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Author Topic: Alternative Medicine: if it worked, they would just call it medicine
Samprimary
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STORY ONE: two point five billion dollars spent indiscriminately on researching very dumb things that are not true and should not have even been considered credible enough for pilot tests.

quote:
Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.

quote:
"You expect scientific thinking" at a federal science agency, said R. Barker Bausell, author of "Snake Oil Science" and a research methods expert at the University of Maryland, one of the agency's top-funded research sites. "It's become politically correct to investigate nonsense."

Many scientists say that unconventional treatments hold promise and deserve serious study, but that the federal center needs to be more skeptical and selective.

"There's not all the money in the world and you have to choose" what most deserves tax support, said Barrie Cassileth, integrative medicine chief at Memorial Sloan-Kettering Cancer Center in New York.

"Many of the studies that have been funded I would not have funded because they seem irrational and foolish — studies on distant healing by prayer and energy healing, studies that are based on precepts and ideas that are contrary to what is known in terms of human physiology and disease," she said.

quote:
[C]ritics say that unlike private companies that face bottom-line pressure to abandon a drug that flops, the federal center is reluctant to admit a supplement may lack merit — despite a strategic plan pledging not to equivocate in the face of negative findings.

Echinacea is an example. After a large study by a top virologist found it didn't help colds, its fans said the wrong one of the plant's nine species had been tested. Federal officials agreed that more research was needed, even though they had approved the type used in the study.

"There's been a deliberate policy of never saying something doesn't work. It's as though you can only speak in one direction," and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.

Critics also say the federal center's research agenda is shaped by an advisory board loaded with alternative medicine practitioners. They account for at least nine of the board's 18 members, as required by its government charter. Many studies they approve for funding are done by alternative therapy providers; grants have gone to board members, too.

"It's the fox guarding the chicken coop," said Dr. Joseph Jacobs, who headed the Office of Alternative Medicine, a smaller federal agency that preceded the center's creation. "This is not science, it's ideology on the part of the advocates."

quote:
ongress created it after several powerful members claimed health benefits from their own use of alternative medicine and persuaded others that this enormously popular field needed more study. The new center was given $50 million in 1999 (its budget was $122 million last year) and ordered to research unconventional therapies and nostrums that Americans were using to see which ones had merit.

That is opposite how other National Institutes of Health agencies work, where scientific evidence or at least plausibility is required to justify studies, and treatments go into wide use after there is evidence they work — not before.

"There's very little basic science behind these things. Most of it begins with a tradition, or personal testimony and people's beliefs, even as a fad. And then pressure comes: 'It's being popular, it's being used, it should be studied.' It turns things upside down," said Dr. Edward Campion, a senior editor who reviews alternative medicine research submitted to the New England Journal of Medicine.

That reasoning was used to justify the $2 million weight-loss study, approved in 2007. It will test Tapas acupressure, devised by Tapas Fleming, a California acupuncturist. Use of her trademarked method requires employing people she certifies, and the study needs eight.

http://www.msnbc.msn.com/id/31190909/ns/health-alternative_medicine//

STORY TWO: Zicam is this stuff that was sold in supermarkets and drugstores as a 'cold remedy' you snort up your nose, and it contained zinc and has caused at least a hundred and thirty people to lose their sense of smell permanently, which apparently can sort of happen when you snort zinc. Under nearly any scenario, this product would never have been allowable on shelves, but by classifying it as a 'homeopathic remedy,' Zicam's manufacturer could confer upon it a unique legal status wherein it can be sold as a 'drug' to treat an ailment, and won't get routinely reviewed for safety or benefit by the FDA.

quote:
Zicam belongs to an under-the-radar but legal sector of the drug industry called homeopathic remedies. They hold a unique legal status: They are mainly sold without prescription as legal drugs claiming to treat specific ailments, yet they are not routinely reviewed for safety or benefit by the FDA. The agency rarely acts unless safety questions arise after marketing.

Most scientists say homeopathic remedies contain active ingredients in such low concentrations — often 1 part per million or less — that they are usually safe.

But FDA spokesman Sandy Walsh says that "consumers purchasing homeopathic products should be aware that they have not been reviewed by the FDA."

Zicam's maker, Matrixx Initiatives, of Scottsdale, Ariz., contends Zicam is safe. It blames the apparent side effects on the colds and infections that people were treating, not on the treatment. However, the company agreed to suspend shipments and reimburse customers who want refunds.

It already agreed to settle about 340 Zicam claims for $12 million in 2006. It was still dealing with 17 lawsuits earlier this year, as well as more than 500 more patients who may sue in the future, according to its filings to the U.S. Securities and Exchange Commission.

Richardson, 46, says he used Zicam just once. His mother, a retired nurse, offered him some for his stuffy nose. He had just started a new job as a salesman and wanted to work at his best.

So he held the nasal gel to his nose, pumped and inhaled. He immediately felt a burning sensation but acknowledges that his sense of smell was already diminished by the cold. It was only when health returned — but not sense of smell — that he began to worry.

quote:
The FDA said Zicam Cold Remedy was never formally approved because it is part of a small group of remedies that are not required to undergo federal review before launching. Known as homeopathic products, the formulations often contain herbs, minerals and flowers.

A warning letter issued to Matrixx on Tuesday asked the company to stop marketing its zinc-based products, but the agency did not issue a formal recall. Instead, regulators said Matrixx would have to submit safety and effectiveness data on the drug.

“The next step, if they wish to continue marketing Zicam intranasal zinc products, is for them is for them to come in and seek FDA approval,” said Deborah Autor, director of FDA’s drug compliance division.

The agency is requiring formal approval now because of the product’s safety issues, she added.

The global market for homeopathic drugs is about $200 million per year, according to the American Association of Homeopathic Pharmacists. The group’s members include companies like Nutraceutical International Corp. and Natural Health Supply.

Matrixx has settled hundreds of lawsuits connected with Zicam in recent years, but says on its Web site: “No plaintiff has ever won a court case, because there is no known causal link between the use of Zicam Cold Remedy nasal gel and impairment of smell.”

The company said in a statement Tuesday that the Zicam Cold Remedy’s safety is “supported by the cumulative science and has been confirmed by a multidisciplinary panel of scientists.”

But government scientists say they are unaware of any data to support Zicam’s labeling, which claims the drug reduces cold symptoms, including “sore throat, stuffy nose, sneezing, coughing, congestion.”

Matrixx said it will consider withdrawing the products, which accounted for about 40 percent of its $111.6 million in sales last year.

STORY THREE: Related to the boffo fact that homeopathic remedies are a two hundred gazillion dollar industry or whatever, this is immensely frustrating because homeopathy is a frightfully stupid thing and it does not work and you should never, ever support it or trust in the idea that it works at all ever.
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0Megabyte
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Well, perhaps 2.5 billion dollars is worth it to show people, in a more concrete and thorough manner, how stupid it is, so they'll stop.

But that's giving too much credit to humanity, I wager...

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andi330
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I stopped years ago, when I took St. John's Wart to help with problems with depression. The only good thing that came of it? I can tell a psychiatrist in the future to be careful of what drugs he or she may put me on, because I couldn't sit still for more than 5 seconds in a row when I was on the stuff. Which really annoyed my college roommate.
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TL
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There was a time when meditation was considered by our culture to be stupid and laughable. Yoga as well. Acupuncture. Etc. Now we know these things work.

I'm 100% certain that most of the homeopathic and "natural" drugs on the market today do not work.

I also leave room for the possibility, however slight, that there exist cell salts that do what they are advertised to do.

Echinacea does work. It certainly works for me, anyway. It's the only one of these things I would personally advocate for, though. Because it's the only one that has given me, time and time again, nearly immediate and obvious results. I've tried a few other things, but I doubt they did anything for me.

I also take fish oil three times a day along with my daily multi-vitamins. It's supposed to do a number of things for you -- including help with depression. Which is why I started taking it. I don't know where these things -- omega oils, vitamins, etc -- fit within your vision for a world in which we can't go to the supermarket and buy natural remedies.

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Juxtapose
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I'm not at all certain that acupuncture works.
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Audeo
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I was going to write a post about some of the interesting research regarding the placebo effect, which is really cool, but then I watched the video on homeopathy, which is really funny.

For those of you who are not aware of the precepts of homeopathy I'll outline them briefly.

1) Treat like with like. This means that if a person is suffering from hives, you would give them something (like poison ivy) that causes hives to treat them. If they suffer from diarrhea you give them a laxative etc.

2) The substance must be serially diluted, and the more diluted it is the stronger the solution. In the video he has two over the counter homeopathic remedies one of which has been diluted (one part remedy into ten parts water) 30 times, another 1500 times. As he points out Avogadro calculated that after 23 such dilutions there should only be one molecule left in the solution, at 30 there is only a one in 10^7 chance of any of the original substance remaining.

3) Each dilution must be shaken in a certain way to preserve the 'vibration' of the original substance, usually this means 10 times in each plane (up/down, left/right, forward/backward).

That being said homeopathy is not the only form of CAM (complementary and alternative medicine). I think where CAM seems to help the most is with patients where allopathic medicine seems to fail, specifically with chronic pain management. Disease like myasthenia gravis can be cripplingly painful, but even our most powerful pain medication only work marginally better than placebo. One of the most interesting thing about funding CAM is finding out that placebo does not mean doing nothing. Rather giving a placebo often activates the body's own pain control pathways and it can be more effective than giving a drug which artificially activates those pathways. Often CAM is effective at relieving symptoms (subjective feelings like fatigue, pain, nausea) however CAM is rarely effective at reducing signs (objective findings like swelling, irregular heart rhythms, tumors). So it has its place, particularly in helping people with chronic pain. However it has its limits in that it rarely 'cures' anything. It's like taking a cough drop, it makes your throat feel better, but if your immune system doesn't kill the underlying infection nothing is going to change.

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MightyCow
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I oppose homeopathic medicine on many fronts. Not only does it sometimes harm people (in addition to explicitly not helping), it also has a horribly steep opportunity cost. Every person who is being treated with homeopathic medicine is not receiving a more effective actual treatment. Every penny spent on homeopathic medicine could have gone to real research or treatment. Every minute spent looking up information on a homeopathic cure could have been spent learning how to manage the problem in a more beneficial way.

Every doctor, scientist, pharmacist, nurse, researcher, etc. who devotes time to studying and recommending homeopathic medicine isn't becoming a more effective health care worker, researching a real cure, improving their patients' care in meaningful ways, and so on.

Besides just the $200 million a year that could be going to research, hospital staffing, education, and so on, imagine how many millions of hours are wasted by both patients and care givers. It's horrifying.

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AvidReader
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I find it scary on the grounds that I had no idea that Zicam was homeopathic. I never heard "Not FDA approved" in the ads, and I certainly never heard it from people who took it. I hope it at least had a big label on it or something.
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Scott R
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There is a label calling it homeopathic on the box.

We bought some this season on the recommendation of a friend; it didn't work, IIRC.

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FlyingCow
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I don't like the whole market for homeopathic remedies, and especially the lack of regulatory control, but I'm actually not that put out by spending millions of dollars on "home remedies" or "herbal remedies" to see if any of them have merit.

If scientists had never experimented on willow bark, we'd never have gotten aspirin.

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Christine
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There is a difference between a home remedy and a homeopathic one. IMO, the homeopathic remedies are a loophole -- something snake oil salesman can use to put their stuff on the market. Anything a person wants to put on the shelf and claim does x needs to be verifiable.

But I tend to think we over medicate ourselves in the first place, whether through homeopathic or FDA-approved drugs. Every cold, every headache, every sore throat does not need a trip to the drugstore. A cup of herbal tea with honey in it is my first line of defense against a mild to moderate sore throat. Rest, fluids, and time takes care of most viruses -- there's little else we can do except let our bodies fight.

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Frisco
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*throws out his cowbell*
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Scott R
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HEY! I need that!

:chases after:

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Teshi
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quote:
But I tend to think we over medicate ourselves in the first place, whether through homeopathic or FDA-approved drugs. Every cold, every headache, every sore throat does not need a trip to the drugstore. A cup of herbal tea with honey in it is my first line of defense against a mild to moderate sore throat. Rest, fluids, and time takes care of most viruses -- there's little else we can do except let our bodies fight.
Yes, but honey and lemon is not a remedy, really, it's a symptom-reducing agent, like a cough drop.
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Samprimary
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quote:
Originally posted by FlyingCow:
I don't like the whole market for homeopathic remedies, and especially the lack of regulatory control, but I'm actually not that put out by spending millions of dollars on "home remedies" or "herbal remedies" to see if any of them have merit.

If scientists had never experimented on willow bark, we'd never have gotten aspirin.

That is absolutely absolutely true, but what we have here is an obvious series of cases where money is being allotted to studies not on the validity of claims that would otherwise suggest prospective viability.

It's being allotted because there's a a bad, nonscientific bias on the board that determines where our money can go.

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Samprimary
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STORY FOUR:

you guys remember HeadOn, right?

quote:
As of September 2008, there are two versions of HeadOn available in stores: "Extra Strength" and "Migraine". Chemical analysis of the Migraine formulation has shown that the product consists almost entirely of wax. The three active ingredients are iris versicolor 12× (a flower), white bryony 12× (a type of vine), and potassium dichromate 6× (a known carcinogen). The "×" notation indicates that the three chemicals have been diluted to 1 part per trillion, 1 part per trillion, and 1 part per million respectively.[10][11] This amount of dilution is so great that the product has been described as a placebo[12]; with skeptic James Randi calling it a "major medical swindle"[11]. The formula for the Extra Strength version of the product is the same as the Migraine except that it excludes the iris versicolor.
How do you get away with selling tubes of wax to people as a medicinal treatment?

quote:
It is sold as a homeopathic preparation.
Oh i seeeeeeeeeeeee
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Tresopax
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quote:
That is absolutely absolutely true, but what we have here is an obvious series of cases where money is being allotted to studies not on the validity of claims that would otherwise suggest prospective viability.

It's being allotted because there's a a bad, nonscientific bias on the board that determines where our money can go.

I'd consider it to be pretty irresponsible of the government if many people are out using these techniques yet the government took a dogmatic approach and didn't allocate any research effort to try and find out if they work. It's not only unscientific to assume this stuff has no "prospective viability" without actually testing it but it's also dangerous to let people go about doing it without seriously looking into what effects it has.

If it's popular, it's being used, then yes it should be studied.

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Traceria
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quote:
Originally posted by Juxtapose:
I'm not at all certain that acupuncture works.

My cousin, who had cancer as an infant and has had a lot of complications from treatment that young contracted Lyme's Disease and has been having severe pain in the areas in which he'd been weakened due to the cancer treatment. He has actually received acupuncture, and while it doesn't necessarily attack the root of the problem, he says it helps him deal with the pain caused by it.

quote:
Originally posted by Christine:
But I tend to think we over medicate ourselves in the first place, whether through homeopathic or FDA-approved drugs. Every cold, every headache, every sore throat does not need a trip to the drugstore. A cup of herbal tea with honey in it is my first line of defense against a mild to moderate sore throat. Rest, fluids, and time takes care of most viruses -- there's little else we can do except let our bodies fight.

Thanks for mentionting that, Christine. I tend to fall in a similar camp. Not that many people would care to know, but I've treated yeast infections with tea tree oil and got faster and far less messy results than many prescriptions provide.

quote:
Originally posted by Teshi:
Yes, but honey and lemon is not a remedy, really, it's a symptom-reducing agent, like a cough drop.

I don't think she said it WAS a remedy. "...first line of defense against a mild to moderate sore throat." It's something to help with the symptoms, not against the virus itself, which she did say the body just needs time to fight.
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Christine
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quote:
Originally posted by Teshi:
quote:
But I tend to think we over medicate ourselves in the first place, whether through homeopathic or FDA-approved drugs. Every cold, every headache, every sore throat does not need a trip to the drugstore. A cup of herbal tea with honey in it is my first line of defense against a mild to moderate sore throat. Rest, fluids, and time takes care of most viruses -- there's little else we can do except let our bodies fight.
Yes, but honey and lemon is not a remedy, really, it's a symptom-reducing agent, like a cough drop.
I never said it was a remedy. My point, which I perhaps didn't tie together well enough, was that a lot of the little bugs that go around don't get cured. They get fought off by our own immune system. We don't need to take medicine every time we get a cold. Relieving the symptoms and getting rest is all that is really needed for a lot of what's going around.
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Teshi
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I was referring to this:

quote:
There is a difference between a home remedy and a homeopathic one...

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Tarrsk
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Edited to note that I'm responding to Tresopax's post.

I would agree in the cases of "herbal medications" such as echinacea, which could conceivably contain compounds that have the effect they claim. In fact, my roommate works in a natural products lab at Harvard where they basically do exactly that: collect samples of plants, fungi, etc, extract and purify compounds, and use modern biochemical techniques to see if they bind any known pathogenic substances. She's had some success isolating some novel compounds that bind to and modulate the activity of receptors expressed by malaria.

What shouldn't have time or money wasted on it is homeopathic medicine, which is essentially water. Hell, give the money to people who are actually studying water with some level of scientific rigor.

In a sense, this is roughly akin to government-funded research into creation science (albeit without the religious component). In both cases, you have a well-intentioned public being fed nonsense by people with a vested interest in spreading their disinformation. For creationism, it's a religious/ political ploy. For homeopathic medicine, it's profit margin. In both cases, significant work has already been done to show that they lack any scientific merit. To continue spending hundreds of millions of dollars "researching" this stuff when we already know it's a load of bullcrap is to, as MightyCow noted, effectively block research that could actually generate life-saving cures.

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Tstorm
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I'm surprised that your first source claims there is no benefit for glucosamine, Samprimary. This study (nccam.nih.gov), for instance, seems to indicate that there is at least some truth to the glucosamine claim.

Anecdotally, I can speak to this, as I know a few people with 'moderate' joint pain that swear by the stuff. Of course, that isn't worth a hill of beans, and I'm not about to go substituting sugar pills for my mom's glucosamine pills to make a point...

(I'm aware that the vast majority of health claims by the alternative medicine crowd are complete hogwash.)

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mr_porteiro_head
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quote:
Alternative Medicine: if it worked, they would just call it medicine
Just like alternative music, right?
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Scott R
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[Smile]

My grandmother swears by accupressure.

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hobsen
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Homeopathic remedies activate the placebo effect for believers. When they are mere water, they do no harm, while effective medicines often have dangerous side effects. And people who take them sometimes avoid visiting a doctor's office or pharmacy where they may contract something worse.

Taking a vitamin pill is something I do now and then to help make up for a careless diet. But the study on them I remember concluded that people who take vitamins die a little younger than those who do not. That may be a false correlation, but people tend to get too much vitamin A in their diets anyway, and the effect of taking that in a pill may outweigh any benefits. Some very tasty yellow vegetables contain large amounts of vitamin A, and that substance is poisonous, even if essential to life. Ah well, people will die of something anyway.

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Jenny Gardener
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I'm studying herbalism myself, and there are definitely biochemical bases for plant medicines. Salicylic acid, as mentioned before, is present in willow bark and other plants. Opium from poppies, digitalis from foxgloves, and many other substances are derived from plants. In many cases, various phytochemicals interact with each other in the plants in ways that they don't when isolated. That's hard to study, because concentrations of different chemicals can vary depending on the species of the plant and growing conditions. That doesn't mean an herbal remedy can't or won't work; it just means that it's hard to study the great variety of herbal preparations available. I think it is definitely worthwhile, especially when most herbs are easy to grow and prepare for oneself...like growing one's own food, herbal remedies can contribute to a more self-sufficient lifestyle while avoiding some of the downsides of mass-manufactured and marketed medicines.

As a personal example, I find that Lady's Mantle is just as or sometimes more effective at relieving menstrual cramps as aspirin or Tylenol or ibuprofen. It's much less expensive, since it grows in my garden, and it doesn't adversely affect my body the way Tylenol does these days (I have weird digestive/tummy symptoms when I take it). Now, mind you, this is an herb I have researched and understand...I'm not blindly accepting a marketer's "cure-all" advertisement. I think it's very important to find out what claims are true, which are false, and which cannot be answered by the current state of our ability to research. I believe it's important for people to be able to make informed choices about everything they choose to put into their bodies, from nettle tea to MSG and preservative laden canned soup.

As for "alternative" as a label...Well, there is "standard" medicine which is going to the doctor, getting tests, and taking your prescription to the pharmacist. And then there are other therapies, which may or may not help, called "alternative" because they are different from the most common approach. That does not mean that they are harmful or ineffective, nor does it mean that they are going to be harmless or effective. It's just a different choice. Sometimes I want to eat "alternative" foods from the standard fare I find at a party, or participate in "alternative" activities than the ones that are standard in my community. Does that mean that my choices are going to be less healthy or viable than following the crowd?

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Traceria
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[Hail]
You put that very well.

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Juxtapose
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quote:
quote:
Alternative Medicine: if it worked, they would just call it medicine
Just like alternative music, right?
Yep, and for similar reasons.

quote:
My cousin, who had cancer as an infant and has had a lot of complications from treatment that young contracted Lyme's Disease and has been having severe pain in the areas in which he'd been weakened due to the cancer treatment. He has actually received acupuncture, and while it doesn't necessarily attack the root of the problem, he says it helps him deal with the pain caused by it.
I'm glad your cousin found pain management that works for him. I'm sure, though, that I don't need to tell you about placebos. From what I've read on acupuncture (not a great deal, admittedly) pain management is where acupuncture shows the most promising results. It's also an area where placebos can be most effective. TL wrote above that these days we know that acupuncture works, and I just wanted to point out that that isn't so.

quote:
And then there are other therapies, which may or may not help, called "alternative" because they are different from the most common approach.
The problem that Sam is pointing out is that in the vast majority of cases where a therapy is called "alternative," it is not more effective than a placebo. If these things worked as promised, standard medicine would assimilate them.
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hobsen
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Agreed, Jenny Gardener wrote an impressive post. And growing herbs gives some confidence they have not been grown on a chemical waste dump somewhere, where the soil may be loaded with lead and mercury and selenium. I am not sure how much foods and herbs take up of such heavy metals in the soil, but it would worry me.
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King of Men
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Nobody is objecting to the idea of finding out what works. But the article posted outlines a pattern of setting out to answer the question "Does X work?", getting a 'No', and refusing to accept that. That is not the right way to do it.

Now, if there are nine subspecies of some particular plant, and one of them doesn't work, then fine, testing the other eight may be indicated, but why not test all nine in the first place? Switching subspecies after the first one returns negative is a classic case of not blinding, and a really great way to get a one-sigma result in one of the other subspecies and taking that as evidence that the plant does have healing properties, to the great detriment of patients treated with it for the next fifteen years.

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Traceria
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quote:
Originally posted by Juxtapose:

quote:
My cousin, who had cancer as an infant and has had a lot of complications from treatment that young contracted Lyme's Disease and has been having severe pain in the areas in which he'd been weakened due to the cancer treatment. He has actually received acupuncture, and while it doesn't necessarily attack the root of the problem, he says it helps him deal with the pain caused by it.
I'm glad your cousin found pain management that works for him. I'm sure, though, that I don't need to tell you about placebos. From what I've read on acupuncture (not a great deal, admittedly) pain management is where acupuncture shows the most promising results. It's also an area where placebos can be most effective. TL wrote above that these days we know that acupuncture works, and I just wanted to point out that that isn't so.
Perhaps it's hard to support results reported like this, but seriously, I would NOT attribute the relative success he's encountered with acupuncture to a placebo effect. He admits it does not rid him of this pain, but it does seem to help him cope by taking enough of the edge off that he can function normally. He's on a multitude of pain medications that no early twenty-something should need to such degree. He sees multiple specialists at John Hopkins, so it's not like he's just seeing a lone general practitioner. Please don't assume that everyone who receives acupuncture is automatically going to experience a placebo effect.
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Juxtapose
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I don't think everyone who gets acupuncture is going to experience a placebo. I doubt I would since I'm pretty skeptical of it in the first place. I suspect there are other effects going on in certain alternative therapies like acupuncture and chiropracty that have to do with things like human contact and the patient being the clear focus of attention. But I still think that placebo forms the fundamental basis for most positive success in alternative therapies.

quote:
I would NOT attribute the relative success he's encountered with acupuncture to a placebo effect.
Why not? The human mind is not to be underestimated.
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Traceria
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It's really hard to sum up just how much pain, etc. he experiences and to build up his medical history enough to make a good case. Suffice it to say, I find it highly improbable that if going on doctor-prescribed high and frequent doses of oxycodone (for starters) doesn't do it, then what would make, even in the depths of his mind, it seem like acupuncture would work instead? Why would that one therapy work better than so many others if there wasn't some value to it for its own sake?
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Jenny Gardener
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Here's an informative link, very general, about acupuncture from Mayo Clinic:

http://www.mayoclinic.com/health/acupuncture/sa00086

Here's a theory , mentioned in the article, about how/why it might work:
"Many practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body's natural painkillers and increase blood flow. "

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Belle
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Even if it is effective for him, that doesn't prove that acupuncture as a therapy is effective for a large number of people. Anecdotes do not equal evidence. Your insistence that other therapies didn't work before does not mean that he cannot still achieve a placebo effect from acupuncture. The placebo effect has been studied extensively...and it is pretty powerful. Probably moreso than you're giving it credit for.
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Mrs.M
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These fads do real damage - I've seen children put on diets and vitamins (with NO CLINICAL EVIDENCE of success) in lieu of therapies that have been shown clinically to have good rates of success.
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rivka
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quote:
Originally posted by hobsen:
That may be a false correlation, but people tend to get too much vitamin A in their diets anyway, and the effect of taking that in a pill may outweigh any benefits. Some very tasty yellow vegetables contain large amounts of vitamin A, and that substance is poisonous, even if essential to life.

While vitamin A toxicity from pills is not uncommon, it is almost unheard of from vegetables. OTOH, certain animal sources (polar bear liver, for example) can absolutely cause it. IIRC, it has a lot to do with the particular form of vitamin A found in these three sources, and how well our bodies can filter out excess.
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Juxtapose
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"Why would that one therapy work better than so many others if there wasn't some value to it for its own sake?"

In cases that rely on the patient's subjective analysis of the effectiveness of the treatment - things like pain or depression - the placebo effect can match, or sometimes even exceed, the effectiveness of active medication.

Some people are also more susceptible to placebos than others. If your cousin responds readily to a placebo, then his pain reduction could be as high as 5 units (on a 10 point scale). There's a big difference between an 8 and a 3.

EDITED to include the quote I was responding to and to expand on my answer.

[ June 22, 2009, 02:09 PM: Message edited by: Juxtapose ]

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Jenny Gardener
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I think there is a difference between fads and the reasonable, rational use of alternative therapies. NOTHING is a cure-all, a miracle pill. Whether it's a diet, a religion, a drug, an herb, or a toy marketed to your children, one needs to make reasonable choices. I do not think acupuncture can cure cancer, but I do believe it can help the body deal with it. I think a person should be informed about the known limitations and risks of any remedy, medicine, or practice, as well as the purported results. Then it is up to him or her to decide how to proceed. One of the challenges that alternative medicine brings up is the reality that sometimes "cures" can kill, or do nothing other than make you feel something is being done, or contribute to other quality of life effects. Sometimes doing nothing can kill. But whose choice is it when it comes to health, life, and death? To me, this overlaps with discussions about abortion and taking people off life-sustaining machines. While most alternative medical approaches aren't likely to directly kill someone, Mrs. M. brings up the good point that some folks choose to follow them exclusively to the detriment of their families. This happens with the religious approach of Christian Scientists, too. Where is the balance? And who should be in charge of determining that balance? How do you find a healthy framework that considers both the right of the individual to choose one's fate and yet doesn't harm the larger society?
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Traceria
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quote:
Originally posted by Belle:
Even if it is effective for him, that doesn't prove that acupuncture as a therapy is effective for a large number of people.

Actually, I believe I said somewhere up there, "Please don't assume that everyone who receives acupuncture is automatically going to experience a placebo effect." I did not want acupuncture written off completely because I knew of his experience. I'm not saying that his experience proves anything about it being effective for a large number people. It did, however, make a difference to him, a single person. And again, I say, I also do not think it was the placebo effect that produced the result. I'm sorry I ever brought him up as a possible example of effective therapy with acupuncture. You don't know him, his medical history, his personality, what his doctors have been saying, and so on and so forth. That's about all I've got short of compiling the content of his medical records for you. They'd tell a much better story, and it's just not worth the effort to try to summarize here without them ready to hand.
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Jenny Gardener
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That brings up a question, though...what if a therapy is indeed effective for a small subset of people, but not others? Is it ok to write off that therapy as something that isn't scientific? Wouldn't it be a valid scientific query to wonder why it worked in certain people? What do those people have in common? What do they not have in common? How could those findings affect what doctors recommend for different types of patients?
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dread pirate romany
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Very good points,
Jenny.
I use glucosamine and chrondroiten for arthtitis. If I take it faithfully, I have little pain. If I forget for a few days, I do experience pain. That's enough evidence for me.

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Juxtapose
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Traceria,
I've said more or less what I wanted to, and I'm willing to drop it. I just wanted to add that I didn't mean any of my statements as an attack against your cousin, in any way. I took pains to say things the way I did, but I thought I'd say so explicitly.

--

Jenny,
If a therapy is effective for a subset of the population, I would expect that effect to show up in clinical testing, which I'm not opposed to in most cases. Part of the problem, though, is that in many alternative medicines there is the absence of even a plausible mechanism for effectiveness. Homeopathy springs to mind. When there is a limited quantity of money available for testing, which therapies do we focus on? I think plausibility goes a long way to answering that question.

EDIT - But I don't think that popularity, by itself, is sufficient to show plausibility.

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Tarrsk
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It's important to keep in mind that we aren't, for the most part, criticizing the use of alternative medicines as much as we are the spending of public funds on researching alternative medicines. People can do whatever they want, and let's face it, who cares if your pain is being relieved by the placebo effect or not, as long as your get that relief?

My point of contention is and always will be the funding. The unfortunate fact of the matter is that we have a limited amount of money to spend on biomedical research, and must therefore make hard choices about what projects deserve funding - and which ones do not.

This is normally done via a process analogous to peer review, in which research proposals are submitted to funding agencies such as the NIH, and then evaluated by other scientists in relevant fields. I won't pretend that this system is perfect - believe me, it causes plenty of headaches for everyone concerned - but it usually does a reasonably good job of weeding out bad science.

The troubling thing about much of the "science" associated with homeopathic medicine is that it doesn't stand up to the standards expected of other biomedical research.

First of all, one of the basic assumptions being made is flatly contradicted by everything we known about chemistry and physics. Avogadro's number is a universal constant, and if you dilute a solution 1:10 thirty times, you will end up with pure water every single time. Not a single molecule of your putative active compound will be left. Your solution, at this point, is literally just a placebo. For reasons that should be obvious, this line of reasoning will get you absolutely nowhere with any halfway-decent set of reviewers.

The other two rationales proposed by homeopathic medicine proponents ("treat like with like" and "vibration") do not explicitly contradict basic chemistry. One could even argue that vaccination is a form of "treat like with like" - although given what we know about immunization, it's due to a very specialized situation, and not something from which you can extrapolate some sort of universal law.

So those latter two ideas aren't obviously wrong (or at least, can't be shot down by pointing to examples to the contrary). Unfortunately, they aren't supported by anything we know either. It's the Invisible Pink Unicorn fallacy: sure, we can't disprove the existence of the IPU/ "vibrations," but that doesn't mean we should be spending time learning to ride it when there are plenty of perfectly normal horses available.

Ultimately, this is why the National Center for Complementary and Alternative Medicine was created: homeopathic medicine offered nothing of true scientific value or interest, and so traditional biomedical funding agencies would have nothing to do with it. Proponents of homeopathic medicine instead had to pull the creationist runaround, lobbying congresscritters and senators into creating a new funding agency just for them, that wouldn't require the same level of scrutiny. And thus $2.5 billion was pissed away on a fantasy.

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King of Men
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quote:
And thus $2.5 billion was pissed away on a fantasy.
I don't think I agree with this, actually. The article quoted in the OP mentions tests of specific substances, not homeopathy; there is no pseudoscience in the hypothesis "Echinacea may have good effects against colds through a mechanism we don't yet understand." (If you see any pseudoscience, I would like you to explain what is different about "Willow bark may have good effects against headaches through a mechanism we do not yet understand.") It is not an obvious waste of money to scientifically test a therapy which has much anecdotal evidence in its favour. What is a waste of money is to refuse to accept the result of those tests, to not blind yourself properly, and to continue to insist on the anecdotes when they have been contradicted by data.
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Tarrsk
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KoM: You're right, I misread what the $2.5 million quote was used for. As I said earlier, I don't have any issues with research into natural products or the chemistry of traditional medicine. I also agree that the folly in those cases is the refusal to accept the results of studies, particularly when you've been demanding them for years.

On the other hand, homeopathic medicine (which is what my post was intended to address) is nothing more than bunk and doesn't deserve a single tax-payer dollar.

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MightyCow
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quote:
Originally posted by Traceria:
I'm not saying that his experience proves anything about it being effective for a large number people. It did, however, make a difference to him, a single person. And again, I say, I also do not think it was the placebo effect that produced the result.

This type of thinking is exactly the reason alternative medicine has such a large following. Lots of people know someone who feels like they were helped with alternative treatments, and almost all of them don't think that it was placebo effect in their particular case, no matter how many studies might contradict them.

That's one of the ironies of the placebo effect. It works because you think it's something else.

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hobsen
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Thanks, Rivka, it turns out your information was more recent. I had become wary of vitamin A toxicity about 1980, when multivitamins usually provided 100% of the RDV and claimed only 25 times that would be toxic. That seemed to me reckless.
quote:
According to a 2002 Harvard Medical School study of 72,000 women, those who consumed between 4,300 international units (IU) and 6,600 IU a day of vitamin A had a 43 percent higher risk of hip fracture than those who consumed 1,700 IU or less. The risk was greater in women who got even more than 6,600 IU. Only one kind of vitamin A, retinol, was linked to weaker bones. It's found in animal foods (dairy, liver, eggs, etc.). Beta-carotene, which the body converts to vitamin A, is found in fruits and vegetables. It doesn't increase the risk of hip fractures. The vitamin A in supplements can come from retinol (often called vitamin A palmitate or acetate), from beta-carotene, or from a combination of the two. (Check the label. Some simply list vitamin A, which isn't very useful. But many brands also disclose what percentage of their vitamin A comes from beta-carotene. If so, the rest is retinol.)

To protect bones, we limited our Best Bites to no more than 4,000 IU of retinol. But even less would be better, since people also get some vitamin A from their food. Our limit is especially important for women (so far, no studies have been done on men's bones and vitamin A).

Roche Vitamins, a major manufacturer of vitamin A, says that many of the vitamin-makers it supplies have agreed to lower their retinol levels to 2,500 IU. That may make the numbers in our chart outdated by the time you read this, so check your labels.

Checking the label on my current bottle, I find my pill today contains about 70% of the RDV, with 2500 IU of retinol. So the manufacturer did become alarmed, and took appropriate action, which shows corporations can sometimes be more responsible than people think. The current dosage would seem to me safe, so long as the consumer avoids vitamin-fortified breakfast foods, sports drinks and the like. And those polar bear livers also, which probably give at least ten times the safe amount in every pound of meat. By the way, I should not think promoting osteoporosis would be the only worry in taking too much Vitamin A, but that effect probably was a major cause of the earlier deaths I noted for those who took their daily multivitamins. So that may no longer be true.
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Tatiana
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Glucosamine is something my very strict and mainstream-medicine rheumatologist told me to take. There must be some peer-reviewed studies showing it does good, or she would never have told me that.

Several therapies that started out as alternative have ended up mainstream. Garlic for heart disease is one I can think of. Vitamin C as an anti-oxidant was once very alternative and now my mainstream-medicine endocrinologist told me to take 3g a day for that.

It makes a lot of sense to spend money testing things that have a lot of anecdotal evidence that they work. The parts-per-trillion dilution stuff sounds completely wrong, for sure. But that doesn't mean other sorts of alternative medicines are all mistakes. Many, even most may be. But some may be golden. That's a good reason for science to test them, I think.

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Audeo
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I would agree that ignoring the results of the studies is absurd. However, not everyone ignores these results. There are a collection of people who make a lot of money off herbal remedies and supplements, and they will probably not ever agree with studies like the echinacea one.

Where it will help is in giving doctors something concrete to tell their patients when they ask about it. It also exposes any risks to herbal treatments (like St. John's Wort) that a doctor can present to a patient. As a physician when a patient asks about certain herbal supplements I'd like to be able to say, "here's a well funded double blind study that says it does not help with these symptoms, and may cause these side effects." Otherwise I'm left, when asked about it, to say "Well, there's no research to support it, but there's none to say it doesn't work either."

While the guy down at the supplement store will present all kinds of dubious 'evidence' to support his claim that it does work. Even if the supplement salesperson disagrees with the results, the results give physicians a leg to stand when disagreeing with their 'evidence'. At the end of the day the patient will have to decide who they believe, but at least physicians have some evidence on their side stronger than 'I think it is unlikely.'

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