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September 04, 2006


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One word: AARRRGG! One of the Science blogs mentioned "a pinata of stupid" earlier this month; seems apt in this case.

I seem to recall another facet of the 2005 study that puts a big hole in the homeopath argument, some of the patients included in the homeopathy trial as success stories were also still recieving conventional medical treatment at the same time as the homeopathy? So, no surprise they decided they felt better surely?

Anyone else heard about this or is my memory playing games with me?

I was interested in the mention of thalidomide: perhaps Ms Sturzaker ought to read up on its history.

In the UK, thalidomide was leapt upon by the Distillers' Company, who saw it as a safe way to enhance one's lifestyle. They weren't Big Pharma by any stretch of the imagination.

Early studies did show an increase in foetus resorbtion in rabbits (often a bad sign) and Sir George Somers, the only proper pharmacologist to work on the drug said that on the basis of the animal trials, he would have "thrown it out the window".

However, he was released from his contract and effectively gagged. Chemie Gruenenthal, the originators of the drug, backpedalled and denied any problems with thalidomide, but the evidence began to mount.

One Australian doctor, McBride, examined a phocomelic ("flipper-limbed") child, and the affliction was so rare he had to look it up in a Victorian textbook. In the next few weeks, he saw several more.

The fact is that,even as a flawed and dangerous drug, thalidomide's effects were so strong and evident that even Gruenenthal's big-shot lawyers couldn't explain them away, try as they might.

The science of drug administration and testing was tightened as a result, and Distillers dropped out of the "recreational drug" business. Heads rolled - contrast that with the "Big Pharma will cover it up!" mantra.

Contrast that with homeopathy. Hasn't changed for 200 years, and its effects, if any, are buried in the statistical noise floor. It never changes, because it doesn't have to: it doesn't do anything in the first place.

She does (implicitly) raise one important point: homeopaths often get good results through having lengthy, detailed consultations, while conventionally qualified doctors often '[dole] out take-two-aspirin-and-go-to-bed-early advice when the realities [are] far more serious.'

The pitch is queered. Conventional doctors need to be given more time for proper diagnoses - this would reduce the misdiagnoses and inappropriate treatments that result and which power the CM market as well as causing suffering.

(Bear in mind this is from the perspective of someone familiar with NHS care, where doctors are well-paid but given ridiculously small amounts of time per patient.)

"homeopaths often get good results" - they do?

Did I miss something?

Did I miss something?

I guess so. If homeopaths didn't get good results then homeopathy wouldn't be so popular... or so successful in non-placebo-controlled 'studies'. Note that I wrote through having lengthy, detailed consultations - the consultation process itself gives the treatments effect: treatment provided by a trained homeopath can constitute a very effective placebo (not all placebos are equal).

One reason this queers the pitch is that conventional patients do not benefit from the added fillip of the placebo effect (so it's 'effective placebo + ineffective treatment' against 'minimal placebo + effective treatment': 'effective placebo + effective treatment' would undoubtedly be more effective).

The second reason is that, as I said, doctors do not (get the chance to) discuss symptoms in as much depth as might be necessary. Patients are pelied upon to communicate their problems, but a patient visiting the doctor because of recent severe headaches (say) may not think to report the pains in his legs that he's been having for months - even though both might be due to the same parasite. The knowledge of a patient that a 'holistic' practitioner such as a homeopath or acupuncturist elicits would be invaluable to a conventional doctor.

The trouble is that people assume that any apparent improvement (usually just that they think they feel a bit better) is down to the tap-water "remedies" themselves, and some of the patients then eschew conventional treatments.

That's OK if we're just talking about the odd headache (I'm a firm believer in avoiding medication when not needed), but the worry is that cancer patients or people with other life-threatening diseases will waive much-needed mainstream treatment.

The homeopathy brigade like to slag off "allopathic" treatments, since, supposedly, they don't treat "the whole person". I therefore do not find it inconceivable that some homeopaths would never consider handing over their "valuable insights" to a doctor for nothing.

Another thing: do all homeopaths and acupuncturists carry out these detailed examinations? Do they understand the implications of certain symptoms? On learning of a pain in a certain part of the body, do they go to the trouble of pinning it down precisely, as a good doctor would?

Or is it a case of "Stomach pains? Just take some homeopathic arsenic"?

I'd bet that there are many homeopaths who only perfrom the most perfunctory survey, just as there are doctors who take the time to get to the root of their patients' problems.

It's as easy to generalise about one discipline as the other. However, consider when homeopathy came into being (18th century). Medicine as we understand it was non-existent then, but there was no sudden fall in death rate due to the introduction of Herr Hahnemann's marvellous discovery. If homeopathy was any good whatsoever, surely it would have had a noticeable effect on the huge mortality rates?

Yet the introduction of Salvarsan, penicillin, antisepsis, anaesthesia and other medical advances all had dramatic influences on public health. No arguments. You didn't have to believe in them for them to work.

At the beginning of the 20th century, average life expectancy in the developed world was, I believe, 38 years. Homeopathy had been around for over a century, but it didn't seem to do much, despite the supposed value of lengthy consultation.

Modern "allopathic" medicine has also been around for about a century, but the average life expectancy now is around 80 years.

You're preaching to the choir, unnamed one!

What got me thinking about the consulitation issue, though, is that I recently met up with an old friend who is now an acupuncturist. While I have - let's say - doubts about the efficacy of acupuncture per se, it became clear in conversation with him that an acupuncturist really does seek to learn about all that ails a patient rather than relying on the patient's first reported problem.

While he then goes on to give (probably) worthless treatment, the investment of time and effort he puts into learnng about his patients is laudable and is something that should be more common among doctors. My own experience of doctors has been that they tend not to be very rigorous about eliciting reports of symptoms - despite the fact that many diseases produce a wide array of symptoms, often not obviously related, without which a correct diagnosis may not be forthcoming.

This is about doctors' attitudes (yes, I know it's far from universal) combined with the problems of heavy patient loads. As an example, take this comment from the Endometriosis Association of Victoria:

...[F]or many women the road to diagnosis is long and drawn out. ...it took the women an average of four years to obtain a diagnosis after they had first reported their symptoms to a doctor... partly due to doctors' attitudes to the symptoms of endometriosis. Many doctors do not listen seriously to women's complaints about their symptoms ... and therefore do not consider that there may be a physical cause for such complaints.

It's easy to sneer at 'holistic' approaches (I do!), but doctors were to elicit that level of information and dedicate a similar amount of attention to diagnosis then conventional medicine might not have such a tarnished image.

Again, I am not endorsing altie treatments. I am exclusively pro-EBM - jst think that diagnosis it not what it could be, and that a greater investment of time in diagnosis would also reap health benefits through placebo and thus further boost the success rate of contemporary medicine.

PS Mortality rates are only a good measure of success in treating fatal illness. Quality of life measures are important in the treatment of chronic disease, and it's there that alti treatments often score well (see the study I referenced above) because it is there that the placebo effect can be most effective. Dont scorn the placebo!

Sorry, outeast, I forgot to sign the last post. I do agree that medicine would benefit if doctors had more time to spend with patients.

However, I also think that it's in the interests of alties' bank balances to find as much wrong with you as possible - the fad spa "doctors" of the 18th centuries certainly had the knack of finding all sorts of ailments you never knew you had.

I think a non-medically-qualified homeopath is likely to interpret every little ache and pain as a major problem, muddying the water and raising a plethora of possibly insignificant health issues.

It's not just length of consultation, but quality. I'd like to see some real evidence that the detailed quizzing of altie practitioners gets right to the nub of the patients' health problems.

Does anyone, ever, go to an altie practitioner who says, "You're perfectly healthy"?

I doubt it. I imagine if I went to a homeopath, he'd read equal importance into every least twinge, ache or discomfort,and I'd end up convinced that I was one step away from being a basket case.

So that's treating the "whole patient", is it?

Doctors can ask the right questions to zero in on a problem, not just scattergun every least pain. No,they can't spend all the time they'd probably want to on each patient, but at least they're likely to get to the crux of the matter.

The fact is, everyone may have a whole plethora of ailments at any one time, but if it was really affecting your quality of life, you wouldn't fail to bring it to the doctor's attention.

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