Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Here is an interchange of letters from this week’s BMJ. George Lewith says more money should be spent by the government on research on alternative medicine. Well, only if it is spent properly, and that is not what has happened in the past. (Letters here, if you have a subscription.)
In all probability money spent in this way would be money down the drain, just as it has proved to be in the USA. As pointed out by Wallace I. Sampson, M.D., NCCAM has spent almost a billion dollars on research into alternative medicine, and
“. . it has not proved effectiveness for any “alternative” method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed.”
It is a bottomless pit, and there are more promising ways to spend the money.
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| George T Lewith, Reader in Complementary Medicine, University of Southampton Primary Medical Care, Aldermoor Health Centre, Southampton SO16 5ST Send response to journal: Re: Valuing Research |
I remain unclear about John Garrow and David Colquhoun’s position with respect to “funding CAM”. Are they suggesting that there should be no funding for CAM research or are they suggesting this embargo should apply to the provision of CAM services within the NHS? If the former, how do they justify this position with respect to the many UK taxpayers who use CAM each year and for whom the government has some obligation to provide information? Competing interests: None declared |
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| John S. Garrow, vice-chairman HealthWatch The Dial House, Rickmansworth, WD3 7DQ Send response to journal: Re: Taxpayer funding of CAM research |
Dr Lewith wants clarification of my view about public funding of CAM research. It has changed over the last 7 years. In 2000 the House of Lords Select Committee (HLSC)advised the Department of Health to fund research on acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy to see if these therapies were safe, more effective than placebo and good value for money, At the time I supported this decision. However in 2003 it was disclosed that £1.3m had funded 8 research projects, at the Universities of Leeds, Southampton, Bristol, Brunel, Sheffield and York, but none of these were directly testing the safety, efficacy or value-for- money of the main CAM therapies.[1] I noted that these Universities did not have as good a record of research into the efficacy of CAM as Exeter, which had applied but failed to get funding. It was also noticable that the panel awarding the grants tended to work at the funded Universities. CAM research is not so impoverished as Dr Lewith implies. The onus is now upon the researchers who received £1.3m from the taxpayer, and more from the Foundation for Integrated Health, to tell us what answers they have found to HLSC’s very pertinent questions. Only in the light of these answers can we judge if they deserve further public funding. If initially the Government had an “obligation” to fund CAM research I think the £1.3m discharged it, and now there is an obligation on CAM practitioners to show that they have not misappropriated these funds. [1]Garrow JS et al. UK government funds CAM research. FACT 8:397-402, 2003 Competing interests: None declared |
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| David Colquhoun, Prof of Pharmacology UCL Send response to journal: Re: Funding for alternative medicine research |
I agree entirely with John Garrow’s response. A corollary of his analysis is that, if there is to be any more funding for research in alternative medicine, it is essential that the allocation of the money should not be in the hands of alternative medicine people. The reason for that is that past experience has shown that they will give the money to projects that don’t answer the real questions. If no applications are received that address the proper questions with rigorous experimental design then the money should be clawed back and spent on something that has a better chance of being a real advance. I am perpetually amazed by the reluctance of advocates of alternative medicine to subject their claims to proper tests. The only interpretation that I can see of this failure is that they themselves believe, deep down, that the tests would be failed. I hope that isn’t the explanation though, because if they were convinced that the tests would fail, it would mean that we are dealing with fraud, not just delusion. Competing interests: None declared |
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57 Responses to Should there be more alternative research?
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GREAT!!! Excellent work, David!
By the way, I had the question why you protest so against the state funding of investigations of homeopathy effectiveness (better – non-effectiveness!). Now my question has been answered:
“…none of these were directly testing the safety, efficacy or value-for- money of the main CAM therapies…”
“…the allocation of the money should not be in the hands of alternative medicine people…”
I knew, of course, that these villains didn’t carry out any investigations! They simply stole money! But it was my own opinion.
And now you have given real evidence for it.
Good post.
So medical scientists that are implacably against alt med should be given funds to do the research into CAM therapies. We’ll definitely reach a consensus using that approach…
I still don’t understand your opposition to empirical evidence. Humans have used plants as food and medicine for thousands of years. When it comes to plants as food you don’t question the judgement of our ancestors (no calls for trials into the efficacy of broccoli, for example). And yet, in the case of plants as medicine, you imply that our ancestors got it very wrong. How so?
What I actually said was that the distribution of funds should be in the hands for people who understand what constitutes empirical evidence. And you don’t have to look far to see that our ancestors got a lot of things wrong.
And I’m saying the people that would meet with your approval also seem to be inherently opposed to alt med.
Likewise, you don’t have to look very far to see that our ancestors got a lot of things right. You still haven’t told me how it is possible that plants used as food have an effect on our bodies, and yet plants used as medicine have no effect at all. This seems totally implausible…
You don’t seem to understand how new knowledge is acquired. It isn’t the people who have to be approved, but, as with any other grant application, the design of the experiment.
The evidence about the effects herbals has been reviewed here. It is less than impressive,
Interesting post and discussion, but should it be ‘so-called alternative research’? One could argue that research (whether into antibiotics or acupuncture) should be evaluated according to its quality, without any ‘alternative’ standards.
The argument that there are quality problems with studies into CAM seems to be supported by this systematic review of studies on herbs in asthma (excluding TCM): http://www.informaworld.com/smpp/content~content=a783779726~db=all~order=page . Despite the fact that the various studies reported some benefit for most herbs used, this is what the authors (including a researcher in Integrative Medicine) say:
“…Study quality was mixed and therefore caution in interpretation of findings of usefulness of these herbals must be suggested. Limited safety information was mixed and generally was related to GI symptoms, though one herbal investigated reported more serious side effects. Conclusions: Herbs may be useful in treatment of asthma. There is insufficient evidence to make recommendations for or against the use of these herbals. Established effectiveness must be balanced with study quality and safety profile for the herb.”
There is a trend that the better the trial of alternative medicines the poorer the efficacy. This is probably because belief in a treatment from the argument of antiquity, or belief that the plural of anecdote is data precludes CAM believers from understanding the components of a properly controlled study.
Let the practitioners of these dubious and in some cases dangerous products provide the research money themselves. And yes, give it to proper researchers. Science is not antithetical to treatments that are outside the mainstream, it’s just that when properly studied they mostly fail.
Anti-D
It was empirical evidence that lead to Thalidomide being promoted for relief from morning sickness.
One researcher gave some to his wife and it worked. On the basis of this the marketing people then promoted the drug without bothering about doing a proper trail.
This is how CAM works. One use and personal recommendation, “Oh it worked for me or so and so, so you should try it.”
CAM is like Thalidomide. Empirical evidence and lack of real research into how it works (if it works). It is isn’t enough for something to seem to work. We must know if it works. Once I had a cold, I had some chicken soup. a vitamin C pill and went to bed for 24 hours. What cured the cold? The pill, the soup, the bed rest? All of them? None of them? But hang on, I think I had some bread with the soup, maybe that’s what did it? Is this really evidence of anything? But this is the standard of evidence that CAM provides.
Can you think how the soup, pill and bed rest cold cure could be trialled? Post your answer.
If something works, how does it work? How it works is important because you may be doing unseen damage, and it may have applications in other areas. For instance Thalidomide is now used as a treatment for some types of cancer, because how it causes damage is now understood.
You cannot set your own trial conditions. If CAM works as its supporters claim, then this will be evident. Ben Goldacre set out conditions for a trail for homeopathy treatments. If homeopathy works as claimed then it should prove itself easily in this trial.
Setting your own trial conditions is a cop out. I can prove that I can become invisible, run at over 40,000 km per second. But only as long as I can set the conditions for the trial. But if I am confident of my abilities then shouldn’t I be able to pass a test that someone else devises?
If CAM wants the same respectability as proper medicine, then it must submit itself to the same set of rules, scientific and ethical. Resorting to talk of miasmic holes, vital forces and positive or negative spiritual energy is meaningless.
“If CAM wants the same respectability…”
A good point well made, nash.
There’s no point having -more- alternative research unless it is of better quality than has been typical in the past – as can be seen if one follows the second link in this post to ‘UK Govt Funds CAM’. (“Does the treatment offer therapeutic benefits greater than placebo?” is one of the most important questions that must be asked of a therapy – why does CAM seldom ask this question?)
DC – People design experiments. If medical scientists design experiments without taking into account traditional herb use – the underlying philosophy and distinctive practices – then the results of such experiments are always going to be treated with scepticism by herbalists.
This site promotes the irrational belief that the orthodox medical model is self-evidently the only true model for medicine. In other words, nothing can call itself a ‘medicine’ unless it is developed or has evolved within the limits created by the orthodox model of medicine. This assumption is a form of scientism.
Gnash – All drugs have to stand the test of empirical evidence. Once a drug is approved for general consumption evidence continues to be gathered about its harm-benefit in the decades that follow. It is this evidence (the evidence of experience) that makes and often breaks a drug. So don’t turn up your nose at empirical evidence.
Empirical evidence for herbal medicine is not based on recent personal recommendations. It was gathered over hundreds, sometimes thousands, of years, through a number of generations. This was at a time when it was in no one’s interest to falsify or inflate claims about the medical efficacy of herbs.
Anti-D.
May I suggest that you read R.A. Fisher’s classic, The Design of Experiments (1935)? I suspect there is a whole world out there that you are missing, at least a century of thinking about how to wrest information from nature without deceiving yourself. It’s really interesting when you get into it.
Incidentally, it is nothing to do with “orthodox medical model”. The principles that I’m talking about are not restricted to medicine. It just happens that medicine is an area in which it is particularly easy to deceive yourself (and, worse, to deceive others).
Anti-D, I’d be interested to hear your thoughts on Astrology.
DC – My point was philosophical and it still applies to science in general. I’m not anti-science. However, if only scientific claims are allowed to be meaningful then you end up with a very limited view of the world.
Munin – you’ve got the wrong website, mate.
not sure what your point is Anti-D….
If one makes a claim about a treatment (lets say a herb), then it is not especially difficult to test that claim by the well understood techniques of science?
Do you not think it is interesting, even on a philosophical level, to find out if something people believe is actually true? I find that more fascinating than saying relying on anecdote and folk-history.
I certainly don’t think scientific claims are the only meaningful claims one can make – but when the question is simple “does XX cure YY” then that’s a fairly simple test for science.
superburger – I’m not saying that herbs cannot be studied by scientific techniques or that research into herbal medicine is not needed. Neither do I think we should rely solely on the evidence of experience. This kind of evidence is very useful though and no one questions it when it comes to the plant foods we consume.
Science and scientific methodology are not, however, innately objective. Medical science is underpinned by a worldview or philosophy. The philosophy determines the kind questions that are asked, the methods that are used to ‘wrest information from nature’ and the outcomes that are expected. Your question ‘does XX cure YY’ says a lot about your medical world view and the assumptions you make with regard to treatments, patients and illnesses.
Herbalists make assumptions too. Most herbalists believe that it is important, for example, to focus on the terrain of a patient. This will involve strengthening the organism, improving overall function (circulation, digestion, elimination, endocrine and immune function), reducing stress and improving nutrition. Treatment protocols are by necessity patient specific. If the outcomes we expect are different, then how can we always use the same methodology to test them? And this is just one area where the philosophy and practice of herbalists and medical scientists differs. Your ‘simple’ question looks rather simplistic when you take the above into account.
Well, anti-D, a medicine, or other treatment, either works or it doesn’t work and the methods of finding out don’t depend on whether it is herbal or not. I’m just not into your world of parallel universes and ‘alternative’ standards.
Herbal medicine is, after all, just regular pharmacology, but pharmacology as it was practised around 1900, before it was realised how important it was for the safety of the patient to standardise the content of the active principal(s).
To mistake wishful thinking for truth seems like a bad idea to me. It is the mistake made by George Bush (climate) and Tony Blair (WMD), and alternative medicine advocates seem to behave in much the same way.
In 2000 a govt examination of herbal products showed that the strength of active ingredients in a single batch varied by by a factor of ten. Also cross contamination of ingredients was commonplace.
This was from a BBC Radio 4 programme in 2002 about the efforts of CAM to regulate itself.
No matter how individualised your treatment, if what you give your patients can be a tenth or ten times stronger than you anticipate, then individualised patient treatment is irrevelent, what they get is a lottery.
A proper doctors treatment is patient specific, so whats your point here?
But how specific are your treatments? Have you never prescribed the same herb twice for the same condition in different people?
Anti-D’s comments about “terrain” and similar strike me as just another version of “you can’t test this in double-blind trials because it works in a completely different way to science”, an old Altie argument.
And the stuff about “strengthening the organism and improving overall function” is surely a red herring, since real doctors routinely dish out equivalent advice like “take it easy, don’t overdo it, look after yourself, make sure you eat properly and get enough sleep” .
As DC says higher up, we have spent several hundred yrs of scientific method figuring out how to “idiot-proof” our methods of testing against us fooling ourselves through wishful thinking. And as Ben Goldacre explained in the Guardian last week, it is perfectly feasible to subject homeopathy (or herbalism, or any other “individualized” remedy/therapy) to scientific trials. Alties don’t like this because, again as has been mentioned above, almost invariably the finding is that the better designed the trials are to exclude subjectivity, the less evidence for the effectiveness of the Alt therapies can be detected.
And another thing I’d like to add (even if a day late) is that all the sub-claims for herbals cited by Anti-D
“circulation, digestion, elimination, endocrine and immune function”
will not have been tested either. For example, it seems that many alt remedies claim that such-and-such a treatment will “strengthen the immune system”. Since it piqued my interest, I’ve been trying to find publications to see how this has been tested (with relationship to homeopathy in any case) and there’s damn few, I can tell you. None of them in readily accessible journals, either. (I suppose I could write to the authors and ask for a reprint…… but life’s too short!).
Perhaps anti-D could supply me with some reading material on the subject? Some kind of experimental evidence please, not just a book by some geezer who says he knows how to boost your “natural defenses”.
I’m would wager that George Lewith and his Southampton CAM Empire will have had far more Govt funding in the last 5 yrs to investigate CAM therapies than I have had in two decades doing basic research…
Anti-D
While you are here there is one thing you can clear up for us.
Red Clover. It is used as a blood cleanser.
What exactly is meant by ‘blood cleanser’?
What exactly does it do?
off topic as it’s safety rather than research but Mayo Clinic has very recently published this list of herbal medicines which could affect (negatively) outcomes after surgery: http://www.mayoclinic.com/health/herbal-supplements/SA00040/rss=1
DMcILROY – have you considered writing to / calling the alt remedy vendor and asking them which part of the immune system their product affects and how? Thymus? Spleen? Do they have evidence for these claims?
IIRC, Trading Standards have been known to take a dim view of ‘immune system’ claims.
“If the outcomes we expect are different, then how can we always use the same methodology to test them?”
If one expects A,B and C to be the outcomes of treatment, and the reason for this is herb X, then there really is no great difficulty in testing that claim……
i’m struggling to think of a single claim one could make for a herbs’ effect that could not be tested with the right experimental design.
As expected, my previous post brought out a whole congregation of high priests and zealots of medical scientism. I’m sorry but I cannot address all your accusations as I have an important meeting with George Bush and Tony Blair…
DC and others mention active ingredients and the standardisation of herbal medicines. The idea that each dose of a herb has to have the exact same levels of active constituents is an attractive concept for medical scientists used to dealing with pharmaceutical medicines. But this belief is false – herbs can have hundreds of constituents that may contribute to its medicinal activity. Some constituents may have direct activity, while other, so-called ‘inert’, ingredients may increase bioavailability, reduce toxicity, or stimulate function through synergistic activity. Herbalists consider the whole herb to be active. You don’t understand this because you’re too busy trying to make herbs conform to your preconceptions of what it is to be a medicine.
A herb is not the equivalent of an active ingredient. In most cases the so-called ‘active ingredient’ of a herb is not even known. Manufacturers of standardised products often guarantee the presence of a marker compound (as a percentage) – rarely are these known active ingredients. They may help to identify a herb, but are not indicators of therapeutic activity.
Extrapolating the concept of active ingredients to food means that we can legitimately ask: Why consume whole fruits and vegetables rather than pills containing their active ingredients? Furthermore, fruit and vegetables also contain a number of toxic compounds that can be isolated, concentrated and used to kill rodents (for example, isothiocyanates in the brassica family; tropane alkaloids in potatoes, tomatoes, and peppers; opiates in lettuce; prussic acid in stone fruits etc.).
Herbs are complex medicines. Therefore, complex tests are required to test their efficacy. Pharmaceutical drugs are simple (sometimes even primitive) medicines and so require simple tests to determine efficacy. But in some contexts I’d rather take simple medicines and in other contexts I’d rather have access to complex medicines.
“DC and others mention active ingredients and the standardisation of herbal medicines. The idea that each dose of a herb has to have the exact same levels of active constituents is an attractive concept for medical scientists used to dealing with pharmaceutical medicines. But this belief is false – herbs can have hundreds of constituents that may contribute to its medicinal activity. Some constituents may have direct activity, while other, so-called ‘inert’, ingredients may increase bioavailability, reduce toxicity, or stimulate function through synergistic activity. “
From what you’ve said above, you don’t know how much of a herb you’ve given to someone. Why don’t you find out what is happening? Aren’t you even remotely curious? Incidentally, if it wasn’t for scientism you wouldn’t even know the above.
“Herbalists consider the whole herb to be active. You don’t understand this because you’re too busy trying to make herbs conform to your preconceptions of what it is to be a medicine.”
“A herb is not the equivalent of an active ingredient. In most cases the so-called ‘active ingredient’ of a herb is not even known.”
This is not a good thing. So how do you know if the herb you are giving me for a cold is not damaging my liver? You are prepared to give out goodness knows what in random strengths?
“Manufacturers of standardised products often guarantee the presence of a marker compound (as a percentage) – rarely are these known active ingredients. They may help to identify a herb, but are not indicators of therapeutic activity.”
“Extrapolating the concept of active ingredients to food means that we can legitimately ask: Why consume whole fruits and vegetables rather than pills containing their active ingredients?”
We have a digestive system. We take pleasure in eating. But popping more vitamin pills is exactly what a lot of the nutri-bollocks brigade want us to do. But again science comes in. Everything you know about nutrition is a product of science.
“Furthermore, fruit and vegetables also contain a number of toxic compounds that can be isolated, concentrated and used to kill rodents (for example, isothiocyanates in the brassica family; tropane alkaloids in potatoes, tomatoes, and peppers; opiates in lettuce; prussic acid in stone fruits etc.).”
Science again. Chemistry and biology for instance.
“Herbs are complex medicines. Therefore, complex tests are required to test their efficacy. Pharmaceutical drugs are simple (sometimes even primitive) medicines and so require simple tests to determine efficacy. But in some contexts I’d rather take simple medicines and in other contexts I’d rather have access to complex medicines.”
One of the criticisms of the MMR vaccine is that it is a cocktail of chemicals. Just because a chemical cocktail occurs naturally doesn’t mean it is harmless.
Also complex is something that science does well. Again we know that substances in some herbs interact in surprising ways, But again, it is science that finds things like this out. It is CAM that treats people in simplistic and meaningless ways. It resorts to miasmic holes, vital forces and positive or negative spiritual energy.
CAM is like astrology. It has an appeal to antiquity, a lore of seemingly profound knowledge. Superficially some of it seems to be true and it practictoners had mathematical skills that few members of the population had. The workings if anyone asks are very vague and relies on forces that science can’t detect.
Early astrologers observed the stars and planets. Patterns in the movements of certain stars were spotted and these were linked to the seasons. Vital knowledge for agriculture. From this we get calendars. Out of this grew astronomy. Modern astronomy has transcended its roots and if you bother to look into it is actually more interesting and wonderful than astrology.
Modern astrology hangs on its coat tails, e.g. they had to add Uranus, Neptune and Pluto, but they didn’t discover these new planets themselves as their ancient wisdom does not give them the tools both physically and intellectually to do this.
You are an astrologer. Pharmacologists are astronomers. You claim that science doesn’t know everything. It doesn’t, but it certainly knows a hell of a lot more than CAM does.
So to sum up
1. You don’t really know what quantity of a herb you are giving to someone. This doesn’t concern you.
2. You don’t know how a herb you are giving out works at all. So you genuinely have no idea as to whether it is safe or not. This doesn’t concern you.
3. What real knowledge you have about any of the herbs comes from a system you seem to reject.
Nash, you have clearly misunderstood Anti-D’s perfectly reasonable position.
All science is valid, he implies, by quoting scientific information. All science – except in the one or two specific areas where he personally knows better. Because lots and lots of people say so.
I would encourage science to embrace this approach, and forward that email – because Bill Gates *will* send you that money if you do! Lots of people say so. So the evidence has been gathered. The only reason scientists object is that it wasn’t gathered scientifically, such as asking Bill Gates: “will you *actually* send the money?”
Such an approach would clearly be scientism, as it would require a proper test. It’s discriminatory, because since lots of people already clearly *believe* in forwarding the email, it *must* be effective. Lack of dollars sent by Bill gates to individuals is simply down to the fact that the outcome is different every time, and cannot be measured.
Having said that: should money be given to researching alternative medicies? Yes, absolutely. Alternative “medicide” is merely a treatment which hasn’t been shown to be effective scientificaly. Those which have already failed such tests should be given a back seat.
But I read with interest in New Scientist recently that accupuncture clearly had more than a placebo effect on the people who got the treatment. Interestingly, trained accupuncturists had about the same success rate (allowing for statistical error) as people who put needles into people willy-nilly, with no prior experience or training.
So accupuncture may well have something to be said in its favour. Sticking needles into people *does* have an effect, clearly. And we don’t need to waste years of our lives in training to find “power lines” or whatever accupunturists claim they are tapping. Stick in a few needles and the pain is reduced.
Alternative medicine found this out; a cheap and possibly very effective treatment for people with back pain. Cheaper than drugs, too. And WHY it works could give a whole range of other insights.
If further research shows that the initial tests were flawed and it doesn’t work, then – well, bad luck. But that’s science.
So yes – research into alterntive treatments is justified. As long as initial studies show more than a placebo effect. If they don’t, then the research should not be conitnued.
Slightly off-topic perhaps, but Ben Goldacre at http://www.badscience.net/2007/10/543/ covers digoxin in foxglove and the article is well worth a read if anyone is in any doubt about the potential dangers of plant remedies.
“Until a herbal practitioner can show that giving a whole plant instead of an extract really is better, they’re making stuff up when they make those claims…”
This study from the Postgraduate Medical Journal is referenced in the Bad Science post: http://pmj.bmj.com/cgi/reprint/83/984/633 and here on this site: http://dcscience.net/?p=169
I’ve also moved my comments on plant remedies, and on standardisation, from the old page to here, in the hope that ‘Anti-D’ might read them.
[…] This is a slightly modified version of some thoughts from the old improbable science page, where they formed part of the review of a BBC2 series on alternative medicine. It has been moved to the new blog because of the comments posted here. […]
This is becoming a fully-fledged synod of the Church of Scientism. What can I say? I’m not a true believer in your dogmas.
Orthodox medical science is underpinned by a philosophy-worldview that is not value-free. The philosophy is loaded with unexamined preconceptions that influence medical scientists’ perception of our bodies, disease and how to treat it. You consider your preconceptions as self-evident and unproblematic truths. How can they be when you use them to determine what is meaningful in medicine? Scientific methodology is born of its philosophy and cannot be value-neutral. Your preconceptions deceive you and limit your worldview.
You give yourselves away when you sneer at philosophies that are alien to your ‘science’ and call them meaningless. You don’t have the courtesy to acquire even a basic understanding of the alternatives before you stand in judgement of them.
In the face of the ‘other’ you behave like close-minded fundamentalists (quite fashionable at the moment).
Nash – I do not reject science. I believe that a scientist should have an open and inquiring mind. Medical knowledge is not the preserve of orthodox medicine. Orthodox medicine is nothing more than a model – it is not a monopoly on the truth. Plausibility and evidence are a function of the model, though the high priests of scientism would have us believe otherwise.
Anti D
At one time I was considering becoming an astrologer as a career. At one time I was into herbalism as a natural alternative to medicine. I was into all sorts of stuff before it was called new age. So I know all about the ‘other’ as you call it.
The ‘other’ is just a cop-out to cover up for your own lack of understanding. Rather than admit you don’t know something, you assume that it is “unknowable” and invoke the “universe is full of mysteries” get-out-of-jail free card.
Open your mind. Why don’t you read the book that DC suggested.
Anti-D
I think you’re shifting the goalposts here a bit, to a kind of philosophy of science / cultural relativism debate.
You are right to state that a “scientist” view of medicine is “underpinned by a philosophy-worldview that is not value-free”
But where did that philosophy-worldview come from? And how did it come to be so dominant? What you call orthodox medical science was not always so, and the reductionist view of medicine and treatments that is now the norm was accepted because it consistently out-performed the competing philosophical models and the treatments that derived from them.
Personally, that’s why I don’t want to spend my time understanding alternative philosophical viewpoints of medicine. Orthodox medicine has already duked it out against several alternative worldviews and come out on top.
Incidentally, if you don’t in your heart of hearts know this to be the case, why try to justify the efficacy of herbal remedies by their effects on “circulation, digestion, elimination, endocrine and immune function” which apparently are all just facets of the orthodox Church of Scientism philosophical worldview.
DMc – I’m not punting a kind of relativism. That would imply that orthodox and herbal medicine are underpinned by incompatible philosophies competing for different medical truths. Modern herbal medicine has embraced many scientific discoveries (while still acknowledging its past). This scientific knowledge is not exclusively owned by converts to the orthodox worldview. Syncretism of knowledge is possible and in many cases essential. To point out that the orthodox worldview is limited, that its perceptions of our bodies, disease and how to treat it are loaded with unexamined preconceptions, is not to question its very existence.
To say that the orthodox medical model is dominant because it has consistently out-performed its rival models is disingenuous. There are many other factors – social, political, economic – that also need to be accounted for. Dominant doesn’t always equate with right. Knowledge is power. The reverse – power is knowledge – is also true. It is the powerful that determine what is considered knowledge. That is precisely what sites like this one attempt to do. DC and others use orthodox medical science’s pre-eminence and present themselves as guardians of its knowledge. They set up artificial boundaries between their ‘pure’ science and rejected ‘unscientific’ alternatives, while claiming dominion of ‘scientific’ terms and concepts for their exclusive use. Siege-mentality = scientific enlightenment? I don’t think so…
Nash – You keep putting words in my mouth. You’re having a debate with an imaginary Anti-D. It says some interesting things about you and your prejudices
hey Anti-D,
I’m still a bit confused – can you think of an example of an predicted outcome from a herbal remedy that couldn’t be tested by the right experiment?
Or lets say, for example, that we’re both herbalists and I think a 1g dose of herb X (based on personal experience) will be effective. You think 2g (based on *your* experience) is needed. Neither of us want to give too much herb (it’s expensive and it could do harm) nor do we want to give too little (we want to make the person better). Of course the herb might do nothing at all, and we’re both seeing a placebo response.
How could we solve these problems?
“To say that the orthodox medical model is dominant because it has consistently out-performed its rival models is disingenuous. There are many other factors – social, political, economic – that also need to be accounted for. Dominant doesn’t always equate with right.”
Oh please. This tired old Alt trope again.
There are various lines of reasoning that any sane person can comprehend that makes the ludicrousness of this worldview apparent.
One is that NO alt therapy practise is EVER abandoned because some other alt remedy is “proven” to be better. The reason? Since Alties don’t typically work with actual quantifiable and reproducible evidence, there is no way to prove anything works better than anything else. Hence the reason 18th century superstitions like homeopathy tenaciously hang around.
Another way to show the intrinsic silliness of the “you’re only culturally dominant because you’re… culturally dominant” is to take the serious illness of your choice and go:
“Bacterial infection plus mystery herbal brew = septicaemia and a nasty death”
“Bacterial infection plus antibiotics = good chance of survival.”
Repeat with disease of your choice.
Anti-D
Well it’s refreshing to read a different point of view on this forum – even if I do find your comments a bit infuriating.
For example, you say “Modern herbal medicine has embraced many scientific discoveries”
and then follow it immediately by “This scientific knowledge is not exclusively owned by converts to the orthodox worldview.”
It seems to me that you only get the scientific discoveries if you take a reductionist worldview as a starting point.
Saying you want the discoveries, but rejecting the point of view that made the discoveries possible just leaves me speechless.
DMc – I do not reject the reductionist worldview (re-read my last post). It is extremely useful, but it is also limited. Any model is limited and some models are more useful than others. Where is it written that humans must adopt a single worldview? You can if you want to: draw boundaries and draw up your articles of faith, but I contend that you’ll become just as bombastic, bigotted and ignorant as the the good Dr Aust.
superburger – Confusion makes you a scientist, certainty makes you a zealot.
Anti-D. But what doesn’t work is trying to embrace two (or more) mutually incompatible world views at the same time, as you try to do, That is truly the world of parallel universes and of wishful thinking. It is much harder worrk than you seem to think to establish truth. You have to do the experiments. Herbalists and the rest prefer to talk rather than do the hard work.
When I started looking into Alternative Health, its practitioners, and what gets written about it, a couple of years ago, I was notably more sympathetic than DC is – he can probably back me up on this. In particular, I felt herbal medicine and “ethnopharmacology” had something to offer, see e.g. the discovery of artemisinins for malaria among other examples.
It is actually having to debate the practitioners, apologists and professional obfuscators of the AltMed world these last 18 months or so that has turned me “bombastic and bigoted”. In my actual experience, almost all of their schtick amounts to: “We know it works because we KNOW it works, and you are being UNFAIR asking us to test it in your mean controlled trials.”
If the stuff works, then a properly-done test will show if it works. If it does work, then it’s medicine. If it doesn’t work, then it’s not and should be discarded. If it doesn’t work, and the Alties keep bleating about how it really does but you are commiting “category error” by asking it to work in a way that is testable, I call that a con.
Good stuff, Dr Aust. Essentially their argument is that “a watched pot never boils”.
PS – as an erstwhile apologist for the AltMed world, I would just like to say that I personally have found you to be neither bombastic nor bigoted and certainly not ignorant!
I don’t recall writing that herbal medicine couldn’t be the subject of experiment. I’ll give a general example to illustrate what I mean when I write about preconceptions, worldviews and embedded values.
Take simple gastro-oesophageal reflux. Orthodox view: too much stomach acid. Solution: simple antacid or maybe even an H2 antagonist. Herbalist approach: work on the tissues in the affected area – strengthen the tissues and acidity ceases to be a problem. Solution: use a variety of herbs; some with a demulcent action, some with a tonic action, and others with a trophorestorative effect.
That example probably oversimplifies both approaches to a common problem. I know it will be greeted with howls of derision, yet it shows that herbal medicine is not a pale facsimile of orthodox medicine. Herbalists tackle many health problems from a different angle. They ascribe actions to their medicines not recognised by orthodox medicine. They use many herbs to treat individual patients.
Research into herbal medicine is both possible and necessary (and it is also in its infancy). But, if you simply expect herbalists and their herbs to behave like doctors and their drugs, then you are trying to fit a square peg in a round hole. This is not about parallel universes or wishful thinking, it is about perspective. Try to get some perspective.
“Solution: use a variety of herbs; some with a demulcent action, some with a tonic action, and others with a trophorestorative effect.”
Could be a good approach.
How would you know you’d been successful in treating someone? What would happen if you removed one of the herbs from mix.
What mass of herbs required for optimum effect?
What side effects occur?
How much better is the response compared to placebo response?
They’re some of the questions that one should surely be interested to know the answer in.
How is one going to answer these questions? Presumably by scientific experiment – which makes it essentially a problem in biochemistry and pharmacology.
Crucially, is a complex mix of herbs better, worse, or the same as a lump of minty calcium carbonate to suck on.
“They ascribe actions to their medicines not recognised by orthodox medicine. They use many herbs to treat individual patients.”
That’s fine – but if you claim an action, it is always possible to design an experiment to determine if that really takes place.
“Using many herbs” is intellectually no different from giving a HIV patient a cocktail of drugs to supress the virus. Or giving a chemotherapy patient an anti-emetic.
Even annadin extra contains paracetamol, aspirin and caffeine (all of ‘natural’ origin?)
“Research into herbal medicine is both possible and necessary (and it is also in its infancy)”
I suggest that research into the effects of natural or naturally derived products on the human body *is* one of the cornerstones of modern scientific pharmacology.
Interesting one from anti-D.
So what is a ‘demulcent’, or a ‘tonic’? They are both words that were quite common in pharmacology 50 years ago. but they vanished as it was gradually realised that they were figments of the imagination. They were categories of drug action that had no members.
I can agree, though, that
But of course the reason that it is in its infancy is that herbalists just don’t do it. Come back when you have some data seems to be the appropriate response,
Agreed, DC.
If any of the kind of substances Anti-D alludes to have the claimed actions, a well-designed experiment will demonstrate this. Or not, if they don’t. The agents can be tested individually, or together, but they can certainly be tested.
DC – You claim that ‘tonic’ and ‘demulcent’ were categories of drug action that had no members. Fair enough, but herbs are not drugs and never the twain shall meet. Such actions continue to be attributable to certain herbs. Herbalists believe that herbs are more than the sum of their individual constituents, but you believe that they are nothing more than their particular ‘active’ ingredient. Incompatible philosophies or different perspectives?
Round and round we go. Anyone following this little debate will see that we’ve come full circle. I think my contention is true: DC wants herbalists and herbs to behave like doctors and their drugs. But that will never happen.
We all know why there is no research into herbal medicine. Research costs money and only the pharmaceutical industry could afford to do it. They don’t do it because they wouldn’t be able to recoup research costs by patenting a naturally occurring chemical compounds. But wait: the MHRA and their pharmaceutical industry paymasters are presently trying to stitch up herbal medicine via the Traditional Herbal Medicinal Products Directive. Soon we’ll begin to see the kind of sanitised research into herbs that DC would approve of…
But I’ve intruded on this backslapping society for long enough:
DMc – There is hope for you…
superburger – You’re a fish out of water…
jdc325 – Have you ever had an original thought?
The good Dr A – I haven’t changed my mind.
nash – Dude, you’re still away with the fairies…
finally, DC – High priest of the Church of Scientism. Its not abuse, its disabuse…
maybe i am a ‘fish out of water’ – but you’ve conspicuously failed to answer any of my (clearly naive) questions.
that’s a pity.
http://uk.reuters.com/article/domesticNews/idUKL2932889320071129
MHRA warning yesterday about four TCM herbal medicines
Anti-D’s last comment makes my previous points much better than I could. I call this “post-modernist fan-dancing”. Evidence? Testability? …now you see it… now you don’t.
See my 1.41 pm comment from Nov 28th – QED, I would say.
Anti-D wrote: “We all know why there is no research into herbal medicine. Research costs money and only the pharmaceutical industry could afford to do it”.
That’s right – we all know that herbal medicine is financially unrewarding. Oh, hang on…
“The multimillion-pound boom in herbal medicine is threatening to wipe out up to a fifth of the plant species on which it depends…” http://www.newscientist.com/article/dn4538-herbal-medicine-boom-threatens-plants.html
“The herbal products industry generally is believed to be worth thousands of millions of pounds. The World Health Organisation (WHO) estimates that the world market for herbal medicine is worth £41 billion.” http://www.nimh.org.uk/hmaw04_press.html
Anti-D
You think the fairies are real though.
I’ve written a brief blog post re the ability of CAM to fund research – http://jdc325.wordpress.com/2007/11/30/whats-woo-worth/
Hi,
I know this is an old thread but I hope this might spark some interest in a few people.
Can anyone comment on the issue of treatment and diagnosis of thyroid disease? In particular:
1) the problems with ‘reference ranges’ for routine thyroid blood testing.
2) The composition / active ingredient differences between the natural form of thyroid hormone (armour thyroid as it is marketed in the UK) and synthetic thyroxine (often called Levothyroxine).
As I understand it, armour contains T3 and T4 whereas levothyroxine contains T4 alone.
In particular: why did the NHS make the change from one version to the other?
There appears to be empirical evidence that some people do better on the natural version (particularly women). (cf Dr Barry Durant-Peatfield’s claims http://thyroid-disease.org.uk/index.php?option=com_content&task=view&id=18&Itemid=31)
Is there any SCIENTIFIC confirmation of this evidence?
I should at this point explain that I have autoimmune thryroiditis, diagnosed by my GP when we finally did an antibody test. I’m now on Levothyroxine, have been for 2 years. I have continuous chronic pain in my arms that no one has been able to diagnose or treat. I’m wondering if it’s all down to my buggered thyroid gland.
I am not looking for a medical opinion by writing this post, but I would be grateful for a scientific medical perspective on the issues outlined above.
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