In my last post I promised to give my view of why eminent physicians have grossly insulted practitioners of CAM by accusing them of lying to their patients.
Prof. David Colquhoun: Under the heading The Lying Dilemma “To maximise the benefit of alternative medicine, it is necessary to lie to the patient as much as possible.”
Prof. Edzard Ernst: “But the real reason, I have come to conclude, is that people are being lied to. Practitioners of complementary and alternative medicine (CAM) often fail to explain what the evidence shows and does not show. It is a triumph of advertising over rationality:” (New Scientist 26 April 2008)
Okay let us put aside for the moment the following two points:
1. The Pieman clearly shows that less than half of commonly used conventional treatments are evidence based. Should doctors be accused of lying for not sharing this BMJ published pie with their patients? Should my Pieman be mandatory in all medical waiting areas in the country? Would that be good for the nation’s health?
Have Ernst and Colquhoun seen the inane advertising for many unproven conventional medicines on TV? Clearly they feel entitled to use evidence based medicine as a blunt instrument to attack only CAM and not orthodox medicine. They have yet to explain why they do this.
2. Ernst, Colquhoun, Baum and others think nothing of using double standards to attack homeopathy or using their weight as well known doctors to send letters (one of which was inappropriately written on paper with an NHS logo) to influence Patient Care Trust commissioners in their decisions.
Although they do not deny that patients feel better after using CAM or homeopathy, they claim that it is purely the placebo effect. But an independent, unbiased observer might reasonably say: “So what? What’s wrong with that – as long as the patient gets better? Maybe the patients are being hypnotized into getting better?” And this is where these physicians of the utmost fame get into trouble. Their only attempted riposte seems to be to accuse CAM practitioners of lying and lying is indeed unacceptable in medicine.
Now as far as I am concerned, homeopathy, Traditional Chinese Medicine (TCM) and many other forms of CAM have a true physiological effect quite independent from the placebo effect. That is what I believe – pure and simple. If these doctors think I’m deluded, they are entitled to their opinion but many millions of people in the world share my opinion. What is important for Ernst and co. to understand is that according to their way of looking at things, the very fact that homeopaths believe in homeopathy must surely add to what they think is its placebo effect. It’s absolutely clear to me that the vast majority of CAM practitioners believe in what they are doing – no matter how crazy their methods may seem to others.
So in summary:
CAM practitioners believe in what they are doing. Even if these doctors think their results are due to the placebo effect, it is vicious and false to accuse them of lying to their patients. These doctors do this in my opinion, because what really riles them is not lack of evidence (much of their medicine lacks evidence) but what they consider the implausibility of CAM and they are fully aware that an accusation of implausibility is far less damaging than an accusation of lying.
Personally I believe that many forms of CAM work independent of the placebo effect, though self-induced healing due to placebo plays an important part of both orthodox medicine and CAM. As far as proof is concerned, as both orthodox medicine and CAM lack proof for most of their interventions, it is deeply hypocritical to use ‘lack of evidence’ to attack CAM alone.