Uncomplimentary about complementary.

April 18, 2008 8:22 AM

A leaflet on alternative medicine produced by the Prince's Foundation for Integrated Health has been condemned by Britain's first Professor of Complementary Medicine.

Prince Charles has exerted great influence in favour of alternative medicine in the UK, leading to the creation of the Complementary and Natural Healthcare Council ('Ofquack'), due to begin work shortly. Now Edzard Ernst, in a letter to the Times, has called for the withdrawal of an FIH leaflet which he says is misleading: the FIH indignantly refuses, and counter-accuses Prof Ernst of seeking publicity for his forthcoming book.

posted by Phanx (29 comments total)

You know why they call it "alternative medicine"?

If it worked, they'd call it "medicine".
posted by Pope Guilty at 8:52 AM on April 18, 2008 [8 favorites]

I missed the "the" on first reading, and now I'm imagining purple phials full of healing elixirs, administered by a little mustachioed guy while the song "Kiss" plays.

And wow, isn't it really bad form to dis the Prince of Wales like that in public? Anyway, some of the therapies in there are unproven, but the response seems a bit over the top. I don't advocate spending public money on unproven therapies, but I also don't see the harm in trying Reiki, for instance, as long as appropriate disclaimers are included.

The chief benefit of a pamphlet like this may be that it encourages people to take a more active role in maintaining their health. I am not sure how closely the FIH link above parallels the printed leaflet, but after looking over the link above, I am not dismayed by the way the information is presented. Alternative medicine may not work for everyone, but if some people derive benefits from it, even if the benefits are from the placebo effect, good for them. I would urge caution with regard to herbal remedies and things like that, though. But touch therapies? Knock yourself out. Put hot rocks on your ass, and if you feel good, bully for you.
posted by Mister_A at 8:55 AM on April 18, 2008 [2 favorites]

From the first link: "The foundation has already withdrawn some sections of the pamphlet from its website, such as a claim that research has shown healing to have benefits for some medical conditions."

Wait. Healing doesn't have benefits for some medical conditions?
posted by Floydd at 9:00 AM on April 18, 2008

Whilst in general I agree with Pope Guilty regarding CAM, it does touch on the interesting question of if and how it might be possible to harness the placebo effect to treat people. Do placebos work without deception? Sometimes, in special circumstances. Can we expand the useful circumstances without all of the Wizard of Oz CAM theatre? I don't know.
posted by Jakey at 9:01 AM on April 18, 2008

I am a practicing Taoist. I use moving meditation and energetic techniques (self-administered), sitting meditation and relaxation techniques (self-administered), Tui Na (professionally-administered) and acupuncture (professionally-administered) as part of my regular health-related treatments. I also use Western medical resources including several OTC and one Rx medication regularly, as well as regular Western doctors' appointments.

I find all of these methods complimentary and helpful for treatment of a variety of medical conditions that I manage during my daily life.

To me, the alternative medicinal therapies are as valuable as the Western medicinal therapies within my pursuit of well-managed medical issues.
posted by kalessin at 9:09 AM on April 18, 2008 [1 favorite]

Fake acupuncture works just as well as real acupuncture.

Sometimes even better.
posted by Pope Guilty at 9:25 AM on April 18, 2008

Wait, what? We have a Professor of Complementary Medicine? Why? And where did he qualify, Fresh & Wild?
posted by influx at 10:13 AM on April 18, 2008

Speaking as someone who had a empirically measurable difference in the amount my broken, scar-tissue filled elbow was able to move (15 additional degrees of motion almost immediately after beginning the acupuncture and electrical pulse therapy, when MONTHS of physical therapy and two surgeries didn't do jack all), I am extraordinarily skeptical of western medicine's ability to treat certain problems.

Also, Edzard Ernst sounds like a grade-A herbal douchenozzle trying to drum up publicity for his lame book.

(Biased? ME?)
posted by bitter-girl.com at 10:19 AM on April 18, 2008 [1 favorite]

after beginning the acupuncture and electrical pulse therapy
posted by Pope Guilty at 11:25 AM on April 18, 2008

If I didn't make it clear already, I don't have specific symptoms I am treating with the Tui Na or acupuncture. If I had to specify anything that is under treatment with non-western-medicines, it would be "all generalized and specific stress symptoms that I express as I go through daily life".

The reason I still consider it the Tui Na and the acupuncture medicine/therapy is that those stress symptoms are ones that even Western medicine recognizes as contributors to potentially worsen the specific symptoms expressed by the specific conditions I am also treating with Western medicine. These include:
- asthma
- allergies
- high blood pressure
- gastric reflux (heartburn and, in extreme cases for me, esophageal ulcers)
- nocturnal cramps and charlie horses
- TMJ
- bruxism (teeth grinding)

In this case, where the ultimate goal is to reduce stress, specific refutations of the ability of Tui Na or acupuncture to help me with those problems based on whether or not acupuncture is as helpful or not as helpful as placebos are, to me, meaningless.

Why? Because to me, the process of the intake during each appointment, talking about life in general, in a way that's similar to cognitive therapy, and then having a massage (that sometimes involves needles or moxa) and engages in a holistic way not only with my understanding of how my physiology works but also with my spiritual/philosophical understanding of my physiology as well as how the world works does a great deal for me that is frankly rarely or never quantified or characterized in any scientific studies.

I am very glad, Pope Guilty, that apparently Western medicine does everything it needs to do for you. What I am not glad about is your dismissive tone about what non-Western medicine cna do for other people. Wouldn't increasing the joy in the world actually involve shutting your hole now and then?
posted by kalessin at 12:05 PM on April 18, 2008

What I am not glad about is your dismissive tone about what non-Western medicine cna do for other people.

You say that as if modern scientific medicine is used only in the West, only by Westerners; it's almost as if you're trying to make it a race issue. But not all bullshit psuedo-science CAM is non-Western; homeopathy, chiropractic (in the "subluxation" sense, not in the "this will help your back" sense), vitamin megadosing, and naturopathy are all examples of Western "alternative medicine". Furthermore, modern medicine is practiced across the globe and has raised life expectancies and quality of life in places where traditional remedies and medicines were previously the only available sources of "aid".

That a treatment is Western or non-Western is irrelevant to whether or not it is good medicine. What determines whether or not something is good medicine is whether or not it can be shown to be helpful in studies which use the double-blind method and strict controls to ensure that it is the treatment itself which is beneficial- and not a placebo effect.
posted by Pope Guilty at 12:17 PM on April 18, 2008 [2 favorites]

After all, when it comes to psuedo-science, fake medicines and treatments, and other such things, what's the harm?

Here's 2,451 people killed, 117,941 injured and over $138,693,382 in economic damages worth of harm.
posted by Pope Guilty at 12:19 PM on April 18, 2008

All this "data" you're presenting doesn't change the fact that one time magic water made my boo-boo better.
posted by Legomancer at 12:39 PM on April 18, 2008 [2 favorites]

world works does a great deal for me that is frankly rarely or never quantified or characterized in any scientific studies.

This is the key point here: it may work for you: how do we judge if it would work for someone else? How do we know that you wouldn't have got better anyway? How do we know that it wasnt the vapours on the no.46 bus that you took every day when you started the CAM? How do we know it wasnt the placebo effect?

If you are going to make a recommendation to a group of people, and that recommendation requires resources that could be spent elsewhere, or the recommendation has consequences, then you need evidence.

Evidence in the case of medicine originates w/ correctly controlled double blinded trials, to deliberately reduce the influence of the no.46 bus effect, the 'couldve got better by themselves efect' and the placebo effect.

A comment that "this made me feel better" is not evidence: it is anecdote.

The classic case to illustrate the point is the joke about tiger repellent. A guy's walking in Manhattan when he sees a street vendor selling unmarked aerosol cans. He’s curious and asks what’s in them, and the vendor says, “Tiger repellent.” The guy points out that there are no tigers in New York City, and the vendor replies, “See how well it works?”. Controlledly double-blinding the tiger repellent usage would happily disabuse the market of that huckster.

This is not to dismiss the effects you experienced personally. Your comments about physical manipulation along with cognitive therpay imply there should be a controlled way of showing these are the origins of the effects of Tui Na. If you can demonstrate these effects statistically, then you can recommend them to an appropriate group of people. If placebo, then an effective, economical placebo should be devised. If not, then you're not doing medicine, you're doing religion.

Personal revelation should not be the source of health policy, for statistical, ethical and logical reasons.
posted by lalochezia at 12:52 PM on April 18, 2008 [3 favorites]

PS This argument implies a few things. It implies i) that you can do appropiate controls, ii) that the experiment is conducted well (ethically and statistically) and iii) that time-linear causality reigns over the universe at scales that matter to the human experience.

The first point has taken a beating : how do you measure happiness? well-being? I believe it is possible, but more sophisticated measures/models must be made. 'Holism' is not incompatible with the scientific method, it's just that better sets of interdependent variables need to be defined.*

The second point has taken another beating from observers of human behavior: ethics are corrupted by business/govt/personal interest, and statistics are hard. Just because studies are corruptible does not invalidate their use: it just requires vigilance and honesty on behalf of those who would judge the studies. Its worth pointing out that all processes involving human judgement (including revelation, eastern hollistic approaches, etc) are corruptible: only empirical testing has the error checking mechanism built in to it's philosophy.

The third point is one that I and my friends run into a lot, and is in fact the major sticking point in my view. A lot of the propnents of AM don't believe in genuine physical causality and the principle of reproducibility at all or when it involves human beings.
To clarify: causality: cause and effect are always correlated, they are correlated forward in time, and that the same experiement repeated under the same conditions yields the same results.
See as examples: beliefs about the spirit world, intercesion of prayer by an omnipotent and omnescient being, the permeability of time, ill formed-beliefs about human need and wish and how it an influences physical reality, and chopra-woo.

Arguing with them on a point of science is a waste of time: you need to educate and convince them on the reality of causality/reproducibility before arguing about other issues, or you're talking at cross purposes.


* Hard problems with interdependent variables are being solved all the time: e.g. gene regulation, metabolism, morphogenesis, that would have been unthinkable 15 years ago. People cited the complexity of genetic/developmental biology as a limitation of science: that it wouldnt be apossible to quantitatively model these behaviors, now that limitation is being overcome. I believe that behaviour and holistic/gestalt-like phenomenal will fall to this kind of approach as well, given time....
posted by lalochezia at 2:05 PM on April 18, 2008

After all, when it comes to psuedo-science, fake medicines and treatments, and other such things, what's the harm?

Here's 2,451 people killed, 117,941 injured and over $138,693,382 in economic damages worth of harm.

Would you like to compare that with real medicine and treatments?

(What's that? Of course you have to stir the pot - so settling doesn't occur!)
posted by P.o.B. at 2:38 PM on April 18, 2008 [1 favorite]

P.o.B. -- CAM gets people's goat the same way creationism gets people's goat. I think if you hate creationists, you pretty much have to hate anyone who advocates Reiki. They're both pretty dumb, but at least creationism claims to be an ancient belief, and actually is an ancient belief.
posted by Faze at 3:44 PM on April 18, 2008

PS This argument implies a few things. It implies i) that you can do appropiate controls, ii) that the experiment is conducted well (ethically and statistically) and iii) that time-linear causality reigns over the universe at scales that matter to the human experience.

I dunno, there are some things that simply cannot be ethically double-blind tested, by their very nature. For example, I got significant, long-term relief from Ankylosing Spondylitis by changing my diet to eliminate starch (more on this diet, including studies, can be found here). When I first started the diet, my rheumatologist was extremely skeptical -- she kept saying, "I think this is totally wrong, I won't believe it until I see the double-blind studies". I kind of wanted to reply, "well, you find me one thousand AS patients who've never seen a potato before and don't mind living in a featureless white room for six months, and then you'll have your double-blind study. Have fun getting it past the ethics board".

Traditional double-blind studies have little to say with regard to long-term lifestyle changes, and these may well be one of the most fruitful types of "alternative" therapy. I only tried this no-starch diet out of desperation, after undergoing years of marginally-effective mainstream therapy with NSAIDS. Now I've got all the physical causality I need, double-blind study or not -- my hip doesn't hurt much anymore. I went from limping and having trouble sleeping at night to living a perfectly normal life, except with regards to my lunch selections. As for the principle of reproducibility, this may matter to science, but it doesn't matter nearly as much to patients, who want to heal themselves, not others. If the mainstream stuff is not working or is working in bothersome ways, there's no harm in trying non-damaging alternative therapies, and there's no reason why anecdotal evidence should not be considered when empirically supported methods fail.

As somebody who limped around and popped Voltaren like candy for five years before finally giving up my misplaced worries about "chopra-woo", I wish I'd stopped trusting in traditional-medicine-and-nothing-but a whole lot earlier. Of course, that doesn't mean I don't still take an Advil or two when I need to... I don't see where a balanced approach like this is at all irrational.
posted by vorfeed at 4:12 PM on April 18, 2008

As for the principle of reproducibility, this may matter to science, but it doesn't matter nearly as much to patients, who want to heal themselves, not others.

You're certainly eager to sing its praises, despite being unable to say that it was, in fact, cutting out starch that helped you.
posted by Pope Guilty at 5:25 PM on April 18, 2008

You're certainly eager to sing its praises, despite being unable to say that it was, in fact, cutting out starch that helped you.

Heh. That's so funny I could almost laugh. Again, I spent five years in unremitting back pain, during which time I saw three or four doctors and tried numerous different therapies alone and in combination (including NSAIDS, sulfa drugs, ultrasonic therapy, acupuncture, chiropracty, and massage). Nothing worked for more than a few hours at a time, and what did work, worked poorly. Nothing could stop the pain. I wasn't sleeping right, couldn't walk without limping, couldn't get up out of a chair without spending two minutes doing it. And on top of all that, I got AS-linked iritis four or five times, and was worried about the eventual effect of the steroid treatment on my eyesight. I was seriously starting to consider quitting my job and taking disability.

Then, I started a low-starch diet, and within days I stopped hurting. I haven't got iritis since, either. No wonder I'm "eager to sing its praises!" The few times I've fallen off the dietary wagon since then, I've been wrecked by pain within a few hours, including times when I ate things I'd thought were OK, and only found out they had a lot of starch afterward. The latter experience seems to suggest that there's more going on here than the placebo effect. As does Dr. Ebringer's research, which I linked to earlier... but then, you didn't even look at it, did you? This isn't just some fly-by-night wackiness, it's part of a major debate going on with regards to AS, with numerous studies available to support both sides of the issue. This one includes some good links to some. The bottom line is that science doesn't have a definitive answer for why AS occurs. At the moment, the gut-bacteria explanation (which underpins the no-starch diet) is as likely as any other, and has some documented clinical success. Scientifically, I'd say that makes it more than worth trying when all else fails.

I love how some people can claim to be scientific, and at the same time ignore any evidence that doesn't suit them, claiming that others are "unable to say" this-and-that while simultaneously giving mainstream medicine a much lower standard of evidence. Sorry, but I'm not going to forget about Occam's Razor just because I'm the subject of my own experiment -- if it's not cutting out starch that's helped me, then what the fuck is it? I'd seriously like to know, because the preponderance of evidence doesn't point to any other conclusion. What, did I randomly get better upon starting the diet, and then randomly get worse whenever I broke it? Sorry, but that's not a reasonable conclusion. Nor is the placebo effect, since I tried several different placebo-strong therapies with no effect, and was extremely skeptical about the diet to begin with. Again, if I can say that taking an Advil helped me, why the hell can't I say that cutting out starch did? From my point of view, one was clearly much more helpful than the other, and it ain't the Advil.

I'll be the first to admit that this diet doesn't help everyone with AS -- as the Finnish study I linked to above mentions, the progression of this disease is highly individualistic, and varies greatly based on patient history and antibody response -- but it worked for me, and has worked for many others. That's more than worth singing about.
posted by vorfeed at 2:15 PM on April 19, 2008

You can be as insistent on Scientific Method as you like, that's fine. I was raised to be an objectivist atheist, by a biochemist father, and a nurse mother. I can and do read scientific and medical literature. (Sometimes I agree with the studies' methodologies, and sometimes I don't. Sometimes I agree with the studies' findings and sometimes I don't. This is in fact why I do read the source studies much of the time - I find I can't trust others' summaries until I double-check them.)

As I grew up, I found out that I had experiences of things I could not explain purely with the Scientific Method, and I hope you'll pardon me for saying so, but I think that the change (from relying only on objectivist thinking to evaluate and interact with the world to being able to experience and believe in other mechanisms of being and perceiving) has done me a world of good both in the social senses (of being a more tolerant, well-rounded and supportive person) as well as in the healthiness senses (of being less stressed out and controlling, in general). The world has many more shades of subtlety and meaning for me now than it had then.

I am capable of being an informed consumer. You act as if I am not capable, Pope Guilty, lalochezia. That's fine. I can act as if you aren't either, and we will never build any bridges of common understanding.

What I am trying to say is that I disagree that alternative medicines and science-based medicines are incompatible, and I disagree that they are necessarily at odds. And I disagree that all alternative medicines are necessarily harmful. In fact, the two disciplines overlap in my life to almost equal measure and I find both approaches to have strengths and weaknesses and I have found a way to use both therapeutic approaches in beneficial combination in my own life.

I understand that the alternative medicines are perceived by you as woo-woo. That's fine. I'd like you to understand that I feel that sometimes science-based medicine is also woo-woo. If you'll pardon the idiom, I sometimes agree with anti-science-based medicine interests who state that scientific medicine is "guess-work in a white coat".

With respect to harm, I've seen plenty of harm promulgated by the scientifically trained medical professionals I've worked with, over my own care protocols as well as over others' I know. I've seen scientific progress in medicine really develop according to the X steps forward, X-1 steps back methodology, which, while positive, is not nearly as flawless and comprehensive as it sounds like you believe it is. In fact, if I were pressed to try to identify what common trait I saw in the harmful practice of both medical science and alternative medicine, it would be the trustworthiness and ethics of its practitioners.

Saying that you could only trust scientifically trained medical professionals would, to me, be throwing stones in glass houses. Consider the recent issues with the cholesterol drugs and the treatment of heart disease in general with cholesterol-lowering therapies (not nearly the simple metabolic machine everyone thought it was, was it?). How about the number of deaths associated with elective surgeries, and those deaths and injuries associated with other really questionable surgical and pharmaceutical treatments for disorders both large and small (Doctor, what did happen to that oath? The one where you swore "First, do no harm"?). You act like scientific medicine is innocent of that kind of wrongdoing, and that's either outright lying or a kind of subtle rhetoric I hope I will never participate in.

As a critical thinker, a careful consumer, and as a person who has managed my own health issues for about 30-35 years (depending on how independent you think I was when I was 5), I am careful, I am critical, and I do my best to assure that my money isn't wasted and that the businesses I support (including the forms of alternative medicine I have already talked about) are not causing collateral damage to anyone else.

I don't care whether you think alternative medicines will ever be helpful to you, but I often find them (at least specific ones) very helpful for me, and I'll thank you not to write me off as a fool for saying so.
posted by kalessin at 2:15 PM on April 19, 2008

I love how some people can claim to be scientific, and at the same time ignore any evidence that doesn't suit them, claiming that others are "unable to say" this-and-that while simultaneously giving mainstream medicine a much lower standard of evidence.

You are demanding a lower standard of evidence for yourself. Controlled studies create evidence. Individual stories about "well it worked for me!" are anecdotes, not evidence.

In your case, you're quite wrong; the efficacy of a no-starch diet on your affliction could easily be subject to a double-blind test. I'd have a lot more respect for "let's run some tests!" than "It worked for me, okay, and that proves anything whatsoever!"

Saying that you could only trust scientifically trained medical professionals would, to me, be throwing stones in glass houses. Consider the recent issues with the cholesterol drugs and the treatment of heart disease in general with cholesterol-lowering therapies (not nearly the simple metabolic machine everyone thought it was, was it?). How about the number of deaths associated with elective surgeries, and those deaths and injuries associated with other really questionable surgical and pharmaceutical treatments for disorders both large and small (Doctor, what did happen to that oath? The one where you swore "First, do no harm"?). You act like scientific medicine is innocent of that kind of wrongdoing, and that's either outright lying or a kind of subtle rhetoric I hope I will never participate in.

No, no I absolutely do not act like anything of the sort.

Incidents like this are a perfect example of why scientific medicine is superior to alternative medicine. Alternative medicine is not subject to the sort of oversight and correction that scientific medicine is. When medical technology is found to actually do more harm than good, there are structures in place by which that technology can be banned and anyone who continues to use it drummed out of the profession. Alternative medicine has nothing of the same, in part because alternative medicine and its proponents starkly reject anything resembling the sort of scientific testing which discovers dangerous treatments.

Scientific medicine has pulled numerous drugs off the market for being unsafe. And yet thousands of chiropractors across the country continue to tell people that they can cure any number of diseases through spine manipulation, a claim with no evidence supporting it and with an often high cost. Ear candling continues to be offered, despite the fact that it does nothing and can injure or kill the person it's being done to.

Yeah, the FDA pulls medicines sometimes. That it does is a strength of modern scientific medicine, and not the weakness that you want it to be. Self-correction is a property of strong paradigms, and the lack of self-correction is part of what makes CAM the load that it is.
posted by Pope Guilty at 2:56 PM on April 19, 2008

You are demanding a lower standard of evidence for yourself. Controlled studies create evidence. Individual stories about "well it worked for me!" are anecdotes, not evidence.

The only claim I'm making here is that this diet worked for me. Again, if I am qualified to say that Advil or Voltaren worked for me, why am I not qualified to say that the diet worked for me? I don't need a controlled study to tell if something works or not for me, because whether it works or not for me is entirely subjective to begin with. You are way, way, WAY overstating what I'm saying, here.

In your case, you're quite wrong; the efficacy of a no-starch diet on your affliction could easily be subject to a double-blind test.

We're talking about the effect of a drastic and long-term diet change on the inherently subjective self-reporting of chronic pain. I'm sorry, but you're quite wrong -- a double-blind test is never going to conclusively prove this, one way or the other. There is no way to objectively measure pain, much as I'd love for there to be one, and unfortunately AS does not always involve any other measurable quantity. There isn't even a reliable clinical test for AS, much less for how bad the pain associated with it is.

That said, I'd be all for double-blind testing of this diet, if they could get such a test going. It wouldn't be conclusive proof, but it would certainly be interesting. As I've said before, the tests that have been done on this diet showed some degree of efficacy.

I'd have a lot more respect for "let's run some tests!" than "It worked for me, okay, and that proves anything whatsoever!"

The latter has absolutely nothing to do with what I've been saying, here, and is rather offensive in the context of what I have been saying. I don't see where anything I've said has anything to do with "proof" that this diet works, much less "proving anything whatsoever". What I am saying is that because proof is much less important to the individual patient than efficacy, patients may as well go with any non-harmful therapy that brings relief. For example, it's funny to see people lambasting therapies as "placebo", considering the significant relief the placebo effect can bring!

The opposite idea -- that any therapy not already proven by science must therefore surely be worthless and is not worth trying on an individual basis -- is not scientific in the least, and actually limits the pursuit of science. Science shouldn't be limited by preconceptions about "what works"... yet it is, and that's probably a bigger shame than fools who expect to get magical healing powers from candles stuck in their ears. Attitudes like yours are a big part of the reason why mainstream medicine doesn't deal well with certain illnesses, chronic pain among them.
posted by vorfeed at 4:55 PM on April 19, 2008

vorfeed, which is it?
I started a low-starch diet, and within days I stopped hurting.
OR
We're talking about the effect of a drastic and long-term diet change on the inherently subjective self-reporting of chronic pain. I'm sorry, but you're quite wrong -- a double-blind test is never going to conclusively prove this, one way or the other.

Its one or the other.

From your own words it seems like a study would be possible, especially if it only had to last a few days.
posted by Iax at 5:30 PM on April 19, 2008

Its one or the other.

No, it's not. Note the words subjective, self-reporting, and conclusively. No test can conclusively prove a change in pain levels, because pain can't be objectively measured. There's always the chance that the patient isn't reporting his or her pain accurately, especially if you're talking about a short study in which the patient isn't in his or her usual environment.

Also, we really are talking about a long-term thing here -- yes, "within days I stopped hurting", but you can't tell from a short study whether that kind of short-term relief is really caused by whatever you're studying, or is just coincidental. Pain is highly variable. Some days, I just don't hurt as much as on others, regardless of what's going on, so measuring just a couple of days doesn't say much. What does say something is how I feel on average, over time. This is why pain patients are urged to keep daily pain logs. Mine has gone from a daily value of between 6 and 8 on the pain scale during the 5 previous years to about 2-4 in the two years since I started this diet... it's not a cure, certainly, but it's enough to allow me to live well again, and it's more relief than I got from any other treatment I've tried.

At any rate, like I said above, I'd be very happy to see double-blind tests on this diet. I just don't expect them to prove anything conclusively.
posted by vorfeed at 7:06 PM on April 19, 2008

No test can conclusively prove a change in pain levels, because pain can't be objectively measured.

As a matter of fact, patient self-reporting is how studies measure pain. "Subjective" patient experience of pain is pain, and therefore subjective patient reporting of the experience of pain is a valid measurement.

There's always the chance that the patient isn't reporting his or her pain accurately, especially if you're talking about a short study in which the patient isn't in his or her usual environment.

Which is why studies are designed to accommodate that and minimise the disruption.

Also, we really are talking about a long-term thing here -- yes, "within days I stopped hurting", but you can't tell from a short study whether that kind of short-term relief is really caused by whatever you're studying, or is just coincidental.

Which is why some studies are carried out over the course of weeks, months, and even years.

vorfeed, you sound like a creationist explaining why evolution can never be proven scientifically; you don't know what you're talking about and it's clear to anyone who does.
posted by Pope Guilty at 9:25 PM on April 19, 2008

As a matter of fact, patient self-reporting is how studies measure pain.

Um, yes. Now, please explain why patient self-reporting was not good enough to count as evidence before, but all of a sudden counts now. "Individual stories about 'well it worked for me!' are anecdotes, not evidence", yes? Surely you see the problem, here.

You can't conclusively prove pain relief. There will always be subjective factors involved, and thus some reason for doubt. This isn't exactly controversial; the limitations of these kinds of studies are well-known, which is why a lot of time is spent in "minimizing the disruption", and why the percentages which are taken as proof in pain relief studies are often rather low.

Which is why some studies are carried out over the course of weeks, months, and even years.

Yes. Now, explain to me how you intend to ethically control a no-starch diet study over weeks, months, and years, such that your patients cannot break the diet either purposely or inadvertently. This is what I meant when I said, "give me 1000 people who've never seen a potato before and enjoy living in a featureless white room, and then give me a really lax ethics board. You'll have your study". This one is not nearly as simple as you're making it out to be, which is probably why nobody's done it yet.

vorfeed, you sound like a creationist explaining why evolution can never be proven scientifically; you don't know what you're talking about and it's clear to anyone who does.

And you, Pope Guilty, sound like the archetypal Science Is My Religion believer: you are completely convinced that there's no truth that science hasn't discovered, despite the fact that such an outlook is entirely unscientific. You also sound like someone who really, really likes to twist the words of others -- it seems that if you can't do it through out-of-context quoting and willful misrepresentation, you'll do it through bald-faced insults, too. For the last time: I WOULD LIKE IT IF THERE WERE A DOUBLE-BLIND STUDY ON THIS. I really, really would, if only because it might help to shut you up. This is not "creationism", just me trying to explain what has worked for me, and running into the blind wall of your mistrust.

Sorry, but if I were the type to wait for someone to do a double-blind study before I gave a simple diet change a shot, I'd still be taking NSAIDS, and I'd still be in pain. That's not rational, and no amount of "shame on you, you're not scientific enough" emotional blackmail is going to change that.
posted by vorfeed at 10:22 PM on April 19, 2008

Seconding vorfeed. I'm dropping out of this discussion, as Pope Guilty's made all the points I think e's going to make, and not really done anything to change my mind - just piss me off.
posted by kalessin at 10:49 PM on April 19, 2008

Um, yes. Now, please explain why patient self-reporting was not good enough to count as evidence before, but all of a sudden counts now. "Individual stories about 'well it worked for me!' are anecdotes, not evidence", yes? Surely you see the problem, here.

We're talking about the difference between several people in a controlled, double-blind study reporting their perception of pain and random individual persons in uncontrolled, everyday life circumstances reporting pain. Surely you can see the difference here.

Yes. Now, explain to me how you intend to ethically control a no-starch diet study over weeks, months, and years, such that your patients cannot break the diet either purposely or inadvertently. This is what I meant when I said, "give me 1000 people who've never seen a potato before and enjoy living in a featureless white room, and then give me a really lax ethics board. You'll have your study". This one is not nearly as simple as you're making it out to be, which is probably why nobody's done it yet.

Weeks and months would be doable, I think; years would be very difficult. But hey, if your assessment is accurate, only a period of days is necessary.

And you, Pope Guilty, sound like the archetypal Science Is My Religion believer: you are completely convinced that there's no truth that science hasn't discovered, despite the fact that such an outlook is entirely unscientific.

That's not even vaguely true, and I again resent your lying about me; part of the beauty of science is that it is eternally improving, ever investigating new things and learning new facts and facets of reality. I don't dismiss CAM because it doesn't fit into some idealised Scientific Paradigm of Ultimate Reality; I dismiss it because CAM almost universally rejects any sort of control or corrective mechanisms within its varied paradigms, and because it universally fails when subjected to controlled, double-blinded studies.

You also sound like someone who really, really likes to twist the words of others -- it seems that if you can't do it through out-of-context quoting and willful misrepresentation, you'll do it through bald-faced insults, too.

You have done this repeatedly through this conversation; I have not.

For the last time: I WOULD LIKE IT IF THERE WERE A DOUBLE-BLIND STUDY ON THIS.

I cannot believe that you are sincere in saying this. You keep saying this, and then when it is suggested that we do such a study, you insist that no, no, we cannot possibly do such a study, and here are my excuses as to why this aspect of science is exempt from scientific investigation.

This is not "creationism", just me trying to explain what has worked for me, and running into the blind wall of your mistrust.

I didn't say that it was "creationism", I said that:

vorfeed, you sound like a creationist explaining why evolution can never be proven scientifically; you don't know what you're talking about and it's clear to anyone who does.

You use the same dodges and the same special pleading.

Sorry, but if I were the type to wait for someone to do a double-blind study before I gave a simple diet change a shot, I'd still be taking NSAIDS, and I'd still be in pain.

I don't blame or place any opprobrium upon you for trying something; what I object to is your position of "my preferred untested and unproven method is superior to the currently accepted methods, and I reject the idea that it is subject to confirmation."
posted by Pope Guilty at 9:09 AM on April 20, 2008