Skeptics in the Pub talk slides - Prof. Edzard Ernst 2011-09-13
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PC2-2011-Alt Med v2 - 1 Alternative Alternative medicine medicine Edzard Ernst Complementary Medicine Peninsula Medical School University of Exeter, UK Email: [email protected] Website: www.pms.ac.uk/compmed
description
Slides from the talk given by Prof. Edzard Ernst to the Plymouth Skeptics in the Pub group 13th Sept 2011Images removed which may otherwise breach (c)Slides with a green background are explained to be tongue in cheek. Yellow backgrounds are "take home messages"
Transcript of Skeptics in the Pub talk slides - Prof. Edzard Ernst 2011-09-13
PC2-2011-Alt Med v2 - 1
Alternative Alternative medicinemedicine
Edzard ErnstComplementary MedicinePeninsula Medical SchoolUniversity of Exeter, UK
Email: [email protected] Website: www.pms.ac.uk/compmed
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Contents of my lecture• Background• Unsubstantiated claims• Evidence• Outlook• Conclusion
+ provide a few novel “definitions”+ several ‘take home messages’
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I. Background
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AM: definition
…the field of healthcare that re-names itself every 5 years or so.
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Alternative medicine (AM)Complementary medicine (CM)CAMNatural medicineHolistic medicineUnorthodox medicineFringe medicine
etcetcetc
Integrated medicine
Babylonic terminology
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Acupuncture (6)Alexander technique (1)Animal-assisted therapy (1)Applied kinesiology (1)Aquatic therapy (1)Aromatherapy (4)Art therapy (2)Auricular therapy (1)Autogenic training (2)Biofeedback (4)Bioresonance (1)Chelation (1)Chinese herbalism (3)
Six textbooks of ‘Integrated Medicine’
Chiropractic (5)Counselling (2)Craniosacral therapy (1)Environmental medicine (1)Exercise (2)Herbal medicine (6)Homeopathy (6)Hypnotherapy (5)Imagery (2)Laser therapy (2)Laughter therapy (1)Light therapy (1) Magnet therapy (2)
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Massage (6)Meditation (4)Mind body approaches (2)Mora therapy (1)Music therapy (3)Native American healing (1)Naturopathy (4)Neurolinguistig Programming (1)Nutritional therapies (4)Osteopathy (6)Prayer (1)Probiotics (1)Polarity therapy (1)Progressive relaxation (1)Psychotherapy (1)
Continued…
Qigong (3)Reflexology (2)Reiki (3)Rolfing (1)Spinal cord stimulation (1)Spiritual healing (3)Supplements (1)Tai Chi (2)Therapeutic touch (3)Thermotherapy (1)Trager method (1)Thought field therapy (1)Vitamins (1)Yoga (2)
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Acupuncture (6)Aromatherapy (4)Biofeedback (4)Chiropractic (5)Herbal medicine (6)Homeopathy (6)
Six textbooks of ‘Integrated Medicine’(treatments included in at least 4 books)
Hypnotherapy (5)Massage (6)Meditation (4)Naturopathy (4)Nutritional therapies (4)Osteopathy (6)
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1st ‘take home’ message
• Alternative medicine includes a plethora of modalities which have little in common
• Integrated medicine = alternative medicine by another name
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One-year prevalence of CAM-use in general populations
UKIsrael
Hungary
CanadaItaly
FinlandAustrali
aFrance
USGerman
yJapan
10 20 30 40 50 60 70 80(%)
Thomas, et al. J Pub Health 2004;26:152Shumueli, et al. Isr Med Assoc J 2004;6:3Buda, et al. Orv Hetil 2002;143:891Millar. Can J Pub Health 1997;88:154Menniti-Ippolito, et al. EJCP 2002;58:61
Vaskilampi, et al. Hodder/Stoughton 2004MacLennon, et al. Lancet 1996;347:569Bouchayer. Comp Med Res 1990;4:4
Barnes, et al. Adv Data 2004;343:1Härtel, et al. FKM 2004;11:327Yamashita, et al. CTM 2002;10:84
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So why are we Brits so obsessed with
AM?
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<Picture of the Queen removed for ©>
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Money spent on AM/yearMoney spent on AM/yearGlobal ~ 60 billion $
US ~ 47 billion $ ($870m [homeopathy])
UK ~ 1.6 billion £Germany ~ €250 [homeopathy]
=2015: global supplement market
= $93.15 billion
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‘Alternative Medicine’ in the UK media(Source ‘Lexis Nexis’)
No
of a
rtic
les/
mon
th
+ 50,000,000 websites
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2nd ‘take home’ message
• Alternative medicine is popular, costly and incessantly hyped by the media
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II.Unsubstantiated
claims
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AM: definition
…the field of healthcare where anyone can make any therapeutic claim without fear of retribution
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4 examples
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Unsubstantiated claim No.1
xy is effective
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<Picture of Prince Charles looking delighted removed for
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Unsubstantiated claims: chiropractic
Review of 200 websites of chiros and 9 of chiro-organisations:
Results: 95%/100% made unsubstantiated claims
Ernst, Gilbey. NZMJ 2010:123-36.
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Chiropractic: non-spinal conditionsCondition % Conclusion of systematic reviews
Dymenorrhoea
63 “There is no evidence that SM is effective”
Infant Colic 63 “…no convincing evidence…”
Asthma 57 “No evidence to support the use of chiropractic SM”
Otitis ? “No evidence”
Fibromyalgia ? “…there is insufficient evidence…”
CTS 89 “There is no evidence to suggest that chiropractic is effective…”
Hypertension 42 “…chiropractic spinal manipulation cannot be considered an effective treatment”
% = percentage of UK chiros claiming effectiveness
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Those who can make you believe absurdities can make
you commit atrocities
Voltaire
Ceux qui peuvent vous faire croire des absurdités peuvent vous faire
commettre des artosités.
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Unsubstantiated claim No.2
xy cannot be scientifically tested
PC2-2011-Alt Med v2 - 26Yu et al, Pain Manag Nurs. 2011; 12: 41
3733
29 29
15 1310
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Massa
ge
Acupres
sure
Cupping
Herbals
Medita
tion
Chiroprac
tic
Acupun
cture
% "
muc
h im
prov
ed"
Perceived effectiveness of CAM for pain
Sample: 92 pain patients from Taiwan
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Patients
A
B
Time
Compare
The principle of a clinical trial
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Unsubstantiated claim No.3
there is no money in AM (for research)
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<Picture of David Beckham holding up a football shirt
showing a Herbal company sponsorship removed for ©>
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3rd ‘take home’ message
• Unsubstantiated claims abound• Unsubstantiated claims are just
that…they are unsubstantiated,
i.e. “bogus”
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III.Evidence
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AM: definition
…the area of healthcare where sound evidence and rigorous science struggle more than elsewhere to get accepted
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TreatmentCondition
Acupuncture Nausea/vomitingOsteoarthritis
African plum˚ (Pygeum africanum)
Benign prostatic hyperplasia
Aromatherapy/massage
Cancer palliation
Co-enzyme Q10˚ HypertensionGinkgo biloba˚ Alzheimer’s disease
Peripheral arterial diseaseGuar gum˚ Diabetes
HypercholesterolaemiaHawthorn˚(Crataegus spp)
Congestive heart failure
Horse chestnut˚(Aesculus hippocastanum)
Chronic venous insufficiency
Hypnosis Labour painMassage AnxietyMelatonin˚ Insomnia
Treatments* which demonstrably generate more good than harm.
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Systematic review: acupuncture for OA
Inclusion criteria:
Sample:
Results:
Conclusion:
all RCTs, needle-acupuncture, any language
18 RCTs
pain: significantly better than sham
“…acupuncture seems an option worthy of consideration…”
Kwon, et al. Rheumatol. 2006;45:1331-7
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Treatment ConditionMusic therapy AnxietyPadma 28§˚ Peripheral arterial diseasePhytodolor§˚ Osteoarthritis
Rheumatoid arthritisRed clover˚ (Trifolium pratense)
Menopause
Relaxation AnxietyInsomnia
S-Adenosylmethionine˚ OsteoarthritisSaw palmetto˚(Sereona repens)
Benign prostatic hyperplasia
Soy˚ HypercholesterolaemiaSt John’s wort˚(Hypericum perforatum)
Depression
Treatments which demonstrably generate more good than harm… cont.
Ernst, et al. Desktop guide to complementary medicine.
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Unsubstantiated claim No.4
AM is natural and therefore safe
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<Cartoon showing the proprietor of a Natural Herb show dead while 2 police
discuss saying “Looks like he died of natural causes”
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Adverse effects of complementary therapies
Abbot, White, Ernst. Nature 1996; 381: 361
Survey of large sample of British CM users
+++ ~700 Vascular accidents, strokes or deaths* Estimated order of magnitude
Therapy Reporting adverse effects
Deaths*
Spinal manipulation
15.8 % (~50%) +++ ~100
Acupuncture 12.5 % (7-11%) ~100Homoeopathy 9.8 % (~20%) ~10
Herbal medicine
7.6 % (depends) ~1000
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4th ‘take home’ message
• Much of alternative medicine is not evidence-based (but some of it is)
• Much of alternative medicine is not associated with serious risk (but some of it is)
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IV.The Future…
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…has started
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CAM practitioners in the UK
The Times 10 Jan 2004
Design:
Endpoints:
Results:
survey of all UK practitioners of 5 disciplines
5 “best practice criteria”
acupchiroosteohomherb
% fulfilling all
acupchiroosteohomherb
% fulfilling > 3374
1
802
284
100
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“CAM, like conventional medicines, should be subject to careful evaluation of their effectiveness and safety. It is important that treatments…are properly tested and that patients do not receive misleading information…NHS provision for CAM…should be confined to treatments that are supported by…evidence of both effectiveness and safety”
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BCAvs
Simon Singh
…happily promote bogus treatments…
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Opposition is becoming organised
•Sense About Science (UK)•Nightingale Foundation
(UK)•Sceptics in the pub (UK)•Science in Medicine (UK)
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Most UK university degree courses in AM
had to close
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10:23<Picture of someone holding in his mouth a homeopathic bottle labeled “arsen. alb” removed for possible ©>
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Homeopathy on the NHS was reduced by ~40%
Sales of homeopathic remedies declined in
Germany by 2.2% (2009-10)
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~600 complaints about UK chiropractors (GCC)
+Numerous complaints
about homeopaths (ASA)
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“…anyone in medicine today who does not
believe in evidence-based healthcare is in the wrong business…”
Reilly BM. BMJ 2004;329:991.
Conclusion
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Email: [email protected] Website: www.pms.ac.uk/compmed
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