[[People spend a lot on chemo and die anyway. We can only conclude that chemotherapy is
not effective.]]
No, given the survival rates that are known through clinical study, we can only conclude that chemotherapy has a specific probability of working in a specific case, which in no way implies that survival is guaranteed. This can be contrasted with the “evidence” that any quackish alternative therapy will work, which usually consists of no clinical study at all, and scant anecdotal reports.
Please note: I am not “against” alternative approaches in general, although, at this point, I am completely convinced that homeopathy is probably the biggest scam, whether ill-intentioned or not, to be foisted on the population of the world, and I am sorry to see said population embrace it so readily. I am all for trying to find new ways to combat illness, etc. I am also for verifying that these new ways work via reproducible clinical tests before claiming that they work.
If that’s what you think this is all about, you are seriously misguided.
Would you care to share them with us? And is this some way to defend alternative medicine?
Jill said:
Good!
Yup. As Dr. Relman, the past editor of one of the medical journals, has said, there really is no such thing as “alternative medicine;” there is only medicine that works, and medicine that doesn’t.
One of the biggest proponents of alt. med. here in town is the local AIDS support group. This really kind of frosts me, because what these people need are more scientific advances, not sorcery.
One reason is because a new wonder herb seems to pop up every few months. It would be tough for a desk reference to keep track. < sigh >
Agreed – it is difficult. And I don’t want to see doctors put in a position where a patient is afraid to say, “Hey, I’m using this herb,” because then the doc has no chance to spot potential interactions or side effects. But at the same time, doctors should let the patient know (in a kind way) what he thinks of this type of, well, crap.
causality. Bodies are complex systems which are usually opaque to our questioning. Treatment success is judged by outcome. Favorable outcomes reinforce the theory that prompted the treatment, often without direct testing of the theory.
causality (again). If A causes B, the occurrence of A is inevitably followed by B. Treatments are said to cure a disease, even when the treatment works less than 100% of the time.
the placebo effect. The most reliable effect known, and the greatest fudge factor ever.
To the second question:
Given that the discussion is about a body of knowledge that medical doctors claim expertise in, it is only fair to judge their claims in light of their performance. Doctors have been so wrong, so often it’s hard to take them all that seriously. To wit:
phrenology
bleeding
frontal lobotomy
treating the weapon
AZT (? Kary Mullis)
hell, doctors don’t even know why we hurt after exercise (see the thread about whether it’s easier going up stairs or down).
Given the difficulty of the subject and the poor track record of “establishment” medicine, it’s not that hard to believe they might be wrong about something again.
Of course favorable outcomes reinforce the theory that prompted the treatment. But that doesn’t mean scientific medicine uses those alone. That’s why there are placebo trials and double-blind tests. Sometimes it is difficult, because of ethical considerations, to directly test a theory. But I don’t see how you can consider this a “serious methodological problem” – at least not without some concrete examples.
Again, some concrete examples would help. I don’t know who is “saying” that a treatment “cures” a disease, so it’s hard to comment. I don’t think anybody would say, for example, that chemotherapy “cures” cancer. It may kill off the cancer and send it into remission. The person may even – if he’s lucky – never see the cancer again. But if that’s the kind of thing you’re talking about, I think you need to clarify exactly what you’re talking about. And, again, it doesn’t sound like a “serious methodological problem.”
And your point is what? The placebo effect occurs much more often in alternative medicine than in scientific medicine – because the tests of scientific medicine are specifically trying to weed out that effect.
Whose claims are we judging? I thought this thread was about homeopathy (specifically) and alt. med. (generally). Do you normally try to prove that apples aren’t sweet by claiming that oranges are sweeter?
Alternative medicine claims need to be judged based on their successes or failures.
These two first. Phrenology was never taken seriously by most doctors. If you’re actually interested, I’d suggest you read the following two articles; one about phrenology in general, and the second about a doctor who was there at the time and what he had to say about it: http://www.reall.org/newsletter/v06/n09/index.html and http://www.reall.org/newsletter/v07/n02/index.html . Also, do you really want to point to the early 19th century for your examples of how horrible modern medicine is? The same question goes for bleeding.
Again, how long ago was this?
Huh?
You’re gonna cite Kary Mullis for your source? Give me a break! The man thinks he was abducted by space aliens in the form of glowing raccoons!
I haven’t seen the thread, but I didn’t know this was a real stumper, and I’m afraid I’m not going to take your word for it. In any event, if that’s the best you can do (and from this list, it looks like it is), I wouldn’t exactly call this a stellar debating technique.
You have yet to prove that there is a “poor track record” (unless you’re planning to count the early 19th-century as “modern”).
But, again, all of this is tangential to the point at hand. If all you’re going to do is argue that modern scientific medicine has been wrong in the past, that isn’t much of an argument. And it certainly doesn’t prove anything about the claims of alternative medicine. You are basing your argument on a logical fallacy, claiming that because you think somebody was wrong before, it is likely they are wrong now. Sorry, but unless you can do better, you’ve pretty much done nothing to advance your cause.
[[Bodies are complex systems which are usually opaque to our questioning.
Treatment success is judged by outcome. Favorable outcomes reinforce the theory that
prompted the treatment, often without direct testing of the theory.]]
Please give an example of a different method of judging treatment success. Is the fact that your friend John’s next door neighbor’s grandmother’s second husband went into remission after he took homeopathic remedy evidence of the efficacy of the remedy? How would you more accurately judge the efficacy of a treatment than by running a double-blind test with a control group and all that, and then observing the results? Is it perfect? No, doubtless there are minor variables that are playing a role in the test that nobody has thought of yet. But if you know of a better way, I’d like to hear it.
[[Treatments are said to cure a disease, even when the treatment works less than 100% of
the time.]]
The way the press reports medical breakthroughs notwithstanding, I don’t think this statement is accurate. I don’t think that treatments are said to “cure” a disease, I think that they are generally believed to be effective against a disease. Individual results will always vary.
[[the placebo effect. The most reliable effect known, and the greatest fudge factor ever.]]
So much more reason to have products tested through well-designed double-blind studies before touting them as “cures” for anything.
[[Given that the discussion is about a body of knowledge that medical doctors claim
expertise in, it is only fair to judge their claims in light of their performance.]]
Of course. And bringing up a few examples of mistakes that have been made along the way in no way takes away from the volumes of successes that have been realized, as I’m sure you’d agree.
[[To wit]]
I see I was wrong about the likelihood that you’d agree.
[[Given the difficulty of the subject and the poor track record of “establishment” medicine,]]
Once again, a few examples of mistakes along the way in no way implies a “poor track record.”
[[it’s not that hard to believe they might be wrong about something again.]]
Ah, finally we agree. Yet another excellent reason for well-designed double-blind studies.
Sorry for making the same points, David (although it would appear that they need to be made multiple times). I think we were replying at the same time, because your reply wasn’t visible when I was composing my reply.
One that comes to mind is the initial “bran reduces cholesterol” studies. I forget some specifics (like where it was done), but the basics were:
there was a theory that eating bran would reduce cholesterol
a (suitably stringent) study was undertaken with wheat (i think) bran
results were positive
a followup study (at Louisiana State) on rice bran confirmed the first
This follows the usual rules of a good study:
an initial theory prompts investigation (or vice versa)
an experiment is performed to test the theory
the experiment is repeated
Yet the whole thing fell apart. In this case it was simple - people were eating less junk food and more bran. Of course their cholesterol went down.
This is a fun tale of a Gettier counterexample, exactly the sort of thing that happens in complex systems.
Most anybody who goes to see a doctor? When (for example) one is prescribed antibiotics for an infection, certainly the point is to eliminate the infection and hence cure the patient. Or are you claiming that doctors only “treat”, and not cure?
Just that when examining claims (in this case that alt. med. is bunk) one should consider the source.
http://skepdic.com/phren.html claims that “Phrenology was praised by Ralph Waldo Emerson, Horace Mann and the Boston Medical Society” and “It remained popular, especially in the United States, throughout the 19th century”.
Treating the weapon (I forget the exact term) was the practice of applying salve to the weapon that caused the wound. Umberto Eco writes of it in The Island of the Day Before.
Kary Mullis has one more Nobel than the two of us put together, I’d bet. No guarantee of correctness, of course, but this is pretty near his area.
about exercise:
So read the thread. There’s a nice cite for the article.
Please provide the true axioms of medicine/science and the appropriate valid inference rules, stated in an unambiguous formal language (preferably one that supports a naive realist/correspondence theory of perception). I would be interested in seeing your deduction. Until said proof materializes we are better off using “winter rules” - acting reasonably. And being reasonable includes being (especially) skeptical of claims made by an organization that has been wrong before.
Actually, I think homeopathy is a bunch of junk, too.
[[we are better off using “winter rules” - acting reasonably. And being reasonable includes being (especially) skeptical of claims made by an organization that has been wrong before.]]
Now you’re starting to sound more reasonable yourself. However, I would add to your statement above, “and even more skeptical of an organization that has never been proven right before and makes claims anyway.”
I mean, wouldn’t you agree that one should be more skeptical of an organization that has been right 50 out of 100 times than you should be of an organization that has been right 90 out of 100 times? And shouldn’t you be more skeptical of an organization that has been right only 10 out of 100 times? And shouldn’t you be even more skeptical of an organization that has never been proven right at all?
Tominator2 said: “Given the difficulty of the subject and the poor track record of “establishment” medicine, it’s not that hard to believe they might be wrong about something again.”
If it appears that medicine has a “poor track record”, it’s because in science, therapies that are ineffective are abandoned. Medicine has been wrong in the past, some therapies are probably wrong now, and more wrong therapies will be tried in the future. The important point is that doctors do not eternally cling to bad methods; as science staggers onward the quality and effectiveness of medical care improves. Understanding deepens, the knowledge base broadens, and more effective methods are proposed.
Bleeding was accepted practice because doctors at that time poorly understood physiology; as new knowledge was gathered it became increasingly clear that bleeding is ineffective. The technique then eventually fell into disfavor.
The difference between “establishment” medicine and “alternative” medicine is that real medicine continues to seek knowledge and will always discontinue a practice that is proven not to work (albeit sometimes grudgingly; doctors are unfortunately human too). “Alternative” medicine resists studies that may prove them to be wrong and ineffective methods continue to be used even AFTER being proved wrong. Alternative medicine is far more likely to be wrong in the first place because there is little or no scientific basis for it, and much more likely to continue to be wrong because ineffective methods are not abandoned.
Given those facts, I would much rather put my “faith” in mainstream medicine.
Might as well close this one; Holly has said it all. Or maybe not…Holly, why do you think that alternative medicine goes on using proven ineffective methods? Because they have no standard for “proven”?
“Holly, why do you think that alternative medicine goes on using proven ineffective methods?”
People who use alternative (here meaning unproven or disproven) therapies, and I would wager many of those who provide such therapies, honestly believe they work. As long as people are willing to pay money for such things they’ll persist.
The only thing wrong about this picture is that the belief in the efficacy of alternative therapies is not grounded in science, and only those scientific studies showing the therapies work- no matter how badly researched- will be given any notice. I am NOT claiming that science is perfect, but it’s the best method we have for discovering truth.
I met a man who told me the only sure cure for arthritis is to put a potato in your pocket. When the potato “turns to stone”, he said, your arthritis will be gone. Obviously this man has no concept of causality or any clue about the scientific method. He absolutely believes this therapy works and I doubt any scientific study could shake his belief.
I think the only reason alternative medicine hasn’t embraced the Potato Theory of Arthritis is because potatoes are so cheap. If they were 20 bucks a pound, half the people in America would have potatoes in their pockets.
[[One of the biggest proponents of alt. med. here in town is the local AIDS support group.This really kind of frosts me, because what these people need are more scientific advances, not sorcery.]]
I understood the AIDS activist support for “alt. therapy” when there were few effective therapies available from Western Medicine. That is no longer the case.
I’ll tell you what frosts me; when AIDS organizations pressure the government (Public Health Department) to provide “alternative medicine” to people living with HIV/AIDS at taxpayers’ expense. Who decides which herbal remedies get picked up by the state formulary, and who profits from selling them? What would such decisions be based on?
Is someone here questioning the efficacy of AZT as an HIV therapy? It is not especially effective as a mono-therapy (except at preventing transmission from mother to baby… it works extraordinarily well at that, when the mother is treated during pregnancy), but probably mainly because of the continued mutation of the virus. It is still sometimes a drug of choice to be used in combination therapy, as are other, more recently developed anti-reverse transcriptase drugs.
Jill
I was considering not bothering to add a reply, since, as KayT noted, Holly pretty much said it all. But since Tominator was responding to me, I guess I should add in the rest of my $0.02.
Tominator said:
And your point is what? That some scientists made a mistake and other scientists caught it? Well, that’s what the scientific method is all about! How often have you seen an alternative medicine practitioner make a mistake in a study that was caught by another alt. med. practitioner? I can’t recall ever seeing anything like that. They usually band together, circle the wagons against science, and ignore any methodological problems at all.
I said:
You responded:
So now you’re switching from criticizing the doctors and scientist to criticizing those who are patients?
It depends on what the problem is. I was thinking more along the lines of cancer; you were apparently thinking more along the lines of an ear infection. But the main problem was that you were so vague in your staement that I didn’t really know where you were going.
Ok, what are you considering to be the source? The AMA? Doctors in general? All scientists? What?
I never said it wasn’t popular – I said doctors in general had not accepted it. Just because some famous people and one group may have does not mean “doctors in general” did. In any event, as I noted, if the best example of the failures of modern medicine come from almost 2 centuries ago, that’s not exactly a stellar example.
Actually, it’s not really near his area. His area was in chemical reactions – it was a technological advance. Was it an important one? Yes, but I also think it’s important to realize that he is, well, nuts.
Yes – acting reasonably. In this case, acting reasonably means using the scientific method, double proper medical tests whenever possible, etc. It certainly doesn’t mean simply saying, “Oh, well, doctors have been wrong before so they’re probably wrong again.”
What “organization” are we talking about here? I didn’t realize we were talking about an “organization” at all.
I’m glad to hear it. So then why are we having this discussion?
Holly was asked:“Holly, why do you think that alternative medicine goes on using proven ineffective methods?” And she responded:
Well said. I would also add that many people who use such methods are desperate. A recent 48 Hours dealt with this for people with terminal diseases (with a bit less skepticism than they should have). One thing that was notable about that show was the number of people who underwent standard treatment plus an alternative treatment, and when they were cured gave credit to the alternative one instead of the standard one. This is fairly common. “Oh, yes, I did have 9 months of chemo and radiation for my cancer, but I know it was this root the herbalist gave me that did it!”
Overall, I think that alternative medicine continues to exist because people, in general, don’t understand the difference between correlation and causation.
It may be worth noting that Tominator2’s example of bleeding as a therapy doesn’t at all belong to the current medical paradigm, but rather to a long-abandoned one (humors theory). Unless we are going to accept evidence against chiropractic as also discrediting homeopathy, I think that this example must be discarded.
(Actually, bleeding is the accepted therapy in a very limited number of cases. But it’s not a panacea.)
Tominator also offers the bran study as an example of a good study that gave an incorrect result. In fact, it’s a poorly designed study; a good study would have not permitted the substitution of bran for LDLs in the diet (there seems to be only a modest link between dietary cholesterol and systemic cholesterol). The conclusion to be drawn, then, is not the Havard Law of Animal Physiology (“Under carefully controlled conditions, the organism will do as it damned well pleases”), but rather the difficulty of designing a good study, particularly one that includes bran or other soi-disant natural components.
“Kings die, and leave their crowns to their sons. Shmuel HaKatan took all the treasures in the world, and went away.”
