Energy at work; another example of anti-science agendas?

Hi all,

Roger is tied up so I’ll be posting this week, as we settle back into our regular bi-weekly postings. I had an interesting summer writing grant proposals (more on that subject in a later post) and just got back from a conference in the UK. Sadly I have yet to be reunited with my luggage by Virgin Atlantic, but I live in hope.

Upon my return, the latest copy of Canadian Nurse was on my doorstep, and I was interested to find a four page article titled “Energy at work” on new age nursing and the place of alternative therapies in practice. Given this is a supposedly professional journal, I was expecting a balanced and informative article, when in reality I got a thinly disguised article advocating the wonders of therapeutic touch (TT). Granted, it did acknowledge that there was no scientific evidence TT works, or that the human energy fields exist, but overall the article was rather embracing of these alternative approaches.

One of the practitioners, a registered nurse bemoaned the fact she couldn’t use TT in her practice and was not allowed to say “Can I hold you hand and send you a little Reiki?” The fact this would be a very inappropriate thing for an RN to say to a patient seems to go unchallenged in the paper. This is really akin to a physcian saying “Would it be Ok if I inspect these animal entrails to confirm my diagnosis?” An event that would (hopefully) result in a disciplinary action at least:

1) We shouldn’t use or promote any practice that has no evidence of effect on unsuspecting members of the public, and
2) we shouldn’t promote our own personal spiritual beliefs upon others, no matter how well intentioned.

Sadly, articles like this do little to help a balanced discussion, or value the contribution of science in healthcare. Worse still they promote the idea that these alternative practices are just as valuable as evidence based ones. Indeed, some do have value, but this makes nurses look look slightly barmy. I for one, would rather nurses to be promoted as serious health practitioners rather than gullible new age gurus.

Interestingly, the article notes there are currently only 80 members of the Canadian Holistic Nursing association. Which makes me question why the Canadian Nursing Association would publish another paper about these practices (they published a virtually identical paper 6 years or so back) given they are such a minority of the 230 thousand or so RNs in Canada? There are probably 80 RNs in Canada who still believe in alien abductions or that Elvis is still alive, so how about some articles targeted for them from Canadian Nurse if they are aiming to appeal to very small minorities of the profession?

Anyhow, it isn’t just the CNA who seem to be afflicted with an agenda to promote bad science as an equally valid alternative to EBP.On my travels in the UK I came across the Bristol Homeopathic Hospital.

 

This NHS funded hospital offers homeopathic service as a general service for children and adults with a wide range of chronic illnesses and a complementary cancer care service. It claims on its website that homeopathy is useful in the management of:

  • Rheumatology
  • Allergic conditions
  • Asthma
  • Eczema and other dermatology conditions
  • Menstrual and Menopausal problems
  • Digestive and Bowel Problems
  • Stress and Mood disorders

Well not according to Cochrane, or any other credible sources I am aware of. Fine for individuals to pay for this if they wish, but it did make me wonder why UK tax payers money is being spent supporting this? Maybe there is a surplus of cash in the UK health service I have not heard about…

Anyhow, maybe I am just grumpy given my luggage loss or maybe my Chakras are not aligned, but I promise we will not dwell on complementary therapies too much this year, as 1) plenty of other sites cover this area well (such as FSM), and 2) they represent rather an easy target for scientific arguments to challenge, and 3) those that believe are unlikely to change their views based on the evidence.

So this year we hope to tackle some more challenging arguments and ideas in the philosophy of science.

Onwards and upwards!
Bernie

Reference

Jaimet K. (2012) Energy at Work. Canadian Nurse, 108(7) 33-36

Integrated Medicine; the latest trend in health?

Hi all,

As we roll into summer (hopefully a rock n’ roll summer according to Rog) a few developments in the strange world of “integrated medicine” caught my eye. Firstly, I am not really sure what “integrated medicine” is, as none of its proponents seem to be able to come up with a good definition, other than being a “holistic approach.” Frankly, it seems to be a conflation of medicine and stuff that isn’t evidence based and probably doesn’t work but has a strong following of folks who believe in it.

Naming and dividing up pseudoscientific or quasi-scientific practices as a form of medicine is rather an old trick of alternative practitioners. The classic examples being “Western medicine,” “Eastern medicine” or “alternative medicine” to emphasize different philosophical world views behind medical treatments and therapies. In reality, this is of course nonsense, and modern medicine is an evidence based endeavour, and there is simply “medicine” (i.e things that are based on scientific evidence and well-tested theories and actually do work; some better than others granted), and non-medicine (which generally doesn’t work, at least no better than placebo, but sounds hip and cool). Science-based healthcare doesn’t care if therapeutic interventions come from Brighton, Washington, Bejing or Bankok; as long as they work. Integrated medicine does look like the latest in this long line of different terms used to try and make pseudo-scientific practices sound credible.

There is big money behind these endeavours too (and I suspect big profits). A mail-out landed in my mailbox the other day for the Natural Standard website, which looks very well organized and professional when you visit.  It looks like a site dedicated to providing sound and good scientific evidence on complementary as well as established medications.

However, upon closer inspection it seems to present far less than rigerous scientific standards are applied in their recommendations. For example one cited paper suggests that the extract of pulsatilla (a purple flower beloved by homeopaths) may be able to reverse cognitive impairment and be beneficial in the treatment of Alzheimer’s disease. This astounding statement is based on reported research from no-less an authority than the Life Science R&D Center of SK Chemicals in Korea, from it’s laboratory studies. Needless to say lab studies are at the bottom of the evidence pyramid for Evidence Based Practice, and the suggestion at this stage that this may help reverse Alzheimer’s is completely bonkers. Maybe after a wide range of succesful clinical trials you could start to make such a claim, but try getting that one published in the BMJ on the basis of lab studies.

In a similar vein, it looks like things are hotting up for homeopaths in the UK.  A consolidation of existing regulations by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK will come into force on 1st July 2012 despite a campaign by supporters of homeopathy to try and prevent it.­The problem for homeopaths is that under the new regulations there are only 5 appropriately qualified pharmacies which can now dispense the four dozen or so formally registered potions that can be legally sold in the UK. All other homeopathic prescribing and supply not involving a face-to-face consultation with a registered homeopath will be unlawful after July 1 2012. Thousands of unregistered homeopathic remedies that are not included in the regulations will no longer be legal for sale. Even for the handful of legal preparations, supply without a face-to-face consultation will cease and all online or telephone sales will be illegal. I am not sure what Prince Charles thinks of this, but looks like the stage is set for a rapid change in the black drugs market. One can imagine shady looking characters approaching you in the pub and saying “Psst, want to score some good argentum nictrium in a 5C dilution, I have a good deal going…”

This may pose a problem for the The Royal London Hospital for Integrated Medicine  which is advertising for a pharmacist who specializes in (yes you guessed it) “integrated medicine.” The job requires a trained pharmacist with a minimum of 10 years of experience able to deliver clinical pharmacy services, and requires some sort of integrated medicine training (sadly it seems that the NHS is now getting into IM too) but it doesn’t say what that experience should be (maybe trifling with voodoo as a teenager would qualify)? The position would involve dispensing both regular medical medications and ones that probably don’t work too. Your tax dollars (sorry pounds) hard at work. Well at least Obama’s health reform’s went through this side of the Atlantic, so there is cause to celebrate here. Thanks to Andy Lewis of the Le Canard Noir who flagged this story, and also Scott Gavura’s excellent Science Based Pharmacy site.

Anyhow, as Roger noted the summer is upon us and I am off to Vancouver Island (Sooke) on my holidays for a while. Roger will be away for a bit too, so things may be a little quiet over the summer, but we will try and post when we can. We will of course, be back in full swing in the fall with more scientific quandaries for you (and us) to puzzle over.

Onwards and upwards scientists! Have great summer,

Bernie

 

 

Science and Non-Science!

Well we are back into a new term here, and the trend in advertising to equate scientific and non-scientific ideas seems to be as strong as ever here in Canada in the new year. Interestingly, I saw a television advertisement last Friday for a new hospital information system being employed in Canada (Ontario I believe). The advertisement made a point to explain how the system incorporated patient information from both modern medicine, alternative Eastern medicine and natruropathic medicine.

Now this public affirmation of all encompassing healthcare struck me as interesting and I have long been trying to get my head around what naturopathic medicine actually is. I have read a variety of literature on the subject and still find it rather a confusing area, and have come to the conclusion it does not seem to be a scientific endevour. It is of specific interest to us nurses here in BC as naturopaths are one of the few listed health professions (including physicians) who are explicitly identified as being able to give orders to nurses under our professional regulations:

Section 7: Restricted Activities that Require an Order

Health professionals authorized to give orders to registered nurses under the Regulation are dentists, midwives, naturopaths, nurse practitioners, physicians and podiatrists.

(CRNBC 2011)

I must admit I have always found this rather puzzling, as to why naturopaths were selected but not other alternative health practitioners,  and the rationale for this seems to be rather arbitrary.

If we take a look at the statement of the Canadian Association of Naturopathic Doctors they state:

“Naturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease. Symptoms of disease are seen as warning signals of improper functioning of the body, and unfavourable lifestyle habits. Naturopathic Medicine emphasizes disease as a process rather than as an entity.”

This seems not really that different than modern medicine, other than the limitation of focus to primary healthcare. However, reading further we find that  their natural/traditional interventions are based on a range of some decidedly dubious practices, including homeopathy (which despite what many advocates will tell you, is well established as bunk, and neither its theoretical basis or the empirical evidence of its effectiveness stand up to scrutiny).

It seems naturopathy attributes illness to the violation of “natural laws” suggesting that standard medical practices merely treat or suppress symptoms. Naturopathy has some other rather non-scientific ideas in that it does not accept the germ theory of illness, or more worryingly support vaccinations (see http://www.cand.ca/Position_Papers.papers.0.html?&L=0).

Scientific practices have a clearly stated and straightforward underpinning philosophy. We can consider science as:

“Science is the pursuit of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.”

(UK Science Council, 2011)

Philosophically we can resort to the “problem of induction,” and related epistemological arguments to question the nature of evidence, but what is the rationale for blending scientific and non-scientific practices? This seems a very weird thing to want to do in the first place, a bit like saying I believe in chemistry and vodooo to explain the nature of matter, or lets blend astrophysics and astrology to explain the function of the solar system. I know there is this desire to be holistic, but it seems to publicly support disciplines that seem to have a catch-all basis, with rather vague and mystical rationales should be something we should seriously question, especially when dealing with publicly funded healthcare.

This view is growing very untrendy in my profession, and I know Roger and I are likely to be considered dinosaurs in this perspective as the adoption of postmodern notions of holistic being (although we prefer the term “old tuskers”). So I ask, should we be concerned with this trend for non-scientific alternative health practices being increasingly equated with science and evidence based practices? Scientific knowledge may well be flawed, but this all-inclusive approach seems to reflect more of a politically “right-on”stance rather than reflect a real interest in the quality of public healthcare. Its one thing if you or I want to go and pay for a round of crystal therapy if we wish to, but buying into services (with public money) that are popular but have no established utility seems a dubious undertaking in these times of economic woe. Certainly some traditional and alternative health practices have value, but exploring alternative health practices to establish their value using well established scientific methods for evidence based practice  would seem to make more sense for public health care.

All this writing has made my arm ache, now where did I leave my Q-Ray bracelet…

Bernie

CRNBC (2011) Scope of Practice for Registered Nurses. Retrieved from https://www.crnbc.ca/Standards/ScopePractice/Pages/Default.aspx  on 12/01/2012

UK Science Council. (2009). What is Science? | www.sciencecouncil.org Retrieved 8/25/2011, 2011, from http://www.sciencecouncil.org/content/what-science