Doses of Expedience

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Last week, we saw the “first national conference” of the College of Medicine – the organisation that has arisen from the ashes of Prince Charles’ Foundation for Integrated Health. The Foundation closed last year after it failed to provide its accounts after an employee ran off with all the money.

The College of Medicine appears to have perfected the art of ‘bait and switch’ within the world of quackery. Practitioners of pseudo-medicine have tried over the years to find acceptable names for what they do. Not so long again it was called alternative medicine- but that sounded a little confrontational to mainstream medicine. So then it became complementary medicine – but that sounded to subordinate to real medicine. The recent fashion has been to call it integrated medicine – a ‘best of both worlds’ approach where science could be freely mixed with pseudoscience.

So, the College drops any pretence of trying describe quackery in terms of its reality-based cousin and instead now pretends there is no difference. It says it wants to bring ‘patients, doctors, nurses and other professionals together, instead of separating then into tribes.’ It wants to ‘redefine good medicine’ and “renew the traditional values of service, commitment and compassion and creating a more holistic, patient-centred, preventative approach to healthcare.”

Hands up who wants to disagree with those wonderful aims?

The ‘About’ page of the College makes no mention of alternative medicine and instead talks about creating a new medical world that is ‘patient-centric’ and that,

must be rooted in its traditional values of vocation and public service, grounded in good science that takes account of the psychosocial as well as the biomedical, respect the people it deals with – and never, ever reduce patients to mere collections of organs, symptoms or disease.

And so there is the bait.

The switch comes as soon as you delve a little deeper. The founders of the College bear an uncanny resemblance to those that were heavily involved in defunct Prince Charles’ quack charity. And look a little deeper into the web site and you start to unravel what these platitudes actually mean.

The “definition of good medicine” is going to take place through a postmodernist assault on the very meaning of evidence based medicine. The sociologist Dr Michael Loughlin plans to use the College to promote a definition of evidence that will attack the established hierarchy of evidence used in Evidence Based Medicine.

Professor David Colquhoun warned us not to be deceived and that the College will have a “hidden agenda”.

And on the eve of their first conference, their true colours became apparent through a PR exercise to promote quackery within the NHS. Jenny Hope of the Daily Mail uncritically reports on the College’s attempt to push quackery for back pain sufferers. In a headline straight from the College, it is reported that “One in three GPs cannot offer ‘alternative’ therapies to patients suffering back pain”.

The reason for the bleating is that two years ago, Nice made a recommendation that the NHS should be prepared to spend public money on funding chiropractic and acupuncture for people with back pain. It caused uproar as the evidence base for treatments such as chiropractic is not strong. It appears to be no better than conventional advice such as taking paracetamol and exercise. The unfortunate truth is that not much can be done about back pain, but that given time it will resolve itself.

This is why quack treatments such as acupuncture and chiropractic appear to work. A patient may be frustrated that their doctor has not been active enough in solving the problem and visit a ‘spine specialist’. The chiropractor will x-ray the patient and provide a ‘course of therapy’ over many weeks. The inevitable will happen and the back pain will reduce, and the patient – or mark – may conclude that it was the quackery that was responsible.

This makes referring people to such practitioners as somewhat ethically dubious. The patient may benefit from the belief that ‘something is being done’, but they will be put in the grasp of a pseudoscientific doctrine that endorses unnecessary (and probably illegal) X-raying and unscrupulous practices such as long ‘wellness’ courses of treatment.

And of course the massive irony is that whereas the College warn us “never, ever reduce patients to mere collections of organs, symptoms or disease”, chiropractors, of course, are monomaniacs in reducing all illnesses to mysterious ‘subluxations’ of the spine. Acupuncturists, meanwhile, reduce patients to having ‘blocked chi’, or some other mumbo-jumbo, as the cause of disease. There is not much ‘good science’ or ‘respect for the patient’ to be found there.

But the College of Medicine is not really interested in such discussions. It just has a self-serving interest in promoting unscientific nonsense. Indeed, at the conference, the issue of doctors not referring to chiropractors was discussed. The session entitled “Can GPs make the NICE 2009 back pain guidelines work for patients in difficult financial times?” was hosted by Dr Susan Rankine, a GP from a Westminster practice, and two academics, David Peters (Professor of Wishful Thinking) and Dr Damien Ridge from the University of Westminster – or the University of Woominster as it is known due the fact that it is one of the last Universities that still insists on teaching medical pseudoscience. I would not bet on a balanced discussion.

What puzzles me is why some apparently rational people appear to support the College. The Private Eye columnist and rather-sensible-on-most-matters doctor, Phil Hammond, chaired the conference. I asked him on twitter if he was happy to support a conference sponsored by Nelsons which make teething granules for babies that are indistinguishable from fraud – they are homeopathic and contain nothing. They dupe parents into thinking they are doing something for a distressed baby. Hammond failed to address this directly – he said placebos should be labelled as placebos. I agree, but that does not change the fact that Nelsons do not label their products as such and are therefore straightforwardly deceptive. He finished by asking me if I am coming “along to debate, like I suggested, or just letting your head explode from the side-lines.”

Boom.

The College shows no evidence of addressing the central problem of quackery – that it is ineffective, superstitions and anti-science. If I saw the College engaging in meaningful debate about how to utilise and manage a public demand for superstitious medicine, I would be more than happy. But the College shows only an interested in promotion – often through the back door.

Of course, the ever present lurking shadow of the Prince of Wales is a corrupting influence. Judgements may be swayed for the worse by the possibility of being seen to support a Royal cause. The College is a threat to science-based healthcare. And as such, we should not be taking our eyes of it.

11 Comments on Doses of Expedience

  1. What is with you, anyway? I could hardly walk until Chiropractic care gave me my life back by completely unsticking, that is to say freeing up, my entire right pelvic joint, which had become frozen. And I know it was frozen because I couldn’t move it. Are you some kind of shill for the pill-pushers and the knife-wielders?

  2. Basically I’m saying if it works, it works. You can not argue with results, no matter where your allegiance is.

    • No, you’re saying that if you got better, it works. And there is no way of knowing, from your anecdote, that it was the chiropractic that caused the recovery. Did you even read the article, which addressed precisely this point?

  3. Looking back 200 years we evaluate medical modalities available then and now. Some such as bleeding are relegated to history, yet a number are still available. We malign them based on current evidence, but how will we assess them and current practices 200 years from now. CT scans may seem foolish because of the high X-ray dosage. Robotics may be so sophisticated that few surgeons will actually operate. Pain management methods may become based on electronic based neural control techniques instead of drugs.

    The amount of personal interaction between a patient and a practitioner is very important for many people. This is likely to continue 200 years from now as we evolve very slowly biologically, but very rapidly culturally. Homeopathy will probably disappear and be replaced by equivalent electronic nonsense: buzzing, flashing boxes perhaps. Touch practices will survive as people like contact.

    The preceding is speculative and I would enjoy seeing other speculations. I think we know enough now to already evaluate some practices. If anything is certain it is that there will be “magical” nostrums 200 years from now, denounced as completely as “alternative practices are today. In fact some currently recognized good practices having been relegated to the dustbin in the future will be the “alternative” practices. Although the future will achieve fabulous methods for a few, medicine then will be defined by what NHS or equivalent offers the everyman.

  4. “The Private Eye columnist and rather-sensible-on-most-matters doctor, Phil Hammond”

    Noooo! From seeing and hearing him in various interviews and appearances on talk and comedy shows, Dr Hammond is notoriously and quite vociferously very pro-altmed. It used to be on the grounds that “it does no harm”, but since being repeatedly questioned on this, more recently on “whatever makes you better”. He has repeatedly said he doesn’t see what all the fuss is about with us skeptics.

    His slipping and sliding deep into magical thinking is accelerating at a pace.

    • Haven’t seen any sign of actual defense of woo popping up in Private Eye yet however. I’d be appalled if it did.
      That said, they fell for Andrew Wakefield (to give him his full medical title) hook line and sinker, in spite of having M.D. on the staff. I was most unimpressed, and the mea culpa they subsequently published, although positive in itself, was a bit thin.
      So this is a bad sign as a skeptical approach is the lifeblood of Private Eye’s other sections.

      • Contrary to MD’s reply to Mr Quack, the Conference offered no opportunity for any kind of “debate” on any of the issues.

        And the fact that they want to integrate Alternative Medicine with conventional medicine was simply not mentioned.

  5. I agree with your point of view generally, in this post and others. However you say that:

    “The “definition of good medicine” is going to take place through a postmodernist assault on the very meaning of evidence based medicine. The sociologist Dr Michael Loughlin plans to use the College to promote a definition of evidence that will attack the established hierarchy of evidence used in Evidence Based Medicine.”

    And, after reading the page linked to, I don’t see it as the attack you claim it is. To me, it reads like a perfectly sensible call to probe the foundations of EBM. In fact, BMJ books recently published a book doing just that (http://goo.gl/N0ITi). It is by no means an ‘attack’ to point out there is interesting philosophy at work behind EBM. Is it?

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