Closing the evidence gap in integrative medicine

The irony is not lost on Caroline Richmond's cynical comment

""Need a hip replacement? Have some moxibustion instead.""

She's nearer the mark than she obviously realises.

It is not uncommon for acupuncture and moxibustion to be used with
people awaiting hip and knee replacements to ease pain and symptoms during
what, in the UK, can be inordinately lengthy waiting times for surgery.

We also ease the suffering of patients told their medical
investigations confirmed joint replacement is necessary but age, or
concurrent health problems which increase the general risks of surgery,
preclude early surgical intervention, and for whom analgesics and NSAIDS
do not provide sufficient relief such that they had become house-bound.
Although their joints may be beyond recovery by acupuncture &
moxibustion, we are often able to ensure reasonable symptom relief to
allow people to regain some quality of life prior to their usually (but
sadly not always) enormously successful surgery.

That is but one example of successful integrated medicine for which I
have known many grateful patients.

Competing interests:
TCM Acupuncture & Moxibustion Specialist

I am spluttering at the outrageousness of this editorial in today’s
BMJ.

What I think it is saying is that 'integrative medicine' should not
be subjected to randomised controlled trials, and that Mike Rawlins said
so in his Harveian oration (I was present and he didn't), and that
anything that makes even a single patient feel better is OK and therefore
should be in the inventory of desirable interventions.

It's not just 'anything goes' but 'everything goes' -- and presumably
the NHS can pick up the bill.

This non-peer reviewed editorial was written by CAM apologists,
though ones who claim no vested interest in promoting CAM. Ironically it
was juxtaposed with another editorial describing the substantial savings
the NHS is having to make, and it was published on the day the IMF
reportedly warned the NHS must face painful cutbacks. So presumably the
lesson is: up with treatments that don’t work at the expense of those that
do. Need a hip replacement? Have some moxibustion instead.

'Integrative medicine” is the fashionable name for what until
recently was complementary medicine. Way back in the hippie days of the
seventies it was alternative medicine, and before that, when post-war
sanity still prevailed, it was called quackery and only nutcases went in
for it.

Has the BMJ become so broadminded that it cannot discriminate sense
from nonsense? As an opinion piece it might have passed muster, as an
editorial it appals me.

Competing interests:
None declared

Response to Dr Leslie B. Rose BMJ.com 30 September 2009.

An American orthodox doctor, Dr Constantin Hering, set up to debunk
homeopathy; he did the right thing, he studied first, and instead of
debunking it, he became a famous homeopath. Why? Because by knowing what
it was he realised that it works and how it works.

Only those who don’t know (haven’t got the foggiest about the
subject) would, unwisely may I say, even express an opinion instead of
just admitting the most obvious, namely their ignorance of the subject.

Rephrased: sadly, many modern, orthodox, allopathic (and certainly
not traditional) doctors venture into the unknown territory forgetting
that what they say just reflects their state of knowledge and/or
ignorance. Confronted with opposition, they flex their muscle and resort
to argumentum ad hominem. If not wisely, at least loudly.

There is another aspect to doubting: power games. The members of The
Holy Inquisition rejected everything they did not know anything about
because they could. They had the power to do that. Unfortunately, much
of this applies to modern medicine with their powerful political position.

In my rapid response which Dr Rose criticises I wrote very clearly
that it is unwise to even comment on the unknown. That is an age-old
wisdom unless one is unwise and wants to flaunt their ignorance and even
see it as a virtue. Just like the school yard bullies: "yeah, yeah, I can
beat you up and push you around and that’s why I am right". Might makes
right in their philosophy, but does it? It may silence their victims but
it does not make them right.

By appropriate literature I meant any literature which is
unadulterated by the perceived political power and vested interest. That
surely includes homeopathic scientific journals.

Nature on this planet operates on many levels: physical, emotional,
spiritual, macroscopic, microscopic and even submicroscopic level, whether
anybody knows it or not, or whether anybody agrees with it or not. Illness
and healing happen on those levels. Most healing is spontaneous because
the body has that capability whether we take any medication or not.
Sometimes, nature needs a bit of a nudge that’s why it also gave us
natural remedies such as an appropriate food, herbs, minerals, healing
touch (massage), or just urges us to relax and get away from it all.
That’s why the change of air (going away from the stressful environment;
change is as good as holidays) has traditionally been considered an
important part of healing.

There are many ways and systems of healing, reflecting the knowledge
of natural mechanisms. Acupuncture is based on the knowledge of energy
meridians, reflexology on the knowledge that every organ has a spot on our
hands, yes, ears, feet, according to comparative anatomy and phylogenesis.
Naturopathy and herbalism are based on the knowledge of healing properties
of herbs and mineral substances. They have coexisted for centuries and
millenia peacefully and cooperatively. They are traditional.

With the exception of mathematics, all natural sciences are
empirical, i.e. based on observation. Modern orthodox, allopathic
medicine is no exception. Case histories are, and should remain, the
bread and butter of medicine. Meaning, a good modern orthodox, allopathic
doctor should be able to see, analyse and base the diagnosis upon the
observed symptoms in a single patient. To criticise any doctor for basing
his diagnosis on observed facts , is naïve to say the least (one can be
less charitable, of course). The accuracy of observations depends on the
knowledge, experience and intuition of the observer. No amount of diplomas
will replace them.

Homeopathy does not suppress symptoms, instead it used them as a
guide in diagnosis. It’s remedies support and enhance the body's own
defences. In contrast to this, orthodoxy relentlessly suppresses
symptoms, such as fever, pain, rashes, cough (flegm), very often with dire
consequences for the patient. Which system should be considered truly
scientific?

Orthodoxy chases germs, microbes, and often forgets about the host
resistance as a decisive element in whether we succumb or overcome
infections. Louis Pasteur credited with the germ theory of disease,
renounced it on his death bed with his famous last words “The seed
(meaning the germ) is nothing, the soil (meaning the host resistance) is
everything. That was his true message to humanity and modern medicine. If
modern medicine does not know, and/or ignores that fact, it places its
knowledge base in the area of infectious diseases 180 years back. Even
modern orthodox immunology, unadulterated by vested interests, knows
better.

Animals live according to Natures’ laws. It is a purely human trait
to work against Nature. Ignorance is actually considered acceptable. “To
err is human”. Yeah, but is it inevitable and desirable? Learning by
experience is also a human trait. There are power struggles in Nature but
with animals they are based on an advantage, better ability to adapt and
better fitness for the task, such as reproduction, while with humans it
may mean survival of the unable to adapt and of the unfit. Along the
lines “blindness to the truth”. I am, of course, referring to
iatrogenesis.

An important message from history which, unfortunately, has not lost
its relevance for medical practice, was published by Hillary Koprowski
(1962. The role of hyperergy in measles encephalitis. Am J Dis Child;
103: 103-208). He wrote that a very clear statement was made in 1712 on
how not to treat measles.

In a letter to Duchess Sofie, mother of the future George I of
England, Princess Elizabeth Charlotte (Liselotte) von Pfalz, Duchess of
Orleans and widow of the younger brother of Louis XIV, wrote,“Our
misfortune continues. The doctors have made the same mistake treating the
little Dauphin as they did ministering to his mother, the Dauphiness.
When the child was quite red from the rash and perspired profusely, they
[the doctors] performed phlebotomy and administered strong emetics; the
child died during these operations. Everybody knows that the doctors
caused the death of the Dauphin, since his little brother, who had the
same sickness was hidden away from the 9 physicians who were busy with his
older brother, by the young maids, who have given him a little wine with
biscuits.

Yesterday, when the child had high fever, they wanted also to perform
phlebotomy, but his two governesses were firmly opposed to the idea and
instead kept the child warm. This one also would have certainly died if
the doctors had had their way. I do not understand why they don’t learn
by experience. Had they no heart, when they saw the Dauphiness die after
phlebotomy and emetics, not to dispose of her child?”

Modern medicine may not administer phlebotomy, but it relentlessly
suppresses fever in measles, and administers antibiotics which cause
damage to the bowels, diarrhea, and may result in superinfections. It
calls this a standard procedure.

Competing interests:
None declared

I am surprised that a PhD scientist such as Dr Scheibner does not
grasp the principle here. The critics of CAM occupy their position
precisely because they have studied the literature. John Heptonstall may
try to impress with a long list of anecdotal reports and uncontrolled
studies (yes I have checked), but what drives decisions is good science.
The problem for CAM's supporters is that, as the science gets better the
apparent effectiveness diminishes.

So far from not having "the foggiest" (foggiest what?), the reality
is that we are simply responding to what the science tells us. What does
Dr Scheibner mean by "the appropriate literature"? Could it perchance be
literature that happens to support a particular preconception?

Competing interests:
None declared