Respectful Insolence

I once blogged about an article attempting to address the very question in the title of this post, and I’ve also discussed in depth how messy the process of evidence-based medicine can be and why that provides an opening for purveyors of “alternative medicine” (my preferred term to describe it being “non-evidence-based medicine”) to respond to complaints about the lack of evidence supporting their favored woo with a hearty but fallacious tu quoque.

One of the favorite claims of purveyors of non-evidence-based “alternative” medicine is that modern scientific medicine is actually not very evidence-based. Various credulous supporters of such woo will often throw about claims that less than 50%, and perhaps as little as 15%, of modern medical therapies are based on valid scientific evidence. I had always wondered where that figure came from.

Now I know. I’m grateful to Steve Novella for telling me. It turns out that the 15% figure dates back nearly a half-century ago, all the way back to 1961 and wasn’t even looking at how much of medical practice was truly “evidence-based.”

Not surprisingly, Steve then goes on to show that the true figures are very much higher than the canard being thrown around by fans of unscientific, non-evidence-based therapies. Of course, even if the figure were 15% as is often claimed by some advocates of so-called “alternative” medical therapies, that figure would still be at least an order of magnitude greater than the evidence base supporting their favorite woo. That’s one difference between scientific, evidence-based medicine and woo. The other difference is that scientific medicine is always striving to increase the percentage of its therapies and practices that are based on science and well-designed clinical trials, abandoning therapies that are found not to work or not to work as well as newer therapies, while it is incredibly rare for an “alternative” therapy ever to be abandoned by its practitioners even when it is shown conclusively not to be efficacious.

Comments

  1. #1 CP
    November 21, 2007

    Yes, but, you know, you only use 10% of your brain…

    :-)

    .

  2. #2 Manny, in Canada
    November 21, 2007

    I do not know how one would measure this number. The important point is that all new therapies are evidence-based. Thus, eventually, all will be.

    As a surgeon, however, you know that there are many dogmas in Surgery. Do we have to operate on all cases of appendicitis? Where’s the hard evidence? The same goes for small breast cancers, small prostate cancers, etc.

    Internists have their share of dogmas too. Where is the evidence that all patients must be made “euboxemic” to reach their best level of health?

  3. #3 Orac
    November 21, 2007

    Yes, but, you know, you only use 10% of your brain…

    :-)

    Do I?

    Actually, I don’t. ;-)

  4. #4 PalMD
    November 21, 2007

    What a tough nut to crack. I wonder first, do we need to “count” how EB’d we are—I mean, is it the right question. Second, HOW do we count?

    When I prescribe a beta blocker to someone with CAD, is that one “EBM event”? When I prescribe a statin to the same patient, is it another?

    Adherence to guidelines where they exist is, I suppose, one measure. The VA, e.g., keeps very good records of these things.

    The big “quality measures” thing coming down from Medicare soon may also help track things, but I’m sure from the perspective of a small practice doc (ok, me), it may be a pain in the butt, and expensive.

  5. #5 Ken Shabby
    November 21, 2007

    Growing up I was taught to wash my hands with soap and water, using water as hot as I could stand it. This was the mantra taught in health classes in school, and it was taught to nursing students.

    I suffered chapped hands a lot, especially in the winter, when the skin would crack and bleed.

    As an adult I learned that heating water to make it germicidal requires more than an atmosphere of pressure.

    The object of handwashing is to get the germs off, which are in the dirt on our skin and under our nails. Warm soapy water helps us do this. There never was any evidence for the hot-as-you-can-stand-it mantra. Perhaps it was only guesswork involved, but it may have been sadism.

  6. #6 Nemo
    November 21, 2007

    Numbers aside, for me the startling thing is not so much that we don’t know whether treatments work (i.e., are evidence-based), as that, in many cases, we know they work, but we don’t know why. I’m always shocked, in conversations with my doctor mother, to realize how much of the working of the human body is still unexplained. It’s easy to come away from this thinking of medicine as more art than science.

  7. #7 Anon
    November 21, 2007

    You might be interested in the 2006 (fall/winter) edition of Behavior and Social Issues ( http://www.uic.edu/htbin/cgiwrap/bin/ojs/index.php/bsi/issue/view/54 ). It discusses a subset of your question–specifically, how much of modern biological psychiatry is evidence-based. The lead articles make the case that the real story is not evidence, but money and power, that leads to the dominance of the medical model (at least in this subset of the question).

    We often hear (especially in direct-to-consumer ads) that depression is “caused by a chemical imbalance”–but the actual evidence for this is utterly lacking. There is little incentive, though, for following the evidence, when aggressive marketing campaigns can make marginal drugs into billion-dollar profits.

  8. #8 Dan
    November 21, 2007

    Nemo wrote: “It’s easy to come away from this thinking of medicine as more art than science.”

    That is why we in the hard sciences believe that those in the medical profession only practice science. Maybe one day with enough practice they will eventually get it right. ;)

  9. #9 PalMD
    November 21, 2007

    I guess the troll was predictable. Hey, it’s not my blog, but the issue is quite complex.

    As Panda Bear MD wrote, much of medicine is spoken in metaphors, which hopefully match up fairly well with a biologic reality. However, in the presence of “black box’ism” outcomes studies are critical.

    We may not have a great model for what depression is, but we have excellent evidence on certain treatment modalities.

    Bring on the Xenus!

  10. #10 Anon
    November 21, 2007

    If it was my post you were calling a troll, I would hope you might have read the link before reacting. It does not deny the effectiveness of some treatments, and it certainly does not take a scientology-friendly anti-therapy stance.

    It does, however, critically examine the industry. I would hope that this is seen as a positive thing. If the evidence is there, critical examination will show this; if it is not there, that should be made known.

  11. #11 PalMD
    November 21, 2007

    Sorry for the implication, “Anon”, i’ll start parsing through it.

  12. #12 Steven Novella
    November 21, 2007

    Anon wrote: “We often hear (especially in direct-to-consumer ads) that depression is “caused by a chemical imbalance”–but the actual evidence for this is utterly lacking.”

    Actually the evidence for a biochemical basis for mood disorders like depression is quite large and compelling, from multiple independent lines of neuroscientific evidence. It is also growing rapidly with the advent of new tools, like fMRI.

    Unfortunately, there is a large subculture of psychiatry-denial, and not just scientology, but they do drive it as much as they can. It is also prevalent among some psychologists/therapists. There are also the followers of Thomas Szasz, who takes an outdated political view of psychiatry.

    Mental illness is not a conspiracy of the drug industry – that is just anti-psych propaganda. There is a compelling and growing neuroscience to back it up.

  13. #13 daedalus2u
    November 21, 2007

    From my research and understanding, I think that depression is a normal “feature” of a properly functioning brain working under a modest “energy crisis”.

    A severe “energy crisis”, such as from drowning, hypoxia, poisoning, extreme metabolic stress, hemorrhagic shock, endotoxemic shock, organ failure or other near death experiences, often produces a feeling of euphoria. I think euphoria under extreme metabolic stress is a “feature” that allows an organism to “run from a bear”, and if necessary to fight the bear and perhaps win (or more likely perhaps not). Without a sense of euphoria and invincibility, escape from a bear would be much less likely. A euphoric state where the “safeties” of fatigue and pain that normally limit injury are suspended is an important state for an organism to be able to invoke to escape from a predator where any injury short of death is acceptable. However, such a state is extremely dangerous because without the normal “safeties”, injury occurs so easily. Organisms must have an aversive state between the “normal” state and the “severe energy crisis” state (otherwise they would enter that very dangerous state inappropriately). That is what I think depression is, the necessary aversive state between normal and a “severe energy crisis”.

    There are many successful pharmacological treatments of depression, a number of them have the common effect of reducing metabolic demand. For example SSRIs decrease serotonin reuptake. This reuptake consumes ATP, and by maintaining a higher serotonin level before reuptake depletes it, feedback regulation reduces the serotonin that must be synthesized and released. What is called vascular depression can be common as people age, and it is amenable to the same treatments as other types of depression.

  14. #14 PalMD
    November 21, 2007

    Interesting ideas, but without data. To my knowledge, no one has ever correlated affect/mood with specific “energy” states, etc. Sounds a little “woozy” to me, but hey, go and learn.

  15. #15 Joe
    November 21, 2007

    @Manny, in Canada

    Apparently, surgeons do have to operate on every appendicitis. I am sorry that I don’t have the cite at hand; it dates back 20-30 years. Going back to the post-modern-surgery, pre-antibacterial age (or today), what alternative do you have in mind?

    Appendectomy is an example of rational medicine that was substantiated long (<100 years) after it was adopted.

  16. #16 Joe
    November 21, 2007

    My comment was cut off. Appendectomy was substantiated more than a century after it was recommended based on rational considerations.

  17. #17 Anon
    November 21, 2007

    Steven Novella, I would love to hear your critique of the articles in my link, once you have had the chance to view them (I am quite sincere–if these articles are misspeaking, I want to know). One brief bit in particular: in the Wyatt & Midkiff article, p. 143, they mention the Mind Freedom challenge (of 2003), in which the American Psychiatric Association, the National Alliance for the Mentally Ill, and the Office of the Surgeon General of the United States were each challenged to produce evidence that depression or schizophrenia (among others) are biologically based–in particular, “to prove there is any physical diagnostic test that can reliably distinguish those so diagnosed from ‘normals'”, and “to produce scientific evidence that any psychotropic medication can correct a ‘chemical imbalance’ or decrease the likelihood of violence or suicide.”

    (I hasten to add that this Challenge is not by the authors of the sources–they simply describe the challenge as part of their examination.)

    The authors of the challenge were told that the answers they were looking for were widely available in the published literature; the sources cited, though, included statements that pointed out a lack of knowledge of specific biological causes.

    But I am getting ahead of myself–as I said, I would very much like to hear your views after you have had the time to digest the articles, and I thank you for any time you take to read them.

  18. #18 daedalus2u
    November 21, 2007

    There have been a few MRS studies that have shown reduced ATP levels, but it is quite challenging experimental work.

    http://ajp.psychiatryonline.org/cgi/content/full/158/12/2048

    The volumes measured are quite large and ATP is actually regulated in each cell independently. Averages over such large volumes miss virtually all of the details (which are obviously important).

    In some ways I think this is similar to the reduction in brain metabolism reliably observed in virtually all of the neurodegenerative diseases, such as Alzheimer’s where O2 consumption may be down 10 to 18%.

    http://jnm.snmjournals.org/cgi/reprint/37/7/1159

    If we think about this reduction in O2 consumption (and hence in ATP production and consumption) in a “control” sense, is it a few pathways that are out of whack? I don’t think so. I don’t think that a few pathways together contribute so much to overall ATP consumption that they could be so far out of whack (and not be identified by now). I suspect that it is actually hundreds or thousands of pathways that are down regulated; but down regulated in a controlled manner; a down regulation akin to ischemic preconditioning.

    A brief ischemic insult will induce a state that is “protective” of longer periods of ischemia that occur within a window of time following the preconditioning events. My interpretation of that is that long time constant ATP consuming pathways are turned off, to preserve ATP for more important short term pathways. Cells do consume less ATP following ischemic preconditioning, and they have a lower ATP concentration (29.1 +/- 2.5 vs 25.1 +/- 1.3).

    http://www.jbc.org/cgi/content/full/276/48/44812

    My hypothesis is that ATP concentration is one control parameter that the cell uses to regulate the myriad of ATP consuming pathways so that only the most “important” are activated (depending on the cell’s ATP status). If the cell’s ATP status is compromised, it saves ATP by turning stuff off, but it does so in a “graceful” way (as billions of years of evolution have produced).

    In something like Alzheimer’s, I think it is simply an ATP concentration that is a little bit too low, which then activates the ATP conservation mechanisms of ischemic preconditioning. The pathways that are turned off are not unessential, they are just not essential during an ATP crisis which normally is of short duration. The cell turns off ATP consuming pathways that are longer than the “normal” ATP crisis, damaged protein disposal via the proteasome and autophagy (leading to amyloid and Lewy body accumulation), intracellular transport (leading to leukoaraiosis), mitochondria biogenesis (leading to insufficient and damaged mitochondria).

    I think acute ATP depletion also occurs during the hyperpyrexia of stimulant abuse. The heat comes from mitochondrial uncoupling which is dissipating the mitochondrial potential instead of generating ATP. I think the euphoria of stimulant abuse it the euphoria I alluded to in the “running from a bear” example. The sequelae of stimulant abuse mimic the various degenerative diseases. I think because they are from the same thing, ATP depletion that turns off repair. I think that acute severe ATP depletion also can cause acute psychosis, as from hypoglycemia.

  19. #19 Orac
    November 21, 2007

    You might want to leave your comment on Steve’s blog as well. There’s no guarantee that he’ll be back here to check if anyone replied to him.

  20. #20 daedalus2u
    November 21, 2007

    Anon, I briefly looked at those articles and I consider them quite non-scientific and devoid of meaningful content. They present no data to show that there is no biological basis for mental illness; they simply assert that mental health professionals have been looking into biological causation to prevent the “invasion” of non-biological causation based competition and then call for a “paradigm shift” away from biological causation to environmental causation. That is complete nonsense.

    Much of the reply by Jerome Wakefield was exactly on target. He is right; the dismissal of the biological basis of mental illness is pseudoscience. The dismissal of his arguments was without merit (in my opinion).

    The brain is the most complicated organ in the human body by many orders of magnitude. Should we expect biological understanding of the brain to be simple? A cardiologist would think nothing of prescribing half a dozen drugs to treat a heart condition, beta blockers, ACE inhibitors, Ca channel blockers, diuretics, organic nitrates, statins. The heart is a simple pump. What reason is there for believing a disorder that involves the brain can be understood and then treated very simply, such as with a single chemical orally administered once a day? That psychopharmaceuticals work as well as they do is remarkable to me. To me, that is clear evidence that there are many very powerful and interdependent control systems in the brain, and that when they get a little out of whack they cause dysfunction. That the minor perturbations that psychoactive drugs represent can in some cases restore function illustrates just how minor those perturbations must have been in the first place.

    Most mental illnesses have no animal models. Humans cannot be experimented on the way that animals can be. We will never be able to do the kind of invasive experiments on human brains that has been done on animal hearts. 100 years ago, the biological cause of diabetes was unknown. Biologically based treatments were pursued and diabetes is now a treatable disease, not a death sentence.

    These authors want to abandon the search for biological causation of mental illnesses. They are the ones who should have their heads examined.

  21. #21 T. Bruce McNeely
    November 21, 2007

    It really annoys me that the people that accuse medicine of being only 15 or 20% (or whatever) scientific have no qualms about using what amounts to bullshit to support their point. The next time I run into someone trying this crap on, I will stomp on them without mercy. Thank you for this information.

  22. #22 Freddy the Pig
    November 22, 2007

    T. Bruce – I initially misread the second last sentence of your post as “… I will stomp on them without MERCURY.” I must be reading to much about the mercury – autism pseudoscience.

  23. #23 Freddy the Pig
    November 22, 2007

    This biochemical basis of depression etc argument strikes as a case of bit of an either or fallacy. Schizophrenia is another matter – there are significant physical brain differences that occur in both treated and drug naive schizophrenics alike – Steve Novella has mentioned this previously.

    With depression, I believe it can be either situational or biochemical. My son is a Psych Nurse who is working as Mental Health Therapist in northern Alberta. The psychiatrist there is a recent immigrant from Australia and she says that in Oz they try cognitive appoaches bef/ore resorting to medication while in Canada medications are used immediately. I think SSRIs etc are overprescribed, but this does not preclude a biochemical cause for much depression. My son sees SSRIs as often necessary in order ot get a severely depressed individual to the point where they can benifit from cognitive therapy.

    This black and white it’s all biochemical – it’s never biochemical is a false dichotomy, especcialy when lookig at a system as complicated as the human brain.

  24. #24 Graculus
    November 22, 2007

    in Oz they try cognitive appoaches bef/ore resorting to medication while in Canada medications are used immediately.

    Well, as a Canadian, I can attest that that is not true. Both methods, often in combination, are used. It may be true that in Canada drugs are more frequently used, and sooner in the process. I’m not convinced that is a bad thing.

    I think one of the underlying factors in a lot of “anti-psych” is the concept of mental illness as a “moral failing”. Very Protestant, that.

  25. #25 Manny, in Canada
    November 22, 2007

    To Joe, Re. Must we operate on all appendicitis?

    My question, more specifically: if all cases of appendicitis were given IV antibiotics and an hourly echo to ensure the appendix is not ruptured, how many would heal without appendectomy?

    Where’s the study?

  26. #26 DuWayne
    November 22, 2007

    I think that Freddy the pig has a very important point. Medication can be and often times is, a critical component of treatment for depression and many other mental issues. But it should only be one factor of treatment. I know little of how it is dealt with in other countries, but all too often in the U.S. it is the only treatment many people get. I imagine that for some folks it’s enough, but for most people suffering from depression, there is far more going on than just a chemical imbalance.

    It’s not an either/or. Cognitive approaches are important, but so is medication. Especially when the depression is rooted in real life problems. It is often necessary to take a hard look at the root causes of depression. This can be in some ways worse than just living with the depression. Medication can make the difference between successful therapy and a downward spiral into something much worse.

  27. #27 Nat
    November 22, 2007

    The BMJ has published something in the past five years that attempted to quantify the % bulk of the proceedures used in a hospital in the UK that were evidence-based.

  28. #28 Inquisitive Raven
    November 22, 2007

    Growing up I was taught to wash my hands with soap and water, using water as hot as I could stand it. This was the mantra taught in health classes in school, and it was taught to nursing students.

    I suffered chapped hands a lot, especially in the winter, when the skin would crack and bleed.

    When I took EMT class (mid-90’s), we were taught not to use hot water specifically because of the chapping problem.

    The object of handwashing is to get the germs off, which are in the dirt on our skin and under our nails. Warm soapy water helps us do this. There never was any evidence for the hot-as-you-can-stand-it mantra.

    Yep, we were also told to scrub for 15 seconds and rinse for 15 seconds which would accomplish that.

    On the evidence based medicine front, EMS protocols change as more data comes in. As an example, there was this piece of equipment known as a pneumatic anti-shock garment (PASG) or military (medical? depends on who you asked) anti-shock trousers. It was basically a pair of pants with three inflatable chambers that went on with velcro. The idea was that inflating them was supposed to increase blood pressure in the upper body. Well, it certainly did that, and you weren’t supposed to use it if the patient had a pneumothorax or detectable fluid in the lungs, but there was never much evidence that it helped with shock. When I took my class, there was talk of dropping it from the protocols except for immobilizing injured legs. A year or two later, it was, in fact, dropped.

  29. #29 T. Bruce McNeely
    November 22, 2007

    Some comments:
    Regarding treatment of depression – it’s my understanding that cognitive therapy and drug therapy are about equally effective, and more effective than placebo. However, combining drug therapy and talk therapy is more effective than the former therapies alone. (IANAP, however)
    Appendectomies – are done much sooner in the course of the illness now that laparoscopic surgery is the usual procedure. There is much less disruption to the abdominal wall and abdominal cavity, and the appendix can be looked at in situ before making the decision to excise it. Recovery after a laparoscopic procedure is much quicker and better tolerated. Leaving the appendix in place and treating with antibiotics is theoretically possible (and, I think, has been done in situations where surgery was not possible). However, this does leave the patient with a high chance of developing a chronic abscess, bowel obstruction, peritonitis etc.
    For Freddy the pig – I will stomp on them without mercury, too.

  30. #30 PalMD
    November 23, 2007

    The famous “14% negative laparotomy rate” was certainly from the pre-CT and pre laparoscopy days.

    As far as I know, I wouldn’t be an, um, ideal study to have a control group with “obs and abx”. When viscera rupture, the consequences tend to be quite unpleasant.

  31. #31 daedalus2u
    November 23, 2007

    I know someone who had appendicitis misdiagnosed ~40 years ago because (apparently?) the person has an extremely high pain threshold and the doctors didn’t think it could be appendicitis because it didn’t hurt enough. The story is that the pain only got “severe” when the secondary abscesses began to rupture (the abscesses that formed after the appendix ruptured). The person was in hospital for over a month and has quite a massive scar where everything was drained.

  32. #32 Jo
    November 25, 2007

    going off tangent associating here…

    I know this blogs contempt for Choprawoo, but this new one is the perfect antithesis of what you represent, right in Orac’s turf.

    The Future of the Body

    Posted November 23, 2007

    http://www.huffingtonpost.com/deepak-chopra/the-future-of-the-body_b_73898.html

    Excerpt:

    “Medicine has largely turned its back on these findings and rushed headlong into drugs, surgery, and now genetics as the only “real” way to heal. This is in keeping with a long-held prejudice against the placebo effect and psychosomatic disease. Though long proven to be real, easing pain through a placebo is thought somehow to be fake or second-best to easing pain through drugs. Similarly, psychosomatic illness is considered to be “all in your head,” when by definition it is also in the body. The fact is that we will not know what our bodies are truly capable of until we delve deeper into the mind-body connection. Until we do, the future of the body may seem to lie with genetic manipulation when simpler, less invasive, and far less expensive treatments could be at our fingertips.”

    (some of the comments at HuffPo are disgusting)

    This charlatan makes millions selling alternative, mind-body, or non-evidence based medicine.

    http://chopra.com/services

    (Also Ancient Indian Astrology consultation for $300)

  33. #33 Jo
    November 25, 2007

    “A tide of media articles over the past few years has made it clear that medicine is putting almost all its future hopes on genetics. But a small study from UCLA offers an intriguing alternative, one that could be just the tip of the iceberg. Researchers found that children and teenagers who described themselves as positive thinkers had higher thresholds of tolerance for pain. On the other hand, young subjects who had learned less positive coping skills (such as worrying about problems or turning to someone else for help) were less able to tolerate the application of pressure or heat to the skin, which was how pain was measured in the laboratory.

    The significance of these findings is that psychological attitudes changed basic physical sensations. It had already been shown that we don’t all respond to pain alike. When asked to rate pain on a scale of 1 to 10, people who are subjected to the same stimulus come up with far different reactions. What feels like a 1 on the pain scale to one person can feel like a 6, 7, or higher to another. Instead of being simply a physical variation, the new research suggests that personal interpretation is involved. Yet to the person feeling the pain, this isn’t a subjective event. The degree of discomfort is completely real.

    Why is this the tip of an iceberg? I was reminded of Tummo, an ancient form of Tibetan meditation that originated in India as a yogic practice. Buddhist monks who practice Tummo are able to withstand extreme cold without discomfort or bodily harm. Clad only in a thin layer of silk, they can sit all night in ice caves in the Himalayas or on the surface of a frozen lake. Long considered a legendary skill, Tummo has been verified by Western researchers, who discovered in the 80s that the monks are raising their body temperature by up to 8 degrees Centigrade, or 14 degrees Fahrenheit. In essence, they are controlling a feedback loop in the body that is normally automatic. A region of the brain known as the hypothalamus is responsible for regulating body temperature, but in this case the monks are inserting their own intention, and what was once automatic becomes voluntary.

    Apparently the kids who were studied at UCLA are doing the same thing. It still remains a mystery how the Tibetans can withstand a temperature rise of 14 degrees, given that brain cells begin to die if a patient suffers from fever over 104 degrees. Perhaps the control achieved in Tummo can also differentiate which part of the body becomes warm or warmer. But in both cases, it’s the dual nature of the nervous system that proves so fascinating. Most of us allow our bodies to run automatically, and we assume that we cannot interfere very easily, if at all, into processes that go wrong. ”

    http://www.intentblog.com/archives/2007/11/the_future_of_t_1.html

    Wonder if Chopra is saying the same about Tummo and Mind-Body as this:

    HARVARD GAZETTE ARCHIVES

    Meditation changes temperatures:
    Mind controls body in extreme experiments
    By William J. Cromie
    Gazette Staff

    http://www.news.harvard.edu/gazette/2002/04.18/09-tummo.html

  34. #34 daedalus2u
    November 25, 2007

    The generation of nitric oxide during meditation and/or the relaxation response is the physiological mechanism by which it works to achieve stress relief.

    http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16369463&ordinalpos=70&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    However, the Tummo state is likely not a “relaxation state”. Heat is generated by mitochondrial uncoupling. The same mitochondrial uncoupling that occurs in the malignant hyperthermia of malignant neuroleptic syndrome.

    They may be able to raise their peripheral temperature by 8 C. It is likely they cannot raise their brain temperatures that much and survive.

  35. #35 Jo
    November 26, 2007

    more …related stuff about alternative medicine in part two…

    The Future of the Body (Part 2)
    http://www.huffingtonpost.com/deepak-chopra/the-future-of-the-body-p_b_74176.html

    “The New England Journal of Medicine has been much less sympathetic to alternative medicine than the leading British journal, The Lancet, which ran a 2005 article on the effectiveness of homeopathy in treating and preventing colds and flu. Almost immediately The Lancet ran a counter article bolstering the conventional view that homeopathy isn’t effective. This represents the usual confusion. Adherents to alternative medicine clash with the establishment, both sides pointing to their own research, but both sides also having to admit that definitive results never seem to settle their disputes.

    I’ve come to feel that the argument will never be settled until we accept a fact of nature: everyone has a unique response to disease. No single treatment can be expected to cure or prevent illness with complete reliability, and even if Western medicine is right to claim that a drug like penicillin works more often than any alternative, Eastern medicine can point to drug intolerance, side effects, and expense as considerable drawbacks. (Not to mention the exponential risks that often mount when pharmaceuticals are mixed with one another, or with alcohol consumption.) Therefore, each of us needs to consider our own bodies, our own life history, and our own susceptibility. Mainstream medicine constantly tries to sell its one-size-fits-all position, and it shouldn’t. For decades all patients with high blood pressure were put on reduced salt diets that they found hard to tolerate, despite the fact that over 80% of people are not salt sensitive and can eat as much salt as they want. Over that same period low-cholesterol diets were pushed for all patients at risk for premature heart attacks, even though the connection between the cholesterol you eat and the cholesterol in your blood varies widely. To claim that there was a simple correlation was bad science. Meanwhile, the strong correlation between heart attacks and psychological stress was pursued with much less enthusiasm, if at all. Today, of course, newer and better drugs are meant to solve all problems.

    What, then, can you and I do to offset the unpredictable nature of healing? The answer doesn’t lie in a simplistic choice between drugs and surgery all the time or none of the time. We have to envision a new future for the body, and with that in hand, intelligent choices can be made from both sides of the medical menu, mainstream and alternative.”

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