Thursday, August 02, 2007

Alternative Medicine

Lines on Homeopathy.

Stir the mixture well
Lest it should prove inferior,
Then put just half a drop
In the whole of Lake Superior.

Every other day
Take one small drop in water,
You'll be feeling better soon
At the very least you oughter.

Bishop William Croswell Doane (1832–1913), first Episcopal bishop of Albany (NY).

Several correspondents have asked me to endorse their point of view that various 'alternative' or 'complementary' treatments are effective in CLL. I have already endorsed the clinical trial of green tea extract that is taking place in the Mayo Clinic, after I accepted for publication 4 anecdotes about its use in Leukemia Research.

The real problem with alternative medicine is that once any treatment is shown beyond doubt to be effective, it ceases to be 'alternative' and becomes just like any other part of medical knowledge. That means that 'alternative medicine' must consist entirely of unproven treatments.

Nevertheless, many patients are sure that they feel better after alternative treatments, and who are we to deny it? There are many such anecdotes, but the plural of anecdote is not data. How can alternative treatments be fairly tested?

It is believed that the effectiveness of many alternative treatments owes much to the placebo effect. In at least some people the placebo effect is quite real. It may be a genuine physical response, though one that does not depend in any activity of the drug, or other treatment. If placebo effects are real, it would be wrong to deprive patients of them, especially if there is nothing more effective available. For example, if terminal cancer patients say they feel better after having their feet tickled by a 'reflexologist', why should they not have that small pleasure? It follows, therefore, that it is our duty to maximise the placebo effect. Although there is no definite evidence that this is so, it seams reasonable to enhance the placebo effect by close attention from the therapist, kind words, soft lights and relaxing music, 'scientific' machines with flashing lights, pretty nurses and any other accoutrement that can be imagined. (Some might call it impressive mumbo-jumbo.)

Herein lies the dilemma: The whole trend in medicine has been to be more open with the patient and to tell them the truth. To maximise the placebo effect, it is necessary to lie to the patient as much as possible. Nothing is less likely to convince a patient of the benefit of a treatment than a forthright statement that clinical trials have shown that this treatment shows no benefit as compared to placebo. A recent comparison of acupuncture demonstrated that sticking needles into the skin does have a beneficial physiological effect, but it didn't actually matter where the needles were stuck - demonstrating that all that mumbo-jumbo about meridians and Qi force is irrelevant.

Although several British Universities (now called universities, though until recently they were colleges of further education) do offer courses in 'alternative' medicine, one wonders what they teach. Surely a course by the Magic Circle on prestidigitation or by an Advertising Agency on 'misleading the public' would be more useful.

I am indebted to Professor David Colquhoun for the information in this article. I also found this quote there which is a warning to all those who are in danger of being taken in by alternative treatments: "It takes a holistic approach to a client's financial affairs, seeking to rebalance them in the therapist's favour."


Anonymous said...

I offer my dog as a rebuttal to your assertion that acupuncture is worthless because it is just "mumbo-jumbo".

A dog cannot be persuaded of a placebo effect, do you agree?

My dog has arthritis. He walks with a decided limp. After acupuncture, he walks with greater ease. The effects lasts a few days.

Please write my dog and tell him he's crazy for believing acupuncture works.

Terry Hamblin said...

Not at all. I am certain that acupuncture has a physiological effect, the mumbo jumbo is the suggestion that the 'meridians; and 'Qi force' have anything to do with it. That's why there can be an effect in dogs. However, anecdotes are not data.

This is what I said "A recent comparison of acupuncture demonstrated that sticking needles into the skin does have a beneficial physiological effect, but it didn't actually matter where the needles were stuck - demonstrating that all that mumbo-jumbo about meridians and Qi force is irrelevant."

Anonymous said...

'Anecdotes are not data'. Maybe, but this I've seen with my own eyes. A dog cannot be fooled. Either he walks better or not.

I believe there is enough data to show acupuncture is effective.

It makes sense that stimulating a nerve would have an effect on pain (ever hit your elbow's 'funny bone'?)

As far as reflexology goes, it isn't tickling your feet. It is deep pressure. I don't think it helps your liver or anything, but it is relaxing and can make your feet feel good.

Terry Hamblin said...

You are simply re-asserting what I have said. A RECENT COMPARISON OF ACUPUNCTURE DEMONSTRATED THAT STICKING NEDLES INTO THE SKIN DOES HAVE A BENEFICIAL PHYSIOLOGICAL EFFECT. There are several theories about how it works, but the controlled trial demonstrated that the effect was the same whether the needles were stuck into the so-called meridians or quite randomly. 'Anecdotes are not data' means that simple observation cannot control for all the possible variables. To demonstrate that something has an effect you have to control the experiment to show that were it not for that particular event, the apparent consequence would not have happened. Since we can never control all the variables we do randomised controlled trials - recognising that in a large enough population the confounding variables will balance themselves out. Even so you have to be careful about how you collect controls; they have to be representative of the whole population.

Anonymous said...

In a scientific sense perhaps one is bound by protocols to state a hypothesis, have a control group, randomly select test subjects, etc.

Those tests are necessary to satisfy others that your data is not just a chance occurrence.

However, I needed prove anything to anyone. My dog is all the proof I need. He walks pain-free and is happier. 'Nuff said.

I, too, don't believe in Qi, humours, the ether, etc. I believe the Chinese were at a loss to understand what they were seeing, and, like Lowell on Mars, filled the gaps of understanding with something. Humans are disquieted by a lack of understanding; it just doesn't set will with our kind.

Qi, ying-yang and all of that is immaterial to me. Western medicine says, 'evidence-based'.

My dog is all of the evidence I need to continue to pay for sessions, which I watch. I'm the only one in the room after the needles are placed.

Steve Madden said...

Given that distilled water injections can cause hemolysis are we sure that RCTs with placebos tell us anything?

There is no such thing as an inert substance.

Is the placebo effect an excuse to disguise statistical anomolies?