Debate: Alternative medicine does more harm than good

“This house believes that complementary and alternative medicine does more harm than good”. That was the motion of yesterday’s debate, as proposed by Simon Singh. Supporting him was Prof. Michael Baum; opposing him were Prof. George Lewith and Prof. David Peters. Get ready for a debate high on fallacies, low on logic, and with hot tempers!

Each speaker had about a quarter of an hour to talk; then there would be a question and answer session; and finally the closing statements from each “team”. First up was Michael Baum.

Michael Baum
Michael Baum started by pointing out some horrific cases of cancer patients who failed to get proper treatment in favor of CAM, and consequently died a long and painful death. has a large collection of such disturbing stories -check it out.

Baum seems to subscribe to the idea that the C in CAM can be pretty useful (where I partly agree) but the A is defined mainly as what doesn’t work, and therefore should be discarded with no further ado. He also likes to integrate strange kinds of psychological therapies to assist in the treatments of his patients. Things like art therapy, music therapy, and many other forms of psychological support. That’s all nice, as long as you don’t disillusion the patient and do not confused proper treatment with the complementary psychological support. Baum understands this of course, as he has been working for many, many years to that end.

A brief introduction to the possible cognitive biases and the placebo effect, wrapped up Baum’s talk. It would have been much more interesting had the projector been working and we had pictures and graphs, but I won’t complain: Baum was vocally describing his pictures to a very good degree :-)

George Lewith
Following Baum, the master of fallacies went on stage. Lewith started his talk (and went on 5 minutes about this) with “un grande tu quoque” fallacy! Apparently conventional medicine have side-effects. Apparently conventional medicine sometimes do harm. Apparently conventional surgery can sometimes go wrong. Thanks for the info Professor.

Of course he forgot to mention that conventional treatments usually work though. And there is evidence to back this up. Yes, errors (deliberate or not) will always happen. Yes, malignancy will always exist (as in every other context in our society). But how is that an argument in favor of alternative medicine?!? No one knows…

Lewith continued by providing some borderline evidence on the efficacy of some treatments for back pain and migraines, in a desperate effort to show that “yes, there are studies that have positive results“. But alas, when a positive review result comes out we merely reject the null hypothesis. On borderline cases our own hypothesis merely buys some extra time. When a negative review result comes out though, the testing hypothesis is rejected. I personally believe that when a negative review comes out, the treatment in question is in serious, serious trouble! When a strong positive one comes out, confidence is significantly elevated. But when a borderline review comes out, you cannot really say much! It could be bias, it could be randomness, it could be non-specific effects, it could be anything. More on the evidence base a bit later…

Lewith finished by “attacking” placebo controlled trials! He doesn’t like them (I think for obvious reasons :-)). He thinks too much emphasis is placed on placebos. That’s all fine, it is his opinion. What he forgot to tell us is how he proposes then to evaluate alternative treatments?!? And why are those treatments available in the NHS and in educational institutes in scientific courses if they haven’t yet been proven? Lewith seems incapable to understand that this is a major concern of CAM opponents.

Lewith also fails to understand why proper scientists ask for CAM research to stop. He provided a beautiful straw man, distorting the view of his opponents by saying that they simply want research to stop and not determine whether a CAM treatment works or not. But of course this is not the case.

When the Lancet in 2005, following Shang’s damning review asked for the end of homeopathy, it clearly stated why research should now stop. Because after so many years, so many hundreds of trials, so many inconclusive and negative reviews, so many resources spent on researching these modalities, the evidence for efficacy is still lacking. Any honest scientist would reach the conclusion that there is probably no substance to these modalities. CAM proponents do not. Because this is matter of faith for them. They cannot abandon their faith to their pet treatment. And that’s why Lewith cannot think properly and has to resort to fallacies, or play the maverick scientist who fights against the establishment to get more research grants…

Oh, dear…

Simon Singh
Simon Singh followed, and he was the one that nailed it. First off, he immediately brushed aside Lewith’s red herrings about herbs and nutrition by defining alternative treatments as those that have no scientific/biological plausibility. Homeopathy, acupuncture, Reiki, faith healing, etc. Herbs have active ingredients and are in fact used by the pharmaceutical industry (a lot). They need regulations and controlled dosage though. They need trials and safety assessments, just like any other drug.

Nutrition is also a red herring. How is nutrition an alternative treatment? The first thing mainstream physicians will tell you is to fix your diet, get exercise, stop smoking, cut back on sweets and alcohol. But I guess it is good to include as many plausible and potentially effective modalities under the CAM umbrella. This way, average efficacy and total numbers go up significantly -and Lewith is happy!

Simon then he just pointed out the plain obvious: Lewith showed the absolutely best trials with the most positive effects. And these are merely borderline evidence (usually with no clinical relevance) for self-limiting conditions: pain, migraines, and other conditions where the placebo can flourish! But what about the rest? All the other CAM claims for treating liver disease, cancer, AIDS, malaria? This is where the harm comes from. This, and the possible late or misdiagnosis if one doesn’t visit a proper physician.

David Peters
David Peters talked a bit more sense than his “team-mate”. He accepted the dangers of the (many) unwarranted claims of many homeopaths. He suggested that proper education is needed in order to avoid making such claims. But I think here he missed the point. This is a matter of proper scientific and medical education. It doesn’t mean that we should teach that “amethysts emit high yin energy” or that “likes cure likes“. These are two wholly different domains. Westminster unfortunately (Peters’ institution) falls solely into the second domain.

When the debate was finished, one could feel that the usual pattern emerged: on one side, citing the evidence base, damning the malpractices, and pointing out the scientific, logical and ethical shortcomings of CAM proponents. On the other side, te quoque fallacies, straw men and red herrings, and an apologetic defence of the indefensible. Same old tactics…

What about the audience? Well, the audience was significantly undereducated scientifically (and dare I say, on social morals and ethics as well). Some of them were lacking core logical functionality. Others lacked core biological functionality: a young acupuncture student apparently heard nothing from the debate. At the end, in the Q&A session, she provided “evidence” for acupuncture with yet another personal anecdote. Then she asked Simon Singh if in the face of the two damning Cochrane reviews he believed that acupuncture had some efficacy… Hello? Have you been here with us at all? “No!” was Simon’s obvious answer. “Do you have anything else to support your opinion?” the student continued! Apart from two huge Cochrane systematic reviews? Err, no sorry.

And then there was this “lady” that kept interrupting the debate spitting out nonsense about the “power to the patient” mantra. At the Q&A session, she authoritatively granted herself the right to ask a question, which turned into a large collection of fallacies. It all boiled down to her asserting that the patients’ are not idiots; they know what works for them and what not; they understand that homeopathy has a large body of evidence; and they want to be able to choose which therapies they want under NSH.

Michael Baum responded in the only reasonable way one can respond to such gibberish: hard and to the point. When the Royal Homeopathic Hospital was given £200 million of taxpayers money for refurbishments, Baum had serious difficulties finding money to prescribe and distribute a proven cancer-fighting drug*). A drug that saves lives, with a large body of evidence to support this. The “lady”‘s response? She accused Baum of being in the pocket of the Big Pharma. Go figure…

But Baum didn’t properly address other parts of her delirium. Two more fallacies really: first, patients are not experts and cannot check the evidence base for a treatment they might be having. They trust authority, but, most alarmingly, they seem to trust the media lately. Second, and most important, patients have ABSOLUTELY no idea what is good for them. Humans are susceptible to a vast array of biases, misjudgements, and other such nice cognitive issues. Plus, they suffer from this thing called predisposition, you know? And that is exactly why the scientific method was devised; that is exactly why personal anecdotes do not count as evidence; that is exactly why we conduct randomised controlled trials.

I certainly do not object to listening to the patients as to how the delivery of a treatment is made, the social interactions involved and how they can be improved, or how the facilities could be improved. But when it comes to which treatments or which drugs should be administered, the patient MUST not have any influence there (unless there are multiple valid options of course). Because we do not know. We cannot know. If we knew, doctors would be obsolete…

Another one attacked Simon and Baum asserting that no physician knows the cause of any illness so they cannot criticise CAM for a similar reason. Physicians do not know the cause of any illness? I assume this guy does not subscribe to the Germ Theory of Disease.

He also asserted that scientific medicine is a myth and a propaganda that has failed to deliver any of its promises. This guy was near his sixties I think. If scientific medicine has been a failure, he would have been dead for a few decades now, and I would be nearing my final stages of my life as well. The life average at the beginning of the century was below 40. Not to mention the huge advances in quality of life for the patients. For a sixty year old, life experiences don’t seem to have helped him a lot…

But there were also two sensible people that asked questions: a lady asked Lewith, who dismissed placebo controlled trials, how he proposed to check the efficacy of CAM treatments. Good question. No answer. Instead, Lewith started telling us how great he is, and how successful he has been in his career, and how Simon Singh is much inferior when it comes to medicine. M-kay Lewith. You’re the man. Take it easy. Could you please answer the question? No? That’s okay, you’re still the man Lewith. Another guy then pointed out the numerous logical fallacies committed by Lewith. Not bad I say, not bad…

Results of the debate? From 26 supporting the motion at the beginning, 36 did in the end. The 130-something opposing the motion, became 109 at the end (approximate numbers, and there were also the neutrals). I guess we can count that as a victory… Even one less misled individual would be a victory, never mind more than a dozen!

I had a very brief chat with Simon at the end, pointing out to him that there is too much emphasis placed on evidence-based medicine when in fact it should be science-based medicine. Scientific plausibility (which Simon mentioned in his talk) is a hugely important factor when determining the efficacy or safety of a treatment. CAM proponents seem to forget this, and despite the mostly inconclusive and negative clinical trials, they still try to hang on to the occasional borderline significant result…

But where is the science?

  1. * (can anyone remember the name of the drug? []