The perfect way to defend natural remedies

The Good Life Letter 

1st April 2016

  • Why the NHS won’t be offering this valuable natural remedy any more
  • Discover when evidence is never the answer
  • Here’s why science needs to wake up
I’m a reasonable man.

No, seriously... when issues are to be discussed I do listen to the arguments and then make my own mind up.

The tenacity that I then have to defend my opinion can occasionally get me into trouble, but only in an appropriate circumstance.

Lara will testify to the fact that I have spent many an evening with visitors to the house pretending that the absolute tosh they are spouting might have some relevance, whilst biting my lip – holding back my desire to roar my defiance at them for the sake of friendship.

She’ll also point out that as we close the door on their departing forms I do have a varied collection of verbal insults that I can unleash!

So yes, I would class myself as reasonable... and just a bit temperamental!

In my work for the Good Life Letter I also seek out the details and background to the stories which pique my interest and attempt to offer some kind of balanced view, or at least not too over the top.

In this respect I understand the nature of good evidence and clear rationale.

But for the life of me I can’t understand the need for absolute proof at a majorly scientific level for something that has clearly worked for thousands of years.

Where this is all leading is my need to try to put the latest announcement by NICE about acupuncture into some kind of context.

If you didn’t see the story it went like this.

Putting a pin in pain

Acupuncture has been used for many millennia to help resolve pain and other ills, having its foundations in ancient Chinese medicine.

It has been offered on the NHS for treating muscle and joint pain, and administered by GPs and physiotherapists as part of combined therapies.

However, last week the clinical head of NICE announced that its use was being withdrawn from guidelines for lower back pain.

Speaking to the press Professor Mark Baker said ‘Regrettably, there is a lack of convincing evidence for some widely used treatments. For example, acupuncture is no longer recommended for managing lower back pain with or without sciatica. This is because there is not enough evidence to show it is more effective than sham treatment.'
What kind of evidence did they look for?

My own poor knee has benefitted greatly every time I visit my ‘lady with the pins’ and I personally know around twenty other people who have all used this method of treatment for varied aches and pains – all with great success.

A simple search of the scientific databases (Medline, Cochrane and PEDRO) yields hundreds of papers which show convincing trials data that supports the use of acupuncture for pain relief.

Even the NHS’s own website(1) has this to say –

Systematic reviews carried out by The Cochrane Collaboration have found there is some evidence acupuncture may have a beneficial effect on the following conditions:

  • chronic lower back pain
  • tension-type headaches
  • migraines
  • nausea and vomiting after chemotherapy
  • nausea and vomiting after surgery
  • osteoarthritis
  • neck pain
  • irritable bowel syndrome (IBS)

So I really am at a loss about why they have chosen to decry the benefits of using a treatment approach that seems as well supported as many of the drugs they are happy to endorse.

Like I said at the start of this letter, I am a reasonable man and would accept any valid comment on these topics, but for the life of me there hasn’t been any.

The press dug up their classic go-to guy, Dr Edzard Ernst, who has long been writing articles against acupuncture, homeopathy and many other alternative therapies and natural remedies.

He typically went overboard about the lack of scientific proof and sprinkled his comments with phrases like ‘little better than placebo’.

In doing this he and his like miss the point (no pun intended there!) there are people out there who are benefitting.

Maybe the issue is that there are no trials that work for these types of treatments – you see it is difficult to generate a sham treatment that they can be measured against.

If I were to test a new drug then coming up with a placebo sugar pill to test it against is easy, but if I want to test whether acupuncture is effective, how do I get someone to believe they are actually having acupuncture if I don’t stick pins in them?

As a result Dr Ernst and his buddies claim that the trials aren’t effective because there is no exclusion of the placebo effect...

...see what I mean about the problem being the trials rather than the treatment.

But in honour of the date today and to help the naysayers get their head around the idiocy of insisting on 100% proof before they will allow themselves to believe what their eyes tell them – I want to conclude with a fully validated and published report from a few years ago.

Enjoy!

Parachutes don’t work – the proof

From the British Medical Journal, 18th December 2003(2)

Abstract

Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.

Design Systematic review of randomised controlled trials.

Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall.

Main outcome measure Death or major trauma, defined as an injury severity score > 15.

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

What a fantastically reasonable way to counter the argument that some of our most valuable and reliable natural remedies don’t work because there is no accurate trials data to support their use.

Happy April Fools' Day Dr Ernst!

Yours, as always


Ray

References;
(1) http://www.nhs.uk/Conditions/Acupuncture/Pages/Evidence.aspx accessed 31/3/16
(2) Smith, G. C., & Pell, J. P. (2003). Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ: British Medical Journal, 327(7429), 1459.
 




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