Testing whether magic works.

#21
I could be wrong, but I thought I read a quote by Novella saying something to the effect that no further studies are justified due to lack of evidence. Yet, there are some positive results reported--as a single example:

http://www.mskcc.org/blog/clinical-trials-analysis-finds-acupuncture-effective-treating-chronic-pain
It depends upon whether you are talking about acupuncture or needling. Acupuncture is an idea about health based on the flow of qi, which pretty thoroughly lacks evidence. There is some evidence that sticking needles into people has a minor effect on some pain (minor, as in "any additional pain relief is less than the minimum which patients look for").

I also wonder if the studies go into any great depth with regards to the practitioners experience. I personally know western physicians who employ acupuncture in their practice after taking some courses on it, yet their knowledge is no where near others who have studied TCM and that whole philosophy for their entire lives.
Studies have included experienced practitioners.

Linda
 
#22
Yeah, it is a pervasive idea that if you feel better after using something, you feel better because you used that thing. That was one of the things that was discovered when treatments were compared to doing nothing. A surprising number of people will feel better even when nothing has been done.
You should finish the story.
You have omitted the other 50% of it:
The vast majority of patients who keep using or returning to CAM therapies do it because when they suspend the treatment their symptoms come back, their well-being diminishes. They aren't as stupid as you portray them.

In most chronic, non life-threatening conditions CAM can avoid a host of horrible side effects and new health issues caused by the prolonged use of drugs (that were not even designed to be taken for months or years).

cheers
 
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#24
I'm not sure why you think this is "stupid" or why waxing and waning symptoms change anything.
That's what your insinuating,
From your last posts:
it is a pervasive idea that if you feel better after using something, you feel better because you used that thing.
It's the same problem again. Symptoms come and go, chronic conditions wax and wane. Does it make any difference if you take your CAM therapy when they wax and stop when they wane? Or does the waxing and waning go on regardless?
People pay a lot of attention to their symptoms when they are chronic because they are terribly annoying, if you're lucky, or horribly crippling.

What you are doing is make large generalizations assuming that common people is not intellectually equipped to form an accurate opinion as to which remedy is improving or aggravating their health state. In two words: they're stupid :)

And yet you can find tons of anecdotes (yes, the so much dreaded anecdotes) of people who resolved long standing chronic or recurring issues that didn't respond to any conventional treatment.

That's the problem. The claim is made that CAM therapies can do this, but when they are actually tested, doing nothing accomplishes pretty much the same thing as using the CAM therapy.
Clinical studies can say everything and it's contrary. There is no such thing as objective medicine, unless you're measuring physiological parameters instead of well-being.
The type of conclusions you make can be made only if you first fully accept the mechanistic, robotic approach of EBM, which is highly disputed even among practitioners of conventional medicine. Many doctors question the very evidence for it's alleged "superiority" as a methodology.
 
#25
A categorization and analysis of the criticisms of Evidence-Based Medicine.

The major criticisms and limitations of Evidence-Based Medicine (EBM) appearing in the literature over the past decade can be summarized and categorized into five recurring themes. The themes include:

    • reliance on empiricism,
    • narrow definition of evidence,
    • lack of evidence of efficacy,
    • limited usefulness for individual patients,
    • and threats to the autonomy of the doctor/patient relationship.
Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities. To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.

http://www.ncbi.nlm.nih.gov/pubmed/15036077

Full version:
http://skynet.ohsu.edu/~hersh/ijmi-04-ebm.pdf
 
#26
That's what your insinuating,
From your last posts:

People pay a lot of attention to their symptoms when they are chronic because they are terribly annoying, if you're lucky, or horribly crippling.

What you are doing is make large generalizations assuming that common people is not intellectually equipped to form an accurate opinion as to which remedy is improving or aggravating their health state. In two words: they're stupid :)
Well, the problem is that research clearly shows that it is difficult to form an accurate opinion as to which remedy is improving or aggravating our health. For the thousands of years we used this method, we came to the opinion that all sorts of useless and harmful therapies were helping us. Almost none of the stuff we came up with turned out to be true or useful - blood-letting, x-rays, the four humours, qi, the law of similars, mustard baths, Chinese herbal medicine for treating malaria, etc., etc., etc.

Call it "stupid" if you like, but that's the way it is.

And yet you can find tons of anecdotes (yes, the so much dreaded anecdotes) of people who resolved long standing chronic or recurring issues that didn't respond to any conventional treatment.
Yup. Thus demonstrating the uselessness of anecdote.

Clinical studies can say everything and it's contrary. There is no such thing as objective medicine, unless you're measuring physiological parameters instead of well-being.
You are incorrect. That's one of the great things about using the scientific method...even something subjective like "well-being" can be evaluated in an objective way (with blinding and control groups).

The type of conclusions you make can be made only if you first fully accept the mechanistic, robotic approach of EBM, which is highly disputed even among practitioners of conventional medicine. Many doctors question the very evidence for it's alleged "superiority" as a methodology.
You are mistaking the process of looking carefully at the claims to see which might be true, and the policy decisions which have built up around EBM. The idea of looking carefully at the claims has nothing to do with accepting a mechanistic or robotic approach. There is no need to make any sorts of assumptions about mechanism when you look at the sorts of outcomes we are all interested in - well being, freedom from pain or disability, prevention of complications from chronic disease, prevention of death, etc. Regardless of what you think or hope will get us there, the idea of comparing well-being when given one treatment vs. another or one treatment vs. nothing, is valid under any condition.

Linda
 
#27
A categorization and analysis of the criticisms of Evidence-Based Medicine.

The major criticisms and limitations of Evidence-Based Medicine (EBM) appearing in the literature over the past decade can be summarized and categorized into five recurring themes. The themes include:

    • reliance on empiricism,
    • narrow definition of evidence,
    • lack of evidence of efficacy,
    • limited usefulness for individual patients,
    • and threats to the autonomy of the doctor/patient relationship.
Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities. To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.

http://www.ncbi.nlm.nih.gov/pubmed/15036077

Full version:
http://skynet.ohsu.edu/~hersh/ijmi-04-ebm.pdf
Yet none of that suggests that disproven therapies should be used instead of therapies which have a hope in hell of being useful.

Linda
 
#28
Linda, all you are saying is legitimate provided you add the necessary subtitles: "according to a specific philosophical view of medicine".
The one that is so successful at dealing with injuries, acute infections, some life-threatening conditions etc... and utterly powerless with chronic and most degenerative illnesses.

I have been able to get rid of recurring sinus infections and allergies with alternative medicine, after 10+ years of attempts using conventional medicine and getting intoxicated by antihistamine drugs. Removing antihistamines would make thing worse, taking them would reduce the allergy and cause a host of other problems.

Out of frustration I consulted a naturopath and in 6 month time I was allergy free and I never had a sinus infection in 20 years. Just from friends and close relatives I have at least another 10 strong cases for holistic/alternative therapies. That is a little different that doing nothing, don't you think? Provided that doing nothing was exactly what conventional medicine did for me. They had no idea how to cure the disease so they did nothing besides trying to shutdown the symptoms.

I am sure that per your philosophical view, none of this can be regarded as evidence since it's already contradicting the very tenets of such doctrine. It's a dog chasing its own tail.

I think in general I agree with Novella advocating to save money by testing CAM under the EBM paradigm. Most holistic practices don't work under with the assumption that for every symptom you administer a specific substance, and it's highly personalized instead of choosing the best scoring drug from a "hit parade" of RCTs.

According to Novella we might very well substitute doctors with automatons that gather clinical data and throw out pills based on a database of clinical trials.
Good luck with that. :D
 
#30
I have been able to get rid of recurring sinus infections and allergies with alternative medicine, after 10+ years of attempts using conventional medicine and getting intoxicated by antihistamine drugs. Removing antihistamines would make thing worse, taking them would reduce the allergy and cause a host of other problems.

Out of frustration I consulted a naturopath and in 6 month time I was allergy free and I never had a sinus infection in 20 years. Just from friends and close relatives I have at least another 10 strong cases for holistic/alternative therapies. That is a little different that doing nothing, don't you think? Provided that doing nothing was exactly what conventional medicine did for me. They had no idea how to cure the disease so they did nothing besides trying to shutdown the symptoms.

I am sure that per your philosophical view, none of this can be regarded as evidence since it's already contradicting the very tenets of such doctrine. It's a dog chasing its own tail.
Certainly something like that could be tested more formally though. If it got through the testing it would simply be called medicine.
 
#31
Linda, all you are saying is legitimate provided you add the necessary subtitles: "according to a specific philosophical view of medicine".
What do you mean "a specific philosophical view of medicine"? You are talking about the exact same philosophical view when you judge the success of your naturopathic treatment based on whether or not your symptoms went away. That is the same way that medicine judges the success of any treatment. There is no philosophical difference here.

The only difference is that you don't know what would have happened to your symptoms over that period of time if you hadn't gone to the naturopath. People tend to think that if they had done nothing, their symptoms would remain the same. Like I mentioned earlier, it was a surprise to discover how wrong that guess can be.

You can dress up the failure of CAM therapies to show efficacy as a failure to properly take into account individualization. But individualization is just as much a part of medicine as it is of CAM, plus CAM therapies are also tested using individualization. There is no philosophical difference with respect to individualization, either.

Linda
 
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#32
I'd say that if a therapy is certain to do nothing good or bad to a patient (according to materialism), it should be tried without any prior proof - simply see if patients find it helpful.

Of course, some may argue that a 'sham' treatment may do harm because it may encourage a patient to shun ordinary medicine, or it will leave the patient less well off, but that could be solved by giving a patient a one page disclaimer to read.

Ideally, the various alternative medicines could be rated on the internet. I don't trust the medical research establishment to test anything properly :(

David
 
#33
Linda, all you are saying is legitimate provided you add the necessary subtitles: "according to a specific philosophical view of medicine".
The one that is so successful at dealing with injuries, acute infections, some life-threatening conditions etc... and utterly powerless with chronic and most degenerative illnesses.

I have been able to get rid of recurring sinus infections and allergies with alternative medicine, after 10+ years of attempts using conventional medicine and getting intoxicated by antihistamine drugs. Removing antihistamines would make thing worse, taking them would reduce the allergy and cause a host of other problems.

Out of frustration I consulted a naturopath and in 6 month time I was allergy free and I never had a sinus infection in 20 years. Just from friends and close relatives I have at least another 10 strong cases for holistic/alternative therapies. That is a little different that doing nothing, don't you think? Provided that doing nothing was exactly what conventional medicine did for me. They had no idea how to cure the disease so they did nothing besides trying to shutdown the symptoms.

I am sure that per your philosophical view, none of this can be regarded as evidence since it's already contradicting the very tenets of such doctrine. It's a dog chasing its own tail.

I think in general I agree with Novella advocating to save money by testing CAM under the EBM paradigm. Most holistic practices don't work under with the assumption that for every symptom you administer a specific substance, and it's highly personalized instead of choosing the best scoring drug from a "hit parade" of RCTs.

According to Novella we might very well substitute doctors with automatons that gather clinical data and throw out pills based on a database of clinical trials.
Good luck with that. :D
As Linda is pointing out if it works it's medicine. CAM treatments always by their practitioners are believed to work by other rather mystical modalities which Linda listed. So, the benefits you received weren't caused by such modalities, but occurred probably by recognizable means.
 
#35
As Linda is pointing out if it works it's medicine. CAM treatments always by their practitioners are believed to work by other rather mystical modalities which Linda listed. So, the benefits you received weren't caused by such modalities, but occurred probably by recognizable means.
Steve,

Possibly you are not old enough to have been burned by mainstream medicine - I have - but fortunately not irreversibly!

Mainstream medicine is hopelessly skewed by big pharma's need for profits. It is also probably skewed by its adherence to materialistic explanations - even while it struggles with fact that people's minds seem capable of messing up all sorts of medical experiments (the placebo effect).

Even if you only accept the first part of that statement (the malign effect of big pharma), you can see that the science establishment is not a temple to rationality, it is driven by many forces.

David
 
#36
Steve,

Possibly you are not old enough to have been burned by mainstream medicine - I have - but fortunately not irreversibly!

Mainstream medicine is hopelessly skewed by big pharma's need for profits. It is also probably skewed by its adherence to materialistic explanations - even while it struggles with fact that people's minds seem capable of messing up all sorts of medical experiments (the placebo effect).

Even if you only accept the first part of that statement (the malign effect of big pharma), you can see that the science establishment is not a temple to rationality, it is driven by many forces.

David
I've noticed your repeated distrust of many things and that's your monkey on your back not mine and something I suggest you rid yourself of. I am old enough.
 
#37
Steve,

Possibly you are not old enough to have been burned by mainstream medicine - I have - but fortunately not irreversibly!

Mainstream medicine is hopelessly skewed by big pharma's need for profits. It is also probably skewed by its adherence to materialistic explanations - even while it struggles with fact that people's minds seem capable of messing up all sorts of medical experiments (the placebo effect).

Even if you only accept the first part of that statement (the malign effect of big pharma), you can see that the science establishment is not a temple to rationality, it is driven by many forces.

David
Accepting that there are abuses in mainstream medicine, I think we need to be cautious about throwing out the baby with the bathwater.

Abuses in medicine lower the reliability of some medical conclusions. Those abuses should certainly be a focus for improvement (by the way: only accepting studies that were pre-registered in support of approving medications should help - if its not already done - in combating the file drawer effect which is one major abuse of pharma companies who only publish the positive studies and not the negative ones).

But to point to the fact that medical science has abuses as a reason to adopt even less reliable conclusions doesn't seem to be wise to me.
 
#38
I'd say that if a therapy is certain to do nothing good or bad to a patient (according to materialism), it should be tried without any prior proof - simply see if patients find it helpful.
Novella's point is that we've tried this, and what we've found out is that a tremendous amount of time and money have been wasted on ideas which turned out not to be helpful. It sounds like a nice idea, but implementing it means that you have lost the opportunity to do something useful with your time and money instead.

Linda
 
#39
By needling do you mean sham acupuncture?
No, I mean sticking needles in (what gets called "acupuncture" in many of these studies). But it doesn't really matter whether you make the distinction, because none of it has much of an effect.

If you look at the pain studies...the minimum clinically significant difference in pain (the subject reports at least "minimal improvement"), on a pain scale, is about 15 to 20 points (on the 100 point scale). The changes we see in the meta-analysis you referenced corresponded to a baseline pain score of 60, with an improvement to 43 without treatment, 35 with sham acupuncture and 30 with acupuncture (from the full text of the study). So what we see is that there is already a minimum clinically relevant improvement in pain from doing nothing, but there isn't a clinically relevant improvement between doing nothing and any kind of 'acupuncture' or needling.

Linda
 
#40
Novella's point is that we've tried this, and what we've found out is that a tremendous amount of time and money have been wasted on ideas which turned out not to be helpful.
I thought the main point was not that we shouldn't be doing the full scale studies of CAM hypotheses, but rather that they should only be getting the bigger dollars for the bigger studies if they have first gone through the preliminary, less expensive proof of concept type studies that other potential treatment have to go through.

The point he probably should have made more strongly (I only read it once so perhaps he did) is that CAM hypotheses should be approved for the resources to perform those preliminary type tests.
 
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