I'm Not A Doctor, But...

Andy points EoR to Husband and healer 'must share blame'.

Coroner Alastair Hope has been urged to find that prominent Perth toxicologist Peter Dingle and wife's homeopath contributed to her death

On the final day of the inquest yesterday he was also urged to refer two doctors - William Barnes and Igor Tabrizian - to the WA Medical Board over their treatment of Mrs Dingle and to consider whether Mr Dingle's "emotional abuse" of his wife amounted to torture.

(...)

Counsel assisting the Coroner, Celia Kemp, said Mrs Dingle played a part in the "misadventure" that led her to forgo conventional treatment and accept the homeopathic treatment of Francine Scrayen. She said Mrs Dingle did not make the choice alone but with the influence of her husband.

"Dr Dingle's strong anti-conventional views would have influenced his wife," she said.

She said it was likely Dr Dingle, who holds no medical qualification, advised his wife against surgery, chemotherapy and radiotherapy.

EoR's observation of Dr Dingle's advice giving in the media is that he is announced as "Dr" Dingle. No clarification or disclaimer is provided as to the fact that he is not a medical doctor. If someone asks about a specifically medical condition Dr Dingle does, however, invariably state that he is "not a medical doctor". This is immediately followed by "but" and a whole slew of advice (usually involving eating more nuts and fish oils and so on and so forth).

As an example, consider this page from Dr Dingle's blog (which EoR blogged about long ago). EoR leaves it to his readers to determine whether or not Dr Dingle provides medical advice on that page, and in relation to exactly how many conditions. It's not a pretty sight.

More recently, he advises on Breast cancer Anti depressants and Fish oils, wondering "how many woman (sic) have died in the interim" of breast cancer and combined depression drug use. Fish oil, of course, is a wonder substance (and not at all a drug) that works far better in combination with chemotherapy than chemotherapy alone to prolong life. Perhaps Dr Dingle will any day now publish an article wondering how many woman have died in the interim from using alternative therapies?

The jury is still out (if such a metaphor is appropriate) on whether or not SSRIs affect Tamoxifen (EoR's emphasis):

If you take both an SSRI antidepressant, such as fluoxetine or paroxetine, and also take tamoxifen, speak with your doctor about the potential interaction between them. Your doctor may advise switching either to another type of antidepressant or another form of hormonal therapy.

If you are postmenopausal, you may be able to switch to an aromatase inhibitor, a hormonal therapy that is not affected by CYP2D6 inhibitors. In addition, make sure your doctor knows about all the medicines you take, since there are some other medications that are CYP2D6 inhibitors.

Tamoxifen remains the standard optimal treatment for premenopausal women. But regardless of menopausal status, you may be able to switch to another type of antidepressant to manage tamoxifen-related hot flashes. For medical options and other tips on managing hot flashes, read a recent article from our newsletter.

Clinical depression is a serious condition, so do not stop taking your antidepressant without consulting your doctor. Many other treatments exist for depression, including medicines that do not inhibit CYP2D6.

EoR notes that Dr Dingle makes no warning about stopping antidepressant medication in conjunction with a (real) doctor on his blog.

The level of evidence for fish oil as a treatment for depression is shown when most Google hits are for sites such as fishoilfordepression.org, christinas-home-remedies.com and oilofpisces.com. Unfortunately, the jury's still out on this one as well, with some small scale studies indicating there may be an effect (Eor's emphasis again):

A number of studies suggest that fish oil supplements may be an effective add-on (adjuvant) therapy for depression. In fact, some studies suggest that fish oil supplements may be as effective as prescription antidepressant medication — but the two in combination are more effective than either taken alone. However, more research is needed to confirm these results.

(...)

At this time, it's probably premature to make a strong recommendation for or against fish oil supplements as a treatment for depression. Consult your doctor before starting any new dietary or herbal supplement to treat depression, especially if you take other medications.

Dr Dingle again doesn't mention the strength of the studies he relies on, whether there are any contradictory studies, or whether his proclamations are based on preliminary evidence or not. Of course that, like urging people to give up their antidepressants in favour of an unproven alternative, are not in contradiction of the Hippocratic Oath because he doesn't have to adhere to any such restrictive medical standards. Not being a medical doctor.

Hopefully, though, the fish oil is working for Dr Dingle now that his friends at the ABC (though they are still showing him on Can We Help?) and 6PR have abandoned his well-reasoned and considered health advice. At least the newage journal Nova still has a place for him.

Dilbert on Homeopathy