Thursday, May 08, 2008

Evidence-based Medicine: To be applied across the board or just used as a stick with which to beat homeopathy and CAM?

Okay, so far no reply to my challenge of a duel of words with Professor Ernst. There has also been no reply to my alternative suggestion that he withdraw his accusation that homeopaths lie to their patients.

If he is unaware of my challenge then hopefully it will not escape his attention for long. If he is ignoring it then I say: Qui tacet, consentit and will assume that his silence gives consent to what I’ve said.

I’d like to make the following very straightforward points to clarify where I stand on this issue and why I felt so insulted by Ernst’s accusation of lying.

1. May 25, 2006. Thirteen eminent British scientists and physicians including Edzard Ernst and Michael Baum write an open letter to Primary Care Trusts in which they express concern about ‘ways in which unproven or disproved treatments are being encouraged for general use in the NHS’ and go on to say: ‘At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence.’ They particularly attacked homeopathy because of its availability on the NHS.

2. Consequences of this letter:

a) Many Primary Care Trusts responded by preventing GPs in their areas from referring patients to medical qualified homeopathic consultants at NHS homeopathic hospitals. This appalling distrust in GPs ability to make coherent clinical decisions about what is good for their own patients not only deprived patients of homeopathy but also threatened to close down NHS hospitals. This was because under the present system the funding of these hospitals depends on funds generated by GPs referring patients to these hospitals. Thus PCTs comprising many non-medically qualified people have been given the power to deprive patients from receiving homeopathy on the NHS as well as preventing GPs from sending patients to the consultants of their choice.

b) The letter generated a media firestorm with medical journalists such as Ben Goldacre and Simon Singh wading in with highly opinionated but poorly informed opinions on the subject. These and other journalists conveniently label homeopathy as not having scientific evidence for its use – as opposed to orthodox medicine which by implication they believe is always evidence based. This implication is by no means true. Heartened by the media interest in the subject Singh and apparently Goldacre too, have written books on the subject.

I don’t think there can be much dispute about the above so let me give my reaction:

Ernst, Baum and Co. express concern in their influential letter about NHS funds being exclusively for ‘treatments that are based on solid evidence’. Okay fair enough – it’s a valid opinion even though it tends to be exclusively from the Scientism School of Na├»ve Realism but that is another issue altogether. Let’s just say for now it’s a reasonable viewpoint. What I want to ask them is this:

Why do you not attack all forms of medical intervention that are not ‘based on solid evidence’ ? Or did you not know that many, many orthodox medical interventions have no ‘solid evidence’ to back them up.

Want some examples? With pleasure… Show me the ‘solid evidence’ for the following:

1. The use of drugs such as Prozac and Ritalin for Attention Deficit Disorder (ADD)
2. The surgical procedure of spinal fusion for many forms of back pain. (Critics of any medical intervention that is not evidence-based may meditate on the fact that at least homeopathic doctors are not wielding scalpels without evidence based studies to back them up)
3. The use of SSRIs for depression – a treatment that costs the NHS hundreds of millions of pounds a year and yet a recent study by a highly respectable group of researchers concluded that these drugs are no better than placebo! Wow, and the attack on homeopathy not being based on evidence goes on and this is seldom mentioned?

And those three are just for starters… I will be more than happy to give more examples here in the future.

I end with the following apologies:

1. To GPs: I am so sorry to see your autonomy and clinical judgment eroded like this.
2. To Ernst, Baum and Co: I am sorry if I appear to criticise you of being prejudiced against homeopathy. I just don’t understand why you don’t attack all medical interventions that are not ‘based on solid evidence’ such as the 3 examples I’ve given above. I really would appreciate an explanation.
3. To journalists Singh and Goldacre: I believe in freedom of the press and am proud that it was established in the UK. You are not in the same boat as Ernst, Baum and Co. because you are not medically trained. However you could have a field day by attacking all forms of medicine that are not evidence based. In exclusively attacking CAM and not orthodox interventions (some of them multi million pound industries in themselves) you might be depriving yourselves, your papers and your readers of vital information and for this I’m really sorry.
4. To the significant proportion of the British public who have trusted homeopathy since it’s inception in the early 19th century and who funded the building of the UK’s homeopathic hospitals which were invited to become part of the NHS in 1948: I’m sorry that you as a significant minority are being bullied in this way by Big Nanny. We can but hope that things will change soon.

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