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The reddest herring in town

When I argue that this or that unproven or disproven treatment (UDT) should not be used in routine healthcare, I regularly hear the following counter-argument.

When I argue that this or that unproven or disproven treatment (UDT) should not be used in routine healthcare, I regularly hear the following counter-argument.

Much of routine healthcare is not backed by good evidence either; it is therefore unreasonable to be extra fussy about the UDT in question.

It is disarmingly simple and superficially convincing. It also chimes with lay person's opinion and thus regularly wins the popular vote.

Here is a recent example from a letter in the Guardian showing how this reddest of all herrings is being sold to the unsuspecting public:

'The mistake made by Dr Harris and Professor Edzard Ernst is to assume that we have effective treatments for all conditions and all patients. We don't…..For some conditions, we have no effective treatment at all.'

Because the argument is so popular, it is worth analysing it in some detail.

The first thing to note is that the phraseology employed is always general, never specific. Its proponents will not claim 'because this or that specific treatment is not evidence-based, we might as well use our UDT'. Nor do they say 'because we have no effective treatment for this specific condition, we might as well use our UDT'.

Any level of specificity would be too risky – someone could actually know better and prove them wrong. It would be easy to show that there are, in fact, treatments that are more convincingly supported by evidence than the UDT in question. When your own argument does not hold water, it is obviously much safer to be as general as possible – otherwise you might be found out.

The second thing that is remarkable here is the logic behind the argument. Essentially it claims that, because one approach is not perfect, the alternative does not need to be either. Because many people die each year in car accidents, it is not so bad that some also die on the railways. Because China has an abominable human rights record, it is alright to torture a few people in Western prisons. This inversion of logic is, I think, obvious once you see through it.

The third point about our red herring is that it makes its opponents look incompetent, ill informed or even stupid. By telling us that conventional medicine is not always perfect, we are meant to look a bit silly. The typical lay person is bound to think: 'yes, of course, why did these so-called experts not think of that?' But the crucial point that often passes unnoticed is simple: nobody ever claimed that conventional medicine was anywhere near perfect.

My last point is perhaps the most crucial one. The red herring deliberately ignores an essential principle in healthcare. Because not everything is perfect in medicine (as we all know), healthcare professionals have a moral and ethical obligation to improve it. This duty is not served by saying 'if it's like this, we might as well use UDTs'.

What we must do, is improve our treatments in order to alleviate suffering. Advocating UDTs is no strategy to meaningfully improve healthcare – on the contrary, it is likely to have the opposite effect.

Edzard Ernst: The reddest herring in town Edzard Ernst: The reddest herring in town

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