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article imageRichard Dawkins and Michael Baum talk about alternative medicine

By Bart B. Van Bockstaele     Dec 30, 2008 in Health
Renowned biologist Richard Dawkins talks with oncologist Michael Baum about complementary and alternative medicine, about their uses and their dangers.
Michael Baum is a Professor Emeritus of Surgery at University College London. He is specialized in treating breast cancer, has an interest in alternative and complementary medicine and is known for his work related to evaluating and improving the quality of life of patients.
Richard Dawkins is a world-renowned biologist and ethologist and the first Charles Simonyi professor in the public understanding of science. His major contribution to science is the concept that genes, the basic level of the genetic material of living things, do not only have an influence on the organisms in which they reside (the phenotype), but also on the world around those organisms (the extended phenotype).
In his two-part documentary, The Enemies of Reason, Professor Dawkins talks about several different types of superstition and the differences between superstition and the scientific method. For this documentary, he talked at some length with Professor Baum about complementary and alternative medicine (CAM) in general, and homeopathy in particular, and about how the scientific method can very easily be used to test these alternative systems.
Unfortunately, documentaries, by their very nature must be superficial, short, and -hopefully- entertaining, and only a tiny part of this interview has made it into the documentary. Fortunately, the full unedited interview has now been released on YouTube for all to see.
I mention some of the points in this article, but because the interview contains so much information and lasts a bit more than 50 minutes, I have had to leave out quite a bit. I can only encourage you to view the interview by clicking on the link above. It is worth it, and, who knows? It may one day save your life or that of a loved one.
This interview contains a lot of very important information, regardless of how one feels about CAM. Professor Baum starts by explaining the difference between complementary and alternative medicine. For him, complementary medicine is everything that improves the quality of life of a patient undergoing medical treatments, possibly for life-threatening diseases such as breast cancer. Alternative medicine, on the other hand, seeks to replace scientific medicine. Says Michael Baum:
I'm obviously against alternative medicine, because to me, alternative, by definition, means it does not work. If it works, we would use it.
As an example of that, he cites a few medicines of herbal origin that are being used for cancer therapy such as vinca alkaloids form periwinkle and taxanes from yew trees.
Richard Dawkins then switches to the main subject of the interview, homeopathy. He mentions that homeopathy uses ultra-diluted substances that are said to become more potent, the more they are diluted, and how -on the face of it- this sounds like plain bonkers. Yet, so many people swear by it on the basis of anecdotal evidence.
Prof. Baum reacts by stating that homeopathy is a system of beliefs into the nature of evidence and anecdotal evidence that is very hard to shift. What is meant by anecdotal evidence?
1. I have a problem
2. I did something
3. The problem went away
4. Therefore, what I did, works
This can be a powerful experience for the individual, and Baum says that a compassionate, caring medical practitioner must now ask the question if this could simply be the normal history of a self-limiting condition(1) that would have got better anyway or if it could be a placebo effect(2). And of course, it is also possible that this anecdote might hint that there is something active that might be worth exploring, for example, if there would be a lot of anecdotal evidence. However, an anecdote in and of itself is not evidence.
Michael Baum gives a nice example. If you would be standing in court to be judged for murder, you would probably prefer this evidence to be somewhat stronger than just anecdotal, circumstantial evidence. He goes on to say that we accept this for the judiciary and that his patients, who are often facing a life sentence (because of breast cancer) also deserve treatments for which the evidence is stronger than mere anecdotal, circumstantial evidence.
Richard Dawkins then asks how he would go about to test the validity of homeopathy. Baum says that the gold standard of testing is the randomized controlled trial. He explains that the homeopaths always advance two objections to that. First, he says, the homeopaths claim that their administrations cannot be patented and that they therefore do not have the money necessary to do these tests.
Baum says this is just not true. The homeopathic industry is hugely profitable and testing their remedies in controlled trials is simply not very expensive, one reason being that these remedies hardly cost anything. He says that a decent trial could be done for about 30,000 British pounds a year and that this is cheap, especially for an industry that makes millions. He goes on saying that he actually advised the Blackie Foundation at the Royal Homeopathic Hospital on how to design and conduct these trials. They refused.
The other argument homeopaths are always advancing is that they individualise their treatments and that therefore, clinical trials are not appropriate for testing their treatments. Baum says that this is a very poor argument, and he gives two reasons. When one buys a homeopathic remedy over the counter, it is not individualized. One asks for a remedy, say for a cold, and goes away with an off-the-shelf product, so there simply is no individualization. "So, "he says, "they speak with forked tongues." The second reason he advances is that modern testing methodology is perfectly able to accommodate for individualized treatments, and he gives an example on how to organize a four-armed trial.
Professor Baum also explains that he is quite upset with the way that alternologists hijack perfectly good words of the English language and pervert them into meanings they do not have. He gives the example of "holistic," and says that alternologists have debased this word by hijacking it without knowing what it means and that while they think that it means "whole" but that, in fact, holism is about the hierarchical organization of the human subject up to and beyond the family unit where at each level the sum is greater than the parts.
Prof. Dawkins and Baum also talk about the wisdom of allocating NHS (the UK National Health Service) money to homeopathy. Baum says that this is currently a minor problem, but that there is a fundamental principle at stake, namely that now, in the UK, there are two standards for medical products. Proper pharmaceuticals are to be tested rigorously and must show their efficacy, while homeopathic products do not have to show that they are effective. "It makes you weep," says professor Baum.
Later on, they talk about what Baum politely calls "post-modern relativism," the idea that everything is but an opinion. I have an opinion, but you have read some other books and you have therefore another opinion and both opinions are equally valid. As a result, we have now alternative medicine, alternative teaching methods, alternative legal advocates, "but," he says "we haven't yet come up with an alternative Boeing 747 pilot".
He links this to the MMR vaccine crisis where people are being told by alternologists and are convinced that there is a conspiracy of the medical establishment and the government that, in order to protect themselves, they were willing to sacrifice countless children to autism. "This is simply a lie," he says, and he adds that even among his closest friends, there are people who are not immunizing their children and that these children are now unprotected as a result.
Baum goes on giving another example of young women backpacking around the world who are taking homeopathic anti-malarials and as a result, are coming back to the UK with malaria.
Dawkins asks Baum if he can cite a few examples of complementary/alternative therapies for which he does have time. Baum cites art therapy as an example of complementary therapy in which he has invested quite some time. He also cites acupuncture, which is bonkers as an alternative complementary medicine belief system but which does have some value as a complementary therapy, for example in pain management. Still, his belief doesn't seem to go very far.
He goes on giving an example of the importance of clinical trials and tells a story about how he was chairing a meeting in Florence, Italy on the role of CAM in the treatment of breast cancer. He was in serious pain at the time, so much so that he was limping. An acupuncturist offered him a treatment. The next day, he was completely without pain, and even visited the Uffizi gallery for a few hours. The interesting part is that she offered the treatment, but that he didn't accept it. Had he accepted it, the result would have been so spectacular that he would have become a convert. A nice illustration of the importance of controlled trials.
Baum is also telling Dawkins about how many alternologists always go back to some "golden age" of medicine, and argues that there is no such thing as a golden age of medicine in the past, that the golden age is now, and that it will become more golden if only science can continue. He gives the example of Victorian England where life expectancy was not much more than about 40 years and where 30% of the children died shortly after birth whereas now most children survive, and that we now have life expectancies of close to 80 years, leading us to work longer than in the past.
Dawkins and Baum talk about the importance of science education. Baum tells Dawkins that we have a scientifically illiterate population, a scientifically illiterate house of commons and, worse, that they actually take pride into their scientific illiteracy. Scientists have an important task here, he says, and children should be taught the scientific method from early secondary school in order to have a scientifically literate population.
(1) Self-limiting condition: a condition that will go away without doing anything. Colds are a good example. They go away, regardless of what we do or don't do.
(2) Placebo effect: a condition improves as the direct result of a treatment, even though this treatment does not actually do anything to remedy the condition. A good example is a parent giving a child a kiss on its knee after it fell, to make the pain go away.
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