An interesting evening

I have a bit of catching up to do, so I am going to tell you about a presentation I was invited to give last October. This was a meeting of Café Scientifique, a network of local science clubs. We had over 100 attending, a full house. People sit around tables café style, with drinks from the bar, and the idea is to have debate and interaction on scientific topics. I was asked to talk about complementary and alternative medicine (CAM – I won’t define this term again in this blog as most readers will know what I mean). I began by laying out the CAM landscape with a few slides, to explain the various types available, and asked how many of the audience had used any of them. My hand went up as well, as I have tried chiropractic, acupuncture and herbal medicine. I then handed out questions at random for groups around the tables to discuss. The questions included what methods we should use for testing CAM, whether we should use the same or different methods for CAM and orthodox medicine, what information patients should have about CAM, etc. Up to this point I didn’t address at all whether CAM works, I just laid out what’s available. As I handed out the questions, I was asked rather assertively by one lady what qualifications I had to talk about CAM. I was slightly taken aback, and referred to my 30 years in clinical research, so I hope I do know what evidence is. She then tried to claim that science has not yet developed the methods to measure the `energies’ that we all have. I said that to measure something it has to exist.

After 20 minutes we went into plenary discussion, to hear feedback from the groups and generally to debate the questions. I was impressed with the good sense that emerged. Here is what people said:

  • CAM regulation must include proof of efficacy as well as safety
  • There should be a single standard for all health care research, and no special methods for CAM
  • Public bodies should provide information on efficacy and safety of CAM
  • Universities and medical journals were the most trusted sources of information on CAM. Nobody thought the NHS could be trusted.
There were no objections from the floor to these conclusions. One of my questions was about the ethical problems which attend the prescribing of placebos, but nobody spotted the `lying to patients’ dilemma. Of course, it emerged that the lady who challenged me was one of a group of CAM enthusiasts, presumably practitioners, and they happened to get the question about placebo. Instead of answering it, they read out a prepared statement to the effect that the placebo effect is a manifestation of the spiritual dominance of the body and that this was how all treatment works. This brought orchestrated applause from their group but from nobody else. I said “I think you have misunderstood the question”, but they didn’t come back on that. This group took no part in the plenary discussion. My wife and family were on the next table, and reported afterwards that the CAM crowd muttered and gasped with horror throughout my talk, but avoided any head to head debate.
In the last section I presented slides on what is really happening with CAM regulation, what the evidence on it really is (citing data from Bandolier mainly), how evidence is distorted by partisan bodies such as The Prince’s Foundation for Integrated Health, and the problems that attend poor quality trials. I tried very quickly to explain the hierarchy of evidence, and why all this matters. At the end lots of people came up to me with intelligent questions and supportive comments. There were no dissenters. The CAM contingent just slunk away, apart from a very half-hearted heckle near the end of my talk. Yes, this was a science-orientated group so I would expect good sense, but they were mostly CAM users, as shown by the straw poll at the beginning.
Oh, nearly forgot. At the start of the talk I took about 100 homeopathic sleeping tablets. I was still awake at the end.
Now there was a bit of follow up, in the form of one email of congratulation and one of complaint. I’ll only deal with the latter. Here is part of it:

Cafe Scientifique is, I believe, an organisation intended to enlighten non-scientists on scientific matters. Last night’s speaker evidently misunderstood his brief, and felt it was his duty to sneer, mock, even make comments that verged on the libellous about Complementary and Alternative medicine. He may be an independent consultant, but his views were certainly not balanced. “Arrogant” ” biased”, “perched on his pedestal” were some of the comments I overheard on the short walk to [the] car park, and somebody on a near-by table refused to take any part in the Q&A session as a mark of disgust.

There’s no point in boring you with the rest of this diatribe, but I am just highlighting this not to pillory its author (and I don’t know who it was), but to show how a message can be misunderstood. Throughout, I only provided facts. There was not a single statement I made that wasn’t supported by evidence – not one. If there was evidence in support of CAM (eg acupuncture for post-op nausea and vomiting), I said so. OK, I used the example of a homeopathic remedy that was prepared from the blood of an AIDS patient, and asked whether this was even legal. If anyone in the audience had evidence to support this treatment then they could have said so, but nobody did. In fact, throughout the discussion there was not a single challenge to any of the evidence I presented. Instead, the CAM contingent muttered into their beer, gasped, avoided the questions asked, and then complained afterwards. The problem they have is that either they don’t know the difference between facts and opinion, or they choose not to know.

I also want to pick up on the charge of arrogance. I can in an odd way sympathise with this, as it must be very unsettling to have someone arguing from the intellectual high ground, with evidence at their fingertips. I learned a lot from this event, and if I get the opportunity again I’ll be more careful to defuse the confrontation by assiduously stating at every stage that this is not my opinion, it’s simply what the science tells us. Scientists are continually being accused of arrogance. I remember Richard Dawkins in his TV series `The Root of All Evil?’ saying to a creationist: “The reason you say that is that you don’t know anything”. This I am sure wasn’t meant to be rude or arrogant. Indeed I don’t know how on earth Dawkins maintained his composure in the face of such ignorance. It was just a statement of fact. On this subject, the other party clearly did not know anything, or they could not maintain that position.

So to get back to the theme of this blog, there are two lessons that you might like to take away. Firstly, if you live in the UK there’s most likely a Café Scientifique near you. Do go along – it’s good fun and you don’t even have to be a scientist. Secondly, take every opportunity that comes along to tell the truth about CAM, backed up with evidence. If you are a scientist and belong to a professional body, that’s a useful forum. I’ll be adding links to the blogroll here that will help you find that evidence.

And finally – do use evidence carefully, it’s very powerful stuff.

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