A urologist colleague commented recently that he was seeing more mumps affecting the testicles — a threat to fertility. Why? Because the perceived risk meant vaccinations were not given.
Part of the resistance to modern medicine may be the growing popularity of complimentary and alternative medicine. With the publication last week of a guide to alternative and complimentary therapies by the Prince of Wales’s foundation for Integrated Health, which was partially funded by the government, you might be forgiven for thinking that the status of such therapies has been officially established. To most orthodox doctors this is far from the case.
As the demand for such treatments increases, popularised by Prince Charles and glamorised by celebrity endorsements, is it right that taxpayers’ money should be spent on treatments for which there may be little evidence of efficacy?
And why is the threshold for evidence in complimentary medicine so different from that for conventional medicine? I could not introduce a new treatment and expect the NHS to fund it on the same kind of evidence given for chiropractic medicine — body manipulation. Yet Edzard Ernst, professor of complimentary medicine at Exeter University, concluded that “the documented benefits of chiropractic do not outweigh its risks”.
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There is no doubt that sometimes patients using alternative therapies or medicine experience an alteration in their symptoms. And if the role of a healthcare system is to relieve suffering, then anything that does not harm a patient while helping them must be good. But scepticism is not based on a desire to be seen to be “right”, but rather on concerns about mechanisms, safety and efficacy. Are changes in service provision being made on the basis of pressure groups and politics rather than evidence?
The fact that many people “swear by” alternative therapies is not necessarily a testament to the fact that they work. It is the ability to predict reliably what happens when you give a treatment to a patient that is important, not the fact that some patients have got better some of the time. Some patients will get better for reasons that are not fully understood. There are many conditions which have a relapsing and remitting course, and often chronic conditions such as these are not well understood.
So people can get better without any medical intervention at all and even in acute illness people survived before modern medicine — up to 60% survived pneumonia before antibiotics. How, therefore, can we be sure when you see your aromatherapist or chiropractor that it is their specific intervention that has helped?
What you certainly get from your therapist is something that is often not available from your GP — time. Empathy and touching and time to talk is well known to be therapeutic in itself.
But are alternative and complimentary therapies risk-free? The dangers are rarely discussed. Millions of people around the world have their neck manipulated for headaches and neck pain: how many were advised there have been associated deaths from strokes? One study in the UK in 2000 documented more than 30 severe neurological events following neck manipulation. Granted the complication is rare, but why in alternative medicine do you not have to explain the risks?
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There have been deaths reported after acupuncture and a highly effective Chinese herbal remedy for eczema was found to be full of steroids.
To anyone educated in mainstream science the mechanisms that are advanced for some alternative medicines just seem bizarre. Homeopathy is perhaps the best example. Taking placebo (sugar) tablets and spraying them with a dilution of a chemical produces homeopathic remedies. This “potency” is so dilute that the chances of a tablet retaining a molecule of the chemical are pretty remote. The water in the tablet is said to hold a memory of the chemical and this explains the effect. But how does it work — should we not try to find out rather that take verbatim the explanation of the German physician who invented it in the 18th century?
Understanding how diseases and treatments work is vital if healthcare is to progress. Modern life expectancy in the first world is a reflection of that understanding and the reason fewer children die from infectious diseases.
You cannot really progress in science unless you accept your theories might be wrong. There is a degree of bias in the media that seems to adopt a pro-alternative, anti-mainstream stance. A recent Radio 4 programme quoted a paper written in 1986 allegedly proving that homeopathy worked. Fifteen years later the NHS Centre for Dissemination and Reviews published a review saying that there was little evidence of homeopathy having any effect, but that review was not quoted. Why?
But it is not just the level of evidence required that bothers conventional doctors. It is also the fact that some complimentary therapies cloak themselves in a disguise of scientific respectability by using terms that have a definite meaning. Take for example the word enzyme. If you search the internet for enzyme therapies for cancer you will find hundreds of hits. I read last year of a naturopath who gave “enzymes” to a patient who died of breast cancer.
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I have no doubt of his good intentions but the fact remains that an enzyme cannot help a cancer patient in any biological way. An enzyme is a protein which will be broken down in the gut into its component amino acids, which when reassembled by the body might end up as part of the tumour itself. Why do they use such words so loosely?
This comes at a time when the orthodox medical profession is trying more than ever to ensure that patients understand what is wrong with them and how the treatment works, and is also ethically and professionally obliged to do so.
Meanwhile money is being thrown at “treatments” for which no credible understanding exists. There is nothing wrong per se in using such therapies; it is just that those of us on the more orthodox side of healthcare would like to see a more level playing field and a bit more intellectual rigour before we spend our hard-earned taxes on it.
Orthodox doctors are often accused of not having the right attitude toward complimentary medicine. Well, belief is a poor substitute for knowledge. Healthcare must involve wanting to find the truth or get as near as we can come to it. There is a moral obligation to do this, not least in terms of resource allocation but also so that vulnerable individuals such as cancer patients are not given false hope, or worse, have proper treatments delayed.
If the emperor has no clothes then the morally right and intellectually sensible thing to do, is to make sure that someone is employed who knows how to use a mirror.