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Regulating fantasies

Ivor the Engineer said:
When did Steve Novella get his hatred of the medical profession?
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I'm not sure how your remark follows my post but, since you ask, I thought from the tone of Steve’s report that he sounded very proud of his profession.

The problem with CAM apologists and their new baby, “integrated medicine” is that they think, by virtue of being nothing more that touchy-feely that they have all the answers and are occupying the moral high ground. Scientific medicine is a soft target for them because those that support it have to question stuff to do their job correctly and to treat their patients properly. So it’s easy for a homeopath to say “yes, we can cure this” because they are not bound by the same ethics as a conventional practitioner which is to say they don’t have to give evidence to back their claim or give full information about the condition under treatment since most of them denigrate science and rational medicine as a matter of course.

From what I read Steve espouses all the principles of so called “integrative medicine” but he happens to believe that the orthodox medical community has been practicing it for decades and it is only lately that CAM has realised that this is a marketing opportunity and jumped on the band wagon. Evidence based medicine is trying to address “holism” in its careful, analytical, self critical way and answer the public perception that conventional medicine needs to move away from the old paternalistic model to a shared decision making one. But by nature of our instant gratification society this isn’t quick enough for some people and with a consumer base which demands immediate answers while at the same time being unable or too impatient to properly question what is being offered, CAM (unfettered by the need for explanation and having a much better grasp of semantics and marketing) has cynically stepped into the breach. What is more, having done this on entirely false pretences CAM is now accusing orthodox medicine of copying it as conventional medicine continues to move towards what Steve described as the biopsychosocial model of healthcare.

I don’t entirely understand your idea that he hates the medical profession; the impression I got was that he cares a lot for it and its patients. He sounded to me as if he felt that CAM was an irrelevance and a distraction as orthodox medicine tries to address its limitations in a rational way.

Yuri
 
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Yuri Nalyssus said:

I'm not sure how your remark follows my post but, since you ask, I thought from the tone of Steve’s report that he sounded very proud of his profession.

<snip>

I don’t entirely understand your idea that he hates the medical profession; the impression I got was that he cares a lot for it and its patients. He sounded to me as if he felt that CAM was an irrelevance and a distraction as orthodox medicine tries to address its limitations in a rational way.

Yuri
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It was in response to this post and many of the other forum members who equate casting a critical eye at the medical profession (or just disagreeing with Linda usually is sufficient:)) with hating all doctors, nurses and other medical professionals.

It seems for some that medicine has replaced religion, which as we all know is strictly off limits for criticism as far as believers are concerned, and just proves you're angry at God:).

I on the other hand think doctors are no better or worse and just as biased and varied in their views as the rest of us mere mortals who did not go to medical school.
 
Ivor the Engineer said:
It was in response to this post and many of the other forum members who equate casting a critical eye at the medical profession (or just disagreeing with Linda usually is sufficient:)) with hating all doctors, nurses and other medical professionals.

It seems for some that medicine has replaced religion, which as we all know is strictly off limits for criticism as far as believers are concerned, and just proves you're angry at God:).

I on the other hand think doctors are no better or worse and just as biased and varied in their views as the rest of us mere mortals who did not go to medical school.
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OK, I guess you meant that because Steve was criticising the medical profession people would think he hated it. Well, if it's any consolation I thought the post you were actually referring to was equally strange. I agree that docs are mere humans, with human failings (and I suspect that most of the docs on this list might agree as well) but I also think that there are times when docs actually do know more than us "mere mortals" and (paternalistic though it might be) need to tell us what is best - maybe I'm just an ol' fashoned 70's kinda guy.

Yuri
 
Mojo said:
An expert dissection of Dixon's article from Steven Novella: Dr. Michael Dixon - “A Pyromaniac In a Field of (Integrative) Straw Men”.
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I would add one point to Novella's excellent discourse. What is this `soul' that Dixon thinks has to be treated? Since the mind-body problem ceased to be seriously debated, science has not bothered to look for it. I am happy to agree that psychology and sociology need to be considered, but not `spirituality' which frankly is imagination. Yet we spend public money on hospital chaplains.
 
Aha, Number 10 has replied to the petition on making CNHC demand efficacy and safety evidence. They seem to have buried the comments function, which is a pity because I would like to ask why CNHC is allowed to ignore this, when the GMC requires evidence based practice. Can anyone see any value in this petition site? When was the last time the govnt took the slightest notice of a petition? All we ever get is platitudes and ministerial waffle. Look at the most popular petition!
 
Asolepius said:
Aha, Number 10 has replied to the petition on making CNHC demand efficacy and safety evidence. They seem to have buried the comments function, which is a pity because I would like to ask why CNHC is allowed to ignore this, when the GMC requires evidence based practice. Can anyone see any value in this petition site? When was the last time the govnt took the slightest notice of a petition? All we ever get is platitudes and ministerial waffle. Look at the most popular petition!
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Also being discussed here:
http://www.internationalskeptics.com/forums/showthread.php?t=145328
 
I'm surprised the RCP is so tolerant of acupuncture.
As for a turning tide, I suspect that's the wrong metaphor.
I think we're up to our knees in floodwater and it's raining harder then ever.

But some people have started to wear wellies...
 
Of course I agree about acupuncture. They have got it wrong, because they have misunderstood the key issue. They think there is evidence for acupuncture and indeed there are studies in pain and nausea/vomiting, but the latest studies show no difference from sham. That of course is not the issue. It wouldn't matter if we were proposing new regulation for say prescribers of antibiotics, the point is whether we demand evidence or not. Whether there is evidence is another matter.

ETA: But it's a good start. The RCP's integrated medicine committee will have to watch out.
 
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Asolepius said:
Thanks Blue Wode - where do you find the time for all this research? :) So Michael Dixon is chief quack for our king in waiting now? He who waves hands at patients? It's now clear as to the extent of his departure from anything resembling reason. Watch the next official honours list for another gong to add to his OBE. He has all the qualifications.
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Michael Dixon has been at it again in a letter to The Times today. It's a behind a paywall online, but the following is lifted from the paper copy:
David Aaronovitch is right to argue for a robust scientific approach in medicine. However, he is not being logical or scientific when he says that if something is suspected to be placebo then it has no benefit and the NHS should not pay for it.

What about scientific research on remedies that many believe to be placebo? These frequently show that there is a benefit but this is confined to those who believe in the treatment given. Surely, in such cases, it would be logical to say that the treatment was beneficial albeit in a specific group of “believers”. From there, it would be good science to compare the safety costs of this supposed placebo remedy with its currently given alternative before deciding whether “believers” should be able to receive such a remedy on the NHS.

The problem here is that belief and mindset play an enormous part in healing – science needs to take account of this. Patients’ symptoms are frequently metaphors and effective treatment can often be symbolic and culturally dependent. The mind, in the right circumstances, can produce its own healing chemicals often mimicking those given in conventional medicine. Until science can explain healing in psychosocial as well as biomedical language, we must be cautious about “voting for the geeks” as Mr Aaronovitch suggests. It is far better surely that individual treatment should be tailored, within reason, to the patient and their beliefs and perspectives. Further more, might it not be wiser to direct NHS resources according to pragmatic trials of cost effectiveness and safety rather than a limited interpretation of science that excludes the effect of the mind?

Dr Michael Dixon
Chair of Council
College of Medicine.
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Edzard Ernst on why it's neither logical nor appropriate to use pure placebos that only rely on placebo effects:
http://web.archive.org/web/20100103080345/http://www.arc.org.uk/news/arthritistoday/131_1.asp
 
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Bearing in mind Michael Dixon's strong links with Prince Charles...
http://www.ebm-first.com/component/search/?searchword=Michael+Dixon&ordering=&searchphrase=all

...I think it's important to flag up some of his other views on placebos and beliefs:

The following is lifted from his letter to The Guardian on 22nd August 2005:
“It is outrageous to suggest doctors like me ‘embrace integrated medicine uncritically’…. As for devil's claw, Professor Ernst himself recommends it in his book, The Desktop Guide to Complementary and Alternative Medicine, where he says it is effective and ‘only mild adverse effects are on record’.”
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Interestingly, although The Desktop Guide suggests that “devil’s claw can be tried in selected cases” and that “only mild adverse effects are on record”, the risk-benefit assessment clearly states that “the effectiveness of devil’s claw compared to conventional treatment options (e.g. NSAIDS) cannot be judged on the basis of only one comparative trial”. Furthermore, its listed contraindications and precautions/warnings include pregnancy, lactation, gastric or duodenal ulcer, and its listed adverse effects include gastrointestinal symptoms. Additionally, alongside ‘overdose’ it lists cardiac effects, and under ‘interactions’ it says that it may increase anticoagulation effects of warfarin and could theoretically interact with cardiac drugs. It also notes that “the harpagoside content and pharmacokinetic profile have been shown to vary considerably between commercial preparations”. (pp. 100-101)

This from The (Newcastle) Evening Chronicle on 15th November 2004:
“Ravaged by the effects of his condition [severe eczema], the eight-year-old [Ben] was unable to enjoy most everyday things that most children take for granted. Ben received an accolade from award sponsor Prince Charles, who was so moved by his plight that he took a personal interest in Ben’s condition. He made contact with Michael Dixon, Chairman of the NHS Alliance, who, like the Prince, is a prominent supporter of complementary medicine. Mr Dixon referred Ben to the West End Complementary Therapy Project and Hexham-based homeopath Pat Haggie prescribed a range of treatment for him, including a dose of sulphur, a homeopathic skin remedy and calcium carbonate to ease his mood. A Japanese Johrei healer also worked to calm his immune system and improve his metabolism.”
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:rolleyes:

This is from the 'President’s Lecture' which was delivered by Dr Michael Dixon to The College of Chiropractors at its AGM at the Royal Society in January 2003:
“Some say that the idea of integration is intellectually flawed because you cannot merge two systems – a scientifically evidence based and regulated orthodox medical system with a poorly evidence based and generally unregulated complementary approach. These arguments against integrated medicine and health are not only arrogant and self-interested. They are also unscientific and anti-patient. …..Complementary medicine needs to establish a complementary research method, which takes into account the therapist and his approach and also the patient experience and story. …..I recently spoke at a meeting with the Clinical Director of Primary Care, whose presentation showed that only between 10 and 20% of what we do in primary care is itself evidence based. Words like mote and eye come to mind. …..In the swampy lowlands of real life, what I have heard from patients and seen myself is quite sufficient evidence for me and them that chiropractic is effective, safe and cost effective.”
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Sigh. That evidence based figure for primary care is actually around 80%.

And here he is in the Observer on 22nd July 2001:
Devon GP Michael Dixon argues the case for an integrated health serve: “I don’t think that the complementary therapies I suggest to my patients are placebos, but I don’t know. ….It is possible that many complementary therapies have a very small specific effect of, say, 5 to 10 per cent, with a much larger 40 to 50 per cent effect due to the therapist/patient interaction. .….A few days ago, a new patient entered my surgery in tears and said she felt very ill. A few minutes later my computer crashed while trying to produce her prescription. While waiting for it to revive, we discussed potatoes, which turned out to be a subject of mutual interest. When she got up to leave, I apologised for talking about potatoes rather than about her. She smiled and said that she felt much better anyway. Both of us had forgotten about her prescription, which was still jammed in the computer. …..Recent research on aromatherapy suggests that it could improve mental ability but only if the patient believed it would. That would not stop me referring ’believers’ for aromatherapy. Indeed, I would interpret the research as showing that I should.”
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Where to start?
 
Mojo said:
Does he discuss potatoes with all his patients? If not, why not?
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Well quite, where's the harm. I can see potaoeopathy catching on. I feel much better after a packet of crisps and an episode of Foyle's War of an evening and no amount of double blinded sciencey stuff is going to persuade me otherwise.

:D

Yuri
 
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