Bad news for Northern Ireland

[Blue Wode]

According to today’s Belfast Telegraph sCAM could soon be available on Northern Ireland’s NHS:

http://www.belfasttelegraph.co.uk/li...p?story=708922

Ulster health chiefs are set to examine the possibility of breaking with tradition and integrating alternative treatment into GP surgeries across the province.

As a first step, they have organised a special Complementary and Alternative seminar to take place today. Health chiefs will join a range of alternative medicine practitioners.

Among those attending will be members of the British Chiropractic Association and the Northern Ireland Association of Homeopaths.

Around 100 delegates will attend, including GPs and nurses.

Dr Karen Harkin, a GP from Draperstown, said the integration of complementary medicine to the NHS was "absolutely the way forward".

Of course, as this blatant quackery gets pushed through, the General Medical Council’s rules that require GPs to provide their patients with information that is “factual and verifiable" are likely to be completely ignored.

[Oleron]

Depressing.

As if our health service in NI wasn't already one of the most run-down in the UK, they go and do this.

It's a hypochondriacs charter.

[Blue Wode]

An update on this topic from today’s BBC News:

An experiment in allowing NHS patients easier access to alternative and complementary therapies has been launched by NI Secretary Peter Hain.

The £200,000 year-long trial will run in two health practices in Londonderry and Belfast. The main focus will be on anxiety and musculoskeletal problems.

GPs in these areas will now be able to refer patients for therapies like acupuncture, homeopathy and massage.

-snip-

"I am certain, as a user of complementary medicine myself, that this has the potential to improve health substantially," he said.

-snip-

"It will bring together both the mainstream and complementary sectors in what I hope will be the start of a process which will lead to full roll-out across the province."

http://news.bbc.co.uk/1/hi/northern_ireland/6329279.stm

This is the same Peter Hain who claimed that a homeopath managed to clear up his infant son’s allergy problems:

"Complementary therapies, like homoeopathy, get to the cause - rather than just treating the symptoms," he says. "I know from my own experience that they work."

http://www.telegraph.co.uk/news/main...ixnewstop.html

And yet here’s what Professor Sir David King, the government’s Chief Scientific Advisor, had to say about homeopathy in today’s Independent:

There is no scientific evidence whatsoever supporting the use of homeopathy.

http://news.independent.co.uk:80/peo...cle2237709.ece

Not that such a small matter is likely to bother Mr Hain (or even the MHRA).

[Admin]

Would things like homeopathy etc. still 'work' in a hospital environment with short consultations etc.?

Or does integrating mean that these quacks are to be used in their own practices but the NHS picks up the bill?

I can understand that some people benefit from these treatments but I would say it's more down to the psychotherapy style consultation (talking therapy) than the treatment used.

I can't see how either the NHS or the patients would benefit, other than it being free at the point of delivery, from integrating sCAM treatments.

If the treatments have to be made more cost effective to compete with EBM treatments then their mode of action will be removed. If practitioners are allowed to spend an hour or more with each patient only to prescribe a placebo, how could the cost ever be justified?

[Blue Wode]

Would things like homeopathy etc. still ‘work’ in a hospital environment with short consultations etc.?

It would be interesting to know the answer to that.

With regard to chiropractic (apparently one of the therapies on offer), the much touted 1990 Meade Study that compared hospital physiotherapy with chiropractic treatment for low-back pain concluded that chiropractic almost certainly conferred worthwhile long-term benefit in comparison with hospital outpatient management. Significantly, the chiropractic treatment had been administered in private clinics.

I can understand that some people benefit from these treatments but I would say it’s more down to the psychotherapy style consultation (talking therapy) than the treatment used.

That’s very likely. Perhaps if the NHS trained up more GPs it would increase consultation times - something which would then allow them to focus more effectively on patients’ psychological needs and consequently help to eliminate the need for CAM therapists.

[Mojo]

This is the same Peter Hain who claimed that a homeopath managed to clear up his infant son’s allergy problems

Yup, that's the chap.

[Blue Wode]

Good to see a GP speaking out about the march of sCAM in Northern Ireland :

The waiting list for local urodynamics is over 11 months, for non-urgent orthopaedics over a billion years. GPs are busting a gut to switch patients to the cheapest possible drugs and whatever money we do have is thanks to a handsome subvention from Britain. Yet according to a letter we received today, the Department of Health for Northern Ireland has commissioned a complementary therapy pilot project, which will run well into next year.

-snip-

To make it look like they're being scientific, the letter tells us that they have also commissioned an 'independent' audit of the project. Is that rigorous or what?

Don't bother, I can tell them exactly what the audit will say; it'll say how much the patients enjoyed the complementary therapy, it was so relaxing, Smurfs on the wallpaper and all that.

-snip-

Listen pal, or whoever up there in the department has even the most basic knowledge of medicine or some common sense, it is not a new kind of medicine!

In fact, homoeopathy, aromatherapy, iridology and their sidekicks are not even any kind of medicine. They are a festering pile of garbage, inflicted on the gullible and the vulnerable by those who should know better.
It should be the department's job to protect patients from these people instead of colluding with them.

Liam Farrell, MD, GP, County Armagh, Northern Ireland

More…
http://www.healthcarerepublic.com/news/GP/Opinion/775756/When-complementary-isnt-complimentary/

Also good to see David Colquhoun’s interest in the matter in the comments section of the article.

[Boycy]

Just watched a BBC programme about this pilot scheme which presented no useful fact and figures regarding success/failure. The commentary was incredibly one-sided in favour of complementary therapy with perhaps only a tiny mention that clinical tests of these therapies were "inconclusive" which really means negative. To my relief, at the end of the credits a message was displayed stating that the scheme is now over and there are no plans to continue it. I feel sorry for the patients featured, they clearly required psychological treatment which they were not getting. However, an indefinite period of treatment with the quacks featured on this programme is not a long term answer. The programme was Get Well NI, aired Monday May 5 at 9pm GMT. http://www.bbc.co.uk/northernireland...ll/index.shtml

[Blue Wode]

Hello Boycy, and welcome to the UK Skeptics forum.

I completely agree with you. In fact, you can read my comments about the programme at the end of this short thread:
http://www.skeptics.org.uk/forum/showthread.php?t=2466

I managed to catch the programme on Sky on Monday night (thanks to one of the posters here, FarSideOfTheMoon), and I thought it was far too wishy-washy and pro-CAM. It would have been better if they’d spent more time looking at the reasons why – as we were told at the end of the programme – there are no further plans to fund CAM on the NHS in Northern Ireland.

For those interested, you can watch the whole programme here:
http://www.bbc.co.uk/iplayer/page/item/b00b9b3l.shtml?filter=category%3AletterG&scope=ipl ayercategories&start=1&version_pid=b00b99pz

(Available for the next 5 days.)

[tkingdoll]

I feel sorry for the patients featured, they clearly required psychological treatment which they were not getting.

In my opinion, sCAM is a form of psychological treatment. Imaginary cures are great for imaginary diseases, and one of the luxuries of living in a very rich society is pandering to every 'stress' and cough we have. I'm not saying "therefore sCAM is OK", but I am saying it has a place for people for whom conventional medicine has nothing, because such people are not simply going to get a clue that they're lazy, hypochondriac, or paranoid.

But that is not the NHS's problem and never should be, although I guess I could make a case for it being incorporated into NHS psych programs. We need to keep it the hell away from medicine though, lest someone who is actually ill falls for it.

To illustrate what I mean, here's what happened to me recently: I had a double dose of shingles (in the form of Ramsay Hunt) and subsequently got post-viral fatigue (same thing as chronic fatigue syndrome/ME).

I went to a Bupa doctor and she told me that the only real cure is exercise, and indeed exercise would cure me. However, she did inform me that NHS GPs routinely prescribe anti-depressants instead of the fitness regime she prescribed me because...patients don't want to exercise to get well, they don't want all the responsibility of the cure, and they don't want to hear that they're not doing enough. They want a pill. So, they get a pill, cause otherwise they'll quit the exercise after a week and be back at the surgery.

I got my 'prescription' (ten minutes a day walking for the first week, then twenty for two weeks, then half an hour, for six weeks, and to take short naps instead of trying to sleep for ten hours a night). Six weeks later...fit as a fiddle. She told me it would be hell to fight through the fatigue and override my body (which there was nothing physically wrong with), and it was, but I stuck to it because I knew there weren't any other options.

My point is, some people will pester their NHS GP forever because they don't want to face themselves, they just want 'medicine' to make them better. Often it works, as big fat placebos are wont to do. You can't refer these people to shrinks, they'd most likely be horrified and angry. So what do you do? It's easy to see how sCAM fits this gap nicely. The problem is it's based on absolute junk pseudoscience. The advantage is, it's massively helpful as a placebo.

What's the compromise? I don't know. At the Randi talk, Ben Goldacre mentioned a small trial in which patients were told they were receiving a placebo and it still worked! Maybe that's the way forward? I do know that our society will always demand something to cure its imaginary ailments, that's for sure.

[Blue Wode]

In my opinion, sCAM is a form of psychological treatment. Imaginary cures are great for imaginary diseases

Teek, it’s worth remembering that the lady in the BBC NI programme who had been suffering from breast cancer certainly didn’t have an imaginary disease and yet we saw an MD ‘kinesiologist’ supposedly measuring the elimination of toxins from her body by placing a glass vial of some substance (I think it was lead) on her chest and testing her resistance to force applied to her limbs. In addition to that, we witnessed a photographer with neck pain (presumably not imaginary) receiving chiropractic neck manipulation without any mention of the dangers of the procedure and the fact that safer interventions for it exist.

and one of the luxuries of living in a very rich society is pandering to every 'stress' and cough we have. I'm not saying "therefore sCAM is OK", but I am saying it has a place for people for whom conventional medicine has nothing, because such people are not simply going to get a clue that they're lazy, hypochondriac, or paranoid.

I’m not sure that indulging them with sCAM treatments is the way forward. What happens when the sCAM treatments don’t work/stop working?

But that is not the NHS's problem and never should be, although I guess I could make a case for it being incorporated into NHS psych programs. We need to keepi it the hell away from medcine though, lest someone who is acually ill falls for it.

To illustrate what I mean, here's what happened to me recently: I had a double dose of shingles (in the form of Ramsay Hunt) and subsequently got post-viral fatigue (same thing as chronic fatigue syndrome/ME).

I went to a Bupa doctor and she told me that the only real cure is exercise, and indeed exercise would cure me. However, she did inform me that NHS GPs routinely prescribe anti-depressants instead of the fitness regime she prescribed me because...patients don't want to exercise to get well, they don't want all the responsibility of the cure, and they don't want to hear that they're not doing enough. They want a pill. So, they get a pill, cause otherwise they'll quit the exercise after a week and be back at the surgery.

But, if (as you say) exercise is the only real cure, isn’t it inevitable that the anti-depressant patients will eventually be back at the surgery looking for further treatment?

I got my 'prescription' (ten minutes a day walking for the first week, then twenty for two weeks, then half an hour, for six weeks, and to take short naps instead of trying to sleep for ten hours a night). Six weeks later...fit as a fiddle. She told me it would be hell to fight through the fatigue and override my body (which there was nothing physically wrong with), and it was, but I stuck to it because I knew there weren't any other options.

Again, does this mean that the anti-depressant group will have to face the exercise prescription eventually or continue to suffer?

(BTW, I’m glad that you’re in good health again after suffering from such a debilitating virus. )

My point is, some people will pester their NHS GP forever because they don't want to face themselves, they just want 'medicine' to make them better. Often it works, as big fat placebos are wont to do. You can't refer these people to shrinks, they'd most likely be horrified and angry.

But isn’t giving a patient a placebo just a way of prolonging their (psychological) agony? Aren’t they going to have to eventually toughen up and face the reality of their (imaginary) condition?

So what do you do? It's easy to see how sCAM fits this gap nicely. The problem is it's based on absolute junk pseudoscience. The advantage is, it's massively helpful as a placebo.

But for how long? Let’s not forget that Prof. Ernst has concluded that it’s unreliable to count on placebo effects in clinical practice:

“One observation has puzzled researchers and clinicians for many years. Why are placebo-effects so unreliable? Sometimes figures of around 30 per cent are cited to describe the magnitude of the placebo effect: around 30 per cent of people respond to placebo, or about 30 per cent of the total therapeutic effect is due to placebo. These are approximate averages; they do not mean that we can rely on the 30 per cent figure in individual cases. The somewhat confusing truth is that one patient may respond to placebo today but not tomorrow. Similarly there is no such thing as a placebo responder (someone who always benefits from placebo) and a placebo non-responder (someone who never benefits from it). This unreliability makes it problematic to count on placebo effects in clinical practice.”

http://www.arc.org.uk/news/arthritistoday/131_1.asp

What's the compromise? I don't know. At the Randi talk, Ben Goldacre mentioned a small trial in which patients were told they were receiving a placebo and it still worked! Maybe that's the way forward? I do know that our society will always demand something to cure its imaginary ailments, that's for sure.

I think the offer of a (known) placebo has the potential to damage the trust factor that’s so crucial to the doctor-patient relationship. Patients might think that if they decline the placebo, then their doctor, being out of options, may prescribe one anyway.

Perhaps the best that can be hoped for at the moment is for patients to ensure that:

• They have been thoroughly evaluated by a medical doctor
• They have been told of the (lack of) evidence for CAM - as well as its risks
• Having dealt with points 1 and 2, they foot the bill themselves if they still wish to go the CAM route

I would add that ensuring that patients are given accurate information on CAM seems to be the biggest challenge.

[Boycy]

My point is, some people will pester their NHS GP forever because they don't want to face themselves, they just want 'medicine' to make them better. Often it works, as big fat placebos are wont to do. You can't refer these people to shrinks, they'd most likely be horrified and angry. So what do you do? It's easy to see how sCAM fits this gap nicely. The problem is it's based on absolute junk pseudoscience. The advantage is, it's massively helpful as a placebo.

What's the compromise? I don't know. At the Randi talk, Ben Goldacre mentioned a small trial in which patients were told they were receiving a placebo and it still worked! Maybe that's the way forward? I do know that our society will always demand something to cure its imaginary ailments, that's for sure.

You are right, we will always have imaginary ailments. To the sufferers they are as good as real so there may be some merit in incorporating a non quackery based treatment for these individuals on the NHS. Perhaps GP's specially trained in a more attentive consultation approach. Seemingly untreatable patients could be given special referral to clinics where a little more time will be spent on them, maybe throw in a couple of massages and give them advice on caring for themselves mentally as well as physically. I wouldn't mind paying taxes for this if it helped the patients and kept them away from the clutches of CAM. Another benefit of this approach would be that the NHS does not lose track of such patients. There has been and always will be cases where the GP turned out ot be wrong and the patient was really quite seriously ill. To be fair I know the vast majority of GPs are caring and attentive, but they also have appointment books and a room full of other people waiting.