Dr Gabriel Stewart replies to a recent Health Supplement article deriding alternative treatments and puts forward his arguments for why conventional medicine deserves its share of scepticism
In his article A dose of cynicism Paul O'Donoghue again takes a wide swipe at all alternative treatments that fall out of the realm of conventional medicine.
He purports to understand why mainstream practitioners get involved in these treatments. While many alternative treatments are rather bizarre, and patently do not work, there are many well-trained and experienced physicians who integrate beneficial treatments into their practices that are not part of mainstream medicine.
The main reason that these are not accepted is that they have not been proven by the Randomised Clinical Trials so rigorously demanded by mainstream medicine. Yet more than 80 per cent of conventional treatments have not been subject to trials.
Many of the treatments which become part of medical dogma do so as a result of clinical trails, many of which are fatally flawed. The following are some of the problems which have been documented by experts in the field of clinical trials such as Elmer Cranton, author JS Cohen, MD, who wrote a book entitled Overdose: The case against drug companies and James P Carter MD, a professor of nutrition in the US and author of Racketeering in Medicine:
1. Key findings in the body of these trials do not appear in the abstract or summaries of the studies, which is all the physicians, reporters, insurers and others may ever read.
2. References are selected to include only ones that support the papers' conclusions.
3. Side effects which cause drop outs are often omitted.
4. Adverse effects are usually deprecated.
5. Trials are run only as long as the outcome favours treatment.
6. Unfavourable trials are not published.
7. The use of ghost writers and figurehead authors in papers on drug research has been well documented, along with directions from sponsors to authors about what key pages to include and what findings to de-emphasise. This point has been made by a number of medical experts on the issue.
8. Only studies with the most favourable results are published.
9. More importantly, drug research gives details of relative risks, rather than absolute risk. Research findings usually also give details of the reduction of the death rate in specific categories, rather than the overall death rate which should be given in clinical trials. This last point paints a rosy, but inaccurate picture of many trials.
Doctors who incorporate effective treatments in their practices that are not recommended by mainstream authorities, risk losing their licences and all that it entails. The benefits of these treatments can often be demonstrated by clinical observation and further verified by clinical tests. Pharmaceutical firms are not interested in this particular approach as there is no money to be made from these treatments.
Drug manufacturers also have a serious conflict of interest in trying to balance the interests of employees and shareholders against the interest of patients.
A drug can cost up to €800 million to put on the market. Nor is the National Institute of Health (NIH), in the US, nor the US Food and Drug Administration (FDA) free from the pharmaceutical industry's influence. It wasn't until last June the US House of Representatives voted to prohibit doctors and scientists who work for drug companies from sitting on FDA panels. It remains to be seen if this is confirmed by the US Senate or if the drug companies can use their enormous influence to derail it. Clinical observation is the most important vehicle for a physician to assess any treatment.
However, with the advent of ever more stringent audits of doctors, the art of medicine will be further eroded. Doctors will be forced to follow treatments, many of which are based on poor science and flawed clinical trials. The cosy relationship that exists between the medical powers that be, and the powerful pharmaceutical industry will be further solidified.
O'Donoghue comments on treatments that do not have a scientific base. He states: "Try wishing away appendicitis."
Yet this is apparently what happens in 20 per cent of cases.
Twenty per cent of appendectomies reveal appendices that are perfectly normal. While these procedures are entirely justifiable it demonstrates that surgical procedures are subject to the "mind over matter" placebo effect which science cannot explain.
How many other procedures are placebo effect with no scientific basis as demanded by O'Donoghue? It is believed that on average 30 per cent of successful treatments are placebo effects.
For a drug treatment to be ratified, it barely has to exceed this.
O'Donoghue states that many naturally occurring materials are highly toxic. While deaths from alternative practices are rare and when happen get headline-grabbing attention, the same does not apply to conventional treatments. He fails to mention that non error, adverse effects of drugs is the fourth leading cause of death in the US each year. To put this into perspective, more people die from taking drugs correctly, as prescribed by their doctor, every year in the US than are killed in road accidents.
Some of the suggestions of experts to prevent perversion of trials include the following: to prevent "manipulation" all government employees at NIH, FDA or investigating bodies should be barred from any consulting agreements, or any form of compensation or gifts. All clinical trials of devices, tests, surgeries, drugs supplements should be registered with a totally independent NIH or some other investigative body. Independent observers should be assigned to each study to ensure it was not perverted or buried.
Only if these and other measurements are put in place can the public feel assured in following any treatment either mainstream or alternative.
Dr Gabriel Stewart is a practising GP who uses both complementary and conventional treatments. He has a clinic in Dublin.