Dr Wildervanck, you are entitled to your own opinions, but not to your own facts

Dear Charles, if I may call you by your first name as we as faculty used to call our students back in ‘85 when you qualified from the University of Pretoria.

Let me start with the words of Winston Churchill: “The first duty of the university is to teach wisdom, not a trade; character, not technicalities.”

It is now over 30 years since I signed my name and thereby put my reputation on the line when I, together with three other clinical departmental heads, certified to the Health Professions Council that you, Mister Charles Frederik Wildervanck, are fit to practice medicine and could therefore henceforth assume the respected title of doctor.

As part of your education we as faculty saw it our duty to ensure that, apart from the myriad facts and technicalities of practising the profession of medicine you would have the approach to view a patient not just as a disease-struck individual but as a whole and complete person. This applies not only to his or her affliction but also in relation to the environment and relatives as well as society in which she or he lives.

TUKS medical school might care to share some credit for your choice to spend your career in integrative or “holistic” medicine.

In your reply to Ivo Vegter, the reputation you have as graduate of a prestigious university, and given the high regard in which most readers hold medical practitioners, there is a risk that your letter may create or perpetuate some misconceptions, not only about the practice of medicine but the very scientific basis of medical practice.

We, in educating you and your peers, hoped we would instill some basic principles of science and scientific reasoning. In this, we have obviously not been successful. We did not teach you about the common fallacies people make in reasoning. For this I apologise and hope to belatedly partially correct this omission.

You appear to claim that you have insights about the nature of science that differ from Vegter’s. The first rule of science is that he who makes a claim has to provide the evidence. Therefore, I approach your letter with a view to finding evidence for some of your more extraordinary claims.

You claim that “the mind can influence outcomes of physical experiments” and refer to the wave-particle duality as basis for the claim.

Have you actually read the popular work of popular physicist-educators such as Richard Feynman, Steven Weinberg or Lawrence Krauss, who explain that it is the action of energy exchange in the measurement and not the mind doing the measurement that changes the outcome? Yes, Charles, a tree falling unobserved in the forest DOES make a noise.

You claim that “at the very basis of what appears as solid matter, there is uncertainty, which cannot be explained and where nothing is readily predictable.”

This is at best a misinterpretation of Heisenberg’s uncertainty principle which states it is not possible to determine both the position and the velocity (momentum) of a particle at the same time. Either one of the two can be measured to a precision equivalent to the width of North America to less than a few yards, as is popularly quoted. This extraordinary precision is the basis for things like a GPS’s ability to show your location within a few metres, an impossibility if what you claim were to be true. I am surprised that you do not use the two particle entanglement “mystery” with its apparent faster than light information “travel” as part justification of your claims to the ignorance of science.

However, you do not allow for the neuroscientific concept that thought is not “non-physical” or “NOTHING” but an emergent property of the actions of neurotransmitters. So the creation of the neurotransmitter that moves your leg has its origin in the neurotransmitters that lead to the thought you have to move your leg.

You claim: “The story of genetic expression can change without changes in the genetic ‘alphabet’” as if this is somehow part of the “new science” of epigenetics.

Gene expression means that a particular part of coding DNA becomes active in response to the environment and the substances coded for by the segment are produced. This was probably common knowledge when you graduated. Epigenetics is a description of how the effect of environmental conditions can be transmitted to the next generation. You somewhat surprisingly do not claim it, but it does not prove that Lamarck’s theory of inheritance of acquired characteristics must replace Neo-Darwinian genetics. Only that we understood genetic inheritance better in 2005 than in 1985. Not surprising, given the extraordinary efforts and resources of what you term “conventional science” put into the human genome project.

You claim: “Nutritional measures can alter gene expression. Yep: food can do that!”

I am surprised at the claim. Charles, have you forgotten that we taught you that when you eat sugar, it is absorbed into your blood, and when the sugar-laden blood circulates through the pancreas the genes responsible for the secretion of insulin are activated, i.e. they become expressed, to secrete insulin, which causes the sugar to be absorbed into the liver and some other organs? Yep, indeed, food does do that.

But, and this is the point, even if what you claim were true, that we don’t understand the origin of the mind, we do not understand entanglement and as non-physicists we do not understand the implications of the Heisenbeg equation, this does not make the claims of homeopathy or woo-woo science true.

Here you committed the fallacy of confirmation bias, by failing to consider information both confirming and refuting your thesis. If you claim to be scientific, then Charles, be prepared to be weighed by scientific methodology.

Charles, you really must come clean on this one and show the source for your extraordinary claim. It must be very new, as the 2016 and 2017 Nobel prizes for physics have been allocated to the observation of the Higgs boson and gravitational waves. If what you claim is true, the waves made by this DNA discovery would surely have been greater than gravity waves and would be allocated the 2018 Nobel still to be announced in October. Somehow I doubt that it will.

You state: “The following few comments relate to ‘the gold standard’ of medical testing: the randomised, double blind, placebo-controlled trials of pharmaceutical drugs.”

You then embark on a walkabout of several paragraphs without fulfilling your promise of comments on the methodology of clinical trials. I was hoping you would point out some shortcomings so that I could ask you what your alternatives are. The best I can make out is that you say there are many variables differing in each patient and that therefore treatment but be individualised for each patient and for each variable. Forgive me if I surmise incorrectly, but if that is in fact what you are saying then please consider the following – if there are five causes for a disease and each of these causes can be treated by one of two interventions then the total number of treatments for that patient would be 2 to the power of 5, that is 64 ways of treating. How do you select between them? Trial and error? How long to “try” every one?

But more important, if you reject the principle of controlled double-blind trials, how do you decide in the first place you have a truly effective remedy for one of the factors?

Where do you stand on the idea of “proving”? This is the idea that in order to find substances that give rise to symptoms of diseases a number of wise practitioners would get together and take differing amounts of various substances and note the symptoms they cause. By consensus they would then decide what diseases they cure. Who do you trust more, five wise men who followed this method 150 years ago, or a published well-designed placebo-controlled study performed in 600 diseased patients after scientific scrutiny by people with experience in clinical trial methodology?

Where do you stand on the principle of potentiation? This is the idea that by dilution the potency of the effect increases even to the point when there is very little or even nothing of the substance left in the diluting fluid?

What about succussion? This is the idea that by shaking in a special way during the dilution process the effect is made even stronger?

I suspect that these ideas from the 1800s underpinning homeopathy are what Vegter considers quackery. What do you call them? Is it the way to transfer the curative properties of the substance to the glass container and to the remaining water? So, do you believe the curative properties of a substance are separate “things” to the substance itself? Are you really holding a Platonic view of the world, that there is a “chairness” separate from a chair, and what’s more, that you can separate the two? Do you really believe you can sit on the chairness without the chair?

If you do, you are not practising science but magic. You are not fooling me as your teacher, and if you think it is okay to fool your patients with the New Age woo-woo concepts you espouse in your answer just because they can afford it, you are no longer practising ethical medicine.

You state: “I am very anti the portrayal of drugs as solutions to (or worse: cures of) any illness. This does not mean all natural products are safe and effective, just generally so much safer than drugs. Period.”

Yes, Charles, finally something we can agree on – not all natural products are safe and effective. However, it does not follow they are “so much safer than drugs.” Surely this depends on the characteristics of the “natural product” and the drug you are comparing? Also, why do you drop the “general” effectiveness and only compare the “general” safety? What does it help to take something very safe if it has not passed a valid test for effectiveness?

Charles, you have lost me here – surely you cannot expect your patients to fall for this argument? Do you really want us to believe that if you have a patient with ordinary pneumonia you won’t give an antibiotic because the disease is not the result of a deficiency in antibiotics? Conversely, in diabetes are you saying that correcting a deficiency in insulin is not the right thing to do to save the patient’s life even though we do not know the initiating causes? Or maybe you are only talking of a small group of self-limiting diseases that your “holistic” practice focuses on? Or do you run a “wellness” clinic, in which it costs a healthy patient a lot of money for tests and medication including hormones, food and mineral supplements of all kinds to remain “well?”

Antoine L van Gelder FRCP(London) Professor Emeritus University of Pretoria.

Prof Van Gelder was head of the Department of Internal Medicine, University of Pretoria Medical School and the Steve Biko Academic Hospital, 1984 until 2015. He writes in his personal capacity.