Very, very strange, this. I could not access the article at home the other day but I'm at work this morning and was able to access it with no problem (I was also at work when I first read it last week). Perhaps somehow I was "allowed" because I work inside a hospital, but I'm in the US not NZ, so I don't see how that matters. In any case, it's more of a commentary/opinion piece than a true article. Here's the text of it:
Latest Issues of New Zealand Doctor Newspaper
15 August 2012
A frothy public scrap
Viewpoint David Galler
"What can be asserted without evidence can be dismissed without evidence."
You might remember this brouhaha?
A couple of years ago there was intense media coverage claiming that high-dose intravenous vitamin C was responsible for saving the life of a critically ill intensive care patient with swine flu.
As a result of this, with the active encouragement of the "vitamin C lobby", families of patients critically ill with swine flu began to demand the same treatment for all patients in the same position, with the expectation of the same result, a "miraculous cure".
Intensive care specialists disputed the claim being made in this particular case and reacted strongly to the broader claims being made on websites and in the media by this group about the universal healing power of this vitamin when given in high dose.
They did this through media statements by their college and the Australia and NZ Intensive Care Society.
Grant Gillett, the Dunedin-based ethicist, once a neuro-surgeon and "an august personage" to boot, published a piece in the New Zealand Medical Journal and in the Otago Daily Times.
In this, he chastised the hard-hearted doctors for not allowing these patients, facing almost certain death, the opportunity to try this alternative treatment, especially in the face of what he described as some evidence the intervention might be helpful and little evidence that it is harmful.
This was turning into an unusual, heated and public scrap.
Recently, in preparation for a panel discussion at a meeting of the Australasian Association of Bioethics and Health Law, I had the opportunity to reflect on all the hype and furore that surrounded that case.
The panel consisted of Allan Smith, the patient whose life was "miraculously saved", his family's lawyer from Wellington law firm Chen Palmer, me, and an ethicist from the University of Auckland.
My approach was to reflect on these questions:
• What went so wrong in the case of Allan Smith?
• Why did this become so heated and inflamed?
• How might this kind of disagreement be better managed in the future?
On the day, the room was full and you could sense the anticipation about the upcoming discussion. I think the conference convenor was hoping for a good scrap, a fight, a stoush and a stand-off.
For my part, it was good to meet Allan and his family. I have the greatest admiration for them. Crawling back from the kind of illness he had is no mean feat. It's a long and tough journey.
Many people never make it back to the level of function they had beforehand and some remain tormented by fear and memories from the time when they were so ill.
The same occurs for many family members who are deeply traumatised by the ongoing uncertainty about whether their loved ones will survive and everything else that they have been through.
That said, two years on, Allan Smith looked terrific and I told him so. He, of course, still takes vitamin C.
The relationships that we build with patients and families are incredibly important for all of us, as well as for the credibility of our profession and our ability to maintain the trust of the public we serve. Those relationships of trust can never be taken for granted.
They need to be recognised and continually enhanced by being true to the principles of honesty and transparency in an ongoing dialogue with the public.
On reflection, what played out two years ago was a gladiatorial clash of different belief systems. What was needed was mutual reconciliation and recognition of the very different worldviews at play. To have done that in this case, at that time, would have required a set of social skills not present on either side of the line.
For our part, we doctors are a narrowly socialised lot, perhaps more so than most professional groups apart from Catholic priests!
We are not used to being challenged in the way we were then and certainly could have managed that situation better. It's the scientific method that underpins what we believe: a "belief system" based on measurement and evidence; a discipline that has brought us great rewards by way of lives saved, diseases cured and eradicated, and thousands of conditions that once would have been fatal, but now better managed, allow people to lead normal productive lives.
For lay people, not schooled in the same way, different belief systems operate, including, what you see is what you get.
Humans are inherently magical thinkers, so what is truth to one group is not so to another. Positions held are not necessarily based on any kind of rational thought and not always amenable to a rational argument.
Magical thinking, hope against hope, belief in the unbelievable; are natural and optimistic survival mechanisms. We all will do it some time or another. This is very human thinking and we should not deny an individual the right to do that nor discount the possibility that this can be very helpful in a variety of ways.
There would be few more schooled in the scientific method than the late, great, Sir Paul Callaghan; yet, when facing the prospect of imminent death from advanced bowel cancer, he tried high dose intravenous vitamin C, although he acknowledged the lack of any kind of meaningful evidence for its efficacy and that he would not recommend it being used universally.
He talks about this in an interview available on podcast on the Radio NZ website, it makes good listening.
Reconciliation of disputes, such as this, are not helped by a media with no interest in presenting a balanced and better-informed view.
It would have been helpful if Dr Gillett had chosen to address what was at the heart of this public dispute, for it was not about whether an individual patient and a desperate family should have access to an alternative treatment, the real issue at the heart of this dispute for the intensivists was the wild claims being made by the vitamin C lobby about its efficacy in curing all manner of conditions.
Traditional medicine should not pretend to have a monopoly on the truth - in reality, the more we know, the less we understand - we need to manage the knowledge we have with more modesty and be more honest about those things we understand and the things we don't.
What will the clinicians of the 22nd century think of the treatments we are offering today? I suspect not much.
Maybe the public's "faith" in alternative treatments says as much about our own failings and a lack of dialogue than it does about their true belief in the efficacy of the treatments themselves.
But, as we work to resolve this, let us not exploit the vulnerable by making categorical and, I think, deceitful claims for the efficacy of high-dose intravenous vitamin C. More humility from all of us might be the best way to resolve disputes like this.
David Galler is an intensive care specialist at Middlemore Hospital.