Trick or Treatment (39 page)

So far we have two categories of problematic physician. First, there is the ignorant doctor who advises alternative medicine, but who is unaware that it does not really work. Second, there is the lazy doctor, who advises alternative medicine in order to satisfy patients with otherwise untreatable conditions. Both types actively steer some patients towards alternative medicine; but there is a third category – the inconsiderate doctor – who inadvertently frustrates patients so that they seek out alternative therapies.

Surveys from across the world show that users of alternative medicine are motivated at least in part by their disappointment with conventional medicine. Doctors may well do a good job getting the diagnosis and the treatment right, but many patients feel that other, equally crucial, qualities of ‘good doctoring’ are missing. They feel that their doctor has too little time, sympathy and empathy for them, whereas survey data confirm that patients consulting an alternative practitioner are particularly keen on the time and understanding they often receive. In a way, it seems as though some doctors delegate empathy to alternative practitioners.

We believe that there is an important message here: alternative medicine is not so much about the treatments we discuss in this book, but about the therapeutic relationship. Many alternative practitioners develop an excellent relationship with their patients, which helps to maximize the placebo effect of an otherwise useless treatment.

The message for mainstream medicine is clear: doctors need to spend more time with patients in order to develop better doctor–patient relationships. The average consultation is as little as seven minutes in some countries, and even the most generous countries struggle to achieve an average of fifteen minutes. Of course, increasing consultation times is easier said than done. Alternative therapists happily devote half an hour to each patient, because they are generally charging a great deal of money for their time. Extending consultation times with GPs would require greater government investment.

Finally, it is also worth mentioning a much rarer, but more serious problem. There are a few doctors who are genuinely convinced of the power of alternative medicine, despite the lack of evidence. In the most extreme cases, they will apply unproven treatments in the most inappropriate cases, thereby jeopardizing the health of patients. There are appalling instances of this from around the world, including the case of Sylvia Millecam, which was discussed earlier in this chapter. Three of the alternative therapists who treated Sylvia before her death had a formal medical background, so they were brought in front of the Amsterdam Medical Disciplinary Tribunal after her death. This resulted in one of them being struck off, while the other two were suspended. Similarly, in 2006, the UK’s General Medical Council considered the behaviour of Dr Marisa Viegas, who had become a practising homeopath with her own private clinic. Dr Viegas had advised a patient to replace her heart medication with homeopathic remedies, and a short time later the patient died. The General Medical Council declared that she had died of ‘acute heart failure due to treatment discontinuation’, and therefore they suspended Dr Viegas.

8 Alternative medicine societies

A plethora of societies around the world claim to represent practitioners of various alternative therapies. In the UK alone there are about one hundred! They could be a huge force for good, helping to establish high standards, promoting good practice and ensuring ethical principles. They could also encourage the further testing of alternative therapies for both efficacy and safety. In particular, these societies should be clarifying what their practitioners can treat and confirming which conditions are beyond their abilities. Instead, far too many of them make unsubstantiated claims for their particular therapy and allow their practitioners to conduct all manner of inappropriate interventions.

All of these problems exist, for example, among the societies who represent chiropractors around the world. The chiropractic societies have so far failed to establish systems for recording the adverse effects of spinal manipulation, which would at least help to gauge accurately the hazards associated with chiropractic therapy. Moreover, as mentioned in Chapter 4, a UK survey shows that an intolerably high percentage of chiropractors violate the essential ethical and legal principle of informed consent. Yet the General Chiropractic Council does not seem to take action. And the General Chiropractic Council continues to promote chiropractic therapy for various inappropriate conditions, despite the lack of any evidence. Its website claims that chiropractic care can offer ‘an improvement in some types of asthma, headaches, including migraine, and infant colic’ – this is simply not true.

The American Academy of Medical Acupuncture makes even more exaggerated claims, citing a long list of medical conditions that ‘have been found to respond effectively to Medical Acupuncture’, which includes insomnia, anorexia, allergic sinusitis, persistent hiccups, constipation, diarrhoea, urinary incontinence, flatulence and severe hyperthermia. Again, of course, there is no significant evidence to support the use of acupuncture for any of these conditions.

It is also worth noting that many of these societies have generally been weak (possibly negligent) in terms of exposing bad practice. Worse still, when the Society of Homeopaths, based in Britain, was criticized for not taking a firm stand against the inappropriate use of homeopathy, it decided to suppress criticism rather than to address the central issue. Andy Lewis, who runs a sceptical and satirical website (www.quackometer.net), had written about the Society and the issue of homeopathic malaria treatments, which resulted in the Society asking the company that hosts his website to remove the offending page. In our opinion, the Society needs to improve in three ways. First, it ought to police its practitioners more thoroughly. Second, it ought to act publicly and promptly when serious complaints are made. Third, it should listen to its critics rather than silence them.

The community of scientists, on the other hand, encourages criticism and debate within its own ranks. For example, in 2007 the Cochrane Collaboration established the Bill Silverman Prize ‘to acknowledge explicitly the value of criticism of The Cochrane Collaboration, with a view to helping to improve its work, and thus achieve its aim of helping people make well-informed decisions about health care by providing the best possible evidence on the effects of healthcare interventions’. In stark contrast to the community of alternative therapists, here is an organization offering a prize for those who criticize its work. Bill Silverman, you may remember, was the paediatrician who questioned his own theories on caring for premature babies and indeed proved himself wrong.

As well as, in our opinion, inadequately policing its own ranks, it seems that the Society of Homeopaths encourages bad practice. It appears to promote misleading, inaccurate and potentially dangerous ideas. In 2007, on World AIDS Day, the Society organized an HIV/AIDS Symposium in London. A spokeswoman for the Society claimed that the conference was about alleviating the symptoms of AIDS. In fact, there is not a shred of evidence to suggest that homeopathy can ease AIDS symptoms. Worse still, the conference discussed far more ambitious claims. The speakers were Hilary Faircloch, a homeopath who already works with HIV patients in Botswana; Jonathan Stallick, author of a book entitled
AIDS: the homeopathic challenge
; and Harry van der Zee, who believes that ‘the AIDS epidemic can be called to a halt, and homeopaths are the ones to do it’. The last thing that HIV/AIDS sufferers need is false hope and barmy remedies.

9 Governments and regulators

In his book
Bad Medicine
, the historian David Wootton writes, ‘For 2,400 years patients believed that doctors were doing them good; for 2,300 years they were wrong.’ In other words, for most of our history, most medical treatments have failed to treat most of our diseases effectively. In fact, most of the doctors from previous centuries harmed rather than healed our ancestors.

The turning point came with the arrival of scientific thinking, the clinical trial and government regulation to protect vulnerable patients from harm – both physical and financial. The snake-oil salesmen were gradually driven out of business and mainstream medicine was forced to show that its treatments were both safe and effective before they could be employed.

In some instances, it required tragic events in order to bring about regulation. Or, as Michael R. Harris, historian of pharmacy at the Smithsonian Institution, put it, ‘The story of drug regulation is built of tombstones.’ For example, in 1937, a Tennessee-based pharmaceutical company called S. E. Massengill Co. used diethylene glycol as a solvent in the production of a new antibiotic called Elixir Sulfanilamide. There were no regulations requiring pre-market safety testing, so the company only became aware that the solvent was toxic when patients began to report serious side-effects. Typically, children were taking the elixir for a throat infection and were then suffering kidney failure and going into convulsions. The error caused over 100 fatalities, including the death of the company’s chemist, Harold Watkins, who committed suicide when the scandal emerged. The following year American legislators passed the Federal Food, Drug, and Cosmetic Act, which allowed the Food and Drug Administration (FDA) to demand proof that new drugs were safe before going on sale. Regulations were still inadequate in many other parts of the world, but the Thalidomide tragedy of the 1960s compelled many other governments to bring in legislation. The UK Medicines Act of 1968, for instance, was a direct consequence of the Thalidomide disaster.

Alternative medicine, however, seems to have sidestepped these regulations. Buzzwords such as ‘natural’ and ‘traditional’ have allowed them to carry on largely unhindered in a parallel universe that is oblivious to safety issues. For example, in most countries, herbal remedies and other supplements can be marketed without rigorous proof of safety. The burden of proof is reversed: it is not the manufacturer who has to demonstrate that his product is harmless, but it is the regulator who has to prove that the product is harmful – only then can it be withdrawn from the market. This obviously is haphazard, as there are far too many products, so regulators react only when problems emerge. This is much like drug regulation before Thalidomide: a disaster (or several) waiting to happen.

Similarly, alternative practitioners tend to be un-or under-regulated. There are, of course, considerable national differences, but in general alternative practitioners do not require any in-depth medical training or experience. Indeed, literally anyone reading this text in Britain could call themselves a homeopath, a naturopath, a herbalist, an aromatherapist, an acupuncturist, a reflexologist or an iridologist. You might have no training in conventional or alternative medicine, yet nobody could stop you nailing a sign to your front door and placing an advertisement in your local newspaper. It goes without saying that this situation is less than satisfactory. Serious diagnoses can be missed, conditions that never existed can be diagnosed, ineffective or harmful treatments can be applied, wrong or dangerous advice can be issued, and patients can be ripped off – and all this without adequate control or recourse.

By taking such a relaxed attitude towards alternative medicine, governments have exposed the public to medicines that are often ineffective and occasionally dangerous, and they have allowed alternative therapists, often deluded and occasionally disreputable, to ply their trade without hindrance. It would seem obvious that governments ought to be playing a more active role, by banning dangerous or useless alternative therapies and properly regulating those that are harmless and beneficial. Yet most governments have shied away from taking such a stance. For some reason they seem frightened of confronting the multi-billion-dollar alternative medicine industry. Or perhaps they are more worried about the millions of voters who currently use alternative medicine and who might be offended if their favourite herbalist or homeopath were forced to shut up shop.

There are numerous examples that demonstrate the need for governments to intervene, either by banning certain products or by tightly regulating them. For example, it is still possible to buy homeopathic kits for malaria protection on the internet or in your local health-food shop. One product claims to be ‘a credible and highly effective alternative to conventional malaria treatments…Taken daily as a spray under the tongue it is suitable for all from the toughest adult to the tiniest tot: it even tastes good.’ At a price of just £32.50 it seems like a bargain, except it does not work! Nobody seems to be enforcing any advertising or trading standards, and nobody seems to be worried about the public-health issue that is at stake here.

Governments ought to be moving rapidly to regulate therapists and products in order to protect patients, but there are very few signs that this will happen anytime soon. Indeed, there are clear signs that the British authorities are moving in the opposite direction, as they seem keen to encourage the use of largely unproven treatments. Two examples serve to demonstrate the desire of UK officials to return to the Dark Ages.

First, the UK Department of Health helped to fund a 56-page booklet written by the Prince of Wales’s Foundation for Integrated Health. Entitled
Complementary Health Care: A Guide for Patients
, this has been one of the most influential documents in relation to alternative medicine, because it purports to be a reliable source of information for patients, and it was also distributed to every British GP. However, the booklet implies that alternative medicine is effective for a whole range of conditions, when we know that this is simply not the case, or at the very least we know that the evidence is poor.

For instance, the booklet states: ‘Homeopathy is most often used to treat chronic conditions such as asthma; eczema; arthritis; fatigue disorders like ME; headache and migraine; menstrual and menopausal problems; irritable bowel syndrome; Crohn’s disease; allergies; repeated ear, nose, throat and chest infections or urine infections; depression and anxiety.’ Notice that the booklet does not say that homeopathy is effective for these conditions, but the phrase ‘most often used to treat’ certainly implies that patients should consider using homeopathy in all these situations. This government-subsidized propaganda is similarly misleading for chiropractic, herbal medicine, acupuncture and other forms of alternative medicine.