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Dr Michael Dixon of the “College of Medicine” seems to admit that alternative medicine is a placebo

May 26th, 2012 · 15 Comments

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Much has been written on this blog about Dr Michael Dixon, and about the "College of Medicine", which is the direct inheritor of the mantle of the late, unlamented, Prince’s Foundation for Integrated Health. At the time of the foundation of the College it was stated that "The College represents a new strategy to take forward the vision of HRH Prince Charles".

Michael Dixon has also been chairman of the NHS Alliance since 1998. That was one of very few organisations to support Andrew Lansley’s Health Bill. No doubt he will be happy for Crapita Capita to supply alternative nonsense at public expense.

Dr Dixon took offence to a review in The Times of Mark Henderson’s new book, The Geek Manifesto.

aaron.

The review, by David Aaronovitch, said, apropos of the 1023 campaign,

" . . .there was now, almost for the first time, a group of people who were not content to see claims made for discredited treatments without making everyone aware of the science that disproved those claims. And second, what they were doing had implications for public policy."

and

"The geeks represent, for me, one of the most encouraging recent developments in British public life."

This excellent review evidently upset Dr Dixon, because on 20th May, his letter appeared in the Times.

David Aaronovitch is right to argue for a robust scientific approach in medicine. However, he is not being logical or scientific when he says that if something is suspected to be placebo then it has no benefit and the NHS should not pay for it.

What about scientific research on remedies that many believe to be placebo? These frequently show that there is a benefit but this is confined to those who believe in the treatment given. Surely, in such cases, it would be logical to say that the treatment was beneficial albeit in a specific group of “believers”. From there, it would be good science to compare the safety costs of this supposed placebo remedy with its currently given alternative before deciding whether “believers” should be able to receive such a remedy on the NHS.

The problem here is that belief and mindset play an enormous part in healing – science needs to take account of this. Patients’ symptoms are frequently metaphors and effective treatment can often be symbolic and culturally dependent. The mind, in the right circumstances, can produce its own healing chemicals often mimicking those given in conventional medicine. Until science can explain healing in psychosocial as well as biomedical language, we must be cautious about “voting for the geeks” as Mr Aaronovitch suggests. It is far better surely that individual treatment should be tailored, within reason, to the patient and their beliefs and perspectives. Further more, might it not be wiser to direct NHS resources according to pragmatic trials of cost effectiveness and safety rather than a limited interpretation of science that excludes the effect of the mind?

Dr Michael Dixon

Chair of Council College of Medicine.

This letter seemed remarkable to me. It is very close to being an admission that alternative medicine is largely placebo. It called for a reply.

We have been here before. Many people have discussed the dubious ethics of deceiving patients by giving placebos while pretending they are no such thing. There is wide agreement that it is not only unethical, but also unnecessary. Kevin Smith has written a scholarly essay on the topic. Edzard Ernst wrote Mind over matter? Margaret McCartney, the Glasgow GP, and author of The Patient Paradox, has explained it. Some views of Dr Dixon’s approach are less flattering than mine. For example, from the USA, Steven Novella’s Dr. Michael Dixon – “A Pyromaniac In a Field of (Integrative) Straw Men”. And, from Majikthyse, Michael Dixon caught red-handed!, and Dr Aust’s Dr Michael Dixon is annoyed.  The list is almost endless.

.Two replies were published in the Times on 26 May (and they were the lead letters -bold print). One from the excellent Evan Harris, and one from me.

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letters

Here they are as text.

Sir, Dr Michael Dixon’s letter (May 21) is fascinating. He is, of course, a well-known advocate of alternative medicine. Yet he seems now to believe that much alternative medicine is just a placebo. That’s something the geeks have been saying for years, and he appears, at last, to have accepted it.

That being the case, it follows that we have to ask whether placebos produce useful benefits, and whether it is ethical to prescribe them. Nobody denies the existence of placebo effects. But recent research has shown that they are usually both small and transient. Often they are not big enough to provide a useful degree of relief. For example, a recent paper on acupuncture in the British Journal of General Practice showed that it had a remarkably small placebo effect. And placebos have no effect at all on the course of cancer or infectious diseases.

There has been an admirable movement in medicine for doctors to be open and honest with patients. Prescribing of medicines that contain no active ingredient involves lying to patients. That is old-fashioned and unethical.

It is fair to ask why so many people seem to believe in alternative medicine, if even their placebo effects are small. The answer seems to lie in the “get better anyway” effect (known to geeks as regression to the mean). Most of the conditions for which placebos seem to work are things that wax and wane naturally. You take the “cure” when you are at your worst, and next day you are better. You would have been better anyway, but it’s hard to avoid attributing the improvement to whatever you took. That is why alternative medicine is advertised largely on the basis of anecdotal testimonials. And it is doubtless why Dr Dixon advocates “pragmatic” trials: that’s a euphemism for trials without a proper control group.

Psychosocial problems may indeed be very important for some patients. But deceiving such patients with dummy pills is not the proper way to deal with their problems.

D. Colquhoun, FRS Professor of Pharmacology, University College London


Sir, Dr Michael Dixon argues that the NHS should fund placebo treatments such as homeopathy (though he stops short of agreeing that homeopathy is a placebo) on the basis that they can offer limited help to those who “believe” in them. It is no part of modern ethical medical practice to deceive patients into thinking — or failing to disabuse them of the belief — that an inert substance or ineffective medicine has beneficial effects. This can not be justified by the hope — or even expectation — of deriving for that patient the limited psychologically based improvement in symptoms that may follow from the deployment of the placebo.

Pedlars of homeopathy for profit in the private sector will, alas, always seek to fool people into believing the hocus pocus of “memory of water” and the effects of infinite dilution and a lot of bottle-shaking. But doctors have responsibilities not to deceive their patients, even out of a paternalistic wish to assist them to manage their symptoms; and public policy demands that the NHS spends its resources only on treatments that work without deception in a cost-effective way.

Dr Evan Harris Oxford

Follow-up

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Tags: Anti-science · antiscience · College of Medicine · ethics · herbal medicine · homeopathy · Michael Dixon · placebo

15 responses so far ↓

  • 1 socratella // May 27, 2012 at 08:06

    Although “Many people have discussed the dubious ethics of deceiving patients by giving placebos while pretending they are no such thing”, those discussions, yours and Evan Harris’s letters in such a prominent position in The Times bring the topic to the attention of the general public. Bravo!

  • 2 Blue Wode // May 27, 2012 at 20:34

    I think it’s worth noting that it seems to have been Michael Dixon’s inability to cope with ‘heartsink’ patients that propelled him towards dubious placebo offerings of CAM. Indeed, he has confessed that he uses it for “purely selfish reasons”:

    Quote
    What particularly pleases Dr Dixon is that he can provide solutions for patients that conventional medicine has little answers for. ‘I got into the integrated approach for purely selfish reasons. I used to dread appointments with patients with conditions from back pain to allergies, where modern medicine has little to offer. Now I’m able to steer people towards approaches that help them to get better”.
    http://tinyurl.com/cpc5c5f

    It’s also interesting to note that his ‘College of Medicine’ colleague, Dr Peter Fisher (official homeopath to Her Majesty, Queen Elizabeth II), admitted that it was “plain ambition” that got him into homeopathy. You can view his admission between 27.30 mins and 32.22 mins in the following link. It shows him looking very uncomfortable during an interview with Prof. Richard Dawkins
    http://video.google.com/videoplay?docid=-4720837385783230047

    I think the above tells us all we really need to know about these medical ‘professionals’.

  • 3 Guy Chapman // May 27, 2012 at 20:39

    Dixon misses the point. If people want to choose to waste their own money on placebos then that is their lookout, but they have no right to expect the taxpayer to fund their delusions.

  • 4 CrewsControl // May 28, 2012 at 10:30

    Is there not a subtle difference between Dr Harris’ position

    “……and public policy demands that the NHS spends its resources only on treatments that work.”
    (I assume he means above placebo i.e. efficacious.)

    And your own?

    “There has been an admirable movement in medicine for doctors to be open and honest with patients. Prescribing of medicines that contain no active ingredient involves lying to patients.”
    Your stated position is you believe that NHS resources can be (mis)used in this way if the doctors are honest
    “I have no objection to the NHS funding placebos as long as they are honest about what they are doing.” D. Colquhoun http://www.dcscience.net/?p=4117#comments

  • 5 David Colquhoun // May 28, 2012 at 11:06

    @CrewsControl
    Ha -hoist by my own petard!
    I don’t think there is much difference between me and Evan Harris really. I’m not a clinicician, so I don’t have to deal with all the problems that medicine can’t do much about. But there us certainly something absurd about the present position in which GPs are told that it’s unethical to prescribe a placebo (are you listening Dr Dixon?) but they are allowed to refer you to a reflexologist.

    I guess I would have no objection to a GP deciding occasionally to prescribe a bottle of “pink water” if there was nothing else he could do, and thought it might help. What’s objectionable is all the woo merchants lined up to take NHS money.

  • 6 socratella // May 28, 2012 at 11:48

    There is also the danger that GPs may shunt patients presenting with pain off to acupuncturists etc. instead of first establishing the underlying cause by ordering clinical tests or referring to a medically qualified specialist for diagnosis.

  • 7 naturocrit // May 28, 2012 at 17:25

    Interesting admission by Dr Dixon, and charity towards homeopathy.

    Here’s a US naturopath I recently blogged about who claims homeopathy works in “Homeopathy: It’s Not Just Voodoo”

    (see http://tucsoncitizen.com/natural-medicine-tips/2012/05/25/homeopathy-its-not-just-voodoo/).

    She does admit, and I’m not sure this really aids anyone when they’re arguing for the efficacy of a treatment, “you can think I’m crazy if you want, I’m okay with that.”

    What makes it even crazier is that there she writes that reasonably-homeopathy-seems-crazy [implausible and the like, to be polite], yet this is quite in contrast to the North American naturopaths licensure examination [see the NPLEX at NABNE.org ], which more crazily states bluntly that homeopathy is one of their “clinical sciences”.

    -r.c.

  • 8 John Hooper // May 30, 2012 at 20:07

    That was one of the few reasonable articles Aaronovitch has written since he left the Gruaniad.

    I thoroughly enjoyed it.

    In terms of the eternal request for more research into quackery didn’t R Barker Bausell spend about $2Billion of US taxpayers money trying to prove various aspects of non-existent medicine and like, seriously dude, draw a big zip, nada. (I am by no means criticising him here – just the mumbo-jumbo he had to run the stats on).

    But the rubbish just will not go away. My back is seriously screwed (8 fractured vertebrae – possibly more now). A hospital consultant and my GP both suggested acupuncture for the pain. They seemed slightly stunned by the somewhat explosive response.

    The GP even had the gall to say “well it did help my brother in law”. Yeah great – that should make the NEJM.

    I wouldn’t have minded so much if I had just presented with a bit of a twinge from doing the gardening. I realise that “Doctor – my back hurts” must be the bane of a GP’s life but you would think that with 4 MRI scans and about 40 X-Rays showing the extent of the damage (and having had 4 spinal operations to repair some of it) they might have realised it was a bit more than a slight muscle sprain.

    I told them that I undestood the BMA had decreed it was not ethical to prescribe placebos. They went a bit sheepish – one upped the strength of my Naproxen and the other one gave me a suitcase full of Diazepam.

    Nothing like a bit of self-righteous indignation to get better (and more) drugs.

    The indignation might have been less if (after 18 months of tests) they had actually managed to diagnose what is wrong with me rather than keep repeating that I am a “mystery” and “unique”.

    My personal view is that I either have a subluxation of my innate intelligence or there is a qi energy blockage in one of my meridians. I might be wrong though.

  • 9 David Colquhoun // May 31, 2012 at 10:51

    Actually it is NCCAM (a branch of the US National Institutes of Health) that has spent over $2 billion, without coming up with a single useful treatment. Barker Bausell did write an excellent book on acupuncture: the title, Snake Oil Science, says it all.

    I find the NCCAM pages, and their Herbs at a Glance sections, very useful, because the "what the science says" sections are reasonably accurate and theanswer in every case is inconclusive at best. They make an excellent source for people who push alternatives. It avoids the response "you would say that, wouldn’t you".

    I can certainly sympathise about your back problems, because I have them myself. MRIs make no difference to the outcome -beuatiful pictures but they don’t usually help with cure. Low back pain is one of the great unsolved problems of medicine. If only people would say that more clearly

  • 10 socratella // May 31, 2012 at 15:54

    DC’s tweet this morning ‘University College London Hospitals Trust (quack division) says acupuncture is “part of conventional medicine bit.ly/JuW711#UCLH ” seems to be more accurate than he might hope.

    I was recently seen by a locum GP. I was suffering excruciating pain in my left leg. The locum GP searched for “trigger points” in my left leg for which she proposed to prescribe acupuncture as she later wrote to me: “I wondered if you might have a trigger point in your muscles and explained that, if we were able to find a trigger point, acupuncture, which is recommended within the NHS, might help it.”

    To cut a long story short, the locum GP was unable to find any “trigger points” so she took acupuncture off the menu for that particular presenting problem. However, the way she represented acupuncture treatment to me as an ordinary patient is certainly as ” part of conventional medicine” replete with the blessing of an NHS recommendation.

    A subsequent google search revealed that the locum GP is BMAS trained, ie a practitioner of Western Medical Acupuncture.

  • 11 PhDelinquent // Jun 1, 2012 at 12:27

    I am genuinely fascinated by placebo.

    I am taking part in a double-blind randomised controlled trial on daily low-dose aspirin, and I get a genuine feeling of uplift when I catch a news item on the benefits of low-dose aspirin, even though of course I have no idea whether I am taking the aspirin or the placebo. It’s almost as if I really, for a few moments, believe that I am taking the active dose. Does this feeling of uplift in itself do me good, I wonder?

    I am also very interested by the so-called “nocebo” effect, especially in relation to the statutory lists of reported side-effects that come with every prescription. I tend not to read these, but file away the leaflet unseen. Then, if I think I am getting some side-effect, I can refer to the list for information.

    Most people (and notably my mother-in-law) read these lists of side-effects and many must “expect” to get at least one of them (especially my mother-in-law). These then get reported and added to the records for this drug, and the list gets updated. Many of these side-effects are remarkably vague and non-specific (fatigue, nausea, disturbed sleep, and so on), and are the sort of things many people experience in the course of a few days, whether on medication or not. This reporting procedure, therefore, seems to me to be fundamentally flawed. It might be better to not list the side effects, but to advise patients to “report anything unusual” to their doctors as soon as possible.

    Back to the subject in hand, placebo should never be administered (except in trials), either with the patient’s knowledge or without it. The ethical way for doctors to deal with patients presenting with the “better in a few days” type of complaint is surely to medicate as little as possible, educate the patient on the condition (leaflets could be made available) and to reassure the patient that all is well. And most good GPs end by saying, “If you’re still feeling unwell in n days, don’t hesitate to come and see me again.” Mine does – and that pleases me!

  • 12 Craig Aaen Stockdale // Jun 27, 2012 at 13:51

    I love the schedule for the acupuncture conference that the “College” is hosting (http://aaenstockdale.wordpress.com/2012/06/27/prince-charles-college-of-medicine-nails-its-colours-firmly-to-the-mast/). They really have given up all pretense to be anything other than a quack lobby group, haven’t they?

  • 13 David Colquhoun // Jun 27, 2012 at 20:54

    @Craig Aaen Stockdale
    Thanks for that link. Nice post. I agree entirely.

  • 14 Dr Michael Dixon, Golden Duck nominee | Josephine Jones // Sep 18, 2012 at 23:23

    […] Whether or not Dixon personally believes in quackery, he certainly endorses it. As Edzard Ernst points out here, the rebranded College of Medicine continues to promote unproven and disproven treatments, including homeopathy, qigong, reflexology and aromatherapy. […]

  • 15 CrewsControl // Oct 13, 2012 at 16:41

    *

    I’ve just read your response to the NHS Lothian consultation
    on homeopathy. Is there not a little inconsistency creeping into your position?
    You say (vide supra) ‘I guess I would have no objection to a GP deciding
    occasionally to prescribe a bottle of “pink water” if there was nothing else he
    could do, and thought it might help’

    http://www.dcscience.net/?p=5334#comment-11289

    And this in your letter

    ‘It isn’t
    long since an ex-student of mine, now a professor in the University of
    Edinburgh, took his child to doctor and was offered Belladonna 30C. Needless to
    say, he was very indignant about being offered a sugar pill that contained no
    belladonna whatsoever. Despite his (and my) vigorous complaints, nothing was
    done about it at the time.’

    http://www.dcscience.net/Lothian-homeopathy-consultation.pdf

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