"Here, eat this root."

June 15, 2011 9:44 AM

The Triumph of New-Age Medicine "Medicine has long decried acupuncture, homeopathy, and the like as dangerous nonsense that preys on the gullible. Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo. But now many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care—and they’re trying to learn from it."

Single Page Version

Responses to the article will be posted each day (one per day) for the next couple of weeks at Fix or Fraud, a debate on Alternative Medicine. There is currently one response, with a reply from the article author:
* Don't Dismiss These Treatments as Placebos (Taxpayers are funding major studies on alternative medicine -- and for good reason) by Josephine Briggs, M.D., and Jack Killen, M.D. The author's reply is here.

posted by zarq (278 comments total)

This: "studies have shown alternative medicine to work no better than a placebo" directly contradicts this: "alternative medicine often seems to do a better job of making patients well".

The logical conclusion is that it makes patients think they are getting well, which is not the same as getting well.
posted by Malice at 9:49 AM on June 15, 2011 [8 favorites]

At the risk of ruining it... the title of this post comes from a very old joke:

A Short History of Medicine

I have a headache:

2000 BCE: Here, eat this root.
1000 AD: That root is heathen. Here, say this prayer.
1850 AD: That prayer is superstition. Here, drink this potion.
1940 AD: That potion is snake oil. Here, swallow this pill.
1985 AD: That pill is ineffective. Here, take this antibiotic.
2011 AD: That antibiotic is artificial. Here, eat this root.

posted by zarq at 9:50 AM on June 15, 2011 [65 favorites]

The logical conclusion is that it makes patients think they are getting well, which is not the same as getting well.

It could also be that outside the carefully controlled conditions of a clinical trial the patients are doing something else, at home, that actually benefits them. Increased exercise and healthy eating springs to mind. I mean, you could really see holisitic 'medicine' as a gateway drug to the healthy hipster lifestyle.
posted by Slackermagee at 9:54 AM on June 15, 2011

Well, what's New Age?

I've heard that in China, when a patient has an ailment, there's any number of treatment directions considered and it's reflected by a sort of roundtable analysis of the ailment. That is, you'll have a surgeon, a psychiatrist, a physio-therapist, an acupuncturist, a nutritionist etc all engaged in the discussion with none of them immediately taking the lead until it's clear whose expertise is most required.

The traditional med vs new age "argument" seems entirely cultural and I'm hoping it gets left in the dust soon.
posted by philip-random at 9:56 AM on June 15, 2011 [7 favorites]

Doctors often do what patients want. I once had a long bout with the flu, and just to make sure it wasn't anything worse, I went to my MD. She checked me out, said, yes you have the flu, and wrote a prescription for an antibiotic. I looked at her and said, "Flu is a virus." She said, "Yes, but people want to take something."

I have another MD now.
posted by CheeseDigestsAll at 9:57 AM on June 15, 2011 [46 favorites]

Respecful Insolence's response to the article.
posted by cog_nate at 9:58 AM on June 15, 2011 [13 favorites]

Acupuncture doesn't work, now?
posted by KokuRyu at 10:00 AM on June 15, 2011

Homeopathy is a fraud and nonsense that prays on the gullible.
posted by Talez at 10:00 AM on June 15, 2011 [32 favorites]

"Jack, you are a scientist. You do not think that there are things in this universe which you cannot understand and which are true?"
posted by The White Hat at 10:02 AM on June 15, 2011 [1 favorite]

cog_nate: "Respecful Insolence's response to the article."

I love this. Fantastic, rational response. Thanks so much for posting it.

Speaking of bad ideas, in contrast to his previous article, in which he managed at least to get the gist of what Ioannidis teaches but merely spun it in what I considered to be an annoying fashion, the entire idea behind Freedman's new article channels the worst fallacies of apologists for alternative medicine. The whole idea behind the article appears to be that, even if most of alternative medicine is quackery (which it is, by the way), it's making patients better because its practitioners take the time to talk to patients and doctors do not. In other words, it's a massive "What's the harm?" argument. Yes, that's basically the entire idea of the article boiled down into a couple of sentences. Deepak Chopra couldn't have said it better. Tacked on to that bad idea is a massive argumentum ad populum that portrays alternative medicine (or, as purveyors of quackademic medicine like to call it, "complementary and alternative medicine" or "integrative medicine") as the wave of the future, a wave that's washing over medicine and teaching us cold, reductionistic doctors to care again about patients and thus make them better. Freedman even contrasts this to what he calls the "failure" of scientific medicine. I kid you not. Worse, Freedman makes this argument after having actually interviewed some prominent skeptics, including Steve Salzberg and Steve Novella, in essence, missing the point.

posted by zarq at 10:02 AM on June 15, 2011 [3 favorites]

Malice: The logical conclusion is that it makes patients think they are getting well, which is not the same as getting well.

Do not ignore the actual benefits of the placebo effect.

Slackermagee: It could also be that outside the carefully controlled conditions of a clinical trial the patients are doing something else, at home, that actually benefits them. Increased exercise and healthy eating springs to mind.

That's what came to my mind when reading the first article linked. The practitioner reviewed the whole of the patient's life (in a calm and relaxing setting) before applying acupuncture needles, and the long-term treatment included other changes to the patient's life, beyond these acupuncture sessions.

This post reminded me of two recent discussions in my life. First, the Burzynski thread from yesterday, and second, a discussion with a co-worker lived next to an old Native American man when my co-worker was in college. The old man recognized when his college neighbors were sick, and would give them some herbs to make into a tea. My co-worker said he and his house-mates felt great the next day.

There is a wide range of options between hokum and home remedies.
posted by filthy light thief at 10:04 AM on June 15, 2011 [5 favorites]

As science surrenders to the re-dumbening of the general population, bullshit triumphs. But it certainly is no triumph for civilization.
posted by It's Raining Florence Henderson at 10:05 AM on June 15, 2011 [9 favorites]

2007: Oh, wait, snake oil works.
posted by hank at 10:05 AM on June 15, 2011 [1 favorite]

I hate to see acupuncture and homeopathy lumped together as if they have anything to do with one another. There are actually several studies using MRI scans to show effects of acupuncture and CT scans have been used to accurately predict which stroke victims will benefit from acupuncture for some time. But as Talez says, homeopathy is a fraud and nonsense that prays on the gullible.

Also, the skeptic they interviewed is a jerk: chiropractic neck-breaking and artery shearing? The offensive part of that statement is that he claims to be championing the scientifically proven world as he busts out that little nugget of hysteria.
posted by kitarra at 10:08 AM on June 15, 2011 [4 favorites]

from header of article: “Medicine has long decried acupuncture, homeopathy, and the like as dangerous nonsense that preys on the gullible. Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo. But now many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care—and they’re trying to learn from it.”

Learning from it is fine.

There seems to be an environmental effect that helps patients get healthier? Prove it. There seems to be something in poking patients with those needles that improves posture? Prove it. The way that chiropractor manipulates a patient's back seems to help overall health? Prove it.

It's good to be open to options. But doctors who abandon evidence-based medicine are not doctors.

Also: homeopathy is not "no better than a placebo." Homeopathy is worse than a placebo; it can actually poison people in certain cases. It's dangerous malarky that should be eradicated.
posted by koeselitz at 10:09 AM on June 15, 2011 [13 favorites]

Let's separate this into its component pieces:

1. "Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo."

2. "...many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care—and they’re trying to learn from it."

These aren't incompatible, but alone they don't show a "triumph" of alternative medicine. Essentially, they argue that alternative medicine works as well as a placebo and that placebo works "better than mainstream care". At best, we can argue that mainstream medicine can learn something about how to deliver placebos in a way that increases their effectiveness.

I think it was one of Richard Dawkins' documentaries (The Enemies of Reason ?) that showed how much more attention and care that people get when they turn to practitioners of alternative medicine. I find it plausible that this would amplify the placebo effect for these treatments.
posted by Grimp0teuthis at 10:11 AM on June 15, 2011 [8 favorites]

CheeseDigestsAll: "Doctors often do what patients want. I once had a long bout with the flu, and just to make sure it wasn't anything worse, I went to my MD. She checked me out, said, yes you have the flu, and wrote a prescription for an antibiotic. I looked at her and said, "Flu is a virus." She said, "Yes, but people want to take something.""

My kids are treated at a pediatric practice which has five doctors. They have a primary physician, but if they get sick, whichever one of the five is available sees them first.

When they were less than a year old, both kids came down with the flu. The pediatrician I took them to prescribed an antibiotic and when I objected, told me it was "just in case." I raised hell and he doesn't treat the kids anymore.

Repeated studies have indicated that kids who are given antibiotics before their first year (at least two studies say before the six month mark) may develop allergies and/or asthma issues because the antibiotics may disturb intestinal flora. But while prescribing an antibiotic when one isn't needed relieves parental worry, it also harms your kid by building their resistance against a drug that could be helpful to them one day.
posted by zarq at 10:11 AM on June 15, 2011 [5 favorites]

"I've heard that in China..."

Conventional medicine is not provided out of some sense of cultural superiority. Conventional medicine is prescribed because it works.

Broadly speaking, acupuncture in China is now regarded as "rural medicine": treatment that is given in the absence of an accredited doctor and modern facilities. During the Cultural Revolution, "anesthetic acupuncture" was used for both ideological principles and because conventional medicines were in short supply... with a result of massive suffering and death.

As has been pointed out, there is something to be said for sitting down and talking to a patient in a calm, relaxing atmosphere. If it were possible to invest in health services so that every doctor's office had soothing music, bubbling fountains, and an hour's consultation, I guarantee patients would "feel better" afterwards. Lacking that, I'd prefer they were provided something that actually worked to cure their ailment, rather than quackery.
posted by Bora Horza Gobuchul at 10:13 AM on June 15, 2011 [14 favorites]

Since most office visits are for symptoms that are worrisome to the patient, but ultimately not traceable in any way to a clinical malady, it really is the case that whatever path allays the patient's fears is generally fine. That, at it's core, is what a standard office visit boils down to when it is not about treating an obvious illness or managing a chronic disease.

The great difference in "alternative" practices is the tendency of many (chiro and naturopathy are far and away the worst) to lead the patient to believe they are fundamentally broken or lacking in some way, at which point they will spend their lifetime bought into a model of illness. Back pain and fatigue are the two things that create this problem in the worst way.
posted by docpops at 10:14 AM on June 15, 2011 [10 favorites]

Talez: "Homeopathy is a fraud and nonsense that prays on the gullible"

I've convinced 197 people to quit homeopathy.
posted by boo_radley at 10:15 AM on June 15, 2011 [10 favorites]

And the reason most doctors like alternative medicine is the same reason I like WalMart and Disneyland. It acts as a sort of flypaper for all the people I would rather not ever have to deal with in my personal and professional life.
posted by docpops at 10:16 AM on June 15, 2011 [4 favorites]

philip-random: “I've heard that in China, when a patient has an ailment, there's any number of treatment directions considered and it's reflected by a sort of roundtable analysis of the ailment.”

I have a friend who lived in China for ten months. Four months in, she contracted an illness that she suffered mightily with for the next six months straight, a bacteria that turned out to be easily treatable once she returned to the United States. Every practitioner of "Chinese medicine" that she went to gave her disgusting teas and useless acupuncture and everything else in the book. None of it did a bit of good.

Now, when people mention "Chinese medicine" to her in glowing terms, she hits them.
posted by koeselitz at 10:18 AM on June 15, 2011 [24 favorites]

Bora Horza Gobuchul: "there is something to be said for sitting down and talking to a patient in a calm, relaxing atmosphere."

Sometimes we just need people to pay attention to us to feel better/ work harder.
posted by boo_radley at 10:18 AM on June 15, 2011

I think what bothers me about this whole debate is that so much of it seems to be based on what ought to be true from a skeptical (I'd say pseudo-skeptical) perspective.

Acupuncture has been shown to have a measurable effect above and beyond placebo under certain circumstances, but it's dismissed because sticking with people with needles to adjust some unmeasurable quality called qi seems like nonsense.

Actively-managed mutual funds have been shown to be a crap-shoot comparable to throwing darts at the financial pages, but fund management is still a respected billion-dollar business because it seems rational.
posted by lore at 10:18 AM on June 15, 2011 [10 favorites]

Sadly, no amount of acu needles can sew together a ripped tendon.

A shoulder injury, incurred while doing my civic duty as a bicyclist in Berkeley, left me in rather dire straits. I had very limited health insurance, and happened to live with a Daoist stone-ball healer at the time (guess you had to be there). Anyhow, I refused his "treatments" during my time living with this man. He claimed to be somewhat of an exorcist/ghostbuster/lottery oracle. To him, ghosts took up residence in the body, presenting as pain. His duty was to remove the ghosts, thus removing pain. This process, however was excruciating. Clients would come over to the apartment and proceed to writhe, yowl and cry in agony while he kneaded two jade balls over their problem areas. Most clients were return customers, who left looking surprisingly chipper.

White Cloud (the name purportedly bestowed upon my roommate by Heaven) was a Korean native, who left his country and family to pursue fame and fortune as a healer in the epicenter of spiritual flimflam--the SF Bay Area. He was sponsored by two American acolytes, both of whom did healing work in Berkeley. My initial meeting with this trio was via a CL apartment listing, in which I lived for a loooong two months. I became close with the two guys (White Cloud, not so much). After my bicycling incident, they both graciously offered "alternative" treatments. I was receiving bi-weekly acupuncture, cupping and a yoga regimen. Though extremely pleasant in the short-term, none of these treatments got to the root cause of my problem, which was eventually diagnosed via MRI and treated surgically for FREE! But, that's another story.

BTW This is my first MetaFilter comment/post, though I am a long-time peruser. Hello world..
posted by obscurator at 10:19 AM on June 15, 2011 [29 favorites]

If a root or herb has a demonstrable physiological effect, it's not an "alternative treatment". It's just a treatment. We get lots of drugs from natural sources.

But a compound that was manufactured according to FDA-regulated GMP is not equivalent to a compound sold as a nutritional supplement at Whole Foods, even if the active ingredient is the same. Nutritional supplements are not standardized for dose or purity. You literally don't know what you're getting. In the realm of medical therapy, this is a very big deal.
posted by dephlogisticated at 10:19 AM on June 15, 2011 [9 favorites]

Here's the thing I don't get; how come countries that primarily treat patients using TCM (incorporating herbs, acupuncture, etc.) or similar variants don't have drastically shorter average lifespans than countries that primarily treat patients with regular medicine? Or do they?
posted by infinitywaltz at 10:20 AM on June 15, 2011

Now, when people mention "Chinese medicine" to her in glowing terms, she hits them.

If you hit yourself just a little every day, it won't hurt at all when koeselitz's friend hits you really hard later.
posted by It's Raining Florence Henderson at 10:21 AM on June 15, 2011 [7 favorites]

@docpops

well personally I am of the opinion that if anyone is dumb enough to take any of this quack stuff seriously the gene pool is better off without them and are you kidding me did you really just post that

really?

really?
posted by This, of course, alludes to you at 10:22 AM on June 15, 2011

Clients would come over to the apartment and proceed to writhe, yowl and cry in agony while he kneaded two jade balls over their problem areas. Most clients were return customers, who left looking surprisingly chipper.

"It feels so good when it stops."
posted by George_Spiggott at 10:23 AM on June 15, 2011 [1 favorite]

Oh hey, let's learn about acupuncture!

This view was further strengthened by a recent randomized
controlled trial in patients with osteoarthritis examining the effects
of acupuncturists’ communication style [128]. Real and sham acu-
puncture were both more effective in reducing pain than no acu-
puncture at all, but real acupuncture was no better than sham.
Moreover, a communication style generating high expectations in
patients resulted in improved outcomes compared to a normal style,
regardless of the type of acupuncture administered.
posted by Orange Pamplemousse at 10:25 AM on June 15, 2011 [4 favorites]

well personally I am of the opinion that if anyone is dumb enough to take any of this quack stuff seriously the gene pool is better off without them and are you kidding me did you really just post that

really?

really?

What.
posted by Floydd at 10:26 AM on June 15, 2011 [2 favorites]

Here's the thing I don't get; how come countries that primarily treat patients using TCM (incorporating herbs, acupuncture, etc.) or similar variants don't have drastically shorter average lifespans than countries that primarily treat patients with regular medicine? Or do they?

I don't think they do, but that could mean a lot of things. We have a pretty crappy diet in the west, and that doesn't help our lifespan. But the key thing, I think, is that we don't die of a lot of different things. In China you may get accupuncture to treat asthma; here you get an inhaler. Either way you'll likely live a long life, but the inhaler will probably do a better job of improving the quality of your life. Ditto treating back problems with chanting and burning incense vs. getting surgery. You can't tell which one works just by looking at who lives longer.
posted by It's Never Lurgi at 10:26 AM on June 15, 2011

I've had major health crashes twice in my adult life. On both occasions, the cause would be what I'd call holistic. That is, I was living like an idiot (bad food, not enough exercise, erratic sleep, no shortage of drugs and alcohol, bad relationships).

On both occasions, the "cure" started with a trip to my family doctor, who told me I wasn't about to die in the next 24 hours and then got me started on the usual round of tests etc. Meanwhile, I also started eating better, sleeping better, walking more, cutting back on the partying ... and so on.

Over time, through a rather complex combination of "conventional" medical attention, personal responsibility and a whole whack of "other stuff", I got better. My conclusion. Medical science on its own can only solve some health issues for the simple reason that many health issues arise from a complex myriad of causes.
posted by philip-random at 10:27 AM on June 15, 2011 [2 favorites]

I work in evidence-based medicine, albeit on the technical side. Me, some other techies, a handful of marketing androids, and a bunch of doctors work in this office, publishing a physician reference tool. A shocking number of them totally believe in the efficacy of chiropractor, acupuncture, and yes, even homeopathy. It is appalling, and doubly so when I have difficulty explaining why "chiropractors are, to a one, peddling snake oil" is not effectively refuted by "but they made my back pain so much better!" No, dude. Your back pain got better, and you conflated causation with correlation. Every longitudinal study there is says sham acupuncture and chiropractor are exactly as effective as the "real" version, which means the chiropractor without a real medical degree fucking around with your spine is just as effective as I would be if I were to hang a shingle out and start taking on patients.

It's called "alternative medicine" because if it worked, it would just be called "medicine."
posted by Mayor West at 10:28 AM on June 15, 2011 [13 favorites]

infinitywaltz: "Here's the thing I don't get; how come countries that primarily treat patients using TCM (incorporating herbs, acupuncture, etc.) or similar variants don't have drastically shorter average lifespans than countries that primarily treat patients with regular medicine? Or do they?"

Life expectancy incorporates a lot of factors, including diet, lifestyle, public sanitary health measures, access to medical care, climate, economic status, war, disease and infant mortality rates. Medicine is only part of it.

Per quick google searches, here are the average lifespan in:

Australia: 81.5 years
China: 73.3 years.
Germany: 79.9 years
Japan: 82.9 years.
North Korea: 67.4 years.
South Korea: 80.3 years.
UK: 80.1 years
The United States: 78.7 years
posted by zarq at 10:30 AM on June 15, 2011

@this, of course:

Sorry to be so blunt, but it's true. Spending 45 minutes with a patient who believes all of their pain and fatigue is due to nonexistent celiac disease (because every lab test and a biopsy was negative) who won't confront the fact that twenty hours of volunteer work on top of five kids and an alcoholic husband might be more likely a source is going to be much happier with a Naturopath than with me.

And vice versa.

Also, there is no Santa Claus.
posted by docpops at 10:31 AM on June 15, 2011 [5 favorites]

1985 AD: That pill is ineffective. Here, take this antibiotic.
2011 AD: That antibiotic is artificial. Here, eat this root.

My experience has been:

MDs: Here, take this (blood pressure, cholesterol, diuretic) pill. I won't bother suggesting you should eat better and get more exercise, since I'm late for my next patient and I don't feel comfortable having awkward conversations with defensive people and besides, I hardly know you. Besides, the pill will make your symptoms go away.

Bad New-Age medicine: You are sick in every way, you need weekly appointments with me for the rest of your life.

Good New-Age medicine: Let's have a sincere, honest talk about where you could change your lifestyle to help you live healthier.

One of my friends works in a kidney dialysis unit, and the problems they have getting patients to change their habits is one of the biggest barriers to good health outcomes. If New-Age approaches connect with people better and are more persuasive, then more power to them.
posted by anthill at 10:31 AM on June 15, 2011 [20 favorites]

Wikipedia's page on life expectancy is extensive, btw.
posted by zarq at 10:32 AM on June 15, 2011 [2 favorites]

If you hit yourself just a little every day, it won't hurt at all when koeselitz's friend hits you really hard later.

Acupunchin'.
posted by codswallop at 10:33 AM on June 15, 2011 [27 favorites]

Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo.

This is simply untrue, and anyone who claims it is woefully uninformed or is simply being disingenuous. Go to pubmed, search for "herb" or "herbal" or "Ayurveda" or "acupuncture" or search for an "alternative" herb or traditionally used for healing and you will find literally thousands of peer-reviewed trials with varying results. Do people really believe that no healing ever took place before the establishment of the FDA?
posted by Wordwoman at 10:36 AM on June 15, 2011 [15 favorites]

And the reason most doctors like alternative medicine is the same reason I like WalMart and Disneyland. It acts as a sort of flypaper for all the people I would rather not ever have to deal with in my personal and professional life.

This kind of elitist, self-entitled bullshit is a big reason why healthcare is in the crapper in this country. Doctors are overpaid and out of touch - we need more physicians, pronto. It's clear the profession has become too insular and neglectful of its societal obligations and responsibilities. No wonder people are turning to quack-healers.
posted by Slap*Happy at 10:39 AM on June 15, 2011 [12 favorites]

For example, this one. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis.
posted by Wordwoman at 10:39 AM on June 15, 2011 [1 favorite]

Absolutely, Wordwoman. If it's not scientifically proven, it's not medicine and it doesn't work. Ever. Period.

My non-specific backpain which my GP could not treat went away the day after my acupuncture session because it would have gone away then anyway.

My father's lockjaw which no GP or specialist could treat also went away the day after his acupuncture session because it also would have gone away anyway.

All anecdotes like this are the same, and equally worthless. They add up to nothing. I repeat them here only to show how worthless they are.

Only Western medicine has ever been able to treat anything, and the scientific method is absolutely foolproof. It never makes mistakes and it is never in any way skewed in practice by the wishes of large pharmaceutical companies.

Anyone who thinks otherwise is an idiot.
posted by motty at 10:40 AM on June 15, 2011 [12 favorites]

Okay, honest question.

I get the idea that for many of you, if a friend came to you and said "I was having back pain, and I went to a chiropractor, and now I feel much better," you would try to convince them to stop seeing the chiropractor, or at least you would wince inwardly.

What if the friend said "I was having back pain, and I switched to buckwheat-hull pillows in my bed, and now I feel much better."? Would you convince them to stop using buckwheat-hull pillows until there were studies proving they help with back pain? What if there had been studies, but they were inconclusive?

What if the friend said "I was having back pain, and my doctor prescribed me Alodeniphel off-label. Alodeniphel is actually a drug to treat narcolepsy, and it hasn't been tested on back pain, but my doctor said that they've been seeing a lot of effectiveness with some kinds of back pain. Anyway, I feel much better."?
posted by lore at 10:40 AM on June 15, 2011 [10 favorites]

Interesting. My wife and I are sort-of believers in TCM (we use it for some conditions and not others). It does seem to work in many cases -- acupuncture turned our daughter around (within 30 minutes!) so as to avoid a breech birth, the disgusting manually-compounded anti-nausea pills she takes actually work better than any over-the-counter western medicine that I've tried, the hypertension tea I drink works better with fewer side effects than the pills I used to take, and so on.

But neither of us would ever rely exclusively on TCM, nor do we lend much credence to the theories behind it. It could be 100% placebo effect, and that's cool with us -- it's cheap and we're results-oriented.

I think at least some of TCM's respectability is due to 1) it does seem to have demonstrable effect for some conditions under certain circumstances, 2) it exists side-by-side with Western medicine in most places, and therefore its effectiveness as a whole is selectively evaluated by both practitioners and patients like us.
posted by xthlc at 10:40 AM on June 15, 2011 [3 favorites]

Over time, through a rather complex combination of "conventional" medical attention, personal responsibility and a whole whack of "other stuff", I got better. My conclusion. Medical science on its own can only solve some health issues for the simple reason that many health issues arise from a complex myriad of causes.

Is this some kind of joke? Your conclusion about the efficacy of modern medicine is derived from your personal experience?
posted by proj at 10:42 AM on June 15, 2011 [1 favorite]

Ditto treating back problems with chanting and burning incense vs. getting surgery. You can't tell which one works just by looking at who lives longer.

True enough.

Speaking again of so-called "Chinese Medicine". Thus far in this thread, it has effectively been dismissed by entirely anecdotal arguments (I have a friend who ... ). To clarify, when I brought it up, I wasn't thinking of some backwater shanty with a bunch of illegal ivory locked up in the back room (all apologies for the cultural stereotyping here). I was thinking more specifically of a hospital in Shanghai that a Canadian nurse (who was currently treating my sick father) had recently visited.

Again, as she described it, they took a round table approach to all ailments with a number of different disciplines present. Surgeon, physio, nutritionist etc. Key to them all being there and having a useful discussion was that part of their training was to understand and value what the others were bringing to the table. The problem as I see it in the west, is that the various disciplines don't value each other. And this is particularly true of the traditional medical types who seem to view any questioning of their methods as an immediate threat.

Am I arguing for the embracing on non-scientific medicine? Of course not. Am I arguing for a far more holistic view of ill-health and encouraging a far more thorough analysis of so-called "alternative methods", so that we can effectively separate the wheat from the chaff? Absolutely.
posted by philip-random at 10:42 AM on June 15, 2011 [1 favorite]

That’s in large part because mainstream medicine itself is failing.

Mainstream medicine is awesome. I seriously love it like I love sunshine and flowers.

Without mainstream medicine, my partner wouldn't be able to eat food like a normal person. In fact, he'd probably be dead. I would be in constant pain. I would have to seriously worry about dying in childbirth. Multiple relatives have been successfully treated for cancer and they live normal lives even though they're missing various parts.

It can't fix everything, but saying that it's "failing" is silly.
posted by the young rope-rider at 10:44 AM on June 15, 2011 [20 favorites]

Didn't we have this discussion a week ago, only it was about anti-depressants rather than acupuncture? Man, people are just repeating the same thi-- wait, what? Let me read closer...

OK, so let me get this straight. Psychopharmaceuticals result in effects that are basically indistinguishable from placebo. If you take that information to the internet/Metafilter, you get a torrent of responses calling you an asshole for demeaning mental illness, for ignoring X and Y, and for being skeptical in the face of all the good that anti-depressants have done. On the other hand, if you come in and show that so-called new age treatments have effects that are basically indistinguishable from placebo (and are sometimes better, depending on the treatment), you're called an asshole, an idiot, or worse if you seek out those kinds of treatments? Is this really the only Earth I can live on? Maybe it's different sets of people rallying behind these two apparently at-odds responses, I don't know.

I suffer from migraines. I've had five in the past thirteen days. They often prevent me from working, from enjoying life, or for being available to and consistent with my family. It's awful. Numerous doctor and specialist visits and thousands of dollars later, I have a pill I can take 1-2 times a week that makes me feel like shit and gives me about a 60% chance of not feeling awful when I wake up the next day. Thanks, conventional medicine. I see an acupuncturist on Tuesday. Placebo or not, I don't care. I'm willing to try anything, even if it makes me look like an anti-scientific idiot, because so-called evidence-based medicine has been able to do less than nothing for me.

The world is a complicated place, and treatment of long-term, complicated illnesses with no known specific causal agent is incredibly complicated. Simplistic "this is good, this is bad" thinking doesn't help patients, doesn't help researchers, doesn't help the general public.
posted by mister-o at 10:44 AM on June 15, 2011 [17 favorites]

What if the friend said "I was having back pain, and my doctor prescribed me Alodeniphel off-label. Alodeniphel is actually a drug to treat narcolepsy, and it hasn't been tested on back pain, but my doctor said that they've been seeing a lot of effectiveness with some kinds of back pain. Anyway, I feel much better."?

I had a specialist perform minor outpatient surgery, and he gave me a little envelope filled with migraine pills, some kind of acetaminophen with barbiturate, because hey, painkiller is painkiller, right? I got a scrip for Percocet, and found another specialist.

Quack's a quack, even if the duck wears a labcoat and has an impressive sheepskin on the wall.
posted by Slap*Happy at 10:46 AM on June 15, 2011

@Floydd sarcasm segueing into bewilderment is what

I am as much against falsehood as anyone but you have to admit this does sometimes seem to be a sort of cause célèbre for the uh more righteous people.

@docpops

Also, there is no Santa Claus.

oohhh nooooooooo

Seriously, I was counting on him to give me info on the connections between the people of Wal*Mart, Disneyland, alcoholism, and poor education, and why I (as a guy who can afford to go to med school) feel myself radiating so much contempt that way. I guess I'll never figure out this pattern, now.
posted by This, of course, alludes to you at 10:46 AM on June 15, 2011

First, do no barmy.
posted by chavenet at 10:47 AM on June 15, 2011 [1 favorite]

I get the idea that for many of you, if a friend came to you and said "I was having back pain, and I went to a chiropractor, and now I feel much better," you would try to convince them to stop seeing the chiropractor, or at least you would wince inwardly.
Not me - chiropractic from what I recall is about as effective as anything else for back pain. However, when someone claims their chiropractor cured them of deafness things might go a little differently in the conversation.
The overwhelming majority of alternative medicine is pure poppycock, and the occasional success some of it might have, the occasional herb that turns out to have a useful pharmaceutical action, none of that validates the rest.
Making strawman arguments and suggesting sides are completely polarised (motty) doesn't move either side forward.
posted by edd at 10:47 AM on June 15, 2011 [1 favorite]

Again, as she described it, they took a round table approach to all ailments with a number of different disciplines present. Surgeon, physio, nutritionist etc. Key to them all being there and having a useful discussion was that part of their training was to understand and value what the others were bringing to the table. The problem as I see it in the west, is that the various disciplines don't value each other. And this is particularly true of the traditional medical types who seem to view any questioning of their methods as an immediate threat.

I don't think this is the treatment plan for a typical Chinese person. Rather, what you're describing is top-flight medical treatment for Westerners in major Chinese metropolitan areas. I bet if you compared top-flight TCM treatment with top-flight western medicine treatment that the super rich and elite are getting in America, the latter would be more effective. It's not the science, but the implementation that is the big difference.
posted by reformedjerk at 10:48 AM on June 15, 2011

By the way, I think the mods should push PAUSE on this thread for about twenty minutes, in which time we should all spend some time on this thread:

People argue just to win, assert researchers.
posted by philip-random at 10:49 AM on June 15, 2011 [3 favorites]

mister-o: “I'm willing to try anything, even if it makes me look like an anti-scientific idiot, because so-called evidence-based medicine has been able to do less than nothing for me.”

"Evidence-based medicine" simply means "only use cures that actually work." So you seem be saying that you don't really care if a cure works, you're willing to try it even if it's ineffectual. I don't really understand that. Or rather: I get the feeling you don't understand what evidence-based medicine is.
posted by koeselitz at 10:52 AM on June 15, 2011 [1 favorite]

Woah, whatever, go ahead and rub roots and berries on your tumor. Sing to it for all I care. I'll go the scientific route, thanks. And thanks for all the anecdotal evidence about "out of touch" doctors. Maybe I should rate all doctors via the same measure that products are reviewed at Amazon?
posted by Brocktoon at 10:52 AM on June 15, 2011

Poll: how many times has Western medicine saved your life? For me, twice plus the unknowable number of times vaccines saved me from plagues. That's not to mention quality of life. It's nice not to have polio.

Psychopharmaceuticals result in effects that are basically indistinguishable from placebo.

Depends which drug you're talking about. Some work very well, others survive on drug company hype. What you've said is like saying that illegal drugs cause hallucinations.

Essentially, they argue that alternative medicine works as well as a placebo and that placebo works "better than mainstream care."

That's shocking if true. A drug or treatment passes the evidence based medicine test only if it can beat a placebo. Many Western medical treatments do not meet the criteria for calling themselves Western medicine.
posted by justsomebodythatyouusedtoknow at 10:52 AM on June 15, 2011 [1 favorite]

For example, this one. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis.

What do you think that paper shows, exactly, Wordwoman? The authors don't claim any particular effect of ayurvedic 'medicine'. All they claim is that it's possible to study ayurvedic 'medicine' clinically. Notice that there's no control group that gets no treatment or only placebo (for, presumably, the obvious reason). They don't show, here, any increased effect of ayurvedic 'medicine' over absolutely nothing.

And, emphatically, this is exactly the way to study any kind of medicine, 'alternative' or not. If an 'alternative' medicine practice can show reproducible clinical results, then it gets to lose its 'alternative' designation (and the abundant scare-quotes that I insist on using). Otherwise, no.
posted by gurple at 10:54 AM on June 15, 2011 [7 favorites]

lore: “I get the idea that for many of you, if a friend came to you and said "I was having back pain, and I went to a chiropractor, and now I feel much better," you would try to convince them to stop seeing the chiropractor, or at least you would wince inwardly.”

I would feel precisely the same as I would if someone came to me and said: "I read my horoscope this morning and did exactly what it told me to do, and that's why I won $5 in the lottery!" I might not wince or rebuke them, but they'd be full of shit just the same.
posted by koeselitz at 10:54 AM on June 15, 2011 [2 favorites]

Also can we please stop calling it "Western" medicine, I believe that this is a bad way to conceptualize the distinction, thank you
posted by This, of course, alludes to you at 10:57 AM on June 15, 2011 [4 favorites]

Okay, honest question.

I get the idea that for many of you, if a friend came to you and said "I was having back pain, and I went to a chiropractor, and now I feel much better," you would try to convince them to stop seeing the chiropractor, or at least you would wince inwardly.

What if the friend said "I was having back pain, and I switched to buckwheat-hull pillows in my bed, and now I feel much better."? Would you convince them to stop using buckwheat-hull pillows until there were studies proving they help with back pain? What if there had been studies, but they were inconclusive?

What if the friend said "I was having back pain, and my doctor prescribed me Alodeniphel off-label. Alodeniphel is actually a drug to treat narcolepsy, and it hasn't been tested on back pain, but my doctor said that they've been seeing a lot of effectiveness with some kinds of back pain. Anyway, I feel much better."?

Honest answer: I would wince inwardly at #1 and #2, because they're not indicative of anything more than "this weird thing made my problem go away." I totally get that weird things can happen for apparently ineffable reasons. I spent a year and a half fighting a back injury, which just kind of up and got better one day for reasons I can't really explain. But if that friend started advising other people to try the same weird thing? I'd probably say something like "It's really unlikely that your buckwheat pillow is the reason you got better," and then my friend would mischaracterize a statement intended to mean "the plural of anecdote is not data" as actually meaning "you are LYING about this THING that happened to you, and your experience is not VALID," and would get really huffy and refuse to talk about things in terms of populations and not individuals, because that's apparently what people do when you tell them their story is not repeatable in lab experiments.

#3 wouldn't bother me as much, because if his doctor is prescribing something, chances are really good it had a significant effect at p <.05, and probably his doctor has a medical degree and is unlikely to try things that are actively harmful to his health.

Also I am your biggest fan every from the Brunching Shuttlecock days and it is deeply internet-weird that I am discussing alternative medicine with you
posted by Mayor West at 10:58 AM on June 15, 2011 [3 favorites]

"Evidence-based medicine" simply means "only use cures that actually work."

No, it does not mean that. It means cures that have been scientifically validated through clinical trials. Big difference.
posted by Wordwoman at 10:58 AM on June 15, 2011 [3 favorites]

Lore,

Your question is, imo, a really, really good one. Basically my feeling is that if a person's quality of life is being corroded my something not potentially threatening then whatever path helps them is perfect. In that regard, chiropractic has been a miracle for some of my patients and I have a few that I refer to because their interventions are just as useful as a pill and they, like I do, stress that long term the best treatment is rigorous attention to fitness.

So again, if an alternate path helps you sleep better, be happier, be in less pain, feel less fear about a harmless but persistent symptom, then anyone who can step up and help is welcome into the tent, as long as they don't pretend to know that their treatment is somehow magical or revolutionary. Once you prey on the patient's vulnerability you deserve to be banished.
posted by docpops at 11:01 AM on June 15, 2011 [3 favorites]

For a group that likes to shout "the plural of anecdote is not data" so much, this thread definitely instills a great confusion in me.

"If a friend told you that...."

Doesn't matter how the rest goes; it's second-hand information I cannot verify and will be treated as such. As in: I will consider it in the future if it seems to apply but will ascribe no special value to it in absence of solid corroboration.
posted by Dark Messiah at 11:02 AM on June 15, 2011

It's called "alternative medicine" because if it worked, it would just be called "medicine."

Don't need anything more than that.
posted by MattWPBS at 11:03 AM on June 15, 2011 [2 favorites]

"Evidence-based medicine" simply means "only use cures that actually work."

No, it does not mean that. It means cures that have been scientifically validated through clinical trials. Big difference.

Do you have some other definition of "it works" other than "after carefully studying this in a controlled setting to ensure accurate observations, we have determined that treatment Y is a remedy to condition X."

You can't re-define something just because it doesn't mesh with your own conceptions.
posted by Dark Messiah at 11:04 AM on June 15, 2011 [3 favorites]

Except possibly this as well.

Tim Minchin's excellent Storm.

http://www.youtube.com/watch?v=HhGuXCuDb1U
posted by MattWPBS at 11:06 AM on June 15, 2011 [4 favorites]

Headache? Here, eat this root.

Ailment? Aliment.
posted by jamjam at 11:09 AM on June 15, 2011 [3 favorites]

The all or nothing thing going on here is really getting at me. What about all of the drugs yanked off the market because they kill people, let alone aren't affective? The "scientifically validated through clinical trials" is a great idea until it interferes with someone's profit margin.

What about the research that is blocked and therefore garnering any kind or enough scientific driven results about them are impossible (cannabis, stem cells, etc.). Medicine is big business and curing people for a small amount of money just doesn't fit that model.

An apple a day? No no no, just give me my apple extract pill from Merck thank you.
posted by premortem at 11:09 AM on June 15, 2011 [11 favorites]

It might be interesting¹ to see how education, income, and possibly geographic location correlate with disposition toward and against these "natural therapies".

1: depressing, predictable
posted by This, of course, alludes to you at 11:12 AM on June 15, 2011 [1 favorite]

A year after my car wreck, I was still having trouble with neck pain and turning my head to the left. I went through a round of doctors and was told to take ibuprofen. Yay. No references to a physical therapist, nothin'. It might be something I would have to "deal with," as they put it.

After months and money and more than enough doctors' offices, a friend suggested I try a chiropractor, who told me I was pretty flexible as it was, but that he could see I definitely could not turn to the left as much as to the right. He checked out some muscles, showed me where I was holding some joints in an asymmetrical fashion (I had my left shoulder hiked way way up) , did some stuff with TENS to exhaust some locked up muscles, and gave me some very specific exercises to do. A few weeks into it, my neck stopped hurting and I could turn my head almost as far to the left as I could before. He said, "I think we're done, because you're moving well and you're holding your body right. If it hurts again, try the exercises. If that doesn't work, come back." I never had to.

I think that's something the medical establishment could pick up on, rather than functioning as human Pez dispensers of NSAIDs. Wild idea, I know.
posted by adipocere at 11:13 AM on June 15, 2011 [32 favorites]

Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo.

The end. Move on humanity. Please.
posted by Decani at 11:13 AM on June 15, 2011 [4 favorites]

Homeopathy is a fraud and nonsense that prays on the gullible.

Not just the gullible, but also the poor and uninsured.
posted by Malice at 11:13 AM on June 15, 2011 [3 favorites]

That’s in large part because mainstream medicine itself is failing.

What the fuck? I literally would not be alive it weren't for mainstream medicine. We are, as a species, healthier than we've ever been. And it weren't for idiots claiming that vaccines are bad juju, we'd have eliminated even more diseases than we have.

Science, it works bitches.
posted by lumpenprole at 11:14 AM on June 15, 2011 [6 favorites]

What about all of the drugs yanked off the market because they kill people, let alone aren't affective?

True. Very true.

There are shitty, destructive "alternative" medicines as well. Of course they can't get pulled off the market because they're not regulated at all and then you have homeopathic teething tablets with dangerous levels of belladonna and...

There is bad mainstream medicine, and there is bad "alternative" medicine. I do not give a shit if people go to a chiropractor for their back pain. There's no reason to knock them or criticize them for it. We all do irrational things.

It starts to bother me when irrationality is embraced and "alternative" providers are allowed to step outside of the bounds of their knowledge and start infringing on useful and necessary medical care.

For that reason, if the government is going to endorse "alternative" medicine (or the Mayo Clinic, or whomever) then they need to get started on effectively regulating it and governing it.
posted by the young rope-rider at 11:16 AM on June 15, 2011 [1 favorite]

That’s in large part because mainstream medicine itself is failing.

To the extent that lots of people are sick today, they're sick because they don't have access to enough mainstream medicine.
posted by Apropos of Something at 11:16 AM on June 15, 2011 [6 favorites]

That’s in large part because mainstream medicine itself is failing.

I agree it's failing in providing treatment -- at least here in America. But that's a social failure, in that it's because of our failure to make sure that everybody is covered. If you have insurance, mainstream medicine, for its many foibles, remains the safest and most effective way to get treatment for an illness.
posted by Astro Zombie at 11:17 AM on June 15, 2011 [3 favorites]

A Phase III clinical trial is nothing to sniff at. They're not perfect, they're not infallible, they're not 100% immune to manipulation, but they are the most statistically powerful means we have of determining efficacy for a given treatment. All FDA-approved drugs have to pass Phase III clinical trials. All of them have to beat placebo, and commonly they have to beat current standard of care as well. They have to be well-tolerated, with reliable absorption and clearance and a low incidence of adverse effects.

The fact that some drugs are yanked from the market after adverse effects or lack of efficacy becomes apparent is not an argument in favor of alternative medicine—it is the opposite, because alternative treatments do not have any similar protective mechanisms in place.
posted by dephlogisticated at 11:18 AM on June 15, 2011 [2 favorites]

Also can we please stop calling it "Western" medicine, I believe that this is a bad way to conceptualize the distinction, thank you

Yes, but if what is sold to Westerners as alternative medicine did not invoke the exoticized other, it would lose its main source of appeal for people who have access to effective treatment. Not for nothing do alternative medicine salespeople juxtapose the alleged cold, impersonal rationality of "Western" medicine with the alleged natural, harmonious, intuition of alternative medicine. It's just a way of retaining the concept of the noble savage.
posted by Marty Marx at 11:19 AM on June 15, 2011 [13 favorites]

Mainstream medicine is failing only in the sense that as a society we are becoming better at developing endemic levels of things that medicine has no way to combat, which is to say the effects of laziness, unrealistic expectations, short-attention spans, lowered pain thresholds and anxiety thresholds in adults who never actually experienced real adversity (note the number of WW2 vets who ever complain about anything), and a near-total absence of exercise is creating a species that cannot be "treated" since the disease has yet to be defined.
posted by docpops at 11:20 AM on June 15, 2011 [2 favorites]

I feel bad saying what I think needs to be said: if you were having a health issue of some kind and acupuncture, lay-on-hands, homeopathy worked... it was psychological. AltMed has been shown, over and over and over, to work no better than a placebo. If it isn't fixing something physically then there was never anything else that could fix the physical symptom (well, okay, maybe LSD).

A lack of doctor/patient interaction is a failing of the practice of medicine, not medicine itself. Physical therapy is a medical practice. We know how joints work and which stretches/routines generally get joints to work as they should and to a full range of motion. Chiropractics... my experience with it was some physio and a lot of hand waving.
posted by Slackermagee at 11:22 AM on June 15, 2011 [2 favorites]

It may be time to stop practicing medicine if you insist on diagnosing your patients' medical complaints as moral inferiority and insufficient stoicism.
posted by Slap*Happy at 11:23 AM on June 15, 2011 [12 favorites]

It may be time to stop practicing medicine if you insist on diagnosing your patients' medical complaints as moral inferiority and insufficient stoicism.

OK, but maybe that is exactly who needs to be in medicine. Not because it is inherently judgemental, but because those practicioners with 15 or 20 years of experience are better able to counsel their patients why they aren't about to die of a rare wikipedia disorder without ordering 2 grand in blood work and CT scans.

But if you really think what I said isn't applicable please offer a coherent rebuttal instead of a pithy takedown.
posted by docpops at 11:27 AM on June 15, 2011 [3 favorites]

I'm not really arguing in favor of alternative medicine. I am just really surprised that the forward thinking people of metafilter are standing behind the FDA and intstitutionalized medicine as a monolith of infailability. These things are fluid and new studies come out saying that "there is potential here" and "the long-standing treatment we've used has been shown reduced efficacy in the light of new findings." Calling some herbal treatment that has been around for thousands of years complete bullshit because its not endorsed by the FDA and fed to me in a pill form is close minded.

Big Pharma's sole responsibility is not to make you better. It is to remain profitable to their shareholders.
posted by premortem at 11:27 AM on June 15, 2011 [5 favorites]

docpops: "Mainstream medicine is failing only in the sense that as a society we are becoming better at developing endemic levels of things that medicine has no way to combat, which is to say the effects of laziness, unrealistic expectations, short-attention spans, lowered pain thresholds and anxiety thresholds in adults who never actually experienced real adversity (note the number of WW2 vets who ever complain about anything), and a near-total absence of exercise is creating a species that cannot be "treated" since the disease has yet to be defined."

Are you exclusively treating bratty teenagers with overdeveloped senses of entitlement?

At least four things you mention: anxiety, obesity, lack of exercise and short attention spans seem quite clearly definable and treatable. If you're trying to say that they're all part of a new societal illness that didn't exist before, that's clearly inaccurate. Perhaps it has merely become more acute.

I spent a lot of time as a kid around my grandfather and his peers, all of whom were WWII vets. They had no problem complaining about every thing under the sun. Adversity is subjective to the person experiencing it, and the lessons one may take from those experiences probably varies widely between individuals.
posted by zarq at 11:31 AM on June 15, 2011 [11 favorites]

If it's not scientifically proven, it's not medicine and it doesn't work. Ever. Period.
That is...no. Things that have been scientifically proven would have worked better than placebo before they were vetted. They just hadn't been vetted yet.

There are plenty of home remedies that work. To take a basic example, there's scientific evidence that peppermint and ginger can successfully treat some forms of nausea and indigestion. (In fact, the NIH's MedLine Plus has a site dedicated to herbs and supplements, which provides analysis and journal references.) When you drink some ginger tea, you won't know how much zingerone you're getting on a milligram basis. But it's still effective. Not every treatment has to come in sealed packaging, or in pill form.

As goes the rest, it depends on the condition. If you have a pain or psychiatric condition that is improved by placebo, and that is not caused by a resolvable underlying condition, then great. Enjoy the crap out of your placebo. Especially if it involves attention, and someone trying to help you improve your diet and exercise habits. And if you want to take a pill, heck, there are some placebos that have continued support from the FDA. Just make sure you're exploring your traditional medicine options, as well.
posted by evidenceofabsence at 11:31 AM on June 15, 2011 [1 favorite]

I am just really surprised that the forward thinking people of metafilter are standing behind the FDA and intstitutionalized medicine as a monolith of infailability.

Who is doing that? Medicine is a fallible institution. But because it is a scientific one, we can learn from our failures, rather than keep repeating the same mistakes over and over again, because we believe in an invalid, untested premise.
posted by Astro Zombie at 11:31 AM on June 15, 2011 [5 favorites]

Chiropractics... my experience with it was some physio and a lot of hand waving.

Pretty much, yeah. But many practitioners are very, very responsible, and I think it's misguided to say that it's irrational to see one about back pain. I was once referred out by a physician to a chiropractor, and I've known lots of other people who have too. Chiropractics goes astray by not condemning and distancing itself from the stupid, irresponsible, claims that are made for it, often by its own professional associations. But if you have back or neck pain from a habituated problem like bad posture and lack of exercise, a chiropractor can do a really good job of getting you out of pain and in a position to start exercising and living better. They will X-ray you and send you right back to a doctor if there's any indication of disease or trauma that needs to be treated medically.
posted by George_Spiggott at 11:33 AM on June 15, 2011

stupid, irresponsible, claims that are made for it, often by its own professional associations. But if you have back or neck pain from a habituated problem like bad posture and lack of exercise, a chiropractor can do a really good job of getting you out of pain and in a position to start exercising and living better.

Out of curiosity, can you point to any evidence that this is true?

And it's worth remembering that GPs are usually not scientists -- they don't do research. They can be pretty susceptible to woo.
posted by Astro Zombie at 11:37 AM on June 15, 2011

Do you have some other definition of "it works" other than "after carefully studying this in a controlled setting to ensure accurate observations, we have determined that treatment Y is a remedy to condition X."

Sure. In the case of herb, it would mean that it's pharmacologically active and beneficial for a given condition. Willow bark, which contains a compound similar to aspirin, is a traditional herb that "worked" for pain and inflammation centuries before the advent of clinical trials. And surely there are patients in clinical trials right now for whom a therapy "works," whether or not the study has yet been completed.
posted by Wordwoman at 11:38 AM on June 15, 2011 [3 favorites]

At least four things you mention: anxiety, obesity, lack of exercise and short attention spans seem quite clearly definable and treatable.

Sure, if it's allopathic medicine that means a pill, and all of the above would be better treated in a venue of more education and better societal influences long before you get to my door. And even a cursory review of the data will tell you that obesity really isn't treatable. It simply isn't. Even bariatric surgery looks to be worse than we had hoped. But if you want to spend $250 per hour on medical advice that you can get from a dozen better places go for it. Most people don't pay a mechanic to tell them to get regular oil changes and fill their tires with air.

The point people don't want to see is that society is collapsing in on itself and they are looking to doctors to fix what is essentially a cultural phenomenon. These issues aren't very treatable once they take hold in adulthood.
posted by docpops at 11:38 AM on June 15, 2011

Who is doing that? Medicine is a fallible institution. But because it is a scientific one, we can learn from our failures, rather than keep repeating the same mistakes over and over again, because we believe in an invalid, untested premise.
posted by Astro Zombie at 11:31 AM on June 15 [+] [!]

Anything not FDA approved / handed out by your GP = alternative medicine = complete wonkery.
posted by premortem at 11:39 AM on June 15, 2011

Out of curiosity, can you point to any evidence that this is true?

Nope pure anecdote (happened to me/to others in front of me/people I know) and appeal to authority (direct conversations with doctors). But it's not a very challenging proposition -- the stuff about chiropractic that works is basically physical therapy with followup.
posted by George_Spiggott at 11:40 AM on June 15, 2011

Sort of corollary to the question above: If a friend said "I just came back from the chiropractor, and my back feels amazing," would you judge them any differently than if they said "I just got a back rub from a friend, and my back feels amazing"? If so, why?
posted by evidenceofabsence at 11:40 AM on June 15, 2011

A chiropracter made my back pain better once. Mostly because he had one of those massage tables with the hole for your face in it, and turns out, that was exactly the position I needed to get my neck in to get rid of the horrible crick that was plaguing me. 20 minutes and I was cured. This was in the days when getting an actual massage meant going to a shifty part of town or else a very exclusive spa, so it was chiro or nothing.

He then tried to sell me on weekly adjustments for an indefinite amount of time to cure my issues (can't remember if it was the one-leg-shorter spiel or the misaligned vertebra spiel). I declined.

So clearly the answer is; everyone needs one of those tables.
posted by emjaybee at 11:41 AM on June 15, 2011 [1 favorite]

Anything not FDA approved / handed out by your GP = alternative medicine = complete wonkery.

There hasn't been much of that in this thread. Or any. There has been concern voiced that you won't know precisely the quantities of medicine you're taking if it's just a root you're chewing on -- or if it's even the root you need, since there is no organization to provide oversight and make sure the contents of an alternative medicine package is what it claims to be.
posted by Astro Zombie at 11:42 AM on June 15, 2011

Everyone I've ever known personally who was helped by either "Western" medicine OR so-called "Alternative" medicine arrived at the practitioner by some form of automobile. Car. Ambulance. Bus. The only logical conclusion is that car exhaust can cure almost anything.
posted by It's Raining Florence Henderson at 11:42 AM on June 15, 2011 [6 favorites]

the effects of laziness, unrealistic expectations, short-attention spans, lowered pain thresholds and anxiety thresholds in adults who never actually experienced real adversity (note the number of WW2 vets who ever complain about anything) (note the number of WW2 vets who ever complain about anything)
...

The point people don't want to see is that society is collapsing in on itself and they are looking to doctors to fix what is essentially a cultural phenomenon.


Well, at least they pay you to read them snippets of David Brooks columns. I hope you're not providing mental health services. Or pretending to.

But if you really think what I said isn't applicable please offer a coherent rebuttal instead of a pithy takedown.

1) The claim that WW2 vets were made stoics by real adversity, unique to their experience in WW2 is a myth. Not all WW2 veterans saw combat, or adversity. Not all people who have seen adversity sufficient for you to deem it real adversity are WW2 veterans. Of the WW2 veterans who did see combat and real adversity, not all of them were stoics. Some of them, a great many of them, in fact, complained endlessly about integration, feminism, communism, and sexual liberation because of their own irrational fears.

2) Even that aside, why would a doctor expect patients to only seek medical help for "real" illnesses? If people could know what was wrong and whether it was worth worrying about without without any specialized training, there'd be no need for a specialized class of doctors to begin with. Part of providing medical care is clearing away false positives.

3) Being stoic about apparent illnesses makes it harder to get effective care for real diseases in their early stages. Valorizing those who are stoic about apparent illnesses discourages people from going to the doctor, for fear they will be seen as hypochondriacs, when in fact, they just aren't doctors. If you want to do any sort of preventative care, and you should, stoicism is a problem, not a solution, for medical care.
posted by Marty Marx at 11:43 AM on June 15, 2011 [16 favorites]

If a friend said "I just came back from the chiropractor, and my back feels amazing," would you judge them any differently than if they said "I just got a back rub from a friend, and my back feels amazing"? If so, why?

I wouldn't. But if either came and said "I am now cured of a ruptured disc," I'd be suspicious. And chiropractors, for the most part, don't claim to be massage therapists. There is a whole theory of misalignment that isn't rooted in science.
posted by Astro Zombie at 11:44 AM on June 15, 2011 [2 favorites]

The point people don't want to see is that society is collapsing in on itself and they are looking to doctors to fix what is essentially a cultural phenomenon. These issues aren't very treatable once they take hold in adulthood.

You don't appear to hold any respect for mental health as an aspect of medicine, and seem to be using this "tough love" nonsense as a treatment for psychological conditions.

A good indication that a pithy takedown is exactly what the doctor ordered.
posted by Slap*Happy at 11:44 AM on June 15, 2011 [2 favorites]

It might be interesting1 to see how education, income, and possibly geographic location correlate with disposition toward and against these "natural therapies".

Here you go. Trends in use of complementary and alternative medicine by US adults: 1997-2002.
posted by Wordwoman at 11:46 AM on June 15, 2011

Does alternative medicine have a $200 pill that will protect you from the death-scourge of acid reflux for a full 24 hours???? Hmmm?????
posted by George_Spiggott at 11:46 AM on June 15, 2011

Additionally, as the studies seem to say that just having a hobo under a bridge rub your back will do about as much good as chiropracty, it bothers me that they charge as much as they do. Next time my back hurts, I'm getting it treated for the cost of a bottle of Ripple.
posted by Astro Zombie at 11:46 AM on June 15, 2011

Does alternative medicine have a $200 pill that will protect you from the death-scourge of acid reflux for a full 24 hours?

I have acid reflux. I treat it, when it acts up, with an over-the-counter medicine that costs about 20 cents per pill, and I don't eat just before I go to sleep, and I prop my head up, exactly as my doctor recommended. It works, and now I no longer have a chronic cough, as I did for two decades.
posted by Astro Zombie at 11:48 AM on June 15, 2011 [1 favorite]

docpops: "Sure, if it's allopathic medicine that means a pill, "

Is psychiatry not considered allopathic medicine? Because anxiety doesn't necessarily have to be treated with drugs, and obesity could easily be a result of psychological stresses and issues that could be talked through and perhaps resolved with a trained psychiatrist or psychologist.

There are also treatable physical conditions which make people more prone to obesity, such as PCOS -- one of the most common female hormonal disorders. It appears in anywhere approximately 5-12% of women of reproductive age. If a woman has PCOS, self-educating herself on obesity, diet plans and exercise aren't going to help her manage her condition without diagnosis and treatment.

Respectfully, I think you're overgeneralizing. And I think examples probably abound that disprove the idea that "if you want to spend $250 per hour on medical advice that you can get from a dozen better places go for it."
posted by zarq at 11:49 AM on June 15, 2011 [1 favorite]

Astro Zombie: Dunno. The people I know who go to acupuncturists or chiropractors aren't laboring under some kind of delusion that they're cured. They mainly do it because it feels nice. As goes the cost, I wonder if that plays into the effectiveness of the treatment. The more bitter the medicine, the more effective::The more expensive the service, the more apparently worthwhile?
posted by evidenceofabsence at 11:50 AM on June 15, 2011

Marty Marx,

Great points. The WW2 vet analogy is a poor one, and your are correct that stoicism is bad for care. It is hard to convey how wearying it is to see people elevate the natural aging process - by all accounts a true gift - with catastrophe. It is likewise worrisome to see patients demand fixes that do not exist for self-inflicted problems of obesity and poor diet. I actually do a lot of mental health counselling and love doing it. All primary care docs do a lot, actually. I guess a better way of putting it is that when someone has watched friends die of illness, has weathered an economic depression, has waded through real adversity, their expectations of what constitutes catastrophe changes. I could tell them as much, but almost by definition if they truly believe that it is a tragedy that they can no longer run twenty miles a week and demand to be fixed, or want a pill for fatigue but won't exercise, they just don't always end up being any more receptive to being told the harsh truths that most people a generation ago recognize intrinsically.
posted by docpops at 11:52 AM on June 15, 2011

Do they have acid reflux in countries like Spain where they sit down at regular times and eat prepared meals and spend time over them; or just in this one, where we jam a microwaved frozen thing from Costco down our throat whenever we can spare a moment?
posted by George_Spiggott at 11:52 AM on June 15, 2011 [1 favorite]

George_Spiggott: "Do they have acid reflux in countries like Spain where they sit down at regular times and eat prepared meals and spend time over them; or just in this one, where we jam a microwaved frozen thing from Costco down our throat whenever we can spare a moment?"

Yes, they still do.

I have esophageal reflux. It's a physical disorder, not a dietary one. I have a hiatal hernia, and the sphincter at the base of my esophagus/top of my stomach does not close correctly. It never has. Certain foods and drinks, being overweight and laying horizontally on a full stomach can exacerbate the condition. So can stress.

Taking time to eat and digest helps. Not being obese helps. Eating healthy, non-irritating food also helps. But the root cause is (to my understanding) typically a physical one.
posted by zarq at 11:59 AM on June 15, 2011 [6 favorites]

where we jam a microwaved frozen thing from Costco down our throat whenever we can spare a moment?

That doesn't define my diet. And I've had acid reflux since I was a boy, and my parents made me homemade meals with a sort of obsessive eye toward fresh, healthy food.

As to your question: Yes, about 15 percent of the population of Spain has GERD. About the same as Americans; maybe slightly less.
posted by Astro Zombie at 11:59 AM on June 15, 2011 [4 favorites]

kitarra: "chiropractic neck-breaking and artery shearing?"

Are you claiming these things don't happen? Just so you know, they do.

Chiropractors can help certain conditions, I won't deny that. But there are still chiropractors out there that do "neck adjustments", and these techniques are very dangerous, and potentially even deadly.
posted by idiopath at 11:59 AM on June 15, 2011 [1 favorite]

Astro Zombie: Dunno. The people I know who go to acupuncturists or chiropractors aren't laboring under some kind of delusion that they're cured. They mainly do it because it feels nice. As goes the cost, I wonder if that plays into the effectiveness of the treatment. The more bitter the medicine, the more effective::The more expensive the service, the more apparently worthwhile?

There are many ways to feel nice that don't involve giving money to scam artists. Acupuncture releases endorphins, an effect you can get from a brisk job. Chiropractors do mild physio and massage, which can be had from people who aren't charging you hundreds of dollars to sever your spine trying to improve your hearing.
posted by kafziel at 12:01 PM on June 15, 2011

OK, I get that some conditions are nebulous and that there's some controversy over how prevalent depression as a medical condition are and all that, but let's not put acid reflux into that category when we have things like fluoroscopy and manometry that can show me my esophageal sphincter failing in real time, OK?
posted by infinitywaltz at 12:02 PM on June 15, 2011

@Marty Marx

Yes, but if what is sold to Westerners as alternative medicine did not invoke the exoticized other, it would lose its main source of appeal for people who have access to effective treatment. Not for nothing do alternative medicine salespeople juxtapose the alleged cold, impersonal rationality of "Western" medicine with the alleged natural, harmonious, intuition of alternative medicine. It's just a way of retaining the concept of the noble savage.

Very well said, for real. Thank you.

@docpops

Mainstream medicine is failing [...] the disease has yet to be defined.

The point people don't want to see is that society is collapsing in on itself and they are looking to doctors to fix what is essentially a cultural phenomenon. These issues aren't very treatable once they take hold in adulthood.

Okay, I was with you through the quiet classism and the whole "greatest generation" bit, but come on. Throwing in millenarianism? You oversold it.
posted by This, of course, alludes to you at 12:03 PM on June 15, 2011 [2 favorites]

A brisk job will cure a lot of things, I think we can all agree on that.
posted by premortem at 12:04 PM on June 15, 2011 [1 favorite]

A brisk job will cure a lot of things, I think we can all agree on that.

And only costs $5! Same as in town!
posted by Astro Zombie at 12:07 PM on June 15, 2011 [3 favorites]

Every so often I like to pick up Pliny the Elder's Natural History to remind myself of how lucky I am to live in the modern era. The terrifying thing is that I've heard some of the same horrifying 'cures' stated by people who should know better. Strangely, though, not the headache cure of wearing a bra on your head, which is a pity. That one should be revived, just because.
posted by lesbiassparrow at 12:09 PM on June 15, 2011 [1 favorite]

It is hard to convey how wearying it is to see people elevate the natural aging process - by all accounts a true gift - with catastrophe. It is likewise worrisome to see patients demand fixes that do not exist for self-inflicted problems of obesity and poor diet.

Fair enough, and I may have been overly harsh in making my point. The medium encourages bombast. That said, what you're describing sounds like the effects of burnout. It is tough to see people who really care about their clients come to resent them--think of, say, overworked public defenders or teachers complaining about worthless clients or stupid students--not least because really caring is what makes them susceptible to burnout in the first place. If that's the case, be sure to care of yourself; you'll be taking care of your patients too. IANAD.
posted by Marty Marx at 12:12 PM on June 15, 2011

Poll: how many times has [scientific] medicine saved your life?

Six, maybe eight - I've lost track of my hospitalizations at this point. And that doesn't count vaccinations, or the "might never have been born" factor of my dad's ruptured appendix.
posted by nickmark at 12:18 PM on June 15, 2011 [1 favorite]

Marty Marx,'

I can appreciate how it mind sound like burnout. The neat thing about primary care, though, is that you really do come to care for the people you treat, and so even the most enervating person has a depth to them that allows you, in almost any situation, to find something enjoyable to see in them. My comments are more directed at the problem of medical care as seen from space, not from inside the exam room.
posted by docpops at 12:20 PM on June 15, 2011

Anything not FDA approved / handed out by your GP = alternative medicine = complete wonkery.

I think some people mistake experimental medicine, which is based on plausible scientific hypotheses and limited experimentation with the goal of becoming mainstream, with alternative medicine, which is based on principles that are scientifically implausible and cannot ever be part of mainstream science.
posted by melissam at 12:25 PM on June 15, 2011 [3 favorites]

As an aside, my sister was watching Bones recently and I saw them mention a sternal foramen. When I looked it up I found this disturbing article: Fatal cardiac tamponade after acupuncture through congenital sternal foramen. Basically a sternal foramen is a hole in the sternum and an unfortunate acupuncturist accidentally went through it, killing her. 6-9% of men have a sternal foramen and a smaller percentage of women.
posted by melissam at 12:34 PM on June 15, 2011 [1 favorite]

Cardiac tapenade may be fatal, but it is delicious.
posted by It's Raining Florence Henderson at 12:37 PM on June 15, 2011 [5 favorites]

I know more about this than you can possibly imagine!
posted by diogenes at 12:38 PM on June 15, 2011 [4 favorites]

This is testable. It's an absurd case of special pleading to say "alternative medicines" (a catchall for implausible treatments lacking evidence) works when you're not looking but doesn't work when you are. If patients get subscribed these treatments and they work, then evidence exists to prove it. Incorporate all of the crap you think is happening and test it.

Bullshit like this doesn't require a frontpage post or a few hundred comments. It requires an experiment. If these "doctors" still believe their stuff works, they can elaborately set up their holistic approach with everything they think matters and test it. It's not outside science.

Some of these approaches probably work. There is no benefit by association, however, and before you make claims you need to do the experiment. Why haven't the experiments been done? Because most of these assholes know their shit's fake, but they also know that their patients are too ignorant to care.

It's not outside science. Test it.
posted by Buckt at 12:38 PM on June 15, 2011 [3 favorites]

It works every time. You talk shit about somebody on the web and they show up.
posted by Astro Zombie at 12:39 PM on June 15, 2011

The problem, I think, is that people expect their family doctor to be a one-stop shop for all things medical, when that just isn't the reality. GPs are really more like glorified receptionists, simply directing patients to the appropriate treatment, which is inevitably found elsewhere, from a specialist or a pharmacist.

Oddly enough, a lot of people really don't like that. And it's something alternative medicine does not do. There is nobody standing between patient and treatment. It's just right there. You have to pay through the nose and go back every week and never stop clapping your hands so Tinkerbell doesn't die, but, hey, it's at least streamlined.

Also, I've been through the alternative medicine thing, and, yes, it's at least 90% bullshit designed to extract as much money from the patient as possible, but I'll be damned if the 'doctors' weren't more pleasant and informative (baloneously so, but still), rather than rushed, dismissive, and worthlessly unknowledgeable like every GP I've ever had the displeasure of being forced to visit for largely bureaucratic reasons.

If the medical establishment has anything to learn from alternative medicine, it's that.
posted by Sys Rq at 12:45 PM on June 15, 2011 [2 favorites]

but I'll be damned if the 'doctors' weren't more pleasant and informative

For $20, I'll tell you that I love you. Same as in alternative medicine.
posted by It's Raining Florence Henderson at 12:48 PM on June 15, 2011 [2 favorites]

Well, exactly. But real doctors get paid, too, right?
posted by Sys Rq at 12:49 PM on June 15, 2011

Okay - maybe I say that for all the customers. But with you it's different. You were really, really good. Next time, we'll fix your aura. But only because I can see how special you are. $20, please. Discount, because I love you.
posted by It's Raining Florence Henderson at 12:50 PM on June 15, 2011

GPs are really more like glorified receptionists, simply directing patients to the appropriate treatment

I have more respect for the person who says they don't know the answer and sends me up the chain of authority and expertise than the person who enthusiastically wants to heal me.
posted by dgran at 12:50 PM on June 15, 2011 [2 favorites]

I'm as skeptical as just about anybody but I think we're missing a syllogism here: 1. alternative medicines are placebos, and 2. placebos can be powerful medicine. Doctors regularly prescribe treatments that they know are not more effective than placebos, not because they don't know or care or want the patient out of their hair, but because they don't have a better treatment to offer and know that the effectiveness of the placebo effect has been thoroughly proven – not only in medicines, but even for surgery, e.g. arthroscopic débridement for osteoarthritis.

So, should doctors reject alternative treatments that they know are only placeboes? I'm not sure why, since they don't always reject conventional treatments on that basis, if they believe that they can trick a patient into curing himself. The oath is to "do no harm" and "prescribe regimens for the good of my patients according to my ability and my judgment" – not to be honest.
posted by nicwolff at 12:53 PM on June 15, 2011 [2 favorites]

Yep - "Real" doctors get paid, too. Even if they don't help you. Because you aren't paying for a friend or a pat answer. You're paying for someone to apply the best answers that science can provide. Will you get what you paid for? Hard to say. Doctors are people, with all the attendant failings implied by that statement, and all the attendant pluses, too. But at least when you pay the doctor, you're also getting the benefit of the centuries of science on which they stand. Better than a happy ending any day.
posted by It's Raining Florence Henderson at 12:55 PM on June 15, 2011

Does alternative medicine have a $200 pill that will protect you from the death-scourge of acid reflux for a full 24 hours???? Hmmm?????

You say this like reflux isn't a big deal (and I'm sure that for a lot of people it isn't a big deal) but my partner had severe damage to his esophagus from reflux, to the point where he couldn't eat normally and was significantly underweight. He had to have emergency surgery when a normal sized piece of food got stuck in his esophagus and prevented him from swallowing for nearly a day. A few months later he needed an additional surgery to further repair his damaged esophagus.

He takes a pill for reflux every day. I have no idea how much it costs our insurance company; I do know that they throw a fit about it on a regular basis so I'm assuming that it's expensive.

Point being: just because you don't need a treatment doesn't mean it's useless or for whiners.

And frankly, even if his problem were caused by scarfing meals from CostCo (it's not, his mother is an amazing and healthy cook and he's had reflux since infancy) does that mean that we shouldn't get medical treatment for the problem? Is it only an actual medical problem that deserves treatment if those who suffer from it lead perfect lifestyles full of slow/raw/organic/fermented foods eaten at a leisurely pace?
posted by the young rope-rider at 12:58 PM on June 15, 2011 [3 favorites]

nicwolff: "alternative medicines are placebos, and 2. placebos can be powerful medicine."

3. medicine that actually does something also applies the placebo affect. Plus it does something else too!

not that you didn't know that already
posted by idiopath at 12:58 PM on June 15, 2011 [2 favorites]

docpops: "Sure, if it's allopathic medicine that means a pill, and all of the above would be better treated in a venue of more education and better societal influences long before you get to my door. And even a cursory review of the data will tell you that obesity really isn't treatable. It simply isn't. Even bariatric surgery looks to be worse than we had hoped. But if you want to spend $250 per hour on medical advice that you can get from a dozen better places go for it. Most people don't pay a mechanic to tell them to get regular oil changes and fill their tires with air. The point people don't want to see is that society is collapsing in on itself and they are looking to doctors to fix what is essentially a cultural phenomenon. These issues aren't very treatable once they take hold in adulthood."

It sucks that so much of medicine is playing catch-up to socioeconomic and behavioral processes that began decades before the patient entered your clinic. That said, I don't think that Medicine can simply wash its hands of these problems. We didn't back down from AIDS and I don't see why we should back down from obesity just because the etiology is less discrete.

The Medical Home model's been around for almost two decades and I still hear physicians balking at the thought of referring out to dietitians or exercise coaches. Obesity is eminently treatable, and treatment failure can't just be chalked up to nonadherence. SDM and MI technique have come a long way in addressing barriers and improving adherence, and if a practice doesn't have the resources to employ those tools then it needs to refer out. Maybe this is a little too Pollyanna, but I think that it's neglectful to look at the morbidity and mortality associated with obesity, diabetes, and heart disease and decide that it's not our domain; these clods won't just wash away if clinicians fail to get involved in mankind.
posted by The White Hat at 1:01 PM on June 15, 2011 [1 favorite]

Look, sometimes one thing works and sometimes it's another.

My example: I used to be the health reporter at a newspaper. I got assigned to do a series on "alternative medicine." I woke up on the day I was to go to the health food store with impending laryngitis. I called my HMO, who said, "There's nothing we can do. Stop talking, but you're going to lose your voice anyway." I went to my appointment with a croaking voice, they gave me friar's balsam (which I now recommend to everybody with a throat ailment), and the laryngitis went away. If I start taking that stuff when a throat ailment comes on, it goes away quickly. So there's a clear win for the hippie-dippie over the medical establishment.

On the other hand, if I had an ailment that only antibiotics are gonna cure, drinking tea isn't going to work. What it really boils down to is, detective work needs to happen. You should probably try traditional routes first, but if medical science hands you some pills, shrugs, and says, "Deal with it," then hell, why not try the weird shit if rational shit isn't working? Assuming that you research whatever the hell you're doing first before you try it.

On a related note, I interviewed an acupuncturist for the same series and he said, "I have NO IDEA how the hell this works, but it seems to." This was a guy who had actually gone to China to study it. Whether it's placebo or not, I vote for "whatever works."
posted by jenfullmoon at 1:03 PM on June 15, 2011 [4 favorites]

The White Hat -

The Medical Home is a joke. Know why? Because if all you are doing is a slightly better job of treating 1/2 the population while denying care and insurance to the rest your society still goes bankrupt.

And the studies on "coaching" and nutritional advice for obesity reflect that in the end the patient generally never gets any less obese, save for a minute change that does not alter the course of their life.

But the weirdest part of what you said is that I would dance like a man on fire if I could refer a patient for help with their weight. But I can't. Insurance does not pay. Not to help you quit smoking, or eat better, or really anything that would be useful, so it's up to us in the middle of an already overscheduled day to "do something".
posted by docpops at 1:05 PM on June 15, 2011

Yep - "Real" doctors get paid, too. Even if they don't help you. Because you aren't paying for a friend or a pat answer. You're paying for someone to apply the best answers that science can provide. Will you get what you paid for? Hard to say. Doctors are people, with all the attendant failings implied by that statement, and all the attendant pluses, too. But at least when you pay the doctor, you're also getting the benefit of the centuries of science on which they stand. Better than a happy ending any day.

I AGREE!!!

It's just that, you know, sometimes having to physically go to a GP's office and pay like $50 for a ten-minute appointment just so I can ask for a referral to someone who actually knows something about my condition is kind of a pain in the ass.

Streamlining. That's all I'm saying. Occasionally pretending to give a shit would just be a bonus.
posted by Sys Rq at 1:06 PM on June 15, 2011

You say this like reflux isn't a big deal (and I'm sure that for a lot of people it isn't a big deal) but my partner had severe damage to his esophagus from reflux, to the point where he couldn't eat normally and was significantly underweight. He had to have emergency surgery when a normal sized piece of food got stuck in his esophagus and prevented him from swallowing for nearly a day. A few months later he needed an additional surgery to further repair his damaged esophagus.

I think reflux is a great example of what experimental medicine is, versus alternative. In alternative medicine, you are relying on things that are scientifically implausible. You can try acupuncture, but there is no scientific mechanism for it working and therefore no way to separate the placebo effect from any real effects. Contrast that with the EXCELLENT doctor who treated me for severe chronic reflux. He had read the medical literature and seen a small, but promising study on low-carb helping reflux. On his recommendation I did low-carb and experienced remission from symptoms. Further exploration of the scientific literature fought that preliminary studies were finding a lot of reflux patients have eosinophilic esophagitis, a food allergy. I turned out to have this and elimination of the offending foods meant I no longer needed a low-carb diet. Perhaps someday these can be part of mainstream reflux treatment, particularly since the long term effects of proton pump inhibitors are questionable.
posted by melissam at 1:07 PM on June 15, 2011 [4 favorites]

Nonsense. Every ailment I don't have personally is sheer hypochondria.

(Apologies if I was insensitive, the young rope-rider.)

(OTOH I still find that one pill for toenail fungus to be some combination of hilarious and depressing.)
posted by George_Spiggott at 1:08 PM on June 15, 2011 [1 favorite]

the natural aging process - by all accounts a true gift

Not by my account.
posted by adamdschneider at 1:08 PM on June 15, 2011

It's just that, you know, sometimes having to physically go to a GP's office and pay like $50 for a ten-minute appointment just so I can ask for a referral to someone who actually knows something about my condition is kind of a pain in the ass.

We don't like it either, but the very specialists who fought the gatekeeper model fifteen years ago now won't see you unless we set up your consult like a Titleist ready for a drive at Pebble Beach. Sorry you got stuck in the middle.
posted by docpops at 1:10 PM on June 15, 2011

Occasionally pretending to give a shit would just be a bonus.

Just like in town!
posted by nickmark at 1:12 PM on June 15, 2011 [1 favorite]

The problem for me with what is called alternative medicine is that you can make all sorts of claims and no one prevents nonsense or bad stuff being done. Example: homeopathy has as yet not been shown to work. I have not seen any statistics that prove it to be a valid form of medicine, and yet there are "doctors" who hang up a shingle and offer this as medical help.
Now alternative medicine might in most cases be harmless,but if one goes this route he might not get the treatment that is really needed.

The Chinese have what we would call alternative medicine--that is, ancient approaches to curing problems, and they teach this even today. But they also offer what we can simply call Western medicine, and one has a choice.

What we do know: placebos work in traditional medicine. So they should also work in alternative medicine. Ergo: both forms of medicine work!
posted by Postroad at 1:12 PM on June 15, 2011

Has anyone linked to Mitchell and Webb's Homeopathic A&E yet?

"Right, get me a bit of Blue Ford Mondeo ..."
posted by George_Spiggott at 1:18 PM on June 15, 2011 [3 favorites]

It's important to distinguish between healthcare and evidence-based medicine. The first is the entire system: I live in the US, so my employer pays my insurance company to pay my doctor to take care of me. Evidence-based medicine employs the scientific method (rigorous clinical trials at best, time series without intervention at worst) to determine whether the treatment works. Then, of course, there are the social factors: agriculture subsidies, smog in cities, lead in older homes, your mother's socioeconomic status. These exist outside of the purview of the healthcare system but greatly influence your health.

Saying that access is better at the acupuncturist's than at your PCP's doesn't condemn "Western" medicine, it just says that the healthcare system kind of sucks!
posted by teragram at 1:23 PM on June 15, 2011

This rarely comes up with my patients, thankfully. Homeopathic anesthesia has been conclusively discredited.
posted by etherist at 1:24 PM on June 15, 2011 [3 favorites]

placebos work in traditional medicine. So they should also work in alternative medicine. Ergo: both forms of medicine work!

Someone who is gullible in one subject is probably gullible in other subjects, ergo anything I say is the truth.
posted by It's Raining Florence Henderson at 1:24 PM on June 15, 2011

I suffer from migraines. I've had five in the past thirteen days. They often prevent me from working, from enjoying life, or for being available to and consistent with my family. It's awful. Numerous doctor and specialist visits and thousands of dollars later, I have a pill I can take 1-2 times a week that makes me feel like shit and gives me about a 60% chance of not feeling awful when I wake up the next day. Thanks, conventional medicine. I see an acupuncturist on Tuesday. Placebo or not, I don't care. I'm willing to try anything, even if it makes me look like an anti-scientific idiot, because so-called evidence-based medicine has been able to do less than nothing for me.

Well you're in luck my friend, because it so happens I'm having a special on my non-western alternative medicine, learned from traditional African healers!

At no charge, I have already done my examination of your problem, and I can definitely say that it is due to WITCHCRAFT! Yes, one of your family or significant others is a witch, and has been causing you to suffer migraines. But fear not- for the low, low price of $60.00 I will create a counter-curse which will halt the witch's magic, and give immediate relief from your pain (repeat treatments will be necessary of course as the counter-curse wears off). If you want a permanent treatment, then for a low, low $300.00+ expenses I will come to your home and eliminate the witch. Our treatment is guaranteed! If after killing the witch you continue to have the symptoms, for no charge we will hunt down and kill the second witch that must be cursing you!

Don't delay in finding and killing the person near you who is a witch- freedom from chronic pain is just a credit card number away!
posted by happyroach at 1:31 PM on June 15, 2011 [2 favorites]

OK, to all the people advocating alternative medicine here, I present this article to you: http://www.nytimes.com/2008/09/11/health/research/11knee.html.

In the study mentioned (and one previously) researchers determined that, contrary to what doctors thought (before properly controlled studies were done), a particular type of surgery for arthritis was completely ineffective (no better than sham surgery).

So, my questions are: Given your position on alternative medicine, what would you suggest to someone considering this surgery? Would you tell them you believed the treatment to be effective or not, based on the evidence? Does your logic line up with what you would say about any other treatment, say, acupuncture?

Keep in mind:
1. The treatment was thought to work.
2. Controlled studies showed people were no better than if they hadn't had the treatment.
3. In these two important respects, this situation is exactly analogous to studies of acupuncture, etc. The fact that it is "western" medicine is irrelevant.
posted by Philosopher Dirtbike at 1:35 PM on June 15, 2011 [1 favorite]

No, it does not mean that. It means cures that have been scientifically validated through clinical trials. Big difference.

Do you have some other definition of "it works" other than "after carefully studying this in a controlled setting to ensure accurate observations, we have determined that treatment Y is a remedy to condition X."

It should be obvious that there are some things -- long-term lifestyle changes, primarily -- which are very difficult or impossible to run a double-blind test on, assuming modern ethical human-research standards. It should be equally obvious that there are many conditions for which conventional medicine has no good explanation and/or cure. Add outright political bias against some effective treatments (see: cannabis, opiates, ephedrine) to our bias toward profitable treatments which fit the double-blind model, and it becomes likely that there are many treatments which may work even though they're not officially approved.

In short: yes, most people have definition of "it works" other than "after carefully studying this in a controlled setting to ensure accurate observations, we have determined that treatment Y is a remedy to condition X" -- they say "after trying this, I got better". Placebo or not, relief of symptoms is what matters to the patient. Insisting that it's not "really" happening is rarely helpful.

That said, a lot of "natural" medicine is dangerous or scammy bunk, and could stand to be replaced (with some safer and less predatory bunk, at the very least): homeopathy, chiropracty for ailments other than back pain, "energy"-based touch healing, crystal blah blah blah etc. However, the idea that FDA approved treatments are The Only Things That Work is equally bunk. And lifestyle is the elephant in the room for most people -- if some of the "energy" healers and crystal-waggers are addressing that in an effective way, then it follows that even the bunkiest of the bunk can make a difference.

I think it's high time for an overhaul of our medical (and social) ideals; we need to look at health in a more holistic, preventative, day-to-day way, and we need to change society and our environment so that it promotes good health rather than illness. Do that, and the oh-so-important distinction between "natural" medicine and "Western" medicine will fall away.
posted by vorfeed at 1:39 PM on June 15, 2011 [5 favorites]

Philosopher - maybe a better question is whether acupuncturists and chiropracters are doing their own studies to see if their therapies stand up to scrutiny. I can at least know that most of what I recommend is being challenged and if it turns out over time to be ineffective I will eventually know that.
posted by docpops at 1:40 PM on June 15, 2011

Wait, I just want to make sure: When we're talking about brisk jobs, are we talking about handjobs or blowjobs?

I just want to know what I should be searching for on PubMed.

Aw, shucks.
posted by evidenceofabsence at 1:41 PM on June 15, 2011

And, success!
posted by evidenceofabsence at 1:42 PM on June 15, 2011

People love Traditional Chinese Medicine. I just feel bad that Traditional European Medicine like blood-letting and cobwebs doesn't get more cred.
posted by the jam at 1:44 PM on June 15, 2011 [3 favorites]

Your search has produced this awesome image of a bat going down on another bat.

HERE EAT THIS ROOT INDEED.
posted by Astro Zombie at 1:45 PM on June 15, 2011 [6 favorites]

OH MY GOD I WAS LOOKING AT THAT SAME EXACT IMAGE WHEN YOU POSTED.

No joke.

So, if alternative medicine isn't going to fix us, what will?
posted by evidenceofabsence at 1:47 PM on June 15, 2011

So, if alternative medicine isn't going to fix us, what will?

Daily exercise, luck, and a good attitude, mostly.
posted by docpops at 1:49 PM on June 15, 2011

I'm waiting on the medical nanobots.
posted by Astro Zombie at 1:50 PM on June 15, 2011

For some things, there are no cures. Trust me on that one.
posted by It's Raining Florence Henderson at 1:52 PM on June 15, 2011

Daily exercise, luck, and a good attitude, mostly.

And blowjobs. You forgot blowjobs.
posted by evidenceofabsence at 1:53 PM on June 15, 2011 [1 favorite]

I know that when I bought into the holistic thing, I tried about fifteen different commonly used herbs to treat my condition. Not all at once, unless recommended. I did them all for the allotted period of time (for example, Vitex has very specific instructions on its use).

As much as I wanted them to work, as much as I believed, in the end I had to look at the evidence in front of me. It did. not. work. In fact, two of them may have made it worse.

If these things do work, then they should work or have some effect on everyone who takes them, not just some - as often the rebuttal is 'well maybe it just didn't work for you!' NO, bullshit.

This is why scientific research is important. If a medicine works, it works. It should have some effect for almost everyone. I'd have more faith in the ones that actually affected me adversely than the ones that did nothing at all.

I don't have schizophrenia, but if I take depecote, I know it will effect me. If I don't have an infection, but I take antibiotics, I'll still feel the effects of it.

And for the record, I don't consider things like 'stem cell research' to be homeopathic. Just because something is rejected or untested, doesn't make it homeopathic. It does not automatically fall into that category. Likewise, I don't believe that all homeopathic medicine is BS (for example, aspirin was once homeopathic). Just most of it.
posted by Malice at 1:53 PM on June 15, 2011

docpops: maybe a better question is whether acupuncturists and chiropracters are doing their own studies to see if their therapies stand up to scrutiny.

Yes, that was what I was getting at - properly investigating the method, and acting on the basis of evidence from the investigation is what counts. The type of method ("alternative" or "Western") is irrelevant. they're just words. If a person wouldn't recommend the knee surgery because it hasn't been shown to work, why would they advocate homeopathy or acupuncture?
posted by Philosopher Dirtbike at 1:53 PM on June 15, 2011

why would they advocate homeopathy or acupuncture?

I guess, to be honest, it is because we are desperate at times to bring something marginally useful to a patient's dilemma. And as I say all the time, if it cannot cause harm, and one is aware of the lack of proof behind it, who am I to posture that it is not a reasonable course of action (unlike knee surgery, with all the terrible risks of infection and anaesthesia)?
posted by docpops at 1:57 PM on June 15, 2011

Dirtbike, the article you linked to is about the same study that I cited as evidence that the placebo effect is powerful. Because all surgery has risks, and the study shows that this surgery has no benefits over the placebo, doctors should not recommend this surgery.

The interesting question is: since the study shows that both the surgery and the placebo have real benefits to the patient, why shouldn't doctors recommend the placebo?
posted by nicwolff at 1:59 PM on June 15, 2011

docpops: "The Medical Home is a joke. Know why? Because if all you are doing is a slightly better job of treating 1/2 the population while denying care and insurance to the rest your society still goes bankrupt.

And the studies on "coaching" and nutritional advice for obesity reflect that in the end the patient generally never gets any less obese, save for a minute change that does not alter the course of their life.

But the weirdest part of what you said is that I would dance like a man on fire if I could refer a patient for help with their weight. But I can't. Insurance does not pay. Not to help you quit smoking, or eat better, or really anything that would be useful, so it's up to us in the middle of an already overscheduled day to "do something"."

1) Medicaid is already looking into using Medical Home-style Patient Centered Case Management. Docs don't seem to like it much, but it reduces ER usage.

2) You've got a point about not having a lot of good longitudinal data on weight loss, but just about every study I've ready has suggested that intensive case management reduces dietary intake, increases physical activity, and reduces BMI by nontrivial amounts. Most of the long-term studies I've read involve relatively short interventions with followup occuring months and years after the intervention is over. To me, that seems a little like giving a patient half a course of antibiotics and then publishing ten-year survival data. Some examples of good outcomes with intensive case management oriented at addressing barriers:

Befort, C. a, Nollen, N., Ellerbeck, E. F., Sullivan, D. K., Thomas, J. L., & Ahluwalia, J. S. (2008). Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial. Journal of behavioral medicine, 31(5), 367-77. doi: 10.1007/s10865-008-9161-8 (you'll have to read a little bit into this one-- the reason they didn't see a difference between groups was because the control group also focused on identifying barriers and providing social support).

Rimmer, J. H., Rauworth, A., Wang, E., Heckerling, P. S., & Gerber, B. S. (2009). A Randomized Controlled Trial to Increase Physical Activity and Reduce Obesity in a Predominantly African American Group of Women with Mobility Disabilities and Severe Obesity. Preventive medicine, 48(5), 473-479. The Institute For Cancer Prevention. doi: 10.1016/j.ypmed.2009.02.008.

3) Correct again, but slightly myopic IMO. While lots of insurance plans cover tobacco cessation treatment and a few select behavioral interventions, you're right that this is a rare occurrence. That said, the resources exist if you take the time to go out and find them. I work almost exclusively with the uninsured here in Philly and the docs (and PAs, and nurses, and dietitians) I work for face the same challenges that you do, but they've chosen to get creative instead of discouraged. My city has a free quit line that covers nicotine patches and gum. Many churches have exercise groups (to say nothing of the services available at the YMCA). Hell, my local agricultural extension office offers "dining with diabetes" classes. While these certainly aren't the best options, they offer social support and assistance in identifying and overcoming barriers, both strategies (as in the papers above and elsewhere in the literature) proven to improve intermediate outcomes. Talk to a few social workers in your area and you might find a few diamonds in the rough.
posted by The White Hat at 2:02 PM on June 15, 2011

Here's a direct link to the full NEJM article.
posted by nicwolff at 2:02 PM on June 15, 2011

And as I say all the time, if it cannot cause harm, and one is aware of the lack of proof behind it, who am I to posture that it is not a reasonable course of action

It isn't reasonable just because there's no harm; if there's no evidence, or evidence showing that it doesn't work, that still makes it unreasonable. At best you are arguing that unreasonable beliefs are harmless.

But that's clearly false with respect to alternative medicines. They make a lot of money, and that money is coming from somewhere. And they are sometimes pursued instead of treatments shown to be effective, sometimes resulting in the severe illness or death.
posted by Philosopher Dirtbike at 2:05 PM on June 15, 2011

happyroach: " Don't delay in finding and killing the person near you who is a witch- freedom from chronic pain is just a credit card number away!"

His full comment included this:

The world is a complicated place, and treatment of long-term, complicated illnesses with no known specific causal agent is incredibly complicated. Simplistic "this is good, this is bad" thinking doesn't help patients, doesn't help researchers, doesn't help the general public."

Which strikes me as pretty logical and reasonable.
posted by zarq at 2:07 PM on June 15, 2011 [1 favorite]

Big Pharma's sole responsibility is not to make you better. It is to remain profitable to their shareholders.

"Aggressive marketing of these [integrative medicine] clinics can also generate substantial patient demand (even a small integrative clinic can take in several million dollars a year)." Not to mention companies that sell unregulated herbal or homeopathic remedies.

So clearly the answer is; everyone needs one of those [massage] tables.

Mr. epersonae's been wanting to get one of those for forever now.

Everyone I've ever known personally who was helped by either "Western" medicine OR so-called "Alternative" medicine arrived at the practitioner by some form of automobile.

Ha! I bike to most of my doctor's appointments. On the bike trail even, so your so-called exhaust medicine does nothing for me! ;)
posted by epersonae at 2:10 PM on June 15, 2011

You're clearly an alien.
posted by It's Raining Florence Henderson at 2:13 PM on June 15, 2011

When I get into these sorts of conversations with people, I'm always struck by the dichotomy they present between these endlessly-caring woo practitioners and those cold, dispassionate, rushed medical doctors. Seriously, if your doctor acts like this, get a new doctor! There are some good ones out there. I'm one of those patients that always has a zillion questions and lots to discuss with my doctor and my doctor always makes time for me, listens to me, and answers my questions. He NEVER just shoves a prescription at me and dashes out, like some doctors I've had. A woman I know, another patient of my GP's, has anxiety issues and is particularly terrified of breast cancer; our doctor gave her his HOME PHONE NUMBER so she could call him when her fear gets out of hand. She calls him at night every once in a while and he reassures her that she's okay.

If your doctor sucks, keep looking until you find a good one. There are some amazing ones out there.
posted by WorkingMyWayHome at 2:17 PM on June 15, 2011 [2 favorites]

If a medicine works, it works. It should have some effect for almost everyone.
Not so. Take antibiotics: Each antibiotic treats a specific spectrum of bacteria. It's possible to take an antibiotic and have nothing much happen, because you're infected with a type of bacteria it doesn't treat. And yet, you could have all the same symptoms but a different type of infection, and the drug would work like gangbusters.

For the record, I'm not super into alternative medicine. I use a couple really basic herbal remedies (ginger, peppermint, and chamomile tea, more or less). I think homeopathy is bunk and have never tried acupuncture, but would never turn down a back or foot rub. Just in case you're offering.

I interned in a natural product chemistry lab in high school. The process by which pharmaceuticals are derived is totally fascinating to me. The tiniest amount of the right purified organic compound can have a huge impact on a person's well being. It still surprises me that we can consume plant and animal matter all day, willy-nilly, and end up more or less fine (sorry, phenylketonurics).

So, I'm all for state-of-the-art lab coat medicine. But I also like to keep in mind that, as they are investigated, some traditional remedies will pass the placebo test. And that not everyone who goes to a chiropractor is a small-minded fool who's being taken for a ride. And that sometimes, the traditional option, while not perfect, is a lot easier and cheaper than the medical alternative.
posted by evidenceofabsence at 2:18 PM on June 15, 2011 [3 favorites]

(An example of the latter: Pot versus marinol for chemo patients.)
posted by evidenceofabsence at 2:20 PM on June 15, 2011

Nicwolf, there's no placebo effect shown in the 2002 study. There was no group who did not receive a placebo, so it can't show an effect of placebo. What it does show is no effect of the surgery on top of the placebo.

You may be thinking of this 2008 study which did include a non-sham group, and given the 2002 results, we can say that the brief effect of the surgery is essentially a placebo effect (however, I'm not sure I even believe the placebo effect here, since it doesn't appear they corrected their p values for multiple comparisons - getting two out of 15 results <0.05 isn't out of bounds under the null hypothesis).
posted by Philosopher Dirtbike at 2:25 PM on June 15, 2011

To reiterate what's been said before - 'western medicine' is a rubbish term since homeopathy is German, chiropractic is from America (D D Palmer was Canadian, living in the USA), osteopathy is American, naturopathy evolved in Europe and the US, thought field therapy is American, aromatherapy was named by a French man, the oldest example of trepanation is from France (admittedly around 5000 BC), Bach flower therapy is British, Gerson therapy was developed in the USA by a German, iridology is from Europe, and the list goes on.

Bullshit is a global problem. Please stop mislabelling evidence-based medicine as 'western'.
posted by edd at 2:25 PM on June 15, 2011 [9 favorites]

Philosopher - we may be talking about slightly different magnitudes of treatment. For example, it is really hard to treat people who suffer from sinus irritation. Steroid nasal sprays, room air purifiers, etc. are tried, but often don't help. I know that many of my patients and myself included have been helped dramatically by sinus rinses. So I often recommend them. The patient will spend about ten bucks plus time and gas and may get some burning, but it may help. I am not aware that there is a good study out there in support of it. Same with cranberry extract for urinary trouble. Same with probiotics for digestive issues. Same with magnesium for restless leg syndrome. On and on. But all these conditions are a pain and sometimes really miserable for people, so there has to be a place at the table for anecdotal and as yet unproven remedies, in my opinion.
posted by docpops at 2:25 PM on June 15, 2011

1) Medicaid is already looking into using Medical Home-style Patient Centered Case Management. Docs don't seem to like it much, but it reduces ER usage.

Again, my point is not that the "medical home" will fail, it is that any paradigm that excludes millions of people (the working poor and uninsurable) will fail.

Regarding resources for smoking, obesity, etc., you make great points, but most people won't follow through on the most mundane referrals, much less truck across town for a meeting with a volunteer dietician. In the real world, we are going to lose the battle with obesity once it has taken hold. You need to get to the patient before they become trained in Western behaviors that lead to obesity.
posted by docpops at 2:29 PM on June 15, 2011

On a quite different matter, I'd caution against p-values in studies of alternative medicines. p-values tell you the chance of getting the result given the null hypothesis (i.e. by chance). They do not tell you the probability that the commonly accepted alternative hypothesis is true. They most certainly do not even give you a vague idea, let alone the actual probability that an a priori improbable hypothesis (like homeopathy) is true.
posted by edd at 2:30 PM on June 15, 2011

I know that many of my patients and myself included have been helped dramatically by sinus rinses.

This is where you are wrong. I'm a cognitive psychologist, and I can tell you that study after study shows that people are very bad at evaluating evidence. You're no different; everything you mention could simply be confirmation bias. That's why we have science and statistics. You believing that something works is not evidence that it does, at least on the basis of anecdotal evidence, because we are all very fallible reasoners.
posted by Philosopher Dirtbike at 2:31 PM on June 15, 2011 [1 favorite]

I have found from my own observations that cognitive psychologists tend to be wrong all the time.
posted by Astro Zombie at 2:33 PM on June 15, 2011 [1 favorite]

This is where you are wrong. I'm a cognitive psychologist, and I can tell you that study after study shows that people are very bad at evaluating evidence. You're no different; everything you mention could simply be confirmation bias. That's why we have science and statistics. You believing that something works is not evidence that it does, at least on the basis of anecdotal evidence, because we are all very fallible reasoners.
posted by Philosopher Dirtbike at 2:31 PM on June 15 [+] [!]

I wonder if you can see how bizarre and paternalistic that sounds. So a person that reports daily headaches and post-nasal drip and a deficiency in nasal breathing quality is not able to accurately report improvement in their own symptoms after a week of lavaging a restriced cavity with saline?
posted by docpops at 2:36 PM on June 15, 2011

[Use of isotonic NaCl solution in patients with acute rhinosinusitis]

From a search for "sinus irrigation."
posted by evidenceofabsence at 2:37 PM on June 15, 2011 [2 favorites]

And by "no different" does the fact that I might have the vantage point of seeing hundreds of cases a year of a given problem allow me any advantage at all when it comes to observing possible ameliorative options?
posted by docpops at 2:38 PM on June 15, 2011

Astro Zombie, I make my living as a methodologist showing cognitive psychologists where their methodology is insufficient to support their claims, so I agree; scientists are just as fallible as anyone else, and we have peer review and the scientific literature to help weed out weak reasoning.
posted by Philosopher Dirtbike at 2:39 PM on June 15, 2011

Astro Zombie: "Your search has produced this awesome image of a bat going down on another bat.

From the caption: "Vignette shows a female performing fellatio, drawn by Mei Wang."

NO WAY.

HERE EAT THIS ROOT INDEED."

Great. Now I'll never be able to tell that joke again without hearing a mashup of the 1960's BatMan theme and Bow Chicka Wow Wow porn music in my head.
posted by zarq at 2:39 PM on June 15, 2011 [1 favorite]

I wonder if maybe the NHS should just have a "be nice room". Patients with particularly persistent symptoms should just be taken in to a room, made a cup of tea and someone chats to them for a bit. They would pay special attention to them, ask them which biscuits they prefered and listen to their problems. Not like a therapist or a counsellor. Just a concerned, friendly and intelligent person with some certificates on the wall. They would then pretend to pass their conversation on to the doctor (who actually knows how to cure stuff but has little time for such frivolities).

I have a few friends who have long-term ailments and the amount stress and feeling like they are helping themselves seems to matter more than what ever medication they get. It's these kinds of people who are most likely to resort to alternative medicines, being disgruntled with the quick and unsympathetic systems they have been passed around.

They would also send them presents on their birthday.

I'd feel a lot happier about NHS money being spent on an activity like this than homeopathy.
posted by pmcp at 2:47 PM on June 15, 2011 [6 favorites]

Study after study shows that Bow Chicka Wow Wow porn music cures anything that isn't cured by automobile exhaust (aliens, take heed!).
posted by It's Raining Florence Henderson at 2:49 PM on June 15, 2011

I think I saw a Lancet study on nasal irrigation which said, "Yes, good. Not too often. Daily is too often."

Right now, I have this thing worked out involving a compound derived from plant matter that treats a common, rather minor condition. In terms of the steps involved, it sounds utterly insane, but each individual step is logical. The tests I have done on myself work, rather visibly, much to my satisfaction. However, between everyone treating anything involving plants like I am sticking pins in a poppet and the ongoing dysfunctional BDSM relationship between Big Pharma and the FDA, I have nowhere to run with it. Pity.
posted by adipocere at 2:49 PM on June 15, 2011

docpops: I wonder if you can see how bizarre and paternalistic that sounds. So a person that reports daily headaches and post-nasal drip and a deficiency in nasal breathing quality is not able to accurately report improvement in their own symptoms after a week of lavaging a restriced cavity with saline?

They may be able to accurately report an large improvement. But if symptoms fluctuate, one is likely to over-interpret natural variability as "improvement". This is just a fact. To make matters worse, even when one can accurately report improvements, one cannot make inferences about the cause without proper methodology. That's what this debate is essentially about - the causes of improvement. Understanding of the conditions under which causal inferences was hard-won in science, over the course of centuries. Don't just pretend the problems that scientists have been struggling with for so long don't exist.
posted by Philosopher Dirtbike at 2:50 PM on June 15, 2011

That sentence should be "under which causal inferences can be made", of course...
posted by Philosopher Dirtbike at 2:52 PM on June 15, 2011

I have this thing worked out involving a compound derived from plant matter that treats a common, rather minor condition. In terms of the steps involved, it sounds utterly insane...

1) Fill bong with beer
2) Pack bowl with plant compound (not too tightly)
3) Apply flame to bowl
4) Inhale deeply. Deeeeeeeeeeeply.
5) Hold it...
6) Hooooooold iiiiit....
7) Don't laugh!
8) Don't cough!
9) Exhale
10) Did you hear something? I think I heard something! HAHAHAHAHAHAHAHA!
posted by It's Raining Florence Henderson at 2:54 PM on June 15, 2011 [3 favorites]

Don't just pretend the problems that scientists have been struggling with for so long don't exist.

It's not that they don't exist. It's that they don't matter, not to the patient. A patient with annoying nasal symptoms cares about subjective, personal relief. If they seem to get that from nasal lavage, the "conditions under which causal inferences can be made" about nasal lavage are quite moot. Scientists may care, but the patient does not.

Medicine is more than making cut-and-dried pronouncements as to which treatments are proven to "work", and requiring all treatment to follow science in this way would allow many to suffer. We do not fully understand how and why many seemingly effective drugs work; we do not fully understand the relationships between comfort, mental attitude, nutrition, self-care, and healing (to name just a few variables which are very rarely controlled for under "proper methodology"). Asking doctors to forgo harmless treatments which have brought people subjective relief for centuries is not just an attack on "confirmation bias" -- it's an attack on the very idea of medicine, as practiced since Hippocrates.
posted by vorfeed at 3:08 PM on June 15, 2011 [2 favorites]

Sorry, missed this:

docpops: And by "no different" does the fact that I might have the vantage point of seeing hundreds of cases a year of a given problem allow me any advantage at all when it comes to observing possible ameliorative options?

Do you want me to tell you that you're superior to everyone else, and that you have a magical ability to avoid all the cognitive failures that everyone else has? That you aren't susceptible to the reasoning errors that other doctors fall victim to? That the doctors who recommend the aforementioned knee surgery have fallen victim to? Is that what you want me to say?

If you don't have the support of properly controlled studies, your evidence is shaky at best, despite your confidence. I don't care how many patients you've seen.
posted by Philosopher Dirtbike at 3:19 PM on June 15, 2011

If these things do work, then they should work or have some effect on everyone who takes them, not just some - as often the rebuttal is 'well maybe it just didn't work for you!' NO, bullshit.

This is why scientific research is important. If a medicine works, it works. It should have some effect for almost everyone. I'd have more faith in the ones that actually affected me adversely than the ones that did nothing at all.

That's a ludicrous expectation. I've put truckloads of evidence-based medicine into my body that I might as well have thrown over my shoulder for all the effect it had on me. Everybody I've ever known who had a chronic illness could tell you the same thing. People don't turn to herbs and acupuncture because they're bored of effective treatment. There are loads of us that traditional medicine can't seem to do a fucking thing for.
posted by two or three cars parked under the stars at 3:20 PM on June 15, 2011 [3 favorites]

The biggest failure of "Western" medicine is this idea that physical and psychological problems are separate issues. Some problems are of more physical nature, but none of them wouldn't benefit from addressing psychological issues.
posted by Soupisgoodfood at 3:23 PM on June 15, 2011

From BMJ: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Abstract: "As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."
posted by Wordwoman at 3:26 PM on June 15, 2011 [1 favorite]

Vorfeed, you're attacking a straw man by making what I'm saying stronger than it actually is. I never demanded "proof" that a treatment works. My argument is different; it is rather about evidence, understood in the context of our own likely failures of reasoning and knowledge/lack of knowledge about the world. I don't demand proof, but I do expect evidence.

Second, you seem to think I'm arguing against "alternative" medicine that does no harm. Much of the the alternative medicine discussed in this thread does demonstrable harm in addition to its demonstrable ineffectiveness.

Third, as multiple posters have pointed out, there are other ways of getting the care benefits you describe; the "alternative" medical techniques have little to do with it. "[C]omfort, mental attitude, nutrition, self-care, and healing" are orthogonal to the evidence-based vs. "alternative" medicine debate.
posted by Philosopher Dirtbike at 3:33 PM on June 15, 2011

Wordwoman: I see the humorous value in that, but RCTs are ended early when they show blatant and overwhelming evidence that something does excessive harm or good. RCTs are frequently framed as the be-all-and-end-all but they're not - they're the most powerful kind of test and needed for drugs with relatively non-obvious effects that can be confused with placebo, or when you need to carefully assess the incremental benefit over another treatment, or indeed when people steadfastly insist something works when it doesn't, but in the case of something like parachutes or insulin you just don't bother. You get on with handing out parachutes and syringes and enjoy the sight of people not dying.
posted by edd at 3:35 PM on June 15, 2011

Much of the the alternative medicine discussed in this thread does demonstrable harm in addition to its demonstrable ineffectiveness.

Could you cite some large-scale studies that quantify that harm, perhaps as compared to adverse events that occur with the use of conventional medicine?
posted by Wordwoman at 3:38 PM on June 15, 2011

We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Aerodynamics: well-understood principles, measurement can be done to high-precision, across-participant variance is low.

Medicine: more poorly-understood principles, measurement is often low-precision, and across-participant variance is high.

Good for a chuckle, but that's it.
posted by Philosopher Dirtbike at 3:40 PM on June 15, 2011

Could you cite some large-scale studies that quantify that harm, perhaps as compared to adverse events that occur with the use of conventional medicine?

Well there's this and this, but I think the results are completely justifiable under the rubric of alternative medical cures.
posted by happyroach at 3:44 PM on June 15, 2011

From BMJ: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Abstract: "As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."

This was not written and is never quoted by anyone with even a passing familiarity with engineering or aviation history. Because parachutes have been exhaustively tested.

Also, when were you planning to jump out of an airplane armed only with a sackful of herbs and needles? An ancient Chinese flying spell? An astrological chart? I hear flying carpets are good for that when western science fails. Prayer. Prayer is good for curing gravity. Anyone? Anyone at all?
posted by It's Raining Florence Henderson at 3:48 PM on June 15, 2011 [3 favorites]

You know, sometimes anecdotal evidence and tradition works out better than hard science. Think Michael Pollen and diets.
posted by Soupisgoodfood at 3:49 PM on June 15, 2011

As far as the patient is concerned, it's what works. Period.

My earlier comment may have given the impression that I have something against Western medicine. I do not. It's great. It has saved my life (and the lives of loved ones) on more than one occasion, and there are large domains of - largely more serious - health-related issues where no alternative quack gets to go anywhere near it, and nor should they.

The scientific perspective is fantastic for the statistical macro-level. Drugs, surgical procedures and other treatments that provably work in most cases are brilliant. Used properly, the scientific method is excellent for identifying these and incrementally improving them over time.

The usefulness of some alternative medicine kicks in at the point where standard medicine - for whatever reason being largely unable to say 'we don't know and there's nothing we can do' - starts giving you random painkillers and hoping that both you and your condition go away and don't come back.

That's when Western medicine starts - in practice - diverting from its scientific roots and lurches towards quackery itself; that's why the slang in my part of town still refers to *all* doctors as 'the quack'. Local commercial constraints also reduce the effectiveness of evidence-based medicine: thank fuck I am not in the US (I'd be dead from a bad case of impecuniousness) but here in the UK my local GP has a strict rule that appointments may be made for one condition only.

So, round my way, if you have a multi-faceted condition involving, say, severe stress, depression, insomnia *and* eczema, you're shit out of luck. You have to choose a single symptom and work your way through specific treatments for it. None of those treatments are likely to work for you, because the actual problem is not so much the specific symptoms as some underlying thing that this particular doctor's surgery from the outset will actually point-blank refuse to deal with.

There are some fantastic, hard-working, dedicated GPs around. Not in my area of London, alas. Small wonder, then, that there also seems to be a larger number than usual of acupuncture and alternative medicine clinics in my local high street.

From the patient's perspective, it really doesn't matter whether the medicine was evidence-based, comes from a close study of TCM or was made up on the back of the envelope in the pub one night. All that matters is whether or not it works. And as I said above, if the price I have to pay for getting rid of my back pain was demonstrably confusing correlation with causation, then call me an idiot.
posted by motty at 3:52 PM on June 15, 2011 [1 favorite]

It might seem to only matter to you that it works, and this might well be the case in the short term. However, I would prefer that if someone is going to give me willow bark as a pain killer they'd better approach its method of action scientifically, rather than, say, claim it is due to magic that has rubbed off from the fairies that lived in the branches of the tree, because one of those approaches is going to lead to newer and better medicines and one of them isn't.
The whole framework has implications for healthcare beyond simply 'does this work?'
posted by edd at 3:57 PM on June 15, 2011 [1 favorite]

Motty: As far as the patient is concerned, it's what works. Period.

Hey, I agree. Let's find out what works! I propose we do it with a reliable method, say, science.
posted by Philosopher Dirtbike at 4:01 PM on June 15, 2011

Spoken like a true undergraduate, Philosopher Dirtbike. I trust you never suffer from a painful condition that your doctor cannot deal with, but if you do, I'm sure you'll sit there suffering until the science catches up. Forgive me for being a complete fucking moron, but I'll be over the road at the acupuncture clinic having my pain actually relieved.
posted by motty at 4:06 PM on June 15, 2011 [3 favorites]

Most patients don't have the time, money, or knowledge to conduct their own scientific studies. And even if they did, that wouldn't guarantee them a useful answer.
posted by Soupisgoodfood at 4:07 PM on June 15, 2011

A lot of evidence based science is turning up some realities a lot of people would be surprised might be incredible relevant in medicine. Like that (gasp) diet affects prenatal and child development and adult health. At the epigenetic and even the genetic level.

WHO KNEW?

Also that the availability of loving functional parents affects brain development, immune health, hormonal regulation and basically the bodies systems in general. The types of activities available in a home affect the same thing. Indoor and outdoor air pollution such as mold/roach pollution/dust/car pollution affect development of asthma and immune conditions. Immune conditions affecting the brain. And so on and so forth.

Our health is deeply connected to our environments, social interactions and in fact the activities in our daily lives.

This isn't "alterna" any thing, this is just science.

It's high time we realize that most chronic diseases develop slowly and are caused by specific environmental and social conditions--- in fact environments can CAUSE some genetic mutations during prenatal development meaning saying a disorder is genetic no longer rules out environmental causes of the genetic alteration.

It's absolutely imperative that we use evidence based research to understand these phenomena and that we remain critical and skeptical of all science since all of it is done by and interpereted by humans who are biased and capable of gross errors.

That being said, research is opening up doors of both prevention and treatment that mean making structural changes that enable disease prevention in the daily lives of human beings as well as assistance on the individual level with making lifestyle changes that have proven ridiculously difficult for human beings to make.
posted by xarnop at 4:15 PM on June 15, 2011 [2 favorites]

I was diagnosed with a mental disorder and put on a combination of drugs that the pharma reps were recommending for non-approved use in the mental health arena. The mental disorder vanished when I changed a couple things about my living situation and then I started reading up on the drugs I'd been prescribed. There was no evidence that the most expensive one of them had any use in treating my non-existent mental disorder, and the manufacturer eventually repaid me for what I spent.

A few years later, I get rear ended by a police car. I'm at a stoplight, she's going 45 and blinded by the sun. The surgeon that the lawyer sent me to recommended surgery and no work for six months. The chiropractor got me back to work in 2 weeks, for a grand total of 415 USD.

What we know of science is manipulated by big money.
posted by Mr. Yuck at 4:24 PM on June 15, 2011 [2 favorites]

That people benefit so much from chiropractors doesn't surprise me at all. Posture is a lot more important than most people seem to think.
posted by Soupisgoodfood at 4:30 PM on June 15, 2011

Mr. Yuck- Yes, but has anyone checked you for poisoning?
posted by evidenceofabsence at 4:35 PM on June 15, 2011 [3 favorites]

People don't turn to herbs and acupuncture because they're bored of effective treatment. There are loads of us that traditional medicine can't seem to do a fucking thing for.

Thank you.

My experience is that the "traditional model" tends to handle emergencies and other acute situations rather well. Where it gets fuzzy is the chronic stuff, the stuff that has taken some time to manifest and comes and goes, and may (or may not) be attributable to any number of coinciding environmental, psychological, nutritional, even spiritual issues.

What I'd love to see in discussions such as this is some vulnerability (for lack of a better word) on the part of those who argue so vociferously for the "traditional model", particularly with regard to these "grey area" concerns.
posted by philip-random at 4:36 PM on June 15, 2011 [2 favorites]

Article summary:

We know alternative medicine practitioners are quacks...but they're such nice quacks.
posted by storybored at 4:39 PM on June 15, 2011

Spoken like a true undergraduate, Philosopher Dirtbike. I trust you never suffer from a painful condition that your doctor cannot deal with, but if you do, I'm sure you'll sit there suffering until the science catches up. Forgive me for being a complete fucking moron, but I'll be over the road at the acupuncture clinic having my pain actually relieved.

Luckily, there are a whole lot of conditions that evidence-based medicine does know how to treat. Arguments for evidence based medicine don't depend on its completeness, but rather the methodology for determining which treatments are effective. One would expect an evidence-based perspective to lack treatments precisely because it demands evidence. When an approach has treatments for everything under the sun? That's when you get worried that you're being taken for a ride.

Also, you sound like ass with your "true undergraduate" comment (aside from being very far off).
posted by Philosopher Dirtbike at 4:41 PM on June 15, 2011 [2 favorites]

My apologies, Philosopher Dirtbike. I was indeed very far off with that remark, it was wrong of me, and I should not have made it.
posted by motty at 4:59 PM on June 15, 2011

This is a silly debate: if controlled trials repeatedly show that something works better than placebo—whether that something is massage, an herb, or anything else— it's medicine, it's not "alternative." If trials show that it doesn't work better than placebo, it's placebo.

The idea that since massage started as an "alternative" practice means that it is forever alternative even after its been shown to be effective for a certain condition is absurd. Similarly, if a widely used practice is no better than placebo and carries risk of harm—like lots of back surgeries— it doesn't get to be called evidence-based medicine any more.

Also. re: life expectancy. It's certainly the case that places without widespread access to Western medicine (and sanitation, especially!) have much higher mortality rates, full stop. The reason the U.S. does so crappily on mortality is high economic inequality and no national health care system: best places for life expectancy have highly advanced medical care, national health systems and reduced inequality. AKA, Scandinavia wins again (and also Japan).

Finally, the idea that "alternative" medicine is better at managing chronic conditions and doing prevention is pretty ridiculous, too: they do no better at getting people to stick with diet and exercise than anyone else!!!
posted by Maias at 5:03 PM on June 15, 2011 [14 favorites]

Also, how about we stop dumping holistic treatment in with homeopathy? I can't think of anything more rational than considering the bigger picture when it comes to treating medical problems.
posted by Soupisgoodfood at 5:08 PM on June 15, 2011 [2 favorites]

Also, you sound like ass with your "true undergraduate" comment (aside from being very far off).

I think it was Larry Niven who said that Freshman and graduate students think that they know everything.
posted by goethean at 5:17 PM on June 15, 2011 [1 favorite]

Could you cite some large-scale studies that quantify that harm, perhaps as compared to adverse events that occur with the use of conventional medicine?

It depends on the treatment, it depends on the condition...there's nothing similar about using chiropractors for back pain and using chelation for autism.
posted by the young rope-rider at 5:57 PM on June 15, 2011

No doubt, YRR, but the assertion that "much" "alternative medicine" is harmful has been made up-thread, and it's a popular trope among fervent CAM critics. I am genuinely interested in seeing evidence thereof (and obviously, anecdotes and isolated case reports do not qualify). Indeed, there is plenty of data about injuries and adverse effects from conventional pharmaceuticals. Since the claim that CAM is "often dangerous" is usually made in the context of dismissing any modality for which there is not a firm FDA-approved evidence base, well, let's see the evidence.
posted by Wordwoman at 6:25 PM on June 15, 2011

me: "Evidence-based medicine" simply means "only use cures that actually work."

Wordwoman: “No, it does not mean that. It means cures that have been scientifically validated through clinical trials. Big difference.”

I was simplifying a bit, but I'd be interested to hear the difference between "what works" and "what has been shown through clinical trials to work." Are you suggesting that clinical trials are not scientifically valid?
posted by koeselitz at 7:23 PM on June 15, 2011

goethean: “I think it was Larry Niven who said that Freshman and graduate students think that they know everything.”

No, that's "tenured professors." Most freshmen and graduate students just cower in the shadow of the massive egos of the professors.
posted by koeselitz at 7:25 PM on June 15, 2011

I was simplifying a bit, but I'd be interested to hear the difference between "what works" and "what has been shown through clinical trials to work." Are you suggesting that clinical trials are not scientifically valid?

I'd guess what she's getting at is that a) cures can actually work without being proven, and b) proven cures don't always actually work for everyone.
posted by Sys Rq at 7:28 PM on June 15, 2011

Second, you seem to think I'm arguing against "alternative" medicine that does no harm. Much of the the alternative medicine discussed in this thread does demonstrable harm in addition to its demonstrable ineffectiveness.

You went off on docpops in a very personal, very condescending manner for suggesting that nasal irrigation helps to clear sinus irritation. I was responding to that directly.

Please, feel free to link to studies which corroborate the "demonstrable harm" of nasal rinses, when used as directed by a doctor.

"[C]omfort, mental attitude, nutrition, self-care, and healing" are orthogonal to the evidence-based vs. "alternative" medicine debate.

The point I was making is that these variables are also orthogonal to evidence, at least in the context of most clinical trials. That's a problem, since physiological and psychological studies suggest that they are not at all orthogonal to treatment outcomes...
posted by vorfeed at 7:43 PM on June 15, 2011

"Mr. Yuck- Yes, but has anyone checked you for poisoning?"

Poison control is an important part of life. I worry more about poisoning than most people with big green heads.
posted by Mr. Yuck at 7:55 PM on June 15, 2011 [3 favorites]

Maybe an irrelevant point this far into things, but it really needs to be said that with each passing year I see more and more unexpected/unfortunate outcomes caused by the execution of good evidenced based medicine. Sometimes the best thing you can say about "alternative" options is that it occupies a patient with a sense of some sort of forward momentum and treatment that cannot possibly bring them harm, all the while knowing that in time they will likely recover on their own. Feel free to parse that and pick it apart all you like, but trying to capture the human psyche's effect on treatment is too slippery.
posted by docpops at 8:33 PM on June 15, 2011

zarq: Is psychiatry not considered allopathic medicine?

Yes, I didn't know what to be more impressed by within this article. That it stepped, however briefly, outside its usual Atlantic brand name medical institute list to mention Wayne State, or that it managed to waffle on so long about reducing "stress" and the need for "empathy" and patient-centred communication without apparently acknowledging that Western med already has a speciality for that: psychiatry. I've been in on a lot of "alternative" procedures and a bunch of them struck me as therapy session in drag. Or Magick-lite - the rituals of which I've also seen produce profound alterations within people.
posted by meehawl at 8:44 PM on June 15, 2011

docpops: "The great difference in "alternative" practices is the tendency of many (chiro and naturopathy are far and away the worst) to lead the patient to believe they are fundamentally broken or lacking in some way, at which point they will spend their lifetime bought into a model of illness. Back pain and fatigue are the two things that create this problem in the worst way."


And let's not forget that their primary motivation in this is PROFIT. They're as self-interested as the next salesman, and for all their claims they don't give a rat's ass about anything but their own income.
posted by sneebler at 9:30 PM on June 15, 2011

Likewise, I don't believe that all homeopathic medicine is BS (for example, aspirin was once homeopathic).

Just a quick comment: I think you might be getting homeopathy mixed up with medicine made from herbs and other plants. Homeopathy was invented in the late 18th century and involves diluting a substance and shaking it in a special way. It's based on the idea that 'like cures like' (otherwise known as sympathetic magic). Aspirin originally came from the bark of a willow tree, but people back in 500BC were making powders, etc from the bark and using them directly, not diluting and mucking about with it.
posted by harriet vane at 11:31 PM on June 15, 2011 [2 favorites]

You went off on docpops in a very personal, very condescending manner for suggesting that nasal irrigation helps to clear sinus irritation. I was responding to that directly.

No, it was not personal, as I made clear by saying that everyone suffers from these cognitive failures, and linked to articles in the medical literature discussing particular cognitive errors we all make and how they impact doctors. I even cited a particular example from the medical literature where failures happened and had consequences. Why should it be condescending to imply that docpops is like everyone else when reasoning about causation from observational data?

It is the reasoning that is the problem; sometimes it leads to more benign outcomes, sometimes not. Nasal irrigation is probably benign at worst, effective at best. I don't know the relevant literature. But when, say, people oppose vaccination because of their "alternative" medical philosophy? That's real harm.

The point I was making is that these variables are also orthogonal to evidence, at least in the context of most clinical trials. That's a problem, since physiological and psychological studies suggest that they are not at all orthogonal to treatment outcomes...

That's fine, and that's evidence for their effectiveness. Every trial can't study everything, and certainly clinical trials can be improved (unfortunately, the powers that be are quite conservative; sometimes they oppose what would be clear improvements in methodology). But as I said before, no one is claiming that an evidence-based approach is perfect or complete. It just happens to be the only thing that has a chance of leading to justified beliefs about which treatments work.
posted by Philosopher Dirtbike at 11:54 PM on June 15, 2011

It sounded like you were dumping people who try homeopathy and people who are against vaccination in the same camp. The rationale for each one can be quite different, surely?
posted by Soupisgoodfood at 12:26 AM on June 16, 2011

Substittute: "Again and again, carefully controlled studies have shown psycho-pharmacological medicines to work no better than a placebo"
http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
posted by dougiedd at 12:43 AM on June 16, 2011

It sounded like you were dumping people who try homeopathy and people who are against vaccination in the same camp. The rationale for each one can be quite different, surely?

I don't know what you mean by "camp". The logic underlying homeopathy has been widely used to bolster anti-vaccination arguments. Surely the groups don't coincide 100%, but that's not really what I'm saying. Non-evidence based medicine has very little to constrain its explanations and proposed cures, so sometimes various examples of non-evidence-based medicines will align, and sometimes not.
posted by Philosopher Dirtbike at 1:37 AM on June 16, 2011

It sounded like you were dumping people who try homeopathy and people who are against vaccination in the same camp. The rationale for each one can be quite different, surely?

They are both based on accepting absurd non-facts in the face of overwhelming evidence to the contrary.
posted by kafziel at 2:17 AM on June 16, 2011

here is a confession from the front

http://www.reddit.com/r/IAmA/comments/i115h/iama_chiropractic_assistant_for_two_years_and/
posted by Postroad at 4:00 AM on June 16, 2011

You know what they call alternative medicine that works?

Medicine.
posted by unigolyn at 4:23 AM on June 16, 2011

Acupuncture has been shown to have a measurable effect above and beyond placebo under certain circumstances.

No, it hasn't.
posted by unigolyn at 4:40 AM on June 16, 2011 [1 favorite]

There have been quite a few studies comparing acupuncture to sham acupuncture and other placebos (where sham acupuncture consists of having the acupuncturist stick needles in people but in the wrong places, not the locations indicated by acupuncture theory, or pretend to stick needles in people without actually doing so). Acupuncture is no more effective than sham acupuncture for pain relief, however it is more effective than no treatment or a regular placebo, apparently.

So there is scientific evidence that there is something about the acupuncture procedure that helps patients deal with pain, but it has nothing to do with qi, and it's not necessary to actually stick needles in people to get it to work. So a question is do we try to figure what it is about acupuncture or sham acupuncture that does seem to help people deal with pain? (In other words, the research that's been done might indicate that a series of guided relaxation exercises modeled on what acupuncturists do, minus the bit about sticking needles in particular places, could help patients with pain management.) Or do we reject any such line of research and possible treatment, because any such treatment would necessarily be psychological and subjective?
posted by nangar at 5:05 AM on June 16, 2011

I had a housemate for a while that was a chiropractor, she was just out of uni and starting up in a practice. Led to a few awkward conversations, but I never openly told her I thought it was bullshit. They had some kind of scanning machine that sounded like something scientologists would use. As she was just starting up she was trying to give away free trials. I turned her down.

The main reason for this is because she anecdotally told me that on her course was practicing on one of her fellow students and gave them a stroke.

I'm sure something else might have triggered something like that - but the idea that people trained in 'crazy-back-cracking-pseudo-science' might have the opportunity to do something so harmful has put me off even just doing it out of curiosity (or for amusement).
posted by pmcp at 5:09 AM on June 16, 2011 [3 favorites]

I wasn't well-versed in the controversies surrounding chiropractic treatment, so I did some reading last night. In case anyone else is interested:

Wikipedia: Chiropractic
Wikipedia: Chiropractic Controversy and Criticism
Chirobase: Your Skeptical Guide to Chiropractic History, Theory and Practices
The National Council Against Health Fraud: Position Paper on Chiropractic
posted by zarq at 6:49 AM on June 16, 2011 [2 favorites]

As much as I wanted them to work, as much as I believed, in the end I had to look at the evidence in front of me. It did. not. work. In fact, two of them may have made it worse.

If these things do work, then they should work or have some effect on everyone who takes them, not just some - as often the rebuttal is 'well maybe it just didn't work for you!' NO, bullshit.

This is why scientific research is important. If a medicine works, it works. It should have some effect for almost everyone. I'd have more faith in the ones that actually affected me adversely than the ones that did nothing at all.

Some things work, and some things don't. The failure is in assuming that we have complete knowledge of the breadth of ailments. If a treatment works for some, and not for others, the problem is that the cause of the problem hasn't been defined correctly. Sometimes it is the placebo effect, sometimes it isn't.

I see this ALL THE TIME in my work fixing computers. People rarely want to drill down to find the cause of something. It is too easy to fall into the see symptom -> apply solution mindset, when problem solving requires see symptom -> identify cause -> apply appropriate solution.

So when the Skeptics (the religiously skeptical) see that some solution is not perfect, they call it a scam. "Chiropractic doesn't work for everyone, they are lying to you!" Wrong. When the problem is something that Chiropractic can fix, then it works just fine. When it's not, it won't.

There are lots of well done studies that start from incorrect assumptions. That all depression is the same. That all "back pain" is the same. Maybe that research leads to further work on redefining the problems and the root causes, but all the followers of Skepticism see is "it didn't work any better than a placebo!" Yeah, but it worked really well for the ones it worked for.

It is like taking 10 people and handing them a sandwich. Only three people ate it, and only one person liked it. Was that a good sandwich, or were some people more hungry than others?

The limitation of the scientific method is that at some point, the results are analyzed by our imaginations. We can only imagine why the results didn't go the way we expected and iterate through the various causes and effects that we can think of. Eventually we will stumble on an answer that works well enough. In medicine, though, sometimes you have to go with "we don't know why it works, but it does work really well for some people and it might as well be made available for people to try."

This is a real problem I have with people like Penn and Teller on their Bullshit program. (Sometimes.) It's almost a rhetorical fallacy sometimes, where they force people to prove claims they didn't make, or didn't make nearly as strongly as they are made out to have.

Sort of along the lines of "Hello Mr. Chiropractor. We see some chiropractors claiming to be able to cure herpes. Can you cure herpes? No??? You are a fraud, and all these patients who seem happy and say their pain is gone are fools. Look how clever we are- you can't prove a negative!"
posted by gjc at 8:03 AM on June 16, 2011 [2 favorites]

So, my questions are: Given your position on alternative medicine, what would you suggest to someone considering this surgery?

I love that study (if it's the same one I'm thinking of) because I have had the knee arthroscopy that was studied, and I have experienced complete remission of pain in that knee ever since the surgery almost 2 years ago. It's very interesting to think that the placebo effect--which I am very susceptible to when it comes to any kind of pill--might account for at least some of my improvement.
posted by not that girl at 9:17 AM on June 16, 2011

Yes - totally agree - treat the whole person... not just the symptoms
posted by DougN at 10:08 AM on June 16, 2011

That IAMA brings up my biggest problem with chiropractors--treating and "adjusting" children (including newborns!) and "diagnosing" people. Not within their scope of ability.

They need to be regulated.
posted by the young rope-rider at 10:41 AM on June 16, 2011

gjc: that's not how it is. Plenty of standard treatments don't work for everyone or don't work the same for everyone. A decent trial can still identify that they're sometimes effective (and sometimes identify subpopulations they work better or worse for). But many of these treatments don't seem to work at all in RCTs.
Also remember RCTs aren't hard trials to pass. They're designed to remove the confounding circumstances that hide effectiveness. They make it so that real signals stand out more, not less. That plus good statistics makes real treatments stand out even more clearly than in the anecdotes you keep hearing. Details of it only working for a few don't matter - a statistically significant few will stand out.
posted by edd at 11:03 AM on June 16, 2011

Nasal irrigation is probably benign at worst, effective at best. I don't know the relevant literature. But when, say, people oppose vaccination...

docpops's earlier point was that patients often don't want to hear that they should just sit their illness out. He then gave nasal irrigation as an example of an ideal solution to this problem, since, as you say, it's benign at worst, and at best (and anecdotally in his experience, and as it turns out, according to some studies), it is effective. The patient has a low-risk, possible-benefit way in which to be proactive, without going to get an adjustment, or down some infinitesimally diluted poison, or what have you.

This is where you jumped in to tell docpops that he should be aware that he is working from anecdotal evidence, even though I'm pretty sure he was aware of that, since it was more or less part of his point. Then you started citing examples of shitty knee surgeries, and people who oppose vaccination—again, veering off from the "low risk, possible benefit" point, and getting kind of hyperbolic.

Medical practitioners have to treat patients in the present, which often means making decisions about their care before studies have been completed, or before the FDA approves use (hence the prevalence of off-label prescribing). They are also responsive for suggesting low-risk palliative care, like squirting saline in the nose, or say, using menthol rubs, which don't provide decongestion but the illusion of decongestion. It is possible for doctors to be mindful of the flaws inherent in acting from experience, but ultimately, still act. And to do without ZOMG SERIOUS MEDICAL CONSEQUENCE VACCINE DENIALISM.
posted by evidenceofabsence at 11:26 AM on June 16, 2011 [1 favorite]

Why should it be condescending to imply that docpops is like everyone else when reasoning about causation from observational data?

Drawing conclusions about causation from observational data is part of docpops' job, and obsessing over whether or not harmless home-care procedures have enough evidence to support them is not his job. As I said before, a doctor who won't suggest that rinsing one's nose out might help with sinus irritation is allowing people to suffer for the sake of "science", and that's a no-no for doctors. No amount of shouting about confirmation bias will change the fact that the practice of family medicine is not strictly (or even primarily) evidence-based, and never has been.

But when, say, people oppose vaccination because of their "alternative" medical philosophy? That's real harm.

Yes, certainly, but that has little or nothing to do with doctors who recommend nasal lavage, even though confirmation bias may lie behind both. Context matters. Harmful alternative medicines are not bad because they're not-evidence-based -- they're bad because they are harmful.

It just happens to be the only thing that has a chance of leading to justified beliefs about which treatments work.

I disagree. Human experience and intuition also leads to justified beliefs about which treatments work, especially on an individual basis. For instance, treatments which primarily address pain or comfort rather than objectively measurable outcomes are notoriously difficult to obtain good "evidence" for. Their effectiveness tends to vary between individuals, and the placebo effect seems to play a significant role in our self-perception of pain. Comfort and pain do seem to be significant to overall recovery, though, so we cannot simply assert that harmless palliative treatments "don't work" without inviting poor outcomes.

As I see it, we can either live without things like the hot toddy, chicken soup, Mom's grilled-cheese sandwiches with the crusts cut off, throat lozenges, megadoses of vitamin C, and yes, nasal lavage (running all the way up to medical marijuana and adequate doses of opiates), or we can admit that Evidence-Based Medicine is a powerful tool, but not the only tool in the medical toolbox. Sometimes people just want to do something to feel better... and since being better seems to follow from that, we'd be fools to make everyone smash their neti pots so we can win the epic war against woo.
posted by vorfeed at 12:12 PM on June 16, 2011

From much earlier:

But while prescribing an antibiotic when one isn't needed relieves parental worry, it also harms your kid by building their resistance against a drug that could be helpful to them one day.

In most cases that I am aware of (as a biologist and not a doctor) antibiotics do not actually work on your child. People cannot build up a resistance to antibiotics. What antibiotics do is kill bacteria and other parasites [see also], often by disrupting its ability to replicate. (Conversely, chemotherapies work by killing ALL replicating cells, including human cells. That includes teh lining of your stomach and hair follicles, hence the common side effects of loss of appetite and hair loss). If they are overused, those common infectious agents may develop a resistance to the antibiotic. Then we can't use that antibiotic to treat it - this is how we get MERSA. The statement above isn't completely wrong, just off on the details.
posted by maryr at 1:30 PM on June 16, 2011

It's really off-putting the extent to which so many people utterly dismiss personal experience and observation ("anecdotal evidence"). I am allergic to many nuts, including cashews. If a well-designed research study shows that cashews are good for the health, does it mean I should eat them, despite my personal observation that cashews make me sick? How about peanuts? Should I eat peanuts and go into anaphylactic shock if a research study has shown peanuts to be good for a condition I have?

One of the many problems with relying so religiously on studies is that what works for the majority may not be what works for an individual, and vice versa. It is possible that some of these modalities that many of you are mocking do work for some people and some conditions. To mock someone for even trying an alternative modality when conventional medicine has failed to cure them is extremely callous.

I'm also not sure what people think they are proving when they link to descriptions of bad effects instances of "alternative" medicine has had. So an acupuncturist once killed a woman because he punctured her heart. The implication that that proves that acupuncture is quackery is ludicrous. I could link to all sorts of examples of mainstream doctors causing harm. The individual doctors (or acupuncturist) may have been practicing improperly, and the fact that they caused harm may say everything about their ability, skill, or focus and nothing about the modality they were working in (to use another analogy, if I burn dinner, it doesn't mean that the recipe was to blame). Or, it may be a case of "shit happens". But really, if we're going to do a link war, I think I'll find that link I posted here a few months ago about the hundreds of thousands of people who die per year in the US as a direct result of errors made in hospitals--temples of evidence-based medicine.

It's also off-putting to see people dismissing modalities they know absolutely nothing about. Sure, it's fine if you just personally are uninterested in learning more about a modality, and you have no interest in trying it. But to extend that to mocking and disrespecting human beings who have devoted their lives to practicing a certain modality, without even bothering to educate yourself about what's involved, is shitty of you. I am personally very skeptical of homeopathy, but at least I know what it frickin' IS. And is not. Many people here seem unaware that there is great debate within chiropractic about what the role of the chiropractor is, and even about whether things like subluxation are legit. But many just lump all chiropractors into the "quack" category. Your methods for investigating the validity of chiropractic and other "alternative" modalities are, ironically, very cursory, facile, and unscientific.

I've got to address the comment about the "occasional herb" being useful, too. Your vaunted mainstream medicine has gotten many of its pharmaceuticals by standardizing extracts of plants. Why is it that you dismiss the usefulness of the actual plants themselves? It's amazing to me how many people would rather take a pill for nausea rather than make some ginger tea, or take broad-spectrum antibiotic pills rather than use some garlic topically and/or internally. We are losing the cultural wisdom of remedies that can be used without seeing a doctor. The medical e$tablishment has done a bang-up job of convincing most people that they have no where else they can turn.

Disclaimer: I work as a massage therapist in a chiropractic office, so this discussion is especially relevant to me.
posted by parrot_person at 7:51 PM on June 16, 2011 [4 favorites]

The hospital I used to live next door to has killed one patient in the recent past, and set fire to another.

Meanwhile, my best friend used acupuncture to coax her unborn daughter out of the breech position a day before she went into labor.

Just saying, modern medicine isn't perfect, and alternative medicine isn't necessarily quackery. Try to have an open mind, on all sides.
posted by palomar at 9:27 PM on June 16, 2011

It's really off-putting the extent to which so many people utterly dismiss personal experience and observation ("anecdotal evidence"). I am allergic to many nuts, including cashews. If a well-designed research study shows that cashews are good for the health, does it mean I should eat them, despite my personal observation that cashews make me sick? How about peanuts? Should I eat peanuts and go into anaphylactic shock if a research study has shown peanuts to be good for a condition I have?

I'm also not sure what people think they are proving when they link to descriptions of bad effects instances of "alternative" medicine has had. So an acupuncturist once killed a woman because he punctured her heart. The implication that that proves that acupuncture is quackery is ludicrous. I could link to all sorts of examples of mainstream doctors causing harm. The individual doctors (or acupuncturist) may have been practicing improperly, and the fact that they caused harm may say everything about their ability, skill, or focus and nothing about the modality they were working in (to use another analogy, if I burn dinner, it doesn't mean that the recipe was to blame). Or, it may be a case of "shit happens". But really, if we're going to do a link war, I think I'll find that link I posted here a few months ago about the hundreds of thousands of people who die per year in the US as a direct result of errors made in hospitals--temples of evidence-based medicine.

These two paragraphs directly contradict each other, each arguing the same issue in opposite directions. Might want to clarify what if anything you're actually trying to say.

Nobody's dismissing medicinal plants and herbs for being plants and herbs. What people are dismissing is the use of plants and herbs with untested, undemonstrated value in place of actual medicine. That is, in fact, the whole idea behind evidence-based medicine - that before you tell someone that X works on Y, you make sure that X actually works on Y. Exercise the most basic of scientific rigor and get some actual evidence behind your claims before you use them as a basis for medical treatment. When the complete body of herbal medicine has been tested, exhaustively, and demonstrated conclusively to function no better than a placebo? Then someone who persists in recommending herbal treatment is at best an idiot, and most frequently an active scam artist.

It is telling that as simple a concept as "Don't claim that things work when they don't" is so controversial in the alternative medicine field.
posted by kafziel at 1:54 AM on June 17, 2011 [2 favorites]

The hospital I used to live next door to has killed one patient in the recent past, and set fire to another.

Meanwhile, my best friend used acupuncture to coax her unborn daughter out of the breech position a day before she went into labor.

Just saying, modern medicine isn't perfect, and alternative medicine isn't necessarily quackery. Try to have an open mind, on all sides.

That's because a lot of medicine isn't science and a lot of doctors aren't scientists. My sister is a scientist and doctors DO NOT like her. Whenever she catches doctors using treatments that are outdated and unproved, she doesn't tolerate it. For example, they prescribed her a drug with significant side effects and it had been proved that it didn't even work in 2009! As Atul Gawande has documented in the New Yorker, hospitals refuse to adopt practices that save lives like treatment checklists. The whole medicine industry is full of unintentional woo and because people don't except it, it does kill.
posted by melissam at 6:52 AM on June 17, 2011 [1 favorite]

parrot_person: “It's really off-putting the extent to which so many people utterly dismiss personal experience and observation ("anecdotal evidence"). I am allergic to many nuts, including cashews. If a well-designed research study shows that cashews are good for the health, does it mean I should eat them, despite my personal observation that cashews make me sick? How about peanuts? Should I eat peanuts and go into anaphylactic shock if a research study has shown peanuts to be good for a condition I have? One of the many problems with relying so religiously on studies is that what works for the majority may not be what works for an individual, and vice versa. It is possible that some of these modalities that many of you are mocking do work for some people and some conditions. To mock someone for even trying an alternative modality when conventional medicine has failed to cure them is extremely callous. ”

This is not how studies work. Studies have treated the existence of allergies, and can work with them. Studies are a tool of evidence-based medicine, not the whole of it, and studies can be used carefully and judiciously to study scientifically the effect of medicines on people.

In other words, evidence-based medicine is not crippled by an over-reliance on studies; to the contrary, evidence-based medicine plans from the outset to work around the problems that studies pose. So I think you're raising a non-issue here.

Also, the problem with anecdotal evidence is that it's very, very easy to misread. We're often blind to what's going on in our own bodies; and even those who try to be conscious of these things are often unaware of them. That's the point of scientific examination of them; we're trying to get outside our own experience to ascertain the actual truth about things. This is absolutely essential in medicine because we're talking about life and death.

If I had a cancerous growth that was impeding my ability to breathe, and I snorted ground-up coca leaves, I could say that the coca leaves cured the cancerous growth because suddenly I was able to breathe much better. But if I continued to snort the coca leaves constantly, the cancer would keep growing and ultimately I'd die. Immediate perception is not enough in medicine. And "well, it works for me" is not a good argument for any medical treatment – because whatever "works for you" today could kill you tomorrow. The only way to know it won't is through scientific study.
posted by koeselitz at 9:07 AM on June 17, 2011

And "well, it works for me" is not a good argument for any medical treatment – because whatever "works for you" today could kill you tomorrow. The only way to know it won't is through scientific study.

There are thousands of years of tradition supporting the use of certain herbs. How is using them so different than, say, the thousands of years of tradition that let us know that indeed, apples, potatoes, and swiss chard are not poisonous? Nobody's run those through clinical trials, after all. How is health and healing so very different from literally every other human endeavor, such as architecture, cooking, making clothing, endeavors for which it would be absurd to dismiss and deride pre-20th century efforts. Are you really telling me that our forebears with their marvelous ingenuity -- the ones who figured out how to build Machu Picchu, how to circumnavigate the ocean, how to domesticate cattle (shall I go on?) -- were completely incapable of figuring out which plants might, say, ease a headache, reduce asthma symptoms or serve as a disinfectant -- and that they'd just doggedly keep using plants that killed their patients? The idea that everything about health and medicine must be left to the professionals is bizarre -- as is the idea that anything we might do ourselves for our health is dangerous (see saline rinse discussion above). As for your last sentence, c'mon now! Vioxx! Bone marrow transplants for breast cancer! Anti-TNF inhibitors and tuberculosis! No, scientific study does not guarantee at all that you won't be harmed or die. The claim that conventional medicine is risk-free is untrue and irresponsible (even my doctor tells me about the risks of the drugs she prescribes and the risks of various procedures). And -- conventional medicine works marvels. But let's not oversell it or deride other modalities.
posted by Wordwoman at 1:21 PM on June 17, 2011

There are thousands of years of tradition supporting the use of certain herbs.

There are thousands of years of tradition of sacrificing virgins to ensure a bountiful harvest.

Tradition ain't worth much.
posted by Sys Rq at 1:26 PM on June 17, 2011 [1 favorite]

Wordwoman: "Are you really telling me that our forebears with their marvelous ingenuity -- the ones who figured out how to build Machu Picchu, how to circumnavigate the ocean, how to domesticate cattle (shall I go on?) -- were completely incapable of figuring out which plants might, say, ease a headache, reduce asthma symptoms or serve as a disinfectant -- and that they'd just doggedly keep using plants that killed their patients? "

Sometimes they were, yes. Because the damage being done wouldn't show up unless someone used a medicinal herb for a long time. Say, years or even decades.

When I was a kid, my family grew several Comfrey plants in our backyard, along with a number of other herbs. Comfrey has a long history of use as an herbal medicinal. Each fall, we dried, then brewed selected leaves and roots for tea as a natural prophylactic treatment against my asthma. In the 80's, health food stores used to carry comfrey root pills that could be used for similar purposes, and I always kept them on me, right next to my asthma inhaler.

And then the health food stores stopped carrying them, because the FDA issued a warning about Comfrey. Why?

Wikipedia has a decent summary: (Emphasis is mine.)

Contemporary herbalists view comfrey as an ambivalent and controversial herb that may offer therapeutic benefits but can cause liver toxicity.

One of the country names for comfrey was ‘knitbone’, a reminder of its traditional use in healing bone fractures. Modern science confirms that comfrey can influence the course of bone ailments.

The herb contains allantoin, a cell proliferant that speeds up the natural replacement of body cells. Comfrey was used in an attempt to treat a wide variety of ailments ranging from bronchial problems, broken bones, sprains, arthritis, gastric and varicose ulcers, severe burns, acne and other skin conditions. It was reputed to have bone and teeth building properties in children, and have value in treating "many female disorders". Constituents of comfrey also include mucilage, steroidal saponins, tannins, pyrrolizidine alkaloids, inulin, and proteins.[citation needed]

Internal usage of comfrey should be avoided because it contains hepatotoxic pyrrolizidine alkaloids (PAs). Use of comfrey can, because of these PAs, lead to veno-occlusive disease (VOD). VOD can in turn lead to liver failure, and comfrey, taken in extreme amounts, has been implicated in at least one death. In 2001, the United States Food and Drug Administration issued a warning against internal usage of herbal products containing comfrey. There are ways to remove the pyrrolizidine alkaloids from comfrey, and some herbal product manufacturers have begun doing so (although the products will still be labelled “for external use only”).

Excessive doses of symphytine, one of the PAs in comfrey, may cause cancer in rats. This was shown by injection of the pure alkaloid. The whole plant has also been shown to induce precancerous changes in rats.

Natural medicinals aren't perfect, and our ancestors weren't infallible.
posted by zarq at 1:36 PM on June 17, 2011

Sometimes they were, yes. Because the damage being done wouldn't show up unless someone used a medicinal herb for a long time. Say, years or even decades.

Do you really believe that this does not happen with pharmaceuticals? (Paging Docpops.)
posted by Wordwoman at 1:47 PM on June 17, 2011 [1 favorite]

me: “And "well, it works for me" is not a good argument for any medical treatment – because whatever "works for you" today could kill you tomorrow. The only way to know it won't is through scientific study.”

Wordwoman: “There are thousands of years of tradition supporting the use of certain herbs. How is using them so different than, say, the thousands of years of tradition that let us know that indeed, apples, potatoes, and swiss chard are not poisonous? Nobody's run those through clinical trials, after all. How is health and healing so very different from literally every other human endeavor, such as architecture, cooking, making clothing, endeavors for which it would be absurd to dismiss and deride pre-20th century efforts. Are you really telling me that our forebears with their marvelous ingenuity -- the ones who figured out how to build Machu Picchu, how to circumnavigate the ocean, how to domesticate cattle (shall I go on?) -- were completely incapable of figuring out which plants might, say, ease a headache, reduce asthma symptoms or serve as a disinfectant -- and that they'd just doggedly keep using plants that killed their patients? The idea that everything about health and medicine must be left to the professionals is bizarre -- as is the idea that anything we might do ourselves for our health is dangerous (see saline rinse discussion above). As for your last sentence, c'mon now! Vioxx! Bone marrow transplants for breast cancer! Anti-TNF inhibitors and tuberculosis! No, scientific study does not guarantee at all that you won't be harmed or die. The claim that conventional medicine is risk-free is untrue and irresponsible (even my doctor tells me about the risks of the drugs she prescribes and the risks of various procedures). And -- conventional medicine works marvels. But let's not oversell it or deride other modalities.”

I don't see anything here that contradicts what I said. Scientific study is the only way to know whether or not something will be harmful. It does not guarantee perfect wisdom; but it is the only way to test. As such, it has been used for thousands of years by intelligent people. Never did I claim that people born before 1900 were idiots; on the contrary, I spend most of my time with my head in the books of people born before the year 400 BC.

I am a Christian, and, as such, a spiritual person who cares about the ineffable. But I do indeed deride "other modalities" if those modalities refuse to explain to me how they work, or demand that I accept them as safe and effective based not on evidence but on tradition or (worse yet) on phony or faulty conceptions like those that underly chirophractic or acupuncture.

On the other hand, no, I don't mind if a 3000-year-old potion of valerian root is recommended to me, so long as it can be proven that it's likely to be effective. I am not biased toward things merely because of their modernity. I'm swayed by rationality and measured thought. When Aristotle makes arguments which accord with rational thought – which he does more frequently than most scientists, it should be noted – I'm swayed by him. But Aristotle doesn't ask me to gobble roots strictly based on tradition.

Evidence-based medicine encompasses these "other modalities," and remains as the sole useful test of them. They are not in themselves necessarily harmful, but tradition must be tested by scientific thought. And, yes, this is the only way to avoid killing people and to improve medicine.

“Do you really believe that this does not happen with pharmaceuticals? (Paging Docpops.)”

Do you really believe that "evidence-based medicine" and "the pharmaceutical industry" are the same thing?
posted by koeselitz at 1:51 PM on June 17, 2011

(In fact, I sometimes get the feeling we're talking past each other here. I know a lot of people have a problem with the pharmaceutical industry, and they express that via solidarity with "alternative medicine." But if we actually talk to doctors, particularly those who care about evidence-based medicine, we find that those same doctors dislike the pharmaceutical industry just as much, if not more. This is not as simple as people would like to think; and you don't have to abandon science to stand against corporatized medicine.)
posted by koeselitz at 1:55 PM on June 17, 2011

Wordwoman: " Do you really believe that this does not happen with pharmaceuticals? (Paging Docpops.)"

Sure it does. As a kid I also used to take Theophylline for asthma crises, and that's been largely abandoned by doctors because of harmful side-effects. I used to get adrenaline shots during the worst asthma attacks. Albuterol through a nebulizer is now given instead. Far less dangerous.

I'm saying we shouldn't be accepting anything on blind faith. Nor accept anything solely because it's "traditional." As research studies progress, we learn. It's up to us to apply that hard-won knowledge, mindfully.
posted by zarq at 2:09 PM on June 17, 2011 [1 favorite]

Wikipedia has a decent summary: (Emphasis is mine.)

Contemporary herbalists view comfrey as an ambivalent and controversial herb that may offer therapeutic benefits but can cause liver toxicity. ...
posted by zarq

Many of the formulations in traditional herbals (such as Mrs. Grieve's, as I recall) include comfrey.

I think this is mainly because of its toxicity to the liver.

One of the big problems with herbs is that their active ingredients are usually rapidly metabolized by the liver and thereby lose their effectiveness; including a liver toxin such as comfrey slows down this process, potentiating and enhancing the therapeutic benefits of the other ingredients.

Synthetic derivatives of botanicals are often tweaked by such expedients as adding fluorine atoms in strategic locations to make them harder for the liver to break down.
posted by jamjam at 2:35 PM on June 17, 2011

Meanwhile, my best friend used acupuncture to coax her unborn daughter out of the breech position a day before she went into labor.

Just saying, modern medicine isn't perfect, and alternative medicine isn't necessarily quackery. Try to have an open mind, on all sides.

No one worth listening to has ever claimed that modern medicine is perfect.

As for the breech baby - sometimes babies turn themselves around to the right position. A single instance is not a clinical trial. If clinical trials say that accupuncture can turn a baby out of breech with blah blah percentage then that's a different matter, but a single anecdote really means nothing.
posted by It's Never Lurgi at 4:36 PM on June 17, 2011

As a general rule nowadays if something hasn't been out for at least five years I won't touch it, unless it's a truly unique conundrum. The modern pharmaceutical industry as seen from medicine's front lines is fairly gross.
posted by docpops at 10:11 PM on June 17, 2011 [1 favorite]

Oh man, I have all kinds of things to say, but before I do, an aside:

Synthetic derivatives of botanicals are often tweaked by such expedients as adding fluorine atoms in strategic locations to make them harder for the liver to break down.

Wait a minute. Is this also true of purely synthetic pharmaceuticals? Is that the reason that every goddamn drug I'm on has Cytochrome P450 interactions? My poor, beleaguered CYP2D6 enzymes need to know.
posted by evidenceofabsence at 11:01 PM on June 17, 2011

These two paragraphs directly contradict each other, each arguing the same issue in opposite directions. Might want to clarify what if anything you're actually trying to say.

Perhaps the problem is not in what I wrote but in your ability to or interest in understanding it. If you read it again and still don't understand it, I am willing to attempt to answer any specific questions you have about it. If that is the case, you might want to explain what it is that you find contradictory, instead of just labeling it so and leaving it at that.

Nobody's dismissing medicinal plants and herbs

Actually, yes they are. I was responding to statements that have been made here including most specifically the statement about "the occasional herb that turns out to have a useful pharmaceutical action".

When the complete body of herbal medicine has been tested, exhaustively, and demonstrated conclusively to function no better than a placebo?

Now who's being contradictory?? First, you say that "nobody's dismissing medicinal plants and herbs" and then you dismiss "the complete body of herbal medicine" as functioning no better than a placebo.

I've actually read about plenty of studies that demonstrated the medicinal usefulness of plants or herbs to be greater than that of placebo. I referred to ginger and garlic earlier. Here are just a few results from a quick search of pubmed:

http://www.ncbi.nlm.nih.gov/pubmed/21631494 ("At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief vs 39% for placebo")

http://www.ncbi.nlm.nih.gov/pubmed/20842754 ("Sixty chemotherapy cycles of cisplatin/doxorubicin in bone sarcoma patients were randomized to ginger root powder capsules or placebo capsules" . . . "Acute moderate to severe nausea was observed in 28/30 (93.3%) cycles in control group as compared to 15/27 (55.6%) cycles in experimental group (P = 0.003)")

http://www.ncbi.nlm.nih.gov/pubmed/20418184 ("This study demonstrates that daily consumption of raw and heat-treated ginger resulted in moderate-to-large reductions in muscle pain following exercise-induced muscle injury.")

http://www.ncbi.nlm.nih.gov/pubmed/19250006 ("Ginger is an effective herbal remedy for decreasing nausea and vomiting during pregnancy.")

http://www.ncbi.nlm.nih.gov/pubmed/21403792 ("We can conclude from our study that Immumax [a natural multiherbal formula] is helpful in reducing the duration and severity of common cold symptoms")

http://www.ncbi.nlm.nih.gov/pubmed/20352147 ("After nine months, garlic supplementation was associated with a 24.66% increase in baseline arterial oxygen levels (83.05 mmHg versus 66.62 mmHg; P<0>Then someone who persists in recommending herbal treatment is at best an idiot, and most frequently an active scam artist.

Lovely. So which are you calling me, pray tell? I'm pretty sure I could refute either of those claims in my case, just let me know which one you are making.
posted by parrot_person at 12:03 AM on June 18, 2011

This is not how studies work. Studies have treated the existence of allergies, and can work with them.

My point was not about allergy per se; it was that the results of clinical trials are not applicable to everyone. Studies can make statements about what works or doesn't work for most people. A study can fail to produce statistically significant results, but a handful of people may have been truly helped. And a study that produces marked results in the majority of people still doesn't produce results in everyone. It's fairly ridiculous to be so relgiously devoted to the results of clinical trials that one would ignore what works and doesn't work for their own body.
posted by parrot_person at 12:11 AM on June 18, 2011

"Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo."- Absolute truth, carefully controlled studies! Only here's the question, who control studies? Pharmaceutical giant corporations! The so-called traditional medicine associations, which are concerned to protect their big money! I have always found it strange that traditional medicine is called what occurred a hundred years ago, while non-traditional fuels thousands of years.
posted by vorsta at 12:23 AM on June 18, 2011 [1 favorite]

Studies can make statements about what works or doesn't work for most people. A study can fail to produce statistically significant results, but a handful of people may have been truly helped.

Alternative treatments, which are what we are discussing here, already have a lot of people claiming anecdotal evidence in support of them. It wouldn't be unreasonable to ask a homeopath how many people with a certain condition they are able to treat. They might respond 'around 70%' for example. If, then, a good study shows that this clearly isn't actually the case then it's entirely reasonable to assume they are wrong and that it treats noone at all, rather than assume there's some tiny residual effect just below the statistical power of the study.

If something claiming powerful action turns out not to have it, the reasonable thing is to chuck it in the bin, not assume that it's got dramatically less power just below the ability of the study to spot. After all, if it really had that weak an effect how would the original practitioner ever have discovered it without an even more powerful study?

In other words, a study can fail to produce statistically significant results, and a handful of people may in principle have been truly helped, but it would be wrong to assume that this is the case and also wrong to invest any more energy in it if the original claim has already been disproved.
posted by edd at 5:37 AM on June 18, 2011

When the complete body of herbal medicine has been tested, exhaustively, and demonstrated conclusively to function no better than a placebo? Then someone who persists in recommending herbal treatment is at best an idiot, and most frequently an active scam artist.

Sure! But the complete body of herbal medicine hasn't been tested. Not by a long shot. Plus, not all herbal treatments are equal. Plus herbal treatment =! acupuncture =! homeopathy =! aural healing with the power of butterflies and shiny, shiny crystals. Which is why generalizing, and tossing around terms like "idiot" and "scam artist" is kind of annoying.

In a broad sense, there are three classes of treatment. In layman's terms, they are works, doesn't work, and dunno. In more sciencey terms, they are those that have proved, consistently, to work better than placebo (i.e., wherein the null hypothesis can be comfortably rejected, which we interpret as efficacy), those that have not consistently worked better than placebo (i.e., wherein the null hypothesis cannot be rejected, which we interpret as inefficacy), and those that have not been tested sufficiently (i.e., wherein the null hypothesis cannot be rejected, but that says nothing about efficacy).

"Don't claim that things work when they don't" is just fine. But for the sake of science, don't lump together "tested and ineffective" and "we don't know for sure if it works or not." The former should never be recommended. Some of the latter are far too risky to bear recommending, some can merely be taken with a grain of salt; in instances where there's negligible risk or cost and potential benefit, I say, educate yourself but go for it. I also think that there are psychological and pain-relief benefits to be had from the placebo effect; yay for mind hacking. I'm sorry if that makes me an idiot scam artist.

If you do believe in science, try to avoid sloppy generalizations. Make sure you're distinguishing between widely different treatments, and more importantly, between the concepts of "proved ineffective" and "insufficient proof." Don't discount the positive benefits of the placebo effect. Keep in mind that best practices in medicine change over time, i.e., that some things that are currently categorized as "works" may be downgraded in the future. Don't assume that all approved drugs and treatments in common medical practice work better than placebo (for drugs, phenylephrine and Prozac come to mind; for treatments, many forms of non-CBT/DBT therapy). Remember that even solid treatments don't work for all individuals. And don't fall back on tautological arguments like "alternative medicine that works is just called medicine"; if we're being honest, the average person would consider an unproved pharmaceutical in a Phase 1 trial to be "medicine" and taking powdered ginger for nausea to be "alternative medicine." Finally, remember that being mean is a good way to get people to dismiss logical arguments out of hand.

tl;dr: 1) Science demands that we remain critical, but also that we keep an open mind about that which has not yet been tested conclusively. 2) Ha ha Tim Minchin and all, but try not to be a jerk. Storm is an idiot, but she's also a straw woman.
posted by evidenceofabsence at 12:16 PM on June 18, 2011 [2 favorites]

An example of a common unproved but low-risk treatment that has potential benefit: Upthread I mentioned that I, like a whole lot of people, sometimes drink chamomile tea when my stomach is upset. Out of curiosity, I looked to see whether significant research has been done.

Per the NIH, "Chamomile has not been well studied in people so there is little evidence to support its use for any condition." They go on to say that early studies point to possible digestive and skin condition benefits. PubMed has a handful of studies on various chamomile supplements and flavinoids, but no basic studies relating to the efficacy of tea as a digestive aid. (And honestly,"Does chamomile tea settle the tummy?" is about the least sexy, resume-worthy, funding-grabbing kind of science I can imagine.) So, yeah, it might be bunk. It also might not. I'm gonna say that people can keep drinking chamomile tea if it pleases them, and do so without being superstitious idiots who destroy herd immunity by not vaccinating their children.
posted by evidenceofabsence at 12:24 PM on June 18, 2011

And honestly,"Does chamomile tea settle the tummy?" is about the least sexy, resume-worthy, funding-grabbing kind of science I can imagine.

On the plus side, it could easily be followed by Dr. Soon-To-Be-Famous' new book -- Toast: A Multidisciplinary Approach.
posted by vorfeed at 10:41 PM on June 18, 2011 [4 favorites]

evidenceofabsence: Is that the reason that every goddamn drug I'm on has Cytochrome P450 interactions? My poor, beleaguered CYP2D6 enzymes need to know.

The fact that so many of the things we ingest have significant hepatic enzyme interactions is both a legacy of our evolutionary past and a major facilitator of it. Because we descended from initially omnivorous, arboreal ancestors and passed through a phase of primarily fruit- and plant-eating subsistence (this is also why we lost the ability to synthesise Vitamin C), we were selected for metabolisms that could detoxify a wide range of plant toxins. Plants seem to have begun an accelerated development of a lot of their defensive toxins during their initial flowering phase of evolution (and there are some theories about this leading to a reduction in animal biodiversity and some extinctions as larger herbivores failed to adapt quickly enough). As our foraging and then hunting ranges expanded and primate->hominid dispersal increased, we encountered as a clade progressively more and more diverse toxins and so an increasingly active" liver biochem was selected for.

No other animal has evolved and adapted to occupy so many ecological niches as us, and to eat *every* *damn* *thing* from those niches. That's why we can "safely" eat plants and foodstuffs that appear innocuous to us but can easily kill our domestic animals or pets (such as chocolate for dogs, or acetominophen/paracetemol for cats). Without your expansive cytochrome system kicking into action to detoxify all the crap you eat, there'd be a lot more things that could kill you or make you seriously ill. A by-product of an such an expansive cytochrome system is that there are sometimes toxins or substances that through CYP metabolism become paradoxically toxified. Sometimes in medicine we use this deliberately, such as when we give a potentially toxic, low-potency pro-drug and rely on hepatic enzymes to slowly convert this into an effective, more toxic drug... but at a slow rate creatig a lower concentration. The risk of many of the herbal supplements here is not just that they can rev up a cytochrome and cause a beneficial drug to be cleared too quickly for a therapy to be effective, but that they can also rev up a toxifier (or block a detoxifier) and result in someone getting too high a dose.
posted by meehawl at 8:46 AM on June 23, 2011 [2 favorites]

In the 15 days since this was posted, additional posts have shown up over at the debate page.

* The Family Physician of the Future: The landscape is shifting, but what does this mean for day-to-day practice? One doctor offers his colleagues a new road map. (Reid Blackwelder, MD)

* What's Eating the Small, Loud Band of Alt-Med Critics?: The author speculates on why a tiny but outspoken group of scientists continues to detest alternative medicine. (David H. Freedman)

* America, Land of the Health Hucksters: A British doctor laments the rise of alternative medicine on American soil. (David Colquhoun, Ph.D.)

* Why Traditional Medicine Matters: Ancient health care systems might not be backed by modern research, but that doesn't mean they aren't scientific. (Vasant Lad, M.A. SC.)

* First, Do No Harm: A doctor who wants to stay true to the Hippocratic Oath must often turn to alternative medicine, not just convention. (Mimi Guarneri, MD)

* Why Health Care Works Better Than Disease Care: When it comes to our deadliest diseases, "alternative" approaches are measurably more effective than drugs or surgery. (Dean Ornish, MD)

* Changing Times Call for Smarter Doctors: Whether a treatment is conventional or alternative, the medical profession should be doing what works. (Andrew Weil, MD)

* Evidence, Not Anecdotes: The author responds to Steven Salzberg's argument about the dangers of accepting alternative medicine. (David H. Freedman)

* A 'Triumph' of Hype Over Reality: Alternative medicine is unscientific at best and dangerous at worst. (Steven Salzberg, PhD)
posted by zarq at 2:41 PM on June 29, 2011 [2 favorites]