Archiv

Archiv für die Kategorie ‘Interview’

Wieviel Medizin ist evidenzbasiert?

26. September 2011 9 Kommentare

Vor einigen Wochen stolperten wir im GEO-Magazin über die Behauptung, dass nur 40 % der medizinischen Behandlungen evidenzbasiert seien. Da der Artikel viele Fehler enthielt (wir haben über die Mängel gebloggt) und keine echte Quelle angegeben war (abgesehen von der Behauptung, dass es sich um ein Zitat eines früheren Präsidenten der Bundesärztekammer handle), waren wir geneigt, die Aussage ohne weitere Betrachtung zu verwerfen.

Aber dann dachten wir über die Frage nach und begannen zu suchen. Wir fanden ein offizielles Dokument zu Evidenzbasierter Medizin und eine der Evidenzbasierten Medizin gewidmete Webseite des British Medical Journal, die beide diese Behauptung stützen.

Clinical Evidence

Klinische Evidenz für Medizin

Die BMJ-Seite enthält ein nettes Diagramm, das zeigt, dass die Wirksamkeit von 51 % der medizinischen Behandlungen unbekannt ist. 51 %. Weitere 15 % sind schädlich oder zumindest wahrscheinlich ineffektiv. Wir waren verblüfft. Nach diesen Zahlen wäre Medizin (etwa 40 % erwiesene Wirksamkeit) gar nicht soviel besser als Alternativmedizin (etwa 0 % erwiesene Wirksamkeit).

 

 

Ein Anteil von 51 % bei medizinischen Behandlungen mit unbekannter Wirksamkeit? Wow. Perplex fragten wir Professor Edzard Ernst:

Sie kennen vermutlich die folgende Seite:
http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

Die Übersicht ist ja nicht gerade berauschend. Was ist Ihre Meinung dazu?
Ist es nicht unfair auf alternative Methoden herunter zu blicken, wenn es noch solche Lücken in der Medizin gibt?

  • Erstens: Zum Teil beruht die niedrige Prozentzahl der Behandlungen mit bewiesener Wirksamkeit darauf, dass in dieser Übersicht auch die Alternativmedizin enthalten ist.
  • Zweitens enthält die Einschätzung alle medizinischen Behandlungen, auch solche, die nur selten angewendet werden. Betrachtet man die Prozente für effektive Behandlungen, die täglich angewendet werden, kommt man auf einen Wert von etwa 80 %.
  • Drittens ist der Prozess Wissenschaft auf Medizin anzuwenden noch relativ jung – wir betrachten da einen Vorgang, der noch lange nicht abgeschlossen ist.
  • Viertens, wenn ein Bereich nicht optimal ist, so ist das keine Rechtfertigung für einen anderen, noch schlechter zu sein.

Alternativmedizin ist in den Zahlen inkludiert? Na dann, das erklärt einiges.

“By definition”, I begin
“Alternative Medicine”, I continue
“Has either not been proved to work,
Or been proved not to work.
You know what they call “alternative medicine”
That’s been proved to work?
Medicine.”

(Storm von Tim Minchin)

Edzard Ernst and the Half-Quack Prince

4. September 2011 Keine Kommentare

When we contacted Edzard Ernst about the disgraceful interview in the Telegraph, we were presented with the opportunity to do a full interview. It was very interesting and a bit alarming…

As you may know, Edzard Ernst is the first Professor of Complementary Medicine, and more or less retired, two years prior to the official age of retirement. To understand the reasons for his early retirement and some of our questions, we need to look back a few years:

Edzard Ernst became professor for Complementary Medicine in 1993 and has built quite a reputation as a man of science and as a researcher. But in 2005, things took a rather strange turn. Economist Christopher Smallwood, personally commissioned by Prince Charles, claimed a lot of money could be saved applying CAM treatments. Unfortunately, this position was not supported by evidence. Not in the least! Edzard Ernst called it “complete, misleading rubbish.”. To cut a long story short, Prince Charles’ private secretary complained about Edzard Ernst who became “persona non grata” at his university.

Mr Ernst had been promised further funding, but all fundraising died down at that time. (This is actually quite an obvious development, since most CAM institutions apparently do not want real science to have a look at their methods) He had been promised the university would match initial funding of his unit, but this did not materialize. The unit was not able to keep all employees. He was informed the unit would be entirely dismantled after his retirement.

And so he negotiated. The deal: Immediate retirement and getting re-hired part-time for a year to help find a successor. The unit was not to be shut down.

Professor Edzard Ernst officially retired in May. We did not like that kind of horse-trade, but if Professor Ernst is fine with it, it is fine with us, too. The world is complicated, and so be it. The only part of the bargain we truly liked was that Professor Ernst may choose his successor. Well, at least this is what we assumed when we started asking…

But let’s get started with the interview:
Professor Ernst, when you started examining these methods scientifically, did you expect to meet such massive opposition or did that come as a surprise?
Lots of things were very surprising to me: that alternative medicine practitioners in the UK are often anti-scientific untrained non-medics, that so many of our results turned out to be negative, that there was so much public interest in my work, that alternative medicine enjoys royal protection in Britain etc, etc. The fact that I soon came under increasingly bitter criticism from the enthusiasts was, of course, a result of all this.

Most “alternative professors” practice Cargo-Cult-Science. Why does critical approach seem to be so unusual?
Yes, most if not all of my colleagues use science as a drunken man uses a lamppost – for support and not for illumination. I have come to the conclusion that this is due to them being primarily advocates of alternative medicine and true scientific scrutiny comes at a far remote second or third place.

In which way could this be improved?
One would need to make sure that critical scientists are appointed, for instance, by looking closely what any candidate has previously published. If it is mostly poor science or promotional pseudo-science, the person should be disqualified.

Do you agree with the way your results are being communicated?
I am often misquoted from both sides of the divide. The Telegraph article, for instance, claimed that I am against all alternative medicine. This is not true; I am against all ineffective or unsafe treatments, and that is very different.

You are compelled to a state of “retirement” now, as a result of the éclat with “Prince Charles”. (Smallwood report)
Was there any reaction by the Prince (or someone from his environment) after you called him a ‘snake-oil salesman’?

I offered to go in order to save the unit. My med school is now looking for a successor. Previously I was told that they will close the unit on my retirement. When I called Charles “snake oil salesman” there was no reaction from him or his entourage at all. I did not expect a reaction.

So, you are looking for a successor; do you believe he will have an easier life? Or do you think Prince Charles and his ilk will also try to throw a spanner in his works?
It depends what he/she will do. It would be easy to have it easy in that position; either one does very little or one does only stuff that upsets no one [such as surveys] or one does some basic research that is not so relevant to the public or one avoids all publicity – there are many ways.

The reaction of Charles and other enthusiasts of bogus medicine will depend on the work of my successor and the public image it receives.

Are there promising candidates for the position yet?
I have not yet heard of any.

How much freedom do you have in choosing a candidate? Can you choose/decide freely?
Sadly, I was only involved in drafting the job description. Everything else is out of my hands. I offered my further assistance but the offer was so far not accepted.

ERRM. Half a second. Wait.
What the …??? We understood the deal Professor Ernst made to save his unit, but so far we were under the impression that he will choose his successor!

We winced and mourned the loss when Professor Ernst retired (even when, in an interview, he said he was over the moon with that solution; that he feels exhausted, feels the scars from the many battles). We felt the loss. And now once more, we feel very strongly about the issue at hand!

Dear University of Exeter, to whomever it may concern, do not forget you (probably) have the only real chair of alternative medicine in the entire world (the entire world!), the only position respected by the scientific community and not just by quacks and royal half-quacks. Please, pretty please, do not gamble with your reputation.

Professor Ernst, can the public assist you in any way? Is it possible for us ordinary citizens to help your unit in any way to continue work same as before the éclat?
Public support will be a crucial element whenever controversies arise. I had lots of it – despite all the flack.

This answer is too diplomatic for our liking!

We know there are lots of supporters of Mr Ernst and his fantastic work out there, fighting an eternal battle against the overwhelming degree of lunacy in the world; therefore we would like to encourage all of you to join this fight, too. You may think it is premature, the university of Exeter should be given a chance. Certainly, but once they have taken a decision, it will be too late. We have to take a stance now and proactively defend this chair.

Let’s tell the university that we, the public, will not accept a quack or mediocre scientist in that position. While he/she will not be able to fill the gap, he/she has to be a true scientist! We will accept nothing less!

Edzard Ernst versus poor journalism in The Telegraph

29. August 2011 Keine Kommentare

Bitte beachten, dieser Artikel existiert auch auf Deutsch: https://blog.psiram.com/?p=3908

During these last few weeks, we blogged a lot about poor journalism in German publications, as e.g. „Die Welt“ and in „GEO“.

When we noticed a recent interview in the „Telegraph“ with Edzard Ernst, we were enthused, since we are huge fans of Mr Ernst.

We are certain most of our readers have already heard about Edzard Ernst, and probably read „Trick or Treatment“, a book on alternative medicine he wrote together with Simon Singh. Despite his being known here already, we would like to give our readers a short introduction;

 

Mr Ernst is the first Professor of Complementary Medicine in the world at the University of Exeter, England. He is the world’s leading expert on alternative medicine and a stalwart defender of scientific methodology. His position is probably best expressed in his own words (from an interview with Mr Ernst and Simon Singh):

For us, there is no such thing as alternative medicine. There is either medicine that is effective or not, medicine that is safe or not. So-called alternative therapies need to be assessed and then classified as good medicines or bogus medicines. Hopefully, in the future, the good medicines will be embraced within conventional medicine and the bogus medicines will be abandoned.

 

His work has earned him a lot of respect by scientists all over the world.

Back to the topic at hand. The article published in the Telegraph turned out to be – errrm, well. Let’s put it like this, it had a particular touch. We had expected something different, something more sound, with more style.
Taken aback, we decided to ask Professor Ernst about the article:

What annoyed you most about the „Telegraph“ article?

In my view, the most irritating thing was the attitude of the journalist. She seemed to belittle science and promote non-science. This is what one might expect from a cheap women’s magazine but not from the most-read UK broadsheet.

Well, we cannot agree more, the article sounded very condescending to us. The journalist’s attitude is probably most aptly described with „So what, I couldn’t care less“.

Unfortunately, the worst is yet to come. We asked Professor Ernst about the quality of the article and possible mistakes. He was so kind as to provide a few examples:

There were too many factual mistakes and inaccuracies to mention. For instance, there is no such thing as „recuperative medicine“. I told her that I had the chair of rehabilitation medicine in Vienna. Similarly, I never said that at the peak my unit was doing 20 research projects; I told her that once we were 20 researchers. At that stage, we ran many more than 20 projects and even now we conduct about 20. These may look like trivialities but they are, in fact, the result of poor journalism.

Well, our German readers probably agree this is nowhere near what GEO or Die Welt published, but it is bad enough. Shouldn’t a journalist strive to get the facts straight? We are not certain which is worse: The blatant mistakes easily detected in our German newspapers or the negligent, lackadaisical mistakes in the Telegraph?

Edzard Ernst und der dürftige Journalismus im Telegraph

29. August 2011 1 Kommentar


Please note: This article also has an English version: https://blog.psiram.com/?p=3902

In den letzten Wochen haben wir viel über dürftigen Journalismus in deutschen Magazinen und Zeitungen, wie „Die Welt“ und „GEO“ gebloggt.
Als wir vor einigen Tagen ein neues Interview im „The Telegraph“ mit Edzard Ernst bemerkten, waren wir begeistert.

Vermutlich kennen die meisten unserer Leser Herrn Ernst; einige haben wahrscheinlich “Gesund ohne Pillen – was kann die Alternativmedizin?”, ein Buch über Alternativmedizin, das er zusammen mit Simon Singh schrieb, gelesen. Trotzdem möchten wir ihn kurz vorstellen:

Edzard Ernst ist der erste Professor für Alternativmedizin der Welt und lehrt an der Universität von Exeter, England. Er ist weltweit der führende Experte für Alternativmedizin und ein unerschütterlicher Verteidiger der wissenschaftlichen Methodik. Seine Position drückt er wohl am besten selbst aus (Auszug aus einem Interview mit ihm und Simon Singh):

For us, there is no such thing as alternative medicine. There is either medicine that is effective or not, medicine that is safe or not. So-called alternative therapies need to be assessed and then classified as good medicines or bogus medicines. Hopefully, in the future, the good medicines will be embraced within conventional medicine and the bogus medicines will be abandoned.

 

 

Seine Arbeit hat ihm den Respekt von Wissenschaftlern auf der ganzen Welt eingetragen.

Nun, zurück zum aktuellen Thema. Der Artikel im Telegraph erwies sich als, äh also, nun ja. Sagen wir mal, er hatte einen besonderen Touch. Wir hatten etwas anderes erwartet, etwas Solideres, mit mehr Stil.

Verblüfft entschieden wir uns, Professor Ernst über den Artikel zu befragen.
Was hat Sie am meisten am Artikel gestört?

Meiner Ansicht nach war das Ärgerlichste die Einstellung der Journalistin. Sie schien Wissenschaft herabzusetzen und Unwissenschaftlichkeit anzupreisen. Das mag man vielleicht von einer billigen Frauenzeitschrift erwarten, aber nicht vom meistgelesenen Blatt Großbritanniens.

Wir könnten nicht mehr zustimmen, auch uns erschien der Artikel sehr herablassend. Die Einstellung der Journalistin ist offenbar treffend klassifiziert mit: „Was auch immer, interessiert mich nicht sehr“.
Aber das ist noch nicht das Schlimmste. Wir fragten Professor Ernst noch nach der Qualität des Artikels und nach potentiellen Fehlern. Er war so freundlich, uns ein paar Beispiele zu nennen:

Es waren zu viele faktische Fehler und Ungenauigkeiten, um sie aufzuzählen. Zum Beispiel existiert eine „recuperative medicine“ („stärkende Medizin“) nicht. Ich teilte ihr mit, dass ich den Lehrstuhl für Physikalische Medizin und Rehabilitation in Wien innehatte. Ebenso habe ich nie gesagt, dass meine Einheit zu Spitzenzeiten 20 Forschungsprojekte durchführte; ich erwähnte, dass wir früher 20 Forscher waren. Zu diesem Zeitpunkt betrieben wir weit mehr als 20 Projekte und selbst jetzt führen wir etwa 20 durch. Dies mag nach Trivialitäten aussehen, sind aber tatsächlich die Ergebnisse von mangelhaftem Journalismus.

Unsere deutschen Leser werden uns vermutlich zustimmen, das kommt dem, was GEO und Die Welt abgedruckt haben, nicht nahe, aber es ist schlimm genug. Sollte ein Journalist nicht danach streben, die Fakten korrekt darzustellen? Wir sind uns nicht sicher, was schlimmer ist: Die groben Fehler (die man leicht sieht) in unseren deutschen Magazinen oder die schlampigen, gleichgültigen Fehler im Telegraph?

Interview mit einem Vampir

24. März 2009 5 Kommentare

Nein, ein Vampir ist er dann doch nicht, unser Sysop. Aber weil in letzter Zeit viel Quatsch über Esowatch geschrieben wird, gibt er uns heute mal ein Interview.

Mehr…