Wednesday, September 14, 2005

I wish I had said that

I'm working on the History Carnival for Thursday; so I don't have a lot of time. I hadn't planned on posting today at all, actually, but when I came across this article, I just had to post. I can't believe I didn't notice it a while ago, when it first came out.

In this letter, published in BMJ, Michael Baum, Professor Emeritus of Surgery at University College London, chastises Prince Charles for his fondness for quackery and his recommendation that cancer patients try the Gerson therapy. I take this excerpt from it because it is one of the best and most concise rebukes of fashionable nonsense I have heard. Here he lets the Prince have it with both barrels, using that oh-so-British exaggerated respect:
The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research. I'm sensitive to the danger of abusing this power and, as a last resort, I know that the General Medical Council (GMC) is watching over my shoulder to ensure I respect a code of conduct with a duty of care that respects patients' dignity and privacy and reminds me that my personal beliefs should not prejudice my advice.

Your power and authority rest on an accident of birth. Furthermore, your public utterances are worthy of four pages, whereas, if lucky, I might warrant one. I don't begrudge you that authority and we probably share many opinions about art and architecture, but I do beg you to exercise your power with extreme caution when advising patients with life threatening diseases to embrace unproven therapies. There is no equivalent of the GMC for the monarchy, so it is left either to sensational journalism or, more rarely, to the quiet voice of loyal subjects such as myself to warn you that you may have overstepped the mark. It is in the nature of your world to be surrounded by sycophants (including members of the medical establishment hungry for their mention in the Queen's birthday honours list) who constantly reinforce what they assume are your prejudices. Sir, they patronise you! Allow me this chastisement.
"Allow me this chastisement"? I love it. So British. No doubt alties will resent Mr. Baum (I still can't get used to the way the British refer to surgeons as "Mr.," rather than "Doctor") for "arrogance" for claiming that his 40 years of experience and 25 years of research should count for more than the Prince's love of quackery. I only hope that, once I've reached 40 years in practice, I remember his rebuke. He then goes on to explain why anecdotes are not good enough evidence of effectiveness:
Many lay people have an impressionistic notion of science as a cloak for bigotry. Nothing could be further from the truth. The scientific method is based on the deductive process that starts with the humble assumption that your hypothesis might be wrong and is then subjected to experiments that carry the risk of falsification. This approach works. For example in my own specialism, breast cancer, we have witnessed a 30% fall in mortality since 1984, resulting from a worldwide collaboration in clinical trials, accompanied by improvements in quality of life as measured by psychometric instruments.

You promote the Gerson diet whose only support comes from inductive logic—that is, anecdote. What is wrong with anecdote, you may ask? After all, these are real human interest stories. The problems are manifold but start with the assumption that cancer has a predictable natural history. "The patient was only given six months to live, tried the diet, and lived for years." This is an urban myth. With advanced breast cancer the median expectation of life might be 18 months, but many of my patients live for many years longer, with or without treatment.
Go get 'em, Mr. Baum. Sharing Mr. Baum's specialty, I've discussed this very shortcoming of "testimonials" multiple times, but in most detail here.

But here's where he sums it up perfectly:
I have much time for complementary therapy that offers improvements in quality of life or spiritual solace, providing that it is truly integrated with modern medicine, but I have no time at all for "alternative" therapy that places itself above the laws of evidence and practises in a metaphysical domain that harks back to the dark days of Galen.
That's exactly what the vast majority of alternative medicine tries to do, unfortunately.

8 example(s) of insolence returned:

At 9/14/2005 3:58 PM, Anonymous Fledgist said...

Didn't Galen actually know some medicine? I don't think he was a quack -- or no more than any other physician in the Roman Empire.


At 9/14/2005 7:17 PM, Anonymous Anonymous said...

Well, if you look up Galen in wikipedia, for example, you should get a sense of what he means. This was a age of thinking of the body having "humors", and rampant bloodletting.
For his time, one might say Galen was state-of-the-art, but if you were ill I doubt you would wish to be transported in time to be under his care.


At 9/14/2005 7:28 PM, Blogger Orac said...


In actuality, Galen did the best he could in his time. For example, the dissection of human cadavers was forbidden; so he tried to make due with monkeys and made analogies. However, back then, medicine was not in the least bit scientific.


At 9/14/2005 8:52 PM, Blogger wm said...

The British reference to surgeons as "Mr" goes back to the time that all "cutters" were barbers. The doctor would call in a barber to do the actual sawing of the bones.


At 9/15/2005 1:11 AM, Blogger Orac said...

I've heard that history before, but it doesn't seem to make it any less odd for this American surgeon to hear his British counterparts called "Mr."


At 9/15/2005 2:53 PM, Anonymous Prof. Mike Baum said...

I'm flattered by your interest in my piece published in the BMJ in July 2004. Why did it take you so long?
When I qualified in 1960 I was a doctor, when I gained my FRCS in 1965 I became a Mr,when I was promoted to the chair of surgery at Kings College London in 1980 I became Professor and after challenging HRH I lost my chance of becoming Sir! So please call me Prof.


At 9/16/2005 7:19 AM, Blogger Orac said...

Prof. Baum, I'm honored you noticed. The reason I only noticed it now is because it was mentioned in a Guardian article recently, which I got to through another website.


At 9/29/2005 11:38 PM, Blogger Bill Hooker said...

inductive logic—that is, anecdote

This is a bit offtopic, but while (faulty) induction is the connection between anecdote and unfounded conclusion, it is also largely the basis of methodologically sound science. Strictly deductive logic is difficult to apply to research problems, because the necessary premises are often impossible to construct.

(This has, of course, nothing to do with the substance of Prof Baum's elegant and sorely needed rebuke to Prince Charles.)


Links to this insolence:

Create a Link

<< Home