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CIVILISATION may be understood as the gradual march of the scientific method into every nook and cranny of human inquiry.
This has yielded spectacular advances in understanding, but also induced a backlash from those whose world view rejects scientific methodology and its conclusions. The advances and backlash play out on political, economic and social fronts.
One current battleground involves conventional scientific medicine (SM) versus complementary and alternative medicine (CAM).
The outcome of this battle is important because public and private resources are diverted from the loser to the winner, and patients can receive treatments that may be effective, ineffective, or even harmful.
Friends of Science in Medicine (FSM) is a coalition of health practitioners and scientists concerned about the backlash against scientific methodology in Australian health care. Anti-vaccinationists, homeopaths, iridologists and other CAM proponents compete with SM for government recognition, training of practitioners and funding of services, as has been documented by FSM.
FSM is specifically troubled by the increasing proliferation of “pathology tests” that are unsubstantiated by scientific methods, and are marketed to the public by the test providers and CAM practitioners, or via political lobbying to government, to gain funding. Such strategies have been successful.
Some of these tests include “live blood analysis”, hair analysis for “toxins” (non-forensic), “liver detoxification profiles”, “clot retraction tests”, “cancer” tests not performed by National Association of Testing Authority (NATA)-approved laboratories, electrodermal screening devices and food allergy tests not performed by NATA-approved laboratories.
With the support of the Royal College of Pathologists of Australasia, FSM has recently sent an advisory paper, “Recommendations for Pathology Tests in Australia” to the federal Health Minister and other agencies, together with a letter calling for legislation to protect and warn the public of the difference between SM and CAM.
It is essential that scarce public resources are allocated only to pathology tests validated by rigorous scientific methods, provided by accredited laboratories and documented in peer-reviewed scientific literature. Publication of a claim on the internet is not, of itself, sufficient substantiation.
Unsubstantiated pathology testing is bolstered by the use of pseudoscientific jargon, fabricated claims of scientific validity, celebrity endorsements and claims that SM practitioners conspire to oppose CAM merely to protect their supposed lucrative incomes and prestige.
FSM respects the right of all patients to make their own choices in health care. But their choices should be informed.
Government and health care professionals have a vital role to play in informing that choice. When the choice has not passed scientific muster, the individual rather than the public should pay for the choice.
Society also accepts that we should protect children and other vulnerable people who are unable to make autonomous choices, and pathology testing should be no exception.
FSM recognises that the future is, by definition, unknown. SM does not have all the answers.
A claim for any new test should be met with cautious scepticism until it has been scrutinised using scientific methods. If the proponents of a new test are shown to be correct, they are entitled to the financial benefits and recognition from their discovery.
The test will then join other SM pathology tests, and be welcomed by SM practitioners as the latest weapon in the arsenal to investigate disease.
FSM recognises the profound fact that patients seek hope. SM cannot cure all ills, and its practitioners are ethically bound to admit this. Many CAM practitioners do not feel so constrained.
We must be vigilant to ensure that only pathology tests with a sound scientific foundation receive public funding. We must also foster the public’s understanding of the difference between tests that have or lack this evidence.
More generally, we should ask why the distinction between SM and CAM is becoming blurred, and who benefits or is harmed by this loss of distinction.
Health care is fundamentally an ethical endeavour, and that must be the foundation of professional practice.
Dr Adrian Cachia is a consultant pathologist based in Sydney and Professor Graeme Suthers is a pathologist at the University of Adelaide. Both are members of the Friends of Science in Medicine.
Acknowledgement: We are grateful for the advice and energy of Emeritus Professor Alastair MacLennan, vice president Friends of Science in Medicine, on this article.
The logic of “A physiological medicine doctor” is flawed. The actual test may be performed on conventional pathology science (well even this is not always) but the pre- and post- test thinking is not. The equivalent for his/her logic would amount to “if I write something with pen and paper then it has to make sense because it is based on conventional writing principles” which is obviously not true.
At least in my field of microbiology, those “functional” tests that are performed are always interpreted wrongly. The shonky practitioners are essentially interpreting microbiology tests in a way that no qualitied medical microbiologists would interpret, because we know there is no evidence to support that, or to interpret it that way would be over-extrapolation of what is being supported, or what is done does not answer the question. To put it simply, we know the limitations of the test, therefore we don’t overclaim. And overclaiming is a hallmark of snake oil salesman.
It is actually not about conventional vs alternative medicine. Chinese medicine never claimed to deploy modern pathology tests to aid their diagnosis. It has its own system, which is based on thousands of years of empirical evidence. And in China Traditional Chinese Medicine doctors and conventional doctors actually come together in some hospital to co-consult.
More insidious than the clearly fraudulant testing described by Cachia and Suthers is the rush to market by the diagnostics industry and pathology laboratories that should know better with new tests. Nowhere more than tin nucleic acid amplification tests (PCR and its relatives). If these tests were pharmaceutical agents, they would still be in phase 1 to 2 testing. All too often tests are offered as “routine” before their characteristics (sensitivity and specificity) have been evaluated in the populations to which they are marketed, and certainly well before they have been evaluated for cost-effectiveness.
What is required is full disclosure, accountability and awareness of the measurable and the imponderables that may or may not or do work to influence outcome, that need to be taken into account, and to not exploit by adding deceit e.g. to promote pseudoscience in the name of pure science. That is the ethical standpoint that is required if we are to comfortably live together and for civilisation to be able to progress.
If ”A Physiological Medicine doctor ” was right, and strategies were valid just because of popularity, we would all be recommending homeopathy, a Maccas diet and recreational drugs.
I do “alternative” medicine full time. All my patients are those that conventional medicine is unable to help.
Conventional pathology has not helped these patients to get better. The so called shonky pathology is acyually based on very sound conventional pathology science. They help me understand what is wrong with my patients. they help me “cure” some 90% of these unfortunates.
So if conventional medicine is unable to help these patients, then these patients are ” psycho-somatic”.
But if the shonky pathology and my treatments get these patients healthy, then I am defrauding my patients and I am a quack.
How convenient. Conventional medicine wins both ways.
But at the end of the say, what really matters is if my patients get better.
I know what my patients think. If they get better, and off all their treatments, they will support my shonky pathology and my quackery against all the so called scientific evidence based medicine that does not work.
By the way, the work quackery comes from those who use mercury. Does this also include dentists and vaccines that contain thiomersol?
Hair analysis-my hair is shampooed, conditioned, and has “ends therapy” applied-, then is rinsed in local water, and exposed to local air- surely my hair analysis is an analysis of the products which I apply to my hair, local water an local air-not an analysis of my body which produced it before I treated it.
The FOS need to be careful not to become Fascists of Science in their efforts . While there is a case for saving public funds, saving individuals from harm and exploitation, if we go too far down the FOS pathway practitioners become mere ants unable to innovate unless supported by megabuck research efforts. The research dollar at the primary level has already been narrowed down to only the big players. I am a rural GP whose only foray into CAM territory is to try out prltherapy injections for chronic pain sufferers. Seems to work sometimes. I am worried about an early morning knock on the door having confessed.
No medical investigation (pathology/imaging etc) should be legal unless validated, ie evidence based. Furthermore all medications, whether supplied on prescription, or over the counter, should be available unless similarly supported.
This is a problem all over the globe and not confined to Australia only. The public would suffer as the titles of such tests are very attractive.
A global consensus is needed to address this issue.
Indeed this is an important article, however it is not just the test per se but its interpretation and guidance to the test requestor that should also be scientifically validated and this is a continuing process as new publications/data become available.
This is a very important article in support of scientific medicine. It is of great concern that there is proliferation of pseudo-science, promulgated by practitioners of alternative medicine, in the 21st century. More education of the general public is needed so that fully informed choices can be made. This type of scientific education should start in kindergarten. We need rational thinking on all these topics based on the best scientific evidence.
An academic colleague has just reminded me :
“I presume that Healthscope operate a fully accredited pathology laboratory. They offer Functional Pathology Testing including Hair Mineral Analysis and much more – see the following link for details http://www.healthscopepathology.com.au/index.php/functional-pathology/tests/“
I guess they need the $$$’s!