Angry Doctor

Saturday, September 16, 2006

How NOT to argue for Alternative Medicine

I wrote this one up yesterday but Blogger ate it up.

But I thought the
fine letter provided by the writer (mentioned in this previous post) utilised so many same-old-tired flawed arguments for Alternative Medicine, it was too good to pass up.

So here's angry doc's advice on how NOT to argue for Alternative Medicine.


"All very constructive, this evidence-based name-calling, but there are some serious issues at stake here.

The first is the implied infallibility of the mainstream health professions, namely that their methods are always right, and ours are always wrong. Clearly, neither is true. Anecdotally, we all know of cases where GPs failed to notice something serious and doled out take-two-aspirin-and-go-to-bed-early advice when the realities were far more serious.

As an osteopath, I have come across cysts and tumours missed by patients' GPs and I have had patients come to me exasperated by the failures of mainstream treatment. That is not to say doctors are bad at their job, I do not wish to characterise GPs in the same way some GPs characterise us (earlier this year, osteopaths were accused of "sham treatment"), since that is clearly not the case. After all, many patients are sent to me by more enlightened members of the profession, but there ought to be a wider recognition of the diagnostic basis of much complementary treatment."


1. Two wrongs do not make a right

Just because western medicine is not infallible does not make alternative medicine effective. Argue with logic and evidence, not smear tactics.


"Osteopaths and chiropractors (the areas I am most familiar with) train for four or five years, learning anatomy to the same degree as doctors, as well as studying physiology, the respiratory system, the cardiovascular system, pharmacology and pathology, among others, which all help in our diagnostic triage - we are becoming more and more often the first port of call for many patients.

All patients undergo a detailed documented case history when they first see an osteopath, where we screen for any medical conditions and assess their suitability for osteopathic treatment. The insinuation that the professions are peopled with fly-by-nights with no real medical knowledge is untrue, insulting - and unworthy of the wider medical profession.”


2. Garbage in, garbage out

It is the quality of the subject you study that makes the difference, not how long you spent studying it. Just because you spent years studying it doesn’t make the subject of your study 'right'. Don't go on about how much you study - prove the results of your study with evidence.

3. It's not a popularity contest

Just because more people are coming to you does not mean you are right either – it just means you are popular.


"Again and again, doctors refer to evidence bases as their catch-all for ruling out complementary medicine. In practice this is fine - though it comes from the profession that brought you thalidomide and is beginning to wonder whether rushing herceptin through the net was really so wise."


4. Don’t knock evidence - you might need it later

Evidence-based medicine does not rule out alternative medicine - alternative medicine rules itself out of mainstream medicine by its own unwillingness or inability to provide quality evidence.

If you reject 'evidence' as the basis for deciding whether a mode of therapy should be accepted or not, what do you propose to use to back your own claims?

1. Two wrongs do not make a right (yes, using the same flawed argument a second time in the same letter still doesn't make it right)

Yes, thalidomide is bad for you. Vioxx may be bad for you too. But lots of other western medicine drugs are good for you. Again, two wrongs do not make a right, so pointing out the failures of western medicine does not support the position of alternative medicine.


"However, the medical profession is a multi-million pound industry backed by pharmacological giants. The complementary sector cannot compete - we cannot pay for trials, we do not have multi-nationals encouraging treatment dependency."


5. Be honest – it *is* about the money

The alternative medicine business is *also* a multi-million pound industry. More than a billion pounds, it seems.

In fact, if like you said more and more people are using alternative medicine, that makes it a multi-million pound *growing* industry.

You can't claim to have no money for trials because unlike the Big Pharmas, your therapies are traditional and natural, and do not take millions of pounds to develop!


"It is the exact opposite - if there is a theory underlying all complementary medicine, it is that the human body works quite well on its own and needs tweaking as little and as naturally as possible. If you want clinical evidence - how about millions of years of human history?"


6. 'Natural' doesn't mean 'better'

It is not natural to have chlorine-disinfected drinking water or smallpox vaccination, but those things do a lot of good.

Hemlock, on the other hand is all natural, as is dying of malaria.

Having your spine manipulated on a chiropractic couch, having steel needles stuck into you, and having a burning candle stuck inside you ear are not natural, so don't knock your own practices.


"Ironically, one of the few areas that a large-scale trial has been done is the area that started this current row. Homeopathic medicine is indeed controversial, as in order for a homeopath to treat a patient, the person's individual symptoms have to be taken into account in order to make an individualised prescription. This means that homeopathy does not perform exceptionally well in random controlled trials - where one group of people are all given the same medicine and another group are given a placebo."


7. Don't use 'individualised' as an excuse for a lack of system

If every individual is special, then how does a homeopath know what treatment to prescribe for each of them?

Either there is a system where signs and symptoms allow a patient to be diagnosed of a condition or a syndrome, and a treatment be recommended, or there is no system.

If there is a system, it can be studied.

And if there is no system, why bother spending years studying it? In fact, how do you teach or learn it?

(Yes, angry doc scoffs at the idea of 'individualising treatment' in western medicine too; it’s just putting people into smaller pigeon-holes – they are still not 'individuals'.)


"When homeopathic trials are based upon individualised prescriptions we see a very different picture. At the end of 2005, the results of a large six-year study of 6,500 patients at Bristol Homeopathic Hospital reported 75% improvement in their health."


8. Learn statistics, and learn how to design a proper trial

A few thousand people saying that they *feel* better about their health does not make a trial – it makes a
survey.

Also, surveying follow-up patients imparts a bias to the survey and make it a poor study.

It’s a bit like surveying repeat customers at a restaurant – if they didn’t like the food there they wouldn't be back in the first place.


"The sad thing about arguments such as this is that both sides of the medical divide could work at their best together.

Earlier this year, a report commissioned by Prince Charles (OK, bear with me - he didn't write it) said that patients using the "big five" complementary therapies - osteopathy, chiropractic, acupuncture, homeopathy and herbal medicine - would greatly benefit from their treatment, while the NHS would reap economic rewards.”


9. Don’t appeal to authority

Especially when the authority is not an authority on the subject.


"The report was written by Christopher Smallwood, who commented at the time: "The weight of evidence we have examined suggests that complementary and alternative medicines could play a larger role in the delivery of healthcare, and help to fill recognised gaps in healthcare provision."
He went on to call for the NHS's drugs watchdog to assess the cost-effectiveness of complementary therapies and he asked the government to boost funding for the therapies on the NHS."


10. Be aware of what you are quoting

The disclaimer on the
freshminds site on the study reads:

The contents of this publication constitute research, the results of which have not undergone clinical trials or any other form of testing or validation for the purposes of any kind of medical treatment, diagnosis, therapy or advice. The said contents are published for the purposes of information only. None of the said contents should be considered medical advice or a recommendation of medical treatment or therapy. This publication should not be relied upon as a basis for administering or seeking medical treatment, diagnosis or therapy and neither commissioners, financiers or related parties, nor any of their employees, subcontractors or agents shall be held responsible for any action that you take in reliance upon any of the information contained in this publication. You should always consult your health care professional for specific advice relating to any medical questions.


"Such support is welcome, even if the basis is economics not health, and the new rules on homeopathic treatment are a small step in the direction of bringing complementary medicines into the mainstream - a journey already made by physiotherapists, after all. But while snide asides about eye of newt and wing of bat continue to emerge from those in the medical profession who forget why we use the word complementary in preference to alternative (it is alongside, not instead of), it will be a struggle. And the real losers will be the patients."


11. Try to gain acceptance on your own merit

It doesn’t matter whether we call you 'alternative' or 'complementary' – if you can’t provide evidence for efficacy, you should not be accepted.

Physiotherapy proved its efficacy, and nobody calls physiotherapy 'alternative' or 'complementary' – they call it 'physiotherapy'.


Trying to gain acceptance by quoting the example of physiotherapy just makes it look like you think you can't make it on your own merit.


Well, there they are.

angry doc would have liked to keep the list of advice to a nice round number of ten, but blogging is not an exact science...

Labels:

8 Comments:

  • Brilliant.

    Just caught up with the article in the Grauniad.

    My standard patter on "natural" goes like this:

    "But is it natural doctor?"
    "What, you mean like cowdung and Deadly Nightshade?"
    "No, of course not doctor, but you know what I mean when I said "natural".
    "No, I don't, I really don't!"


    ++++++++


    Thalidomide? V.good for dermatitis herpetiformis and leprosy I understand.

    It's all a balance, isn't it.


    JOhn

    By Blogger Dr John Crippen, At September 17, 2006 12:28 am  

  • ouch. the medical empire strikes back! impressive salvo, i must say. thumbs up.

    By Blogger The Angry Medic, At September 17, 2006 4:26 am  

  • I always tell my patients that they should try to stick to one form of medicine or another - it's probably not a good idea to mix-n-match treatments.

    By Blogger tscd, At September 18, 2006 5:15 am  

  • Great rebuttal. Its most unfortunate when people are misled by unsubstantiated articles in the mass media.

    By Blogger Edgar, At September 18, 2006 7:49 pm  

  • Thank you all.

    tscd, I too tell my patients to stick to one form of medicine... preferably one that doesn't involve me! :)

    By Blogger angry doc, At September 18, 2006 8:16 pm  

  • very good blogger site!.

    Do you know BBC News (14/09/2006) Acupuncture for low back pain is cost-effective and works, according to medical researchers. Two studies on bmj.com suggest a short course of acupuncture would benefit patients and healthcare providersThe cost is well below the threshold used by officials to decide whether the NHS can afford to fund a set treatment, they said. Up to 80% of UK residents experience back pain at some point in their lives, costing the NHS £480m a year.—(BBC News 14/09/2006)

    And, What do you think about it? Something as follow:

    Chinese acupuncture practitioner had almost been accused for website’s ads in Bristol

    Dr Zhentong Han is a Chinese registered acupuncturist with twenty years of clinical experience. He is very popular among the patients in the area with outstanding technique. The appointments for him in the clinic in Bradford were always full, however, at Bristol, another place where he set up his business; there were troubles from the competitions in the same field.

    It started at the acupunctural website of Dr Han(http://www.backachetherapy.co.uk), which occupied the NO.1 place in a international websites about acupuncture (http://www.passion-4.net/tables/Acupuncture.html). Because of the large number of patients attracted by this website which introduced traditional Chinese acupuncture for backache therapy,and top position in yahoo and google. it caught great attention of other businesses in the same field in a very short time. Some practitioner even registered company names using key words about acupuncture , and notified Dr Han and other practitioners to stop using the some key words for advertising the website. Or else they would probably be charged by the law.

    Dr Han claimed that he regretted deeply for the matter, but he didn’t want to get involved in this legal dispute, for the purpose of having a website is not to score high on the network, but to have more patients understand the most veracious Chinese traditional acupunctural techniques through his website, so to help more patients get rid of the pain.

    Bristol Chinese Pain relief Acupuncture
    www.backachetherapy.co.uk

    By Blogger backcare, At September 18, 2006 8:59 pm  

  • I believe the convenient term for the fallacy described by #3 is "argumentum ad populum" or the "bandwagon fallacy".

    By Blogger John Riemann Soong, At September 25, 2006 8:49 am  

  • Thanks for imparting the stuff. That is very opportune phentermine side effects at this site as I am going through difficulties like it, also I'm actually intending testing this myself.

    By OpenID nicoleshe, At August 30, 2012 7:32 pm  

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