Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

An important new blog opposing fraud in medicine – EdzardErnst.com

We have too much fraud and irresponsibility in medicine. Not all of what is criticized is fraud, because the people pushing these treatments may just be ignorantly promoting treatments that have no good evidence to support them.

The people claiming that a treatments works because there is no proof that the treatment is harmful are abusing their responsibility to their patients.

Is there an important distinction between this irresponsible abuse of patients and fraud?

One is intentionally misleading others, while the other is first misleading himself, so that he can honestly present nonsense as something he believes in.
 


 

Dr. Edzard Ernst is an alternative medicine doctor who wanted to know what really worked in alternative medicine, but could not find any good evidence. He designed some research to find out what really works.

As a good scientist, when the results of the research did not provide the answers he wanted, he changed his mind and he published the negative results.
 

In a nutshell, I am not someone who judges alternative medicine from the outside; I come from within the field. Arguably, I am the only researcher in this area who is willing [or capable?] to state publicly what is wrong with alternative medicine. This is perhaps one of the advantages of being an emeritus professor![1]

 

But is Dr. Ernst completely dismissive of alternative medicine?
 

People who criticise alternative medicine tend to claim that all of it is unscientific rubbish which we should discard. However, I am not convinced that this opinion is correct. I aim to adhere to the principles of evidence-based medicine and know that they can be applied to alternative medicine as much as to any other area of healthcare. This means that I will not dismiss everything that comes under the umbrella of alternative medicine. Our research has shown some treatments to work for some conditions, and where this is the case, I will always say so.[1]

 

I use a more inclusive definition of alternative medicine. I include the nonsense that is claimed to be part of real medicine, but is not supported by good medicine.

Look at ACLS (Advanced Cardiac Life Support).

ACLS is primarily about resuscitation from cardiac arrest, which is much more than just temporarily getting a pulse back.

ACLS is primarily about survival to go home with a brain that still works.

ACLS treatments that are included in the resuscitation guidelines are –

Chest compressions – Good evidence of improved survival from cardiac arrest.

Defibrillation – Good evidence of improved survival from cardiac arrest.
 

Unfortunately, ACLS does not stop with treatments that work. The following are also included –

Ventilations – No evidence of improved survival from cardiac arrest.

Epinephrine – No evidence of improved survival from cardiac arrest.

Vasopressin – No evidence of improved survival from cardiac arrest.

Phenylephrine – No evidence of improved survival from cardiac arrest.

Norepinephrine – No evidence of improved survival from cardiac arrest.

Amiodarone – No evidence of improved survival from cardiac arrest.

Lidocaine – No evidence of improved survival from cardiac arrest.

Magnesium – No evidence of improved survival from cardiac arrest.

Atropine – No evidence of improved survival from cardiac arrest. Removed in 2010 due to a lack of evidence, even though the rest of the treatments remain, for now.
 

I don’t criticize alternative medicine because it is an easy target, but because of the similarities with the dangerous parts of real medicine.

If we don’t learn from our mistakes, our patients pay for our arrogance.
 

What follows is, I think, quite simple: this blog will differ from other blogs on the subject. It will provide critical evaluation because, in my view, this is what is needed. But it will not engage in wholesale alternative medicine-bashing. Most importantly, it will provide comments and perspectives that are based on many years of conducting and publishing research in this area.[1]

 

While I do engage in wholesale bashing of alternative medicine, I do ask for people to produce valid evidence that the treatments they are pushing are safe and efficacious. Without evidence, the treatment is nonsense.

With ACLS, I take a similar approach.

There is a lot of nonsense in ACLS, but not all of ACLS is nonsense, and ACLS seems to be improving. These abuses from ACLS are only some examples of the failure of real medicine to grow up and eliminate wishful thinking from medicine.

If we care about our patients, we should not abuse them with nonsense.

If we care about our patients, we need to know that the treatments we give are more likely to provide benefit than harm.

Without evidence, we are ignorant of benefit (if any) and harm (how much harm).

Everything can cause harm, but not everything can cause benefit.

Too many of us mistakenly assume that it is appropriate to demand evidence of harm, but inappropriate to demand evidence of benefit. This is just treatment by logical fallacy.[2]

Our patients deserve more intelligent and more ethical treatment than that.
 

Go read what Dr. Ernst writes.
 

Footnotes:

[1] A New Blog on Alternative Medicine. Why?
Published Sunday 14 October 2012
EdzardErnst.com
Article

[2] Argument from ignorance
Wikipedia
Article
 

Argument from ignorance, also known as argumentum ad ignorantiam or “appeal to ignorance” (where “ignorance” stands for: “lack of evidence to the contrary”), is a fallacy in informal logic. It asserts that a proposition is true because it has not yet been proven false, it is “generally accepted” (or vice versa).

 

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