In which I also apply for a job as a homeopath

In which I also apply for a job as a homeopath

News reaches these Canadian shores of an extraordinary job opportunity: a £68,000 per year post for a homeopath to work just two afternoons a week. I have decided to apply.

ooOoo

To HR, NHS Tayside:

Herewith, my application as candidate for the position of Specialty Doctor of Homeopathy in your hospital.

Statement of Principles

Homeopathy is an important and essential healthcare modality. No other treatment protocol has so effectively medicalized the interpersonal neodialectic discourse that is the essence of healing, or, to put it in the crude vernacular, a ‘cup of tea and a bit of a chat’. I applaud NHS Tayside for standing firm against the totalitarian paradigm of evidence based medicine, and for their willingness to challenge the patriarchal dogma of so-called ‘Clinical Excellence’.

Qualifications

I have received many years of education at the patellae of my matrilineal elder, who elucidated a profound critique of modernism via juxtaposition with her own critical Marxist theory. The class divisions inherent in hospital hierarchies are ripe for desublimation and subversion and, in accordance with cultural libertarianism, I consider myself fully qualified (that is, unqualified, or, to use a postdialetic neologism, de-qualified) to excel in the position of Specialty Doctor of Homeopathy.

I do not hold any medical qualifications, although I do have a doctorate in the biological ‘sciences’, which I hope will not be held against me; admittedly, while the extensive exposure of the self to the microfascistic paradigm of so-called ‘peer review’ and ‘scientific standards’ may be seen as an impediment to the successful practice of a pre-Enlightenment system of knowing such as Homeopathy, I believe it instead gives me the critical perspective to self analyse, deconstruct and reject the status quo of rationalism that is the abundant narrative in hospital care.

I have a lifetime of experience in making, pouring and drinking tea, both alone and with other people, and am able to, at the same time and to a very high standard, listen to other people talk about their medical issues, pets, kids or gender conflict and sexual identity in the patriarchal, neo-liberal relational terrain of marriage to the differently-gendered (or like-gendered) ‘other’.

Finally, I am able to dispense homeopathic remedies while maintaining the standards of pseudo-scientific, Enlightenment-challenging narrative and discourse that is the defining characteristic of this particular treatment modality. This application is submitted as evidence of this ability.

Availability

I do currently reside in a different country, but rest assured, for £68,000 a year and for just two work sessions a week, I would move to Tayside in a regular, non-artery-clogged heartbeat. I hear the deep fried Mars Bars are to die for, as well as standing as a marvellous symbol of the paradigm-challenging nature of this job opportunity; in a country with the worst health outcomes in all of Europe, it takes guts to de-employ 500 proper health care workers and hire a homeopath instead.

Thank you for your consideration,

Doc.

ooOoo

A chiropractor struggles to defend chiropractic

A chiropractor struggles to defend chiropractic

Lawyered up

The British Chiropractic Association took Simon Singh to court for libel. In a stunning example of the Streisand Effect, the criticism that they were trying to suppress –  that their claims that “chiropractic can be used to children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying” were unsupportable – have come under new, unprecedented scrutiny.

Richard Brown, chiropractor and Vice President of the BCA, tried to defend chiropractic in the pages of New Scientist. Here is some analysis of his unconvincing defence.

Chiropractors are so misunderstood

Brown:  Many critics – including Edzard Ernst  – hark back to the origins of chiropractic. This has the clear intention of suggesting that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases. While a tiny minority retain this view, most are aware that such claims have long since been debunked.

Let’s take a look at his first testable claim: that a tiny majority of chiropractors retain the view that “spinal misalignments are responsible for the majority of diseases”. Palmer’s original belief was that subluxations of the spine cause disease, and that correcting subluxations, therefore, will correct the disease. What do UK chiropractors believe?

A  survey of chiropractors in the UK (from 2007) found that:

Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.

Far from just a tiny minority, we can see that clear majorities of chiropractors hold the belief that asthma, GI complaints and PMS can all be treated with chiropractic. Large minorities believe chiropractic can help with hypertension, infertility, osteoporosis and obesity. Infant colic, ear infections and childhood muscular problems were believed to be treatable by chiropractic by more than 50%. A fair reading of the survey will see that it shows a majority belief that spinal misalignments play a role in at least these aforementioned, non-spinal diseases.

Of course his actual statement,  “that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases” is extreme and exclusionary, and deliberately so. A critic will find it hard to factually dispute, which succeeds in shifting the frame away from the areas of debate where chiropractic is weak, viz. the evidence and the philosophy. One must, on the evidence, accept that his statement is likely to be true, as there surely are but few chiropractors who firmly believe subluxations to be the cause of every disease. However, a majority of chiropractors do still cling to the ludicrous belief that subluxations are the cause of the aforementioned diseases, as the evidence clearly shows.

Brown also uses the rhetorical device of ‘conceding the point’. By admitting that the basic principle of chiropractic has “long since been debunked” – he even uses the language of the skeptic – he hopes to get the readership on his side. But in a scientific publication, defending chiropractic will take more than decorum. One also needs logos.

Cherry picked data

Brown: Claims that chiropractic is dangerous overlook two recent pieces of research. One found no causative association between chiropractic manipulation and stroke. The other concluded that the incidence of stroke after chiropractic was no greater than after a consultation with a general practitioner (Spine, vol 32, p 2375, and vol 33, p S176).

Here is the second testable claim: that there are two research papers that demonstrate the safety of chiropractic that the critics have overlooked. For a skeptical, scientific audience, that’s a sit up and listen moment, but as one is reading the claim and not being Gish-galloped with it in a live debate, the audience has the luxury of testing it out. There are two questions we can ask. First, what do the two papers say, and are they of good enough quality to support the idea that chiropractic does not cause stroke? Secondly, where do the papers fit into the larger body of research on the safety of chiropractic?

Spine, vol 32, p. 2375.  Safety of Chiropractic Manipulation of the Cervical Spine. A Prospective National Survey. (2007). This survey was the first national, large scale effort to poll chiropractors and estimate incidence of adverse events arising from cervical spine manipulation. The authors found that minor side effects of chiropractic manipulation were common, including neck pain, stiffness, soreness and headaches. However, no serious adverse events such as stroke or hemorrhage were reported by the chiropractors. So, no stroke, but the paper is far from a ringing endorsement for the safety of chiropractic. They report that manipulation of the neck commonly leads to headaches, a finding that is profoundly concerning. And there are other criticisms: patients were not followed up, it is not known if chiropractors under-reported adverse events, and people may not have told their chiropractor about a serious adverse event after chiropractic treatment. If they found themselves in hospital with a vertebral arterial dissection, they would have more important things on their minds. To keep things in context, a number of researchers have found that there is an association between chiropractic and stroke. A survey of chiropractors, like this one, does not invalidate all the research that preceded it.

Spine, vol 33, S176.  Risk of Vertebrobasilar Stroke and Chiropractic Care. Results of a Population-Based Case-Control and Case-Crossover Study. (2008). This paper is very popular among chiropractors, who see in it validation for their practice of manipulating the neck vertebrae. I’ll not recap it in depth, but will just say, again, that one paper does not supercede all that has preceded it, and wonder why it is that it takes a survey or an indirect population study, like this one, to identify the risks of chiropractic. It begets the question: does the profession not want to find out the risks for itself? Apparently not. For a more detailed look at what the researchers found, go here.

So, placed into context, Brown’s cherry picked citations rather reveal that there are risks associated with chiropractic, and chiropractors themselves have done little research, on their own initiative, to quantify these risks. Furthermore, there is a large body of research that shows an association between chiropractic and stroke, and Brown would do well to read up.

More to chiropractic than spine bending

Brown: Our critics also make the mistake of equating chiropractic with spinal manipulation, especially with regard to treating non-spinal conditions such as asthma. This demonstrates a lack of understanding of the fact that chiropractors utilise a range of treatments, including postural advice, reassurance and exercise.

I suppose that if one cannot defend the claim that subluxations cause asthma, one should retreat from the claim. Why argue for something that is factually indefensible? The problem with what Brown says here is that he seems to suggest that chiropractors can utilise postural advice, reassurance and exercise… to treat asthma.

It is no surprise to me that chiropractors do more than spine bending. Practice growth and financial success in the chiropractic business is not held back by the same barriers that real doctors face, like prescribing restrictions or evidence based medical practice. Take a look at a chiropractor’s office and see what they have to offer. In fact, Richard Brown, our valiant defender of chiropractic, offers all manner of wonderful woo at his clinic: aromotherapy, reflexology, ear candling and Indian Head Masssage.

So yes, there’s more to chiropractic, but not much more.

I know you are, but what am I?

Brown: Ernst and others claim that chiropractic lacks evidence, pointing to a paucity of randomised controlled trials. This overlooks the fact that many accepted medical interventions have little or no research evidence to support them.

No, it doesn’t overlook that fact, because that fact is not, in fact, relevant. What is relevant is the fact that chiropractors lack evidence in support of their claims, and ignore the evidence that disprove their claims.

Medical interventions, when found to be unsuccesful, will be discarded. Chiropractic, when found to be unsucessful, will just insist on being tested again and again until the researchers get their sums ‘right’.

Summary

The last thing the chiropractic profession wants is scrutiny, but by suing Simon Singh, that’s exactly what they got. This is a profession that chooses to sue a science writer for criticising their claims, rather than countering with the evidence. It is a profession that won’t look for evidence of harm from chiropractic unless first prodded to do so. It is a profession where the majority are adherents to a discredited, bogus 19th century pseudo-medical concept of disease. It is a profession so divorced from reality that the best they can muster in their defence is a grab bag of rhetorical tricks and diversions and the hammer of English libel law, because, as they well know, the evidence for chiropractic just isn’t there.

free debate

Homeopathy Awareness Week 2009: Zicam!

Homeopathy Awareness Week 2009: Zicam!

Its homeopathic awareness week!

Were you aware that homeopathic nasal cold remedies can burn out your sense of smell? The FDA wants you to know about it.

Zicam make popular homeopathic products such as nasal sprays. Two of their products, Zicam cold nasal gel and and Zicam cold nasal swabs, were recalled by the FDA this week after they were found to destroy people’s sense of smell.

There is more to homeopathy than the snake oil gambit of diluting a compound so much that not a trace of the original remains. The philosophy of homeopathy is, rather,  The Law of Similars, or ‘like cures like’. If a chemical causes a certain set of symptoms, then treating a disease that produces those symptoms with said chemical will effect a cure.

Hence Zicam, et hinc illae lacrimae.  The homeopathic (active) ingredient in Zicam is Zincum Gluconicum, or zinc gluconate, which was approved by the Homeopathic Pharmacopeia Convention in 1997. It was ‘proven’ to produce cold like symptoms in healthy individuals, and added to the The Homœopathic Pharmacopœia of the United States (HPUS) that year. HPUS dictates the maximum strength that a compound can be for over the counter use, although based on what criteria I know not. For Zinc Gluconicum it is a 1x dilution, that is, one part compound to nine parts water. Zicam actually used a higher dilution, 2x, where the previous dilution is taken and diluted a second time. The final dilution is 1:100. Bear in mind that Avogadro’s limit is not reached until around 24x dilution, and many homeopathic over the counter preparations are diluted beyond that, and you can see Zicam’s mistake: their homeopathic cold remedies actually contained ingredients.

Not only that, the effect of using actual ingredients in Zicam neatly disproves the concept of the Law of Similars and the essential philosophy of homeopathy. Sticking harsh chemicals up your nose, it turns out, has potentially life threatening consequences. It doesn’t cure congestion or sinus pain; it causes sinus pain and the loss of smell.

Why did Zicam do it? Probably because, by labelling an over the counter treatment as homeopathic, they avoided the regulation and safety testing that would be demanded for proper drugs.

Remember, homeopaths, Avogadro’s limit is your friend. Make sure that your treatments contain nothing at all and you will avoid these unpleasant lawsuits.

The FDA can’t regulate a placebo.

When $2.5 billion can’t buy the results that you want…

When $2.5 billion can’t buy the results that you want…

Its been ten years since the National Center for Complementary and Alternative Medicine (NCCAM) was established. Ten years and $2.5 billion dollars. What do they have to show for it?

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.

Senator Tom Harkin, the driving force behind NCCAM, has long been aware of the problem. From the outset, the center was bedeviled by practitioners of evidence-based medicine. The “unbendable rules of randomized clinical trials”, as he described them, proved unforgiving. Harkin lambasted scientists for their resistance to accepting therapies on faith: “It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies.”

Sadly, his valiant defence of alternative medicine from the Armies of The Enlightenment was all in vain. After being described as ‘Tom Harkin’s folly’ in a New York Times editorial, in 1998, the center was elevated to the status of National Institute of Health center. It was to be run under a mandate of promoting a rigorous and scientific approach to the study of alternative medicine.

The result has been a disappointment to Senator Harkin.  He told a Senate hearing in 2009, “One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short.” After all, the center has been “disproving things rather than seeking out and approving things.”

I see the problem, Senator. If only scientists had not adhered so rigidly to RCT standards. If only they had been willing to accept other sources of information. In fact, their willingness to disregard folk wisdom and tradition and their privileging of evidence-based medicine is, well, gosh darn it, it’s almost fascist. Not all the way fascist. Lets say… microfascist.

hitler-baby

As someone far more intellectual than I once wrote, “the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge.” The problem? Scientific research operates inside a post-positivist paradigm that excludes alternative forms of knowledge. I would argue that by refusing to contemplate the experiential, the traditional, the imagined and the anecdotal, the evidence-based movement  “acts as a fascist structure”. Indeed, credentialed “scientists”, through their “secular priesthood” hold a monopoly on the production of scientific knowledge.

Senator, by privileging ‘regimes of truth’ like evidence-based medicine, the NCCAM has been a good example of microfascism in action. If you want to see your center fulfil its original intention, if you want to see an end to microfascism in the National Institutes of Health, if you want to prevent the elimination of alternative ways of knowing and the reduction of health sciences to the totalitarian ideology of evidence-based medicine, that ‘regimented and institutionalised version of ‘truth”, take back the NCCAM. Alternative medicine can never be integrated with the singular, totalising ideology of evidence-based medicine and its microfascististic worldview.

It is in deconstructivism that the radical singularity of knowledge that is complementary and alternative medicine will find a welcome space of freedom to territorialise and colonise.  It is time for CAM to resist the totalitarian program of randomized controlled trials, to decolonise the masculine narratives of large sample sizes and competing hypotheses.

It is time for CAM to embrace postmodernism. And then you can get the results you want.