I very regularly get comments criticising me for being negative and destructive rather than using my time being positive and constructive. Here is a recent such remark:
Edzard, with his string of qualifications, should offer a remedy to the coronavirus. Ok, I get it, homeopaths are “quacks” but what has Edzard got to offer. Talk is cheap. Rather than warming on the “inability” of the homeopaths to prove their worth, Edzard should prove that he is better than them but sadly he is simply someone who has no substance. What good is he to mankind and the patients when he cannot offer a solution but rather finds faults with “quacks”. That even a beggar can do better than him. Until he is able to offer a cure, he has no business going around finding fault with others.
It is true that many if not most of my posts are about disclosing bogus claims of practitioners of so-called alternative medicine (SCAM) or revealing the limitations of SCAM research. I see why SCAM proponents see this as a negative activity. However, I view it as a positive contribution: if I show today that this or that claim or therapy is not evidence-based, I might prevent some patients from using it tomorrow. In turn, this would prevent them from wasting their money and – more importantly – would guide them towards making prudent therapeutic decisions which, in some cases, could even save lives.
Other critics of my work are keen to point out that I should not constantly criticise SCAM but rather do something about the many weaknesses of conventional medicine. I feel that my work might be helpful for that as well. Let me explain.
Pointing out how much of SCAM is bogus begs the question, why then are so many people using it? One answer which I have often given (here and elsewhere) is that consumers are looking not so much for effective treatments but for what used to be called the ‘art’ of medicine:
- compassion,
- undersatnding,
- empathy,
- sufficient time with their clinician,
- a warm therapeutic relationship.
These are things they often do not find when consulting their conventional physicians, and these are things they often get from their SCAM practitioner. This insight should lead to the next logical step, namely to boost compassion, emapthy, etc. in conventional medicine.
Clearly, these qualities are at the core of good healthcare, and clearly we do not require SCAM for patients to benefit from them. The science and the ‘art’ of medicine are not mutually exclusive; there is no good reason why they should not go together. And it is time to put the ‘art’ back into science-based medicine. Delegating it to SCAM practitioners is a disservice to patients.
So, what good is my work to mankind and patients? This is a question that I cnnot answer. All I can do is hope that my criticism will make a small contribution towards improving future healthcare.
31 Responses to How can criticism of so-called alternative medicine improve healthcare?
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As a Canadian, I know people around the world point to our health-care system with envy.
Yes, if I had a heart attack, broken leg or was diagnosed with Lupus, the out-of-pocket cost to me is zero. (Of course, it’s not actually free. You should see my tax bill!)
However, waiting for elective surgery can take months, sometimes years; getting appointments with specialists usually takes months and, when you get into the doc’s office, you get 10 minutes and one issue. (If he is your friend, as mine is, you get 12 minutes—still one issue, though.) While these last “rules” are broken all the time, the fact is, the system is broken and we don’t get the treatment we need, deserve and have paid for.
Because I can think critically, I don’t rush off to the ND (Not Doctor), homeopath or acupuncturist. I get in line at the doctor’s office. I can easily see, however, how those who don’t know better, would seek out alt-med if only because then they would get someone who would listen to them and give them the time they need.
Edzard, you say the ‘art’ of medicine should encompass the following: compassion, understanding, empathy, sufficient time with their clinician and a warm therapeutic relationship.
Yes they are all very desirable components of a health professionals attitude (SCAM or conventional) towards their patient or client. But we need to remember these human characteristics are not taught in medical school – and even if they were, how would you verify if a newly qualified doctor possessed these qualities and to what degree?
Human emotions and their physiological effects on the body are complex and cannot be taught in the classroom. It’s no surprise therefore that GP’s in the UK often prescribe placebo pills to their patients, knowing they are likely to achieve similar or even more effective results than conventional drugs…. just a thought.
they are teachable and they are taught in med school; alas the ‘system’ later drains it out of many clinicians.
“alas the ‘system’ later drains it (…compassion, understanding, empathy, sufficient time with their clinician and a warm therapeutic relationship…) out of many clinicians.”
At what point is it drained out to the point where the clinician should not be practicing? “Understanding” seems pretty important if you’re diagnosing and treating patients. As does “sufficient time”.
Would you want to see a clinician drained of understanding, who diagnoses and treats after spending an insufficient amount of time with their patients?
I beg to remind that the education and upbringing of future physicians is not limited to the classrooms of medical schools. Medical schools in my part of the world do actually teach the important aspects of human interactions, emotions and empathy but medical students, interns and residents are mostly taught bedside manners and other principal aspects of the art of medicine and health care at the bedside, in the clinical rotations, seminars, clinics and one-on-one mentorship situations. I have decades of experience myself in mentoring students and young physicians in this respect.
MG’s assertions display a profound ignorance and prejudice of modern medical education and training, an attitude that is commonly propagated by internet based snake-oil peddlers and other non-medically qualified charlatans. His generalisation about assumed, dishonest prescription practices of UK general practitioners simply substantiates this conclusion.
Mike Grant:
Evidence please that “GPs in the UK often prescribe placebo pills…”
Pills such as?
And which GPs?
(Apart from homeopaths.)
Have you reported them to the GMC for treating without informed consent?
If not, why not?
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058247
We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances.
this shows that many UK GPs use placebo but EXTREMELY rarely
” ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for suspected viral infections.”
Do you suppose there’s any risk involved with prescribing antibiotics when there’s no evidence of benefit?
“77% (95% CI 74 to 79) used impure placebos at least once per week.”
77% is extremely rare?
not a very smart question!
“AT LEAST ONCE A WEEK” = extremely rare
Over 3 out of 4 clinicians prescribing a placebo every week…we have different definitions of “rare”.
that’s for sure
I don’t think I would call this extremely rare, either. On the other hand it clearly constitutes a small minority of prescriptions.
In any case doctors have been harnessing the power of the placebo effect for as long as there have been doctors. At least these days when they choose to do so it is with the full knowledge of what they are doing, and in the light of a large body of evidence that it works.
“doctors have been harnessing the power of the placebo effect for as long as there have been doctors” particularly, because with every prescription of a non-placebo therapy, there will be a placebo effect as long as they have compassion, empathy etc.
@EE
OK professor
Yet in many cases… nothing has been cured. Symptoms have been masked, much like in the CAM therapies.
Don’t delude yourself because you have some “science based” “clinical trials” … in you pocket.
I would not dream of deluding myself; that’s your game
“On the other hand it clearly constitutes a small minority of prescriptions.”
Clearly? “At least once per week” could mean anywhere between one and all prescriptions, by the 77% of clinicians. Even if we generously assume only one – it might be a small minority of prescriptions, but that doesn’t mean it’s rare.
“…in the light of a large body of evidence that it works”
If there’s evidence that antibiotics work for suspected viral infections (the example they used), it wouldn’t fit the criteria for ‘impure’ placebo (“efficacy is unknown”).
@EE
If I delude myself. Why is it that has SBM failed me and my family so much ? I know what I live.
The definition of SBM is… over-promise and under-deliver.
@JMK
Eh? Placebo’s do not work, by definition. Studies interpreted to claim otherwise, omitted the effect of the natural course of the problem, the “got better anyway” change in measured effects.
Prescribing a “placebo” is in effect prescribing something that does not work with the intention of entertaining the patient while nature takes its course. Such action is easier than trying to explain to the patient that nothing needs to be done. An example is a doctor in my country (now deceased) who was famous for following any fad that was in style at that time. One of them was injecting his patients with magnesium, telling them it was a veritable panacea. His colleagues mumbled criticism but he did not kill anyone so he was left to his antics. I have spoken with several patients of his who described the magnesium injections as performed with a tiny syringe of the insulin-type. He was simply using the deception of giving an ineffective remedy. He actually gave his patients extensive dietary and lifestyle advice that were of course the effective intervention in the encounter.
I have come to the conclusion that such practice is unethical as it involves dishonest deception. Prescribing the “wrong” treatment, what the researchers call “impure placebo” is even worse as such interventions can produce harm by adverse effects inherent in the intervention. I consider the term wrong and misleading.
If someone is, after reading my above comments, preparing to tell us about Ted Kaptchuck’s infamous exxperiments with “open-label placebo” you can spare your efforts. His conclusions that placebo works despite the patient knowing, were wrong. His experiment was in effect “rigged” to produce the results he hoped for.
Bjorn,
Placebos have no pharmacological action, but that is very different from saying that they have no effect. If that were true it would not be necessary to use them in clinical trials. A patient’s symptoms depend strongly on their expectations.
In oncology this applies particularly to pain and to treatment-induced nausea and vomiting. Although drugs such as granisetron have transformed the delivery of chemotherapy, for instance, nevertheless if the patient thinks they are going to vomit then they will, regardless of what chemotherapy they are having or what premed you give.
As another example, pain is experienced entirely in the mind. The severity and the amount of distress are influenced by the patient’s mood, their understanding of why they have pain, their beliefs about their treatment and what effect it is going to have on them, what their latest scan results were…
Of course a placebo isn’t going to be much good at treating an infection or modifying the natural history of most diseases. But if a patient believes that eating ginger biscuits or wearing an acupressure wrist band is going to stop them vomiting then I am not going to challenge this.
@JMK
Deception is at the top of a slippery slope that may lead to betrayal of trust, or even harm, at its bottom. There are drugs, albeit never perfect, for nausea and pain. If you combine them with the truth and some TLC (tender loving care) and reassurance, you will get the same ´effect´, and probably even more, as you will get from a fake accupressure wristband or phoney oriental needling, at the cost of a little effort. Further, this little effort will give the clinician a good feeling of having provided good holistic[sic] care. Putting a £2 elastic band with a plastic knob, accompanied with a lie, on the patients wrist, will certainly reward the vendor but will leave the clinician (at least me) with a feeling of having betrayed someone who trusts him to provide him honestly with the best care available.
It is also in my opinion unethical not to tell the truth to my patient who wants to buy a magic bracelet. In my country, law forbids me to do anything that will incur unnecessary costs for the patient.
As the old saying goes the flak is always heaviest when you are directly over the target. Just wish I had discovered your site years ago. Its nice to be able to take a reality break after all the fantasy being widely spread throughout the internet world.
Do keep up the good work. Some of us appreciate it.
many thanks
It is a good thing to expose deception and fraud. I can’t speak for Prof Ernst but this is why I continue to do what I do to expose CAM for what it is.
CAM is non-science-based medicine which the body of evidence shows doesn’t work any better than placebo; this has been demonstrated time and again. This doesn’t mean science-based medicine is without fault, noone would claim otherwise. But we can’t fill the ‘gaps’ with wishful thinking like homeopathy and acupuncture, pretending to vulnerable patients by cherry-picking the evidence that they are effective. If conventional medicine has unacceptable side-effects we need to work to improve that medicine, if rushed practitioners and surgeons are percieved as distant and impersonal we need to ensure they have enough time to do their job properly.
Just because bad things happen doesn’t mean we should stop calling out CAM for what it is – bogus wish-fulfillment and deception.
tldr – Keep flying the flag, Prof!
Niall
Worth noting that the remark you quote is a most negative, destructive, asinine one. Classic tu quoque ignorance.
@Lee Turpenny
Please advise readers to whom your comment is addressed: it’s not self-evident to me.
My comment is not nested; it’s addressed to Edzard in response to his post.
Well, right back at you – your post makes no sense whatsoever!
Ahem, this post directed to Lee Turnpenny, nach 🙂
Eh? Re-read, and can’t see what the problem is. But, to clarify…
As an example of criticism accusing him of being negative and destructive, Edzard quotes this remark:
‘Edzard, with his string of qualifications, should offer a remedy to the coronavirus. Ok, I get it, homeopaths are “quacks” but what has Edzard got to offer. Talk is cheap. Rather than warming on the “inability” of the homeopaths to prove their worth, Edzard should prove that he is better than them but sadly he is simply someone who has no substance. What good is he to mankind and the patients when he cannot offer a solution but rather finds faults with “quacks”. That even a beggar can do better than him. Until he is able to offer a cure, he has no business going around finding fault with others.’
This remark attacking him is, I consider, negative, destructive and asinine.
Do let me know if there is anything else I can help you with.
Thanks for the clarification, and apologies for the misunderstanding 🙂
Niall
De nada.