My name is Drew Rouble, and I am a Canadian medical student at the University of Toronto (U of T). I am a proponent of consumer advocacy and the protection of patients from healthcare exploitation, specifically that caused by natural health or complementary and alternative medicine (CAM). There is considerable amounts of misinformation about CAM that confuses patients and medical professionals alike. To aid informed decision-making about CAM, I created NaturoFAQs.com as a resource to provide concise, simple, non-judgemental, and enjoyable summaries of the evidence (or, more frequently, lack thereof) behind natural medicine.
The need for consumer health advocacy
Many people have frequently-asked questions (FAQs) about natural health and CAM: “What is it? Does it work? Is it safe? What’s the evidence?”. By answering some of these natural health FAQs, NaturoFAQs aims to educate consumers and healthcare professionals about these products and practices.
NaturoFAQs is based on the highest-quality scientific evidence currently available: systematic reviews, randomized controlled clinical trials (RCTs), and clinical guidelines from major medical organizations. The website contains references to hundreds of these sources and reports what the best-available science says, without the spin of marketing agencies or organizations that profit from CAM.
My goal is to provide easily-understandable access to the science-based reality of natural medicine. I hope that by providing references to, and scientifically honest explanations of, the published literature examining CAM, patients can empower themselves to make fully informed decisions about their healthcare. If they understand what the evidence says about natural health practices, they may be less likely to fall victim to predatory marketing. The key is providing that information without judgement and with the best interests of patients in mind.
My motivation: filling an educational gap
Throughout my (admittedly minimal and ongoing) training, I have encountered something curious. Although medical trainees and practitioners know a lot about medical science, they sometimes know very little about medical pseudoscience, like naturopathy and other forms of CAM. That is perhaps an unsurprising revelation to some. Why should medical students and doctors be fluent in fringe-topics and unscientific practices? Well, in my humble opinion, failing to understand and advocate against such nonsense does a disservice to our patients.
As members of the medical profession, it is likely that my colleagues and I will encounter many patients that are interested in CAM. However, if a future patient asks for advice regarding this topic, a medical trainee will be confronted with a series of important self-reflective questions:
- What do I actually know about CAM?
- Can I ensure that my patient is fully informed with the facts before they make treatment decisions? (i.e., Do they have informed consent)?
- Perhaps most importantly: Do I know enough to protect my patients from exploitation by natural health industry?
Medical school does very little to help us recognize health scams and to understand CAM practices from a scientific point of view. The consequence is that many medical students cannot confidently answer the above questions. Worse still, some students may be led to believe that such practices have scientific legitimacy. After all, if CAM is so popular, and many prestigious universities are researching it (including U of T, which is currently running a study to test homeopathy for children with ADHD), it must be legitimate, right?
This knowledge gap reflects actual conversations that I have had with some classmates. I have even had professionalism concerns raised against me by colleagues for providing reasonable criticism of the exploitative nature of some naturopathic practices. (Apparently, pointing out patient exploitation by naturopaths can “offend” some people.)
If future medical practitioners cannot accurately advise about popular CAM therapies—or worse, if they actively promote them—patients and consumers are doomed to rely upon profit-driven providers of natural medicine who, more often than not, conceal the whole story about their treatments or just don’t know any better. Likewise, if medical professionals do not speak out against unscientific treatments, or do not have informed knowledge on the matter, patients may be led to believe that their physicians either support such practices or do not care if their patients use them. Such an outcome is, in my still humble opinion, a failure of the medical profession to advocate for our patients’ right to ethical care, which depends upon fully informed consent.
I hope that NaturoFAQs can aid consumers and medical trainees alike in differentiating between dishonest marketing tactics and high-quality scientific evidence. If not, at least we can laugh at my attempt to get a rise out of my variously opinionated classmates.
(Drew Rouble’s opinions are his own. They do not necessarily reflect those of the University of Toronto. NaturoFAQs.com is not affiliated with the University of Toronto.)
I agree with your well written article. Most medical doctors do not know the core beliefs of most of the CAM disciplines. For example, they do not know that homeopathy is infinite dilutions of a substance. They do not know that chiropractic is based in manipulating the spine/subluxations with a belief that this can have an effect on all diseases. Doctors are probably most familiar with something like acupuncture, as this is not such a foreign concept to them, and they can hypothesize mechanisms of action (of course they do not know that it is often based on ancient meridians). In essence, medical doctors do not care or show feigned interest in CAM until which point it interferes with their treatment. Such examples would include the cardiac patient that chooses chelation instead of a CABG/angioplasty or the cancer patient that foregoes chemo/radiation/immunotherapy for herbs/acupuncture/hyperthermia/(and more scam treatments than i can list). In general, medical doctors put up no fight to the expansion of scope of practice of naturopaths/chiro but then roll their eyes in exasperation when it happens.
Actually, I think many, if not most, doctors do know that homeopathy is infinite dilutions. I recall once when I was working the triage phone desk, a parent asked if it was OK to give her kid some homeopathic medicine. The doctor said “Sure, it doesn’t do anything anyway.” Most are familiar with chiropractic too, especially if they live in a woo state like Colorado where lots of people have a “cafeteria approach” to health care, going to all kinds of practitioners, including mainstream medical ones.
Your story is an example of one, so it’s hard to say that “most” doctors take any paraticular stance based on that. What concerns me with your anecdote is that the doctor (or you) didn’t seem to note that in his blasé approval (based in fact), he was also passively letting the mother think that there might be value in the “treatment”. That is NOT ok.
I was just giving an example. I’ve worked with a lot of them, and most of them know that. As I said, lots of people here use all kinds of “practitioners”. This alternative medication is on all the shelves around here, even in “real” pharmacies. The child was not critically ill, either, I believe s/he had a cold. Good Grief!
No offense meant. But my point stands, as David above has also noted.
I was just giving an example. I’ve worked with a lot of them, and most of them know that. As I said, lots of people here use all kinds of “practitioners”. This alternative medication is on all the shelves around here, even in “real” pharmacies. The child was not critically ill, either, I believe s/he had a cold. Good Grief!
I do believe that medical doctors just roll their eyes and ignore CAM and patients that use it until it directly effects the care suggested by said medical doctor. You are correct, that this is probably not enough, in that it does not emphasize to the patient that said medical doctor frankly believes that it is all bullshit.
I do believe that medical doctors just roll their eyes and ignore CAM and patients that use it until it directly effects the care suggested by said medical doctor. You are correct, that this is probably not enough, in that it does not emphasize to the patient that said medical doctor frankly believes that it is all bullshit.
???How does saying “It doesn’t do anything anyway” amount to thinking there might be value in the treatment??? It’s what wise doctors would say rather than waste their time arguing.
I disagree. Such a response lets the patient think there might be some value in the treatment or that the doctor approves of it. Keep in mind that this comment (in the example) was made to an assistant, not the patient. I realize that docs don’t have the time to educate each patient, so my view is more of an ideal than a criticism.
Hey drew. You may wish to review areds1 and areds2 vitamin studies for macular degeneration.
Hey drew. You may wish to review areds1 and areds2 vitamin studies for macular degeneration.
it is quite clear that a course on basic statistics and critical thinking should be required in every high school curriculum.
Critical thinking yes, I would replace or better augment statistics with probability theory. Yesterday I had a case where a Masterstudent consulted me on a matter of tumor localizations, glioblastoma to be exact. She wanted to test whether the central lobe was less effected and was bitterly disappointed that we got a p value of 0.2. I told her that the p-value as intended by Fisher is a fuzzy measure to determine whether something was worth a second look and told her to write just the values and her interpretation (i.e. tendency with a pvalue of ….) and leave out the whole significant/non-significant stuff which is of questionable value anyway.
As did she fall asleep as you babbled?
Too bad it wasn’t done when you were in school
Not defending CAM here, but making the point that those claiming to debunk CAM need to do a lot better – after all it’s those folk who are arguing for an evidence base.
– NaturoFAQs.com doesn’t have an identifiable author, It’s one thing to post here, but you should be ‘out’ on the site.
– Reliance on Cochrane is perhaps a mistake when there is a lot of concern about Cochrane’s internal bias.
– Ernst and Colquhoun pop up, unfortunately IMHO. Those guys come over as angry old men with an agenda – their own sites and ramblings are incendiary and poorly argued. They and their acolytes take a no-prisoners ad-hom approach to anybody not 100% aligned.
– Ernst is interesting since he pioneered ‘sham needling’ in acupuncture investigation, and this seems to be an accepted approach: frankly it’s unbelievable to me that a patient is unable to tell the difference. I can tell whether a *real* needle has been properly inserted, let alone a sham application.
Me? good experience w/Acupuncture, Homoeopathy is bunk (IMO), and on the fence over chiropractic (too many schools to make a blanket statement). Science degree and work in Tech.
As I keep repeating the mantra from public health school “unless you are God, you must bring data”. It is your opinion that Ernst is an angry old and that Cochrane has internal bias (perhaps a bias on your end) , but as long as they can supply the data and the statistics are valid…then it is up to you to supply data to the contrary.
My opinion about Ernst is indeed my own, although shared with others. You can make up your own mind by checking out hig blog/site and the comments btl by him and his acolytes.
Cochrane’s wikipedia page highlights their internal bias. Since the rest of the article reads like a press release I find that significant. Good that they recognise they have work to do, but not so good that Drew and naturoFAQs rely so heavily on them.
PS watch out for mantras. IME they lead to torpor rather than clarity. And what’s all this God nonsense anyway?
David gets in a snit when he debates. I fear he’s young and wants to change the world. He provided a Canadian “study” (it was a report) about a segregated religious group in B.C. that experienced a measles outbreak. 450 infected, no deaths and only one case of encephalitis that resulted in a complete recovery. David was livid that 5 cases were from outside the group, and he made unsubstantiated claims vaccines kept all others in the area measles free. He will not admit it blew up in his face. 450 now are immune for life and healthier than before the outbreak. They also will never be a measles threat again. Actually a very positive outcome.
My comment was flippant.
I appreciate you have some pain going on AutismDadd and it’s hard. I’m still gonna get all Matthew 7:3 on your ass though.
God be with you.
Quote: “segregated religious group in B.C.” Liar, liar, pants on fire. It was NOT a segregated group.
Was…based on the definition of segregated
Nobody gives a fart about your definition of segregated. The paper and witnesses state definitively the non-segregation of the community. You are a liar.
Definitions don’t lie. Just because they interacted to some degree doesn’t change the fact they were a singular group. And its reflected in how the group became infected and overcame. You and David just can’t bear the thought they didn’t die or suffer.
Quote from the paper: ” This community is known to object to vaccination. This population is NOT SOCIALLY OR GEOGRAPHICALLY isolated [….]”. As I said, you are a liar.
And further: “The Netherlands outbreak resulted in approximately 2,600 reported cases
of measles, 182 hospitalizations among children and the death of one
child from complications of measles”. You are not only a liar, but you would also accept the death of children for your “natural immunity”. You are co-responsible for this death child. You are really disgusting.
I’m not discussing the Netherlands, nice deflection. Even objecting to vaccines makes them segregated. You just can’t absorbed through your cement skull
The measles virus does not care one single little bit about vaccine rejections. Not socially or geographically isolated equals not segregated. As i said, you are a delusional, dishonest man. As for the Netherlands. Natural immunity by a measles epidemics is what you want, dead children you will get. You are plainly and simply disgusting. Dishonest, morally wrecked and disgusting.
How many of the 450 in B.C. Canada died or had long term reactions?
A measles epidemy you want, dead children you will get, you disgusting man. Hoever, the dog barks and the caravan moves on, ignoring it.
The correct answers are zero and zero
As I said. A drunkard defending his drunk driving by arguing that nothing happened on a particular drive. Additinally lying about the circumstances of the drive. Disgusting, dishonorable and a shame for his country.
Zero and zero
How many of the 450 had autism? Never vaccinated and a random sample of mixed age and gender. Perfect!
How many of the 450 had autism? Never vaccinated and a random sample of mixed age and gender. Perfect!
What is the deth rate in a measles epidemics you find “natural” ? Approximately 1 in 1000. What is the complication rate with lasting diasability ? 10 in 1000. Don’t come up with autism. You are a drunk driver justifying his recklessness by nothing happened in one drive.
What is the deth rate in a measles epidemics you find “natural” ? Approximately 1 in 1000. What is the complication rate with lasting diasability ? 10 in 1000. Don’t come up with autism. You are a drunk driver justifying his recklessness by nothing happened in one drive.
Its a valid point, and here’s a glorious opportunity to validate autism in 450 unvaccinated.
Done with 500.000 participants. Woof, woof, caravan moves on.
Why not? Afraid of what you’d find?
500.000 participants, vaccinated and unvaccinated no increased autism rate found. case closed. Woof, woof, caravan moves on.
500.000 participants, vaccinated and unvaccinated no increased autism rate found. case closed. Woof, woof, caravan moves on.
Chicken Little Buk Buk the farmer moves on
You are somebody who wants to unecessarily expose children to a 2 in 1000 chance of death and to a much higher chance of permanent disability. This amounts to child abuse. Are you a child abuser ?
I call that response the equivalent of expensive pee. Strange how many vaccine fanatics are excessive in their accusations, not to mention inaccurate. Trying to insult me by implying I’m a child abuser is juvenile. Thomas Almighty has exposed himself as an emotional hateful man.
For your “natural immunity” you take into account that your child has a small but real chance to die. You take into account that your child has a not so small and very real chance to be permanently disabled. You are a case for child protective services – as any child abuser – whether you want or not.
Scare tactics and fear mongering. Not very impressive coming from a professional scientist. Likely you aren’t as knowledgeable about illness as you pretend. Maybe you opinions belong in a plastic bag with the dog doo
Here’s a thing:
https://uploads.disquscdn.com/images/f52b41a7e782fc04ed11c26960cd22a3f707bafe96a8ef7de732139c648edc55.jpg
For your “natural immunity” you take into account that your child has a small but real chance to die. You take into account that your child has a not so small and very real chance to be permanently disabled. You are a case for child protective services – as any child abuser – whether you want or not.
I call that response the equivalent of expensive pee. Strange how many vaccine fanatics are excessive in their accusations, not to mention inaccurate. Trying to insult me by implying I’m a child abuser is juvenile. Thomas Almighty has exposed himself as an emotional hateful man.
You are somebody who wants to unecessarily expose children to a 2 in 1000 chance of death and to a much higher chance of permanent disability. This amounts to child abuse. Are you a child abuser ?
Chicken Little Buk Buk the farmer moves on
This shows how you do not understand how to design a study. This would only be a representative sample of compared to a vaccinated sample within the same group.
No it shows you won’t answer my questions. How many of the unvaccinated 450 had autism.
This shows how you do not understand how to design a study. This would only be a representative sample of compared to a vaccinated sample within the same group.
See autism dadd, this is why you need to learn statistics. A sample size of 450 is too small to study when the incidence is relatively rare. Even if your unvaccinated sample had a higher rate of autism of 1/50 this would be rejected as a a spurious occurrence. Similarly if the rate was 1/125, it means nothing as sample size is too small.
I asked if there were, but instead you beat around the bush
I’m not beating around the bush. It wasn’t looked at. Even if it was looked at, it is not a big enough sample to be meaningful. Even if 50 had autism, you would not be able to conclude that nonvaccination causes autism.
Really? And you tell me I’m blind?
Really? And you tell me I’m blind?
Thanks for confirmation of your complete ignorance of statistics. This means (a) you are not competent to assess *any* clinical studies and (b) your statements involving statistics are complete garbage. BTW I am using you as an example how conclusions are NOT done. You just shot yourself in the knee and don’t even realize it.
So how many of the unvaccinated had autism. Its a simple question Thomas Almighty, but one you refuse to answer.
I do not answer you because it is statistically useless. Even if you would gobble now “see I told you”, studies disprove you. Once again. THERE IS NO LINK BETWEEN VACCINATION AN AUTISM, best documented here: http://www.ncbi.nlm.nih.gov/pubmed/12421889. That matter is settled and everything you say is either a lie or morally rotten to the bone. 450 sick children and no suffering. How cynic can one get.
Sticking to the propaganda
A child being in the ICU for encephalopathy while parents worry is not exactly a noneventful course. i thought your theory for help autism occurs from vaccines is partly due to encephalopathy. So maybe this child will become autistic …so again not a benign outcome
Well did the child become autistic from wild measles then? I’m going to guess no and that you are grasping at straws. Time to admit we now have 450 healthier children, of many ages and both sexes randomly chosen. A great study with a very positive outcome.
That would be ZERO
That would be ZERO
Wow a professional blowing up that way is quite disturbing.
Wow a professional blowing up that way is quite disturbing.
Aside that, one of your “defences” was that no one died. Well in the Netherlands a child died. Unnecessarily. It voids your “defence”. You are like a drunkard who defends drunk driving with the argument that nothing happened so far.
Double Standard Mr Austrian. You don’t give a damn about vaccine safety so why show others worry about one child? You don’t care about thousands you fool
How many children were killed in Austria by their pet dog last year? Should dog ownership be stopped?
How many children were killed in Austria by their pet dog last year? Should dog ownership be stopped?
That child may have had faulty genes. In today’s world everything is coincidence or caused by the parent’s genes right?
They object to vaccinations, that makes them socially separate from the vaccinated
“[…] NOT SOCIALLY OR GEOGRAPHICALLY isolated […]”
The only thing that counts is geographical and/or social isolation. Aside that you do not realize that this does not matter. Exposure to measles in an unvaccinated community -> epidemics of 450 cases with a 2 in 1000 chance of death. Exposure in a vaccinated community. 5 cases. What your justification attemts have the same flying capability of those of a reckless drunk driver claiming “nothing happened so far”. What you want is an epidemic and what you will get is dead children. That is chiseled in stone.
What nonsense. You sound like an old woman behind a locked door.
Everybody understands the difference in penetration rates. Once again. 1 case leading to 450 suffering vs 1 case leading to 5 suffering. You advocate a measles epidemics and you will get dead children. You are not fit to be a Dad.
Another old woman response. Hide under the bed Thomas the KILLER DISEASES are everywhere!!!!
The 450 didn’t suffer. They now have stronger immunity because the virus taught and programmed their immune systems. Never a need for a measles vaccine and no chance of another outbreak in the 450. Its a WIN/WIN and no harm was done.
Funny story for you Thomas…showing just how ignorant these anti-vax people can be…and how little they actually research the crap they spit out.
This nefarious anti-vaxxer was trumping out the ridiculous trope that shaken baby syndrome is actually due to vaccines..
He/she says it is true, even the NIH endorses this finding and has it on their website.
I say, that is impossible.
He/she says type in this statement and it links to the NIH and you will see that it is true..
So I type it and it links to PUBMED, which of course does have NIH in its address.
This so called knowledgeable anti-vaxxer, who does all this “research”, had never seen pubmed before.
Of course the journal that this “article”was published in was “medical hypotheses”—which I’m surprised is even indexed in pubmed!
I meet such people all the time. TCM, homeopathy, anti-vaxx. In Austria courses in homeopathy are even offered by the Austrian Medical Association, believe it or not. To a certain extent I understand the rationale which is that the patient wants it, this way he is attending at least an MD and not some Heilpraktiker (though they are forbidden to practice). The pattern is Google university and Yahoo college combined with a massive logical fallacy (appeal to nature) and a disdain for big pharma. Coincidentially I did some research in this area (Proteeolytic enzymes like Bromelain, Papain and such to be exact). It is always amusing to see the faces if I tell a few stories how homeopathic companies really work. The only difference is the larger profit margin – on the side of the “alternative” company.
Don’t pee yourself David it just a small misunderstanding.
Actually it is not a misunderstanding. This guy is still arguing with me that he is right. He thinks because a paper is indexed on medline that it is a statement from NIH and an endorsement. It is one of 16 million citations.
Even you are smarter than this guy autism dadd!
Seems you have many arguing with you. You are the common denominator.
Seems you have many arguing with you. You are the common denominator.
Don’t pee yourself David it just a small misunderstanding.
There was no suffering. All are well and immune to measles for life. Your fear mongering doesn’t hold true.
There was no suffering. All are well and immune to measles for life. Your fear mongering doesn’t hold true.
Let me explain something to you. The Mortality of measles in industrialized countries is 2 per 1000 (Perry RT, Halsey NA (May 1, 2004). “The Clinical Significance of Measles: A Review”. The Journal of Infectious Diseases. 189 (S1): S4–16). if an immunocompromised person ctches the virus, mortalite is 30% (Sension MG,
Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N,
Duma MN, Ryder RW (1988). “Measles in hospitalized African children with
human immunodeficiency virus”. American Journal of Diseases of Children (1960). 142 (12)). The infection penetration rate is that high that everybody gets the virus. That means hundreds of thousands of cases and on average 2 death per thousand cases. Let me lecture you further: I have the education to interpret the data, you don’t even have the education to speak a second language or understand proper English. Despite your anonymity here, people know about your stance. I sincerely hope they call CPS. Got that ?
What I get from that is you are narrow minded and can’t but release your propaganda in the face of information that shows otherwise. Funny how autism is blamed on faulty humans, but several deaths from measles isn’t. Tell me how many vaccinated children still developed measles and how many of them died.
Nobody cares what you get from me. Facts are facts. Autism is NOT caused by vaccines as HUGE studies showed, mortality by measles alone is around 2 in thousand. What I see from you is a stupid individual with a learning resistance that can hardly be trumped.
Nobody cares what you get from me. Facts are facts. Autism is NOT caused by vaccines as HUGE studies showed, mortality by measles alone is around 2 in thousand. What I see from you is a stupid individual with a learning resistance that can hardly be trumped.
What I get from that is you are narrow minded and can’t but release your propaganda in the face of information that shows otherwise. Funny how autism is blamed on faulty humans, but several deaths from measles isn’t. Tell me how many vaccinated children still developed measles and how many of them died.
So you think a week long fever up to 40° is no suffering for a child. What for a cynic comment. No compassion. You are morally rotten to your core.
I think your lederhosen are too tight. Blood is not reaching your brain. You want to state worst case scenario because fear mongering scares parents. There was no description of any of the 449 suffering, just the one who made a FULL RECOVERY!
Everybody understands the difference in penetration rates. Once again. 1 case leading to 450 suffering vs 1 case leading to 5 suffering. You advocate a measles epidemics and you will get dead children. You are not fit to be a Dad.
“[…] NOT SOCIALLY OR GEOGRAPHICALLY isolated […]”
The only thing that counts is geographical and/or social isolation. Aside that you do not realize that this does not matter. Exposure to measles in an unvaccinated community -> epidemics of 450 cases with a 2 in 1000 chance of death. Exposure in a vaccinated community. 5 cases. What your justification attemts have the same flying capability of those of a reckless drunk driver claiming “nothing happened so far”. What you want is an epidemic and what you will get is dead children. That is chiseled in stone.
They object to vaccinations, that makes them socially separate from the vaccinated
You are too stupid to realize that this study reaffirms the power of vaccines as well as herd immunity. I hope you keep posting it on all your websites as anyone with reading comprehension will come to the conclusion that vaccines are indeed beneficial
Wow David, are you blowing a gasket? I find it bizarre that medical professionals can be so narrow minded. We have direct evidence that a measles vaccine was not required in the case. That’s quite startling. I wonder too how many of the 450 have autism, ADHD, allergies etc. Do you know if follow up studies are being done to take advantage of this amazing opportunity?
As I keep repeating the mantra from public health school “unless you are God, you must bring data”. It is your opinion that Ernst is an angry old and that Cochrane has internal bias (perhaps a bias on your end) , but as long as they can supply the data and the statistics are valid…then it is up to you to supply data to the contrary.
To me this whole article and site for that matter sound completely and wholeheartedly negative on anything that is NOT main stream medicine.
I would question any person on this site…..Have you been to a chiropractor? Have do done any protocol with natural substances? If the answers are “NO” then really you don’t have a clue about all sides.
I think it’s important to clarify homeopathy is NOT Natureopathy. Any good MD that practices main stream and Natureopathic medicine as an Integrative doc understand far better all the potential modalities and possible side effects of either types of treatment.
This is not about anecdotal evidence, which is the worst form of evidence. This is evidence based medicine which naturopathy is largely not.
So vitamins and minerals play no part in health, wellness and disease prevention???? Vitamins and minerals are and have been integral in main stream medicine for many years………Thus why every packaged food is fortified with vitamins and minerals………However, now it is about “throw you on drug…A,B or C.” Or immune therapy drugs….or anti anxiety, or anti depressants. …….OH and the list could go on. There is enough evidence, for those with genetic predispositions, that supplementation, at a docs direction can have lasting positive effects on health and well being with out being “pill pushed” from main stream medicine.
Additionally, anecdotal is just a word for main stream medicine to discredit anything that they disagree with.
First, anecdotal evidence is subject to a lot of bias which invalidates most of it. Example: Treatment/prevention of scarlet fever by belladonna. Very popular in the 19th century, base mostly on anecdotal evidence until somebody looked at a very hard parameter, namely mortality. This lead to a quick phase out of belladonna as treatment for scarlet fvere since the mortality rate showed no difference. Now guess who is still using this modality ? If you say naturopaths you are correct. As for supplements. The problem with vitamisn, supplements etc is that there is no storage of excess. I.o.W. if you do not suffer from vitamin or supplementt deficiency (which is usually not the case with healthy nutrition) vitamin supplements only leads to a very expensive urine.
“vitamin supplements only leads to a very expensive urine.”——–You are kidding correct???
You are correct in say “with healthy nutrition”….however, you don’t generally know you are deficient until you have a problem.
I challenge anyone to try Zinc, vitamin C and Vitamin A at the first hint of a viral infection or reactivation. Again, when you have not experienced so called “anecdotal” evidence….you really cannot speak to the efficacy or veracity of supplements. Many “treatments” in main stream medicine, have and still do vitamins.
Well, I have read the literature. At best the effect is very modest. See, the body is programmed to keep vitamins at a certain level. Too low -> problems. Too high -> expensive pee.
OK, so you agree that vitamins and minerals and the lack thereof cause problems…..Thus the need for supplementation if it is needed.
Thanks for agreeing!!!!!
http://www.ncbi.nlm.nih.gov/pubmed/8801180
http://www.ncbi.nlm.nih.gov/pubmed/27546360
http://www.ncbi.nlm.nih.gov/pubmed/27538982
http://www.ncbi.nlm.nih.gov/pubmed/27540095
http://www.ncbi.nlm.nih.gov/pubmed/27540461
http://www.ncbi.nlm.nih.gov/pubmed/27543618
http://www.ncbi.nlm.nih.gov/pubmed/27515213
This is 7 of hundreds for ONE vitamin….Shall I go on????
I started to read the abstracts of the first two and they all contain the word “vitamin deficiency”. We know that already. A reasonable western diet under normal conditions gives one all the vitaimns needed and vitamin supplements lead to expensive pee.
OK, so vitamins play a critical roll in health….thank you for agreeing with me. So are you saying if you take vitamins you are wasting your money? What is your point of expensive urine??? IF a person takes supplements, doesn’t that by default prevent many “diseases” where vitamin deficiency plays a roll? So really, it is just insurance and that “expensive urine” as you put it really is a potential insurance premium and will most likely save you money in the long run…..have you be happier and healthier….longer potential life span……Other than the “expensive urine” what is the down side if you are doing them???
Didn’t I explain this to you ? Once again:
(1) a reasonable diet prevents vitamin deficiency.
(2) vitamins can not be stored in the body.
(3) the body is programmed to keep vitamins at a certain level.
(4) any surplus is going straight into your pee.
In other words, eat healthy and forget about supplements.
To answer your question, if you eat fairly healthy, vitamin supplements will NOT prevent disease, see points 1-4
Didn’t I explain this to you ? Once again:
(1) a reasonable diet prevents vitamin deficiency.
(2) vitamins can not be stored in the body.
(3) the body is programmed to keep vitamins at a certain level.
(4) any surplus is going straight into your pee.
In other words, eat healthy and forget about supplements.
To answer your question, if you eat fairly healthy, vitamin supplements will NOT prevent disease, see points 1-4
Does any process cause issues…… that the above 4 things become irrelevant and untrue?
Can you name one?
If you have a heightened vitamin depletion, f.i.during a severe disease this might become an issue.
OK so your previous statement is incorrect….here is what you wrote:
(1) a reasonable diet prevents vitamin deficiency.
(2) vitamins can not be stored in the body.
(3) the body is programmed to keep vitamins at a certain level.
(4) any surplus is going straight into your pee.
In other words, eat healthy and forget about supplements.
Again, vitamins play a key roll in disease treatment and prevention.
What about aging?
What about autoimmune issues such as pernicious anemia.?
What about pregnancy? Folic acid is prescribed all the time….preventatively I might add.
Your four statements are patently false…..well maybe with the exception of number 4….which we agree. The idea that we get all we need from our diet…..esp here in the US with all our “vitamin and mineral fortified” packaged foods.
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/#h5
https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/
https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/
Just one quote from Seleninum————————————————–
Because of its effects on DNA repair, apoptosis, and the endocrine and
immune systems as well as other mechanisms, including its antioxidant
properties, selenium might play a role in the prevention of cancer [2,9,34,35].
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820055/
I think this is enough evidence of supplementation and the fact that it works.
Once again, these for points are valid for healthy persons, If you have a condition depleting your vitamins you might need supplements. But the healthy individual with a fairly reasonable diet will only produce expensive pee. Clear enough ?
So which came first…the disease or the depletion???? Ah…now that is the question to be answered.
If you have a heightened vitamin depletion, f.i.during a severe disease this might become an issue.
Does any process cause issues…… that the above 4 things become irrelevant and untrue?
Can you name one?
OK, so vitamins play a critical roll in health….thank you for agreeing with me. So are you saying if you take vitamins you are wasting your money? What is your point of expensive urine??? IF a person takes supplements, doesn’t that by default prevent many “diseases” where vitamin deficiency plays a roll? So really, it is just insurance and that “expensive urine” as you put it really is a potential insurance premium and will most likely save you money in the long run…..have you be happier and healthier….longer potential life span……Other than the “expensive urine” what is the down side if you are doing them???
Talk about pills being pushed, I remember a time in the 1970s and 1980s when naturopaths and heath foods stores were promoting toxic doses of vitamin A. And the list goes on.
I never have seen one commercial pushing vitamins on TV. Can you say the same about big pharma with drugs and vaccines???? They are not even close. And yes, I grew up in the 70’s.
This is not about anecdotal evidence, which is the worst form of evidence. This is evidence based medicine which naturopathy is largely not.
Homeopathy is actually an integral part of naturopathy. One does not have to have experienced a “treatment” in order to understand the basic principles behind it. Yes, I have visited a chiropractor. He had me mightily impressed with his talk of subluxations blocking the flow of my body’s “innate healing energy”. I’m forever grateful to the science-minded writers who set me straight on the evidence, (or lack thereof), of the plausibility and efficacy for chiropractic adjustment. (Lower back pain was not my complaint, and that’s the only condition for which chiropractic shows any good result.) As one skeptical friend put it, “I think I just paid $60 for a hug from a nice man who smelled really good. I don’t usually pay for that,”
NaturoFAQs.com————–I must say this website is quite disingenuous at best.
Why “must” you say that?
Well, it was quite stupid and untruthfull in many regards……so I MUSTA needed to say it.
Geesh!!!
How is it “stupid”?
What is it being untruthful about?
Basically the complete negativity of anything alternative. That is stupid and untruthful.
The best way to counter the stuff written here is to post the evidence showing the author the error or their ways.
Nah, not really. It really is much like the “scientific method” Let people try different ideas.
No one can say vitamins and minerals don’t play key rolls in health….both physical and mental and in the prevention of disease. It is just that simple. Most people know this. Geesh, I can’t believe I am arguing with a guy that has a spongebob picture……who is the really dummy!!!???
It’s pretty clear based on your answer.
Yep.
http://www.ncbi.nlm.nih.gov/pubmed/8801180
http://www.ncbi.nlm.nih.gov/pubmed/27546360
http://www.ncbi.nlm.nih.gov/pubmed/27538982
http://www.ncbi.nlm.nih.gov/pubmed/27540095
http://www.ncbi.nlm.nih.gov/pubmed/27540461
http://www.ncbi.nlm.nih.gov/pubmed/27543618
http://www.ncbi.nlm.nih.gov/pubmed/27515213
This is 7…… of hundreds……. for ONE vitamin….Shall I go on????
Was that so hard?
No it wasn’t actually…..
Don’t you find it strange that “natural medicine” with it’s push for vitamins and minerals is considered “alternative”???? Yet, much of the main stream medical docs are now starting to get on board with it.
I never said vitamins were alternative.
Doctors regularly prescribe vitamins when there is a need.
I can extrapolate……..So taking them before the need arises would be better….Thanks!!!
I didn’t say that either. But if you want to take them, go for it.
I didn’t say that either. But if you want to take them, go for it.
I can extrapolate……..So taking them before the need arises would be better….Thanks!!!
Rich, the problem is how naturopathy works. A combination of “natural” remedies (logical fallacy appeal to nature) with traditional remedies (logical fallacy: appeal to tradition). There is no alternative medicine, but only medicine that works. This medicine is subject to scientific scrutiny and methods are abandoned if they do not work. Therefore one does not have to disprove naturopathy, but demonstrate that it works before applying to patients – and there is where naturopathy largely fails.
Appeal to traditions : vaccines
sigh. no. Vaccines are not a tradition, they are a medicine with 1000 years of successful human trials. Billions of lives saved. Billions of lives extended. Vaccines were mankind’s first successful shot at extending life spans. And vaccines are accepted as science the same way old medicines like aspirin are. Because they work. Not because they are old traditions. They are old medicine that works.
Speaking of old medicine–the same allergy testing routine of skin pricks that was practiced over 100 years ago by doctors is still the gold standard of allergy discovery today. It’s still used at Stanford where all of my testing was done. Not tradition–an old medicine that is still better than anything else.
OK DR Semantics
Thanks Thomas, great comment.
I think there’s an enormous elephant hidden between “only medicine that works” and “This medicine is subject to scientific scrutiny”. That elephant is the authority of “scientific scrutiny” and it’s truthiness. From Thomas Kuhn to Karl Popper we might remember that we’re working with the best scientific hypotheses and experiments we can presently conceive. I think scientific method has brought us great advances over medieval leechings and bloodletting – and that was only the rich city dwellers’ fate since country-dwellers had no such ‘medicine’ but local remedies.
So you’re demanding that practices which never claimed to accord with said scientific method at any time since Francis Bacon should subject themselves it *as if it were absolute*.
My practical example concerns acupuncture and the idea of testing needling against fake needles. Experimenters would pick, say, low back pain, and determine *the* acupuncture treatment for this, needling points X,Y,Z… then as control fake-needling (I assume) random points A,B,C. Finding are then that there’s no significant difference between the two. The thing is, there *is* no standard tx for low back pain: the practitioner assesses the patient afresh on each consultation and needles appropriately. So the experiment isn’t doing acupuncture vs control, it’s doing fake vs fake, and gets exactly the result you’d expect. This is one reason why I’m so dismissive of Edzard Ernst, who came up with the fake needling approach – even though he *must* have known it wasn’t valid, and yet he *still* argues for it. It’s almost as if Ernst *set out* to find acupuncture ineffective.
Sorry about all the elephants.
[Edited for Grandma]
Rich, the “personalized treatment therefore you can’t do RCT” is an old argument to defend the failure of homeopathy. However, the argument is false. With an RCT you can test almost anything. A probably drastic example: Imagine you compare a group of expert acupuncturists with a group of chimpanzees poking needles into humans, the parameter is some pain score after a week of treatment. If the treatment is successful the experts should be better than the chimps. The exact nature of the treatment is irrelevant. One expert could do rain dances with acupuncture, one could use other acupuncture points etc.If they know what they are doing they should be better than the chimps. For an RCT the exact treatments for the patients is unimportant. If the experts who carefully selected the treatment do not perform better than the chimps who selected by chance, the treatment design process (in this case personalized picking of the points on every appointment and needling them) is ineffective. Additionally the hypothesis behind the treatment is likely false. Additionally there is something like the prior probability. If the hypothesis the treatment is based on and supports is unlikely, even a p-value of 0.01 might be irrelevant. for a discussion of this see here: Nature 506, 150–152 (13 February 2014) doi:10.1038/506150a. Acupuncture is based on belief system that is extremely unlikely which means that it is unlikely to work.
Ya… If I wanted to test such a thing with my extremely limited background (chemistry lol) I would simply set the expert up to determine all the points to be needled (he should be able to do this WITHOUT needling, right?) and then you split the patients into 2 groups: those who are needled in the “expert opinion’s” spots and those who aren’t. Of course, blind everyone to which ones receive the correct needling. You could also split the two groups further into sham acupuncture (sheaths or whatever for the fake needling) and those who actually get it…
The complaint that the method can’t be studied is a cry of desperation imo, and doesn’t seem to be based on anything but the briefest thought about how to excuse the methodology for it’s failures in testing (or possible testing)
Sounds simple doesn’t it? My degree is in Chemistry as well FWIW 🙂
You’ve maybe not experienced acupuncture.
Treatment typically proceeds in a sequence of testing (pulses etc), needling or moxa, repeat the testing and adjust treatment. In terms of pulses etc patients will likely respond differently, so that their states at completion of the treatment will differ.
Individuals will have overall different pulse pictures, different degrees and duration of illness, and different circumstances in their day-to-day lives.
I’m not really saying the method can never be tested, but more that in general it isn’t actually *being* tested. I agree with Thomas that in principle RCT can test almost anything, but in practice it’s used bluntly to evaluate e.g. back pain wherein neither your suggestions nor standard RCT design will actually test the method. The site I’m criticizing cites far too many studies where RCT is used to test fake vs fake, and is therefore doing nobody any good.
Quote: “neither your suggestions nor standard RCT design will actually test the method.” This is wrong, an RCT *always* compares two methods and nothing else. The difficulty is how to chose the control. A possible design would be targeted acupuncture vs randomized acupuncture. This design would answer the question if the method of chosing individualized points is superior to just randomly chose points.. Another design would be acupuncture vs just needling the patient randomly. This design would answer the question whether special points exist. The next design would be needling vs non-penetration. I.o.W. RCTs DO answer a lot of questions. However alone the fact that all RCTs so far yield pretty weak results is an indicator that acupuncture has a very limited scope at best.
I don’t think I disagree with anything you’ve written Thomas.
However when you say “The difficulty is how to choose the control” you’ve already gone ahead of where my concerns arise and hence my strong criticism of the NaturoFAQs site.
That is to say: RCT always compares two methods, but are we clear about which two methods we’re testing?
It seems that most studies start with the assumption that “acupuncture treats X”, where X is back pain, gout, etc. But this is a false assumption and derived from a rigid mechanistic scientism which I’ve mentioned above. This view inherently fails to respect the method under test and ends up testing fake vs fake.
An experimental design which allowed the patient to be treated rather than the ailment would be more legitimate. This would be complex and expensive to run, and so for the most part the invalid “acupuncture treats X” designs have been used. I’m no expert, but I would imagine that you’d need huge populations to get useful data over a range of ailments, durations, severities, lifestyle factors etc. and yet genuinely be doing RCT.
In consequence the evidence-based anti-CAM folk are busy putting up sites like NaturoFAQs with lots of alleged evidence that is flawed and was never going to evaluate the effectiveness of the Tx in the first place.
If there *are* studies which genuinely allow patients to be treated over the range of ailments which present then I’d really like to know about them. But I’m an amateur and I see that even the pro’s like Drew haven’t seen fit to filter the references (Drew’s lists of references for the most part look like a few well-known papers and then a list of search results from Cochrane).
The argument we treat the whole patient and not the ailment is very old and always comes up if the argument personalized medicine can’t be tested by RCTs fails. But this is a misconception.
What an RCT actually does is to determine the probability to get the observed data under the assumption that the methods applied are equally effective. That means it answers the question how high is the probability that I get my data if I assume treatment1 and treatment2 are equal. I.o.W. an RCT tells one whether a treatment is snake oil or not. For this question it is completely irrelevant if you treat the entire patient, do a symptomatic treatment or just sing to the moon.
If you have the hypothesis acupuncture is an effective treatment, the prior probabilty of your hypothesis comes into play. Given the fact that acupuncture is remarkably resistant to sound explanations the prior probability of the hypothesis acupuncture works is low to very low. This in turn means that even with p-values around 0.01 the probability of your hypothesis to be true (i.e. acupuncture works) is still low. This is what I mean with if your treatment does not show strong effects (as reflected by low p-values) it rarely makes sense to look for a baby in the bathwater that has been thrown away.
I’m not arguing ‘the whole patient’. That’s a different, and weaker, argument. I’m arguing that we apply acupuncture *as acupuncture is done*.
Your RCT descriptions are no doubt sound, but you’re not responding at all to my key point that (in most studies) acupuncture is not being done, but instead a simulacrum – another fake if you like. Where are the studies which genuinely evaluate an actual clinical situation? I don’t think Drew knows, and I think the site is no more than shoddy propaganda as a result.
I’m sure it’s possible to come up with a neutral hypothesis, or to factor a bias in.
Acupuncture is resistant to explanation when those asking for the explanation refuse to consider the models provided by TCM.
– It’s fine in clinical terms where pulses and other indicators change in accordance with the model during and after needling or moxa,
– fine in TCM terms where those changes align with TCM principles.
– It’s also fine in subjective terms where meditators and taoist practitioners are able to precisely and consistently describe the effect on their internal state.
But you evidence-based folk won’t even hear it – always always have to have it in those dried up sciencey terms while utterly failing to recognise the limits, historical and otherwise of taking an absolute position. Over centuries there have been many hypotheses only subsequently proven, many maps which are clinically superb but not (yet) fully supported by RCT studies, and as for the subjective realm – give me an RCT study on what it’s like to fall in love.
I think you are confusing an RCT with a determination of efficacy. The verum arm of a RCT is as closely to the ideal *real* situation as possible whereas the placebo arm is the simulacrum. I can not imagine that anybody would waste money by NOT doing a verum. Remember, clinical studies are expensive. Likely you misunderstood the study design. With regard to TCM models, they violate several theories thus making them extremely unlikely. That means even if you reject the null hypothesis (acupuncture equals placebo) the probability that the alternative hypothesis is based on a TCM model remains low, because the prior probability is so low.
Thomas you’ve missed it again. You have infinitely more knowledge of methodology than I do, yet you’re missing my critical point – that the verum arm is not actually doing acupuncture. It might as well be singing to the moon for all the test of acupuncture that you get out of it.
When neither the verum nor simulacrum are doing acupuncture then you’re just applying for grants and paying the rent, while polluting the stream for real research.
Of course clinical studies are expensive, but that’s not a valid reason to substitute them with invalid RCT studies, let alone build a “trust me I’m a med student” persona on top. Actually you might get something pragmatically useful out of it, but as soon as you get overly hung up on rigorous statistical analysis or defining subgroups (like “back pain”) then you lose the value and you’re just running spreadsheets like a freshman.
I’m afraid I laughed at “TCM models … violate several theories”. TCM models are a heuristic, developed over time in a clinical setting and (probably) by introspection. It’s not designed like a piece of safety-critical software using formal mathematical notation Thomas – it’s experience over possibly thousands of years. It’s rough around the edges. If the theory doesn’t fit then surely the theory should change – heck that goes for good old scientific method too (see Popper). If you’re stuck on having to have a watertight theory with a 1:1 mapping to real life with no loose ends then you’ll be fine with throwing a probe into orbit around Jupiter, but I’ve no idea what you would do on a date 😉
You are holding on to RCT as the gold standard, and to “evidence-based science” as an absolute and only way of evaluating effectiveness. In the context of e.g. US legislation and the kind of claims made by some extreme CAM trolls (e.g. a post just a little while ago on this site) I think that’s a valid starting point. Nobody in that world seems interested in a middle-gound – both biomed and the alts have a lot of ego, power, money, and prestige tied up in being right. However I’m interested in what actually happens in the case where we’re all conscious and open-minded actors and f’d up people, business models and politics haven’t screwed the pooch.
Then post references to an example (or better examples) where you think that the verum arm is not doing acupuncture and a specific argument why it is not doing acupuncture.
Well, no. Sorry. Look at the list of references on Drew’s site for acupuncture – non-specific low back pain, chronic pain, post-op vomiting, migraine… I’d suggest that all these are already taking the view that there is a treatment for X.
Well, OK, let’s have a look. I picked one at random , other than excluding anything Ernst had a hand in 😉 –
11) White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G. Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain. 2012;153(2):455–462. doi:10.1016/j.pain.2011.11.007.
I found a pdf here: http://www.dcscience.net/white-2011-acupuncture-placebo-rct.pdf
If you look at $2.2 where “real acupuncture” is constrained to needling a small subset of possible points only using “Western acupuncture”, and placebo acupuncture uses non-penetrating needles.
It’s at this point I throw up my hands
– firstly how on earth is restriction to 6 points (out of some 400 in TCM) a realistic evaluation? A TCM practitioner can pick from any? This is utterly ridiculous as a study about acupuncture.
– secondly, despite the claim that non-penetrating needles have been validated – I frankly don’t believe it. I, and everybody I’ve asked, can tell the difference between a penetrating needle inserted correctly to the point, vs incorrectly inserted 1-2mm away. It is completely and totally obvious. If studies are finding people who can’t tell the difference then their ability to feedback on pain relief or anything else must be in some serious doubt.
– thirdly, there’s no description of pulses or any other diagnostics being used.
So as I say – an utterly laughable and amateur study wrapped up in all sorts of pseduo-credible scientism, but fatally flawed at the outset. In fact worse than I’ve been arguing – they don’t even let the practitioner do the job.
Thomas all the RCT and peer-reviewed papers in the world are a waste of time if this is the quality of the underlying research that’s being done. You can run spreadsheets and p-values until the cows come home, but the verum is a nonsense.
Edit to add that the paper’s reference in support of the non-pen needles has several of the same authors. I’m suspicious.
First, you should read the paper exactly. Acupuncturists could chose from a list of points freely and chose to use 6 points in the mean. I.a.W. the list was much bigger, resp. they came close to real acupuncture. As for your second point, being able to recognize non treatment likely diminishes the placebo effect. If we assume that some people in the placebo arm were able to “unblind” the study, this would lead to an overestimation rather than an underestimation of the effect of acupuncture due to the diminished placebo effect. That in turn means that the effect of acupuncture is even smaller than reported in this study.
Here’s the thing: acupuncture wasn’t being done in the verum, therefore absolutely
everything that follows, no matter who benefits from the stats, is
illegitimate. This seems to me quite basic and self-evident.
You’re right, 6 points was the mean # points used. My genuine mistake in a quick reading. There was a restricted set of points, although the study doesn’t say how many or which – they could have been nowhere near where TCM might, uh, tend, to treat ;). Neither does it say that any diagnostics (e.g. pulses) were carried out. Both aspects are significant components of acupuncture treatment, yet not mentioned here. So once again, it looks very mush as if acupuncture wasn’t being done – just another simulacrum.
On the point (none intended) of the non-penetrating needles alone, yes you’d decide that the placebo effect would be diminished. But that seems such a rubbish excuse for poor design – “so we made a sloppy mess of almost everything else in the design but hey that would all work in favour of the verum anyway so we’re good. Everybody agree? Right let’s get on with the p-values”. The fact that the authors make a strong play of them being valid suggests either misdirection or misunderstanding on their part – misdirecting the reader to say that’s significant in terms of good design, or misunderstanding if they really do think it is significant. Either way they are right down the rabbit hole.
I’m interested that the fake needlers apparently used the same set of points to select from as the real needlers used. We know there’s acupressure, where the points but not needles are used. I wonder whether the fake needles on valid points might not have had an effect and skewed the results back towards the simulacrum?
Just so distasteful, don’t you think? I find it of a similar quality to, say, homoeopaths saying their woo works by potentising water molecules by dilution and succussion, except that these guys are supported by funding, peer reviews an whatnot.
Based on your arguement that we can’t properly test tcm with an RCT….one should actually see a very strong treatment effect versus the assigned control. That is, you seem to mostly be complaining about the difficulty choosing an appropriate control.
You are correct that an RCT design would not be so useful if your outcome measure is overall health. However if we can narrow this down and agree on an outcome measure such as improvement in back pain or relief from migraines…then RCT can be designed
As I said, if anythig the treatment effect will be overestimated as it will be difficult to control and blind (patient realizes that they are getting fake needles)
But the ingesting thing is that even with sham needles, the acupuncture studies show no significant effect….as I said, with poor controls and poor blinding one would expect an overestimate of effect. So to me this is even stronger evidence that it does not work
I am not sure if you understand the gist of what I am saying as I am typing quickily on my iPhone between patients
David you’ve replied to me I think three times, and each time you’ve misrepresented my points.
I don’t think I’m arguing that we can’t properly test TCM with RCT, although I think it would be heinous complex and expensive. I don’t think overall health would necessarily appropriate either. More a case of whatever the patient presents with we treat according to acupuncture or control, and follow the outcomes. Over time we build a large dataset and we can look at e.g. back pain out of that. I think the reliance on RCT in medical studies isn’t always the right way to go, and I know there are some concerns even among the orthodoxy.
Nor am I *primarily* complaining about the difficulty of choosing a control although it seems obvious that neither fake needles nor fake TENS are valid – the primary complaint is that the choice of method for the verum is invalid – it’s not acupuncture. Also to argure “well it skews in favour of the verum” only serves a bias, when we want to get at some kind of truthiness.
I’m arguing that this study, picked from one of Drew’s lists of – references (where the heck *is* the author anyway?!), *doesn’t* test TCM with RCT. I’m arguing that
– the design assumes there is a tx for the ailment,
– the points restriction and lack of diagnostics mean the practitioner hasn’t actually been doing acupuncture,
– this”Western acupuncture” likely bears little relation to TCM,
– both controls and verum may essentially be doing the same thing,
– that this ‘same thing’ can result in effects in all 3 cases therefore all you really have is practitioner effect,
and the outcome shamefully is one more unexamined result that seems to go against TCM when it does nothing of the sort. Helpfully for the anti-CAM lobby though it becomes one more brick in the wall of “no proof”.
I am missing something here. I think you are suggesting that in the studies both the treatment and control work equally well versus doing nothing at all…therefore the treatment is still worth doing ?
I’ve made no statement as to whether the treatment is worth doing. We can’t tell from the study we’ve been discussing.
Here it is. Brace yourself:
The study didn’t do any acupuncture.
It isn’t possible to be more simple. The study says it tests acupuncture, but the verum isn’t acupuncture. It’s a child’s drawing of acupuncture. A vague wave in the direction of acupuncture, a fart in it’s general direction. The study says nothing about acupuncture, everything about the researchers’ arrogance, ignorance of what they are testing, the environment around them that supports their failure, and the dishonesty of the medical business.
You do realize that simply assigning patients to either control or treatment and collecting in a database…is a flawed study design which would give no useful information ?
Dude I’m responding to your diversionary tactics, not proposing a watertight and practicable methodology where far bigger brains than I have failed.
How about you deal with my key point: Here’s a study claiming to assess acupuncture that doesn’t actually do acupuncture, yet Drew uses it as evidence against acupuncture.
I don’t have anything better, let alone RCT-flavored. But I don’t *need* anything better – you do.
How hypocritical and dishonest is that of Drew to put such a study on his site, the researchers (smart people, technically speaking I’m sure) to persist with such a flawed study and publish it, and of you to continue to attempt redirection away from it?
But that is where you are wrong. It is on the onus of the practitioner to prove it works. Would you be happy if we just started giving drugs and doing surgeries based on anecdotes
Nope. Generally the practitioners and their patients are at least as happy as if they went to the doc and that’s as good as proof for a lot of people. Most folk don’t need any more.
Consider what you mean though by “proof”. What you likely mean is it has to be proven according to an extremely strict, constrained and scientism-dictated approach that it seems is actually not able to adequately carry out the method under test anyway. How would that be better if the CAMs did it instead?
You, the professional scientists, are unable to do the science properly. In this thread you’re still wiggling away from this truth.
“Would you be happy if we started giving drugs and doing surgeries based on anecdotes?”
David that’s just an inflammatory and dumb question. Why argue from extremes? Why provoke in such a way? It’s almost trolling. Any reader of this thread can see you ducking and diving.
I have at no point suggested such an approach, nor would I. Anecdotal evidence in large numbers is considered pragmatically valid in specific areas. Not, of course, when you can do full-blown RCT with all the knobs on. But you *should* know you can’t do too much RCT in medicine – you can’t placebo somebody with cancer, or a broken leg. But you can do a lot of testing and evaluation as to treatments and outcomes using theory, animals, large populations, follow-up interviews, cadaverous dissection… and make reasonable decisions with good and repeatable outcomes.
I am not wiggling in anyway. I am pointing out the double standard They CAM does dubious practices that they have not proven to be beneficial.
It is a cop out to say that one cannot test specif aspects of a discipline such as acupuncture in TCM.
That is like me saying that bloodletting is part of my overall treatment plan and if you look at in isolation it does not work…but when combined with my hypertensive pills and cholesterol pills…it is highly effective in treating metabolic syndrome.
I have a feeling that you have a very limited background, if any, in science and statistics
But we’re not *talking* about CAM double standards, we’re talking about yours based on your implied support for Drew’s site and the invalid research he cites.
If you want to test e.g. acupuncture then you have to respectfully find out what acupuncture is. Then you test it as a whole. You don’t make up some BS “Western acupuncture”, and you don’t pick arbitrary pieces. FIRST, you test as a whole. Then if you get some interesting results further research might ask “Well which bits are most important?”, and then you might pick some pieces to test. Just because RCT is hard, or you can’t get the grant, doesn’t give you license to screw with the method you’re testing and then claim *it* didn’t work. Face it: you’ve done crappy science.
Your bloodletting example is just plain dumb, and I’m sure you know it.
My background in science and stats is as good as it needs to be to address your implied ad-hom. For heaven’s sake David we’re not doing science or statistics yet. When we can get to a place where we’re actually evaluating acupuncture *then* we can start doing science. Until then it’s your bias hidden behind a veneer of respectability.
But we’re not *talking* about CAM double standards, we’re talking about yours based on your implied support for Drew’s site and the invalid research he cites.
If you want to test e.g. acupuncture then you have to respectfully find out what acupuncture is. Then you test it as a whole. You don’t make up some BS “Western acupuncture”, and you don’t pick arbitrary pieces. FIRST, you test as a whole. Then if you get some interesting results further research might ask “Well which bits are most important?”, and then you might pick some pieces to test. Just because RCT is hard, or you can’t get the grant, doesn’t give you license to screw with the method you’re testing and then claim *it* didn’t work. Face it: you’ve done crappy science.
Your bloodletting example is just plain dumb, and I’m sure you know it.
My background in science and stats is as good as it needs to be to address your implied ad-hom. For heaven’s sake David we’re not doing science or statistics yet. When we can get to a place where we’re actually evaluating acupuncture *then* we can start doing science. Until then it’s your bias hidden behind a veneer of respectability.
Nope. Generally the practitioners and their patients are at least as happy as if they went to the doc and that’s as good as proof for a lot of people. Most folk don’t need any more.
Consider what you mean though by “proof”. What you likely mean is it has to be proven according to an extremely strict, constrained and scientism-dictated approach that it seems is actually not able to adequately carry out the method under test anyway. How would that be better if the CAMs did it instead?
You, the professional scientists, are unable to do the science properly. In this thread you’re still wiggling away from this truth.
“Would you be happy if we started giving drugs and doing surgeries based on anecdotes?”
David that’s just an inflammatory and dumb question. Why argue from extremes? Why provoke in such a way? It’s almost trolling. Any reader of this thread can see you ducking and diving.
I have at no point suggested such an approach, nor would I. Anecdotal evidence in large numbers is considered pragmatically valid in specific areas. Not, of course, when you can do full-blown RCT with all the knobs on. But you *should* know you can’t do too much RCT in medicine – you can’t placebo somebody with cancer, or a broken leg. But you can do a lot of testing and evaluation as to treatments and outcomes using theory, animals, large populations, follow-up interviews, cadaverous dissection… and make reasonable decisions with good and repeatable outcomes.
You do realize that simply assigning patients to either control or treatment and collecting in a database…is a flawed study design which would give no useful information ?
Re experience over thousands of years. Experience can be very dangerous. A classical example are Monty Hall like problems were experience can cost you dearly. Another example is herbal medicine – where only approximately 15% of (experience based) established herbs display a pharmacological effect warranting further research. Experience from the prescientific era is extremely susceptible to all sorts of bias therefore this number is quite reasonable. The same goes for TCM.
A scientific theory always trumps experience. Do you know why ? Because “theory” refers to a concept that is extremely well supported by data, can be used to predict events and is highly unlikely to change substantially. So if a model violates a theory, the model must change.
Experience is what gives rise to data. It’s valid under certain – fairly obvious – conditions.
I would argue that theory and data/experience go pragmatically hand in hand, but that if we all observe X when the theory says Y then there’s possibly a problem with the theory.
Rich, apparently you do not understand what a theory is. You seem to use the term in the sense of “the theory of evolution is just a theory”. This is NOT how scientists use the word theory. In fact a scientific theory is a model that is extremely well supported by data, can be used to predict events and has withstood Poppers falsification test time and time and time again. A scientific theory is as close towards being fact as we can possibly get. Therefore any hypothesis that violates not only one but several theories is very unlikely.
Not at all. I agree that the theory of evolution is as close to fact as we’re likely to get. I think you’re being absolutist again: the logical fallacy is attempting proof by association – ToE is ultra-strong theory, whereas CAM and biomed you’re dealing with much weaker theories wherein that feedback loop allows theories to be refined or even thrown out. Phlogiston anybody?
I see you do not understand what a theory in the scientific sense is. *All* theories are ultrastrong. CAM and biomed are NOT theories, they are not even hypotheses but collection of treatment modalities. Phlogiston was also not a theory, but a hypothesis (despite being called a theory). Theories that are violated by TCM include germ theory and a lot of what we know about anatomy.
Sorry Thomas, this “scientific sense” is where it all falls down. Of course all theories are indeed ultrastrong by definition, until they are falsified. That’s a very specific definition, and only really useful in a very restricted domain. Theories aren’t absolute, and their construction does not include all data, all prediction.
You’re spending your time being absolutist – locked in a statistical representation trying to explain a world that doesn’t conform. All sorts of theories will have to change to incorporate much that we experience every day – love, subjective feeling, how consciousness arises out of meat…
I think we need the humility to recognise that theories are not absolute, and to make it explicit. Now I think that the falsification of a theory may arise from outside of that theory – new data, new theories which better explain/predict etc., so your absolutist position is particularly frustrating since you’re depending on some kind of magic whereby “oh hay, here’s the new absolute theory”.
But this is somewhat abstract, compared with the almost criminally bad study I dicsussed above
Rich, once again. A theory is not ultrastrong by definition, it is ultrastrong because it is supported by tons of data has withstood tons of attempts to disprove it. It is also ultrastrong because it is data derived. The key concepts of TCM are hypothetical and philosophical constructs postulating things that can not be seen or measured and that contradict scientific theories (germ theory for instance, but others too). In such a scenario science always trumps. Aside that, if your methodological framework is largely based on things that can not be measured or seen, it can not be derived from quantifyable experience, can it ?
I can’t agree. For some value of ultrastrong there is surely some corresponding value of ‘tons of data’. Some theories are (loosely) ‘better’ than others because they explain, predict more accurately based on more or less supporting data. I’ll take Newtonian mechanics being pretty strong over a range of phenomena, mostly billiard balls. But it’s weak as a baby at the sub-atomic level. I’m looking for a chink in your armour that says that maybe, just maybe, despite our ivory tower abstract definitions of what a theory is, there may be stuff we’re not yet grokking with science, and that we’re certainly not going to find out with such poor studies as those we’re discussing above.
You can be absolute today, but only if you admit that you’re going to want a different absolute tomorrow. Actually you can’t – either absolutism falls apart or you’re forced to be dishonest. What would be great would be the recognition that the world is rough at the edges, and that if we’re intellectually honest we’ll continue an inquisitive investigation into reality balancing models of enquiry, theories, data like spinning plates and willing to give a little tweak where required to keep the game alive.
Rich, Newtonian mechanics, specifically the gravitational part is a very good example to demonstrate what’s wrong with your approach. For millenia it was believed (from experience) that bodies fall with different velocities, that was until Galilei did his revolutionary graviational research. Newton expanded existing mechanical laws to a cohesive concept, namely Newtonian mechanics. Planck, Einstein etc. expanded Newtonian mechanics to Quantum mechanics. For TCM, otoh, to work one has to toss roughly 70% of our anatomical and functional knowledge over board. An example is the concept of Bing and Zheng. This concept is similar to homeopathy, expanded by a “diagnosis” which has in many instances nothing to do with anatomical or biochemical realities. This approach puts philosophy over reality and such approaches never fly. In the Wikipedia article on TCM you find an example with nose and mouth bleeding caused by liver-fire burning the lung and injuring blood vessels. The treatment is a concoction strengthening the lung.
Anyway, you yourself have put that main problem with TCM elegantly into words: “However I don’t think (and this is my view only) that germ theory
invalidates TCM. Some causes of imbalance are now better understood, but
the TCM treatment models are the same.”. In other words some things have been discovered, now we better understand a philosophical postulate but the treatment has not changed. In short, data have been squeezed into a model and not the other way round. That is not how medicine works because models have to be adapted to new knowledge and not vice versa.
Thomas, this is good stuff.
Allegedly Galilei didn’t do the Tower of Pisa experiment – it was a thought experiment that separated a 2lb rock into 2x1lb rocks tied by a string. He asked how fast it would fall, since (per Aristotle) a 2lb rock should fall twice as fast as a 1lb rock. So Galileo was philosophising in advance of data. At what point did his theory become ultrastrong?
I’m not sure that QM ‘extended’ CM, as much as rolled it up and chucked it in a cupboard, only to be brought out when we’re talking about billiard balls or inclined planes.
Point is for both examples a theory was overturned. Leaving aside the details, surely this establishes the principle that “there’s stuff we don’t yet know about”?
Re germ theory and TCM I think you’re mistaken again. I’m saying that sensible TCM prac will pre-pend his treatment with a bit of germy common sense. So on those lines a sensible prac will tell them to sort out hygiene etc before even thinking about acupuncture. That’s just common sense. Even the ancient Chinese must have wondered a bit about just how an imbalance came about, and howcome the entire village got the same vomiting imbalance at the same time after heavy rains.
This is all good fun, but isn’t addressing the dodgy study and the problem of the anti-CAM lot often doing a very bad job of pulling together credible anti-CAM evidence. That’s not to say that CAM works, but is to say that the science lot have a boatload of bias and a ton of bad science. If you set yourself up as an authority these days then surely you have to back it up effectively – if you God is science than you have to do some damn good science, yet we’ve seen from that study that it’s not always the case.
Meanwhile I have work to do, and the natives round here are restless. Thank you so much for the debate: it’s been informative and useful. I’m assuming I’ve persuaded you to move to China to study TCM for a decade in it’s full context so you can provide some balance to your absolutism and ultimately bring some real clarity to the field 🙂
Catch you again I’m sure.
As with the falling experiments, Galileo had predecessors. Galileo was NOT philosophising, Galileo was proposing an experimentally verifyable hypothesis. Quantum Mechanics DOES expands conventional mechanics because of the correspondence principle which says that all objects obey quantum mechanics with classical physics being an approximation for large collections of particles. The laws of Newtonian mechanics represent the means of the laws of Quantum mechanics. As for your sensible practicioner, he practices hygiene (which is a western concept) because he knows TCM does not work. As for the study, you should really *read* the whole and try to understand it. They had two placebo controls, one with nonpenetrating needles and one with pseudoelectroacupuncture. There was no difference between the two placebos suggesting that your acupressure argument is void. There also has been a strong practicioner effect (which are placebo effects mostly placebo effects). A Practicioner effect that strong in comparison to the main effect suggestst that the main effect is a placebo.
Galileo: I think you apply differing standards for the things you are for and the things you are against. Drew’s referenced studies aren’t interested in experimentally verifiable hypotheses – the one we looked at misrepresents the verum, uses a simulacrum that could have the same effect (yes, the fake TENS* too). If you really want to know about CAM you have to step over and insist that your rigorous standards are applied to the studies which claim to support your position: it’s dishonest to accept that kind of nonsense while being down-the-line with the opposition.
*Surely fake TENS is bobbins too – you feel a tingling sensation with TENS, how the devil can you fake it? The study also applied the fake TENS to the chosen points using electrodes which themselves may have stimulated the points. We already dealt with this Thomas. The more we look the worse this study gets!
So there’s no difference between acu, fake needles, and fake TENS partly because the verum isn’t doing acupuncture, and partly because they’re all three doing a similar thing. That says nothing about whether there are points or whether acu works or not, just that a bunch of folk failed to respect the method-under-test enough to design a half-decent study then went on to claim an authoritative outcome in a supportive and unquestioning community. The bias is immense.
QM: point taken, but kind of irrelevant. QM WAS a massive revolution in physics. If we’d all said of CM “it’s ultrastrong, therefore absolute: leave it alone” we’d not bother to build particle accelerators – that’s the implication of your absolute/ultrastrong theory position.
The sensible practitioner says there’s no point in her using TCM in the example, since the patient will just come back next week with the same ailments having re-exposed themselves. It’s what you’d do irrespective of what treatment you had to offer. Once they’ve stopped piling on the stimulus you can see where you are.
Rich, you should really *read* the study and try to understand it. Look who the principal investigator is. it is practicioner 3, i.e. an acupuncturist. Second for fake TENS the same argument goes as above for unbliding, only this time you can’t come up with acupressure. Finally, apparently you are not aware what a strong practicioner effect (a known placebo) means. Just look at the numbers. The effect for practicinoer 3 is almost twice the average effect for the two others. That means that the practicioner effect is large compared to the acupuncture effect which in turn is a strong indicator that the acupuncture may be in fact a placebo. These problems are very accurately described in the discussions setting
I have read it, but really there’s no point going beyond $2 – the point that the design falls apart in a shambolic heap of comparing three versions of essentially the same test. It’s illegitimate.
Acupressure was a way to say that (in the acu world) you can get effects at points using means other than needles.
So the study lets both controls do things at acu points. The verum does things at acu points. Surely that’s a massive problem? Even ignoring the restricted set of points and the lack of diagnostics/pulses – which itself is enough to chuck the study away..
Now you want to bring in practitioner effect ignoring the prior fact that the practitioner isn’t actually doing acupuncture. The practitioner effect will of course be exaggerated because all 3 treatment modes are essentially the same!
The problem with pulse diagnosis is that it could be measured very well, by using machine learning techniques. Doing so would be an excellent proof for the the existence of acupuncture points. However, tis does not fly either since pulse diagnostics also violates basic principles of how the body works.
The problem with pulse diagnosis is that it could be measured very well, by using machine learning techniques. Doing so would be an excellent proof for the the existence of acupuncture points. However, tis does not fly either since pulse diagnostics also violates basic principles of how the body works.
You may not be familiar with the subtleties of pulse diagnostics. However the point is that there were none in the study – that alone invalidates the claim they are doing acupuncture.
“Pulse diagnosis also violates basic Western white-man medical establishment principles of how the body works” FTFY
IN the same way that QM and CM can be both explainers of phenomena is there any way you can conceive of more than one model of body function?
I have read it, but there’s no point beyond $2 where it falls apart in a shambles of doing the same thing three times. It’s illegitimate.
I used acupressure to indicate that (in acu world) effects are possible at points using means other than needles, not to assert that acupressure was going on. Both controls and the verum are doing things at points. The verum isn’t doing acupuncture at all – restricted points and no diagnostics.
Only when you’ve dealt with those showstoppers can you think about practitioner effect – of course it’s exaggerated because that’s the ONLY factor actually in play. There is no acupuncture effect to be compared because there is no acupuncture.
BTW this “Western acupuncture” thing is getting to me. More arrogant and elitist white men doing weekend courses and then telling the world they’re experts in somebody else’s domain.
Hmm… my posts are disappearing. Glitch.
Acupressure was an example of action at a point without needles. Fake needles and fake TENS are also examples. The verum is not doing acupuncture.
Of course you see exaggerated practitioner effect because that’s all you’ve got going on – control and verum are basically the same thing
Like the Greeks, the Chinese recorded epidemics of disease for which they applied various remedies, both as treatments and preventatives.
Austrian double talk
Dude please don’t screw with the discussion. We’re having fun here.
I didn’t discuss TCM in the other reply.
In straight objective absolutist western scientific terms 😉 – yes, key concepts of TCM are hypothetical and philosophical. In terms of clinical practice and introspection – both leading to predictive consensus – TCM concepts have utility. Diagnostics and other tools allow feedback loops.
They derive from a time when germ theory wasn’t known. However I don’t think (and this is my view only) that germ theory invalidates TCM. Some causes of imbalance are now better understood, but the TCM treatment models are the same. Pragmatically Chinese hospitals apply modern hygiene alongside TCM recognizing they are both useful. I think any modern TCM practitioner who said germs weren’t a factor wouldn’t be worth listening to.
Science always trumping is IMHO an arrogant stance – we don’t have good theories of love yet, sociology is a science… you have to live in a very restrictive subset of reality to hold that view.
No, meat arises out of consciousness, but one would never know that until they were fully conscious of consciousness.
“fully conscious of consciousness”
That’s your problem right there @Marcel. Where are you going to stand to be conscious of an axiomatic everywhere consciousness?
We’re made of meat: https://youtu.be/7tScAyNaRdQ
Om Shanti
It seems that you missed the humor, but if you must know, everywhere.
“It seems that you missed the humor” – you’re joking, right?
You can’t stand everywhere dude. Your feets is too big. You can only stand somewhere, and then duality pokes you in the eye. How it is is how it is, and this view is like a smile on a dog.
What you meant to say I’m sure was “deep in the neural substrate”
Neural substrate? A mere reflection of consciousness, or, if you like, the Tao, but let’s not go there. I mean, “How can you be in two places at once when you’re not anywhere at all?
There you go again: reflection in what?
I can’t speak for you as, to be perfectly frank, you’re not passing my Turing test right now.
But I’m right here.
How do I know? I’m pink, therefore I’m spam. See: meat again. Take care not to put Descartes before des horse my friend.
You’ll find that people like T.M. deal in absolutes at least they claim so, even in the face of evidence to the contrary. Its why science and medicine can’t advance, these types stand in the way. We’d still be living in caves with Thomas as our leader.
Why don’t you stop using theory if you mean Model then. The accepted definition doesn’t support your statements. https://uploads.disquscdn.com/images/7b798856628625ba00e85fb5cff09d2160b258c8200dc4666aff5faedab1d617.png
To Thomas, NO ONE understands ANYTHING until Thomas Almighty informs them.
The dog barks, the caravan moves on, ignoring it.
Thomas, that gets an up vote and a big smile!
You love that story. Get the plastic bag
Experience is what gives rise to data. It’s valid under certain – fairly obvious – conditions.
I would argue that theory and data/experience go pragmatically hand in hand, but that if we all observe X when the theory says Y then there’s possibly a problem with the theory.
To Thomas bias exists ONLY in things not in the narrow sense of “SCIENCE”
There are some other points:
First, a trial may estimate the treatent effect correctly, or may under resp. overestimate it. The source for overestimation is almost always poor matching of patients or a bad placebo not controlling for the placebo effect. The source of underestimation is almost always poor matching of patients.
Second, the treatment in the verum arm is always designed in the way that it represents the treatment under ideal conditions.
Therefore the problem with RCTs in acupuncture is *not* the verum arm as you think, but proper selection of the placebo in order to avoid overestimation of the treatment effect.
If you take into account the “ideal treatment” approach taken in trials, a more realistic approach would lead to a lower observed efficacy of the treatement, which is indeed the case in *all* follow studies monitoring efficacy in the real world.
Taken together this points towards a low efficacy of acupuncture, if any.
You’ll find Thomas, David and Jonathon Graham similar in that their stubborn natures won’t allow much mental flexibility. As many times as you suggest white or gray areas they will strictly stay with black only.
The argument we treat the whole patient and not the ailment is very old and always comes up if the argument personalized medicine can’t be tested by RCTs fails. But this is a misconception.
What an RCT actually does is to determine the probability to get the observed data under the assumption that the methods applied are equally effective. That means it answers the question how high is the probability that I get my data if I assume treatment1 and treatment2 are equal. I.o.W. an RCT tells one whether a treatment is snake oil or not. For this question it is completely irrelevant if you treat the entire patient, do a symptomatic treatment or just sing to the moon.
If you have the hypothesis acupuncture is an effective treatment, the prior probabilty of your hypothesis comes into play. Given the fact that acupuncture is remarkably resistant to sound explanations the prior probability of the hypothesis acupuncture works is low to very low. This in turn means that even with p-values around 0.01 the probability of your hypothesis to be true (i.e. acupuncture works) is still low. This is what I mean with if your treatment does not show strong effects (as reflected by low p-values) it rarely makes sense to look for a baby in the bathwater that has been thrown away.
Does it not make sense to reference the few well known papers and systematic reviews? It seems like you want “balance” by referencing studies that showed a positive effect. That is the problem with CAM, almost all the studies that show positive effect had no control group or have lack of blinding. So it would provide a false balance to include such studies
It only makes sense if those papers genuinely support your position. I’ve tried to argue that the methodology is blinkered and flawed, and that most studies test fake against fake and of course deliver no significant results.
It’s not about ‘balance’, it’s about understanding that you absolutely cannot take seriously a paper that claims to test e.g. acupuncture for back pain, because there *is* no such thing as a standard tx for back pain. And there are lots of those kinds of papers in Drew’s references. It’s quite possible that papers which genuinely investigate acupuncture also show no better than placebo, but at this point we don’t know.
I think Drew’s referencing is lazy, which works in service of his prejudice and the site.
If acupuncturists are claiming that acupuncture can help pain, then why do you need a standard of care treatment. Just compare acupuncture for back pain versus placebo which is sham acupuncture. You seem to be saying that you know acupuncture does not work for back pain do why bother doing the experiment.
If acupuncturists are claiming that acupuncture can help pain, then why do you need a standard of care treatment. Just compare acupuncture for back pain versus placebo which is sham acupuncture. You seem to be saying that you know acupuncture does not work for back pain do why bother doing the experiment.
Acupuncturists claim benefits for back pain according to various criteria, but probably not (if they have any sense) including RCT-based studies. While RCT is simplistically described as the gold standard, there are known problems with it as a one-size fits all approach. There are also problems with the assumption that the state of evidence-based scientific method in 2016 is an absolute.
One practical problem is that of “translation” from TCM into western mind-set, I guess for practitioners as well as patients, whereby we have to pretend we’re talking the same language. So a patient will present with back pain and the prac says “let’s have a look”. She doesn’t necessarily tell the patient she’s balancing kidney yin by needling liver XII or whatever, since it has no meaning in their “back pain” world.
You say “acupuncture for back pain”. Please try to consider that there exists a model wherein there is NO standard tx for back pain: I don’t know whether it works “for back pain” in RCT terms because the studies I’ve seen are not testing it.
I’m critical of Drew’s site not because I’m a shill for CAM – get me on to homoeopathy and you’ll see another side – but because it sets out to rubbish CAM while providing lazy references and not understanding what’s represented in them.
Acupuncturists claim benefits for back pain according to various criteria, but probably not (if they have any sense) including RCT-based studies. While RCT is simplistically described as the gold standard, there are known problems with it as a one-size fits all approach. There are also problems with the assumption that the state of evidence-based scientific method in 2016 is an absolute.
One practical problem is that of “translation” from TCM into western mind-set, I guess for practitioners as well as patients, whereby we have to pretend we’re talking the same language. So a patient will present with back pain and the prac says “let’s have a look”. She doesn’t necessarily tell the patient she’s balancing kidney yin by needling liver XII or whatever, since it has no meaning in their “back pain” world.
You say “acupuncture for back pain”. Please try to consider that there exists a model wherein there is NO standard tx for back pain: I don’t know whether it works “for back pain” in RCT terms because the studies I’ve seen are not testing it.
I’m critical of Drew’s site not because I’m a shill for CAM – get me on to homoeopathy and you’ll see another side – but because it sets out to rubbish CAM while providing lazy references and not understanding what’s represented in them.
The biggest problem is in defining that criteria. If you define your criteria ahead of time, then you can still use RCT-based studies. Unfortunately, when it comes to acupuncture, it’s always the case that, when the RCT fails, the response is, ‘Oh, that’s not the right criteria.”
Yeah, that kind of excuse happens far too often. I’ve found it a lot esp with homoeopaths, where they continually move the goalposts each time you nail them. But it happens on the other side as well – e.g. fake needles claimed good based on a study of 37 subjects where 40% could tell the difference.
You might enjoy the discussion above where I’ve taken a study and tried to show how appallingly bad it is – irrespective of what the claimed outcome is. It’s not just defining your criteria, but good design etc. and actually paying some respect to the method-under-test so that it isn’t misrepresented even before you begin.
Does it not make sense to reference the few well known papers and systematic reviews? It seems like you want “balance” by referencing studies that showed a positive effect. That is the problem with CAM, almost all the studies that show positive effect had no control group or have lack of blinding. So it would provide a false balance to include such studies
I’m curious Rich–can these supposed pulses be picked up electronically or mechanically, as can venous or arterial pulses?
What a pathetic trolling comment.
Take a few hundred TCM practitioners claiming pulse skills. Take a few thousand random people. Take the pulses, make a diagnosis for each, by each. Compare.
Your reliance on ‘electronically or mechanically” marks you out as an idiot. For 99.9999% of our existence, we were oblivious to the existence of electromagnetic radiation.
Has this been done? If so, cite the publication where I can find the results of the comparison, please.
Ya… If I wanted to test such a thing with my extremely limited background (chemistry lol) I would simply set the expert up to determine all the points to be needled (he should be able to do this WITHOUT needling, right?) and then you split the patients into 2 groups: those who are needled in the “expert opinion’s” spots and those who aren’t. Of course, blind everyone to which ones receive the correct needling. You could also split the two groups further into sham acupuncture (sheaths or whatever for the fake needling) and those who actually get it…
The complaint that the method can’t be studied is a cry of desperation imo, and doesn’t seem to be based on anything but the briefest thought about how to excuse the methodology for it’s failures in testing (or possible testing)
Hi Thomas, My experience of debating this with homoeopaths is that they continually flip-flop between a “specific tx for X” and “every patient is an individual”. I’ve given up on them not only because there’s no level I can consider the possibility that homoeo works, but because they can’t get a straight argument together.
But your comment is about RCT rather than homoeopathy per se, and I agree you can in principle test almost anything with RCT and that the precise tx administered would be irrelevant. It probably gets complex quickly though:
– monkeys won’t help you balance out practitioner “bedside manner” and placebo.
– you can’t use fake needling for acupuncture because it’s not credible. I’d argue that if a person can’t tell the difference then they can’t be trusted with a subjective evaluation of their pain reduction.
– any number of other factors must be controlled for over the period of evaluation – exercise, diet, emotional upset.
– but mostly, people don’t seem to actually do RCT in such a manner – bringing me back to my original criticism of the NaturoFAQs site. I’ve only skimmed the references, but from what I’ve looked at they are almost all e.g. “acupuncture effectiveness for lower back pain”. If there were actually studies along the lines you suggest, and if Cochrane-like systematic reviews concentrated on those alone, then we might be getting somewhere. As it is, the site attempts to overwhelm with apparent negative studies without discriminating those where there’s a valid (for both science and the therapy being studied) model and those which start from the condition.
I can’t speak to probabilities and such as I’m not familiar and not about to read up on it.
Acupuncture as a belief system has ‘000’s years backup in Chinese history, and anecdotally after a number of years of Taoist meditation practice I find it to be consistent with my own subjective experience. In the same way and despite a lot of subjective investigation I can find no similar support for homoeopathy. We’ll likely disagree on this, but IMHO the subjective domain is one where science as yet has little purchase. Remember Popper 🙂
I use monkeys as an allegory for doing something by chance. Anyway, as for your placebo arguments. Pain and pressure reception is something very strange and depends heavily on the distribution of receptors. I.o.W. it is well possible to needle somebody painlessly without this person having an exact feeling what is happening. But you do not need fake needling. You can compare a real acupuncture where the points are assigned by an expert with an acupuncture where you needle the patient at any coincidentially selected spot on the skin. The consensus of the literature is that acupuncture might be of some value in lower back pain but is of very questionable value in other pain conditions. In my experience this is a typical pattern of false positive observations because real effects reveal themselves pretty quickly and clearly. A p-value should not so much been used to try “establish” an effect where it is doubtful (this approach is very prone to false positives), but to help disregarding effects that seem to be there but aren’t. To put it bluntly: If you don’t have a clear statistics, it’s rarely worth to search for a baby that has potentially been thrown out the bathing water. As for your argument to tradition. Ancient egyptian medicine has a more than 4000 long tradition, yet is not used anymore.
Monkeys are cool. I think my point about apparent practitioner competence and placebo might still stand though.
If you needle somebody without sensation then you probably haven’t hit the point. AFAIK patient feedback about the quality of sensation is an indicator to the practitioner that they have hit the point. Palpation alone prior to needling is only half the job. You do have to work with the model you’re testing. If there’s no point at the random needling location then you don’t get the feedback. If there *is* the correct sensation at the random location then maybe you’ve hit another point altogether, so you’ll have to take that possibility into account as well. On the sciencey side I guess you’ll have to account for variations in receptor distribution as well.
Consensus in the literature on lower back pain might be valid or misdirection – I’m not sure it’s relevant. I’m still looking for those studies which do take account of how acupuncture is practiced rather than an artificial “does it work for condition X” approach which, while no doubt simplifying experimental design is still basically testing fake vs fake and getting the expected results. And again – the site I’m criticising doesn’t even begin to consider these complexities while providing a boatload of potentially-questinable studies to support it’s anti- position.
I wasn’t trying to make an argument from tradition, which I recognise as a possible fallacy. I was responding to your comment about an unlikely belief system, which I felt trivialised the vast background that acupuncture has compared to, say, homeopathy or even (winks) scientific method.
I don’t know too much about ancient egyptian medicine but I suspect that turned out differently because a) there were some aspects whcih correspond well to modern medicine and b) (mostly) the persians conquered Egypt and typically tended to wipe out the culture of their conquests rather than (as Christianity has done) to subsume/incorporate it.
Thanks for the exchange Thomas, I’ve appreciated your clear arguments.
There are pro-vaccine advocates implying vaccination is natural too, which is nonsense. Injection and by passing our true immune mechanisms borders on Franken-science.
Rich, the problem is how naturopathy works. A combination of “natural” remedies (logical fallacy appeal to nature) with traditional remedies (logical fallacy: appeal to tradition). There is no alternative medicine, but only medicine that works. This medicine is subject to scientific scrutiny and methods are abandoned if they do not work. Therefore one does not have to disprove naturopathy, but demonstrate that it works before applying to patients – and there is where naturopathy largely fails.
As an Ontario resident, I am so pleased to see a UofT student doing this! And I am quite disgusted, but not really surprised, that they would be doing a study on homeopathy for ADHD at UofT.
I am a PT grad from McMaster. Even in 2000, they had various “practitioners” come in to give talks about various CAM practices. I recall the students thinking how silly the therapeutic touch demonstration was, but we just laughed…. we were not mature enough to complain about it.
I commend you for taking the initiative to create your site. It’s not nice to have some classmates get ruffled by your willingness to take a stand against sCAM’s, but I’d rather have someone like you for a doctor than a “shruggie”.
So you oppose efforts to help those with ADHD. What other things do you oppose that might help others? Let me guess, pharmaceuticals are the ONLY course of action we should support. Are you a pharma rep?
“So you oppose efforts to help those with ADHD.”
I am afraid you have reached an erroneous conclusion. I have re-read my post, and don’t see where I suggested that. I am a PT; we are pretty caring people on the whole, who would never oppose good research into ADHD.
“Let me guess, pharmaceuticals are the ONLY course of action we should support.
I don’t understand how my post could be interpreted this way.
“Are you a pharma rep?”
No, I really am a physiotherapist. I understand how online posters could conceivably be faking their identity, but I really am a PT!
Once again, Drew, thanks for caring enough to make your site. We need more champions for reality-based medicine!
AutismDadd, you made several assumptions here, with poor evidence. What if I concluded a few things about you? Like, you must have autism, and epilepsy, along with spelling difficulties, and have a dad. Am I right? I have the powerful evidence of your online name; I can’t be wrong about my conclusion!
One reason I avoid posting on sites I read, like this one, is that a lot of space is taken up by comments like yours. You did not seek clarification, but jumped to quite silly conclusions about me. Seriously, do you really believe the comments you made above? Pharma rep? Pill pusher etc?
I would like to continue to post once in a while, but I won’t reply again to this kind of post. I just wasted half an hour of time I could be spending with my autistic child.
You said you’re disgusted they are testing homeopathy at U of T. Ergo what would someone conclude? On these sites we have more than enough shills and deniers who muddy the discussion with misinformation. You stated off sounding like one with the above statement. As a parent with an autistic child I’m for any avenue that might help and I’m only disgusted with those who oppose this much needed research.
Do you have the slightest clue how homeopathy is supposed to work?
Tell me, does it (homeopathy) violate any basic laws of chemistry?
If yes, explain.
If, no, explain.
Who cares? If you have a point make it, why beat around the bush?
Don’t blame me for your inability to understand. The fact you don’t know how homeopathy works and why it’s complete crap doesn’t surprise me at all.
Beating around the bush
Still nothing. You are a complete waste of time and space. A religious zealot.
No I’m not, but hey beating around the bush isn’t something to crow about either.
Still nothing. You are a complete waste of time and space. A religious zealot.
Do you have the slightest clue how homeopathy is supposed to work?
Tell me, does it (homeopathy) violate any basic laws of chemistry?
If yes, explain.
If, no, explain.
Homeopathic treatments for ADHD, however, don’t fall into the realm of “things that might help”, AD: they’re just water.
So you oppose attempts to help. Real nice
It’s fraud you fool. It’s just WATER! The only thing it does is prey on desperate people.
BTW, you owe me a new irony metre.
You’re fine with homeopathy trying to “help” but somehow vaccines that actually working are evil. You’re unbelievable!
You certainly botched that reply. You sound idiotic
No, I don’t: I oppose homeopathy because it has been factually established not to be of any more help than placebos.
Sounds like you do. Shameful
Better get your hearing checked then, AD.
What?
Don’t you have a child to raise, rather than seemingly hours to spend trolling people with obnoxious, nasty, and immature comments that contribute nothing to any kind of productive discussion?
bbbrraaattt
Sounds like you do. Shameful
Let me explain something to you: you do NOTHING WHATSOEVER to help those with ADHD or autism. You promote pseudoscience and quacks.
That doesn’t explain squat…you are closed minded and have tunnel vision.
You deliberately spread false information. This is called lying. Lying never helps a case. Got that ?
The Pharmaceutical Industry perfected the art of lying. And your education trained you to follow orders
Let me explain something to you: I know how to read clinical studies. I know how to think data based. You do not. You have no education. You even do not know the meaning of “segregated” or “suffering”. In fact your moral education is so low that you would accept deaths of children as happened on several occasions when a measles outbreak happened.
So making assumptions makes you Thomas Almighty?
The whole world lies. Big Pharma lies. Government lies
So you agree that chiropractic has it’s place and does some good…..thank you for clarifying and confirming what I was saying.
The evidence for the efficacy of chiropractic consists of this: for lower back pain it works about as well as the standard treatment. Time, rest, antinflammatory meds info pamphlet on strengthening the lower back. That’s it; there’s no good evidence that chiropractic is useful for any other condition.
The evidence for the efficacy of chiropractic consists of this: for lower back pain it works about as well as the standard treatment. Time, rest, antinflammatory meds info pamphlet on strengthening the lower back. That’s it; there’s no good evidence that chiropractic is useful for any other condition.
Chiro consists of Tens Unit use, manipulation, massage, diagnosis of certain skeletal issues and ways to mitigate their effects…….and a whole host of other issues. Again, you are saying it….that chiro has a net positive effect on certain conditions. Thank you for agreeing with my position.
Actually, you’re describing physiotherapy. And really, the “thank you for confirming my position” is kind of silly when it’s clear I am not.
Actually, you’re describing physiotherapy. And really, the “thank you for confirming my position” is kind of silly when it’s clear I am not.
Chiro consists of Tens Unit use, manipulation, massage, diagnosis of certain skeletal issues and ways to mitigate their effects…….and a whole host of other issues. Again, you are saying it….that chiro has a net positive effect on certain conditions. Thank you for agreeing with my position.
So you agree that chiropractic has it’s place and does some good…..thank you for clarifying and confirming what I was saying.
Hello, Britt Marie. Love the blog! I somehow discovered this blog last night…Oddly enough it came up in a search engine when I I was reading an about Malachi Love-Robinson, the 18-year-old man in Florida who set up a bogus clinic and was “practicing medicine” with no formal medical degree.
Not sure if you’re familiar with the story, but it sounds like you have enough on your hands right now, with studying for your M.S. degree.
Not particularly familiar with the whole naturopathic medicine route. I’m originally from the Chicagoland area, and I knew someone from my “church” (which l later realized was a very unhealthy and cult-like religious organization…but alas, that is another story…) who was attending naturopathic school – it must have been the one in Lombard.
2 comments. One little nit-picky comment: shouldn’t u change the title to “confessions of a former naturopathic doctor”
2) This is very interesting to me because I relocated – about a year ago- to the N. side of Seattle suburbs, not far from Bastyr – the school *seems* to have a positive reputation in the area….leave it to “alternative Seattle” to come up with these things.
I wonder if perhaps in a more conservative area this school would not thrive?
I’m not sure who wrote this (you or a commenter) but this school is def. “which doctor”
Furthermore, many of these things u were taught (homeopathic remedies) a person could just research and learn on their own…(disclaimer: yes, I know that is true of many grad school programs…but some of these “home remedies” could be easily looked up online/bookstore/library.)
Seems such a pity to pay med school prices to learn crap…
*Witch doctor*…so many typos.
My point is: sorry that you had to go through this…hopefully your blog will help others.
I’ve been involved in a long thread with Thomas and David, in which the technicalities have obscured the reason I came here. So forgive me for posting a summary below to bring it up to date.
I’m here critiquing Drew’s new anti-CAM site. He’s conspicuous by his absence – he’s even anonymous on the NaturoFAQs.com site, which I think is a poor job Drew.
My criticism is based on his use of a pile of references to boost the same old “evidence-based” arguments, in particular he has what looks mostly like a listing of search results from Cochrane. I doubt very much whether Drew has reviewed them before posting them up. It would take weeks.
I picked acupuncture and argued generally that many studies don’t actually test acupuncture because they start from the idea of a specific treatment for a given condition. I’m not advancing the simplistic “we treat the whole person” argument here, but a more nuanced approach which would undoubtedly require enormous patient populations, cost and complexity to evaluate if we insisted on RCT.
Going from the general to the specific in response to Thomas I picked a random-ish study and opened it up (acupuncture ref 11). It turned out to be complete rubbish (for reasons discussed elsewhere in the big thread), but nevertheless it provides all the technical analysis, presumably peer review, and publication for posterity and the ‘benefit’ of anybody who likes to come along and cite yet another study that claims to find acupuncture to be of limited or no use.
In a nutshell: you can’t run studies where the verum isn’t doing acupuncture and then make any claim about acupuncture whatsoever.
That’s only one study. I have no time to explore the rest of Drew’s references
to see if any of them are valid. But that’s the point isn’t it – shovel a big pile of pseudo-evidence onto the website. Very few people whether pro- or anti- will take the time to investigate, they’ll just run their preconceptions. Drew’s site builds a positive reputation as does Drew, but the truthiness of the proposal that acupuncture might be worth doing is left a long way behind fame, fortune, and the onward march of so-called science-based big business medicine.
If you’re anti-CAM and trying to demonstrate it doesn’t work, and you have some allegiance to truth rather than merely ‘winning’, then you have to do a lot better. The edifice of apparent legitimacy of alt-med studies is very clever, but it looks like it might
just also be very dishonest.
You should read trick or treatment
The problem I see is that there are is a paucity of studies in the literature that can be accepted as evidence. You can pick up a whole journal and they disobey every rule of study design ….no predicted effect, no power/sample size calculation, no blinding, no control and then guess what 10/13 patients say they are better…therefore it is s positive result.
Hilarious!
We seem to be agreeing that there’s precious little evidence either way.
My next statement would be to suggest that we might all put aside our agendas and go for some truthiness.
Then I checked out Trick or Treatment – written by Singh and Ernst, who are IME two of the most vocal yet least rigorous opponents of CAM I’ve come across. I’m proud to be blocked by both on Twitter, basically for making the same points as I’m making here – if you ain’t got the evidence then be honest about it, and if you’re claiming the superiority of science then you have to use it properly yourself.
I think Singh and Ernst are at least as bad for the anti-CAM brigade as they are for the pro-CAMmers ‘cos they are such cowboys.
I might yet get a used copy of TorT off Amazon for a penny, or I might just open a cold beer. It’s a sunny Friday afternoon here.
Basically, rich, you are a big hypocrite. You have preconceived ideas and are not willing to listen to the research. You said from the beginning that you believe in acupuncture but not homeopathy. You now say that anecdotes are reasonable evidence to show that acupuncture and TCM are reasonable and effective treatments. Then isn’t it hypocritical to reject homeopathy as there are just as many (if not more) anecdotes that homeopathy is highly effective.
The rest of us follow the data. When Cochrane does studies (or metanalysis for that matter) they make initial criteria on what is an acceptable study design regardless of the outcome. They then take all the studies that meet that criteria and look at the results. They do not have different criteria for CAM versus other disciplines. Cochrane does not have any agenda to prove CAM does not work.
No no and no again. You’re determined to misrepresent me at every turn.
I am willing to listen to the research where it is valid. I dug into the study we discussed didn’t I to find out what the research really said? We picked a study and it failed miserably – again and again you won’t address it. Somebody else’s ideas are so strongly preconceived in their white western cultural context that they can’t even respect the treatment they purport to be testing to actually find out how it is done and emulate it in an RCT.
I don’t ‘believe’ in either acupuncture or homoeopathy. I have current positions based on various experiences and thoughts about them. I’ve personally gone further than anecdote and done both studying and introspection. Introspection in terms of assessing my own bias as well as subjectively exploring my own subtle experience. While not hard evidence of course, it leads to stronger positions IMO than “it worked for my Aunt’s dog” anedotalism. I’ll change my views when the factors supporting them change.
Anecdote may be a part of the picture in a pragmatic approach to determine usefulness of a treatment. Stronger evidence types are much more preferable if available – clinical experience, looking at outcomes, and RCT. If the RCT is too hard, too expensive, or results in the controls group dying for example, then we’re not going to go RCT are we? So we pick a lesser degree of evidence and proceed with care. Surely?
Follow the data? Sure, but your data has to be worth following. I don’t accept, and nobody *should* accept, Cochrane or anybody else as an infallible authority. Mistakes can be made – doesn’t have to be bias.
You are right. You shouldn’t accept them as infallible source. However, you need to show how it failed not just say it could have failed, and therefore I do not believe it.
You are right. You shouldn’t accept them as infallible source. However, you need to show how it failed not just say it could have failed, and therefore I do not believe it.
No no and no again. You’re determined to misrepresent me at every turn.
I am willing to listen to the research where it is valid. I dug into the study we discussed didn’t I to find out what the research really said? We picked a study and it failed miserably – again and again you won’t address it. Somebody else’s ideas are so strongly preconceived in their white western cultural context that they can’t even respect the treatment they purport to be testing to actually find out how it is done and emulate it in an RCT.
I don’t ‘believe’ in either acupuncture or homoeopathy. I have current positions based on various experiences and thoughts about them. I’ve personally gone further than anecdote and done both studying and introspection. Introspection in terms of assessing my own bias as well as subjectively exploring my own subtle experience. While not hard evidence of course, it leads to stronger positions IMO than “it worked for my Aunt’s dog” anedotalism. I’ll change my views when the factors supporting them change.
Anecdote may be a part of the picture in a pragmatic approach to determine usefulness of a treatment. Stronger evidence types are much more preferable if available – clinical experience, looking at outcomes, and RCT. If the RCT is too hard, too expensive, or results in the controls group dying for example, then we’re not going to go RCT are we? So we pick a lesser degree of evidence and proceed with care. Surely?
Follow the data? Sure, but your data has to be worth following. I don’t accept, and nobody *should* accept, Cochrane or anybody else as an infallible authority. Mistakes can be made – doesn’t have to be bias.
Basically, rich, you are a big hypocrite. You have preconceived ideas and are not willing to listen to the research. You said from the beginning that you believe in acupuncture but not homeopathy. You now say that anecdotes are reasonable evidence to show that acupuncture and TCM are reasonable and effective treatments. Then isn’t it hypocritical to reject homeopathy as there are just as many (if not more) anecdotes that homeopathy is highly effective.
The rest of us follow the data. When Cochrane does studies (or metanalysis for that matter) they make initial criteria on what is an acceptable study design regardless of the outcome. They then take all the studies that meet that criteria and look at the results. They do not have different criteria for CAM versus other disciplines. Cochrane does not have any agenda to prove CAM does not work.
Rich, as for the study, the study demonstrates very well that acupuncture Western Style has a limited efficacy at best. Your main point of critics was the non-use of pulse diagnosis. Given the incoherence of treatments based on pulse diagnoses (mentioned below) I think that acupuncture (Western or TCM style) is unlikely to work. Anyway, Britt does not have to do a lot more better.
Practicioners of CAM claim that their treatments work and they base this claim to a good deal by an appeal to traditions. As we have seen, appealing to millenia old knowledge contains maybe 80% pseudoscience.based on models violating todays knowledge. Nevertheless CAM practicioners claim their treatments work. Britt does not need to disprove CAM. It is exactly the other way round. CAM practioniers need to show their treatments work.
Non-use of pulse diagnosis is just one way in which acupuncture was not done in the study. Whether you think that pulse diagnosis is good, bad, or monkeys it is nevertheless a part of acupuncture practice. If you’re testing acupuncture you test it. Same with choice of points. You don’t drop pieces out for *any* reason. And like David, you’re *still* avoiding the key point – how is it a test of acupuncture if acupuncture isn’t being done?
You guys do have to do a lot better, because you’re providing false arguments from authority, summarised for people who in the main will not investigate the truthiness of your claims. Many will not be able to, will not have time to, or will have a pre-existing bias. That’s fundamentally dishonest, and hypocritical when you go on to demand that CAM instead proves itself according to whatever rubric you dreamed up with your spreadsheets, p-values and apparently blindfolded peer reviews.
If it weren’t for folk like you Thomas trying to run CAM out of town on such risible premises most people would bimble along with a few herbs or whatever here and there to make their lives a little more comfortable. Practitioners would make a decent but not great living. Big pharma (cf Ben Goldacre) would be rightly looking for a new job.
You could spend a bit of effort using that big brain of yours to start getting angry about dodgy studies, medical malpractice, excessive deaths in hospitals, iatrogenic illnesses and so on. You’d save $bn from health budgets.
Rich, i am very angry about dodgy studies. However in the CAM realm things are FAR WORSE. There is a study on CAM users in breast cancer in Canada. 80% survival with state of the art treatment, 40% survival with CAM. Despite these abysmal number there are entire clinics (Coleen Huber comes to mind) offering these death sentences.
Your statement “summarised for people who in the main will not investigate the truthiness of your claims.” is absolutely how many CAM practicioners work.
CAM (and this includes acupuncture) often works the way we take some ancient knowledge, assume it works and throw it onto the patient. This is not how medicine should work. Medicine should work the way that treatments are tested FIRST and used LATER. It is not rely on some ancient people, throw it onto the patient and test later, especially if the technique derives from a medical system that is fraught with pseudoscientific semiesotheric teachings.
Re Big Pharma and a few herbs, I guess if you take an Aspirin, you take an Aspirin rather then willow bark tea, right ? Do you know why ? Because with drugs you know the side effects, dosage etc. which you never really know with herbs.
“in the CAM realm things are far worse”. I doubt it.
Any death is regrettable, and I agree we should be addressing clinics like you mention. Homoeopathy for HIV/AIDS in South Africa comes to mind too.
How many unnecessary deaths do you think there are due to medical negligence? I’m finding numbers around 750,000pa in the US alone, although I haven’t dug deep into them.
Are deaths from government & pharma-supported medicine less significant than those from choosing CAM instead?
In the end a very small percentage of people refuse chemo/surgery in cancer, and maybe not all of those use CAM instead. Given death as a possible outcome I think many folk will make their choices very carefully and inclusive of quality of remaining life, age, and progression of the illness at diagnosis. I think the factor of choice and hence agency is important to many people. On the other hand we don’t have much choice about what we’re exposed to by orthodox medicine when we go for say a minor procedure and go home with a flesh-eating bug.
You’re batting for the wrong side Thomas: you’d be a *great* asset on the side of choice, personal freedom and empowerment. You know it makes sense.
With in the CAM realm things are far worse I meant studies investigating whether a treatment works or not. The problem with CAM is that they throw unproven – and in many cases not working treatments onto patients. One of the most striking cases lately was this boy in Canada. The problem with CAM is not direct death or damage caused by drugs, but delay of proper treatment. Since most of the people end up in classical medicine and don’t make much fuss of it these numbers are difficult to estimate. However judged from the few cases that come to court it must quite a problem.
As for your advocacy of choice. This requires informed consent. Most people can not assess the validity of evidence behind a treatment. If you look at the websites of CAM practicioners you will find none who honestly says that the treatments offered are unproven and experimental at best. This is another problem of CAM because essentially it is dishonest.
Yes, lots wrong with CAM. If you’re going to oppose it you have to do a proper job.
Choice and informed consent: yes again, but we’ve seen that the evidence behind studies can be very dodgy. If you want folk to trust your anti-CAM position then you have to be solid all the way down. If a study into acupuncture doesn’t actually do acupuncture – as we’ve seen – then you’re on very weak footing, and all you have is a weak argument from authority that falls apart at the first prod. Is that really the best you can offer?
Rich, for me there is no CAM or conventional medicine but only medicine that works. I do not have to be solid in any way. I just have to ask a six word question: Is there fairly reasonable scientific evidence ? Then it is YOUR task to present these data. This is the problem of CAM. The answer to this question is largely no, which renders these treatments ethically and medically questionable.
Once again. In order to justify a treatment we do not have to disprove it. The one proposing the treatment has to present supporting data. For CAM this is largly not the case, but this is NOT how medicine should work.
As for your choice argument, I am in favor of patients choice. Patients should have the ability to chose any treatment they want. However, I am also in favor of honesty, i.o.W. CAM practicioners should label their treatments accordingly, i.e. experimental at best, Voodoo at worst.
Rich, for me there is no CAM or conventional medicine but only medicine that works. I do not have to be solid in any way. I just have to ask a six word question: Is there fairly reasonable scientific evidence ? Then it is YOUR task to present these data. This is the problem of CAM. The answer to this question is largely no, which renders these treatments ethically and medically questionable.
Once again. In order to justify a treatment we do not have to disprove it. The one proposing the treatment has to present supporting data. For CAM this is largly not the case, but this is NOT how medicine should work.
As for your choice argument, I am in favor of patients choice. Patients should have the ability to chose any treatment they want. However, I am also in favor of honesty, i.o.W. CAM practicioners should label their treatments accordingly, i.e. experimental at best, Voodoo at worst.
Yes, lots wrong with CAM. If you’re going to oppose it you have to do a proper job.
Choice and informed consent: yes again, but we’ve seen that the evidence behind studies can be very dodgy. If you want folk to trust your anti-CAM position then you have to be solid all the way down. If a study into acupuncture doesn’t actually do acupuncture – as we’ve seen – then you’re on very weak footing, and all you have is a weak argument from authority that falls apart at the first prod. Is that really the best you can offer?
With in the CAM realm things are far worse I meant studies investigating whether a treatment works or not. The problem with CAM is that they throw unproven – and in many cases not working treatments onto patients. One of the most striking cases lately was this boy in Canada. The problem with CAM is not direct death or damage caused by drugs, but delay of proper treatment. Since most of the people end up in classical medicine and don’t make much fuss of it these numbers are difficult to estimate. However judged from the few cases that come to court it must quite a problem.
As for your advocacy of choice. This requires informed consent. Most people can not assess the validity of evidence behind a treatment. If you look at the websites of CAM practicioners you will find none who honestly says that the treatments offered are unproven and experimental at best. This is another problem of CAM because essentially it is dishonest.
We follow the evidence. If the preponderance of evidence shows that a treatment works we use it and if it shows it doesn’t we discard it. Name one treatment that CAM purveyors have discarded over the years?
In my field of ophthalmology, there have been many vitamins etc pushed. Very large well done studies have shown that a formulation of vitamins slows down macular degeneration if one has category 3 macular degeneration. So I recommend this to every one of my patients who meets this criteria.
You need to divorce yourself from your preconceived ideas and look at the evidence available
“We follow the evidence”
Of course. Agreed. But the evidence has to be good.
We have here a site NaturoFAQs.com, and a post from the mythical Drew that claims to provide a summary of the evidence so that biomeds can be authoritatively informed.
Yet we looked, and immediately found a study where the data was based on bad application of the method being tested.
That calls into doubt the professional ethics of everybody involved.
I’m sure the vitamin regimen you mention *does* have much stronger evidence. Certainly it’s more amenable to RCT, administering vitamins is much simpler than acupuncture, and conceptually easier as well.
Dude I’m not anti-science or pro-CAM. I’m anti the unsupportable proselytising the passes itself off as science as much as I’m anti some of the bonkers claims made for CAM.
I disagree. You are unhappy with the study design as it did not meet YOUR definition of acupuncture. The TCM definition of acupuncture based on meridians is not plausible by what we know about science, and therefore these practitioners were testing acupuncture based on a more plausible mechanism.
Rich, the problem isn’t that studies where data is based on bad application return negative results for acupuncture’s effectiveness: the problem is that studies where data is based on good application return results no better than achievable by placebos.
The problem is that here’s a site that over-exaggerates the value of the referenced studies in support of the author’s own bias to advance essentially a political manifesto supported by big business. But, you know: shareholder value is God.
What site are you referring to? I haven’t referenced one in my post.
And if you’re going to suggest that the results of appropriately designed, appropriately blinded and controlled studies published in peer-reviewed journals are not the correct form of evidence o which to base our conclusions regarding the safety and efficacy of alternative medical treatments such as acupuncture, what do you suggest we use instead–arguments from antiquity, anecdotal accounts, personal testimonials or ‘gut instinct’?
We follow the evidence. If the preponderance of evidence shows that a treatment works we use it and if it shows it doesn’t we discard it. Name one treatment that CAM purveyors have discarded over the years?
In my field of ophthalmology, there have been many vitamins etc pushed. Very large well done studies have shown that a formulation of vitamins slows down macular degeneration if one has category 3 macular degeneration. So I recommend this to every one of my patients who meets this criteria.
You need to divorce yourself from your preconceived ideas and look at the evidence available
Again, hypocrisy …why do you agree that homeopathy should not be used to treat hiv. There are again just as many “studies” and anecdotes showing the amazing effectiveness of homeopathy.
Again, hypocrisy …why do you agree that homeopathy should not be used to treat hiv. There are again just as many “studies” and anecdotes showing the amazing effectiveness of homeopathy.
“How many unnecessary deaths do you think there are due to medical negligence? I’m finding numbers around 750,000pa in the US alone, although I haven’t dug deep into them.”
Undoubtedly an estimate, the figure may be overblown.
Here’s an excerpt from a report I prepared for a client several years ago:
“Using data derived from 4 studies spanning the years
2008 to 2010, an evidence-based estimate published in 2013 determined that preventable deaths associated with adverse events in US hospitals number at least 210,000 per year. An accurate figure was precluded by limitations of the
primary tool used to gather the data and the incompleteness of the available records. Based in part on estimated errors of commission in hospital records, it was further concluded that premature deaths in association with preventable
harm may amount to 440,000 hospitalized patients annually, or approximately one-sixth of deaths from all causes in the US each year (James, 2013).”
I can already hear the apple-to-oranges hypothesis that the medicines and procedures proffered by naturopaths would result in fewer deaths. But when the available evidence shows they are not effective, their administration would effectively constitute preventable harm.
James JT (2013). A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 9(3):122-8.
Top data.
Surely if one-sixth of preventable deaths in the US each year simply didn’t go into hospital then many of them would have lived longer. Medicine kills millions: fact.
Yet Thomas, with whom I think I was discussing this, is happy to attack naturopathy on this point. IMO claims like homoeopathy curing HIV/AIDS are pretty damned wicked, but even including that and early/avoidable deaths from cancer – sheesh… you and Thomas have a fecking cheek to point back at CAM on this.
“Surely if one-sixth of preventable deaths in the US each year simply didn’t go into hospital then many of them would have lived longer.” Not necessarily. Without any treatment, they could easily have died sooner.
Me again rich. You are misinterpreting the data. If a patient comes in to emergency with a ruptured abdominal aneurysm ….taken to operating room and dies on the table….that is medical error. Many of the cases called medical error are such cases where the patient would have died and heroic attempts were made to save them.
If all The worlds CAM practitioners disappeared tomorrow, I do not think the worlds health would suffer one bit. If all medical personnel disappeared tomorrow…
I admittedly not looked at your paper in question until now. I am not sure why you have a probers with this study design. They are looking at acupuncture not based on TCM They never said they were examining TCM and the heading on said website is acupuncture not TCM.
Your hypothesis is that doing acupuncture by a TCM practitioner taking into account pulse diagnosis etc may have given better results.
The theories of vital energy and energy meridians are equal in plausibility as homeopathy principles!!!
However Drew’s site lumps this in with acupuncture in general. He makes no distinction between western and chinese, yet proffers authoritative advice that acupuncture (all of it) doesn’t work. Unethical.
I just had a look at a definition of Western – they drop all the ‘woo’, but rather than develop a theory of points themselves they still use the classical points, on the assumption that they’ll be the right ones. I think that’s nuts, no more than a cargo cult approach. But hey, Western practitioners are usually doctors, physios etc. Maybe they did an entire weekend course! Arrogant cultural imperialists. Throw them to the dogs!
My hypothesis is that doing acupuncture by TCM practitioner i.e. traditional acupuncture would have maybe given results we could have confidence in. You’d still have to deal with problems of the simulacra having effects though.
Lets’ not get hung up again on Thomas’ definition of a theory. Living my life isn’t a science and from a selfish personal point of view I don’t care.
Pragmatically I’ve found that Taoist ideas have utility in my own life. I know others who have found the same, and many who don’t agree (but those who actually undertake any Taoist practice often get it). Academic study gets you nowhere with it – read the menu vs. eat the meal. I think they are based on extensive and internally (fairly) consistent principles. IME they have some predictive and explanatory capability. However I can’t get any sense of any utility in the homoeo principles – I think they are arbitrarily made up by a bunch of trippy Germans in the 18th century. I’m currently holding the view that at some point we’ll be able to get a more objective handle on the Chinese stuff. I’m doubtful about homoeopathic principles.
Anyways. We’ve spent several days on this David. Let’s go and have a weekend and forget about it all for a while – I remember why I rarely engage in this stuff any more.
Have a good weekend!
“However Drew’s site lumps this in with acupuncture in general. He makes no distinction between western and Chinese”
Is there actually a substantial body of clinical evidence demonstrating that “Chinese acupuncture”, however you care to distinguish it from “western acupuncture”, is more effective than appropriately matched placebos as a treatment for non-self-limiting illnesses and injuries?
If not, I fail to see what benefit we’d realize by being careful to distinguish between the two.
Missing the point dude. A little bit of investigation, say wikipedia, would show you that the two are very different. Only once you get that then is it worth considering clinical or any other evidence.
You’ve got a bit of racism in your eye.
I’ve done considerable research regarding acupuncture and other alt med therapies, although I tend to rely on peer-reviewed journal articles rather than Wikipedia. It actually indicates les of a difference between “Western and Chinese” acupuncture as you characterize them than between the thin-needle acupuncture invented during the Cultural Revolution and the original (i.e. traditional) “Chinese acupuncture” which was a form of bloodletting using lancets rather than needles.
I’ll have to remind myself to tell my Chinese daughter and Cambodian son I’m prejudiced against Asians–they could use the laugh.
However Drew’s site lumps this in with acupuncture in general. He makes no distinction between western and chinese, yet proffers authoritative advice that acupuncture (all of it) doesn’t work. Unethical.
I just had a look at a definition of Western – they drop all the ‘woo’, but rather than develop a theory of points themselves they still use the classical points, on the assumption that they’ll be the right ones. I think that’s nuts, no more than a cargo cult approach. But hey, Western practitioners are usually doctors, physios etc. Maybe they did an entire weekend course! Arrogant cultural imperialists. Throw them to the dogs!
My hypothesis is that doing acupuncture by TCM practitioner i.e. traditional acupuncture would have maybe given results we could have confidence in. You’d still have to deal with problems of the simulacra having effects though.
Lets’ not get hung up again on Thomas’ definition of a theory. Living my life isn’t a science and from a selfish personal point of view I don’t care.
Pragmatically I’ve found that Taoist ideas have utility in my own life. I know others who have found the same, and many who don’t agree (but those who actually undertake any Taoist practice often get it). Academic study gets you nowhere with it – read the menu vs. eat the meal. I think they are based on extensive and internally (fairly) consistent principles. IME they have some predictive and explanatory capability. However I can’t get any sense of any utility in the homoeo principles – I think they are arbitrarily made up by a bunch of trippy Germans in the 18th century. I’m currently holding the view that at some point we’ll be able to get a more objective handle on the Chinese stuff. I’m doubtful about homoeopathic principles.
Anyways. We’ve spent several days on this David. Let’s go and have a weekend and forget about it all for a while – I remember why I rarely engage in this stuff any more.
I admittedly not looked at your paper in question until now. I am not sure why you have a probers with this study design. They are looking at acupuncture not based on TCM They never said they were examining TCM and the heading on said website is acupuncture not TCM.
Your hypothesis is that doing acupuncture by a TCM practitioner taking into account pulse diagnosis etc may have given better results.
The theories of vital energy and energy meridians are equal in plausibility as homeopathy principles!!!
Drew states, “. . . some herbal products work, but the
majority do not [1-2]. The difference, however, is that most herbal
remedies are advertised by their manufacturers/prescribers as being
effective, regardless of the evidence to support those claims.”
It is also true that the majority of plants traditionally used as medicines have yet to be subjected to sufficient studies to show they work or do not. In many instances, a given plant may have had a relatively minor effect against a disease, but in its time and culture, any reported effect was enough to warrant its continued use, whether from a written description or an oral tradition.
That is very true. Additionally herbal medicine is fraught with observational bias and pseudoscience. There is a very interesting study by cravotto et al. (J Clin Pharm Ther. 2010 Feb;35(1):11-48. doi: 10.1111/j.1365-2710.2009.01096.x.
Phytotherapeutics: an evaluation of the potential of 1000 plants. Cravotto G1, Boffa L, Genzini L, Garella D.
The result is sobering. They investigates 1000 medically used plants, of these 156 had clinical trials with 9 plants displaying considerable pharmacologic effects. Taken together that means that only roughly 6% (possibly up to 10 or 15%) of plants used in herbalism display a pharmacologic effect. Although plants contain a wide array of interesting compounds, using the plant per se is most likely NOT a good choice.
That is very true. Additionally herbal medicine is fraught with observational bias and pseudoscience. There is a very interesting study by cravotto et al. (J Clin Pharm Ther. 2010 Feb;35(1):11-48. doi: 10.1111/j.1365-2710.2009.01096.x.
Phytotherapeutics: an evaluation of the potential of 1000 plants. Cravotto G1, Boffa L, Genzini L, Garella D.
The result is sobering. They investigates 1000 medically used plants, of these 156 had clinical trials with 9 plants displaying considerable pharmacologic effects. Taken together that means that only roughly 6% (possibly up to 10 or 15%) of plants used in herbalism display a pharmacologic effect. Although plants contain a wide array of interesting compounds, using the plant per se is most likely NOT a good choice.
At the consternation of some of the readers here, you and I agree on a lot of facts. The particular study you mention provides a sobering view, but there being so many plants lacking adequate investigation in human clinical trials, whether it serves as an accurate extrapolation for the percentage of plants that can be used as effective medicines in the form of crude extracts is questionable. To that I would add that while numerous plants display pharmacologic effects, that doesn’t mean they are either useful or safe as crude medicines.
I think the extrapolation is valid, though only as a very rough estimate, for following reason: If you assume that the plants with sufficient trials to detect pharmacological effects are a random sample, the sample is big enough to allow conclusions. However, I think it is not. Most likely the sample is biased towards plants said to display strong effects in herbal medicine, i.o.w. it would overestimate the percentage. Even if we assume underestimation, I don’t think that the underestimation is that big that more than 15% of the plants display large enough effects.
Prevention is everything, but ultimately, purines in the blood… dirty blood leads to all types of ailments. Keep the blood clean! Water makes lots of new, fresh blood. [ph-y-sic]
Prevention is everything, but ultimately, purines in the blood… dirty blood leads to all types of ailments. Keep the blood clean! Water makes lots of new, fresh blood. [ph-y-sic]
Great! I could package, label, and market water “Gluten Free”. More than that, I could sell it to the gullible as the latest “Detox Solution”. Move over herbal diuretics and laxatives! (none of which result in the removal of pesticides and other industrial pollutants). Because people are gullible and that’s where the money is, I could also sell them antioxidants. But please, don’t let them know that antioxidants and oxidative stress have not lived up to their hypothesized role as the basis for disease, at least not in any well controlled clinical trials. Now, if I can make up enough stuff to convince them that sciency things like clinical trials are just not cool or natural, I could make an even bigger buck!
Great! I could package, label, and market water “Gluten Free”. More than that, I could sell it to the gullible as the latest “Detox Solution”. Move over herbal diuretics and laxatives! (none of which result in the removal of pesticides and other industrial pollutants). Because people are gullible and that’s where the money is, I could also sell them antioxidants. But please, don’t let them know that antioxidants and oxidative stress have not lived up to their hypothesized role as the basis for disease, at least not in any well controlled clinical trials. Now, if I can make up enough stuff to convince them that sciency things like clinical trials are just not cool or natural, I could make an even bigger buck!
CAnada is stepping up, US should do the same.
http://www.theglobeandmail.com/news/national/health-canada-to-change-standards-for-natural-health-products/article31810843/?cmpid=rss1&click=sf_globefb
“The new regime would classify many vitamin, mineral and homeopathic
products and cosmetics as “low risk,” meaning they would not be licensed
by Health Canada. Manufacturers would still have to meet Health
Canada’s quality standards, but they would be prohibited from making
disease treatment or prevention claims on product labels. Any other
claims on product labels would have to be accompanied by a disclaimer
stating the information has not been verified by Health Canada.”
As I see it, Canada is copping out to save a buck. Adopting what has euphemistically been called a “quack Miranda warning”, Canada would be imitating the abdication of requirements for evidence practiced in the U.S. under the Dietary Supplement Health and Education Act (DSHEA). Nearly every week in the U.S., a warning letter is issued by the F.D.A. to yet another company brandishing the disclaimer while making obvious medical claims for products regulated as dietary supplements. To expect that Canadian purveyors of supplements would be more obedient to the law is entirely fanciful.
Leaving aside the risk of using homeopathic preparations in lieu of effective medicines, depending on the dosage, rather than qualifying as “low risk” substances, some vitamins and minerals pose definite risks to health.