Bad knees

[Drug addict]

 

how would YOU define "Alternative medice(s)"?

 

The range of alternative medicines is huge, going from accupuncture to homeopathy to traditional chinese medicine, and so it is somewhat difficult to come up with a definition for 'alternative medicine'.

 

I guess what I mean when I talk about alternative medicine is those interventions for which there is no supporting evidence (which may also cover some conventional therapies), but more importantly practitioners do not want to take part in rigourous trials to show that their intervention is better than a placebo. If any trial shows that an alternative medicine is not effective, the design of the trial is automatically derided.

 

Another huge sticking point with alternative medicine is their rejection of science when they talk about things like 'chi' and 'ying and yang'. For example with accupuncture there are no known anatomical structures which correspond to meridians.

 

I am not blindly against 'alternative medicine'; herbal medicine makes sense as so many drugs come from natural sources (though there are problems with dose standardisation and quality assurance.) What I really want though is hard evidence (i.e. RCTs) that these interventions are effective and not just due to placebo effects.

[JohnB]

While I can fully agree that there are problems with many of the "Alternative therapies" around, I wouldn't write them off.

 

My wife came down with a damaged Meniscus, the cartilage in the knee. We went the full route (short of surgery) to attempt to heal it. Six months of physio, walking on a cane, the whole box and dice. No luck.

 

With accepted wisdom, as shown on this site, http://www.arthroscopy.com/sp05005.htm there is no real cure and surgery was the only option left.

 

We were put onto a sports therapist who studied Chinese medicine and went to see him. Three weeks later the cane was no longer needed.

 

Interesting to note that when our normal General Practioner was told of the treatment, namely poultices, she laughed and said "That's what we put on horses". She didn't like it when I pointed out that we do that because it works.

 

A couple of years later, Theresa tripped going up some steps and again damaged her knee, but just bruising this time. MRIs were ordered to make sure.

 

The point of the story is that we now have two sets of MRI pics, the first showing the damage to the Meniscus and the second showing no damage at all. Of course, MRIs are just "anecdotal evidence" with no basis in scientific fact so we shouldn't pay too much attention to them.

 

The specialist who ordered the second set was to say the least amazed when he saw the first set. (We specifically asked him about Meniscus damage.)

 

Placebo effect is a possible answer of course, but that doesn't explain how something without a blood supply that is not supposed to repair itself did so.

 

Just something to ponder.

[YT2095]

I am not blindly against 'alternative medicine'; herbal medicine makes sense as so many drugs come from natural sources (though there are problems with dose standardisation and quality assurance.) What I really want though is hard evidence (i.e. RCTs) that these interventions are effective and not just due to placebo effects.

aye

 

I`m an advocate of Herbal medicine also, although Standardisation can be an issue, esp with some of the more potent varieties.

with regards to acupuncture, only today I saw on the news that there`s Evidence emerging for its effectiveness in Arthritis pain releif, it didn`t go into much detail though.

I`ve had it myself some years ago, and it seemed to work reasonably well, and some of the local doctors are taking courses in it and actualy administering it as a treatment in surgeries, my father in law went to have it done, he seemed quite impressed as to it`s effects also

[zpoot]

heh, i'm coming in kind of late. this is sort of a reply to Coquina. I was in gymnastics, and my back was hurting for a while, but i hated doctors so i didn't do anything about..heh. stupid me.Then my mom forced me to go to one, and i had a stress fracture and cuz i didn't do anything about it, i have a defect. I can't remember what it's called..but it healed open or something..i'm not sure how to explain...but i can't sit in the same position for a long time, and if i stand too long it starts to hurt and if i bend over it makes a cracking sound

[YT2095]

My guess (and that all it is) is that it may be a cartilliage problem, perhaps worn away in some areas?

[Drug addict]

Here's the patient summary of the study on acupuncture use in arthritis: http://www.annals.org/cgi/content/summary/141/12/901 (the full text of the paper reporting the study isn't free for six months, and my uni doesn't subscribe to annals of internal medicine )

 

Edzard Ernst, professor of complementary medicine at the Penisula Medical School, universities of Exeter and Plymouth, writes a column in the Guardian (http://www.guardian.co.uk) about complementary medicine which is interesting. His latest column is about the use of misletoe in cancer (http://www.guardian.co.uk/g2/story/0,,1377721,00.html).

 

All I want is the same level of evidence for alternative therapies as is demanded for conventional medicines. If the evidence shows that they are effective, fine, make them available on the NHS (but why is homeopathy available on the NHS? )

[YT2095]

Acupuncture is available on the NHS, I didn`t know they were wasting money on "homeopathy" though ((

[zpoot]

maybe, i dunno. My friend had a stress fracture too and she said hers does the same thing.

[Drug addict]

I didn`t know they were wasting money on "homeopathy" though ((

 

It's worse than you think; not only can doctors prescribe homeopathic products, there are also NHS homeopathic hospitals!

[Drug addict]

It's interesting to read the responses (http://bmj.bmjjournals.com/cgi/eletters/329/7480/1450) on the BMJ website to the article by Harlow et al regarding use of magnets to alleviate pain in OA (http://bmj.bmjjournals.com/cgi/content/full/329/7480/1450).

 

Surprising how most of those who are supportitive of the trial manufacture or distribute magnets...

[JohnB]

All I want is the same level of evidence for alternative therapies as is demanded for conventional medicines.

 

All I want is for conventional medicines to live up to the standard they demand of alternative medicines. Far too many do not. (But that is perhaps a topic for another thread.)

 

The point is that conventional medicine failed totally with Theresa, alternative medicine did not. Add to that, we have MRI evidence that the prevailing medical belief that the cartilage will not repair itself is false. Any diagnosis based on this belief is therefore both unscientific and flawed.

 

The fact is that many people are turning to alternative medicines (despite the hysterical rantings of the medical profession) because in many cases they work where conventional medicine does not.

 

If I seem passionate about this, I am. My wife was put through six months of hell, sacrificed on the altar of "Conventional Medical Treatment" with a condition that was later cured in 3 weeks. If conventional medicine had got off it's bloody high horse and listened to the other side for a change, Theresa and God knows how many others could be spared years of pain and suffering.

 

But I guess there's more money in treatment than cure. (And they'd have to admit that they don't know everything, something which is very hard for anyone to do.)

[Drug addict]

The level of evidence for conventional medicines is not always great, and it doesn't help when companies withhold evidence. However, there has been a move to evidence based practice in order to improve practice.

 

What I find interesting (amusing? disturbing perhaps), is that the majority of conditions alternative therapies are advocated for are those where conventional medicine is ineffective or has nasty side effects. I mean why do you not see alternative therapies for blood pressure control, asthma, or epilepsy to name a few? Alternative therapies generally target those people who are vulnerable. If these therapies are effective, prove it properly not by using anedoctes or testimonials.

 

Should conventional medicine be more open minded? I'm ready to listen if there is decent evidence behind the claims being made.

 

Medicine is built on science, and I don't think anyone involved in medical science would claim that we know everything. There are huge areas where comparitively little is known, for example nervous system diseases. If medicine did claim to know everything, why is there so much medical research being conducted? Look at the amount being invested by drug companies into R&D - it's an astronomical amount. Look at the number of journals there are in the medical research area. To take cancer research as an example, you have the British Journal of Cancer, the European Journal of cancer, Cancer Research, Cancer Letters, Clinical Cancer Research, Anticancer Research, Cancer,and Nutrition and Cancer, and I'm sure there are many more.

 

One of the fundamental differences between conventional medicine and alternative medicine is that conventional medicine is always evolving and moving forward, it is open to new ideas (eg bacteria causing stomach ulcers, prions etc., etc), whereas alternative medicine is static. I've heard justifications of some alternative therapies on the basis that they are 'traditional' or old. Well they really did a lot for life expectancy didn't they!

[ed84c]

Ill send you some free if you like YT, we have ample, my dad sells them, (yes I know that means hes a drug dealer)

[coquina]

I think one of the biggest problems is that people are so gullible and believe everything they read, and "truth in advertising" seems to have gone out the window.

 

It's just the modern version of the snake oil salesman - "magical weight loss drug - you don't have to exercise, eat all you want, and we'll guarantee you'll lose 30 pounds in a month or we'll give you your money back.

 

I will bet you that people don't reorder because it doesn't work, but that hardly anyone asks for their money back. It doesn't matter - all they have to do is collect the first $50 or $75 from several thousand gullible people and they're rich.

 

However, I have always been interested in "Folk Remedies" - so many things that were originally learned on a "hit or miss" basis, but were passed down from generation to generation. I'll give you two examples.

 

1. If you have hay fever, eat a tablespoon of raw local honey a day.

 

As late summer arrived, my husband would develop the most God-Awful case of hayfever you ever saw. He eyes would be red and tearing - his nose would be continually running, and he would sneeze incessantly. We went to a farmer's market, and a man was there selling local honey. The beekeeper saw my husband's condition and suggested he try the old folk remedy. He did, it took a season to work, but he never had hayfever again. The principle is the same as "allergy shots", but it's a lot cheaper and it's tasty too.

 

2. One summer, when I was a teenager - I had a terrible ingrown toenail. I had gone to my regular doctor, who had sent me to a foot surgeon, who had removed the entire nail, but it grew back worse than ever.

 

An old woman lived in the neighborhood - this was in the 60's and she must have been at least in her 80's - so we're talking about some one who was born before the turn of the century and had lived her whole life in a very rural environment. She saw me limping and asked me what was wrong. I told her I had an ingrown toenail, and she said, "Well, honey, I can fix you right up. What you need is a poultice." I figured that since modern (and very painful) surgery, hadn't cured the problem, I'd give her poultice a try.

 

I went into her house and she brewed up a vile smelling concoction. I don't know what all was in it, but I suspect the two main ingredients were sulphur and creosote. She dipped a long piece of gauze in it and wrapped it round and round my toe. Then she told me to leave it alone and take it off after 3 days. The pain gradually lessoned and when the 3rd day arrived I unwrapped the gauze. Out of the end of my toe popped a nail spur. It was a sliver of toenail that had separated from the main nail and was growing into the flesh. It had wrapped its way all the way around the end of my toe, and when it popped out, it was about 1/2" long. The poultice softened the skin and allowed it to break free - the relief was immediate. When the surgeon removed the toenail, he apparently hadn't gone all the way to the corner, and that piece of nail had continued to imbed itself deeper and deeper into my flesh. It still hurts to think about it.

[Drug addict]

I think one of the biggest problems is that people are so gullible and believe everything they read' date=' and "truth in advertising" seems to have gone out the window.

 

It's just the modern version of the snake oil salesman - "magical weight loss drug - you don't have to exercise, eat all you want, and we'll guarantee you'll lose 30 pounds in a month or we'll give you your money back.

 

I will bet you that people don't reorder because it doesn't work, but that hardly anyone asks for their money back. It doesn't matter - all they have to do is collect the first $50 or $75 from several thousand gullible people and they're rich.

[/quote']

 

And if anything the internet has probably made things worse as it is almost impossible to regulate. What people really need to be taught is how to evaluate websites and claims being made.

 

I've no doubt some of the "Folk remedies" are beneficial, and it must be an interesting area to study. Those examples you've given can be rationalised and as I've said previously I have less of a problem with things like herbal medicine because it can be explained. The point I was trying to make with regards to 'traditional' therapies is that to defend them purely on the basis that they have been around a long time is ridiculous. Blood letting was practiced for a considerable length of time but isn't performed today because we know it is dangerous.

[coquina]

Blood letting was practiced for a considerable length of time but isn't performed today because we know it is dangerous.

 

But in the newest of therapies, leeches are used to suck the excess blood out of reattached digits and limbs.

 

There used to be a science forum called "The Why? Files" - through it I became friends with a doctor from Darwin, Australia who has done practiced a lot in the aboriginal communities. Reading about their remedies was fascinating - for example, they put honey on infected wounds. They figured out it has antibiotic properties because it doesn't rot in the hive.

 

That is not to say honey is superior to modern antibiotics, but it is interested to know what they figured out over thousands of years of trial and error with what was available to them.

[JohnB]

DrugAddict, please don't think I'm against Modern Medical Practice (MMP), I'm not. I'm of the opinion that MMP doesn't have all the answers, so the therapist I see depends on the percieved condition. If I have an infection or need a broken bone set, then a GP is the closest and easiest answer.

 

Where I have a severe problem with MMP is it's underlying belief that the body is, in essence, nothing more than a machine. This basic belief is unproven (and in my belief, false) and therefore a "non scientific" base for diagnosis.

One of the fundamental differences between conventional medicine and alternative medicine is that conventional medicine is always evolving and moving forward,

Yet each of the remedies and procedures that are dispensed with were put forward as "proven" or "safe" when introduced. How can someone claim to have scientific "proof" of the effectivness of a treatment, only to have it thrown away as useless or dangerous 30 years later? The only logical conclusion is that there was no proof to begin with.

it is open to new ideas (eg bacteria causing stomach ulcers,

That is, if you'll pardon the expression, bullshit. Bacteria causing stomach ulcers, and the cure for them was known as far back as the 1940's. The cure was simple and effective but Doctors couldn't tell because the cure wasn't "sactioned". We had the stupid situation of Doctors telling patients how to cure the ulcer, saying "But don't tell anyone I told you." I know this one from familial experience.

The level of evidence for conventional medicines is not always great,

It's often bloody woeful, and opposing evidence is often ignored.

 

Let's take some basic "scientifically proven" medicines and treatments.

 

Starting with the biggy, Thalidomide. "Proven" and "safe" for mothers to take as a treatment for morning sickness? Whoever "proved" that one should turn in his white coat.

 

Ritalin, used to drug supposed ADHD sufferers into a more pliable state. Firstly there is no scientific proof that the condition known as ADHD even exists. Yes there are "difficult" children, but the proof that they are suffering from a "disease" that needs "treatment" is nonexistant. To quote the psychiatrist Peter Breggin;

 

"Hyperactivity (HA) is the most frequent justification for drugging children. The difficult-to-control male child is certainly not a new phenomenon, but attempts to give him a medical diagnosis are the product of modern psychology and pshchiatry. At first psychiatrists called hyperactivity a brain disease. When no brain disease could be found, they changed it to "minimal brain disease" (MBD). When no minimal brain disease could be found, the profession transformed the concept into "minimal brain dysfunction". When no mininal brain dysfuntion could be demonstrated, the label became attention deficit disorder. Now it's just assumed to be a real disease, regardless of the failure to prove it so. Biochemical imbalance is the code word, but there's no more evidence for that than there is for actual brain disease."

 

Ritalin has been used for over 30 years but there is very little to zero proof that it actually works. (Except in the short term.) I point you to the work of Howard M. Schachter Ba. Pharm. It's a .pdf of his meta-analysis.

http://www.laleva.cc/choice/Ritalin_Studies.pdf

Using 62 randomized trials involving a total of 2897 children. The important part is that the trials lasted on average 3 weeks, with the longest being 28 weeks. Is it "scientifically sound" to prescribe a drug for years on the basis of a 6 week trial? I think not.

 

Or my personal favourite. "Electo-Convulsive Shock Therapy". Strap a person down (so they hopefully won't break anything) and run an electric current through them. If it occurred in any place other than a hospital it would fall under the UN catagory of "Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment" and it's proponents in court for Crimes against Humanity.

 

But they're Doctors using a "proven" and "effective" treatment for the good of the patient aren't they? No, sorry, the treatment was discontinued in the 1980s because it didn't cure anybody. Not one. Zero. Nada. Zilch. Pity it only took 40 odd years of frying people's brains to work that one out. And where was the "proof" that originally backed the treatment? Oops, there wasn't any.

 

I mean why do you not see alternative therapies for blood pressure control, asthma, or epilepsy to name a few?

 

Theresa was an chronic asthma sufferer. Her medications were Becloforte 4 puffs 4 times daily, Ventolin 4 puffs 4 times daily, both Prednisone and Cortizone when she was hospitalized (about every 6 months, almost weekly when she was a teenager. And we have a ventilator now gathering dust on a shelf.). Since seeing an alternative therapist the dose is 2 puffs of Ventolin before she goes to bed. Next question?

 

Add to that (for example) the Helsinki Heart Trial showed that while a drug regimen may lower your blood pressure (of the 4,000 men involved, the 2,000 in the drug treated group had 27 less heart attacks, but the mortality rate was medicated 45 :- unmedicated 42.) it won't statistically effect the mortality rate. So where is the "scientific proof" of the effectiveness of medication? The "Mr Fit" trial in the US is also enlightening in that regard. So the point of the drug regimen is...?

 

The simple reality is that MMP is neither as "scientific" or "proven" as the medical fraternity would like us to believe. Any arguments that MMP is "Scientifically sound" or "based" can be shown to be untrue extremely easily.

 

The only real difference between us is that you view Alternative Therapies with good Scientific Scepticism, but I view both with it. As soon as I'm assured that something is "Scientifically proven" or "safe", I know I'm hearing a lie, as there is no such thing as a "safe" drug.

 

You seem to be more interested in whether a treatment is "proven", I'm more interested in whether it "works". Scientific study or not, if 5,000 peple say a treatment works, I'm inclined to believe them. (Or at least give them the benefit of the doubt.)

 

Sorry for the length of the post, but I feel it is an important subject.

[Drug addict]

Yet each of the remedies and procedures that are dispensed with were put forward as "proven" or "safe" when introduced. How can someone claim to have scientific "proof" of the effectivness of a treatment, only to have it thrown away as useless or dangerous 30 years later? The only logical conclusion is that there was no proof to begin with.

 

Clinical trials involve relatively small numbers of people and are conducted over a relatively short period of time, yet if you have a successful drug, there may be millions of people taking it. That is why you have post-marketing surveillance and pharmacoviligance to pick up effects which are unlikely to show up in trials. It is likely that medicines are going to be discarded as time progressess. Not because they are useless, but because more effective alternatives have come along. Whenever looking at medical treatment the words 'at present' should always be foremost in your mind.

 

 

That is, if you'll pardon the expression, bullshit. Bacteria causing stomach ulcers, and the cure for them was known as far back as the 1940's. The cure was simple and effective but Doctors couldn't tell because the cure wasn't "sactioned". We had the stupid situation of Doctors telling patients how to cure the ulcer, saying "But don't tell anyone I told you." I know this one from familial experience.

 

but helicobacter pylori wasn't discovered until 1982 and even then it took some time for acceptance of the idea that it was responsible for stomach ulcers. See for example

http://puck.ingentaselect.com/vl=5552385/cl=23/nw=1/fm=docpdf/rpsv/cw/rcop/14702118/v2n2/s19/p147

http://www.kjm.keio.ac.jp/past/52/2/80.pdf

 

Starting with the biggy, Thalidomide.

 

Inital research with thalidomide was for anticonvulsant effects, but it was found to have sedative properties instead. Remarkably, it did not cause death in overdose. This was before the discovery of the benzodiazepines when the only available sedatives were barbiturates which can be fatal in overdose, especially with alcohol. How the jump was made to it being safe in pregnancy I don't know. Some good did come from this though as regulatory systems were overhauled.

 

Interestingly, thalidomide is making a comeback and is being used in multiple myeloma and for a number of tumours.

http://www.pharmj.com/Editorial/20040214/articles/thalidomide.html

 

Re hyperactivity and ritalin:

I think hyperactivity is one of those conditions which was previously underdiagnosed, but is now being overdiagnosed. My younger brother was diagnosed with ADHD circa 1990 and prescribed ritalin. It made a huge difference to him, when he actually took it. Damn, I've gone and given some anedoctal evidence! That meta analysis does look interesting, though it is a few years old now and so could be out of date.

Actually, here's a slightly more recent article:

http://btuk.clinicalevidence.com/ceweb/conditions/chd/0312/0312_i1.jsp?btuk=1

 

ECT is still used today, and can be very effective in patients suffering from certain mental illnesses such as depression or schizophrenia who are refractive to treatment. It is very different to the popular misconception of the treatment

http://www.medhelp.org/lib/ect.htm

 

 

Theresa was an chronic asthma sufferer. Her medications were Becloforte 4 puffs 4 times daily, Ventolin 4 puffs 4 times daily, both Prednisone and Cortizone when she was hospitalized (about every 6 months, almost weekly when she was a teenager. And we have a ventilator now gathering dust on a shelf.). Since seeing an alternative therapist the dose is 2 puffs of Ventolin before she goes to bed

 

It looks to me like her therapy was inappropriate, or she had poor inhaler technique, which is incredibly common. In addition to the becloforte she should also have been on salmeterol (Serevent) and theophylline tablets or alternatives, according to the British Thorasic Society guidelines

http://www.brit-thoracic.org.uk/sign/mainframe_download.html (see page 6)

 

From doing a few quick searches, it seems the Helsinki heart trial and the MRFIT trial were done in the 70s and 80s (it does help if you include links!) Nowdays if you are hypertensive you are likely to be on aspirin and a statin as well. And here's a story about a trial using newer antihypertensives:

http://news.bbc.co.uk/1/hi/health/4080181.stm

 

Of course no drug is 100% safe, but then life is inherently risky. Just getting out of bed in the morning can be a significant risk for some people.

 

I want evidence to show that something works - data is not the plural of anedocte. 5000 might say something worked for them, but how many people did it not work in? That is one of the key questions.

[JohnB]

Thank you for your reasoned reply. (I got an error for the clinical evidence link though.)

 

Re the helicobacter, sorry if it didn't make it into print back then, but the fact remains that the local GP here was curing duodenal ulcers in the 1940s. And asking all patients not to tell anyone. When the big announcement was made back in 1982, a number of oldsters I know got a big chuckle out of it.

 

In some ways you are making my case for me with some of your other points. To put a drug on the market without full testing, is an act of faith; "We don't believe it will do too much harm." Think about this for a minute. We don't know it's safe and we don't know if it will have horrific side effects, so we'll give it to thousands of people and find out. This you call having a "scientific" base?

How the jump was made to it being safe in pregnancy I don't know.

But you're saying that medicine is based on scientific research, there must have been data, mustn't there? Where is it? Or could it be that medicine isn't quite as "scientific" in it's approach as you might think?

Some good did come from this though as regulatory systems were overhauled.

I'm sure that makes those affected feel much better.

I think hyperactivity is one of those conditions which was previously underdiagnosed, but is now being overdiagnosed.

How can that be? Medicine is a science isn't it? It has scientific precepts we are told. 1 plus 1 always equals 2 in every science, except in medicine where it's just an opinion that it might.

 

Re Theresa' Asthma. Poor inhaler technique is depressingly common. (I've actually seen people spray the ventolin into the air in front of their face and take a deep breath.) Her technique was checked though and found perfect. All that is actually beside the point. She has not changed her technique. Previously she needed the drugs, now she does not. There were no notable changes to lifestyle or workplace. The only difference between then and now is the visits to the Alternative practitioner.

 

The point shown in the very large Helsinki and Mr Fit trials was that in the case of moderate hypertension, drugs made no difference to the mortality rate. Where is the scientific basis for a treatment that doesn't have an effect? Of course the drugs lower blood pressure, that is what they are designed to do. There are many causes for moderate hypertension, but moderate hypertension isn't a disease.

 

The BBC article is a good example. Yes, the new drug is highly effective in lowering BP. So what? In very large trials it's been shown that lowering BP (for moderate hypertension) won't make you live any longer.

 

If I can put it this way. If I had moderate hypertension, I could take drugs and live say 40 more years. (I'm 43) Or I could not take the drugs and live just as long. So why take the drugs? On what scientific base should I take the drugs? They won't help me live longer, or, on the evidence better. In fact, I would be more at risk from long term side effects, wouldn't I?

 

There appears to be a depressing tendency over the last 20 odd years to classify symptoms as diseases. It's much older than that, but it seems to gathering pace.

 

Take the names of some diseases. Tonsillitis is a simple one. I get a bacterial infection in my tonsils and they swell up and go red. I go to my GP and he says I have Tonsillitis, as if it's a disease. I respond with "No sh*t Sherlock, my tonsils are inflamed, I know that, that's why I'm here." The inflamed tonsils are a symptom, the disease is a bacterial infection. The cure is therefore a broad spectrum antibiotic. (I'm not aware of viral Tonsillitis, but I suppose it must happen. In that case antibiotics are useless, so I guess it would be "wait and see if we need to take them out." Which seems the only sensible thing to do.)

 

There is a double standard involved sometimes too. If I go to an alternative therapist and get better, that's "unscientific alternative medicine", if my GP gives me a sugar tablet and I get better, it's "Placebo Effect". This may put a name to it, but it doesn't explain why it is or how it actually works. (But it has an official sounding name that we can file odd results under.)

I want evidence to show that something works - data is not the plural of anedocte. 5000 might say something worked for them, but how many people did it not work in? That is one of the key questions.

I agree. The problem is that somtimes anecdotal evidence is all we have. Some time ago (down here) a number of parents were pointing the finger at a food additive (number 82, I think) as a possible cause for ADHD. These parents found that by not giving their children bread containing this additive, they no longer needed Ritalin. What they were asking for was a scientific study to see if they were mistaken, because all they had was anecdotal evidence.

 

Noone would listen to them because all they had was anecdotal evidence, and they couldn't get anywhere with a study because noone would start one without scientific evidence. Catch 22.

 

Another excellent example is Dr. Holt in Western Australia. He got blacklisted by the profession over 20 years ago for claiming to have a potential "cure" for some cancers. The standard argument is that he has no "scientific" backing for his patients claims and therefore should be disregarded. His patients argue that the thousands of them still alive would be a good reason to have a scientific study to settle the issue. It took a current affairs program publisizing the controversy to actually get a study started.

 

Dr. Holt is a member of the Royal Colleges and has an entire alphabet after his name. (Literally) He was head of the WA Cancer Institute for years. When someone like that makes a claim like that, I would expect both the laity and the medical profession to at least look scientifically at the technique and give him a fair hearing. No such luck. He was deregistered and blacklisted, without any study being done. Read a bit more on the arguments here. (Not the best site, but it's got the basic story right.)

http://www.cam.net.uk/home/Nimmann/healing/john-holt-cancer-treatment.htm

 

In the case of Dr. Holt, he tried to document his findings. They were refused because had been blacklisted. So no medical scientist would study the technique because the Doctor involved was blacklisted by the profession and noone in the profession would look at his claims because the medical scientists hadn't studied them. A circular reasoning that has nothing to do with science of any kind.

 

All I've really been trying to say is that medicine is a dicipline where rather than good "Science", "Best Guess" and "Opinion" often play a very large role. And in that respect, it is no more valid or invalid than many Alternative Therapies.

[Drug addict]

John, I'll post a reply when I've had some sleep; I've been up for about 36hrs solid now so anything I posted would probably not make much sense [insert joke here]

 

One little caveat though, I think if you look back you'll see I said medicine was based on science, not that it is a science. A subtle but important distinction.

[JohnB]

Partying does that to you young fellas, you just can't keep up.

 

Catch you later.

[Drug addict]

Partying does that to you young fellas' date=' you just can't keep up.

[/quote']

 

I wish it was partying! In the coming week I have two exams, a clinical care plan to do, one 1500 word ethical assignment to hand in, a research proposal to hand in, I start my final year lab project and a conference I've organised is taking place on Saturday. Roll on 5:30 Saturday is all I can say!

[JohnB]

Busy.

 

If you would rather adjourn the debate for a while, I understand. Exams are far more important than an internet conversation.

 

Good luck with them.

 

FWIW, the Ethical Essay should be a snap. I've seen a number of your posts around here and you seem a very ethical person.

[Drug addict]

Just a few quick points while I'm on a break:

 

Drug testing & safety: clinical trials in patients with the disease which the drug is going to treat is the final stage of testing. Prior to this you have trials in healthy humans, in animals and in cells. I'll expand on this later once I've had time to check some references. Considering how rare some side effects are, it is unfeasable to expect them all to be detected. As an example, the occurence of rhabdomyolysis with statins is 1 case in 100,000 patient years (I'll try and find a source for this other than the BNF), i.e. to detect this in a clinical trial, before releasing the drug, you would have to test 100,000 patients for a year to even pick up one case.

 

Thalidomide: more than anything else I'm professing my ignorance at what teratogenicty testing they did back then, and what the regulatory systems were like. The drug wasn't licensed in America, but I'm not sure why. My comment about the reform of regulatory systems wasn't meant to sound trite, I was just illustrating the cliche that every cloud has a silver lining. The FDA in America gained their current powers in the late 1930s after people were killed by a sulphanilamide solution made with diethylene glycol. At that time it was not an offence to sell dangerous, untested or poisnous drugs.

[JohnB]

Hi mate, how are the exams going? Shouldn't you be studying? Or is cnducting an internet debate how you unwind?

 

I actually agree with you on testing, you can't test for everything but, it just seems that some of the tests are a bit short and sometimes miss some biggies. Worse if the company involved doesn't give out all the figures.

 

On Thalidomide, I brought it up to show how the "scientific base" of medicine failed dismally. I realize that your comment was of the "Silver Lining" variety, but I just wanted to remind you that thousands still live with the dark cloud.

 

For the profession it was "Oh dear, let's change the system so we don't make that mistake again." For those thousands effected? They're still living with it. (BTW, I expect that some Doctors are still having nightmares about the results of their prescribing the drug, so they count as victims too.)

 

The thing is, as you say, medicine is not a science. It's a business. People, (Doctors, etc) provide a service for money. Unlike many, I expect a Doctor to be a human being. If the choice is between their "principles" and putting food on their childrens table, I think it's an odds on bet which way they'll jump. Most would expect that of a plumber or carpenter, why should a Doctor be any different?

This leads to the situation where diagnosis becomes based on "opinion", not "science."

 

To illustrate; The Australian Institute of Health and Welfare in it's 1994 (yes, I know it's old, but that doesn't change the figures) report "Australia's Health 1994" looked at, among other things the incidence of Myringotomy in Australia. (Page 294)

 

In 1986, in New South Wales, 2,954 of these operations were performed. By 1992 the figure had grown to 11,186. Huh? A fourfold increase in 6 years? They suddenly found that many extra cases worthy of surgery? Perhaps. Australia is a reasonably homogonous place with the lifestyles and health of it's citizens not varying markedly from state to state. Yet the rate of this surgery in 1992 was twice as high in South Australia as NSW. SA had 3.5 times the rate as Tasmania and 1.5 times the rate of Victoria. Are the South Australians really that much more in need of surgery, or do the SA surgeons just prefer to cut? If the latter, is there a scientific basis for this preference?

 

I read some time in the last year or so, (I'll try to find a link or the article if you wish) that the rate of Tonsillectomies and Appendectomies in SA is something like 8 times the rate in Queensland. It would seem that surgical intervention in SA is based more on "Fad, Fashion or Opinion" than on anything science may have to say on the matter.

 

How do the rates compare between say, Manchester and London? The people live near (from an Aussies POV anyway ) each other, their food will be similar, the rates should be similar if treatment is based on science. If there is a large disparity, what is the scientific reason?

 

You will perhaps note that I haven't brought up Flouridation of water yet. Personally I'm opposed to mass medication, so I'm against it for philosophical reasons. I'm still reading various reports for the scientific aspect, but so far it doesn't look good for the pro flouride group. Melbourne has had flouridation for years, Brisbane never had it, yet the incidence of tooth decay in both cities is almost exactly the same. Doesn't seem to be any "scientific base" for putting rat poison in the water yet.

 

Cheers, and again, Good Luck with the exams.