Tuesday, 8 July 2014

A skeptical approach to medicine

In my 'day job' I am an independent FCA regulated adviser on private medical insurance advising clients in the UK and around the world. I have worked in this field since 1994 and as you might guess do a lot of work with clients on involved and technical plans covering a range of scientifically proven medical interventions.

Or so you might think.

Away from this day job I am what is termed a 'skeptic' - someone who wants, nay demands to see evidence for any given claim whether it be medical, scientific, stories in the media and so forth.

Is it surprising therefore that many medical insurance plans include a range of benefits for which there is absolutely no evidence for their efficacy. In fact I would go further. They cover some interventions which are in potentia quite harmful - in so far as using them without considering more effective treatments could result in harm as medical problems are left untreated.

I am of course talking about what can be deemed 'Complimentary and Alternative Medicine or CAM's.

Here's some extracts from insurers literature on this area :

£1,000 combined overall limit for therapists (physiotherapist, osteopath and chiropractor), acupuncturists and homeopaths charges.


f you’re suffering from back or neck pain, food intolerances or other general ailments, your GP or specialist might refer you to a therapist. Therapies we cover include:


Physiotherapy, chiropractic, osteopathy
On specialist referral

These product literature extracts are from three of the largest UK private medical insurers and as you can see all three of them would cover between them :

Chiropratic treatment, Osteopathy, Acunpuncture and Homeopathy.

The problem is, these are clinically ineffective therapies that do nothing beyond acting as a placebo (incidentally, from an ethical standpoint real doctors are not really supposed to prescribe placebo treatments although many do).

Lets take these four modalities in turn and gently mock them.

1) Chiropratic

This method of manipulation of patients was in fact invented in 1895 by a gentleman called D D Palmer. 

Chiropractors are not doctors, they are not 'medically qualified' (unless they happen to be medical doctors or nurses or physios who have trained to be a chiropractor. The basis of this practice 'chiropractic subluxation' has no robust significant evidential support. There is also some evidence to show that there a significant, albeit rare risks associated with this modality that may lead you to think that the benefit:gain ratio simply isn't worth the risk - probably a good idea to check before you visit one.

2) Osteopathy

Kind of like Chiropractics poor cousin, osteopathy was invented in the USA in the 1870's.

It relies on the following principles :

  1. The body is a functional unit. An integrated unit of mind, body, and spirit ("Man is Triune" – A.T. Still[20])
  2. The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself
  3. Structure and function are reciprocally interrelated
  4. Rational therapy is based on consideration of the first three principles

Sounds really scientific doesn't it ?

According to the British School of Osteopathy you can train to become an osteopath in a  couple of years, oh and there's no evidence it works beyond placebo. Here's what the NHS website says about this modality :

When we use a treatment and feel better, this can sometimes happen because of a phenomenon called the placebo effect, and not because of the treatment itself. To find out more, watch avideo about the placebo effect.
This means, although many people treated by osteopaths report good results, it is not always clear how effective the treatment actually is for certain conditions.
3) Acunpunture

So Chi and meridians anyone ?

When someone shows me where my chi lives I might try acupuncture. Dozens of (largely) poorly conducted studies have tried to justify acupuncture over the years. The larger and more professional and rigourously conducted the trial the less the effect this CAM seems to have.

The problem is, there are dozens of different versions of this treatment, all claiming different meridian points and so on - here's what the NHS says :

However, for the majority of conditions for which acupuncture is used, the scientific evidence is inconclusive or there has been no attempt to collect good-quality evidence. For a small number of conditions, there is evidence that acupuncture does not work.
More research is needed into the effectiveness of acupuncture on a wide range of conditions.
The National Institute for Health and Care Excellence (NICE) say that acupuncture is an effective treatment for persistent lower back pain.

Incidentally, a luke-warm hot water bottle is also an effective treatment for lower back pain and it doesn't cost £ 40 an hour - who knew ?

4) The ultimate is non-scientific nonsense - Homeopathy

This was invented in 1796 by German : Samuel Hahnemann.

In essence Homeopathy says that a substance that causes a symptom can, when diluted to teeny tiny concentrations in water actually cure the problem. That's right - the poison when diluted will cure you. 

Depending on the dilution of the 'remedy' a homeopathic potion or pill could have not one single atom of the starting substance (a 12C dilution is only 60% likely to have one molecule left and any thing over this dilution level is just water) but that's ok because homeopathy uses a method of whacking the potion with a leather book called 'succussion' this enables the water to retain a memory of the original substance.

To get a feel for how homeopathy works and how utterly bonkers it is try this video :

Putting aside the fact that there is no possible scientific method for any of this rubbish to work - think about it .... there are actually NHS Homeopathic hospitals - in London and Bristol

So that's all right then - that's money well spent.

Lastly the Commons Science and Technology Committee reported in 2010 that homeopathy doesn't work beyond placebo - but the conservative government refused to act upon this report and ban this mumbo jumbo on the NHS.

For the full scoop on homeopathy can I suggest that you watch this 'documentary' :


So whilst most elements of a medical insurance plan are scientifically based, this one bit certainly isn't - I'd always recommend against using these kinds of modality but if you are considering them either via your PMI plan or (horror of horrors) paying for it yourself maybe do a bit of research about what it is that you're considering and then go and see a real doctor instead.


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