The usual tedious stuff in this 1000 word pro-CAM piece in the Guardian today: “CAM is good because medicine is bad”, “CAM is not researched because it doesn’t have big money” (in fact there are plenty of incompetent CAM trials, a bad trial costs as much to perform as a good one), “some authority figures say CAM is good”, and no attempt to address any criticisms except to complain that they are persecutory.
The whining and rhetoric I can cope with; an ignorance about evidence based medicine, so profound that she can’t even get the most basic terminology correct, is fine too (she refers to “random controlled trials” which means nothing, I presume she means “randomised controlled trials”); but she seems to allude to a trial that does not exist, and that is the thing, as usual, that I find most offensive.
“Ironically, one of the few areas that a large-scale trial has been done is the area that started this current row. Homeopathic medicine is indeed controversial, as in order for a homeopath to treat a patient, the person’s individual symptoms have to be taken into account in order to make an individualised prescription. This means that homeopathy does not perform exceptionally well in random controlled trials – where one group of people are all given the same medicine and another group are given a placebo.
“When homeopathic trials are based upon individualised prescriptions we see a very different picture. At the end of 2005, the results of a large six-year study of 6,500 patients at Bristol Homeopathic Hospital reported 75% improvement in their health.”
I whacked this over to firstname.lastname@example.org in a spare moment, don’t know if they’ll use it.
Alongside the usual attacks on the medical profession which are characteristic of alternative therapistsâ€™ brand building – thalidomide pops up from 1957, I see – Nicola Sturzaker attempts to recruit scientific evidence in support of her arguments. Firstly she suggests that placebo controlled trials of homeopathy are flawed because all patients are given the same homeopathic treatment and this is not how homeopaths work. There is no reason not to simply substitute a placebo sugar pill, in a study, for whatever individualised sugar pill a homeopath prescribes, and if these trials are not done enough for homeopaths then homeopaths themselves should simply do them, just as orthopaedic surgeons assess their different ways of managing fractures.
More seriously, she then says that â€œwhen homeopathic trials are based upon individualised prescriptions we see a very different pictureâ€ and references some work to support this, quoting various figures from it. I found the study she quotes, and it is not actually a trial at all, it was simply a survey in a homeopathy clinic, where they asked the patients who came back if they felt any better. A pleasant enough exercise, but there was no placebo, and no control group at all, nothing was compared with anything: this was very simply and clearly not a trial. It is this level of ignorance about the most basic concepts in evidence based medicine which makes the debate with alternative therapists so fabulously circular.
Dr Ben Goldacre
(Bad Science, The Guardian)