Frequently asked Questions.
Real Secrets of Alternative Medicine has set out a general thesis that camistry provides beneficial effects due to placebo responses mediated in the same way as hypnotic experiences and response expectancies.
Most questions can be answered by reference to the web sites of associations and practitioners who practice in CAM. Just pick the CAM in which you are interested and use your favourite search engine. Do not believe all you read – retain your critical faculties and ask questions. Bear in mind that randomised double-blind controlled trials are the “gold standard”, but not essential. There should nevertheless be at least some plausible evidence, however it has been obtained. And by ‘evidence’ is meant an objective credible account which is offered by rational persons, and which is reproducible by other investigators – not simply anecdotes of the subjective experiences of enthusiastic wudoka. It goes without saying that all results should be published, not just the ones which prove the point the author wishes to make. Publication bias is research misconduct, but you must be the judge.
I have given a number of lectures and talks based on these themes and these have resulted in questions worthy of further explanation. Amongst questions regularly encountered are the following:
Q Why do Camists not distinguish between the beneficial effects of the therapeutic relationship with a patient and the effects of the therapies or remedies they use?
A They must answer for themselves, but this conflation does prevent proper assessment of each element and disguises the fact that in all cases studied, CAM therapies and remedies themselves have no significant effect on any specific disease process. Patients benefit from the attention of a camist due to placebo responses, but camists also claim their methods can treat diseases. An an alternative mind-set is needed to believe that, and is why CAMs are ‘alternative’. As to whether the camist is deluded and does not understand the importance of the distinction between the two types of effect, or is deliberately seeking to mislead in order to promote unsubstantiated treatment methods – that has to be assessed on a case by case basis and is for you to judge. If so, you may regard the camist as being a quack. If the camist sells products or practices or otherwise gains pecuniary advantage from inherently worthless products or procedures, you will have to consider whether they are frauds.
- Q: Managing low back pain (LBP) is always contentious, Real Secrets reviews suggestions that manipulation by chiropractors, osteopaths or physiotherapists achieve similar outcomes, so on what basis can a practitioner be selected?
A: Indeed so, but chiropractic and osteopathy are not just manipulation. Chiropractors claim they are ‘primary health-care professionals’ – that they can make diagnoses and can adjust subluxations to release ‘innate intelligence’ – a ‘vital force’ mediated by nerves. Osteopaths claim manipulation releases much the same force, mediated by arteries. They may seek to disguise such beliefs, but if so, why are they practicing chiropractic or osteopathy and not physiotherapy? If you want ‘vital forces’ released then either high or low impact manipulation may help you. If you want your joints and musculoskeletal soft tissues manipulated, consider that a doctor or physiotherapist can do this without claiming to access any ‘vital force’. Such ‘forces’ have never been identified by scientific consensus, their nature remains in the dimension of metaphysical speculation, and practitioners who claim to be able to utilise them have to be challenged as being mistaken and misguided.
- Q: Why do people train as chiropractors and not osteopaths or physiotherapists?
A: Or indeed, as nurses or doctors. Each practitioner must make their own career choices and explain their own reasons. I have not been able to identify any consistent reasons but all practitioners state they ‘want to help patients’. Some have admitted ‘it was the only course which would accept me.’ Some: ‘it was the nearest to where I live.’ I have to assume all will understand and believe in the nature of the particular CAM they choose and can rationalise and explain their reasons for choosing a specific CAM – for otherwise they would simply be quacks or even fraudsters. You must judge their answers – just make sure you ask!
- Q: NICE guidelines say acupuncture can be ‘considered’ for the management of chronic low-back pain (LBP). Real Secrets suggests otherwise, why?
A: Most of NICE guidance on acupuncture is: ‘Do not’. Some suggests: ‘More research needed’. For LBP the review did not distinguish between having a constructive therapeutic relationship with a practitioner and the therapy of inserting needles itself. NICE has no evidence needles are needed, and therefore acupuncture is not needed. Caring is of course always necessary.
- Q: My relative has found CAM of benefit for managing pain. Surely it can’t all be placebo can it?
A: What else could it be? We know there are no active molecules in homeopathic pillules; no spinal subluxations which can be adjusted; no meridians along which a ‘force’ passes to balance other dimensions after needling of the skin; no vital forces in plants that cannot be refined by pharmaceutical scientists to even more basic natural compounds; no forces, energy fields or ‘aura’ that can be manipulated by the waving or the laying on of hands. Every patient has their own past individual imaginative encounters on which to base new experiences and their own expectancies and responses to suggestions. Each patient will find they respond to different CAMs variously. At different times, one particular CAM may seem ‘best’ for the individual. Placebo responses are powerful, highly individualised, and vary with the particular CAM technique employed – but any variation does not imply that is because of the CAM therapy itself, rather the variation is because of the patient’s expectation and response to the therapist. That is the nature of placebo.
- Q: Why are so few CAMs funded by the NHS?
A: In general, public policy requires that if tax payers’ money is to be used for healthcare, there is plausible evidence for the benefit of any proposed treatment, remedy or procedure. In the case of CAMs, most can demonstrate benefit from a constructive therapeutic encounter with an empathic attentive practitioner – but such care can and should be provided by any appropriate healthcare professional. The unique aspect of CAMs is the particular therapy, procedure or remedy used. And there is no scientifically plausible evidence for effects of any CAM on any specific disease or illness. If there was, it would be ‘medicine’.
As Jeremy Hunt, Secretary of State for Health, said: ‘I need to follow the science and what science says, what the evidence says. I support doing what the scientific evidence says.’ And in answer to a question put to him in the House of Commons by Conservative MP David Tredinnick (who is keen to see homeopathy and Traditional Chinese Medicine ‘integrated’ with the NHS) Hunt stated: ‘Where there is good evidence for the impact of Chinese medicine then we should look at that but where there isn’t we shouldn’t spend NHS money on it.’ These views are endorsed by the majority of doctors – but not all. (http://www.dcscience.net/BBC%20Radio%205%20Live%20DC%20Eames.mp3).
- Q: Why do some doctors and nurses support the use of CAM?
A: Because doctors and nurses care – and if the patient wants to access a CAM, many will try and oblige rather than attempt to explain all the issues. Hence the value of considering the Real Secrets. Some orthodox professionals may actually have belief in one CAM or another, though it is unethical for them to proselytise such faith to patients.
May the wu be with you all.
- Jonathan Dimbleby, personal communication.