I probably shouldn’t get into this, being just a retired mathematician. But…
I have long felt that medicine is partly an art and partly a science. The art part is doing what works, whether or not you understand why. The science part is based on actual understanding and designing treatment around that. An example of the latter is that once AIDS was understood as being caused by a retrovirus, then a drug that blocked reverse transcriptase became on obvious treatment. And it was at least temporarily effective, although the side effects were harsh.
An early example of “what works” was the use of cowpox to inoculate against smallpox based on the observation that most milkmaids didn’t get smallpox.
One of the biggest changes in medicine in my lifetime has been the growth of scientific medicine. And one of the heartening. As for the OP, bullshit.
You’re the second one who’s pointed that out.
The former girlfriend is actually his sister – which doesn’t make me trust his methods any more. The ex contacted me to ask if she should partake of his alternative treatments. I would guess she’s asking me in particular because she knows I dabbled in ‘martial arts medicine’ and also in ‘new age stuff’ (as I noted in the OP) and she wanted to know what I currently think about them.
I didn’t want to put it in the OP, but my instinct is to think that if she didn’t trust her brother’s alternative treatments enough to just go with them; if she felt she needed to ask for a second opinion, even from someone who might still be a ‘believer’ then she should go with her gut feeling and just not trust in them. I figure if a quarter (or more) of the effectiveness of “woo” is in the placebo effect, then she’s already got too much doubt to let it work.
Anyway, it’s lovely to see the discussions. Carry on!
Agreed. Another “art” aspect of it is diagnosis of a patient in a clinic. There have been lots and lots of attempts to create checklists and flow-charts and diagnostic algorithms, but in a great many cases, it still comes down to an experienced doctor’s personal intuition.
The formulaic approach to diagnosis is, obviously, getting better and better every year. Computer diagnosis, like speech recognition, is a rapidly developing field. But, at present, an experienced doctor gets better results. “Hm… I don’t like the sound of that cough…”
Exactly right that many aspects of the diagnosis part as art. Human intelligence is really good at pattern recognition … problem is that sometimes we see things in inkblots too!
Evidence-based however does not require understanding why it works. It inspires figuring out why.
To be fair there are many things done in Western Medicine that are done without controlled trials, that are based on anecdotes and how we were taught, no different than much of what is done by some in “alternative medicine.” In each case some would hold up well in a controlled trial and some would possibly not. I’d not be surprised if some herbs used historically and traditionally were effective. For many less “serious” but recurrent and/or chronic conditions some Western choices have no better evidence basis than do herbs and have fewer years of use behind them. The problem there as much as anything else is that the Western product is likely the same thing each time you buy it; the herb may be called the same thing but often is something different when sold by different stores or even the same store on different days.
This, precisely this. That is science in a nutshell and is how we isolate the medicine that works.
The only addition I’d make is that after drawing your conclusions it must continue to be a iterative process of critical observation and refinement. Keeping what works and discarding what doesn’t. Always open to possibility of error.
That is where alternative medicine and woo-woo in general falls down.
The sound of a cough. Is that using the senses and it appearing to be intuition?
It was said that our old country doctor could diagnosis many illnesses just by smelling the patient. It seemed eerie to people but was experience based.
Well, obviously it’s using the senses… The “intuition” part is that the doctor himself couldn’t tell you what it was, exactly, about the sound of the cough that raised his concern. In a great many cases, experts make decisions on almost subliminal levels of sensory evidence.
How many days for an antibiotic course? Most of them are just that way because they have been.
The number of docs who still advise cough and cold meds … no evidence any of 'em do diddly.
Some things docs have done because they way they understand things it should work …
Holding off on foods associated with allergies in infancy - should have worked and was advised, done for decades without any trials comparing early versus late. Counterintuitively it may actually turn out that early is better. …
Also in peds, the urologists many of whom STILL advise invasive evaluations for pediatric febrile urinary tract infections and long term suppressive antibiotic courses despite the lack of any trials ever showing that such decreased any adverse outcome.
Some docs who do follow up XRs for pneumonia.
I am sure that there could be long thread of things dcs do because we believe it makes sense to do them but for which we have no real evidence about. Some that we have stopped as evidence came along and some that evidence finally supported and some that we still just do. In the former was one of my favorites - a few decades ago the norm was treat early childhood intoeing with these appliances that kids wore called Dennis-Brown bars. And indeed after a year or so in them kids feet no longer toed in. Of course eventually it was realized that untreated after a year or so they no longer toed in either.
Currently is the fad of helmets for flat heads. No evidence they are needed and some that heads generally round out as well without 'em. But many get 'em.
Okay, so, seriously. What if this wasn’t cancer (which seems to have quite a variety of woo in causal and treatment theories)? What if the malady was…what was it that killed Bruce Lee? Cerebral Hemmorhage (sp?) from someone flattening his head with a kick? The legend is that he asked for aspirin and the person he asked gave him some kind of Chinese herb that she used for migraines or something. Did the ‘alternative’ approach make it worse/do nothing/help/distract?
–G???
[My personal view there is that, by the time his head was hurting, it was probably too late. But I’m not the medical expert here so that’s why I’m asking all of you.]
