Assaulting alternative medicine: worthwhile or witch hunt?
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1075 (Published 15 February 2012) Cite this as: BMJ 2012;344:e1075All rapid responses
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Why should it matter if the public want alternative medicine and are prepared to pay for it? Why shouldn’t university courses teach mumbo-jumbo medicine to feed the alternative medicine industry? What is wrong in believing in meridians or phials of magic water containing nothing but water?
I think it would be wrong to assume that critics of alternative medicine are that bothered if the public chose to avail themselves of crackpot medicine. I suspect they don’t really care.
What critics of altmed do care about is NHS professionals practicing magic medicine at the tax payer’s expense and for universities to ‘legitimise’ under-graduate courses in alternative medicine, giving them a level of respectability that they do not deserve.
The fact that some conventional university courses may be hard to justify does not mean that alternative medicine should fill the void.
Competing interests: No competing interests
Sir,
From both Ray Moynihan’s interesting article [1] and the ensuing rapid response letters in the BMJ, it is apparent that there is a visceral dislike of alternative medicine coupled with a strong streak of intolerance among some health care professionals.
If people trust in alternative medicine and believe that it is of benefit to them, they should be free to use it. And, if they wish to ignore the lack of scientific evidence, then that is their business. Provided they pay for treatment, their choices have nothing to do with anyone else.
Why, then, can’t the opponents of alternative medicine leave it at that? Why are they so driven to eradicate alternative medicine? Is it because they consider it their duty to purge society of false beliefs? Perhaps that explains their demand that university departments teaching alternative medicine be disbanded. But there is an obvious problem: a similar case may be made against many other disciplines, not least to large parts of conventional medicine. [2] Where, exactly, is the line to be drawn between acceptable and unacceptable courses?
Or is it, as suggested by some correspondents, all about stopping a waste of tax-payers’ money? In these straitened times, this may have some appeal but, again, the argument is rather one-sided. Closing some departments carrying out conventional research – that is, research based on questionable methodologies producing results that make little, if any, difference to the lives of patients [2] – would produce much greater cost savings than anything achieved by shutting down courses in alternative medicine, not to mention putting an end to squandering public money on worthless drugs and other interventions.
I hold no brief for alternative medicine. But is it really more deserving of censure than those areas of conventional medicine based on dubious methods and false claims of efficacy?
James Penston
References
1. Moynihan R. Assaulting alternative medicine: worthwhile or witch hunt? BMJ 2012;344;e1075.
2. Penston J. Stats.con – How we’ve been fooled by statistics-based research in medicine. The London Press. London, November 2010.
Competing interests: No competing interests
Professor Colloquin says I do all my colleagues an injustice by suggesting they lack communication skills and empathy. On the contrary, the vast majority are revered by their patients for their caring mature but unfortunately there are a minority who lack one or the other or both. It is also often the case that time constraints come into play and the patient leaves the consultation dissatisfied. They then seek out therapists who they hope can fulfil their needs.
He also suggests that his doctors provide sympathy. Cancer patients do not want sympathy but require their doctor to be empathic as any good practising physician knows. They need their doctor to try and understand what they are going through and help them cope with both their physical complaints and psychological trauma. They do not need or want their doctor to say ‘there, there’.
The Star Throwers website suggests that certain nutrients may have some effect in some tumours. The good Professor states that these suggestions are barmy. If he had bothered to look through PubMed for the anti-tumorigenic effects of pomegranate juice and not relied on his preconceived ideas, he would have been surprised to find a number of articles, including its efficacy in a phase II trial in prostate cancer.
I conclude with the following quotation that says it all: Progress is impossible without change and those who cannot change their minds, cannot change anything – George Bernard Shaw
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I notice that Ron Law has ignored the main point I was making. Does he, or does he not agree that propofol, lignocaine and penicillin (etc etc) are advances or not? Does he decline to have a local anaesthetic at the dentist because it is a product of Big Pharma?
I agree, and pointed out myself, that success has been a lot slower in the central nervous system. Some things, like anticonvulsants, are useful, if imperfect. Analgesics are also pretty imperfect too, but not useless.
The fact that Big Pharma resorted to dishonest concealment of data in the case of SSRIs brings shame on the companies. All I can say in response to that is that the shameful concealment was not uncovered by herbalists or chiropractors. It was brought to light by conventional scientists and doctors who realise the critical importance of looking at all of the data.
The problem for herbalists etc is that they haven't got much data, and most of what they do have says that their concoctions don't work. You don't have to believe me. All the information can be found on the site of NCCAM, the branch of NIH that has spent over a billion dollars of US taxpayers' money on researching many sorts of alternative medicine, without producing a single useful treatment. If you check their Herbs at a Glance guide you'll find that next to none of them have good evidence for effectiveness. That's why there is no herbal preparation that has marketing authorisation from the MHRA. In order to get the MHRA kite mark on a herb, you are not even allowed to submit any evidence that the herb works. The MHRA considers that irrelevant (yes really, I'm not joking). All you need to do is show that it's likely to be safe.
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Professor Colquhoun says "It's hard to understand the relevance of the comment by Ron Law. In case he hasn't noticed, medicine has moved on since 1542 (though herbalism has changed remarkably little)."
Henry the VIIIths Herbalist Charter was about medical politics, money and greed. The medical industry has indeed moved on. It has developed the business model to the point that if State subsidies were removed the industry would collapse... herbalism stands on its own two feet without state subsidies.
The good professor then says, "SSRIs seem to be almost ineffective for mild/moderate depression, but they are still thought to be useful in serious depression."
The use of "seem to be almost ineffective" and "thought to be useful" is hardly evidence of medicine having moved on... nor is it a convincing basis for claiming that pharmaceutical medicines are science based.
He says, "It isn't at all clear what Ron Law means when he talks about the "battle of the paradigms". One paradigm is science. What's the other? Making stuff up?"
In light of the above, can Colquhoun advise which paradigm is science? SSRI's are still multi billion dollar sellers based on what? Made up evidence?
Competing interests: No competing interests
Dear EDITOR,
A group of people calling themselves to be “The Friends of Science in Medicine” (thereafter “The Friends”) proclaim that they are concerned about Australian universities allegedly teaching pseudoscience which puts patients at risk suggesting that the orthodox medicine is the only real science which does not put patients at risk.
1. Science is simply “an organised system of knowledge” and does not imply infallibility, holding the sole claim for universal truth and superiority over other sciences. However,“The Friends” failed to demonstrate that orthodox medicine (the medical system they prefer and consider superior to other systems of medicine, such as complementary medicine) is safe, effective, superior and holding the sole claim to being proved by scientific trials. The term Iatrogenesis comes to mind, based on well-publicised postlicensing clinical disasters and ‘doctored’ trials of medications and vaccines. In Australia it is admitted that 18% of hospital admissions are due to deleterious effects of pharma medications.
2. By calling complementary medicine unscientific or pseudoscience, “The Friends” are not only showing ignorance of the materia medica of naturopathy, homeopathy, acupuncture, chiropractic, osteopathy and herbalism, to mention just a few complementary medical systems, but also of many other sciences, such as physics of polymers, submolecular physics, chemistry, electromagnetics, paradoxical doze effect of medications, dynamics of stress response and of health and sickness, and even much of the existing valid orthodox medical research, and more particularly of immunology.
3. Their efforts to stop universities teaching complementary medicine in Australia, are anti-democratic, anti-freedom of speech, and far from friendly, comparable with the documented historic intolerance of Nazism, Lysenkoism in the former Soviet Union and other totalitarian regimes. They are in effect practising intolerance and scientism (an inappropriate and unjustifiable glorifying of science).
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Henry Mannings insults his fellow physicians when he says that the they lack empathy, and that going to believers in alternative medicine is the only way to get sympathy. That, thank heavens, is not my experience of GPs or consultants. I guess that it's in his interest to propagate that myth because if you look at the web site of his organisation, the Star Throwers Cancer Charity, you can find a whole range of pretty barmy treatments. At least at the Royal Marsden I didn't have anyone recommending liquorice or pomegranate juice to add to my distress. Just a good surgeon and a lot of smiling nurses.
Competing interests: No competing interests
I'm quite surprised that David Peters, clinical director at Westminster University, dares to show his head in the BMJ after the revelation of some of the dangerous nonsense that is taught in some of the courses run in his department. This is the man who tolerates dowsing (yes, dowsing, with a pendulum) as a method of choosing herbal concoctions for patients. Things are so bad at Westminster that I didn't even have to use the Freedom of Information Act in the first place. Disgruntled insiders sent me copies of the slides that were being inflicted on their students, including the now infamous "amethysts emit high Yin energy".
If you still believe that university courses in alternative medicine are taught in a scientific way, please just look at the slides here, and here, and here. They are scarcely credible.
Several people have said here that alternative medicine should be in universities because that is the only way to get it tested properly. That would be fine it it were true, but in fact the people who populate these departments are, almost without exception, true believers who hardly ever test their ideas. Just check the publication records of the people in Dr Peters' department if you don't believe me.
Incidentally, if Peters had read my own account, he would know that I don't claim to be solely responsible for the fact that his university has shut down all but two of its pseudo-science courses. He doesn't seem to have noticed that the internet has changed everything. Hundreds of bloggers are now involved in debunking medical nonsense and bad journalism. Even the Daily Mail now often debunks the sort of ideas that Dr Peters likes so much. The best of the bloggers have better developed critical faculties than can be found in the Departments of Health and Education, and a lot better than can be found among the vice-chancellors who allow their universities to be used to propagate crude pre-enlightenment myths. No doubt their efforts have contributed to the decline in the number of applications to his courses. If the vice-chancellors haven't got the courage and integrity to shut down the courses, the public will do it for them.
Sorry, Dr Peters, you've been rumbled. The sceptics are not going to go away. You have been fortunate to live through an age when it became fashionable to believe things that aren't true (everything from WMD to,ahem, dowsing). That age is coming to an end, and about time too.
Competing interests: No competing interests
I’m sorry that Mark Donohoe thinks that I’ve been unfair to him. Perhaps I should go into a bit more detail.
When I said “I can see no evidence of his activities in PubMed”, I meant that I can see no activity that relates to testing the efficacy of the treatments that he is happy to prescribe. That remains true.
I said "Judging by the quality of the evidence produced by the companies that support his web site, it seems he hasn't been very successful". This remark was prompted by looking at the site specified on his comment, http://cebcom.net/ , the Centre for Evidence-Based Complementary Medicine. Its slogan sounds fine: “We are a company committed to the future of Complementary Medicine, not only in Australia but globally”. The problem is that this site seems to be singularly free of any evidence.
The site does advertise “The CEBCoM Integrative Medicine Practitioner Finder App”. It says “The App has been supported by three great sponsors committed to evidence-based IM, Bioceuticals, Bio-Concepts and Flordis. These three companies sell typical evidence-free herbal and chemical (amino acid, glucosamine) products. My comment about the quality of their evidence was prompted, in particular, by the advertisement by one of these sponsors for their weight loss product (see http://www.bioconcepts.com.au/). “Baseline weight and measurements were taken for two female patients.” “After eight weeks of treatment both had achieved significant weight loss, increased energy and sense of well being.”
Donohoe may regard this as evidence. I don’t.
In principle, university-based courses should do the research to show which, if any, alternative treatments work. In practice, they do nothing of the sort. They are populated by people who are committed to their own particular myths, whether it’s chiropractic or herbs. They do next to no proper critical testing of these ideas. That’s why they have no place in a university.
Competing interests: No competing interests
Re: Assaulting alternative medicine: worthwhile or witch hunt?
I presume that Viera Scheibner is the person who makes money by selling books that preach the evils of vaccination. It might have been helpful if we'd been told.
If it was left to people like Viera Scheibner, we'd still live in a world where smallpox and polio were rampant.
I rest my case.
Competing interests: No competing interests