How many of those listed medical problems does acupuncture effectively treat? I ran down the first five or so indications on the list, and four out of the five comprehensive reviews looking at treatment of those conditions found that there was either no evidence for acupuncture’s effectiveness or that the evidence was equivocal. There was some evidence that acupuncture might be helpful in preventing migraines, but the review noted that placement of needles didn’t seem to be all that critical (this is in accord with recent study evidence that sham acupuncture seems to be as effective as “real acupuncture” - in other words, it’s placebo effect).
I don’t necessarily condemn all placebos. The trick is to ensure that they’re cheap, safe and that they’re presented in such a way as not to deceive the patient.
“Woo cannot meet these standards and has to fall back on anecdotes, mantras like “medicine has been wrong before” and conspiracy-mongering.”
Until the woo is shown to be non-woo. then the prior arrogance is still justified. I see how it works now.
Look. I don’t really give a shit one way or the other. I have no dog in this fight so to say. But the medical profession does have a long history of dissing what it doesn’t understand - like the RECENT examples I gave about Lovaza and Niaspan. How would the average GP have responded to fish oil and niacin for serious cardiac problems 15 or 20 years ago? Not well. I can tell you that from personal experience. But like a cat walking into a glass door, as soon as their back on their feet, it’s like they never said diddly against either. That’s some world class denial.
Absolute bull. When those two drugs went through the same trials as all the other drugs and passed, they were accepted by the medical profession. Before the tests established what it was in those substances that made it work and what dosages were effective, it was dangerous crapshoot as to what you were taking and how it might effect you. Pleading for ignorance and superstition to win out over the scientific method is a hell of a way to care for your fellow human…but it sure sells the useless pills and quack treatments in those non-peer reviewed magazines owned by the quacks, doesn’t it?
Like there were lots of doctors who were even suggesting that the crap shoot might work? BULLSHIT. To even consider the idea of something like that being effective was complete anathema, and if you want to contend otherwise, then you must have grown up on a different planet than I did.
Doctors in general are arrogant as hell until you have them by short curlies and rub their nose in their mistake. And even then you have stragglers.
And what serious consequences? From impurities - possibly, but you could still limit your exposure by only buying from firms that followed GMP. But in that case, how about the equivalent of fish? How much fish to you have to eat before it kills you? How many 1gram capsules does that equate to?
Also, if you had an open minded GP, he could test your blood chemistry to see the changes - just like mine does now with Lovaza.
Even with niaspan. I had been told that even 500mg would cause liver damage, yet now I take twice that. Again, the results are as apparent in my blood work now as they would have been 20 years ago. When did they start measuring HDL ratios? 15 years then? The point - a long fucking time ago.
The issue here is arrogance - of dismissing anything that can’t be explained. Well, guess what. Our ignorance far exceeds out knowledge - in medicine as in everything else in the universe.
That would require the specific blood test to be available. A lot of tests which are now routine were not even available 20 years ago, or had equivalents which took a lot longer than the current versions. Not available, not as “the machines were expensive” but as in “the machines had not been invented”; often the biochemistry involved wasn’t yet known. What I do agree with you on is that
As Strassia said,
My experience is that many doctors know that “when patient has symptoms A, insert pill B”, but have no understanding of any of the science behind that, and see no reason why they should understand it. Every time I hear a medical student or a doctor whine about such useless courses as chemistry I want to bitchslap them from here to Mercury, and sadly I do hear it. Those doctors who are happy to treat their own craft as some sort of magical rainbowey box are a lot more likely to fall for any well-vendored woo than the ones who take it seriously. Same as any other professional, a doctor can not know everything there is to know about his own profession, but having a knowledge of its foundations and being conscious of the limits of your own knowledge go a long way towards making one a better professional - in medicine or in anything else.
Nava: Lovaza is used to treat hypertriglyceridemia - pretty sure the could easily test for triglycerides 20 years ago. Hell, if I dig I might even be able to find some old labs with it. Same for HDL but I’d have to do some research. I feel pretty confident about 15 years though. the point is that both would have made these “alternative” treatments available at least a decade sooner than they in fact were. But no, it wasn’t “good medicine” until you nailed down why it worked. I think you have already sent that ship sailing - thank you btw.
I wasn’t talking about triglyceride tests specifically, I talked about “many current tests”. The one that checks my mother’s “blood sugar” now, for example, which doesn’t look at the concentration of glucose but of a complex of glucose, wasn’t available 17 years ago in the hospital lab where I worked that summer. It may have been available in some hospital somewhere, but that didn’t do doctors in our area any good (and that particular lab happens to be one of the best-equipped in Spain and have a manager who publishes a couple of research articles per year).
Yes, A1c. I assumed you were criticizing the factual basis of my argument by saying that testing for the targets of these alternative therapies would have been expensive or impossible. That’s what I responded to.
In 1990 I was a programmer for a lab that only did blood tests for life insurance policies and they were ready to test for ApoE1 - so to say that HDL (target of niacin) or trigs (target of lovaza) where out of reach is dubious at best.
The one thing I love about my doctor is his open mind. This is what lets him be a more effective doctor: he will look at any studies, and is willing to be proven wrong. He’s definitely willing to try things that won’t hurt. He was the first doctor in our area to start testing for Vitamin D levels, for instance.
Certainly that happens, it is harder to believe that something works if we do not understand why it would, but that is not what is being expressed here. Here the idea is that it is irresponsible tell someone to do something if there is no evidence that it works other than anecdotes and no understanding of it of what the potential risks involved are. Accepting our ignorance is no excuse for giving up on the scientific method as a means of reducing it. It is a cause to embrace it all the more.
Yes, some are quicker to dismiss that which makes no sense to them and sometimes things that make no sense work anyway, even if for reasons that are different than are offered by those who promote it. But to deride doctors for wanting evidence? That’s goofy.
Jackmanni my point is not to hijack into a discussion about acupuncture but to help the medical side here appreciate the fact that sometimes things out of the alternative side actually work at least as well as things the traditional side can offer for the same problem and that sometimes we do not hold things to the traditional side to the same standards we demand for the woo. For much of what we advise evidence based medicine is still only a distant goal and we fool ourselves when we believe otherwise.
We agree on all of the substantive issues, I’m sorry you don’t see it that way. I think you are letting my sometimes ascerbic tone influence my intended meaning.
I greatly admire doctors as a class, but as a class they are also the most arrogant people out there. I should know since I was a lawyer long ago and we probably have the arrogance lead in the minds of most people. So I need to keep track of the competition. Anyway, that leaves a huge chunk of the profession that does not fit that unflattering description. My current PCP is one - mostly. But he’s an old fart like me so I cut him some slack. The people who do the research all their colleagues laugh at are another group. This list goes on . . . and on.
Also, I never said you should recomend CAM to everyone. In fact, I specifically limited it to people with such a predisposition. Even then, you should try to limit their exposure to trustworthy practitioners who would not subvert the real treatment.
In fact, my initial argument didn’t even cared about efficacy. I was promoting the idea purely as a way to make that bitch “the placebo effect” work for a living by making it ethically acceptable to employ it under the guise of CAM. It’s only when we got to the point of labeling many ancient arts as intentional frauds perpetrated by amoral hucksters that I had to draw a line and point out that while proof may be evanescent, disproof is even more so. Therefore no one’s interests are served by taking the traditionally strident and intolerant attitude that novel ideas often get - and not just in medicine either.
How long did it take for Posner to get everyone to “believe in” prions? Hell, there are still people out there, in an ever shrinking minority to be sure, who still think the idea of an infectious protein perverting normal proteins is hokum - or worse. If his research had ready application to things like Creutzfled-Jacob, should we have listened to him at the very beginning, or waited, and if the later, for how long? What if lives could have been saved? That’s how it was with nutritional supplements - even Vitamin D as mentioned above by BigT.
It should ALWAYS be about an intelligent UNBIASED weighing of the relative risks and rewards. I think we both would agree on that. But we also know that except in rare cases, that is NEVER what happens.
The medical industry implicitly makes some pretty bold claims, that they understand how the body works and that they have the means to correct problems with our bodies. They set their prices accordingly and they actively prevent others from playing in the medical game. Fair enough if their claims were true and they restricted themselves to the areas they really understand, but they don’t. The difference between a doctor using a placebo and a fortune teller is the huge difference in price.
When my doctor prescribes Cestor based only on the literature the Pharm-rep gave him, he is practicing mild woo. Unless he has real knowledge about that drug or its effect on any condition he is not doing anything that any other person couldn’t have done with a prescription pad and a white coat. That is just as woo as me selling snake oil.
As long as people recognize that “Western” medicine incorporates its own fair share of woo, I don’t see what the point of getting worked up about this is.
I went to see an immunologist a little while ago who gave me a twenty-minute lecture about probiotics and herbal supplements and the like. I complained to her boss, the managing practitioner, and he basically said that half their patients want to be told about that stuff.
The problem with Vitamin D is that the main proponent of its importance in overall health, Dr. Michael Holick, really makes it all sound like woo. I haven’t read his books, but I have seen him speak a couple of times, and while he’s enormously entertaining (especially in the midst of otherwise painfully dry internal medicine meetings), he wouldn’t be out of place at 4:00AM on basic cable.
He’s probably right in his overall point that Vitamin D deficiency is underappreciated and undertreated, but one could be forgiven for initially dismissing him as a huckster.
Problem with this type of conjecture is that your doctor is most likely too busy treating his patients to actually have time to do the clinical research on every medication he prescribes. I work at a University Hospital. We have lots of great scientists/doctors/clinicians who do the clinical and basic research on their treatments and disorders. Not all doctors have the time, nor the expertise to run the tests themselves. So should I not go to a doctor who is also not a research scientist and has tested every med they prescribe? No, that would be foolish, expensive and a huge waste of time for all involved. You don’t ask Bill Gates or Steve Jobs to fix your computer, so why are you expecting the developer of a drug to treat your condition?
I would like to bury the terms “Western Medicine”, “Eastern medicine” and “Alternative Medicine” in a deep grave and fill it with cement. There is Medicine, double-blind tested for effectiveness and safety using real science. There is Potential Medicine, in the process of being tested, but not yet judged to be ready. There is Woo, which is promoted through word of mouth and carefully selected testimonials using buzzwords like “ancient”, “unconventional”, “alternative”, “Eastern”, “complementary”-as if adding these buzzwords somehow excuses them from being tested for safety and effectiveness.
I was surprised to see celebrity Doctor Mehmet Oz, a Harvard educated heart surgeon who seems to provide pretty sound health advice usually, promote acupunture on the Oprah show (my wife watches her…:D). I read someplace that his wife is a CAM practitioner, so maybe he has a bias as a result.
I’m not sure we are talking about the same thing here. Of course a doctor shouldn’t have to do all his own research but a doctor who recommends a treatment or drug should have more information and understanding about that treatment than a pamphlet someone gave him. His reputation, and pricing, is based on the idea that he fully understands the situation and can offer insight and perhaps even remedy. If the acupuncture or homeopathy salesman drops off some samples and pamphlets at his office, a doctor needs to have the training and take the time to assess the value of those treatments, or he needs to not make a recommendation. The same is true of any other drug or treatment. Just passing along whatever the salesman hands you isn’t treating patients any better than any of the woo professions.
Anyway, that leaves a huge chunk of the profession that does not fit that unflattering description. My current PCP is one - mostly. But he’s an old fart like me so I cut him some slack. The people who do the research all their colleagues laugh at are another group. This list goes on . . . and on.