Re: On the Couch column, Health Supplement, February 14th.
I am a retired doctor and find the weekly Health Supplement of much interest.
A sentence in the interview with Orla Hardiman, consultant neurologist, surprised me today. Rejecting alternative medicine, she declared: "If something works it should be possible to prove [ it]."
Now this simply just does not follow, for if something works it may well be that it will always be impossible to prove it.
I offer several examples: One alternative medicine idea is that to help to prevent breast cancer, women ought to not wear bras, especially tight ones and the more hours a day they wear them the greater the risk of breast cancer. Now how on earth are we going to investigate this?
In theory, one sets up a clinical trial over 10-20 years comparing one thousand women in their early 30s, who wear bras as usual and 1,000 matched women who do not. There is no way that this could be done.
Another idea is that to help prevent this disease, women should not eat dairy products - the hormone IGF1 is supposed to be a cancer-promoting factor. Again there is no way the similar necessary trial could be set up. The dairy industry would hardly finance it.
Dairy products are also blamed for promoting prostate cancer and again I do not think that a proper trial could ever be set up to run the 20 years needed.
If one sticks rigidly to the dogma of evidence-based medicine, then if patients ask one about avoiding the above factors to lessen their risk of getting the above diseases, one has to say regretfully that there is no "real" evidence that they are relevant.
Apart from these sorts of prevention, which form the bulk of "alternative medicine", there can also be controversial claims of various plant extracts, which can do all sorts of wonderful things, eg the most controversial of all, laetrile to help stop cancer growing.
It is not unreasonable that there could be such extracts, but there is no way that they can ever be proven to work. To set up clinical trials, which would be ethical and lead to clear answers, is just not possible.
So we will never be able to establish if laetrile usually has a beneficial effect, or only sometimes or never, because no properly conducted trial has ever been done and never will be done.
Even when the research can be organised and financed it can be a long time before a treatment becomes established by fully completed trials; these delays can make it difficult for doctors to treat a condition, even when there are already results making it likely that a treatment works.
Glaucoma is a very common disease and memantine is being assessed for its effectiveness in protecting the retina from damage. Until the trials are completed, which may take years, what should one do with a patient who wants something done now to help prevent further loss of vision?
Personally I would prescribe memantine now, but presumably Orla Hardiman could not.
Alistair McFarlane, Cambellstown, Letterkenny, Co Donegal.