Hard News: Miracles just rate better, okay?
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<quote>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.
It performed better than sham treatment or known-inefffective therapies, and no better or worse than standard medical care. Both performed better than sham treatment. The authors clearly seem to find that some things treat back pain usefully and others don't.
You've been repeatedly touting this review and I don't think it actually serves your argument at all well.</quote>Russell you are still ignoring salient points. The report makes a distinction in the above piece between 'ineffective' and 'effective' therapies, yet their report finds that the difference is not statistically significant since nothing is actually effective.
I have pointed this important point out to you several times now. It is becoming tedious in the extreme that you seem unable to grasp it. Several eminent people got rather grumpy at Cochrane for, having proven there was no statistically significant difference between the 'ineffective' and 'effective' treatments it then talks about them as different groups.
This is why the numbers matter more than the words.
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Why don't nested quotes work? Why didn't I press preview?
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conseismal: I can't speak for others, but I apprehend "anecdata" blend of anecdote and data as delightful; thus it has found its way into my verbal bag of tricks -- this case gives it a brief, to this case it is suited, I'm stone glad of its use, delightful portmanteau that it is.
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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'd only trust them if they worked on me.
I like where you're coming from here Russell, good on you.
Timely and well researched post Dylan.
and Jackie thanks, you hit the nail on the head with this: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.
There's a certain irony that those who will never acknowledge and enjoy the benefits of 'faith based' treatment are usually skeptics.
Hope your husband keeps on trucking for a good while longer there Jackie.
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I have pointed this important point out to you several times now. It is becoming tedious in the extreme that you seem unable to grasp it. Several eminent people got rather grumpy at Cochrane for, having proven there was no statistically significant difference between the 'ineffective' and 'effective' treatments it then talks about them as different groups.
This is why the numbers matter more than the words.
My apologies, Peter. But this is the first time you've made it clear that your characterisation of the numbers varies so greatly from that in the review authors' own plain-language summary, and in their professional summary:
Main results
Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low-back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results.
I've read no other reference to what you're saying or to any related squabble over the results, so you can hardy blame me for assuming that the authors meant what they wrote in their summary.
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The report makes a distinction in the above piece between 'ineffective' and 'effective' therapies, yet their report finds that the difference is not statistically significant since nothing is actually effective.
If this is true, then it's outrageous. To say something is effective in science-speak requires statistical significance.
However, I don't see where you find evidence for your claim that nothing is actually effective. The evidence isn't overwhelming, the effect sizes are not large, but there is evidence for effectiveness.
There is quite a distinct mismatch between their plain language summary/abstract and their final conclusion
Therefore, we conclude that spinal manipulative therapy is one of several options of only modest effectiveness for patients with low-back pain. Truly effective therapy for such patients remains elusive.
as compared to
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
Relevant to the rest of the discussion, among these other treatments of 'modest' effectiveness according to Cochrane are acupuncture, exercise, some herbal preparations and rofecoxib (Vioxx!!!). Bed rest seems one of the few things that is not modestly effective.
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Several eminent people got rather grumpy at Cochrane for, having proven there was no statistically significant difference between the 'ineffective' and 'effective' treatments it then talks about them as different groups.
I'm at the point I'd like to have the names of these eminent people, and some references for the lack of efficacy for conventional treatments.
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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.
The World Health Organisation re: Acupuncture)
Darwin wouldn't have had a clue what a gene was, let alone how genetics work but it didn't prevent him from coming up with the single most important idea in genetics.
Tibetan medicine is even older than Chinese medicine but there in the Medicine Tantras are descriptions of seven different types of organisms that cause disease.
Tibetan medicine also details which foods are low gylcemic index and which are high. With their medicine tantras they were able to treat diabetes (type 1, as type 2 was non-existent) with considerably more success than any other type of physician before Banting and Best cracked it.
The detailed descriptions of the biochemistry of digestion are quite remarkable. And although no one 2,600 years ago would have had any way to map any of this, there it is in the ancient medicine tantras.
Interesting note: I had quite a serious duodenal ulcer in 1980 - even before cimetidine was widely available - and the dietary advice given back in my era was quite wrong. Milk is pretty much the last thing you should drink; the high protein content causes the production of pepsinase. The dietary advice found in the medicine tantras for treatment of duodenal ulcers is absolutely correct, as is the advice for diabetes, and many, many other ailments.
Dismiss it if you want. That's why Sydney Brenner coined the term "Occam's Broom". It's so convenient for sweeping any evidence that doesn't fit your theory under the carpet...
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you know, there's a book to be written about stereotypes of the unchanging Orient and alternative medicine.
i mean, seriously, how does it make sense to say that tibetan medicine is even older that chinese medicine; these things change and i would be utterly astonished if there's any useful sense in which one can talk about the `age' of a medicinal tradition* and there's no sensible reason to correlate age with correctness & in fact if you start saying that humours beat the germ theory based on age you will get laughed at.
also, isn't it interesting there's lots of popular interest in the medicine of yer eastern courtly cultures, but comparatively little interest** in how people in the Amazon deal with illness, despite the fact that the Amazon is proverbially fruitful in terms of drugs?
* Hobsbaum and Ranger are I think the authorities here but in particular if you look at British hedgewitchery, the traditional medicinal system I am most familiar with, you will find that it is mostly made up as people go along and things are traditional if they go back 20 years or so.
** except of course amongst pharmaceutical companies, who are utterly uninterested in bits of tiger but really rather keen on funny little plants from the Amazon basin. The fact big pharma has to answer to shareholders and the FDA etc may be of note here.
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you know, there's a book to be written about stereotypes of the unchanging Orient and alternative medicine.
i mean, seriously, how does it make sense to say that tibetan medicine is even older that chinese medicine; these things change and i would be utterly astonished if there's any useful sense in which one can talk about the `age' of a medicinal tradition*
Even if age did count, the "western tradition" arguably starts with Hippocrates (born in 460BC -- let me see, just a little less than 2500 years ago). So it would be roughly a draw :-) And, if you want, you can cherry-pick Hippocrates for his treatments that sound modern while ignoring all the waffle about getting your humors out of whack...
[PS And yes, this is intended to be a little tongue in cheek]
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To be fair, I don't think it's age per se that the proponents of 'alternative' medicine are highlighting. (After all, Christianity is a couple of thousand years old and we all know that's bogus). The inference seems to be that if a "medicinal caste" has been operating continuously for a long period of time, they must have been doing something right or they'd have been run out of town.
There are alternative hypotheses - eg. closed borders preventing access to alternatives, oppression of local alternatives (or is that restricted to 20th C western medicine?), or a few lucky guesses (given the flawed model they're working from) coupled with low expectations and high tolerance of high mortality rates. And maybe an incremental switch to 'modern' alternatives that really do work.
I tend to think the truth is that Western medicine is your best bet for figuring out what is broken, but hasn't been great at providing a complete fix because it hasn't been holistic enough and people are complicated. It's much better at relieving symptoms, but any hocus pocus is good for that.
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The inference seems to be that if a "medicinal caste" has been operating continuously for a long period of time, they must have been doing something right or they'd have been run out of town.
Of course, this also applies to pre mid 19th century European medicine, but oddly enough, nobody ever wants to go back to miasmas and humours and dying because we don't know about antibiotics.
(Actually I'm sure there's a pagan healing type of thing that no doubt makes great bones about going back to Glastonbury Tor etc etc while ignoring the fact that there exists a perfectly healthy ancient British tradition of healing & it's called `doctors using medical science'.)
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With respect, unless one traces the history of Tibetan medicine to the Buddha himself, it's difficult to find any solid evidence that the tradition dates back any further than around 1200 years. That's not to detract from it's possible efficacy - I firmly believe that traditional forms of healing that appear to produce results are every bit as worthy of objective study as "funny little plants from the Amazon basin".
While I have no direct experience of Tibetan medicine, the three months I once spent sharing a house with Tibetan people in suburban Katmandu taught me that they're a highly pragmatic people. When one of the women there was recommended to undergo surgery after being diagnosed by the local hospital as suffering from gallstones, they sought out a trusted lama who'd led their party into exile back in 1959. Before confirming that surgery was their best option he asked them to return with the x-rays so that he could see the offending stones for himself.
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And every so often, some of those nutty pre-"modern-medical" treatments come back into vogue for entirely different reasons. Like leeches, which have now become the gold standard for encouraging healing in skin grafting and other reconstructive techniques. Or using maggots on gangrenous or otherwise dying skin as a non-surgical intervention for wound cleaning. So much for the absolute superiority of "modern medicine" (ie: drugs and surgery) over historical methods.
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Um, that's not what modern medicine is. If you go back to the turn of the century, modern doctors were very very wary of drugs, because there weren't many that worked. Nowadays drugs work, so they are seen as intrinsically part of modern medicine, but that's something that's happened comparatively recently.
The point being that modern medicine is, like science, and philosophy, not a body of facts but an activity.
Drugs and surgery really aren't what would have defined modern scientific medicine a century ago; back then it would have been `prevention, diagnosis, outlook'. But the method, the idea of checking against empirical reality, would have been the same, which is what is seen as definably `modern'.
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I find the idea that it's a case of modern, scientific medicine vs. traditional, alternative medicine quite limiting and stupid. In some cases the two work together rather beautifully, in fact.
Take home births. My Mum was telling me last week about the fear that women had where she grew up of giving birth in hospital, because it led to so many of them dying of puerperal fever - the docs hadn't worked out that they needed to wash their hands in between patients. When they did, hospital births became the safe option. Nowadays, home births are making a comeback and for pretty sound reasons: there's less intervention and the outcomes are statistically better (although the statistic is skewed by the fact that women at greater risk of complication will give birth in hospital). It's also much cheaper for the public purse and some women prefer it. But it's a comeback that is made possible by the fact that you can still medicalise the birth if it needs to be.
Or take homeopathy: I've had a pretty awful experience of it in New Zealand, but back home I had a GP who practiced it (now that he's gone, an oncologist friend) and it always worked great for us, if only because it reduced our use of drugs we didn't need. I'm not sure I'd trust somebody who's not an MD to prescribe them for me though.
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*chokes*
In the first case, why are home births "alternative medicine?" To me home birth isn't an alternative form of medical care, it's just a choice of where it's provided. Your midwife or GP at a home birth is quite likely to be deploying modern drugs and using modern tools and practices all the same.
In the second, I have to say, well blimey, I guess a doctor would know when they can get away with prescribing distilled water, sure... and what does "reduced use of drugs we didn't need"
mean? If you didn't need drugs, what were the homeopathic remedies doing? -
In the first case, why are home births "alternative medicine?"
You haven't been following the debate concerning midwifery much, have you? Lots of people seem to regard it as alternative. At any rate, it's what was there before doctors and obstetricians started to intervene in births, so it's most definitely traditional.
In the second, I have to say, well blimey, I guess a doctor would know when they can get away with prescribing distilled water, sure...
Define "get away with". My GP had absolutely nothing to gain by prescribing homeopathic remedies. He was also acknowledged when he died as having been one of the great diagnosticians that the city had had. He was a brilliant man, a brilliant scientist. My oncologist friend who takes homeopathic remedies works for Pfizer as a head of research. She doesn't "get away with" nothing either.
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If you didn't need drugs, what were the homeopathic remedies doing?
Doubting (not knowing, really) whether they have any actual properties or not, I've always considered them a form of mental discipline, a little rite of getting better. Belladonna and Mercury at alternate hours when I had a the flu as a wee boy. Worked a treat. Did I heal any faster? Couldn't say. I know I took antibiotics a grand total of once between the ages of 0 and 18. Now my children barely get through the door of all the GPs we've been to see in New Zealand (that is to say, quite a few) and it's amoxycillin a go-go.
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Actually, I used to be married to a midwife, and heard nothing else from dawn to dusk for the three years of her training :D I am aware that home births are traditional, but lots of traditional things can be valid within modern medical practice..
By "get away with" I mean "give you something that will do you no harm". Although if it comes to that, I expect the vast majority of practitioners of alternative therapies do it in good faith and not as any sort of conscious fraud.
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lots of traditional things can be valid within modern medical practice..
Which happens to be the point I was making, yes.
By "get away with" I mean "give you something that will do you no harm".
Scientists study the placebo effect precisely to explore how "doing no harm" can turn into "doing good", no?
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You haven't been following the debate concerning midwifery much, have you?
I guess that depends what you mean by alternative, but if you mean "not using mainstream western medical science", most home births don't fit within that, at least not in whole. They'll often have an alternative sideline - homeopathy etc.
But then again, a birth which works well is still a very natural experience, and in the most part not too different from how it was done hundreds of years ago. Informed by some Western medical science, but still often using traditional techniques.
Where there's complications of course, it rapidly changes.
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Where there's complications of course, it rapidly changes.
We planned three home births for our kids, were able to complete two. We had a good experience in hospital of the one that needed to be medicalised, an even better one of the other two. That said, if we had had to sign a document saying that by choosing to give birth at home we'd forfeit our right to hospital treatment in case of issues, of course we would have opted for the hospital.
Having non-medical options is good. The fact that we can access osteopaths has been *great* for my partner. It doesn't mean that she didn't try physiotherapists first or that physiotherapy is bad or that there needs to be an either/or antagonism between the disciplines - I'd in fact always like to hear from a scientifically trained person first. But if s/he tells me to try acupuncture, I just might.
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Scientists study the placebo effect precisely to explore how "doing no harm" can turn into "doing good", no?
For sure. To me this is an amazing conundrum -- we can cause other people to do fantastic things but only if we relax our normal rules on what kind of deception is acceptable (and I guess at some level, I would be happy to be deceived too if it cured my cancer, thanks).
For what it's worth, a friend of mine who has been suffering from severe and prolonged insomnia confided in me recently that she had got some stuff from the homeopathist and it was really doing the trick. I decided that was a bad time to share my opinion about the scientific basis for homeopathy, so I nodded and said "that's great, I'm glad you're sleeping better." But if she had said she was getting treatment for diabetes, or glaucoma, or a tumour... I think I would have said something.
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