The difference between real medicine and woo though is that with real medicine, if need be, a doctor can access the scientific studies that support the claims. Woo doesn’t have real support of this nature.
First, I am not now nor have I ever been a doctor, or any type of medical practitioner (I currently work in biotech, but I am a hardware guy, not a biology guy).
I agree that doctors can practice too much woo when it comes to FDA released drugs as well. Using drugs off label with no evidence is no different than using CAM treatments. I also think the FDA process needs to be overhauled. The case against most modern antidepressants is pretty scary. After reading Talking Back to Prozac I wanted to check out some of the claims about the shenanigans the author claims occurred during the effectiveness testing (reparsing and combining negative study results to make them look positive). This was in 2003. The FDA did not have the original studies online, but they did have some new things, like a letter of warning to Eli-Lilly not to submit approval requests with studies showing a lack of efficacy (this was about releasing Prozac to treat adolescents). Also the use of acid blockers to treat ulcers and acid reflux is a sore point for me.
But the solution is not to throw the door open and just do anything that someone pitches. We need to make doctors more skeptical, not less.
The problem with most studies on CAM is that they are not released in reputable journals, they tend to follow less rigorous standards, and they are very difficult to double blind.
Take acupuncture. How do you double blind that? The closest I have read is one study that was rigorously single blind (used a technique with the application tubes to simulate the needles) and showed that only real correlation to relief of symptoms was to belief in the procedure (the more certain they were that they had received the real treatment, the more likely they had relief. The next closest is the one mentioned above that basically had untrained practitioners learn to do acupuncture either correctly or incorrectly (using the wrong locations on the body). That showed no difference between the two groups.
Bottom line on the placebo issue is that using CAM practitioners as a placebo, in my opinion, does do harm by diverting resources and setting up a false equivalency. The more doctors recommend these treatments, the more people trust them, the more insurance companies cover them, the more universities and even the FDA spends time and resources on them.
I am a big believer in efficacy studies. I want to know why things work as well, but efficacy and safety should drive what treatments are used.
As an aside, it’s wise to know the correct terms for alternative treatments, however woo woo you may view their effectiveness. In this case, you are using “Reishi”, when you mean “Reiki”. Reiki is a form of “energy medicine”, so more out in left field as the medical profession goes, with little research done to prove effectiveness, if double blind studies ever can be done on it.
Reishi is the fruitng body of a fungus, Ganoderma sp. lucidum and tsugae, which has thousands of years of human medicinal use; the chemical components can be scientifically analysed, research has been done, and therefore repututable studies can be made on effectiveness.
Though both Reiki and Reishi are classed as alternative medicine, they are not at all alike in the way they are used, or in documented research. It’s easy to confuse the two words, sure, both Japanese, but, knowing the proper terms and what they mean is important in discussing why exactly they do or do not work.
Ahem…it appears you haven’t actually read the references you gave. A random check of 4 of the Cochrane reports shows these conclusions (all bolding mine):
Just because there is a Cochrane report on a topic doesn’t mean they endorse it. Contrary to your assertion, Cochrane has NOT found acupuncture effective, except as a placebo.
True, I’ll grant you that. And I also grant you that the basic education and training of a real doctor if far from woo. But I hope that they continue to maintain those standards later in their practice and not rely on “I could look it up if I wanted to.” I don’t know how much time a GP spends keeping up with trends but I could see how easy it would be to slip into the woo. Especially so when your patients come in telling you they want some Boneva, some Viagra and a recommendation to a good homeopathic dispensary, because the TV said to ask.
There is no such thing as “alternative” medicine. There is only medicine that has been scientifically shown to work and that which hasn’t. If any practice or substance now considered alternative were shown to work with the same certainty that real medicine has shown, it would cease to be alternative and become, simply, “medicine.”
Thanks elelle: isn’t reishi also a kind of spirit energy? Been watching some anime lately (Bleach) and it comes up frequently but not sure the dubs/subs are accurate.
Anyway, not to change the subject. Thank you.
Are you thinking about Reiki? (Otherwise known as TT)
No, that’s just it. They spell it and pronounce it Reishi. Here is the Bleach wiki entry. Reishi | Bleach Wiki | Fandom
It’s probably just word they co-opted for their own use. But usually, anime takes it’s terms from regular Japanese. Like in a lot of anime they talk about shinigami (evil spirits) - but in that case, it really is the japanese name - Shinigami - Wikipedia
IDK. Next you’ll tell me I’m imagining that my cats aren’t really conspiring against me - which just means that YOU are also a part of the plot. :eek: 
Just because there is a Cochrane report on a topic doesn’t mean they endorse it. Contrary to your assertion, Cochrane has NOT found acupuncture effective, except as a placebo.
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I said “some” … look at the others. Some yes and some know. In short read them all before you snark.
I suspect that, as long as there are ordinary folk who are unwilling to accept “we don’t know” as an answer, woo in medicine will persist.
In part, it is the fault of scientific medicine - it is so very effective, that it raises the expectations of ordinary people that everything has a cure, if only you look hard enough - while at the same time giving little weight to the entirely subjective all-in-your-head aspects to healthcare. This leaves a population prone to seek its own answers, and find them in various flavours of snake oil.
Here in Canada, the government has gotten in on the act - for example, by licensing homeopathic medicines as “natural health products”, which obviously gives these products a gloss of “official” legitimacy:
It includes a requirement for “scientific” evidence to support health claims:
… which is, of course, all nonsense from the get-go, as homeopathic medicines are, pretty well by definition, no different from water.
I don’t expect acupuncturists to explain why it works any more than I expect an MD to know why every med works. The fact is, my drug book is *full *of “Mechanism of Action Unknown”. Just gave a patient Flovent today, in fact. While it appears to be an anti inflammatory corticosteroid, it’s got that caveat: Mechanism of Action Unknown. I haven’t counted, but I’d estimate that 25-35% of the medications in these 1400+ pages have Mechanism of Action Unknown in their listings.
I’m more interested, mostly academically, in what works in studies. That lets me save some time, using the most effective (on most people) treatments first. Still, there are always some people for whom a drug or therapy works, even if that’s not statistically more people than a placebo. Statistics and studies tell us what works for populations, not individuals.
What I’m *most *interested in is what works for this patient here, in front of me right now. Is their pain relieved by Reiki? Well, then they should keep doing it. I might think it’s malarkey and note to myself that there are few to no studies showing its effectiveness…but I’m also not going to talk the patient out of the relief that they’ve found. If I’m to believe them that they’re in pain when they say they’re in pain (and I am), then I’m also going to believe them that they’re not in pain when they say they are. Does this patient have less edema and require less Lasix when they drink dandelion tea, without adversely effecting their potassium levels or other body systems? Ok then, that’s what I need to know. Keep on keeping on, my friend.
The things that we’re currently taught in nursing school to use with patients which were “woo” when I was growing up are guided imagery, biofeedback, and meditation for pain relief. We can suggest yoga or pilates for relaxation and flexibility and strength training. We’re also expected to have a working knowledge of cultural specific therapies so that we don’t, for example, call the social worker when a child comes in with bruises from Gua Sha. But we’re not supposed to recommend Gua Sha as a treatment ourselves.
I admit, I get a thrill when I see herbals in the hospital supply closet. We’ve got herbal lotions and skin barrier creams now. I think that’s awesome. Are they any better for the general population than the old lotions without herbs? I dunno. I don’t know if anyone’s done any studies on them. But I see skin breakdown repairing itself more quickly than when my grandmother and my grandfather and my aunt were given nothing but petroleum jelly for their skin breakdown. Anecdotal, I know. And yes, I’d be interested in seeing a study on it. But in the meantime, when I have the choice to grab an herbal ointment vs. petroleum jelly, I’m grabbing the green stuff.
Even those FDA approved, clinically studied drugs whose mechanism of action is known only work on some percentage of people far less than 100%. Often a patient’s medications are changed dozens of times before the right combination for them is found. Doctors have to let the studies go and look at their patients and what’s working for them, whether or not the study says it should. We absolutely need researchers, to tell us what works for most people most of the time. But we also need bedside judgement calls, where our focus is on one person at a time and what works for them.
Since, after randomly looking at a half-dozen, I was unable to find any that heartily endorsed acupuncture as positive, perhaps you would like to show me the way?
And no, something that says, “further studies are needed” isn’t a ringing endorsement. Show me one that says, “Acupuncture has been shown to be significantly more effective than a placebo and should be used instead of conventional medicine.” Anything else is just wishful thinking.
You are welcome to set the bar where ever you want. I’d just ask that you if you require a Cochrane “ringing endorsement” for something that you consider “alternative” that you hold traditional approaches to the same standard. Me I’ll accept less enthusiastic assessments:
Migraines?
And others …
And of course the fact that you wouldn’t even bother to read through more than the first several because you already know it is just woo is the telling part.
Now then. Let’s hold some traditional approaches to the same bar, shall we? Flu shots for those under two? I advise 'em and the CDC recommends I do. But …
How about for those with asthma?
(Mind you these are one that I believe are important on the basis of evidence that does not meet the Cochrane standard, but we are using your bar here.)
Use of long term prophylactic antibiotics for recurrent UTI prevention, which has been advised for decades? Cochrane documents that there is no significant benefit, they’ve been used this way for decades without a comparison to no medication, and other sources have shown that there may in fact be some harm, and others that question if there is any need at all, but Pediatric Urologists still advise it for the most part. Which is good, since before that they were advising surgery that had never had any evidence of benefit either.
Surely the length of medication courses is based on solid evidence. Nope.
Heck, even using them at all has been done with no evidenciary support for years, and when looked at the evidence is scanty at best.
That last link was for sinusitis; another recent favorite of the ENTs is nasal irrigation … too bad there is no solid evidence it works.
If you are over 50 and male you can expect prostate cancer screening at your doctor visit. Yet
I really could go on for quite a while. Much of what is done that you probably question naught would not meet the same standard you require of that which you are unfamiliar with. Some really shouldn’t be done. Some should be done because the evidence while inconclusive is enough to conclude, tentatively, that the likely benefit is greater than any reasonably likely harm and/or other cost.
My simple point: be aware of your bias and be aware that our patients may have different biases. When we dismiss the “alternative” out of hand with out even looking at the evidence, when we hold the “alternative” to a markedly different standard than we do our usual interventions, then we are as woo-ful as those who accept the “alternative” with no demand for evidence at all.
Talk about the pot calling the kettle black.
Science does not hold alternative medicine do a different standard. Quite the contrary. It is precisely because most woo cannot meet the same standards that it is called alternative.
If any of those studies you hold in such high regard are replicated and shown to meet the same standards as other medicine, they will be accepted into mainstream medicine and no longer be alternative. So far, they have not, and we are still calling them alternative for good reason.
Conversely, if mainstream procedures and drugs are shown, by the same standards, to NOT be effective thru good science, they will be removed from medicine – who knows, perhaps they can become “alternative” :dubious:
I was about to repeat what I said in post #47, but Czarcasm said it at least as good if not better, so I’ll repeat him instead:
You are quite confused.
Medicine is not the same as science. When done well it uses science as a tool. “Alternative” does not necessarily equal unproven and “mainstream” most certainly does not necessarily mean that it has met some standard of proof. We like to delude ourselves that it does but often the evidence is lacking or even ignored in favor of extant biases. Confirmation bias is very real in medicine.
I used Cochrane as the acupuncture cite because Cochrane is not just a study I hold “in high regard”; Cochrane is hard-assed rigid about reviewing the evidence and only accepting as effective that which meets their often unreasonable bar. (Hence their conclusion about influenza vaccinations which are based on rejecting a whole raft of epidemiologic evidence as not good enough for them.) Cochrane saying something is unproven does not mean it is ineffective, but Cochrane saying it is effective is pretty powerful as an assessment. (Please note again, they have found it works for some indications; there is no reason to believe, or to disbelieve, that it works for others.)
Medicine is unfortunately not always done well: often science is not used like it should be. We sometimes … too often … accept things out of tradition without ever examining the evidence. We accept things before they are tested because they fit with our theoretical understanding and we reject things before even examining the evidence because the proposed mechanism is hokum and we do not have an explanation that makes sense to us. Physicians do things without proof and continue to do things proven ineffective because it is hard to change. If you read my post you’d have seen how the treatment and work-up of recurrent pediatric UTIs by most specialists today illustrates that point. You can read this 2005 letter to the editor to see that in 2000 the lack of any evidence justifying imaging after a first febrile UTI was pointed out
yet now, in 2010, despite the fact that the guideline recommendation is still an opinion statement biased to doing that which was being done, and that more studies have been done leading to even greater doubt that aggressive imaging is really needed and is not likely to cause more harm than good, the practice still stands as standard of care. And even those of us who appreciate its lack of evidenciary basis are reluctant to go against such a guideline. And I say that as the writer of that letter in 2000. (At least Australian doctors have modified some … but go against a guideline like that in litiginous America? Be real.)
What mainstream has going for it is that we at least believe that we should be evidence based (our actual implementation is spotty at best but we are at least trying to get better at it) whereas much of that which gets called “alternative” feels no need to meet that burden.
DSeid, I tend to agree with your opinions on medicine most of the time - but the problem with your listing of Cochrane reviews on acupuncture is you appeared to be suggesting that they all support acupuncture’s effectiveness in treating varying conditions. Instead, the majority of the cited systematic reviews demonstrate either no benefit or insufficient evidence to support a benefit. Of the remainder, I’ve seen none that support any benefit due to the stated basis of acupuncture - i.e. the “qi” that the needles are supposed to be influencing.
The dubious basis of acupuncture has been reinforced by studies showing that “sham” acupuncture (no actual penetration of the skin, something that can be simulated by devices so that neither the practitioner nor the patient knows whether the needles have actually gone in or not, allowing for double-blind studies) works as well as the “real thing”. Hell, even “gentle poking” of the skin with toothpicks has shown as least as much benefit as “real” acupuncture. So, as mentioned previously, the evidence strongly suggests any benefits of acupuncture are a placebo effect. This isn’t necessarily a bad thing if some patients will get relief from pain, but we do have to weigh costs and safety against benefits with any placebo. And if we don’t need trained practitioners to find those allegedly important needle insertion points (as research has shown), maybe these treatments can be provided much more cheaply.
More on acupuncture’s role in quackademic medicine here.
(Note: I once tried acupuncture myself for an annoying condition that wasn’t responding to conventional therapy. The practitioner was very nice, the treatment wasn’t painful, and it didn’t work. Meaningless anecdote, I know.)
One more key difference between evidence-based medicine* and CAM that needs to be highlighted: In mainstream medicine, researchers and practitioners are constantly discovering ways that treatment can be improved and that ineffective and/or unnecessarily hazardous therapies can be discarded. Sometimes it takes awhile for changes to be instituted, but improvements regularly are made. From the CAM perspective, this is a defect - proponents proudly assert that their brand of woo has not changed in hundreds or thousands of years. And that’s true. How often have you heard, for instance, of Traditional Chinese Medicine tossing out a treatment because it doesn’t work or is dangerous? Or chiropractors who use a collection of anecdotes to support back manipulation for internal medical complaints - when have they ever decided that such treatment doesn’t work for any given condition? Do homeopaths reject any of the nonsense that permeates their field? Not that I’ve ever seen.
I sense an agenda here. 
And it’s one that motivates quite a few CAM supporters. What I don’t get is why, when one has a bad experience or experiences with physicians whom one decides are incompetent or greedy - why put one’s faith in woo practitioners who are incompetent and money-driven, instead of finding MDs who are compassionate and know their stuff?
*DSeid’s comment about EBM (evidence-based medicine) not sufficiently applying to a lot of what physicians do is correct. That, however, is not a reason to reject EBM and figure that anything goes - it’s a reminder that while a lot of progress has been made in having good evidence-based standards for medical practice, much work remains to be done. Failings (amply and vigorously debated in the medical community) stand in stark contrast to the world of woo, where what our distant ancestors did is golden, testimonials are more valid than properly-conducted research, and quackery reigns supreme.
**It is not true that medicine rejects any therapy unless its mechanism is known. The most prominent example is aspirin, whose ability to reduce fever, pain and inflammation was accepted for many years before its mechanism was elucidated. The mirror image of this is woo, where therapies (homeopathy, acupuncture, ear candling, you name it) are based on mechanisms that have never been demonstrated to exist and are often clearly bunkum.
Your definitions are wrong and exactly reversed:
I can agree with you there, and not just in medicine. It is because of biases of all kinds that the scientific method is used to reduce or eliminate them.
Cochrane is good, but nothing is perfect and it cannot be the last word, as science is continually evolving, testing, and questioning. And those reports are not strong support for woo; most are strongly against or at best, neutral. You can cherry-pick the ones that sound best, but the pickings are mighty slim.
Jackmanni, if the impression was given that I was implying that the whole list was endorsed by Cochrane, then that is regrettable; but the fact is that acupuncture dose appear to be effective for some indications. Cochrane is not perfect, far from it, but they tend to err in having too rigid a bar, not too loose of one. I understand your point about the double blinded control but then again consider this: in the migraine review acupuncture worked better than traditional mainstream-accepted prophylaxis. If acupuncture is exclusively a placebo effect then what does is say about our woo when that placebo arm is more effective than our standard accepted mainstream treatment? Do you dismiss traditional migraine prophylaxis as readily as you do the acupuncture arm? Why or why not? It is that bias that I think we need to beware of.
Since I have already stated
it is clear that we are in agreement on your next point and agree that it should be highlighted. EBM, real EBM, not just opinions and extant biases packaged as EBM, is the goal … even when the proposed mechanism is clearly hokum. (Afterall, theophylline still worked even if the reasons for its working that I learned in med school were wrong.) I do not mean to imply that anything goes.
And that is the error that I believe musicat makes: (s)he believes that something labelled “alternative” is quackery by definition, and therefore its possible efficacy need not even be considered or evaluated. That belief is itself an extremely anti-scientific stance that rejects out of hand observations which are not easily explained by the current models.
Don’t get me wrong: most of what we all refer to as woo really is woo, and I am as upset by its market driven embrace by some institutions as anyone, and bemused by otherwise intelligent people, including physicians, who buy into some of it uncritically. Revealed truths, unchanging, are not a basis for progress in knowledge and understanding. But sometimes the hokum explanation was grafted on to something that was, years ago, found to work by trial and error, and really does work. Just because the sun isn’t actually pulled by a chariot across the sky does not men that it will not appear tomorrow. Things that have been used for thousands of years have occasionally had that staying power because they have been sometimes effective, even if the folk science explanation for it (be qi or some other bullshit) is crap. I am not so fast to automatically dismiss the alternative as ineffective and mock-worthy if there is no harm presented by its use. And I want my patient families to keep me in the loop so I can gently infect them with my skepticism and keep them away from the more malignant parts of the woo spectrum. That can only happen if I engage with some respect for what they believe. It does end up being like a lot on the traditionl side: the evidence is not in and we still need to decide; if there is little risk of harm then we may decide that it is still worth a try, even while we are honest about the lack of proven efficacy.