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delirium happy

Just keep on trying till you run out of cake

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I like reality.
delirium happy
This is something that came up in a conversation I had on IRC earlier. Since I was in danger of starting to rant at people who didn't care, I figured I'd take it to LJ. After all, ranting at people who don't care is precisely the point of LJ.

There is no such thing as "complementary and alternative medicine" (CAM). There are two types of medicine: there is medicine that works, and medicine that doesn't work. If a technique works then it is adapted into "mainstream" medicine. If a technique doesn't work, it continues to be practised by quacks, kooks, and well-meaning fools. There are plenty of decent scientific tests conducted, to check whether or not these things work, hence the works/doesn't work dichotomy.

Furthermore, medicine that doesn't work isn't just worthless it's actually actively harmful. It promotes all sorts of idiocy and unclear thinking. It makes people think that things can work just because they want them to work, and that reality will warp to meet their beliefs. This leads to all sorts of crap like people trying to cure a treatable cancer with homeopathy as opposed to things that actually work like chemotherapy. It also leads to crap like people refusing to get their kids vaccinated.

In fact, while I'm at it, let's rant about that. Vaccinations do not cause autism. Lots of data has been analysed in great detail by lots of very smart people. Vaccinations do not cause autism. Vaccinations do however, prevent disease. Thanks to people listening to quacks and fools and not vaccinating their kids, I now live in a country in which measles is endemic again. Yay. And let's not even start about how fucking stupid "chelation therapy" is.

I understand the counter-cultural need to reject some of the materialism and fatalism that can be a side-effect of today's scientifically-oriented society. I understand the attraction of faith, of believing in something without any proof. I just wish that people would stop throwing the baby out with the bathwater, and rejecting all the benefits of scientific thought. Reality is what it is, though, regardless of what you believe.

I think you're leaving out time and the acquisition of knowledge. There is medicine that works and medicine that doesn't work, and while the odds of medicine that works may be higher in the mainstream, there are both sorts to be found in and out of the mainstream.

T'ai Chi was helping people to keep from falling long before anyone did experiments to prove it.

Telling people to lose weight to cure whatever ails them is commonly done in the mainstream, and shouldn't be.

That is fair enough.

I divide medicine into three categories: stuff that works, stuff that doesn't work, and stuff we need to do more research on.

My father has me focusing a lot on the last category. He's a retired doctor and a strong supporter of science. But my health problems are such that not only is there nothing that is known to work, but most of what my normal doctors have tried has been actively harmful. So, we look around for stuff that is currently under study and anecdotes. If we had any real science to fall back on, we wouldn't use anecdotes, but we don't have any.

He has me taking omega-3 supplements because there are a lot of studies pointing toward the idea that people need more omega-3 than they tend to get. And he wants me getting more vitamin d for the same reason and some research implying that very large doses of vitamin d may be important for healing damage. But it's too soon to tell. These studies may well get overturned, and we both know that. But there is no science that has stood the test of time that can help me. And trying some of the wackier things actually seems to be helping. The wackiest thing I am on is d-ribose. D-ribose is essentially sugar. It's a form that your body converts sugars it eats into. A healthy person should never need to consume d-ribose because their body will turn food into it anyway. If my body doesn't have any more use for d-ribose than anyone else, then I am effectively eating 5g of sugar in the morning and 5 at night and it is exactly that bad for me. But if my body is having trouble producing the products of the energy cycle from the food I eat, as one hypothesis goes, then giving it something closer to the energy it actually uses may help. And it does seem to help when I am on it, and it isn't very harmful.

I would never use unproven methods when proven ones exist, but when they don't it can be worth exploring what is not yet well tested.

Vaccinations do not cause autism. We have massive data showing that. Vaccinations will, in a small number of cases, lead to encephilitis, massive brain damage that will destroy a person's ability to think and learn or even kill someone. However, your odds of developing such severe side effects are lower than your odds of developing severe effects from the diseases the vaccinations prevent (in most cases, the rubella vaccination is a bit more complicated, but again the odds overall are better if people get vaccinated than if they do not), and that is why we take them. Nothing is 100% safe, but vaccinations are the safest course we have.

Chelation therapy has a very good role to play - for people who have had toxic metal exposure. It has no place for cases of autism unless the autistic person has also been chewing on lead or similar.

With the vaccination thing, too, some people believe that the unpleasant side effects are triggered by getting a whole shitton of vaxes at once. A friend of mine who subscribes to this theory is getting around it by having her kid's vaccinations spread out over a longer period of time than is standard. Besides, I thought it was mercury in an older version of some vaccine that was thought to cause problems anyway?

You're not leaving much room here for the possibility that "mainstream" medical techniques may be found to be ineffective as more data becomes available, or that what does and doesn't become mainstream is influenced by non-scientific factors (for example: what drugs are and aren't widely used has more to do with what can and can't be patented than one would like.)

In other words, I think you need a bit more complexity in your analysis.

disagreeing that *everything* in altmed is bogus

Okay. While benzodiazepines can help my panic attacks by making them stop outright (and putting me to sleep in the process), aromatherapy is also very much helpful, as is biofeedback, in helping me return to my base-level of anxiety. Neither of the latter is, to my knowledge, considered part of traditional medicine.

Edited at 2008-08-14 05:13 (UTC)

I don't believe in giving up mainstream medicine lock, stock and barrel, but neither do I believe in rejecting "alternative" medicine lock, stock and barrel.

I will continue to take the medicines my doctors have prescribed for me, because I know what happens if I don't take them. I die. And diabetic ketoacidosis is a really, really horrible way to die. So is not being able to breathe.

I hate it when people try to get me to stop taking my medicines and say that "Oh, you just have to eat a proper diet, get plenty of exercise, don't smoke, don't drink, go to bed early and get enough sleep and then you won't need any medicine anymore." No, honestly, doing all of that is certainly good for you, but guess what: none of it is going to make my pancreas start working again, and it's not going to get rid of the inflammation in my lungs.

I also know, though, that practising relaxation exercises and focusing on my breathing helps bring my blood pressure down without taking any medication. And that taking magnesium helps my restless legs syndrome. And that taking salmon oil helps my anxiety. So I think there are some ways that complementary medicine can work in conjunction with mainstream medicine, such as the way that eating a proper diet and exercising doesn't cure my diabetes, but helps me control it.

But I certainly believe in vaccines. Getting the mumps is what triggered my diabetes in the first place. If I'd been vaccinated, I might never have developed diabetes, or if I had, it would have been at a later age.

And diabetic ketoacidosis is a really, really horrible way to die.

Why do you think that? As someone who survived it, I think it'd be quite a painless, easy death. My blood-glucose level was 840 when I was hospitalized and diagnosed with diabetes. I remember nothing about that day (or the two days after I came out of my day-long coma, except for a ten second period when they moved me out of ICU to a normal room, for some reason...), so I think it's safe to say if I had died, I wouldn't have felt a thing.

I pretty much agree with the rest of what you said, though. Though I think it's safe to say that mainstream medicine realizes that relaxation therapies can help lower blood pressure...

Regarding CAM, sorry Rho, but I'm with Ben Goldcare on this one - where the lying and excessive and stupid claims are kept to a minimum, and actually harmful aspects removed, CAM can have a vital role in helping the placebo effect.

Sadly this cannot be properly translated into traditional medicine, because of bureaucracy and because a lot of it actually works by virtue of ceremony (the more elaborate the application, the greater the placebo effect).

Of course, this is not to deny the real harm many such practitioners cause, but rather to note that they can have a place alongside actual treatment to maximise the efficacy and deliver messages in a manner which patients will take to heart (strangely, people accept mystical reasons more than rational, and frankly it doesn't matter why they follow through, just that they do make the necessary changes).

Do placebos count as "medicine that works"? They do work sometimes; that's why we have double-blind drug trials. When there's no treatment that's been rigorously shown to be more effective than a placebo, mainstream practitioners tend to just give up. Alternative practitioners don't.

The mainstream specialist that my parents took me to when I was 11 told me to "learn to live with it". I don't remember the exact words of the flaky alternative guy I saw when I was 12, but they weren't that. I'd rather be given a placebo and some assurance that it's more than a placebo, even if that assurance is baseless, than nothing at all.
Of course I'd rather be given a known good treatment instead. Then I get the non-somatic* effect plus (since I'll have done a bit of research to determine that the treatment is known to be good) the placebo effect.

* You might want to call this the "'real' effect", but an effect is an effect. BTW, hypnotherapy has been shown to be effective for the condition I was told to "learn to live with", even though it's essentially just telling people that they're going to feel better.

When there's no treatment that's been rigorously shown to be more effective than a placebo, mainstream practitioners tend to just give up. Alternative practitioners don't.

Um, what? I'm pretty sure the entire pharmaceutical industry is founded upon the idea of finding something that works better than a placebo. They don't just give up if it doesn't happen the first time or the hundredth time.

If a technique works then it is adapted into "mainstream" medicine.

If only it were that simple. Unfortunately, the notion of 'scientific progress' as being something where correct ideas are upheld and false ideas are discarded is undermined by a serious study of the history of science.

The efficacy of a treatment method is not the only determinant of its acceptance into mainstream medicine - 'who supports it' and 'how well can they explain it' are both very important.

You're right about vaccines, and you're right that a lot of the support for CAM comes from a knee-jerk hatred of the status quo - some of the most brutal medical negligence I've received was at the hands of an acupuncturist. But throwing out the baby with the bathwater, (by claiming that everything worthwhile about CAM has been accepted by mainstream medicine) is a mistake, no matter which bath you're emptying.

I'll agree that "who supports it" is a bit important in this corporate world, but "how well they can explain it" isn't. Copaxone is one of the best drugs out there for treating MS, and nobody has a clue how it works.

There's a lot of stuff out there that hasn't *been properly tested* yet - so whilst, yes, stuff *actually* falls into work/doesn't-work what we have in *practice* is work/doesn't-work/no-clue.

I think rejecting well tested medicine because of some theory about how science is dreadful is silly (but people are allowed to be silly). But most (probably all) medicine has side effects, and sometimes it's not worth the side effects *to a specific person*. If so then you might say "stuff it I'll just cope" but then you might find that taking yoga classes makes you calmer and better able to cope (for instance).

I think a lot of people take a lot more drugs than they strictly need to (for instance a great deal too many people take unnecessary/unhelpful antibiotics) and if those people could go get aromatherapy instead I'd be all for that.

A lot of CAM stuff whilst totally bunk for what it *says* it does does fill a need for a calming, relaxed environment and provides encouragement and support. (Some doesn't of course). A spot of meditation is no-way-no-how going to cure you of cancer - but it might make you feel better while the cancer-curing drugs/radiation gets to work.

Yes, there is stuff that works and stuff that doesn't. Getting things into the correct categories is harder. A good friend of mine (who is cautious of analgesic drugs for her own reasons) has had good results with acupuncture; she investigated it after reading about a study in Hong Kong in which patients who had no preference between chemical anesthesia for surgery and acupuncture for surgery were assigned to one or the other at random, and the two worked about equally well (based on reported pain levels: it's hard to really normalize anything about pain-killers). It's taken a long time to get our (US or UK) medical systems to really recognize that yes, even small children can be in significant pain, and it matters. (The US system also spent a long time being so paranoid about narcotic addiction that they wouldn't give people dying of cancer adequate painkillers. Some still are.)

Similarly, the people who "think that things work just because they want them to work" includes the advocates of almost every weight-loss diet, both at the level of "eat/don't eat these things, and you will lose weight" and "lose weight and all your medical problems will be solved." But they have weirdly skewed medical "studies" to back them up: very selective use of data, actually ignoring results, or defining as success things that would count as failure in almost any other context. (I suspect a piece of this is because lots of people would rather say "lose weight and your unrelated problem will be better" than "I'm sorry, you have thus-and-such, and we don't really know how to treat it, but I can assure you that it's not fatal.")

You're probably right about that last being a piece of what's going on, but I think most of it is a belief that fatness is simply bad, and any method of getting someone to lose weight (especially if it involves effort) is good.

I am supposed to be working, not getting into internet arguments, but this post is such a mixture of very good points and totally wrong-headed ones that I really have to comment.

Yes, works versus doesn't work is a much better categorization than mainstream versus alternative. It is also entirely true that quackery and promotion of medicine that doesn't work is actively harmful. I am with you all the way on vaccination scares and plaguing people with non-functional alternative "therapies".

But if you are being both empirical and honest, you can't assume that "works" is a better name for "mainstream" and "doesn't work" is a better name for "CAM". Lots and lots of mainstream medicine doesn't work well at all; talk to anyone with a chronic condition or a syndrome that doesn't have an obvious physiological or biochemical cause. Lots of mainstream medicine works, but has side-effects arguably worse than the disease. Lots of mainstream medicine works sometimes for some people, but it's completely unpredictable which patients it will help. Equally, lots of alternative medicine has measurable positive effects, if only because the placebo effect actually does something (that's why you have to control for it in scientific medical trials). Also, taking time to listen to people and taking their medical concerns seriously is not obviously worse than fobbing them off with a pill that might have had some statistical effect on some possibly related condition in rats.

You say confidently that chemotherapy actually works; in practice, there was almost no improvement in cancer survival rates between 1930 and 1990. You must have heard of cancers that are or become resistant to chemotherapy, and it is common knowledge that chemotherapy has debilitating side effects. Not to mention that colleagues of mine in Scotland carried out a study which indicated that somewhere around 20% of patients receiving chemo are underdosed or overdosed by an order of magnitude. The picture is improving slightly with modern rational therapies, but a lot of cancer patients go through months of probably unnecessary suffering and die anyway. And really, mainstream medicine for cancer is a lot better than the options that exist for something like ME or any number of rare and poorly understood pain conditions. Things that work: antibiotics, vaccinations, certain surgeries, are pretty much the exception rather than the rule when it comes to mainstream medicine.

It's simply not true that mainstream medicine is always scientific, nor that any proven alternative medicine will seamlessly become mainstream. There are financial and social pressures that favour some kinds of medicine over others, not to mention biases in how medicines are judged due to simple wrong beliefs in the medical community. Hopefully, those wrong beliefs will eventually be revised when the empirical evidence is overwhelming, but doctors and scientists don't know everything right now. I agree that the baby of scientifically based medicine is very well worth having, but there is an awful lot of bathwater of establishment arrogance and forcing everything into simplistic, mechanistic models that don't reflect reality well.

While I agree with the sentiment - I could rant about homeopathy till the cows have turned every molecule in the world's oceans into milk - I think you've handwaved the whole "Medicine isn't science; It's engineering." factor. Disturbingly vast numbers of medical decisions are made on the basis that "this is what did the last n times, and it seemed to work" or "common sense[1] says that doing X will affect Y in $desirable_way". Which is the logical way to go about treating a patient, building a bridge or writing some software, but lacks the exhaustiveness required to be truly scientific. In medicine, science is something you do retrospectively. I think Medicine gives Science a bad name.

I think it's a case of some things being effective, and some things being ineffective. It seems extremely unlikely that "mainstream medicine" or CAM have a monopoly on either. Mainstream medicine covers treatments which have later been proved to be ineffective at a population level, as well as those which would have been dismissed as quackery until some boffin isolated the active chemical in $magic_hippy_herb and some other boffin worked out its active mechanism.

CAM also, as a general rule, involves a greater degree of listening to the patient and considering their symptoms in context. Which strikes me as an extremely sensible[2] thing to do both as a diagnostic technique and a means of reducing stress levels or whatever. What people seem to overlook is that this isn't a function of it being 'alternative', more of a bad tradition of mainstream medicine.

While it's understandable that people are drawn to CAM because they feel the practitioners are taking them more seriously, there's no real reason why "mainstream medicine" couldn't, in principle, be just as approachable. It infuriates me that people dismiss "mainstream medicine" in principle because it's often practised by arrogant twonks.

Also, where is this scientifically-oriented society of which you speak, and where do I sign up? :)

[1] Nasty stuff, common sense. It's what people use when they don't have access to relevant statistics. See this site for an interesting case study in evidence vs common sense.

[2] Of course, if someone can cite a peer-reviewed study demonstrating that taking the patient seriously is ineffective, I'll change my opinion. :)

What people seem to overlook is that this isn't a function of it being 'alternative', more of a bad tradition of mainstream medicine.
An excellent point and something I had not really considered as an explanation for why people seem to believe in CAM's. Interesting comment.

Reality's cool, but the reality of the situation is that our society is fixated on instant gratification. So things like meditation and massage which can be helpful in maintaining good health are largely ignored in favour of drugs that treat symptoms.

Also, some folks are cheapskates (like me). Native plants can be used medicinally for free, where the drug that does the same thing costs an arm and a leg.

I think of massage as instant gratification.

I agree with every part of this.

It makes me sad and angry to see some of the 'alternative' medicine places here saying they can cure/treat HIV/AIDS and other BIG, like cancer. It's downright dangerous.

Upon reading comments above I am inclined to agree that yes, not all *proper* medical, as it were, treatments work, but on the other hand, that doesn't guarantee the alternative to that treatment will work either. There are also, as rottenfruit says, some native plants etc which genuinely do work and are simply the naturally occuring version of the synthetic mainstream meidical version but yeah. Effective alternative remedies are few and far between.

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