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Original post by Fibsy
I can imagine homeopaths rejoicing


The Nobel wasn't awarded for quack-science nor for traditional Chinese medicine: it was awarded to a scientist who managed to isolate an active pharmacological compound, which could then be researched and turned into a drug, based on a plant which had been colloquially used in TCM. This drug has gone on to save millions of lives and was game-changing in the battle against malaria.

Original post by Hydeman
To be perfectly honest, I consider alternative or complementary 'medicine' to be charlatanism of the worst kind. My gut instinct would be to deny it any funding, although I understand that that's not my decision to make. I'll probably need to provide an argument in favour as well if it comes up in an interview, which I'm hoping it won't.


Why do you think patients might prefer alternative/complementary medicine? Is A/CM offered on the NHS? What's the research base behind, say, acupuncture?
Reply 41
Original post by TheThiefOfBagdad
In light of this year's Nobel Prize winner (one of) for medicine, what are your opinions on traditional Chinese medicine? Should more research be put into all of the herbal remedies?


I think more focus should be on pharmaceutical drugs that show more potential, for example aspirin. There is a lack of funding and slow progress with regard to aspirin. It is long out of patent and most trials have been publicly funded, with pharmaceutical firms not being very interested. The vast majority of lab research is focused on cancer. However, aspirin has been shown to have great effects in areas like stroke, diabetes, heart attack, dementia and gastro-intestinal cancers.

In my view, public funding should go towards researching drugs like aspirin, but there should be nothing stopping private companies from investigating herbal remedies. If public funding was redirected from aspirin to homeopathy then I would be outraged.

:smile:
Original post by spacepirate-James
Why do you think patients might prefer alternative/complementary medicine? Is A/CM offered on the NHS? What's the research base behind, say, acupuncture?


As far as I know, the A/CM provision on the NHS is very limited and you're certainly likely to be put at the back of a very long queue of people who want these things done without paying for them.

I don't know of any research that has found conclusively that most A/CM actually works -- it seems to me that it works if the patient expects it to work (e.g. placebo effect). My mother, for instance, had some acupuncture done privately and it apparently relieved a lot of pain that wasn't helped by modern Western medicine.

Patients might prefer it because they've tried more conventional treatments and found that they haven't had the desired effect, because they've heard from others that a certain kind of A/CM works wonders or they have a doctor who, while being a scientist, swears that chiropractors are miracle workers as far as neck pain goes. Any number of reasons, really.
Original post by Hydeman
As far as I know, the A/CM provision on the NHS is very limited and you're certainly likely to be put at the back of a very long queue of people who want these things done without paying for them.

I don't know of any research that has found conclusively that most A/CM actually works -- it seems to me that it works if the patient expects it to work (e.g. placebo effect). My mother, for instance, had some acupuncture done privately and it apparently relieved a lot of pain that wasn't helped by modern Western medicine.

Patients might prefer it because they've tried more conventional treatments and found that they haven't had the desired effect, because they've heard from others that a certain kind of A/CM works wonders or they have a doctor who, while being a scientist, swears that chiropractors are miracle workers as far as neck pain goes. Any number of reasons, really.


I think what you said is key. Understanding the reasons why some patients and doctors might lean towards A/CM is important. I've known a few very 'scientific' GPs who are trained in acupuncture; equally we've all had personal experiences of family/friends who have benefited from A/CM. The point is to not shut this down from the outset but think about why people might be inclined towards A/CM, and what might that health service offer patients which they cannot find normally.

Then there's the whole ethics of whether we should be offering a placebo treatment, as well as the inevitable funding dilemma. On the whole there will always be that minority of patients who do benefit from A/CM, and sometimes it can improve their lives drastically. The research-base is as you said inconclusive: I think the research on acupuncture has shown it to be more mixed than other forms of A/CM however.
(edited 8 years ago)
Original post by spacepirate-James
I think what you said is key. Understanding the reasons why some patients and doctors might lean towards A/CM is important. I've known a few very 'scientific' GPs who are trained in acupuncture; equally we've all had personal experiences of family/friends who have benefited from A/CM. The point is to not shut this down from the outset but think about why people might be inclined towards A/CM, and what might that health service offer patients which they cannot find normally.

Then there's the whole ethics of whether we should be offering a placebo treatment, as well as the inevitable funding dilemma. On the whole there will always be that minority of patients who do benefit from A/CM, and sometimes it can improve their lives drastically. The research-base is as you said inconclusive: I think the research on acupuncture has shown it to be more mixed than other forms of A/CM however.


There's your interview script for if it comes up as a question. :lol:

Seriously though, that's some good arguing. :smile: I must just pinch a point or two for later use!
Reply 45
Acupuncture does have a physiological basis. I came across it when learning about pain on an online pharmacology course.
Our body naturally produces its own pain relieving chemicals called enkephalins. Inserting needles into the skin prompts the body to increase enkephalin levels, thus having a relaxing pain-relieving effect.
In addition to the pharmacological explanation, the placebo effect presumably also comes into play.

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(edited 8 years ago)
Original post by nexttime
When the tube drivers go on strike it costs us millions of pounds


Interestingly, the opposite...!!
http://www.cam.ac.uk/research/news/london-tube-strike-produced-net-economic-benefit
Original post by Clunkles
People are attracted to other careers because they can become true specialists, and can focus on doing one thing. GPs need to be integrated more into the health system, allowed to become specialists, and possibly given 3 day - 2 day contracts of hospital and primary work.
Most GPs really enjoy what they do, the reason we don't have enough is because we need more of them than any other doctor - allowing opportunity to properly specialise may entice more into the trade.


I suggest you never say that in an interview, especially if there is a GP on the panel!! GPs are rightly proud that they are one of the last vestiges of truly general medicine. Sending GPs into hospitals is pointless. They have a broad base of skills rather than niche stuff, and there's already a shortage of GPs in the community. Sending generalists in to hospitals which are already staffed with existing specialists makes no sense and leaves a huge gap. Their skills are in primary care and in being able to tackle the massive range of problems which make up the general - either to deal with them entirely or to know enough that you can send them on to the relevant specialist for that small part of medicine. That's what they're good at!

It's the "to be a proper doctor you must specialise" mentality that totally misses the point of GP and is rife in hospitals, which has led to the continual denigration of GP - not just by politicians who do a fantastic job of running them down 24/7/365 but also by hospital colleagues :| What about your specialism actually being that you know an awful lot about a whole range of things?

GP is its own skill set. It's just never advertised. Not that that's the main reason for people not doing GP - although incessant negative public image is definitely a factor.
Original post by Fibsy
I can imagine homeopaths rejoicing


I think you should be very careful about making the distinction between homeopathy vs complimentary and alternative medicines! The former contains active ingredients at such low concentrations, that they're practically pharmacologically inert, and thus inefficacious. The latter, however, do contain active ingredients at concentrations that are pharmacologically active, and the MHRA - the regulator of medicines and healthcare products in the UK - can, and does, issue licenses to herbal products, having been satisfied that they are safe and efficacious.

http://www.rpharms.com/pharmacy-practice-resource/homeopathic-and-herbal-products.asp
Original post by thegodofgod
I think you should be very careful about making the distinction between homeopathy vs complimentary and alternative medicines! The former contains active ingredients at such low concentrations, that they're practically pharmacologically inert, and thus inefficacious. The latter, however, do contain active ingredients at concentrations that are pharmacologically active, and the MHRA - the regulator of medicines and healthcare products in the UK - can, and does, issue licenses to herbal products, having been satisfied that they are safe and efficacious.

http://www.rpharms.com/pharmacy-practice-resource/homeopathic-and-herbal-products.asp


Fair point but just to clear something up about homeopathy -- most homeopathic medicines don't have anything in them. It's just water. The concentrations claimed are more or less impossible to achieve for the sort of people who sell these things (we're talking more dilute than a drop in the ocean). So yeah, homeopathic medicine is about as effective as drinking water to cure random illnesses. xD
Original post by Hydeman
Fair point but just to clear something up about homeopathy -- most homeopathic medicines don't have anything in them. It's just water. The concentrations claimed are more or less impossible to achieve for the sort of people who sell these things (we're talking more dilute than a drop in the ocean). So yeah, homeopathic medicine is about as effective as drinking water to cure random illnesses. xD


Haha so true :P, anyone who has read 'Bad Science by Ben Goldacre' will know just how ridiculous homeopathy is, their positive effects are entirely based on placebos. And the research they claim to prove its success are falsified or exaggerated because of the way they do the scientific 'research' invalidly.
Original post by Jibberjab123
Haha so true :P, anyone who has read 'Bad Science by Ben Goldacre' will know just how ridiculous homeopathy is, their positive effects are entirely based on placebos. And the research they claim to prove its success are falsified or exaggerated because of the way they do the scientific 'research' invalidly.


I haven't read it but I can guess. :lol: I've watched a documentary or two about it and done a bit of Internet research on it. I'll probably read up on it before going to any interview though.
(edited 8 years ago)
Original post by Hydeman
I haven't read it but I can guess. :lol: I've watched a documentary or two about it and done a bit of Internet research on it. I'll probably read up on before going to any interview though.


haha, yeah good idea it is a good book and pretty funny at times so I recommend it
Reply 53
Original post by Hydeman
Fair point but just to clear something up about homeopathy -- most homeopathic medicines don't have anything in them. It's just water. The concentrations claimed are more or less impossible to achieve for the sort of people who sell these things (we're talking more dilute than a drop in the ocean). So yeah, homeopathic medicine is about as effective as drinking water to cure random illnesses. xD


One of Richard Dawkins' documentaries has a very interesting section on homeopathy. It's hilarious how much he detests it. :tongue:

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Original post by Fibsy
One of Richard Dawkins' documentaries has a very interesting section on homeopathy. It's hilarious how much he detests it. :tongue:

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That's one of the ones I've watched. :lol: I almost mentioned it but I thought, 'they might think it's not a real documentary at all if I mention Richard Dawkins.' Oh well, that cat's out of the bag now. :smile:
Original post by Hydeman
Fair point but just to clear something up about homeopathy -- most homeopathic medicines don't have anything in them. It's just water. The concentrations claimed are more or less impossible to achieve for the sort of people who sell these things (we're talking more dilute than a drop in the ocean). So yeah, homeopathic medicine is about as effective as drinking water to cure random illnesses. xD


Yes, and that's exactly why I made the distinction between homeopathy vs complimentary / alternative medicines. :smile:
Original post by thegodofgod
... the MHRA - the regulator of medicines and healthcare products in the UK - can, and does, issue licenses to herbal products, having been satisfied that they are safe and efficacious.


Efficacious? What level of efficacy do they have to prove?
Original post by nexttime
Efficacious? What level of efficacy do they have to prove?


My bad - it isn't efficacy as such, but the fact that the herbal product in question has been used for a certain indication for a significant period of time (30 years), of which 15 years must have been within the EU.

A medicinal product must be of a good quality, safety and efficacy in order to gain a marketing authorisation (MA, licence) - herbal medicines don't tend to undergo rigorous clinical trials, so can't be proven to be efficacious, and so can't gain a MA. They can, however, be given a Traditional Herbal Registration (THR), if it meets the criteria mentioned above. All herbal products with a THR are listed on the MHRA website.

http://bhma.info/index.php/legislation-on-herbal-medicines/

http://www.pharmaceutical-journal.com/opinion/comment/what-you-need-to-know-about-herbal-products-in-light-of-legislative-changes/11073409.article (not sure whether you will be able to see this one)

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