Time for an update on the Science and Art of Medicine – Living Medical Traditions exhibit in the Science Museum, London!
If you’re not familiar with the backstory, do check out these posts or listen to my report in the Pod Delusion live 2nd birthday episode – go, make some tea and a sandwich while it’s on or something :D
Briefly, we’ve been trying to improve the Science Museum’s alternative medicine exhibit as there were some serious problems with it. It largely came across as promoting alternative treatments, even advertising practitioners and generally being worryingly uncritical, with no reference to the results of reliable studies (i.e. that most of the ‘treatments’ are no better than placebo and many carry serious risks) – and indeed no mention of the wonderous placebo effect at all.
We are extremely glad that the Science Museum has chosen to listen to these complaints and do something about them. To take a second look at something (that people have worked hard on and are likely proud of) with an objective eye, receive criticisms, consider them and make some changes – that is admirable, it’s scientific and what we might expect from such a great institution.
I think in summary, some very important changes have been made, which is excellent. But more could (and should) be done as it’s still far from the resource it could be (I’ll come back to this at the end*).
Last year the museum proposed some changes, based on discussions with Simon Singh and the rest of us. They decided the main sections to focus on were homeopathy and acupuncture – while I agree these were the ‘main offenders’, the whole gallery exudes quite a credulous vibe, but I am completely accepting that a total overhaul would take a lot of time and money so let’s look at these two sections for now.
From the correspondence:
As you know, we are already proposing to make some changes, on the advice of trustees, to make it quite clear that we are describing specifically the Indian context. In general, as far as I can see, you share the sense of what changes out to be made. You have nonetheless expressed two concerns that we should like to address. We will therefore follow your suggestion and add a parenthetical observation:
Homeopaths believe that ‘like cures like’. This means that homeopathic practitioners will give a remedy – often highly diluted (to the point that a bioscientist would say it contains no active substance at all) – that produces the same symptoms as the illness.
I presume the focus is on India because of the resources available for the exhibit. I’m not sure why otherwise, given that homeopathy was invented in Germany and is used worldwide, to varying degrees of disaster (I’m not exaggerating – keep an eye out for Martin Robbins’ experiences of homeopaths in Africa for more in that vein).
The other strange thing here, for me, is bioscientist. What does that mean? Also, chemists, physicists and mathematicians all agree that the very idea of homeopathy is ridiculous and scientifically meaningless.
The homeopathic travel kit was proposed to be removed entirely but as you can see only the caption has gone – so now people just don’t know what it is. I suppose it would be odd if it were just an empty space? Some text has been removed from the panel and now simply describes the image of a woman preparing her ‘homeopathic treatments’ at a ‘baby clinic’ – which makes me sad in itself.
They have also, as Alex suggested, changed their wording – all cases of doctor have now been replaced with practitioner. This is a good thing.
From the correspondence:
You have also raised the issue of acupuncture. Taking on board all the advice we have been given we cannot agree with David Conquhoun‘s suggestion that the advice of NICE should simply be dismissed. NICE set the national standard estabilishing whether a “clinical treatment [or set of clnical procedures] is considered highly effective, cost effective and safe, as well as being viewed as a positive experience by patients.” Whilst there may be good reasons for overturning their conclusion about the efficacy of acupuncture this process has to be achieved by debate in the public arena, and that has not yet happened.
Obviously I, and no doubt David, would dispute this, but I’ll just leave that there and move on.
The old board:
Painkillers alone just weren’t helping Stephen’s knee pain caused be osteoarthritis, so his general practitioner [GP] recommended acupuncture. Here’s his story.
Stephen is a retired clinical psychologist, but still enjoys walking and travel. His knee pain was severely restricting his day-to-day activity and he was considering a joint replacement. But he was anxious to avoid surgery of that kind because of concerns about complications and the variable success of the procedure.
His doctor recommended acupuncture – this is offered by his NHS GP surgery and administered by biomedically trained medical and nurse acupuncturists.
Fine needles were inserted into acupuncture points around Stephen’s knee and areas of local tenderness and left in place for up to 15 minutes. Each treatment led to greater and more prolonged relief of Stephen’s symptoms.
After four weekly treatments at first, Stephen now comes to the acupuncture clinic every 6-8 weeks for a ‘top-up’ which keeps his symptoms under control. Aside from reducing pain and the need for painkillers, the acupuncture has allowed Stephen greater mobility, which itself is important in managing the symptoms of osteoarthritis. As a result Stephen thinks his quality of life has improved.
The last sentence no longer says ‘…his quality of life has improved enormously‘. Finally, a new caption underneath:
Acupuncture has been rigorously tested by medical researchers for a variety of ailments. These tests have shown that acupuncture can relieve pain and this is why it is available as a treatment on the NHS. The NHS summarised its current judgement in a review published in 2010 on the internet at:
So osteoarthritis of the knee is cited as a condition for which positive evidence exists. Rheumatoid arthritis, on the other hand, has been shown to be unaffected by acupuncture treatments. What’s important to note is the qualification on this page:
this evidence does not allow us to draw definite conclusions…More research is needed to investigate whether acupuncture works for these conditions.
So I’m still not sure the exhibit expresses the weakness of the current evidence – but at least there’s a link.
Most pictures have been removed, as have captions suggesting GPs endorsed the treatment as effective. For some reason the (presumably fictitious) patient’s name has been changed from Ian to Stephen and he’s now suffering from osteoarthritis in the knee instead of shoulder/neck pain, presumably due to a quick read of the above link.
Mention of Stephen being a retired clinical psychologist is interesting. To me this would suggest an attempt to legitimise his choice of acupuncture as he was involved in medicine himself. Appeal to authority?
Finally, another change that was accepted to be important was the wording that greets visitors on the first explanatory panel. The new is on the left (bit small, sorry) and the old on the right.
Thankfully, the following statement was added:
Contemporary research shows that many of the practices are, from a scientific point of view, ineffective.
And an important clarification has been made:
even today 40% of the population of China use Traditional Chinese Medicine clinics as their first (and often only) choice for healthcare.
Whereas before it was simply an argumentum ad populum – that loads of people use it, ergo it must work/be acceptable (bottom of the right-hand photo).
Other changes made & suggested
Most importantly, the awful interactive video display has been removed completely.
What is disappointing is that some of the things I would consider to be quite dangerous are still there. For example, this description of the herbal product Masturin, about which I can find no actual research, but oft-repeated claims of this nature:
Uterotonic, specific for female disorders. Prepared from herbal ingredients like Saraca indica, Withania somnifera, Abroma augusta, Berberis aristata, Rauwolfia serpentina and iron acting solely on female reproductive system.
- Uterine tonic
- very effective in P.I.D.
- Relieves pain in Dysmenorrhoea
A herbal uterine tonic it tones up the nerves and ensures pain free and regular periods. Made from herbs
It worries me that this product is on display along with the claim that Joshanda ‘treats colds and flu’ – it’s this kind of uncritical exposure I take issue with. I know the anthropologists want to claim it’s about looking at culture but I really think you can do that in a safer, more informative way.
Also I was disappointed to see no changes to ‘Professor’ Shi Zaixiang’s board, relating to the claim that he was diagnosing and treating Ménière‘s disease. Also the acupuncture model at the start has not been adjusted so that it no longer claims ‘point BL-60 can be used to treat headaches‘.
*I’m not saying that it should all be a total bloodbath (which is what many ‘skeptics’ might want) but it should reflect what the research has shown – more obviously and comprehensively. It should explore negative sides to these traditions (and more recent inventions) – for example, as my friend pointed out, the devastating impact of TCM on wildlife, making many species endangered and even extinct. Also, ideally (and for me most importantly), tieing in the placebo effect with modern medicine and how the discovery and development of the randomised controlled clinical trial has revolutionised healthcare.
The main thing that drives otherwise rational and caring people to submit themselves and others to quackery when they are vulnerable is ignorance – not of the wilful kind, but most people just don’t know how medicine works. Juxtaposition of
alternative ineffective treatment modalities with confirmed effective medicine is the perfect teaching tool.
I’m not trying to be patronising. I am frequently upset by hearing of parents dragging terminally ill children around the globe chasing false hopes and subjecting them to invasive, pointless treatments that often cost them their life savings and cause the child a lot of pain when they could be doing fun things and enjoying what life they have with their loved ones.
What’s a shame is that available expertise hasn’t been utilised. I find this puzzling:
The suggestion that we consult Edzard Ernst is of course a valuable one. However there seems to be little disagreement about the facts (beyond the discussion in which we turn to NICE as an authority). Instead the issue which has been very helpfully brought out in these debates is whether the exhibit can be misconstrued.
I would say that consulting an expert in alternative medicine in constructing an exhibit about alternative medicine would be useful in tackling clarity and factual issues alike.
If anything can be done to make the general public more aware of what they can and can’t trust, medicine-wise, I’m for it. I think this gallery could play a part in that – but at the moment it isn’t. To be noted is that they are planning a ‘radical overhaul’ of medicine in the museum generally so more input from funders and visitors would no doubt be useful.
To finish, there’s this hilarious comment in the TCM section:
You don’t have to be ill to need treatment
Well that just sums up alt med perfectly, doesn’t it!! (Also, lifestyle is important in medicine and wellbeing full-stop. Any doctor worth their salt will tell you that, and we hear it all the time; medicine IS holistic. Why do people think otherwise?!)