Thursday, December 2, 2010

Alternative Medicine - the debate

Dec 2, 2010

Stick to mainstream medicine till there's proof

MR RICHARD Seah's letter ('Mainstream doctors shouldn't be insensitive to alternative medicine'; Nov 19) misses the point made by the writers whom he criticises (Dr Choo Su Pin and Dr Toh Han Chong, 'Don't make cancer harder than it is'; Nov 11).

Mr Seah targets the conclusions of the writers without dealing with their reasoning.

The crux of Dr Toh and Dr Choo's letter was that bioresonance therapy was not an 'alternative' treatment, but rather could actually be risky; patients were either overly frightened by the less than accurate diagnostics of bioresonance or worse, forsook conventional cancer treatment therapies for an unproven one, thereby giving up a potential cure.

Far from being dismissive and close-minded, they did acknowledge in their letter that 'there may be some treatments and supplements that may indeed be proven beneficial one day' but qualifed it by stating that 'these cannot be oversold beyond what is known about their true benefits'.

Dr Ang Peng Tiam's take on anti-cancer diets ('Food for thought'; Nov 18) should be taken in context. He was merely warning against giving up a regular diet in favour of other diets especially because chemotherapy requires adequate nutrition, and not arguing against alternative medicine.

The point these other writers were trying to make is this: Unless and until such alternative treatments are proven to be safe, effective and accurate, we should not choose them over conventional ones. Doing so could cause us either unnecessary worry or additional suffering that leads to premature death.

Tang Shangjun

Mainstream medicine isn't a cure-all...

I HAVE been a practising family doctor since 1994 and seen my fair share of chronic debilitating diseases and cancers causing much suffering and death over the years.

Often, I find myself helpless in preventing the onset of such illnesses or providing relief to my patients even with advanced Western medicine.

[Yes. Everybody dies. Not every illness can be prevented or cured. You are not god. Pain and suffering is part of life. Death is also part of life. If you are a doctor because you think you can save everyone, you will indeed feel helpless, and you will indeed find that even advanced medicine will not save all your patients. If you think you can save everyone, your medical training is sorely inadequate. If you think salvation is in alternative medicine, please switch and stop practicing western medicine.]

Our body has a remarkable capacity to heal itself, much more quickly than people realise, when we address the underlying causes of illnesses. And for many people, the choices they make each day and what they eat each day will determine their health in the long run.

[I have no disagreement with the above paragraph... within reason. But if the lungs were punctured, or one was acute appendicitis, please do not tell the patient to rest at home and let the body heal itself. I'm all for self-medicating, or the power of a good rest and yes, I think I should eat more healthily, and yes, my diet and life choices affects my health. But these are not arguments for alternative medicine.]

We should not begrudge those who prefer a vegetarian diet and seek alternative treatment. It is their choice and who are we to decide for them when we don't even know ourselves?

In short, we are all learning. I remember years ago when traditional Chinese medicine (TCM) was not recognised by medical practitioners. But now, there is a TCM practice even in major hospitals.

[I seriously wonder about the efficacy of that.]

[April 2016 comment: If we agree that the human body has a remarkable ability to heal itself, then sometimes the best thing you can do is to let the body heal itself. It is more natural, less intrusive, and if the body fights off an illness, it gets stronger and immunity in the future. If so, the best thing doctors can do is generally to let the illness "run its course" - which is simply letting the body heal itself.

However, when people go to a doctor, they want a "cure". Or more correctly, they want relief. They want the pain and discomfort to go away. Here's the thing, a significant portion of the effect of medicine is "placebo" effect. And most of the medicine you get from your doctors provide symptomatic relief - pain-killers, fever suppression, nasal decongestant, etc. Only antibiotics are actually targeting the cause of your illness. 

Much of TCM medication or herbs are intended to work over the long term - strengthening one's immunity, and fighting off disease. However, most of TCM treatments have not been objectively proven as efficacious. But it doesn't matter.

If most illnesses can be allowed to "run its course" without undue harm to the patient or the general public, then it does not matter if the patient is treated by western medicine, TCM, or self-medicates/rest at home. 

Channelling patients to TCM relieves the hospital of demand for western doctors. Sure. you can read that to mean that TCM is recognised by medical practitioners.]

As doctors, we should keep an open mind as there is always more to learn.

Dr Benny Lim Jit Biaw

...No, but it's the be-all, unlike alternative healing

I REFER to the letter by Mr Richard Seah ('Mainstream doctors shouldn't be insensitive to alternative medicine'; Nov 19).

Mr Seah's polemic against Dr Andy Ho's article ('Sending out the wrong signals'; Nov 6) completely misses the point and grossly oversimplifies the view of allopathic medicine on complementary and alternative medicine (CAM).

Mr Seah's contention that Dr Ho and Dr Ang Peng Tiam ('Food for thought'; Nov 18) displayed 'rudeness and insensitivity' by dismissing CAM as pseudoscience fails to take into consideration the duties of the two medical men.

Medical professionals are accountable only to the health and well-being of the patient. 'Culture' and political correctness take a backseat when providing information concerning patient care. Mr Seah's implied assertion that doctors should permit CAM on grounds of sensitivity thus, holds no water.

[Good point.]

Doctors acknowledge that the patient has autonomy in matters of his health and is free to choose his choice of therapy. This does not preclude doctors from speaking out against quackery and 'snake oil' salesmen brazenly promoting a panacea that provides little benefit beyond a placebo effect. Doctors must provide necessary information verified by the scientific process for patients to make informed choices.

Mr Seah implied that CAM holds more value than allopathic medicine is wont to give. However, CAM is a body of unverified practices that have questionable outcomes and doubtful methodologies.

Homeopathy, for example, has long resisted the golden test of efficacy - the double blind trial. Mr Seah's argument that 'qi' and other pseudoscientific concepts in CAM are 'holistic' is a tired argument raised countless times. It is puzzling that the public demands drug trials and testing for drugs but yet does not demand the same rigour from CAM.

Certainly, not all aspects of CAM are worthless. Pharmaceuticals recognise the value of traditional Chinese medicine (TCM) - for example Artemisinin, a first-line antimalarial derived from herbs. However, the fact that once CAM has been accepted by the scientific and medical community, it becomes 'mainstream' rather than 'alternative' seems to fly over CAM proponents' heads.

Singapore has come a long way in the field of science and it is precisely because of its 'advanced medical technology' that old practices that have little footing in science are abandoned.

Oon Ming Liang

Beware, be very aware of mumbo jumbo...

I AM writing in response to Mr Richard Seah's letter ('Mainstream doctors shouldn't be insensitive to alternative medicine'; Nov 19).

While I agree with Mr Seah that there are indeed other traditional forms of medical practices that have been passed down through the generations in different cultures, one thing must be made clear: If these practices are not scientifically proven, they cannot be considered as treatments to be endorsed.

Mr Seah quoted bioresonance as an example in his letter, criticising mainstream doctors for dismissing this as mumbo jumbo. The fact of the matter is that it has been scientifically proven that it is no more effective than a placebo; that is, it would be equally effective as tap water.

There is no scientific basis for its efficacy; just your imagination. Yes, the mind is a wonderful tool and has been able to help heal the body, as shown by Professor V.S. Ramachandran in his research on the phantom limb; yet to attribute the mind's powerful healing effects to bioresonance, or some other mumbo jumbo, is irresponsible.

I am not saying that mainstream medicine is infallible. However, there is a reason why there are exacting standards to prove the efficacy of a treatment before it becomes adopted as mainstream. This is to protect unsuspecting citizenry from quack treatments, regardless of whether the doctor has published a book or not. If a treatment has not undergone peer review and trials, it cannot be considered responsible treatment.

Ian Dyason

...Sure, but doctors should try a dose of humility

I REFER to the letter by Mr Richard Seah ('Mainstream doctors shouldn't be insensitive to alternative medicine'; Nov 19) and couldn't agree more with him.

I suffered from a chronic gastric condition for 20 years. I was treated by both general practitioners and specialists in both government and private clinics. I was put through all kinds of tests and prescribed many medicines... but these did not improve my condition.

A friend introduced me to bioresonance therapy last year and my health has since improved.

Instead of criticising and making negative comments about alternative medicine, why aren't these professionals in medicine humbling themselves to find out why people are not sticking to conventional treatments but seeking alternative ones instead?

Lim Swee Har (Ms)

[I'm glad BRT "worked" for you. But as Dr Benny Lim and Mr Ian Dyason noted, the the human body has great restorative powers, and the human mind too. Please consider the case cited by the oncologists - one a false diagnosis of gastric cancer by BRT, scaring the woman into expensive medical test and procedures only to prove that she has no cancer.

If someone told you that rubbing a magic stone over your abdomen everyday for 2 weeks would cure your gastric, and it really happened, would you believe that the stone was magic? Or would you want to see the magic stone heal other people?]

Nov 25, 2010

Alternative medicine unsafe? Not true

MAINSTREAM medical doctors routinely warn that complementary and alternative medicine can be dangerous, the latest instance being Monday's report about hypnotherapy ("When you wake, you will excel in school").

In that report, psychiatrist Brian Yeo warned that "hypnotherapists have the power to elicit information that the subject may not ordinarily want to reveal".

I believe hypnotherapists will attest that such an assertion is untrue. If indeed hypnotherapy has such powers, the police and security forces might as well use it to elicit confessions from suspected criminals and terrorists.

[In this case, I would say that Mr Seah has a point. The powers of hypnotherapy is overstated by Brian Yeo. I would not be surprised if he was misquoted by the reporters. But if he wasn't he really should be ashamed of himself for saying such stupid things.]

In reality, a person cannot be hypnotised against his will. One hypnotherapist explained to me: "If a person has no desire to stop smoking, I cannot use hypnotherapy to make him stop."

Dr Yeo also warned that "anything that has the power to do good also has the power to do the not-so-good".

This is a general statement that applies to anything and everything - including psychiatry.

An Internet search for "harm of psychiatry" will throw up many reports and medical studies about the damage done by psychiatric drugs and other forms of psychiatric treatment.

Ditto if you do a search for "harm of medicine". Studies of iatrogenic illnesses - caused by medical treatment - show that in medically advanced countries like the United States, medical care is the third leading cause of death.

By contrast, complementary and alternative medicine rarely cause harm. Insurance companies know this. They charge complementary and alternative medicine practitioners much lower premiums for professional indemnity insurance.

Richard Seah

[Partly it is because the proper authorities would not allow untrained, unscientific practitioners near deadly or potentially dangerous equipment, devices and ingredients. If I say my alternative medicine involves placing my hands on the patient's head and letting my qi flow into him to cure him, I probably won't need malpractice insurance. If my alternative medicine involves putting the patient in a tub of milk and applying an electric current through him, or if involves cutting open the patient in order to massage the pancreas to stimulate the flow of qi, the authorities will probably be down on me like a ton of bricks, and no insurance company should want to insure me.

So treatments like BRT where the equipment is no more dangerous than an ECG/EEG machine, insurance companies will be as glad to take your money as you are prepared to take the money of your gullible victims... I mean patients.]

The original article, and the letter from Cancer specialists that started the debate.

Nov 6, 2010

Sending out the wrong signals

By Andy Ho

SEVERAL non-physicians are offering 'bioresonance' as a cure-all for ills ranging from allergies and addictions to autism and cancers.

All for $150 to $300 for one to 1-1/2 hours at a device that looks like any oscilloscope you might find in a physics lab.

Recently, a Bedok general practitioner called Dr Erwin Kay was censured by the Singapore Medical Council for 'treating' patients with the device. He was fined $5,000 for professional misconduct.

But while bioresonance is not accepted as a method of medical treatment that trained physicians may use, it is perfectly legal for non-physicians to offer it.

In the United States, by contrast, the extravagant claims that these operators make for bioresonance may see them hauled off to court.

For instance, in October 2002, a bogus cancer cure guru, David L. Walker, had to settle with the US Federal Trade Commission (FTC). The FTC, which works to prevent consumers from being defrauded, had taken him to court for claiming that he could cure cancer with his bioresonance machine.

What practitioners like Mr Walker claim their 'remedy' can do is based on the unproven premise that cells in the human body have a natural vibration or resonance. Hence, bio-resonance. That is, they vibrate or resonate at 'healthy frequencies' whereas unhealthy cells supposedly do so at different frequencies.

It follows, therefore, that healthy frequencies should be applied to ill bodies to bring them into balance once again. Such rebalancing apparently would free unhealthy cells of unspecified toxins accumulated in the course of ill health.

What is needed, then, is a device that can detect these differences in frequencies, determine which organs are ill and then deliver opposite waves to 'cancel out' the unhealthy frequencies. This is where the bioresonance device comes in.

In use, the electrodes linked to the device are applied to the patient's skin to supposedly diagnose one's conditions. The electrodes send out electrical signals that perform their 'wave interference' work adroitly, thus leading to a rebalancing of frequencies.

The stated frequency range at which rebalancing occurs is said to vary greatly from 10 Hz to 150,000 Hz. Computerised data recording goes on even as the electrodes emit their healing frequencies.

Computer power is also used to analyse the data and interpret the results to give an indication of the patient's health.

Signal intensity is then varied according to these analyses, which may also direct the practitioner to focus the electrodes on a specific part of the anatomy where treatment is particularly needed. Of course, several sessions are needed to achieve re-balancing and healing.

There is absolutely no credible scientific evidence to support this gobbledegook. The evidence that does exist utterly refutes its theory and practice.

In a randomised, double-blind trial involving children in Davos, Switzerland, who had an allergic skin condition called atopic dermatitis, bioresonance was found to have no curative effect at all.

In a separate trial, bioresonance electrodes were tested for accuracy in the diagnosis of allergies to house dust mites or cat dander. Their accuracy was compared to that of the standard skin-prick test used by dermatologists. There was absolutely no correlation between the two sets of results.

A similar trial published in the British Medical Journal in January 2001 also showed that the bioresonance machine failed to diagnose skin allergies.

Since these are not life-threatening conditions, perhaps the practice of bioresonance is quite harmless. Not so, however, when it is also claimed to cure cancer.

Though there have been no clinical trials to test this claim, it is based on completely erroneous science. Advocates argue that the bioresonance device can kill cancer cells by releasing tumour suppressor genes that have become 'suppressed'. Alternatively, or in addition, it is said to attenuate hyperactive oncogenes or genes that cause cancer.

Actually, cancer arises when mutations develop in these genes, not because they are suppressed or become hyperactive, respectively. Once mutations have developed in them, genes cannot be restored to their previously normal state.

The p53 gene helps to regulate when a particular type of cell will divide in two. It also leads defective cells to 'commit suicide'. But when p53 mutates, it can no longer do these things, so cancer develops.

But bioresonance advocates claim that p53 is 'suppressed', not mutated, in cancer cells. For this reason, it is argued, bioresonance can be used to reinvigorate p53, thus curing the cancer.

But genomics studies show p53 is mutated, not suppressed, in cancers.

In sum, bioresonance is junk science. Advocates may trot out testimonials from satisfied customers, but testimonials are not data. Its efficacy can be proven only with trustworthy data obtained from rigorous trials with blinded controls.

But since anyone may make and sell these devices - that is, the technology can no longer be patented since it is widely available - no one has any incentive to invest in such studies.

Be that as it may, unless and until such studies are done, one should stay away from this 'therapy'.

Nov 11, 2010
Don't make cancer harder than it is

AS MEDICAL oncologists, we were heartened to read Dr Andy Ho's column last Saturday ('Sending out the wrong signals').

It is a daily struggle trying to convince some desperate cancer patients that they are unwittingly giving away their time and money to mumbo jumbo like bioresonance therapy.

Earlier this year, a woman was referred to our centre after she was told by her bioresonance therapist that she had Stage 2 gastric cancer detected by bioresonance. In the end, she did not have any cancer but ended up with a needless CT scan, upper gastrointestinal endoscopy, blood tests and a lot of unnecessary anxiety.

More recently, another patient asked a colleague if she should go for bioresonance therapy at a popular bioresonance therapy centre. One cannot say that bioresonance therapy and similar unproven therapies are harmless, as they can lead to unnecessary investigations, wastage of money and resources, and worse, patients refusing conventionally proven therapy with evidence of real benefits.

We remember a patient with potentially curable lymphoma who refused curative chemotherapy and went on a strict diet based on its recommendation as anti-cancer therapy.

He was only 35 years old and almost died from renal failure and other electrolyte abnormalities caused by the diet before he eventually died from the lymphoma itself.

It is frustrating, especially when patients refuse conventional therapy which can potentially achieve good outcomes and even cures in favour of unproven alternative therapies.

It is easy to exploit vulnerable cancer patients, create fear and promise unsubstantiated hope. Cancer patients and their relatives may willingly pay for unproven therapies with little or no solid basis in science, common sense or evidence but solely based on hearsay, if there is even a glimmer of hope for their often terminal illness.

While most alternative treatments, like mangosteen juice and wheatgrass, have not shown anti-cancer effects in humans, others like chelation therapy, oxygen therapy, coffee enemas and various antioxidant therapies have been reported to cause dangerous effects in patients.

We respect that there may be some treatments and supplements that may indeed be proven beneficial one day, but these cannot be oversold beyond what is known about their true benefits.

It is our responsibility and that of the media to educate the public and point people in the right direction and away from baseless cancer-treatment claims.

Dr Choo Su Pin and
Dr Toh Han Chong
National Cancer Centre Singapore

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