Medical Skepticism

Skepsis’s last article on Menopause Madness [Skeptic 53] reminded me of my recent prescribing of progesterone cream for a well informed patient at her request. The good GP I am (I have faith, sometimes in evidence-based medicine!), I looked up the evidence on such creams and also perused the articles given to me by my patient. There was one Randomised Control trial, review article by a gynaecologist plus a lot of very biomedical in vitro research which was of little use to me. Not much in the Cochrane database and a little on MEDLINE. One clinical trial of reasonable quality showed some results in terms of symptom improvement. Safety issues hadn’t really been researched but then again wild yam cream must be natural and therefore OK huh?

Anyway I prescribed the cream after checking that at least it had been formulated with some attention to quality (i.e. not a Chinese formulated import). Thus both myself and my patient realised that we were trying a relatively unproven medication with probably a wide margin of safety.

This took me back to the problem in medicine in that too often we have used unproven therapy. On what high ground can we stand when we debunk “alternative” or “complementary” therapies? As an example, it has taken 20 years at least for the non-evidence-based unsubstantiated excesses of antibiotic prescribing in medicine, both hospital-based and primary care, to finally be acknowledged by the slim majority of practitioners. As Skeptics, we should ensure our own house is in order and close the gap between what we preach and what we do.

Thus, what do we do about that great realm of the unproven and unprovable (under current scientific methodology). We may recognise the deficiencies of current scientific methodology (Does a true skeptic accept qualitative research?) but that still leaves a great dearth of scientific knowledge in medicine, especially primary care.

Which brings me back to Neil McKenzie’s comments on the Medical Council statement on alternative therapies. I believe that we need to focus on the processes of scientific inquiry in medicine both mainstream and alternative, not on debunking anything that we regard as “unscientific”. Don’t forget that in the early 1980’s, medicine debunked chiropractors and osteopaths without being aware of the extensive scientific research in the US and Europe on manual therapies.

Anyway for some quite bed time reading, look up this Cochrane review:

“The Matter of Intercessory prayer for the alleviation of ill health” Roberts L., Ahmed I., Hall S., Sargent C.

for some enlightening scientific enquiry and remember that important oxymoron: skeptics have faith in science.

Jim Vause

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