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Ayurveda in the Modern age
March 7, 2013 10:03 AM   Subscribe

Ayurveda: Hoax or Science? "'Western science identifies these systems as folklore. They don’t see it as an organised system of knowledge—this is an alien epistemology to them because their medical traditions only go as far back as the medieval times and renaissance.' There is also the very real problem of complexity in natural-product research. It is harder to develop a drug from Ayurveda than it is to build a synthetic molecule, because of the large number of compounds in each Ayurvedic herb. All these factors are responsible for the state of Ayurvedic medicine today."
posted by dhruva (89 comments total) 11 users marked this as a favorite

 
“Western science identifies these systems as folklore. They don’t see it as an organised system of knowledge—this is an alien epistemology to them because their medical traditions only go as far back as the medieval times and renaissance.”

Hippocrates predates the earliest Ayurvedic texts by about 300 years, so not quite.
posted by atrazine at 10:14 AM on March 7, 2013 [10 favorites]


because their medical traditions only go as far back as the medieval times and renaissance

Such renowned medieval figures as Galen and Hippocrates, for example.
posted by yoink at 10:14 AM on March 7, 2013 [19 favorites]


If only there were some way to separate effective treatments from those that perform no better than an placebo ...like a special kind of test or something.
posted by leotrotsky at 10:14 AM on March 7, 2013 [124 favorites]


The theoretical basis for ayurveda may be bollocks, and from what I've heard, same with some of the diagnostic practices--checking in minute detail the patient's tongue--but just a cursory look at the main link: I found the mentioned herb, ashwagandha, about 5 years ago, and since I started using it I found I could ditch the $600 a month anti-seizure and mood stabilizing medication I'd been on (price went down after it became generic). Sure that's anecdotal, but I've also been following the research publications. Many of the active ingredients of Western medicine were first found in traditional remedies (aspirin in willow bark, etc.) Dismissing something because stereotypical hippies like it seems to be a powerful mental block--looking at the 10th anniversary of the Iraq war, that seems to be what allowed us to make that mistake too. (On preview: this was in response to a deleted comment!)
posted by Schmucko at 10:18 AM on March 7, 2013 [11 favorites]


The thing is, it's not ALL bullshit. Some of it is, but frankly, so is some current Western medicine. Yes it needs to be studied, but assuming it CAN'T be valid doesn't make sense to me. Surely over thousands of years they hit on at least SOME stuff that actually works! (And I am as pro-rationality and anti-hippie-nonsense as they come.)
posted by showbiz_liz at 10:19 AM on March 7, 2013 [12 favorites]


There is a simple question, which is outlined in the text: Does the Ayurvedic Remedy you are interested in lead to good clinical outcomes in an appropriately-sampled, well-controlled double-blinded clinical trial?

If so, come aboard! Science wants you! We don't care if it's been discovered by folklore, inspiration or the scientific method. We bow to the inherent wisdom of the thousands of indigenous practicioners that may have discovered this by a vast, painful, trial-and-error clinical investigation. If it is good value for money compared to other treatments, as a society, we should pay for it, and promote its use and the people who use it.

If not, then, if you are part of a group that is represented by the trial, then YOU WOULD BE ADVISED NOT TO TAKE THIS DRUG as it is not good medicine. As a society, we should not pay for it, and we should prosecute its peddlers for fraud.


on preview: see leotrotsky.
posted by lalochezia at 10:21 AM on March 7, 2013 [32 favorites]


It's not a hoax, it's just utter, utter feel-good natural hippie mother earth bollocks that's already been disproved a thousand times over.

That feels like a criticism of homeopathy (which I hope we can all agree is terrible), rather than Ayurveda.

There are certainly herbs that contain active ingredients that can have beneficial medical effects. The trick is finding the right herbs, figuring out what the active ingredients are and proving the effects.

I thought that the article did a decent job of talking about why it's hard to do all of those proofs (stuff like how different varietals in a species can contain differing amounts of the useful stuff) without getting too much into the "drug companies would never study this stuff b/c you cant make money selling plants" paranoia.

"You know what they call alternative medicine that’s been proved to work? Medicine."
posted by sparklemotion at 10:22 AM on March 7, 2013 [2 favorites]


The thing the "alternative medicine" people never seem to get is that the medicine is only "alternative" until some scientific study demonstrates its effectiveness. Hippocrates wrote about the use of willow bark as a pain and fever reducer, for example, and that was part of "traditional medicine" in his day and by no means part of "modern medical science." "Modern medical science," however, is happy to claim aspirin as one of its tools because salicylic acid (which can be derived from willow bark) has been demonstrated to have a number of medical uses.

There can certainly be financial distortions in this process (if no one stands to benefit financially from testing a medicine it is harder--though by no means impossible--to get the tests done; which makes it difficult to bring unpatented, abundantly available herbal remedies, for example, to widespread double-blinded testing). But while this is a real hurdle and one of the reasons we need to make sure that the state continues to fund medical research and not leave it solely to Big Pharma, it really has nothing to do with this B.S. notion that western scientists look at traditional remedies and say "Oh noes, that falls outside of my epistemology, I can't possibly believe it will be helpful." The "epistemology" of "western medicine" is actually pretty simplistic: "if it can be shown to work, we'll use it." (Sometimes it's even worse than that: "if someone tells me it works and gives me nice freebies, I'll use it" or "if I have a gut feeling that it MUST work, no matter what the studies say, I'll use it"--but that's a discussion for another day).
posted by yoink at 10:23 AM on March 7, 2013 [20 favorites]


The problem seems to be that many of these remedies seem promising, even in placebo-controlled double blind studies, and yet the studies aren't being systematically put together in a way to allow doctors to recommend proven remedies in the same way as pharmaceutical drugs. And there's no profit in developing traditional, unpatented herbs into pharmaceuticals.
posted by Schmucko at 10:25 AM on March 7, 2013 [3 favorites]


I recently opened up my rock collection for the first time in 30 years or so. I was googling some minerals I wasn't very familiar with, like realgar. I was amazed to find that this toxic stuff gets used in traditional Chinese medicine. Apparently it is used in Ayurveda too. It does not fill me with confidence that these ancient physicians knew what they were doing.
posted by DarkForest at 10:26 AM on March 7, 2013 [3 favorites]


This was awesome reading. I feel like one thing ayurveda gets right is the application of synthesizing life history, daily behaviors, past experiences, parental health variables, and essentially the huge realm of variables that go into human health- into healing the human body.

Even among naturopaths there just aren't people who try to pull together all the pieces into a comprehensive system of medicine that reflects the amount in influence our environments and choices have one our health (and the ways our health and past affect our ideologies and behaviors).

The complex interplay of how variables relating to human health can spiral into disease producing coping mechanisms vs a return to homeostasis and health is actually something we're studying with science right now.

They are ahead of us. The role of maternal health in the womb, emotional abuse and neglect, toxic exposures, traumatic experiences, poor diet... these are all scientifically proven to adversely effect immune system, hormonal regulation, and epigenetic regulators of how the body functions.

I'm not saying the herbs work, or even that the treatments work.I think we need to use science to measure these variables accurately-- but what we're finding with science is remarkably that the theory base behind "the science of life" is actually quite reflective of how the disease process works.

The idea that the majority of disease happens by magic, is a totally random process, and by bad genes is itself folklore. Folklore westerners want to hold onto despite the lack of science behind it. The reason we don't want to let go of it is that it was the first time we really considered that disease was something that could happen to good people, something people deserve support and care with recovering from, and it was a great antidote to the just world fallacies and consequent moral inferiority sick people were treated with.

Also the idea that all of ayurveda has "been disproven" is not based in science. A lot of ayurvedic teachings about health are common sense and based in very real science. Getting adequate sleep, preventing the body from being too cold or too warm, eating a healthy diet, getting exercise that matches a persons body and health needs, making slow changes so as not to disrupt the system too quickly, emotional support and expression, receiving nurturing hands on bodywork, having loving healthy friendship and social time, avoiding excess of extreme activities or environments and consumption...

These are all things that are not only common sense but fairly scientific in terms of being good for human health. Yes we need to study them with science, but currently we don't have doctors reading about this research or educating patients about what they can do in relationship to their specific health problems. Most doctors would agree living a healthy balanced life is a good thing to do- but not many doctors spend a lot of time teaching people what medical science would view as "a healthy stable life" leaving people to guess and read pop articles made up out nonsense as being "health". I want people to get better and more reliable education about what healthy choices and lifestyles look like and that means better research and better public access and education about that research.
posted by xarnop at 10:28 AM on March 7, 2013 [10 favorites]


The thing the "alternative medicine" people never seem to get is that the medicine is only "alternative" until some scientific study demonstrates its effectiveness. Hippocrates wrote about the use of willow bark as a pain and fever reducer, for example, and that was part of "traditional medicine" in his day and by no means part of "modern medical science." "Modern medical science," however, is happy to claim aspirin as one of its tools because salicylic acid (which can be derived from willow bark) has been demonstrated to have a number of medical uses.

I'm as Mr Science as they come, but this isn't quite true. If you go to the doctor, they are NOT going to prescribe you willow bark. They are going to give you a pill. "Alternative medicine" is not always about woo-woo treatments, it can also be about (potentially) woo-woo contexts or holism or whatever and sometimes there's no way to test the externalities that modern medicine ignore (contributing to Pfizer or growing your own medicine vs chemical plants or whatever).
posted by DU at 10:30 AM on March 7, 2013


sometimes there's no way to test the externalities that modern medicine ignore

Such as?
posted by yoink at 10:32 AM on March 7, 2013


xarnop: "These are all things that are not only common sense but fairly scientific in terms of being good for human health."

They're also totally generic, and not at all unique to ayurveda. In fact, most of those things are things my grandmother would have told me are good, and most people realize are good out of pure common sense.

So get back to me when this "alternative system of medicine" has something to offer beyond what everyone ever with a shred of common sense already knows.
posted by Joakim Ziegler at 10:34 AM on March 7, 2013 [4 favorites]


Such as?

A list of examples directly followed what you quoted. I'm sure anyone who partakes of alternative remedies (unlike myself) can give you a dozen more potential things they care about that are not covered by the FDA's charter.
posted by DU at 10:39 AM on March 7, 2013


there's no profit in developing traditional, unpatented herbs into pharmaceuticals.

I know I said something similar to this, but it really needs to be qualified very, very carefully. For one thing, there's a good reason that "modern medical science" will not, in general, want to prescribe straight, unprocessed, herbal remedies--and that is because plants are generally bad at producing regular, repeatable, measurable doses of any active ingredient. Medical science wants to know what particular chemical, or group of chemicals, in a given plant is therapeutic and at what dose.

But that also means that pharmaceutical companies have every incentive to explore "traditional medicine" to look for currently unidentified medically beneficial chemicals. Unless the recipe just turns out to be "boil up a bunch of plant X" it's very likely that whatever drug they do develop out of a given herbal remedy is likely to be patentable. And, in fact, Big Pharma are actively engaged in scouring accounts of traditional medicines all over the world trying to find potential drugs to develop.

Then add to that the fact that there is still quite a lot of medical research that is not, simply, designed to fatten the wallets of pharmaceutical company shareholders and even plants that do not show promise for patented, highly profitable medications do get proper, double-blind tests. Look, for example, at St. John's Wort or Echinacea. Of course, the studies in those cases tend to show that they're bunk--but that's the problem with "alternative medicine," you have to kiss an awful lot of frogs before you find your handsome prince.
posted by yoink at 10:40 AM on March 7, 2013 [6 favorites]


But a lot of people DON'T understand how their behaviors affect their health. In fact rationalizing and disbelieving common sense cause and effect variables about human health is very common.

In fact trauma, abuse, neglect, and physical pain can cause us to alter our coping mechanisms and our beliefs about those coping mechanisms to survive poor conditions. Coming out of that is a difficult process that involves a lot of changes to behaviors that are contributing to poor health.

Therapists and doctors frequently fail to do an eval on people's daily behaviors and overall health choices and these details can make a huge difference in recovery. Imagine if you had a serious disease that your choices was causing or contributing to and no one even told you that's why you were so sick?
posted by xarnop at 10:41 AM on March 7, 2013 [2 favorites]


A list of examples directly followed what you quoted.

You mean "woo-woo contexts or holism or whatever"? I don't really see those as "examples." Could you give an actual descriptive example of a "woo-woo context" or "holism" that is structurally unamenable to double-blind testing?
posted by yoink at 10:42 AM on March 7, 2013


Imagine if you had a serious disease that your choices was causing or contributing to and no one even told you that's why you were so sick?

I suspect that you're talking here about "causes" that are unsubstantiated by scientific testing. Because when it comes to causes that have been substantiated, doctors talk about them all the time: obese people are told to lose weight, smokers are told to quit smoking, heavy drinkers are told to cut down, drug addicts are told to seek help etc. etc. etc. It is simply untrue to suggest that there is some general bar in Western medicine against connecting "life choices" to disease.
posted by yoink at 10:45 AM on March 7, 2013 [4 favorites]


For the herb mentioned first in the article, ashwagandha, there IS a patented extract with uniform proportions of active ingredients (Sensoril, standardized a certain % of withanolides). Reading to the end of the article, I see that now there are approved drugs without single active ingredients. Perhaps there's some oversimplification in laying the problem that these remedies haven't been incorporated into Western medicine at the evil pharm companies, but the current system does seem biased against beneficial ayurvedic remedies. Maybe lucrative alternative medicine market would suffer if their herbs could be brought into the medical mainstream too.
posted by Schmucko at 10:49 AM on March 7, 2013


I'll put it another way, how many doctors watch people's food choices, exercise habits, stress and trauma creating choices-- and lament the simple cause and effect process they are watching?

Ayurveda offers people a space to voluntarily take a peak at their own choices in a supportive environment where their unhealthy choices with both be understood and also discouraged. Ayurveda basically offers a harm reduction approach to taking control of your behaviors in relation to you health, with compassion for the reasons your behaviors may have gotten out of wack and with a lot of support and detailed action steps to re-align yourself with healthy behavior.

That is not a space that western medicine provides. In fact therapy itself is often unproductive at uncovering the details of people sleeping, eating, exercise, socializing and daily habits. Unless the person seeking therapy brings those variables to the table, it's possible to go therapy for a long time talking about your mother or the past sexual abuse and not address that you regularly stay up til 4 in the morning and your hormones are out of wack and not going to get better until you address specific variables keeping you out of wack.
posted by xarnop at 10:51 AM on March 7, 2013 [4 favorites]


Hello? Has anybody here, like, actually read the linked article? It might be nice to discuss it!
posted by Wordwoman at 10:52 AM on March 7, 2013 [10 favorites]


That is not a space that western medicine provides.

This just isn't true. It may be that some doctors are crap at this and some are good at it, but I've talked "food choices, exercise habits, stress and trauma creating choices" with every single family doctor I've ever had. My hmo is constantly offering me special tips on these matters. My employer gives me a cash reward every year if I fill out a "wellness" questionnaire that looks--in detail--into all these issues and awards me an overall health score based on my answers and provides specific follow-up on any areas of concern; they do this under the advice of "western medicine" because they want to lower their overall health insurance costs.
posted by yoink at 10:59 AM on March 7, 2013 [9 favorites]


Hello? Has anybody here, like, actually read the linked article? It might be nice to discuss it!

If you have a specific issue from the article you feel is getting insufficient attention you might want to raise it rather than just randomly snarking at the whole thread.
posted by yoink at 11:00 AM on March 7, 2013


Thousands of other herbs and formulations are in similar stasis—they enjoy immense popularity and a Rs 8,000 crore market among Indians, but modern medicine rejects many of them.

The willingness of people to pay for things rarely has anything to do with actual efficacy....

Although, as always, points for working "crore" into sentence. I love that word!
posted by GenjiandProust at 11:01 AM on March 7, 2013 [2 favorites]


This part reminded me so much of going to the doctor in the US: "According to Jalihal, tonics such as Liv.52 have no proven action. They are merely given to placate the patient."

We may see our medicine as intellectually superior, but we overprescribe and overtreat for the same reasons.
posted by mittens at 11:04 AM on March 7, 2013 [2 favorites]


Sure, yoink. The core of the article is this:

Why hasn’t the dazzling array of research into Ayurveda resulted in proven drugs? Why are these drugs incomparable to modern medicine? Is it that Ayurveda works on faith alone? If so, what is one to make of the thousands of ‘scientific’ studies arguing for Ayurvedic drugs?

I'm genuinely interested in what people have to say about this; not so much interested in one-liners like leotrotsky's (speaking of snark).
posted by Wordwoman at 11:06 AM on March 7, 2013 [1 favorite]


I read it. And the gist of it is that there may be benefits to some herbs and practice, but as of yet they haven't been subjected to science and thus aren't scientific.

But I guess it's more fun to imagine an anti-naturalist conspiracy, or alternatively, whacko new age hippie crap.
posted by graphnerd at 11:07 AM on March 7, 2013


Turmeric is amazing.
posted by discopolo at 11:09 AM on March 7, 2013 [3 favorites]


Sure, yoink. The core of the article is this:

As far as I can see the bulk of the thread discussion is entirely relevant to what you claim you want to discuss.
posted by yoink at 11:09 AM on March 7, 2013


" they do this under the advice of "western medicine" because they want to lower their overall health insurance costs."

Right... but that doesn't sound like a point person available to help you with problem areas? The perspective of ayurveda that our behaviors themselves reflect situations of "disease" is fairly in line with what we're learning about gene/environment interactions and epigenetics. Addictive behaviors and impulse control problems resulting in poor health decisions are frequently the result of prior poor health variables in the family or parents.

"Why hasn’t the dazzling array of research into Ayurveda resulted in proven drugs?"

Maybe because of knee jerk reactions against promoting such research making it unpopular in scientific communties who see it as stupid hippie stuff "already disproven".
posted by xarnop at 11:10 AM on March 7, 2013 [2 favorites]


But I guess it's more fun to imagine an anti-naturalist conspiracy, or alternatively, whacko new age hippie crap.

It might be fun to imagine I'm imagining that!
posted by Wordwoman at 11:11 AM on March 7, 2013 [5 favorites]


Could you give an actual descriptive example of a "woo-woo context" or "holism" that is structurally unamenable to double-blind testing?

Let's say I think profiting from making medicines to help people is wrong. Therefore I don't want to give money to drug companies. If I go to the regular doctor, I'm going to get a prescription for aspirin. Instead, I make friends with someone who owns a willow tree and they let me eat the bark.

The FDA cannot test the claim "profiting from making medicine is wrong". Therefore I would be participating in a working alternative medicine for reasons that cannot be tested.
posted by DU at 11:15 AM on March 7, 2013 [2 favorites]


Slate had a totally AMAZING article about chemophobia- the irrational feeling that taking an herbal remedy is somehow not the same as taking a "chemical".

The simple names favored by the alternative medicine community provide an illusion of safety and comprehensibility that the chemical names can’t match. Another common chemical name for methotrexate is amethopterin, which comes from the roots meth, Greek for wine, which I might stretch to spirits, and pterin, Greek for feathers. And naproxen is a chemical analog of salicylic acid, which can be extracted from willow bark.

http://www.slate.com/articles/health_and_science/medical_examiner/2013/02/curing_chemophobia_don_t_buy_the_alternative_medicine_in_the_boy_with_a.html
posted by forkisbetter at 11:15 AM on March 7, 2013 [5 favorites]


I'm genuinely interested in what people have to say about this

My impression of the article is that there may be benefits. However, they have not been systematically explored or subjected to truly rigorous research. While this may be because it is difficult to identify which of many active compounds (or which interactions of the many active compounds) in an herbal remedy is really effective for the problem, at least some of the problem seems to be an unwillingness by the practitioners to submit to rigorous testing.

A serious problem with alternative and traditional medicine is that it is insufficient for a remedy to be effective; the explanation for the effectiveness of the remedy must also be true. Sadly, while many traditional systems yield useful remedies, generally the underlying concepts are not supported by deep research. Acupuncture, for example, seems to have some value, but the underlying ideas about meridians don't seem to have anything to do with whether it works or not. Similarly, whatever benefits ginseng has has nothing to do with the fact that the root kind of looks like a little person.
posted by GenjiandProust at 11:19 AM on March 7, 2013 [1 favorite]


I feel saying "What wackos" is like the gold star of "I'm smart and scientific"

Homeopathy HAS been disproven and is based in NONSENSE. Ayurveda is a very complex system of different types of treatments that promote whole person health. I want more research into using this approach personally. Our hormonal, immune, and various bodily systems are very responsive to emotional conditions and environmental variables.

As ayruveda suggests, injuries to the body/psyche that happen in the womb cause worse damage than injuries that happen to a toddler, than injuries that happen to a teen. Imprinting of poor environmental variables does work like this, and is cumulative.

I don't know which of you are reading trauma research, human development research, or epigenetic/gene environment research but these are concepts that are in fact a big part of research right now and the general public is a bit behind on reading the research or keeping up with it. The idea that our environments shape our health, thinking, and behaviors is pretty grounded in reality.

And no it's NOT always common sense how to heal the body/mind/emotions, that's why we need science to help uncover the truth. Since pharmaceutical options get the most research, it's very hard to get good research on other strategies that might even work a lot better for many conditions. Also I think herbs can be harmful. I want research on their effects both positive and negative.

"A serious problem with alternative and traditional medicine is that it is insufficient for a remedy to be effective; the explanation for the effectiveness of the remedy must also be true. "

Which is why, of course, you're also opposed to psychiatry, right?
posted by xarnop at 11:22 AM on March 7, 2013 [8 favorites]


There's a difference between "this hasn't been studied properly so we can't know for sure if it works" and "this hasn't been studied properly, therefore it DOESN'T work."
posted by showbiz_liz at 11:23 AM on March 7, 2013 [1 favorite]


Right... but that doesn't sound like a point person available to help you with problem areas?

That's what the GP is for: to look at the whole person, give generalised advice, prescribe simple medicine, and refer you to specialists if you need them. If your GP isn't doing this, then you need a better GP.
posted by talitha_kumi at 11:25 AM on March 7, 2013 [2 favorites]



I was amazed to find that this toxic stuff gets used in traditional Chinese medicine. Apparently it is used in Ayurveda too. It does not fill me with confidence that these ancient physicians knew what they were doing.

Of course, we all understand that dismissing all of Ayurvedic medicine because some practitioners combined minerals and metals with the herbs is not scientific.

If not, then, if you are part of a group that is represented by the trial, then YOU WOULD BE ADVISED NOT TO TAKE THIS DRUG as it is not good medicine. As a society, we should not pay for it, and we should prosecute its peddlers for fraud.

This is also not a scientific statement. Unproven is unproven, it is not fraud. No scientist would definitively say that something that has not been tested in clinical trials is untrue or nonexistent.

I wish people would stop letting emotional responses get in the way of actual scientific principles.
posted by oneirodynia at 11:30 AM on March 7, 2013 [4 favorites]


That's what the GP is for: to look at the whole person, give generalised advice, prescribe simple medicine, and refer you to specialists if you need them. If your GP isn't doing this, then you need a better GP.

I don't think anyone gets a GP like this anymore. I was assigned a doctor at the practice years ago. Every time I visit, I see someone different. I met the guy once. Unless I'm going to pay EVEN MORE, I can't switch to anyone else and besides all the 99%-level practices are run the same.

That right there i's another reason a person might choose alternative medicine. If you can get 80% of the attention of a person who is 30% effective, it might be better than 10% of the attention of someone who is 90% effective.
posted by DU at 11:30 AM on March 7, 2013 [8 favorites]


Yeah, um prescribing a bunch of meds for.... allergies IBS anxiety, panic attacks, attention problems, hashimotos.... yeah doctors do lots of prescribing for symptoms.

Looking at family health, and life variables? Come on. Please. It's either physical or emotional and you're getting a pill. Yes all doctors recommend "living healthy" but they aren't going to sit down and tell you DETAILS of how to do that unless you've got a REALLY fancy doctor. They also arent' going to explore how and when your instinctual behaviors started taking you in an unhealthy direction and bringing them back in line. Sure they can tell you you have hashimotos and to exercise and eat well, but you need better details than that.

And until we put some pressure on the market for treatments and solutions that acknowledge the actual factors that go into creating and maintaining diseases in people we're not going to get those kind of solutions.
posted by xarnop at 11:41 AM on March 7, 2013


A lot of this stuff actually works - I'd take a teaspoon of Amrit Dhara for a tummy ache, or a cup of tea with tulsi and honey for a sore throat over over-the-counter pharmacy pills or tonics any day - but it's going to be a long time before you get much of it in scientifically-tested pill form for all the reasons in the article.

In the worst cases, it's tied up in nationalism, post-colonial religious insecurity, superstition and pure greed. In the mean time you have no idea what's in the jar - and successive governments have happily indulged voters' insecurities by granting existing practice almost complete legitimacy, no matter how transparently unscientific (and possibly dangerous) it is.

Homoeopathy is completely relevant to this discussion, for instance, because as I understand it, under the regulations it now has as much legitimacy as ayurveda. It's unbelievably stupid and regressive.

I had a heated discussion recently with a family member who was working with one of the major alt-medicine retail manufacturers, and he pointed me to their clinical trials page as support. The "clinical trial" reports were eye-wateringly poor - "Patient X had Y symptoms. After N days of treatment with Y dosage of this drug, outcome was ..." No control group. No placebo. Nothing but a bunch of anecdotes.
posted by vanar sena at 11:46 AM on March 7, 2013 [5 favorites]


That's what the GP is for: to look at the whole person, give generalised advice, prescribe simple medicine, and refer you to specialists if you need them. If your GP isn't doing this, then you need a better GP.

GPs don't spend much time with individual patients these days. I've known people who prefer alternative practitioners in large part because they can take more time to talk to patients and consider issues like sleep habits, nutrition, and exercise. In theory, mainstream western medicine acknowledges the importance of those sort of lifestyle issues. In practice, the dominant business models in the U.S. (I can't speak to other countries) make it difficult for doctors and patients.
posted by Area Man at 11:50 AM on March 7, 2013 [3 favorites]


And no it's NOT always common sense how to heal the body/mind/emotions, that's why we need science to help uncover the truth. Since pharmaceutical options get the most research, it's very hard to get good research on other strategies that might even work a lot better for many conditions. Also I think herbs can be harmful. I want research on their effects both positive and negative.

I would say that it's never common sense. Complex systems are complex, and the fact that there is a lot of money involved in medicine makes it really difficult to do systematic research on complex systems that are not likely to make someone money. Medications are already complicated to research and the chemistry is the easy part. Too much "whole body" study seems to boil down to "I think this worked for me." And it's not like there aren't a ton of money to be made in traditional medicine and its fellow travelers.

"A serious problem with alternative and traditional medicine is that it is insufficient for a remedy to be effective; the explanation for the effectiveness of the remedy must also be true. "

Which is why, of course, you're also opposed to psychiatry, right?


It depends on what you mean. Are we talking about medication? therapy? what?
posted by GenjiandProust at 11:51 AM on March 7, 2013


Unproven is unproven, it is not fraud.

We should not be prescribing unproven drugs. We should especially not be prescribing unproven drugs claiming they have efficacies and safeties that have not been proven. This is by definition, fraudulent.

No scientist would definitively say that something that has not been tested in clinical trials is untrue or nonexistent.

We're not claiming "it doesn't exist" - we're saying "until you have demonstrated this has an outcome better than not giving the drug, you should not prescribe it, and furthermore, if you DO prescribe it, you are likely actively harming the patient and society at large"
posted by lalochezia at 11:51 AM on March 7, 2013 [5 favorites]


Thirding the comments about GPs. If their function is supposed to be all that other stuff we're missing, they sure don't have enough time/attention to do it. Most don't even remember you from one visit to the next in my experience.

(Also--tangential, hobby horse aside: wouldn't it greatly reduce the risk of spreading infectious disease through medical care if GPs still did house calls? Requiring everyone who might potentially have an infectious disease to congregate in clinics and hospitals doesn't seem to be working out so well, what with all the new superbugs finding those places to be such convenient disease vectors nowadays. But as in so many other areas of American life economic reasoning--not sound medical thinking--are driving those kinds of choices these days.)
posted by saulgoodman at 11:52 AM on March 7, 2013 [2 favorites]


On a different note, I know a doctor who travelled in India as part of a group of physicians visiting from the U.S. He repeatedly met with Ayurveda practitioners who would tell him about medicines that had were effective in fighting cancer. He'd then engage and try to discuss setting up scientific studies only to be ignored or shot down.
posted by Area Man at 11:54 AM on March 7, 2013 [4 favorites]


If you begin a talk with the phrase, "western science" I have to assume the discussion is taking place in the market as opposed to the university. The pursuit of understanding the fundamental nature of all things does not discriminate through geography.
posted by Slackermagee at 11:56 AM on March 7, 2013 [6 favorites]


It's said that there is no such thing as scientifically-proven complementary/integrative medicine-- that once a treatment is proven empirically it simply becomes medicine. I'd like to expand on this later this evening, but in the mean time it's important to realize that the Ayurvedic pharmaceutical industry is driven by exactly the same profit motives as the biomedical pharma industry. I suspect anyone who would try to sell me a product of unproven safety/benefit, traditional or otherwise.
posted by The White Hat at 11:58 AM on March 7, 2013


We're not claiming "it doesn't exist" - we're saying "until you have demonstrated this has an outcome better than not giving the drug, you should not prescribe it, and furthermore, if you DO prescribe it, you are likely actively harming the patient and society at large"

Does your passion about this extend to the frequent use of off-label prescribing by conventional physicians?
posted by Wordwoman at 11:59 AM on March 7, 2013 [3 favorites]


I don't think anyone gets a GP like this anymore.

My GP is like this. I can't imagine I just happened to get the one GP in the entire US who still gives physicals and talks about life choices and how they affect health?

Yes, there are bad "western" general practicioners out there. Painting all doctors as primarily 'treating symptoms' is just as bad as painting all unproven medicine as 'worthless' without doing tests first.
posted by muddgirl at 12:03 PM on March 7, 2013 [1 favorite]


Also, it will be incredibly hard to patent (& defend upon challenges) medicines derived from traditional remedies. So what are the incentives to prioritize investigations into these streams over others?
Ayurveda is a science based on observed effects that has been refined over centuries. Sure, there are lots & lots of unscrupulous practitioners willing to make a quick buck but that points to an entirely different area that needs addressing.
posted by asra at 12:09 PM on March 7, 2013


Several of these studies conclude with positive findings, leaving ellipses of expectations.

Zero. The number of Ashwagandha-based drugs a practitioner of modern medicine can prescribe.


Several? What like, seven? Out of 573 studies? That's not very compelling, credulous author of a breathless piece on Ayurvedic medicine. The scientific naïveté of some promoters of alternative medicine approaches that of medical school graduates.
posted by Mental Wimp at 12:14 PM on March 7, 2013 [2 favorites]


asra: "Also, it will be incredibly hard to patent (& defend upon challenges) medicines derived from traditional remedies. So what are the incentives to prioritize investigations into these streams over others? "

In my unhinged rant above I forgot to mention this as another factor in the alt-med establishment's mistrust of the allopathic industry - paranoia about biopiracy, both imagined and justified. I was surprised to find that there was a Government press release about this. The USPTO-granted patents on neem and turmeric come up in these discussions very often.
posted by vanar sena at 12:15 PM on March 7, 2013


My GP is like this. I can't imagine I just happened to get the one GP in the entire US who still gives physicals and talks about life choices and how they affect health?

Whoops, our bad. We are getting personalized, detailed service from our GPs after all. Thanks for the fix!
posted by DU at 12:24 PM on March 7, 2013 [4 favorites]


My GP is like this. I can't imagine I just happened to get the one GP in the entire US who still gives physicals and talks about life choices

So you can't imagine you're just one node of anecdata that violates an otherwise pretty clear statistical norm? Because I can.

I can also imagine that the dozens of other acquaintances I've talked to about this problem were the outliers and everyone else's care is just great. I can imagine all sorts of things. I might even imagine that lack of meaningful national standards of medical practice and regional economic and regulatory conditions creates huge amounts of disparity in quality of care in American medical practice from one regional market to another. But then we can both imagine all kinds of stuff all day. What are the facts?
posted by saulgoodman at 12:29 PM on March 7, 2013


Out of the four large cow-dung pieces two portions of the sufuf are spread out...

Sign me up! We$tern Medicine is bullshit. I demand real bull shit!
posted by Mayor Curley at 12:38 PM on March 7, 2013 [2 favorites]


Ah, the gentle majesty of non-falsifiable hypotheses. You know what's great for lung cancer? Exorcising the spirits of your angry ancestors, a procedure done correctly only by the shamanistic spiritual leaders of a tribe of central Costa Rica.

Well, of course it WORKS. They've been doing it for CENTURIES, and they wouldn't keep doing it if it didn't work. Several studies have shown a strong correlation between demon-spirit exorcism and long-term remission; those studies aren't in PubMed, but I'm sure you'll take my word for it. And look how low their incidence of lung-cancer mortality is! They have tons of first-hand accounts of people successfully not dying of lung cancer, which is what you must mean by "clinical data." And it sure sounds a whole lot safer than voluntarily ingesting CHEMICALS.
posted by Mayor West at 12:42 PM on March 7, 2013 [4 favorites]


The ex post facto self-evident claims that science has it already figured out makes these conversations just as frustrating to read as it is to see people talk about healing crystals.
posted by P.o.B. at 12:48 PM on March 7, 2013 [2 favorites]



We're not claiming "it doesn't exist" - we're saying "until you have demonstrated this has an outcome better than not giving the drug, you should not prescribe it, and furthermore, if you DO prescribe it, you are likely actively harming the patient and society at large"

Does your passion about this extend to the frequent use of off-label prescribing by conventional physicians?


This is an excellent point, and one of the few novel ones in this post. There is a reason why these are "off-label", because manufacturers don't want the liability of having unproven therapies attempted.

So, yes, my passion does go that far. I think that for pathologies with effective treatment, that off-label prescription should be disallowed until clinical trials are done. Note that these clinical trials should be easier than from scratch, since a lot of the safety issues have been taken care of (from the original clinical trials), and only the efficacy ones remain.

Note the conclusion to the study you cited:

"Conclusions: Off-label medication use is common in outpatient care, and most occurs without scientific support. Efforts should be made to scrutinize underevaluated off-label prescribing that compromises patient safety or represents wasteful medication use."

I would note that one can do retrospective meta-analyses of some off-labe prescriptions if it is done in a more controlled environment than a lot of complementary medicine , so you can infer something about efficacy. But as a rule, unless off-label prescription is for a desperately serious condition with no effective treatment, off-label prescriptions should be disallowed.

Thanks for keeping the discussion civil and on point.
posted by lalochezia at 12:53 PM on March 7, 2013 [1 favorite]


They've been doing it for CENTURIES, and they wouldn't keep doing it if it didn't work.

Oh, what, you mean like praying?
posted by unSane at 12:56 PM on March 7, 2013 [5 favorites]


And, yes, I realize that the actual implementation of evidence-based medicine in the real world is deeply flawed, but we should move towards correcting those flaws, not introducing a whole bunch of new, non-scientific, non-addressable flaws (i.e. non falsifiable assertion based medicine) into a broken system
posted by lalochezia at 12:57 PM on March 7, 2013 [3 favorites]


As ayruveda suggests, injuries to the body/psyche that happen in the womb cause worse damage than injuries that happen to a toddler, than injuries that happen to a teen. Imprinting of poor environmental variables does work like this, and is cumulative.

This is not only bullshit, but this is dangerous anti-woman bullshit. Pregnant women in the US are under so much pressure and scrutiny all the time - being told by their doctor, family, and perfect strangers that they're Doing It Rong no matter what they're doing and generally being treated as walking incubators. Add to that the pressure of if you don't control your uterine environment perfectly your kid will be chronically sick as an adult?

I hope that idea NEVER takes off in the US. I can only imagine the stress - which won't help the woman or fetus - of trying to keep a perfect uterine environment. I mean, hell, we're already told we have to expose our fetuses to Mozart so they'll grow up to be smart! What's next? We have to read poetry at our bellies for six hours a day? Eat nothing but Ayurvedically approved foods? Controlling women's bodies in the name of doing what's "best for the baby" happens enough. It does not need to be encouraged further.*

I have a chronic condition. My epilepsy is the result of genetics, not because my mother didn't provide a suitable uterine environment.

*Note: I am not talking about encouraging pregnant women to give up harmful behaviors or adapt their lifestyles in ways that have been proven beneficial. I'm saying that women who are trying to have a healthy pregnancy deserve the freedom to decide how they do that.
posted by sonika at 1:07 PM on March 7, 2013 [11 favorites]


Speaking of biopiracy, did anyone read that section about research restrictions? Having to get pre-approval from an Indian government bureaucracy just to study effectiveness would sure put a damper on getting proper studies done ...
posted by R343L at 1:08 PM on March 7, 2013


Imagine if you had a serious disease that your choices was causing or contributing to and no one even told you that's why you were so sick?
-- xarnop

Anecdata:
I had that very thing happen to me. Given a family history of heart disease, and a disposition to be round rather than angular, not to mention gastrointestinal issues of my own, I carefully adjusted my diet to emphasize whole grains, raw/lightly cooked vegetables/fruits, and exclude as many fats or animal products as possible. Vegan lite. In addition to other plant proteins/combinations, I ate a lot of soy; mostly as tofu, miso, and tempeh. And while my bloodwork looked great and I was a reasonable size, it was mostly because I was too nauseous and in pain to eat much. I stuck to it for over two years, convinced it would eventually get better.

The newly-developed gastric acid reducing medications didn't seem to help. (I take them daily now, and they make a huge difference.)

Guess who can't metabolize certain soy proteins? Guess what high-fiber diets do to intestinal ulcers? My healthy, vegetarian, holistic, doctor- AND naturopath-recommended diet made me feel even worse than I was before I started. The fix was pleasant - no soy (turns out other beans make a lower-yield tofu-like solid); judicious dairy/egg/fish/meat consumption; fewer high-fiber foods, learn how to cook. Unfortunately I also learned how to deep-fry...
posted by Dreidl at 1:08 PM on March 7, 2013 [1 favorite]


More anecdata; I have epilepsy. While trying to get the right anti convulsants, I also tried "alternative" medicine. Every damn thing. Massage. Supplements. Ayurveda. Eating for my "blood type." Every. Fucking. Thing. Save for acupuncture, for whatever reason. None of it helped.

What helped was finding a good neurologist, getting a sleep specialist to help me manage my sleep to avoid triggering seizures, and getting the right medication. I am nearly 100% seizure free and can increase medication doses and get more sleep when I have breakthrough seizures and thus generally only have one or two at a time before they stop again. I used to have seizures every day.

I would be the first to believe in alternative medicine. I wanted to believe. I absolutely do believe people when they say it works for them, but just like my anti convulsants don't work on all types of seizures, alternative/traditional therapies don't work in all situations - which is why things like epilepsy were long misunderstood and poorly controlled. The past was not a golden age of medical marvels. People lived with chronic conditions and died of diseases modern medicine can now cure.

Western medicine is not perfect - and can probably learn things from other cultural forms of treatment, under proper testing - but it's evolving and works a fuck ton of a lot better than what we used to have.
posted by sonika at 1:21 PM on March 7, 2013 [3 favorites]


Like Wordwoman, I'd really recommend reading the actual article, if you haven't.

The author advocates clinical testing of traditional Ayurvedic remedies, and spends a lot of time countering the position quoted in the post*, explaining the necessity of controlled clinical trials, and why developing drugs from herbal remedies is tricky. He puts a lot of the blame for the paucity of good-quality clinical trials of Ayurvedic medicines on the Indian government, not Western medicine.


(* This is a quotation in the original article, and a position the author pretty clearly disagrees with. It's a teaser quote in the FPP, not anything like a synopsis of the article.)
posted by nangar at 1:22 PM on March 7, 2013 [3 favorites]


Did anyone else notice the paragraph about the inconsistency of herbs? This seems to be pretty obvious to me, as growing conditions will change flavors (wine, chile peppers, heck even squash and tomatoes). This is the biggest problem with running clinical trials on herbs. There is no standardized dosage (thinking about it now, this is also my biggest worry about the minuscule amount of marijuana research allowed- how do they check dosages, although for pot they are usually looking at reducing nausea, not curing diseases). That's why the researchers look for pure compounds.

Atropine comes from deadly nightshade. The right amount allows some pretty amazing stuff. Any more and well, there is a reason that plant has its name.

Continuing this thought- if you did test one of these compounds and found it to work, it would be a generic-proof medicine. The herbs would have to always come from the same places under the same conditions until they could figure out why those herbs did what they do. I'm surprised big pharma isn't crawling all over that.
posted by Hactar at 1:25 PM on March 7, 2013


It's a teaser quote in the FPP

In retrospect, that was a really bad choice on my part. I found the article very neatly balanced between the two fields, and very even handed in it's approach towards Ayurveda and modern medicine.
posted by dhruva at 2:00 PM on March 7, 2013


Speaking of homeopathy, while I don't think it's effective, did Madeleine Ennis ever figure out what was causing the positive effect she found in her studies? (See number 4--linked here years ago)
posted by whatgorilla at 2:58 PM on March 7, 2013 [1 favorite]


It is simply untrue to suggest that there is some general bar in Western medicine against connecting "life choices" to disease.

Really?

Ok, can you explain the FDA recommendation to 'eat whole grains' to diabetics when that is a high glycemic food item?

(VS follow the 1880's eat fat+protein+low carbs?)
posted by rough ashlar at 3:21 PM on March 7, 2013


The problem is western medicine right now is that science got too expensive.

I'm dead serious. Once you get into the billions to validate a substance -- and you lose billions on those substances that don't make the cut -- you literally cannot afford to complete scientific validation on anything that doesn't have rock solid patent protection. Nature doesn't care; an individual chemical or cocktail is as effective or ineffective as it was before the validation. But there are finite resources and genuine business risks, and our insistence on maximum levels of safety and efficacy means we don't discover the safety and efficacy of most things.

It's hard to admit, but our "western system" isn't working well anymore. You may have noticed the lack of new antibiotics, or the quiet but noticeable trends to find off-label uses for things.

This all being said, it's important to realize all this comes from a history of quackery that Medicine still remembers, and (as the homeopathists have shown) is constantly at risk of returning to.
posted by effugas at 3:42 PM on March 7, 2013 [5 favorites]


Hi. I'm a scientist. I study coherent energy transport; I'm trying to figure out some problems with some weird interplay between wavelike transport of energy through complicated, large molecular systems, and the effects of disorder and perturbation from the local environment. We're interested in how correlations in fluctuations might assist energy transport. Yesterday I came up with an idea for connecting certain novel optical effects to superconducting qubits; we don't know if it will work, but it could be amazing.

You know where we get all the exotic stuff we study? OUT OF SWAMP MUCK. We scrape the gunk off the bottom of our boots and look at photosynthetic protein structures that these bacteria make.

Why am I bringing this up? Because a lot of people in this thread are repeating a claim that isn't true -- that there's some 'Western science and medicine' firewall, and anything that doesn't come sealed under argon from Sigma-Aldrich is an anathema to the scientific community. It's nonsense. We're super interested in grungy stuff. A lot of our experiments start with wadding up a bunch of spinach in a blender. People in my little field
are messing around with stuff they scrape off the beaks of birds, or mashed up bits of cow eyeballs.

If someone finds some herb that has useful effects, people in biomedicl research look at it. In the alternative medicine systems of the world, there are often some useful remedies. Those tend to be the low-hanging fruit -- things that consistently work stand out, and are recognized, and will get double blind tested. But most of these systems are packed. full. of. nonsense.

If it doesn't stand up to extensive double blind testing, it is not a genuine, therapeutic medicine.

And, as a side note, a lot of the praise that some alternative systems of medicine receive smacks of orientalism. Ooh! How exotic, a traditional remedy from Kashmir. Would you take the same medical advice from one of my brothers from rural Virginia?
posted by samofidelis at 3:51 PM on March 7, 2013 [14 favorites]


"This is not only bullshit, but this is dangerous anti-woman bullshit."

This is itself silly. No where in pointing out that unhealthy environmental conditions can be bad for the fetus do I say this involves shaming women and you interjected that all on your own.

I'm saying it because pregnant women DESERVE BETTER CONDITIONS not to be regulated and shamed if they are stressed?????

I have done a lot of reading domestic violence, sexual assault, trauma, poor diet, pregnancy, human development and health problems and the ways they overlap. I'd be happy to compare notes with yours, on what basis are you claiming I speak "bullshit"? Resiliency is strange, some types of exposures can turn out to provide opportunities to build strengths and adaptations and some can send the body the other way. And some can do both or not cause a problem for the body.

The fact that getting assaulted can cause poor health in women, and subsequently affect the pregnancy is not about women handling stress "wrong". It's about assault being bad for humanhealth and people deserving both to be protected and to be offered support and health care that addresses the physical problems that can manifest from environmental variables.

The fact that I think a lot of current medical practice is itself bull in no way means I think naturopaths have a fucking clue what they are doing. I don't think they do at all. Which is why they need science. The fact that our environment can affect our health doesn't mean that we have mastered the art of how the environment affects various different types of individual bodies. It doesn't mean that we don't need to create tools repair the body or have a medical system.
posted by xarnop at 5:34 PM on March 7, 2013 [2 favorites]


House calls need to come back. I use these folks rather than going to a GP brick and mortar most of the time.

I'm all for finding active constituents but I also think it's worth exploring combinations that naturally occur in various sources, ie in the case of cannabis. And I don't want this to be driven entirely by pharmaceutical companies who have an interest in modifying the compound over time in order to keep patenting it and would like to reserve the right to use crude drugs like coffee, tea, and weed at my pleasure and to tell other people that in my experience they work wonders.

Nobody is exactly threatening that right. But Orrin Hatch notoriously cosponsored an anti drug act years ago that would prohibit any dissemination of information about illegal drugs or analogues while simultaneously being a huge proponent of Ephedrine and other powerful herbs, seeking to prevent the FDA from taking any action on banning or regulating any "nutritional supplements," aka "a combination of powerful, kinda effective, or useless things that aren't yet illegal or classified as medication." He had his reasons but I'm too lazy to hyperlink from my phizzone.

In short, I think we should study certain herbs suspected to be awesome (did I mention Kratom yet?) while also studying active constituents in isolation and combined with other alkaloids in the plant. It doesn't always make sense, but patenting an alkaloid and then spending decades tweaking it to keep it patented while also hitting a reset button on long term outcomes data doesn't always make sense either.
posted by lordaych at 6:28 PM on March 7, 2013


Anecdotally, the random GP I got to prescribe things like flonase is a total indifferent non listening fast paced douche but he ended up being right here and there when he blew me off and said try X instead. But he's a total pusher, wanting to put me on lipitor at age 30 due to low but not crazy low HDL and normal LDL levels. He mentioned maybe exercising and eating right for awhile if I wanted to go that route but was favoring the pill quite clearly.
posted by lordaych at 6:32 PM on March 7, 2013


I foolishly said Ephedrine (active constituent) instead of "Ephedra" in my first comment when mentioned Senator Hatch. I go'way nau
posted by lordaych at 6:36 PM on March 7, 2013


samofidelis,

Your field is not defined by billions of dollars that will not be repaid if patent protection can't keep everyone else from free riding on your research. Drug discovery most certainly is. Your experience means nothing to their economics.

It's not that there aren't lots (and lots) of quack treatments. It's that we can no longer credibly say that absence of full multistage clinical trials rules out either safety or efficacy. We've created an incredibly high bar for innovation in the chemical realm, and I'm not saying that's without cause, but such stringent limitations has its side effects.

What I'm expecting is for other nations to do their own drug discovery efforts, because the cost of importing from the US is so much greater than the cost of doing their own validation. Hell, they're doing our validation anyway (in providing the people for clinical trials) so it's not like they don't have some experience in this space.
posted by effugas at 6:46 PM on March 7, 2013 [3 favorites]


(And for the record, I'm a scientist too, working in information security. I'm rather familiar with quackery.)
posted by effugas at 6:46 PM on March 7, 2013


A serious problem with alternative and traditional medicine is that it is insufficient for a remedy to be effective; the explanation for the effectiveness of the remedy must also be true.

I agree that it's nice to have some sort of explanation for effectiveness, but mechanisms of action are way overemphasized in modern pharmacology. In a lot of cases, mechanisms either aren't as important as they were first thought to be, or they end up being complete horse shite, or we've found drugs to be effective even not knowing anything at all about their mechanism of action. Some pertinent examples:

-Statins -- conceived of as a method to block cholesterol synthesis, and hence lower cholesterol, but also shown to have other properties independent of cholesterol lowering which contribute to their effectiveness in preventing cardiovascular disease. When I prescribe a statin to someone these days, often times I don't really care what their LDL level is afterwards (or beforehand, for that matter), because in many cases it just doesn't make a difference.

-Antidepressants and the bioamine hypothesis -- for all the talk of serotonin and norepinephrine, it seems like most of the recent studies on how these drugs work are focusing on other things, like increases in BDNF and increased cell growth, because, as I understand it, there isn't a whole lot of direct evidence for the serotonin-norepinephrine bit.

-Methotrexate -- works great for autoimmune diseases, thought to work by inhibiting an enzyme involved in folate metabolism, except that we eat tons of folate in our diet, and half the time that it's prescribed people are supposed to take folic acid supplements anyway, so why does it still work? Turns out it's likely some other mechanism that makes it effective.

-Gold -- one of the first treatments for rheumatoid arthritis, and I'm pretty sure they had no idea how it worked when it was first introduced, yet it's still a conventional treatment option, albeit not first-line.

Lots of other examples, and I can track down citations if desired.
posted by greatgefilte at 7:35 PM on March 7, 2013 [6 favorites]


If I understand right, one of the essential differences between ayurveda and western medicine is that wm looks for universal rules and at the same time looks at rules at the low, most precise level; ayurveda's approach is somewhere in the middle. For example, the way wm poses the question is: is it good or bad to be overweight? That's a rule at a universal level. It seems like a simple question and some of the news in the last few years suggest that sometimes it may be good, and it's not clear why.

At the other end of wm, the questions that are posed are like "which chemical affects which neural pathways and what happens next, and is it a positive or negative effect?"

Now contrast this with Ayurveda: out of the four types of people (which are fuzzily-defined), for one type it is good to be somewhat overweight and bad to be underweight, for one it's the other way around, and for two types it's best to have average weight.

It seems like Ayurveda starts with a fundamentally unprovable leap and then stops and says, ok, now that we made this leap, if we proceed on the assumption the leap was valid, does it create a set of guidelines that generally tend to help people? WM on the other hand, even when it raises a hypothetical question, it needs to be provable and it needs to be one small incremental thing at a time.
posted by rainy at 8:40 PM on March 7, 2013


xarnop: "it's possible to go therapy for a long time talking about your mother or the past sexual abuse and not address that you regularly stay up til 4 in the morning"

If you don't ask your patients about their sleep cycles, their sleep hygiene and their subjective sense of sleep quality then you are not doing a complete general medical interview. This is pretty much Medical Interviewing 101. Of course, you can teach people this but whether they choose to do it or not in practice is another issue.
posted by meehawl at 9:21 PM on March 7, 2013


greatgefilte--

I can't possibly express how curious I am about further examples (and how much I appreciate an actual practitioner on this thread). My sense is that we really don't know why a lot of things work, because the complexity of their effectiveness exceeds our capacity for comprehension.
posted by effugas at 9:40 PM on March 7, 2013


Effigas, I don't know how to say this more politely without expending more effort than I care to, but you don't know what you're talking about. Half my lab is in a research hospital. My research institute trains plenty of chemists who go to work in pharmaceutical companies.


My sense is that we really don't know why a lot of things work, because the complexity of their effectiveness exceeds our capacity for comprehension.

This is mystical woo nonsense. Does it pass a double blind test? Then it works. If it does not, then it does not, so to speak. Tons of conventional therapies work by unknown mechanisms. Hell, no one understand anesthetics.
posted by samofidelis at 12:04 AM on March 8, 2013 [4 favorites]


" This is pretty much Medical Interviewing 101. Of course, you can teach people this but whether they choose to do it or not in practice is another issue."

Yeah I've taken a lot of medical history questionare's and they are not comprehensive nor has that information ever made it's way into guidance from a doctor other than the basic "don't smoke, don't drink too much". So no, it's certainly not standardized and therapists DON'T tend to do a general healthy living consultation about regulating sleep schedule, healthy diet, choosing activities that promote health rather than are destabilizing... etc

I think the herbs and treatments involved in ayurveda are suspect and should be tested for efficacy and safety. But the framework is much more comprehensive than I've seen from any western doctor. Ayurveda is very nurturing, and supportive. People who have a lot of emotional pain or physical pain are very under supported with that. Our system is very cold in regard to really helping people who need comprehensive help. Specialists are all divided, they don't communicate with each other, people who don't know enough to work the system get worse care... etc.

Ayurveda isn't just about taking a specific drug to fix a specific condition-- it's about asking bigger questions about a persons life purpose, finding meaning, doing activities that will promote physical and emotional wellness in the person and living in a way that promotes health, emotional expression, and self actualization. It's about seeing specific health problems in this context and connecting the dots between all the areas of a persons life. Western doctors DO NOT have the time for this and I am of the mind that guidance with create a healthy life SHOULD be a separate entity than doctors who have spent many years learning what drug to give in response to which condition. I think they should practice the art they learned. I think that health guidance is something people need a lot more support and services with.

And I think health guidance should line up with actual research into the matter. I do think trying to do standardize research on WHAT IS HEALTHY FOR ALL HUMANS we lose the ability to do research on humans as unique individuals with differing emotional/psychological/ and physical needs. We do a lot of generalized research, see how inconsistent it is and then think the whole field should be tossed because individuals vary so much we can't even figure out what is or isn't healthy. I think we can if we change our thinking about what health is and what variables go into it.

A western doctor or therapist might tell you to go fix your behavior, or do this cognitive trick to change your thinking etc. An ayurvedic practitioner will provide the actual supports to help you fix your behavior and make meaningful change. I don't care about the framework, I'm find with tossing ayurveda as a framework-- I just think there is a lot we could learn about supporting and facilitating meaningful health in humans from their framework.
posted by xarnop at 5:31 AM on March 8, 2013 [1 favorite]


Also what I've watched among people struggling with life and health issues is that they might want to exercise more, or cook healthier food but struggling with actually making that happen. I think most people, especially when ALREADY physical or mentally ill need meaningful help making these kinds of changes.

Also I think that often we tell people to make change that are standardized changes that aren't going to help that specific person and might make them worse. (I.e. eat whole grains for someone with celiac?). Telling someone who is sick to do a whole lot of work (that might in and of itself make them sicker because they don't have the energy for it)- that isn't even clinically proven to match their specific health needs? Will make people stop asking professionals for help.

I know a lot of social workers and counseling types and for many their knowledge of health (biological science of) is as good as anyone who reads pop health info. Meanwhile doctors aren't knowledgeable about human behavior or how to help humans make meaningful change and often AREN'T actually all that knowledgeable about nutrition and and what sorts of tests and dietary recommendations would match the persons condition. When I got IBS I was not recommended to a nutritionist. I got a chat about increasing fiber and which foods have fiber. This is NOT the kind of tests and recommendations that were needed. (How about severe food allergies combined with being sexually abused and failing in school and having no relationship with my parents? Make a stomach queasy much? More fiber is nice and all but it's not the right solution, neither was the IBS pill.)

If you start from a framework of, "let's talk about what's going on in all the domains of your life and create a comprehensive health plan that brings in the right supports so you can reach a place of emotional, psychological, and physical health" it's a very different framework than what we have now.
posted by xarnop at 5:43 AM on March 8, 2013


I recently opened up my rock collection for the first time in 30 years or so. I was googling some minerals I wasn't very familiar with, like realgar. I was amazed to find that this toxic stuff gets used in traditional Chinese medicine. Apparently it is used in Ayurveda too. It does not fill me with confidence that these ancient physicians knew what they were doing.

LOL, yeah, dumb ancient people, lol Arsenic minerals. Did you even read that article? I read it because I've seen some olde concoctions that used arsenic, or salts of lead and I always thought "Why would you use that as medicine?". So I took the time to read the article, which was very good, thank you. I found some very interesting and unexpected things. I still have no idea why they used salts of lead, am making no statements on it, and included it simply as another example of a mineral that was used medicinally that to my common sense seems ill-considered, especially for such benign conditions as sore nipples.
"Arsenic toxicity is highly dependent on the chemical form and, where known, the acute oral LD50 values in rodents are also included under each arsenic compound in Figure 1."

"The oral LD50 for arsenic trioxide (i.e., arsenolite) in mice is 33-39 mg/kg (Carter et al., 2003), similar to sodium arsenite, but the LD50 for realgar is 3.2 g/kg, a difference of 100-fold compared to sodium arsenite (Zhang et al., 2004)."

"However, in many cases, a significant portion of some forms of mineral arsenicals are poorly absorbed into the body and would be unavailable to cause systemic damage. The disposition of these arsenicals in the body depends on various key factors including solubility, absorption, distribution and excretion."

"The average total arsenic concentration in a Niuhuang Jiedu Pian is about 7 ± 1% (i.e., 70,000 ppm), corresponding to 28 mg arsenic per pill, of which only 1 mg arsenic finds its way into the blood stream, and 40% of this absorbed arsenic (0.4 mg) is excreted in urine (Koch et al., 2007)."
OK, so at this point, they've already established the LD50 and done testing to compare the acute toxicity of various forms of As-containing compounds. So these modern scientists, at least, are fully aware of the toxicity of the substances, and are also aware that the mineral compounds are less toxic than some of the other compounds and elemental forms. That's cool, but they're still toxic, right? Why would anyone take a toxic substance? Then I got to this part, which really piqued my interest:
To overcome the low solubility and poor bioavailability, realgar nanoparticles have been prepared by cryo-grinding with polyvinylpyrrolidone and SDS, and arsenic solubility can greatly increased compared to crude realgar powder (Wu and Ho, 2007). Realgar nanoparticles show remarkable increases in bioavailability both in vitro and in vivo.
Whoa, whoa, whoa, nanoparticles to increase bioavailability? Are these still being studied for treating things?
Orpiment is mainly used externally as louse-killer, a cure for scabies, for snake bites, insect stings, and skin diseases (Pharmacopeia of China, 2005; Koch et al., 2007). Orpiment is included in Quingyi Piwen Dan, a preparation of detoxication and laxative use with other 74 herbs, but its use alone in oral remedies is not common. Nanoparticles of orpiment have been prepared, and they were effective in killing leukemia K562 cells in vitro (Lin et al., 2007). [...] Realgar is less toxic as compared to arsenic trioxide, and is now used alone or in combination for hematologic malignancies (Lu et al., 2002; Shen et al., 2004). Recently, Realgar-Indigo naturalis formulae have been shown to be very effective against promyelocytic leukemia (Wang et al., 2008). Realgar acts as the principal component of the formula, whereas other plant active ingredients (such as indirubin and trashinone IIA) serve as adjuvant ingredients, in inducing acute promyelocytic leukemia cell differentiation and the degradation/ubiquitination of promyelocytic leukemia-retinoic acid receptor- oncoprotein, in enhancing G1/G0 arrest in APL cells through hitting multiple targets, and in intensifying Aquaglyceroporin-9 expression and thus facilitating transportation of realgar into APL cells (Wang et al., 2008).
Then - I'll admit it, I started thinking, I'm seeing a lot of Wangs [pause] I wonder if this is, you know, some sort of Chinese medical conspiracy. Let me get some perspective. Hmm, let's try "Clinical trials of arsenic trioxide in hematologic and solid tumors: overview of the National Cancer Institute Cooperative Research and Development Studies.": Arsenic trioxide inhibits growth and promotes apoptosis in many different cancer cell lines. [...] The safety and pharmacokinetics of arsenic trioxide are also being evaluated in pediatric patients with refractory leukemia and lymphoma. The results of these ongoing studies should provide important insights into the clinical utility of arsenic trioxide in these diseases. Well, that sounds great and all, but a lot of potentially therapeutic agents never get developed into medicine, I wonder how far it's progressed. Hmmm...maybe we can check wikipedia:
Arsenic trioxide under the trade name Trisenox (manufacturer: Cephalon) is a chemotheraputic agent of idiopathic function used to treat leukemia that is unresponsive to "first line" agents. It is suspected that arsenic trioxide induces cancer cells to undergo apoptosis. Due to the toxic nature of arsenic, this drug carries significant risks. Use as a cytostatic in the treatment of refractory promyelocytic (M3) subtype of acute myeloid leukemia.[8][9] The combination therapy of arsenic trioxide and all-trans retinoic acid (ATRA) has been approved by the U.S. Food and Drug Administration (FDA) for treatment of certain leukemias.[10] University of Hong Kong developed a liquid form of arsenic trioxide that can be administered orally.[11]

Arsenic trioxide also appears to be a promising therapeutic agent for autoimmune diseases.[12]
So maybe next time instead of being so dismissive, if you bother to actually check into what you're tossing out because it's old and you don't understand it, you might find something interesting. You might find that these ancient physicians found a mineral that was useful as a chemotherapeutic agent without the use of western science, and you might wonder how they figured that out. Who knows, you might even investigate it or do studies on it, you might even develop it into "Trisenox: A Real Medicine" that's accepted by the FDA, but you probably won't because someone already did.

I apologize if I'm coming on too strong on this, but this is a really great example of how the hurf-derf modern medicine circle jerk club can just as easily lapse into non-scientific examination of things they don't understand. I've seen just an incredible amount of off-hand dismissal of anything that is not the product of some billion-dollar pharmaceutical firm (who we know never release things that are later demonstrated to be ineffective or harmful) as some sort of fairytale bullshit. Medicine has its roots in plants.
posted by nTeleKy at 8:36 AM on March 8, 2013 [2 favorites]


We use all sorts of toxic chemicals in "western" medicine. The whole idea behind chemotherapy, for instance, is to flood the cancer patient's body with cell-destroying chemicals--those chemicals, if all goes to plan, are supposed to kill cancer cells slightly faster than the body's own cells. But even in the best case, chemotherapy wreck's the patient's body.

People like to "Hurf Durf" things on the basis of very shallow analysis. I think it makes us feel superior and in control of subjects we otherwise find threatening. It's surprisingly comfortable to be deeply ensconced up one's own ass, it seems.

All the same, medicine is medicine. If a treatment works, we should at least try to figure out its scientific basis so we don't risk misusing it or otherwise doing unintentional harm out of ignorance.
posted by saulgoodman at 9:41 AM on March 8, 2013


Plenty of natural things are toxic. I used to like sassafrass tea. It turns out to cause liver cancer. I've had harm (physical and financial) done to me by a naturopath, acupuncturist, and chiropractors.

Many products used by traditional western medicine are based on and/or use natural ingredients, like digitalis(foxglove) and aspirin(willow bark). It's best if the dosages are standardized, and the products are tested thoroughly for effectiveness & toxicity.

Many natural products remain to be tested. But most/ many won't be tested by American/ Western medicine, because there's no profit to be made. No drug company can patent aspirin, so it gets no advertising and is not tested for effectiveness against much of anything, and has grown into disuse, though it has a great deal of effective uses, and low side effects.

I don't want Chinese herbs from an unknown "healer" or Indian herbs to make my temperament cooler, hotter, or less blue or purple. I want the Chinese, Indian, Bolivian or whatever herb or product that is known to have N% effectiveness and M% risk of X side effect. So, I want my government to fund research on lots of remedies. Profit in health care has mostly been great for corporate shareholders. The naturopath who screwed around with my shoulder for weeks makes a lot of money. I'll bet many acupuncturists, Chinese medical herb purveyors and others are in it to make a living; fine by me, if their products can be shown to be effective. But if there's no research, I don't want to be experimented on.
posted by theora55 at 2:34 PM on March 10, 2013 [2 favorites]


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