Margaret McCartney: Charities should respect evidenceBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3336 (Published 25 July 2017) Cite this as: BMJ 2017;358:j3336
All rapid responses
Marion Brown has gently questioned McCartney’s comments about the potential harm caused by charities which “ promote non-evidence based interventions. “ McCartney gave as an example The Homeopathy Action Trust.
Perhaps McCartney will provide her own evidence base which enables her to make these comments ?
What harm, potential or real, does she have in mind ?
If she has no evidence and examples in support, she may wish to withdraw her remarks.
The old saying that people living in glass houses, should not throw stones, comes to mind.
After many decades of conventional medical practice in Wales and abroad, with a long standing interest in homeopathy and other complementary approaches, I have yet to see a patient harmed by these latter approaches. Unfortunately the same cannot be said of the use of conventional medications, or interventions, by me, or by colleagues.
In the many roles that contented ‘retired’ GPs may find for themselves, I am regularly bemused at the narratives of patients who come from dozens of different practices. Nearly always because they have been on SSRIs or other psychotropics for months or years, with the reason for the initiating prescription lost in the mists of time, the patient usually having no memory of ever being told, initially, about the dangers of habituation, and the difficulties of stopping. The evidence base for SSRIs suggests that they only help in severe depression.
There is also a wealth of information that the evidence base for SSRIs and other modern psychotropics, together with the incidence of side effects, serious, even fatal, has been manipulated in such a way that their over prescription becomes normalised.
This grim state of affairs has been discussed in detail by Peter Gøtzsche (1), one of the founding members of the Cochrane Collaboration.
His book should be obligatory reading for any doctor who prescribes psychotropics.
Especially by those who criticise practitioners using other safer approaches, that lack the advertising and incentivising methods which are employed by pharmaceutical companies.
1 Peter Gøtzsche. Deadly Psychiatry and Organised Denial.People’s Press, 2015.
Competing interests: NHS homeopathy. NO income from homeopathy.
An interesting juxtaposition of articles here. One of the news items announces that the NHS will stop funding homeopathy and then this article. Is it any wonder that some charities support homeopathy when even the NHS will fund it? This nonsense has to stop. A publicly funded health care system must be stewards of the money it is entrusted with by the public. This means spending on items (drugs, interventions, surgeries) that have a strong evidence base and good value-for-money (although I'd admit this is difficult to define). The fact that 'Aunt Alice' swears by tincture of wood for her heart is NOT good evidence. If a group wishes to pay for this treatment independently, then let them, providing they will also pay the costs of any health care that arises because of adverse events. But they are not a charity, and it is not evidence-based until proven otherwise.
Competing interests: No competing interests
Dr McCartney asks that charities are made to respect the evidence of the efficacy of “complementary, alternative or holistic” therapies that they may offer “for the public benefit”.
She says that “charity” is a word associated with “goodness, selflessness, and altruism” and argues that these non-medical treatments, especially when offered by charities, “should also be evidence based, because otherwise we risk needless harms”.
We are all well aware of the Hippocratic Oath, to do no harm, that the medical profession is bound by. Nevertheless medicines prescribed by doctors, and taken as prescribed, can and do cause immense harms – and not necessarily due to doctor error. The guidelines may be incorrect or misleading and the harms not even recognised for what they are.
Medically unexplained symptoms, including various somatic, functional and neurological symptoms and disorders, are currently an extraordinarily popular topic of doctor ‘education’ – indeed the August 2017 issue of the British Journal of General Practice carries a research article entitled ‘Helpful strategies for GPs seeing patients with medically unexplained physical symptoms’ (1). The BMJ carried a major article “How should we manage adults with persistent unexplained physical symptoms” (2) in February 2017 to which I (and others) responded suggesting possible reframing of, and explanations for, such symptoms (3).
My rapid response (4) to the recent BMJ article “Judging the benefits and harms of medicines” (5) questions whether the evidence of the harms of medicines is being hidden in plain sight?
We have a Public Petition currently under consideration by the Scottish Parliament Petitions Committee which may be of interest to Dr McCartney and colleagues: PE01651 Prescribed Drug Dependence and Withdrawal (6).
Perhaps charities – and other sorts of enterprises - offering complementary and alternative treatments to attempt to alleviate the (sometimes terrible) harms and suffering that may actually have been caused by medicines ‘taken as prescribed’ are in fact helping to keep the great ‘medicine’ and ‘healthcare’ gravy train on the tracks?
Visiting our doctors unfortunately also exposes us to “risk of harm, profits people selling quackery, and allows a societal acceptance”.
Competing interests: No competing interests