Yesterday, a press-release about our new book has been distributed by our publisher. As I hope than many regular readers of my blog might want to read this book – if you don’t want to buy it, please get it via your library – I decided to re-publish the press-release here:
Governments must legislate to regulate and restrict the sale of complementary and alternative therapies, conclude authors of new book More Harm Than Good.
Heidelberg, 20 February 2018
Commercial organisations selling lethal weapons or addictive substances clearly exploit customers, damage third parties and undermine genuine autonomy. Purveyors of complementary and alternative medicine (CAM) do too, argue authors Edzard Ernst and Kevin Smith.
The only downside to regulating such a controversial industry is that regulation could confer upon it an undeserved stamp of respectability and approval. At best, it can ensure the competent delivery of therapies that are inherently incompetent.
This is just one of the ethical dilemmas at the heart of the book. In all areas of healthcare, consumers are entitled to expect essential elements of medical ethics to be upheld. These include access to competent, appropriately-trained practitioners who base treatment decisions on evidence from robust scientific research. Such requirements are frequently neglected, ignored or wilfully violated in CAM.
“We would argue that a competent healthcare professional should be defined as one who practices or recommends plausible therapies that are supported by robust evidence,” says bioethicist Kevin Smith.
“Regrettably, the reality is that many CAM proponents allow themselves to be deluded as to the efficacy or safety of their chosen therapy, thus putting at risk the health of those who heed their advice or receive their treatment,” he says.
Therapies covered include homeopathy, acupuncture, chiropractic, iridology, Reiki, crystal healing, naturopathy, intercessory prayer, wet cupping, Bach flower therapy, Ukrain and craniosacral therapy. Their inappropriate use can not only raises false hope and inflicts financial hardship on consumers, but can also be dangerous; either through direct harm or because patients fail to receive more effective treatment. For example, advice given by homeopaths to diabetic patients has the potential to kill them; and when anthroposophic doctors advise against vaccination, they can be held responsible for measles outbreaks.
There are even ethical concerns to subjecting such therapies to clinical research. In mainstream medical research, a convincing database from pre-clinical research is accumulated before patients are experimented upon. However, this is mostly not possible with CAM. Pre-scientific forms of medicine have been used since time immemorial, but their persistence alone does not make them credible or effective. Some are based on notions so deeply implausible that accepting them is tantamount to believing in magic.
“Dogma and ideology, not rationality and evidence, are the drivers of CAM practice,” says Professor Edzard Ernst.
Edzard Ernst, Kevin Smith
More Harm than Good?
1st ed. 2018, XXV, 223 p.
Softcover $22.99, €19,99, £15.99 ISBN 978-3-319-69940-0
Also available as an eBook ISBN 978-3-319-69941-7
END OF PRESS RELEASE
As I already stated above, I hope you will read our new book. It offers something that has, I think, not been attempted before: it critically evaluates many aspects of alternative medicine by holding them to the ethical standards of medicine. Previously, we have often been asking WHERE IS THE EVIDENCE FOR THIS OR THAT CLAIM? In our book, we ask different questions: IS THIS OR THAT ASPECT OF ALTERNATIVE MEDICINE ETHICAL? Of course, the evidence question does come into this too, but our approach in this book is much broader.
The conclusions we draw are often surprising, sometimes even provocative.
Well, you will see for yourself (I hope).
14 Responses to Medicine, magic and morality (press-release by our publisher, Springer)
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Had this book pre-ordered and read it as soon as it arrived.
Since the complementary and alternative “medicine” has such a positive image and good moral reputation in many people´s minds (unfortunately including many politicians), I think this book it extremly valuable.
As with religion, it is of course very difficult -if not impossible- to convince CAM believers with rational arguments, I consider it very important to have this objective overview of the moral issues, e.g. for discussions with those persons not completely unreceptive to scientific and moral arguments.
Thank you Prof. Ernst and Dr. Smith for taking the effort to thouroughly evaluate the detrimental moral implications of CAM, which are often ignored in my experience.
Taking a stroll to Waterstones shortly. This will be with me all weekend at Doncaster Chess Congress: there are a small proportion of woo merchants and lots of curiosity-driven competitors.
The biggest driver of ‘CAM practice’ is the profit motive/greed/fraud plus the prophet motive – camists want to be loved and well thought of – hence their present thrust to be ‘integrated’ with conventional medicine.
We all know camistry can make patients ‘fee better’, but what percentage of camists sincerely believe their chosen modality affects specific pathological processes, and what percentage know full well such claims are tosh, but practice anyway?
If that question has not been answered, it should be.
I feel another book coming on…!
This one is excellent and highly recommended.
We will never convince camists and camees of the errors of their ways – for the believers, the emotions generated are too strong – but we don’t need to.
We who value integrity in healthcare, ethically need to ensure gullible and vulnerable patients, and politicians/persons of importance who lack insight, understand the issues and give fully informed consent before agreeing to treatment with a CAM practice. This book will be of great help in these laudable aims.
And those of us with good conscience must do all we can to ensure no public funds are spent on camist practices.
“what percentage know full well it is tosh, but practice anyway?
If that question has not been answered, it should be.”
How would you even begin to research this?
You need a lie detector and a very lenient ethics committee that allows you to recruit therapists against their will!?!?
“You need a lie detector and a very lenient ethics committee that allows you to recruit therapists against their will!?!?”
Will there be waterboarding? #NotSeeingAProblemWithThis
only for homeopathy [with shaken water, of course]
So the question should not be researched into?
I have read that the integrity of practitioners is ‘not doubted’. Why not? How do we know they are honest?
This is a job for sociologists, psychologists (perhaps with forensic training), experts in complementary medicine…
They should be getting on with investigations on the basis that it is, on the balance of probabilities, the case is that most CAM practitioners are quacks seeking to take advantage of gullible, vulnerable patients.
What therapist with integrity would not want to assist with such research? What would they have to hide, or be ashamed about?
Given there is no evidence of the beneficial effects for CAMs (or they would be incorporated into ‘medicine’), the default position must be that those making claims of benefit are quacks – and if they gain financial benefit from selling their services, training courses, books, they are frauds.
If they wish to counter this presumption, it is for the camist, the practitioner, to provide evidence of their propriety and integrity. To demonstrate what energies are generated by Reiki manipulations; to identify what ‘subluxations’ are ‘adjusted’ by spinal manipulation and how ‘innate intelligence’ has any effect on any specific condition; to show that their homeopathic pillules have an effect different from placebo pillules (when prescribed to a large enough group, with randomised controls, in a double blind analysis); to show that it really matters where skin is pricked by belone needles (I prefer the Greek for ‘needle’, rather than the Latin, ‘acus’) ; to demonstrate that ‘herbals’ or ‘supplements’ really do provide benefit (and therefore should be taken up by the pharmaceutical industry, as some are).
“Extraordinary claims require extraordinary evidence” was a phrase made popular by Carl Sagan. However, Laplace writes: “The weight of evidence for an extraordinary claim must be proportioned to its strangeness”. Also, David Hume wrote in 1748: “A wise man … proportions his belief to the evidence”, and “No testimony is sufficient to establish a miracle, unless the testimony be of such a kind, that its falsehood would be more miraculous than the fact which it endeavors to establish.” (Wikipedia).
Failure to provide the evidence is unethical. Patients must be properly informed, and not be misled by practioners, politicians or proponents of the alternative medicine industry. Patients should read ‘More harm than good’!
“What therapist with integrity would not want to assist with such research? What would they have to hide, or be ashamed about?”
Judging from my experience of ~20 years of trying to co-operate with these practitioners, few volunteer to work with scientists once they realise that the results of the research might be not in their favour.
of course, the question should be researched; I just don’t know how it can be done.
While I don’t, for a moment, doubt that some CAM practitioners fit this description, I have not yet met one. The small handful of pseudo-medicine quacks I have personally encountered all fall into the category of ‘sincere believers’. They overrate their personal experience of ‘healing’ (post hoc fallacy) and rely heavily on publications and websites that support their views (confirmation bias). They are commonly ignorant of biomedical science, but not entirely — one camist I know really well is an MB.ChB-qualified doctor, registered with the GMC.
They are all deaf and blind to reason and critical thought, stuffing their fingers in their ears and saying ‘la-la-la’ if I try to argue with them. One recently terminated a discussion with “You’re a scientist: you won’t understand.” They also share a sense of disappointment with orthodox medicine: they all have examples of people who’ve suffered from medical treatment.
Among the many woo supporters who post comments on this blog I can’t think of one who comes over clearly as a charlatan: they all seem to fit the characterization of the ones I know personally. The most regular homeopathists, chiropracticists, acupuncturists, reikists, etc. whose stuff we read here are typically ignorant of what constitutes dependable evidence, and immune to reasonable argument, but they all seem to truly believe the nonsense they spout. They think they are party to something ‘nature-friendly’ or ‘spiritual’. I think most camists are comparable with ministers of the many religions prevalent on this planet: they know what they believe, and their beliefs outweigh considerations of reality.
Edzard has already explained how difficult it is to find a practitioner willing to co-operate in a truly scientific investigation. They view science with disdain (even though they rely on the technological spin-offs of science for too many daily routines to list here) and they know just as well as a religious person that science will not confirm their beliefs.
But the over-riding question posed by More Harm Than Good is whether or not practising any form of ‘healing’ based on a sincerely held belief is ethical. The resounding answer has to be ‘no’ and I’d recommend this book as an essential resource for anyone who doubts this. But what to do about it? People should be free to believe and practise whatever they want. (I respect the right of folk to believe weird things, but have zero respect for the beliefs themselves.) The exception, obviously, is when the belief causes demonstrable harm to other people.
Our society tolerates a lot of harms when enough people ignore the risks and/or they contribute to the economy. We kill six jumbo-jet-loads of people on the roads of Britain every year because so many folk want to drive as fast as possible and ignore proscriptions on drink-driving and use of phones while driving. (Of course, the motor industry is also a major component of the economy.) We’ve known for 50 years that smoking is an inevitable contributor to pulmonary dysfunction yet we have still not taken the obvious step of entirely outlawing the sale of tobacco products.
We live in a democracy: the best we can hope for in the case of pseudo-medicine are the continued efforts of people like Edzard Ernst, Richard Rawlins and the many other sceptics who write books and blogs soberly explaining the downsides and the potential harms. We have to be indefinitely patient. You can lead a horse to water…
I agree with you, Frank, I think that most CAM supporters/practitioners are scientifically ignorant, but not per se “bad” people. The parallels with religion that you draw are obvious, and regarding converting “believers”, let me quote Christopher Hitchens ” (…) I’ve said repeatedly that this stuff cannot be taken away from people, it is their favourite toy and it will remain so (…)”.
A colleague of mine, although being a Professor in Biology at a German University, tends to defend some CAM treatments (osteopathy and acupuncture), despite the fundamentally flawed rational of these treatments and the scientific evidence against them.
Similar to religion, even well educated people seem to be able to maintain a weired “mental divide” when it come to their spiritual toys, which I can not comprehend and find fascinating.
For me, it would be most important that governments must be pressured to stop tolerating the double standard in terms of medical treatments when it comes to CAM, and that coverage of CAM by health insurance companies must stop.
TL;DR: …it takes time!
The trouble with people holding irrational beliefs is that it is expensive to swap belief systems… leaps of faith, qualitative leaps, require energy and the path towards rationality reduces entropy. It is this price that makes the procedure troublesome and it is far more efficient to carefully distribute the effort over the victims.
We are born without reason, guided by stimuli. When we begin to gain an understanding of the world, the lucky ones get some systematic education. There is noone that might simply take for granted that, for example, table salt is, in fact two things bound together, strong poisons no less! Or that some people cannot perceive colors… or that it is totally impossible to construct a square with an area equal to a circle of a given radius. We cannot grasp the fact that a wire encircling the entire earth tangentially along the equator and one encircling the entire earth at a height of 1 meter along the equator differ in length less than 7 meters in total!
When we begin with education, a vast amount of knowledge is implanted in our minds and, after at least a few years, we can live without wondering anymore who draws this colorful arc on the sky sometimes after a rain episode or a very humid sunny day, while we comfortably enjoy some bee-puke on a slice of toasted bread. But it takes years and it doesn’t always work out well.
We have all been there. Logical fallacies and the (dis)connection between belief and evidence should be established during childhood. It is always disheartening to watch irrational beliefs in grown-ups, but in due time, this can be reversed. The only trouble is that this is an entire mission, even for isolated cases, and it’s not to be taken lightly. Often, only a very close person with a fairly strong sentimental bonding can bring reason to someone and, still, it takes a large amount of time and devotion.
Repeating facts and showcasing or requesting evidence is not very efficient for lost grown-ups anymore. It requires a diversity of tactics, and this is an area where alt-med is very strong. Because these practitioners (prophets, more accurately) don’t lose time in clinical studies, don’t spend nights in front of their screens correcting mistakes and double-checking that they didn’t miss an outlier or copied the wrong values, they don’t lock themselves in labs with not-fancy-at-all spectrophotometers, centrifuge machines, old worn-out test tubes, some 3-day old sandwich leftovers and a consolation-prize chocolate bar or choc chips, they have ample time to preach. Healthcare should probably begin employing a preaching attitude too… one of promoting science and reason in public.
I find it appalling that shameless frauds come to schools to inform parents about homeopathy, and even worse, that some of them are doctors. It is about time to implement a new attitude in healthcare, of not only disseminating what works, but also persistently and proactively teaching what doesn’t! The public is gullible, but it’s also open to suggestions. It is very often indispensable to “get there first” and inform about what they should strongly avoid, before close encounters of the CAM type turn open minds to minds wide shut.
I wonder if friends of WDDTY will be removing the book from its current shelf in book shops and place it in the Fiction section?
sCAM doesn’t have friends; it has Acolytes.
I wonder what a fair description for such an act would read like…