Recent rapid responses
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Displaying 1-10 out of 92 published
30 December 2004
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
· Complementary therapies provided are well-tolerated and popular
treatments
· A high level of patient satisfaction was reported
· There was evidence of health improvement, and a cost offset for
conventional care.
· The savings in primary care alone amounted to 41% of the pilot cost.
· There was a reduction in the use of conventional medicines
· The number of GP consultations was reduced
· There was a beneficial impact on other services
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
Competing interests: None declared
Beach Houses, Royal Crescent, Margate, Kent, CT9 5AL
10 October 2004
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
Competing interests: None declared
Royal Berkshire Hospital
27 September 2004
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
Competing interests: None declared
Headache and Neurology Clinic,Sao Paulo,Brazil,01124-010
24 September 2004
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
Competing interests: None declared
Permanente Medical Group 92807
22 September 2004
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
Competing interests: None declared
12 Chillingworth Road London N7 8QJ
8 September 2004
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
Consultant Geriatrician and Senior Lecturer,
University of London, St. Georges(Retd).
Competing interests: None declared
Competing interests: None declared
St. Helier Hospital, SM1- 3EX
6 August 2004
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.
Competing interests: None declared
Home 4575
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
Competing interests: None declared
l3 Ardwick Road, London, NW2 2BX
2 August 2004
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.
Competing interests: None declared
Carmel, CA 93923
30 July 2004
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
Competing interests: None declared
Ipswich, Qld. Australia 4306








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