is a philosophy discussion group meeting on the 3rd Tuesday of every month
from 7.30 to 9.30pm
in the The Bull
in Tanners Street. We cover a large range of topics
. If you have an idea for a topic that you would like us to cover why not drop us a line
? There's no charge for membership and everyone is welcome to drop in. Just bring your brain and some beer money!
Alternative vs Evidence-Based Medicine
Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard care provided in conventional doctor's surgeries and hospitals. There is much debate about whether such treatments are genuinely effective, no better than placebo or downright harmful. The following videos and articles provide some background for discussion of the issue.
- Key ideas in Complementary and Alternative Medicine
- If you don't read anything else, read this!
- Ben Goldacre interview (video 4:00)
- New Scientist talks to Ben Goldacre about his new book 'Bad Science' and why he is passionate about revealing bad practice in medicine. He wants people to understand the basics of evidence based medicine. The media get it often wrong, eg, Andrew Wakefield and MMR scadal. It was based on only 12 case study. Wakefield extrapolated too far and was selective in his evidence. But the principal guilt lies with the media who blew the whole affair out of proportion in order to produce dramatic headlines. Second example: the MRSA affair. False positive results were coming from a bogus laboratory which the press used as it bolstered their own story.
- Alternative Medicine (Wikpedia article)
- Alternative medicine is any practice claiming to heal that does not fall within the realm of conventional medicine. It may be based on historical or cultural traditions, rather than on scientific evidence.
Example of a non-scientific treatment
- The final days of Charles II (video 5:27)
- The principal physician at the death of Charles II kept a diary describing the final week of Charles' life and detailing his treatment. He had six top physicians at his beside and they they threw at him everything that 17th century medicine had to offer. This provides us with a good example of traditional, pre-scientific medicine and in all its main characteristics it is identical with present-day alternative medicine.
Discussion of Homeopathy
- Ben Goldacre and Hans Schrauder on homeopathy (video 7:52)
- Discussion on BBC News 24 featuring Ben Goldacre about the effectiveness of homeopathy. This followed the Commoms Science and Technology Committee recommendation that the NHS should not fund homeopathy because it was no more effective than placebo.
- Homeopathy news item (video 4:45)
- Professor David Colquhoun on the effectiveness of homeopathy. He is in discussion with an NHS GP who uses homeopathy in conjunction with conventional medicine. This is where the idea of 'complementaty' medicine comes in.
- Ben Goldacre explains Homeopathy (video 3:04)
- Homeopathic remedies are dilluted to such a high degree that with luck one molecule of the active ingredient may be left in the mixture. If such remedies are effective then there is no known scientific theory that can account for it's effect. Goldacre also points out that so far there has been no fair random trial that has shown homeopathy to be more effective than placebo.
The placebo effect
A placebo (Latin for 'I shall please') is a pharmacologically inert substance (such as saline solution or a starch tablet) that seems to produce an effect similar to what would be expected of a pharmacologically active substance.
- Placebo effect (Wikipedia article)
- The placeco effect (Skeptic's dictionary entry)
- Ben Goldacre on the placebo effect (video 4:55)
- Goldacre points out the amazing effects of placebo. Just changing then colour of a tablet can render it more effective. Even childen and animals can respond to placebo.
- The Placebo effect (video 4:09)
- Sean Mackey explains the placebo effect. Mackey is the chief of Stanford's Pain Management Division and an associate professor at the School of Medicine.
This is my favourite snake-oil remedy and is included here as a good example of a completely bogus treatment. It involves paying someone to place a lighted candle in your ear which is supposed to extract toxins from your body. Scientific research has shown that it is at best ineffective and at worse positively dangerous.
- Leaflet on ear candeling put out by Canadian Health
- Ear candeling (Wikipedia article)
Evidence-based medicine (EBM) has been defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."
Essentially, evidence based medicine entails evaluating the efficacy of treatments using double-blind testing and rejecting simple anecdotal evidence. As Goldacre says in his book "Data is not the plural of anecdote". Defenders of alternative medicine tend to argue that the methodology used in clinical trials is not appropriate to their practice as they treat "the whole person" and not just a disease.
- Evidence-based medicine article from Wikipedia
- Evidence based practice
- An example from nursing training.
- John Crofton and TB trials (video 7:38)
- John Crofton pioneered the randomised controlled trial in a 1948 BMJ paper which looked at the antibiotic streptomycin to treat TB.
- A History of Clinical Research (video 3:20)
- Clinical Trials (video 4:59)
- How Double Blind Clinical Trials Are Done (video 1:41)
- Tim Minchin's 'Storm' (video on You-tube 10:39)
- Very funny. A 'must-see'.
- Quackwatch (web site)
- Quackwatch is an international network concerned about health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere.
- Ben Goldacre on Detox (video 6:55)
- He explains why bogus science like detox is harmful.
- New Age Medicine (1 of 2): from Penn & Teller's 'Bullshit' series (video 14:00)
- New Age Medicine (2 of 2): from Penn & Teller's 'Bullshit' series (video 13:15)
- Forbidden Healing (video 10.5 mins)
- This is a presentation by a pressure group called 'The Alliance for Natural Health'. They are lobbying in favour of 'natural' remedies arguing that the European Union's Traditional Herbal Medicinal Products Directive is an attack on the right of individuals to choose alternative remedies if they wish. This is interpreted as a conspiracy by the big pharmaceutical companies to protect their interests. Others might construe it as an attempt to protect the public from untested remedies. (Listen the first 1 min 52 secs to get the gist).
- However, one valid point that may come out of this is that if any of these traditional remedies are effective (and they may well be) there is little chance that they will be taken on by big phama for testing as they are not capable of being patented. Therefore they will not turn a profit. As small herbalist organisations are unlikely to have the money to run trials themselves, potentially cheap and effective treatments will be lost to the public. Could central governments take on testing these kinds of remedies for licencing? Alternatively, could there be a lower-level of testing which would simply establish that they were harmless? Such remedies could be sold with a warning on the packet that they have been shown to be harmless but there is no evidence that they work.
National CAM organisations
- Directory of national organisations controlling CAM (web site)
- British Complementary Medicine Association (web site)