What a new consumer health magazine doesn’t tell you

A new magazine, What Doctors Don’t Tell You, claims to help the public find safer, more effective treatments. Margaret McCartney, a Glasgow GP, takes a critical look at the October issue:
 

It looks just like any other magazine on the shelves of the newsagent aimed at middle aged women: glossy, 100 pages, with a smiling, confident looking woman on the cover. What Doctors Don’t Tell You, a monthly magazine that launched in September 2012, claims to explain how to “discover treatments that are safer and more effective".
The headlines don’t mention celebrity gossip but instead promise subjects such as “Cervical cancer alert: what every mother (and daughter) should know about the new jab,” “How I avoided a hysterectomy through diet,” and “Unsteady gran? It’s drugs that cause the falls, not old age.” The magazine has regular columns, such as “Pet’s corner” and “My medical horror story,” and a column in which a retired general practitioner can “speak freely about his unorthodox but highly successful approach to treating ‘the incurables.’”
But how fairly does What Doctors Don’t Tell You reflect the evidence? It raises valid concerns in an article about the influence of the drug industry on doctors’ decision making in the United States. Another article on falls in older people describes how “prescription drugs are a major cause of the common problems we usually put down to ageing.” But rather than presenting “what doctors don’t tell you,” the article quotes from Michael Oliver, the professor of cardiology who wrote a personal view on overtreatment of older people in the BMJ in 2009 that was reported widely in the lay press.[1] Several points in the article reasonably relay the associated problems of polypharmacy in older people. However, the article also states, for example, that drugs such as propranolol and dipyridamole are “too dangerous for use in the elderly,” referencing a study published in JAMA in 1994.[2] This study was based in the United States, where prescribing policy is different, and so may not relate directly to the UK population, and it focused on “potentially inappropriate” drugs identified through a cross sectional survey rather than on individual assessment of each prescription.
The editor of What Doctors Don’t Tell You, Lynne McTaggart, ran the magazine originally as a website and newsletter, which launched in 1990. She told me, “The reason my magazine exists is because modern medicine just isn’t working very well. That’s the bottom line. The American Medical Association has come out to say that correctly prescribed drugs is the third leading cause of death in America and that probably goes for all of the West.” She is clear that her publication, which she says has a circulation of 40,000, is for “intelligent people of any age who want to know more about what works and what doesn’t work in conventional and alternative medicine. They want to know more, to be able to control their own health. They don’t want to be told after the fact, when they’ve suffered a side effect, ‘Oh yeah, that had to do with medicine,’ because they are not getting enough information.”
In the October issue’s news section the article “Thyme is better for acne than creams” starts, “Thyme is more effective than prescription creams for treating acne . . .The herb outperformed pharmaceuticals in a series of laboratory tests, killing the actual bacteria that cause acne . . . Not only is thyme more effective, but it’s kinder on the skin too, say the researchers. Most pharmaceuticals cause a burning sensation and irritation to the skin, whereas thyme and other herbal preparations have none of these side effects.” The article references the Society for General Microbiology’s spring conference in Dublin this year. This research was reported through a press release; it was an in-vitro model; and the researchers did not compare side effects with current prescription creams.[3]
Another article says, “Army personnel with noise deafness and tinnitus are commonly deficient in B12, but enjoy an improvement in symptoms after taking B12 vitamins.” The study referred to contained 12 patients receiving vitamin B12 and was not a randomised controlled trial.[4]
The editorial on Gardasil, headed “Lock up your daughters,” warned that “your doctor and your daughter’s school nurse are not likely to tell you about the 100-plus American girls who suddenly died after receiving an HPV [human papillomavirus] vaccine.” Although there are valid concerns about the long term efficacy of HPV, to suggest that it has led to death is alarmist and does not reflect or explain the evidence collated by the Food and Drug Administration.[5] Informed choice has to be about fair information, not scaremongering; we should hardly wish for a repeat of the measles, mumps, and rubella (MMR) vaccine debacle.
Although medical journals carry advertisements for drugs, the ones in this magazine are an extraordinary shrine to non-evidenced based medicine, such as “Comra therapy,” which says it can treat “allergies, arthritis, asthma, autoimmune . . . muscles, neurology, organs, osteoporosis, skin, stress strokes and many more.” It costs from £1600 (€2000; $2600) and combines “infrared laser with magnetic field, ultrasound and colour LEDs.” Or there is the “Q-Link Clear device,” which can “fight electronic stress” and combat “poor performance and fuzzy thinking.” Is McTaggart satisfied with the advertisements her magazine publishes? She said that she was “not completely happy with some of them” and wanted “some of them changed” but declined to tell me which or why.
It is right to criticise medicine, but the same standards must be applied to all interventions, “alternative” or not. We now realise how important it is to ensure that fair evidence, free of bias, is used in making medical decisions. There is no point in substituting bad medicine for bad science, and it is not clear from this magazine where the hierarchies of evidence stand, and the limitations and uncertainties that arise in research are not consistently explained. The magazine’s liability statement — “the publishers cannot accept any responsibility for any damage or harm caused by any treatment, advice or information contained in this publication” — should perhaps be better printed on the cover, in an unmissable font.

1  Oliver M. Let’s not turn elderly people into patients. BMJ 2009;338:b873.
2  Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the
community-dwelling elderly. JAMA 1994;272:292-6.
3  Society for General Microbiology. Thyme may be better for acne than prescription creams.
28 Mar 2012. www.sgm.ac.uk/news/releases/DUB12_MGE.cfm.
4  Shemesh Z, Attias J, Ornan M, Shapira N, Shahar A. Vitamin B12 deficiency in patients
with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14:94-9.
5  Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccine: a
closer look at the safety data. www.cdc.gov/vaccinesafety/Vaccines/HPV/Index.html#data

British Medical Journal (10th October 2012) [BMJ 2012;345:e6817]

Quack medicine

Five pages of quackery devices at Collect Medical Antiques website.

The Irrational Health Service'

Free online video (47mins 48 secs) of Part 2 of the 2-part Channel 4 series "The Enemies of Reason" by Professor Richard Dawkins in which he looks at how health has become a battleground between reason and superstition. Although a total of over £1.6 billion a year is spent on superstitious alternative remedies in the UK, 80% of them have never been subjected to properly conducted trials.

Your disease, your fault

“Earlier this week, my colleague Dr. Gorski explored a common theme in alternative medicine: the idea that all disease is preventable. This implies that all disease has a discrete cause and that individual behavior can mitigate this cause. If biology worked this way, my job as an internist would be very different. Many people would love to believe that life is this predictable, and that they have that much control over their health, but they don’t. Most disease represents the interaction of environment and genetics, and you can’t change your genes (with a few exceptions, of course). It’s natural to want to be able to exert an impossible level of control over your health, but when unscrupulous charlatans play on these beliefs and fears, they can cause, rather than prevent problems.” Peter Lipson MD, Science Based Medicine (9th September 2010)

Is There an Alternative Medicine?

“A large amount of serious research into previously unstudied practices, largely funded by the NIH, has resulted in many articles in mainstream journals. And, guess what, almost ALL of the long-term traditional CAM practices have been found to be safe but INEFFECTIVE. And what has happened in practice? The American Medical Marketing Machine (AMMM) has done its thing. As the published scientific studies have one by one found CAM practices to be ineffective, more Americans are using CAM than ever. And, such use often is now in mainstream institutions, sterilized, and sold as "Integrative Medicine," which Mr. Google numbers at 1,230,000 results. Looks like there will always be snake oil sellers as long as there are snake oil buyers.” George Lundberg, MD, Editor-at-Large, MedPage Today (23rd August 2010)

“Integrative” oncology: Trojan horse, quackademic medicine, or both?

“Cancer patients, as I say frequently, are among the most vulnerable of patients. Many of them are facing a very unpleasant death without treatment; seeing that they receive the most effective medicines and treatments we have, free of quackery, is a moral imperative, and I fear that we will soon be failing our patients. We now even have a Society of Integrative Oncology promoting the “integration” of pseudoscience into oncology.” David Gorski MD, Cancer Surgeon, Science Based Medicine (16th August 2010)

Absence of Evidence Is Evidence of Absence

“I can think of many cases where absence of evidence provides robust evidence of absence. The key question is whether evidence should exist but does not.” Victor Stenger, Physicist; author of The Fallacy of Fine Tuning: How the Universe is Not Designed for Us (14th August 2010)

The cult of celebrity doctors

"Our obsession with media-anointed physicians has its pitfalls. A standardised approach to medicine and a focus on 'feel-good' topics are among them." Los Angeles Times (14th June 2010)

Alternative Medicine and Pseudoscience with Scott Gavura

Despite the dramatic improvements in the extent and quality of our lives, largely owing to modern medicine, our current health care system has fostered a backlash, manifested in part by the emergence of non-science-based "alternative" health care practices . This trend has driven a need for dialogue on how best we should balance evidence-based decisions against demands for consumer choice - regardless of the science. In this presentation, Scott Gavura, BScPhm, MBA, discusses how health care decision-making differs from all other goods and services, and how this impacts on the choices we make, both as individuals, and in aggregate. Through an interactive discussion, he facilitates a dialogue on the opportunities for science advocates to effect positive change in health at the patient- and population-level. Toronto (28th May 2010) [1:14:09mins]

What ‘holistic’ really means

“Quacks are fond of using cuddly words like ‘holistic’ and ‘integrative’, partly, one suspects, in an attempt to gain respectability and to disguise some of their barmier views.” Professor David Colquhoun, DC Science (25th May 2010)

So is this peer review?

“…next time you are offered a paper from a peer reviewed journal, remember this story.” Majikthyse blogspot (27th April 2010)

“Holistic Medicine” —  It means whatever we say it means

“Looking at the whole patient in its real life context is a valuable element to understanding health and disease. Using any and all therapies that sound good to us regardless of whether or not they have real value is a mistake. Unfortunately, the popular use of “holistic” to market CAM therapies confounds these unrelated approaches.” SkepVet blog (27th April 2010)

21st Century Snake Oil

'60 Minutes preview. Hidden cameras expose medical conmen who prey on dying victims by using pitches that capitalise on the promise of stem cells to cure almost any disease. CBS News (16th April 2010)

Longing for a past that never existed

“Advocates of alternative health have a romanticized and completely unrealistic notion of purported benefits of a “natural” lifestyle...they long for an imagined past that literally never existed...That both cancer and heart disease are among the primary causes of death today represents a victory, not a defeat. Diseases of old age can become primary causes of death only when diseases of infancy and childhood are vanquished, and that is precisely what has happened. Alternative health as a form of fundamentalism also makes sense in that it has an almost religious fervor. It is not about scientific evidence. Indeed, it usually ignores scientific evidence entirely. All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false. None of it works, absolutely none of it.” Amy Tuteur, MD, Science Based Medicine (18th February 2010)

The anarchy of evidence

“We have all heard of the ‘hierarchy of evidence’. It describes a hierarchy of study designs for testing the effectiveness of therapeutic interventions and enables us to contemplate the relative merits of different types of investigations. In my field, complementary medicine, the logic behind this hierarchy has remained a hotly disputed topic. Many believers in complementary medicine seem to reject it and some even seem to have started promoting something I call the ‘anarchy of evidence’. Enthusiasts of this or that complementary therapy invariably seem to be in favour of evidence-based medicine — but only as long as its application to their subject generates the results they had hoped for! Whenever the evidence fails to show that their therapy is effective, they call for a different standard. The reason is simple: enthusiasts are led by belief rather than evidence: if a rigorous randomised clinical trial does not demonstrate that their therapy is effective, it usually is not the treatment but the test that is deemed to be at fault. The thought that their belief was wrong is unthinkable to believers.” Edzard Ernst, British Journal of General Practice (February 2010)

One true cause all disease

“Chiropractors, homeopaths, naturopaths, acupuncturists, and other alternative medicine practitioners constantly criticize conventional medicine for “only treating the symptoms,” while alternative medicine allegedly treats “the underlying causes” of disease. Nope. Not true. Exactly backwards…I’ve discovered the one cause of all the one-cause theories: a deficiency of critical-thinking skills combined with an overactive imagination. And, of course, a failure to test beliefs using the scientific method.” Harriet Hall MD, Skeptical Inquirer, (January/February 2010)

Stars Vs. Science

“From Jenny McCarthy to Tom Cruise, some Hollywood hot shots are leading a war against modern science… The proliferation of modern cable television and radio talk shows--not to mention things like Twitter and YouTube--provide forums for stars with wacky notions, says Stephen Barrett, a retired psychiatrist who runs Quackwatch.org. The shows go for entertainment value over scientific credibility, he says. "Talk shows don't pay any attention to whether the advice on their program will kill people. ... Producers consider it entertainment," he says, adding: "Never take health advice from a talk show."” Forbes.com (14th January 2010)

The terrible harm that alternative medicine can do

“Advocates of homeopathy, nutritional therapy and similar treatments often promote their remedies with the promise that, unlike conventional medicine, they are natural, kind and can do no harm. If only it were true.” Article by Jeremy Laurance, The Independent (12th January 2010)

Celebrities named and shamed for crazy comments made in the name of science

“From special diets and miracle cures to chemicals, vaccines and evolution — there seems to be no limit to the subjects on which some celebrities will speak. But while some may be talented actors, athletes, TV presenters and pop stars, science is not their forte. A compendium of cod science and misconceptions espoused by celebrities is published today…” Times Online (4th January 2010)

The Rise of Placebo Medicine

"It is my contention that terms such as 'complementary and alternative medicine' and 'integrative medicine' exist for two primary purposes. The first is marketing — they are an attempt at rebranding methods that do not meet the usual standards of unqualified 'medicine'. The second is a very deliberate and often calculating attempt at creating a double standard." Article by Steven Novella, Science Based Medicine (12th August 2009)

Regulating nonsense

“What statutory regulation of yet more quackery will do is enhance its perceived standing in the eyes of the public: “if it’s regulated by the Government, it must be OK”. What we don’t need are more quacks calling themselves “a primary health-care profession“. That does not protect the public. AltMeds — including the FIH — talk incessantly about increasing consumer ‘choice’; but the public’s choices are reduced when quackery is covered in a veneer of statutory respectability.” Zeno's Blog (5th August 2009)

Grand delusions

“From crop circles and alien abductions to faith healers, many secretly believe in strange phenomena - and it has more to do with human psychology than with reality.” Article by Lauren Monaghan Cosmos (August 2009)

What would $34 billion of Quack money buy you?

"Today the US National Center for Complementary and Alternative Medicine has issued a report that shows that Americans spend $33.9 billion out-of-pocket on complementary and alternative medicine per year. This is the figure that people spend on such things as homeopathy ($3B), yoga and qi gong ($4B) and non vitamin supplements ($15B). The report does not include purchases of vitamin and mineral supplements and estimates suggest this could triple this spend. The NCCAM has spent nearly a billion pounds on researching CAM and has failed to demonstrate the efficacy of any complementary medicine. Yes, its all quackery and these Americans are wasting their money." The Quackometer (31st July 2009)

Mitchell and Webb take on quackery

Top-notch satire of pseudoscience: 'Homeopathic A&E' and 'Lifestyle Nutritionists'. Each video segment lasts approx. 2mins. The Times Online (15th July 2009)

The death and rebirth of vitalism

"Vitalism, an ancient and discredited philosophy, has become irrelevant in modern thinking with two important exceptions: alternative medicine, and religion. That, right there, should tell you something important." Article by Peter Lipson, MD, Science Based Medicine (24th June 2009)

CAM Research — Much Ado About Nothing

"After a decade of research, and 2.5 billion dollars of taxpayer money, government funded research into so-called "alternative" medicine has little to show for it… The NCCAM double standard has not served the public well. It has wasted a great deal of money, and worse it has given a significant boost to health claims and modalities that don't work and the practitioners who use them. The NCCAM should go away." Article by Steven Novella, NeuroLogica blog (11th June 2009)

'A shabby smokescreen for unproven treatments'

"The long and short of it all this is simple. "Integrated medicine" is a term that, to many consumers, sounds seductively attractive; its two basic concepts seem meritorious. In reality, it is a shabby smoke screen behind which unproven or disproven treatments are (re-)admitted into routine healthcare. When this happens, patients are clearly not better but worse off, and healthcare is in danger of disintegrating into utter nonsense." Article by Professor Edzard Ernst, BBC 'Scrubbing Up' blogspot (25th March 2009)

Winnowing the Chaff of Charlatanism from the Wheat of Science

"Experts and lay people alike can sometimes find it difficult to demarcate the absurd. Here I propose a set of criteria that may be helpful in achieving this in the realm of healthcare: falsifiability, plausibility and some hallmarks of pseudoscience. Applying this method is unlikely to be fool-proof but it might be a valuable aid in discriminating credible from incredible health claims." Commentary by Professor Edzard Ernst, Evidence-based Complementary and Alternative Medicine (February 2009)

Are we being hoodwinked by alternative medicine? Two leading scientists examine the evidence (Part 1)

"While some therapies do provide some health benefits (e.g. osteopathy), most have nothing to offer. Many popular therapies are "effective" only because they are good at eliciting a placebo response; making the patient feel better simply because they believe the treatment will help. You might feel that as placebos help patients this alone justifies the use of the therapy. But any treatment that relies on the placebo effect is essentially a bogus treatment. And it's far from cheap. If alternative practitioners are making unproven disproven or vastly exaggerated claims and if their treatments carry risks then we are being swindled at the expense of our own good health." By Simon Singh and Professor Edzard Ernst Daily Mail (April 2008)

The healthcare show: an evidence-free zone?

"…the vast majority of the gadgets, medicines, books, etc. seemed to be everything but evidence-based. In fact, one had to look long and hard to find anything associated with evidence at all. When I asked whether this was perhaps unusual, I was told that this show was much like the many others that take place all over the world…..Healthcare gadgets that do not demonstrably work are not health care, they are just trickery, and medicines that do not work are at best a rip-off." Edzard Ernst, Focus on Alternative and Complementary Therapies [FACT] (March 2008)

Quackery and superstition — available soon on the NHS

"Put not your trust in princes, especially not princes who talk to plants. But that's what the government has decided to do. The Department of Health has funded the Prince of Wales Foundation for Integrated Healthcare to set up the Natural Healthcare Council to regulate 12 alternative therapies, such as aromatherapy, reflexology and homeopathy. Modelled on the General Medical Council, it has the power to strike therapists off for malpractice. This is perplexing. How does a regulator decide what is good practice and what is charlatanry when none of it has peer-reviewed, scientific evidence that it works?" Polly Toynbee, The Guardian (8th January 2008)

Researcher criticises alternative medicine

R. Barker Bausell says he arrived at the University of Maryland's alternative medicine centre with an open mind toward exploring the potential of acupuncture, herbal remedies and other unconventional treatments. But after five years as research director, he quit the Center for Integrative Medicine in 2004, convinced of one thing: None of the alternative treatments he has seen works any better than a placebo. Baltimore Sun (2nd January 2008) [Two-page article]

Sticking a needle in alternative medicine

"Exotic therapies such as acupuncture might make people feel good. But the role of medicine is to cure patients' illnesses, not make them happy." Article by Stuart Derbyshire, Spiked Online (28th November 2007)

The age of endarkenment

Why is no one questioning the rise of new-age nonsense in the name of science? Article by David Colquhoun, The Guardian (15th August 2007)

Shark cartilage in the water

Oncology specialist, Professor Jonathan Waxman of Imperial College London speaks out against the "vile and cynical exploitation" of cancer patients by the purveyors of alternative medicine. British Medical Journal (25th November 2006)

The blind person in the driving seat

"…with regard to CAM, patients may be in the driving seat but they are not in a good position to steer safely. They are either left in the dark, e.g. by conventional healthcare providers, or they are offered information that is inaccurate, e.g. by providers of CAM…..it is clearly legitimate and necessary to insist that CAM practitioners provide reliable information to their patients. In fact, the provision of full information on medical treatment is a precondition for informed consent, which is a fundamental legal and ethical requirement for all healthcare providers, including CAM practitioners." Edzard Ernst, Focus on Alternative and Complementary Medicine [FACT] (September 2006)

Alternative medicine 'intellectually dishonest' — cancer specialist

Professor John Crown, consultant medical oncologist at St Vincent's and St Luke's Hospitals, Dublin, hits out at complementary and alternative medicine, branding it "intellectually dishonest" and accusing it of capitalising on the vulnerability of seriously ill patients. Irish Medical News (6th February 2006)

Good Intentions Don't Treat Serious Infections…

"…regardless of their intentions, the fact remains that those in alternative fields just do not have the training to identify the sometimes subtle presentations of severe illness." Clay Bartram, MD, Unintelligent Design (29th November 2005)

Bridging the Chasm between Two Cultures

A former leader in the New Age culture — author of nine titles on auras, chakras, "energy", and so on — chronicles her difficult and painful transition to skepticism. Karla McLaren, Skeptical Inquirer (May 2004)

The real health scare

"The fact that devotees of alternative therapies have a tendency to die rather more quickly than those who accept conventional treatment goes largely unspoken." Opinion in The Daily Telegraph (21st March 2004)

Gurus and gibberish

Francis Wheen on the snake-oils and quacks of our age. New Humanist (31st January 2004)

Being wholistic

Article by Jeffrey K. Aronson, MA, DPhil, MBCHB, FRCP, (Reader in Clinical Pharmacology), Focus on Alternative and Complementary Therapies [FACT] (December 2003)

Freedom of Informed Choice

Are consumers truly free to make informed choices about complementary and alternative medicine? Article by Paul Lee, Skeptic Report (September 2003)

Put alternative medicine back in its box

"Just as reason cannot be reconciled with irrationality, so orthodox medicine cannot be integrated with alternative medicine." Dr Michael Fitzpatrick, Spiked-health Online (26th June 2002)

The rise and rise of CAM

"The new vogue for CAM, particularly within the medical profession, seems particularly strange when we consider that scientific medicine progressed and developed by questioning, among other things, divine and secular authority. It insisted on excellence in its pursuit of truth, advances in diagnosis and treatment of disease…. Yet despite all this progress, the medical profession is now willingly embracing the very mystical practices it transcended 200 years ago." Article by Brid Hehir, Spiked-health Online (2001)

Cancer Quackery Examined

Professor Ray Lowenthal's paper examines 'alternative and complementary' treatments for cancer, finding they leave a great deal to be desired. The Skeptic (Autumn 2001) [Professor Lowenthal is Director of Medical Oncology at the Royal Hobart Hospital, Tasmania] [pdf]

Weasel words

“Weasel words give the impression of taking a firm position while avoiding commitment to any specific claim. Advertisements tell us that certain products help or may help (prevent, stop or fight) this or that.  A toothpaste helps fight tooth decay. A new drug may help relieve pain. Note that the ads do not say specifically what the product will or can do. The only weaker claim they could make would be that their products may or may not help this or that.” (The Skeptic’s Dictionary)“Weasel words give the impression of taking a firm position while avoiding commitment to any specific claim. Advertisements tell us that certain products help or may help (prevent, stop or fight) this or that. A toothpaste helps fight tooth decay. A new drug may help relieve pain. Note that the ads do not say specifically what the product will or can do. The only weaker claim they could make would be that their products may or may not help this or that.” (The Skeptic’s Dictionary)