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Snake Oil, Holistic Medicine and other questionable practices
joshofalltrades
Class TraitorSmoke-filled roomRegistered User regular
Class TraitorSmoke-filled roomRegistered User regular
So I've always kind of wondered about acupuncture. You see these people laying down with all these needles sticking out of them and you kind of go, "That is supposed to relieve pain?!" I mean, I just had blood drawn for some tests recently and the second the needle went in me, I immediately wanted it out of me. Granted the nurse was a total goose and she was kind of jamming it around in there, trying to find purchase in my giant, bulgy, clearly visible vein and it made me super nauseous and almost black out, but still. Needles might be some people's thing, but for pain relief?
Well, I finally decided to look it up and see just what exactly it's supposed to do.
Okay, it sounds to me like the Wikipedia article is doing the most amazing dance in order to seem unbiased. If there was clear evidence supporting acupuncture as a truly effective treatment that has use above and beyond a placebo effect (something that could be gained with sugar pills instead of needles), it would be in the article.
But why are we, the world, so preoccupied with indulging these potential (note that word, because I don't doubt that there are those who truly believe that their practices do good no matter what science says) charlatans? People who use homeopathic remedies, snake oil and yes, acupuncture will defend the perceived benefits to the death. While I don't believe acupuncture is harmful per se (in the hands of an experienced practitioner, obviously), wouldn't greater benefit be reaped from discovering the real source of a problem and fixing it through scientifically sound methods?
This thread isn't aimed at people who take a variety approach to treatment. If you are truly ill and are throwing shit at the wall to see what sticks, for instance seeing a doctor and getting herbal remedies because you heard from somebody that it helped them with the same thing just to try anything for relief, this isn't about that. This thread is purely about the idea that we have to indulge unproven practices by not calling them out as scientifically unproven.
Well, I finally decided to look it up and see just what exactly it's supposed to do.
Wikipedia wrote:Acupuncture has been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century, but it remains controversial among medical researchers and clinicians.[3] Research on acupuncture points and meridians is preliminary and has not conclusively demonstrated their existence or properties.[4] Clinical assessment of acupuncture treatments, due to its invasive and easily detected nature, makes it difficult to use proper scientific controls for placebo effects.[3][5][6][7][8]
Evidence supports the use of acupuncture to control some types of nausea[9] and pain[10] but evidence for the treatment of other conditions is equivocal[3] and several review articles discussing the effectiveness of acupuncture have concluded it is possible to explain through the placebo effect.[11][12]
The World Health Organization[13] and the United States' National Institutes of Health (NIH)[5] have stated that acupuncture can be effective in the treatment of neurological conditions and pain, though these statements have been criticized for bias and a reliance on studies that used poor methodology.[14][15] Reports from the USA's National Center for Complementary and Alternative Medicine (NCCAM), the American Medical Association (AMA) and various USA government reports have studied and commented on the efficacy (or lack thereof) of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and that further research is needed.[5][16][17][18]
Okay, it sounds to me like the Wikipedia article is doing the most amazing dance in order to seem unbiased. If there was clear evidence supporting acupuncture as a truly effective treatment that has use above and beyond a placebo effect (something that could be gained with sugar pills instead of needles), it would be in the article.
But why are we, the world, so preoccupied with indulging these potential (note that word, because I don't doubt that there are those who truly believe that their practices do good no matter what science says) charlatans? People who use homeopathic remedies, snake oil and yes, acupuncture will defend the perceived benefits to the death. While I don't believe acupuncture is harmful per se (in the hands of an experienced practitioner, obviously), wouldn't greater benefit be reaped from discovering the real source of a problem and fixing it through scientifically sound methods?
This thread isn't aimed at people who take a variety approach to treatment. If you are truly ill and are throwing shit at the wall to see what sticks, for instance seeing a doctor and getting herbal remedies because you heard from somebody that it helped them with the same thing just to try anything for relief, this isn't about that. This thread is purely about the idea that we have to indulge unproven practices by not calling them out as scientifically unproven.
joshofalltrades on
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I wouldn't be surprised if people used to think that willow bark's properties were due to caring spirits or something.
Unfortunately, the bullshit that surrounds actual and non-actual beneficial practices shields them from proper study, preventing actual benefits from being derived from them and obscuring the possibility of such.
Of course they would. People who look for "alt med" treatments fall under a bunch of headings. Some are distrustful of the medical industry specifically. These would be your "all conventional medicine is designed to treat symptoms and not the cause of diseases, because doctors/pharmaceutical companies/the reptilian government get more money that way" conspiracy theorists.
Some of them don't think that science's findings are true at all. Either because they've a personal experience or personally convincing annecdote that "proves that vaccines cause Autism" or "the flu vaccine doesn't work" all the way up to "the earth is hollow and filled with dinosaurs." Or they're ideologically opposed to certain scientific findings.
Either of those groups also has a scummy layer of con artists at the top, and a bunch of people with diagnosable mental issues mixed in.
One of the premises of the free market system, which is supposed to ensure the efficient allocation of goods, is that consumers are perfectly rational and have perfect information.
So, what is precisely not the case with snake oil.
I don't read the blog, prefering to listen to the podcast, but the blog's way more germane to the topic of this thread. I think most of the people on D&D would find something to like in both. (Though I'd start on episode 33 of the podcast.)
My youngest cousin is the only one of us that got her ears pierced as a baby. Most of us thought that my aunt was an absolute nutjob (she was and still is but that's another story). But she took my cousin to a doctor who also did accupuncture, and he pierced my cousin's ears in the 'exact right spot' to where she wouldn't need glasses.
She's now 21 and the only member of my family that doesn't have glasses. So... yeah, i got nothing, just wanted to tell that story...
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When I was 17, my dad refused to take me to see a dermatologist about my acne unless I agreed to let an acupuncturist treat the problem first.
I went to her two or three times, and each time she stuck very thin needles into my back and legs. They didn't hurt, and the worst part was simply having to lie still for around an hour.
After three sessions or so, she finally told him that my skin problems were probably a hormonal thing that she wasn't equipped to treat, and that I'd be better off seeing a dermatologist.
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If people are being relieved of their aches and pains via acupuncture, though it doesn't actually do anything physically, it means their pain was all in their head to begin with. They need a different kind of treatment. The talking kind.
Damn, I could have sworn it was going to be Chinese ghost hexes, too.
All pain is in your head. It's just a question of how best to treat it.
It's also worth noting that the placebo effect is not a universal positive. It can also, unsurprisingly, can cause drymouth, dizzyness, nausea, loss of sleep, etc. This is just one of the many reasons not to advocate for sugar pills (or acupuncture) as being run-of-the-mill treatments.
http://www.youtube.com/watch?v=866YvYJRvWw
There was a pretty famous study a few years back that compared acupuncture to placebo... where the acupuncturist for the placebo group used retractable trick needles. And both the placebo and the treatment group showed positive benefits. (I'm feeling kind of lazy about digging up a link right now.)
Your post, however, highlights what I believe is part of the appeal (and effectiveness) of alternative medicine. General practitioners in private practice have to see 18-24 patients per day to stay afloat. (Again, feeling kind of lazy about digging up links...) If the GP is filling out forms, handling basic business management tasks, and working reasonable hours, that's not a whole lot of face time per patient. And of course medical offices aren't the most relaxing of environments. Going to the doctor can feel like a dehumanizing experience even with the best bedside manner.
I think an effective alt medicine practitioner is more likely to sit down, take the time to talk to you, make sure you feel relaxed. And some of the alt medicine practices I've seen seemed more like spas or masseurs than doctors' offices. Who wouldn't want to go someplace that feels a little bit more like pampering? And if your complaints are at all affected by the placebo effect - if they're stress or depression related, with vague symptoms like 'fatigue' or 'aches and pains' - I can see how a more attentive holistic approach could be efficacious in a way that a strict medical approach would not be.
the "no true scotch man" fallacy.
Yeah actually.
Nonsexual personal touch is kind of a Big Deal(tm).
the "no true scotch man" fallacy.
There are also those of us who, though skeptical, tried it as a last resort before dropping the nuke on our bodies.
I suffered a back injury in a car accident a couple years ago, and after several months of physical therapy and medication, most of my body had healed except for a location on my thoracic spine. They continued treatment and pain management. They then started talking surgery. However, both the physical therapist said to give acupuncture a shot. I mean, I wasn't paying for it anyway, and maybe a miracle could happen that could avoid surgery. Basically, a final shot before starting more invasive procedures.
So, yeah, it's basically just sticking needles in you. In my case, it was in my back. Yes, it feels like little pin-pricks going in. The acupuncturist did make me feel a little better when we start by telling me that whole "adjusting chi" thing was bullshit, and the real idea is that the little pin-pricks would case a relief of endorphin which will then cause the area to go numb. Low and behold, that's pretty much what happened. I barely felt him removing the needles. I did help, although the help was admittedly short-lived and was little more than temporary pain relief.
Yes, this is purely anecdotal and is not evidence. I am wholly in favor of science-based medicine, and am an avid follower of Steven Novella's work. This attempt at acupuncture was purely as a "let's try it, since I have nothing to lose from it anyway" kind of deal. I'm still dealing with the back pain. I will probably require surgery eventually anyway, but my doctor is reluctant to do something that invasive at this point while the pain is still manageable.
Why is the world so preoccupied with these practices? People believe it, either through confirmation bias, tradition, or being told by someone they think could maybe might be an authority, and thus they demand respect for it regardless of whether that respect is warranted. And when you have a lot of people believing in something and arguing so ardently, others who aren't the most well informed, or have nothing to lose, will give it the benefit of a doubt. Especially if the subject can be coupled with the "What does it harm?" comments. America is a partially free country, so while "What does it harm?" is a pretty useless question in comparison to "Does it actually help?", people are allowed to do what they want to do.
At its most benign, alternative medicine is an expensive way of inducing a placebo effect.
At its most harmful, it can actively severely hurt or kill people. There are cases of people becoming severely crippled due to improperly performed chiropractic adjustments, or extreme practices like 'breathetarians' resulting in people suffering severe malnutrition.
In between, and more commonly, it's a problem when somebody uses ineffective alternative treatments in lieu of proven treatments for serious conditions. Somebody who uses homeopathy instead of chemo for cancer is an extreme example.
And when the culture surrounding alternative medicine involves sowing FUD and distrust towards legitimate honest medical practitioners, public health at large is harmed. When such ideas enter public policy, resulting in resistance to vaccination or fluoridation programs, the potential for harm to the general good is considerable.
the "no true scotch man" fallacy.
Though I gotta wonder how some of these 'medicines' get away with it. Does the box just say 'Won't kill you!' and is technically correct?
Just saying, if this box of pills says it will help fix, let's say, migraines and it's just water (with an infinitely small amount of X ingredient) - isn't that a flat out lie? Can't someone sue them for that?
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Technically, a product cannot be marketed in the US towards any specific disease unless it has been approved by the FDA for that disease.
So if a bottle of - um, I dunno - Coenzyme Q says "use for migraines" technically that's illegal, but enforcement is spotty. You'll see that most (all?) of them have fine print saying "Not approved or proven to cure any disease..." or something of that nature.
And it's not illegal for me as a third-party to say "Coenzyme Q might help your migraines" which makes some situations, like a chiropractor selling bottles of supplements, a legal gray area.
the "no true scotch man" fallacy.
Just as fun, different approach:
Acupuncture was performed using traditional points on group A. Group B had needles systematically though with the points randomized from group A.
No difference. Study is published. Splinter acupuncturist sect pops out of nowhere and claims that the points in point B are the "right points" and the "traditional points" are pretenders.
Yeah, I had a couple of flatmates who were training in TCM use me as a guinea pig. helped with little stuff like sinus trouble, headaches etc for sure. Back when I was a teenager it helped with nasty periods, too.
Like incen's mentioned, the mechanism of action is unclear at best, but its not harmful, it cheap, non invasive, and really doesn't hurt at all.
I have seen some pretty amazing nerve-blocking effects from certain needling practices, so they have some potential as a knockout-drug alternative in some patients.
Basically its too new a field to call quackery or not on the basis of the research. Give it a couple decades.
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With that aside, I think its really important to note that all alternative medicine isn't the same. Colour bullshit and crystals and stupid woo-woo handwaving really shouldn't be lumped in with TCM, nutrition research and herbal medicine research at all, and it really, really shits me that natural medicine colleges do that.
For links to interesting studies.
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That is pretty cool, but still no substitute for the primary research. Be aware that by using that infographic, you're letting an unknown third party filter a tremendous amount of raw info for you. Posting this kind of link does rather undermine the way we're getting up in the grill of the credulous in this thread
Well, you can't trust those damn Chinese to get anything right
I agree with you on the general principle of "don't believe everything you read."
I like that graph a lot, though. I generally agree with the order in which the various treatments are presented, but I would actually move the "worth it line" down a row to include green tea, melatonin, omega-3 for depression, and Coenzyme Q10.
(I notice it's missing a bubble for melatonin and depression.)
But yeah, one aspect of the graph that jumps right out at me, to prove your point here, is the placement of St. John's Wort. SJW is proven to be effective for depression - or more precisely, one of the molecules in SJW. But not all SJW extracts have that molecule, and it is not consistent between extracts, and it is not always properly labeled. So while it deserves to be placed in the "proven" category, the emptor still needs a big caveat towards buying SJW products.
the "no true scotch man" fallacy.
And, as MrMister hinted above, the placebo effect is real. It's not magical or imaginary. So if somebody does 'nothing' and you see a temporary remission of psychosomatic or stress-aggravated symptoms (like headache, fatigue, insomnia) then something real happened even if the only reason the real thing happened is because you expected it to happen (which also implies that if you expect a doctor's treatment to help you, you'd get the same benefit from the doctor in addition to whatever good the doctor's non-hippie treatment does for you).
the "no true scotch man" fallacy.
It's not really covert. Hospitals are hotbeds of infectious diseases. Institutional pneumonia and MRSA are major problems in any facility which houses a lot of sick people. Nursing homes and residency programs for the mentally ill have the same problems.
That's why the future is going towards more outpatient care (small clinics, community outreach, mobile vaccination trucks, etc.) and towards more privacy in inpatient care (like private rooms rather than double beds).
the "no true scotch man" fallacy.
That's the problem with herbal extracts - quality control. Our science hasn't advanced far enough to manage a consistent product, and there's no freaking chance of us being able to synthesize complex molecules of any kind, let alone balance the chemical mixtures that lie behind the efficacy of the 'right kind' of natural product.
One of the things that really jumps out at me in these threads is how ignorant supposed skeptics are of how dependent we are on naturally sourced drugs because we can't make them. Anything with more than a couple of dozen atoms? no chance. We're wild-harvesting, in many cases, including some vital anti-cancer drugs and anesthetics. We can't even manage to farm some of this shit! And many of those drugs are subject to the exact same quality control problems as herbal supps - they just have the advantage of a large company armed with patents behind them.
Plenty of fields are in the same boat, research-wise - soil and water toxicity in particular. We try to regulate a lot of environmental substances, but picking 'safe' levels is incredibly difficult, because its hard to understand the myriad pathways substances take in biological organisms.
Earlier today we were talking about what should and should not qualify as a "food" for food stamps in the US, and I was thinking about edge cases... like why is a diet soda with no calories and added caffeine a food, while a vitamin supplement is not?
So I started to look up how caffeine is derived.
Apparently it's way too expensive to do a full synthesis so nobody does it. Instead, they just reclaim the natural caffeine that's removed from decaffeinated coffee. And that's what goes in things like Jolt Cola and No-Doz.... just coffee extract.
Caffeine is one of the oldest simplest molecules we know about and we're still just harvesting that from natural sources.
Hell, I've been arguing since the US invaded Afghanistan that instead of burning down the opium fields, we should just buy the opium off of them and use it to make morphine. But the INCB (the UN version of the DEA) is cockblocking that.
Have you read my rant about chirality in generic drugs? I've got my soapbox and a microphone right here.
the "no true scotch man" fallacy.
Yep, totally agree.
the "no true scotch man" fallacy.
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That's often true, yeah. I dunno about "most" but yeah, that's the problem I was alluding to.
the "no true scotch man" fallacy.
I don't like this understanding, as when I think "tax" I tend to imagine that there might be some societal benefit derived from the money extracted. This kind of tax just feed into a parasitic industry that does real harm, as you note with respect to public understanding of science, and as seen in the case of the vaccination insanity.