Letter to the Editor

Dear Keith,

In your November 1987 issue, Dennis Dutton (page 3) asks whether it matters that sick people, especially cancer sufferers, are not discouraged from using "alternative" or "complementary" treatments, The answer of course is the one that he himself has given: it does and it doesn't.

If the treatment is harmless, the patient may nevertheless get an increase in well-being from the placebo effect. There is some evidence (though I do not know quite how strong) that the placebo effect is not a purely "psychological" effect but, at least in painful conditions, the release of endogenous pain relievers may be stimulated. It has also been suggested that the responsiveness of the immune system may be influenced by the state of mind of the patient. Neither of these suggestions should be particularly surprising if one accepts that psychological events in the final analysis have a physico-chemical basis.

If the work of the scientist in his pursuit of knowledge is to "make sure of truth" then he/she may object when others judge truth by lesser standards that his/her own. I would suggest that for one with knowledge to remain silent or to imply that departures from the truth as he perceives it do not matter is to allow more blurring of the distinction between "hard" and "soft" science or even, to' coin a word, between science and nonscience (to be pronounced almost like "nonsense").

However, it is remarkable how few people habitually think in a logical way, and of those that do, relatively few have even an elementary grasp of probability and statistics. I do not think it is condescending to recognise that a substantial proportion of the population rarely if ever thinks in a logical way and becomes puzzled or confused when simple non-sequiturs and post-hoc fallacies are pointed out. The easy way out, particularly when one is hard-pressed for time, is to say to oneself that as long as the patient suffers no direct harm, it does not really matter—except in the long run—and what busy doctor can be concerned with that?

Yours faithfully

Bill Morris.