Another ‘boring rant’ about Dr Michael Dixon
Vs
The Quackometer has been commenting on the bunfight between Prof Edzard Ernst and Dr Michael Dixon (Why I support alternative and complementary medicines - 17 Feb 09) reported in Pulse today.
Dr Dixon is the Medical Director of the Prince’s Foundation for Integrated Health.
Pulse have been working hard to fan the flames and they quote Dr Dixon.
‘As a commentator who has never practised general practice in this country, Professor Ernst should stop lobbing grenades and telling us how to do our job,’ he said.
I am a GP and I think Prof Ernst raises an utterly valid and critical issue. I am very happy, indeed positively enthusiastic, for him to lob a few grenades. Incidentally, I am not aware that being a general practitioner is a requirement for assessing evidence. Would Dr Dixon apply the same logic to professors of cardiology or rheumatology? And how should we do our job? I wasn’t aware that it was a GP job to pimp glorified market research as evidence. I recently posted about the Northern Ireland CAM ‘Trial’ and I quoted Dr Dixon in brief. Here is his full statement.
Dr Michael Dixon, the Foundation’s Medical Director, said:
‘The Northern Ireland health service should be congratulated for their open-mindedness in carrying out this study.
‘Patients have clearly benefited – and so has the health service. Reduced prescribing and less need for hospital treatment has saved NHS money.
‘What’s more, all the GPs involved wanted to continue practising integrated healthcare with the option to refer heir patients for complementary therapies. That’s a ringing endorsement.
‘This trial shows that an integrated approach is practical and works in well in NHS primary care. We hope that integrated services will now be provided to the wider population in Northern Ireland.
This is a set of conclusions that are simply not justified. Dr Dixon raps things up in his article for Pulse thus:
Without sounding too evangelical, I believe every patient and GP should have the chance of having things that I have enjoyed over the past 15 years since my conversion to an integrated approach.
Belief is not necessary, simply having an open mind in these things is enough.
That’s the second quote where Dr Dixon has mentioned having an open mind. It is clearly a prime requirement in order to adopt complementary practices. My mind is open, but it’s not vacant and an open mind on its own is simply not good enough. An open mind is just a blank slate on which we should be recording good science-based medicine for the benefit of all patients. Not pseudo-science mumbo-jumbo. His comments on the Northern Ireland pilot are a triumph for the potential of the ‘open mind’ to overcome the basics of evidence-based medicine. Doctors have to be guided by the evidence and I am happy to be guided by Prof Ernst in this respect.
Prof Ernst alludes to this need to be guided by the evidence in his letter.
The GMC’s Good Medical Practice (2006) Para 3c states:
In providing care you must provide effective treatments based on the best available evidence.
A few GPs need to reflect on this GMC stipulation: as a registered medical practitioner what is the evidence base on which you justify using alternative medicines?
Dr Dixon has quite sensibly evaded a direct debate with Prof Ernst on the evidence base. The whole CAM edifice is constructed on the shifting sands of belief so although Dr Dixon can suggest that ‘belief may not be necessary’ there is not much else to fall back on with CAM.
You should write in to Pulse, Euan, if you haven’t already.
I stuck a couple of snarky comments on the other things they ran about the survey, as did David Colquhoun. But I think it would mean more coming from a GP. Many of the advocates seem to take the view that scientists like DC and me are rabidly anti-CAM.. just because. You see this line everywhere in the CAM promotion: “But if it helps my patients….”
Is it no longer PC to call things that are scientifically impossible scientifically impossible? Or even just “placebo therapies”?
I seem to remember Phil Peverley in Pulse writing a splenetic column about homeopathy – not PC but pretty funny.
Yes, it is certainly a recurrent theme to see the advocates as immediately labelling scientists as ‘anti-CAM’.
The ‘you’re not a GP’ tone is an appalling, embarrassing non-argument and it makes me blush to my toes. The whole approach of general practitioners to CAM needs a significant re-adjustment.
I am a fulltime GP and find Prof Ernst has a limited view, however support him fully on his view about autogenic training, a NHS recognised form of self-hypnosis which he patronises and supports. I also prcatice conventional medicine with homeopathy and acupuncture in the best interest of the patient/ person consulting me, with regard to the fact there is clinical evidence currently for approx 15 % of conventional medicine.
I can’t comment on autogenic training but I am not sure how Prof Ernst’s view can be regarded as being limited. I’ve found his assessments to be fair and free of bias.
I have no doubt that the vast majority of practitioners of CAM have patient interests at heart. I am completely prepared to accept that when a professional like a fulltime GP spends time with a patient talking about their health there is a major psycho-social intervention going on that is very likely to benefit a patient. I am just not prepared to accept the suggestion that it is the 200C remedy that is the intervention. It is, to quote Dr Aust’s comment from my most recent post, far more likely to be stealth psychotherapy.
Regarding the 15% figure you quote for conventional medicine you may be interested in this post at SBM which fisks some of Dr Michael Dixon’s dubious arguments. Here is one quote:
You will find further references there as well. Thanks for making the time to comment.
Homeopathy does have a place
26 Feb 08
I write with reference to the homeopathy debate (‘Does homeopathy have any place in general practice?’).
I was called out at 3am to treat a man with right-sided quinsy. He was pyrexial, tachycardic, drooling and with such a degree of trismus, lancing his boil was impossible.
While examining him, the homeopathic remedy I had been reading about came to mind – Belladonna, a classic for sudden onset of inflammation with a hot red right cheek, pyrexia, dilated pupils, lachrymation, visible throbbing carotid pulsation and worsening of symptoms after midnight.
I had a homeopathic starter kit to hand so I popped a pill of Belladonna 30c in his mouth.
On returning 10 minutes later to set up a drip and administer his IV cefuroxime and metronidazole, I was somewhat surprised to find him sipping water. His pyrexia and tachycardia had settled.
I sent him home with antibiotics and he didn’t need to reattend, although he did have his interval tonsillectomy three months later.
I was amazed and intrigued and have explored integrated medicine since. Belief in homeopathy still escapes my scientific comprehension, and yet patients get better. My partners send their heartsinks to me – these patients seem to stop attending the surgery or do so less often, and I gleefully tick the QOF boxes.
Not proof, nor evidence, but something to think about.