The Irish Times

Myksyk

Just wondering about people's point of view on Paul O'Donoghue's last Skeptical Eye IT article about why professionals get involved in the CAM market and the reply article in the IT yesterday by a Dublin GP. Personally I was disappointed at the decision by some sub-editor to put the title "A Dose of Cynicism" on Paul's original article - was this a semantic error, ignorance or cynicism itself? And what about the GP's arguments?

Any thoughts?

davros

If I understand Dr Gabriel Stewart's argument correctly, we should embrace alternative medicine because some clinical trials of conventional medicines are flawed. Besides that creative leap in logic, the flaws in the trial process he identifies are not enough to imply that the drugs that pass successful clinical trials do not work.

Some of his points just seem plain wrong. For example:

It is believed that on average 30 per cent of successful treatments are placebo effects. For a drug treatment to be ratified, it barely has to exceed this.

Is not one of the purposes of a double blind clinical trial to cancel out the placebo effect?

Or this:

Twenty per cent of appendectomies reveal appendices that are perfectly normal. While these procedures are entirely justifiable it demonstrates that surgical procedures are subject to the “mind over matter” placebo effect which science cannot explain.

Is he saying that a diagnosis of appendicitis is always correct and that therefore when a healthy appendix is extracted it has been cured by the mind in the meantime?

I don't have Paul's article to hand here though I read it at the time. That title is awful but precision in the use of words has long been abandoned in The Irish Times. Along with any discrimination between fact and fiction in the areas of health and science.

By the way, if anyone is looking for that article, it's in Tuesday's Health Supplement, on page 4.

Myksyk

With regard to the 'barely exceed' bit, I wonder is he referring to information on prazoac trials which seemed to indicate that they had a significant effect but only a few per cent above what might reasonably be accounted for by the placebo?

I had the same thought on the appendicitis reference. I was amazed at the naivete of saying that if a diagnosis of appendicitis was made but a healthy appendix was extracted then obviously it had been 'cured' in the meantime by "wishing it away".

Yossie

Dr Stewart rather disingenuously fails to mention exactly what these “beneficial treatments” that “many well-trained and experienced physicians” integrate into their practices, actually are. The reason for his omission becomes obvious once you do a search for the good doctor on Google. It appears that the doctor is Ireland’s principal promoter and provider of a controversial alternative treatment known as Chelation-Therapy. This treatment does seem to have had some mainstream uses in the past in the area of acute heavy metal poisoning. However, it is also vaunted by believers as a treatment for Autism and as an alternative to bypass surgery as well as helping Alzheimer’s and diabetes, not to mention that old public favourite “anti-aging”. Here are some sites of interest:

Dr Stewart’s “clinic”/business http://www.chelation-ireland.com/

From skeptic’s dictionary http://skepdic.com/chelate.html

From spiked-online http://www.spiked-online.com/printable/0000000CAE25.htm

From Quack Watch http://www.quackwatch.org/01QuackeryRelatedTopics/chelation.html

Statement from American Heart association http://www.americanheart.org/presenter.jhtml?identifier=4493

I’m enjoying Paul’s articles (despite the “cynicism”:mad: ), perhaps Paul’s next article could examine Chelation therapy, although I fear any “expose” of the doctor might inflate his business.


As regards the doctor’s wider points made against mainstream medicine: To me it sounds like Dr Stewart wants people to throw the baby out with the bath water. The tactic of juxtaposing the very real ills of modern medicine against the “benefits” of CAM is common among the latter’s supporters. John Diamond’s book “Snake Oil” deals well with this point. Diamond makes it clear that he held no torch for modern medicine or its practitioners, but more importantly that CAM should not receive any credit from the former’s vices.

Diamond describes his many trips (well before any tumor) to the doctor’s surgery with vague but genuine complaints of not feeling well; headaches, occasional palpitations, fatigue, indigestion, etc. The doctor runs his tests, which invariable would show nothing markedly abnormal. This is a situation that is probably not unfamiliar to most people who have past a certain point in their lives. The doctor offers some platitudes and suggests that an improvement in lifestyle and diet might help. Ones first reaction is “this can’t be right! – I know myself that there is something wrong, I want a second opinion.” In most cases when, like Diamond, we heed the advice and drop the daily bottle of vodka, the multiple espressos, the many fags, the spicy food, the fourteen-hour days and start exercising and relaxing more, he/we find that with time most of the symptoms subside. There is clearly no medical mystery behind such improvements and it is not surprising that this is a large tactical element of alternative remedies i.e. improved lifestyle. GP’s are confronted daily with these problems of modern living as much as with diseases which have more obvious physiological origins. The time and resources to effectively help these people simply isn’t available, something that the CAM people take full advantage of.

Hence, GPs are inclined to take a soft-line about their patients going in for CAM, since for the main they see them benefiting from the “holistic”, personalised lifestyle care of “no harm” treatments. The following quote is taken from an editorial in The Lancet last year about homeopathy which relates to the need for GPs to take a tougher stand against such mumbo-jumbo:

“Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homoeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homeopathy’s lack of benefit, and with themselves about the failings of modern medicine to address patients’ needs for personalised care.”


A good many of these “beneficial treatments” fall into the bracket of things that along with lifestyle changes can help our overall sense of well being e.g. massage, meditation, and the like. These are all things that are already part of quality palliative care and as long as nobody is suggesting that there is some mystical mechanism at work, then I don’t have a problem with it. If you find it relaxing etc then great, just don’t fall for the mumbo-jumbo. As Prof. Crown said at his ISS talk “I like a good foot rub as much as the next man”.

I doubt very much if any of the really non-mainstream methods e.g. homeopathy, mind-body-soul alignment, etc, are in much use by GPs. I would also like to know how many of these un-trailed treatments have as their proposed mechanism of action some novel interactions not previously known to or perhaps even denied by modern science.

As regards the “corruption of medical research” (greatly exaggerated imho) I’ll quote Richard Feynmen “if you're doing an experiment, you should report everything that you think might make it invalid — not only what you think is right about it... Details that could throw doubt on your interpretation must be given, if you know them”. Having said that there is a need to keep the robust checks that are in place, up-to-date and effective.

Imho, the approach Dr Stewart’s takes provides cover and succour to those, like himself, who use the same arguements, that it the moneyed vested interests of big business, corrupt reductionist western science etc, that is keeping them and their “therapies” from getting a fair deal and into mainstream legitimacy. What is clear to me is that it is his vested Business interest which is the malign influence on the debate.

Myksyk

I see another assortment of health options in the IT yesterday including a completely uncritical advertisement for 'face-reading' ... and I mean advertisement, not article ... although I presume that it was intended to be an article.