Dealing with pain
Time for a fresh look at complementary medicine
Edward Baldwin, member of House of Lords1 1 London SW1A 0PW
Lord Baldwin—who chaired the British Acupuncture Accreditation Board 1990-9, was joint chairman of the Parliamentary Group for Alternative and Complementary Medicine 1992-2002, and served on the House of Lords Science and Technology Select Committee inquiry into complementary and alternative medicine in 2000—asks that both complementary and conventional practitioners keep an open mind.
Scientific rigour does not always go with complementary and alternative medicine, where assumptions often go unchallenged. But the need for rigour is sometimes as evident on the conventional side as on the unconventional.
Having been a serious user of complementary and alternative medicine for nearly 20 years, and finding myself more recently in positions where I have tried to draw attention to some of the remarkable things that seem to be happening in the field, I want to emphasise the need for clear thinking if we are to discover what works, to what extent, and for whom.
Evidence (however you choose to define it) is crucial; but it needs to be based on solid foundations. My first experience of the unusual was 35 years ago. Having damaged my knees through too vigorous an outing in the British hills, I was sent to see specialists, culminating in two eminent gentlemen in Harley Street.
They prescribed varying forms of treatment and did me no good at all. Nor did a sports expert in the United States, who suggested the problem was in my mind.
Three years later, hobbling with knee bandages and a mindset of incurability, I was directed by a colleague to a spiritual healer in a back street in Cambridge. He spent half an hour waving his hands over my knees while discoursing on his life as a school-master and Harold Wilson's politics. I felt nothing, though I had been warned to expect heat or cold.
I shall never forget my astonishment at levering myself out of bed the next morning to find the pain had vanished, never properly to return. What is the orthodox explanation for this cure? The placebo effect. But no one has asked me what I in fact expected.
Since the placebo effect may depend on the patient's conscious or subconscious attitudes to treatment, this might be thought relevant. It would be encouraging if well conducted studies had been done to discover what patients do expect in varying situations, but my impression is that this has not been a research priority.
How likely is it that a patient who has consulted a succession of the best white coats, and has had three years of failure and pain, will expect to be cured by a blind old man without qualifications in an upstairs bedroom who is not even concentrating on the job? Not very. (I actually felt rather foolish visiting him.)
And if the placebo effect is so powerful—because my cure, though not total, was permanent—why did it not manifest itself for any of the previous orthodox interventions where I did expect results? I conclude that, although the placebo effect remains a possible explanation, it is an unlikely one.
Since then I have observed with what ease it is paraded by doctors, and with what lack of rigour. The suspicion that "placebo effect" can be a cover for the discomfort the medical mind experiences when faced with the unusual is reinforced by the tendency of doctors to give explanations before they have ascertained the facts.
Beata Bishop writes well of this in her challenging account of recovery from metastatic malignant melanoma by means of an intricate organic vegetarian regimen.1 When she attempted to "interest some doctors in the life-saving potential of the Gerson therapy... with two exceptions all the doctors whom I approached chose to make categorical statements rather than ask questions."
This is a common observation among people who have recovered from diseases after using complementary medicine, as Judith Glassman chronicles in The Cancer Survivors.2 I have experienced it myself several times.
If complementary medicine's successes are dismissed because they are deemed impossible, the evidence will never be gathered, and medical knowledge may lose valuable opportunities to move into new areas. After all, many medical advances begin with anecdote.
Philosophically, one of the most suspect arguments is "Unusual things demand unusual proof"; for who may say with authority what is "unusual" before the game has even started? When, for example, a researcher writes in Science that "not 1000 experiments with 10 million trials and by 100 separate investigators giving total odds against chance of 10 to the one-thousandth to 1" will persuade him about something he considers impossible,3 one fears for scientific objectivity.
And when the conjurer James Randi pursues his campaign against homoeopathy with the analogy of looking for a unicorn in the garden, his image reveals his own prejudice by postulating a result that all must agree is impossible. It reminds me of the argument against meteorites in Victorian times: "Stones do not fall from the sky, for there are no stones in the sky."
Reasoning is not the only area in which many commentators on complementary and alternative medicine discard their usual rigour: this is also evident, less excusably, over basic facts.
Last year a general practitioner writing in the Sunday Times on 12 June about Michael Gearin-Tosh's account of his unconventional journey through multiple myeloma4 wrote "not that coffee-ground enemas can cure cancer." No, and neither can anaesthetics.
But just as the latter is indispensable in cancer surgery, so the former is a necessary adjunct to the Gerson and some other therapies, without which the rapidity of the process of tumour breakdown can be overwhelming. Neither claims to cure.
Mainstream commentators on complementary medicine too often allow themselves a carelessness with the facts that they would not dream of, or get away with, when discussing conventional treatments.
I could cite many similar examples of the plain failure of critics to do their homework. This does not help rational debate. So, complementary medicine practitioners (if you are reading this), please think about, question, and test what you do, and avoid comfortable assumptions.
And, medical commentators, please consider your arguments and do your homework as rigorously with complementary and alternative medicine as you would expect to do in your own disciplines. In this way we patients are most likely to benefit.
Competing interests: EB received an honorarium for chairing the British Acupuncture Accreditation Board 1990-9 and has received the occasional speaking fee when addressing professional bodies of complementary and alternative medicine.
1 .Bishop B. A time to heal. London: Arkana, 1996.
2. Glassman J. The cancer survivors. New York: Dial Press, 1983.
3. Price GR. Science and the supernatural. Science 1955;122: 359-67.[ISI]
Gearin-Tosh M. Living Proof. London: Scribner, 2002.
4. BMJ 2003;326:1322 (14 June)
Complem Thera in Med, 9/03
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