scientific evaluation": but no matter. Baum, we learn, reads the Daily Express, has treated thousands of patients, feels able (amazingly and perhaps unwittingly revealingly) to place the GMC and the monarchy in the same sentence, and is possessed, he announces, of "power and authority". So who but a fool would doubt that his architectural and artistic sensibilities, like his scientific ones, are of the highest order? We certainly relish his every word and are thoroughly gratified to be informed by him. The generous-hearted Prince will feel that his cleverer and most humble subjects, of which Baum is a very beautiful example, occasionally fire off indignant reproach in a variety of directions, but that this does not necessarily diminish them as a human. We commoners are less certain. For example, Baum doesn't care for the public press — though he nonetheless laments that he "only gets one page of exposure when a prince gets four". Demonstrating his altruistic concern, he exhorts that patients' lives may be ruined by the media's predilection to attention-grabbing but incomplete medical headlines, merely to sell newspapers [1]. But most unscientifically (for a doctor of his stated calibre), he does not balance this truth with other important facts. He does not remind us that many single and serial medical disasters would be continuing yet had it not been for the press, who, with the police and the public, are still the nearest thing the health services have to clinical accountability. And Baum, the Prince may be amused to hear, is at odds not just with him but with the Chief Medical Officer too. Oh yes. Together with an ex-president of the GMC (to which institution Baum appears to be inseparably affianced) he finds the CMO's idea of a 'duty of candour' for doctors a distinctly unpalatable one [2,3]. A worrying development this, the Prince may think. It would seem a pretty fundamental issue for medico-politicians to agree upon. Instead, they disagree via journals. Logic and science are intermittent even with Baum. The sagacious Prince will forgive this inconsistency of course. He may ruefully wonder though, with good reason, whether his old accusations of medical complacency are not still as applicable as ever. Author: William G. Pickering. Date: 12.7.04. References: 1. Baum M. Frenzy to feed the media can be bad for patients. BMJ 2002;325:774 (5 October). 2. Donaldson L. Making amends. Available on the Dept of Health's website at www.doh.gov.uk/makingamends. 3. Baum M. (co-signatories: Elias-Jones A, Hurwitz B, Irvine D, Neale G, Prabhu U). Making Amends misses the point. BMJ 2004;328:407 ( Competing interests: None declared |
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre LS27 8EG
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Sir I appreciate what Luke is trying to say but let him remember that people were being cured of, and curing themselves of (and will continue to be cured of) all manner of disorders long before 'molecular biology' was uttered. Sometimes simple is most effective. Regards John H. Competing interests: None declared |
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Louise Mclean, Homeopath W5 2HE
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Well done Prince Charles for speaking out as very few can get this kind of media coverage. There are in fact many cancer cures that have been actively suppressed and as Croft Woodruff points out, studies that have been shut down, presumably influenced by the medical and pharmaceutical establishment since they may harm their profits. I myself had a hard immovable breast lump with burning pain and heat and swelling under my arm. I was quite scared and loathe to submit myself to a doctor for examination, knowing that I would be bullied into having surgery and chemotherapy. This was in 1996. Luckily I was treated with homeopathic medicine which resulted in a complete cure and all of those symptoms are long gone. I saw pictures showing how chemotherapy leaves burn wounds when it comes in contact with the skin. One can only imagine what it does to the body when given internally. Watching someone in a collapsed state with their hair falling out can hardly logically be described as a healthy cure! It is high time we had proper unbiased studies using all the natural cancer cures, herbal, homeopathic and nutritional, etc. that are available. Louise Mclean Competing interests: None declared |
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Simon C Ottman, GP and Chinese Herbal Practitioner Stainbeck Surgery 7a Stainbeck Lane, Leeds LS7 3SL
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I wholeheartedly agree with Professor Baum that fair scientific scrutiny must indeed be applied to all therapies. This is especially the case when it is paid for by the public purse. Much is made of the willingness to adopt an integrated approach subject to rigorous scientific testing but little revenue for research flows from such statements. Furthermore, where good quality research is done, it receives scant attention. In the field of Chinese herbal medicine, there are many pharmacological papers published each year, yet when I ask my colleagues what they know about this discipline, they refer to the Great Ormond Street trial of eczema (1) and liver toxicity. Invariably, they forget that the outcome of this trial showed herbs to be beneficial in mild to moderate atopic eczema. As an NHS general practitioner much of my time is devoted to treating patients with chronic conditions. Intensive hospital investigations are followed by quasi-scientific diagnoses of exclusion (such as irritable bowel disease, chronic fatigue syndrome, fibromyalgia) and costly drug treatments of limited clinical efficacy. For patients such as these who have been failed by our allopathic approach, integrated medicine (2) using scientifically validated treatments offers a solution. As a practitioner of Chinese Herbal Medicine I am able to offer an integrated approach to anyone who walks in through the door of my private clinic, unless, ironically they happen to be an NHS patient of mine. Ethical considerations prevent me from treating my NHS patients in any private capacity, and constraints on NHS funding prohibit me from offering herbal treatment in my general practice. Thus my chronically ill NHS patients must continue the cycle of morbidity and ineffectual drugs indefinitely. As a general practitioner I wish to access the best of all proven treatments. As a Chinese herbal practitioner, I call for continued research into the efficacy and cost effectiveness of this discipline. I would welcome the opportunity to prove the deservedness of this discipline as part of an integrated approach that should be accessible to all. 1. Sheehan MP, Rustin MHA, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992;340:13–17 2.Rees L, Weil A. Integrated Medicine (Editorial) BMJ 2001;322:119- 20 Competing interests: None declared |
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Mark Struthers, GP Her Majesty's Prison, Bedford, UK
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Dear Professor Rudolph The very limited power and authority of the heir to the British throne rests on an accident of birth. It is very easy to mock the prince; he advocates carrot juice and coffee enemas to enhance a cure for cancer. The enormous power of the American president rests on an electoral disaster and a gullible people. Who cares – or should care at all - about the matter? George W Bush and his acolytes authorise a Texan plan to subdue these people with powerful and enriching narcoleptics [1] That’s a ‘sardonic view.’ Yours respectfully Mark Struthers [1] Bush plans to screen whole US population for mental illness. Jeanne Lenzer 19 June 2004 http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458 Competing interests: I shall remain a monarchist in view of the alternatives on offer |
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krishna g. badami, transfusion medicine specialist christchurch
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This discussion highlights the need for combining an open mind with rigorous scientific assessment. The history of medicine, like the histories of other things, ought to teach us that today's orthodoxy could well end up as tommorow's heresy and vice-versa. Competing interests: None declared |
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Bruce G Charlton, Editor in Chief - Medical Hypotheses University of Newcastle, NE1 7RU, UK
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Neither Prince Charles nor Professor Michael Baum seem to understand the nature of alternative healing and its proper relation to orthodox medicine [1]. Alternative healing is essentially a branch of New Age spirituality [2]. The New Age movement constitutes the largest and most rapidly-growing spiritual practice in the contemporary world, being well-adapted for modern scientific societies since it focuses on subjective psychological states such as integration, authenticity and self-expression which are ignored by other social systems including medicine [3]. The primary evaluation system of New Age healing is based upon subjective feelings, and is therefore utterly different from the socially-established evaluations of science [4]. This subjective evaluation system makes New Age healing immune to challenge by science or medicine. New Age validity is a matter of what ‘works for me’; contradiction from other people is re-defined as ‘your truth’ [2]. Individual experience is the ultimate authority, and if an individual claims that they find acupuncture, homoeopathy, crystals or runes to be effective in achieving subjective spiritual goals such as self -exploration, individuation and personal development, then there can be no argument from medicine or biology. The wide range of choice, competition and continual innovation in New Age systems of healing ensures that there is little chance of the public becoming habituated or fatigued by the stimuli on offer – there is always something novel to experience [3]. It seems clear that orthodox medicine and New Age healing systems can co-exist quite comfortably so long as neither tries to claim supremacy over the other’s proper domain. But orthodox and alternative cannot and should not become integrated, for precisely the reason that they are totally different forms of activity with different rules and purposes. To integrate would be to damage what is valuable in each [3]. Therefore there is no point in performing ever-more inevitably inconclusive (because inapplicable [5]) randomized trials of New Age therapies. Neither should alternative/complementary studies be published in the scientific literature. Nor should non-scientific healing be a part of orthodox medical training or practice. A clear demarcation between the spiritual and the scientific is vital not only to efficient science, but also to effective spirituality. References 1.Baum M. An open letter to the Prince of Wales. BMJ 329: 118. 2.Heelas P (1996) The New Age movement. Blackwell: Oxford. 3.Charlton B, Andras P. The modernization imperative. Imprint Academic: Exeter, UK, 2003. 4.Hull DL (1988) Science as a process. Chicago University Press: Chicago. 5.Charlton BG. Randomized trials in alternative/ complementary medicine. QJM 2002; 95: 643-645. Competing interests: None declared |
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Ellen C G Grant, physician and medical gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, Surrey, KT2 7Ju, UK
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Editor – Yes, science is worth the effort as it is about unveiling truth. Michael Baum is pleased breast cancer deaths have fallen.1 He does not mention the huge increases in breast cancer incidence which has matched the fluctuations in hormone use (mostly as OCs and HRT) since the 1960s.2 The most unscientific thing I can imagine is to cause breast cancer by exposing women to exogenous hormones and then to be delighted with the results of giving hormone receptor blocking drugs (plus radiotherapy and chemotherapy) as treatment. Coffee or other enemas can help eliminate toxic metals from the body, e.g. mercury from dental amalgams. Blood levels of metals and white cell sensitivity tests for each metal are available. Metal-free dentists may recommend enemas to help remove the metals which are being used by the dental profession but are increasingly causing symptoms like peripheral neuropathy and allergic reactions.3 After removal of metal contaminated crowns and bridges, faecal elimination is also helped with ingestion of chlorella, which is high in chlorophyll, and large doses of vitamin C, to prevent mercury being eliminating turning into the more toxic methyl mercury. Carrot juice is part of the “Eat more fruit and vegetables” campaign which has become establishment advice and is based on numerous trials showing anti-oxidants have health benefits which include cancer prevention. Prince Charles’ remarks did have a helpful scientific basis while Michael Baum said nothing to stem the increase in breast cancer diagnosis. 1 Baum M. An open letter to the Prince of Wales: with respect, your highness, you've got it wrong. BMJ 2004; 329: 118. 2 Grant ECG. Increases in breast cancer incidence http://bmj.com/cgi/eletters/328/7445/921#55298, 1 Apr 2004 3 Grant ECG. Re: Rapid Responses; Authors' reply. http://bmj.com/cgi/eletters/328/7445/921#55843, 6 Apr 2004 4 England J D, Asbury AK. Peripheral neuropathy. Lancet 2004; 363: 2151-2161. Competing interests: None declared |
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Steve Hickey PhD, Biophysicist Manchester Metropolitan University M1 5GD
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Professor Michael Baum’s open letter to the Prince of Wales uncovers a level of ignorance and arrogance that holds back development in medical science. Baum seems to argue that the Prince does not have the necessary scientific support or background for his ideas but then illustrates his argument with an inaccurate description of the scientific method. He argues that the Prince is embracing unproven therapies. This is true, as the scientific method does not prove things. There are no proven results in science as all facts are to a greater or lesser degree provisional. The term "scientific proof" is used as shorthand for people who claim scientific support but do not understand the scientific process. This term can indeed be used as a “cloak for bigotry” to support unscientific arguments by less-able members of the medical profession. Baum suggests the scientific method is based on the idea that experiments carry the risk that your “humble idea” might be shown to be false. He is mistaken as the specific purpose of an experiment is to refute a hypothesis, that is to show that an idea is incorrect. This change of emphasis leads to the central processes of replication and refutation that give the scientific method its unique power. In science, anyone can suggest a hypothesis. Even royalty are not excluded. There may be no royal road to mathematics, but in science we even allow a Prince his opinion, especially if it describes an new idea. A good hypothesis is an idea that could be correct, generally seems reasonable, and often suggests a simple experiment that can show it is wrong. Perhaps Baum might like to ponder just how much of medicine is based on other disciplines and has developed from the findings of people who are not members of his profession. Digitalis and smallpox vaccination originated with folk remedies. If Fleming, Florey and Chain had followed Baum’s approach, we might still be waiting for penicillin to be “proven”. Baum suggests that his extensive experience and training gives him a privileged position. In scientific terms, this is also incorrect. A call to personal authority is unscientific. Many years ago, physicians might have made an equivalent claim of long professional experience to support blood-letting. Physicians persevered with blood-letting as a therapy, apparently not noticing that it weakened and killed their patients. Moreover, this insular approach has hindered progress throughout the history of medicine. The scientific method is the primary tool to prevent people arguing from biased experience. Furthermore, all such experience should be considered biased and require independent scientific validation. The only reliable form of knowledge, in this area, is refutable knowledge. Baum suggests that alternative therapies need to be proven by scientific methods before use. The idea of scientific proof seems to permeate the medical profession but, in addition to being technically inaccurate, it is out of date. The appropriate decision-making technique is cost-benefit analysis from the theory of games. Requiring scientific proof is a means of sidelining alternative treatment and may be used to suppress complimentary theories. The medical establishment provides funding for experiments and clinical trials and this process is subject to bias. If people in authority withhold resources for trials, the treatment will remain untested. Since the treatment continues to be untested it can be ignored and disparaged. Furthermore, the term unproven can always be applied no matter how strong the supporting evidence. Baum relates anecdotal evidence of increased survival times in cancer patients as an urban myth. However, case studies and small-scale experiments have an important place in the scientific method. To illustrate the paradox, we might wonder if understands just how difficult it would be to robustly justify his statement that he has witnessed a 30% reduction in breast cancer mortality since 1984. The population, environment, nutrition, early detection and instrumentation have all changed over that time and historical controls are deprecated in the scientific method. Baum’s attack on the Prince comes at an interesting time for me as I have just released a book with Dr Hilary Roberts that is concerned with the misuse of science to suppress non standard therapies “Ascorbate, the science of vitamin C”,[www.lulu.com/ascorbate]. In this book, we report that vitamin C was found to be toxic to cancer cells as long ago as 1969 [Oncology, 23, 33–43]. Over the following 35 years, despite accumulating experimental, biochemical and clinical evidence, the medical profession has failed to perform the necessary experiments for the use of intravenous sodium ascorbate in cancer to be refuted or enter normal medical practice. One set of clinical trials was performed by researchers at the Mayo Clinic who failed to understand the difference between intravenous and oral doses [J Am C Nutrit, 19, 423-425]. These trials are now considered flawed. Unscientific medical bias has ignored a treatment that Linus Pauling suggested could reduce the death rate from all cancers by 75%. Pauling was denied funding for clinical trials, despite being a double Nobel Prize winner and one of the greatest scientists who ever lived. Just in case Professor Baum thinks this oversight is an isolated case, Dr Tom Levy’s book “Vitamin C infectious diseases and toxins”, [Xlibris press], reports over 1200 studies on the use of large doses of this substance. Dr Robert Cathcart who urged clinical trials was also ignored despite having treated thousands with high dose vitamin C and claiming astounding clinical results. The theory that vitamin C can cure, heart disease has also not been tested in humans, in over 50 years of published research, despite substantial supporting evidence. (Yes, the hypothesis is for a treatment of heart disease described as curative.) These experiments would have required only a minute fraction of the budget used to support medical research for a single year. Millions are dying unnecessarily if these longstanding but under researched claims are true. That is a high price to pay to support a level of medical arrogance exceeding that of royalty. I wonder how many times Baum has experimentally confirmed or refuted a claim for an alternative therapy. Baum could have performed a simple experiment to refute the efficacy of coffee enemas. However, he has chosen to attack a soft target. The Prince is not a member of the medical profession and has selected a relatively weak hypothesis. It is easy for Baum to ridicule the Prince as a layman and get widespread support from the more conservative elements of the medical profession. Baum’s attack on the Prince has the quality of a playground bully. I am currently asserting that the use of vitamin C and other therapies is denigrated and attacked by the medial establishment potentially leading to many millions of unnecessary deaths. This too is an open challenge. If Baum feels the need to attack the use of alternative medicine in cancer, I am more than willing to defend the use of vitamin C based on the scientific method. Competing interests: None declared |
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Adam Jacobs, Director Dianthus Medical Limited, London SW19 3TZ
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Many practitioners of CAM would love to be able to conduct the trials that could prove their methods are effective, but often can't because of the high cost of doing good quality research. Prince Charles would like to see CAM treatments used more often, and if I have understood correctly, would like to see more research on them. He also has unfeasibly large amounts of money at his disposal. Perhaps His Royal Highness should put his money where his mouth is and fund the research into his favourite CAM treatments out of his own pocket. Wouldn't that make everyone happy? Competing interests: A great deal of respect for the Prince's farming methods: I find his 'Duchy Originals' sausages truly delicious. |
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susanne mccabe, gardener/ cardiff cf 24 3pf
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Michael Baum's attitude is worrying. Charles Windsor is reported to have said that he is not only in favour of complementary treatments but that they should be properly researched and that importantly those who consult practitioners in mainstream as well as complementary medicine should be given information about all treatments so that they may make decisons involving their own lives. Two weeks ago on Spiked On-line Michael Baum supports a medical trainee's view that individuals should not be given all copies of letters doctors write to each other.(Copying letters to patients, Spiked On- line).His view is supported by the Lead for Patient and Public Involvement in Camden Primary Care Trust this week,Spiked On-line.(Brid Behir, Power to the Patient). Seems there is a very long way to go before compliance with people's rights is standard across the country - they again are being quietly ignored in Camden, an area with high numbers of people who are able to inform themselves and take action where necessary but equally high numbers of extremely disadvantaged people who will not even be aware their rights or that new guidelines have been introduced in order to modernise not only services but the relationship betwen those who use and those whoprovide services. Whatever the NHS belongs to us all - it is unethical for people in useful positions to deny others the rights they enjoy themselves. Competing interests: None declared |
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Eddie vos, maintains health-heart.org Sutton (Qc) Canada JOE 2K0
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I agree with professor Eeckels to divert money for Third World
mothers and children but he gives no evidence as to why this should come
from research budgets in "alternative medicine", an avenue proposed by
Prince Charles. The research money thus saved would be entirely insignificant.
Please tell me, what would be wrong using the US$b10/year spent on Lipitor instead, a single drug that proved to save zero lives, as per the final data of the ASCOT trial and that, as per the Lipitor.com website [accessed 2004-7-12]:" [Lipitor] has not been shown to prevent heart disease and heart attacks." Now THAT is U.S. FDA approved evidence-based medicine. For the unconvinced: here are 2 statin trial mortality graphs [ALLHAT and ASCOT]. The 2004 U.S. pharmacy price for Lipitor is $3/day, enough to nourish/supplement an entire Third World extended family. How much more money would be freed taking virtually all women off statin drugs, also an evidence based approach if female all-cause mortality in published trials means anything [BMJ 328 (7436): 404)]. The savings from this single drug class, part of "orthodox" medicine, would free sufficient funds to supply the basic micronutrient needs to the entire world, Third or not, an "alternative" approach recently shown to be of significant benefit in Africa even in such "impossible" disease as HIV/AIDS. Competing interests: None declared |
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Gerald Beuchelt, Software Engineer/Researcher Massachusetts, U.S.A.
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As a theoretical physicist I strongly appreciate your open letter and the related media attention you created. It is very timely to draw public attention to the dangers of relying on so-called 'alternative' medicine. You are more than correct to demand clinical studies of CAM methods - preferrably as true complement to a proven method. If such studies show improvements BEYOND the baseline of standard methods, such CAM methods might be suitable as adjunct treatment. It seems to me that quite a few of formerly 'complementary' treatments have undergone clinical studies in the past. As far as I knoe, certain herbal treatments as well as aspects of accupuncture have significant medical value are are now being used in mainstream medicine. Others might follow. I think it is also undisputed that a good diet is - at least - helpful to improve overall health as well as the immunological response capabilites. But you are right to point out that such efforts can - at best - be seen as complimentary today. The arguments of some proponents of CAM above seem to miss out one of the most crucial benefits of the deductive method (which has a far longer history of just '200 years'): Reproducability. Sound scientifical research is based on hypothesis and experiment, which either leads to falsification or (temporary) confirmation as a working hypothesis. Again, I applaude your civil courage to stand up! Gerald Beuchelt beuchelt -at- yahoo -dot- com Competing interests: None declared |
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Heather M. Goodare, retired 3 Glengyle Terrace, Edinburgh EH3 9LL
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The Prince of Wales does not need me to defend him, but I should like to join in the discussion. 'Medical humanities', especially the arts in complementary care for people with cancer, owe much to your advocacy, but as you know, research in complementary medicine presents great methodological problems. Some remedies such as herbal medicines can be researched in the same way as ordinary drugs, but this does not hold for most therapies such as massage, art therapy or music therapy. All we can say for most such interventions is that they may improve quality of life and give spiritual support. It is particularly difficult to research 'packages' of therapy such as those provided at the Bristol Cancer Help Centre, as was illustrated by the disastrously flawed study of breast cancer patients attending the Centre in the eighties. (1) As for genuinely alternative medicine, such as the Gerson therapy, the problems are compounded by the fact that such programmes are beyond the reach of all but a tiny minority, for two reasons. First, they are extremely expensive, requiring cartloads of organic produce, and assistance to help prepare all the juices. Second, they require a huge amount of dedication and motivation on the part of the patient. Following the Gerson regime is very tough for both patient and family. How could one possibly randomise patients to undertake (or not to undertake) such a programme? Funding is also problematic: although the cost of the Gerson programme compares favourably with the drugs used in advanced cancer, there would be no pay-off for pharmaceutical companies if it were shown to be effective. Funding must come from elsewhere. In the meantime, we are dependent on 'anecdote' to document such matters. But much research stats from one anecdote, or case history. For the Gerson therapy, apart from Dr Gerson's own 50 case histories (2), we have some outstanding, well-documented examples in the UK such as those provided by Beata Bishop (3) or Michael Gearin-Tosh (4), with Frances Carroll (5) even partly supported by her health authority. In my view we should welcome such pioneers, and applaud their fighting spirit. Things have moved on since the eighties, when it was difficult to find organic produce: now it is in every UK supermarket, and the 'five a day' slogan is everywhere to be seen. The role of nutrition in cancer prevention is recognized: its role in care and even possibly cure has yet to be determined, but we must not turn away from such evidence as already exists. We should also seek methodologies and funding that will enable us to research nutritional therapies in a manner that will satisfy both orthodox and alternative practitioners, as well as the general public of potential patients. Proponents of such therapies do not 'lack the courage of their convictions': they do lack research funding, and perhaps new ideas about methodology. We still have much to learn. 1 Bagenal F S, Easton D F, Harris E, Chilvers C E D and McElwain T J. Survival of patients with breast cancer attending Bristol Cancer Help Centre. Lancet 1990; 336: 606-10. 2 Gerson M. A Cancer Therapy - Results of Fifty Cases. Del Mar: Totality Books, 1977. 3 Bishop B. A Time to Heal. London: New English Library, Hodder and Stoughton, 1985. 4 Gearin-Tosh M. Living Proof: a medical mutiny. London: Scribner, 2002. 5 Revill J. Now Charles backs coffee cure for cancer. London: Observer, 27 June 2004, p. 3. Competing interests: Heather Goodare attended the Bristol Cancer Help Centre as a patient in 1987. |
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Sandra H Rowles, retired health service manager Home - MK2 2RW
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I am writing to say how disappointed I was to read you pouring scorn on the complementary therapy approach that Prince Charles supports. I would have hoped that, with all the experience you claim you have, you would have been able to take a much broader view of healing and value the sharing of ideas in order to help people like me who have cancer. I am a qualified nurse and health visitor and ended my working life working for my local Health Authority as a Senior Manager. I worked for the NHS for 30 years before I took early retirement on health grounds in 2002. I have had 3 breast tumours, one of which was ductal and have had two mastectomies and a double reconstruction – 1994 & 1996. In February 2002 I was informed that I had metastatic growths in my bone and lymph – the diagnosis being confirmed by a CT Scan and a bone scan. I felt totally devastated and my husband and I began to face and plan for my early death. This involved doing my best to get as much out of the months I had left but it was difficult when I was receiving very negative messages from the medically qualified people around me – messages that were more in their ‘body language’ than what they actually said. My sub- conscious mind tuned into this though because I, too, knew what I thought would be the inevitable outcome. The cancer machine started rolling and I felt as if I was rapidly losing control of my life as decisions and plans were being made with what I considered to be little actual discussion. I had radiotherapy for my bone cancer and was prescribed hormone treatment for the other cancer. I read all the information available for patients on the drugs I was offered and for me that information fell far short of what I needed to know. I then managed to get hold of the clinical trials of the hormone treatment and gained a view of the risks and benefits as demonstrated by those trials. All the literature I read was detached, scientifically presented and lacking in any humanity. I realise why this is but I can assure you, it did nothing to inspire confidence in me. I felt well at the time, I was not afraid to die but I wanted to have a good death and to live what life I had left to the full. I needed information based on research into quality of life but there was very little available. So, having read the clinical trials of the hormone treatment and gained a view of the possible side effects, I decided not to take them and to pursue a ‘natural’ approach instead. My Oncologist responded to my request for a longer consultation to discuss it all, she did me the honour of respecting my views, and we agreed that I would review that decision if my condition deteriorated. I asked all my friends and my church to pray for me. I then went on a 2 day Introductory Course at the Bristol Cancer Help Centre of which Prince Charles is the Patron. They turned me around and gave me hope. They also gave me back the control over my life, which I felt I had almost lost. I went there dying from breast cancer, I left there living with it! Since that time I have been on amazing journey of discovery. I read books, some of which have been written by eminent surgeons like you, full of real life stories, of people who have fought back effectively – books which are far more inspiring and encouraging than a barrage of statistics where people are reduced to numbers and lose their humanity. I learned to overcome the fear and fight the negative messages I was receiving; I learned to tune in to my body and to follow what it told me to do. I discovered how essential it is to deal with the Body, the Mind, the Emotions and the Spirit in a totally holistic way. I have discovered that, when it has the right nutrition, when it is nurtured and balanced in every way, the body does have the capacity to fight disease itself – even secondary breast cancer - without necessarily needing aggressive medical intervention. I have discovered that we all need an individual, integrated plan depending on our situation and this is something that purely evidence -based, scientific medicine, which tends to concentrate on the area of the body which is affected, while trying to rush through patients in pursuit of NHS targets, often does not have the time, knowledge or resources to help with. The plan may involve a mix of conventional treatment and complementary medicine or complementary therapy alone, but I suggest it should always involve good nutrition. Yes it will need constant review, but time should be taken to find what is right for each individual and no one should be pressured to follow one particular path or another. It is essential to tap into the knowledge held by the real ‘expert’ – the person himself or herself! In the same way that I rejected conventional drug treatment, I dismissed the more extreme forms of ‘natural’ treatments as I felt that they would not nurture my body in the way I needed or improve my quality of life. So, with the help of 2 qualified Naturopaths, I developed the programme I am now on and which I am willing to send to you if you are interested. What a shame that more complementary therapies cannot be made available on the NHS – it has cost me a great deal but I don’t regret one penny of it! So here I am, 2yrs 6 months later – feeling healthier than I have felt for years, happy and enjoying every day. In fact, I am considering looking for part-time work in the autumn. The physical evidence of my cancer has vanished. I have not had a repeat bone scan but I have no bone pain. I need no painkillers for anything, not even a headache. As an added bonus, the wheat allergy I had has completely gone so I am enjoying ordinary bread for the first time in years. Every day I thank God for this miracle and for the knowledge and understanding I have been given. I also thank God daily for Prince Charles and his willingness to speak out for us. He could so easily just live his life of luxury without giving a thought to those of us who are far less privileged. But instead he has had the courage to look outside of the box, to see beyond medical science and quantitative research. You say you have 40 years of knowledge and research behind your approach, yet many of the therapies you dismiss so critically have been around far longer and are far more grounded than all the drugs our modern society has come to depend on. It seems to me that Prince Charles, as a patron of the Bristol Cancer Help Centre and the President of the Foundation for Integrated Health, has far more information and authority on which to base his comments than merely ‘an accident of birth’ as you put it. And, as Robert Potter has said in his response - “at least he is willing to look forward and embrace change in the hope of saving lives”. So I am writing to ask you to think again, to have the courage to put your head above the parapet and take off your blinkers. Start to discover the riches and knowledge of healing that are given to us in our wonderful Universe. Open your mind to the profound truths which are out there and which will come to you if you seek them. And, above all, join with me in blessing Prince Charles daily for his courage and all he does and says. Yours sincerely
Competing interests: None declared |
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Wolfgang H Furste, Salaried GP Sunderland SR3 2ANP
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Dear editor, Professor Baum bases his authority on 40 years of study and involvement in cancer research. He rightly points out that evidence medicine is about testing a hypothesis. An important question remains: How do we generate hypotheses? Often, they start with an anecdote, a story with an unlikely, unusual outcome that gives us an impression that beneath this “story of interest” may lie a truth worth discovering and testing. He criticises the Gerson therapy as anecdotal. How much time did Professor Baum devote to the study and research of this therapy? Has he spoken to doctors and patients of the Gerson clinic about their qualitiy of life and cure rates? Personally, I have. I have seen patients with metastatic melanoma survive 5 years. I have seen their quality of life. It left an impression. Interestingly, there was no principal antagonism to orthodox medicine. After all Dr Gerson was an eminent phyiscian himself quite capable of critical appraisal. Unfortunately, his voice was not often listened to by the medical world. Prince Charles may have just had an impression, perhaps after speaking to a cancer patient, that his theory was worth listening to and his hypothesis that his diet might be beneficial worth testing and make his voice heard. Perhaps he hasn`t got it all wrong? How can we be so sure if his ideas have never been put to the test? Wolfgang Furste, GP in Sunderland, e-mail: wolfgang.furste@tiscali.co.uk Competing interests: None declared |
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BM Hegde, Retd. Vice Chancellor Mangalore-575004. India
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Dear Sir, Probably this is the most commented upon open letter in the BMJ-and for good reasons. Let us not sit in a glass house and throw stones at others. Barbara Starfield and colleagues in their article in the JAMA (2000) have recorded that around 44,000 to 98,000 patients die annually in the USA alone due to medical errors and nearly 100,000 people suffer from unknown side effects of known drugs! Millions of people are known to become chronically ill because of medical interventions. Diagnostic and therapeutic misadventures are the cause of a new syndrome- the Ullyssis syndrome. "Science without Sense" is a good book written by an eminent epidemiologist, Steven Milloy, on the vagaries of statistical methods in medicine. People who swear by the reductionist science in medicine should know that the body does not work in bits and pieces, but works as a whole. Our prognostications, especially in cancer patients, are no better than the astrologer's predictions of the future. One has to read the highly scientific paper by Prof. Firth (a noted physicist)in the BMJ 1991 Decemebr issue, on the science of CHAOS-and the doctors (in)ability to predict the unpredictable. I would like to remind the molecular biologists that the bits need not make the whole. Water, when reduced, becomes hydrogen and oxygen. Both are highly volatile, but then whole water puts out the fire.Our presumption that water would be highly volatile because hydrogen and oxygen that make up water are volatile, is what is wrong with our medical science. One cancer specialist wrote (if I remember right) that the way we burn our cancer patients with the "proven" methods reminded him of the way our ancestors used to brand every patient with red hot iron! Today's reductionist science is tomorrow's folly, but the wholistic science of Ayurveda and Chinese medicine are based on logitudinal observational research for thousands of years. Today we have realised that good observational longitudinal research is as good, if not better, than cross sectional research. If one goes deep into the so-called evidence based research, one quickly discovers that it is evidence burdened, instead. Where there are more doctors per capita population there is less health, has been the finding of a study in Europe. If one were to use the present day screening methods, all of us will be patients. Statistically, 5% of the normal population will become false positive for every parameter screened. If one goes through the total body scanner, screening five hundred parameters at a time, for every 100 healthy people screened, two thousand five-hundred false positive abnormalites will be discovered. Who then will be a well man today? That much for statistics and science. William Harvey was to be killed for saying that blood circulates through the heart, as he went against the teachings of Galen (around 127 AD). In what way are we different from the 17th Century scientists in condemning something that does not fit in with our thinking. Rather, we should congratulate the Prince for asking us to investigate these claims of other systems to find out the truth. True science is curiosity to know the truth. Commercial science is the one that wants only reductionist methods to prove or disprove any claim. What do controlled studies control? They do not even compare 1% of man in the controlled study as man is not his phenotype alone. His genotype and cosciousness are not even considered in controlled studies! Schrodinger's Cat Hypothesis would explain our logic very clearly and finally let me remind our "scientists" that the only certainty in medicine is uncertainty-Hail Werner Heisenberg! Yours ever,
Competing interests: Interested in patient welfare! |
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Trisha Greenhalgh, Professor of Primary Health Care University College London
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The late John Diamond wrote in his newspaper column that he had been diagnosed with cancer. He received hundreds of letters from readers, many of whom described 'cures' from cancer with alternative therapies. Diamond - with nothng to lose and potentially much to gain - followed up every letter and sought corroborating evidence. In every case one of three explanations fitted: (a) the person didn't have cancer in the first place; (b) alternative cures were being taken alongside conventional treatment; or (c) the person wasn't cured. He wrote up his experiences in two books: 'C - because cowards get cancer too' and 'Snake Oil'. The former also includes the best lay explanation of the merits of the randomised controlled trial that I have ever read. Competing interests: I have recently completed a course of acupuncture for a sports injury. I once referred a patient to Accident and Emergency with a perforated rectum from a self administered coffee enema. |
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Joseph C Watine, Consultant, Laboratory Medicine Hôpital de Rodez, France
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I am always fascinated by the way the British are so interested in their Royals! In France, we got rid of all these people more than two centuries ago! Competing interests: I feel like a communist sometimes! |
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Dai Roberts, Head of Research & Development St. Ann's Hospice, Manchester, UK. SK8 3SZ., Alison McNulty, Christine Waterman
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Professor Baum’s letter is an excellent response to…to…what exactly? Prince Charles’s speech given at the Complementary Therapies & Cancer Care Research Symposium on 24th June 04? Or a response to the articles published in the Express and Guardian newspapers? If it’s the latter, I’d be inclined to agree with Professor Baum on the risks of promoting ‘whacky’ practices of any sort (not that I’m in any way qualified to judge). I would also hope that any doctor from whom I may receive any future advice or treatment, takes their responsibilities to their patients as seriously as Professor Baum appears to. If it’s the former, i.e. a direct response to Prince Charles’s speech, I’m rather perplexed! The context of the symposium, which I attended myself, was the opportunity to bring together organizations and individuals from across the UK and US, involved in service delivery, promotion and/or research from both the fields of conventional cancer care and those involved in complementary therapies or integrated health - with the aim to initiate strategies for the development of perhaps rigorous, collaborative and prioritised research in the field, addressing the issues pertinent to cancer patients in the UK today. Throughout the two day conference, the words ‘complementary’ and ‘integration’ were constantly used, not ‘alternative’. My interpretation of Prince Charles’s brief mention of Gerson’s therapy (for which there appears to be a dearth of peer reviewed publications), was in the context of an ‘anecdotal case study’ and an example of why we do need more rigorous research initiatives in the field of CAM (Complementary & Alternative Medicine), to prove or disprove their merit. The fact is millions of people in the UK now use CAM. And so, if the field is now being put under the scrutiny of ‘orthodox’ scientific approaches, such as the randomized controlled trial, I for one am happy! Finally, I’d encourage all to read Prince Charles’s speech (www.princeofwales.gov.uk) and not the slanted interpretation offered by the Express! Competing interests: None declared |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Sir I would ask Trisha Greenhalgh what evidence John Diamond was likely to uncover about the hundreds of cancer patients for whom she says he "followed up every letter and sought corroborating evidence" for him to conclude "In every case one of three explanations fitted: (a) the person didn't have cancer in the first place; (b) alternative cures were being taken alongside conventional treatment; or (c) the person wasn't cured". I also read his work and could not have arrived at Trisha's conclusion anymore than John Diamonds. I doubt he had access to all the information one requires to make conclusions about personal medical and alternative medical histories - especially to be able to state that a patient 'did not have cancer', that 'alternative cures did not work' because they were 'alongside conventional treatments', and 'the patient wasn't cured'. I suspect these were subjective, not scientific, views. Perhaps Trisha could explain how he could arrive at the conclusions she states he did from the 'corroboration' he obtained? Regards John H. Competing interests: I am a practitioner of TCM-acupuncture & moxibustion |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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Wasn't it Irwin Page who declined to use alternative therapy because he didn't intend to be "the smartest man in the cemetary"?* Something John Diamond might say under the right circumstances. As to the other tall story about a perforated rectum from a coffee enema (self-administered at that!), one should always let the coffee cool first and never try to insert the entire pot! In conclusion, what exactly was your point? * he wasn't Competing interests: None declared |
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Ellen C G Grant, physician and medical gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, Surrey, KT2 7JU, UK
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Editor - As a Professor of Primary Health Care Trisha Greenhalgh must be familiar with the importance of maintaining a good nutritional status. Red cell essential fatty acid(EFA) profiles have been available for decades and deficiencies are extremely common. Blocks in EFA pathways are frequently due to micronutrients deficiencies even in individuals who are currently symptom-free. "Snake oil salesman" was the term used by Caroline Richmond in her unfortunate obituary for David Horrobin, a fellow lymphoma sufferer.1 Among the numerous critical Rapid Responses to this obituary were many highlighting the importance of David Horrobin’s work. Eddie Vos wrote, "There are near universal deficiencies in omega-3 fish-oil type fatty acids and snake oil would probably be the best land-based source”.2 David was a brilliant lecturer on the subject of polyunsaturated fatty acids. He kindly gave me his book containing the effects of EFAs on some cancers.3 He wrote that he was hoping that he could use omega-3 EFAs to treat his own mantle cell lymphoma.4 Unfortunately this was not to be but he knew there was a problem delivering high enough concentrations to cancer cells in vivo for most effect. David was also concerned about the ethics of large trials.4 Randomised controlled trials (RCT) can be misleadingly reassuring. The Women’s Health Initiative RCT confirmed that combined HRT increases the risk of breast cancer, vascular diseases and dementia but underestimated the increased risk of osteoporosis and colorectal cancer, in my opinion.5- 7 The risk of osteoporosis has now been shown to be increased by 65% in women stopping HRT within the previous 5 years. In the WHI colorectal cancer trial, patients with the disease in the group randomised to take placebos were twice as likely to have taken HRT for more than 10 years before the RTC started. 1 Richmond CD. David Horrobin BMJ 2003; 326: 885 2 Vos E. Snake oil, COX-2 inhibition, and Dr.Horrobin http://bmj.com/cgi/eletters/326/7394/885#31402, 21 Apr 2003 3 Horrobin DF. New approaches to cancer treatment. Unsaturated lipids and photodynamic therapy. Churchill Communications International Europe, London 1994. 4 Horrobin DF. Are large clinical trials in rapidly lethal diseases usually unethical? Lancet 2003 Feb 22; 361(9358):695-7. 5 Grant E C G. Hormone therapy can cause osteoporosis. http://bmj.com/cgi/eletters/329/7456/0-f#65639, 3 Jul 2004 6 Grant E C G. HRT may not prevent colorectal cancer http://bmj.com/cgi/eletters/328/7440/602#53006, 12 Mar 2004 7 Grant EC. Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med. 2004 Jun 3;350(23):2417-9. Competing interests: None declared |
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Jacqui Gath MBCS C Eng, Working in IT (Full time) Sheffield S11 9HR
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As a breast cancer patient of 17 months standing (and albeit suffering a suspected recurrence) I researched and looked hard at all the usual stuff - surgery, death rays, carcinogenic poisons - and decided to eschew all but surgery and use a modified Gerson therapy afterwards. This was not only in the hope of obtaining a cure, but also to improve my health which had deteriorated somewhat over the previous two years, and to boost my immune system in the hope that my body would become more efficient and able to stave off this disease. This is something the over-paid purveyors of poison, (since when did anyone deserve to earn £120 a half hour for the benefit of their stale recommendations to pointless treatment) neglect at their patients peril. And it is peril. The patient usually pays for this 'advice' with his or her life, not the oncologist. Moreover, the quality of life between diagnosis and death can be a miserable affair, with side-effect after side -effect being treated by an endless series of expensive and deleterious drugs. As a mere patient, one has to ask whether oncologists would be so keen to take their own 'medicine' if they were also diagnosed with cancer. Certainly we diagnose cancer earlier, but the mortality has essentially been the same for the last 30 years. The treatments are also essentially the same as they have been for the last 30 years, too. For some cancers, (non small cell lung cancer) there is anecdotal evidence that patients live longer without chemo-therapy. If that is the case doctors, shame on you for even giving it. The whole issue of toxic systemic therapy, or chemo, needs a rigorous re-evaluation. Old treatments should be reassessed and survival compared with patients choosing no treatment at all. This should be done at the very least and should not be difficult. Any patient with any sense refuses chemo altogether so there are plenty of us out here in the real world to contact. As for alternative or complementary - it is no good looking to see the effect of an extra 100mg a day of vitamin C. We are talking about rebuilding the body and bringing the immune system into balance. This takes agressive nutrition. In the case of vitamin C taken orally, we may be talking tens of grams. My choice may, or may not, have served me well. However, my health has improved dramatically. When I look at the quality of life 'enjoyed' by my less fortunate sisters who have succumbed to the blandishments of their oncologists, and compare with my own good health, I feel very fortunate. I would choose this path again. A true scientist has an open mind. Baum shows no sign of this. Competing interests: A woamn with breast cancer |
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G Robert N Jones, Cancer research scientist 30 Poplar walk, London SE24 0BU, UK.
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Professor Baum is kinder to the alternativists than he need be. The raising of false hopes and the debilitating charges levied by many clinics and so-called treatment centres together with the ineffectiveness of their procedures constitute a scandal of international dimensions and border on criminal deception. Nowhere in medicine other than in cancer do the alternativists and the quacks flourish. Why? Simple; while advances in almost all other medical specialities over the past 70 years have been brilliantly successful, the continuing failure of cancer treatments stands out like a sore thumb. Survival from chemotherapy remains dismal; indeed, in 1982 Professor Baum himself described the practice to me as a lead balloon. Not surprisingly responses to Professor Baum's letter divide sharply into two camps, a majority being in warm agreement. But nobody ever questions the justification for the manner in which a solution to the cancer problem has been and continues to be pursued. Our repeated failures still do not lead us to ask if the underlying reasoning is not fatally, fundamentally, flawed. Why not? Nearly 100 years ago Emil Fischer commented: If we wish to catch up with Nature, we shall need to use the same methods as she does. Nature herself utilises a powerful mechanism of destruction every time that sepsis from Gram-ve organisms or preparations therefrom cause haemorrhagic necrosis in sensitive tumours (for references, see [1]). Instead of seeking to catch up as Fischer advised, the cancer fraternity obstinately clings to the principle of imposing any one of a huge number of ingenious preconceived means of dying on the cancer cell. Nature reacts to this arrogance with disdain. Instead of cooperating, her consistent response to most chemotherapeutic regimens is to provoke cruel side effects, modern equivalents of the medieval torture chamber. Having discovered how endotoxin causes tumour necrosis [1], I have spent 30 of the past 45 years in cancer research seeking to devise and establish a safe means of destroying cancers in man by selectively disrupting energy metabolism inside the growths. A cheap, safe and humane self-medication protocol [2] is accessible whereby the patient is moved from the cancer clinic into his/her previous environment while sustaining the full force of the therapy. Side effects are negligible. This is revolution; therefore nobody wants it. The oncological establishment excels at suppression. In August 1983 Professor Baum angrily denounced in private a brief but scientifically- based memorandum advocating chlorpromazine monotherapy on the sole, wholly mistaken, grounds that the concept constitued alternative, fringe, medicine. In 1986 he declined three separate opportunities to consider the same thesis in the form of a review [3] as the basis for a clinical trial. At the time Professor Baum was Director of the CRC Clinical Trials Centre; a precious chance radically to alter the chemotherapeutic landscape was squandered. Time moves on. A short report of a pilot study comprising 35 patients on the DIY therapy [2], twice turned down, is shortly to be resubmitted. Fourteen patients, including those with metastatic cancer of the breast and colon, non-Hodgkin lymphoma, cancers of the pancreas, brain, lung, spinal cord, and bone showed positive responses; of these half survive. The burning need is to evaluate the effectiveness of the procedure [2] in clinical trials. Professor Baum will no doubt argue vehemently that the evidence is too flimsy to support such a course of action. Scientific evidence supporting the DIY protocol [2] is available [1]. Hard copy of this document and the 1985 review [3] are being sent to Professor Baum together with a challenge to refute their contents. In the interests of cancer patients generally the matter deserves wide exposure. I would be more than happy to engage the power of Professor Baum's authority and experience in public debate. Despite Professor Baum's denials, a loose but highly effective combination of pharmaceutical companies, funding organisations, pernickety regulations, molecular biologists and uninformed oncologists has for far too long been working against the advent of a solution to the terrible scourge of cancer. Throughout this sorry story the basic problem has been the lack of dialogue at all levels. The time has come to discard bigotry, ignorance and prejudice and to move on. How about it, Professor Baum? [1] Notes on the treatment of cancer November 2001. http://www.cancersupportwa.org.au/Spotlight/index.htm [2] Phenergan updated October 2000. http://www.ciss.org.au/articles.shtml [3] Jones GRN. Cancer therapy: phenothiazines in an unexpected role. Tumori 71: 563-69, 1985. Competing interests: GRNJ spent almost two years in Professor Baum's department from 1982-83. He admits to a brash unashamed wish to bring about the defeat of cancer. |
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Neville D Yeomans, Professor of Medicine the University of Melbourne, Footscray 3011, Australia
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Hilary Butler has a partial point but what she has missed is that the P-value lets her and anyone else know HOW likely the results were to be a 'fluke' rather than a real difference (Fisher ended up deciding that odds of 20:1 against were getting too long to be likely to chance, but he acknowledged that he had simply chosen where to draw a line arbitrarily). Many journals now require that the exact P value be given - for exactly that reason of allowing the reader to make their numeric judgements - rather than for authors to just say whether P was above or below 0.05.
If a jury were weighing a case against one in a civil court, they would actually consider a P of 0.45 to be significant (i.e. the balance of probabilities [0.55] in the opponent's favor); Fisher perhaps thought that the basis for being convicted for murder ('beyond all reasonable doubt') might be a safer standard!
Competing interests: None declared |
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Abram Hoffer, Psychiatrist Victoria BC
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http://www.princeofwales.gov.uk/speeches/health_24062004.html You might have published Prince Charles lecture in full as the best response to Professor M Baum's personal views letter. A. Hoffer Competing interests: None declared |
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Joao N Bento, Independant researcher Bracknell, RG12 9YR
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I think Michael Baum's criticism of the Prince of Wales and of alternative medicine is premature, as there has not been nearly enough research into this field for anyone to be able to make informed or conclusive statements about complimentary medicine. I write this as a one time sceptic of all forms of alternative medicine, until I had a chance introduction to homeopathy about six years ago. I discovered that homeopathy devotes a great deal of attention to hereditary disease. This sparked off an interest in the subject, which eventually led me to read up on genetics. As a result, I think I have stumbled across a relatively unexplored area of genetics, which is the role of non-coding DNA in our genomes, more commonly known as junk DNA. The information I have uncovered on this subject has proved highly controversial, but, in my opinion, I think it is of sufficient importance to warrant further investigation. I have therefore published a short extract of my findings on this subject on the following website: http://myweb.tiscali.co.uk/geneticframework I would be interested to hear Michael Baum's comments on this. Nuno Bento Competing interests: Independent researcher into homeopathy ad genetics. |
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Margaret C Anderson, Patient Retired (former Civil Servant), Ludlow SY8 1RA
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Unfortunately, 'rigorous tests'have not prevented CM treatment from producing an unacceptable amount of iatrogenic illness and death. Those of us with a long history of ADRs to conventional drugs, which made us worse instead of giving the intended and hoped for benefits, are very thankful for CAM - preferably provided by a doctor who has added further skills to a classical medical training. I am no advocate for quacks or quackery, but a practitioner from a professional body seeking to follow the recommendations of the European Parliament and the UK House of Lords Select Committee on Science and Technology, regarding CAM training, qualifications and regulations, is a very different matter. Of course alternative therapies should be tested, but like must be compared to like if the results are to have any validity. It is pointless to measure treatments functioning at different levels against each other. Another point that seems to have been overlooked is that when health became an industry, patients were turned willy-nilly into customers - and customers are increasingly likely to apply Trading Standards criteria to what is on offer. They want to know whether 'it is fit for its purpose' i.e. "Does it work? Is it safe?" and, if forced to look in the private sector because the NHS has nothing for them "Is it value for money?". Their first port of call when a health problem arises is their GP, and only if s/he is unable to help are they likely to look further afield. When they do, why should they persist if what they find is useless or harmful? It would not make sense. I am one of a sizable and probably growing section of society which can appreciate the advances made in modern medicine but, mostly unable to profit from them, need an alternative form of therapy. CAM has done more than 'offer improvements in quality of life' and 'spiritual solace', it has dealt effectively with post-polio sequelae (assessed by CM as 'irreversible'), atrial fibrillation, arthritis, and problems following poisoning by pesticides and solvents. I too have lost friends on CM to cancer, and, at thirty, had to have an operation to remove the hinges of my jaws, and was told the condition could recur. Nearly fifty years on it has not done so, and thanks to 'mixing and matching' CM and CAM for the best achievable outcomes I can enjoy life in spite of limitations, and am able to do a little voluntary work to give something back. I am very grateful to my doctors down the years who have cared for an unintentionally awkward customer, and been willing to 'look beyond the box'for remedial measures. How are 'unproven therapies' to be proven if they are not tried? Given a cautious, commonsense approach and careful auditing of patients, none should be harmed and much may be learnt. If Prince Charles was advocating a more open-minded approach to CAM, then (though no sycophant!) I am with him. Medical science is, after all, 'a work in progress' and I respect it (my dictionary defines 'science' as 'a quest for truth') but for me the crucial question is "What fruit does the tree bear?" For patients, the proof of the pudding is in the eating - and CAM has kept me out of hospital, and enabled me not just to survive, but in many ways to thrive. Don't knock it, Professor Baum, one day you too might need it. Competing interests: None declared |
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Erich K. Ledermann, Medical Practitioner in Private Practice 13 Ardwick Rd, London, NW2 2BX, Allan Withnell
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I am not choosing the Gerson treatment for cancer, chosen by the Prince of Wales as an example of Holistic Medical Science, but I am selecting a paper, “The Natural Cure of Coronary Heart Disease” (Nutrition and Health, volume 17, No 1, 2003 by A.Withnell) and discussing the reaction to this paper, which constitutes the official mechanistic scientific treatment of coronary heart disease. This approach involves the prescription of drugs that aim at a correction of the disturbance of the faulty heart action and of operations such as bypassing interrupted cardiac blood flow. Alan Withnell, a Retired Area Medical Officer, living in Gloucestershire in England, developed the symptoms of coronary heart disease in 1989. After some time he adopted a regimen of diet and exercise, practiced at the Pritkin Longevity Centre in California, U.S.A. Within five months Dr. Withnell was able to abandon all medication and was symptom free. His medical colleagues maintained that the Consultant’s diagnosis must have been wrong, as a cure of coronary heart disease could not have occurred by lifestyle changes alone. Dr.Withnell decided to review the natural history of coronary heart disease, his findings strongly suggested that the increase in incidence in the last hundred years from virtually nil to epidemic proportions is due to lifestyle changes and that the disease can be reversed. Dr. Withnell listed a number of doctors who have influenced many patients to change their lifestyles with great success. They have utilised mainly plant-based diets whose composition is the same or similar to that which Pritikin originally used and which is still extant at the Longevity Centre. Dr. Withnell concludes that the possibility of reversal of coronary heart disease has profound implications for its treatment with enormous potential the National Health Service. Dr. Withnell describes the case of Nathan Pritikin who chose a diet of low fat (5-10 percent of total calories, low in protein (10 to 15 percent and unrefined carbohydrates 75-85 percent). His exercise consisted in walking and later jogging, but the diet was considered to be more important. His doctors were subsequently astonished to observe on a further ECG that there was no sign of myocardial ischaemia. Dr.Whithnell quotes the role of atheroma in heart disease in different studies and provides a list of five eminent cardiologists and cardiac surgeons in America who value the Pritikin treatment. The paper closes with 24 references of well-known scientific status. Competing interests: None declared |
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Robert A. Da Prato, Physician Portland OR 97229
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Thirty years ago I was a medical student UCLA when Nathan Pritikin, the founder of Pritikin Longevity Centers (I believe they were called something like that) was a patient there, dying of cancer. As I recall he was in his late 60's. His followers made much of the fact that at autopsy he had the whistle clean arteries of a teenager. I made much of the fact he was dead at a relatively early age, particularly for a longevity guru. One person cannot make a generalization, of course. However, reducing one manner of dying merely increases another, which may be sooner or may be later but worse in terms of suffering. Almost invariably the comprehensive truth is ignored, particularly when one is selling something. Having said that I have to agree with the author that environmental change (such as medications and altered diet) can dramatically improve symptoms and signs of disease; however, these must be judged against the inevitable long term consequences (some good, some bad) of any environmental intervention. Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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Dr. Ledermann's response is somewhat off the subject. It appears to me that he has just come across Pritikin's Miracle Cures, or rather the anecdotal ramblings of it. Pritikin was a book publisher who did not have the slightest hesitation to try his hand in medical matters, he took over the treatment of himself because, as he saw it, no one was capable of doing the job. Very early in the game, Nathan Pritikin made up his mind that fats, all fats were inherently bad. He soon practiced what we could call 'selective medical philosophy' and blind-folded himself to any evidence, including that concerning the essential fatty acids. Fats, he reasoned, were all bad (and I do think that he had a briefcase full of papers by Ancel Keys at the ready)and, thus, carbohydrates had to be the good guys. There is no doubt that he achieved spectacular results with people who had one and a half feet in the grave but long term outcomes are not available. If Dr. Ledermann believes that Pritikin's way is the solution to cardiovascular problems then he is most certainly mistaken. I had a similar reaction in the 70's in California when I thought the wheel had been invented again. Later, his chief nutritionist, Marie-Louise Gittleman 'outed' the truth about the 'oversight' that fats were important, too. Pritikin died of a nasty form of Leukemia, actually he expedited the process, and -as is the custom with the descendants of these gurus- his followers quickly changed the basic philosophy of Pritikin's Postulates. His son quickly added in the fats, Gittleman made an art out of talking fats and oils and the Longevity Center lost its identity. The question is: What caused the spectacular successes of the Pritikin Therapy? I do not have the entire answer but suffice it to say that the human body is more than capable to not only survive, but to thrive under extreme conditions. The body is challenged to the extreme and the very survival is at stake. It can often meet the challenge. Now, if we tried this with the low carbohydrate, high fat, high protein diet of the famous arctic explorer Vilhjamur Stefansson, who not only lived with the eskimos but also found their eating habits superior and adopted them for himself, what results would we see? Pritikin proved only that man could partially arrest failing health by following a bizarre diet. We may call his diet 'alternative medicine' but we know today that there are better ways. Once again, it makes the point of Dr. Abram Hoffer even more important: Read the entire text of Prince Charles' speech and you will understand. People like Baum, who hide behind words and embarrassing walls of fear will never understand this. As I said in an earlier post, they 'haven't got it' . And isn't that a shame. Competing interests: None declared |
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Earl Baldwin of Bewdley, President, Parliamentary Group for Integrated & Complementary Healthcare House of Lords SW1A OPW
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I have read carefully the Prince of Wales’s speech, and Professor Baum’s rebuke, and can’t find much to get excited about. Among the Prince’s main points are that 80% of cancer patients use some form of CAM, and less than 1% of the research budget goes into these treatments. From this he argues that we need more research into their efficacy and safety, and more integration. He spends two sentences on a Gerson anecdote, which he acknowledges as such (“one patient’s experience cannot hold water as evidence”), and one on Gerson patient numbers as showing the need for more evidence. I think you have to be implacably opposed to what 4 in 5 cancer patients are doing to believe that the Prince has spoken outrageously. Beyond this, what is evident from Baum’s article is a significant omission and an assumption. The omission is any acknowledgement of the many failures of orthodox treatments, and the damage they can do, which is what chiefly impels patients towards other approaches, and which should counsel a certain humility 1. The assumption can be seen in Baum’s concession to CAM regarding (only) “quality of life or spiritual solace”: it is that CAM has no curative role in cancer. This is fatal to proper debate as well as unscientific. Only good research, building on existing case studies and analyses, will yield answers. You can’t just assume that because you have 25 years’ involvement with mainstream cancer you know the picture in other areas. In the House of Lords Select Committee enquiry into CAM, on which I served in 1999-2000 2, we received evidence on the alarmingly low proportion of patients who tell their doctors what CAM therapies they are using. Would I confide in Professor Baum if I were his patient? I think not. A more important question is, whose agenda should rule in the final analysis: patients’, for whom the Prince tries to speak, or doctors’? 1. Bailar JC III, Gornik HL. Cancer undefeated. N Engl J Med 1997;336:1569-74. 2. House of Lords Select Committee on Science and Technology, Session 1999-2000, 6th Report: Complementary and Alternative Medicine. Competing interests: None declared |
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Hazel Thornton, Honorary Visiting Fellow, Department of Health Sciences, University of Leicester. "Saionara", 31 Regent Street,, Rowhedge, Colchester. CO5 7EA
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The research agenda has been dominated for too long by clinical scientists, academia and industry. Numerous research questions that patients would like to see answered, on topics that are of interest to them and affect their quality of life, remain to be answered. Comparisons of therapeutic interventions in properly controlled fair tests are the best way of determining their usefulness. [1] It is also necessary that all possible benefits and harms are rigorously investigated and properly reported, without suppression of patients` input. [2] Patients` and clinicians` anecdotal experiences should equally be evaluated in well-conducted qualitative research to provide reliable evidence to guide the care of patients. This evidence is as necessary as the purely biomedical evidence provided by quantitative studies. The NHS Health Development Agency has commissioned and published a report that considers integrative approaches to qualitative and quantitative evidence. [3] Professor Kelly, in his `Forward`, describes it as "an evidence-based solution to a question of social justice". He states: "The issue of combining data from different research traditions is of paramount importance." Implementation would address what is termed "content bias". Earl Baldwin of Bewdley`s resume [4] of the Prince`s and Professor`s expositions reinforces just how necessary this integration is. The most urgent need is to listen to the patient`s voice if care, as well as cure, is to be researched and provided. [1] James Lind Library. www.jameslindlibrary.org. [2] Hazel Thornton. A right to know. Chemistry and Industry., 2004; 6:15 [3] Mary Dixon-Woods, Shona Agarwal, Bridget Young, David Jones, Alex Sutton. Integrative approaches to qualitative and quantitative evidence. Report to the NHS Health Development Agency. March 2004. ISBN 1-84279-255- 5. 222.hda.nhs.uk [4] Earl Baldwin of Bewdley. bmj.com Eletter: The prince and the Professor: who`s got it wrong? http://bmj.bmjjournals.com/cgi/eletters?lookup=by date and days-1 67798. Accessed 20 July 2004. [5] Michael Baum. An open letter to the Prince of Wales: with respect, your highness, you`ve got it wrong. BMJ 2004; 329:118 Competing interests: None declared |
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Michael O'Donnell, Loiterer Loxhill GU8 4BD
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I’ve just retuned from my GP’s crowded waiting room and read Hazel Thornton’s words: “The most urgent need is to listen to the patient’s voice if care, as well as cure, is to be researched and provided.” It’s the definite article that gets me. I suspect my GP’s waiting room harboured as many different voices as different faces. In the low places which I inhabit, the patient’s voice is legion – a truth that seems to be recognised more readily by those who practise medicine than those who preach about it. When it comes to interpreting what our voices are saying I would put greater trust in the GP who was running 45 minutes late today because of the care with which he listened to our stories than in an Honorary Visiting Fellow at the Department of Health Sciences in Leicester ... ... or even the Fourth Earl Baldwin of Bewdley, formerly Viscount Corvedale, educated at Eton and Trinity, Cambridge, whose only occupations declared in Who’s Who are membership of the House of Lords and Chairman of the British Acupuncture Accreditation Board (1990-98). Doubtless both are motivated by the very best intentions but, at my time of life, I get irritated by people inhabiting places like St James’s Palace, the House of Lords, and the groves of academe who get the urge to speak up in, albeit unwittingly, patronising tones on behalf of me and my friends in low places. Most of us are quite capable of speaking - and thinking - for ourselves, thank you. Just as most of us - and, over the past few years I have made a lot friends in waiting rooms and hospital wards - seem able to find doctors who are prepared to listen to us and help us make our decisions. Competing interests: Age has removed my forelock and I own no cap to doff. James Willis's book Friends in Low Places is one I much admire. |
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John Hopkins, General Practitioner Newton Aycliffe DL5 4SE
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Dear Dr Smith Michael O’Donnell hits the nail on the head. As a general practitioner I watch people dying of cancer every week. To them much of the debate above would be so much meaningless rhetoric. People always couch these things in terms of power; the power of established medical practice, the challenge posed by alternative medicine, the arrogance of doctors, the ignorance of those who criticize them. The reality is that, in the face of mortality and the terrible conditions that precede it, we are all, in the end, powerless. Surgery and other modern treatments offer hope, drugs like morphine offer the comfort they have done for generations, if people find herbs work for them, that can only be for the good as long as they aren’t deceived. At the front line, all that matters is what works. Competing interests: None declared |
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Darren J Bradley, Philosopher Stanford, USA, 94305
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Whatever mistakes we think Prince Charles may be guilty of, using inductive logic is not one of them. Inductive logic is not a fancy term for anecdotes, as Professor Baum seems to think. Inductive logic is the rigorous study of probabilisitic inferences in the same way as deductive logic is a study of certain inferences. Unfortunately the price of the certainty of deductive logic is that it is only applicable in mathematics. Science must use inductive logic (we can never know any scientific hypothesis with certainty, as Descartes taught us). If only Prince Charles really did use inductive logic his methodology would be above reproach. Darren Bradley, Stanford, USA Competing interests: Philosopher - Specializing in inductive logic |
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Hazel Thornton, Honorary Visiting Fellow, Department of Health Sciences, University of Leicester "Saionara", 31 Regent Street, Rowhedge, Colchester, CO5 7EA
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Dear Dr. O`Donnell, Folk are not always what they seem In the groves of academe. See: http://www.le.ac.uk/press/press/bestinformedpatient.html Sincerely, Your gowned, but not bald, patient fellow. Hazel Thornton, Hon. D.Sc. (Leicester) Independent Advocate for Quality in Research and Healthcare. Competing interests: None declared |
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Richard Carlos, research scientist 231 Roehampton Lane, London SW15 4LB
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22 July 2004 The Editor British Medical Journal Professor Michael Baum, mentions “The epistemology of medicine, or in simple words, the nature of proof” and calls alternative medicine above the laws of evidence (1). I would point out a Danish study of alternative therapy in which women who underwent orthodox treatment following breast cancer developed metastases; they were divided into two groups: control and experimental. One group received placebo and the other group 30mg per day of CoQ10. A few months later one of the women was found to be free of cancer; instead of taking 30mg/day she was taking 390mg/day. Another patient who learned of this started taking 390mg per day and her primary and metastatic tumours disappeared as well. The above was an epistemologic [sic] study (2). I would also like to cite a study carried out at the Veterans Administration Hospital in Wisconsin where some prostate cancer patients were left untreated and some underwent orthodox treatment with the result that both groups survived about the same after 15 years’ of follow-up, (3). With regards to his claim that there has been a 30% fall in mortality among breast cancer patients since 1984 may I point out that these statistics are based on death certificates as the cause of death and as these certificates have to be completed according to international rules they usually give the cause of death as due to intercurrent illness mainly as a result of the chemotherapy, rather than cancer (4, 5). He also states that many of his [cancer] patients live for many years. Perhaps I should point out that the diagnosis of cancer in based on histopathological examination and we have seen many errors in the past in this matter especially with respect to cervical smears which fortunately can be verified by repeat examination of the slides, whereas the remainder cannot be readily verified and can be subject to cover up if benign. Perhaps Prof. Baum would provide scientific evidence that current therapies work by citing a single study which compared the survival times of treated and untreated cancer patients. In addition perhaps Prof. Baum could provide reference to a single study showing that treated cancer patients survive longer when compared to untreated controls. Surely if clinical trials, a euphemism for clinical experiments, can be carried out, comparison of treated and untreated cancer patients can also be performed. (1) Baum, M. An open letter to the Prince of Wales: with respect, your highness you’ve got it wrong. British Medical Journal 2004;329: 118 (10 July) (2) Lockwood K, Moesgaard S, Folkers K. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochemical and Biophysical Research Communications. 1994 March; 199(3): 1540-1508. (3) Graversen, P. H., Nielsen, K. T.; Gasser, T. C., Corle D. K. and Madsen, P. O. Urology, Radical prostatectomy versus expectant primary treatment in stages I and II prostatic cancer. A fifteen-year follow-up. 1990 Dec;36(6):493-8 (4) Case, R.A.M., Hosker, M.E., McDonald, D.B. and Pearson, J. T. Tumours of the urinary bladder in workmen engaged in the manufacture and use of certain dyestuff intermediates in the British Chemical industry, Part I: The role of aniline, benzidine, alpha-naphthylamine and beta- naphthylamine, Brit. J industr. Med. 1954:11, 75 (5) Case, R.A.M., Hosker, M.E. and Pearson, J.T. Tumours of the urinary bladder in workmen engaged in the manufacture and use of certain dyestuff intermediates in the British Chemical industry, Part II: Further consideration of the role of aniline and the manufacture of auramine and magenta (fuschine) as possible causative agents, Brit. J Industr. Med. 1954:11, 213 Richard Carlos Cancer Prevention Research Trust Competing interests: None declared |
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Alexander Molassiotis, Reader in Cancer and Supportive Care School of Nursing Midwifery & Health Visiting, University of Manchester
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It was interesting to see the huge and extraordinary response to Dr Baum's personal view on the recent (and others not so recent)comments by the Prince of Wales about complementary and alternative medicine (CAM). He takes the view that only evidence based practices should be used, such as that of the good old fashioned orthodox medicine ('espistemological methods', 'science of proof'). He has, however, ommitted to tell us that the very same medicine he is practising is not based entirely on evidence: Brighthope (1) remind us of comments made by prominent scientists such as the editor of BMJ that 85% of medical treatments are not supported by solid scientific evidence and only about 1-5% of articles published in medical journals are 'scientifically sound', concluding that there is a poverty of medical evidence to support the majority of medical practices. The state of evidence in surgery, Prof. Baum's specialty, is also poor, and more should be done to overcome the problems inherent in randomised controlled trials of surgery, we are told by Dr Richard Smith addressing the Royal Australasian College of Surgeons annual scientific congress in Melbourne last May (2). Thus, accusing CAM for being unproven in light of the above is to say the least hypocritic. The Prince of Wales in his speech, that I listened first hand being part of the audience where it was delivered, did not promote any alternative treatments as stated, but rather he mentioned 1-2 examples of what he had heard from patients who used juices or the Gerson diet (devoted a few seconds only on that) in order to highlight the importance of looking at the evidence of such anecdotal reports (where the emphasis was). The comment by Dr Baum that the Prince of Wales promoted carrot juice and Gerson diet was, to say the least, an oversensationalised out-of -context comment that I have no idea what purpose it served. I note that Dr Baum has 'much time for CAM that offers improvements in quality of life or spiritual solace', letting me believe that he has difficulty believing that CAM may have biological actions and actually cure a disease. I temporarily forgot that the latter is the domain of orthodox medicine! We forget of course that many common medicines that save lives are actually derived from plants and herbs (ie. aspirin, digoxin, taxol etc) now synthetically produced with our modern technology. That biological methods is the domain of medicine makes me also think that behind the whole debate around CAM are issues of professional power and medical autocratism, mixed with a reasonable amount of ignorance and prejudice. Over the last 10-15 years we are witnessing a shift in the boundaries of health and medicine, and a good number of medical professionals have difficulty adjusting to it. Of course I believe that certain CAM therapies have side effects and of course I believe that certain CAM therapies can be dangerous and waste of money, effort and energy. But until the point we can be able to say that with confidence, we cannot take away from the patients the increased hope that such treatments can provide but also the right of the patients to decide what their own treatment package will include; and we should start listening to patients and what they want a little bit more. After all, if all was great with orthodox medicine, would patients need to turn to CAM? CAM therapies are here to stay, irrespective of our personal views and beliefs about them. It is our responsibility and duty both to protect patients from harm, but also provide more choice to patients and broaden the boarders of medicine by integrating CAM therapies that have shown the potential of playing an important role in the management of illness. There is a rapidly increasing amount of literature showing the effects of many CAM therapies, and I suggest that many medical colleagues read such literature so they can have a more open minded, less arrogant and an evidence-based opinion about CAM. 1. http://www.thegreenline.com.au/Resources/Brighthope.htm 2. Medical Observer weekly, http://www.medobs.com.au/ Competing interests: None declared |
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P J Moran, Retired General Surgeon Ipswich, Qld. Australia 4306
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It is not true that there is no interest in examining 'alternative' treatments of cancer. The NCCAM (a division of the American NIH) promised Hildebrand, of the Gerson organisation, that they would perform a large-scale clinical trial of the Gerson treatment if the proponents could produce about a dozen cases of well-documented cancer remission (Prince Charles please note)!. The Gerson clinic was unable to do so, despite the many thousands of patients to have used this treatment to date. Rather than looking to gather such prospectively, they went on to publish an extremely flawed study (too many lost to follow-up etc) of their five year survival rates from melanoma, which fails to establish worthwhile benefits from what is an extremely arduous, life-consuming treatment method (all documented in <1>). Dr Abram Hoffer is one of the complainants posting a rseponse above, and often held up as an example of one whose spectacular results with cancer have been ignored by a mythical medical "establishment". Linus Pauling published dramatic results from Hoffer's orthomolecular (megavitamin) treatment of cancer <2>. I wrote to Dr Hoffer asking if I could have access to the case histories of these patients, pointing out that on the published information he should have had an extraordinary number of dramatic remissions of cancer that was "in an advanced stage" when first seen by him. Very many of his patients are still alive many years later, whereas "controls" virtually all died within months. Dr Hoffer is still writing books about orthomolecular treatment and claims that Pauling's predictions about these patients have been confirmed. He presumably still has all the information, but will not allow it to be seen by me. (This correspondence is available to any who wish to contact me. ) My message is that those who think that the present thirty or forty claimants to useful "alternative" cancer treatments should be being investigated further (despite habitually negative results with similarly promoted treatments in the past) are exerting pressure in quite the wrong direction. If the proponents cannot or will not demonstrate clearly how they know their treatments work, why should limited resources be diverted into investigating them? We are not talking about sophisticated controlled studies. Any cancer treatment of an effectiveness commensurate to the usual hype should be able to produce a measurable remission rate within a small prospective series of patients with proven active cancer. Peter Moran MB BS BSc(Med) FRACS FRCS(Eng) Queensland Australia moringa@gil.com.au 1. Hildenbrand GLG, Hildenbrand C, Bradford K, Cavin SW. 5-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review. Altern Ther Health Med 1995-09;1(4):29-37 2. Hoffer A & Pauling L: Hardin Jones Biostatistical Analysis of Mortality Data for a Second Set of Cohorts of Cancer Patients with a Large Fraction Surviving at the Termination of the Study and a Comparison of Survival Times of Cancer Patients Receiving Large Regular Oral Doses of Vitamin C and Other Nutrients with Similar Patients Not Receiving These Doses. Journal of Orthomolecular Medicine 8:1547-167, 1993. Competing interests: None declared |
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Howard D. Straus, Author, Nonprofit Executive Carmel, CA 93923
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Dr. Moran has totally ignored the well over 100 published reports by Gerson in the peer-reviewed literature and by many other medical scientists confirming his work. When Gerson submitted five well- documented cases to the NCI in 1956, he was told that five cases was too small a sample, and they would need 25 more. When he submitted the requested 25, he was told that he would need 125 more. Seeing that no matter how many cases he submitted, more would be required, Gerson demurred. Ever since then, the NCI has responded to inquiries with the half-truth, "Gerson was asked for documented cases, but refused to provide them." This, unfortunately, has been the response of the medical establishment and their servants, the governmental cancer agencies for decades. They show no interest in changing the status quo, which is phenomenally lucrative, to the tune of $160 billion a year in the US alone. Prevent cancer, and at least some of those billions disppear. Cure it, and there go highly lucrative careers in oncology and surgery. The American Cancer Society has been in existence nearly 100 years, during which time the cancer rate in the US has risen by more than tenfold. In their charter, they are required to disband when a cure for cancer is found. The executives of this multibillion dollar activity are in no hurry to lose their lucrative positions, to say nothing of their pharmaceutical company funding. The US government and various pharmaceutical companies are generous in their support of chemotherapy research and other useless pursuits (judging from the past decades of failure), but when they demand more research results from alternative therapy providers, there is NEVER a penny of funding proffered to support this research. These people are expected to fund their own research, while defending themselves against attacks from industry and government simultaneously. A case in point is Nicholas Gonzales, MD, in New York. The NCI was given funds by Nestle to support a research project into Gonzalez' methods, and the entire cancer establishment in the US tried to keep the study from happening, going so far as to attempt to lift his license while he was out of the country, visiting Nestle in Switzerland to present some interim results. Before any progress can be made in this area, the medical hypocrisy must stop, and some real attempt must be made to provide facts to the users of the various therapies. If the therapies are truly as useless as has been claimed, that would quickly become clear in controlled experiments. But experiments done by people like Peter Lechner at the Landeskrankenhaus in Graz, Austria have show quite the opposite. Why is nobody quoting Lechner's paper? Why have his documented positive results evoked no interest whatsoever? Where are the true medical scientists? References: Lechner, P. "Dietary regime to be used in oncological postoperative care." Proc. Oesterreicher Gesellsch. f. Chir., Jun. 21-23, 1984 History of the Gerson Therapy: contract report by Patricia Spain Ward PhD, for the Congressional Office of Technology Assessment, 1988. 5th edition. Gerson Institute. Straus, H. Dr. Max Gerson: Healing the Hopeless, Quarry Press, Kingston, ONT. 2002. Competing interests: I am Dr. Gerson's grandson and biographer, author of Dr. Max Gerson, Healing the Hopeless |
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Peter J Moran, Retired General Surgeon Ipswich, Qld. Australia 4306
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I have not ignored your grandfather's results. I know he was sincere, but have no way of assessing the merits of such historical material. Those looking at his results were not necessarily very biased. I have seen enough testimonials and "best cases" to be aware that with a few very rare exceptions they suffer from incomplete information, such as proof of active cancer, the outcome is consistent with the very variable natural history of some cancers, there is an underestimation of the effects of conventional treatments also used, or they don't even allow for the fact that most patients using alternatives would be using up to a dozen other methods at the same time. They also do not take into account the possibility of not uncommon diagnostic or prognostic errors. The average 'alternative' cancer practitioner is a naturopath, psychiatrist, dentist, laboratory scientist, TB sanatorium doctor in the case of your grandfather, or has some other occupation that does not usually enable them to learn much about the behaviour of cancer. They thus will never know such things as that 7% of those having palliative operations for bowel cancer (where metastases were suspected or the cancer was thought to be incompletely removed) are still alive ten years later <1>!! We get unexpected outcomes in our practices, too! With historical material such as your grandfather's, there is the further problem that medical technologies for assessing the presence, type, and extent of cancer were much less precise. So contemporary data is needed, especially now it is ever so much easier to follow the progress of most cancers. We also need SOLID data, and the protagionists must learn what we mean by that, as Hildebrand did through her association with the OAM (The predecessor of the NCCAM) and then discovered she didn't have it. For those who are sincere about their "alternative" treatments, it has become a matter of standing out from a veritable crowd of claimants. This is why I say the pressure MUST be on them to produce a smidgeon of systematic, prospective, contemporary (and thus confirmable), and detailed data showing at minimum that active cancers don't just continue on their merry way on their treatment (as Gonzales did, although he does carefully select those he treats). Those who continue to avoid doing this must remain suspect. Those who support them despite all, with allegations of bias and impossible conspiracies should think again. In the back of our minds there is always the fact that Laetrile, shark cartilage, megadose oral vitamin C, the Di Bella treatment and other subjects of major claims and public excitement were unable to perform when subjected to prospective trials. (Yes, yes, I know it is all the Big Pharma conspiracy. Don't you think enough of our patients are using these methods for us to have some idea how well they work?) Peter Moran 1. McLeish JA, Thursfield VJ, Giles GG. Survival From Colorectal Cancer in Victoria: 10-year follow up of the 1987 management survey. ANZ J. Surg. 2002,72: 352-356) Competing interests: None declared |
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Howard D. Straus, Nonprofit organization executive Carmel, CA 93923
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Dr. Moran has used the same old argument that has been floated for years: if it was cured, it cannot have been cancer, but must have been misdiagnosed. He goes a little further, implying that in the 1950s the technology and knowledge was such that the doctors then might not have recognized cancer, they were that backwards. Cancer in the United States was an enormous problem in the 1950s, though not as pervasive as it is today. One in four people got cancer sometime in their lifetimes. Huge cancer research centers had the most sophisticated equipment for diagnosing and treating the disease, including Memorial Sloan-Kettering Cancer Research Center in New York City. Gerson did not ever, nor does the Institute today, depend on his own laboratories, biopsies or diagnoses for determination of the presence of cancer, but relied on tests performed by other, often hostile, physicians and laboratories. This is specifically due to a long history of accusations like Dr. Moran’s of fraudulent or mistaken diagnoses. Many of his patients had been through years of cancer treatment, mostly radiation and surgery at the time, before he saw them. Now, if the disease he was treating really was NOT cancer, then these poor patients had been hoodwinked, burned and mutilated, often nearly to death, by surgeons and radiologists pretending that they had cancer, or perhaps doing repeated draconian treatments for the wrong disease over the course of many years. Gerson published his monograph, A Cancer Therapy: Results of 50 Cases, including X-rays, medical records and photographs of some of his best cases. If these patients were left in that condition by surgeons who either ignorantly thought they had cancer or were deliberately misleading them, that is a worse indictment of the oncology community than it is of Gerson. Might it still be occurring? As far as misdiagnosis, cancer was a well-known disease 50 years before Gerson began treating it, though not as widespread as it is today. There is no way that spreading melanoma can be mistaken for a something else. The “misdiagnosis” accusation started when Gerson began curing tuberculosis in the 1920s, because “everyone knew” that tuberculosis was incurable. Thus, if he cured it, it must not have been tuberculosis! He was accused of retouching X-rays (a total impossibility, as any radiologist knows) to make it look like lung tuberculosis had been cured! It would be interesting to know if all so-called misdiagnosed cases were sent to Gerson to be cured, or if the epidemic of misdiagnosis during Gerson’s lifetime extended itself throughout the oncology community. Dr. Moran insults his fellow physicians when he implies that the massive cancer industry in the United States was either lying or was so sloppy as to misdiagnose the majority of their cancer cases, mistakenly sending millions of patients to expensive, lengthy and painful treatment for the wrong disease. And why would the patients have come to Dr. Gerson? After all, if they didn’t have cancer in the first place, and the conventional treatment they were receiving was apparently relieving their disease, they would have stuck to it. That was NOT the case. Patients came to Gerson only after conventional treatment had failed, often repeatedly, to stop the progress of what they were told was cancer, confirmed by biopsies, X-rays, tests and their oncologists. Almost all Gerson’s patients came to him in terminal condition, having suffered from years of treatment for their ostensible cancer. Many of these patients are still alive today, over 50 years later, including melanoma, pancreatic and liver cancer recoveries. As far as the “pharmaceutical conspiracy” that Dr. Moran dismisses so lightly, it may not be so in the UK or Australia, but in the US, the corruption and influence the pharmaceutical industry has over medical journals has gotten so pervasive and massive that it became a subject of complaint not just by paranoid alternative practitioners, but by Dr. Marcia Angell, the departing Executive Editor of the New England Journal of Medicine, who said in her farewell editorial that "large-scale breaching of the boundaries between academic and for-profit industry" is taking place. Dr. Angell is the epitome of the establishment physician. Drug companies may not be in direct collusion, but they are all pursuing the same goal, maximizing profits at any cost, including corruption of government, the democratic process, regulatory agencies, research laboratories, researchers and medical journals. References: Angell, M. “Is Academic Medicine for Sale?”, New England Journal of Medicine, Vol. 342, No. 20, May 18, 2000 Gerson, M. “A Cancer Therapy: Results of 50 Cases”, Fifth Edition, The Gerson Institute, San Diego, CA, 1990. Competing interests: I am Dr. Gerson's grandson, and the author of Dr. Max Gerson: Healing the Hopeless. |
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Erich K. Ledermann, Medical Practitioner in private practice l3 Ardwick Road, London, NW2 2BX
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In response to Dr. Herbert H. Nehrlich’s article “Pritikin was motivated-but did he have any answers?” I have not just come across Pritikin’s Miracle Cures or rather the anecdotal ramblings of it”. I do not think that his “spectacular results” were only with “people who had one and a half feet in the grave”. I assume that Dr.Withnell and others who benefited from the Pritikin Longevity Center in California had ‘long term outcomes.’ I agree that a modification of the diet must be considered which can improve results. This would still be a holistic treatment, clearly different from the usual treatmernt of cardiovascular disease which is mechanistic. Competing interests: None declared |
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Michael D Innis, Director Medisets International Home 4575
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Editor, Twenty years ago, on the 150th anniversary of the BMA, Prince Charles was appointed its president and admonished the medical profession for its complacency - according to Professor Baum. It is a great pity His Royal Highness is not in that position today as the complacency of the profession in tolerating the fabricated diagnosis of Shaken Baby Syndrome sends hundreds of Her Majesty’s subjects to prison and needs the four page exposure of this atrocity which His Royal Highness can command. Only in England and its former Colonies, {America, Canada and Australia} are doctors so ready to condemn innocent parents for what is essentially a medically induced condition when an adverse vaccine reaction can be identified as the cause. In these countries Judges and Juries have been deceived into believing the word of doctors rather than that of parents when determining the cause of a subdural haemorrhage, unexplained bruise or so-called “fracture.” Complacency again afflicts the medical profession and again it needs to be admonished by the Prince to save hundreds of families from false accusations. “It is restlessness, anxiety, dissatisfaction, agony of mind that nourish science." Please, your royal highness, help us nourish medical science by sharing our agony..”[Baum] Michael D Innis MBBS; DTM&H; FRCPA; FRCPath. Competing interests: I have exposed false allegations. |
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Dr. Sankar. K. Das, Consultant Geriatrician (retired) St. Helier Hospital, SM1- 3EX
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To the Editor, BMJ. Ref: Personal views by Michael Baum “An open letter to Prince Charles”. BMJ volume 329, 10th July 2004. Dear Sir, It is interesting to read Professor Baum’s letter about alternative medicine, but as a Consultant geriatrician, who has worked in the NHS for 30 years, I would like to say that it is always better to keep an open mind when approaching patients suffering from intractable, untreatable cancers, leukaemia and many other diseases that are not wholly responsive to using exclusively allopathic (chemical) medicinal approaches. I remember at least two cases with cancer while working in the NHS, and both cases were renowned people from the UK. I met both patients in the Eighties at Dr. Iscle's Black Forest Clinic in the Bavarian Alps, where he used alternative medicine and his own theories to treat cancer. His method was (1) exchange transfusion in adults, (2) use of spring water from the Alps springs, (3) plenty of green vegetables and at times the use of (4) turmeric root and neem leaf powders, especially if the patient had Hepatic metastasis. All patients came to Dr. Iscles after they had bitter experiences with chemotherapy and radiotherapy in our top NHS hospitals. To my utter surprise, I found that both the cases above had extended their lives from Dr. Iscle’s treatment for at least another two- three years and lead an almost normal life. I must conclude that (with reference to the Prince of Wales’ article on 13th August 1984 in the BMJ and BMJ volume 322 “20th January 2001), I am happy to support his idea of alternative medicine without any reservations, especially as people in India and China continuously practise all kinds of Indian ayurvedic and Chinese herbal remedies in their respective countries and have successfully done so for around 5000 years. It may also be noted that herbal medicine will not cause any unpleasant side effects when compared to chemical allopathic medicine. As a Geriatrician, I saw many cases with unwanted reactions to chemical compounds and to prevent such reactions we continuously add more drugs to counter the bad effects of the original drugs. Therefore, alternative therapy, scientific or not, may be an acceptable alternative even though it is contrary to Dr. Baum’s belief. I would always advise ladies suffering from aggressive breast cancer, not responding to allopathic medicines, to try Tibetan herbal holistic medicine at the Himachal Pradesh clinic in India. I totally believe that it is better to invite death softly and pleasantly without causing intractable pain, sloughing of skin, bleeding from all orifices and many other complications which we very proudly produce by prescribing all known chemical remedies to our patients. Hence, when Prince Charles supports a glass of carrot juice and coffee enemata, I totally agree with him, and his suggestion of the usefulness of alternative therapy is better than violent chemical reactions caused by allopathic remedies possibly without exception. The proud allopathic doctors should accept that after using their cumulative knowledge for the last 150 or so years, they have failed to cure cancer and should at least accept the validity of 1000 years of alternative medicine as practiced in India and China. It should also be noted that the term ‘Alternative Medicine’ does not imply that the use of anti-cancerous drugs is avoided. In fact, herbal remedies are used to counteract the cancerous cells and leukaemia cells. These herbal products are also known to have some immune-boosting properties and so the patient can resist the disease with their own bodies. Contrary to the use of chemical substances that not only destroy the cancerous cells but also destroy the immune system, thus making sure that the patient cannot survive for long. Professor Baum should not forget that the scientific evaluation of complementary and alternative medicine (CAM) using controlled trials might not always give satisfactory results. Articles published recently in the newspapers stated that allopathic medicine only proves 60% of the effective scientific values of their chemical substances and the result of 40% are considered to be scientifically flawed. Therefore Michael Baum’s pride in the scientific evaluation, may not be justified. Professor Baum should also not forget that a glass of spring water, carrot juice, green vegetables and fresh fruits definitely show superior results to chemical medicine, which is regularly prescribed by the so called experts in European countries to treat cancer, leukaemia and many other intractable diseases. Therefore I do not believe that His Highness, the Prince of Wales ‘got it wrong’ about alternative medicine after all! Yours sincerely. Dr S.K. Das,
F.R.C.P (London and Glasgow), F.C.C.P
Competing interests: None declared |
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Michael Fox, Chief Executive of The Prince of Wales's Foundation for Integrated Health 12 Chillingworth Road London N7 8QJ
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The Prince of Wales's keynote speech to the joint symposium, which this Foundation, the National Cancer Research Institute and four of the UK's leading cancer charitie (Marie Curie Cancer Care; Bristol Cancer Help Centre; Macmillan Cancer Relief and Breakthrough Breast Cancer) held in June, attracted considerable media attention. Much of the interest was generated by inaccurate and misleading reports of his speech. We all want to understand what works and what doesn't, whether that be conventional, complementary or alternative approaches to cancer. As The Prince of Wales pointed out, if up to 80% of patients with cancer try complementary or alternative treatments following diagnosis, then surely it makes sense to investigate their efficacy. The Science and Technology Select Committee on Complementary and Alternative Medicine (CAM)'s report in December 2000 recommended that the Department of Health should provide this area with dedicated research funding in order to develop "Centres of Excellence". It has been good to see that in response, the Department of Health has made funding available (particularly in its endeavour to build up research capacity), but more needs to be done. The establishment by the National Cancer Research Institute of a special interest group on research into complementary therapies is a significant step forward in the cancer field and one that this Foundation strongly supports. As The Prince of Wales said, it is essential to adopt a collaborative approach to cancer research - one which takes into account all methods used by cancer patients. Competing interests: The Prince of Wales is the President of the Foundation for Integrated Health |
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John Y Davenport, Physician Permanente Medical Group 92807
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Dr. Baum provides us a superb example of expository writing in his defense of reasoned medical science over anecdotal medicine. I understand his need to provide a quiet and deferential response to the Prince’s advocacy of coffee enemas and carrot juice but from this side of the ‘Pond’ we say ‘Hogwash!’ John Davenport MD, JD Competing interests: None declared |
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CELIO LEVYMAN,MD,MSc, Senior Neurologist Headache and Neurology Clinic,Sao Paulo,Brazil,01124-010
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Congratulations to Prof. Baum. In UK the public positions of the Prince of Wales are acting against the serious Science and Medicine. However, in many other places of the world, the “alternative” Medicine reaches intolerable points, and public personalities, as Prince Charles, artists and so on go in defense of practices, as I say, at least very bizarre. As the author points, the “alternative” methods should pass to the rigid protocols and methods of “orthodox” Medicine to obtain scientific and evidence-based positions: in other words, there are not “alternative” or “orthodox” methods, only one thing, the real Medicine: if an unusual method should be approved by scientific methodology, they don’t be named “alternative”, only a medical branch one. Competing interests: None declared |
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Andrew D LAWSON, Consultant in Pain Management Royal Berkshire Hospital
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What is it about royal patronage that makes a treatment effective? The debate about alternative medicine will run and run , particularly when the Prince of Wales is such an advocate, but we have to ask ourselves if there was not such patronage would the government have spent £20m on the Royal London Homeopathic Hospital or would it be so keen as to integrate such treatments into the NHS? On Radio 4 this week Anna Ford presented a piece on CAM ( complimentary and alternative medicine ). She described the ground breaking research ( in 1986) of an earnest and entirely believable Dr Reilly and went on to interview a Dr Fisher who is the "Queens Homeopath". Of what relevence , other than to give gravitas and weight and credibility to his comments, is the fact that he has been so honoured? Dr Fisher stated " everybody who's done that concludes that the evidence says homeopathy really does work compared to placebo, it is not a placebo effect" . So it really does work then. But the University of York has a place called the NHS centre for dissemination and reviews and it published a major piece of work on Homeopathy in 2002. Its Effective Health Care series commented " there is currently insufficient evidence either to reccomend homeopathy as a treatment for any specific condition or to warrent changes in provision". So not everybody has come to the same conclusion as the Prince of Wales or Dr Fisher. I am sure that both earnestly believe in what they say but can we justify spending public funds on more unproven treatments, yes there is much in stndard medicine that is "unproven", on the basis of belief and royal patronage. Competing interests: None declared |
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Allan J Sweeney, Doctor of Philosophy in Alternative Medicine Beach Houses, Royal Crescent, Margate, Kent, CT9 5AL
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I very much enjoyed the review by Michael Baum. It was enjoyable because it was so audaciously hardhitting against both aristocracy, and the explosion of grassroots people who are now seeking CAM (Complementary and Alternative Medicine). Though for a moment I saw his name as Bohm, the chap who invented the atom bomb to destroy much of humanity. Could Michael Baum's apparent addiction to "an NHS old world order" be at least equally destructive? Perhaps he could read the Final Report on Clinical Governance for CAM in Primary Care by Westminster University to the Department of Health and King's fund. He will be pleased to note that recommendations are advanced to promote adequate measures of CAM therapies within the NHS. He will also note that PCTs and GPs are currently conducting studies into the efficacy versus effectiveness arguments, and that a key recommendation is that a business case be made for each CAM therapy. The notion is already widespread that CAM could be appropriately and cost-effectively integrated into medical practice. Such integration will have its greatest impact wherever current conventional practice is less than fully satisfactory, perhaps because of adverse effects, their unacceptability to patients, poor compliance, or because of economic or other reasons, and where CAM has effective options to offer. CAM is often shown to be very cost-effective. Access (for CAM) to mainstream funding is opening up. There are now moves by many governments towards exploring the actualities of CAM, such as when, why, and how it works. We have reached the stage of funds being made available for CAM research. For example: It is only recently that university departments, statisticians, large databases and full-time research staff - all the elements that help build and maintain a research culture in conventional medicine - are backing CAM practitioners who want to conduct research. As CAM therapists’ professional bodies develop and academic groups form, coherent research programmes are developing. So there has been a steady growth in the volume of published evidence on CAM. Access to mainstream funding is opening up. For example, the Department of Health is currently running an awards scheme to develop research capacity for CAM in Universities across the country (in the UK). A successful pilot in Newcastle West PCG (now a Newcastle PCT locality) provided complementary therapy to NHS patients to address patient choice and inequity of provision of this service. Conditions chosen were those where the patient’s needs were poorly met by conventional treatments. The pilot clearly demonstrated that
Although randomised controlled trials RCTs are sometimes seen as the apex of clinical research, there have been recent moves towards Energy Based Medicine (EBM). Relatively few RCTs looking into the efficacy of CAM have been conducted. However, much of what is done in conventional health care, for example most surgery, physiotherapy, counselling therapy has hardly been the subject of RCTs. Moreover, it is estimated that only a quarter of what is published in the best professional journals is based on RCTs: clinical case studies, qualitative research and basic research all figure there too. David Sackett, originator of the EBM movement, defined EBM as integration of a range of the best available research evidence in the light of clinical experience and taking patient preferences into account. It seems that RCTs may not be the most appropriate research modality for many CAM therpaies, and other types of research protocols may be more relevant to exploring CAM. There is potential for CAM research and service provision. Micozzi (1996) has described these as: Persistent or relapsing illness with little or no tissue damage; No effective conventional treatment is available; Conventional treatment is unsatisfactory or requires continual use of conventional drugs; Elective surgery has been proposed, but immediate attention is unnecessary; Conventional treatment is inappropriate; The nature of the disease intractable, or the patient is determinedly non- compliant. Within the past 30 years, there have been increasing numbers of studies around the world researching, and demonstrating that the CAM therapy, healing, can have significant or highly significant efficacy, effectiveness, and cost-effectiveness, with fewer contra-indications, when compared to orthodox medicine. Ref Dr Dan Benor, Healing Research Volumes 1-3. Although I realise Michael Baum is not in a minority of one on the issues he raises about CAM in general and cancer in particular, it seems he could be left behind and become like the last smoker left alive. Did he not say he was the only one to speak against The Prince of Wales's BMA speech? By the way, the grand-daughter of the atom bomb inventor is now a priest, and has studied CAM therapies. I wonder how Michael Baum's grandchildren might evolve? As a Doctor of Philosophy in Alternative (and Complementary) Medicine, I would welcome private correspondance from such a hardhitting man as Michael Baum. But would he want to correspond with me? I doubt it. Go ahead Michael, make my day, prove me wrong. Competing interests: None declared |
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