An open letter to the Prince of Wales: with respect, your highness, you've got it wrong
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7457.118 (Published 08 July 2004) Cite this as: BMJ 2004;329:118All rapid responses
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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: No competing interests
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: No competing interests
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: No competing interests
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: No competing interests
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: No competing interests
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: No competing interests
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: No competing interests
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: No competing interests
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: No competing interests
Explosions of CAM?
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: No competing interests