Sequel Thread To Holistic Doctors, and medicine

This is a reply to LindaLou's last message, Message 294, in the now closed Holistic Doctors, and medicine thread. We're not talking about "some cases," we're talking about methods for best understanding the way the real world really works. Clinical scientific studies are so vastly superior an approach to anecdote there really isn't anything to discuss. This appears to be a misleading claim, because Wikipedia's entry on Paxil says this: On to another claim: This, too, appears to be a misleading claim. Once again from Wikipedia's entry on Paxil: I do not have a medical background and have very little interest in reading reports from clinical studies. My primary interest in this discussion is in pointing out how inferior anecdote is as a way of learning about the natural world, but as Pink Sasquatch pointed out earlier, much of your information appears to be either inaccurate or misleading.But you don't stop at misinformation, you continue on to denigration: Clinical studies are conducted by human beings, and so they are vulnerable to all the frailties the human flesh is heir to. Anecdotes are also the product of human beings, but have none of the scientific rigor. The kind of precise information you're asking for is not available for most drugs, including aspirin. Human bias is a problem in all research. And so your solution to the problem is...anecdote? Do you think the human bias in anecdote is somehow less than in clinical studies? Drug interaction *is* a very real problem, but when I read the information about a drug it usually has a rather long section about drug interactions. Paxil's list is particularly impressive, for instance see http://www.drugs.com/cons/Paxil.html.No human endeavor is perfect, and pointing out imperfections in current methods in order to argue for the return to less reliable approaches from the stone age of medicine is particularly wrongheaded.The development of methods like double-blind studies that ferret out what is actually true is one of the great advances of modern medicine, and it represents a quantum leap from anecdote, home remedies and old wives tales.--Percy

Hi LindaLou,You were talking about your neighbor coming down with Type II diabetes, and then you said this: Due to the unfortunate juxtaposition with the story about your neighbor's experience with diabetes, I think many people would conclude that you're saying that studies at PubMed are claiming that Zyprexa helps diabetes, which it of course does not, since diabetes is one of risks of Zyprexa. I think what you intended to say is that PubMed contains studies supporting the effectiveness of Zyprexa as a treatment for depression, which no doubt is true. It's not really an antidepressant, though. It's actually an antipsychotic that is most effective with some forms of schizophrenia, and I've seen it work. It's amazing. The delusions and disconnects from reality just disappear.You continue to use anecdote to argue for anecdote and against science. Perhaps you should conduct a double-blind study of the relative effectiveness of anecdote and double-blind studies.You also continue to denigrate medical science. As bad as you think it is, and even if everything you said were actually true, it's still far and away superior to any alternative. For example, world mortality rates have not dropped because of the contributions of alternative medicine, but because of improvements in the delivery of traditional medicine to more regions of the world.--Percy

Hi LL,The focus of the discussion really can't move on to your claims until it is established that they have a valid scientific foundation. For example, you begin with this: Maybe Zyprexa shouldn't be prescribed for depression, I don't know. The relevant question is why you think you know. Is the data you used to reach your conclusions scientific or anecdotal? But we've already been over this ground. No human endeavor is without flaws. By what strange beast of logic do you conclude that the way to address flaws in current methods is to return to old methods that are even more flawed? And you know this how? Through anecdote? By a self-selected group? Who are performing self-reporting? Of their subjective conclusions about their condition and its causes? And you know this how? (repeat the rest of my previous paragraph)You see, the most important point in this thread isn't whether modern medicines are over-prescribed and do harm, not that that isn't important. But what's far more important is that we're using clinical trials to establish the efficacy and other effects of drugs, and we're not using methods from the stone age of medicine like anecdote. Whatever problems modern medicines might have, they'd be far worse if they were assessed via anecdote rather than clinical studies.In other words, your approach is wholly unscientific and your conclusions are therefore seriously in question.--Percy

Oh, and your claim about 6-week trials was about antidepressants, not antipsychotics, and your claim has already been shown to be wrong in the case of Paxil.Since the American Psychiatric Association recommends that a patient switch to a different drug if there's been no effect after 6-8 weeks, and since it is well understood that these drugs often take a while to have an effect and then even longer for the patient to subjectively assess the effect, trials of more than 6 weeks would seem to be a requirement, and so my expectation would be that if you investigate the clinical trials for antidepressants you'll find that they included some longer than at least 8 weeks. For those where you find that is not the case then in the absence of offsetting information (such as that a particular drug under study is know to work very fast based upon animal trials) I would share your concerns. And I share your concern, but my question was how you know that Zyprexa shouldn't be prescribed for depression. The answer is that you don't really know, it was just a specific expression of your overall skeptical view of off-label prescriptions. "Current methods" means clinical trials, especially double-blind studies. "Old methods" means anecdote.In other words, I was pointing out that you're using the inevitable flaws (and also in some cases misperceived flaws, as with the errors in your criticisms of the STAR*D efforts) in scientific studies to argue for a return to anecdote, a far worse approach with far more flaws.Concerning the claims of Breggin and Hoffer, I can't see how I could object to any conclusions they reach that are based upon replicated clinical trials. Unfortunately for them, none of their conclusions satisfy this requirement, and their conclusions are generally rejected by the broader medical community.The romantic appeal of the lone adventurer braving misguided opinions, antagonism and downright rejection but who trudges on and ultimately triumphs is wonderfully satisfying, but while able to convince those with a mystical, romantic bent who rely upon anecdote, Breggin and Hoffer are unable to convince those for whom well-designed, well-conducted and replicated clinical studies are the gold standard. No, of course not. I'm not criticizing you for questioning. I'm criticizing you for concluding. On the basis of anecdotal evidence. Which is well-known and well-established to have significant reliability problems. It is not the case that you have presented valid evidence and I've declared it insufficient. You have instead presented anecdote as evidence, which it is not. The QuackWatch guy has a great quote, which I'll paraphrase in my own words: "The plural of anecdote is anecdotes, not evidence." Your concerns are legitimate, but your answers pushing solutions based upon anecdote is wrongheaded. Push people like Breggin and Hoffer to perform the clinical studies that would validate their positions, instead of pushing uninformed lay people to accept anecdotal findings.--PercyEdited by Percy, : Grammar.

I think LindaLou's objection is legitimate, but only with regard to terminology. There might be a better term than "chemical imbalance" for referring to the chemical pathways thought to be a factor in some forms of schizophrenia, especially since "chemical imbalance" is a term widely used within the quack community. The Wiki article on schizophrenia doesn't itself use the term.But what you were referring to seemed very obvious to me, and I'd be surprised if LindaLou wasn't also aware of the suspected involvement in schizophrenia of certain chemical pathways.--Percy

Hi LindaLou,I think you might be confusing the discussion with me with discussions you're having with others. I'm not questioning your diet-and-supplement regime. As I and others have said, if you've found something that works for you then I think that's great. What I'm questioning is the basis upon which you draw your conclusions, which is anecdote (drawing conclusions from personal subjective experiences, including one's own), a known poor way of reaching valid medical conclusions.Even worse, you're urging others to follow your anecdote-based advice.About Breggin and Hoffman being published in mainstream journals, many, many ideas published in mainstream journals haven't been accepted by the broader scientific community. This evidently includes Hoffer and Breggin. And as has been pointed out, Breggin has had to resort in recent years to publishing in journals he either edits or established himself. Of course you should be skeptical. I believe my very words about this were, "I share your concern."The point I was making was that your declaration that Zyprexa should not be prescribed for depression stemmed from your general skepticism about off-label prescriptions, and not from any scientific evidence that Zyprexa is contraindicated for depression. You ask who's going to invest money in research that has no substantial payoff? Good question. That still leaves anecdote as an extremely poor method of medical investigation. The solution is to figure out ways to overcome this obstacle to nutrition research, not to rely upon anecdote.You still seem unaware of just how poor a method anecdote is. For very obvious things it does just fine. For example, most cultures have identified the hallucinogenics available in their environment, and there are a small number of examples of natural medicines being identified in the environment this way, but for the most part complex and subtle medicinal effects can only be ferreted out by clinical studies.When you in effect say, "Well, conclusive clinical studies aren't available in this area, therefore I'll rely on anecdote," your conclusions are very likely to be wrong. Relying upon personal anecdote, no matter from how many well-meaning people, is known to have severe problems involving many fallacies, most prominently among them the placebo effect and confirmation bias.Further, the opinions of a couple scientists cannot outweigh the preponderance of medical opinion. The likelihood of the majority of a large community being wrong is much smaller than the likelihood that a couple mavericks are wrong. You're just piling fallacy upon fallacy.--Percy

What part of "I share your concern" don't you understand?I was objecting to your claim that Zyprexa shouldn't be prescribed for depression because your claim was not based upon evidence that Zyprexa is contraindicated for depression, and your unqualified declaration seemed to imply some sort of information to that effect. In reality your declaration was based upon your more general skepticism about off-label prescriptions, and not on any specific knowledge about the effectiveness of Zyprexa on depression. This is consistent with my theme that conclusions should derive from valid studies.And I was not saying I'm not concerned about off-label prescriptions. I didn't want to get more specific than that because we'd be drifting off-topic, so let me just briefly say that though I share your concerns, your characterizations of such prescribing as unsupported by clinical data is untrue. For example, here's a study on olanzapine (Zyprexa) and depression, and it was just the first item of a Google Scholar search: But whether Zyprexa is appropriate for depression, psychotic or not, is a separate issue from how you reach your conclusions. What I was criticizing was not your conclusion that Zyprexa shouldn't be described for depression, but the way you reached your conclusion, which was from your more general opinion that off-label prescriptions are always bad practice. Off-label means not approved for that purpose. It doesn't mean no clinical studies have been performed, and so it would a mistake to automatically draw such a conclusion as you have done.Your arguments against traditional medicine seem to be not against the scientific procedures themselves but against the people and groups involved, accusing them of greed, lack of concern for patients, and turf-protection. Unfortunately for your argument, the people working in alternative medicine, being just as human, are as prone to these foibles as anyone else. In addition, alternative medicine has a huge profit advantage over traditional medicine, since there's no regulation and no testing. Homeopathy is the greatest scam on earth: no testing required and they're selling the cheapest possible concoction imaginable: water. I think you're continuing to confuse me with others you're discussing with. I'm not dismissing Breggin because I'm not discussing him. I'm not really interested in addressing the specifics of any of your claims, or Breggin's claims, or Hoffman's claims. I'm not questioning your claims, but the methods upon which your claims are based, which rely heavily on anecdote, and upon the work of people who publish in their own journals, and whose work has not persuaded the larger scientific community, and, in Hoffman's case and even to a lesser extent Breggin, whose work is ancient.Concerning the question of what one should do when traditional medicine has failed, all I can say is that the only reliable way of ferreting out reliable information about the real world is the scientific method. If you happen to chance upon effective treatments by other methods then I'm happy for you, you were very lucky, but that doesn't change the fact that the scientific method is superior by far to all others for gaining accurate knowledge.I also continue to believe you're doing a great disservice to uninformed laypeople by encouraging them toward unscientific approaches.--Percy

Again, I share your concern. Including yours. And what an easy living it is! With no FDA regulation or testing requirements, one only need construct arguments convincing to laypeople unqualified to assess them.LindaLou, laundry lists of big pharma misbehavior may be an indictment of something, but not of the scientific method.You say that you think the worker bees in big pharma are honest, that it is the higher-ups who are culpable, but alternative medical companies have higher-ups, too. And profit motives. And everything else that all money-making concerns have, except they don't have to deal with FDA regulation and the rigors of the scientific method.Regarding things of possible medical value, except for those with obvious immediate effects such as hallucinogens, the best way to ferret out the effects is with statistically and rigorously well-designed placebo-based double-blind studies.The history of clinical studies in the field of medicine is that the early studies and the smaller studies and the not-so-well-designed-or-implemented studies can be very useful in indicating if further study is warranted, but they are not conclusive, and these kinds of studies tend to outnumber the larger more rigorous (and expensive and time-consuming) studies. The gold standard of clinical trials are large placebo-based double-blind studies.For this reason, you will be able to find many studies in the technical literature that appear to support your case, but there will be other studies that contradict it. How do you or me, non-experts, decide which is right? You've chosen anecdote. I and most others have chosen to recognize that as non-experts we are unqualified to assess this literature without help, and so we accept the guidance of the consensus of the scientific community qualified to assess it.But Molbiogirl is not a non-expert. Regarding your rebuttals of her most recent posts, I do think there are legitimate issues to complain about regarding quote-mining, since one shouldn't be expected to have to mount a spur-of-the-moment rebuttal to a website of data gathered over a period of years, so if that's what Molbiogirl is doing then you have a point. But I don't agree with your paragraphs-long questioning of Molbiogirl's motives. She's not the one willing to adopt unscientific approaches based on misgivings about things that are true of all people and organizations everywhere, including those in alternative medicine.Think about what you're actually claiming: "The people on my side are honest and wouldn't lie and are motivated only by a desire to help people, while the people on your side are greedy, motivated by profit, and unconcerned about the people they're allegedly trying to help. You've been taken in by this dishonest bunch."Aside from the naiveté such expressions display, demonizing the other side is a common debate fallacy, and we will hopefully see less of this as the discussion continues.The problems of alternative medicine are made clear by the examples that Molbiogirl presented to you. Being inherently unscientific, its practitioners base their treatments upon adherence to principles that aren't supported by real-world evidence, and so they are much more likely than traditional medical practitioners to do harm. As far as learning the ropes here, there's nothing special about this place. Science is science. It's by far the best method we've ever had for figuring out what's really going on in the real world. Ferreting out small but statistically valid characteristics of medicines whose medicinal effects vary from one individual to the next is something that takes knowledge, training, skill and experience, a combination not in plentiful supply. Those who can operate at the top echelons of demanding scientific fields are rare and special people. Those who cannot perform at this level instead work on perpetual motion machines or try to prove ESP right and Einstein wrong, or go into alternative medicine where they can avoid their peers and instead work at persuading laypeople who are much less demanding of evidence.Almost all scientific fields are highly specialized, and even Nobel Prize winning scientists are but laypeople outside their own field, so even they have to rely on the scientific consensus of other fields. Scientists vie through their research presented in technical papers and replicated by other scientists to build a consensus within their own subcommunity. Those who withdraw from such efforts and evade peer-review by publishing in their own journals lose the right to have their ideas seriously considered, and appealing to laypeople unqualified to assess such ideas only compounds their error.--Percy

Read what I said again. I said it is legitimate to complain about quote-mining and that "if that's what Molbiogirl is doing then you have a point."In other words, I reached no conclusion either way about whether you were quote mining. And somewhere in my post I told LindaLou that her paragraph's long criticisms of you weren't really appropriate.Also, I think LindaLou is using a different definition of quote mining than we usually see here. She's using it to refer to drawing material wholesale from websites, while we usually use it to refer to drawing quotes out of context to make it seem the author was saying something he never intended.--Percy

I don't think I included a specific reason, but it is telling that you find your own accusation "pretty harsh" when turned on yourself. Interesting mirror you're holding up to yourself.The point I made a couple times in my previous post was that you're personalizing the debate. You accused Molgiogirl of quote mining, you questioned whether she was actually reading any of the studies, you accused traditional medicine of greed and uncaringness. I suggest you stick to the facts. But I didn't say that a pill for every ill is the way to health, did I. Could we perhaps have fewer attempts at emotional appeals, fewer swipes at strawmen, and more accuracy?What I said was that reliable medical knowledge comes from well designed and conducted placebo-based double-blind studies. Anything that isn't based upon the consensus of results from the relevant collection of studies should not be considered something that is known, and anything that is admitted to rely upon anecdote should be considered highly questionable. Well, then I think that's wonderful, and I just can't imagine where I got such a mistaken impression. I'm glad I was wrong, because if I didn't really see such charges in your previous posts then that means I won't see them in your future posts, either. Good news! Of course allopathic medicine doesn't have all the answers. But that doesn't make anecdote a reliable method for gaining information. Anecdote remains about the worst method one could think of. And giving insufficient weight to consensus opinion is not a course often associated with success, either. Why are you phrasing the question this way? You're implying that I'm just a puppet of whoever cornered me and convinced me. I am capable of making up my own mind and forming my own opinions, and my methods are scientific.And why are you asking a question that has already been answered? One obvious danger of alternative medicine is that it can delay effective medical care. Depending upon the condition this could be irrelevant or fatal, depends upon whether we're talking about a cold or cancer. And even prescribing vitamins isn't benign, for instance, megadoses of vitamin A can be fatal. Well yes, of course. But you're referring to individuals poorly equipped to assess the validity of the claims that are made. Good show! I'm hoping that you gain an understanding of how important it is for your advice to be firmly grounded in scientifically valid findings.--Percy

You're again reacting to a point I wasn't making. Maybe mainstream medicine is just as bad as you say it is. Naturally I, and most others here, disagree with you. But let's assume for the sake of discussion that the aspects of mainstream medicine that you've been focused on are just as bad as you say.What's the better approach?Anecdote? No, of course not.Conclusions at odds with the consensus of mainstream medical opinion? Again, of course not.Here's a possibility to consider. One reason that quacks have been so successful through the ages, particularly those using approaches that did no harm, is that people recover from a great many illnesses and conditions with just the passage of time, and those that do recover will likely credit any quack treatments they might have received. You might have gotten better simply because you got better and not because of any diet change.But you'll never know because for you your recovery and subsequent good health is evidence in itself, when what is really required to know what happened for sure is a well-designed clinical study of a number of people in situations similar to yours.--Percy

This is one of the key questions surrounding alternative medicine, since so many of its claims are based upon herbs and vitamins and other supplements. The reason we're in this sad situation where these items are not regulated by the FDA is because when congress passed the laws that established the FDA, language was inserted specifically grandfathering and thereby excepting these categories.--Percy

I think the Wikipedia article on naturopathy sums it up pretty well: As long as people go to their naturopath for colds and "feeling poorly" there's probably little to complain about, but people with cancer, amoebic dysentery, emphysema, bowel obstructions, heart disease and so forth also go to naturopaths. The delay due to the journey from naturopath to effective medical treatment will vary, and this increases the probability of unsatisfactory outcomes, including fatalities.The poster child for alternative medicine gone bad died about 20 years ago in Massachusetts. His name was Chad Twitchell, his parents were Christian Scientists, and he died after several days when his bowel obstruction was treated with prayer. His parents fled the state to avoid prosecution and were found guilty of child abuse in absentia.I'm sad to see that time has forgotten Chad Twitchell. A few years ago you could still find his story on the Internet, but the only remaining mention now is from me earlier this year.--PercyEdited by Percy, : Spelling.

It should be obvious that a superior alternative to medicines and treatments backed by clinical trials that rigorously apply scientific methods will not be found in anecdotal approaches. The effects of most naturopathic treatments cannot be distinguished from placebo, so in most cases seeing a naturopath will do no harm. But if one has a serious medical condition then naturopathic approaches can only delay effective medical care.The positive effects on health of all vitamin supplements and of most herbs on healthy people with relatively normal diets has not been established. Most good quality studies find no measurable effect. The absence of clinical studies demonstrating efficacy is a danger, as witness vitamin E, once touted as improving health and longevity due to its anti-oxidant qualities.At heart the problem of quackery is epistemology taken to the individual level. Most people acquire knowledge anecdotally, building up an internal database of useful but uncorrelated and often insufficiently supported information. They have knowledge in that they know, but they don't know how they know, because they don't know how the source of their knowledge, usually other people, knew. So you drink green herbal tea when your gout acts up because grandma said to, and sometimes it helps and sometimes it doesn't, and for most people this seems to confirm the advice.But scientific approaches, which represent a method of inquiry completely unfamiliar to most people, work to establish a couple of things when applied to the medical area. First, they work to establish cause and effect. If you try this treatment, how many patients get better, how many worse, and how many do not respond. Second, they try to identify mechanisms by which the treatment might be causing its effect. This is tough to do in trials involving people, who, of course, cannot be treated like lab rats, which can be tested and analyzed even to the point of mortality, so it often isn't possible to establish mechanisms.Most naturopathic approaches are lacking in both areas in that cause/effect has not been established in clinical trials, and no mechanism has been identified. The lack of a mechanism is not fatal to most claims, but it is fatal to some, such as homeopathy and therapeutic touch.It is interesting to note that this discussion is revealing what I'm sure many of us already suspected, that those who buy into one form of quackery are likely to buy into others, and it appears to all come down to how well one understands the difficulty inherent in reliably puzzling things out in a very complex real world.--Percy

It's inevitably going to appear to onlookers that at a minimum LindaLou and PurpleDawn have battled you to an impasse, and that at worst you're engaging in moving the goalposts and even dissembling.This isn't a criticism, just an observation. How in the world are you going to going to explain to laypeople the questionable benefits of alternative medicine when LindaLou has found studies supporting the benefits of vitamin C therapies, and when PurpleDawn has discovered that there are journals like Complementary Therapies in Medicine that publish research papers citing the positive benefits of homeopathy, and that even has someone from Harvard Medical School on the editorial board.Most of alternative medicine, especially homeopathy, is obviously all bunk, but how are you going to make that case when the very sources of information you keep encouraging people to use include research that says it isn't bunk? Do you badmouth journals like Complementary Therapies in Medicine? Badmouth the researchers? That's likely to come across as ad hominem. Do you encourage accepting some research results while rejecting others? On what basis, one that laypeople would accept and understand and that doesn't seem like simple bias and cherry picking?Sure, scientifically you're on solid ground, but how do you help laypeople understand this while avoiding giving the impression of bias and close-mindedness?--Percy