Last night, a friend who I have not seen for a little while, asked me an important question. She was well aware of my blogging activities as my blog rss feed pipes through delicious and then twitter and onto my facebook account, or something. Why my fascination with criticising alternative medicine? A difficult question – and after a few pints and the energy for a one word answer, I responded “sport”.
Fortunately, a journalism student asked me some interview questions that allowed me the indulgence of providing a little more depth to my reasoning. I repost them here for the record after bashing them out whilst also trying to cook a mushroom stroganoff. The strog was a success. I hope these answers are also digestible.
Is there any evidence that alternative medicines work?
That depends on which alternative medicine you mean and what condition you want it to work for. It also depends on what you mean by ‘work’. A complex question. What we do know is that most alternative medicines are essentially inert – they have no specific effects. Homeopathy uses medicines so dilute that no medicine remains. Reiki is just a form of faith healing. Acupuncture is just sticking pins in your body at arbitrary points. Reflexology is just a foot massage. Bach Remedies are just dilute brandy. Practitioners may claim specific effects due to ‘quantum theory’ or Chinese Meridians and Qi, but these are just pseudoscientific explanations with no basis of evidence or rationality. Some therapies may have specific effects such as chiropractic, but the evidence suggest that this is only effective for lower back pain and then pain killers may be just as good, and much cheaper. A few herbs have been shown to have specific effects, but patients have no way of telling if their herbs contain the right amount of active ingredient and are not contaminated with other compounds.
Do you think there is any merit in using alternative medicines and
therapies or is it more of a danger to health?
Even though specific effects may be non-existent, or at best unpredictable, alternative medicines may well give non-specific effects and these may indeed have positive effects. The use of alternative medicine may well give a sense of empowerment and control, lift the mood, reduce anxiety and make pain more bearable. Together, these effects tend to be clumped under ‘the Placebo Effect’. In itself, this is not harmful and it is clear to see why patients like to take alternative medicines. The dangers are wider though. Firstly, in order to gain a good placebo effect, you have to believe that the therapy will work. The therapist then has to be a liar or deluded about their own powers. Trust in medicine is pretty important and it can be argued that the mild benefits of placebo do not outweigh the loss of integrity in delivering a placebo. Also, placebo effects are not magic. They have effects concerning beliefs but do not generally alter the course of the illness. With serious illnesses, people taking alternative medicine may delay or avoid treatment with proven beneficial and necessary effects. Practitioners too fail to limit their claims to what can be expected from a placebo treatment as they often do not realise this is what they are doing. Therein lies the danger of alternative medicine.
Should more alternative medicine be integrated into the health system?
I see little problem with integrating alternative therapies that are not based on pseudo-science into mainstream practice when there are evidenced benefits to be gained. People with terminal illnesses, or those undergoing difficult treatments, may well benefit from such things as massage, music therapy and other anxiety reducers. However, I see little evidence amongst the champions of ‘Integrated Medicine’ that they worry about what works and what does not. The Princes Foundation for Integrated Health advocates all sorts of disproven and nonsensical therapies that may well do more harm than good. Such bodies never rule out any therapy – they have no standards by which they can judge their ‘integration’ effective. As such integrative medicine is just a back door attempt to gain public funding of quackery and it is a massive distraction from researching and funding genuine complementary therapies that people may well gain real benefits from.
Why choose conventional scientifically-tested medicines over alternative
therapies and medicines?
Patient choice is an important concept in health care thinking and rightly so. However, proponents of alternative medicine use the ideal of patient choice as a way of justifying quackery within the healthcare system. Choice is only really empowering when it is informed. That is, choice works when patients have available to them all the relevant information in a way that is not distorted by false or unproven claims and where the benefits and side effects can be compared on equal terms. For doctors, giving choice to the patient is vital, but they should not feel forced to provide treatments in the name of ‘patient choice’ when it is against their clinical judgement and the available evidence. People in all sorts of situations make difficult choices on the available evidence. We do not buy a second hand car on the word of the salesman. We seek independent and impartial evidence that the car is sound, not stolen and right for me. We would definitely feel we did not have a genuine choice of car if all we had was misinformation and raw salesmanship to hand. Why we are less diligent in our health choices is a fascinating question.
Is there anything you would like to add?
I believe the study of health beliefs and alternative medicine gives a fascinating insight into what it means to be human and how we form our opinions and views of the world. Human beings existed for most of their history with little more than familial care and plenty of ritual in the face of illness. For that reason, attempts to ban alternative medicine will be futile. It appears to fulfil some sort of deep need that mainstream medicine fails at. We are part of the first few generations that can begin to understand the true nature of disease and use technology to alter the course of illness. We may be becoming more technically adept at reducing suffering and early death, but we may be missing out on the human needs of such a process. But also, modern medicine can be pretty brutal in the face of deadly disease. Risks are taken to save lives and much discomfort is endured on the path to recovery. The tension that exists is between allowing alternative medicine to provide the ritual of healing that may be missing without allowing it to appear to provide alluring and easy answers to suffering that do not really exist. What is so disappointing is that the practitioners of alternative medicine do not want to take part in that debate but instead want to cling to their nonsensical beliefs and unevidenced practices. And it is on that point that real conflict exists between mainstream and alternative medicine.
Digestive, nutritious and delicious. There’s one question that I wish was asked, and it’s “Why mainstream medicine dismisses numerous accounts of people who say alternative medicine helped them?” The answer (the best one so far I read in Ben Goldacre’s Bad Science) gives great insight into what alt med is and why people keep returning to it.
Or you could rephrase that as “why does alternative medicine dismiss numerous accounts of people who say that it didn’t help them”.
Or “why don’t the alties explain why it kills people in droves” (I regard 300,000 dead from AIDS in South Africa as “droves”).
The “worried well” only return to it because it didn’t kill or seriously incapacitate them and coincided with them getting better anyway. Once you have died from unproven and untested treatments or had a stroke from chiro it is remarkably difficult to return to your quack of choice.
They also return to it because they are misguided, deluded, misled, incapable of evaluating the evidence and are fundamentally stupid (even if they are well educated).
I think one critical danger of alt med you haven’t mentioned concerns diagnosis. I can see the dilemmas around prescribing placebos, but if you validate alt practitioners by sending people off to them for ‘treatment’ when you have no cure, then they may turn to them for diagnosis when they subsequently have a condition which could be cured, alleviated or palliated. And if that condition happens to be (say) ectopic pregnancy which is then treated by moxibustion, then you may well have a dead patient on your hands.
I don’t agree at all that alternative/complementary medicine is necessary for us!! I lived in society where alternative/complementary medicine was absent. Moreover it was forbiddenn fact. And it was healthy and normal society. And I was healthy person and never feared to come to doctors. And now, when different quacks are prosper in our country and penetrate to real medicine, I am afraid to come to doctors and now I am sick. I hate quackery and quacks!
Moreover, I don’t believe even your skeptics-quackbusters, when they try simultaneously to be busy in quackery, for example your Edzard Ernst. And I think that Professor Baum makes rough mistake when he tries to plant the elements of complementary medicine in hospitals. And I think that after this his criticism in address of quackery turns into zero. And I shall never cease to rail at Colquhoun for his collaboration with Ofquack. What is he seeking there? He knows best of all that it is nonsense! Or do he seek an entertainment there? Let he come to circus if he wants to entertain yourself.
Down with any quackery!
John H, as I’m rereading my comment, I see now that mentioning Ben’s book is the only thing that shields me from being taken for an alt med fan. Certainly, barring that one piece in parentheses, I do sound here like one!
But I am not, I’m just well aware that very many people when faced with scientific arguments on one side and their aunt’s ethusiastic account of how acupuncture eased her migraine on the other, tend to side with the aunt. And that’s a problem, because as long as there are very real people who honestly claim that homoeopathy, or any other woo of their choice, “worked for them”, alt med will have new customers.
We know that the existence of those cases is explained by a number of factors from confirmation bias to regression to the mean, but to the layman these stories sound very convincing. That’s why it’s so important to explain them as Ben Goldacre did in his book – all the time bearing in mind that the goal is to inform the reader, not to win an argument.
Hat Eater (presumably of nutritious and delicious hats).
Just for the record I wasn’t suggesting you were an altie fan. I was merely trying to build on the valid question you raised (and more or less answered, or at least pointed to an answer).
Yet another pointless and meaningless death posted on DCs site. A quack kinesthesiologist (if it is spelled wrong I don’t really care too much) effectively killing some bloke with a peanut allergy. Another statistic for whatstheharm.com who won’t be returning for advanced quackery or whinging to a quacksoc.
“Choice is only really empowering when it is informed. That is, choice works when patients have available to them all the relevant information in a way that is not distorted by false or unproven claims and where the benefits and side effects can be compared on equal terms.”
Informed choice would be great if it was achievable but unfortunately it clearly is not. It is the height of ridiculousness to think that the average patient can make an informed choice on most medical matters.
Just think of the seemingly straight forward problem of whether to have a PSA test for prostate cancer. Most patients are incapable of seeing beyond the media’s promotion of this non-evidence based test, even if their doctor has not also been co-opted by the media hype and actually provides him with the evidence (which does not support having the test).
Informed choice is an illusion.
BillyJoe
“That is, choice works when patients have available to them all the relevant information in a way that is not distorted by false or unproven claims and where the benefits and side effects can be compared on equal terms”
Hmmm, that reminds me, I need to register to vote….
“It is the height of ridiculousness to think that the average patient can make an informed choice on most medical matters.”Quite right.
Of course people should be allowed to make choices about their medical treatments. To claim people cannot make sensible choices that are right for them is ridiculous. Of course, given choice, people may well exercise that by making bad choices. My point is twofold: doctors need not agree with that choice or feel obliged to act on it; and, the inclusion of alternative medicine routine undermines that decision making process by including nonsense into the mix.
Svetlana;
” And I shall never cease to rail at Colquhoun for his collaboration with Ofquack. What is he seeking there?”
See LCN’s one-word response at the top of this page- sport.
Sport?
It is meanly.
In 2005 my mother died because of such “sportsmen”.
I am not interested in Ernst and Baum. Baum is old. And Ernst is a quack. But it is necessary to make David to leave Ofquack.
An excellent post. The only thing I’d add is that one of my biggest concerns re CAM is that very often the practitioners of it aren’t content with their field taking a complimentary role; they want it to *be* medicine. And because they can’t argue it on a scientific level playing field, they do so with lies, half truths and ugly smears. “You’ve got a tumour, and you’re thinking of getting radiotherapy? But radiation CAUSES cancer! Homeopathy is side-effect free, and we can sort that tumour for you”.
The constant rubbishing of real medicine is (for my money) the most pernicious aspect to CAM.
“Of course people should be allowed to make choices about their medical treatments.”
I’m saying that it is an illusion that they are actually making an informed choice. The average patient can never have sufficient knowledge in the time available to make an informed choice. They make choices based on information supplied by their doctor. This information is nearly always biased, incomplete, or even wrong. On controversial topics patients may attempt to get independant advice form various sources but, without a great deal of background knowledge, they will be unable to distinguish good from bad.
“To claim people cannot make sensible choices that are right for them is ridiculous.”
Unfortunately, it is true for the average patient. Even most patients.
It is possible for a well educated person who takes a special interest in one particular aspect of medicine, and who has considerable amount of time available to research it properly, to come to an informed decision about that one aspect of medicine. However, that situation is pretty rare.
“Of course, given choice, people may well exercise that by making bad choices.”
They make “choices” based on media hype. They make “chioces” based on the biased, imcomplete, or wrong advice of their doctor. They make “choices” based on propaganda of self-interest groups. Thery make “choices” based on there attraction to altmed. What they do not do, except in the exceptional cases, is to make informed choices.
“My point is twofold: doctors need not agree with that choice or feel obliged to act on it; and, the inclusion of alternative medicine routine undermines that decision making process by including nonsense into the mix.”
Couldn’t agree more.
But I’m sure a fully informed doctor would see patients every day who are under the illusion that they are making informed choices, but whose choices are merely a reaction to media hype, the misinformation suppied by altmed, or propaganda put out by self interest groups. On the other hand, if the patient merely agrees with the doctors opinion, which is necessarily biased, incomplete, and sometimes wrong, what sort of a choice is that?
BillyJoe
You can lead a horse to water, but you can’t make it drink and all that. Oh, and you can make sure the water is safe to drink.
My two’pennorth on choice is that in this extremely complex society we do not really have any (other than for the most mundane things).
I have to go to a doctor for medical advice.
I have to go to a dentist for dental stuff.
I have to go to a solicitor for legal advice/help.
I have to go to a garage to get my car fixed.
I have zero choice in these matters other than rejecting the considered opinion of a professional.
Rocko – you were spot on. My only minor quibble is that when you said “Homeopathy is side-effect free” you really should have left “side-” out of the sentence.
Surely this is more than just ‘sport’. Dont you discuss what society would be like if run on scientific principles?
The above could be a draft manifesto for the ‘Scientist Party’ with Andy Lewis as Health seceretary. Dawkins as leader ect.
You say those things as if they are bad?
Good question, Andy!
And I agree that it is not bad at all.
Quite the reverse – it would be just well. Very well!
Maybe must we propose this idea to Dawkins?
I shall do it! 😉
OK. I have written to Dawkins about it.
Strangely! And why indeed do people consider the idea of ruling of society by scientists as a funny joke? It is just most normal ruling!
Why does nobody consider as a idiotism a ruling of society by monarch-degenerate or money-bags, making their capitals by dirty wildcats or lie? Why do people allow persons with insufficient education and wild backward views to become politicians? Why do people allow the politicians to make a war, to tell a lie, to adopt silly laws, etc?
Why do you call “good” all these dirty things and to try to laugh at absolutely normal and reasonable ruling?
It is simply odd, put it mildly!
Do you want to know what was next? 😉
Dawkins has come to his forum, looked at my proposal and… has hoisted sail! 😀 Off!! 😉
However, I don't think that the idea itself is bad. I think that the leader is not suitable – too anxious about self-laudation (Though I see that the form of our proposal was a bit non-serious. But clever man must see a essense of thing, but not its form). It necessary to seek a leader, which would be less selfish. Then the idea will cease to be merely silly joke like it looks in worriedwell's comment.
And by the way, choice of leaders continues… 😉
People proposed Ben Goldacre:
http://richarddawkins.net/forum/viewtopic.php?f=17&t=80851&p=1961428#p1961428
I explained there why I don't agree.
My comments were no joke.
It is obvious to me that sooner or later there will be a strong lobby for scientific principles for life to be incorporated into the manifesto of a political party. It is more likely to be an existing political party in my opinion.
I think a commitment to evidence-based policy making in government would probably be one of the biggest and most important political shifts to happen since universal suffrage. You are absolutely right. What alternative is there?
worriedwell,
Oh! As it turns out you had good intentions! 🙂 Then – it is well!
However, I don’t agree with you that it will be an existing party. Not at all. It will be a new party. Moreover – a party of new type!
Andy,
evidence-based policy will be only one aspect of new party strategy. Freedom of speech, antimilitarism, secularism, anti-discrimination on the different basis, etc, etc – all of this the aspects of work of really good party! And I would consider this question more widely. Why only Scientist Party? Remember one my comment to your previous post here? I said about the significance of intelligentsia in modern world. Not only scientists! Teachers, doctors, engineers, scientists, etc – i.e. educated people, who live by Reason – all of them are intelligentsia. So, probably, more right solution of question is Intelligentsia Party. And I said that modern historic period is special. Intelligentsia became a class. New political class. Great political force. It is very important world event.
Glad that one of you sceptic scientists has come into the open….Thank you Svetlana
“Strangely! And why indeed do people consider the idea of ruling of society by scientists as a funny joke? It is just most normal ruling!”
Closest thing to a modernist Stalinist manifesto I’ve seen recently and also completely bonkers. It seems that you are the lunatic fringe and not the people that you are accusing.
A-a-hhh! What a comer! 🙂 And we simply missed you! 😛
Oh, David Colquhoun is quite right. Just the style of discussions of such people shows their rotten essence.
“Stalinists”, “microfascists”, “maoists”, “extremists” – this is usual set of “laudative” and “caressing” epithets, which different quacks and ignoramuses use for definition of skeptics and bloggers 🙂
What a kind folks! 😛
Oh, and how they love a laws! 😉 Do you know about such their trait, friends? No? But Simon Singh, Andy Lewis, David Colquhoun and other bloggers know!
Ha-ha! I a bit poked in Internet just now. Google showed that Stewart Mcowan is a brassbound fanatic homeopath. And recently he tried zealously to find out in Exeter University whether Professor Edzard Ernst are a homeopath actually or not… 😉 Oh, what an inquisitive monsieur!
inquisitive… inquisitor…. inquisition… The Inquisition! Eh? 😉 It seems within modern homeopathy has appeared new inner Inquisition!
As for me, you have mistaken, sir homeopath. I am not Stalinist. You estimate me too mildly! 😉 I am a Scientist, New Marxist, Communist, Skeptic and Atheist. So you will not be given no mercy! 🙂
“I am a Scientist, New Marxist, Skeptic, and Atheist. So you will be not given no mercy.”
Well your English is piss poor and you don’t seem to realise that the majority of the human population prefer to make their own decisions in life regardless of inevitable mistakes. You are barking mad! All human beings are innately illogical at times – Even scientists! Only lunatics though expect the illogical to be legislated out of existence. Soviet Russia attempted this and simply created a madhouse. You are obviously one of its sad inmates.
And yes. I am inquisitive at times. What wrong with that? My ancestors spent centuries fighting for the right to run their own lives the way they wanted and think the way they wanted. I respect science when it knows its place as the servant and not the master.
You madam, are the backward one dreaming of the golden days of the gulag.
1) Question to Dawkins
http://richarddawkins.net/forum/viewtopic.php?f=17&t=80851&p=1964826#p1964826
2) Why do all people here keep silense? Maybe will someone explain me, eh? 😉 No? 🙂 OK! I shall answer this question myself. You keep silence, because though you agree with me in the debate against quack, however, you are afraid of my communistic views.
But why??!!
Because all of you (as well as this quack!) believe that communism is either a stalinism or such stupid regime, which was in USSR and coutries of Eastern Europe in the end of XX century.
You are wrong.
Such "communism" failed, because it was ruled by proletariat. However I am partisan of communistic society, which is ruled by Intelligentsia. And you know that Intelligentsia and dictatorship is incompatible things. Ruling of intelligentsia can be only a democracy. Democracy, as you know, is an absence of discrimination and repressions. Other traits of communism in my model of society will remain immutable.
And I think that only quacks, ignoramuses and fools can object against Reason in power. Do you agree?
“My ancestors spent centuries fighting for the right to run their own lives the way they wanted and think the way they wanted.”Do you believe that this quack want to run his own life? Not at all! He wants to run YOUR lives. He wants to deceive you, selling you a shit instead of good medicines.
He wants to expose your children to mortal danger, when he doesn’t vaccinate his own children.
He wants to drive out you from your universities, taking your places in them and placing in university’s education a ancient idiotism instead of real science.
He want you to be non-educated idiots and to choose his quackery instead of good science and medicine.
He want your government to adopt stupid laws, which will help him to swindle you with impunity.
Yes, he wants to run lives, but not his own life! He wants to run your lives!
And now, could local public point my mistakes in English? I would be grateful.
Why does local public remain voiceless?
Do you agree that I try to return you to “golden days of the gulag”?
And maybe do you agree with him? Do you side with homeopathy? Indeed. Even David Colquhoun takes part in Ofquack!.. 🙁
Yes, I know – I am the only one such communist in the world. In any case I haven’t met still a communist which share my position completely. Similar communists were once. But they were killed in gulag or repressed by other way.
Yes, I know about repressions and gulag. Nevertheless I accept the name “communist” for me, because I know that communism is a good. Communistic study was perverted and slandered. Actually communistic doctrine is created for intelligentsia, and hegemonism of proletariat is main mistake of marxism. I know about the mistakes of Marx. But I see that they were caused by historic conditions – intelligentsia didn’t exist in his times. And I know how those mistakes must be repaired. I said about it above. Thus, I think that my name “communist” is honest and good. It is not a danger/harm.
But!.. Homeopathy is not a good! Homeopathy is a quackery! And anyone here agree with me. So, when your Edzard Ernst is simultaneously a homeopath and skeptic, it is dishonesty, though poor Ernst tries to be honest. He delude himself. And he is in jeopardy because of it. Indeed! Look at this quack above. He is collecting a damnatory evidences against Ernst. The only thing which can rescue the hapless professor – to change the name of his Chair, because actually, Ernst is busy with useful and right work. He is busy with evidence-based medicine and methodology of medicine. It is very simple! And his real activity must be merely legitimated.
And several words about freedom of choice, since the homeopath above has touched it.
Yes, in the modern world people have the right to choose whether to drink alcohol or not to drink. Moreover, in some countries people have the right to choose even whether to use a narcotic or not to use. And in other countries people are allowed to choose whether to have arms or not to have arms.
But if people start to choose whether to kill other people or not to kill, then it is not choice! It is crime.
So, the problem of CAM in most cases is not a problem of choice. It is a problem of criminal law.
Svetlana – once again – stick to the points raised in the post.
OK, Andy.
But suddenly a problem has appeared.
Where is DC’s blog??!! I can’t get his blog!
Please, test: http://dcscience.net
David’s blog vanished…
What happened?
Is it only my problem or not?
In reply to Snetlans I am not a blind fanatic.
I have confessed before my frustrations with homeopaths not to pursue enough proof that they can recognise homeopathic remedies from blanks. Peter Fisher of the London Homeopathic Hospital attempted this with potentised Bryonia sent out in the post to volouteers who either received this or a blank. There was a positive statistical result but ideally an objective non-homeopath should be conducting the trial with a larger number of subjects. Also a much larger group of people should be enlisted. All experiments need to be repeated.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B8CWK-4MDGN8P-4&_user=2169529&_origUdi=B6WXX-4K991BS-4&_fmt=high&_coverDate=07%2F31%2F2001&_rdoc=1&_orig=article&_acct=C000010098&_version=1&_urlVersion=0&_userid=2169529&md5=fa5490d62cd15310a98d4a1a4afe97b5
That no further experiments were undertaken after an OK result is quite sad and baffling.
Lastly Svetlana,
As you are a self-appointed member of the 'intelligentsia' as Marxists usually are, I cannot recommend a book by Hayek too highly. This is his 'Counter Revolution of Science – Studies on the Abuse of Reason.' It can be purchased cheaply on Amazon. Once you have finished that you could polish off your education with his Road to Serfdom and the Conceit of Socialism.
http://www.amazon.co.uk/Counter-revolution-Science-Studies-Abuse-Reason/dp/0913966673/ref=sr_1_4?ie=UTF8&s=books&qid=1241695486&sr=8-4