Respectful Insolence

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgVacation time! While Orac is off in London recharging his circuits and contemplating the linguistic tricks of limericks and jokes or the glory of black holes, he’s rerunning some old stuff from his original Blogspot blog. This particular post first appeared on December 27, 2005. Enjoy!

Since the very beginning of this blog, I’ve said that I’d love to see “alternative” medicine treated on equal footing with conventional medicine. Of course, this doesn’t necessarily mean what alties think it does. When I say “equal footing,” I don’t necessarily mean that alt-med should be treated with equal respect, although that might be the effect in some cases. No, what I mean is that it should be subject to the same standards with regards to efficacy and safety as that conventional medicines must meet before being approved for use and widely used by physicians. To my mind, if alt-med practitioners want to be treated with the same level of respect as conventional physicians and have their methods used more widely, it is only fair that they should have to jump through the same hoops and meet the same standards that conventional physicians and conventional medicines do.

Not surprisingly, craving the acceptance and legal status given to conventional physicians by our society, some alt-med practitioners like to claim that they, too, want their remedies to be investigated scientifically, to have them tested in the same way that conventional drugs are tested. True, they often add a boatload of caveats, such as complaints that they’re too busy treating patients to do clinical trials or research, that they can’t get funding for their work (a much smaller problem since the National Center for Complementary and Alternative Medicine started handing out big grants to alties), or that drug companies aren’t interested in studying their remedies because they can’t make a profit off of them (never mind that supplement companies seem to do quite well selling them). Some of them are sincere, but I’ve always suspected that most of them would really prefer that science be kept away from their treatments.

So it was with interested that I read this story out of Britain:

Millions of people use it to deal with illnesses ranging from asthma to migraine. Prince Charles believes it is the answer to many of the evils of modern life. But now Britain’s first professor of complementary medicine, Edzard Ernst of Exeter University, has denounced homeopathy as ineffective.

‘Homeopathic remedies don’t work,’ he told The Observer. ‘Study after study has shown it is simply the purest form of placebo. You may as well take a glass of water than a homeopathic medicine.’ Nor is Ernst’s disdain confined to homeopathy. Chiropractic, which involves spine manipulation to treat illnesses, and the laying on of hands to ‘cure’ patients, are equally invalid, he says.

Not surprisingly, his views and his studies have provoked furious reactions. Chiropractors and homeopaths have written in droves to Exeter to denounce him. But now the scourge of alternative medicine says he is going to have to quit because Exeter will no longer support him or his department. ‘They have never provided me with the money they originally promised me. Now we have been told in no uncertain terms that this department is going to close.’ The university denied the charge. ‘Professor Ernst’s department has enough money to go on for a couple of more years,’ said a spokesman. ‘We are still trying to raise cash. It is premature to talk of closure.’

Dr. Ernst sounds like a man after my own heart. In fact, he was hired in order to bring scientific rigor to the study of alternative medicine. The problem is, he was serious about doing just that:

Ernst, then a professor of rehabilitation medicine in Vienna, took the job to bring scientific rigour to the study of alternative medicines, an approach that has made him a highly controversial figure in the field. An example is provided by Ernst’s study of arnica, given as a standard homeopathic treatment for bruising.

‘We arranged for patients after surgery to be given arnica or a placebo,’ he said. ‘They didn’t know which they were getting. It made no difference. They got better at the same rate, whether they got arnica or the placebo. And arnica is a classic homeopathic remedy. It doesn’t work, however.’

In another study, Ernst got five homeopaths to examine children with asthma. ‘Children are supposed to respond better than adults to homeopathy, and asthma is said to be particularly responsive to homeopathic treatments,’ he said. ‘However, again we found no evidence that homeopathy worked.’

Of course, the real surprise would have been if Dr. Ernst had found actual evidence that homeopathy did anything at all. After all, homeopathy uses successive dilutions of the “active ingredient” to levels where there may not even be a single molecule of it in the specimen. Dr. Ernst is correct; homeopathy is no more better than drinking a glass of water because it is no more than drinking a glass of water.

But, contrary to what you may think, Dr. Ernst is not hostile to alternative medicine:

Nevertheless, Ernst insists that he is a supporter of complementary medicines. ‘No other centre in the world has produced more positive results than we have to support complementary medicine,’ he said. ‘Herbal medicine, for instance, can do good. If I was mildly depressed, I think St John’s wort would be a good treatment. It has fewer side-effects than Prozac. Acupuncture seems to work for some conditions and there are relaxing techniques, including hypnotherapy, that can be effective. These should not be used on their own, but as complements to standard medicines.’

I’d agree with him about some of the herbal remedies (although St. John’s Wort has not lived up to initial studies) and hypnotherapy, but I’m a bit less convinced about acupuncture. Certainly, at least one of Dr. Ernst’s own studies showed it to be no better than sham treatment. (I’ll say one thing about this guy; he’s published like a maniac over the last couple of years.) Dr. Ernst has also exposed some of the antivaccination bias in alt-med circles:


Ernst’s opponents also claim some of his research methods are unethical. Once, a colleague pretended to be a pregnant mother and asked homeopaths and chiropractors if she should give the MMR vaccine to her child. Most said no. Ernst published a paper on these findings.

I believe this is the study in question, and the abstract states:

Complementary and alternative medicine (CAM) has become a popular form of healthcare and the predictions are that, it will increase further. The reasons for this level of popularity are highly diverse, and much of the motivation to turn to CAM pertains to a deeply felt criticism of mainstream medicine – many people (are led to) believe that conventional interventions, including immunisation, are associated with the potential to do more harm than good. Thus, it is hardly surprising that CAM also lends support to the “anti-vaccination movement”. In particular, sections of the chiropractors, the (non-medically trained) homoeopaths and naturopaths tend to advise their clients against immunisation. The reasons for this attitude are complex and lie, at least in part in the early philosophies which form the basis of these professions. The negative attitude of some providers of CAM towards immunisation constitutes an important example of indirect risks associated with this form of healthcare. The best way forward, it seems, would be a campaign to clarify the risk-benefit profile of immunisations for both users and providers of CAM.

Precisely. There is a strong bias against western medicine, including immunizations, among many providers of CAM, and they can influence people from foregoing “conventional” medical treatments and preventative measures known to be efficacious. Personally, I don’t see how it is “unethical” to test whether homeopaths and chiropractors are giving out harmful medical advice. To me, it’s no different than investigative journalism. No doubt, studies like this are among the reasons that Dr. Ernst is probably quite correct when he observes, “‘I think my peers would prefer someone who didn’t rock the boat.”

Of course they would, because, far more often than not, scientific scrutiny of alternative medicine remedies reveals that they do not do what CAM practitioners claim that they do. When they do, often they become part of conventional medicine, which is as it should be. More often, however, they do not. Whatever the result, we need researchers willing to examine these therapies scientifically to identify the ones that have therapeutic value and discard the ones that do not.

Comments

  1. #1 Thinker
    August 30, 2007

    Whatever the result, we need researchers willing to examine these therapies scientifically to identify the ones that have therapeutic value and discard the ones that do not.

    Which I completely agree with. At that point, however, alties always say “but we can’t afford trials / the “establishment” has stacked things against us by making it so expensive / yada yada yada …”

    Codswallop! If you have sufficient initial results to credibly claim that your proposed therapy will be significantly better than what is already available, getting funding should not be a major problem. If you don’t have anything that proves your therapy is effective and safe, how on earth can you claim the right to start giving it to patients?

    Also, the above just addresses the supply side of the equation. How do we get people/patients to see that despite the limitations of the current approval processes, evidence-based medicine is still the best way to sort out which the best therapies are?

    How is it that we fail so massively in communicating this to people?

  2. #2 Kristjan Wager
    August 30, 2007

    If they can’t get “big pharma” to fund it because of lack of profit, then why not ask the health departments in countries with socialized health care? I know the Danish department of health would love to have remidies that are cheaper and/or more effective. As a matter of fact, the Danish state does fund research into alternative medicine, and while the people handling the funding/research is less critical than what we’d like, they still have debunked a lot of garbage.

    As much else these people say, it’s just lies and bad excuses.

  3. #3 Dunc
    August 30, 2007

    More to the point, if they can’t get “big pharma” to fund it because of lack of profit…

    …then how come they’re making money hand over fist? If anything, CAM is probably more profitable than evidence-based medicine.

  4. #4 Mongrel
    August 30, 2007

    Which I completely agree with. At that point, however, alties always say “but we can’t afford trials / the “establishment” has stacked things against us by making it so expensive / yada yada yada …”

    They also tend to quote the all inclusive, concept to market, figures for ‘testing’ when moaning about expense

  5. #5 Dr Aust
    August 30, 2007

    The market for Alternative Medicine is huge, so I don’t buy this line that “we can’t afford to run trials”. It is total garbage.

    In some countries, notably Germany, the herbal medicine manufacturers do fund research. It is subject to the same well established “funder biases” as Pharma research, but at least it is done and gets published in proper peer-review journals.

    It seems self-evident that most Alt remedy pushers don’t run proper trials because there is no legislation that forces them to. Inter alia, I find it simply baffling that the Chelation quacks are allowed to stick drips in people and run EDTA into their veins (a procedure with clear and well-documented dangers) without having had to demonstrate efficacy.

    While it would not always be easy to make this “show efficacy” for other stuff (like “healing touch”) where there is no actual remedy, pill, or treatment, in these cases it could easily be made illegal to have ADVERTISING making medical claims for which there is no basis.

  6. #6 Joe
    August 30, 2007

    Actually, quacks do conduct “research” and publish in their own “refereed” magazines. Some of the magazines are general, others are devoted to homeopaths, chiropractors, etc. Unfortunately, what passes for “research” in alt med usually would not make it into a school science fair, and the fanzines are not worth the paper they are printed on.

    The most recent homeopathetic “clinical” study I read was typical. The author treated “skin conditions” (acne, warts, allergies, they are all “skin conditions”) and all 15 subjects’ conditions resolved within 2 years. By the way, the patients were all receiving standard medical care; but it was really the homeopathy that worked. Did I mention that there was no randomization or blinding?

    A few weeks ago Orac did an excellent deconstruction of one of the rare CAM articles that appeared in a medical journal.

    No, money isn’t all that sCAM “researchers” lack.

  7. #7 Rob
    August 30, 2007

    As further evidence of Orac’s central point that alt-med promoters don’t want their therapies scientifically evaluated, consider the chief executive of The Society of Homeopaths frank admission of the point in a letter to the Guardian in 2005:
    “It has been established beyond doubt and accepted by many researchers that the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy.”
    In other words: homeopathy is an effective and valuable form of medicine but shouldn’t be subject to the same tests as every other medical treatment or procedure, lest it appear to be ineffective.

  8. #8 Rob
    August 30, 2007

    As further evidence of Orac’s central point that alt-med promoters don’t want their therapies scientifically evaluated, consider the chief executive of The Society of Homeopaths frank admission of the point in a letter to the Guardian in 2005:
    “It has been established beyond doubt and accepted by many researchers that the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy.”
    In other words: homeopathy is an effective and valuable form of medicine but shouldn’t be subject to the same tests as every other medical treatment or procedure, lest it appear to be ineffective.

  9. #9 Rob
    August 30, 2007

    Apologies for duplication: server error on the first submission of the comment, so I resubmitted thinking it hadn’t been received.

  10. #10 Alex, FCD
    September 2, 2007

    “It has been established beyond doubt and accepted by many researchers that the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy.”

    Then what the hell is?