Richard Seah / Guest Writer
Why is The Straits Times waging a vociferous campaign against alternative therapies for autism – and singling out biomedical treatment?
On its own, an ST article questioning alternative and complementary therapies is nothing unusual. But three articles within a space of 10 days does seem, to use a word from one of the articles, “bizarre”.
Moreover, two of those articles were written by the same journalist, Radha Basu, and both articles essentially said the same things. Is the ST so short of articles that it needs to repeat itself so soon? Even after another senior writer, Dr Andy Ho, has already affirmed several of the points initially raised?
At the same time, at least two letters to the ST Forum page commenting on those articles – one by me and one by my friend John Yeo, who is a biomedical practitioner with an MSc in Exercise and Nutrition (see below) – have been rejected for publication. Because, you know, “The Straits Times receives an average of 70 letters a day….”
If healthcare professionals who have been aggressively attacked are not given the right to respond, and present their case, who will be?
This “right of reply” is something that the PAP government makes a big issue about whenever it gets criticised by the foreign media. Yet our own media does not grant similar right of reply to our own citizens.
Something strange – bizarre – is going on. Let’s take a closer look at those articles.
____________
On 11 August, Radha Basu wrote an article titled Autism ‘cures’: helpful or harmful?
The article is peppered with emotive words. She describes chelation therapy as “bewildering” and quotes a US report that calls it “voodoo”.
[Editor’s note: Chelation - a method of removing certain heavy metals from the bloodstream, used esp. in treating lead or mercury poisoning.]
The article goes on to highlight “reports of at least one botched-up chelation-related death in the US.” All this makes it sound as if chelation is highly dangerous, when, in fact, the single case of death was not due to chelation. Rather, it was due to the procedure being “botched up”.
The pertinent background, omitted from the ST report, is that in this instance, the doctor had administered the drug via direct injection when it should have been given via a drip, slowly over two to three hours.
Moreover, the drug used in this case was EDTA, which is rarely used in biomedical treatment. The most commonly used drug is DMSA, which is an oral / transdermal drug approved by the US FDA for treating acute lead poisoning.
DMSA has also been found to be effective for treating mercury and other heavy metal poisoning. And since it has been scientifically proven that many autistic children have higher levels of mercury in the body, using DMSA to remove mercury from autistic children is not unjustified.
But by discussing DMSA and then mentioning a case of death (indirectly) involving EDTA, Ms Basu made it seem as if all chelation is dangerous. This is irresponsible reporting. It is fear-mongering.
Ms Basu further describes two other biomedical treatments – hyperbaric oxygen therapy (HBOT) and neurofeedback – as “bizarre”.
She fails to mention that HBOT has been medically used for decades and is offered by many hospitals around the world, including Tan Tock Seng Hospital and Singapore General Hospital. She also fails to mention that HBOT has been scientifically proven to be safe and effective for the treatment of various physical as well as neurological conditions.
Plus, she fails to mention that soft chamber HBOT (using mild pressure and without pure oxygen – the type used for autism treatment here) is approved by the FDA as a Class IIa medical device for home use in the US.
As for neurofeedback, it is but a modern, enhanced version of biofeedback. And biofeedback itself has been around since the 1950s and has also considerable scientific backing. In fact, biofeedback is endorsed by prestigious mainstream medical institutions including The Mayo Clinic.
It is indeed strange (bizarre) that Ms Basu should describe these two therapies as bizarre.
Throughout, Ms Basu asserts that the various alternative treatments for autism – including nutritional therapy, CFGF (casein free, gluten free) diet, HBOT, etc – are unscientific, ineffective and dangerous.
These assertions are simply NOT TRUE. A simple search on the medical database PubMed will throw up a good number of peer-reviewed and published scientific studies affirming both the safety and efficacy of the various treatments.
Ms Basu goes on to highlight the “high costs” of alternative treatment for autism, ignoring the fact that conventional autism therapy often costs even more money!
As for parents who said their children have benefited from alternative treatment, Ms Basu casts a strong doubt with her own comment, “For now, at least.”
Such a comment is utterly insensitive and offensive. If you were the mother interviewed, whose autistic child had shown improvements, how does it feel to have the journalist proclaim to over a million readers that the improvements are only “for now”?
__________
On August 16, ST followed up with a commentary by Dr Andy Ho, who is trained as a medical doctor, titled Autism: Desperately seeking a cure.
Except for calling alternative and biomedical practitioners “quacks”, Dr Ho was at least more factual and less emotive in his writing.
But he, too, resorts to scare mongering. For example, he cites the use of two drugs, Avandia and Actos, which he describes as “potentially deadly”. In reality, these drugs – in fact, drugs in general – are hardly ever used by alternative practitioners.
Dr Ho offers a simplistic – to the point of being unscientific – explanation as to why autistic kids sometimes get better after alternative treatment. He writes:
“Sometimes, fad therapies seem to work because autism, like many other disorders, displays a natural pattern: Symptoms get worse at times and diminish at others. When symptoms get really bad, parents hunt for magic cures; and when the symptoms abate naturally afterwards, the improvement is attributed to the new ‘cure’. Parents want to believe.”
Such an explanation totally ignores cases where symptoms had persisted for years and then subsided, or went away completely, following alternative treatment. It also ignores – and belittles – the scientific literature that supports the effectiveness of such treatments.
Dr Ho’s comment is that parents “want to believe”.
My comment is that doctors and other skeptics like him “don’t want to believe”.
_______
Finally, on August 20, the ST published a second article by Radha Basu titled Saving people from peddlers of false hope. As mentioned earlier, the article essentially makes the same points as her earlier article, except that it no longer specifically mentions biomedical treatment.
She ends of by calling for penalties against alternative practitioners who make “false claims”.
What about journalists who make equally false claims about treatments being unscientific and ineffective, without checking out the research that is readily available?
Shouldn’t they, too, be penalised?
The above article reflects the author’s personal views.
———-
About the author:
Richard Seah used to be journalist with Business Times 1980-89 and then self-published a newsletter on natural health, called The Good Life between 1989-96. He is now a free lance writer and web-builder and he work closely with several alternative / complementary health practitioners, including Mr John Yeo, nutritionist of The Authism Recovery Centre – hence his interest in and familiarity with the subject of autism treatment.
About John Yeo
John Yeo is a nutritionist, biomedical practitioner and parent of an autistic teenage daughter.
———–
Thank you everyone thus far for contributing to what is, and I am sure most of you will agree, a very interesting thread.
My name is Darren and I am a doctor. This is just in case ‘angry doc’ has any issue and gets too angry with me being anonymous, just like you did on August 30th, 2008 4.11am. In fact, what pushed me to contribute to the thread was chiefly because of ‘angry doc’’s reply to ‘Just a mom of 2’ that day.
I believe it is clear there are 2 camps right now, and neither appears to be giving in. In my humble effort, I wish to bring the 2 camps just a little bit closer together. I will call the two camps ‘Doc’s’ and ‘Everyday people’. I will attempt to synthesize the current situation and perhaps, the best way forward.
Doc’s: Having been taught evidence-based medicine for what it seems to be our whole life, it is difficult for us to accept any drug or treatment without the so-called scientific methodology which included but not limited to the pre-clinical trials and the clinical trials (Phase I-IV). At this point, I will like to remind everyone that these methods are mainly to make sure that drugs are safe. Even if the drugs perform marginally better, even in optimal conditions (ie Phase III), as long as they are safe, there usually get approval and have patent rights. Which means patients sometimes pay for a so-called ‘better’ with no better response. Doctors will say that ,”Well, there are other cheaper drugs in the market, so why don’t you try those? There produce the same response. Maybe just a higher risk of diarrhoea.”. Honestly ‘Doc’s’, if the patient was your next-of-kin, and you have the financial capability, will you offer this option to them? I guess not.
Everyday people: And perhaps this is where sometimes we find ourselves trapped. I use ‘we’ because I was a patient. Again, you can be cynical and think that I am cooking this story up, like I said I think it is much better if we come together than to remain apart. Even if ‘Just a mom of 2’ is a fake (and I doubt it), can any of the doctors claim that her story is impossible and that it only happens in fairy tales? ‘First, do no harm. Perhaps ‘Doc’s’ do the most harm by actually dashing away any glimmer of hope. As long as we are not recommending treatment with harm is there any harm?
CAM is something that is coming on us whether ‘Doc’s’ like it or not. Most, if not all, public hospitals have a TCM unit in them now. Rather than adopting a ‘holier-than-thou’ attitude, ‘Doc’s’ should treat the patient and not do a ‘do this because I know best’. Ed wrote, “Just because something has been around for a long time does not mean that it is tried and tested”. I agree. However I also believe that just because something has been around for a long time, it should be respected. Unless Ed, you suggest that only ‘Doc’s’ are people with brains and the rest of us are fools? Surely not!
The goal is the same. Better health for all. The methods are different. And therein lies the problem. ‘Doc’s’ are running the 100m dash while the ‘Everyday people’ are running the marathon. (If the analogy is poor, I apologize). But essentially that is the problem. However, things are changing. Go to PubMed search engine and search for ‘complementary alternative medicine’ and you will see many hits. But almost none for ‘complementary alternative medicine phase III’.
I have no problem with anonymity, Darren, since you are stating a position based on facts and arguments and not an anecdote.
My assessment of the central issue here however differs from yours.
The issue here is more basic than that of FDA approval or phase I – IV trials – it is about what the best way to know if and to what degree a particular intervention improves a certain condition.
Let’s look at ‘mom of 2s’ account again. Her children suffered from a condition that “impedes their growth and they are delayed where the usual milestones are concerned”. They underwent “Biomedical Science, TCM, CST and GFCF” and now they are “healthy and alive, and high functioning”.
While that may be all that matters to ‘mom of 2′, I think there are other questions we should ask.
- Which of the modalities of treatment contributed to the improvement observed? How much of the improvement can be attributed to each of the modalities?
- How much improvement is due to the treatment, and how much is due to natural progression? (After all, the condition is supposed to *delay* milestones.)
- Are the improvements, in fact, due to the various treatment, and not just the natural history of the condition?
How do we know, at the end of the day, whether and what to offer to children with the same condition as ‘mon of 2s’ children?
You and I both know that the best way to answer those questions is through a properly designed study that includes the following features:
0. A plausible physiological basis for the treatment being tested.
1. A large enough study group.
2. A treatment arm (or arms) and a credible-placebo arm.
3. Proper randomisation into each arm, with a large enough population in each arm.
4. Adequate blinding of the subjects and researchers.
5. Low drop-out rate.
6. Proper collection and analysis of the data.
(The reason why I numbered the first feature 0 is because I think it can be waived if casual observation suggests a high probability of efficacy – if efficacy is proven the physiological basis of the mechanism can be worked out later. Others may disagree.)
I think you will agree, Darren, that this is a fair way to assess a ‘conventional’ mode of treatment. The question then is why are we willing to waive that for CAM and accept anecdotes as proof of efficacy instead?
Why, if the proponents of CAM are so sure of the efficacy of their modality of treatment for conditions which conventional medicine has no answer to, if they are so sure of their safety, if they are so supportive of research into CAM, and if they are (as mentioned by Energetic Believer) making good money out of CAM, are there so few high quality studies on CAM that show evidence of efficacy?
Do the PubMed search, Darren, and look at the studies. Look at the studies from the high Impact Factor journals and not the dedicated CAM ones with known publication bias (search PubMed on the subject of publication bias in CAM journals while you are at it too, in fact). Look at how many of them fulfill the criteria I laid out above. Count how many there are, and see what they say about the efficacy of CAM for the variety of conditions which their practitioners claim they are good for.
Now tell me: am I doing more harm by ‘dashing hopes’, and are CAM practitioners doing more harm by giving false hopes?
I agree with your classification of people into ‘Docs’ and ‘Everyday’. However, a person doesn’t have to be a doctor or scientist to be a ‘doc’; ‘Everyday people’ can also learn to look at issues with a critical mind if they are willing to question the way we take things from granted. That is the main reason why people like myself, Leng Hiong and Ed blog.
Finally, as one doctor to another, I would like to say this to you, Darren: you do not have the luxury of being an ‘Everyday person’. As a doctor, your role is that of an advocate for your patients. Your duty is to advise them on what their options are and to give them sound advice on what the efficacy, risks, and benefits of each are, based on the best evidence available. It is not playing peacemaker and trying to “bring the 2 camps just a little bit closer together” with no regard for facts and evidence.
Thank you for your clarification AngryDoc.
I’d just like to deal with this thing that Darren quoted me on:
“However I also believe that just because something has been around for a long time, it should be respected. Unless Ed, you suggest that only ‘Doc’s’ are people with brains and the rest of us are fools? Surely not!”
For what reason, Darren, do you base your respect on? Shouldn’t respect be earned and not just be a function of time? We respect the elderly because of their accumulated wisdom and respect other people because of the things they have done and the roles they have played. In what way does archaic methodologies with no proven efficacy earn our respect? Do you respect the idea of the sun revolving around the earth just because it is old?
As what Angrydoc has said, the main motivation of Clearthought bloggers and many other like-minded skeptic blogs, we are here to encourage people to think critically and objectively. Anybody can learn to assess evidence and to come to a logical, well informed decision. In this case, our vociferious opposition to this article stems from our desire to help in public education on such matters.
I would also like to reinterate Angrydoc’s point that a doctor’s role is to provide the best evidence of efficacy and safety to his/her patients and not to play the role of being the “middle-man” between two opposing sides. A responsible physician should give sound, clinical advice based on the best clinical evidence supported by good science, as Angrydoc has detailed above. It is frightening to believe that a physician should choose to do otherwise.
Hi Darren, thank you for your insightfut sharing. You are definitely a “compassionate” doctor I would be comfortable taking my children to.
I really do not know why there is all this “fighting” (or online debate) over this topic. If something works for you, be it anecdotal whatever, it works, period. It doesn’t work for someone else, there could be so many reasons why. Sorry, I am not schooled in all this cheem things so I don’t see it at such a “high level” as the opponents to CAM.
It is interesting for me to read all these comments anyway!
Alternative medicine works and don’t work at times. Allopathic medicine works and don’t work at times. These are real facts. Only an idiot would insist otherwise. Dismissing either is clearly demonstrative of a closed mind.
Reality is all that matters to those who benefitted from either or both treatments. Don’t need a government or FDA or HSA sanction to prove otherwise.
Btw, are there scientific and clinical evidence to prove that GOD or any other Deities exist? I hate to have innocent happy good people pray to ducks. Quack! Perhaps, to protect the ignorant, all places of worship must bear an ISO certification to prove something is there for worship before being allowed to open, unless of course all donations is patented and goes directly into the coffers of ..ahem…u know who.
Anyone who is reading this, and especially the owner of this blog, should check out the plugin that lets you automatically link text for affiliate links and SEO purposes. The plugin does a bunch more too. It can cloak links and set links so that they are either followed or not follow by search engines and stuff like that. I mostly just use it for automatically linking keywords to my affiliate links. It beats the heck out of manually creating affiliate links. By interlinking your deeper pages, this tool can really help to boost your search engine ranking for interior pages of your website or blog. Once you give this thing a try, you will certainly want to use it on any new or existing blogs that you own. Professional bloggers use this tool quite a bit but even the casual blogger will find it very useful. Check it Out -> http://adf.ly/1WHxH