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

Dudely · **#781** by **Dudely** » Jun 19, 2010 3:22 am

TMB wrote:
Shrunk wrote:
DST70 wrote:
Homeopathy is said to be ineffective mostly because it gives inconclusive or poor results in clinical trials. Clinical trials are the product of a medical paradigm that assumes a 'normal' level of diversity in human health. It's focussed on diagnosing and grouping common symptoms, and doesn't acknowledge the variation of individual response to disease and treatment. It's not a surprise to me that homeopathy doesn't show a lot of success in clinical trials.

Wrong. It is precisely because of the "variation of individual response to disease and treatment" that randomized controlled trials are necessary. If there was uniformity in response, then trials would be unecessary.

I would say wrong again. Randomised, controled trials exists to ensure that causation is not mixed with correlation, when it comes to efficacy of various drugs and treatments. However it also highlights just how much of any medical process is taken as self evident. We do not conduct randomised, controled trials to confirm that swelling arises following a bone break, we infer this on anecdotal evidence and using our judgement of inference. If someone does not feel well and they are also running a fever, we do not run a trial to make sure we are not confusing cause with correlation. This are extreme examples, but it highlights just how much we rely upon self-evident things in any human system, not only conventional medicine.

To dismiss judgement and inference in experienced practitioners as anecdotal evidence, would also mean that much of conventional medicine also is dismissed for the same reason. The actual scope of trils is very limited and mnay doctos infer from anecdotes.

This also applies to normal life. If a kid at school gets bullied and then feels upset, next time around he infers that bullying makes him upset, he does not need a trial to confirm this for him. The process around just about every form of human behavior is based upon direct experience and inference, not trials. This does not mean that trials are not useful to ensure that causation and correlation are not confused, but it means they are just a small part of conventional medicine.

The range of apparent symptoms arising from food intolerances seems bewildering. Should we suspend judgement and treatment until every one of these has been verified by a trial? If we consider food intolerances to be part of conventional medicine, imagine how limited we would be if we could only operate on the basis of things proven in multiple trials. There is also a big difference between using trials to ensure that treatment works and does not have side effects, and trials that are conducted to establish cause and correlation.

There is a difference between the anecdotal evidence you are talking about and stuff that it winds up people made up. The reason we don't need trials for some things and the reason we can sometimes rely on our own experience is because of repeatability. I don't need a dozen experiments run and confirmed by peer review to tell me that if I jump I will fall back down. This can be inferred from how easy it is to repeat and how consistent it is. We know the things which DO require trials, as these are the things that people don't always agree on, or that you can't repeat yourself due to time/skill constraints.

Can you seriously say the same about homeopathy? And if you can't, then doesn't that mean it doesn't just fail scientific standards, but basic standards we use judge thing with in our daily lives? I wouldn't trust a friend, who told me it was ok to jump off a dangerously high cliff as there is a special vine that will catch me at the bottom, unless I was sure it could be repeated!

Shrunk · **#782** by **Shrunk** » Jun 19, 2010 11:29 am

TMB wrote:
Shrunk wrote:Wrong. It is precisely because of the "variation of individual response to disease and treatment" that randomized controlled trials are necessary. If there was uniformity in response, then trials would be unecessary.

I would say wrong again. Randomised, controled trials exists to ensure that causation is not mixed with correlation, when it comes to efficacy of various drugs and treatments. However it also highlights just how much of any medical process is taken as self evident. We do not conduct randomised, controled trials to confirm that swelling arises following a bone break, we infer this on anecdotal evidence and using our judgement of inference. If someone does not feel well and they are also running a fever, we do not run a trial to make sure we are not confusing cause with correlation. This are extreme examples, but it highlights just how much we rely upon self-evident things in any human system, not only conventional medicine.

And therefore you conclude that a statement like "Soft tissue swelling often accompanies a fracture" is no more scientifically valid than, "Water possesses a 'memory' for substances that have been dissolved in it, but not all substances, just ones that have been intentionally introduced by a homeopath and has been 'potentized' by shaking in a specific manner (but don't ask us what this 'specific manner' is because we have no idea, which doesn't mean we can't still do it anyway). Even though this 'memory' cannot be demonstrated in any empirical manner whatsoever, and is inconsistent with all known principles of physics, we nonetheless know it exists and, moreover, makes this water an effective treatment for all illnesses, including cancer and AIDS."?

Seriously?

If that's not your point, then I'm not sure what your point is. That in clinical practice physicians often, of necessity, must rely on hunches, intuition, experience and inductive reasoning when solid empirical evidence does not exist to guide a particular decision? That physicians often err in assuming how strongly supported their interventions are actually supported by evidence? That physicians are often unable or disinclined to provide a patient the optimal degree of individual attention, and it is therefore incumbent upon patients to take an active participatory role in their health care?

I would not disagree with any of these statements, and any one would be the basis for an interesting discussion. But, as Mr. Samsa has reminded us, none of these are the topic of this discussion.

This discussion is about homeopathy, a doctrinal belief that attempts to present itself as scientific, but which bases it's premises on quasireligious pseudoscientific dogma, and whose adherents continue to practice in defiance of rigorous scientific evidence that their interventions are no more effective than placebo.

Shrunk · **#783** by **Shrunk** » Jun 19, 2010 11:36 am

Dudely wrote: There is a difference between the anecdotal evidence you are talking about and stuff that it winds up people made up. The reason we don't need trials for some things and the reason we can sometimes rely on our own experience is because of repeatability. I don't need a dozen experiments run and confirmed by peer review to tell me that if I jump I will fall back down. This can be inferred from how easy it is to repeat and how consistent it is. We know the things which DO require trials, as these are the things that people don't always agree on, or that you can't repeat yourself due to time/skill constraints.

I would just add that a basic principle of scientific investigation is that all potential confounding variables should be controlled for as much as possible. Since the placebo effect is a known variable in clinical investigation, RCT's are the most effective method of dealing with this. As GenesForLife has already mentioned, this does not mean that an RCT is required in all basic science research. When physicists detonated the first hydrogen bomb, they did not need to compare it to a placebo bomb to ensure that the resulting explosion did not just occur randomly.

tytalus · **#784** by **tytalus** » Jun 19, 2010 10:39 pm

Shrunk wrote:When physicists detonated the first hydrogen bomb, they did not need to compare it to a placebo bomb to ensure that the resulting explosion did not just occur randomly.

It may be that the necessary technology had not been invented yet. Alas, it now seems to have been...

TMB · **#785** by **TMB** » Jun 19, 2010 10:56 pm

Dudely, you said,

There is a difference between the anecdotal evidence you are talking about and stuff that it winds up people made up.

Of course there is, but you skirted my other examples, when you said this

he reason we don't need trials for some things and the reason we can sometimes rely on our own experience is because of repeatability. I don't need a dozen experiments run and confirmed by peer review to tell me that if I jump I will fall back down. This can be inferred from how easy it is to repeat and how consistent it is.

What about a conventional paediatrician who tells us that vaccinations will cause harm to my daughter and should not have them? Her judgement is based upon what scientific repeatability? Because she has seen it, in untested, randomised trials enough times to know what is really happening? What about doctors who recognise that repeated use of antibiotics will cause harm to internal bacteria, things they know because they apply their judgement. Our gynae who was prepared to accept that we were using stuff that overturned his normal medical protocols, because he had good enough judgement to know that taking an inflexible approach to the medical ‘one size fits all’ is just as dangerous as ignoring it totally. You have chosen extreme examples to argue this case, why not try some of the more difficult ones? The principle is the same. Medical science cannot possibly apply randomised trials for all cases, and any effective practitioners apply their judgement recognising this. Those who apply the medical protocol without any judgement do not understand the basic issues that apply to conventional protocol. This does not mean we should not apply protocols to homeopathy.

We know the things which DO require trials, as these are the things that people don't always agree on, or that you can't repeat yourself due to time/skill constraints.

Just consider the thalidomide example, at what point did someones judgement kick in to recognise that birth defects were arising from its use, something hopefully they had enough judgement to do before a trial proved it? Use this example in your argument and see how you go by applying the above process to thalidomide

Can you seriously say the same about homeopathy? And if you can't, then doesn't that mean it doesn't just fail scientific standards, but basic standards we use judge thing with in our daily lives? I wouldn't trust a friend, who told me it was ok to jump off a dangerously high cliff as there is a special vine that will catch me at the bottom, unless I was sure it could be repeated!

Agreed, however I do not advocate the use of homeopathy unless you find that it works for your situation. I am making the point that blindly following a protocol for its own sake seems to be a common human failing, and often they are unable to focus on the health of the patient. I offered numerous examples above to point this out. Why are you not using one of these to dismantle the argument? Standard protocol is using steroid injections for multiple pregnancies (triplets in our our case). We were told we had no choice, but to follow protocol. Only when we questioned this, did we discover that a simple and logical alternative, that had nothing to do with alternative medicine was available, it was just pure judgement. Our gynae also saw this and we avoided unnecessary and probably harmful treatment. This was just blind compliance to protocol and suspension of critical judgement. The danger with any standardised protocol is the suspension of our critical faculties, including medicine, either alternative or conventional.

TMB · **#786** by **TMB** » Jun 19, 2010 11:15 pm

Shrunk, you said,

And therefore you conclude that a statement like "Soft tissue swelling often accompanies a fracture" is no more scientifically valid than, "Water possesses a 'memory' for substances that have been dissolved in it, but not all substances, just ones that have been intentionally introduced by a homeopath and has been 'potentized' by shaking in a specific manner (but don't ask us what this 'specific manner' is because we have no idea, which doesn't mean we can't still do it anyway).

NO, although one could use these examples to establish the principle. I would look to the Thalidomide examples, or one of the others I provided to see that blindly following any protocol, alternative or conventional, has issues. Why don’t you use some of my other examples and see if they are dismissed so easily?

Even though this 'memory' cannot be demonstrated in any empirical manner whatsoever, and is inconsistent with all known principles of physics, we nonetheless know it exists and, moreover, makes this water an effective treatment for all illnesses, including cancer and AIDS."?

I have not suggested this, and if you were not cherry picking my posts this should be obvious. I am suggesting that we blindly follow protocols of al kinds and cause significant , avoidable damage in conventional medicine. Blindly following alternate treatments is just as dangerous, simply do not suspend critical judgement when finding effective treatments.

If that's not your point, then I'm not sure what your point is.

Then read my posts more carefully and I am sure it will become apparent.

That in clinical practice physicians often, of necessity, must rely on hunches, intuition, experience and inductive reasoning when solid empirical evidence does not exist to guide a particular decision? That physicians often err in assuming how strongly supported their interventions are actually supported by evidence? That physicians are often unable or disinclined to provide a patient the optimal degree of individual attention, and it is therefore incumbent upon patients to take an active participatory role in their health care?

And this demonstrates that we often blindly follow protocols, suspend our judgment and become so focussed on method that we lose sight that healing is the primary aim. The above is an argument for principle. I accept that the argument around how well homeopathy fits normal protocols is challenging, but it still works in many cases. Consider then, that perhaps the method has some issues, rather than dismissing the treatment.

I would not disagree with any of these statements, and any one would be the basis for an interesting discussion. But, as Mr. Samsa has reminded us, none of these are the topic of this discussion.

The title of this is ‘the danger of science denial, so I think the points are valid

This discussion is about homeopathy, a doctrinal belief that attempts to present itself as scientific, but which bases it's premises on quasireligious pseudoscientific dogma, and whose adherents continue to practice in defiance of rigorous scientific evidence that their interventions are no more effective than placebo.

I disagree, we are debating the danger of science denial, so arguments about homeopathy are relevant as examples, just as blindly following conventional protocols are. If science is about reality and not protocol, then I suggest you take an argument about homeopathy in to a thread titled, “is homeopathy, a doctrinal belief that attempts to present itself as scientific etc”,

Dudely · **#787** by **Dudely** » Jun 19, 2010 11:49 pm

How does any of this help the argument for homeopathy?

tytalus · **#788** by **tytalus** » Jun 20, 2010 1:48 am

Because we're blindly following protocols and not heeding the potency of anecdote.

Shrunk · **#789** by **Shrunk** » Jun 20, 2010 11:32 am

OK, TMB. I'll follow your assumption that my failure to agree with you is because I have not adequately understood what you're trying to say, and not because your argument is flawed or has not been presented clearly.

Is this what you're trying to say: That "conventional medicine" is at times guilty of rigidly following a "protocol" rather than taking all available evidence into account, including that evidence pertinent to the particular patient in question? And that this rigidity also constitutes a failure to adhere to the scientific method? Am I getting it right now?

If so, I still fail to see how that is an argument in favour of homeopathy and other "alternative" treatments. These "treatments" are distinguished from "conventional" medicine by one feature only: A rejection of empirical evidence as the basis for determining the efficacy of a treatment, relying instead on unverifiable (and often frankly nonsensical) theoretical models and anecdotal "successes" as being sufficient to determine efficacy.

If you need evidence for this, simply read Nancy Malik's posts in this thread.

Once an "alternative" treatment has garnered enough empirical evidence to support its efficacy, it ceases to be "alternative" and instead become absorbed into mainstream medicine.

By abandoning any empirical basis to its "treatments", complementary medicine does not achieve flexibility and open mindedness. Rather, it exemplifies the very rigidity and inflexibility you decry in "allopathic" medicine. This is demonstrated by the fact that Nancy Malik (or any other homeopath of whom I am aware) has been unable to list a single homeopathic treatment that has been abandoned over the past 300 years. Either you believe homeopathy is the only discipline in which its practitioners have achieved a superhuman infallibility, or that they are rigidly and dogmatically insisting that their treatments work in the face of all contradictory evidence.

Dr. Nancy Malik · **#790** by **Dr. Nancy Malik** » Jun 20, 2010 8:17 pm

Shrunk wrote:
If someone takes a homeopathic medication and feels better, it is proof that that single person felt better after taking that single homeopathic preparation on that one occasion. It does not in any way demonstrate that the homeopathic medication operated in any specific way to actually treat the person's disease.

Now replace the word homeopathic with conventional, and read it again.

Dr. Nancy Malik · **#791** by **Dr. Nancy Malik** » Jun 20, 2010 8:25 pm

TMB wrote:Shrunk, you said,

Right. Hence the need to repeatedly try to falsify a hypothesis even once it has seemingly been confirmed experimentally. Technically you're correct; no theory can be said to be correct with 100% certainty, as you never know if the next observation will falsify it.

Correct but it does not mean that the system is able to validate reality. It just means that within certain confines it is able to do this. Its not able to certify with any certainty what is false. I accept that it evolves and improves its capability as it goes, but its still a mistake to take a position of certainty on something being false. Take the example of the venom of the African boomslang. By all accounts (not science I know but I do not think anyone bothered to apply SM to this), this was not a venomous snake, and this was the position of scientific knowledge, it was not classified as dangerous etc, despite locals insisting that it was. What passed as SM at the time arose because of observations, its a shy snake, and has back fangs, so does not often bite and even then not effectively. However once observation included some incidents with Europeans, they re-classified it as venomous. You might claim that it proves the system is self-learning, and it is, but it still only provides the wisdom of hindsight.

However, after a sufficiently large number of falsification attempts have failed, it can be said for all practical purposes that the theory is correct with a certainty that approaches 100%.

What exactly defines sufficient? At the time thalidomide was certainly given sufficient testing, otherwise they would not have released it. What they had missed was sufficient time to measure the effects further down the line. They changed their minds once birth defects appeared, but once again only with the benefit of hindsight.

What is the long term issue that will come from excessive hygiene? Is it reduced resistance to infection? It now appears so but we did not think so a decade ago. What do we know about the long term effects of giving steroids to mothers expecting premature delivery. We know it helps lung development in the at risk, underweight foetus, but what does it do to them in the long-term. They don’t have any idea in allopathic medicine, because they cant draw any conclusions until they have gone through the process of a full study.

What are the implications of vaccination against measles? That it prevents measles we know, but there also appears to be evidence that a dose of measles allows development of our immune systems, and vaccinations might undermine this. Vaccinations of kids under 6 months now does not appear to get done much, again the benefit of hindsight, but no certainty of being right.

This means they are following this protocol without question because they can say no studies exist that prove long term issues. When I was confronted with this scenario for my own kids, we found there was an easy way around the protocol, it just required looking from a different perspective. Medicines flaws (all systems) result from human short sightedness and the inability to question prevailing wisdom.

As gets mentioned many times, the flat earth was a 100% certainty until we knew better. In fact it could not be doubted based upon what we knew about reality. The geo centric solar system was similar. This issue was the lack of open minds to what people knew with certainty.

Which is precisely the error Nancy Malik continually makes in this thread: Accepting isolated, uncorroborated observations as evidence even when they have been refuted by further, more systematic and reliable observations.

I am not in a position to comment about homeopathy in terms of how it works etc, except for the fact that it works for me and my family and has done many times. You might ascribe this to placebo, and perhaps you are correct, but thats just anecdotal to.

The second point exists because of the first. As with the evidence based legal systems, we are simply not in a position to repeat the past with exact fidelity. This means that real stuff that did happen, cannot be proven, although logically we know it is not because the past did not happen in a certain way, just that we are unable to effectively repeat history. This means that we are forced by the method to discount things that do not pass this test. This does not mean these things exist or are effective, just that SM is not effective in assessing them.

I agree. All that we know from personal experience is our knowledge. Our shared knowledge is Science. Current science may not yet become "absolute and final" but in process of it

Dr. Nancy Malik · **#792** by **Dr. Nancy Malik** » Jun 20, 2010 8:28 pm

DST70 wrote:
Dr. Nancy Malik wrote:What if someone witnessed a car accident and the Police wanted them to make a statement? Would the statement in court be dismissed as anecdotal evidence? Would the police, even if they arrived at the scene of the accident to find the person still there comforting the passengers or trying to help, say they had not been there and their evidence is non existent?

That's a good analogy to make. It would depend on what criteria the court sets as necessary to count as evidence. (I think it's sometimes forgotten how anecdotal evidence is in fact an important and necessary part of healthcare.)

David.

Many clinical tests come to diametrically opposed conclusions. You could say that the problem was discovered through anecdotal evidence - and merely confirmed through a peer reviewed study.

Dr. Nancy Malik · **#793** by **Dr. Nancy Malik** » Jun 20, 2010 8:34 pm

Dudely wrote:
Homeopathy is said to have an effect. If it indeed has an effect then that means it has a cause. If it has a cause this can be found through study. No "external/objective and internal/subjective categories" bullshit. Just hard-up causes and effects. THAT is science, and that is why people have such a problem with stuff like homeopathy- it's a medicine with NO study of its causes (because none can be found) and very little testing.

How conceited for science to assume they know all there is to know about something they have not yet even found the means to quantify!

campermon · **#794** by **campermon** » Jun 20, 2010 8:37 pm

Dr. Nancy Malik wrote:

How conceited for science to assume they know all there is to know about something they have not yet even found the means to quantify!

Science makes no such claim!

:popcorn:

Dr. Nancy Malik · **#795** by **Dr. Nancy Malik** » Jun 20, 2010 8:38 pm

Shrunk wrote:
TMB wrote:I am not in a position to comment about homeopathy in terms of how it works etc, except for the fact that it works for me and my family and has done many times. You might ascribe this to placebo, and perhaps you are correct, but thats just anecdotal to.

Wrong. Your family's experience of getting better with homeopathy is an anecdote. The question of whether homeopathy is any more effective than placebo can only be determined by controlled trials, not by anecdote.

The problem isn’t with the use of anecdotal evidence. It’s with the double standard applied by the conventional regulatory establishment that holds complementary & alternative medicine to an absurdly higher standard. If informed anecdotal evidence is allowable for 85% of all medical procedure and drug usage, why is alternative health held to an impossible 0% standard?

Shrunk · **#796** by **Shrunk** » Jun 20, 2010 8:48 pm

Dr. Nancy Malik wrote:The problem isn’t with the use of anecdotal evidence. It’s with the double standard applied by the conventional regulatory establishment that holds complementary & alternative medicine to an absurdly higher standard. If informed anecdotal evidence is allowable for 85% of all medical procedure and drug usage, why is alternative health held to an impossible 0% standard?

Maybe because that's just another fantasy "fact" you've extracted from you posterior.

And once a treatment has been unequivocally determined to be ineffective, as homeopathy has been, then it is dropped. To present it as an effective option to a patient becomes malpractice. Unless, of course, you call yourself a "homeopath".

Dr. Nancy Malik · **#797** by **Dr. Nancy Malik** » Jun 20, 2010 8:55 pm

Ubjon wrote:Those that are interested in the effectiveness of homoepathy might want to review the Cochrane Institutes website as they have looked in to this

Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder - http://www.mrw.interscience.wiley.com/c ... frame.html

Homeopathy for chronic asthma - http://www.mrw.interscience.wiley.com/c ... frame.html

Homeopathy for dementia - http://www.mrw.interscience.wiley.com/c ... frame.html

Homoeopathy for induction of labour - http://www.mrw.interscience.wiley.com/c ... frame.html

Homeopathic medicines for adverse effects of cancer treatments - http://www.mrw.interscience.wiley.com/c ... frame.html

Complementary and miscellaneous interventions for nocturnal enuresis in children - http://www.mrw.interscience.wiley.com/c ... frame.html

The long and short of it seems that current clinical trials on homoepathy have been of poor quality and we need to the results of correctly carried out clinical trials before drawing any conclusions - http://www.mrw.interscience.wiley.com/c ... frame.html

Homeopathy medicine for various disease conditions http://www.trusthomeopathy.org/research ... dence.html

Dudely · **#798** by **Dudely** » Jun 20, 2010 9:09 pm

Dr. Nancy Malik wrote:
Shrunk wrote:
TMB wrote:I am not in a position to comment about homeopathy in terms of how it works etc, except for the fact that it works for me and my family and has done many times. You might ascribe this to placebo, and perhaps you are correct, but thats just anecdotal to.

Wrong. Your family's experience of getting better with homeopathy is an anecdote. The question of whether homeopathy is any more effective than placebo can only be determined by controlled trials, not by anecdote.

The problem isn’t with the use of anecdotal evidence. It’s with the double standard applied by the conventional regulatory establishment that holds complementary & alternative medicine to an absurdly higher standard. If informed anecdotal evidence is allowable for 85% of all medical procedure and drug usage, why is alternative health held to an impossible 0% standard?

You have to be joking.

Dr. Nancy Malik · **#799** by **Dr. Nancy Malik** » Jun 20, 2010 9:10 pm

DST70 wrote:
Shrunk wrote:

It's very easily done. You use a standardized self-rating scale for pain. The rating is subjective, but so long as the conditions of the trial are well-controlled that doesn't matter. Improvement, or not, in pain control can still be determined.

But would the conditions of most well controlled trials allow for different types of pain - sharp, burning, electric, dull, chronic, intermittent, stinging? Worse for sitting; or being near electrical equipment; or near the sea? I'm labouring the point a bit, but you can see where this is going. Study design means decisions get made about confounding variables.

Adding on to it

Pain-appears gradually and disappears gradually, appears gradually but disappears suddenly, appears suddenly and disappears gradually, appears suddenly and disappears suddenly, directions of pain-backward, downward, forward, outward, extending to-, on left side, on right side, radiating, etc

Shrunk · **#800** by **Shrunk** » Jun 20, 2010 9:12 pm

Dr. Nancy Malik wrote: The problem isn’t with the use of anecdotal evidence. It’s with the double standard applied by the conventional regulatory establishment that holds complementary & alternative medicine to an absurdly higher standard. If informed anecdotal evidence is allowable for 85% of all medical procedure and drug usage, why is alternative health held to an impossible 0% standard?

Here you go, Nancy: A list of all drugs currently approved by the FDA.

Pick any number of them at random, then demonstrate that 85% of them have only anecdotal evidence to support their efficacy. Either that, or admit your claim above is, shall we say, not quite accurate.

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

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