Alt Med does harm

A very good point PZ. I can't say I'd ever really considered the cost to science of proving that alternative medicines don't work.

Ask Steve Jobs whether alt medicine is harmful. He admitted to his biographer that his insistence on using alt therapies instead of real medicine may well have shortened his life. It might even have shortened it by a lot.

It might it be wise to admit that we should be studying the "placebo" effect, and the role of the mind in healing? What role does mood and belief play when the immune system battles disease?

Well, there's always the Templeton prize, PZ, if you're willing to sell morals for money and praise any deity. :P

So, just so I'm clear, and because I'm not very familiar with this field, was all of this money spent on things that had already been well studied (or reasonably so) without finding any supporting evidence, or was any of it on claims that had not been (or were poorly) studied already?

'Cause I can understand the latter, but agree that the former is a big waste.

If I thought the NCCAM was genuinely trying to determine the truth behind the claims (and then, of course, move on, never to look at the debunked ones again), rather than to find a reason to believe in them, I'd probably support money spent on that.

For a survey on the efficacy of prayer and other voodoo methods, see Gerald Weissmann's essay "Galton's prayer" in his book "Galileo's gout", wherein he notes that "our government has spent more than $2.3 million om prayer research since 2000", and that in 1872, Francis Galton showed that "intercessory prayer offered on behalf of those who knew they were prayed for was bad for one's health."

I agree with Wilson that the context of the studies is important. It surely can't be a waste (although I'm a bit shocked by these figures) if these studies are the first reliable ones to actually show that these 'remedies' are bogus. In some areas though, you're absolutely correct; continuing to study something is just a waste of time. Homeopathy for example, has been studied enough, and makes little enough sense, and its followers have been so indoctrinated against the means of 'western science', such that further research should only be paid for by homeopaths.

Aren't these studies comparable to studying the effectiveness of abstinence-only sex education programs, or the DARE anti-drug program? Some people are convinced these programs work, but the only way to find out is by studying the results. When they are clearly shown not to work, we should abandon them and move on.

A study, published in 1998, sensationally exposed the claims of a popular "energy medicine" modality called Therapeutic Touch. The 9-yo experimenter had a $10 "grant" ($15 in today's dollars) from her parents for out-of-pocket expenses, and the study concluded "that TT claims are groundless and that further use of TT by health professionals is unjustified." (JAMA. 1998;279:1005-1010)

Of course, there was a lot of volunteer time given to analyze the experimental results, research the background of TT, and prepare the paper for publication. (Publishing original research in a top-tier medical journal takes no small effort.) So the final costs of the study were well above the experimenter's costs, but still nowhere close to the size of any of the grants given out by NCCAM, even for energy medicine.

By definition, the vitalistic mechanisms postulated for CAM modalities are highly implausible (contrary to known physical science) and so not worth the expenditure of scarce resources. Moreover, to fund research lends credence to probably mistaken ideas, leading both researchers and the public astray as to what is potentially fruitful.  Doug Stalker made these points cogently way back in 1995, when NCCAM was only the Office on Alternative Medicine with a budget that was a tiny fraction of what it is now. (Stalker DF. Evidence and alternative medicine. Mt Sinai J Med. 1995;62:132-43).

As Dr Oz and his wife (promoters of "Reiki"--a Japanese variant of TT) have shown, scientifically based judgments on a metaphysical practice carry no weight with practitioners.
The problem is that NCCAM listens to the practitioners, and not to the science. That's why NCCAM should be history.

I was once heard a faith healer said, "When a person is dying, he will do and pay anything just to add years to his life." Then we laugh! And people always believe in magic. One friend i know who go to poland as massage therapist, said, they have more customers when they added prayers to the massage they were doing. They believe on the magic, not on the massage. So, we laugh how crazy people are. Man believes in magic the Lord do to them, but do not believe His existence...

Alternative medicine just can't compete on any level with the sinkhole which is normal medical practice in the US. Regular medicine kills and injures more people every year than alternative medicine. And mostly just gets away with it.

@Putin
I guess that comment depends on how you define "kills and injures". Real medicine involves procedures and treatments which carry risks, and occassionally result in harm to patients. For the most part, alternative medicine does absolutely nothing - either good or bad. Many conditions like colds and minor infections will get better all by themselves, whether treated or not. But when someone dies or is seriously harmed because he took sugar pills or had someone wave their hands over him, instead of getting antibiotics, or taking insulin, or having his appendix removed, then would you agree that alternative medicine harmed or killed him?

After all, most patients of Alternaticve Medicine have been declared "beyond recovery" by the industrial medicine system IM (a more fair tern than "real medicine"), so IM has nothing to offer, then what's the beef?

Considering this extremely negative "selection bias" tainting the data on AM, isn't the fact that so many "unrecoverable" patients live to tell their store a big plus in favour of allowing AM to freely compete?

The beef is that people who are desperate are spending money and time on "therapies" that don't do anything. They are being taken advantage of by charlatans. Well-structured double-blind tests can show whether a treatment works, and if it does it will be adopted as a standard treatment. Personal stories don't mean anything - they suffer from a strong selection bias. It may make sense to do a properly controlled study based on personal stories, but the results are determined by the study, not the stories. As the saying goes, "What do you call alternative medicine which has been proven to work? Answer: Medicine."

This article is ridiculous, in that it lumps aaaaaaallll alternative medicine together without making ANY distinctions between the 90 or so different therapies and claims that the whole field has nothing to offer. Sure there are charlatans and weakly supported, bogus treatments, but the AMA lists "side effects from adverse reactions to pharmaceutical drugs or mishaps in the hospital as being the 4th biggest killer in this country! Open your eyes to the massive failure of traditional medicine in this country to lead society to overall better, more complete health, not to mention the costs. There are thousands even millions of people in this country who have taken the time to be their own health advocate, do the research, make the difficult changes in lifestyle and integrate age-old modalities in to their approach to well-being. The bio-medical model alone and left to its own devices, without recognizing the body's own miraculous healing capabilities which often just need to be supported, is a top-down, myopic, disjointed model that has been adulterated by all the whores in this country whose only priority is sustaining unhealthy people for ongoing prophets. Have fun spending all your household GDP on fighting the "diseases" which will mysteriously "attack" you as you age. Good plan!

>> The beef is that people who are desperate are
>> spending money and time on “therapies” that don’t do anything.

Such as chenmotherapy? No, chemotherpy besides doing anything it kills.

http://www.ncbi.nlm.nih.gov/pubmed/15630849

"... it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required...."

What you claim is the MONOPOLY OF MAKING MISTAKES for the pjarmaceutical industry.

>> As the saying goes, “What do you call alternative
>> medicine which has been proven to work? Answer:
>> Medicine.”

Not too fast:

the tetanus vaccine has never been tested for efficacy:

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf

“… Efficacy of the toxoid has never been studied in a vaccine trial. …

why does Industrisl Medicine use remedies that have neven been proven to work or be safe?

First, cherry picking partial quotes is never a credible approach. The rest of the paragraph from which you quoted only the first sentence says
"It can be inferred from protective antitoxin levels that a complete tetanus toxoid series has a clinical efficacy of virtually 100%; cases of tetanus occurring in fully immunized persons whose last dose was within the last 10 years are extremely rare.". Thus there is very credible evidence showing that the immunization is effective. It should be noted here that it would be unethical, if not criminal, to conduct a standard test of the tetanus vaccine, as that would require immunizing some people with the vaccine and others with a placebo, then seeing who contracts a deadly disease. As there is overwhelming evidence that it works, there is no reason to needlessly kill people to prove something that is already known.

Second, chemotherapy clearly does work in certain cases, and is of very little value in others. It is probably overused, and each patient should be given an opportunity to make an informed decision, with a clear understanding of the risks, side-effects, and realistic chances of success. However, the same applies for any alternative therapy as well. But hearing stories about a few people who claim to have been cured by an alternative therapy is not a valid basis for making an informed decision. This is why I made my initial post in this thread - these therapies should be tested using the same approach used for conventional treatments, and if they are proven useless they should be abandoned. I have no doubt that most will be proven useless, but there may be a few that show promise, and these should be further studied.

"... It can be inferred ..." means the protective value of the induced antibodies has never been verified and is, therefore, SPECULATIVE and no better than AM.

In these condition, the claim that it has a 100% efficacy is just amazingly ridiculous, not even tested vaccines claim total success rate!!!

Besides, it is a fact that vacine-induced antibodies do not necessarily mean protection, therefore the ass-umption made by the CDC is totally unacceptable.

http://www.sciencedirect.com/science/article/pii/S0264410X01002882

“…It is known that, in many instances, antigen-specific antibody titers do not correlate with protection.… immunological correlates of protection are largely unknown for many infectious diseases… the immunological mechanisms of vaccine-induced protection remain unknown… whenever correlates of protection have been proposed, they only refer to serum antibody titers… there is complete lack of any parameter of cellular-mediated immunity known to correlate with protection… it is crucial to extend studies in the attempt to define correlates of protection for the most important vaccine targets… “

"...cases of tetanus occurring in fully immunized persons whose last dose was within the last 10 years are extremely rare..."

Really? let's look at the findings in Tetanus Surveillance:

http://www.cdc.gov/mmwr/preview/mmwrhtml/00053713.htm#top

"...(13%) of the 122 non-neonatal patients with supplemental data were reported to have received at least a primary series (i.e., three or more doses) of TT before onset of illness (Table_1), including two (40%) of the five non-neonatal patients aged less than 20 years. Three (60%) of the non-neonatal patients aged less than 20 years were unvaccinated because of their parents’ religious objections. The fourth case occurred in a boy aged 14 years who was bitten by a dog and who had received his last dose 2 years previously...."

So, of the children under the age of 20 treated for tetanus, 40% were vaccinated!!! One within the last 2 years.

Tetanus Surveillance covering the years of 1998-2000 (released in 2003) demonstrate:

"... Eight of 50 patients (16%) with known vaccination history during 1998–2000 had received >3 doses of tetanus toxoid with the last dose <10 years before the onset of tetanus (Table 1). All eight patients had nonwork-related acute injuries; six did not seek medical care before the onset of tetanus, and three were aged <20 years...."

In this case, 37.5% of the cases with supplemental data under the age of 20 years were fully vaccinated (ie. at least a primary series of 3 tetanus vaccines).

Pleas practiioners of Industrial Medicine, rid your own turf of false assumtions and unverified remedies first!

"...Second, chemotherapy clearly does work in certain cases..."

Without placebo controlled studies - and chemo has NONE - you can never know whether those cases were due to the cancer receding naturally, which is a very common occurrence.

Any remedy used by Industrial Medicine which is not proven in controlled studies - such as chemo and most vaccines - should be included in the Alternative Medicine list for lack of scientific evidence of their efficacy.

"...As there is overwhelming evidence that it works..."

Without controlled studies? yeah right! so "overwhelming" that no scientific verification is required... The same argument is used by the practicioners of Alternative Medicines.

"... these therapies should be tested using the same approach used for conventional treatments,..."

But ... but... you waive some conventional treatments the requirement of controled trials because the evidence that they work is "overwhelming". Define "overwhelming" in a way that leaves out AM!

I only know one scientific standard of verification of a proposed treatment: comparison to non-treatment in a controlled trial!

"Define “overwhelming” in a way that leaves out AM!"

Give me an example of an alternative medicine approach which you believe is effective based on overwhelming evidence.

And comparison to non-treatment is not meaningful. It must be comparison to treatment with a placebo. While these are equivalent from a medical perspective, they clearly are not from a clinical perspective.

"...Give me an example of an alternative medicine approach which you believe is effective based on overwhelming evidence...."

You brought up the concept of "overwhelming evidence" outside of controlled trials... I have no idea of know what you mean by that. Please explain before I'm able to respond in your same context of meaning.

"...comparison to non-treatment is not meaningful. It must be comparison to treatment with a placebo. ..."

A placebo is a non-reatment, stop beating around the bush and get to the point.

How can you ever have "overwhelming evidence" of a treatment's efficacy and safety that's never been proven in a controlled clinical trial?

I didn't find the cherry-picked quote that you cited, but the paper clearly supports my point, beginning with the very first paragraph:

"Despite widespread availability of a safe and effective vaccine against tetanus, 124 cases of the disease were reported during 1995-1997. Only 13% of patients reported having received a primary series of tetanus toxoid (TT) before disease onset. Of patients with known illness outcome, the case-fatality ratio was 11%."

The tetanus vaccine is clearly extremely effective. People who have received it within the past ten years are vastly less likely to get tetanus. That's overwhelming evidence.

A placebo is different than non-treatment, as measured by outcomes. Therefore treatments must be compared to placebo, which helps people about 30% of the time. This is why homeopathy has a following - it works some of the time. But it happens to work about the same percentage of the time as sugar pills. And that's not a coincidence, as the two treatments are identical. Comparison must be between treatment with a placebo and treatment with an experimental drug or method.

Studies have shown that praying for people makes them get better in some cases, but only if they know that they're being prayed for. Thus it's clear that knowledge of being treated in some way can affect the outcome. That's why the control group must receive a "treatment", instead of being untreated.

"...The tetanus vaccine is clearly extremely effective. People who have received it within the past ten years are vastly less likely to get tetanus. That’s overwhelming evidence...."

In the 70s a team of researchers in Taiwan looked at many variables and found that people who had toasters in the home were less likely to have children.

This is "overwheming evidence" that population reduction can be achived by distributing free toasters in every home!

Certainly, Mark, you have trouble understanding the difference between correlation and causation, therefore you fail to understand the absolute need of controlled clnical trials as the only way to discard confounding factors both known and unknown when looking for "overwhelming" evidence.

Your judgement "The tetanus vaccine is clearly extremely effective" even faisl to take into account such a basic biasing factor which is the tetanus vaccine coverage rate:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a2.htm

Tetanus Vaccination Coverage

"...In 2010, the proportion of adults receiving any tetanus toxoid–containing vaccination (i.e., tetanus and diphtheria toxoid [Td] or Tdap) during the past 10 years was 64.0% for adults aged 19–49 years, 63.4% for adults aged 50–64 years, and 53.4% for adults aged ≥65 years..."

So even if we assume the vaccine is the only factor involved, with a 60% population coverage and a 13% of the sick reporting vaccination, we can say the failure rate of the tetanus vaccine is at least 22%!!! (13/60)

This is far from deserving an "extremely effective" score in my book, and I won't even enter into a second onbious bias which is SELF REPORTING: "...13% of patients REPORTED having received a primary series of tetanus toxoid..."

Your "overwhelming evidence" makes water no matter how you look at it, it is biased all over and it cannot be used as EXCUSE not to carry out a properly controlled clinical trial.

Putin, it is unethical not to treat people when we have something that we know helps them. Therefore, any new treatment must do better than the current treatment, not better than nothing.

Make up your mind--is placebo no treatment or a treatment? Keep in mind that no alternative medicine treatment has a better success rate than placebos do.

Contrary to your assertion that alternative medicine is given mostly to hopeless cases, it's mostly dabbled in by people who are feeling a little blah. Then they report the same kind of subjective improvements that users of placebos do.

Others have noted that alt-woo believers will get mainstream medical treatment, try their alternative method, and then claim that they were cured by the alternative without ever mentioning the proven treatment that almost certainly was what actually cured them. To me, that's lying.

Do you know what they call alternative treatments that have been proven to really work? Conventional medicine.

"Get the flu jab," pleads widower.

Ignorance and fear can kill.

"Studies have shown that praying for people makes them get better in some cases, but only if they know that they’re being prayed for. Thus it’s clear that knowledge of being treated in some way can affect the outcome. That’s why the control group must receive a “treatment”, instead of being untreated."

Actually, well designed studies show that people do worse when they know they're being prayed for. They're more likely to develop complications and more likely to die.

"..Putin, it is unethical not to treat people when we have something that we know helps them..."

Your "ethical" trump card is old an it's persistently violated by mass vaccinations, which themselves are subrepticious clinical trials (since the risks and benefits are largely unknown).

It is unethical to claim you have a remedy and give it to people without knowing the consequences. But before you claim it's "something that helps" you must prove it is actually the case. This can only be done by comparison to placebo.

What's more, in the case of vaccines there are millions of prople all over the world that reject vaccinations, so there' s plenty of volunteers for the control group of an ethical clinical trial.

In the end your logic is extensible to AM, since its practicioners just "know" the AM remedies will help patients, so it will not be "ethical" to carry clinical trials.

What a crock!

"...Ignorance and fear can kill..."

If you haven't done your homework, then you are the ignorant:

http://www.ncbi.nlm.nih.gov/pubmed/20614424

Vaccines for preventing influenza in healthy adults.

Source; Cochrane Database Syst Rev. 2007;(2):CD001269.

“… WARNING: ...An earlier systematic review of 274 influenza vaccine studies published up to 2007.... The review showed that reliable evidence on influenza vaccines is thin but there is evidence of WIDESPREAD MANIPULATION of conclusions and spurious notoriety of the studies…”

This "scientific methodology" is how the snake oil masters at GlaxoSmithKline pushed their H1N1 unproven "vaccine" before WHO officials, such as Dutch professor Albert Osterhaus, investigated by the Second Chamber of the Netherlands Parliament for intimately positioned to personally profit from the billions of euros in vaccines allegedly aimed at H1N1.

http://www.financialsensearchive.com/editorials/engdahl/2009/1208.html

Original Dutch source: http://web.archive.org/web/20100115060109/http://www.minvws.nl/nieuwsbe…

"..Do you know what they call alternative treatments that have been proven to really work? Conventional medicine...."

But you say clinical trials on un roven vacines - and on cancer chemo - were not carried out for being unethical... this means those "conventional unproven treatmets" could be very "ethic", but they're also very unscientific.

"The tetanus vaccine is clearly extremely effective." Bullshit anecdote Mark. There is no need for a vaccine, even if the EBM existed to prove it worked because the condition is easily dealt with by using a simple antibiotic.

This whole thread is a distraction, the conventional medical system is the biggest killer in the US, the medical peer reviewed system for 'proof' is the biggest arse fuck of lies, apart from the banking chaos experts out there.

"What’s more, in the case of vaccines there are millions of prople all over the world that reject vaccinations, so there’ s plenty of volunteers for the control group of an ethical clinical trial. "

Hi Putin, I offered my family as a control we never got vvaccinated, nor have any of my friends either. They turned it down as an offer, these people still believe that antibodies protect us from disease, it really is like talking to flat earth doll fuckers.

They also believe in flu pandemics, it's so basic, most of them don't even pay any tax they just sit at home wanking over pictures of orac!

"Keep in mind that no alternative medicine treatment has a better success rate than placebos do." Mongo

uHH let's put some perspective here, if the flu jab is bullshit why is it still dished out? So can you provide a reference for your statement or is it an anecdote?

“Get the flu jab,” pleads widower.
Ignorance and fear can kill.

Conning someone who has just lost their husband into joining a marketing campaign for the flu jab is sick. There is no EBM for the flu jab it is totally dishonest, someone should write to this women and help her sue the fucking drug companies that have abused her, it's sick.

Excuse me if someone has already addressed this, but I got tired of all the bitching. Who applied for the grants to conduct these studies, and who granted them? Maybe the grant makers are just more willing to fund pie-in-the-sky nonsense than real science, or maybe they want to disprove all these crackpot theories. Proving a negative is very difficult, usually all you can prove is lack of positive results. Or maybe they just don't like your grant proposals.

most patients of Alternaticve Medicine have been declared “beyond recovery”

I don't understand how anyone can say such a thing. As Monado said, "it’s mostly dabbled in by people who are feeling a little blah".

it’s mostly dabbled in by people who are feeling a little blah

I don’t understand how anyone can say such a thing.

Are there differences between the continents or something? Over here, most alt-med is homeopathy, and it's used by people who don't have anything serious. I understand homeopathy is much less widespread in the US, where chiropractic is much more common...

See David? You can't lump so many different approaches from different cultures into one denomination "Alternative Medicine".

Let me remind you that "Alternative" herbal remedies have been copied by pharmacology and ahsped into pills, because they work.

Then they're not alternative anymore.

Some work, some don't, some haven't been tested (yet are sold as working anyway).

"..some haven’t been tested (yet are sold as working anyway)...."

The tetanus vaccine, for example, has never been tested scientifically:

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf

“… Efficacy of the toxoid has never been studied in a vaccine trial..."

According to your rules, the tetanus vaccine is Alternative Medicine.