As readers of my posts here and also at my own blog (see link below) will know I am (amongst other things) a financial services professional operating in the private medical market and most decidedly not a clinician. However, I have a life long interest in science and medicine that is actively encouraged by my profession and interactions with both NHS and private clinicians mean that I take a close interest into this area.
I find that a working knowledge of science, medicine and the political issues that underpin them to be immensely valuable for me day to day. I would describe my world view within this context as being ‘skeptical’. In the more modern context of the word this means that I accept or seek to derive knowledge based upon an active application of the scientific method and would hold that the best way to test information received is using an evidence based approach.
So I would identify myself as a ‘skeptic’ and hope to apply this to all areas of my work and leisure time. You may be surprised to learn that this skeptical approach is not necessarily one that only applies to doctors and scientists and that like myself many ‘lay people’ are skeptics – there is a strong skeptical movement in the UK and around the world and I will discuss this in more detail in part 2 of this article – in fact I suspect that it is true to say that some clinicians wouldn’t necessarily fall within this skeptical mindset or even identify that strongly with many of its tenets – as I will examine during this and the subsequent article.
You see the ‘skeptical approach’ means that certain things endemic within the medical ‘sector’ and society more generally are to me as a skeptic a complete anathema. In essence my view (and notably the current scientific consensus in fact) is that many if not all of the so called : ‘Supplements, Complimentary and Alternative Medicine (SCAM) modalities are no more than complex and expensive exercises in offering participants the placebo effect (I hesitate to call users of SCAM : ‘patients’ as they are most commonly not seeing qualified medical practitioners but rather well meaning lay people who have been effectively duped into believing a non-scientific approach to patient care is valid in some way).
So my point here is that all of the following treatment modalities are generally unsupported by proper science and as such should be rejected as viable effective treatment forms other than if explicitly acknowledged by practitioners as offering ‘comfort’ from their attention and enhancement of the placebo effect. In essence a 30 minute consultation with an a SCAM practitioner makes you feel better not from from the ‘active treatment’ offered but rather because your SCAM practitioner [insert treatment protocol of choice] : pokes you with a needle; rubs your feet, massages your aura, gives you magic water etc and then vitally spends time listening to you.
The list of SCAM’s below is not intended to be exhaustive but I would consider the following main SCAM categories as invalid treatment forms other than for the comfort/placebo process mentioned in the previous paragraph :
Acupuncture /Acupressure, Chiropractic/Osteopathy, Homeopathy, Reiki, Chinese Medicine, Ear Candling, Kinesiology, Naturopathic medicine, Reflexology
I’m sure I am upsetting proponents of many of the above SCAM practices as they read this article but think about this for a second : There is little or no evidence to support the use of these SCAM practices. In many cases there is no plausible biological mechanism for their action – what effect there has ever been demonstrated under scientific testing tends to recede the more scientifically rigorous the study (sometimes called the ‘decline effect’) to the point where replicating results (a vital element of scientific proof) is impossible.
Anecdotal evidence for efficacy of a treatment is not evidence – it is possible to assert any effect using anecdotes but this is a logical fallacy (the ‘hasty generalisation’ fallacy) and the fact that a given SCAM practitioner views their treatment to have worked is both unsurprising and just as likely to have arisen from regression to the mean (i.e. a user of homeopathy gets ‘better’ following their taking of a homeopathic remedy having come down with flu. Of course they would have gotten better anyway without the remedy – flu works like that). The only way to ferret out real effects from this regression to the mean effect is of course to split those treated into two groups and treat one with the so called remedy and have another as a control group and we are back in the land of blinded trials and away from anecdotal stories.
I am not going to pass comment here on what I believe to be ‘wrong’ in the practice of SCAM – it is not for me to pass judgement on what could (generously) be viewed as well meaning lay people offering placebo services to their customers – the inherent problems with using non-scientific and unproven methodology versus tested scientific protocols should be obvious – suffice to say that it is for the practitioners and proponents of SCAM to demonstrate the efficacy of their ‘wares’ using the same fundamental process as would apply to all medical procedure – evidence of efficacy and safety usually proven via robust double blinded studies and so on.
The caveat to all of this is of course that, if using the scientific method, if strong proof of a position that is contrary to my current opinion arises I will re-assess my position in light of the new evidence – this is the fundamental basis of skepticism and of course the scientific method that underpins it. So as and when a robustly constructed double blind trial proving [insert chosen SCAM modality] works is published in a respected, peer reviewed journal with results that can be replicated then I will change my opinion as should any honest skeptic.
At this point in the article I would just mention that some elements of accepted mainstream medicine (sometimes called ‘western’ medicine by SCAM proponents) are only partially evidence based or indeed wholly non-evidence based. This is a common ‘defence’ of SCAM modalities – the premise being that since all of ‘western’ medicine isn’t evidentially based so our non-scientific practice must be OK as well. Firstly this is a non sequitur – conflating the two together is not a coherent argument. Secondly there are indeed elements of medicine that fall into this category. For example the use of SSRI’s for the treatment of certain mental illness does not fall within the category of properly evidenced treatment. But thirdly, and here is where the key difference arises – the use of SSRI’s is held to be controversial and any cursory search of the literature on-line shows that mental health professionals are acutely aware of the literature available and have and will continue to change their opinions based on the changing scientific evidence.
This first part of my comment on medical and scientific skepticism was a statement of general belief and hopefully gives some background on my views as to the relevance of these kinds of SCAM therapies. In part two I am going to move on to discuss how we can educate ourselves to be wary of being taken in by non-scientific and pseudo-scientific practices in medicine and in life more generally.
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