An open letter to the Prince of Wales regarding the use of alternative medicine

July 9, 2004

Hi all,

Taken from: http://bmj.bmjjournals.com/cgi/content/full/329/7457/118?

ehom

Twenty years ago, on the 150th anniversary of the BMA, you were

appointed its president and used your position to admonish my

profession for its complacency. You also used this platform to

promote " alternative " medicine. Shortly after that I had the

privilege of meeting you at a series of colloquia organised to

debate the role of complementary and alternative medicine (CAM). Of

course, you won't remember me but the event is indelible in my

memory. I was the only one of my colleagues unequivocally to

register dissent.

A few days later you had a four page supplement in the London

Evening Standard, promoting unproven cures for cancer, and the paper

invited me to respond. I requested the same space but was only

allowed one page, which at the last minute was cut by a quarter to

make space for an advert for a new release by Frankie Goes to

Hollywood. Furthermore, the subeditors embarrassed me with the

banner headline, " With respect your Highness, you've got it wrong "

(13 August 1984). As I have nothing more to lose I'm happy for that

headline to grace the BMJ today.

Over the past 20 years I have treated thousands of patients with

cancer and lost some dear friends and relatives along the way to

this dreaded disease. I guess that for most of my patients their

first meeting with me was as momentous and memorable as mine was

with you.

The power of my authority comes with a knowledge built on 40 years

of study and 25 years of active involvement in cancer research. I'm

sensitive to the danger of abusing this power and, as a last resort,

I know that the General Medical Council (GMC) is watching over my

shoulder to ensure I respect a code of conduct with a duty of care

that respects patients' dignity and privacy and reminds me that my

personal beliefs should not prejudice my advice.

Your power and authority rest on an accident of birth. Furthermore,

your public utterances are worthy of four pages, whereas, if lucky,

I might warrant one. I don't begrudge you that authority and we

probably share many opinions about art and architecture, but I do

beg you to exercise your power with extreme caution when advising

patients with life threatening diseases to embrace unproven

therapies. There is no equivalent of the GMC for the monarchy, so it

is left either to sensational journalism or, more rarely, to the

quiet voice of loyal subjects such as myself to warn you that you

may have overstepped the mark. It is in the nature of your world to

be surrounded by sycophants (including members of the medical

establishment hungry for their mention in the Queen's birthday

honours list) who constantly reinforce what they assume are your

prejudices. Sir, they patronise you! Allow me this chastisement.

Last week I had a sense of déjà vu, when the Observer (27 June) and

Daily Express (28 June) newspapers reported you promoting coffee

enemas and carrot juice for cancer. However, much has changed since

you shocked us out of our complacency 20 years ago. The GMC is

reformed and, as part of this revolution, so has our undergraduate

teaching. Students are taught the importance of the spiritual domain

but also study the epistemology of medicine or, in simpler words,

the nature of proof.

Many lay people have an impressionistic notion of science as a cloak

for bigotry. Nothing could be further from the truth. The scientific

method is based on the deductive process that starts with the humble

assumption that your hypothesis might be wrong and is then subjected

to experiments that carry the risk of falsification. This approach

works. For example in my own specialism, breast cancer, we have

witnessed a 30% fall in mortality since 1984, resulting from a

worldwide collaboration in clinical trials, accompanied by

improvements in quality of life as measured by psychometric

instruments.

You promote the Gerson diet whose only support comes from inductive

logic—that is, anecdote. What is wrong with anecdote, you may ask?

After all, these are real human interest stories. The problems are

manifold but start with the assumption that cancer has a predictable

natural history. " The patient was only given six months to live,

tried the diet, and lived for years. " This is an urban myth. With

advanced breast cancer the median expectation of life might be 18

months, but many of my patients live for many years longer, with or

without treatment.

I have always advocated the scientific evaluation of CAM using

controlled trials. If " alternative " therapies pass these rigorous

tests of so called " orthodox " medicine, then they will cease to be

alternative and join our armamentarium. If their proponents lack the

courage of their convictions to have their pet remedies subjected to

the hazards of refutation then they are the bigots who will forever

be condemned to practise on the fringe.

I have much time for complementary therapy that offers improvements

in quality of life or spiritual solace, providing that it is truly

integrated with modern medicine, but I have no time at all

for " alternative " therapy that places itself above the laws of

evidence and practises in a metaphysical domain that harks back to

the dark days of Galen.

Many postmodern philosophers would have us believe that all

knowledge is relative and that the dominance of one belief system is

determined by the power of its proponents. However, perhaps we

should all remain cognisant of the words of the Nobel laureate

Jacques Monod: " Personal self satisfaction is the death of the

scientist. Collective self satisfaction is the death of the

research. It is restlessness, anxiety, dissatisfaction, agony of

mind that nourish science. " Please, your royal highness, help us

nourish medical science by sharing our agony.

By Michael Baum, professor emeritus of surgery and visiting

professor of medical humanities University College London .

If anyone with a bit of clout and wants to reply to this in writing

in the BMJ, the direct link is

http://bmj.bmjjournals.com/cgi/eletter-submit/329/7457/118

I hope someone will!

Attilio

July 9, 2004

Thanks for the tip Attilio. I have submitted this.

Challenging Baum on the scope of his methodology

G.A. Bates,

ex-social worker and retired teacher

Leicester, England, UK

Send response to journal:

Re: Challenging Baum on the scope of his methodology

Email G.A. Bates

Michael Baum's " chastisement " of Prince Charles needs to be challenged for

no other reason than he is wrong to suggest alternative medicine is the

result of inferior thought and lacking in scientific credentials.

Laying the groundwork for his argument Baum puts great play on the 'new

skills' learnt by doctors in the last 20 years including " epistemology ..

the nature of proof. " . Baum then goes on to give a very brief account of

modern scientific method (what is in fact Popperian falsificationism) which

is at the root of so-called 'null hypothesis methodology' the cornerstone of

modern statistics employed by scientific research. OK. So far so good. Then

he states:

" You [Prince Charles] promote the Gerson diet whose only support comes from

inductive logic-that is, anecdote. .. "

and ..

" .. I do beg you to exercise your power with extreme caution when advising

patients with life threatening diseases to embrace unproven therapies. "

Braun then proceeds to differentiate between the more simplistic inductive

process, and falsificationism (or refutation) on which modern research is

built. It is textbook stuff alright. Just one thing Michael Baum forgets -

all primary knowledge is based on anecdotal experience.

We naturally 'associate the positive' in our experience. To

characteristically or habitually 'deny the negative' (this would be

'refutation of the null hypothesis' in Popperian terms) is virtually

impossible because we are 'creatures of contact' and not abstract entities.

The schemata of formal reasoning arrive much later in life and even then we

communicate our experience in terms of affirmation, rather than denial. This

is quite evident in the syntax of language: even the language that Baum

uses:

" If their [CAM] proponents lack the courage of their convictions to have

their pet remedies subjected to the hazards of refutation then they are the

bigots who will forever be condemned to practise on the fringe. "

The juxtaposition of positives: IF <conditional statement / cause> THEN

<conclusion / effect> makes intuitive sense to all regardless of

mathematical ability or inherent truth - there is no better way to express

an IDEA, but this is not refutation - it is affirmation. How then, does this

phenomenology of experience and communication relate to medicine and

epistemology? Simply this: Our knowledge, intuition and feeling about the

world from the moment we begin to experience it is based on a substrate of

proof by association, not denial by refutation. In this way, the

'methodology of the anecdote' serves as a vital link between the solipsism

of the womb (extreme relativism) and the archaic world paradigms that have

survived the vicissitudes of time and modern science to give us a great

wealth of viable alternative and traditional medicines. Popper himself went

to great lengths to make the point that falsificationism has a limited

context and to apply the notion incorrectly leads to a fragmentation of

knowledge [1].

I hope this brief exposition will stimulate Michael Baum and others in the

mainstream of medicine to consider the merits of alternative medical

paradigms per se, rather than attempting a transplant into the unnatural

surroundings of a controlled trial that is bound to suffer either rejection

or total suppression. This does not imply a return to witchcraft or

spiritism (indeed traditional chinese medicine - rejected that path

thousands of years ago in the Nei Jing, a famous text of antiquity). Rather

we should understand the 'methodology of the anecdote' as a kind of

time-conditioned (dare I say dialectic-historic) filtering of evidence that

the laboratory is incapable of reproducing.

I'd say respectfully to Michael Baum that " A little knowledge is a dangerous

thing " and ask him not to forget where Popper's falsificationism

originates - in a sound scepticism of the pretentious, both ancient and

modern [2]. Let us applaud Prince Charles for fighting the corner for CAM.

Thank you Sir! We owe you a great debt for helping to keep alive these

ancient treasures in a throwaway world.

Yours faithfully,

Mr. G.A. " Sammy " Bates

www.prostateman.org

1. " The fact that most of the sources of our knowledge are traditional

condemns anti-traditionalism as futile. ..... without tradition, knowledge

would be impossible " Karl R. Popper: Conjectures and Refutations. Routledge

1963. ISBN 0-415-28594-1. p. 28

2. " For the simple truth is that truth is very often hard to come by, and

that once found it may easily be lost again. Erroneous beliefs may have an

astonishing power to survive, for thousands of years, in defiance of

experience, with or without the aid of conspiracy. The history of science,

and especially of medicine, could furnish us with a number of good

examples. " Karl R. Popper, from his lecture " On the Sources of Knowledge and

Ignorance " first delivered before the British Academy in 1960. Proc Br Ac

46.

Competing interests: None declared

-

" " <attiliodalberto

Friday, July 09, 2004 11:52 AM

An open letter to the Prince of Wales regarding the use of

alternative medicine

Hi all,

Taken from: http://bmj.bmjjournals.com/cgi/content/full/329/7457/118?ehom