Tuesday, December 27, 2005

More evidence that alternative medicine boosters don't really want scientific evaluation of their therapies

Some holiday leftovers from last week (in other words, written last week, but not yet posted).

Enjoy (I hope).

Since the very beginning of this blog, I've said that I'd love to see "alternative" medicine treated on equal footing with conventional medicine. Of course, this doesn't necessarily mean what alties think it does. When I say "equal footing," I don't necessarily mean that alt-med should be treated with equal respect, although that might be the effect in some cases. No, what I mean is that it should be subject to the same standards with regards to efficacy and safety as that conventional medicines must meet before being approved for use and widely used by physicians. To my mind, if alt-med practitioners want to be treated with the same level of respect as conventional physicians and have their methods used more widely, it is only fair that they should have to jump through the same hoops and meet the same standards that conventional physicians and conventional medicines do.

Not surprisingly, craving the acceptance and legal status given to conventional physicians by our society, some alt-med practitioners like to claim that they, too, want their remedies to be investigated scientifically, to have them tested in the same way that conventional drugs are tested. True, they often add a boatload of caveats, such as complaints that they're too busy treating patients to do clinical trials or research, that they can't get funding for their work (a much smaller problem since the National Center for Complementary and Alternative Medicine started handing out big grants to alties), or that drug companies aren't interested in studying their remedies because they can't make a profit off of them (never mind that supplement companies seem to do quite well selling them). Some of them are sincere, but I've always suspected that most of them would really prefer that science be kept away from their treatments.

So it was with interested that I read this story out of Britain:

Millions of people use it to deal with illnesses ranging from asthma to migraine. Prince Charles believes it is the answer to many of the evils of modern life. But now Britain's first professor of complementary medicine, Edzard Ernst of Exeter University, has denounced homeopathy as ineffective.

'Homeopathic remedies don't work,' he told The Observer. 'Study after study has shown it is simply the purest form of placebo. You may as well take a glass of water than a homeopathic medicine.' Nor is Ernst's disdain confined to homeopathy. Chiropractic, which involves spine manipulation to treat illnesses, and the laying on of hands to 'cure' patients, are equally invalid, he says.

Not surprisingly, his views and his studies have provoked furious reactions. Chiropractors and homeopaths have written in droves to Exeter to denounce him. But now the scourge of alternative medicine says he is going to have to quit because Exeter will no longer support him or his department. 'They have never provided me with the money they originally promised me. Now we have been told in no uncertain terms that this department is going to close.' The university denied the charge. 'Professor Ernst's department has enough money to go on for a couple of more years,' said a spokesman. 'We are still trying to raise cash. It is premature to talk of closure.'

Dr. Ernst sounds like a man after my own heart. In fact, he was hired in order to bring scientific rigor to the study of alternative medicine. The problem is, he was serious about doing just that:
Ernst, then a professor of rehabilitation medicine in Vienna, took the job to bring scientific rigour to the study of alternative medicines, an approach that has made him a highly controversial figure in the field. An example is provided by Ernst's study of arnica, given as a standard homeopathic treatment for bruising.

'We arranged for patients after surgery to be given arnica or a placebo,' he said. 'They didn't know which they were getting. It made no difference. They got better at the same rate, whether they got arnica or the placebo. And arnica is a classic homeopathic remedy. It doesn't work, however.'

In another study, Ernst got five homeopaths to examine children with asthma. 'Children are supposed to respond better than adults to homeopathy, and asthma is said to be particularly responsive to homeopathic treatments,' he said. 'However, again we found no evidence that homeopathy worked.'
Of course, the real surprise would have been if Dr. Ernst had found actual evidence that homeopathy did anything at all. After all, homeopathy uses successive dilutions of the "active ingredient" to levels where there may not even be a single molecule of it in the specimen. Dr. Ernst is correct; homeopathy is no more better than drinking a glass of water because it is no more than drinking a glass of water.

But, contrary to what you may think, Dr. Ernst is not hostile to alternative medicine:
Nevertheless, Ernst insists that he is a supporter of complementary medicines. 'No other centre in the world has produced more positive results than we have to support complementary medicine,' he said. 'Herbal medicine, for instance, can do good. If I was mildly depressed, I think St John's wort would be a good treatment. It has fewer side-effects than Prozac. Acupuncture seems to work for some conditions and there are relaxing techniques, including hypnotherapy, that can be effective. These should not be used on their own, but as complements to standard medicines.'
I'd agree with him about some of the herbal remedies (although St. John's Wort has not lived up to initial studies) and hypnotherapy, but I'm a bit less convinced about acupuncture. Certainly, at least one of Dr. Ernst's own studies showed it to be no better than sham treatment. (I'll say one thing about this guy; he's published like a maniac over the last couple of years.) Dr. Ernst has also exposed some of the antivaccination bias in alt-med circles:
Ernst's opponents also claim some of his research methods are unethical. Once, a colleague pretended to be a pregnant mother and asked homeopaths and chiropractors if she should give the MMR vaccine to her child. Most said no. Ernst published a paper on these findings.
I believe this is the study in question, and the abstract states:
Complementary and alternative medicine (CAM) has become a popular form of healthcare and the predictions are that, it will increase further. The reasons for this level of popularity are highly diverse, and much of the motivation to turn to CAM pertains to a deeply felt criticism of mainstream medicine - many people (are led to) believe that conventional interventions, including immunisation, are associated with the potential to do more harm than good. Thus, it is hardly surprising that CAM also lends support to the "anti-vaccination movement". In particular, sections of the chiropractors, the (non-medically trained) homoeopaths and naturopaths tend to advise their clients against immunisation. The reasons for this attitude are complex and lie, at least in part in the early philosophies which form the basis of these professions. The negative attitude of some providers of CAM towards immunisation constitutes an important example of indirect risks associated with this form of healthcare. The best way forward, it seems, would be a campaign to clarify the risk-benefit profile of immunisations for both users and providers of CAM.
Precisely. There is a strong bias against western medicine, including immunizations, among many providers of CAM, and they can influence people from foregoing "conventional" medical treatments and preventative measures known to be efficacious. Personally, I don't see how it is "unethical" to test whether homeopaths and chiropractors are giving out harmful medical advice. To me, it's no different than investigative journalism. No doubt, studies like this are among the reasons that Dr. Ernst is probably quite correct when he observes, "'I think my peers would prefer someone who didn't rock the boat."

Of course they would, because, far more often than not, scientific scrutiny of alternative medicine remedies reveals that they do not do what CAM practitioners claim that they do. When they do, often they become part of conventional medicine, which is as it should be. More often, however, they do not. Whatever the result, we need researchers willing to examine these therapies scientifically to identify the ones that have therapeutic value and discard the ones that do not.

7 example(s) of insolence returned:


At 12/27/2005 2:20 PM, Anonymous HCN said...

This observation is coming from my memory... the online documentation does not seem to go back far enough.

I remember learning what homeopathy was by hearing a TV news story about upcoming study about it. Apparently Bastyr University announced that it was going to do a study on homeopathy. This was over 15 years ago when Bastyr was still located in a building near Seattle's Green Lake that it rented from the school district (I used to walk to it so that my now teenage boys could play at its playground).

I remember being flabbergasted when the either the newscaster or the Bastyr representative described what homeopathy actually was (a bunch of nothing really). Before I had always associated it with some kind of herbal medicine (a couple of years before I had taken a class on herbal medicine at the local Experimental College, and I did own Earl Mindell's "Herb Bible", which to its credit did list the bad stuff including bad interactions).

I never did hear what the outcome of the "study" was. I checked www.pubmed.gov and found a list of 80 cites there that listed "Bastyr", but none have to do with homeopathy.

Does anyone know what happened to that study? Did it happen? Were the results suppressed because they did not come out the way someone wanted them to?

 

At 12/27/2005 7:15 PM, Blogger Tim said...

There was an article in today's Saskatoon Star Phoenix about the popularity of alternative medicine here in Saskatchewan. http://tinyurl.com/d35nn

 

At 12/28/2005 9:02 AM, Blogger Kristjan Wager said...

There is actually a Danish research center for alternative treatment under the the Danish Ministry of Health. It is researching alternative medicine, trying to find the effects and side-effects.
They seem a little to unwilling to criticize, but they are working hard to uncover the most dangerous alternative treatments, and to find those that actually work.

Their English website can be found here, it contains next to no information (unlike their Danish website).

 

At 12/28/2005 1:25 PM, Blogger Abel PharmBoy said...

Ernst is indeed the real deal and deserves credit for objective analysis of all types of alt-modalities.

Not well-appreciated in the US is that his group at Exeter and Pharmaceutical Press publish a journal called FACT, Focus on Alternative and Complementary Therapies. It's a digest of abstracts from alt med studies worldwide with commentaries from academics here and abroad about appropriateness of sample size, methodologies, etc. Since my NIH-funded work often drifts into that area, I find FACT useful for general info, med school teaching, and fodder for my fledgling blog.

They also host an annual symposium at Exeter/Peninsula Medical School on alt med therapies (usually in September - Ernst's philosophy truly is that if an alternative therapy proves safe and effective, then it should indeed be part of medicine. (i.e., what do you call alternative medicine that works? Medicine!)

 

At 12/31/2005 5:35 PM, Anonymous Alison said...

I think it would be wonderful if alternative medicines were subject to testing - not only would it weed out the ineffective, but it might even, through scientific testing, show treatments that work, or treatments that work in ways other than alternative medicine proponents use them. For me, the only thing I swear by is chiropractic - and I've made darn certain that each chiropractor I've visited knows that all I expect is for my back to stop hurting. For that reason, I've never been lured into chiro as a cure for anything else. I can tell you for certain that it works on my back far better than any medication or exercise or patronizing nice-little-girl pat on the head I've gotten from regular doctors. So bring it on, and let's separate the wheat from the chaff.

 

At 1/03/2006 10:20 AM, Blogger Ginger Yellow said...

The Guardian's Ben Goldacre had a related piece recently: http://www.guardian.co.uk/life/badscience/story/0,,1675784,00.html

 

At 1/04/2006 12:51 PM, Blogger That Girl said...

I would like to really see a study of why people "turn to" homopathic rememdies - the very phrasing implies that they were once "believers" in Western medicine.
What is wrong with people purchasing a placebo when western medicine has failed them?

 

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