Where might this take up in future? To a world where the full range of "remedies" that are subsidised by the public dollar have to pass the same tests of effectiveness.

By that standard, Sue, a whole range of pharmaceutical solutions would surely not qualify.

For example: where is the independent evidence to support that nicotine replacement therapies, subsidised by the federal government, stop smoking and prevent recidivism?

Is this what we might come to expect here?
http://ethicalnag.org/2012/04/23/practice-variation/

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000216

http://ethicalnag.org/2010/07/23/quit-smoking-cold-turkey/

BHSc in Acupuncture is oxymoronic.

Ian Ashman.
You'd want me on your side if this happened to you or someone in your family:
http://margihealing.wordpress.com/2009/05/20/medical-negligence-and-the-meaning-of-life/

Margaret Macdonald - if my mother had a subarachnoid harmorrhage, I would not be seeking an acupuncturist.

When elderly women who have fallen and are "not quite right" present to your clinic unexpected, and without appointment, what is your approach to their investigation and management?

Dr Ieraci
you've missed the point entirely, which does worry me - but no longer surprises me - as it was medical staff in an ED who missed the point entirely when my Mum was admitted by ambulance to that ED within minutes of her original 'face plant' into the footpath.

The many significant failures which occurred in that ED have subsequently been investigated and acknowledged by Dr Chris May, director of Emergency Medicine at that particular hospital. Why not give him a call? He'll remember Mum and her case. He's subsequently invited her back to his ED on a couple of occasions to 'educate' his staff, and invited Mum to be the opening speaker at a subsequent Emergency Medicine conference.

My mother was discharged from that ED a couple of hours after original presentation with a significant head injury and an UNDIAGOSED sub-arachnoid haemorrhage. The ED staff there discharged her into my care with the brusque advice "if you have the neurosurgical nursing experience you say you have, you won't mind getting up during the night to do some head injury obs, will you?"

When I had my mother reviewed as a matter of urgency by her GP the next day - I didn't trust that any other ED would manage her any differently than the first ED - it took me half an hour to persuade him that there was something terribly wrong with Mum. At that stage, nobody had bothered to CT scan Mum's head /brain/neck. I was concerned she had a sub-dural haematoma, and told him so. He was markedly reluctant to send her for any investigations and under some duress from me, apologised to the private radiology practice for ordering a CT scan so late in the day.

Every singly failure to diagnose and failure to treat which Mum endured was due to medical negligence. We placed our faith in one ED, one general practice, and one major public hospital, And we did it in a timely manner, every step of the way encountering DOCTORS who refused to go back to basics and take a proper collateral history or to listen to the patient's family.

If someone ever - unexpectedly - brought a relative to my acupuncture practice with a history of a fall and being 'not quite right' I would do what I did for my Mum: expect a bunch of ED docs and GPs and a tertiary hospital to do the right thing, to do it promptly, and to do it correctly.

Sadly, after our family's experience, once I'd called the ambulance for this hypothetical elderly lady and seen that she was safely in the care of the ambos, the next thing I'd do would be drop to my knees and pray. Why?
Because hospitals can be dangerous places, and there is nobody more dangerous than a doctor who has gotten it wrong.

Ms Macdonald - I have not missed the point at all. I have never tried to argue that trained doctors are correct in their diagnosis 100% of the time. I am trying to outline the difference between the parctice conditions of emergency medicine doctors - who learn from their errors (as you ahve outlined) and battle working conditions that would be unacceptable in any other profession.

So, aksed what you would do in this situation, you defer again to orthodox medicine. "expect a bunch of ED docs and GPs and a tertiary hospital to do the right thing, to do it promptly, and to do it correctly."

That's my point exactly. Do you also place the same expectations on yourself as a therapist?

And another point in this discussion - pointing out individual errors within the public health system does not add any credibility to non-science-based therapies.

"Mainstream doctors certainly do not provide patients with a sense of well-being."

Can you support that statement, Suriya Vij?

Therapies such as homeopathy have not been shown to relieve symptoms beyond placebo - and expensive placebos they are too. I sipport withdrawal of my tax dollars from these "remedies".

As Ian says in his article:

"...you just have to pay for them yourself without getting an insurance rebate from the government..."

Anyone who likes to pay for unproven and possibly harmful quackery is still welcome to do so - hopefully without my taxes subsidising their fantasy.

Simon Porteous - are you aware of a medical system that does not treat diabetes with dietary management? This is the mainstay of blood sugar stabilisation - though not all patients can do it successfully.

As far as "heart disease" goes, it depends what type of heart disease you mean. Only certain types of coronary disease are amendable to modification of lipid intake - and all this research is conducted within the orthodox community. Other forms of heart disease have nothing to do with diet.

Could you name the "obstetric procedures" that you feel are performed "with no regard for the evidence" (are you up on obstetric evidence?)

Perhaps we should limit the practice chiropractic to low backpain - where there is evidence of roughly equivalent effect to other mainstream therapies.

Oh - and what is the evidence for mammography? (Was that meant to be a rhetorical question, or do you really not know?) On the basis of large series of data, age recommendations have been moved to to 50 years from 40. From this 2009 paper: http://www.ejcancer.info/article/S0959-8049(09)00221-4/abstract
"How effective are breast cancer screening programmes by mammography? Review of the current evidence":

"Randomised controlled trials showed that breast cancer screening by mammography reduces breast cancer mortality in women over age 50 by 25–30%."

Hi Sue,

For diabetes good medical care does include dietary management. I would suggest that good dietary management is rare.

Even Diabetes Australia admit that "...over time most people with type 2 diabetes will also need tablets and many will also need insulin. It is important to note that this is just the natural progression of the condition..."

Dr Neal Barnards research has demonstrated that diabetes type 2 can be reversed with a low fat, low glycaemic plant based diet, and the diet is well accepted by patients.

This has been my experience aswell.

For heart disease, angioplasty is used to treat the symptoms of angina, how effective is it? What are the 5 year follow up results like? How does it compare to Dr Caldwell Esselstyns work on reversing heart disease with a low fat plant based diet? (The answer is angioplasty is expensive and has poor long term outcomes)

As far as inappropriate obstetric procedures - have you seen the caesarian section rates in our hospitals? They are horrific. Now if a woman want to have an elective caesarian for her own reasons thats not for me to argue with but should tax payers foot the bill?

As far a mammography goes Dr John McDougall wrote a newsletter article on this topic in 2006. Here is the link: http://www.drmcdougall.com/misc/2006nl/dec/fav5.htm.

Ian,

I'm not sure what the difference between reversing diabetes with a plant based diet and ameliorating it with a vegan diet (other that a vegan diet isn't necessarily low fat or low GI) is.

The point of eliminating animal products from the diet is that animal products are not low fat, contain haem-iron and it's possible that the animal proteins upset insulin sensitivity.

Yes people lose weight on a low fat, low GI diet, plant based diet, and the fact that they can do it without having to pay attention to energy consumption is one of the strengths of this diet and one of the reasons it's so well accepted by many patients.

If people could stick strictly to Diabetes Australia diet recommendations including the energy restriction component I'm sure that they would do well. Unfortunately it's hard to stick to because going to bed hungry gets old very quickly.

We don't suggest alcoholics cut the alcohol consumption to 1 drink a day, we tell them to eliminate it completely. I'd suggest recommending a low fat, low GI plant diet works the same way.

And your right type 1 diabetics are still going to need medication but there is evidence to suggest that they too with benefit from the same dietary approach.

Again, I agree that "getting the wider community to accept vegan diets" can be difficult, but does that mean we shouldn't do it? It helps when the clinician is trained to provide the necessary support and encouragement. Also just like it's hard to take the quit smoking advice from our health care practitioner who smokes themselves, I believe it's much easier to provide health care advice when we follow our own advice.

Thanks for all your articles Ian. They are always thought provoking, informative and entertaining.

Simon Porteous - I'd be interested to see the work that suggests that Type 1 diabetics would "benefit from the same dietary appproach."

Since their problem is islet cells not being able to make insulin, rather than obesity-related insulin resistence, how would diet influence thier islet cell function?

Do you treat diabetics? What therapeutic model do you use and what are your results like? Do you audit your practice?

Sue -

Do you think it's possible that Type 1 diabetics also suffer from insulin resistance? A high fat diet is able to produce insulin resistance in healthy (non-diabetic) people, why not type 1 diabetics?

Yes I do treat diabetics, for back pain, neck pain, headache etc. I also provide dietary advice and suggest that it may help their diabetes management. It should be obvious that i recommend a low fat, low gi plant based diet, not only because it improves diabetes management, but also heart disease, osteoporosis risk and cancer risk.

I do recommend patients stay in close communication

So far the results for diabetes have been excellent.

oops, forgot to finish the sentence,

I do recommend patients stay in close communication with the GP to make sure they are on the appropriate medication.