{"id":2934,"date":"2015-07-20T21:17:20","date_gmt":"2015-07-20T20:17:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2934"},"modified":"2015-07-20T21:46:48","modified_gmt":"2015-07-20T20:46:48","slug":"on-the-other-hand","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/07\/20\/on-the-other-hand\/","title":{"rendered":"On the other hand…"},"content":{"rendered":"

… the phenomenon of apologising for the wrong thing<\/a><\/span> comes\u00a0alongside people taking umbrage at the wrong thing. \u00a0Last week, the\u00a0BMJ<\/em> ran a head-to-head feature<\/a><\/span> on the “question” of whether doctors should recommend\u00a0homeopathy. \u00a0This was the latest in a series of articles in which a question is posed, apparently strictly on the understanding that it’ll accommodate a polarised debate, and one person is invited to give a “yea” response, and another to give “nay”. \u00a0I won’t bother here with a screed about homeopathy: Edzard Ernst does a good job in the BMJ<\/em> piece, as have many others across the blogosphere. \u00a0(You could do worse, for example, than to have a wander through the\u00a0Anomalous Distraction<\/em> blog<\/a><\/span>, which is written by an ex-schoolmate of mine, and which also has lots of pretty pictures of proteins and things.) \u00a0Since it’s a nice day, and I’m in a reasonably good mood, I’ll even admit that when Hahnemann was working, something like homeopathy was probably as good a punt as anything else that medicine had to offer. \u00a0But… y’know.<\/p>\n

Aaaaaanyway<\/em>… \u00a0A rather angry letter appeared<\/a><\/span>. \u00a0I think it’s worth examining, because it makes a number of normative and value\u00a0claims; and if norms and values aren’t the meat and veg of an ethicist’s life, then\u00a0we might as well go home.<\/p>\n

This article omits a third representation from the most important people in the discussion – the patients – of whom I one. I have successfully and exclusively used Homeopathy for more than forty years.<\/p><\/blockquote>\n

There’s a difference between anecdote and data – and we’re not told why homeopathy has been used. \u00a0It’s quite possible to go 40 years without being seriously ill; and there’re even some serious illnesses that’ll sort themselves out with a bit of luck. \u00a0But, with my ethicist’s hat on, there’s a problem here with importance. \u00a0Patients are important to medicine because without patients there would be no need for medicine. \u00a0Patients might also be important in terms of being the proper primary concern of medics. \u00a0But it doesn’t follow from that that patients’ views are the most important things\u00a0to consider when it comes to deciding what doctors should prescribe. \u00a0Why would they be?<\/p>\n

I find it insulting and demeaning to have my own experience of Homeopathy [sic<\/em>] downgraded to an “anecdote” as do the hundreds of thousands of other patients who regularly use Homeopathy. Edzard Ernst has no mandate to speak for anyone other than himself; he is neither my physical nor my mental guardian.<\/p><\/blockquote>\n

This is the bit about being upset by the wrong thing. \u00a0What is insulting or demeaning about someone saying that your preferred treatment doesn’t work, can’t work, and shouldn’t be prescribed? \u00a0That’s not a personal attack – not even on homeopaths. \u00a0It’s just a scientific criticism. \u00a0(Imagine a mainstream scientist whose technique for\u00a0some procedure is generally held to be misguided; if her colleagues tell her that, she might\u00a0feel<\/em> as though she’s being got at – but there’s no reason to suppose that she is. \u00a0If her integrity is impugned, that’s a different matter. \u00a0But simply being told you’ve got something wrong is neither here nor there; and while it might smart, that isn’t the fault of the person who tries to put her right.)<\/p>\n

If you have evidence for homeopathy, then present it. \u00a0Being upset because someone has rejected it isn’t evidence. \u00a0Oh – and if Edzard Ernst has no mandate to speak for hundreds of thousands of other patients, why does this correspondent? \u00a0Curious.<\/p>\n

I am more than capable of making my own decisions, based on my own intelligence, research and experiences. Simply put, he should mind his own business.<\/p><\/blockquote>\n

The question posed was whether doctors should prescribe homeopathy. \u00a0Minding one’s own business has nothing to do with it. \u00a0And, of course, what’s sauce for Ernst is sauce for the pro-homeopathy Peter Fisher. \u00a0tu quoque<\/em>. \u00a0(While we’re at it… didn’t I warn of the “I’ve done my research” response\u00a0a couple of weeks ago? \u00a0Why, yes: I did<\/a><\/span>.)<\/p>\n

It is high time that due respect was given to the voice of the patient as accorded in Human Right Law and the Equality Act and attention paid to the basic Right on Informed Consent.<\/p><\/blockquote>\n

Informed consent doesn’t mean you get a right to particular treatments: only that you get to refuse ones you don’t want. \u00a0Sorry. \u00a0Ditto human rights law. \u00a0As for the Equality Act (2010)<\/a><\/span>: I searched for the word “patient”, and it doesn’t appear once.<\/p>\n

GP’s trained only in allopathic medicine who have neither training nor experience of Homeopathy simply do not have the ability to influence patients’ decisions.<\/p><\/blockquote>\n

Yeah, they do. \u00a0The whole point of medical training is to be able to look at the evidence for what works and work out how best to administer it. \u00a0Honestly, if homeopathy worked, it’d be taught. \u00a0You don’t even get to play the Big Pharma Shill conspiracy card here, because if homeopathy worked, Big Pharma would be pushing\u00a0that, too.<\/p>\n

I strongly resent anyone who has nothing more than their personal bias and prejudice<\/p><\/blockquote>\n

– and evidence!\u00a0 Don’t forget evidence –<\/p>\n

refusing to give me what I and my family have found to be the most efficacious treatment available. \u00a0There is a very simple financial argument to this question as well. Patients would not continue to pay for Homeopathy privately if it did not work. Patients are not fools. They clearly understand value for money which is why Homeopathy continues to flourish.<\/p><\/blockquote>\n

People pay for things that don’t work all the time. \u00a0The fact that they’ve paid for it might actually make them more likely to think that what they’ve bought works, because they have an interest in not believing that they’ve been sold a pup. \u00a0(I used those Vibram Five Finger things for ages, on the basis that I’d paid a bloody fortune for them. \u00a0That was fallacious, too.) \u00a0But, still: if someone wants to go on buying homeopathic remedies, then that’s up to them, just so long as noone else is harmed. \u00a0It doesn’t follow from that that doctors ought to help out. \u00a0In just the same way, if I happen to believe that nailing a carrot to my wall as a smoke detector is a good way to protect my home, then that’s fine and dandy. \u00a0That doesn’t mean that the Fire Brigade should lend me a hammer.<\/p>\n

GPs would do well to consider the cost savings to be gained from integrating Homeopathy in to their practices.<\/p><\/blockquote>\n

Well, there’d be fewer people with costly illnesses of old age, for sure.<\/p>\n

There’re three points to make here. \u00a0The first is that insults may be morally important, but a perceived insult doesn’t have to be.<\/p>\n

The second has to do with consent and patients’ rights. \u00a0However important you think that consent is, we should perhaps be wary of thinking that this means that the patient is wholly in charge. \u00a0Admitting that the patient has a veto on a given medical decision doesn’t mean that he has a right to propose or insist on certain courses of action. \u00a0The medic is still the gatekeeper – and, I’d’ve thought, for fairly good reasons. \u00a0While doctors can make mistakes\u00a0–\u00a0sometimes big ones – and while patients might\u00a0be better informed in some cases, the odds are still in favour of the medic’s judgement being more finely honed than the patient’s. \u00a0More: when it comes to decisions about whether doctors should use such-and-such a procedure, there is nothing improper about the terms of any debate being medical: asking patients what they’d like isn’t necessarily a good move, and patients have not, by that token, been wronged by their voices not being given a platform. \u00a0In one sense, patients were omitted from the\u00a0BMJ<\/em> piece. \u00a0But it doesn’t follow that anyone was wronged by that.<\/p>\n

Finally, that allows us to put flesh on the bones of Ernst’s contribution. \u00a0It seems reasonable to say that, in the absence of evidence, doctors should not recommend homeopathy. \u00a0That doesn’t commit us to the belief that it doesn’t work; there’s always room for a mismatch between our best account of the world, and the world as it is in itself. \u00a0Maybe homeopathy does work. \u00a0Still, that is in a sense irrelevant: it’s the evidence that’s relevant, and right now,\u00a0what little evidence there is in favour of homeopathy is massively outweighed by the evidence that (a) homeopathy\u00a0doesn’t work, and (b) conventional medicine works far better. \u00a0Of course, there might be outliers; but the general shape is clear. \u00a0The current state of the evidence shouldn’t be ignored: and when it comes to treatment decisions, what the evidence\u00a0does<\/em> suggest is, I’d’ve thought,\u00a0the proper foundation for treatment options. \u00a0Patients can decide whether they want to accept what the evidence supports; that’s not the same as giving the option of what it doesn’t.<\/p>\n","protected":false},"excerpt":{"rendered":"

… the phenomenon of apologising for the wrong thing comes\u00a0alongside people taking umbrage at the wrong thing. \u00a0Last week, the\u00a0BMJ ran a head-to-head feature on the “question” of whether doctors should recommend\u00a0homeopathy. \u00a0This was the latest in a series of articles in which a question is posed, apparently strictly on the understanding that it’ll accommodate […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,575,963,1542,563,328,2745,576,1544],"tags":[],"class_list":["post-2934","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-bmj","category-curios","category-in-the-journals","category-language","category-philosophy","category-professionalism","category-the-art-of-medicine","category-the-nhs"],"yoast_head":"\nOn the other hand... - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/07\/20\/on-the-other-hand\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"On the other hand... - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"… the phenomenon of apologising for the wrong thing comes\u00a0alongside people taking umbrage at the wrong thing. \u00a0Last week, the\u00a0BMJ ran a head-to-head feature on the “question” of whether doctors should recommend\u00a0homeopathy. \u00a0This was the latest in a series of articles in which a question is posed, apparently strictly on the understanding that it’ll accommodate [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/07\/20\/on-the-other-hand\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2015-07-20T20:17:20+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-07-20T20:46:48+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2015\\\/07\\\/20\\\/on-the-other-hand\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2015\\\/07\\\/20\\\/on-the-other-hand\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"On the other hand…\",\"datePublished\":\"2015-07-20T20:17:20+00:00\",\"dateModified\":\"2015-07-20T20:46:48+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2015\\\/07\\\/20\\\/on-the-other-hand\\\/\"},\"wordCount\":1550,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Blogosphere\",\"BMJ\",\"Curios\",\"In the Journals\",\"language\",\"Philosophy\",\"Professionalism\",\"The Art of Medicine\",\"The NHS\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2015\\\/07\\\/20\\\/on-the-other-hand\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2015\\\/07\\\/20\\\/on-the-other-hand\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2015\\\/07\\\/20\\\/on-the-other-hand\\\/\",\"name\":\"On the other hand... - 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