Ernst hammers sCAM again

[Asolepius]

This article in today's Daily Mail will probably stir up the woos a bit. Quite well balanced for the Mail.

 

[Mr Clingford]

It doesn't sound as though it is from the Daily Mail - I thought immigrants and the Labour Party were the reason for complementary medicine.

WHat do you think of the objection raised by comp med practitioners that double-blind trials don't fully address and permit their approach to work?

 

[Asolepius]

WHat do you think of the objection raised by comp med practitioners that double-blind trials don't fully address and permit their approach to work?

It's rubbish. Randomised controlled trials (RCTs) are not the preserve of medicine, or a construct of the drug companies or the medical establishment. RCTs are used throughout the whole of science to test hypotheses. This is a key tool for understanding the universe, not just for testing therapies. If the CAM community thinks they are not appropriate to test their therapies, then they are admitting they are not real. And as Ernst says, RCTs can be designed to test CAM. When you do that, the effects get smaller and mostly disappear.

 

[Mongrel]

WHat do you think of the objection raised by comp med practitioners that double-blind trials don't fully address and permit their approach to work?

Not really, a double blind trial would be (roughly);

1) Patient sees practitioner for specific problem after being assigned\accepted to the trial
2) Practitioner prescribes remedy
3) Patient randomly chosen to recieve prescribed remedy or placebo by an independent person, this data is kept secret till the end of the trial.
4) Remedy dispensed by 3rd party to person in 3, this then passed to Practitioners or their staff, who should have no idea which is remedy and which is placebo, to supply to patient
5) Patient takes remedy
6) Patient progress tracked by third party and Practitioner until end of trial
7) Data collated

It doesn't matter at point 3 and 4 whether its a homeopathic remedy, coffee enemas or antibiotics. If there is any justification for confidence in a treatment it will have a clear advantage once the data is collated

 

[Mr Clingford]

Thank you both. Let's hope we have plenty more good trials that will lead to sorting this one way or the other. I hope that this comp med ceases to be by becoming science.



Mongrel, I like your sig.

 

[Mojo]

It doesn't sound as though it is from the Daily Mail - I thought immigrants and the Labour Party were the reason for complementary medicine.

Nah, the Wail thinks sCAM is a good thing, so it can't be caused by immigrants or Labour.

 

[Thing]

WHat do you think of the objection raised by comp med practitioners that double-blind trials don't fully address and permit their approach to work?

They're absolutely right, it doesn't. But that's not a valid objection.

It's always good to ask them why they think it is that the test that makes it hardest to cheat or be misled by wishful thinking is the one they least want to do.

Meanwhile in the article:

But, says Prof Ernst, Prince Charles is 'amazingly resistant to the scientific approach

That's Prince Charles FRS if you don't mind. The Royal Society was given that name in an attempt to suck up to Royals (it didn't work) and they're still doing it today. Is there one living FRS with the will to call for HRH to be stripped of his FRS? The mechanism exists, I'm assured.

 

[Mojo]

From the article:

Meanwhile, alternative treatments that promise to cure cancer 'are downright irresponsible, if not criminal'.

In fact, under the Cancer Act 1939, it is a criminal offence to advertise a treatment as being able to cure cancer.

 

[Asolepius]

That's Prince Charles FRS if you don't mind. The Royal Society was given that name in an attempt to suck up to Royals (it didn't work) and they're still doing it today. Is there one living FRS with the will to call for HRH to be stripped of his FRS? The mechanism exists, I'm assured.

Wow, I had forgotten about that. I'll make some enquiries. For one thing, how did he get it in the first place? It's supposed to be for distinction in science.

 

[Mr Clingford]

Wow, I had forgotten about that. I'll make some enquiries. For one thing, how did he get it in the first place? It's supposed to be for distinction in science.

Probably an honour bestowed on the occasion of his birth, or passing his 'A' levels (he did pass them, didn't he?).

 

[Mojo]

Probably an honour bestowed on the occasion of his birth, or passing his 'A' levels (he did pass them, didn't he?).

Yeah, 2 of 'em. History and French.

Oh, and don't forget his Reith Lecture.

The idea that there is a sacred trust between mankind and our Creator, under which we accept a duty of stewardship for the earth, has been an important feature of most religious and spiritual thought throughout the ages. Even those whose beliefs have not included the existence of a Creator have, nevertheless, adopted a similar position on moral and ethical grounds. It is only recently that this guiding principle has become smothered by almost impenetrable layers of scientific rationalism.

 

[Asolepius]

Yeah, 2 of 'em. History and French.

Way below the requirements for Cambridge, but they accepted him anyway.

Oh, and don't forget his Reith Lecture.

Blimey, I had forgotten about this - what an amazing load of woo-woo rubbish. An attack on science if ever I saw one. I particularly like the bit about the rational approach reducing respect for the world we live in. The truth is that priests have been teaching us for millennia that the world was made for us to exploit.

 

[Mojo]

I wonder if that bloke from the Times is reading this.

Hello? Mr. Pierce?

 

[Mojo]

The Wail story now has some comments. A nice mixture of ad-homs, bluster and general half-wittedness...

 

[Cynric]

The Wail story now has some comments. A nice mixture of ad-homs, bluster and general half-wittedness...

That was depressing reading. All Ernst said is that CAM should be put on a scientific foundation if it's going to last into the future (rather than disappear/reappear like a fad). And what do the comments say?

Lock him in a room with some cancer quack till he sees sense.
I've taken CAM and I felt better so it must work [because I am the world].
Big Pharma is killing us with drugs. Therefore CAM works.

It's as bad as religion sometimes, this CAM business.

 

[Blue Wode]

Here’s a snippet from a letter - that’s clearly not worded in the interests of patient safety - which Peter Dixon, Chairman of the General Chiropractic Council, sent to the Editor of the Daily Mail on Tuesday:

Your readers really shouldn’t let Professor Ernst’s Christmas bout of ‘bah humbug’ put them off from consulting chiropractors.

-snip-

As for your reporter’s mention of spinal manipulation carrying a ‘risk of dangerous side-effects including strokes’ Actually there’s no available evidence to show that manipulation of the neck by chiropractors has ever caused a stroke. Professor Ernst likes to speculate about this and then say that as his assertions have never been proved to be wrong he must therefore be right - which is a bit mischievous – but always good for a newspaper story.

http://www.gcc-uk.org/files/page_file/DAILY MAIL 12 December 2006.pdf

Professional stuff.

I wonder why they keep quiet about the issues that were discussed here:
http://www.internationalskeptics.com/forums/showthread.php?t=65430

For the benefit of drive-by readers:
http://www.ukskeptics.com/factsheets/Chiropractic.pdf
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

 

[Mojo]

Here’s a snippet from a letter - that’s clearly not worded in the interests of patient safety - which Peter Dixon, Chairman of the General Chiropractic Council, sent to the Editor of the Daily Mail on Tuesday:

Your readers really shouldn’t let Professor Ernst’s Christmas bout of ‘bah humbug’ put them off from consulting chiropractors.

-snip-

As for your reporter’s mention of spinal manipulation carrying a ‘risk of dangerous side-effects including strokes’ Actually there’s no available evidence to show that manipulation of the neck by chiropractors has ever caused a stroke. Professor Ernst likes to speculate about this and then say that as his assertions have never been proved to be wrong he must therefore be right - which is a bit mischievous – but always good for a newspaper story.

Professional stuff.

Has this paper been mentioned anywhere?

all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases.

I found it after reading a transcript of a talk Ernst gave about medico-legal issues relating to "alternative medicine" (Medico-Legal Journal vol 74 p. 56), in which he talked about under-reporting of adverse incidents after spinal manipulation:

So what about the safety? For back pain, which is obviously the big indication for chiropractic, it is no better than exercise. Let's compare it to exercise. Exercise is pretty harmless and pretty cheap. What about spinal manipulation? We have conducted a survey with all British neurologists. We had a very good response rate. Most of them participated, and we asked them whether they had seen any neurological complications after upper spinal manipulation within a year's time, and this discovered 35 cases, including 9 strokes and other serious complications after chiropractic. Now 35 cases is not a lot, chiropractors would say, and I hope there is a chiropractor here, because I like discussions, and particularly heated ones. I would disagree, because we then looked these cases up and traced them down and found that none of these 35 cases had previously appeared anywhere; nobody knew about these cases; in other words, under-reporting in this series was precisely 100%. Now, if under-reporting is 100%, any estimation of incidence figures is nonsensical and the true incidence of these complications is anybody's guess. Chiropractors say complications are extremely rare. I hope they are extremely rare, but unless we have proper data we don't know and, as I said, with under-reporting of 100% estimates are nonsensical.

[My bold]

"Nobody knew about these cases". That certainly seems to include Peter Dixon.

 

[Blue Wode]

"Nobody knew about these cases". That certainly seems to include Peter Dixon.

I suspect Peter Dixon does know about the problem, but unfortunately for the public, the General Chiropractic Council seems to have adopted a policy of telling off anyone who publishes anything negative about chiropractic. Just have a look through its press release section:
http://www.gcc-uk.org/page.cfm?page_id=182

Regards the JRSM paper, I’m sure the profession dismissed it because its findings had depended on case reports based on recall.

Even the research paper in Neurology in 2003 that concluded that spinal manipulative therapy was independently associated with vertebral arterial dissection
http://www.neurology.org/cgi/content/abstract/60/9/1424
was quickly rebutted by the Council as being “seriously flawed” and it proceeded in typical fashion to declare in a press briefing statement that “There is no evidence that neck manipulation causes stroke”:
http://www.gcc-uk.org/files/link_file/Press_GCCNeurology_130503.pdf

The fact is that neck manipulation for neck pain cannot be justified due to there being a safer treatment option:

Spinal manipulation for neck pain is a treatment with unknown benefits and unknown harm. Because of this and the fact that serious risks are on record, a responsible risk–benefit assessment cannot ignore the risks and cannot come out in favour of spinal manipulation. Remember the supreme law in medicine: first do no harm. Other therapies for neck pain exist, e.g. exercise, which are supported by at least as good evidence for benefit and which are at the same time free of significant risks. The inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain.

Quoted from the second section of this debate:

Spinal manipulation for neck pain – more good than harm?
Ernst E, Focus Altern Complement Ther 2004; 9: 107–10
http://journals.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

Perhaps if the General Chiropractic Council wasn’t so busy with the “promoting the profession” aspect of its remit it would take a more cautionary attitude.

 

[Badly Shaved Monkey]

From the comments at the Hate Mail

" it was reflexology to a very painful ''FOOT area'' on my foot that released my stuck knee."

The therapist must have been cross-eyed.

Manipulation of my elbow area relieved my constipation?

 

[Cynric]

This article in today's Daily Mail will probably stir up the woos a bit. Quite well balanced for the Mail.

My bold.

So far mine is the only pro-Ernst comment they've printed, and they edited out all my comments about egocentric anecdotal evidence ("I got better so it must work") being useless, and only printed the last sentence.

Oh well. I suppose it makes me look concise, unlike the rambling CAM rants.