Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
"Treating evidence with contempt"
- Edzard Ernst (8 October 2008)
-
People who live in glass houses
- John P Heptonstall (10 October 2008)
-
Matthias Rath - Peer Reviewed References Re HIV treatments
- NONE NONE (14 October 2008)
|
|
|||
|
Edzard Ernst, Laing Chair of Complementary Medicine Peninsula Medical School
Send response to journal:
|
My job is to conduct rigorous research into alternative medicine. For 15 years, I have studied the effectiveness and safety of treatments like acupuncture or homeopathy. Often, the results were not what the proponents of these treatments had hoped for. One would have thought that this might lead to debate, further research or even health policy changes. Sometimes it did but recently we have witnessed an new phenomenon. People or organisations promoting highly questionable treatments are treating the evidence with contempt and flex their legal muscle to have it their way. A few examples: The ‘New Zealand Journal of Medicine’ recently published an article demonstrating that most chiropractors use the title “doctor”. They argued that this might mislead patients and cause harm. As a consequence, the chiropractors sought to silence the journal by threatening legal action 1. Fortunately the attempt failed. ‘The Guardian’ was sued for libel by Mattias Rath. The paper had exposed Rath’s strategy of convincing the South African government that his vitamin pills were more effective than antiretroviral drugs for treating AIDS. The Guardian put up a fight and eventually Rath dropped the libel action and was ordered to pay costs. An editorial in the Guardian noted that Rath's activity in South Africa "provides a terrible illustration of the potential consequences of treating the evidence with contempt" 2. Simon Singh recently condemned the British Chiropractic Association (BCA) for advocating chiropractic care as a treatment of childhood asthma and a range of other paediatric conditions. Instead of arguing their corner publicly, the BCA filed a libel action against Simon Singh 3. The case is likely to come before the courts soon. When I critically commented on a report which Prince Charles had commissioned on the cost-effectiveness of alternative medicine 4, my University received a letter from Charles’ first private secretary, Sir Michael Peat, to “draw attention” to what he perceived as a “breach of confidence” on my behalf. It took a gruelling 13 months of an internal inquiry at Exeter University to clear my name. After publishing a book with Simon Singh which evaluated the evidence for or against homeopathy and other alternative treatments 5, UK homeopaths are currently engaging in an elaborate campaign of multiple letter writing, repeatedly invoking the Freedom of Information Act to harass and silence me. The present letter shows that they have failed. All of this “is not just unpleasant, it is also unhealthy”, commented Ben Goldacre 6. I would add that the frequency of these events in recent months is outright scary. People who use legal muscle and power rather than reason and debate are a danger to reason and progress. What is at stake here is our right, I would argue our duty, to speak out against misleading claims and dangerous concepts. We should find ways of protecting us against such enemies of reason. Reference List (1) Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. NZJM 2008; 121(1278):15-20. (2) Anonymous. Vitamin deficiency. Leader editorial. The Guardian 2008; 13 Sept. (3) Eden R. Doctors take Simon Singh to court. Telegraph.co.uk 2008; 16 Aug. (4) Henderson M. Prince plots alternative treatments for the NHS. The Times 2005; 24 Aug:1. (5) Singh S, Ernst E. Trick or treatment? Alternative medicine on trial. Bentam Press: 2008. (6) Goldacre B. With their money, myopia and abuses, these pill makers match big pharma. The Guardian 2008; 13 Sept:34. Competing interests: None declared |
|||
|
|
|||
|
John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
Send response to journal:
|
Potentially libellous claims must be defended. Where is the evidence that the references Ernst supplies involve other than potentially libellous claims against alternative practices or practitioners? When one accuses organisations or people of misdeeds one must have supporting evidence or risk a responsible reaction. His statement “People or organisations promoting highly questionable treatments are treating the evidence with contempt and flex their legal muscle to have it their way…“ does not appear to be supported by his references, he qualifies his neither legal nor universally accepted opinion with irrelevant examples: - He states, “The ‘New Zealand Journal of Medicine’ recently published an article demonstrating that most chiropractors use the title “doctor”. They argued that this might mislead patients and cause harm. As a consequence, the chiropractors sought to silence the journal by threatening legal action…” And why not? If the NZJM directly or indirectly accuses chiropractors, who have ‘doctorates’ in chiropractic or any other discipline, of using their qualification to mislead patients thence cause harm – as Ernst says (though what harm necessarily has to do with a patient, who believes that a chiropractor has a doctorate, from whom he/she receives a chiropractic treatment is unclear, perhaps Ernst could enlighten us?) – rather than cite a specific case or cases with evidence of a chiropractor intentionally misleading a patient, the NZJM deserves to be investigated for that unreasonable attack. There appears to be no legal or moral reason why practitioners of all forms of medicine, including CAMs, should not publish their qualifications as long as there is no attempt to mislead. There is a dilemma, but it is more do with physicians using the term ‘doctor’ inappropriately thereby misrepresenting themselves as having doctorates when most do not, than it has to do with those qualified through post-graduate studies who make no attempt to deceive. Were the term restricted to use as meant, ‘doctor’ referring to one qualified by doctorate and not necessarily in medicine, there would be less opportunity for deception and more likelihood of a patient asking the origin of the doctorate. Then a patient who prefers to see a physician with or without postgraduate qualifications in medicine, who is also qualified in the CAM, can do so but those patients who prefer a practitioner who is not a physician can do so. He states, “ ‘The Guardian’ was sued for libel by Mattias Rath. The paper had exposed Rath’s strategy of convincing the South African government that his vitamin pills were more effective than antiretroviral drugs for treating AIDS. The Guardian put up a fight and eventually Rath dropped the libel action and was ordered to pay costs. “ Whether Raths’ pills are more effective in treating AIDS than antiretrovirals I have no idea, that does not appear to be the focus of the legal action, but Rath was reacting to what he considered a libellous attack by a newspaper against him. What has that to do with Ernst’s claim? Perhaps Ernst can explain? He further states, “An editorial in the Guardian noted that Rath's activity in South Africa "provides a terrible illustration of the potential consequences of treating the evidence with contempt" “ yet that is not about evidence but about the opinion of the Guardian; what has an Editorial to do with scientific evidence, is it not an Editor’s opinion? He states, “Simon Singh recently condemned the British Chiropractic Association (BCA) for advocating chiropractic care as a treatment of childhood asthma and a range of other paediatric conditions. Instead of arguing their corner publicly, the BCA filed a libel action against Simon Singh. The case is likely to come before the courts soon.” Anyone who publicly condemns a profession or professionals must have proof for their claim. Is Singh using opinion or sound science – say via peer reviewed medical journal - to justify an attack on a body of professionals? Surely a legal defence on behalf of all such professionals is in order. If Singh can support his attack with sound science he has nothing to worry about. He states, “When I critically commented on a report which Prince Charles had commissioned on the cost-effectiveness of alternative medicine, my University received a letter from Charles’ first private secretary, Sir Michael Peat, to “draw attention” to what he perceived as a “breach of confidence” on my behalf. It took a gruelling 13 months of an internal inquiry at Exeter University to clear my name. “ Publicising opinion rather than peer reviewed science, especially that which breaches confidences also, may require legal sanction – and why not; what is Ernst trying to say, that he should be exempt through his position of rules others must adhere to? He states, “After publishing a book with Simon Singh which evaluated the evidence for or against homeopathy and other alternative treatments” yet appears to ignore the fact that a book is not a scientific peer reviewed publication. Reasonably, legal sanction faces those who publicise claims that cannot be scientifically or otherwise, proven. If UK homeopaths are unhappy with attacks on their professional status and image they have every right, as long as within the law, to respond reasonably to those published attacks on their integrity and the integrity of their practices. “ ‘All of this “is not just unpleasant, it is also unhealthy”, commented Ben Goldacre’ “ suggests that Ben Goldacre should be the arbiter according to Professor Ernst. Is that not a rather strange position for a man who purports to be dedicated to science, evidence and proofs? “I would add that the frequency of these events in recent months is outright scary. People who use legal muscle and power rather than reason and debate are a danger to reason and progress. What is at stake here is our right; I would argue our duty, to speak out against misleading claims and dangerous concepts. We should find ways of protecting us against such enemies of reason. “ I think Ernst misses the point. There is debate and there is libel. A respected journal, or a predesignated venue, can be a focus for such a debate. Publishing potentially libellous attacks in books and newspapers is not a good way to initiate a debate. One cannot allow public attacks on professionals and professions to ensue without threat of legal or other reasonable action. There is also one man's reason and another man's reason. No one has the monopoly on reason - any scientist knows that. Not long ago in this medium Professor Ernst with Dr Adrian White effectively accused an unknown Japanese acupuncturist of killing a patient in Japan. Their accusation was not based on scientific or legal or indeed any serious investigatory evidence – no acupuncturist had been identified nor accused nor investigated in Japan nor had the practice been formally accused by Japanese officials, yet Ernst was happy to enter into print via the eBMJ. After I questioned the reliability of their evidence for that accusation in the eBMJ, and under heading Re: “Toxic shock-like syndrome probably caused by acupuncture”, on 2nd August 2000 Ernst’s co-writer Dr. Adrian White wrote “Our original letter unambiguously listed the association as ‘probable’ in the table, but the wording of our text may have erroneously implied that the association was definite”. I think Ernst needs to be reminded about “people in glass houses” and “casting the first stone”. Competing interests: None declared |
|||
|
|
|||
|
NONE NONE
Send response to journal:
|
This response was removed on 28 October 2008 | |||