White Coat Underground

Answer this question…

A colleague of mine asked a great question: if you have one question to ask a booster of so-called alternative medicine in a public forum, what should it be? I’ll give you my answer below the fold, then open the thread to see what you think.

My answer: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

I have information that some other skeptical doctor-bloggers seem to agree with this. Why? Why not ask, “can you give me specific evidence of a proven alternative theory/modality?”

The power of methodological naturalism is that it works. By ruling out supernatural causes as being irrelevant, thereby requiring testable and falsifiable hypotheses, we have developed the most powerful way of describing and predicting the universe around us. Nothing has ever come close to being as powerful. And a good deal of that power lies in being able to reject disproved hypotheses, rather than invoking a deus ex machina to hold on when the facts dispute our beliefs.

What separates science-based medicine from everything else is this willingness to reject a hypothesis. It is rarely seen in alternative medicine. When homeopathy is proved over and over to be nothing more than water, believers simply look for more excuses, even resorting to a “your science is inadequate to test my magic” argument.

So, when confronted with a cult medicine believer, this is the first question I will ask: “which of your beliefs has the evidence caused you abandon?”

Comments

  1. #1 Michael Simpson
    April 20, 2009

    I just love falsifiability.

  2. #2 Rev Matt
    April 20, 2009

    I don’t know that it would be a particularly fruitful line of questioning. Most of the SCAM practitioners and adherents I’ve known tend to drift from one to another and ones that they get bored with or don’t make enough money from they are only too eager to disavow while promoting their new new belief system. And they would believe that qualifies as having abandoned a methodology because of the evidence.

  3. #3 PalMD
    April 20, 2009

    You know, i get that a lot..that, “don’t engage them because they lie/cheat/whatever and will find a way to wiggle out and turn it against you.”

    That didn’t happen with the n-path thing. I got very detailed and sincere responses from n-paths, which to my mind did not measure up to real care. Only one or two displayed actual charlatan traits. Most altmed folks are well-meaning true believers and so will jump at the chance to give what they consider to be a good answer.

  4. #4 Russell
    April 20, 2009

    Whether a theory is testable is not determined by whether it involves supernatural entities. There are quite a few would-be prophets whose failed prophecies are in the record books. And I can imagine easy tests that would prove well enough the existence of a god capable of foretelling the future. There are also entirely physical theories that cannot be tested.

    More, I’ve yet to hear anyone offer an operational definition that specifies how to tell when something is supernatural. If it’s going to be part of methodology, I need to know how to run the test.

    Yes, testability is important. That can be asserted, in its own right. The problem with tying that to “methodological naturalism” is two-fold. First, it is just plain incorrect. Second, it grants too much to those who would push all sorts of gods, ghosts, and things that go bump in the night. They respond — then with some justice — that their views are being ruled out by assumption, that what they want to push is simply beyond the scope of science to dispute.

  5. #5 PalMD
    April 20, 2009

    Thanks, Russell. That’s exactly the kind of response i’m hoping for (and hoping people will discuss).

  6. #6 Russell
    April 20, 2009

    BTW, I agree with your question. I was just picking a nit at the notion of methodological naturalism.

  7. #7 PalMD
    April 20, 2009

    Clearly, as i have stated previously, I am not a philosopher. That’s why it’s good to have smart readers.

  8. #8 Coriolis
    April 20, 2009

    Russel is quite right and it’s a common annoyance I have whenever somebody tries to bring in some notion of “materialism” or “naturalism”, whichever side they are pushing from.

    By most people’s definitions, even electromagnetic radiation wouldn’t be seen as materialism, much less anything to do with curved space-time in general relativity. And yet they are certainly testable physical theories (most of classical GR anyways). So we have no need to constrain ourselves to “materialistic” or non-supernatural explanations.

    If the shit works, it works and that’s all that matters. The thing is, their shit doesn’t work.

  9. #9 PalMD
    April 20, 2009

    I’m unclear on this…are you saying that for materialism and naturalism, you must pass a “tangibility” test? Indirect measurements aren’t OK? Because this doesn’t ring true to me. There is a difference between “intangible” and “supernatural”. I’m not sure how EM violates materialism, since energy/matter exert measurable influence on the universe. Yes, “materialism” somehow implies “matter”, but i don’t think we exclude energy.

  10. #10 Russell
    April 20, 2009

    Electricity doesn’t seem spooky now. There was a time in the past when it was a bit more mysterious. Its use to bring the monster to life is the one part of later Frankenstein movies that was true to Mary Shelley’s original book, written a couple of decades after galvanism was discovered, but before the laws of electricity were worked out.

    So what once was mysterious became less so, and once was science fiction and used as a hook by countless charlatans is now considered a paradigmatic example of hard physics. Which is one reason why I think notions of materialism or naturalism should be examined carefully, to see if their accounts of what counts as material or natural hold up. It’s interesting that even more philosophical criteria of what science should study have sometimes fallen by the wayside. Well into the 20th century, some philosophers wanted to require strict causality of natural law. I don’t know whether physicists were just more intellectually flexible or if they just more took Bell’s law to heart, but the inherent weirdness of quantum mechanics is no longer held against it. If classical electricity isn’t spooky, there’s no doubt that wave functions are.

  11. #11 PalMD
    April 20, 2009

    Its use to bring the monster to life is the one part of later Frankenstein movies that was true to Mary Shelley’s original book, written a couple of decades after galvanism was discovered, but before the laws of electricity were worked out.

    In fact, Shelley was expressing the common contemporary notion of vitalism. In this case, it was the new-fangled ‘lectricity that gave the Monster his “elan vital”.

    I think that spooky doesn’t rule out natural…

  12. #12 Blake Stacey
    April 20, 2009

    I think objects of different weight falling with the same acceleration is spooky as Wednesday Addams.

    The original novel Frankenstein name-drops “galvanism” in chapter 2: young Victor experiences an impressive thunderstorm, hears a bit about electricity — the hot new thing at the time — and consequently gives up reading the alchemists in favour of studying mathematics. The book doesn’t really specify how the monster was brought to life, just that young Victor studied death and decay and figured out how to reverse the process.

    To examine the causes of life, we must first have recourse to death. I became acquainted with the science of anatomy, but this was not sufficient; I must also observe the natural decay and corruption of the human body. In my education my father had taken the greatest precautions that my mind should be impressed with no supernatural horrors. I do not ever remember to have trembled at a tale of superstition or to have feared the apparition of a spirit. Darkness had no effect upon my fancy, and a churchyard was to me merely the receptacle of bodies deprived of life, which, from being the seat of beauty and strength, had become food for the worm. Now I was led to examine the cause and progress of this decay and forced to spend days and nights in vaults and charnel-houses. My attention was fixed upon every object the most insupportable to the delicacy of the human feelings. I saw how the fine form of man was degraded and wasted; I beheld the corruption of death succeed to the blooming cheek of life; I saw how the worm inherited the wonders of the eye and brain. I paused, examining and analysing all the minutiae of causation, as exemplified in the change from life to death, and death to life, until from the midst of this darkness a sudden light broke in upon me — a light so brilliant and wondrous, yet so simple, that while I became dizzy with the immensity of the prospect which it illustrated, I was surprised that among so many men of genius who had directed their inquiries towards the same science, that I alone should be reserved to discover so astonishing a secret.

    Hence the joke in Young Frankenstein with the book entitled “How I Did It”.

    (When the monster comes to life, there isn’t a storm going on. Yellow moonlight is shining through the window shutters, and Victor spends the night pacing in the courtyard.)

  13. #13 Russell
    April 20, 2009

    Well, no, spooky doesn’t rule out natural. But I don’t know any property that does rule out natural. Except, perhaps, the complete absence of any evidence that something exists.

    Suppose, this year, a way were discovered to speak with the dead. Not in the fuzzy, moaning low-baud seance sense, but a true, high quality audio line. Your departed relatives would talk with you, recalling facts that only they could know. Marilyn Monroe and Jimmy Hoffa would recount last nights. Memorabilia and treasure long lost would be found as those past who solely knew their locations directed their descendants to their location. Secrets long thought taken to the grave would be revealed.

    Well, at first it would be taken as supernatural. But scientists are a curious lot. And soon they would be investigating what the dead were like: Did those who went senile before they died remain so after? Do they have their own motivations and adventures in the afterlife, or merely recount their past knowledge? Do they sometimes lie? Is their dialogue with use voluntary or must they answer when rung? And soon, we’d have theories of how this was happening. In a decade or two, it would come to seem not so spooky. That long again, there would be a science of ghosts. After a century, when philosophers speak of the supernatural, they would laugh at the old days when ghosts were so considered.

  14. #14 prolix
    April 20, 2009

    The power of methodological naturalism is that it works.

    Here’s an analogy, not, mine, but Nancy Cartwright’s. Suppose I went drilling for oil. The first well hits oil at 5000 feet, the second at 10.000 feet and the third at 15,000 feet. Can I assume the fourth well will strike oil. Similarly, even if philosophical naturalism has worked so far, can we assume it will work in every case? Considering some of the problems yet unsolved, the mind-body problem and hard AI, I think not.

  15. #16 prolix
    April 20, 2009

    When homeopathy is proved over and over to be nothing more than water

    If you’re going to try to disprove homeopathy, it’s going to take more than waving your hands in the air and making noises of disapproval. You’re going to have to make a survey of the research to date and give a fair summary of it, with citations.

  16. #17 prolix
    April 20, 2009

    I just love falsifiability

    Maybe you should broaden your reading in philosophy of science beyond Karl Popper.

  17. #18 PalMD
    April 20, 2009

    @prolix

    HAHAHAHAHAHAHA

    (wiping tears)

    HAHAHAHAHA

    OK, here’s the way it works: if you’re going to promote a practice whose acceptance would require us to re-write most of our physics and chemistry textbooks, the onus of proving it is on you.

    Also, we’ve debunked the magic water many times, both in this space and at sciencebasedmedicine.com

    To believe in homeopathy requires a whole different level of faith than is required to believe in, say, gravity.

  18. #19 RMM Barrie
    April 20, 2009

    prolix: For a start at The Cochrane Library

    http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004845/frame.html

    Part of the conclusion: “There is no convincing evidence for the efficacy of homeopathic medicines for other adverse effects of cancer treatments.” And this comes from the bad guys.

  19. #20 RMM Barrie
    April 20, 2009

    To the original question; no question. As noted, all of the alt med that I have seen is based on a belief as a foundation ( kind of like asking a religious leader why the belief in a particular deity). Then belief is justified with all the soft claims without any real hard evidence of efficacy and many escape routes for failures. It is never the treatment, “we only got the application wrong, so we will add a little more of this”. Go to the web page of Mona (www.drmonamorstein.com) and she practices more specialties and wider range of very different “treatment” modalities than any MD has a long enough life to complete all the internships. They do the easy stuff, claim the hard with “sciency” descriptions, but as Mona demonstrated, just above that and things get muddled. It is also noted that they never get involved with things that are readily measurable, like surgical outcomes, and only the far side of woo lays any claims to malignancies, as two examples. In the crudest way of putting it, they believe their own nonsense, call themselves doctors of medical practice, and never know what they do not know. Their true expertise is rationalisation and out of context quote mining.

  20. #21 PalMD
    April 20, 2009

    They do the easy stuff, claim the hard with “sciency” descriptions

    That’s “science-y” : )

    What I think it accomplishes in certain settings (such as a medical school) is to effectively show off the emperor in his new clothes. It’s not effective in a room full of cult members, but in a room full of med students, docs, and shruggies, i think that the recent n-path discussion has shown it to be effective.

  21. #22 Dr Benway
    April 20, 2009

    I’m not a philosopher. But I’ve argued with a few.

    Methodological naturalism is a method of inquiry. As a method, it’s ontologically neutral.

    One may be hard-nosed (materialism, naturalism, physicalism), mystical (dualism), or taking the piss (idealism). It doesn’t matter. For the method would appear no different in a universe of matter as compared to a universe of material illusions.

    Whenever anyone says, “oh Popper” reflexively with a roll of the eyes in response to the word “falsifiability,” I know I’m dealing with a repeater rather than a mind capable of original thought.

    If there’s a way to establish a causal relationship between independent variable A and dependent variable B without falsifiability –that is, without an effort to disprove competing hypotheses– I’d love to hear about it.

  22. #23 Joe Average
    April 20, 2009

    Naturopaths use the same anti-infective medicines that medical doctors used 50 years ago.

    To mock the naturopaths is to mock the treatments of the medical doctors from 20th century. I mean for almost every naturopathic remedy, I can find you an obscure journal report of a medical doctor using the same treatment on the same disease.

  23. #24 RMM Barrie
    April 20, 2009

    PalMD
    Science-y: I can spell, just cannot type and proof read very well. One out of three proficiencies should then qualify me for the potentisation of the Mother Tincture, to many dilutions of the helpful substances, which I may or may not read the ingredient list properly like 10 to the 23rd,to create memory (as proven by Jacques Benveniste) by proper succussion (shaking) not stirring!

    Problem is, many in society believe the nonsense, and hurt themselves. How does one reach this rather large group when the popular press is more often wrong than right.

  24. #25 PalMD
    April 20, 2009

    That’s a bit of a tu quoque joe. If i were to practice like my dad did in the mid to late 20th century, i’d be in big fucking trouble.

  25. #26 DLC
    April 20, 2009

    I liked your question.
    I might amplify it with “and how was it proven to be ineffective ?”

  26. #27 Tsu Dho Nimh
    April 20, 2009

    Joe Average said, “Naturopaths use the same anti-infective medicines that medical doctors used 50 years ago.

    Make that 150 years and I’ll believe you. I have some medical books from that era you would agree with.

  27. #28 Dr Benway
    April 20, 2009

    Prolix:…even if philosophical naturalism has worked so far, can we assume it will work in every case?

    Let’s say the scientific method cannot provide useful answers to several of our questions. Two questions follow:

    1. What method will you use to determine when you ought to use the scientific method to solve some problem, and when you ought to use some other method?

    2. What is the nature of that other method?

  28. #29 Dr Benway
    April 20, 2009

    Oh, Prolix, be careful not to conflate “naturalism” or “philosophical naturalism” with “methodological naturalism.” The first two are ontological positions while the last is not.

  29. #30 Michael Simpson
    April 20, 2009

    Joe Average–150 years ago, both cell theory and the germ theory of disease were barely understood. If Naturopaths are using treatments from the 1850’s, they ought to be arrested and jailed. Your comments are so ridiculous as to make me wonder if you’re serious. And I bet you can’t find a reliable citation for any of these ridiculous treatments from the last 20 years. And no, your beloved Wikipedia doesn’t count as a reliable source.

  30. #31 Joe Average
    April 20, 2009

    “your science is inadequate to test my magic” argument.
    — As I said, I love medical doctors. I spent some time looking at the old medical journals, veterinary medicine, naturopathic medicine, testimonials(anecdotal evidence), and new medical journals from the past 5 years, for alot of diseases. Just an odd hobby I picked up recently. I’m no doctor and I make no secret of that.

    Let me try to respond to your statement above. If a naturopath cures a disease that medical doctors cure, it’s no big deal.

    The real challenge is to cure a disease where the cause is unknown. Within that group of diseases, there are plenty of medical doctors and naturopaths to claim to have cured a patient here or there; but that is anecdotal evidence, which is not accepted here, right? Not until a clinical trial proves the effectiveness, correct?

    So it makes it rather tough for naturopaths to get clinical trials($100 million?) on non-patentable treatments(old drugs). Perhaps a bit harder for a naturopath to raise this money with a medical proffesion that has a bias against them?

    But those are just excuses; excuses are for losers; I don’t like excuses, either.

    Want to see a clinical trial on a naturopathic remedy for Dandruff? Perhaps a treatment for Rosacea?(I chose 2 benign diseases, since I got in trouble in the other thread) Maybe a 2009 study on the genetics behind Parkinsons disease, which seems to confirm the naturopathic remedy for this disease?

  31. #32 Joe Average
    April 21, 2009

    “If i were to practice like my dad did in the mid to late 20th century, i’d be in big trouble.”– PalMD

    “If Naturopaths are using treatments from the 1850’s, they ought to be arrested and jailed.” — Michael Simpson
    — Anti-infectives like Iodine, Acetic Acid, Boric Acid still appear in an ENT’s arsenal of drugs. Newer doesn’t always mean better. Quite often newer drugs are tested against the Placebo and not against older drugs. I mean Celebrex has never been proven clinically more effective than Aspirin.

    But that’s not the point. I mean doctors used to be opinionated. They used to get to experiment(on non-deadly diseases). Heck doctors used to drain blood from people. As Michael pointed out there are a lot of old treatments that doctors used to practice that if practiced today would get you jailed.

    On the other hand, don’t you feel a little hand-cuffed? Having an opinion on a disease, but you can’t try it for fear of lawsuit? This lawsuit scare has got to be a terrible burden on many doctors I imagine. I guess that’s part of the business, but it seems unfortunate. Any opinion on this or any other doctor related topic? I mean I get the us vs. them stuff. I’m not a doctor, and I want to hear the stories about crappy patients. Bizzare Medical Stories. New Treatments. Personal Treatment protocols on diseases. Personal Opinions on diseases. New ideas. That’s kind of what I’m looking for out of a medical blog. Perhaps I’m in the wrong place. If you have a link recommendation for me, let me know.

  32. #33 Marilyn Mann
    April 21, 2009

    An example of a medical practice that is being reevaluated in the wake of recent clinical trials is tight glucose control. Summary from Physician’s First Watch:

    “Skeptical Look at Tight Glycemic Control

    Tight glycemic control in type 2 diabetes can overburden patients with complexity and cost, giving “uncertain benefits in return,” according to an Annals of Internal Medicine perspective published online.

    The authors reviewed recent trials that compared tight versus more relaxed glucose targets. The results, “suggest that tight glycemic control may not reduce the risk for all-cause or cardiovascular mortality, stroke, amputations, or even microvascular complications.” They did find one clear message: Tight control greatly increases the risk for hypoglycemia.

    They argue for “a change in emphasis” in diabetes care, away from “interventions that overwhelm the patients’ capacity to cope clinically, psychologically, and financially.” And they say that clinical HbA1c targets should not be the same as those used to measure quality of care. Quality measures set too low, they write, “invite clinicians to ignore patient burden, context, and goals.” Keeping levels between 7% and 7.5% “seems reasonable and feasible for many patients.”

    http://www.annals.org/cgi/content/full/0000605-200906020-00118v1

    There were also commentaries published recently in BMJ and JAMA. I can get the cites if anyone is interested.

  33. #34 Mojo
    April 21, 2009

    My answer: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

    The problem with this question is that proponents of alternative medicine often appear to think that the fact that they have never abandoned any practices or therapies is a strength rather than a weakness.

  34. #35 DuWayne
    April 21, 2009

    Shorter Joe Average –

    Because we still use a few things that we used fifty, one hundred and even more years ago, my magic is more powerful than your science…

    (if it helps support your argument, I just took a centuries old treatment for pain – but I also took a couple of drugs that are far younger and far more important to my functioning, so you may not want to use me after all)

  35. #36 Marilyn Mann
    April 21, 2009

    When the facts change, I change my mind. What do you do, sir?

    —John Maynard Keynes

  36. #37 Jimbo Jones
    April 21, 2009

    Joe Average: In your comments, I see straw men. They do not help your position, no matter how hard you try to appear reasonable.

    So it makes it rather tough for naturopaths to get clinical trials($100 million?) on non-patentable treatments(old drugs). Perhaps a bit harder for a naturopath to raise this money with a medical proffesion that has a bias against them?

    Apply for a grant. Like almost all medical researchers do. Why should naturopathy be special? If you can show a treatment to be effective in culture, you get a shot at a grant for animal testing. Show that to be effective and step up to the plate for a shot at human trials. Just like everyone else.

  37. #38 Dianne
    April 21, 2009

    So it makes it rather tough for naturopaths to get clinical trials($100 million?) on non-patentable treatments(old drugs).

    NCAAM exists to fund studies like this. And it has a better pay rate than any other part of the NIH. Thus, it’s actually easier for naturpaths to get funding than for MDs. Except that they have to have a clinical trial that an IRB won’t laugh at and the willingness to test their ideas.

  38. #39 Coriolis
    April 21, 2009

    I think Russel explained quite well what I was getting to with his ghost analogy – essentially, it doesn’t matter whether it “seems” supernatural, if it works, it will be science (eventually).

    To answer what you asked about whether materialism requires “tangibility” – I think most of the various alt-med nutjobs think so, and hence they whine about it. Many of their “theories” are based on some type of mystic energy that we apparently don’t know about (vitality, chi, whatever). So they believe that science is only concerned with tangible things – and here we are not considering their ideas because we’re narrow like that.

    Of course that’s not the actual distinction between a scientific claim and quackery – the real distinction is, as you say, whether it has any measurable effect on the real world. Practically all of physics outside of classical freshman physics is intangible, and would appear mystical if we weren’t so used to it. So I would just dispense with this whole argument over what “materialism” is or isn’t, and just point out the fact that what they do doesn’t work. And more importantly, that they don’t have a method of distinguishing the ones that work from the ones that don’t.

    Which incidentally is exactly what your original question points out.

    The only problem with it is that without extra explaining, most people (who aren’t on your side already) probably wouldn’t understand the significance of having failed theories.

  39. #40 Ray Ingles
    April 21, 2009

    The problem with the word ‘supernatural’ is that it’s hard to pin down a definition. But if you look at how people use it and when and where, I think that it’s possible. So far as I can see, when people say ‘supernatural’, they mean ‘unknowable’. That is to say, something that’s beyond human comprehension. My key evidence is that once something has a comprehensible explanation, it’s not ‘supernatural’ anymore.

    The novel “Lord Of Light” by Roger Zelazny has a passage about this:

    “If by demon you mean a malefic, supernatural creature, possessed of great powers, life span and the ability to temporarily assume virtually any shape — then the answer is no. This is the generally accepted definition, but it is untrue in one respect.”

    “Oh? And what might that be?”

    “It is not a supernatural creature… The four points of the compass be logic, knowledge, wisdom and the unknown. Some do bow in that final direction. Others advance upon it. To bow before the one is to lose sight of the three. I may submit to the unknown, but never to the unknowable.”

    The character who said that later invents demon-repellent. :->

    More about the futility of the concept of the ‘unknowable’ here.

  40. #41 ildi
    April 21, 2009

    “By most people’s definitions, even electromagnetic radiation wouldn’t be seen as materialism, much less anything to do with curved space-time in general relativity.”

    Who are these “most people” to whom you refer? Even that everyman’s source, wikipedia, disagrees with this archaic definition of materialism.

  41. #42 Russell
    April 21, 2009

    As evidence that scientists happily turn their eyes to things labeled supernatural, we have two examples hot from the ScienceBlog presses this morning. David Ng writes on the evolution of the unicorn’s horn:

    http://scienceblogs.com/worldsfair/2009/04/the_evolutionary_biology_of_th.php

    Not to be outdone, PZ references a study on the human-vampire population ecology:

    http://scienceblogs.com/pharyngula/2009/04/theoretical_ecology_of_vampire.php

    Q.E.D. ;-)

  42. #43 Joe Average
    April 21, 2009

    Here is a new study on Parkinson’s Disease(2009)… seems to link it to Manganese Poisoning as one potential cause. It mentions something about Manganese killing some kind of Yeast as well.
    http://www.uphs.upenn.edu/news/News_Releases/2009/02/parkinsons-manganese-print.html

  43. #44 Calli Arcale
    April 21, 2009

    That’s a great quote about the unknowable. My favorite is a bit terser, and comes from the Doctor Who serial “Robots of Death”:

    “To the rational mind, nothing is inexplicable; only unexplained.”

  44. #45 PalMD
    April 21, 2009

    Joe, your reading comprehension in incomprehensibly poor. The fact that the words “Parkinsons” “manganese” and “yeast” appeared together does not lead to your conclusion. In fact the paper mentions the known fact that one cause of Parkinsonism (not parkisons) is so-called manganese poisoning in welders. They used this knowledge to examine the interaction between a particular protein and manganese.

    Yeast was used to model the whole thing. It was a tool, like a wrench or hammer.

  45. #46 Joe Average
    April 21, 2009

    Understood. Thanks for the clarification, PalMD.

  46. #47 PalMD
    April 21, 2009

    Joe, I gotta say, of all the credulous commenters who come by here, you seem to have the most open mind. This seems to allow you to absorb a whole lot of bad info, but also you seem open to understanding the truth. I can’t say how completely refreshing that is (and no, that doesn’t mean i expect you to agree with me all the time).

    I like that article—it’s interesting, and i’m sure folks around here would be happy to read in, explain it, and discuss it. But it doesn’t have much to do with the original topic, although at a quick glance it may see so.

  47. #48 PalMD
    April 21, 2009

    (sorry if that sounded patronizing)

  48. #49 Jeff
    April 21, 2009

    Perhaps you’re asking the wrong question. My question is this:

    Can you please give specific examples of FDA approved, conventional therapies that should be abandoned because they have been found to be dangerous and harmful?

    How about statin drugs:
    http://www.wellnessresources.com/freedom/articles/researchers_document_the_dangers_of_statins/

    Especially when there are effective nutritional solutions to high cholesterol without statins’ side-effects:

    http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=2069&query=Inositol%20Hexanicotinate&hiword=Hexanicotinate%20INOSITOLS%20Inositol%20

  49. #50 PalMD
    April 21, 2009

    In fact, Jeff, it is precisely the correct question, and mainstream medicine can answer it easily. Statins are a poor example because of their exemplary safety and efficacy.

    Every day, though, we abandon therapies due to data.

    For example, lidocaine for post-MI arrrhythmias, Vioxx for osteoarthritis, unopposed long-acting beta agonists for obstructive lung disease—basically, the idea forms the basis for much of medical research. We do studies to get answers, good or bad, not to confirm our prejudices.

  50. #51 The Perky Skeptic
    April 21, 2009

    PalMD, in fact, your question seems to be a great way to identify whether someone is sincere in their practice vs. an actual charlatan out to make a buck from a sCAM. The sincere ones will at least TRY to describe their methodology, because they believe in what they’re doing, while scammers will just evade, evade, evade, like someone out to sell a Perpetual Motion Machine franchise.

    As much as some of the comments on these naturopathy threads have been annoying, at least the majority of them have been sincere. I have a great deal of respect for people who will willingly subject their beliefs to a skeptical audience.

  51. #52 Russell
    April 21, 2009

    In prescribing drugs, I wish doctors were also somewhat conscious of costs, as well as efficacy. Why, for example, do they first write a script for the latest and expensive PPI, instead of recommending omeprazole, which is now beyond its patent and reasonably priced? That is one example, among many. To most people, there is a significant difference between a drug that costs $100/month and one that costs $12/month. Now yeah, I understand that drugs improve. But why not first offer the patient an old stand-by that works well for most people, and is reasonably priced, before pushing the latest and greatest?

    ‘Course, that is another issue entirely.

  52. #53 John H.
    April 21, 2009

    @PalMD

    If i were to practice like my dad did in the mid to late 20th century, i’d be in big fucking trouble.

    My father told stories of his father’s medical practice (1920’s to 1950’s), and how he dispensed essentially sugar pills for some of his patients’ ailments. Today that would be clearly unethical. I suppose back then, people’s expectations weren’t quite so high. A good placebo was sometimes good enough, particularly if you had nothing better to offer.

    That said, I know he was a good doctor who cared a great deal for his patients. Wish I’d had a chance to meet him.

  53. #54 Joe Average
    April 21, 2009

    “NCAAM exists to fund studies like this. And it has a better pay rate than any other part of the NIH. Thus, it’s actually easier for naturpaths to get funding than for MDs.” — Dianne
    — Dianne,
    Since you mentioned NCCAM, here is a new article on NCCAM. It is a rather interesting article.

    Debate over the future of NCAAM takes to the blogs(march 23, 2009)
    http://achsedu-natural-health-education.blogspot.com/2009/03/debate-over-future-of-ncaam-takes-to.html

    For more information on NCCAM clinical trials:
    http://nccam.nih.gov/research/clinicaltrials/alltrials.htm

  54. #55 PalMD
    April 21, 2009

    @russell…

    Things are improving. Overall I think generic rx rates are up to about 70%. I know my personal rates of generic rx are quite high, and since the $4 programs at major big box stores rx treatment has really become much more affordable.

    One of the big exceptions in glucose meter strips, etc.

  55. #56 CyberLizard
    April 21, 2009

    One of the big exceptions in glucose meter strips, etc.

    Tell me about it. They practically give away the meters knowing that they’re gonna sell the strips for $1, $2 a piece or more. Helps that your supposed to check your bgl 4 times a day. Add that to the $140/month my wife pays for her diabetes meds and it adds up.

  56. #57 Greg Laden
    April 21, 2009

    Hey, man, you totally stole your question from me. As it happens I end up on a fair number of what I’ll call for lack of a better term examination committees for what (again) for lack of a better word I’ll call “CAM graduates.” I ask for an accounting of what was thought to be likely or posssibly true ten years ago that has been proven wrong, tossed out, since.

    I usually get pretty good answers, actually. Of course these are fresh college grads in a high end program (which is not a CAM program, just includes some CAM people) so this is not unexpected.

  57. #58 bob
    April 21, 2009

    Personally, I think even mentioning philosophy in the lead-up to the question gives these guys too much wiggle room. Getting your hands dirty discussing “naturalism” is necessary when you’re talking philosophy (say, with a theist or post-modernist), but I don’t see why it’s necessary here. We’re talking about the real world: life or death. Their treatment works or it doesn’t. Their patients die or get better, and science is the only way to accurately measure that. Anything else isn’t even “philosophy” or some -ism, it’s special pleading.

    If “their magic” cannot be tested by science, that means that it doesn’t have an effect in the real world and thus people shouldn’t be betting their lives on it. Period.

  58. #59 PalMD
    April 21, 2009

    Already had enough trouble with “post-modernist” comments on the naturopathy thread—concerned re my hegemonic Western ideas of medicine

  59. #60 Michael
    April 21, 2009

    To go back to the beginning of the thread.

    “I just love falsifiability — Michael Simpson”

    And

    “I don’t know that it would be a particularly fruitful line of questioning. Most of the SCAM practitioners and adherents I’ve known tend to drift from one to another and ones that they get bored with or don’t make enough money from they are only too eager to disavow while promoting their new new belief system. And they would believe that qualifies as having abandoned a methodology because of the evidence. — Rev Matt”.

    Rev Matt describes SCAM practitioners, not SCAM advocates and believers. Most SCAM practitioners (I believe) are just trying to get by and make a living and hope that they are helping. They are not interested in evidence.

    The SCAM advocates do not believe any negative evidence, and have the utmost faith in the dodgiest positive study. The problem for scientists is that it is not possible to PROVE that a treatment does not work. There is always a possible problem with the evidence: it could have been fabricated; or the experiment wasn’t done right; or something. This is great for the CAM research industry, who get 100’s of millions to look again and again and again at treatments with good evidence on little or no effect.

    So, the problem with falsifiability is that it doesn’t work well in practice. And it doesn’t work at all in theory.

    (I seem to have falsified falsifiability. Does this get me into an endless loop?)

  60. #61 Dianne
    April 21, 2009

    Since you mentioned NCCAM, here is a new article on NCCAM. It is a rather interesting article.

    Yes, a number of people, including bloggers, have questioned whether NCCAM is a useful center to have, particularly since the money being spent there could be spent on more promising non-CAM therapeutic possibilities. All the more reason for naturopaths who have all natural, side effect free methods for curing diabetes, hypertension, and male pattern baldness to get their grants in NOW. If there were a series of well conducted, positive studies using CAM then no one could reasonably argue that NCCAM is a useless appendage to the NIH and its funding–and the future funding of CAM–would be safe. If, of course, any of these cures actually works better than placebo. Of those so far tested results have generally been…disappointing.

  61. #62 Michael Simpson
    April 21, 2009

    So, the problem with falsifiability is that it doesn’t work well in practice. And it doesn’t work at all in theory.

    The philosophy of science has evolved over time to build a framework that allows us to test our theories of the natural world. Science allows for self-correction, and if didn’t, we’d never progress (one of the hallmarks of the pseudoscientific crowd).

    Falsifiability eliminates magic, supernatural, and faith-based theories. It also sometimes makes scientific conclusions sound a bit weak, but we understand that. The pseudoscientific crowd cannot allow themselves to believe that their theories can be falsified. So, yeah, falsifiability is very useful.

  62. #63 Dr Benway
    April 21, 2009

    Michael:

    The problem for scientists is that it is not possible to PROVE that a treatment does not work. There is always a possible problem with the evidence: it could have been fabricated; or the experiment wasn’t done right; or something. This is great for the CAM research industry, who get 100’s of millions to look again and again and again at treatments with good evidence on little or no effect.

    So, the problem with falsifiability is that it doesn’t work well in practice. And it doesn’t work at all in theory.

    We operationally define terms like “prove” and “work” up front, to insure that it *is* possible to prove that a treatment does not work.

    We try to rig the experiment to make cheating very difficult. And we assign degrees of confidence to any claim, based on how well corroborated or replicated the finding by independent parties.

    People may set the evidential bar impossibly high. They may insist homeopathy works in spite of years of unimpressive research. This is “special pleading,” and it’s not ethical.

  63. #64 Dr Benway
    April 21, 2009

    Did scienceblogs do something to their code? Blockquotes seem to give me more grief lately.

    My own words begin at “We operationally define.” I would never say anything slanderous against falsifiability. For how can cause-and-effect be sorted without falsifying competing hypotheses?

  64. #65 Dr Benway
    April 21, 2009

    NCCAM needs to go, just as “CAM” needs to go. The term “CAM” is more associative than logical. Consequently, ‘CAM’ as a category is not helpful to a scientist.

  65. #66 Whitecoat Tales
    April 21, 2009

    The problem with CAM, is that to a lay person without enough education on the subject, it “feels” less irrational on first glance.

    NCCAM gives alt-meddies a bunch of big words to feign being reasonable.

    That’s one of the reasons why asking an alt-meddie, or denialist for citations doesn’t work. Often you get buried in a see of tangentially relevant studies, bad studies, and completely irrelevant citations that they fully expect you not to even look up before they’ve moved on.

    For similar reasons, I feel the question’s we’ve seen here just dictate the manner in which our fraud of the day will evade you.

    Check out PalMD’s naturopathy threads. One of the naturopaths – the post-modernist one, explicitly gave practices that he felt the evidence didn’t support. To his credit, he ruled out homeopathy. To his discredit, he didn’t rule out much else.

    Even when alt-meddies think that they’re doing evidence based medicine, they’re real understanding of the subject just isn’t adequate to the task.

    Actually, thats true for many MD’s – we spend alot of time in class being told to look up journals, we get taught how to search for legitimate information. Functionally, alot of MD’s just aren’t scientists, and I don’t see that changing in the near future. We don’t get taught how to actually evaluate a study, not in any realistic detail.

  66. #67 Joe Average
    April 21, 2009

    “I think quite frankly that in this center, and previously in the office before it, most of its focus has been on disproving things, rather than seeking out and proving things.”

    “The idea that the center is spending lots of money running large clinical trials of such practices as homeopathy and ayurvedic medicine “is a misperception,” the director said. She noted that most such proposals lack methodological rigor and aren’t approved.”

    “A study in December comparing real and sham acupuncture in 162 cancer patients who’d undergone surgery found no difference in their levels of pain.”
    — Might as well cut NCCAM. It doesn’t seem to satisfy anyone. Accupuncture(sticking needles in someone) to study pain levels? This is some really wierd stuff they study over there. Accupuncture therapy for Eczema might be a more interesting study (not that I would want my tax dollars going to that one, either, though). NCCAM seems rather miguided, though.

    When someone claims a religious miracle, the catholic church sends out a bunch of investigators to verify was this a “real” miracle, or was this just some delusional nut with a bout of indigestion.

  67. #68 Joe Average
    April 21, 2009

    Off-topic: I found a neat new article today.

    Horse stem-cell technique to be tested in people
    http://www.newsdaily.com/stories/tre53e4wj-us-stemcells/

  68. #69 PalMD
    April 21, 2009

    Patients will receive injections containing millions of their own stem cells, which have been extracted and multiplied up in a laboratory, and can regenerate new tissue to repair damaged regions.

  69. #70 Roger
    April 21, 2009

    So much of this very thoughtful exchange is right on the edge of what is essentially wrong with dismissing a 200 year-old methodology which is abused by it’s detractors because it shouldn’t work and further abused by its promoters who are at pains to give a rational explanation as to why it should. Which brings us to the original question: name some alternative medicine theories that were abandoned because they didn’t work. Despite persistent maltreatment by its enemies and bewildering misrepresentation by its friends, homeopathy has nonetheless not been abandoned by its nearly eight generations of patients, a good many of whom are scientifically literate. The scale at which homeopathy does or doesn’t operate is the fervent study of nano science with a moist vocabulary that couldn’t have even existed a few minutes ago: submicron particles in an ordered geometry, which, because of their increased surface to volume ratio, are short-circuited by surface discharge and behave exotically. Little wonder that homeopathy’s adherents resort to embarrassing, non-natural expressions. Little wonder, too, that homeopathy’s ardent dismissal, far from being a scientific refutation at the heroic scale of these contemporary, submicron mysteries, is merely a settled convention.

  70. #71 Michael Simpson
    April 21, 2009

    Roger. Like many of woo-pushers, you use a lot of words, combined into sentences that really mean nothing.

    Homeopathy is simply impossible. There are 0 molecules of anything in homeopathic potions, and as such, they can have no effect, other than delivering some water to your system. And if you are implying that somehow water retains a memory of those molecules (and I know this not from your words, but from reading way too much about homeopathy), again, there are no mechanisms that make that possible. Your comments are just random words that really have nothing to do with physics, biochemistry, or chemistry.

    But if you want to believe in magic, please see creationism, alien abduction, and ghosts.

  71. #72 PalMD
    April 21, 2009

    Roger, i have no idea what your point was, but it was poorly made.

  72. #73 Joe Average
    April 21, 2009

    “Homeopathy is simply impossible. There are 0 molecules of anything in homeopathic potions, and as such, they can have no effect, other than delivering some water to your system.”
    — Well, I consider homeopathy a quack science. I haven’t spent much time studying this one to form an educated opinion, though.

    My understanding is that the homeopathic remedy for thrush is boric acid. This is also a veterinary treatment for Thrush in horses. There are clinical trials in the past and ongoing studying this particular remedy for this problem. So I wouldn’t go as far as to say that it’s all 100% junk.

    ps. If you would like to see a clinical trial on this remedy, I will post it.

  73. #74 JPPhD
    April 22, 2009

    Average Joe@ 73:

    My understanding is that if the homeopathic treatment contained a detectable amount of boric acid then it is not a true homeopathic treatment.

  74. #75 bob
    April 22, 2009

    Roger, to use your odd verbiage, much of what you said was on the edge of being essentially wrong. What did you not understand about this discussion? Your post, once I sift through the verbose BS, seems to be nothing but arguments from antiquity, special pleading, arguments from popularity, and literal pseudo (i.e. fake) science. Which are, you know, precisely the kind of obfuscating bullshit and lies this post was meant to dispel. Again, how did you miss that?

  75. #76 Joe Average
    April 22, 2009

    “My understanding is that if the homeopathic treatment contained a detectable amount of boric acid then it is not a true homeopathic treatment.”
    — I was kind of wondering about that as well. What is the dosage and frequency, etc…

    Not that I want to spend much time studying homeopathic medicine, here is a website that talks about this particular remedy, and mentions other homeopathic remedies as well.
    http://www.truestarhealth.com/Notes/2265000.html

  76. #77 HCN
    April 22, 2009

    Joe Average, you really have do not know much about homeopathy, yet you need to post a commercial about the stuff?

    Here is a question for you, Andre Saine claims that homeopath works better for rabies than our modern standard care, yet there does not seem to be any documentation for this claim (see http://www.theness.com/neurologicablog/?p=41 ). Can you use your Google-fu to find that real actual scientific evidence that it is better to treat rabies with homeopathy that that stuff started by Pasteur? Remember because rabies is almost 100% fatal, this is a very testable claim (it just depends on how many mice you wish to sacrifice).

    Websites that are commercials are not considered scientific evidence, you have to work harder than that. It has to be published in a journal that could either be in my medical school library or at a minimum be seriously considered by a veterinarian who really cares about the science of treating animals — so a journal that is in a school of veterinary science would be required. (vets who love animals really hate it when animals suffer, especially those who have had to treat these animals who have been ineffectively treated with nonsense and are suffering, see: http://www.vetpath.co.uk/voodoo/index.html )

  77. #78 Joe
    April 22, 2009

    Concerning how dilute a remedy must be, it is my understanding that homeopathic remedies must be diluted and succussed (shaken). Therefore, a 1X prep (10% concentration) could be considered homeopathic. So, I asked a doctor who is an expert on homeopathy about the necessary dilution and she replied “How long is a piece of string?” I guess my question remains open, and I am reduced to measuring lengths of string.

  78. #79 Joe Average
    April 22, 2009

    “yet you need to post a commercial about the stuff?”
    — That was not my intention at all. I wanted to cite a source that boric acid is a homeopathic remedy for thrush. How would you know I wasn’t just making stuff up?

    Additionally, if one had the inclination to look at homeopathic treatments for other diseases, maybe just to laugh at them… one could.

    I mean there are real doctors here, who know something about pharmacology.

  79. #80 Joe Average
    April 22, 2009

    “Remember because rabies is almost 100% fatal”
    — As I said, I believe it’s a quack science… mineral water, mostly. Lot’s of strange stuff in there.

    I wasn’t aware that there are homeopathic vets (which unbelievably do exist). As you said, it is unethical to treat any potentially fatal disease with this mineral water.

  80. #81 Mu
    April 22, 2009

    Roger, there’s no “submicroscale mystery” to be discovered. I remember, 20 years ago in grad school, people were flipping individual molecules, and were taking pictures of it with atomic resolution. Since water is made up of atoms, any structure therein has to be on a larger than atomic scale. And we can probe those structures if they exist with a variety of methods, Xray, light and small angle neutron scattering, atomic force, scanning electron and transmission electron microscopy, surface plasmons, you name it, science has it.

  81. #82 Michael
    April 22, 2009

    Michael Simpson and Dr Benway,

    I do not disagree with you that falsification is very useful. What I tried to explain is the limits of falsification.

    Falsification works well for science, because science (and most scientists) are pragmatic. If the evidence suggests that an idea doesn’t float, they will let it sink. However, the criterion for deciding what is acceptable evidence that an idea is false is pragmatic, based on gut feeling, and not based on logic. Scientists in effect bet that the future will be like the past — philosophers call this induction.

    In contrast, mathematicians and logicians prove theorems — philosophers call this induction.

    David Hume became suicidal when he realised that you cannot prove that the future will be like the past, that induction can never provide the proof that deduction can. This doesn’t worry scientists because they are pragmatic, and know that their bets are the best possible under the circumstances – even if they often get them wrong. Eventually the bad ideas will be weeded out, and the good ideas will evolve by Darwinian selection.

    However, falsification as a guiding principle is not accepted by CAM. They are delighted to parade positive studies, and will do anything to discredit negative studies. Any intelligent punter would find the evidence in favour of CAM having real effects so slight that they would lay their bets elsewhere.

    The NCCAM is spending about $120 to $300 million a year on trials of CAM, which we know won’t work. Why aren’t they spending that money on finding out how the placebo effect works, and how practitioners and patients can make it work optimally for them. We know that placebos work. But, apart from disguising them as CAMs, we don’t know how apply them in practice. This is the weakest area of modern medicine, and the area where there is the greatest chance of making major progress.

  82. #83 antipodean
    April 22, 2009

    I’m sorry Michael but knowingly prescribing placebos to your patients is inherently unethical.

    For a start it’s a breach of informed consent when used in routine clinical care.

  83. #84 Michael
    April 23, 2009

    antipodean

    “I’m sorry Michael but knowingly prescribing placebos to your patients is inherently unethical.

    For a start it’s a breach of informed consent when used in routine clinical care.”

    You may be surprised to learn that I agree with you when your assumptions about deception and uninformed consent are true.

    The gold standard for evidence on the effectiveness of a treatment with moderate effects is the double blind, placebo controlled, randomized trial. This sort of trial is required by ethics committees (although there may be ethical problems with the assumption of equipoise that I don’t want to be distracted by).

    The problem is that placebos are effective, and this effect is exploited by sCAMs but not by scientific medicine. Scientific medicine should be trying to discover how placebos work so that we can ethically exploit these mechanisms in our practice, and make them work at least as effectively as the CAMs do.

    Do we really know that the placebo effect is 100% dependent on deception?

    And, we do know that a lot of people are not upset if they are deceived considerately.

  84. #85 Heraclides
    April 23, 2009

    This article, and the concluding question, strikes a chord with a recent post on Open Parachute, which quotes “Subordination of belief to what is true is not natural to people.” (http://openparachute.wordpress.com/2009/04/22/belief-not-the-same-as-truth/)

  85. #86 Dacks
    April 23, 2009

    Michael,
    You are incorrect in saying that the placebo effect is ignored in standard medicine. Virtually all treatment has a placebo effect. It is more or less unavoidable – seeking treatment for a problem has an effect on your perception of that problem. The question is whether there is any effect above and beyond the placebo response. If a doctor prescribes something that he or she believes to have no effect other than placebo, that is unethical.

  86. #87 Dr Benway
    April 23, 2009

    Humans instinctively seek out someone wise and caring when they’re sick. Simply finding such a person can relieve some of the suffering of illness. Makes sense, eh?

    Young men instinctively seek youthful, curvaceous, female companionship –also makes sense. And today, thanks to plastic surgery and cosmetics, older, less curvy women can now take advantage of a young man’s fancy.

    Similarly, it’s possible for incompetent, unstudied, uncaring persons to fake the appearance as such in order to provoke a placebo response in certain patients.

    But why not simply *be* competent, studied, and caring, and let the placebo response happen naturally? Isn’t this best course for all concerned in the long run?

  87. #88 Michael
    April 23, 2009

    I meant that standard medicine does not fully take account of the placebo affect because we do not understand how to do this. We know that it helps to look wise, and to look caring. We also know that “theatre” is very important. For example an injection or a suppository may be more effective than a pill; surgery more effective than drugs. Also radiological imaging, price, colour of the pill or liquid, taste, dress of the practitioner and much more are important modifiers of the placebo affect. And there is a dose-response effect: the more dramatic, the greater the placebo affect.

    To maximize the placebo effect we need to be more than competent, studied, and caring. It is a tall order. And we need to divert some of the research money spent on sCAMs to investigating ethical placebo effects.

  88. #89 Coriolis
    April 23, 2009

    I think Michael makes a very good point – after all the purpose of medicine is to help people. Why shouldn’t we scientifically investigate what is the most effective way to induce a placebo effect? If it can actually help cure certain diseases, at least my sense of ethics would say that it’s unethical not to. Counter-intuitive as that may sound.

    Of course it probably wouldn’t make much of a long-term difference for most diseases, but it’s worth investigating. In fact I’d be amazed if people haven’t done at least some studies on the differences between placebo effects, although being a physicist I haven’t heard of any.

  89. #91 Dr Benway
    April 23, 2009

    One man’s placebo is another man’s “yuck.”

    Thankfully, because we want therapies that are more than a brief emotional pick-me-up, we’re not required to shift our personal styles for each patient to maximize a potential placebo response.

  90. #92 antipodean
    April 23, 2009

    Michael’s definiton of the placebo effect which includes being nice to people and caring.

    I don’t think this is a matter of science or maximising placebo effect (as Coriolis suggests). It’s simply a matter of good manners and being a humanist.

    If you start maximising good manners as a therapeutic tool you are then obliged to inform your patient that they are reciving treatment in the form of you being nice to them. You can imagine that this is not going to work very well. How do they give informed consent to a pleasant good-natured clinical encounter tailored to give maximum placebo effect and still have it actually work?

  91. #93 Michael
    April 24, 2009

    Too much information.

    If you are obliged to inform your patient that they are receiving treatment in the form of good (bedside) manners, there is an awful lot of other information of similar importance that you need to get across. For example, a critical appraisal of all the evidence on all the treatment options; a detailed balance sheet of all the pros and cons, and all the possible pathways. Apart from being impossible, it is unlikely to be desired by anyone.

  92. #94 Denice Walter
    April 24, 2009

    My question to the woo-provider ( or follower of whimsy-based medecine): why is it that doctors, nurses, teachers,and psychologists *usually* tend *specialize* in one area while the alternative med purveyers aren’t so constrained?For example, a “nutritionist” might talk about cancer, heart disease, as well as psychological issues; a DO(of woo)might talk discuss nutrition, as well the influence of angelic presences.Someone without out any discernable education or training might be an “expert” in nutrition, ecology,lifestyle issues,vaccination, etc.(the three examples given are real people who have been discussed frequently here.)

  93. #95 Coriolis
    April 24, 2009

    Yes I guess I wasn’t thinking very clearly. At a philosophical level I don’t have a problem with putting on a show and being deceptive, if it helps people get over a problem that they believe they have. I.e. if an elaborate set of lies could somehow permanently help someone with depression or something along those lines.

    But in practice there are so many problems with that, at least for most things that are not purely psychological, that it probably wouldn’t be workable.

  94. #96 ganv
    April 26, 2009

    I really liked some of Russell’s comments earlier in this thread. I agree with him that we scientists should really drop the presumption of ‘methodological naturalism’. There is simply no way to define ‘natural’ before doing the science, so it doesn’t work to make any form of ‘naturalism’ an assumption of science. This concept has been used with great harm in attempts to combat intelligent design. The intelligent design movement is not wrong because they violate some assumption of naturalism. They are wrong because they can’t make any predictions that are empirically confirmed. The bit of truth that leads many to want to include naturalism as an assumption should instead be described as an expectation that new ideas either make close connections with known scientific theories or provide overwhelming empirical evidence. We simply are not going to accept some new ‘homeopathic ordering of water’ that violates our known theories of statistical mechanics without overwhelming evidence.

  95. #97 Dr Benway
    April 26, 2009

    ganv, you’re confusing “naturalism” and “methodological naturalism.” The former is an ontological position. The latter is not.

    If it were up to me, I wouldn’t have invented the term “methodological naturalism” for the scientific method. Too confusing for people who don’t read much philosophy. But hey, nobody asked for my opinion.

  96. #98 a-l-e-x
    April 27, 2009

    I have a problem with your lumping folk medicine in with alternative medicine that actually works. There are actually herbal alternatives that work, have a basis in science for why they work, and the fact is that many medicals utilize them (doctors who arent narrow-minded, that is.) Also, let’s not let the pharmaceutical companies get away scot free. I will answer your question, but first I want to copy and paste some discussions I had with another blogger on this subject.

    Those posts will be upcoming:

  97. #99 a-l-e-x
    April 27, 2009

    Do you deny the efficacy of certain alternative medications such as Saw Palmetto (for BPH) and St John’s Wort (for mild to moderate depression)? The efficacy of both has been proven through double blind clinical trials that have been published in scientific literature. As a matter of fact, I know of quite a few doctors who employ herbal medicine alongside conventional treatments. And I know of many doctors who speak out against corruption in the pharmaceutical industry (to be specific, most recently, I was talking to a cardiologist who complained about how AstraZeneca was marketing Crestor– he said they were actually trying to bribe doctors to prescribe their product!)

    I understand your concerns about many aspects of alternative medicine which have proven to be not effective, but dont stereotype and make a blanket statement that all forms are ineffective– because in certain areas, such as herbal medicine, there are certain treatments which do rise up to the level of prescription medicine in terms of effectiveness and with far fewer side effects.

  98. #100 a-l-e-x
    April 27, 2009

    http://en.wikipedia.org/wiki/Hyperforin

    Pharmacology

    Hyperforin is a prenylated phloroglucinol believed to be the main active constituent responsible for the antidepressant effects of extracts of St John’s wort.[3] Hyperforin has been shown to inhibit the uptake of the neurotransmitters serotonin, dopamine, noradrenaline, GABA and glutamate.[4] It was identified as a specific activator of the ion channel TRPC6 which is involved in neuronal axonal sprouting. The activation of TRPC6 causes entry of sodium and calcium ions in neuronal cells which can explain the inhibition of neurotransmitter uptake.[5]
    Hyperforin is also thought to be responsible for the induction of the cytochrome P450 enzymes CYP3A4 and CYP2C9 by binding to the Pregnane X Receptor (PXR).[6]

    http://en.wikipedia.org/wiki/Huperzine

    Huperzine A has also attracted the attention of Western medical science. It is currently being investigated as a possible treatment for diseases characterized by neurodegeneration – particularly Alzheimer’s disease.[2][3] It has been found to be an inhibitor of the enzyme acetylcholinesterase.[4] This is the same mechanism of action of pharmaceutical drugs such as galantamine and donepezil used to treat Alzheimer’s disease. Huperzine A is also a NMDA receptor antagonist[citation needed] which protects the brain against glutamate induced damage, and it increases nerve growth factor levels.[citation needed]

    Clinical trials in China have shown that huperzine A is comparably effective to the drugs currently on the market, and may even be a bit safer in terms of side effects.[citation needed] Currently, the National Institute on Aging is conducting a Phase II clinical trial to evaluate the safety and efficiency of huperzine A in the treatment of Alzheimer’s disease in a randomized controlled trial of its effect on cognitive function.[citation needed] Recently, it has been investigated for its effectiveness against epilepsy in an initial 20-person clinical study by Harvard University neuroscientists examining its worth and side effects in those who are not satisfactorily treated by existing pharmaceuticals.[citation needed]

  99. #101 a-l-e-x
    April 27, 2009

    Some other substances that Ive found to be of some benefit:

    Co-Enzyme Q10:

    http://en.wikipedia.org/wiki/Coenzyme_Q

    Supplementation

    Because of its ability to transfer electrons and therefore act as an antioxidant, Coenzyme Q is used as a dietary supplement.

    According to the Mayo Clinic[9] “CoQ10 has been used, recommended, or studied for numerous conditions, but remains controversial as a treatment in many areas.” Further clinical results are needed to determine whether the supplementation with Coenzyme Q10 is beneficial for healthy people.

    [edit] Mitochondrial disorders

    Supplementation of Coenzyme Q10 is a treatment for some of the very rare and serious mitochondrial disorders and other metabolic disorders, where patients are not capable of producing enough coenzyme Q10 because of their disorder. Coenzyme Q10 is then prescribed by a physician.[10]

    [edit] Heart failure

    There is some clinical evidence[11] that supplementation with Coenzyme Q10 is beneficial treatment of patients with congestive heart failure. However, The American College of Cardiology recently published an expert consensus document concluding that the value of coenzyme Q10 in cardiovascular disease has not been clearly established.[12] The Mayo clinic says that there is not enough scientific evidence to recommend for or against the use of CoQ10 in patients with coronary heart disease.[9]

    [edit] Migraine headaches

    Supplementation of Coenzyme Q10 has been found to have a beneficial effect on the condition of some sufferers of migraine headaches. So far, three studies have been done, of which two were small, did not have a placebo group, were not randomized, and were open-label,[13] and one was a double-blind, randomized, placebo-controlled trial, which found statistically significant results despite its small sample size of 42 patients.[14] Dosages were 150 to 300 mg/day.

    [edit] Cancer

    It is also being investigated as a treatment for cancer, and as relief from cancer treatment side-effects.[15]

    [edit] Cardiac arrest

    Another recent study shows a survival benefit after cardiac arrest if coenzyme Q10 is administered in addition to commencing active cooling (to 32–34 degrees Celsius).[16]

    [edit] Blood pressure

    There are several reports concerning the effect of CoQ10 on blood pressure in human studies.[17] In a recent meta-analysis of the clinical trials of CoQ10 for hypertension, a research group led by Professor Frank Rosenfeldt (Director, Cardiac Surgical Research Unit, Alfred Hospital, Melbourne, Australia) reviewed all published trials of Coenzyme Q10 for hypertension, and assessed overall efficacy, consistency of therapeutic action, and side-effect incidence. Meta-analysis was performed in 12 clinical trials (362 patients) comprising three randomized controlled trials, one crossover study, and eight open-label studies. The research group concluded that coenzyme Q10 has the potential in hypertensive patients to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without significant side-effects.[18]

    [edit] Biosynthesis

    The benzoquinone portion of Coenzyme Q10 is synthesized from tyrosine, whereas the isoprene sidechain is synthesized from acetyl-CoA through the mevalonate pathway. The mevalonate pathway is also used for the first steps of cholesterol biosynthesis.

    [edit] Inhibition by statins and beta blockers

    Coenzyme Q10 shares a common biosynthetic pathway with cholesterol. The synthesis of an intermediary precursor of Coenzyme Q10, mevalonate, is inhibited by some beta blockers, blood pressure-lowering medication,[19] and statins, a class of cholesterol-lowering drugs.[20] Statins can reduce serum levels of coenzyme Q10 by up to 40%.[21] Some research suggests the logical option of supplementation with coenzyme Q10 as a routine adjunct to any treatment that may reduce endogenous production of coenzyme Q10, based on a balance of likely benefit against very small risk.[22][23]

    [edit] Absorption and metabolism

    CoQ10 is a crystalline powder that is insoluble in water due to its low polarity. It has a relatively high molecular weight (863 g/mol) and its solubility in lipids is also limited so it is very poorly absorbed in the gastrointestinal tract.[24],[25] Absorption follows the same process as that of lipids and the uptake mechanism appears to be similar to that of vitamin E, another lipid-soluble nutrient. Emulsification and micelle formation is required for the absorption of fats. For CoQ10, this process is chiefly facilitated by secretions from the pancreas and bile salts in the small intestine.[26] A general rule is that the higher the dose orally administered, the lower the percent of the dose absorbed.[26]

    Data on the metabolism of CoQ10 in animals and humans are limited.[24] A study with 14C-labeled CoQ10 in rats showed most of the radioactivity in the liver 2 hours after oral administration when the peak plasma radioactivity was observed, but it should be noted that CoQ9 is the predominant form of coenzyme Q in rats.[27] It appears that CoQ10 is metabolised in all tissues, while a major route for its elimination is biliary and fecal excretion. After the withdrawal of CoQ10 supplementation, the levels return to their normal levels within a few days, irrespective of the type of formulation used.[28]

    [edit] Pharmacokinetics and bioavailability

    Some reports have been published on the pharmacokinetics of CoQ10. The plasma peak can be observed 2-6 hours after oral administration, mainly depending on the design of the study. In some studies, a second plasma peak was also observed at about 24 hours after administration, probably due to both enterohepatic recycling and redistribution from the liver to circulation.[29] Tomono et al. used deuterium-labelled crystalline CoQ10 to investigate pharmacokinetics in human and determined an elimination half-time of 33 hours.[30]

    Phosphatidyl Serine:

    http://en.wikipedia.org/wiki/Phosphatidyl_serine

    Memory and cognition

    Early studies of phosphatidylserine distilled the chemical from bovine brain. Because of concerns about Bovine Spongiform Encephalopathy, however, modern studies and commercially available products are made from soybeans. The fatty acids attached to the serine in the soy product are not identical to those in the bovine product, which is also impure. However, preliminary studies indicate that the soy product is at least as effective as that of bovine origin. [1][2]

    On May 13, 2003, the U.S. Food and Drug Administration stated “based on its evaluation of the totality of the publicly available scientific evidence, the agency concludes that there is not significant scientific agreement among qualified experts that a relationship exists between phosphatidylserine and reduced risk of dementia or cognitive dysfunction.” FDA did, however give “qualified health claim” status to phosphatidylserine, stating that “Consumption of phosphatidylserine may reduce the risk of dementia in the elderly” and “Consumption of phosphatidylserine may reduce the risk of cognitive dysfunction in the elderly”.

    [edit] Sports nutrition

    Phosphatidylserine has been demonstrated to speed up recovery, prevent muscle soreness, improve well-being, and might possess ergogenic properties in athletes involved in cycling, weight training and endurance running. Soy-PS, in a dose defendant manner (400mg), has been reported to be an effective supplement for combating exercise-induced stress by blunting the exercise-induced increase in cortisol levels.[3] PS supplementation promotes a desirable hormonal balance for athletes and might attenuate the physiological deterioration that accompanies overtraining and/or overstretching.[4] In recent studies, PS has been shown to enhance mood in a cohort of young people during mental stress and to improve accuracy during tee-off by increasing the stress resistance of golfers.[5]

    [edit] Attention-deficit hyperactivity disorder

    First pilot studies indicate that PS supplementation might be beneficial for children with attention-deficit hyperactivity disorder.[6][7]

    [edit] Safety

    Traditionally, PS supplements were derived from bovine cortex (BC-PS); however, due to the potential transfer of infectious diseases, soy-derived PS (S-PS) has been established as a safe alternative. Soy-derived PS is Generally Recognized As Safe (GRAS) and is a safe nutritional supplement for older persons if taken up to a dosage of 200 mg three times daily. [8] Phosphatidylserine has been shown to reduce specific immune response in mice. [9][10]

    [edit] Dietary sources

    PS can be found in meat, but is most abundant in the brain and in innards such as liver and kidney. Only small amounts of PS can be found in dairy products or in vegetables, with the exception of white beans.

  100. #102 a-l-e-x
    April 27, 2009

    So there are two examples right there. Its interesting that you guys do so much hand wringing over nutraceuticals and yet are silent about the atrocities committed by large corporations like Monsanto, which is basically Gestapo-esque, if not fascist in the way it destroys the environment and attempts to use threats to silence anyone who oppose them.

    http://en.wikipedia.org/wiki/Monsanto

    About Monsanto– I provided you a link about numerous times them having been sued and lost (in America as well as other countries) for dumping PCB’s (notable examples, Anniston, AL, UK, India) and how theyve threatened networks (FOX) when reporters were exposing them. If you had bothered to read the link, you would have seen the documented proof.

    About the other stuff– Ive posted links and references to the pharmacologically active ingredients in two natural supplements. Yes, many (maybe most) natural supplements dont work, but my argument was that doesnt mean you can characterize them all that way. And I did post the evidence, along with references– I was being belligerent, because most of this can easily be gotten online in a few seconds searching the medical journal of your choice. At any rate, doctors have been recommending both of these supplements, so they wouldnt be doing that unless they had something to back it up right?

    I actually have a medical background, so I dont usually listen to alternative medicine practitioners, I do my own research through various channels, so if AMPs are making claims about supplements outside of that which their ingredients can logically produce than theyre being fallacious. My main point, as I resulted above, is that there are SOME that do work, if the active ingredient is standardized and taken in the right amount.

    Also, Im not sure what you mean by “mainstream medicine” but the reason Ive been told that neither Hyperforin or Huperzine (let’s just use the names of the chemicals instead of the plant itself) havent been patented by large pharmaceutical companies is that natural substances arent patentable and they cant turn a profit on them? At any rate, Ive noted that many pharmacies carry both OTC, in the standardized amount (SJW 450 mg 3% hyperforin, Huperzine 50mcg) and the amount quoted in the studies is 900mg per day at that standardization level for SJW and 50-100mcg per day of Huperzine A.

    Also, Ive noticed doctors questioning the motivations of large pharmaceutical companies– one example is Crestor and AstraZeneca. Do you remember when the FDA told AZ to pull the false and misleading Crestor ads (where they were saying that Crestor was found to be safe) when the FDA said no such thing? About a month ago, I read a cardiologist’s blog where he claimed AZ was trying to bribe doctors into prescribing Crestor and that this was standard fare for the pharmaceutical industry. And then we have the class action lawsuit going on in Australia, concerning Merck (already infamous for Vioxx), where they were trying to coerce doctors to prescribe their meds. Also, we have the Celebrex scandal (and yet theyre still allowed to air TV commercials? I notice a double standard here!) Honestly, how much do you trust pharmaceutical companies? I brought Monsanto into this as well, since theyve been trying to push hormonized milk and meat on us (which is now going off the market, thanks to consumer pressure and the fact that major retailers wont sell it) and the fact that numerous studies have shown that its linked to numerous ailments was enough for the Canadian Ministry of Health, WHO and other health organizations to ban it– but the FDA was the lone voice insisting on its “safety.” So, honestly, I know that the natural supplement industry hasnt been straight with us– but lets not let large pharmaceutical companies or Monsanto off the hook either. If the WHO and various ministries of health condemn a company, Id believe them before I’d believe the FDA.. after all, the FDA has undergone PLENTY of scandals and links between the FDA and major drug companies are too close for comfort (going back to Crestor, do you remember the scandal that ensued when the FDA comissioner resigned and admitted that Crestor had nto been recommended for approval, and yet it was “pushed through at the last moment” in spite of various studies going against it? The grass isnt much greener on the other side either.

    BTW, here’s a link to the class action lawsuit against Merck

    http://www.news.com.au/business/story/0,27753,25273468-462,00.html

  101. #103 a-l-e-x
    April 27, 2009

    And before the misunderstanding even occurs, let me apply some preventative medicine: Im not bashing DOCTORS! I specifically stated that Ive met several doctors (or read their blogs), many of whom bash pharmaceutical companies for trying to push them to prescribe medications which they, THE DOCTORS, dont want to prescribe. I also posted a link to a class action lawsuit in Australia concerning Merck, which proves my point.

    Some alternative medicine is clearly quackery, while other types have science on their side (for example, the use of some medicinal herbs.) To lump everything together is to show clear bias at best, and extreme ignorance at worst. Now, in answer to your question as I promised: I’d ask them if they trust these treatments enough to give them to someone they really care about– i.e., close family, best friends, etc. In the case of those who practice alternative medicine with a firm foothold in science, Id also ask if they feel liberated by being able to practice medicine altruistically, without the taint of greed placed by big business, which has corrupted conventional medicine– as stated by doctors themselves.

  102. #104 Joe
    April 27, 2009

    Alex, the question was: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

    You have ignored the topic. Moreover, anybody can copy-paste from Wiki; but we rarely do because it is an unreliable source of information. For example, I’ll eat my hat if phosphatidyl serine is commercially purified by distillation. Sometimes I start with Wiki; but I ignore the text and look at the references.

  103. #105 Dr Benway
    April 27, 2009

    The spambots have been getting smarter. They now bring content that almost fits the topic under discussion.

  104. #106 ScepticsBane
    April 27, 2009

    @ A-l-e-x

    Alex, great comments on the various drugs, could you mention any references you use for pharmaceutical drugs – medicinal herb interactions. The PDR Herbal reference is totally inadequate.

    Also, regarding Big Pharma drug pushing – a recent NY Times article mentions a group of Harvard Med School students in a pharmacology class who got ticked off when a professor dissed one of the students for questioning the side effects of a cholesterol lowering drug. One of the students investigated and found that the prof was a paid consultant for several pharma companies some of which manufacture chloesterol lowering drugs.

    @PalMD
    Good question. Not easy for the alt med proponent (like me) to answer. It’s wery wery kompleecated! Take Acupuncture – there’s the classic version which has been officially suppressed by the sanitized and scientized TCM version.
    I’m currently having fun engaging myself in the 3 to 5 year study of classical Chinese to read the original sources.
    It’s sort of like someone who speaks English learning the language of Beowulf to read some medical texts. Some believe they threw out the baby with the bathwater. There are, however, modern experiential points (called empirical points) which differ from classical useage. Likewise, classical points supposedly good for some certain condition have been discovered, in modern research, to be not as good, even ineffective, in some cases, for the classically mentioned purpose.

    Take Homeopathy… there was a huge fight in the old days over using the high dilution remedies. High dilutions appear to have won the battle based on clinical performance. They worked, against all common sense and understanding of Avogadro’s law, they worked. Then there’s the modern school which seeks to bottle up sunshine and do other odd things which are loathed by the classical Homeopaths who stick to more tried and true paths. Then there’s the water memory gang of whom one famous Homeopath, George Vitoulkas, takes a dim view. Your question is hard to answer because all of Homeopathy, at the scientific level, remains under research and its evidentiary base remains at the case and clinical level. Remedies that Hahnemann suggested have sometimes been superseded by other approaches based on what school of Homeopathy you’re talking about.

  105. #107 Joe
    April 27, 2009

    @ScepticsBane | April 27, 2009 9:53 AM

    Are you suggesting that “traditional” acupuncture is no-longer practiced? I doubt it, do you have reliable evidence? What information (not conspiracy) led to its demise? That is the nature of the question.

    Bearing in mind that homeopathy makes thousands of individual claims that must be evaluated (well) individually, where is the evidence that they mostly worked? I can’t find it, despite the fact that I have a very long and successful record of finding what I seek in the scientific literature. (Sometimes serendipity is indispensable; so, sue me.)

    To continue, what is your evidence that “traditional” homeopathy has gone away? I suspect that the newer notions co-exist with tradition.

    Quacks don’t abandon anything (there may be irrelevant schisms)- mostly, they just rationalize. See James Randi’s book “Flim-Flam” (Prometheus, 1982).

  106. #108 ScepticsBane
    April 27, 2009

    @Joe

    “Quacks don’t abandon anything (there may be irrelevant schisms)- mostly, they just rationalize. See James Randi’s book “Flim-Flam” (Prometheus, 1982).”

    Pardon me but I do not chose to be so illogical and unscientific as to designate all practitioners of Homeopathy, including the MD’s and other dedicated medical professionals who have embraced and applied it, as “quacks”.

    In addition, I have no interest whatsoever in anything the “Amazing” Randi, or any other stage magician or “professional” debunker has to say about anything whatsoever.

    I have made no statements at all as to which version of either Acupuncture or Homeopathy are or are not being practiced. I believe that the answer to PalMd’s question can be found in a detailed examination of current practice of some of those alternative medicine schools of thought, including the schisms, in comparison with historical writings. The illusion that there had been nothing discarded remains just that.

    The other illusion, that your search for evidence that Homeopathy works has failed despite your excellent search skills is easily answered. You may be looking in completely the wrong places!

    Good luck in solving these problems, it is a journey we must all make from the cozy safety of past orthodoxy into the uncertain and unfamiliar terrain of the future. I most seriously suggest that you fire your “guide”, the Amazing Randi.

  107. #109 Joe
    April 28, 2009

    But, but, Mr. Bane,

    You are still avoiding the question: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

    You wrote “The illusion that there had been nothing discarded remains just that.” … “The other illusion, that your search for evidence that Homeopathy works has failed despite your excellent search skills is easily answered. You may be looking in completely the wrong places!”

    Okay, wouldn’t it be simple for you to cite the “right” places to clarify the illusions? Or, are you protecting the profit margins for Big Homeo? I promise not to reveal your secrets.

  108. #110 Alex Reynolds
    April 28, 2009

    The reason I pasted the links from wiki directly is because they all cite studies as referenced in the footnotes. It wasnt my intention to clog up the whole thread with a bunch of double blind studies, however, you can go look the studies up yourself on the footnoted links. Anyway, you cant put herbal medicine in the same category as spiritual healing, and other varities of flim flam, because these actually have a basis in science (my original purpose in pasting the information was to illustrate what the active ingredients are, theyre chemical structure, and their pharmacology.) If the only thing you consider science is that which is part of big business– then its your definition which is skewed, not mine. To bolster my claim that MANY doctors agree with me that big pharmaceuticals are like a cancer to pure science, here is the site of a doctor Ive been corresponding with:

    http://www.medicationsense.com/articles/july_sept_04/crestor_truth.html

    Medication side effects are the #4 leading cause of death in the U.S. annually (JAMA 1998). Yet, few people receive adequate information when medication is prescribed. This website is dedicated to providing information to help you and your doctor make informed, intelligent choices about medications and natural alternatives to maximize the benefits and minimize the risks of treatment. Note: This website is free of drug company or government influence. Jay S. Cohen M.D.

    The Marketing of Crestor
    Why isn’t Crestor marketed at lower, safer doses? Drug companies like to keep dosing simple, because simple dosing makes doctors’ job easier. The fact is, doctors are inadequately trained about medications. Their one pharmacology course covers hundreds upon hundreds of drugs, but not deeply. Doctors assume that drug companies and the FDA are providing complete information with the best doses, when in fact they aren’t. That’s why doctors rarely question irrational drug company guidelines even when the guidelines tell doctors to prescribe the same strong doses to young and old, big and small, healthy and frail.

    I could list hundreds of quotes about problems with drug research and marketing, but the following two will suffice. The first is from Dr. Andrew Herxheimer, the highly respected expert at Britain’s renowned Cochrane Centre:

    “Drugs are often introduced at a dose that will be effective in around 90% of the target population, because this helps market penetration. The 25% of patients who are most sensitive to the drug get much more than they need.17″

    Actually, with statins, the number is probably much higher. Dr. David Kessler, when he was FDA commissioner, wrote this about marketing strategies vs. medical science:

    “Pharmaceutical companies are waging aggressive campaigns to change prescribers’ habits and to distinguish their products from competing ones, even when products are virtually indistinguishable. Victory in these therapeutic-class wars can mean millions [billions today] of dollars for a drug company. But for patients and providers it can mean misleading promotions, conflicts of interest, increased costs for health care, and ultimately, inappropriate prescribing.18″

    My articles and books contain dozens of examples of excessively dosed drugs. Crestor is another. In October 2003, Dr. Richard Horton, editor of the Lancet, published a scathing critique of Crestor’s marketing, stating that the manufacturer’s tactics “raise disturbing questions about how drugs enter clinical practice and what measures exist to protect patients from inadequately investigated medicines….” Yet, Horton added, the manufacturer will “do whatever it takes to persuade doctors to prescribe rosuvastatin, including launching an estimated $1 billion first-year promotional campaign.19″

    So, even though the FDA has repeatedly cautioned doctors about using new drugs when older, better known drugs are available, the onslaught of drug reps and intensive advertising pushing Crestor has worked. By early 2004, 27% of all new prescriptions for statin drugs was for Crestor. The Wall Street Journal reported:

    “AstraZeneca sales force (Crestor) was making more calls to doctors than any of its competitors. Beginning in late February, reflecting the sales calls, new prescriptions of Crestor began to rise and overtook Lipitor by the beginning of March.20″

    Once again, intensive marketing trumps medical science — and patient safety. Is this how we want our health care system to run?

  109. #111 Alex Reynolds
    April 28, 2009

    more from Dr. Cohen:

    What You Should Do
    A favorite tactic of drug companies is to provide free samples. Drug companies know that once you are started on a medication, you won’t want to switch. So sales reps shower doctors with samples, and doctors think they are doing you a favor by giving you a free sample when starting a medication. But they aren’t doing you a favor at all.

    So if your doctor offers you free samples of Crestor, respectfully decline. Drug companies don’t provide samples because of their altruism, but as hooks to boost sales of new drugs against established competitors. Unless a new drug really offers something important, resist the pitch.

    When Baycol was withdrawn because of dozens of deaths, Newsweek asked me what I thought. My response: “I think it’s frightening that 800,000 people were taking Baycol. Baycol was the newest and least known statin, and it offered nothing superior to other statins. No one should have been exposed to Baycol unless the other five statins had been tried first unsuccessfully, and that is very few people.22″ My opinion remains exactly the same about Crestor.

    The marketing of Crestor is an outrage. The frequent prescribing of super-strong Crestor by doctors is symptomatic of how dominant the drug industry is in influencing the knowledge and decisions of doctors. We must change this. If your doctor suggests Crestor, ask why. Unless there’s a very good reason, tell your doctor you would prefer a statin with a longer track record. If your doctor dismisses your opinion, you can quote the top drug experts at the FDA, as they recently wrote in the Journal of the American Medical Association:

    “Clearly, physicians and patients should be aware that recently marketed drugs are at risk of being found to cause unsuspected serious adverse effects…. A physician considering prescribing a new drug should consider carefully the reason for the choice, particularly when an equally effective alternative is available, as there is always some risk of an undiscovered adverse drug reaction.23″

    Anyone who thinks that the pharmaceutical industry is completely altruistic in its goals is seriously naive or corrupt themselves.

  110. #112 Alex Reynolds
    April 28, 2009

    Alex, the question was: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

    The short and honest answer to this is no– I cant. But my reason is that the only area I focus in is natural herbal remedies… I dont concern myself with homeopathy, or acupuncture, etc. I have a science background and use it to research the pharmacology of these products and I handpick a few that can be of some value. I do oppose many of the practices of large pharmaceutical companies because I consider myself a purist– one who pursues science for its own benefit, not for profit or greed. This is why I sympathize with doctors who complain that the pharmaceutical industry is trying to run their profession for them. But its a sad reality of the world we live in, that a few very wealthy people control a disproportionate share of the medical industry.

  111. #113 ScepticsBane
    April 28, 2009

    @Alex Reynolds

    Many thanks for the comments on big pharma.

    In your herbal work, is there a standard reference listing herb – pharmaceutical drug interactions?

    Thanks
    SB

  112. #114 Alex Reynolds
    April 28, 2009

    Thanks, SB. I have found the following reference guide useful:

    http://www.amazon.com/Herbal-Interactions-Adverse-Evidence-Based-Reference/dp/007142153X

  113. #115 Alex Reynolds
    April 28, 2009

    Here is a more descriptive entry for the book:

    http://shopping.msn.com/prices/herbal-drug-interactions-and-adverse-effects/itemid2945445/?itemtext=itemname:herbal-drug-interactions-and-adverse-effects

    Authors: Brinker, Francis
    Source: HerbalGram; Fall2004, Issue 64, p66-68, 3p, 1 color photograph
    Document Type: Book Review
    Subject Terms: BOOKS — Reviews
    DRUG interactions
    NONFICTION
    Product: HERBAL-Drug Interactions & Adverse Effects: An Evidence-Based Quick Reference Guide (Book)
    People: PHILP, Richard B.
    Abstract: Reviews the book “Herbal-Drug Interactions and Adverse Effects: An Evidence-Based Quick Reference Guide,” by Richard…
    : 1757
    Accession Number: 15136681

    Assists clinicians in quickly recognizing and avoiding potential adverse reactions and interactions that can occur between more than 150 of the most common herbal remedies and prescription/over-the-counter medications. This quick-reference is organized alphabetically and includes drug interactions, side effects, and highlighted cautionary notes for each entry.

  114. #116 Joe
    April 28, 2009

    @112 “Alex, the question was: “Can you please give specific examples of alternative medicine theories and modalities that have been abandoned because they have been found to be ineffective?”

    The short and honest answer to this is no– I cant. But my reason is that the only area I focus in is natural herbal remedies…”

    So, you cannot think of any herbs that have been taken off the market because they were ineffective or dangerous? I can cite several that should be, and have been.

  115. #117 ScepticsBane
    April 28, 2009

    @Alex R.

    Thanks, good reference book!

  116. #118 Alex
    May 6, 2009

    I can think of several herbal remedies that have been taken off the market also or abandoned by practitioners, but I thought the OP was refering to acupuncture, spiritual healing, homeopathy, etc.

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