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critical thinking & journalism

This morning's NZ Herald carried an item on a study into immigrant doctors in NZ practising non-western medicine: how they perceived themselves & their role in patient health, & how their patients saw them. It certainly caught my attention - so much so that I found the original paper on line & looked at that too.

What I'd like to talk about here is the rather uncritical way in which this research was reported and the lack of investigation into its findings.

The research project found that some immigrant doctors, unable to find work within the NZ health system, set up practices using traditional (alternative) methods. They reported feeling 'marginalised' by the health system, in that they weren't able to access the same range of resources as mainstream doctors, that they had less status (compared to mainstream doctors & also to their prior situation in their home countries), and that there were increased costs to their patients due to lack of government subsidies for alternative treatments. And this was summarised well in the paper.

But what concerned me on first reading the newspaper article (& subsequently the research project) was the way in which the project's recommendations were reported. A range of alternative treatments were identified: acupuncture & homeopathy among them. The article provided anecdotal 'evidence' in support of some of these treatments. And here's my first point of difficulty: anecdotes are just that, personal, individual statements, collected in an uncontrolled way. (And the plural of 'anecdote' is not 'data' - I wish I could remember who said that!). For example, if a patient is using both mainstream & alternative treatments for a particular health problem, there's no way of determining which (if either) is effective. The patient may feel very strongly that the alternative treatment is helping - but this is not evidence of its effectiveness.

The article ends with recommendations from the study. These include the suggestion that New Zealand should look at "other OECD countries and their experiences of integrating and improving access to TCM, Ayurvedic and homeopathic medicine." And further, that there should be more studies on "the effectiveness of these medical traditions to ease the burden of symptoms ... where Western medicine is ineffective". Well, this sounds quite reasonable, doesn't it?

However, a bit of digging around by the reporter would have uncovered the fact that there have already been a large number of well-designed studies into the efficacy (or otherwise) of alternative treatments. Acupuncture, for example: 'sham' acupuncture, where the needles are either placed randomly or retract into their handles rather than puncturing the skin, produces the same patient response as 'normal' acupuncture - strong evidence of a placebo effect. One such study, involving 1200 patients with long-term back pain, was reported on by UK doctor & writer Ben Goldacre, who said

The paper itself was very interesting. It took 1200 people, with an average of 8 years back pain each: we can assume not been helped by biomedical treatments. They were split into three groups: one group had medical treatment; one group had proper, real, bells and whistles, needles in the “meridiens” acupuncture; and one group were treated with pretend acupuncture.

The results were fascinating: they set a threshold for “improved” (which was either a 33% improvement in 3 aspects of one score, or 12% improvement on another measuring scale). They found that people having acupuncture were almost twice as likely to reach this level of improvement in back pain as people on medical treatment (which had already let them down for 8 years of course). But even more interestingly, the pretend acupuncture group, where they just bunged needles in any old place with a bit of ceremony, did just as well as the people having proper, posh, theatrical, genuine acupuncture. (Read the rest  of Ben's article here.)

Properly controlled, double-blinded clinical trials have shown the same thing for homeopathy: any perceived benefits are due to the placebo effect. (The best source of statistical data from large-scale studies & meta-analyses is the UK's Cochrane Library.) Do we really need to spend our scarce health dollars on more of the same? Shouldn't we expect a bit more in the way of investigative reporting & critical thinking - on all issues, not just those focused on science or health?

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Acceptance of (unvalidated) alternative health seems to be extremely widespread and even condoned by government and healthcare facilities. It's a big problem which needs to be countered a lot more than it is.

I see an extra, related, problem here. This is that a widely accepted concept of 'multiculturalism' opposes the questioning of cultural practices coming into the country via immigration.

Most of us accept, and really appreciate, a lot of the visible culture - the dress, music, language, food, etc. This is helping to produce a NZ culture much richer than it used to be.

But, on the downside, we often find liberal acceptance (or at least silence about) practices or attitudes we have thankfully got over in the past. The position of women, attitudes towards homosexuality, attitudes towards apostasy, etc. Liberals will often blame Salman Rushdie, or the Danish, cartoonists for the violent reaction to them - and refuse to criticise the extremism of those who make the death threats!

I can't help thinking that this uncritical 'multiculturalism' will only reinforce an uncritical acceptance of unvalidated, or even dangerous, alternative health practices because they are associated with an immigrant population.

These issues are being confronted to some extent in Europe but practically ignored here.

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