Wednesday, October 01, 2008

Doctors and Scientists in Glass Houses

It seems that my last post has made things just a little less than comfortable for stone throwers living in glass houses. (aka as critics of homeopathy who assume that most of conventional medicine is clearly ‘evidence-based’.) Some are even desperately appealing to colleagues for reinforcement. Unfortunately for them it’s not easy to sell houses these days – especially glass ones.

I really had a few good laughs while browsing at one of the internet homes of the disciples of scientism as they squirmed to defend the fact that orthodox medicine can hardly claim to be evidence based – as is clearly illustrated in the pie baked by the BMJ’s handbook of clinical evidence.

Let’s look at a one attempt at refutation and riposte to me simply drawing to attention the fact that huge swathes of orthodox medicine are simply not evidence based.

Brian Kaplan on Homeopathy and evidence based medicine

I have been wearily arguing with a couple of homeopaths on another forum for a couple of weeks now but today one has posted this link to a blog by Brian Kaplan
in which Kaplan moans about the medical establishment attacking "homeopathy for not being evidence-based, the obvious implication is that orthodox, conventional medicine is indeed based on reliable evidence."

He has found this from the BMJ
a pie chart showing the current knowledge about treatments that work.

He obviously thinks this trumps all arguments (as will the homeopaths I am talking to) because "only 15% of orthodox interventions are definitely evidence based."

I think he is being ridiculous because 44% of treatments are beneficail, likely to be beneficial or a trade of between benefits and harms (which sounds pretty good to me), whereas homeopathy has little proof of benefit at all. Plus, at least medicine is looking at its faults and addressing them.

But I would be really interested to know what people cleverer than me make of this - and grateful for any points to further my side of the argument. Thoughts anyone?

Here are some thoughts for you, your colleagues and your allies:

Okay, out of generosity of spirit I’ll give you that 44% (even though the BMJ would definitely not) So – for the sake of discussion - now you have 59% that is more or less ‘evidence-based’. So let’s discuss the remaining 41%, shall we? That is almost 50% - or half of 'orthodox' practice. So what you are admitting is that almost half of what is considered as scientific medicine is actually equivalent to garbage. Rather than attack homeopathy first (and there are legitimate areas of weakness but we have never made any claim that homeopathy is such a broad spectrum panacea as the worshippers at the orthodox medical temple insist we have), why don't you focus on the at least 41% of ‘scientific medicine’ that clearly does no good at all – but is not even politely accused of ‘not being based on evidence’?

Once that is cleared up, feel free to throw stones at the houses of homeopathic doctors and other people against whom you clearly are impressively biased.

Since I am a qualified medical doctor and an idealistic one to boot, please understand that nothing of what I say of this arises from envy or a campaign to 'push' homeopathy, but rather a desire for conventional medicine to come clean and admit that until the almost 50% detritus is unclogged from the orthodox system, you have no right to assail any alternatives (such as homeopathy) that are known at least to cause no harm. (Primum non nocere – Remember that one?) The latter assumption is from my perspective, since I am fully prepared to use any orthodox intervention that I see fit and appropriate in any clinical situation. In other words while you irrationally attack what I do, I will feel free to pick and choose only the best of scientific medicine for my patients and ignore big chunks of it that are not evidence based and may well cause harm to patients. Homeopaths who ignore the hard core 15% should not be defended but I don’t know any homeopathic doctors who do this.

It might be a good idea now to calculate the cost in pounds as well as morbidity/mortality of the (at least) 41% of non-evidence based conventional medicine. I predict it will be deeply shocking. Would you like to do it, or would you like it done for you by an impartial economist who will undoubtedly make your numbers look like child's play. Why? Because they will include all sorts of measurements such as quality of life impairment, productivity losses, impact on the national budget and taxes, etc.

That 41% (at least) out there is a festering wound that you seem intent on defending or hiding with bandages. As far as I am concerned it is an 800-pound gorilla sitting in your surgeries and scientific laboratories. So why not declare a bust on ~50% of your temple now and avoid more pain down the road – it really will be to the benefit of the public at large.

Okay I’ve agreed that 15% (sometimes it’s given as 13% but I’ll give you 15%) of orthodox medicine is hard-core evidence based and homeopaths should never ignore this – and the ones I know certainly do not. Thus, any homeopath who attacks the entire edifice of medicine is almost as guilty as you so called ‘100% orthodox practitioners’ who ‘apparently’ exclusively use evidence based medicine. 'Almost', since the ~40-50% of unproven medicine you use poses dangers that would likely not otherwise be broached in a more benign, more whole patient oriented medical practice.

For the time being I’ll choose to watch your activities through the glass walls of your houses but really hope to see you cleaning up some of the rubbish (at least 41% of the contents, remember?). And if you have a hard time getting rid of some of the grime, I’m always available to help you steam-clean, hoover and de-louse your house in general. This is not a time for us to be uncharitable to our neighbours. In the end it is the health of the people that matters and as doctors we should all still put our patients first.

Note: May I be absolutely clear that all my comments are directed only at those critics of homeopathy who have used ‘lack of scientific evidence’ as a reason to attack, abuse and insult a system of therapeutics that whole person orientated medical doctors have used alongside orthodox medicine to serve the British public well for nearly 200 years.

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