tag:blogger.com,1999:blog-104609642024-03-13T16:39:16.009+00:00Dr. Brian Kaplan ArticlesA Personal View of Medical MattersBrian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.comBlogger73125tag:blogger.com,1999:blog-10460964.post-8802242057564284492009-03-10T20:39:00.003+00:002009-03-10T20:51:11.480+00:00New Website and Blog launchedMy new website and blog has now <a href="http://drkaplan.co.uk/">launched</a>, and I look forward to your visit.<br /><br />Many thanks<br />Dr. Brian Kaplan<br />London<br /><br />PS: This Blog will not be updated in future.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-76105485003487164732008-11-23T17:52:00.004+00:002008-11-23T19:36:30.571+00:00Some thoughts on staying wellThe poet Longfellow writes:<br /><blockquote style="font-style: italic;">Joy, temperance, and repose, slam the door on the doctor's nose.</blockquote>And ‘slamming the door on the doctor’s nose’ can simply be translated into practising effective personal preventative medicine. Personally, I’d add exercise to the list but that would spoil the metre – so let’s look at the 3 qualities espoused by Longfellow.<br /><br />JOY: No doubt about it: Love, happiness and <a href="http://drkaplan.co.uk/drk/humour-and-health.htm">laughter</a> are good for your physical health. A pity doctors don’t try to prescribe these much – even though pioneers like Patch Adams, MD have been promoting this sort of ‘medicine’ for some time now.<br /><br />TEMPERANCE: Doctors have no problem in prescribing this. The problem is more about how to get patients to ‘take the medicine.’ Personally I feel that patients don’t often appreciate direct and unoriginal advice which they can experience as patronising and condescending. Thus they need another way of being persuaded to live healthier lives. More about this in a future post…<br /><br />REPOSE: Ah, this is the one. How do we rest? How do we release stress? How do we stop being stressed in the first place? All doctors, especially GPs, know that a huge amount of the patients seeing them are suffering from problems either caused or at least exacerbated by stress. But what can they do about it? Tell patients to take it easy? Think that will work?<br /><br />Fortunately there is something doctors can do about this. <a href="http://www.autogenic-therapy.org.uk/"><span style="font-style: italic;">Autogenic Therapy</span></a> is a marvellously effective method of reducing stress. It takes a bit of dedication by the patient but is easy to learn. Just look at what Prof. Edzard Ernst (a man with whom I totally disagree with on so many things, not least homeopathy being available on the NHS) has to say about it in <a href="http://www.guardian.co.uk/lifeandstyle/2004/jun/15/healthandwellbeing.health">this article</a> written some years ago. I totally agree with <span style="font-style: italic;">every word </span>he writes here. It is a huge pity that he has become well known for <a href="http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/books/non-fiction/article3764173.ece">trying to ‘debunk’ various forms of holistic medicine </a>and being part of the movement to thwart Britain's GPs from being able to send patients to NHS homeopathic clinics than for his open endorsement of Autogenic Therapy.<br /><br />Anyway you can get an excellent eight session course in Autogenic Therapy on the NHS at the Royal London Homeopathic Hospital (See Prof. Ernst, where else would you get Autogenic Therapy on the NHS if it were not for the RLHH? Can this <span style="font-style: italic;">possibly</span> be a hospital you would like to have removed from the NHS?). To get Autogenic Therapy on the NHS you will need a referral from your GP, but even without that, you can still attend a course there privately at a hugely discounted rate compared to private practice.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-54537855694359759162008-11-16T21:06:00.006+00:002008-11-17T08:36:31.450+00:00I really must lighten up<span style="font-size:85%;">Prof. Colquhoun has noticed my last post and accused homeopaths of being ‘deluded’ and concluded that my ‘paranoid tone’ is an indication that <span style="font-style: italic;">they </span>(presumably those whom I’ve dubbed <span style="font-style: italic;">The Disciples of Scientism</span>) are ‘<a href="http://dcscience.net/?p=282">winning</a>’. Reading this I realised that ‘losing’ is far less of a problem for me than forgetting to take my anti-psychotic medication!<br /><br />He also accused me of getting my facts wrong about that letter to Directors of Commissioning which I apparently incorrectly alleged was on NHS paper. I don’t have the stomach to discuss this anymore. I got my information<a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/theweek/DH_079859"> here </a> on the website of the Department of Health. They believe in an ‘evidence-based’ society so they should have ‘evidence’ to justify sending out such a message. The Department of Health uses the word ‘inappropriate’ about the use of the NHS logo so I suggest he take up the argument with them and not me.<br /><br />Finally he denies accusing homeopaths of lying to their patients. But he has posted:<br /><br /><blockquote>This suggests that, in order to maximise the placebo effect, it will be important to lie to the patient as much as possible, and certainly to disguise from them the fact that, for example, their homeopathic pill contains nothing but lactose.<br /></blockquote><br />Okay, maybe somehow that can be read in a way that doesn’t accuse homeopaths of routinely lying to their patients – but it’s not easy to avoid being left with that impression.<br /><br />He also accuses me of posting ‘splenetic comments’. Now this observation really hit home. Maybe I can’t do much about my ‘paranoid tone’ and being ‘deluded’ because these may be symptoms of a previously undiagnosed medical condition.<br /><br />Now sing Sondheim’s lyrics to the music of Leonard Bernstein from the wondrous musical, <span style="font-style: italic;">West Side Story</span>:<br /><blockquote><br />Right! Officer Krupke, you're really a square<br />This boy don't need a judge, he needs an analyst's care<br />It's just his neurosis, that oughta be curbed<br />He's psychologically disturbed</blockquote>However for venting spleen even on one occasion, I must be contrite; there is quite enough splenetic expression in the world without me adding to it. So please forgive me that dear reader. I will endeavour to be light and breezy from hereon out.<br /><blockquote></blockquote><blockquote><blockquote><br />Life is far too important a thing ever to talk seriously about it. (Oscar Wilde)<br /><br /></blockquote></blockquote>So I’ll try not to be too serious either. They say that if you take life too seriously you may end up with a serious dis-ease and I’m not keen on that either.<br /><br />Actually this may be a very good time to start to talk about other aspects of whole person medicine. So in a non-splenetic spirit of reconciliation and tender feelings between members of the medical profession, in my next post I will write about a form of <span style="font-style: italic;">whole person medicine</span> that is <span style="font-style: italic;">far from well-known </span>(I’m not talking about something we would obviously agree on such as treating syphilis with Penicillin here*), extremely effective and <span style="font-style: italic;">enthusiastically endorsed</span> by both myself and none other than the very doctor I challenged to a duel on a point of honour, Prof. Edzard Ernst!<br /><br />* Here is a joke by my friend, the Scottish comedian, Arnold Brown that goes something like this: ‘Whenever I hear someone criticise Scots for being hard-drinking, uncouth Rab C. Nesbitt type characters, I say: “Thank Heavens Alexander Fleming sobered up long enough to discover Penicillin"<br /><br /></span>Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-7874632356504496442008-11-09T13:20:00.010+00:002008-11-09T22:51:16.496+00:00That Letter of the Disciples of ScientismDr. David Colquhoun writes about me and that UCL debate in his rather <a href="http://dcscience.net/?p=282#hom">sneering blog</a> in which he accuses anyone using alternative medicine of <a href="http://dcscience.net/improbable.html">lying to their patients</a>. This is a blatant and untrue insult which he arrives at via an illogical and irrational cascade of argument. Suffice to say that I've yet to meet a doctor using homeopathy who does not believe his or her homeopathic prescriptions have an effect independent of the placebo effect. Prof. Colquhoun might not think that homeopathic remedies have a physiological effect but homeopathic doctors using them certainly do. Anyway this is what he has to say about the UCL debate and myself:<br /><br /><blockquote>Dr Brian Kaplan was there. He had given the meeting some publicity, in a web posting that also kindly gave publicity to our 2006 letter to the Times. He didn’t like the letter, which is unsurprising given that it turned out to be more effective than we could ever have hoped.<br /></blockquote><br />For once I agree with everything Prof. Colquhoun says here.<br /><br />I <span style="font-style: italic;">was</span> at the meeting and was happy to give it advance publicity.<br /><br />I was also more than happy to give publicity to the <a href="http://www.homeowatch.org/news/baum.html">letter </a>that Colquhoun et al, a group of doctors and scientists, I have called Physicians of the Utmost Fame (apologies to Hilaire Belloc) wrote to NHS Directors of Commissioning. More than anything else, this letter was a slap in the face for Britain’s 40 000 GPs as it sought to go above their heads and <span style="font-style: italic;">thwart</span> any of them that would like to send a patient for NHS homeopathic treatment.<br /><br />Colquhoun is also right in saying that I did not like the letter. Here are my reasons:<br /><br />It was inappropriately and highly misleadingly written on paper that had an NHS letterhead. This is what the Department of Health <a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/theweek/DH_079859">thinks of that</a>:<br /><br /><blockquote>A document entitled “Homoeopathic Services” which was distributed to Directors of Commissioning earlier this year has caused some confusion because it carried the NHS logo.<br />We would like to clarify that this document was not issued with the knowledge or approval of the Department of Health and that the use of the National Health Service logo was inappropriate in this instance.<br />The document does not represent any central policy on the commissioning of homoeopathy and PCTs continue to be responsible for making the decisions on what services or treatments to commission to meet their community’s health needs.<br /></blockquote><br />But of course this ‘correction’ was almost invisible after chief executives of 476 NHS Trusts had read this highly personal and opinionated viewpoint of the The Disciples of Scientism – <span style="font-style: italic;">on NHS paper!</span> So yes I do agree it was effective. Expedient, opportunistic, misleadingly written on NHS paper, patronising and condescending to GPs – but <span style="font-style: italic;">effective</span>, yes. And thus I must conclude that Prof. Colquhoun thinks that the end justifies the means. There are two possible reasons for this:<br /><br />1. The people of the UK are too stupid or too uneducated to choose the sort of doctors they want and must be forced to have only medicine approved of by the Disciples of Scientism.<br /><br />2. The General Practitioners of Britain cannot be trusted not to refer patients for ‘implausible’ forms of medicine such as homeopathy. This is my main point and has been for some time. <span style="font-weight: bold;">Homeopathy is not and </span><span style="font-weight: bold;">never</span><span style="font-weight: bold;"> was <span style="font-style: italic;"></span> available <span style="font-style: italic;">on demand</span> to the British public.</span> You had to get your GP to refer you to an NHS clinic to get homeopathic medicine. Thus an honourable course of action by the Physicians of the Utmost Fame would have been to write their letter to a journal widely read by GPs such as the British Medical Journal. But GPs might have not appreciated the condescending and patronising tone of the letter and reserved the right to choose to refer to whatever NHS clinics they liked. Knowing this, the professors chose to go over the heads of GPs and write a letter (totally inappropriately on NHS paper) to chief executives of 476 NHS Trusts with the power to <span style="font-weight: bold;">thwart GPs </span>who wanted to send patients for NHS homeopathy!<br /><br />Do I like that? No, Prof. Coquohoun I <span style="font-style: italic;">don’t</span>. Bullying Britain’s GPs, leaving the utterly spurious impression that conventional medicine is based on solid evidence while homeopathy isn’t, writing to non-medical bureaucrats utterly inappropriately on NHS paper thus giving the <span style="font-style: italic;">false</span> impression that your pompous letter was somehow an NHS document (a ‘technicality’ that would have your entire case for a reform in NHS policy unceremoniously thrown out in a British court of law), is definitely not to my taste. Perhaps I should wake up, abandon conscience, read <span style="font-style: italic;">The Prince</span>, and fully understand that the end always justifies the means.<br /><br />Professor David Coquhoun, I’m happy to debate this with you. Feel free to be assisted by the jeering journalist, Simon Singh or preferably the medically trained journalist, Ben Goldacre. Bring along the man who also nastily accused homeopaths of ‘lying’ to their patients, Prof. Edzard Ernst. I tried to defend honour in traditional British manner by challenging him to a duel – but alas no reply. Whatever happened to chivalry? In fact bring any of your fellow Physicians of the Utmost Fame or any of the other 13 Disciples of Scientism who co-signed that letter. Your case is so weak it has been transferred to the Intensive Care Unit.<br /><br />Anywhere, any time, on any media, in front of any audience. I’m ready…Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com4tag:blogger.com,1999:blog-10460964.post-32496352054186924542008-11-03T11:45:00.007+00:002008-11-03T13:16:09.553+00:00The Tide is Turning!Good news friends. The tide is starting to turn… Homeopathy is starting to defend itself in earnest against biased attacks in the medical literature and media in general.<br /><br />A press release by the Faculty of Homeopathy today shows that the ‘conclusions’ of a paper in the Lancet entitled ‘The End of Homeopathy’ have been called into serious doubt. As Dr Peter Fisher puts it: they cast ‘serious doubts on the review, showing that it was based on a series of hidden judgments unfavourable to homeopathy’ No space for the detail but here are the references:<br /><br /><span style="font-style:italic;">Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol 2008. doi:10.1016/j.jclinepi.2008.06.015<br /><br />Rutten ALB, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy 2008. doi:10.1016/j.homp.2008.09.008.<br /></span><br /><br />More amusing and therefore much more appealing to me was an <a href="http://www.nytimes.com/2008/10/24/health/24placebo.html?ref=health">amazing article</a> in the New York Times (you might need to register to read it but free registration to the NYT is not a bad idea) citing a study that shows <span style="font-style:italic;">half of US doctors<span style="font-weight:bold;"></span></span> prescribe 'placebos', but they are not really placebos like<span style="font-style:italic;"> homeopathy</span> (please pronounce with a sneering tone) because they have active ingredients that are known to have <span style="font-style:italic;">adverse</span> effects. Thus I conclude that from the point of view of Scientism it is better to prescribe a placebo that may well cause harm to a patient than to give patients <span style="font-style:italic;">homeopathic</span> (have you perfected that sneer yet?) medicines that nobody accuses of having side effects. And if you have any doubts about the sheer <span style="font-style:italic;">scale </span>of adverse effects that orthodox drugs can produce just read this <a href="http://www.latimes.com/features/health/la-sci-drugs23-2008oct23,0,635901.story">recent article.</a> It is clearly better to give a medicine that can have a bad effect than one that can’t have <span style="font-style:italic;">any</span> effect. That way at least the doctors that prescribe them don’t look stupid. <span style="font-style:italic;">Primum non nocere</span> (‘First do no harm’) said Hippocrates but what did <span style="font-style:italic;">he</span> know? Or for that matter what did any of the Greek philosophers know? They can go and jump in the River of Elitism as far as Scientism and The Dumbed Down Society are concerned. We have the ‘philosophy’ of Naïve Realism to explain everything these days. And we have journalists like Ben Goldacre (medical doctor) and Simon Singh (not a doctor) to jeer at anyone who subscribes to inane concepts such as holism, vitalism and whole person medicine. And if they are not considered sufficiently qualified there is always the greatest exponent of Scientism on the planet (besides the magician, James Randi) Professor Richard Dawkins to call upon to <span style="font-style:italic;">prove</span> that homeopathy is nonsense. After thousands of years of unsuccessful efforts, this man has finally <a href="http://richarddawkins.net/RDbooks">disproved the existence of God</a> so what chance has homeopathy got against him? We, homeopaths lie vanquished in the gutter next to God licking our wounds. What can we possible say except that at least we are in good company?<br /><br />And never, never forget the main message of this post: Medical doctors retain the inalienable right to prescribe placebos as long as those placebos can be shown unequivocally to have an effect on patients. Whether that effect is positive or negative seems to be besides the point!Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-89389867107427298882008-10-31T09:12:00.006+00:002008-11-25T16:43:45.647+00:00That Debate at UCLThis House would no longer make homeopathic treatment available on the NHS:<br /><br />For: 65<br />Against: 53<br />In abstention: 37<br />The motion was therefore carried.<br /><br /><br />You can see Prof. Colquhoun's comments and hopefully my reply on the <a href="http://www.debating.org/dev/2008/10/21/science-prevails/#comments">UCL debate website.</a><br /><br />No count (as is done by Intelligence Squared debates) was taken before the debate but clearly most people had come with their minds made up.<br /><br />Peter Fisher gave a good account of homeopathy and he and his colleague easily won the rational debate.<br /><br />Prof. Colquhoun made the astonishing claim to the effect that the great majority of orthodox interventions ARE in the sector of evidence based medicine. Astonishing because he offered NO PROOF and <span style="font-weight: bold;">NO EVIDENCE</span> for this. Clearly the same rules do <span style="font-style: italic;">not </span>apply to homeopathic doctors and Professors of orthodox medicine! I would love to debate this with him.<br /><br />The jeering journalist, Simon Singh, had much to say. Memorable was his referring to homeopathy as a 'spherical bastard' by which he means that which ever way you look at it, it's a 'bastard'. Obviously he does not care to look at it from the point of view of the over 90% of patients who visit the Royal London Hospital being very satisfied with the service. <span style="font-style: italic;">(Note added on 25/11/2008: </span><span style="font-style: italic;">Simon Singh has been in contact with me since the debate and has made it very clear that although he did talk about 'spherical bastards' in his allotted time during the debate, this was before he actually began to speak about homeopathy and that consquently I misunderstood what was simply him quoting a joke by the astrophysicist, Fritz Zwicky. He has made it clear that it was not his intention in any way for anyone to think that he was referring to homeopathy as an example of a 'spherical bastard')</span> He also cited his vile 'study' showing that homeopaths supported giving homeopathic prevention for malaria. 'Ten out of ten homeopaths' phoned apparently were happy to do so. I KNOW this is false (and I wrote about this at the time) because I was phoned up and made it clear <span style="font-style: italic;">in no uncertain terms </span>that people should take orthodox malaria preventative medicine and anyone advising any alternative is giving criminally negligent advice.<br /><br />But overall I expected no better from Singh and Colquhoun. My great disappointment was with the students. They missed the point of the debate which was not whether homeopathy is plausible or 'scientific'. It was about whether it should be allowed on the NHS - an issue of civil liberty in many ways. The point that Colquhoun and his cronies sought to go over the heads of GPs to <span style="font-style: italic;">prevent</span> rather than <span style="font-style: italic;">dissuade</span> (which would have been at least an honourable course of action) by writing to PCTs asking them to disallow GP referrals to homeopathy in their areas was never discussed. These physicians of the utmost fame also sent this letter containing their private opinion on paper with an NHS logo! It's not just me that thinks that this was inappropriate at best and highly expedient at worst. Just look at what the <span style="font-style: italic;">Department of Health<span style="font-weight: bold;"></span></span> thought about it <a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/theweek/DH_079859">here</a>. But of course the letter is famous/infamous and this <a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/theweek/DH_079859">rebuke</a> from the Department of Health is invisible to most people. Perhaps these eminent doctors think the end justifies the means when it comes to clamping down on GPs who would like to refer patients to <span style="font-style: italic;">other doctors</span> who use homeopathy.<br /><br />That Colquhoun, Ernst and co. are using the nanny state to further their cause is understandable from their point of view but to see young students inadvertently voting for 'tighter controls', a more regulated society and more of the nanny state, was rather sad. My view is that the whole campaign to stop the provision of homeopathy on the NHS (and remember YOU CANNOT GET NHS HOMEOPATHY WITHOUT YOUR GP REFERRING YOU)by attempting to restrict the referring rights of GPs in this way is a condescending and patronising slap in the face for Britain's 36 000 GPs.<br /><br />But my friends, the tide is turning. In my next post I will cite many articles in which the Disciples of Scientism come under heavy attack for their 'philosophy' (Naive Realism in my opinion) and their attempts at achieving hegemony in medicine. Thank heavens for this. Natural, whole person orientated medicine (to complement conventional, more mechanistic medicine) will never die. Fresh ways of presenting it will appear in response to the Naive Realism of <a href="http://www.homeowatch.org/news/baum.html">The Disciples of Scientism</a> and you will see some of them in my next post.<br /><br />As Hopkins put it:<br />'And for all this, nature is never spent;<br />There lives the dearest freshness deep down things'Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com1tag:blogger.com,1999:blog-10460964.post-3027794679434870742008-10-18T15:05:00.013+01:002008-10-19T14:08:27.096+01:00Homeopathy on Trial: The Debate and The LetterOn Monday night, the 20th October 2008, I will attend a debate at University College London at 7.00 pm. The motion is: 'This House believes homeopathy should not be available on the NHS’ The debate is free and open to all and <a href="http://www.ucl.ac.uk/maps/ucl-maps/ucl-maps/map3_hi_res">this</a> is how you get there.<br /><br />Speaking against the motion: Dr Peter Fisher - doctor, specialist physician,chief consultant at the Royal London Homeopathic Hospital and homeopathic physician to the Royal Family.<br /><br /><br />Speaking for the motion: Simon Singh - author, journalist and TV producer<br /><br />But fear not for the intrepid Singh! It is he who has home ground advantage for UCL is the spiritual home (okay really sorry to use <span style="font-style:italic;">that</span> word to describe disciples of Scientism - but you know what I mean) of <span style="font-style:italic;">four</span> of the authors of a <a href="http://www.homeowatch.org/news/baum.html">famous/notorious letter</a> attacking the provision of homeopathy on the NHS, Professor David Colquhoun, Professor Lewis Wolpert, Professor Michael Baum and Professor Peter Dawson. <br /><br />I have referred to this <a href="http://www.homeowatch.org/news/baum.html">letter</a> before in these pages and accused it of trying to thwart the wishes of Britain's GPs. Homeopathy is only available on the NHS <span style="font-style:italic;">if</span> your GP refers you to an NHS homeopathic clinic. But Coquhoun, Wolpert, Baum, Ernst and co. (see below) did <span style="font-style:italic;">not</span> address this letter to GPs; they wrote to Patient Care Trusts (PCTs) essentially appealing to them to <span style="font-style:italic;">prevent</span> GPs in their areas from sending patients to NHS hospitals. Although some would describe such an action as patronising and condescending to GPs, they were quite successful with some PCTs banning GPs from referring patients for homeopathy! GPs are quite at liberty to send patients for all sorts of <span style="font-style:italic;">unproved</span> orthodox interventions of course. Anyone reading these notes knows that huge swathes of conventional medicine are far from being evidence based. I've used <a href="http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp">a pie from the BMJ's Handbook of Clinical Medicine</a> many times to illustrate this.<br /><br />Their letter was an open one so I thought it opportune to re-publish it here and annotate it.<br /><blockquote><br />We are a group of physicians and scientists who are concerned about ways in which unproven or disproved treatments are being encouraged for general use in the NHS. We would ask you to review practices in your own trust, and to join us in representing our concerns to the Department of Health because we want patients to benefit from the best treatments available.<br /></blockquote><br /><br />As a physician myself, I wholeheartedly concur with this opening statement. We need to have a way of accurately assessing whether a treatment is proven or unproven. May I suggest this <a href="http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp">immaculately constructed diagram</a> that appears in the British Medical Journal’s Handbook of Clinical Evidence as a guide to making such assessments.<br /><br /> <br /><br />This will enable us to categorize any form of medical intervention in terms of how well it has been proven. I feel confident that learned physicians such as yourselves will agree that assessing any intervention ‘alternative’ or ‘orthodox’ needs just such an objective assessment of its proven efficacy. <br /><br /><blockquote>There are two particular developments to which we would like to draw your attention. First, there is now overt promotion of homeopathy in parts of the NHS (including the NHS Direct website). It is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. Despite this, a recently-published patient guide, promoting use of homeopathy without making the lack of proven efficacy clear to patients, is being made available through government funding. Further suggestions about benefits of homeopathy in the treatment of asthma have been made in the ‘Smallwood Report’ and in another publication by the Department of Health designed to give primary care groups “a basic source of reference on complementary and alternative therapies.” A Cochrane review of all relevant studies, however, failed to confirm any benefits for asthma treatment.</blockquote><br /><br />Fellow physicians, I do not think it becoming of us to focus on or attack any one form of intervention in isolation as this may invite criticisms of inherent bias. It is incumbent upon us to agree on standards of proven efficacy and then objectively rate each intervention. The BMJ’s pie cited above, could be used until the appearance of a better objective methodology of assessment. May I respectfully suggest that our opinions (necessarily subjective) of what is ‘implausible’ are somewhat less important than objective assessment. <br /><br /><blockquote>Secondly, as you may know, there has been a concerted campaign to promote complementary and alternative medicine as a component of healthcare provision. Treatments covered by this definition include some which have not been tested as pharmaceutical products, but which are known to cause adverse effects, and others that have no demonstrable benefits. While medical practice must remain open to new discoveries for which there is convincing evidence, including any branded as ‘alternative’, it would be highly irresponsible to embrace any medicine as though it were a matter of principle.</blockquote><br /><br />I absolutely agree that adverse effects of any medical intervention are a major concern for us all. Thus surely any form of treatment that is included in the repertoire of NHS doctors should not only be given its rightful place in the pie diagram but also be included in another diagram constructed to show all documented risks and side effects. In this way physicians and patients will be able to make accurate efficacy versus risk assessments on any treatment in any condition. Obviously the same criteria should be used objectively for <span style="font-style:italic;">all</span> forms of interventions otherwise we risk being seen as biased in favour of treatments that we subjectively consider ‘plausible’.<br /><br /><blockquote>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. Furthermore, as someone in a position of accountability for resource distribution, you will be familiar with just how publicly emotive the decisions concerning which therapies to provide under the NHS can be; our ability to explain and justify to patients the selection of treatments, and to account for expenditure on them more widely, is compromised if we abandon our reference to evidence. We are sensitive to the needs of patients for complementary care to enhance well-being and for spiritual support to deal with the fear of death at a time of critical illness, all of which can be supported through services already available within the NHS without resorting to false claims.<br /></blockquote><br />I agree that funds should only be automatically available for treatments based on ‘solid evidence’. I take it that you would agree that only the sector of the BMJ’s pie representing the 13% of orthodox interventions that have been <span style="font-style:italic;">proved</span> to be beneficial, qualify for automatic funding by the NHS. It is vital that funding for anything lying outside this segment be decided by objective assessment on a level playing field and not ‘plausibility’ which is highly subjective. Some may suggest that the medically uneducated general public should have a say about which – if any – of the treatments (both orthodox and alternative that do not have ‘solid evidence’ behind them) should be funded by their taxes. This would be consistent with the current zeitgeist where the people are promised ‘choice’ in their lives. So perhaps we could have a ‘People’s Choice’ segment of the pie representing funding. Or perhaps the power of decision should always remain with physicians who are better qualified to speak about the health and taxes of the people than they are themselves.<br /><br />May I also respectfully suggest that the term ‘spiritual support’ is unbecoming of gentlemen of your standing in the medico-scientific community, has none of Popper’s falsifiability and therefore should be considered somewhat less than scientific. Therefore it is my humble opinion that it should not be used in discussions of this kind. Even if (in a bad case scenario for medical science), ‘spiritual support’ was shown to be evidence based medicine, surely we physicians are <span style="font-style:italic;">at least</span> as capable of administering it as uneducated ‘alternative’ or ‘complementary’ practitioners?<br /><br /><br /><blockquote>These are not trivial matters. We urge you to take an early opportunity to review practice in your own trust with a view to ensuring that patients do not receive misleading information about the effectiveness of alternative medicines. We would also ask you to write to the Department of Health requesting evidence-based information for trusts and for patients with respect to alternative medicine.</blockquote><br /><br /><br />Gentlemen physicians, I could not agree more that these matters are not trivial. But may I respectfully request more respect for our colleagues on the coalface of primary medical care – our NHS general practitioners. I accept that until we have constructed a new pie showing which treatments not in the crucial 13% segment of the BMJ pie, should be funded for various reasons such as patient demand (however irrational that can be at times) we leave such decisions to our hardworking GPs and not to non-medically qualified people in administration who may not find it easy to make objective assessments about complicated but profound medical issues. In addition our noblest efforts on behalf of the public risk being seen as patronizing and condescending by our tireless GPs who will soon be consulting on weekends.<br /><br /><br /><span style="font-style:italic;">Primum non nocere.</span><br /><br />Your colleague,<br />Dr Brian Kaplan <br /><br />Finally for the record, these are the doctors that signed the <a href="http://www.homeowatch.org/news/baum.html">open letter</a> to Patient Care Trusts (PCTs - which comprise mainly <span style="font-style:italic;">non-medical</span> people) in order to persuaded them to thwart GPs in their areas from referring patients to NHS homeopathic physicians.<br /><br /><br /><br /><blockquote><br />Yours sincerely<br /><br /> * Professor Michael Baum, Emeritus Professor of Surgery, University College London<br /> * Professor Frances Ashcroft FRS, University Laboratory of Physiology, Oxford<br /> * Professor Sir Colin Berry, Emeritus Professor of Pathology, Queen Mary, London<br /> * Professor Gustav Born FRS, Emeritus Professor of Pharmacology, Kings College London<br /> * Professor Sir James Black FRS, Kings College London<br /> * Professor David Colquhoun FRS, University College London<br /> * Professor Peter Dawson. Clinical Director of Imaging, University College London<br /> * Professor Edzard Ernst, Peninsula Medical School, Exeter<br /> * Professor John Garrow, Emeritus Professor of Human Nutrition, London<br /> * Professor Sir Keith Peters FRS, President, The Academy of Medical Sciences<br /> * Mr Leslie Rose, Consultant Clinical Scientist<br /> * Professor Raymond Tallis, Emeritus Professor of Geriatric Medicine, University of Manchester<br /> * Professor Lewis Wolpert CBE FRS. University College London</blockquote>Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-73637437514897825212008-10-12T12:07:00.003+01:002008-10-12T14:09:26.026+01:00The BMJ Pie that doth mislead us allMaybe I should give up talking about how homeopathy has served this country well for nearly 200 years. I <span style="font-style:italic;">thought</span> I presented a convincing expose of the apparent ‘evidence basis’ of orthodox medicine using a <a href="http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp">pie</a> published by that well-known supporter of all things alternative, wacky and charlatan – The British Medical Journal’s Handbook of Clinical Evidence.<br /><br />I <span style="font-style:italic;">thought</span> that the pie showed that only 13-15% of conventional techniques were purely evidence based and another 44% were of probable benefit but did not have the evidence basis demanded of homeopathic doctors for their art. I <span style="font-style:italic;">thought</span> I was being generous in ‘giving’ orthodox medicine the whole 44 + 15 = 59% as ‘more or less evidence based’ even though my colleagues told me that such generosity had no chance of being reciprocated. But further discussions on this <a href="http://forums.randi.org/showthread.php?p=4089918">forum</a> (<span style="font-style:italic;">please</span> read the important views of this learned forum on the site of the man I like to call King of Scientism and Magician Extraordinaire, James Randi) have now convinced me otherwise.<br />Finally I see that this pie is profoundly misleading because as one of the above mentioned Disciples of Scientism has correctly pointed out, it somehow does not consider the frequency of use of recognised orthodox interventions.<br /><br />THUS WITH DEEP REGRET I MUST CONCLUDE: The publication of such a dangerously misleading pie (and no parallel diagram to take into consideration frequency of use of interventions) is an act of profound medical irresponsibility inexplicably uncharacteristic of a publication by (until now) one of the world’s top five medical journals. British medicine simply isn’t what it used to be and from now on I will look exclusively trans-Atlantically for truth, elegance and beauty in medicine.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-19543594071363250662008-10-01T13:26:00.005+01:002008-10-01T13:40:58.553+01:00Doctors and Scientists in Glass HousesIt 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.<br /><br />I really had a few good laughs while browsing at one of the <a href="http://forums.randi.org/showthread.php?p=4038585">internet homes of the disciples of scientism</a> as they squirmed to defend the fact that orthodox medicine can hardly claim to be evidence based – as is clearly illustrated in the <a href=" http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp">pie</a> baked by the BMJ’s handbook of clinical evidence.<br /><br />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.<br /><br /><span style="font-style:italic;"><br />Brian Kaplan on Homeopathy and evidence based medicine<br /><br />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<br />http://drkaplanarticles.blogspot.com/<br />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."<br /><br />He has found this from the BMJ<br />http://www.clinicalevidence.com/cewe.../knowledge.jsp<br />a pie chart showing the current knowledge about treatments that work.<br /><br />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."<br /><br />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.<br /><br />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?<br /></span><br /><span style="font-weight:bold;"><span style="font-weight:bold;"></span></span><br /><span style="font-weight:bold;"><br />Here are some thoughts for you, your colleagues and your allies:</span><br />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’?<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br /><span style="font-weight:bold;">Note:</span> 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.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-70474678088608284482008-09-11T12:21:00.011+01:002008-09-30T18:47:33.285+01:00Let critics of homeopathy eat humble pieI promised to use a pie to put everything into perspective and here it is - a pie baked by the highly reputable British Medical Journal’s Handbook of Clinical Evidence.<br /><br />The Background: Prof. Edzard Ernst and others have repeatedly attacked homeopathy on the basis that there is no evidence to suggest that it works. Ernst even went as far as to claim that homeopaths were lying to their patients – a claim to which I took the strongest possible objection: I challenged him to a duel albeit with merely words as weapons. <br /><br />In the ongoing debate there is something that never seems to be sufficiently discussed. When Ernst and company viciously attack homeopathy for not being evidence-based, the obvious implication is that orthodox, conventional medicine is indeed based on reliable evidence. There is just one little problem with this implication: It is simply not true. And here is <a href="http://www.clinicalevidence.com/ceweb/about/knowledge.jsp">the pie that proves this</a>. Now please know that this is not a pie baked in <span style="font-style:italic;">my</span> kitchen. The source of this pie is the British Medical Journal of Clinical Evidence, as respectable source of information on scientific medicine as can be found on the planet. Okay, eat, swallow, digest and assimilate this pie and then we will discuss. <a href="http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp">This pie</a> represents the proven effectiveness of modern medical interventions or treatments.<br /> <br /><br />Now let’s take a deep breath, put aside all prejudices, sit back and look at the pie again and agree on 3 facts:<br /><br />1. A mere 13% of medical interventions are proven to be beneficial – ie. evidence based. I suspect that’s a lot less than you thought and hardly powerful ammunition for people like Ernst and his henchmen to use against homeopathy and alternative medicine. 13% that’s <span style="font-style:italic;">thirteen</span> per cent.<br /><br />2. 21% of interventions are ‘likely to be beneficial’. That means they are likely to help but there is no hard evidence to prove this. Hmmm, that reminds me of the many thousands of patients who say they have been helped by visits to homeopathic hospitals in England.<br /><br />3. We simply don’t know if 47% of interventions are of any use at all! And we are talking about <span style="font-style:italic;">drugs and surgery</span> here – not eating an apple a day or doing 20 minutes meditation twice a day or taking a few pills that homeopathy’s detractors describe as pure placebo.<br />And side effects obviously occur more frequently with orthodox drugs than they do with homeopathic medicines – a fact Ernst and co. cannot deny since they think homeopathic remedies simply cannot have any effect independent of a placebo response!<br /><br />So what does this say about all the attacks on homeopathy for not being evidence based and on homeopaths for lying to their patients. Now I’m going to make some strong statements here because I believe that homeopathy’s detractors have got away with murder and this really does need to be redressed:<br /><br />Ernst accused homeopaths of lying ( interview in The New Scientist on the 28th April 2008) to their patients because of lack of evidence that homeopathy works. Yet only 13% of orthodox interventions are definitely evidence based. Did he accuse orthodox doctors of lying to their patients about 87% of their treatments? Did he allow the public to assume that just about all of orthodox medicine is evidence based? Did he use evidence based medicine as a club to bash homeopathy exclusively when only 13 (sic) % of orthodox interventions are definitely evidence based. Is this unequivocally honest? Is this what we expect from a Professor of Complementary Medicine? Does this reek of bias against homeopathy? Is this in the public interest? <br /><br />1. If most of medicine is not evidence based and many drugs (by their manufacturers’ admission) are capable of causing side effects, this actually means that most of orthodox medicine not only lacks evidence of its efficacy but actually can do harm. And certainly more harm than homeopathy! I find this quite stunning because it means that doctors like Ernst should be telling their patients: ‘Orthodox medicine is superior to homeopathy because homeopathy is not evidence based and at least 13 (thirteen!)% of conventional medicine is! And before you make your choice let me warn you that side effects are much more common with orthodox drugs!’ Do they do this? Do politicians ever admit mistakes? Does anybody actually say ‘Fair cop guv’?<br /><br />2. Homeopathic doctors do use orthodox medicines on occasion, usually when there is an excellent indication for their use in a specific clinical condition ie. strong evidence. Could this mean that homeopathic doctors tend mainly to use the orthodox interventions that comprise the 13% of the pie that represents evidence based medicine?<br />So is it just possible that homeopathic doctors use only the best 13% of orthodox medicine and homeopathy for everything else? You know something – this could really be close to the truth. I don’t know of a homeopathic doctor who wouldn’t treat syphilis with penicillin or appendicitis with surgery. We do use orthodox medicine when it really does work. And we do consider orthodox medicines which may be of benefit – when homeopathy doesn’t do the trick. What we don’t do is use medicines that could do a lot of harm when there is no evidence for their use. This we leave to the huge majority of orthodox doctors some of whom (such as Ernst, Baum and co.) have the audacity to criticise us!<br /><br />I suggest therefore that homeopathic doctors that are respectful of the best of orthodox medicine might just be the most efficient users of evidence based medicine. This may be true simply because orthodox doctors feel obliged to use sectors of the pie (ie 87% of it) that are not evidence based simply because they feel that they must try something. Homeopathic doctors however can use their homeopathic remedies safely instead of using drugs and surgery in situations where their efficacy has not been proved and even carries the risk of doing harm. So exactly who do the general public need protection from?<br /><br />Needless to say, the attacks on homeopathy will continue. I suggest to all defenders of homeopathy that citing the pie above is the best possible defence of our art. Show it to our detractors, let them taste it and if they still refuse to eat humble pie – well then be courteous and only throw it into their faces very, very gently.<br /> <br />Source of the pie: BMJ Clinical Evidence Handbook, Summer 2007, Figure 1, page 4 http://www.clinicalevidence.com/ceweb/about/knowledge.jspBrian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-16055016387040715372008-08-10T12:15:00.004+01:002008-08-20T10:21:42.943+01:00Hypocrisy of attacks on homeopathy to be exposed soonFollowers of this blog are familiar with my position with regard to the relentless attacks on homeopathy by the likes of Prof. Edzard Ernst and others who use evidence based medicine as a club with which to attempt to batter homeopaths into submission. Over and over they repeat that there is no valid evidence to support the view that homeopathy works.<br /><br />Supporters of homeopathy claim otherwise. We say that scientific trials of homeopathy generally show a positive effect. We say that the fact that many thousands of patients with difficult to treat conditions claiming to have been helped at NHS homeopathic hospitals for the past 200 years is also ‘evidence’ of efficacy as is the fact that homeopathy has survived this long while many other forms of therapy have come and gone. <br /><br />Ernst, Baum and a group of physicians then managed to persuade PCTs (patient care trusts) to prevent GPs in many areas from sending patients for homeopathy on the NHS, a tactic that for this author implies that they think both patients and GPs are too ignorant or stupid to realise they are being duped and need to be protected from themselves. The nanny state agreed in many (but by no means all) areas and many GPs who wanted to send patients from getting homeopathic treatment on the NHS were prevented from doing so by people (in the PCTs) who are not doctors! <br /><br />I’ve written about this many times and when Ernst accused homeopaths of lying to their patients I challenged him to a duel on this blog. Well a duel of words, but unsurprisingly I never heard from him. I simply read of him calling for ‘tighter controls’ on alternative medicine. Obviously he continues in his quest to protect the gullible British public (and GPs!) from their own ignorance. But in a society that seems to welcome and bleatingly acquiesce to more and more regulations, Ernst has perhaps found his time and place in the world while more libertarian people like myself blog on in the hope that people will wake up and say they are not stupid and don’t need nannies like Ernst protecting them from their own ignorance.<br /><br />My next blog will be a final word on this. There is a limit to how much time I am prepared to read, think and talk about those who wish to control and coerce people whom they think are unable to think for themselves. In that blog, which will appear within a week, I will expose the incredible hypocrisy of the attacks on homeopathy using a simple pie diagram. After that, this voice will address other important medical issues of the day. However the challenge of a duel still stand, Prof. Ernst...Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-57657757985439225302008-06-26T10:21:00.002+01:002008-06-26T10:25:38.047+01:00Medical Debate TonightMedical Debate Tonight<br /><br />Tonight there will be a debate on the ‘Best of Medicine’ at the <a href="http://www.wellcomecollection.org/exhibitionsandevents/events/WTX048079.htm<br />">Welcome Collection</a>. Homeopathy, initially nominated for the ‘Worst of Medicine’ debate scheduled for 17th July has been nominated for tonight’s debate and Dr Sara Eames of the Royal London Homeopathic Hospital will speak in favour. Should be interesting…<br /><br />I won’t be there tonight but have booked my place for the 17th of July, assuming homeopathy is still nominated.<br /><br />My personal opinions of the Best and Worst of Medicine:<br /><br />Worst Medicine: When doctors out of fear, think of themselves first instead of their patients. Stringent regulation, box ticking and increasing fear of litigation make this more likely. Far from benefiting patients it makes them feel like they are being regarded as robots by doctors following rigid criteria about how diseases (as opposed to patients) should be treated.<br /><br />Best Medicine: Well-educated doctors, instead of acting out of fear, making decisions based on knowledge, experience, wisdom and importantly, personal conscience.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-74924511626785923172008-06-12T10:28:00.006+01:002008-06-12T11:10:08.789+01:00Debating the 'Worst of Medicine'On the 17th of July the Welcome Institute is hosting a discussion/debate on the 'Worst of Medicine'<br /><br />The following subjects have been nominated as candidates for the Worst of Medicine.<br /><br /><span style="font-weight:bold;"><br />1. The BMI farce</span><br />nominated by Patrick Basham & John Luik<br />The Body Mass Index is an inaccurate measurement of people's healthiness, yet it is used to scare and hector the population.<br /><br /><span style="font-weight:bold;">2. Epidemiology: medicine gone wrong?</span><br />nominated by Rob Lyons<br />In today's frantic search for the origins of disease in our lifestyles and environment, the value of epidemiology has been greatly overstated.<br /><span style="font-weight:bold;"><br />3. The homeopathy hoax</span><br />nominated by Baum and Ernst<br />All serious thinkers should have a closed mind on the question of homeopathy: it is anti-scientific and simply does not work.<br /><span style="font-weight:bold;"><br />4. Healthy living is a sickness</span><br />nominated by Dr Michael Fitzpatrick (GP & a speaker at the live debate with William Schabas, Director, Irish Centre for Human Rights & David Wootton, Professor of History, author of 'Bad Medicine')<br />GP and author Dr Michael Fitzpatrick says the injunction to be super-fit and super-healthy is ruining our quality of life.<br /><br /><br />Let's look a little closer at these:<br />1. BMI: Of course this is not a totally accurate measurement of 'health'. Who says it is? It does give useful information as does an 'apple-shaped' body. There is no way this can 'win' the title of Worst Medicine and it seems that it's just being nominated to give someone a chance to voice an opinion on its limited usefulness in medicine.<br />2. Epidemiology: The worst of medicine? That's ridiculous too. It may have its limitations, it may indeed have been overstated but it's always been a valid science and useful it its place. Another ridiculous nomination.<br />3.Healthy Living is a sickness - Yeah, sure and life is a terminal, sexually transmitted disease. A really insightful observation.<br />4.Which leaves Homeopathy is a Hoax - clearly set up not only to lose but to be trashed in public.<br /><br />I think I've made the point several times that homeopathy is <span style="font-style:italic;">not</span> a hoax which would imply that homeopaths know that they are deceiving their patients. I challenged Edzard Ernst to a duel for accusing homeopaths of lying to their patients. I chose words as weapons but to date have received no answer - which does not surprise me. A challenge to a duel was considered an honorable response to the slur of an accusation of lying in this country 150 years ago so I've done my job in defending the honour of homeopathy. Ernst and others may believe that what homeopaths tell their patients is untrue but that does not mean they are lying. Richard (The God Delusion) Dawkins and Christopher (God is not Great) Hitchens are obviously no great fans of the Almighty and clearly do not agree with what the Pope or any other religious leaders say but as far as I know, they are not accusing these leaders of <span style="font-style:italic;">lying.</span><br /><br />Ernst<span style="font-style:italic;"> has</span> accused homeopaths of lying. Ernst and Baum are accusing homeopaths of perpetrating a hoax (in this discussion)<br />I've had enough insults from these eminent professors. I don't know if they will attend the debate on the 17th of July but I'll be there. So dear reader, why not come along to a <a href="http://www.spiked-online.com/index.php?/wellcome/responsesform">free debate </a>in central London and give your view.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-29227109779614449132008-05-29T11:09:00.003+01:002008-05-29T11:17:53.289+01:00Homeopathy:The Public are being misled by OmissionTo be honest dear reader, I am getting rather bored with discussing the irrational attacks on homeopathy in the media and prefer to read more positive literature rather than read the biased, self-righteous and insulting comments made about homeopaths and homeopathic doctors by doctors such as Edzard Ernst and journalists such as Simon Singh and Ben Goldacre whose lack of medical education doesn’t seem to deter from writing articles and books with strongly-held opinions. I’d love to know who buys these books and why.<br /><br />Anyway let’s wrap up a few points.<br /><br />1. The Duel: I challenged Prof. Ernst to a duel (with only words as weapons) for accusing homeopathic doctors of lying to their patients. Guess what? No reply. The age of chivalry, ladies and gentlemen is dead – but at least I tried.<br /><br />2. Attack on Homeopathy is pernicious: I must justify that and I will. The club used to try to beat homeopathy into submission is that it is not evidence based. Now to look at all health interventions on this basis would be fair and consistent. If something has the requisite quality of evidenced you put a tick next to it if it does not you put a cross but it’s only fair to look at all medical interventions this way. <br /><br />Ernst, Singh, Goldacre, Baum et al have conveniently allowed the public to believe that conventional medical interventions are all evidence based and homeopathy is rubbish because it is not. Both statements are patently untrue. Interpretation of trials of homeopathy is controversial to say the least and but I won’t get into that here other than to say it is not at all ‘well established’ that the trials show that homeopathy is no better than placebo. In fact most trials in my opinion seem to show that it does have a clinical effect independent of placebo.<br /><br />My first accusation is more serious – that the public are being misled by omission. These eminent doctors are conveniently not telling the public something very, very important and that is this (please forgive the capitals but if I could make light shine out of the screen though the letters in the next sentence I would) <span style="font-weight:bold;">MANY, MANY INTERVENTIONS IN ORTHODOX MEDICINE ARE NOT EVIDENCE-BASED.</span> And although these are used in serious conditions such as coronary heart disease, depression (to the tune of hundreds of millions of NHS pounds) and back pain – there is no attack on them by those that attack homeopathy and CAM. I’ve listed these before but let me say once again to Ernst et al who selectively attack homeopathy and CAM for not being evidence based.<br /><br />Surgery: Show me the evidence base for spinal fusion for chronic back pain.<br />Paediatrics: Show me the evidence base for the use of drugs such as Prozac and Ritalin in ADHD<br />Cardiology: Show me the evidence for angioplasty and stents in coronary heart disease.<br />Psychiatry: Show me the evidence for the use of SSRI anti-depressants for depression.<br /><br />and there are many, many more but I don't want to bore you with long lists.<br /><br />And if you can’t… Let me say this:<br /><br />You accuse homeopaths of only getting results by the placebo effect with no evidence. And if you are right (and I certainly DO NOT think you are) you should applaud rather than attack homeopaths for getting results with what you think is merely placebo. Why do I say this?<br /><br />Because surely it’s better and safer to get results with what you think are just pills of sugar of milk than to get results with unproven interventions which use chemicals and even scalpels on patients?<br /><br />Double standards? You bet!Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-68611609889739387832008-05-22T10:59:00.004+01:002008-05-22T11:10:27.451+01:00Medicine, Honesty and Duplicity: The disgrace of the recent attacks on homeopathyToday I am in a very serious mood and on this occasion will choose to ignore Oscar Wilde’s aphorism: ‘Life is far too important ever to talk seriously about it’<br /><br />In my last article I challenged Professor Edzard Ernst to a duel (okay - with only words as weapons) for accusing homeopaths of lying to their patients. For centuries in this country the slur of being accused of lying was considered one of the main reasons for challenging someone to a duel. It was actually considered the gallant thing to do in the circumstances - otherwise the accusation of lying would leave a stain on your character. Of course I have not been accused personally of lying – but as a doctor who does use homeopathy – I certainly object to being generically accused of lying. This was an insulting, wrong and vicious thing to say. The slur can be ameliorated if Ernst admits that it is simply a matter of his English not being up to scratch on that occasion and that what he meant to say was that homeopaths were saying things to their patients that he, Ernst, considered to be untrue. Lying is a different matter and as I’ve said I have never met a homeopathic doctor whom I thought was lying to his patients and I’ve met hundreds of them.<br /><br />I regret to inform you that no answer to my challenge of a duel has been received. Perhaps Ernst prefers to confer with journalists than doctors. He has received far too much publicity already in my opinion. I don’t know what his qualifications or motives are other than the smearing of homeopathy and complementary medicine in this country. The paradox of this is that he claims to have been a homeopath and is apparently still a professor of complementary medicine! I don’t want to give the ghastly negative book he wrote with Simon Singh any more publicity than it has received – but feel the need to reiterate what I consider the hypocrisy and duplicity that is at its core.<br /><br />The basic claim is that most of CAM and especially homeopathy are not ‘evidence based’ (This morning on Radio 4’s Today programme, I heard someone say that we live in an ‘evidentially-based’ society. Holy Jupiter! Must we have our language as well as our society totally deconstructed and then destroyed?) My answer to this was simple: Ernst knows that much of conventional medicine (eg spinal fusion, use of drugs for ADHD in children, angioplasty and stents and many many more examples) is not evidence based. How can he then selectively use ‘evidence based medicine’ as a club to bash homeopathy? Surely he should use it as a weapon to attack any form of medical intervention that lacks the requisite trials and results? Nobody addresses this point and people like Simon Singh and Edzard Ernst outrageously get away with an approach that reeks of double standards. In fact Dr Damien Downing has written an <a href="http://www.alliance-natural-health.org/_docs/ANHwebsiteDoc_303.pdf">excellent piece</a> on Ernst and his approach in the journal of the Alliance for Natural Health which articulately points out how much of what Ernst says applies far more to himself than to those he attacks.<br /><br />So in bullet form:<br /><br />1. Much of CAM is not evidence based. (fact)<br />2. Much of conventional medicine is not evidence based. (fact)<br />3. Therefore it is two-faced and hypocritical to use evidence based medicine as a weapon to attack CAM and homeopathy. <br /><br />It could be used to attack any medical intervention that is not evidence based. That would be consistent but I would still be against attacking interventions that are not evidence based. We should allow doctors to practise the art of medicine as well as the science. This means they are allowed to use interventions that have worked for them or their colleagues and mentors and that suit their style of medicine and personality. Of course in critical situations if they ignore the evidence-based recommended approach to the detriment of their patients they will be called to account.<br /><br />It’s all quite simple really. What is amazing is the amount of publicity this duplicitous, hypocritical and negative campaign has achieved with the result that quangos such as PCTs (Patient Care Trusts comprising mainly non-medical people) are able to threaten NHS homeopathic hospitals with closure by preventing doctors in their areas from choosing to refer patients to homeopathic hospitals! Yes you heard me correctly. Unelected committees consisting mainly of non-medically qualified people have exercised their power under the present system of financing healthcare on the NHS, to prevent GP’s from choosing to send selected patients to other doctors (homeopathic consultants) at homeopathic hospitals! And this has occurred because people like Ernst, Baum and others have misled the media and public by giving them the <span style="font-style:italic;">impression</span> that orthodox medicine is all evidence based (it certainly is not) and that homeopathy and CAM are not (studies of multiple trials do not clearly demonstrate that homeopathy is no better than placebo - as Dr Downing clearly points out in his <a href="http://www.alliance-natural-health.org/_docs/ANHwebsiteDoc_303.pdf">excellent article)</a>.<br /><br />I plead ignorance of their true motives but the fact that so far they have been allowed to get away with this heist and get huge exposure on all the media for their propaganda with the result that many GPs have been <span style="font-style:italic;">prevented </span>from referring patients to specialist homeopathic doctors is not merely tragic for decency and honesty in medicine; it is no less than an embarrassment for liberal democracy in this country.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-2076648874103007142008-05-15T10:57:00.011+01:002008-05-16T09:47:55.529+01:00Orthodox Medicine, Homeopathic Medicine and 'Evidence'Before I write more about homeopathy and evidence based medicine I feel the need to declare who I am and what sort of doctor I am. Other bloggers have described me as ‘a homeopath’ and although technically true, that is not how I would choose to position myself in medicine.<br /><br />WHO AM I?<br />I am a medical doctor who uses a whole person orientated approach which comprises everything conventional medicine has to offer and some methodologies which it does not offer. These include <span style="font-style:italic;">Homeopathy</span> but also <span style="font-style:italic;">Autogenic Therapy</span> (now there is something both Prof. Ernst and I agree is an excellent adjunct to orthodox medicine) and <span style="font-style:italic;">Provocative Therapy</span> which is the clinical application of reverse psychology in medicine and psychotherapy. Patients consult me because they know I will try to choose from these, the sort of medicine that is most appropriate for their particular situation. This could be a combination of any of the above or it might involve referral to a conventional specialist or to a member of a group of holistic physicians that I meet with on a weekly basis. <br /><br />MY MENTOR: I was fortunate to have a mentor,<a href="http://www.wholepersonmedicine.co.uk"> E.K. Ledermann</a>, a medical philosopher, psychiatrist and physician who also used homeopathy in his 70 years of holistic practice in London. He impressed on me both the importance of the mechanistic approach of orthodox scientific medicine when appropriate and the need for a holistic general practitioner to have knowledge of psychotherapy as well as some whole person orientated medical tools at his or her disposal. I see homeopathy (alongside other methods such as traditional Chinese medicine) as a powerful example of such a tool.<br /><br />HOMEOPATHY: Thus homeopathy is an holistic tool that a doctor can use – but only when it is appropriate to do so. In no way does it ‘replace’ conventional medicine. In no way should it ever be used in situations where there is a risk of morbidity or mortality. In many other situations it can be used (in our opinion) to stimulate the inherent regenerative power of the body. If it fails to do the job, we homeopathic physicians are ethically obliged to use conventional medicine to do whatever it can for the patient.<br /><br />It is my belief that doctors using homeopathy in their practices have served the people of Britain well (including every monarch since the early 19th century) and I am proud to be a fellow of the Faculty of Homeopathy.<br /><br />Having declared who I am let me now restate what I think of the recent attacks on homeopathy on the basis that it is not scientific and particularly that it is not evidence-based medicine.<br /><br />HOMEOPATHY, CONVENTIONAL MEDICINE AND ‘EVIDENCE’: Recently homeopathy has coming under stinging attacks for not being ‘evidence based’. By far the most significant of these attacks was an <a href="http://www.homeowatch.org/news/baum.html">open letter</a> to Patient Care Trusts by a group of British professors including Michael Baum and Edzard Ernst among others. The idea appeared to be to persuade these trusts not to allow GPs in their areas to refer patients to NHS homeopathic hospitals because homeopathy was not evidence based. Ernst went on to write a <a href="http://http://www.amazon.co.uk/Trick-Treatment-Alternative-Medicine-Trial/dp/0593061292">book</a> with a journalist Simon Singh continuing these attacks and in interview also allegedly accused homeopaths of lying to their patients – an accusation that I felt morally obliged to respond to and <a href="http://drkaplanarticles.blogspot.com/2008/05/lying-who-is-lying.html">did</a>. Other journalists such as Ben Goldacre then joined the lynch mob and everyone continued to use evidence based medicine as the club with which to bash homeopathy.<br /><br />Along the way a few lone voices occasionally cried out: ‘Hey, not all orthodox medicine is evidence based is it?’ But all the attacks on homeopathy by Ernst, Baum, Singh, Goldacre and others are based on homeopathy apparently <span style="font-style:italic;">not</span> being evidence based which implies that orthodox medicine <span style="font-style:italic;">is</span> evidence based. Otherwise these learned men of medicine and journalism should simply attack ALL medicine that is not evidence based, unless of course there is another agenda here.<br /><br />Well I started to look at the evidence base treatments in common usage in orthodox medicine. And what did I find? A HUGE number of treatments in frequent usage and generating huge revenue for doctors and pharamaceutical companies simply cannot claim to be evidence based. A good place to prove this is the <a href="http://clinicalevidence.bmj.com">British Medical Journal of Clinical Evidence</a>. A short time spent there will show you what I say to be true. How dare these people attack homeopathy for lacking an evidence base and by their attitude allow the public to assume that orthodox medicine is all evidence based? It’s an absolute disgrace and I’d like anyone who disagrees to tell me why.<br /><br />Just for starters here is a short personal list I have of orthodox treatments that are not evidence based. If anyone thinks they are please send me the evidence and I’ll remove that item from the list. And this list is just a sample for starters. It will certainly be continued.<br /><br />1. The use of drugs such as antidepressants and others for Attention Deficit Hyperactivity Disorder in children.<br /><br />2. The surgical procedure of spinal fusion for many forms of back pain.<br /><br /><br />3. The use of SSRIs for depression – a treatment that costs the NHS hundreds of millions of pounds a year and yet a <a href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0050045&ct=1 ">recent study</a> by a highly respectable group of researchers concluded that these drugs are no better than placebo!<br /><br />4. Antibiotics to prevent endocarditis<br />In this weeks 'placebo' issue of the BMJ there was a letter by Neil Herring and David Sprigings that expressed worry over the fact that guidelines on antibiotic prophylaxis in structural heart disease for preventing infective endocarditis have now been changed by NICE because they have found no evidence base forits effectiveness. There have been no(sic) RCTs on this subject.<br /><br /><br />5. Steroids for prevention of ARDS In the Research section there is also a paper 'Corticosteroids in the prevention and treatment of ARDS in adults; a meta-analysis' by Peter, John, Graham, Moran,George and Bersten that showed no convincing treatment effect of steroids in the condition. However the authors also state that 'meta analysis based on a small number of trials with sparse data must be cognisant of limitations in estimation of treatment effects'. You don't see people saying that about trials of homeopathic medicines do you? I wonder why not.<br /><br /><br />FINALLY:<br />I must state that I don’t believe that doctors should be coerced into EXCLUSIVELY using approaches which are evidence-based. I didn’t go to medical school to become a robot. Successful medical practice is an art in which the practitioner uses the tools that suit his or her particular talents and personality. Of course in life threatening situations or where there is risk of morbidity, the standard proven protocols MUST be used. Doctors must be free to practice the art of medicine according to their own consciences. Of course if patients come to grief because of this the doctors can and will be held to account. But selectively to attack and insult a group of doctors (in this case those that use homeopathy in their practices both privately and on the NHS) on the basis that homeopathy is not evidence based while knowing full well that much of conventional medicine similarly lacks the type of evidence base they self righteously scream for in homoepathy, is in my opinion both duplicitous and pernicious.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com2tag:blogger.com,1999:blog-10460964.post-32968388741211078112008-05-08T12:13:00.007+01:002008-05-08T12:36:15.548+01:00Evidence-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. <br /><br />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: <span style="font-style:italic;">Qui tacet, consentit</span> and will assume that his silence gives consent to what I’ve said.<br /><br />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.<br /><br />HISTORICAL:<br />1. May 25, 2006. Thirteen eminent British scientists and physicians including Edzard Ernst and Michael Baum write an <a href="http://www.homeowatch.org/news/baum.html">open letter </a>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.<br /><br />2. Consequences of this letter: <br /><br />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 <span style="font-style:italic;">under the present system</span> 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.<br /><br />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.<br /><br /><br />I don’t think there can be much dispute about the above so let me give my reaction:<br /><br />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 Naïve 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:<br /><br />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.<br /><br />Want some examples? With pleasure… Show me the ‘solid evidence’ for the following:<br /><br />1. The use of drugs such as Prozac and Ritalin for Attention Deficit Disorder (ADD)<br />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)<br />3. The use of SSRIs for depression – a treatment that costs the NHS hundreds of millions of pounds a year and yet a <a href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0050045&ct=1">recent study</a> 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?<br /><br />And those three are just for starters… I will be more than happy to give more examples here in the future.<br /><br /><br />I end with the following apologies:<br /><br />1. To GPs: I am so sorry to see your autonomy and clinical judgment eroded like this.<br />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.<br />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.<br />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.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-31384985125430559552008-05-01T13:46:00.005+01:002008-05-01T15:08:31.072+01:00Lying? Who exactly is lying?Okay I take back my 'surrender'. I don’t surrender to the ‘logic’ of Ernst and Singh anymore and vow to fight them on the beaches if necessary. Why this turnaround? Because I read an interview with the Professor Ernst in <span style="font-style:italic;">The New Scientist</span> on the 28th April 2008 that irritated me – to put it euphemistically.<br /><br />When asked to explain the ‘huge popularity’ of alternative medicine: Ernst replied: ‘…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 the triumph of advertising over rationality:’ Okay Prof – you’ve indirectly accused me of lying and if theres is one thing I cannot abide it's being accused of lying. By all means call me ignorant, naïve, gullible, stupid, ‘new age’, complementary, alternative, homeopathic, idealistic or weird – but how dare you accuse me of lying?<br /><br />I have met hundreds if not thousands of homeopaths in my career. Some have indeed believed in some strange things, some have been very naive indeed in my opinion, but I have never met a homeopath whom I thought was lying to his/her patients. They may have said things to patients that <span style="font-style:italic;">Ernst</span> thinks is untrue but that is very different from lying which is the deliberately not telling the truth. If it is just a matter of your English not being up to scratch, Prof Ernst, just let me know and I'll take back what I say here.<br /><br />TO: ‘often fail to explain what the evidence shows and does not show’<br />I SAY: How often does any doctor spontaneously and without being asked ‘explain’ the <span style="font-style:italic;">evidence</span> behind any course of action? Ernst is fully aware that many drugs and even surgical techniques in orthodox medicine are <span style="font-style:italic;">not </span>evidence based. Doctors (unlike lawyers) don’t discuss ‘evidence’ with patients unless specifically asked. To use this to support an accusation of lying is disingenuous to say the least.<br /><br />TO: ‘the triumph of advertising over rationality’<br />I SAY: This clumsy rephrasing of Oscar Wilde’s witty description of second marriages as the ‘triumph of hope over experience’ is as ridiculous and unfair criticism of alternative medicine as I have ever seen in print because:<br /><br />Advertising of CAM is mild and reasonable compared to advertising of orthodox drugs. Has Ernst ever seen how drugs are advertised on TV and in newspapers or magazines? Apparently he hasn’t seen the idiotic green arrows showing how apparently drugs reach the throat, head etc. not to mention other puerile and anatomically incorrect graphic representations of how drugs apparently work. Which of course bears no resemblance to what they actually do physiologically. To accuse CAM practitioners of using advertising to ‘triumph over rationality’ is not even worthy of being called a sick joke. <br /><br /><br />Homeopathy, one of Ernst and Singh’s least favourite forms of CAM has been attacked and insulted since its inception in the UK in the early 19th century. Frederick Foster Hervey Quin, the man who brought homeopathy to England, became the first of a sequence of Royal homeopathic physicians persisting to the present day and built the Royal London Homeopathic Hospital, once applied to join the Athenaeum Club. When his nomination was considered a certain Dr. Paris, president of the Royal College of Surgeons said: “A pretty pass we have come to when quacks and adventurers are proposed as members of this club.” The following day, the good Dr Paris was challenged either to retract his comments in writing or justify his language with pistols at 12 paces. He wrote the apology.<br /><br />Now I think being accused of lying is even worse than being called an ‘adventurer’ or ‘quack’ so I hereby challenge Professor Ernst to a duel, albeit with words rather than pistols - but that is only for legal reasons ;-) where he can attempt to justify calling homeopathic doctors liars. Alternatively he can retract this outrageous slur. Otherwise - bring it on!Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-20634523075251708892008-04-20T13:56:00.010+01:002008-04-22T18:32:48.349+01:00Unconditional Surrender to Singh and ErnstOkay, finally I give up. It’s <span style="font-weight: bold;">Unconditional Surrender </span>for me. I will not harp on anymore about: the dangers of separating the practitioner from his tools; self-induced healing; the <span style="font-style: italic;">art </span>of medicine, the use of the self in therapy and the healing qualities of holistic doctors that cannot simply be emulated by purely scientific doctors not trained in any particular holistic tool. Why do I give up now?<br /><br />Because a book has just been published that has forced me to lay down all arms, abandon my holistic principles and worship <span style="font-style: italic;">exclusively</span> at the philanthropic Church of Big Pharma and the philosophical school of Naive Realism.<br /><br />This book is called <span style="font-style: italic;">Trick or treatment? Alternative Medicine on Trial</span> by Simon Singh and Edzard Ernst. For a mere £16.99 you can have any illusions you once had about holistic medicine kicked into touch by a journalist and doctor who totally have your interests at heart and conduct a Kafkaesque trial of Altenative Medicine on behalf of the public good. Although many other doctors have tried to disparage homeopathy and holistic medicine in the pasts, these two have put themselves at a much higher level to reveal the truth, the absolute truth and nothing but the truth and therefore are justified in putting the boot into anything Big Pharma (and shareholders of course) would not approve of. This is <span style="font-style: italic;">not</span> to say they <span style="font-style: italic;">work </span>for Big Pharma in any way. I really and sincerly don't think they do. BUT the pharmaceutical industry must be earnestly praising Ernst and singing the praises of Singh on a daily basis. In their view far too much money (that rightfully belongs to them and their shareholders) has been squandered on useless treatments that the public only <span style="font-style: italic;">thinks</span> were useful.<br /><br />When, as a young doctor, I first began to study homeopathy in 1982 at the Royal London Homeopathic Hospital I was deeply moved by the humane and kindly doctors working there and the many patients who had tried everything before coming there and now had finally benefited from homeopathic treatment. Now Singh and Ernst have convinced me that we were all deluded. Me, the patients and the homeopathic doctors. All improvements were imagined… But I really was inspired and thought it true at the time. Why was I so <span style="font-style: italic;">gullible</span>?<br /><br />I do take issue with one thing though. Singh and Ernst are quoted in The Times as saying: ‘In fact the best way to exploit the placebo effect is to lie excessively to make the pill seem extra-special, by using statements such as “this remedy has been imported from Timbuktu etc.”’ This is simply wrong. I have met hundreds of homeopathic doctors and heard many say many strange things – but <span style="font-style: italic;">never</span> have I thought they were lying. The best way to get patients better with medicines that Ernst and Singh think are placebo is for the gullible, inane and misguided prescribers like myself earnestly to BELIEVE that these useless remedies actually help their patients. Faith, belief and confidence in what you are doing are much more effective at getting results than lying. I am not a liar but maybe this book will convince me that I have been wrong all these years about homeopathy – so I will now make a formal statement on behalf of myself and all homeopaths who think along similar lines to me.<br /><br />I hereby state that Edzard Ernst and Simon Singh are honorable men<span style="font-style: italic;"> </span>and have convinced me to make the following statement:<br /><br />1. Homeopathy is worthless because even though patients do remarkably well after consulting us homeopathic doctors, scientific studies have convinced authorities that these improvements are not happening because of the remedies taken. Any other possible reason for the patients' improvement is not scientific and must also therefore be rejected.<br /><br />2. The people of Britain are ignorant of medical science and obviously cannot be trusted to make a decision about whether homeopathy should retain the small place it has in the NHS. Referendums on this issue would be pointless. As Winston Churchill correctly pointed out: 'The greatest argument against democracy is a five minute conversation with the average voter'.<br /><br />3. In this era of what has rudely, ignorantly and unfairly pejoratively been termed 'The Nanny State', informed authorities, be they qualified in medicine or not, will decide whether we the gullible public who pay for the NHS get homeopathy on our democratic NHS - or not. This is common sense and those that unpatriotically refer to it as 'Stalinism' should have severe action taken against them - including detention without trial.<br /><br />4. Trials showing that homeopathy works on animals should be discounted because animals don't respond to placebo and Ernst, Singh and other members of the Naive Realism school of philosophy of science can see no other way in which homeopathy could have a clinical effect.<br /><br />5. In the footsteps of Galileo, we retract whatever statements we have previously and erroneously stated about homeopathy being a useful medical adjunct to conventional medicine and apologise unequivocally for any inconvenience to the State, the public and especially to school of Naive Realism for our previous actions.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-3907174316770416812008-04-13T13:11:00.002+01:002008-04-13T13:26:45.708+01:00DEMOCRACY, HOMEOPATHY AND THE PLACEBO EFFECTOkay, let’s get a few things straight about so called ‘alternative’ holistic medical approaches that are now being vilified because scientific trials have apparently finally shown that they are no better than placebo.<br /><br />The first therapy seemingly chosen to be wiped out for the good of the public in the killing fields of apparently rational scientific evidence-based medicine is Homeopathy.<br /><br />Homeopathy, because of the mystery about how it works is a natural target for those who want to destroy anything that doesn’t fit into their paradigm. Well okay not destroy, but make it unavailable on the NHS. Apparently only rational, proven, and evidence-based systems should be funded by the tax payer – like the Royal Family for example. Now don’t get me wrong – I am a royalist but I am also a medical doctor who uses homeopathy in his practice.<br /><br />Personally I don’t think that democracy should only fund things that are strictly scientific. If the people want a Royal Family and Homeopathy – then that’s good enough for me. A recent survey clearly shows that huge swathes of the international public trust and want homeopathy. But in England we have senior medical figures who are intent and working hard to make sure that the public do not get what they want. They must only get what these doctors think they should get. In other words the public is too stupid or too ill-informed to choose for itself when it comes to health and doctors. Democracy or nanny state? You tell me.<br /><br />Okay let’s look at the issue from the side of the sceptics.<br /><br />THE SCEPTICS SAY:<br />1. Multiple studies of trials of homeopathy show it to be no better at helping people than placebo.<br /><br />2. Although the amount of money spent by the NHS on homeopathic hospitals is small it should be removed and those wanting homeopathy should pay for it themselves – because homeopathy has not passed the test of science.<br /><br />3. Abolishing homeopathy on the NHS would make a little money available for other treatments and better still we can use the Royal London Hospital for ‘real medicine’.<br /><br /><br />ANSWERING THE SCEPTICS:<br />1. Homeopathic doctors dispute the ‘fact’ that homeopathy has been found to be no better than placebo and interpret the analysis of studies as being positive for homeopathy.<br /><br />2. The amount of money spent on homeopathy on the NHS is miniscule and offers good value for the NHS as homeopathic NHS doctors often see and help the most difficult cases including many cases that have been told that they cannot be helped by orthodox medicine.<br /><br />4. Pushing homeopathy out of the homeopathic hospitals of the UK is an act of grand larceny in my opinion. These hospitals were funded and built by benefactors of homeopathy. At the advent of the NHS they were invited to become part of the NHS and did so obviously on the understanding that they would remain homeopathic hospitals.<br /><br />I opine simply that if the public wants homeopathy it should have it. And there is good reason for this: It does not matter how homeopathy works only that it works. I believe that it works completely independent of the placebo effect but let me for a moment ‘assume’ the opponents of homeopathy are correct and that it only works by placebo effect.<br /><br />Remember I said ‘assume’. This is not what I believe but I want to make the case that even if they think their belief system is the absolute truth, the opponents of homeopathy are doing the British public a terrible disservice.<br /><br />SO THE CRITICS OF HOMEOPATHY SAY:<br />1. Homeopathy works no better than placebo<br />2. Therefore it should not be available on the NHS.<br /><br />AND I ANSWER:<br />1. I don’t agree but let’s ‘assume’ this to be true.<br />2. No! no! no! this would be a terrible thing to do even if 1. is proved a million times to be true.<br /><br />WHY WOULD THIS BE A TERRIBLE THING?<br />Because people with very hard-to-treat problems are benefiting from seeing homeopathic doctors at NHS homeopathic hospitals. It does not matter how they are being helped, whether it by homeopathic medicine, hypnosis, suggestion or love. The fact is that they are being helped and they want homeopathic medicine to be available on the NHS. That is democracy.<br /><br />AND FINALLY…<br />The crucial point is that if homeopathy is removed from the NHS what will take it’s place to help the difficult cases who were only helped by homeopaths because of the ‘placebo effect’, self-induced healing, hypnosis, suggestion or call it what you want. The answer: Nothing. <span style="font-weight: bold;"><a href="http://www.homeowatch.org/news/baum.html">Ernst and his anti-homeopathic gang</a> </span>sometimes pay lip service to the ‘bedside manner’ of homeopaths and say that NHS doctor could ‘learn something’ from homeopathic doctors – and what a pity that NHS GPs don’t have time to do this. What? - no time to get patients better by talking and being kind to them? That’s a pity isn’t it?<br /><br />The fact is that they will neither ‘learn’ anything from homeopaths nor ever learn any method of helping people actually get better from illnesses by just talking to them. This is because of a simple fact which is the main point of today’s blog.<br /><br />I believe that homeopathy works independent of the placebo effect. However IF a doctor using homeopathy or any form of ‘alternative medicine’ accused of only working by suggestion, does not himself or herself believe that it works in its own right, then that system becomes a con and a hoax in the hands of that practitioner. And most patients can smell the insincerity of a hoax or a con – whatever the condescending (to the public who want homeopathy) and patronising academic opponents of homeopathy think. The fact is that the majority of patients sense their homeopaths to be kind people who really believe in what they are doing.<br /><br />So Homeopathy should not be removed from the NHS even if it is thought only to work through the placebo effect. Those who would remove it have no plans for replacing it with anything else that will initiate self-induced healing. In striving to remove Homeopathy from the NHS it is not the British public they are thinking of protecting – it is their arrogantly held sense of knowing that only their medical paradigm is valid. The fact that eminent philosopher/doctors such as <a style="font-weight: bold;" href="http://en.wikipedia.org/wiki/Karl_Jaspers">Karl Jaspers</a> and <a href="http://www.wholeperson.co.uk"><span style="font-weight: bold; color: rgb(51, 51, 255);">E.K. Ledermann</span></a> described quite different holistic paradigms of medical approach is of no interest to them. Lederman correctly describes their limited and limiting philosophy of medicine as one of <span style="font-style: italic;">naïve realism.</span><br /><br />Let the people of Britain, not experts of any kind, decide what types of medical care they get. That would be democracy.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-16195015089804685372008-04-01T12:23:00.003+01:002008-04-01T12:29:45.180+01:00Alternative Therapies: MeditationLast night Kathy Sykes explored the ‘alternative therapy’ meditation. Just to categorise this ancient psychological and physiological techniqe as ‘alternative’ seem somewhat ridiculous to me. Still, Kathy Sykes, somewhat straitjacketed by her self-applied label as 'scientist' admitted that regularly sitting quietly and doing nothing except observe her breathing benefited her whole day including her capacity to love. That she knew this before making the programme didn’t deter her from making expensive journeys around the world in search of proof.<br /><br />The facts regarding meditation and health are simple.<br /><br />1. Up to 50% of patients consulting a GP in England are suffering from conditions either caused or made worse by stress – FACT.<br />2. Meditation and relaxation techniques are good for reducing stress and preventing stress from building up in the first place – FACT.<br />3. Therefore meditation is a useful treatment for many patients with many problems – LOGICAL CONCLUSION.<br /><br /><br />But the <span style="font-style: italic;">scientific</span> Ms. Sykes needs scientific proof and for that we must be taken around the world for her to interview meditators, the ‘happiest man in the world’, see machines that show brain changes due to meditation etc. And finally she concluded that it would be wonderful if meditation could be shown to make people happier.<br /><br />But everyone knows that meditation and relaxation makes people happier and very probably much healthier. As the 19th century poet Longfellow put it:<br /><br /><span style="font-style: italic;">Joy, temperance, and repose,</span><br /><span style="font-style: italic;">Slam the door on the doctor's nose.</span><br /><br />I don’t know if it’s merely a symptom of the general dumbing down of our society and particularly that of the BBC, but I found Kathy Sykes’s tone throughout this series very much like that of a primary school teacher slowly and carefully explaining things to her 10 and 11 year old pupils. Of course these explanations were totally from a deterministic, mechanistic view of medicine and the universe. Philosophy of medicine is not quite as simple as that as pioneers of holistic philosophy in medicine such as <a href="http://www.wholepersonmedicine.co.uk">Dr. E.K.Ledermann</a>, have pointed out.<br /><br />We live in a world where NAIVE REALISM RULES! and no it's not okay. This series on alternative medicine taught me very little except remind me to do my Autogenic Therapy meditation regularly.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-59722738358317450492008-03-25T11:33:00.002+00:002008-03-25T12:18:12.786+00:00Reflexology on BBC2 last nightAlternative Therapies BBC2 Monday 24/3/2008<br /><br />In an appallingly crafted hour of 'investigation' into whether reflexology works Professor Kathy Sykes interviews various reflexologists, their patients and eminent scientists. This was very bad TV because you could see the bias from the beginning and the conclusion is telescoped well in advance.<br /><br />Of course an anatomist was wheeled out to show everyone what they already knew: there is no anatomical connection between the soles of the feet and specific areas parts of those soles are connected to according to reflexology. No mention was made of parallels with acupuncture and it's subtle meridians - not fully accepted by medical science but used by the Chinese for a mere 5000 years or so. These meridians are the most plausible explanation for the reflexology effect.<br /><br />Trials showing that reflexology did indeed make patients feel better but no more so than head massage were described to show that it basically is all in the patients' minds. It's okay for others to feel better by being duped but this is not for people like Prof Sykes who think their highly personal mechanistic and deterministic view of the universe is common sense and people who disagree are deluding themselves.<br /><br />I'm used to this low brow fare from the BBC these days - so why am I discussing this?<br />Because this programme by implication expressed a very damaging view of what has been called the 'placebo effect' And as in previous blogs - I have said that it is terribly poorly understood. And so it proved to be last night by the prof.<br /><br />Kathy Sykes came to the conclusion (which we saw coming all through the programme) that it was the ambience, the kindness and most of all the touch that did the healing - not the reflexology. Something was said about touch alleviating the 'emotional burden' of the illness and about GP's not having enough time to do this.<br />Not enough time? She might have added not enough inclination and not enough training but more important than this is a simple point: <span style="font-weight: bold;">These holistic/alternative approaches do not work if the practitioner does not believe in what s/he is doing. </span>A GP who touches his patient on the shoulder reassuringly will get better results than one who doesn't but he won't get better results from this than a reflexologist who sincerely believes that what he is doing works beyond the healing effect of touch.<br /><br />Personally I believe there is more to reflexology than just touch. I believe it works in its own right but also because of the whole healing set up - which would not be there if the reflexologist did not believe in the healing effect of the work. There are other systems of medicine where one part of the body has a map on it that represents other parts. These include auricular acupuncture and iridology both of whom have many adherents including medical doctors. Almost every cell in the body has the DNA to clone the whole body again. Thus it's not surprising to me that one part of the body could have some subtle knowledge about another part. No mention of this of course.<br /><br />The only part of the programme of value was watching Prof Sykes admitting that going to a 'cuddle club' in LA really moved her and made her feel better. Interestingly as she said this, she was unable to look at the camera. Heaven help her if the viewer saw tears in the scientist's eyes as she felt better for reasons her central nervous system could not fathom.<br /><br />This was a programme that probably hurt some people who have benefited from reflexology whatever its operating mechanism. It certainly wasn't good for reflexologists who in my opinion do a lot of good and many of my patients have reported very good results from going to see them. And there is the rub. If patients feel that reflexology does them good then so be it. Let them see reflexologists. But no - in an age of ugly scientism we have people like Prof Sykes on TV there to rid us all of our 'illusions'. No surprise to see 'quackbuster' Raymond Tallis on the programme but no doctor who advocates an holistic approach in medicine. Boy do I love paying the license fee!<br /><br />Science Rules okay? No it's not okay. Medicine is an art as well as a science as every doctor knows. And reflexologists practise the true art of healing a lot better than most doctors, not that I'd go to one if I had appendicitis of course. We doctors can learn from this and what we should learn is something about the art of medicine - not condescendingly diminish people who are genuinely helping others, say it's all in the mind and oh what a pity that NHS GPs don't have the time to get people better using touch, care and love.Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-22174681868943603602008-03-03T12:05:00.005+00:002008-03-03T12:25:50.601+00:00Placebos, self-induced healing, Homeopathy and Anti-depressants<span style="font-weight: bold;font-family:verdana;" >Placebos, self-induced healing, Homeopathy and Anti-depressants</span><br /><br /><span style="font-style: italic;font-family:verdana;" >Declaration of Interest: I am a medical doctor who has used homeopathic medicine for over 25 years and believe that homeopathy has a clinical effect independent of the placebo effect.</span><br /><br /><span style="font-family:verdana;">As the world of psychiatric medicine squirms uncomfortably with the publication of a <a href="http://www.pharmatimes.com/WorldNews/article.aspx?id=12947">significant meta-analysis </a>showing that anti-depressants are unlikely to work better than placebo, it is perhaps time to consider the profound implications of this study. We are not simply talking about a single drug that has been found not to work, we are talking about an industry that gratefully accepts an estimated £380 million pounds of tax payers’ money through the NHS per year in the UK alone. This is an amount that makes the highly contraversial cost of NHS homeopathy look exceedingly trivial.</span><br /><br /><span style="font-family:verdana;">£380 million a year for drugs that ‘don’t work’? Well that is not quite true. The study did not show that the anti-depressants don’t help the people that take them; it showed that that people taking anti-depressants did not do any better than people who thought they were taking drugs for depression and in this there is a world of difference. Stated simply: Patients taking anti-depressants and patients taking dummy tablets both felt better.</span><br /><br /><span style="font-family:verdana;">To me it is clear that both sets of patients got better for one simple reason. They both thought that the drugs would to them good. Why did they think this? Because in the consultation with the doctor or psychiatrist who prescribed the drugs they were convinced that the pills would help them. This was made possible by the fact that the doctors prescribing the anti-depressants were convinced that they would help their patients and this conviction was passed on to the patients resulting in the so-called ‘placebo effect’. I don’t like the term ‘placebo effect’ which feels contemptuous and patronising to patients. It is fairer to say that these patients healed themselves because they had confidence in their medication. I don’t believe that they were conned at all. Their doctors believed the drugs would work and certainly were not ‘conning’ anyone. If there is any con here it can only be that the doctors were conned somewhere along the line – whether this be by over-enthusiastic advertising by Big Pharma, or that Big Pharma failed to publish unfavourable data. The drugs and placebo would not have had such a good clinical effect if doctors knew they were giving physiologically ineffective placebos to their patients. Inauthentic doctoring has a bad smell easily detected by patients and tends to be anti-therapeutic. Thus the big question is why did so many depressed patients feel better on placebo or ineffective medications?</span><br /><br /><span style="font-family:verdana;">The answer is surely in the body-mind connection which holistic practitioners have been ‘going on’ about for decades, if not centuries. There is art in medicine and this art is in the consultation. The findings of this study show just how clinically powerful the consultation can be – even in the long term.</span><br /><br /><span style="font-family:verdana;">In the light of this, let us revisit the controversy surrounding patients receiving homeopathic medicine on the NHS. As I have stated the amount of money this costs the tax payer is trivial compared to the costs of the anti-depressants apparently now shown to be no better than placebo but such financial considerations are not my main point. Homeopathic medicine has been attacked by a <a href="http://www.blogger.com/www.senseaboutscience.org.uk/pdf/Baum%20letter.pdf">group of doctors</a> who say that it should not be funded by the NHS because although it clearly helps patients, it performs no better than placebo. I disagree with this as stated clearly in my declaration of interest at the start of this essay. However let me pretend for a moment that these expert doctors are correct and that homeopathic doctors are only getting results because of their bedside manner and the belief of both them and their patients that homeopathy has a clinical effect. The idea that homeopathy is a ‘con’ is ridiculous if you at least accept that homeopathic doctors <span style="font-style: italic;">believe</span> that their medicines have a clinical effect – a necessary condition to provide an atmosphere of authenticity in the consulting room which is essential for getting results through ‘suggestion’.</span><br /><br /><span style="font-family:verdana;">If we compare homeopathy to these anti-depressants (again as viewed by those who believe that homeopathy only works through suggestion) we see two groups of patients both getting better due to the ‘placebo effect’ or self-induced healing. However the homeopathic patients apparently received placebo while the other group definitely receive drugs that act on the chemistry of the brain. Yet it is only the prescribers of the non-chemical so-called placebos who are being told that they should not be allowed to treat patients on the NHS. This is clearly a travesty.</span><br /><br /><span style="font-family:verdana;">As stated above, I believe that homeopathy works beyond the placebo effect but I say this to those who ridicule it because they believe it is ‘no better than placebo’: Homeopathy is not a ‘con’ because the thousands of medically qualified doctors practising it <span style="font-style: italic;">do </span>believe that it is clinically effective and would not get results or bother to spend many years studying it if they did not believe in its clinically efficacity. I believe my patients get better because homeopathic medication works. To those who think that is only because I believe this that my patients get better I would say the following: How do <span style="font-style: italic;">you</span> suggest that doctors get their patients better by getting them to believe that their health will improve? Prof. Ernst, one of homeopathy’s most vociferous detractors has <a href="http://www.blogger.com/www.pulsetoday.co.uk/story.asp?storycode=4117018">stated:</a></span><br /><br />If certain practitioners such as homeopaths are good at maximising placebo effects, why not learn how to do it? Why not maximise placebo effects when prescribing genuinely effective treatments? If we start systematically investigating how to achieve this, we are likely to rediscover the value of good bedside manners, good therapeutic relationships and of seeing patients as whole individuals.Then patients might no longer feel the need to consult homeopaths in the first place.<br /><br /><span style="font-family:verdana;">I find this statement incredible and naive. When will this ‘systematic investigation’ begin? And much more importantly – why try to prevent patients getting this sort of healing before doctors are educated in some sort of new paradigm of medicine at which he vaguely hints. I find it deeply disturbing that Ernst and his colleagues would choose to attack homeopathy instead of working very hard indeed on this ‘systematic investigation’ in search of what they clearly believe is the healing power of the homeopathic consultation alone and then finding a way of teaching doctors to utilise it. Until then would it not be more logical to avoid attacking homeopathic doctors and campaigning against NHS homeopathy? When a new paradigm of medicine emerges and patients are helped to heal themselves by some new system of applying mind-body medicine, <span style="font-style: italic;">that</span> would be a logical time for them (if not me) to revisit the necessity of homeopathy. Attacks on homeopathic medicine before that time can be considered hypocritical, disingenuous and clearly not in the interest of any patients whatsoever.</span>Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-14249102864094406382007-12-16T15:51:00.000+00:002007-12-17T09:31:16.360+00:00A Witchhunt on Homeopathy<p class="MsoNormal"><b style=""><span style="font-family:Verdana;">THE HOMEOPATHIC WITCHUNT<o:p></o:p></span></b></p> <p class="MsoNormal"><b style=""><span style="font-family:Verdana;"><o:p> </o:p></span></b></p> <p class="MsoNormal"><b style=""><span style="font-family:Verdana;">Attacks on Homeopathy</span></b><span style="font-family:Verdana;"><o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;">Ever since it inception in 1810, <a href="http://en.wikipedia.org/wiki/Homeopathy">homeopathic medicine </a>has endured periods where it has been ridiculed, insulted and generally lambasted. Such periods tend to alternate with times in which it enjoys widespread support. At the moment it is enduring a sustained attack in the media generally supported by eminent scientists whose rhetoric treats homeopathy’s practitioners and supporters with total contempt. The question that needs to be asked is:Why is this happening now?<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;"><o:p> </o:p></span></p> <p class="MsoNormal"><b style=""><span style="font-family:Verdana;">Determinism, Mechanism, Dawkins and God<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-family:Verdana;">This is no place to have a discussion about philosophy of science. Suffice to say that we (in the West) live in a time of determinism, mechanistic thinking and naïve realism in which anything intangible or occult, those things that cannot be touched or seen, are said not to exist. Those who believe in such phenomena are fair game for attack. Richard Dawkins, author of <a href="http://richarddawkins.net/godDelusion"><i style="">The God Delusion</i></a> is one of the attackers. What is remarkable about Dawkins is simply why he thinks he is saying anything new. Believers in things that cannot be grasped by the senses have always been attacked – at least going back to the Enlightenment. Having pronounced his judgment on God, Dawkins goes on to attack homeopathy. As a homeopathic physician, all I can say is that at least we are in good company! <o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;"><o:p> </o:p></span></p> <p class="MsoNormal"><b style=""><span style="font-family:Verdana;">The Enlightenment and its Critics<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-family:Verdana;">In my view <a href="http://en.wikipedia.org/wiki/Age_of_Enlightenment">the Enlightenment</a> was enlightening but not <i style="">that </i>enlightening. Criticism of many aspects of it appears in many parts of Jonathan Swift’s <i style="">Gulliver’s Travels</i>. People like Dawkins would have found themselves satirically attacked by Swift. Alas we have no Swift today, no John Kennedy Toole, no Bill Hicks and particularly no Lenny Bruce to say that everywhere ‘people are leaving the temples and returning to God’.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;"><o:p> </o:p></span></p> <p class="MsoNormal"><b style=""><span style="font-family:Verdana;">The Professors that hit below the belt<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-family:Verdana;">So in this time of naïve realism, a gang of mainly retired doctors have decided to mount a new form of attack on homeopathy. In <a href="http://www.homeowatch.org/news/baum.html">a letter </a>to Patient Care Trusts (PCTs) they pompously dismissed homeopathy and urged all PCTs to prevent GPs in their areas from referring patients to medical qualified homeopathic doctors working at NHS homeopathic hospitals. In other words they <i style="">urged bureaucratic non-doctors in positions of power to prevent doctors referring patients to other doctors! </i>This is the pernicious point that none of the media coverage picked up on. Baum, Ernst, Tallis and fellow enlightened luminaries are entitled to their opinion. They are entitled to form an organisation to perpetrate their view. But in my opinion to seek to influence non-medical bureaucracy to prevent doctors referring patients to other doctors is a cynical, pernicious and underhand exploitation of one of the worst aspects of the ‘nanny state.’ This position taken by these eminent professors generated a media storm in which newspapers such as <span style="font-style: italic;">The Guardian</span> (in particular articles by the ranting radical rationalist, Ben Goldacre) seemed to delight in giving space to. But why do I use the word pernicious? Because there was an honourable course of action that could have been taken by these professorial doctors and scientists that would have been more academically honest. They could have written to every GP in the country and exhorted them not to support homeopathy in any way. The could have written a joint article in the British Medical Journal or any journal read by doctors with the same message. But I think they feared that doctors would still ‘irrationally’ support homeopathy by sending patients to other homeopathic doctors. So they had to go above the heads of GPs and try to win the battle at a bureaucratic level instead. This in my view was underhand and pernicious and nobody seems to have picked up on this.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;"><o:p> </o:p></span></p> <p class="MsoNormal"><b style=""><span style="font-family:Verdana;">The Truth about Homeopathy and NHS Homeopathic Hospitals <o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-family:Verdana;">The simple fact is that since 1948 when homeopathic hospitals in <st1:city st="on">London</st1:city>, Liverpool, <st1:city st="on">Manchester</st1:city>, Tonbridge Wells and <st1:city st="on"><st1:place st="on">Bristol</st1:place></st1:city> chose to become part of the NHS, hundreds of thousands of patients have been help by going to those hospitals. Many of these patients are ‘difficult cases’ that have not been able to be helped by conventional medicine. How exactly they were helped may or may not be a moot point, but to claim as the government ‘advisor’ Sir David King claimed that homeopathy was of <a href="http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=500045&in_page_id=1774">no medical use whatsoever</a> and that it even put lives at risk. Such a comment of complete balderdash is unworthy of a knight, never mind a top scientist. Even homeopathy’s worst enemies do not claim that it is completely ineffective. They claim that it works by the placebo effect or suggestion, that homeopathic doctors get results because of their superior bedside manner or that they give patients more time. Why non-homeopathic doctors are unable to get similar results simply by ‘talking to patients’ remains a mystery. And if they say they haven’t got time to talk to patients and help them get better by doing so – then this is a tragedy for both patients and doctors. Analyses of trials of homeopathic medicines remain controversial. My personal opinion is that most meta-analyses show that homeopathic medicines do work over and above the placebo effect but nobody can doubt that patients benefit from seeing homeopathic doctors.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;">A significant minority of taxpayers want homeopathy to be available on the NHS. Over 200 MPs have signed an early day motion on their behalf. But the witchhunt continues. Let us hope that good old British common sense prevails here and homeopathy remains available on the NHS for those who want it. Patients who feel better after receiving homeopathic treatment are like any other patients who feel better after medical attention. Whether Sir David King or any of the enlightened professors who wrote to every PCT in the country understand exactly<span style="font-style: italic;"> how</span> these patients got better is simply not the point.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family:Verdana;"><o:p> </o:p></span></p>Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0tag:blogger.com,1999:blog-10460964.post-1107937935702214752004-11-30T08:32:00.000+00:002005-02-16T09:48:47.800+00:00# 106: On its way to England: The 1420 Calorie Hamburger! • Careful with Vitamin E • But eat plenty of Porridge • Oscillococcinum<div style="font-family:verdana;"><span style="color: rgb(0, 0, 0);"><b>On its way to England: The 1420 Calorie Hamburger!<br /></b>Yes, dear readers, it's here - the meal, called by a nutritionist 'a heart attack in a bun'.<i> Hardees</i>, the fast food chain in the US who have created this 107g of fat in a sandwich known as a 'Monster Thickburger' make no apologies for the health effects of this £3 hamburger comprising two big chunks of processed beef, four rashers of bacon and plenty of cheese and mayonnaise. A spokesman for the company, describing this mass of saturated animal fat as a 'monument to decadence', made the insightful comment that this was no 'burger for tree-huggers'. The Centre for Science in the Public Interest was less complimentary, saying: 'If the old Thickburger was food porn' the Monster Thickburger is the fast-food equivalent of a snuff-movie.' [sic]. Go on then - supersize me. French fries and a chocolate malted milkshake on the side. You only live once, you know.<br /><br /></span></div> <div style="font-family:verdana;"><span style="color: rgb(0, 0, 0);"><b>Careful with Vitamin E<br /></b>A lot of people take supplements of Vitamin E in high doses for various reasons including menopausal symptoms and raising you libido. Actually the vitamin was shown to raise the sex drive of rats but never proved to have the same effect on humans. This hasn't deterred some people - after all we are living in a rat race aren't we? Anyway, the men in white coats at the prestigious Johns Hopkin University School of Medicine have conducted a study that showed that taking too much of this vitamin can increase your risk of an early death by as much as 10%. Let's be clear about this vitamin then. The daily requirement is 10 iu (international units). Multivitamin tablets contain up to 60 iu and are completely safe. However pure Vitamin E supplement typically contain 400, 800 or even more iu and its these high dose supplements of the vitamin that are being questioned with regard to their health value, especially in the over 60s. As always I recommend one multivitamin a day. If you think you should be taking more than that you should discuss it with your doctor.<br /><br /></span></div> <div style="font-family:verdana;"><span style="color: rgb(0, 0, 0);"><b>But eat plenty of Porridge:<br /></b>The Daily Mail extolled the benefits of porridge giving 6 reasons to start winter days with a steaming bowl of oats.<br /></span> <ol> <li><span style="color: rgb(0, 0, 0);">It helps hangovers by absorbing toxins, neutralising acid and keeping the bowels moving.</span></li> <li><span style="color: rgb(0, 0, 0);">It fights heart disease. Porridge contains avenanthramides that act against fat being laid down in the arteries.</span></li> <li><span style="color: rgb(0, 0, 0);">It boosts energy by releasing sugar gradually until lunch.</span></li> <li><span style="color: rgb(0, 0, 0);">It helps depression due to a high content of Vitamin B6 which boots our serotonin levels. In this way it acts as a 'natural Prozac' (Exercise does exactly the same thing and much more intensely.)</span></li> <li><span style="color: rgb(0, 0, 0);">It's high fibre content may help prevent cancer especially bowel cancer.</span></li> <li><span style="color: rgb(0, 0, 0);">It is rich in zinc (needed for a healthy immune system) and manganese which is good for the bones.</span></li> </ol> <span style="color: rgb(0, 0, 0);"><b>Homeopathic Tip of the Week:</b><span style="font-size:100%;"><i> Oscillococcinum<br /><br /></i></span></span></div> <div style="font-family:verdana;"><span style="color: rgb(0, 0, 0);">As winter approaches, the papers and magazines are full of articles on how to treat and prevent colds and 'flu. I will have more to say about this in future columns but for today let me mention the most famous French homeopathic remedy for viral infections. It's called<i> Oscillococcinum</i> and it is prescribed and used very frequently in France usually in strength 200K. This is an homeopathic remedy easily available over the counter at most French chemists. It's available over the counter here too, but you will need to buy or order it from a specialist homeopathic pharmacy.</span></div>Brian Kaplan, MDhttp://www.blogger.com/profile/17981503111116294462noreply@blogger.com0