There’s bullshit and then there’s professional bullshit
Dominic Lawson quotes the Department of Health replying to an MP complaining on behalf of a constituent about ‘psychic surgery.’ (Yes, psychic.)
“We are currently working towards extending the scope of statutory regulation by introducing regulation of herbal medicine, acupuncture practitioners and Chinese medicine. However, there are no plans to extend statutory regulation to other professions such as psychic surgery. We expect these professions to develop their own unified systems of voluntary self-regulation.”
Other professions? Other professions? Psychic surgery is a profession? In what sense? If psychic surgery and acupuncture are professions, are divination and palmistry and astrology also professions? If so, what distinguishes a profession from just messing around?
Last week, in fact, the Department of Health published the report which outlines the regulation hinted at by Lord Hunt. It is called the Report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and other Traditional Medicine Systems Practiced in the United Kingdom…Acupuncture is at the most respectable end of the alternative health spectrum – its practitioners would be affronted to be lumped in with psychic surgeons. Yet what, really, is the difference?…Pittilo and his band of “stakeholders” have come up with their own way of “regulating” the alternative health industry – which the Government has welcomed. It is to suggest that practitioners gain university degrees in complementary or alternative medicine…
Ah, right – so if you get a degree in Magical Dentistry, then you have a profession, and your profession is regulated, and hey presto, Magical Dentistry fixes your teeth.
David Colquhoun read the report.
The report is written by people all of whom have vested interests in spreading quackery. It shows an execrable ability to assess evidence, and it advocates degrees in antiscience…This steering group is, as so often, a nest of vested interests. It does not seem to have on it any regular medical or clinical scientist whatsoever…You can read on page 55 of the report
“3a: Registrant acupuncturists must:
understand the following aspects and concepts for traditional East-Asian acupuncture:
– yin/yang, /5 elements/phases, eight principles, cyclical rhythms, qi ,blood and body fluids, different levels of qi, pathogenic factors, 12 zang fu and 6 extraordinary fu, jing luo/ meridians, the major acupuncture points, East-Asian medicine disease categorisation, the three burners, the 4 stages/levels and 6 divisions
– causes of disharmony/disease causation
– the four traditional diagnostic methods: questioning, palpation, listening and observing”
That’s embarrassing. Or as Colquhoun puts it, “Anyone who advocates giving honours degrees in such nonsense deserves to be fired for bringing his university into disrepute (and, in the process, bringing all universities and science itself into disrepute).”
It seems that the only regulation necessary here is a mandatory warning that “alternative medicine” is bullshit and you proceed at your own risk.
I mean, the whole idea is silly – real doctors are regulated because of people who practice “alternative medicine.” Regulating “alternative doctors” is just a way of saying, “you’re going to a real snake oil salesman who won’t do anything to help you, as opposed to a fake snake oil salesman who won’t do anything to help you.”
Is the UK the only place in the West where this kind of thing is taken with apparent seriousness? And why?
Magical dentistry seems like a good idea. Apparently it is very stressful looking in peoples’ mouths all day!
I was wondering exactly that. The Bush admin has done all sorts of loony things when it comes to science and medicine, but I’ve never heard of anything as deranged as this. The government commissions a report on alt med from people who are in alt med…? ‘Hello Fox? Could you come over and guard the chicken house?’
Well, it would have to have an overt Christian gloss on it… which makes me wonder why we don’t have licensed ‘faith healers’ over here yet.
True, true – evangelicals think this stuff is witchcraft. I remembered that afterward.
1) In my country, the government body in my country whose job it is to “licence” degrees (“licence” for lack of a succint alternative) is considering offering Batchelor of Science degrees in this subject. When challenged they justified this by saying that it’s what happens in other countries.
That sort of excuse was unacceptable to my teacher when I was 10. Why are people lacking basic education in charge of higher educatino in my country, I wonder cynically ?
2) It’s interesting how this sort of woo has become “complementary” and “integrated”. It used to be “alternative”. Now “complementary” and “alternative” are not synonyms. So I’ve been wondering when the great transformation occurred. On the level of pure principle (and ignoring the woo) we can imagine research finding that different sorts of treatments previously considered alternatives to each other turn out to work well together. But that every single alternative treatment should be discovered to be complementary , and in the same short period of time, beggars belief.
Eric I think these treatments are santioned because at the very least they seem to benefit certain people, this is probably just a placebo effect but if they work for some people why not have some kind of minimum standard? I think all these treatments are crap but you could probably also say that a large number of treatments used by the legitimate medical profession are also of little value.
Richard wrote that “you could probably also say that a large number of treatments used by the legitimate medical profession are also of little value”
At which point I’d ask you for some evidence to support this.
Regarding this aspect of studying “traditional East-Asian acupuncture”:
“causes of disharmony/disease causation”
Do practitioners of “traditional East-Asian acupuncture” really reject the existence and effects of germs ?
There’s a wider point here: it’s not medical doctors who have a problem with the woo, it’s science in general. Homeopathy is nonsense because of what physicists and chemists have learned about the structure and properties of matter in general. Chi as “energy” is nonsense because of the discoveries of physicists. Ditto “crystal therapy”, chakras, reiki and so on.
For a sad story, try reading this: http://www.independent.ie/national-news/our-son-was-promised-hed-be-cured-of-cancer-1421245.html
‘The mother of a terminally ill teenager told a jury yesterday that her son was promised that he would be cured of cancer or “at worst kept alive”‘
Richard, you said “I think these treatments are santioned because at the very least they seem to benefit certain people, this is probably just a placebo effect but if they work for some people why not have some kind of minimum standard?”
But surely ‘seem to benefit’ is the operative phrase here. The question is whether they benefit or not. If it’s only a placebo effect, then ‘alternative or complementary therapies’ do not really confer a benefit at all. It is only thinking that makes them so. In this case, how do you establish minimum standards? Minimum standards here would have to do with the ability of ‘therapists’ to convince patients that what they are doing is helpful, even though it is not. This sounds like a recipe for licensing scam artists, doesn’t it?
The other side of your statement, viz., “you could probably also say that a large number of treatments used by the legitimate medical profession are also of little value,” is surely in need of some support. How large a number? How little value? Which studies? Besides, just compare logevity now with then. Someone is doing something right.
Ask Archie Cochrane….
Treatments do not equal health or longevity. Medicine does not equal treatment, whatever that is..Do we consider the availability of clean water or refrigeration a treatment?
As for a good example of ineffective or questionable effectiveness, try cancer screening…
DFG –
“Treatments do not equal health or longevity”
Er…who said they did? If we’re lucky, they’ll help to prevent death insofar as our personal genetics will allow. They might suppress symptoms, which allow a certain quality of life to be maintained until we kark it. So? What’s your point? Oddly enough, I don’t see so many cases of TB around this town as there used to be…maybe we’ve been doing the odd thing right, now and again, huh?
That having been said,
“Medicine does not equal treatment, whatever that is”
Er..bollocks. OF COURSE medication is PART of a course of treatment in many circumstances – have you EVER heard of evidence-based practice? Because from your comment, I’d have to infer that you’ve never been anywhere near modern medical science in your life. I could quite easily be entirely wrong, but all I’ve got to go on is what you’ve provided…
And as for the little “whatever that is” pay-off, you’re just being a pathetic, evidence-free controversialist now. Lazy, cheap, etc,etc.
“Do we consider the availability of clean water or refrigeration a treatment?”
Er, yes, but again, OF COURSE. Why are you stating the bleeding obvious in a question. D’ya think we’re all fick or sumfing? Oooh, d’ya think clean water & improved nutrition from fresh food might help public health? well, durrrr…
This kind of nonsense is almost as bad as the bloody “wooo” merchants (except you’re just attacking scientific medicine with empty rhetoric, rather than trying to defraud people by flogging them quack ‘therapies’).
Go read Ben Goldacre’s “Bad Science” website and become more enlightened…
(If you already do, and still hold the attitudes you’ve displayed in spite of that, then there’s bugger-all hope for you, I’m afraid).
Plus what G said.
Eric and Paul how about these? http://www.sciencedaily.com/releases/2004/12/041220013546.htm or http://www.antidepressantsfacts.com/RitProChildren.htm or http://www.bmj.com/content/vol317/issue7159/press_release.dtl#(3) Eric what I meant by minimum standards was basicly just background type checks on these practitioners for instance do they have criminal records ect,apart from that let the market decide if people are daft enough to part with hard earned cash for snake oil let them.
Or how about Prozac treatment for mothers with post natal depresion?
Umm Guys,
Did you guys even catch my Archie Cochrane comment?
EBM is vital. I wasn’t actually disagreeing with the premise of the thread, just reacting to the “treatment” comment from Richard. You seem to be reading an awful lot into my comments and making some way-out assumptions.
The comments re: cancer screening, was an attempt to provide some sort of example of the rare cases in which treatment was of “little value”. The example I had in mind was the over-use of breast cancer tests, in particular the requests for biopsies, from young women. Of course, this allows for early intervention, but is also an example of over-testing and an opportunity cost.
Regarding clean water: it takes science to work out why it’s a good thing.
Richard:
A list of atricles does not an argument make. Put it in your own words for us to consider.
To DFG:
Woo is nonsense in its entirety. In every form of it, there is no concern with most if not all of the following: formulating testable hypotheses, doing the tests, ruling out the effect of placebo and spontaneous remission, continual review of effectiveness, and dropping established treatments when better ones come along.
Comparing this with the inevitable flaws in scientific medecine, which does all these things, is absurd. The inevitable flaws come because humans are not infallible, completely moral, omniscient beings. But the scientific approach in medecine allows us to combine our best efforts and to make progress.
On the other hand the only “progress” we’d had in my lifetime from the woo-mongers is a rebranding exercise where “alternative” became “complementary” . This shows the woo industry to have no concern for truth at all.
Paul you need me to convince you that prescribing Ritalin and Prozac to children is a bad idea? The over prescription of antibiotics is hardly contraversial is it? To start with Ritalin was used by heroin adicts in the 1980,s to mix with heroin to make speed balls that alone tells me it is not suitable to give to kids, who are probably hyperactive because they have far to much sugar in their diets, I would asume the Prozac is prescribed along side the Ritalin to bring them down from the speed(another bad idea). Prozac is also over prescribed,it is quite often given to mothers suffering post natal depresion, when this type of depresion can come about because of dietry deficiancies during pregnancy.
Umm, Paul, I am in complete agreement that woo is rubbish. I worded that original post badly/ambiguously.
Umm, Richard. Inappropriate prescription of Ritalin to children is bad. Like inappropriate prescription of anything. (duh, stupid sentence). That junkie comparison is just silly. Like saying pseudoephedrine is bad because you can make speed out of it.
The thing is you appear to be saying the actual treatment is bad/inappropriate, when it’s the diagnosis that you are really railing against.
Richard. Like Paul, I’m not sure what you want to say by referring me to articles on findings regardig drug use, etc. This kind of research is being done all the time, and it includes findings that reveal misuse of drugs, overuse of drugs, resistance to drugs, etc. But your point was?
If all you mean by minimum standards for ‘complementary’ practitioners is doing background checks, in what way does this provide minimum standards for pratitioners? We are talking about people who claim to provide results. Is not the determination of whether or not they do relevant to their measuring up to standards of practice?
Eric I was asked to justify my statement that that a large number of treatments are of little value, I just posted some examples of realy bad treatments.
DFG the difference is Ritalin is a powerfull speed already and with a couple of minuites work it can be prepared for i.v injection, it can also be ground to a fine powder to snort,if I know this do you think kids dont. Anyway why would you give a powerfull speed to a hyper active its barking.
Richard:
A small number of articles does not show that ” a large number of treatments are of little value”.
And over-prescription of antibiotics is often done at the behest of the patient demanding he or she be “given something”.
You wouldn’t be trying the old “false dichotomy” manoeuvre on us, would you ?
Well I don’t know about false dichotomy, but it is incorrect that evangelicals consider ‘alternatve’ medicine to be witchcraft. Unless there is some evidence to the contrary, its just ‘alternative’ medicine – some think its quackery, some not. I do.
I won’t bother asking for evidence, though, I am sure its just the usual rhetorical swinge at evangelicals.
Oh, go soak your head, Chrisper. You’re always doing that and then having to back down. One would think you would learn. What ‘usual rhetorical swinge at evangelicals’? Put up or shut up.
Do you know for a fact that no evangelicals consider alternative medicine to be witchcraft? You can’t, because I know of one who does. I don’t know how representative he is, but on the other hand I do know that he gets pretty much all his opinions from the suburban mega-church he attends, so I think he may well be pretty representative of that particular group. He has a weird obsessive paranoia about New Age thinking of all kinds. (That should all perhaps be in the past tense, the guy is someone I used to work with and for all I know he’s a Scientologist now.)
Paul That excuses the medical profesion then, just because a patient demands something is no reason to give it to them,where would you stop? it is a worthless treatment that is causing harm in general because people are building up imunities to anti biotics. I just gave you some examples (not every example) and you havnt answered those.
Richard:
You haven’t even begun to answer my point of way back, that it’s science not medecine that shows woo to be nonsense.
I already answered your point, by commenting that a few bad practices do not show that “a large number of treatments used by the legitimate medical profession are also of little value”. You haven’t responded to that either.
The original posting by Ophelia was about the woo industry. What have you got to say about that ? I suspect you’re trying to pull the old “sand in eyes” trick: you can’t defend woo so instead you attempt to change the subject by trying to undermine legitimate medecine.
Paul I thought I had made my feelings clear on alternate medicine (or whatever it is)I said I think its crap but if people want to spend their money on it let them,and you do realise that a very large number of antibiotics are being prescribed to a huge number of people ditto for the Ritalin, to me that is a large number of treatments. There are also stacks of other treatmens of little value that I also could have added to the list.
Richard:
This is a philosphical website, so when dealing with an issue the focus is on the philosophical aspects. So when you write “a large number of treatments” the assumption I make is that you are talking about different types of treatments, not the quantity of applications of treatments.
Anyway, you still haven’t backed up your statement that a “large” number of applications of treatments are ineffective. That’s because “large” has to be taken as a relative measure, so you have to give us some idea of the proportion of applied treatments that are ineffective.
It’s actually worse than that. Our medical technology is imperfect, so faced with a difficult medical problem we are often justified in trying anything that is known by science to work in only some cases. (Not always justified, however, as treatments frequently entail risks). The failure of some particular treatment in individual cases does not mean the treatment does not work in all cases.
Regarding the acticle on bacterial resistance to which you linked , I read the following:
“The authors say that veterinary practice must change, that patients must be educated not to expect antibiotics for every infection, that clinical guidelines will be needed to control antibiotic prescribing and that more fundamental research will be required to understand the levers that control antibiotic resistance. “
I note the comment on patients as I made the same point independently. I also can point out that we could not foresee at what point antibiotic resistance would occur.
The other two articles you link to relate to one issue in psychiatry. This site has carried many critical articles on this subject. For me, psychiatry suffers from a critical and often fatal flaw: it does not define what is normal. This puts it at odds with the rest of medecine. Imagine trying to diagnose a medical condition if we did not know the normal range of blood pressure or body temperature. Until it fixes this problem, psychiatry is going to be prey to the sort of problem your articles describe.
Richard,
Are you saying that Ritalin does not work or that it is over-prescribed?
As this page will head into the archives tomorrow (July 1), I thought I’d show people this link now:
http://news.bbc.co.uk/2/hi/health/7461004.stm
“In 1948, a cataract operation meant a week without moving with the head which was supported by sandbags – now it is over within 20 minutes, and most patients have day surgery.
The first UK heart transplant patient in 1968 only survived 46 days – now 24 are carried out in the same period.
In 1958, hip replacements were so unusual that the surgeon who invented them, Sir John Charnley, asked patients to return them after death – now there are 1,000 every week. “
Miraculous.
“its crap but if people want to spend their money on it let them”
1. It’s not always their money.
2. People spending money on alt med includes parents spending money on alt med for children, which is quite different from people making bad choices for themselves.
3. It’s not a question of letting or not letting, it’s a question of doing a decent job of evaluation and regulation.
4. Even if it were a question of letting or not letting – what a mindlessly callous attitude: if people want to kill themselves and their children with meds that don’t work, let them. Why let them? Why the show of indifference? Why, in particular, go to the trouble of commenting to say ‘let them’? What exactly is the fundamental objection here? What is the disagreement? What is the issue? Just disagreeing for the sake of disagreeing? Being ‘contrarian’?
If one is going to make a point of being ‘contrarian’ for the sake of it, it helps to develop some argumentative skills.
O.B people making those choices for their children is a different isue,that should be regulated, I dont think I am being callous,I just dont think it is the goverments job to tell people what to spend their money on or what they should do with their own bodies. DFG I am saying Ritalin should never on any acount be given to a child ever!and it is also over prescribed,ditto for Prozac. Paul good answer.
I also dont see how you can regulate this sort of thing(other than background type checks) because its nearly imposible to evaluate it. I expect we have all met people that swear blind that (insert treatment) cured them of (insert ailment)after their doctor had failed to cure them,I think this is just a placebo effect but how could that be proved and even if it was proved people wouldnt listen. James Randi disproves this sort of stuff all the time but people just ignore his conclusions.
Simple. Anecdote does not equal evidence.Conduct clinical trials. But even that is overdoing it, since woo is nonsense and does not deserve the effort. Though, your point that even in the face of evidence, people would not listen is a good one. But irrationality can only be taken so far.
But it’s not about ‘the government’ ‘telling’ people what to do with their bodies, it’s about telling putative health practitioners what they can do and claim.
Oh, why bother.
I was answering your why let them question O.B not the topic.
DFG is is posible to test a placebo effect?
Richard:
What do you mean by test exactly ?
Hang on, Richard. Is that question re: placebo a continuation of the discussion of Ritalin?
How do you think Ritalin is even available for prescription if not for full clinical trials?
No DFG I was just wondering if placebo could be tested,also thalidimide passed clinical trials.
Richard:
Proper clinical trials are a necessary but not sufficient requirement to evaluate the safety and effectiveness of treatments.
I’m not sure how much research has been done on the placebo effect itself but for example one could test various aspects of it without much difficulty. For example two aspects are empathy in the doctor and the “power” of the appearance of the treatment as perceived by the patient. One could do proper tests by holding all else equals and varying the empathy or some quality affecting the “power”.
However if there is no real treatment involved in the tests then I wonder how ethical they would be. So in practice the tests may not be permitted.
That is true. Though Thalidomide underwent rather inadequate trials and was severly restricted in the early 60’s. It was not subject to the full Phase 3 trials that would be required today. Sadly.
As for Placebo testing…Do you mean a test to determine the most effective means of harnessing the placebo effect? ooooo, good one. Very difficult, constrained by ethical issues, the extent of the understanding the mechanism of Placebo. Have a wander around the BMJ or Lancet websites, you’ll find some of the research areas there.
Thanks guys I was just wondering how could you could regulate the alt med industry because if it only ever gets results because of placebo effect how could you evaluate it, what would seem to make it more difficult would be the empathy with the doctor effect that you mentioned Paul. I think Ritalin was trialed in the late 60s as well although I dont know if it was retrialed for use on so called a.d.h.d.kids.
Richard:
I think what seems to be the “standard” aproach to regulation is wrong. It involves a guild model of professional bodies recognised by statute with the job of enforcing professional standards. It pays no attention to efficacy and it is absurd to prosecute someone for breaking the rules when those acting according to the rules are, technically, engaging in the serious crime of fraud.
Better perhaps would be to have a strict general rule on fraud in this area: force the woo merchants to give large disclaimers to their customers, explaining the nature of the evidence in support of their activities and giving correct prognosis information, with the right of the customer to sue them out of existence if they step out of line and backed up by serious jail time for the worse frauds.
Paul that seems to make sence but you would probably have great difficulty trying to prove cases in civil courts because of the wooly nature of this sort of thing, it is dificult enough to get satisfaction in civil procedings when the facts are cut and dried.