Hard News: Miracles just rate better, okay?
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You see the the big win for osteo, but if Jimmie really did get better on his own, you could easily now be singing the praises of some other theraputic technique that you just happened to try "that day".
I try to keep that experience separate from other consideration of osteopathy because I frankly do not know what the hell happened there.
I'm more comfortable in saying that when he was (I think) 14 and he suffered that painful neck strain, a gentle osteo treatment provided prompt relief. He went in with his neck muscles in spasm and his head almost on his shoulder. He left with his head upright. That was good.
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It never fails to surprise me that people still don't get it. There are many things that happen in this universe, this world, that we just don't know how or why they happen. Why do we have to know. Isn't it enough, Peter, that people get alleviation from pain and other maladies? I understand that it is beneficial that treatments are somewhat based on efficacy. But does it always have to be proven in a medical journal somewhere? Maybe for you, that's important. But as many people have tried to tell you, Peter, all that mattered for them was that it worked. My husband had leukemia, he went the conventional route, he had chemotherapy, they gave him Prednisone. The haemotologist told us that they had no idea why or how, but that steroids enhanced the effect of chemotherapy agents by three times. That was 13 years ago. They still use steroids in conjunction with chemotherapy, and as far as I am aware, they are no closer to knowing the whys and wherefores than they were. So, really, I know you're a scientist, but if doctors can admit ignorance, and quite happily, who are you to say that people can't find their own ways of living comfortably?
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This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.
My highlights. In my mind the last sentence has to be thought about carefully. Doesn't anyone find it strange that the two methods seem to produce the same "more effective" result than sham treatment?
I would LOVE to see the results of doing nothing....maybe gardening even.....but just letting the low back pain recover by itself may be a useful atlernative.
But if I had seen that result in a review of- for instance - was there a steady state universe or was it produced by a creator - then I would still be searching for something else since neither fitted the data. But for some reason there would be a group who would still l stand up and say "See the creator has just as good a review as a steady state theory. Therefore the creator is valid."
Rather, it tells me nothing.
Where are the numbers?
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My highlights. In my mind the last sentence has to be thought about carefully. Doesn't anyone find it strange that the two methods seem to produce the same "more effective" result than sham treatment?
I don't know. But Peter has recommended that particular expert review as the gold standard, and, "strange" or not, that's what its summary says.
Where are the numbers?
In the body of the review itself, presumably.
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because its core theory is, in scientific terms, all kinds of woo.
You know, intellectually, that it can't work. But, oops, it does.
No, that's mis-stating the position. What we "know" (picking my verb carefully here before getting gunned down by Ben on epistemological grounds) is that it is unlikely to work, and if it does, it is probably not working the way that the practitioners claim .
It is no problem to science if it works, and people will investigate whether sticking needles in random places works as well, or whether it has to be needles, and looking at nerves and so on. No big deal.
Herbal remedies were originally often explained by their practitioners through the doctrine of signatures, or humours, or elemental balance, or what have you (and in fact the ones offered by Chinese or Ayurvedic medicine are still explained in those traditions by what I will here rudley label "woo").
Now we know that the ones that work do this by the effects of certain chemicals they contain. This means I still won't trust other remedies based merely on the claim that the doctrine of signatures (or other woo theory) says they ought to work. I'd only trust them if a body of sound trials shows they work, at which point we are leaving woo behind and back in science territory.
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I'd only trust them if a body of sound trials shows they work, at which point we are leaving woo behind and back in science territory.
I'm with you on this.
But when the alternatives are medicines or techniques that have a body of sound trials between them which aren't working to solve my problem, or are causing very serious side effects, then it becomes more likely that I'll start looking over the fence. And that seems to be what people in this thread are saying (I hope I'm not mischaracterising anyone here).
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It concerns me that works for a generally healthy adult white male (the norm for most RCTs, and therefore registration of new medicines) might not work as well for someone from another demographic.
So using it for someone from another age, gender or ethnic group is almost a leap of faith for the prescribing physician?
I know of several autistic children who have reacted very unexpectedly to prescribed drugs, as if their whole metabolism works differently. Conversely it could be possibly that alternative therapies may work more effectively for them than for eg Peter.
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sticking needles in random places
When western medicine includes a proper energy model of the body rather than trying to explain everything in biomechanical and chemical terms, it will be entitled to take cracks at acupuncture.
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And that seems to be what people in this thread are saying (I hope I'm not mischaracterising anyone here).
I'd concur. Essentially the debate is raging around some straw men. On the one hand, the straw man that people who are willing to try alternate remedies are anti-science or anti-mainstream-western-medicine at least. Most assuredly some are, but not all, and pretty much nobody here is. The other is the straw man that anecdotal evidence proves a general theory or set of techniques. No one has said that either. What people giving anecdotes of their treatments are doing is providing evidence against the general claim that everything to do with their selected treatment is totally bogus, nothing but placebo, does nothing and is expensive at best, harmful at worst. These claims take the arrogance of mainstream science far too far, and in doing so they are actually counter-scientific.
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It concerns me that works for a generally healthy adult white male (the norm for most RCTs, and therefore registration of new medicines) might not work as well for someone from another demographic.
Notably the other 51% of the population. How can it be claimed that a tested drug is safe and effective when we know that men and women are biochemically different?
Fortunately that is shifting now as pharma moves to tailor drugs to even more specific groups. In the meantime it is just another example of western medicine not meeting its own supposed standards. But my its acolytes like to have a crack at anyone who points out the emperor's state of undress. Charming.
Most of us take it for what it is, and that is enough. I believe in what medicine can do and in the value of evidence. Self-directed health is going to demand much more honesty though if the information we use to inform our choices is credible. The generation who believed something just because a person in a white coat told them so are dying out.
Also, what Ben just said. I can take others dismissing my own experience far easier than seeing someone like Ben bravely lay out quite personal stuff and then get attacked for it. Respect.
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When western medicine includes a proper energy model of the body rather than trying to explain everything in biomechanical and chemical terms, it will be entitled to take cracks at acupuncture.
Ah, vitalism. I actually have no words.
(Okay, two. What energy?)
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Lucy, it's not unreasonable to say that scientific understanding of electricity in human bodies is highly incomplete. You don't need to invoke woo ("vitalism" here) to agree with that point.
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"Where are the numbers?"
Sorry, I didn't make myself clear. I was looking for the numbers that might suggest doing nothing may be a better option to either of the two "cures".
What I am suggesting is that there may be a third option we are all missing. eg the big bang, that the data fits better.
Doing nothing may be it. I/we don't know. But the point I tried to make was that why do they both give the same outcome? The sameness is the strengeness.
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Not better than placebo it doesn't. We now have a number of different placebos for acupuncture, the absence of which held the analysis of its effectiveness back for some time. When you compare acupuncture with either sham acupuncture or random placing of the needles there is no difference.
Demonstrably untrue:
"Conclusions Acupuncture plus diclofenac is more effective than placebo acupuncture plus diclofenac for the symptomatic treatment of osteoarthritis of the knee."
So given that a number studies on acupuncture have been performed, I would be astonished if a list like Diane's could NOT be compiled.
Occam's broom.
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Lucy, it's not unreasonable to say that scientific understanding of electricity in human bodies is highly incomplete. You don't need to invoke woo ("vitalism" here) to agree with that point.
It is somewhat unreasonable, however, to link however many thousand year old "maps" of "energy flows" in the body to the electromagnetic fields produced by the biomechanical and chemical interactions of the human body. Saying we don't understand it fully is *not* the same as saying alternative medicine understands it any better.
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It is somewhat unreasonable, however, to link however many thousand year old "maps" of "energy flows" in the body to the electromagnetic fields produced by the biomechanical and chemical interactions of the human body.
Why is this unreasonable?
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we don't understand it fully
Fully? How about at all. Arrogance.
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It is no problem to science if it works, and people will investigate whether sticking needles in random places works as well, or whether it has to be needles, and looking at nerves and so on. No big deal.
People are investigating those very things. My point in reply to Peter was that the research doesn't seem to be as done-and-dusted as he was saying. And according to this NIH summary:
Some clinical trials that found no difference between acupuncture and a placebo control (i.e., a "sham" procedure designed to look like acupuncture but not to deliver treatment effects) nevertheless found more benefit in acupuncture than in conventional drug treatment.
Which is actually kind of interesting. And:
Preclinical, basic-science studies continue to show that the effect of acupuncture has a physiological basis.
Basically, it does still seem worth investigating.
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Sorry, I didn't make myself clear. I was looking for the numbers that might suggest doing nothing may be a better option to either of the two "cures".
I can't get the whole review and I wouldn't really back myself to understand the detail, but the authors did clearly say the therapy performed better than sham or known-ineffective treatments, which are something like "doing nothing", one would think.
I suppose the point is that the authors of what is apparently the authoritative review did regard as effective some treatments for back pain. Your resistance seems in part based on not being comfortable with what you're reading.
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I was at a fairly "alternative" event overseas recently and a friend had to go to the medical centre, which is staffed by professional medics but also not off-limits to hippies.
The friendly and competent medics went through their process - did some tests, tried some treatments and eventually my friend was ok - mostly because the condition was self-limiting, but also through the efficacy of the indicated treatments. At no point did they say "you've got X and Y will fix it" because they didn't have that level of certainty - which is how real medicine mostly works.
At one point a hippy (sorry, alternative healer) came by and announced that my friend had an excess of chi and could come by her camp to be rebalanced, or something like that. The hippy, of course, wasn't burdened by knowing what she didn't know - her belief system allowed for instant diagnosis and remedy without the burden of doubt.
I'd suggest that the "alternative" method often appears more attractive to a patient who's impatient with the medical approach, simply because a completely bogus, but confident "diagnosis" is found preferable to a slow, scientific investigation.
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Lucy, it's not unreasonable to say that scientific understanding of electricity in human bodies is highly incomplete. You don't need to invoke woo ("vitalism" here) to agree with that point.
But that's clearly not what Sacha's after here. I mean, we know that electricity is involved in animals and have done since Galvani; it's a pretty accepted part of biology. Yes, we don't know it all yet, but that's true about everything.
It's totally true to say that our understanding of gravity itself is highly incomplete but it is still a hugely useful tool, and people talking about intelligent falling can be safely dismissed as daft, even though, you know, dark matter and the higgs boson and all that are pretty debatable.
The problem is not `woo' it is that Sacha is basically saying that
western medicine doesn't work when in fact it does, and, by the
way, western biological science really does work too.(Where,by `works' I mean makes testable predictions that tend to be true.)
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So given that a number studies on acupuncture have been performed, I would be astonished if a list like Diane's could NOT be compiled.
The 1997 NIH consensus statement that Dyan noted seems to me more significant, for the reasons you've stated.
There are certainly situations in medicine where treatments are used whose mechanism is not understood. Electroconvulsive therapy is one. As monstrous as it might seem, ECT allows some sufferers of major depression to live their lives. As a senior psych nurse put it to me, "They come in, they have it, they have a cup of tea and they can go home and keep living."
I am quite aware of confirmation bias and other issues around the desire for a cure. I could hardly be otherwise: I have two kids on the autism spectrum, and there's probably no field where there's more desperation for miracle cures.
It's very political -- Autism NZ has just cut its ties with its Auckland branch because the latter insists on promoting so-called "biomed" treatment. We've never gone there.
But, even though having a skilled thumb jammed into a spasmed muscle hurts at the time, it's pretty cool when that muscle releases. I have tried sitting around hoping things got better. It wasn't so good.
As I've said, I think there's enough evidence to suggest that my personal experience is not imagined (I wouldn't want to make any warranties in general). And that's not to deny the pastoral dimension of a visit to my osteo. He gently urges me to do the very things Peter recommended (exercise and weight loss). He correctly referred me to my GP when he realised my incipient kidney stone problem, despite its presentation as a bad back strain, wasn't a musculoskeletal issue. We're not exactly talking about some doctor-hating purveyor of woo.
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Notably the other 51% of the population. How can it be claimed that a tested drug is safe and effective when we know that men and women are biochemically different?
This is a bit of an exaggeration. Stage 1 trials are the ones that are usually men -- and are pretty much "is this going to kill a person?" trials. They also involve only healthy subjects, and are not designed to test the effectiveness. By the time trials are seriously testing effectiveness as well as safety, they don't just test on men. There is a little chauvinism/dispensibility about it, in that treatments are tested on animals>men>women>children*
*actually, most drug treatments are not tested on children. It's considered to be too expensive and too hard for an insufficiently big market. By the time you get down to infants there are very few medicines available.
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an increedibly hot discussion, even for a troll! (but i have been advised, by that nice man Gordon Campbell over at yonder werewolf nz dot com, that even trolls can be nice people too, as witness his referring me to the 'moomintrolls' who he sez were therapists in their very own right!) And even the most withering of you must admit that trolls = a tiny bit of excitement plus! My own angle to the eva evanescent centre at this moment then would be to draw some attention at least to the evident iterability of that sign of what has here been called "anecdata", and why THIS term has been chosen over that of the normal 'anecdotes' we otherwise fully expected to come trolling down the pike.. ? is there some sort of deferral of conflict entailed right there within the significantskin of this thusly rendered scene? yrsin error and trial...
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Why is this unreasonable?
Because back in the day people had no way of sensing electricity - short of static friction/lightning - and no understanding of how it worked. It doesn't seem unreasonable to me to assume that the energy flows bit is, basically, guessing. Voltage potentials along neurons were somewhat difficult to observe before the twentieth century.
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