Quackery

Unfortunately, human nature being what it is, deception and fraud have plagued medicine since its earliest history.  People with medical problems make a willing market and there has never been a shortage of those who will supply remedies to ‘help’ them. 

 A quack, by definition, is someone who offers an ineffective or sham treatment.  Shame to say, there are still plenty of these inside medicine today as well as outside - in so called complementary and alternative therapies.

There are two different types of quack: those who deceive themselves and those who are well aware of the deception that they are committing. 

The former are perhaps less culpable: they may be well intentioned, kind, caring individuals who really want to help people and have convinced themselves that their treatment is effective.  This is the more usual type you might meet among qualified doctors. Their patients may speak very highly of them.  Being treated by a therapist,  who is kind, empathic and spends time with you can be a positive experience – so long as whatever it is they are treating you with doesn’t do too much harm. Concerns are sometimes raised if these therapists convince people to accept an ineffective therapy when an effective one could be given instead.

True frauds can be found in medicine too; including medical researchers who falsify their results and doctors who simply inflate their private practice for financial reward (click here for details of a recent case of fraud). 

Both types of quack can be found in complementary and alternative medicine, too. However, just as the presence of quacks in orthodox medicine does not invalidate all of the highly effective treatments offered in our hospitals today, neither does the presence of quacks in complementary and alternative medicine mean that this whole field is worthless.

Doctors are very sensitive to the charge of quackery.  Quacks are our embarrassing forebears.  Our status in society today largely rests on the efforts that we have made to distance ourselves from these ignominious origins.  Our professionalism is based upon principles of scientific scepticism and the absolute primacy of our patient’s benefit – even to the point of self-sacrifice.  As a result doctors are usually the most vocal in vilifying those whom they see as quacks, although this is usually aimed at those outside the profession.

The discipline of providing “evidence based medicine” is central to our conception of modern medical ethical practice.  Essentially, the idea is that such treatments have been proven effective by scientifically rigorous clinical trials – usually randomised controlled trials.  Treatments tested in this way form the “yellow-brick road” on which doctors are safe from the accusation of quackery and patients can be confident they are receiving effective treatment.

On either side of the yellow-brick road there is the forest in which lurk the temptations of treatments that have not been tested and the practitioners who offer them.  Into this forest, physician and patient should venture with caution.

The problem is that the temptations in the forest are almost irresistible.  Not all untested treatments are ineffective.  Every treatment that is eventually tried, tested and accepted into the canon of evidence based medicine has to start life in the forest as an untested treatment.  Other treatments will never be subjected to this rigorous (but very expensive) process.  In addition, the idea of an undiscovered cure which doctors have missed is tempting in its own right.  And finally, sometimes the yellow-brick road just runs out and then where do you go?

In PlanBe, we are trying to provide patients with some tools, some skills and some information to help them navigate their journey with cancer.  We discuss some of the warning flags that can help you spot a quack.  We explain how you can try to weigh up the pros and cons of treatments.  We discuss the evidence, such as it is and where we can find it for each of the possible therapies, diets, and lifestyle changes.

There will be times when the road appears clearly made up of reassuring blocks of yellow-brick, sometimes not (then the traveller must be on their guard!).  In the end we acknowledge that our patients have every right to choose for themselves, we do not have a monopoly of the right course of action, and everyone is responsible for their own well-being.   

Dr Michael Leahy
Consultant Medical Oncologist
The Christie NHS Foundation Trust

Have you ever had experience of quackery? What do you think about the reflections above? Please comment below, or alternatively contact us at planbe@christie.nhs.uk. 

Follow the project team on Twitter:

Dr Michael Leahy

Ben Heyworth

Are doctors holistic?

Doctors today are often accused of not being holistic.  Being holistic is generally considered a feature of alternative or complementary health care practitioners such as homeopaths, herbalists, traditional Chinese doctors etc.  At least, this is often how these therapists portray themselves;  it’s their unique selling point.  

People may be sceptical about whether the treatments offered by complementary therapists really work, but may appreciate the more comprehensive approach and the longer time taken with the therapist in the consultation.  

Despite this widely held view that doctors are not holistic, I can remember being taught in my medical school that we should be holistic in our approach.  We were discouraged from describing patients as “the spleen in bed 2”, and urged to assess the patient fully including their psycho-social and family background.  I’ve generally assumed that my modern medical education equipped me to be much more holistic than doctors of the previous generation. 

Recent reports from the Department of Health continue to recommend the practice of holistic health care. 

Are doctors holistic?

What is holistic care after all?

This train of thought led me to look into what is actually meant by the term “holistic”.  A little internet research revealed that the term has a variety of quite different meanings.  Apparently, first coined by the South African statesman, politician and soldier Jan Christian Smuts in a book in 1927, the term was initially used to mean a philosophy which could be applied to physics, society and biology in which systems are considered as wholes and not collections of parts.

When used in connection with health and health care these ideas have been used to mean that illness and recovery should be seen in the context of a person’s social and psychological situation but also has been appropriated by some simply as a synonym for complementary and alternative medicine to distinguish it from conventional medicine.  One article I read suggested that “holistic medicine is based on the belief that unconditional love and support is the most powerful healer”.

As a result, some doctors apparently prefer to say that they are “wholistic” in their approach so there is no confusion that they practice complementary or alternative medicine.

If doctors are not very holistic, why aren’t they?

Several possible reasons spring to mind.  Perhaps doctors are sceptical of the benefits of this approach?  It’s all a bit woo-woo, after all, and many doctors like to think of themselves as cool, rational, objective and scientific.  In defense, some of the major advances in modern medicine are amazingly powerful: anti-biotic therapy and modern surgical practice, for example.  Perhaps doctors can be forgiven for being blinded by the successes in some areas of medicine and assume that this applies to all.

Another possible reason is simply that doctors don’t feel they have the time: a “holistic needs assessment” sounds as though it will take a long time to conduct; and who knows what intractable problems it might uncover.  Writing a prescription is the work of a moment while taking time to explain the benefits of a change of life-style is not.

Does it matter if doctors are not very holistic?

Yes.  Quite simply: Smuts had it right.  And deep down, all doctors know this.  People are not machines that can be taken to a workshop when broken and fixed (though some people seem to wish it was that simple).  Health and well-being are extremely complex concepts and require a whole system approach or you risk making things worse rather than better.

Dr Michael Leahy
Consultant Medical Oncologist
The Christie NHS Foundation Trust

What do you think about doctors and the concept of being holistic in their approach?  We'd love to hear your views.  Please comment below, or contact us at PlanBe@christie.nhs.uk 

Follow the project team on Twitter:

Dr Michael Leahy

Ben Heyworth

PlanBe: an introduction

PlanBe: a programme for people living with advanced stage cancer

The uncomfortable truth is that there is no simple fix for advanced stage cancer.  Unfortunately, no drug, no therapy, no treatment , can be relied on to magic away this condition in the vast majority of patients.  
Yes, there are one or two (rare) cancers and the tiny minority of patients with the common cancers who can be cured by chemotherapy.  For reasons we still do not understand, they do far better than we would predict, beating all the odds.  But it’s rare.

But that’s not to say that advanced stage cancer is not treatable - far from it.  All patients with advanced stage cancer can be treated - can be helped - with their condition.  And, as a cancer doctor, my daily job is making sure that my patients get the best possible treatment and help so that they can live longer and better with their cancer, even if it cannot be cured completely.

But it’s not a simple business: there is no quick trip to the repair shop and back to being as new again.  

The best outcomes come from a concerted effort on many fronts:  pharmacological, physical, psychological, behavioural, spiritual and social.

It may appear that my job, as a medical oncologist, is constrained to the pharmacological.  And it’s true that most of my day is taken up in overseeing the delivery of chemotherapy and engaging in research to improve it for the future.  But I don’t see myself as a chemotherapist - restricted to a single technology.  I am an oncologist, with training, experience, and understanding of a particular range of medical conditions, and I see my role as helping those patients who come to me with those conditions in whatever way I can.

Not all my colleagues would agree with this view.  Some would say that their job is to deliver the treatments that have been shown to be effective by clinical trials, and anything else is up to the patient – it’s not their business.  And it’s certainly the case that some patients need no encouragement to explore all the other options that exist outside hospital in their search to keep well.  In my experience, these patients often do generally better in various ways than those who simply take their medical therapy and look no further.

My view is that I do have a responsibility to look wider than the pharmacy and the operating theatre to help my patients.  My patients often ask me about what else they can do to help themselves and in focus groups they are clear that they expect the hospital to provide guidance and information.  I believe that we should help people with these choices and also to encourage those who have not thought about their own role in their wellbeing to see the benefits of self-management.

And that’s why we have come up with the PlanBe programme.  PlanBe provides patients with information, support and tools to help and encourage them adopt a range of other activities (in addition to any medical therapy given at the Hospital) and organise them into a day by day regimen to help them live better and longer with their cancer.

For some patients the choice facing them seems bleak – "it’s chemo or nothing" they say.  But this is a false dichotomy.  There is a third way, it’s called PlanBe.  PlanBe is not an alternative to “chemo”, it’s an alternative to “nothing”.

PlanBe is a framework divided into six domains: body; mind and spirit; diet and supplements; complementary therapy; resilience and empowerment; and medical therapy.  Patients are guided through choosing options under each of these headings and putting them together into a health and well-being programme to follow each day.

Dr Michael Leahy
Consultant Medical Oncolgist
The Christie NHS Foundation Trust

We'd love to hear your views.  Please comment below, or contact us at PlanBe@christie.nhs.uk 

Follow the project team on Twitter:

Dr Michael Leahy

Ben Heyworth