Doctors who evangelise

The Telegraph recently reported on a story about a doctor who is in trouble for talking about religion with one of his patients. The story is here – GP rapped for talking about God with patient. According to the Telegraph, Dr Scott shared his faith with thousands of patients in the past because he believes that there is a spiritual element to healing.

People visiting an NHS doctor are expecting to see just that, a doctor of medicine, a general practitioner who will diagnose the problem and prescribe conventional western medicine. They are not expecting prayer or to be referred to an alpha course. They didn’t choose to go to a faith healer, just as they didn’t choose to go to a homeopath or seek out traditional Chinese medicine. A person is of course free to choose those treatments if they so wish, but the point at which they are already talking to a doctor is not, in my opinion, the time to bring it up. A patient talking to a doctor is vulnerable and suffering, and may not make rational choices as a result. Since there is a trust relationship between patient and doctor, if a doctor suggests a treatment that is not within the bounds expected, that trust is violated.

The General Medical Council has said “Our guidance, which all doctors must follow, is clear. Doctors should not normally discuss their personal beliefs with patients unless those beliefs are directly relevant to the patient’s care.” Perhaps surprisingly, I believe the GMC to be wrong. I do not think that the GMC has any right to say that no doctor should ever talk to his patients about God. What I do think is that the NHS doctors should refrain from introducing any religion into the treatment. (Or anything that isn’t medicine, come to that.)

In the case of Dr Scott, it was not completely obvious that there would be a religious aspect to the treatment. In their defence, the practice stated three things:

  • The name of the GP practice, Bethesda, is a biblical reference.
  • There were Christian posters on the wall of the practice.
  • The NHS web page for the Bethesda practice states “The 6 Partners are all practising Christians from a variety of Churches and their faith guides the way in which they view their work and responsibilities to the patients and employees.  The Partners feel that the offer of talking to you on spiritual matters is of great benefit.  If you do not wish this, that is your right and will not affect your medical care.  Please tell the doctor (or drop a note to the Practice Manager) if you do not wish to speak on matters of faith.

Unfortunately, none of these reasons are adequate. The name of the surgery, Bethesda, may be obviously a bible reference, but that is only obvious to Christians. The website states that spiritual advice might be given, but even in the modern age most people would not visit the website of their doctor before visiting. Finally, although there were Christian posters on the wall of the surgery, a patient absorbed in their problems might not read or take in such posters, or might easily look down throughout their visit and miss them. In addition, someone looking for an NHS doctor would simply enquire about the nearest doctor with space on their books. An NHS helpline would happily send patients to the Bethesda doctors without anyone being aware of their religious aspects. Basically, unless the patient was read a statement informing them that they would receive Christian prayer and referrals and asked to agree to it, I would not count the surgery as having obtained proper consent.

I believe that an NHS doctor would be wrong to pray with a patient or to refer them to a religious organisation because that treatment is not within the remit of the NHS and is not funded by the NHS. An NHS doctor would certainly be wrong to introduce these treatments without consent obtained at a time when the patient is able to make an informed choice. Despite this, I disagree with the GMC in their statement that doctors may never discuss religious beliefs. If a privately funded doctor in a practice which clearly advertises their religious aspects and obtains the proper consent shares their faith with a patient, I think they are within their rights to do so. As long as the patient has had to make a conscious choice to visit that doctor while fully aware of the religious aspect, there is no problem. Because of this, I think the GMC should modify their guidance and should drop this case, but also that the doctors at the Bethesda practice must cease to offer religious treatment unless they no longer accept NHS funding and obtain full consent in advance of registration.

Acupuncture

I have already written about Homeopathy and Chiropractic. It should be no surprise to my regular readers that I am contemptuous of acupuncture too. There are several problems with acupuncture.

  1. It is based not on knowledge of biology, but on “qi” (energy.)
  2. It does not cure, but it practitioners claim that it can.
  3. Needles can damage nerves and may cause infection if not sterile.

The first point is important. With most medicines we know the mechanism through which they affect the body. We know which part of the body they alter, and we usually know how they work. Acupuncture is based on the idea of qi, pronounced chi, and meaning a kind of energy that supposedly flows around the body through channels called meridians. We have no evidence of qi or of meridians, but we do have evidence of nerves, hormones, chemicals and all the other concepts that make up the human body. Qi was an attempt to explain life before we had the modern knowledge of how the body works. Now we know better.

Acupuncture does not cure anything. We know it doesn’t, because there have been trials of acupuncture. The acupuncture page on Wikipedia lists many of them. Acupuncture may be effective against pain, although the findings of studies vary and there is insufficient evidence to say either way. It is likely that reported pain relief from acupuncture is largely a result of the placebo effect. This is not necessarily a bad thing, since the important thing here is relief from pain and the placebo effect can do that. Acupuncture may also help relieve pain by distraction through simulation of the nerves and the release of endorphins. This is not proven.

While acupuncture can provide pain relief, it cannot cure disease. It cannot flush out virus or bacteria infection, or cancer cells, and it cannot repair the body when it has gone wrong. The British Acupuncture Council claims that acupuncture can help with all sorts of things – colds and flu, infertility, chronic fatigue syndrome. This is of course absurd.

For the most part, acupuncture is safe, but as it is an invasive procedure there are risks. There is a danger of infection if the needles and the environment are not sterile. There is a danger of damaging a nerve. There is a danger from a needle entering a lung, kidney or other organ if the needle is inserted too deeply.

Overall, then, some people might like to use acupuncture to provide relief from pain, if it works for then. Unfortunately it does not work in enough people to produce a significant result in tests, and the results that it does produce are likely to be from the placebo effect. It certainly doesn’t cure anything, and if people use acupuncture in preference to tried and tested medicine then they may prolong their illness or endanger themselves by effectively leaving themselves untreated. Acupuncture is not entirely risk free anyway.

I know that in spite of my arguments here many people will choose to believe in the curative abilities of acupuncture anyway.  That is their right to do so, but they should understand that belief in qi and the manipulation of qi through the use of needles is not a scientific belief. If anything, it is a religious one.

If someone wishes to choose to use acupuncture instead of researched and tested medicine, I cannot stop them. If it provides pain relief for them, then I am happy for them. I think it is fair to say that of all the alternative treatments, acupuncture shows the most promise of a plausible mechanism and of tests showing a useful difference, at least for pain relief. I take issue with practitioners that make absurd claims about what acupuncture can do; if someone chooses acupuncture because they think that it will cure their viral infection or cancer then they have been conned. At the very least, we have laws against obtaining fees through false claims and against making false claims in advertising material. If someone believes that alternative medicine replaces the need to have vaccinations, then they would be putting the rest of us in danger and that idea would need to be stopped. I wrote about this in my previous blog post, Alternative medicine – a dangerous game.

Related blog posts

Alternative medicine: a dangerous game

Homeopathy again

Do you know what Chiropractic really is?

More on the placebo effect

 

Do you know what Chiropractic really is?

Do you know what chiropractic is? Most people that have heard of it will generally hazard a guess that it is something to do with bad backs. They are sort of right. Chiropractors do manipulate the spine, and other parts of the musculoskeletal system. But they do it in the belief that some or all other medical problems are a result of problems with the spine, and can be fixed through manipulating the spine.

Daniel David Palmer invented the theory of chiropractic in 1895. He decided that all living things have vital energy called Innate Intelligence. Innate Intelligence supposedly flows out of the brain and through the spine to the organs. According to Palmer, misaligned vertebrae block the flow of Innate Intelligence, and that is the cause of all other illness. Palmer also rejected the idea of germs and of vaccination because he thought that all illness is caused by this blockage.

These ideas, of course, have no basis in science at all, and there is no evidence that things work this way. In 2008 the British Chiropractic Association launched a libel case against science writer Simon Singh over an article that he wrote in The Guardian. I have reproduced the relevant part here. See the rest, with notes in this article: The libellous Simon Singh article on chiropractors.

First, you might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that, “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

This lawsuit caused uproar in the scientific world because the BCA was effectively using libel law to silence scientific opinion. Simon Singh’s defence effectively put the efficacy of chiropractic on trial. The BCA dropped their case in April 2010. The idea that chiropractic can be used to treat colic, habits, ear infections and asthma is not only without scientific basis, but also dangerous. Someone seeking treatment for these things will not get the real effective treatment that they need. Promoting the use of chiropractic to treat babies for these things is just cruel. The lack of proper treatment will lead to suffering for the baby, and the chiropractic treatment can itself cause injury and prolonged pain.

Chiropractic does seem to fill a gap in health services. I have spoken to several people in both the UK and the USA who have Ehlers-Danlos Syndrome (EDS) and visit chiropractors. The problem seems to be that physiotherapists and other  specialists within the NHS and conventional healthcare don’t seem to have the knowledge or the time necessary to deal with problems caused by hypermobility. Chiropractors appear to know the musculoskelatal system and especially the spine in a lot more detail, and are willing to help reset subluxations. (Partial dislocations) Chiropractors also take the time to listen to their patients. This could be because they are generally seen privately and so have more incentive to earn their fee.

Unfortunately despite them offering useful help with back and joint problems, I think any good in Chiropractic is negated by the rest of what they believe. For a start, there is room for confusion because chiropractors use the term subluxation in a different sense to the medical profession – they believe that there are dysfunctional segments of the spine that block innate energy, and they call this a subluxation too. Chiropractors believe that these vertebral subluxations (which aren’t subluxations in the normal sense) block innate intelligence and prevent if from reaching the rest of the body. They think that this is the cause of infections and illness. I think possibly the worst thing that chiropractors do is to advise people not to get their vaccinations. I have said before when talking about homeopathy that we all rely on “Herd Immunity” for vaccines to work, and telling people not to have them in the hope that chiropracty or homeopathy will prevent viral infections is not only obscenely stupid, it’s a danger to the whole of society.

Some people will argue that it is acceptable to use a Chiropractor if they stick to actual physical problems and avoid other issues, but in my opinion this is that this gives them some respect in the mind of the public and opens the way for people to fall for the rest of what they say. Ultimately, if a person is spending their own money, and receives some benefit from chiropractic treatment for physical problems, it isn’t my place to tell them to stop seeing a chiropractor. I do think that they are making a mistake though, and I really hope that no one else will see it as a reason to trust a chiropractor for anything else.

 

More Information

UK Skeptics – Chiropractic

The libellous Simon Singh article on chiropractors

On Putting Chiropractic On Trial – Simon Singh’s Defence

Simon Singh libel case dropped

Homeopathy again

This is yet another post on homeopathy and alternative medicines. This one is prompted by a conversation that I had a few days ago which unfortunately resulted in me no longer being friends with someone that I had previously enjoyed talking to. The conversation was prompted because the person in question had put up a link to the “Homeopathy Heals” campaign web site. After questioning her views on the subject I received several comments about how great it was and I responded by asking her to read my recent article on alternative medicine to see what I thought. Unfortunately as soon as she started to read the article she told me “if you believe chiropractors to be useless, nothing written by you is worth reading I’m afraid.” (I mentioned chiropractic at the start of the article. Chiropractors believe that every part of the body can be fixed by manipulating the spine.)

Alternative medicine seems to be as emotional a subject as religion. But then, alternative medicine mostly works through faith. It practically is religion.

The thing is, homeopathy does sometimes do something. And it mostly does that something through the placebo effect. The placebo effect is actually quite effective at treating quite a lot of physical health problems and can help a lot in reducing pain. What it can’t do is cause major physical healing, such as curing diabetes or cancer, or replacing vaccinations.

Part of what makes homeopathy occasionally effective must surely be that homeopaths spend a lot of time with their patients and show more interest in them. I have heard from people that have spent hours or even whole days with their homeopath. That results in a more holistic approach that allows any worries and stress to be talked through, something that rarely happens when our GPs are so rushed.

If people choose to use alternative medicines like homeopathy and chiropractic in the face of all logic and reason then ultimately they are relying on faith. I can be quite happy with people relying on faith, as long as it doesn’t affect anyone else. I am OK with someone using a homeopathic remedy for a headache and having faith that it will work. I am not happy when people use faith instead of vaccines, or force their remedies on children that cannot decide for themselves, or on animals that will continue to suffer. (And I don’t believe for a second that animals are cured by homeopathy. Show me the evidence.)

I am sure that placebos could have their place in medicine. If we can reduce the amount of chemicals and drugs that must be used to treat illness by getting the mind to cooperate, that is a good thing. But the deception that we find in most alternative medicine is wrong and dangerous. Promoting such things by attacking science is especially wrong. We need our medicine to be based on evidence. I am outraged by the fact that Boots continues to sell homepathic treatments alongside real medicine, misleading people into trusting something that they shouldn’t. I am even more angry that the NHS continues to pay for homeopathic hospitals and treatments.

If you want to use homeopathic medicine, and you have faith in it, then it might do something for you some of the time. But know that it works through faith not science and reason. Please don’t inflict it on those that have no choice, and please, I beg you, don’t use it instead of vaccines. Most of all, don’t ever tell me that I should use it, and don’t expect me to respect any of the bizarre attempts at explaining how it is supposed to work.

Related Articles

Alternative Medicine – a dangerous game

More on the placebo effect

Interesting Links

www.howdoeshomeopathywork.com

Homeopathy Heals campaign

10 23 campaign

More on the placebo effect

In my recent post about homeopathy I mentioned the placebo effect, how powerful it is, and that it can even work when the recipient knows that they received a placebo. Well as a follow on from that I suggest that you should watch this thoroughly entertaining video where Ben Goldacre talks more about the placebo effect at Nerdstock.

Alternative medicine: a dangerous game

In this article I discuss why alternative medicines are bad, how the placebo effect works, and how such remedies are dangerous to the user and to others.

I am keenly aware that I need to tread carefully with this post. I know a number of people that will disagree with me, and even a chance that some other people will attempt to sue me.

It is my firm belief that alternative medicines are a danger to health and life for everyone, and not just those that choose to use it. I am talking about treatments such as Homeopathy, Crystal Therapy, Accupuncture, Chiropracty, and many others.

Why they don’t work

I believe many of these methods mentioned here to be a fraud or at most a misplaced faith in something which doesn’t actually have any scientific reason behind it. Homeopathy, for example, is not just without reason for working, it’s actually counter to reason.

I’m picking on homeopathy here mainly because I can’t address all alternative medicines in this article. Homeopathy relies on choosing a substance that is believed to be linked to the health problem in question. That substance is then diluted in water many times over, and the water shaken to imprint “memory” of the substance. Given that most illnesses are caused by viruses, bacteria and genetics, the choice of material for the homeopathic remedy is largely arbitrary.

Leaving aside for a moment the choice of substance that is supposed to help with treatment, I’m afraid that the notion of diluting something to make it stronger just doesn’t wash. True, vaccines rely on a small amount of dead virus to trigger an immune response and train the immune system, but homeopathic medicine is not like that. No, in homeopathy, the substance is diluted so much that there is nothing left at all. Commonly a substance is diluted 100:1, and that is sometimes repeated up to 30 times. After 12 times, though, the likelihood is that not a single molecule of the original substance remains behind. Scientists call this the Avogadro Limit.

Homeopaths counter this by arguing that water “remembers” the substance. This is of course nonsense. The atoms and molecules cannot remember anything. If they did, the atomic or molecular structure would not be that of hydrogen, oxygen or water. Apparently shaking the water in a certain way helps the memory here. I’m not even going to write about what’s wrong with that.

For more information about homeopathy have a look at the excellent resource that is www.1023.org.uk

The placebo effect

Alternative medicines are, dare I say it, actually not without some beneficial effect. Although most do nothing to heal the body or fight infection through any physical changes, they often do help through the Placebo effect. The placebo effect is “measurable, observable, or felt improvement in health not attributable to treatment” and is the subject of much ongoing scientific research. The placebo effect is know to help with pain relief in particular, but also even to improve physical health. It has been observed on conventional and alternative medicine alike, and some scientists even believe that some conventional medicine works more as a placebo than a physical change. The placebo effect is beneficial enough that it is actually worth using as a medical treatment. Recent research found that a placebo can work even if the recipient knows that it is a placebo!

There is also some placebo effect because practitioners of alternative medicine are likely to show more interest in and spend more time with their patients. When NHS doctors are under so much pressure, spending a few hours with them is unlikely, whereas that can easily happen with an alternative medicine practitioner.

Why it harms people

You may think that if an alternative medicine is unlikely to poison someone, and may well even give them a benefit from the placebo effect, that there is no harm in allowing them to use it. Unfortunately, you would be wrong.

Alternative medicines can cause people to avoid conventional medical treatment that works, in a situation where a placebo does not work and leaving a condition untreated could be fatal. Diseases such as diabetes, where the patient needs medicine or insulin, could be left untreated and lead to stroke and blindness. A flu virus could run it’s course unchecked in an elderly person and cause death. I am sure there are many more examples that I could list here.

People that use alternative medicines are also likely to avoid vaccinations out of mistrust of conventional medicine or of fear of side effects. This is the part that could harm us all. In order to eradicate diseases such as smallpox, measles and polio, a critical percentage of the population must be vaccinated. This is called herd immunity. When enough people are vaccinated, the remainder of vulnerable people are unlikely to be infected through other people carrying the virus. There are places where measles and mumps have returned with a vengeance because herd immunity has broken down after many people chose not to be vaccinated.

Opting out of vaccination is as likely to be caused by a failure to understand the scientific method as by the use of homeopathic remedies, but then using homeopathic remedies is also likely to be caused by a failure to understand the scientific method.

Another way that homeopathy harms people is that it receives NHS funding. That’s right, the NHS spends £4 million per year on paying for something that doesn’t work when it could spend that money on a myriad of more sensible things. Homeopathy is stealing from us all.

Conclusion

It is not possible to dismiss all alternative therapies out of hand. Unfortunately, to the average person, medicine is divided into conventional, and alternative. I am guilty taking this line from the science side, but many people view it from the alternative side. Because of this, many people will take the view that because something did work for them, be it through a measurable effect of an active ingredient, or through the placebo effect, that therefore all alternative medicines must work. In practice some work, some don’t. Some are outright harmful, others can be based on sound logic that simply hasn’t been through clinical trials and adopted by the scientific and medical communities.

Those “alternative” medicines that actually use active ingredients such as plant extracts should be tested in full double-blind clinical trials and if they work, adopted in  conventional medicine where useful. The ones that fail should be dismissed and abandoned.

While there may be some benefit from the placebo effect when using alternative medicine, I believe people are much better off in using conventional, tested and scientifically proven medicine. After all, that has a placebo effect too. And as a person with a fairly broken immune system, I beg you, don’t skip your vaccinations. You could kill me.