Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
What to do about CAM
- David Colquhoun (2 October 2007)
-
It's good to talk
- Susan E Farwell (3 October 2007)
-
The most important work I do.
- Dr Edmond V O`Flaherty (6 October 2007)
-
Scientific fundamentalism
- Jerome Burne (15 October 2007)
-
Nice illustration of the problem
- Michael F Vagg (14 November 2007)
-
The true value of the Placebo effect
- Rhys H Thomas (9 December 2007)
|
|
|||
|
David Colquhoun, Professor of Pharmacology UCL WC1E 6BT
Send response to journal:
|
Douglas Kamerow seems to me to be excessively tolerant of people who make a lot of money out of unproven and disproved treatments. I have to say that I prefer the straight talking of his compatriot, Gerald Weissman "If the trend persists, perhaps MIT or Cal Tech will march in step with the medical schools and offer prizes for integrative alchemy or alternative engineering." "It is time for Congress to defund the National Center for Complementary and Alternative Medicine (NCCAM). After ten years of existence and over $200 million in expenditures, it has not proved effectiveness for any "alternative" method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed." That is something that could be done. (The expenditure on NCCAM is now close to a billion dollars.) In the UK NHS, Primary Care Trusts are, quite rightly, withdrawing funding from homeopathy. One homeopathic hospital will close and another is in great danger. Something has been done, at last. Competing interests: None declared |
|||
|
|
|||
|
Susan E Farwell, Registered osteoapth 72 Heavitree Road, Exeter, EX1 2LP
Send response to journal:
|
Douglas Kamerow observes correctly that complementary and alternative medicine is not scientifically proven, yet patients seem to be voting for it with their wallets. He suggests that a sensible approach for the medical profession is 1. To talk to patients about their treatments
May I suggest talking directly to complementary practitioners as well? Most of us are moderately sensible types. Many of us find it almost impossible to catch the attention of a doctor in order to explain what we are doing to their patients and why we are doing it. I can only speak for osteopaths but know that many of my colleagues would value a response to our attempts to communicate. Susan Farwell
Competing interests: I am a registered osteopath |
|||
|
|
|||
|
Dr Edmond V O`Flaherty, GP Gleneagle,Greygates,Mount Merrion,Co. Dublin
Send response to journal:
|
When I became a GP I had no knowledge of any therapy other than what we were taught ih hospital. We kept patients in bed for quite a while after an infarct as we did with patients who had severe back pain.We used drugs which later proved to be highly dangerous. Many years later I developed an interest in nutrition in mental health,using vitamins,minerals,amino acids and essential fatty acids as complemetary treatment and now I use these nutrients for many patients with much satisfaction.If a patient who has seen a cardiologist comes to me and says he heard I could improve his disease I would laugh at the idea. However if a patient who had seen a psychiatrist comes there is a better than 50:50 chance that I can significantly improve his condition.Much work has been done in this field by the late Dr David Horrobin,Professor Malcolm Peet of Sheffield University and Professor Andrew Stoll of Harvard but much more needs to be done,especially in publishing results. Drug companies will not pay anything to advance this type of treatment. Doctors generally have no knowledge and no interest in the subject.I think that is outrageous. This month for example I have 2 patients who have been diagnosed with schizophenia starting at university and all I have done is to try to normalise their biochemistry while leaving their medication to the psychiatrist.This is the most important work I do and the most satisfying.For those interested I have a website at www.omega3.20megsfree.com Competing interests: None declared |
|||
|
|
|||
|
Jerome Burne, freelance medical journalist W9 1EL
Send response to journal:
|
No one could sensibly object to subjecting any form of medical treatment to trials to see if it works, although there is obviously room for discussion about what is the most appropriate form of trial for various types of treatment. What is striking about articles such as Douglas Kamerow's and, even more, David Colquhoun's response, is the underlying assumption that while CAM is devoid of evidential support, conventional medicine sits on a bedrock of science and is firmly supported by flying buttresses of evidence. The basic fallacy here is that medicine is a science. Of course it makes extensive use of science and efforts are made to ensure that treatments are supported by clinical trials, but only a Martian could believe that all of what doctors do is underpinned by evidence. The fact that disciplines such as aeroplane design and bridge building do not have a complementary and alternative arms tells us something. The science underlying these disciplines is pretty well sorted out - Complementary planes don't fly. Medicine isn't like that, as anyone who isn't a scientific fundamentalist knows. Not only is the system it's trying to influence unbelievably complex but it interacts with the environment - and that can include emotional reactions to practitioners as well as responses to chemicals and probably electromagnetic radiation - in ways that are still being unraveled. Conventional medicine understands some of what goes on but much is still a mystery - have a look at the scientific underpinnings of mainstream treatment for CFS/ME or mental disorders - not very impressive. The truth is that many of its planes do not fly which is why CAM thrives. When it comes to the practice of medicine the claim that there is clear blue water between proper medicine and CAM made by the scientific fundamentalist is even harder to support. The BMJ's own web site devoted to evidence based medicine has a revealing chart showing the levels of evidence for standard medical treatments - 50% are based on little or no evidence. A couple more specific examples. A study last year published in the Annals of Internal Medicine based on the prescribing habits of over 3000 American physicians showed that 20% of their prescriptions were issued off -label -i.e not backed up by trials. Not only that but 70% of them were said to have no scientific base at all. Off-label prescribing is common in the UK - tellingly no one knows how common because no records are kept. HRT was prescribed off-label for years until clinical trials showed the dangers; the same is true of prescribing anti-depressants to children which turned out to raise suicide risk. Currently some 200,000 patients with dementia are prescribed anti- psychotic drugs in the UK. However not only are these drugs not licensed for this use but there are proper trials showing they raise the risk of strokes and are ineffective. There are understandable reasons for all these but scientific medicine they are not. Yet I haven't noticed the likes of Dr Colquhoun laying into the manufacturers of these drugs or those who dispense them on the grounds that they are "people who make a lot of money out of unproven and disproved treatments." Unlike anti-psychotic medication, homeopathy doesn't actually kill anyone or induce massive weight gain; it is also far less lucrative. The practise of evidence-based medicine, while a worthy aim, actually applies to a relatively narrow approach to medicine, one that is almost exclusively focused on drugs and biochemistry. This is where the great bulk of the money is spent but it leaves out whole areas of treatment that can be very effective in benefiting patients. Fundamentalists of every stripe are characterised by intolerance and a narrow self-satisfied view of the world - possibly not the best place to start healing people. Competing interests: Co-author of "Food is Better Medicine Than Drugs (Piatkus 2006) |
|||
|
|
|||
|
Michael F Vagg, Consultant in Rehabilitation and Pain Medicine Geelong, Australia 3220
Send response to journal:
|
The above responses illustrate the recurring difficulty with "CAM" which is the faulty logic used by so many of its well-intentioned practitioners. The scientific method works from observation to hypothesis generation to testing and then interpretation of the results. Hypothesis first, conclusion last. If you start with the conclusion, ie 'homeopathy works' then work backwards to find evidence, this is not science, whatever journal it is published in. As but one further example, look at the statement "The truth is that many of its planes do not fly which is why CAM thrives." This is an utter non sequitur. The assertion of an opinion regarding the efficacy of 'orthodox' treatment is not evidence of any type. The reason "CAM" is so popular is that outrageous and unsupported claims are made direct to susceptible consumers and there is no accountability for this. As pointed out, the Clinical Evidence website shows around 50% of 'orthodox' treatments have scientific support. That's 50% more than all "CAM" modalities combined. I also reject the false dichotomy between 'orthodox' and 'complementary' medicine which has arisen because polite people refuse to point out which Emperor has no clothes. Competing interests: None declared |
|||
|
|
|||
|
Rhys H Thomas, ST2 NeuroRehab Rookwood Hospital, Fairwater Road, Llandaff, Cardiff, CF5 2YN
Send response to journal:
|
Sir, It is often said that there is a lack of evidence showing the efficacy of alternative therapies. Critics say that their results are explained by harnessing the placebo effect. (1) That may be true, but since 1990 placebo has been shown to consistently out perform therapy. Placebo have had a total of 15 top 40 hits with an average highest chart position of 17 (standard deviation 9.4) compared to the 12 hits of Therapy? (mean chart placing 22, SD 7.5). In addition, if there was to be a Placebo vs Control trial, the evidence again favours Placebo. Control reached number 17 with their sole top 40 hit ‘Dance with me’ in November 1991. Placebo edges this comparison, as they twice reached number four – initially with their hit ‘Nancy boy’. Practitioners of evidence based medicine should sit up, turn their stereos on and listen to the evidence. Reference Kamerow D, Wham, bam, thank you CAM. BMJ 2007;335:647 Competing interests: None declared |
|||