Sleuth21

Quotes

• Have faith and pursue the unknown end. Oliver Wendell Holmes, 1924
• [A]us so krummen Holze, als woraus der Mensch gemacht ist, kann nichts ganz Gerades gezimmert werden. Immanuel Kant, 1784
• Out of timber so crooked as that from which man is made nothing entirely straight can be built. Translated, dodgily so, by Isaiah Berlin, 1990. My translator wife will provide a better one in due course. [RW]
• These things aren't done in a day, you know. Reinhard Wentz, 2012, referring to his wife's 'upcoming' proper translation of the E Kant quote above
• When I play with my cat, how do I know that she is not playing with me rather than I with her?. Michel de Montaigne,?year

Science and Homeopathy (Paraphrased from de Botton, 2012)

‘Attempting to prove that homeopathy has no evidence-base can be an entertaining activity for scientists and professional sceptics. Tough-minded critics of homeopathy have found much pleasure in laying bare the idiocy of believers in remorseless detail, finishing only when they felt they had shown up their enemies as thorough-going simpletons or maniacs.

Though this exercise has its satisfactions, the real issue is not whether homeopathic remedies work or not, but where to take the argument once one decides that they evidently don’t. The premise here is that it must be possible to remain a committed sceptic and nevertheless find the principles underpinning homeopathy sporadically useful, interesting and satisfying – and be curious as to the possibility of importing certain of the homeopathic ideas into the realm of medical reality.’

Ever so slightly rephrased from Religion for Atheists by Alain de Botton, London, Hamilton, 2012. p11-12.

Note

A note concerning my involvement in the WP:Homeopathy article and discussion:

Family lore has it that my great-great-grandfather worked with Hahnemann. Both my grandfather and his youngest daughter where trained in what was than the great tradition of German regular and humane medicine. In extremis (literally) they both used homeopathic remedies. ‘We do not understand how they work, but they seem to help our patients’. I am old enough to remember when my grandfather (he died in 1952) tried to explain that paradox (which should find some expression in the WP:homeopathy article) in non-scientific terms. Actually, it already is in its historical section. I still have my aunt’s copy of Alexander Beydeman’s painting Homeopathy Staring At The Horrors Of Allopathy (ca. 1857). It is shown in the WP current article

1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the perceived brutality of medicine of the 19th century

My Homeopathic Trajectory

Trajectory of my involvement in Homeopathy and some related subjects in Wikipedia and elsewhere

[year in bold: document in full, or its URL, below]

1983 Letter to THE TIMES, London, gently ridiculing the attempt of homoeopaths to justify their trade. Caption: Body and Mind.

1984 Comment in the NEJM, praising the letter to THE TIMES ‘the best contribution to the debate’ (Why Homeopathy appears to work)

1997 Advisor on several parts of the Prof. Trish Greenhalgh’s series of papers in the BMJ ’How to read a paper…’ which are now listed on the Wikipedia WP:MEDRS site.

2001 Rapid Response to the BMJ 'Restoring the soul of regular medicine'

2001 Presentation during National Sciene Week (UK): Huggin' and Kissin' - Aspects of Information Transfer in Science and Medicine. The Perils of Publishing

2002 Letter in The Lancet ’Futon Bias’

2005 Based on the letter, WP editor Piotrus creates WP article FUTON Bias

2005 I left Imperial College's Library Service!! Free at last! Celebratory lunchtime lecture by Prof. Trish Greenhalgh Narrative based medicine - the evidence: The patient's story - Narrative based medicine in an evidence based world.

2006 NPOV rider added to Futon Bias article by WP:editor Kragen

2006 Dispute flag removed by WP:editor Cberlet with the comment ‘Irony is so delicious. FUTON biased research used to refute concept of FUTON bias. Removing dispute flag’ Thank you Cberlet

2007 With Vipul Sharma: ‘Using Wikipedia’ (for medical students).

2007 ‘Using Wikipedia’ praised as ‘a great handout to help introduce users to Wikipedia as a potential resource. The handout includes links for additional readings on background and issues such as bias, currency, reliability, and plagiarism […] I thought it was excellent and was very pleased when Reinhard agreed to have it posted here. I like that it succinctly covers all the most important points and issues in only two digestible pages.’ on David Rothman's website.

2007 ‘Using Wikipedia’ Visible at UC Anschutz Medical Campus, University of Denver

2010 With Kate Boody [recte: Kate Boddy] ‘Finding the Evidence’ Pragmatic Information Retrieval in the Context of Evidence-based Healthcare Peninsula College of Medicine & Dentistry, Exeter. ppt slide presentation, 48 slides, no sound.

2011 Letter to the BMJ (Rapid Response, not peer-reviewed, definitely not WP:RS, in support of a Personal View’ The NHS is right to fund homoeopathy) under the title ‘Rational Homeopathy?’

2011 Substance of BMJ Rapid Response mentioned in WP:Homeopathy comment page...

The trajectory ends:

2012 10 January 18:40, precisely: Realization that my involvement in WP:Homeopathy, both article and comments, is utterly pointless. Will just work a bit more on my Sleuth21 user page article:

2012 End of January: Draft of re-designed Homeopathy article (mainly Lead) to be completed!

29.01.2012: New Lede added. Will last until 3p.m. GMT at best? Permalink saved as souvenir. Memories are made of this..

1983 Letter to THE TIMES:

Body and Mind

From Mr Reinhard Wentz

Sir, Mr Haviland in his letter (September 14) is wrong in suggesting that “the application of the scientific method to the above questions (how these therapies are believed to work) could only produce little more than nonsense”. The scientific method is based upon structured scepticism and common sense and can very well be applied to claims of effectiveness of alternative methods of treatment by Mr Haviland and others.

It is merely common sense to make the following observations:

1. Many ailments are self limiting and self-curing within a few weeks or months, broadly speaking similar to the time it takes some sufferers to give up hope in traditional medicine. After seeing the alternative healer they better, ascribe this event to his/her intervention while it is in fact only a result of the natural course of the disease.

2. Many healers have a sensible fatherly /motherly (authoritarian?) way of dealing with sufferers, an approach frowned upon were it to be adopted by an NHS doctor. However, this attitude seems to benefit many patients and help their recovery. The healer, in fact, acts as the drug (or rather the placebo), not his particular brand of therapy.

Unless healers can eliminate these and other factors from being the essence of their therapeutic power, I will take my broken leg, my sciatica, my diabetes and eventually my senility to my general practitioner. My depression and my marital problems I take for a walk through the local park. Faithfully yours, REINHARD WENTZ 17.12.1983

1984 Comment in the NEJM by Dr John Lister, praising the letter to THE TIMES

[...] A medical librarian expressed the situation well.10 He pointed out that many ailments are self-limiting and self-curing within a few weeks or months — a period similar to the time it takes for sufferers to give up hope in traditional medicine. After seeing the alternative healer, they get well and may attribute this to the intervention, although it is in fact only a result of the natural course of the disease. However, many healers have a sensible if authoritarian way of dealing with sufferers, which seems to benefit the sufferers even though the activities of the healers have no more than a placebo effect. But unless the healers can eliminate these factors from being the essence of their therapeutic powers, patients will continue to take broken legs, sciatica, diabetes, and eventual senility to their family doctors — depression and marital problems will be taken for a walk in the park. [...]

[Unfortunately, the reference to my letter in THE TIMES (ref. 10 above) was wrong. Reading the NEJM only, nobody could have found the letter, cite it, and push up my H Index value. It still lingers around 10, the same as its reference number in the NEJM. How eerie is that!]

2001 Rapid Response to the BMJ: Restoring the soul of regular medicine

Editor,

It is a great pity that Peter Morrell [n.b.: not unknown as a contributor to the comment pages of WP:Homeopathy] insists on contaminating the discussion on alternative healing systems by suggesting a conflict between it and regular medicine. Such a conflict need not exist.

Regular medicine is anchored in science and factuality, alternative healing methods are part of cultural constructs and belief systems and provide meaning and morality, but cannot be pitched against regular, scientific medicine. It could be argued that homeopathy, ayurveda, traditional Chinese medicine and other healing systems have a higher degree of truth, that they may offer more sustainable remedies for wounds of the heart or of the soul (provided the patients and the healer share the same value system) but their tenets are not generalisable and are not anchored in science. The two areas of experience do not overlap in the external world*, but are integrated only in the heart and mind of the individual doctor and patient.

The growth of alternative 'medicine' in developed countries can be partly explained by the fact that any sufferer choosing alternative therapies knows that the proven remedies of regular medicine remain available to them if something 'goes wrong' or 'does not work'. This is particularly true in the UK, where access to regular medicine is free.

As a mere thought, not a practical suggestion: should users of alternative healing methods in this country be told that by so choosing they exclude themselves from access to regular medicine?

Yours sincerely, Reinhard Wentz

• Gould,SJ: Rocks of ages. Science and religion in the fulness of life. London: 2001, passim

2001 Presentation during National Science Week (UK): Huggin' and Kissin' - Aspects of Information Transfer in Science and Medicine. The Perils of Publishing

Advert in C&W Hospital (London) Newsletter: Huggin’ and Kissin - Uses and Abuses of Citation Analysis and Impact Factors. Unusual citation patterns in science and medicine and associated morbidity (Citopathology). Macaque monkeys, Gaia, memory of water, alternative medicine, Avogadro’s Constant, Erdös and Garfield Numbers, cold fusion, and the Editor’s Parrot. 'Cancer is a funny thing' (J.B.S Haldane). British Researchers’ Modesty Factors compared with their US and German counterparts. With passing reference to Citopathology and the Research Assessment Exercise. CT and ST in attendance.

2002 Letter to THE LANCET (FUTON BIAS)

Reinhard Wentz

Sir, The availability of full-text articles on the internet has greatly improved ease of access to medical information. This development must be seen as a great benefit, but it may have generated a new type of bias.

Everyday information-seeking activities, especially by junior staff and students, often concentrate on research published in journals that are available as full text on the internet, and ignore relevant studies that are not available in full text, thus introducing an element of bias into their search result.

This bias I propose to call FUTON (Full Text On the Net) bias. It will not affect researchers who are used to comprehensive searches of published medical studies, but it does affect staff and students with limited experience in doing searches. This bias may have the same effect in daily clinical practice as publication bias1 or language bias2 when doing systematic reviews of published studies.

I also believe that the FUTON bias will affect the standing of medical journals, since full-text journals on the internet are more visible and may be cited more frequently in the future than the traditional print journals. Publishers of medical journals should feel encouraged to make the content of their journals available as full text to avoid losing out to their competitors. This trend will gain further strength if the journals that make preprints available on the internet or publish internet-only versions of reports are taken into account. [...]

2007 ‘Using Wikipedia’ (for medical students) URL:

http://hslibrary.ucdenver.edu/handouts/class-handouts/wikipedia.pdf

2010 Exeter ‘Finding the Evidence’

URL:http://www.slideshare.net/RWentz/cfakepathexeter-ppt-ppt-new

2011 Rapid Response to the BMJ:

2011: Rational Homeopathy?

There are perfectly rational, EBM-based arguments in favour of allowing NHS physicians to use (specifically) homeopathic 'remedies'. One only has to consider the following scenario:

A 65-year old patient, with well controlled diabetes type 2, learns during her annual medication review that her blood pressure is close to normal, her weight down, her cholesterol level near-normal. The physician suggests, after complimenting her on her success in coping with her diabetes: 'Perhaps we should consider discontinuing two or three drugs(of a total of seven you get) - you obviously have improved your lifestyle and diet, and exercise regularly now. What do you think?'

Patient: 'That's a good idea, especially as one of the drugs you mention always makes me feel dizzy. But I would be concerned about my blood pressure going up again and my risk of a stroke increasing.'

Physician: 'I think you have improved your lifestyle so well that we really should think of reducing your medication. That will be quite safe in my opinion.'

Patient: 'I just remember, a friend of mine got a homeopathic remedy to control her blood pressure and anxiety. I know it's probably just a placebo, but should we try that? '

Physician: 'Interesting that you say that. I don't normally mention it, but I also believe that some of my patients may benefit from homeopathic remedies. They are probably, as you say, just placebos, but if we can safely stop some drugs with worrying side effects which you don't need anymore why not try replacing them with those Hahnemann tinctures?'[There are more elements to the conversation]

The patient discontinues two of the seven drugs.

• No deception is involved: both patient and physician accept that they may just be dealing with a placebo effect

• The placebo effect will be stronger as both patient and physician believe it may be present

• It may be reinforced by the Hawthorne effect (Physician: 'I may write this up and use our experience for the benefit of other patient - you'll be, if you agree, part of an experiment)

• Proper medical care is not delayed while taken mere 'placebos': the scenario takes place in an NHS doctor's surgery

• Costs to the NHS are reduced

• It's more likely that the patient stays off unnecessary drugs.

Homeopathy is part of the rich medico-cultural tradition in Europe. It's safe and (in this scenario) its use is evidence-based. Why stop it in the NHS? Why smash a butterfly on the unfeeling wheels of legislation? Why drive patients into the arms of quacks?

Reinhard Wentz, Dipl, Bibl. Twickenham, England