MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The wishes of a patient do not over-rule medical knowledge!” (Patientenwunsch steht nicht über medizinischem Wissen)

This was one brave conclusion drawn in a discussion about homeopathy during a recent German radio programme. Specifically, the discussion was about the pros and cons of a leading paediatric hospital of the Ludwig Maximilian Universitaet (LMU) Munich offering homeopathy to its patients (they also run a course in homeopathy which we discussed previously).

The wishes of a patient does not over-rule medical knowledge!

This sentence made me think.

Is it correct?

An interesting question with ethical dimensions!

The short answer is NO, I believe..

Patients can always refuse to have a given therapy, if they so wish. Or they might opt for one evidence-based therapy instead of another. And in certain circumstances such wishes may well be completely against the current best medical knowledge.

But this is probably where the dominance of the patient’s wishes over medical knowledge ends — at least, if we only consider wishes paid for by the public purse (otherwise, anyone can, of course, buy almost any rubbish).

And that was not what the above-mentioned discussion was about. It focussed on the arguments by the LMU to justify their offer of homeopathy to sick children. Essentially, they seem to say:

  • We believe in evidence-based medicine (EBM) and are fully dedicated to its principles.
  • We know that homeopathy is not evidence-based.
  • Yet, many of the parents want us to use homeopathy in the treatment of their kids.
  • And the wish of a patient over-rules the medical evidence.

This is, of course, a flawed argument. One cannot subscribe to EBM and, at the same time, administer overt nonsensical, disproven treatments. A patient’s wish does not render a nonsensical treatment evidence-based. If one would follow the LMU logic, one would have to use any idiotic therapy … and could still pride oneself to follow EBM practice. In England, we call this ‘having the cake and eat it’; once you eat the cake, it’s gone and you cannot have it any longer.

What follows is simple: the decision makers at the LMU have been found out with (homeopathically potentised) egg on their faces (for some reason they had this homeopathy enclave for years, it is well-established and, I suspect, even better protected by some people of influence). They quickly tried to find a way out of their dilemma. Unfortunately, they did not think hard enough; the solution to bank on patient choice turns out to be a non-solution.

I therefore suggest they get in line with the role of a University hospital, with today’s medical thinking and medical ethics. This would mean re-considering their homeopathy course as well as their inclusion of homeopathy in publicly-funded routine care.

9 Responses to Does the wish of a patient over-rule medical knowledge?

  • It is good to see that -for a change-, the BR (Bavarian Broadcasting Network) aired a clip that was a clearly on the side of science and evidence based medicine.
    Unfortunately, this seems to be quite rare, since the BR most often is presenting quackery in a quite positive light, e.g. in this recent, very annoying TV clip:
    https://www.br.de/br-fernsehen/sendungen/gesundheit/gesundheit-homoeopathie-schulmedizin-100.html

    In this clip, as often with the BR, homeopathy supporters are interviewed and critical comments on the nonsense that they put forward are lacking. This conveys the message that homeopathy is pretty much acceptable and maybe even advantageous compared to evidence based medicine for minor health issues.
    I think that the editors and journalists (if you want to call them journalists…) responsible for this (and many similar BR clips about CAM) do a very poor job and a disservice to the public by not CLEARLY pointing out the FACTS that homeopathy:
    *contradicts even very basic science
    *contradicts logic and reason
    * is just an outdated belief system
    * can lead to delay of adequate treatment of serious illness
    *is a waste of health insurance (and/or personal) money
    *has a negative risk/benefit balance
    *should therefore not be suggested for ANY heath issue

    I have often wondered why the BR seems to be so prone to quackery. I am aware that this blog is not about religion, but could this be related to the fact that religion is so deeply rooted in Bavarian culture? If I remember correctly, a connection between religious believe and use of CAM has been established.

  • Patients may wish homeopathy worked, but I doubt if anyone wishes for a worthless treatment that will do nothing to alleviate their suffering.
    I personally find the evidence for a “mind over matter” type of placebo to be unconvincing. These effects are probably due to subtle improvement in patient behavior (exercise, diet), and could be achieved even by a patient who is in the least hopeful of moods.

  • I prefer to trust my medical professional, though she’ll insist on giving me information that I strive to digest in context. For this, she has my ongoing respect and deference as a tenaciously studious professional whose invested years to gain and sustain knowledge and understanding of her field.
    I rarely trust a salesperson whose career depends on sculpting phrases and closing techniques to gain repeated custom and recommendation. Homeopaths are salespeople, not medical professionals.

    When talking with my doctor, I seek to determine her assessment of the best option.
    I gave up talking to CAM agents yonks ago.

  • If a doctor says that you have Illness XX and that to cure it, you should take Pills YY, and maybe even have surgery as well, you should say, “Thank you, doctor! I’ll let you know what I will do.” Then you go home and search the internet for knowledge about the illness and about what treatments are effective and which are not.

    The doctor understands conventional medical treatments, and of course he will prescribe them. That’s how s/he earns a living. But there are non-conventional treatments, which cost nothing more than the price of certain foods at the market, and which are far more effective and far cheaper than pills and surgery. Pills and surgery are not the Holy Grail for health treatments.

    Examples? There are too many to mention. But let’s say that you have Parkinson’s Disease. The doctor says you will need to take Pills X, Y, and Z. So you say, “Thank you, doctor! I’ll get back to you.” Then you discover that the medication doesn’t work, but cycling does: https://www.nbcnews.com/nightly-news/video/how-patients-are-using-cycling-to-slow-down-parkinson-s-917498947693

    You have breast cancer, and you discover how by changing your diet the cancer goes into recession whereas the success rate with the Big 3 cancer treatments is expensive and usually ineffective in the long-term.

    You have constipation, and discover how Chinese medicine works quickly, i.e. slapping the backs of both hands fairly hard with an open palm for 10 minutes. (Try it!) No need for pills.

    Knee pain? Cruciferous vegetables. No pills. Cholesterol? Dietary changes. No pills. Uncontrolled lupus? The spice, turmeric. Diabetes Type 2? Dietary change. Migraine? Ginger. Menstrual cramps? Ginger. Etc. Etc.

    In short, the patient should listen to the doctor, but also Google search to see, if there are more effective, cheaper, and natural cures available. There probably will be.

    • the examples you gave us a excellent for having a good laugh … but sadly not much more.

      • You seem to be unaware that mankind was healing illnesses and physical problems for thousands of years before Big Pharma came along with its pills. Natural treatments were the norm: using foods, herbs, the body’s energy system, Qi, etc. I doubt if you have even dared to look at the research at http://www.nutritionfacts.org or the video above (and many others on YouTube) with interviews of people who have got rid of their Parkinson’s disease symptoms by exercising on a bicycle because then you would lose face and your life’s work would be in vain; hence your continuous focus on the easy targets of homeopathy and chiropractice. It’s time to be open-minded and to accept that there are natural treatments, which are more effective than Big Pharma’s pills.

        • “It’s time to be open-minded and to accept that there are natural treatments, which are more effective than Big Pharma’s pills.”
          IT IS TIME TO SHOW US THE EVIDENCE FOR YOUR STATEMENTS

  • My humble suggestion would be to be wary of your own advice Peter. Unfortunately, playing doctor is not an internet pastime. The internet is totally full of crap that desperate patients will easily fall for. You know, all the stuff doctors don’t tell you, because it is bogus.

  • ‘Patient choice’ opens such a huge can of worms. Of course, if an adult, mentally competent patient wishes to refuse a particular treatment, that’s their right. But when a child (a ‘minor’ in legal terms) has a parent making that choice for them, the law often steps in. Some parents have been convicted of manslaughter for refusing medical treatments because of their sincerely held beliefs. And what about when a person actively seeks a treatment to end their life? ‘Patient choice’ becomes deeply moot when it involves assisted suicide.

    In areas outwith medicine, the equivalent of ‘patient choice’ is ‘consumer choice’. Although the caveat emptor (buyer beware) principle should never be forgotten, most governments try to protect consumers by issuing legally enforced standards and regulations. These are aimed to prevent the sale of, for example, electrical goods that do not conform to safety standards, or to preclude over-optimistic description of products for sale.

    In the UK (and probably elsewhere) most people are familiar with the adjective ‘cowboy’ in connection with house-building and repair trades. We hear regularly about ‘cowboy builders’, ‘cowboy plumbers’, ‘cowboy electricians’ etc. Effectively, these people are the equivalent of complementary and alternative medical practitioners. They know a little about whatever trade they purport to deal in, tell convincing (but untrue) stories and use substandard techniques and materials to effect repairs.

    In a typical scenario, a ‘cowboy’ knocks on a person’s door and points out a subluxation in their chimney, or a ying-yang imbalance in their roof, or an energy deficit in their heating boiler. If the person is sufficiently gullible, they’ll find themselves paying unreasonably high prices for an inadequate repair of what may not even have been a problem in the first place.

    I wonder why we don’t routinely apply the term ‘cowboy medic’ to practitioners of what’s been variously referred to on this website as CAM, SCAM, pseudo-medicine, Big Snakeoil, camistry and other appellations. The reason why there is relatively little legal protection of consumers of medicine from the many cowboys who operate on the fringes of medicine is because health and disease are such complicated, individual situations it’s far more difficult than in other consumer areas to differentiate what’s reasonable from what’s not.

    But that should not stop efforts to prevent people from the consequences of their own folly. The worldwide web is a very mixed blessing when it comes to medicine, as the many comments from Peter McAlpine show. He says (above) “You seem to be unaware that mankind was healing illnesses and physical problems for thousands of years before Big Pharma came along with its pills.” Of course we’re all aware of the past millennia of medical history, Peter, but along the way some individuals noted the lousy cure rates associated with most ‘traditional’ medical wisdom and they set out to do better, by applying the simple principles of science.

    Peter also counsels “If a doctor says that you have Illness XX and that to cure it, you should take Pills YY, and maybe even have surgery as well, you should say, “Thank you, doctor! I’ll let you know what I will do.” Then you go home and search the internet for knowledge about the illness and about what treatments are effective and which are not.” Rubbish! Instead of searching all the nonsense on the web that happens to confirm our pre-formed, ignorant beliefs (and regarding videos as evidence of anything at all), we should first search databases like PubMed, or other neutral, dispassionate, authoritative websites for information on their disease. The notion that conventional medicine is a huge conspiracy against nature is untenable bullshit and directly contradicted by the steady increase in average human lifespan since around the start of the 20th century.

    Edzard Ernst is working as a dedicated advocate of consumer protection. It should be patently obvious that ‘patient choice’ should not extend to witchcraft, pseudoscience or reinforce ignorance of biology and medicine.

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