Friday, March 9, 2012

First, Do no harm: Patient Safety and the central fallacy of the "Friends of Science in Medicine" position.

"First, Do no harm"... Or so the Hippocratic Oath is presumed to begin.

The Dwyer/Marron "Friends of Science in Medicine" campaign against the teaching, insurance/reimbursement-for and ultimately practice of Alternative Therapies and Medicines of which they, and they alone, do not approve, is based on a central fallacy:
People are much safer being treated by the Medical Establishment not using Alternative Therapies and Medicines, but exactly the reverse is true. 
The number of Patient Injuries and Fatalities from 'standard' Medical and Hospital care and treatment is more than 1,000-fold greater than Alternative Therapies and Treatments, even on the flimsy data we do have on Establishment Healthcare. Why isn't there good data on our $50B/year spend of Public Money? That's another story.
This debate is "all about Evidence", as in hard-data, but Patient Safety and Quality of Care must be examined first before any debate on Effectiveness can even be started.
The flip-side is the erroneous logic that "Good Science" is somehow causally linked to "Good Patient Care", but FoSiM ignore the Golden Rule of Execution: 
Science and Knowledge don't deliver outcomes, Practice does.
Before the Dwyer/Marron group can argue against any Therapy, Treatment or Medicine, by its own strict rules ("there must always be very strong Evidence"), it must:
Show us the Data! As complainants, the onus is on the Dwyer/Marron group to prove their case, not for everyone else to justify their existence to their satisfaction (which, being undefined, will never be forthcoming.)

Where is their Evidence, the "Good Science" they want from everyone else, to demand any changes? If the modalities they are so implacably and virulently opposed to are harmful, then there must be plenty of irrefutable Evidence, not mere anecdote or self-selected collections/surveys, to support their case. If there isn't already enough, the group should go and create some definitive studies, given their self-confidence it should be extremely easy to do so.  It should take them no time at all to collect and publish some statistically robust studies in a well recognised, peer-reviewed Journal.
The worst logical trick and intellectual swindle played by the Dwyer/Marron group is their conflation and confusion of terms:
  • A slew of unrelated practices are strung together in one long line of gibberish, with no distinction between recognised, well-controlled modalities and others, with all presumed to be 'equivalent'.
    If the Dwyer/Marron group cannot, or will not, distinguish between a piece of crud and a gem, what relevance or vracity do their arguments have? None whatsoever, they fail their own test of "Good Science", which requires correct, unassailable logic, not sensationalist tabloid anti-logic, innuendo and guilt-by-association.
  • In Australia, there is a trivial and essential differentiator between all Medical Therapies, Practices and Medicines:
    • Is there a AHPRA Registration Board? and hence
    • Do Practitioners have a Medicare Provider Number?

    The failure of the Dwyer/Marron group to make this simple and essential distinction invalidates all their arguments, because:
    • just who are they vociferously and ferociously objecting to?
    • The properly certified, regulated and trained Practitioners, approved and controlled by expert Government bodies, or
    • the unregulated, unregistered minority?
  • For the Dwyer/Marron group to disagree with Government Policy and Processes is their Democratic right.
    For them to not understand the way these decisions and processes are changed is via Lobbying and the Political process is both ludicrous and naive.
    The best outcome they can have by attacking Alternate Therapy and Medicine Practitioners is to create a media spectacle and feel righteous and self-satisfied with themselves.
    Without ever once having the possibility of effecting change, because they are lobbying the regulated, not the regulators - the only people in the system with the power to implement their desired changes are being ignored by the Dwyer/Marron group.
Whilst the Dwyer/Marron group and their FoSiM purport a wish "to foster Good Science in Medicine", their actions and statements belie a rabid bigotry, bias and prejudice.

Even in their Constitutions' statement of Object, they don't define or elaborate on their terms:
  • "Good Science" is a vague, ill-defind term. To quote Shakespeare's Macbeth:
    "it is a tale told by an idiot, full of sound and fury, signifying nothing".
  • There are "scientific methodologies" (hypotheses, test, result) and "(apparently) good or valid studies/experiments" with "strong evidence", but "Good Science" is at best a lay-person's term, not something any Professional in the field would use.
  • Likewise, "Medicine" is a broad church...
    There is no definition ever offered for FoSiM's frequently used acronym, "CAM", presumably "Complementary and Alternative Medicine". This has some mysterious meaning only known to the Inner Sanctum of the Dwyer/Marron group. I expect it falls in the category of "I know it when I see it", a throughly undisciplined, non-rigourous and unscientific methodology - because it is inexact, ill-defined and non-repeatable.
I like the Richard Dawkins definition: "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."

Where does that leave the Dwyer/Marron definition of "CAM"?
Invalid and irrelevant, like the rest of their bluster, assertion, dogma and prejudice parading as "the opinion of experts", because they can provide no test or Evidence to show, as Dawkins says, "what works and what doesn't".

The very real risk they face with their simplistic and naive thinking is that if they ever construct testable definitions, then a good deal of their own Establishment Medicine would be found wanting. Not an outcome most Medical Practitioners would embrace.

It comes down to this:
The Dwyer/Marron group have no documented process or methodology to define the Alternative Therapies and Medicines of which they, and they alone, do not approve. They have a loose, informal, self-referential definition: "Good Science, it's what we say it is".
They are self-appointed experts and judges, without credentials, special expertise or relevant experience, who are presuming to force their opinions, biases and prejudices upon the rest of us.
Whenever they cry "Show us The Evidence" or "That's not Good Science", all they are displaying is their own ignorance, ineptitude and biases.

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