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BMJ and sCAM

Deetee

Illuminator
Deetee
Joined
Jul 8, 2003
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This week's BMJ features some articles on SCAM following on from the recent PoWales/Smallwood report, including an editorial which is rather ambivalent, I think
http://bmj.bmjjournals.com/cgi/content/full/331/7521/856

Despite its limitations and the likelihood of bias in its conclusions, we believe that the Smallwood report fulfills a useful political function. It should promote more investment in research on the cost effectiveness of complementary and alternative treatments. Nevertheless, the report's principal recommendation—that NICE (the National Institute for Health and Clinical Excellence) carries out a full assessment of the cost effectiveness of these therapies—is ill advised.
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Nothing about establishing whether the things work in the first place I see....Or perhaps they recognise they don't? And NICE should stick to clinical effectiveness, not cost effectiveness anyway, so I don't see why SCAM cannot be reviewed..

Uncertain evidence of effectiveness does not preclude a positive recommendation in a guideline, and original modelling of cost effectiveness can be part of guideline development
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:mad:

Also http://bmj.bmjjournals.com/cgi/content/full/331/7521/880
http://bmj.bmjjournals.com/cgi/content/full/331/7521/0-h

There is also an ongoing rapid response discussion about CAM here:
http://bmj.bmjjournals.com/cgi/eletters/331/7520/795-a

Enjoy.
Respond, if you wish - (the altmedders certainly will)
 
Some real gems in the Rapid Responses!

For example, as well as trotting out the old canards about people thinking the world was flat until it had been circumnavigated, or that people didn't think Pluto existed because they couldn't see it through a telescope, Dr. Jayne Donegan writes:
When a patient tells me that they woke up one morning and felt full of energy and the next day, they had no energy – can we measure that ‘energy’? No. Does that mean it doesn’t exist – I don’t think so. It just means that we don’t have the tools to measure it.
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Of course the energy doesn't exist! Feeling "full of energy" is a metaphor for how the patient felt. We can't measure it because it's a literary device.
 
Mojo said:
Some real gems in the Rapid Responses!

Of course the energy doesn't exist! Feeling "full of energy" is a metaphor for how the patient felt. We can't measure it because it's a literary device.
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Mojo - you have more commmon sense in your little finger than the good doctor has in her whole being.
 
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I thought Dr. Donegan's name was familiar. She appeared as an "expert" witness for an antivaxxer a couple of years ago. According to Michael Fitzpatrick,
The judge found this doctor guilty of using "selective quotations", of making "unsubstantiated claims", and of "being confused in her thinking, lacking logic, minimising the duration of a disease, making statements lacking valid facts, ignoring the facts, ignoring the conclusion of papers, making implications without any scientific validation, giving a superficial impression of a paper, not presenting the counter argument, quoting selectively from papers, and of providing in one instance no data and no facts to support her claim". It was Dr Donegan's evidence that Lord Justice Sedley dismissed as "junk science" at the subsequent appeal.
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You don't have to take Dr. fitzpatrick's word for it: the original judgment is here and the judgment in the appeal is here. Sedley LJ's judgment is at the end of the second one.
The judge concluded that the medical evidence relied on by the two mothers to show that vaccination is dangerous and unnecessary was untenable. Dr Donegan's report was based on no independent research, and most of the published papers cited by her in support of her views turned out either to support the contrary position or at least to give no support to her own. Not to mince words, the court below was presented with junk science.
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'Nuff said.

Why do people who accept one brand of woo always seem to embrace the whole package?
 
From the second quote:
Not to mince words, the court below was presented with junk science.
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Bravo, bravo. Clear, concise, and explicit. As Randi implied this week, such language is all to absent from the bench.
 
By the way, if Sarah-I reads this, my post above demonstrates how to substantiate allegations about what may have happened in a court case.

Sarah, there's a thread specially set up for you to do the same here.
 
Mojo said:
Of course the energy doesn't exist! Feeling "full of energy" is a metaphor for how the patient felt. We can't measure it because it's a literary device.
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Hmm I think we could given enough time. ATP, glucose and oxygen levels in cells and certian types of brain chemicals could be measured.
 
geni said:
Hmm I think we could given enough time. ATP, glucose and oxygen levels in cells and certian types of brain chemicals could be measured.
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But when someone says "I feel full of energy," this isn't generally what they mean. They just mean they feel good.
 
Mojo said:
By the way, if Sarah-I reads this, my post above demonstrates how to substantiate allegations about what may have happened in a court case.

Sarah, there's a thread specially set up for you to do the same here.
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And, as many of you have probably noticed, it's currently on every single one of my posts.

Sigs are good.
 
I rather like this paragraph from a particularly perceptive and eloquent correspondent...
Many of homeopathy's proponents seem unable to see the truth about homeopathy because homeopathy is a philosophy that has been finely tuned over 200 years to render its adherents incapable of discerning the truth for themselves. This problem is built into the structure of the homeopathic process. Literally any outcome for the patient is used as confirmation of homeopathy's truth. Recovery obviously means the remedy worked. A lack of response merely dictates more prolonged treatment or a change of remedy. More bizarrely, a deterioration is called an "aggravation" and is specifically regarded as a sure sign the remedy is having the desired effect. Homeopathy is not a system of medicine, but a set of excuses. It does not provide successful treatment but a set of narrative tools to accompany the natural history of the disease.
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;)
 
Mojo said:
By the way, if Sarah-I reads this, my post above demonstrates how to substantiate allegations about what may have happened in a court case.

Sarah, there's a thread specially set up for you to do the same here.
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I have been waiting for her to respond to my sig for months. Don't worry, I'm not holding my breath.
 
Deetee said:
I rather like this paragraph from a particularly perceptive and eloquent correspondent...
;)
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:D

The letter to Peter Hain wen into the post today, including, at Lothian's prompting, this final paragraph to elicit a reply;

"On reflection, do you accept that personal anecdote is not a reliable guide to the efficacy of medical therapy? Do you accept that such personal anecdotes do not provide a valid base for health policy?"
 
Mojo said:
I thought Dr. Donegan's name was familiar. She appeared as an "expert" witness for an antivaxxer a couple of years ago. According to Michael Fitzpatrick (http://www.guardian.co.uk/parents/story/0,,1299268,00.html), The judge found this doctor guilty of using "selective quotations", of making "unsubstantiated claims", and of "being confused in her thinking, lacking logic, minimising the duration of a disease, making statements lacking valid facts, ignoring the facts, ignoring the conclusion of papers, making implications without any scientific validation, giving a superficial impression of a paper, not presenting the counter argument, quoting selectively from papers, and of providing in one instance no data and no facts to support her claim". It was Dr Donegan's evidence that Lord Justice Sedley dismissed as "junk science" at the subsequent appeal. You don't have to take Dr. fitzpatrick's word for it: the original judgment is here (http://www.bailii.org/ew/cases/EWHC/Fam/2003/1376.html) and the judgment in the appeal is here (http://www.bailii.org/cgi-bin/markup.cgi?doc=/ew/cases/EWCA/Civ/2003/1148.html). Sedley LJ's judgment is at the end of the second one. The judge concluded that the medical evidence relied on by the two mothers to show that vaccination is dangerous and unnecessary was untenable. Dr Donegan's report was based on no independent research, and most of the published papers cited by her in support of her views turned out either to support the contrary position or at least to give no support to her own. Not to mince words, the court below was presented with junk science. 'Nuff said.

Why do people who accept one brand of woo always seem to embrace the whole package?
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Here’s an update which was posted on this blog this morning:

http://scientific-misconduct.blogspot.com:80/2007/08/trial-of-dr-jayne-donegan.html

For her sins, Jayne was subjected to a lengthy Fitness to Practice Procedure.

The stated charge was that she had written a medical report about the underlying science for the court that:
1. Gave false and/or misleading impressions of the research which you relied upon,
2. Quoted selectively from research, reports and publications and omitted relevant information,
3. Allowed your deeply held views on the subject of immunisation to overrule your duty to the court
4. Failed to present an objective, independent and unbiased view

... and having done so, Dr Jayne Donegan was charged with serious professional misconduct, and with bringing the profession into disrepute.

Unfortunately for the GMC Donegan presented overwhelming evidence to back up the science she had presented to the court, leaving the distinct impression that all four experts should have been placed in her position. The GMC had no choice but to clear her of all charges last week (24 August 2007).

The case appeared to have been brought by the GMC itself, and as far as I am aware there was no complainant. Her report was challenged by "GMC expert, Dr Elliman" who produced a supposedly objective evidence-based report on Donegan's report. Donegan's report had in turn challenged expert reports produced for the fathers.

The entire transcript of this August 2007 "trial" is now available online. A detailed reading of the transcripts (particularly Days 8, 9 and 10) provides one of the best commentaries on science that I have seen. Donegan and her legal team deserve a medal for their contribution to this important narrative.

We will no doubt read nothing at all of this in the Medical Journals (or we will perhaps read yet another distorted version of a medical "scandal" in the BMJ that skirts around all of the relevant principles and lessons in favour of a few lurid but irrelevant personal details).
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Full transcripts of the GMC Fitness to Practice hearing here:
http://www.whale.to/vaccine/donegan3.html
 
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