The Danger of Science Denial - "Alternative Medicine"-Split

Homeopathy, Chiropractic and similar "alternative" views

Discussions on astrology, homeopathy and superstition etc.

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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#741  Postby Shrunk » Jun 14, 2010 3:00 pm

TMB wrote: Does this make it any clearer?


Not really. All of the effective interventions you identified above are part of "allopathic" medicine, and you have not provided a single instance where "alternative" diagnostic or therapeutic techniques were helpful. It's fortunate that the alternative practitioners you encountered were well-versed enough in conventional medicine to be able to identify the possible correct diagnoses and refer to the appropriate specialists, but that's hardly evidence that conventional medicine is ineffective. Quite the opposite, it seems to me.

Your account is very revealing, however, of how "alternative" medicine manages to thrive. If we look at what treatments have been helpful for you in your own account:

Treatment of acute bacterial infection with antibiotics.

Identification of dust mite allergy, and interventions to reduce exposure to allergen.

Identification of celiac disease, implementation of dietary modification with resolution of symptoms.

All of the above are evidence based, "allopathic" interventions. On top of these, you make references to herbal remedies and iridology, but with nothing to suggest that these have actually produced any benefit beyond your conviction that they have. However, because of the type of interactions you have had with the "alternative" practitioners, you are inclined to give them credit for your improvement, while suggesting that allopathic treatments only succeeded despite themselves.

In my experience, where alternative practitioners do tend excel, in comparison to conventional doctors, is in interpersonal skills and "bedside manner", the ability to make a client feel that they are being listened to and that their problems are being taken seriously and given individual attention. Your are quite right to suggest that modern medicine's emphasis on high tech interventions and funding models that reward high-volume practices have increasingly tended to render such traditional values as anachronistic. That's a real problem and an unfortunate situation, but it is not an indictment of "allopathic"medicine as a whole, so much as of the social, political and economic conditions under which it is currently typically practiced.

I applaud your generosity and courage in sharing your personal story with us, and am genuinely happy that you have at least been able to have some resolution of your illnesses. Hoever, I think your story only serves to further demonstrate that the successes of "alternative" medicine are ones of marketing and persuasion, not of actually efficacy.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#742  Postby orpheus » Jun 14, 2010 3:05 pm

natselrox wrote:
orpheus wrote:
natselrox wrote:Only the point is that even if we show all the doctors to be real assholes, we have bugger-all evidence for Homeopathy.


Of course. I was just making a somewhat tangential point that I felt needed to be made.


I didn't mean to say that to you, of course. :thumbup:


No worries. We're cool. :cheers:
Let's try for peace in 2018, shall we?
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#743  Postby DST70 » Jun 14, 2010 3:18 pm

GenesForLife wrote:Give me an example of such a profound multifactorial consideration, DST70.


Someone with insomnia, or heart disease, or hemorrhoids, or depression. Or TMB's case history below.

PS- such multifactorial causative possibilites are removed in clinical trials by means of subject standardization to the maximum extent possible.


Hmmm. I think we might end up disagreeing on how useful it is to try and "remove" multifactorial causes and aim for "subject standardization to the maximum extent possible."
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#744  Postby DST70 » Jun 14, 2010 3:23 pm

Shrunk wrote:As anyone who has read my posts would know, I kinda like analogies, and I think DST70 has provided us with a potentially useful one here.

As we know, brushfires have been a major problem in certain areas such as California. And despite the best efforts of allopathic firefighting technology, they continue to cause much devastation every year.

Perhaps the reliance on allopathic firefighting is misguided, and the intervention I have suggested above should be considered: Firefighting departments should lay off a number of their firefighters and devote a portion of its budget to hiring sorcerers who, in case of fire, will wave magic wands at nearby dry brush. Homeowners could even be given the choice, when their homes are ablaze, of having the invasive allopathic procedures, which often result in serious "side effects" such as water damage and doors splintered by axes, or safe, noninvasive "complementary" firefighting, which are guaranteed not to produce such adverse effects.

Personally, I think this would be a stupid idea, since there is no empirical evidence that waving a magic wand at dry brush can stop or prevent a fire. However, I wonder what Nancy Malik, DST70, TMB, or any other advocates of "complementary medicine" think. Would you agree to such an intervention if your home was burning down? If not, why not?


Thankyou, although I think you've misunderstood the analogy.

You're invoking magic wands as a mock solution but it's disingenuous. What the analogy shows is that - if you're committed to EBM - you have to gauge the efficacy of a course of action on evidence. What counts as evidence though is largely determined by the governing medical paradigm. The proper version has the fire department starting to see beyond a system of hoses and burning buildings, to look at what's going on in local land management, irrigation of the surrounding foliage, amount of nearby BBQs and campfires, that sort of thing.

Personally, if my house was on fire I'd want the fire dept to come round ASAP with a hose.

David

P.S. Sorcery and magic also tend to get terribly misunderstood :(
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#745  Postby Shrunk » Jun 14, 2010 3:47 pm

DST70 wrote: Thankyou, although I think you've misunderstood the analogy.

You're invoking magic wands as a mock solution but it's disingenuous. What the analogy shows is that - if you're committed to EBM - you have to gauge the efficacy of a course of action on evidence. What counts as evidence though is largely determined by the governing medical paradigm. The proper version has the fire department starting to see beyond a system of hoses and burning buildings, to look at what's going on in local land management, irrigation of the surrounding foliage, amount of nearby BBQs and campfires, that sort of thing.


I don't see how my invoking magic wands is disingenuous. I don't see how attending to factors that are empirically demonstrated to increase the risk of fires is analogous to treating physical illnesses with distilled water that is alleged to "remember" what was dissolved in it in the past.

There's a strawman version of "evidence based medicine" that is being peddled here, that has not resemblance whatsoever to the real thing.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#746  Postby GenesForLife » Jun 14, 2010 5:17 pm

DST70 wrote:
GenesForLife wrote:Give me an example of such a profound multifactorial consideration, DST70.


Someone with insomnia, or heart disease, or hemorrhoids, or depression. Or TMB's case history below.

PS- such multifactorial causative possibilites are removed in clinical trials by means of subject standardization to the maximum extent possible.


Hmmm. I think we might end up disagreeing on how useful it is to try and "remove" multifactorial causes and aim for "subject standardization to the maximum extent possible."


Multifactorial diseases such as heart disease, for instance, have a variety of evidentially supported practises dealing with the various factors that may contribute to the disorder in question., from dietary & lifestyle changes to reduce cholesterol to statins to block cholesterol to NSAIDS to surgery. In other words, the cause and effect relationships involved are reduced to each factor separately during testing, this in no way forbids a multi-pronged strategy to combat the disease.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#747  Postby natselrox » Jun 15, 2010 8:07 am

And as a non-commercial break, we bring to you the method of doing actual science...

[youtube]http://www.youtube.com/watch?v=b240PGCMwV0[/youtube]

Science. It works Bitches!
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#748  Postby DST70 » Jun 15, 2010 2:40 pm

GenesForLife wrote:Multifactorial diseases such as heart disease, for instance, have a variety of evidentially supported practises dealing with the various factors that may contribute to the disorder in question., from dietary & lifestyle changes to reduce cholesterol to statins to block cholesterol to NSAIDS to surgery. In other words, the cause and effect relationships involved are reduced to each factor separately during testing, this in no way forbids a multi-pronged strategy to combat the disease.


Agreed, but those multi–pronged strategies come embedded in a rationalist model of medicine. In rationalist models illness is categorised by disease groups, so if you have disease 'A' you'll be treated in the way that disease 'A' always gets treated, as per the results of clinical research. This makes sense under a rationalist model where common symptoms are more important than peculiar symptoms. Whether or not this is the only way of observing human health and illness is debatable.

There's also a problem if you try and "standardize" a sample group too much. The more internal homogeneity the sample group has (more common symptoms), the less representative of the wider population any successful treatment is, so the less 'real world' application it has. Striving for homogeneity in sample groups is not always desirable; assuming it in the world at large is a very debatable concept.

I'm not denying the obvious benefits and huge improvements in medical care from this approach - that would be stupid. But the question remains whether that model is enough on its own to determine the efficacy of a treatment or cure. At least it's something considered by many people, not just alternative therapists.

David
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#749  Postby Shrunk » Jun 15, 2010 3:50 pm

DST70 wrote: Agreed, but those multi–pronged strategies come embedded in a rationalist model of medicine. In rationalist models illness is categorised by disease groups, so if you have disease 'A' you'll be treated in the way that disease 'A' always gets treated, as per the results of clinical research. This makes sense under a rationalist model where common symptoms are more important than peculiar symptoms. Whether or not this is the only way of observing human health and illness is debatable.


So you advocate an "irrationalist" model, instead?

All kidding aside, what actually is the alternative model you are proposing to determine whether treatments are effective?
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#750  Postby GenesForLife » Jun 15, 2010 4:37 pm

The people who come and spout crap about heterogeneity are often the ones who have no idea about the near-identical pathways of disease progression involved in particular diseases, this is why "rationalist" medicine fucking works.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#751  Postby natselrox » Jun 15, 2010 4:44 pm

Homeopathy: Curing with Kindness

The British Medical Association recently called homeopathy "witchcraft", and a parliamentary committee recommended stopping all NHS funding for it. Yet many people, not least members of the Royal Family, swear by it.

So, what are the facts? Why is there still so much uncertainty? And why are emotions flying so high? British homeopaths are this week celebrating their annual Homeopathy Awareness Week – a good occasion to try and find some answers.

Homeopathy was developed almost single-handedly by a German physician, Samuel Hahnemann. About 200 years ago he found that when, as a healthy person, he took the anti-malaria drug quinine, he experienced some of the symptoms associated with malaria. He eventually concluded that "like cures like": any substance that provokes a symptom in a healthy person can be used to treat that same symptom when it occurs in a patient. You cut an onion and your eyes start watering; so a homeopathic preparation made from onions can be used to cure hay fever, a condition characterised by watering eyes.

But homeopaths do not use simple extracts of onions or other substances. Hahnemann also believed he had found that diluting an extract repeatedly in a special way – homeopaths call this "potentisation" – would make the remedy not less but more powerful. How on earth can this possibly work? Therefore, homeopathic remedies are so diluted that typically they no longer contain a single molecule of the onion. The theory of the "memory of water" provides the answer, according to homeopaths. It postulates that, during the dilution process, some mystical "energy" is transferred from the onion to the water. And that "energy" then triggers a healing response in our body.

This is all wishful thinking and romantic fantasy, scientists insist. The war of words is as old as homeopathy itself, but somehow misses the most important point. If homeopathic remedies make patients healthy, the debate is academic.

The proof of the pudding is in the eating. So do homeopathic remedies really have any effect on patients? To find out, we need clinical trials. Today we have about 150 clinical trials of homeopathy. Typically they test the effectiveness of homeopathy by treating one group of patients with homeopathy, while a comparable, second group receives placebos, i.e. sugar pills that only look like the real thing.

These trials have generated vastly different results: some suggest homeopathy works, others fail to do so. It can thus be tempting to cherry-pick and select those data that suit our arguments. This sort of thing has fuelled more and more emotional debates. But that approach is, of course, fundamentally misguided. To get to the truth, we must firstly avoid cherry-picking and look at the totality of the studies, and secondly we have to consider the issue of their reliability. Some trials are biased, but others are not. If we do all this systematically, we are bound to arrive at rather sobering conclusions.

Many researchers across the world have reviewed the evidence and concluded that homeopathic remedies are pure placebos. Five years ago, The Lancet even announced "The Death of Homeopathy". But homeo- pathy did not die. In fact, it continues to thrive and now boasts many supporters, who say, "We are not stupid, we have experienced benefits and therefore know it works."

Homeopaths ignite the debate further by claiming that the clinical trials are artificial, inadequate research tools. They show us "real-life" studies where patients are monitored over time but are not compared to a placebo group. These observations invariably demonstrate impressive success rates after homeopathic treatments. So, we seem to be confronted with a perplexing contradiction: homeopathic remedies are placebos with no specific effects, but in "real life" they seem to work.

The solution to the conundrum is quite simple, however: the remedy does nothing and the homeopath does everything.

If you see a homeopath, you are typically asked many very detailed questions. The homeopath is interested, empathetic and you feel warmly understood. The whole encounter lasts for about an hour, and at the end you receive a prescription. The remedy is a placebo but, never mind, the consultation and the expectations it raises have important effects. This is true particularly if you are suffering from conditions such as insomnia, depression or eczema that respond well to this type of reassuring "mini-psychotherapy". No contradiction at all then. But one nagging question does remain. Does it matter what helps the patient? If it is a placebo so be it, some would say. Regardless of the negative scientific verdict, homeopathy is good for you. What really counts is that it works. Essentially this line of argument implies that, regardless of the negative scientific verdict, homeopathy is good for you.

For a whole host of reasons, I disagree with this line of argument. Honesty is one of them. If the remedy is a placebo, we cannot truthfully pretend it isn't. Such lies may be benign, but they are also unethical.

And it is essential to realise that we don't need a placebo to generate placebo-effects. If a doctor prescribes for patients suffering from insomnia, depression, eczema etc a treatment that works beyond a placebo and, if this is done in a kind and empathetic way with time and understanding, the patient will profit from the specific effects of the prescription and also the non-specific effects of the encounter, which we often call placebo-effects.

Good medicine should always employ specific therapeutic effects (which homeopathic remedies do not possess), as well as the non-specific effects of the therapeutic encounter, i.e. time, understanding, empathy and human warmth, which homeopaths have lots of. Using only one or the other is quite simply not good medicine.

So, when we celebrate Homeopathy Awareness Week, we should honour Samuel Hahnemann – not for inventing homeopathy but for reminding us how important those non-specific elements of the therapeutic encounter really are.


http://www.independent.co.uk/life-style ... 00455.html
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#752  Postby Shrunk » Jun 15, 2010 4:45 pm

GenesForLife wrote:The people who come and spout crap about heterogeneity are often the ones who have no idea about the near-identical pathways of disease progression involved in particular diseases, this is why "rationalist" medicine fucking works.


I also wonder why they set medical science aside as a special case where "rationalism" can be disregarded. If someone were building them a house, and said he had abandoned all empirical principles of structural engineering and simply nailed up a bunch of beams based on the "peculiar" circumstances of this particular house, would then even dare set foot in it?
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#753  Postby natselrox » Jun 15, 2010 4:51 pm

Shrunk wrote:
GenesForLife wrote:The people who come and spout crap about heterogeneity are often the ones who have no idea about the near-identical pathways of disease progression involved in particular diseases, this is why "rationalist" medicine fucking works.


I also wonder why they set medical science aside as a special case where "rationalism" can be disregarded. If someone were building them a house, and said he had abandoned all empirical principles of structural engineering and simply nailed up a bunch of beams based on the "peculiar" circumstances of this particular house, would then even dare set foot in it?


Part of the reason is, I believe, the way Biology is taught to our kids. I mean, post-1953, Biology is no longer the Stamp-collecting science anymore. It is as concrete and accurate as other so-called more 'fundamental' sciences' But when it comes to teaching children, we still go with the soft options as Zoology, Ascent of Sap etc. I'm not saying that these are useless, but they kinda send the wrong signal and make people think that Biology is an obscure science unlike Physics/Chemistry and is fuzzy like Meteorology. So we are left with people who make arbitrary predictions about the diseases which often seem to work. Had we been more rigorous in teaching Biology to our students, I think, the society would have been much more resistant to these quacks.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#754  Postby DST70 » Jun 15, 2010 9:58 pm

GenesForLife wrote:The people who come and spout crap about heterogeneity are often the ones who have no idea about the near-identical pathways of disease progression involved in particular diseases, this is why "rationalist" medicine fucking works.


Perhaps, but there's a few people on this thread - as well as GPs - to whom this would be news indeed. The people "spouting crap" are often patients who mysteriously return to the doctors surgery again and again, despite having received treatment that maps their near "identical pathways of disease progression".

I'm interested to hear why you think that happens?
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#755  Postby DST70 » Jun 15, 2010 10:04 pm

Shrunk wrote:I also wonder why they set medical science aside as a special case where "rationalism" can be disregarded. If someone were building them a house, and said he had abandoned all empirical principles of structural engineering and simply nailed up a bunch of beams based on the "peculiar" circumstances of this particular house, would then even dare set foot in it?


I probably didn't explain it very well - the other approach is empirical. Both traditions go back to the origins of medicine in Hippocratic times. The empirical tradition is not irrational; it differs from the rationalist model though in that causation, treatment and prognosis is recognised as multifactorial and likely different in different settings. EBM is largely an empirical pathway. The rational model sees illness as the result of disease entities which are biochemically or anatomically distinct.

Modern scientific medicine contains elements of rational and empirical models.

David
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#756  Postby GenesForLife » Jun 16, 2010 5:15 am

DST70 wrote:
GenesForLife wrote:The people who come and spout crap about heterogeneity are often the ones who have no idea about the near-identical pathways of disease progression involved in particular diseases, this is why "rationalist" medicine fucking works.


Perhaps, but there's a few people on this thread - as well as GPs - to whom this would be news indeed. The people "spouting crap" are often patients who mysteriously return to the doctors surgery again and again, despite having received treatment that maps their near "identical pathways of disease progression".

I'm interested to hear why you think that happens?


Lack of resolution of diagnostic techniques, because even though the pathways of disease are identical, they often tend to overlap in the symptoms they cause, therefore, treatment is often based on the most likely diagnosis based on observed symptoms, so say, for instance, Dengue and other fevers may still result in fever, and the symptoms look the same, but Dengue can only be identified by specific diagnoses based on reduced platelet counts.

The reason that people keep coming back is that they received treatment based on the diseases indicated by the observed symptoms, which can overlap as the manifestations of the pathological effects of many particular diseases, this automatically does not, in any logically consistent universe, mean that the pathways of disease are heterogenous.

To put it simply, similar symptoms and signs may appear due to different diseases, but each disease has its own pathway of causation and progression,which is common to patients who suffer from the same disease, and "rationalist" medicine is capable of dealing with these diseases once they are diagnosed correctly and the perceived "problem" with heterogeneity is not in the latter, but in the former, which is increasingly being resolved by ever improving diagnostic methods.

Care to make the distinction?
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#757  Postby DST70 » Jun 16, 2010 1:19 pm

Well it's likely going to be a point of dispute how far we currently are along the line of those ever improving diagnostic methods - I'm sure you can point me to all the diseases that have better prognosis these days and I could point to many where diagnostic methods and treatment is still floundering. It depends on perspective.

But are you saying that the only real way to understand and treat disease is with reference to an underlying physical pathology - which, when correctly diagnosed, leads to successful treatment?

And do you mean to say that patient history is not really a factor in the pathway of any given disease?

You seem to be suggesting a very linear, 1:1 mapping of symptomology to disease entity.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#758  Postby GenesForLife » Jun 16, 2010 1:30 pm

Not the only real way, far from it, but currently the best way, and it has resulted in significant improvements. Patient history doesn't change the pathways of disease progression, but may contribute to the symptomatic manifestation of the diseases in question, then again, more factors can still be considered by creating a universal set of 1:1 mapping, I am suggesting a 1:1 mapping of pathological causes to pathological effects, which in turn go on to manifest as signs and symptoms, which may not be 1:1.
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#759  Postby DST70 » Jun 16, 2010 5:26 pm

A universal 1:1 set mapping symptoms to disease would surely be the Holy Grail of medicine; albeit utterly unobtainable.

But the problem in any case is that if it's signs and symptoms that show variance from case to case, this needs not only to be accounted for, but accounted for in a way that makes it irrelevant to the treatment of a given disease based on pathological causes and pathological effects. How do you do that?

And what do you do about illness that has no obvious underlying physical pathology, and therefore where you don't have obvious access to any discrete disease entity?
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Re: The Danger of Science Denial - "Alternative Medicine"-Sp

#760  Postby GenesForLife » Jun 16, 2010 5:30 pm

if there is no obvious underlying physical pathology, investigations must continue until it is rendered obvious, which is why medical science and biology in general has not come to a standstill, but then again, "obvious" is a term that is very much grounded in the inadequacies of our current diagnostic and analytical tools to pinpoint it.

Now, you argue it is unobtainable, care to back that up with evidence?
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