Archive for the ‘Homeopathy’ Category

Dr Michael Dixon is annoyed

March 10, 2010

In which Dr Aust spots that Prince Charles’ favourite GP is in a state of high dudgeon over people being mean about magic medicine. You know – being mean by asking about evidence, and other awkward stuff.

Dr Aust occasionally checks the website of the GPs’ magazine Pulse. This is partly because alerts to it appear on my email and in my Twitter feed.

It is also because the Pulse website has blogs on it; the three I read are by Prof Edzard Ernst, by that excellent blogger (and an on-line acquaintance of mine) the Jobbing Doctor, and by the rather exasperated and often very funny Phil Peverley.

It is a bit of a faff to read the articles at Pulse online because you have to register, but it is free to do so, and once you have, you get an interesting perspective on what is going on in what a lot of doctors I know call “GP-land”.

Including with respect to “complementary”  medicine.

The thing that caught my eye there recently was a distinctly splenetic article (as one splenetic middle-aged gentleman talking about another) written by Prince Charles’ favourite GP, Dr Michael Dixon OBE.

Dr Michael Dixon of the Prince's Foundation for Integrated Health

Dr Dixon is the medical director of the Prince of Wales’ Foundation for Integrated Health, probably the most influential lobby group promoting CAM in the UK.

In the article, Dr Dixon is evidently rather annoyed.

You can tell this from the very beginning, where he describes Edzard Ernst as

“A leading member of science’s militant tendency”

Dr Dixon also referes to his opponents – which seems to be anyone who thinks that CAM should live up to the same standards of evidence as the rest of medicine – as

“the new fundamentalists”

In fact, the whole paragraph that contains this phrase is worth quoting.

“The new fundamentalists rarely, if ever, think about the patient. That is not surprising. Most are not doctors. Even Professor Ernst hasn’t faced a real live patient for at least seventeen years. Those were the days when you could still, just, get away with ‘doctor knows best’. Seems he is still living that dream.”

The last bit of this is particularly smile-inducing – at least if you are a conoisseur of irony.

After all, who is it that is demanding the right to use hocus-pocus on the patients, and not explain exactly what is in the remedies?

Is it Professor Ernst?

Or is it Dr Dixon?

As one respondent puts it (read the article and then comments to find out who):

“It is the very essence of old fashioned paternalistic medicine to pretend that it’s a good idea to deceive the patient for the sake of eliciting a placebo reaction.”

While another commenter characterizes Dr Dixon’s extended harrumph (rather accurately in my view) as an “embarrassing diatribe”.

In fact, the main reason for mentioning Dr Dixon’s article is to draw your attention to the excellence of many of the comments that follow it, and which are well worth a read.

The commenters, as the phrase is, “take Dixon’s ass to school“.

Though I suspect his evident blind spots will mean he will not learn very much.

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PS   For anyone interested in what the medical ethicists think of homeopathy, and the ethical issues involved, the answer can be found here.

ADDED: And via Twitter, and courtesy of the splendidly eagle-eyed “Blue Wode”,  here are two other informative articles about Dr Dixon from Majikthyse and The Quackometer.

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Puffs and huffs of homeopathic smoke

February 22, 2010

In which Dr Aust ponders whether recessions are good for scepticism. Or at least bad for homeopaths.

The sceptical blogosphere has been afire this weekend with the (presumably) leaked news that the  House of Commons Science and Technology Commitee were not terribly impressed with the homeopaths, and that the Committee’s report – to be released Monday morning – will reflect this. Almost makes it worth going to bed early so that I will be awake enough to have a good giggle tomorrow.

My only sadness is that, as far as I can tell from a long “tweet-up” on Twitter, none of the sceptical “citizen-journalists” seems to be able to get into the press briefing tomorrow morning, not even cyber-geek turned Blogzirkusmeister turned 10-23 press supremo turned impressively-bearded U-boat-commander-lookalike turned Guardian freelancer Martin Robbins.

It would be a shame if we have to rely entirely upon mainstream press coverage, since bloggers like Ben Goldacre, Prof David Colquhoun, Le Canard Noir, and Gimpy (see blog sidebar for links) have played a critical part in lighting the fuse under homeopathy’s shaky foundations.

Take that together with the late-breaking (at least for MPs, though better late than never) insight that NHS money you spend on homeopathy cannot be spent on other more sensible things, and you have a recipe for a spotlight finally being turned on the surreal daftness of having an eighteenth century superstition enshrined in Act Of Parliament, and endorsed by the NHS.

Now, I did have a post on homeopathy about three-quarters written, penned two weeks ago as a retrospective muse on the brilliant 10-23 campaign. But it never got finished, largely because I got derailed by a deadline crisis and then by a debate I got involved in under my real-world identity. And  I don’t have time to finish it now.

However, I do have time to quote a bit of it – which is actually itself a quote from what I wrote about homeopathy in a comment on Jack of Kent’s blog about a month back. The trigger for this little summary was that someone asked why sceptics tended to highlight homeopathy’s intrinsic scientific impossibility, rather than talking about the clinical trials.  I reproduce it here because it is perhaps as close as I have come to a reasonably concise explanation of my personal reasons for finding homeopathy risible.

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“The point about homeopathy is that the two approaches [to deciding what is a useful treatment] mesh – the “prior plausibility” approach (aka incomprehensibility, or impossibility) and the “lack of real evidence” detailed-forensic-scientific-analysis-of-the-trials approach.

To scientists, homeopathy serves as a kind of sine qua non demonstration of the way implausible / mystical / belief-based therapies are both clung to (all evidence notwithstanding) and promoted.

As a sub-set of this, homeopathy also shows what happens if you take a completely placebo therapy and feed it into the arena of medical trials, where biases of various kinds are undoubtedly present, and indeed are well-described.

The first point is that most of the studies will be done by enthusiasts / advocates for homeopathy. So you get enough random false positives, people fooling themselves through the psychological need to believe or through lack of technical know-how, finagling of results, over-promotion of wholly inadequately-controlled “positive” studies, “file drawer” burying of the results of negative studies, etc etc. that the homeopaths can always find SOME positive results in the literature.

And all the detailed meta-analysis of the trials which shows that the positives are illusory (essentially, as the study design and size, and hence reliability, improves, the “positive effect” of homeopathy beyond placebo tends inexorably to zero) cannot “unconvince” them.

Coming back to the point [about why scientists tackling the issue in public fora tend to concentrate on talking about how intrinsically silly homeopathy is] we basically default to incomprehensibility because the scientific argument is won, to the satisfaction of all but the homeopaths, who are utterly beyond all convincing (cf the anti-vaccination nuts and MMR).

And… the incomprehensibility argument is quicker, pithier, and easier for a layman to grasp.”

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Meanwhile, how have the homeopaths responded to the last few months’ events?

They have circled the wagons. They have made lots of loud noise about all this being unfair. They have started a snide letter-writing campaign about Dr Evan Harris, one of the very few MPs that actually understands science and medicine. This last one is particularly revealing. Essentially the homeopaths feel it is unfair to have scientifically or medically literate MPs like Dr Harris on the Science and Technology Committee, because such folk seem unusually likely to see homeopathy clearly for what it is. They think that MPs should be selected for a lack of any relevant prior knowledge, presumably because as it would then be easier to bullshit them.

[It is so important not to let that mean old knowledge get in the way of being “open minded”]

Anyway, for a full chronicle of the spasms of nastiness, frivolous complaints and persecution mania over the last few weeks, Gimpy’s blog is a must.

So, if the report is indeed as widely expected, what next?

Probably little, this side of any election.

But that is fine. At least it will be another, and very clear, public statement that faith-based “magical” quack therapies should not be given a special and privileged place in a modern medical system where we strive towards the goal of there being sensible evidence behind what doctors do.

To repeat an old line, if you can show that something works, then it is neither “mainstream” nor “alternative”. It is just “medicine”.

The playing field should be equal for mainstream and alternative “treatments”, in terms of having to demonstrate that they work.

Once that principle is firmly established, we can move forward.

And if you can’t show it works, then your Alternative Therapy of choice can still be your personal luxury –  if you want.  And if you are prepared to pay for it. Though I suspect that in the current economic climate there will be less people wanting to pay than a few years ago.

Which brings me to a final question:

I wonder what the other careers of choice are for an unemployed homeopath?

Hilarious homeopathic handbaggery

February 9, 2010

Over the weekend Lay Scientist blog master and 10:23 press supremo Martin Robbins took issue with the British Homeopathic Association over their presentation of the “evidence” on homeopathy to the House of  Commons Science and Technology Select Committee.

The BHA, it seems, have taken umbrage. (Let me say that again: definite umbrage).

They have responded by having a public huff at him.

I suppose Martin should be grateful they didn’t sue.

He has now responded.

Curiously Martin finds that the BHA seem to have quite a taste for selective quotation.

It’s a great film, if you like garbage

The selective quote is an art long practiced by publicists and PR types, especially when promoting book or films to which the reviewers have not been kind.

For instance, you might see, on the film poster, the line:

“Full of life and colour. McZ remains the doyen of fast action films”

the Guardian

– When the full quote from the newspaper’s film critic was something like:

“Despite it’s complete lack of anything resembling a story, the film is visually full of life and colour. McZ remains the doyen of fact action films – though the characters are utterly wooden, and they and the repetitive car chases, smashes and explosions left this viewer completely uninterested in the outcome”

Pro-Unreality Quote-Mining

Martin R has a special talent for spotting quote mining by the Pro-Unreality Community. You might remember his famous spot when the British Chiropractic Association quoted a study as saying:

“There was weak evidence to support the use of [chiropractic].”

When what the cited study actually said was:

There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture and chiropractic but it was provided in each case by single small trials, some of dubious methodological rigour.”

I wonder if the BCA and the BHA use the same people to write their stuff?

Anyway, please go and have a read over at Lay Scientist. As Jack of Kent says, you have to love any post that starts with a line like:

“Over the weekend I received a rare honour, a press release directed at me with the full intellectual might of the British Homeopathic Association behind it.”

Money is better disaster aid than homeopathy

January 21, 2010

In which Dr Aust suggests that while sending money for disaster relief may not feel like enough, it it better than sending nothing. Even magic nothing.

Earlier this week Dr Aust wrote out a cheque to the Disasters Emergency Committee.

At times of disasters with tragic costs in human lives, people are naturally moved to think about what they can do to help. Money seems a feeble response, in a way – but here in rich countries, money is what we have to contribute. It is also something that is needed urgently, and will continue to be for many years to come.

Beyond that, though – and perhaps other slightly more “political” measures like campaigning for cancelling of Haiti’s debt – there is little concrete you can do.

And anyway, it would be rather arrogant to think you could do anything on the ground. Or even that you know what needs doing. Though certain things are fairly obvious, like medical supplies for overstretched hospitals, or – possibly most urgent of all – getting enough clean water to people to try and head off deadly outbreaks of water-borne infectious diseases.

It would certainly be arrogant, though, to think one knows exactly and precisely what kind of medical treatments are required to deliver the necessary care. How could one know from here?

Some people do seem to think they do know quite precisely, though. You can find a few of them here, or here. Some of these folk seem to think that homeopathic first aid (sic) would be just the thing for the people of Haiti.

It strikes Dr Aust that this is a touch self-centred.

If the homeopaths want to help, they should do what everyone else does and donate their pounds, or dollars, or whatever, through some non-profit NGO (non-governmental organisation) with an existing local presence – like Oxfam, or Unicef, or Save the Children. That would be my first thought, and indeed it seems to be what real aid workers tell you to do too.

To be fair, there are some people on the homeopathy blogs and forums saying this. But there are also some commenters who seem as interested, or more interested, in promoting homeopathy. Or telling you the established NGOs are (to paraphrase)  “just going to spend all your donation on administration and jobs for fat cat managers”

[PS – even if some aid organisations do spend more money on “administrative costs” than others, I think you’ll find it’s just a bit more complicated than that]

Instead, some of these folk want to send homeopathic first aid kits. Or “trained homeopaths”.

To me this smacks of arrogance, and insularity.

It seems to me that it would be a bit like me thinking that I knew exactly – and better than the people at the sharp end – the precise medical interventions, and indeed brand of supplies, that were needed to deal with a diarrhoeal disease outbreak, or some other epidemic, in an unprecedented disaster setting halfway around the world.

It would also be a bit like me telling Oxfam, or the Red Cross, or Médecins Sans Frontières, that I was not going to donate money, but instead was going to buy £££ worth of the remedy of my personal choice – say branded Generic Evul Pharma Dioralyte – and send it to their depot.

Now, I’m sure they could use the Dioralyte, which is a perfectly good product for treating water, and more particularly salt, loss in diarrhoea. Even if it does taste a bit bleagh. (I speak from experience)

On the other hand, perhaps they would prefer something else, like a cheaper unbranded version. Or, in an emergency setting, they might prefer a bunch of water boilers (for sterilizing water) plus a crate of 10 kg tubs of NaCl (sodium chloride, aka salt) and glucose, or sucrose. For the reason why this is useful stuff, see the end of the post.

Or alternatively, perhaps what they would really need is a generator to run the water-boilers. Or bottled gas. Or  well-digging equipment to find a source of water.

Perhaps they need all of the above.

The point, of course, is that I DON’T KNOW just what what would be most useful for the people in the disaster zone, or the local workers on the ground. The local aid workers on the ground, on the other hand, do know.

And what we can do, hopefully, is give their organisations the resources to buy what they say they need and to get it to them.

It isn’t really enough. But it is,  hopefully, something real.


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Edit: There is a brilliant blog post from the British Red Cross blog, pointed out by Zeno (see first comment below), that makes the point about why donating money – not items – really is the best way to help. Highly recommended.

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Appendix:  Salt, sugar and water

When you have diarrhoea you lose water, and salts. The best way to treat you is to replace these, orally if at all possible (and intravenously if that is not enough). For oral rehydration the World Health Organisation defines Oral Rehydration Solutions, and most manufactured (packet) formulae follow these.  The basic points are that they contain salts, and also sugars. This is because you need to replace the lost salts, and salt and sugar are absorbed together in the small intestine via linked transport (“co-transport” is the technical term) of sodium ions and glucose into your intestinal epithelial cells. [Sucrose, table sugar, can be used since it is rapidly broken down into glucose and fructose].

Since severe diarrhoeal disease means that you lose not just water, but also sodium, potassium and chloride ions, the rehydration formulae contain not only NaCl (sodium chloride) but also potassium chloride (KCl). Some versions contain bicarbonate too, since diarrhoea also leads to the loss of bicarbonate ions.   More fascinating stuff about diarrhoea and oral rehydration therapy at Wikipedia.

In emergency settings, simpler “homemade” versions are also used. Perhaps the most famous is:

– one level teaspoon of salt
– eight level teaspoons of sugar

– dissolved in one litre of clean drinking water, or water that has been boiled for 10 minutes and then cooled.

This simple recipe has saved innumerable lives – some estimate as many as fifty million in the last three decades. It is particularly important for children under five who are at increased risk from diarrhoeal disease – the second leading infectious killer of under-fives worldwide.   As Ben Goldacre says, behold the power of ideas, and the scientific principles on which these ideas are based.