Dec 17 2009

“Intrepid, Ragged Band of Bloggers” take on CAM

“When someone comes in with a vague sense of unease, or a touch of the nerves, or even just more money than sense,  you’ll be there for them – bottle of basically just water in one hand, and a huge invoice in the other.”

Mitchell & Webb

David Colquhoun published an excellent editorial this week in the British Medical Journal (BMJ) in which he looks back at the last 100 years of “secret remedies.” He points out that a century ago the medical establishment and government regulators tried to protect the public from unscientific patent remedies, but those efforts were anemic, and eventually faded away. Now we are in the midst of a resurgence of unscientific remedies, and those who should be protecting the public health are not even mounting a half-hearted defense.

David refers to an “intrepid, ragged band of bloggers” along with a few journalists who are the only ones pointing out the folly of abandoning the science-based standard of care in medicine. He writes:

One hundred years on from the abortive efforts to crack down on patent remedies, we need to look again at the efficacy of remedies. Indeed the effort is well under way, but this time it takes a different form. The initiative has come largely from an “intrepid, ragged band of bloggers” and several journalists, helped by scientific societies. It hasn’t been helped by the silence of the BMA, the royal colleges, the Department of Health, and a few vice chancellors.. Even the National Institute for Health and Clinical Excellence (NICE) and the Medicines and Healthcare Products Regulatory Agency (MRHA) could be helping more.

The response of the royal colleges to the resurgence in magic medicine that started in the 1970s looks to me like embarrassment. They avoided the hard questions by setting up committees (often populated with known sympathisers) so as to avoid having to say “baloney.” The Department of Health, equally embarrassed, refers the hard questions to the Prince of Wales’ Foundation for Integrated Health. It was asked to draft “national occupational standards” for make believe subjects like “naturopathy”).

David is writing from a British perspective, of course. I could say the same, however, about the American Medical Association (AMA) and American medical schools. State and federal governments have been terrible – allowing a few zealots and vested interests to slowly erode the standard of care and protections for the public in favor of quack-friendly laws. Senators Harkin and Hatch have diverted medical research funds to chase unicorns (via NCCAM). They have also pushed through laws that cripple FDA regulation of certain health products, like supplements, and create massive loop-holes for the supplement industry to exploit the public.

He also points out the folly of recognizing, through licensure, health professions that are ultimately based on nonsense.

But you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense.

Unless a practice or profession is based upon transparent evidence, how can meaningful regulation take place? If proponents can simply make up their own standards based upon ideology and philosophy, without being held to any external standard, the regulation is a farce.

But there is a glimmer of hope that we may be finally getting through to some elements of the public and the government that science-based regulation is necessary, and the diversions and deceptions of the so-called alternative medicine industry may have begun to crumble. Talking about a recent committee’s review of the evidence for homeopathy, David writes:

The committee’s proceedings are worth watching, if only to see the admirably honest admission by the professional standards director of Boots that they sell homoeopathic pills without knowing whether they work.12 But for pure comedy gold, there is nothing to beat the final session. The health minister Michael O’Brien was eventually cajoled into admitting that there was no good evidence that homoeopathy worked but defended the idea that the taxpayer should pay for it anyway.

Boots is a large British pharmacy chain. The video is worth watching – finally a regulator asking the important questions – does homeopathy work? The answer, as David points out, is “no” but we don’t care, we want to sell it anyway, and taxpayers should pay for it too.

Of course, the lame defenses came also.

Then at the end of the session Harper said, “homeopathic practitioners would argue that the way randomised clinical trials are set up, they do not lend themselves necessarily to the evaluation and demonstration of efficacy of homeopathic remedies.”

Right – homeopaths are experts at the kettle defense. They claim there is evidence that homeopathy works, when there isn’t. When someone is paying attention enough to push them on the details, the least delusional of them must admit there is no evidence, so they retreat to the argument that it is because science is rigged against them. As David then points out, this excuse for lack of evidence is especially lame when it comes to homeopathy – which is typically given as pills. Pill-based treatments are the easiest to control and blind with placebos.

David concludes:

“Imagine going to an NHS hospital for treatment and being sent away with nothing but a bottle of water and some vague promises,” wrote the Sun’s health journalist Jane Symons recently. “And no, it’s not a fruitcake fantasy. This is homeopathy and the NHS currently spends around £10m on it.” It isn’t often that a Murdoch tabloid produces a better account of a medical problem than anything the Department of Health’s chief scientific advisor can muster.

It is a sad state of affairs when not only tabloids, but comedians, are doing a much better job of informing the public about the reality of homeopathy and other fantasy-based treatment than governments, medical organizations, and universities.

Mitchell and Webb capture the essence of homeopathic practice, and alternative medicine in general, better than the BMA, the AMA, and any government official I have ever heard.

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