Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Patients need to contribute to production of evidence-based information
- Hazel Thornton (4 August 2006)
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Evening primrose oil is often needed to replete proven deficiencies of omega-6 essential fatty acids
- Ellen C G Grant (9 August 2006)
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It is dangerous to be right in matters where established authorities are wrong.
- BM Hegde (9 August 2006)
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Which medicine is more science based,?
- Raymond G Holder (10 August 2006)
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A frustrated researcher
- Julie A Reynolds (10 August 2006)
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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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Edzard Ernst calls for the development of responsible evidence-based patient information on alternative medicine. [1] He is correct in suggesting that long held convictions and beliefs will get in the way of people`s acceptance of it: this reaction is regrettably the norm, as those who call for better information for women who attend for mammographic screening, for example, will testify. [2] Although the development of reliable patient information would go some way to improving the situation, there are other barriers of attitude and perception to be overcome. Poor toleration of uncertainty, and poor perception of risk and probability in a risk-averse society hinder rational critical appraisal of evidence. [3] Added to this is the low level of understanding about what constitutes good quality reliable evidence: education of the public about how treatments of any kind should be reliably tested is sorely needed. [4] If the information guide that Ernst proposes is to properly and adequately address the needs and concerns of patients, as well as being relevant, accurate and objective, detailed and comprehensive as he recommends, he must also add patients to his list of scientists, good communicators/writers, and designers who would be engaged in producing this information guide. [5] Hazel Thornton Independent Advocate for Quality in Research and Healthcare. [1] Edzard Ernst. We must give patients the evidence on complementary therapies. BMJ 2006; 333:308 [2] Hazel Thornton, Adrian Edwards, Michael Baum. “Women need better information about routine mammography.” BMJ 2003. 327:101-3. [3] Gerd Gigerenzer. Reckoning with Risk. Learning to live with uncertainty. Penguin Books, 2002. [4] Imogen Evans, Hazel Thornton, Iain Chalmers. Testing treatments: better research for better healthcare. British Library 2006. ISBN 0-7123- 4909-X [5] BMA Patient Information Award. See: Appraisal process and criteria. http://www.bma.org.uk/ap.nsf/Content/LIBBMAPatientInformationAward#app2 Accessed 4th August 2006. Competing interests: None declared |
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Ellen C G Grant, physician and medical gynaecologist Kingston-upon-Thames. KT2 7JU, UK
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Edzard Ernst believes that essential nutrient repletion may be almost certainly ineffective.1 He gives the example of evening primrose (Oenothera biennis) extracts which he writes are surprisingly popular for treating premenstrual syndrome, postmenopausal symptoms, eczema, multiple sclerosis, asthma, or other conditions, yet the evidence is largely negative. Previous Rapid Responses have discussed this subject in detail, which is accessible under “Grant, E” and essential fatty acids.2-5 It is inappropriate to regard essential nutrients as single magic bullets or to use the evidence from unscientific drug-type of trials of essential nutrients as meaningful of benefit. Deficiencies of omega-6 polyunsaturated fatty acids may not have been repleted if other common deficiencies, usually of zinc and magnesium and B vitamins, have not also been repleted. When detailed essential nutrient screening is used, the evidence of deficiencies is scientific and accurately verifiable. Deficiencies of minerals, vitamins and essential fatty acids are prevalent in modern societies. The doubts come from those who do not regularly investigate their patients biochemically. Evening primrose oil capsules, in one gram doses taken two to three times daily, along with fish oils capsules and the mineral and vitamin supplements are often needed to replete biochemically diagnosed deficiencies of both omega-6 and omega-3 essential fatty acids. An adequate essential nutrient status is a fundamental and important basic necessity for health. 1 Ernst E. We must give patients the evidence on complementary therapies. BMJ 2006; 333:308 2 Grant E. Test for essential nutrient deficiencies http://bmj.com/cgi/eletters/330/7496/871#103840, 15 Apr 2005 3 Grant ECG. Re: Measuring Fatty Acids - Possible increases in omega- 3 and omega-6 deficiencies among women. http://bmj.com/cgi/eletters/330/7498/991#108033, 27 May 2005 4 Grant ECG. Essential fatty acids and dermatitis http://bmj.com/cgi/eletters/327/7428/1385#43417, 13 Dec 2003 5 Grant ECG. Zinc and essential fatty acids in asthma http://bmj.com/cgi/eletters/329/7464/489#72650, 31 Aug 2004 Competing interests: None declared |
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BM Hegde, Retd. Vice Chancellor Mangalore 575004, India
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Dear Editor, “Perhaps the most valuable result of all education is the ability to make yourself do the thing you have to do, when it ought to be done, whether you like it or not; it is the first lesson that ought to be learned; and however early a man's training begins, it is probably the last lesson that he learns thoroughly.” wrote Thomas H. Huxley while philosophizing on human ethical values. Medical ethics is nothing but good human ethics. Recent Northwick Park tragedy is still fresh in our mind about the fallacy of extrapolating animal data to humans, while the tragedy of similar data in the case of milrinone, which worked totally differently in rats vis-à-vis humans, is all but forgotten from recent memory. The question of complementary systems of medicine being unscientific is a figment of imagination of those that want conventional medicine to flourish for ever as it has become the biggest milch cow for the industry, by destroying anything that might endanger its supremacy. Exhaustive studies of all the “statistical science” of modern medicine shows that most of it can not stand the test of strict validation as shown by David Eddy using his new computer model ARCHIMEDES, at least in chronic illnesses to begin with. Even in the field of emergency care, where modern medicine seems to be a blessing, there are large gaps in our understanding of the management strategies! Outcome audits of such use in Vietnam and Falklands Wars leave much to be desired in emergency grievous trauma care. Many complementary systems that are being scientifically studied by the Whole Person Healing Group of scientists based in Washington DC (1) have shown the existence of vast amounts of observational research going back thousands of years in some systems like Ayurveda. It will be easy to authenticate these data using the modern “scientific” methods to bring the best in those systems to main line medicine. The data base available could shorten the new drug invention and could totally eliminate our “wrong” method of extrapolating animal data to humans.(2) In addition, we have also been using reductionist science to study a chaotic non-linear dynamic human system, wherein arrhythmia could be healthy while rhythmia could be illness! Just as quantum physics upset the Newtonian Laws of deterministic predictability, complementary systems might upset modern medical foundations. Newtonian Laws should result in the electrons destroying their own nucleus at the atom. Electrons also do not follow the electromagnetic forces at that level! Medical science has to learn a lot from quantum mechanics but, that would need a quantum leap in the thinking of our established “leaders” in the monetary economy. Ayurveda proclaims that the “well” should be preserved and only the “ill” should be treated (leave the “well” alone wrote William Osler) as there is no way to predict the future of a dynamic organism like the human body using phenotypic data alone! Ayurveda also shows how, at the quantum level, energy and matter have no difference-most advanced quantum physics!The heading comes from the French thinker, Voltaire Yours ever, bmhegde References: 1) Roy R. Science of Whole Person Healing. Proc. first International Conference. rroy@psu.edu 2) Heimleich HJ. Countless Medical Mistakes. heimleich@iglou.com Competing interests: None declared |
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Raymond G Holder, Retired engineer Not working BH9 3NF
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I wish the real evidence was available to be given to patients about official and complementary medicine. As I have written previously, the lack of real biological information on the reason for statin side effects which nearly led to my demise forced me to look elsewhere. The so-called complementary medicine which I discovered was more scientific than the industry boosted, statistic based statin treatment. The fundamental nature of the damage done to vital body substances is only mentioned as unimportant side effect symptoms, whereas in reality it is often of a serous and permanent nature. The microbiological implications have been studied academically in many places, but not funded or publicised by Big Pharma, and remain little known to conventional medical practice. By all means let the patient know the abilities of both conventional and so-called complementary treatments, but speak from detailed scientific knowledge of the real modus operandi of both sides. I read daily of the miseries inflicted by statins on very many victims and of the help obtained from supplements not yet in the Formulary. PS Is not cholesterol lowering the modern, less messy, equivalent version of blood letting and the barber's pole? Competing interests: Statin damaged patient now totally reliant on scientifically based, but so-called complementary medicine. |
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Julie A Reynolds, Acupuncturist and MSc Health Services Research student at York University Kings Norton, Birmingham, B38 8RS
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Leaving aside both the playground argument I am tempted to pursue - that the majority of allopathic medicine does not rely on evidence; and the implication that we survive only by peddling our hokum to desperate chronically or terminally ill patients, my reply to Edzard is that we would love to produce some more evidence on which patient information can fairly be based, so can we have some money and support please someone? As an acupuncturist, I cannot speak for others working in the ‘complementary and alternative’ field or indeed others in my profession. But I am also a fledgling researcher, struggling desperately to find funding to continue this side of my career in the hope of deepening our own understanding of our profession as well as that of patients and other clinicians. Of course, I am well aware of the arguments about accepted research methods being unsuitable, but choosing the right design for the right questions is possible, and scientifically rigorous. Our problem is not so much that the research methods we can choose from are unsuitable, rather that the research questions we are obliged to answer are. Some of us would love to be doing detailed research into the mechanisms of diagnosis and treatment within our own paradigm, but the call, quite rightly, for evidence that informs doctors and the public, means that we must pick a condition, labelled/diagnosed in western medical terms, to focus our question on. Yet in practice, the focus of our diagnosis and treatment is on restoring homeostasis in specific ways, based on our own theoretical framework, rather than aiming at one symptom or set of symptoms. This way, we are often able to address a whole range of what appear to be unconnected symptoms in terms of western medicine. The challenge, then, is to try to address the depth of our diagnosis and these broader outcomes in our research, whilst still addressing questions of importance to health service funders, doctors and patients. The statement that ‘complementary and alternative medicine survives only in areas where conventional medicine fails to provide an effective and safe cure’ whilst contentious, does highlight another major issue, which is that the scarce funding that is made available for research in our field tends to be provided to address precisely such issues. Plus researchers tend to pitch for funding on such conditions given that they provide us with a potential ‘opening’. Or else research takes advantage of a convenient situation, such as that of morning sickness patients presenting at a hospital. All this does not help us reflect the clinical reality of practice, which is that in ‘theory’ as well as in my own clinical experience, our medicine is able to address acute conditions of many different kinds, as well as conditions for which conventional medicine is unable to find a cause or even a name. Giving patients information solely based on the evidence so far will rely on this warped picture, not to mention the overall poor quality of much of the research, particularly in terms of external validity. I only argue for a rounded approach – including patients’ views and experiences, as another rapid response correspondent also suggested, and a good explanation of how we work. This should be undertaken for each medicine or therapy; we should not be lumped together any more than, to be fair, ‘conventional medicines’ should. And finally, I argue most of all for more funding and support – so I can help produce the kind of evidence that is fair and useful to us all. Having almost completed the trial I am running for my MSc, I have been looking so far in vain for funding to continue my research career. This is vital as I am, primarily, a self-employed practitioner. It is just the situation that I describe that makes my peers and I give up and retreat into our own private practice. I hope I do not have to give up. I welcome debate on these issues: julie.ann.reynolds@virgin.net Competing interests: Acupuncturist |
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