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The nonsense of "evidence based medicine": Meet PieMan

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Its the 1st of May, and today in Corfu it’s been intermittently blustery and baking.

Alkmini busied herself making a traditional wreath, constructed from leaves and flowers, gathered as we wandered through the spring abundence of our garden and orchard.
Then it was back to work to complete a tedious task, trawling through revision of page-proofs for the 3rd edition of Fibromyalgia Syndrome(FMS): A practitioner’s Guide to Treatment, due out early next year.
Sasha’s back in Athens …. teaching, translating, painting, organising a conference …..so we wont have the joy of her company as we did last Mayday – see her last year’s effort above!

The essential procedure of proof-reading involves numerous simultaneous areas of focus – looking for typos; ensuring that captions to illustrations actually match the pictures they describe; being sure not to miss the cryptic “see page 000” messages, that require identifying what page 000 actually is in the manuscript, so that cross referencing takes the reader to the right page; marking carefully in the text where the publishers should place icons to inform the reader that an accompanying video clip is available to demonstrate the particular topic (for example autogenic training relaxation, or breathing rehabilitation, or a specific manual method of treatment)….. and so on and on, through the 400+ pages.
And then it was done….and ready for electronic transmission back to Edinburgh, chapter by chapter, via the wondrous technology, we now work with so casually.
Because of excessive pressure on the local network I avoid using email attachments and simply upload to the excellent “yousendit” website

One of the most important processes in revising a text such as this is to supply validation – as far as it exists – for the numerous therapeutic methods discussed. Of course, individual chapters authored by others (see below) require that this task falls to their attention as they produce their particular focus on this widespread condition.

  • What are the possible causes of FMS?
  • What methods have been shown to be useful in treating FMS?
  • The link between FMS and CFS; Manual methods of treating FMS
  • Differential diagnosis & the use of dry needling for FMS (Jan Dommerholt and Tamer S. Issa)
  • Integrated medicine and FMS
  • Hydrotherapy and FMS (Eric Blake)
  • Therapeutic Touch and FMS (Pat Winstead-Fry and Rebecca Good)
  • Acupuncture and FMS (Peter Baldry)
  • Microcurrent and FMS (Carolyn McMakin)
  • Cognitive Behavioural approaches to FMS (Paul Watson)
  • Metabolic rehabilitation (i.e. thyroid) and FMS (John C. Lowe)
  • Fibromyalgia and the endocannabinoid system (John M. McPartland)
  • ….and more

For those chapters that I am responsible for (those above with no author name) this task is fascinating.
Key words inserted into various data bases yield literally thousands of pieces of research, through which it is important to search for up-to-date information that might be useful to the reader of the book.
Meet Brian Kaplan’s Pieman
Thinking about this brought my mind to the current efforts of a colleague with whom I work as part of the New Medicine Group, when I am in London – Brian Kaplan MD.
Brian – a fellow ex-South African – is a fascinating practitioner – who employs, among other approaches, homeopathy and Provocative Therapy (a form of psychotherapy).
He’s brilliantly outspoken in his antipathy to the demands of mainstream medical science, who – he points out with gusto – have not looked at their own seriously deficient lack of evidence for many of the methods used regularly by GPs and specialists alike.
Look at the pieman chart above – and you’ll see that, based on evidence published by the British Medical Journal, current orthodox, mainstream, medicine can claim that there is ‘good evidence’ that roughly 13% of what it does is useful.
For the rest, the proportions of commonly used medical treatment, that is supported by good evidence, looks like this:

  • 23% is likely to be beneficial
  • 8% is a trade-off between benefits and harm
  • 6% is unlikely to be beneficial
  • 4% is likely to be ineffective or harmful
  • 46% is of “unknown effectiveness”

So, the next time you hear an ‘expert’ saying that alternative, complementary or integrated medicine has no foundation, and is based on little or no evidence – think hard about who is saying this, and why?
For my part, having spent many months trawling ‘the evidence’ in relation to FMS, I know with certainty that much can be done to help sufferers….I’ve seen, and reported the documentation!

So my Mayday rambling blog post has taken us from the making of wreaths in the garden in Corfu, to my revision blues, and the coming of pieman (via Brian Kaplan’s efforts)

I hope it’s been amusing, illuminating – and wish someone would comment as to which….

3 Comments

  1. Your Pieman blog (and the update on your classic FMS textbook) is both amusing AND illuminating and as always very welcome!

    Thanks for your work Dr. Chaitow!

    Scott Cuthbert, D.C.

  2. I’ll look for the book. Your other reads are a treat as they synthesize a lot of information (more IS better!!).
    Pie man is a truth that all too many practitioners avoid talking about. Or they design a study to prove their point. Only time will tell what treatments work!! In the meantime my mind is wide open!!

    Regards,
    Seth Burke, DPT

  3. I have just discovered your blog and it is a real goldmine of extremely useful information and thought provoking stuff. Also, I agree that something important is being lost in osteopathic education. I qualified in 2000 from the B.S.O. and i can’t help but think we were trained as superphysios rather than osteopaths. Anyway, thankyou so much for this resource.

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