Science-based medicine: Reality check

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VA Hopeful Dr said:
Most of those are opinion/letter to the editor type articles or synopses of news events.
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Your point?
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VA Hopeful Dr said:
Do you get your news from the Letters to the Editor in the newspaper?
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No, I get it from the Huffington Post. :D

Several of those citations are actual studies. And besides, it's the common theme that I was trying to communicate. We can't deny the message here.
 
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facetguy said:
No, I get it from the Huffington Post. :D

Several of those citations are actual studies. And besides, it's the common theme that I was trying to communicate. We can't deny the message here.
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Heh, well played.

I get where you're coming from, and while I still stand behind the evidence as it is right now, I don't think a re-evaluation of the methods is a bad idea so long as it doesn't interfere with ongoing research into new areas.
 
Interesting take on EBM from the former Editor of BMJ: http://www.the-scientist.com/2010/12/1/32/1/ A reminder that it's not as simple as just looking for randomized trials.

And this was interesting: "Finally, even some of the strongest proponents of evidence-based medicine have become uneasy, as we have increasing evidence that drug companies have managed to manipulate data. In the heartland of evidence-based medicine—drug trials—the “evidence” may be unreliable and misleading." Comforting to know.
 
facetguy said:
It's funny that an anonymous nobody blogger (Orac?) mocks a hugely popular website like the Huffington Post.:laugh:
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Orac is not a "nobody blogger." He is very active in the skeptical movement as am I. He is a surgeon and a good friend of Steven Novella, a neurologist from Yale. Novella coined the phrase science-based medicine and also has a blog (http://theness.com/neurologicablog/). I had the chance to meet him at a skeptical convention this year in Las Vegas.

In your opinion, are there any CAM modalities that have merit or value?
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Tim Minchin talks about this in one of his songs where he says...Do you not what they call alternative medicine that works? Medicine.

So is nutrition CAM?
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Please tell me you're not being serious.

there is now a large volume of research suggesting that we have a vitamin D problem, with virtually no downside
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From skim reading, I've seen you mention vitamin D several times. The downside is wasting money on treatments that don't have sufficient evidence. Read this article on the Science-Based medicine website (where both orac and novella among several others contribute): http://www.sciencebasedmedicine.org/?p=8725
 
facetguy said:
Interesting take on EBM from the former Editor of BMJ: http://www.the-scientist.com/2010/12/1/32/1/ A reminder that it's not as simple as just looking for randomized trials.

And this was interesting: "Finally, even some of the strongest proponents of evidence-based medicine have become uneasy, as we have increasing evidence that drug companies have managed to manipulate data. In the heartland of evidence-based medicine—drug trials—the “evidence” may be unreliable and misleading." Comforting to know.
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That's a dangerous game for the drug companies to play (Vioxx and Avandia anyone?). With the FDA taking a closer look at lots of drugs recently, I think the risk/benefit of doing this is going to change quite a bit.
 
facetguy said:
Here's more along the lines of the findings in the JAMA study (see my last post, the first citation -- Boutron et al) from The Atlantic. Good insights from a researcher who analyzes the literature full-time for accuracy ("one of the world’s foremost experts on the credibility of medical research", per the article):

http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/
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I recently read this Atlantic article, "Lies, Damned Lies. and Medical Science" and wished I'd had it when my professors were always trying to keep me focused on EBM. "But Dr. XXX, this patient has had this problem since he flew into Vietnam 40 years ago and no EBM has worked yet." :laugh:
 
The Atlantic article is good, though short on details. A quibble:

Vioxx, Zelnorm, and Baycol were among the widely prescribed drugs found to be safe and effective in large randomized controlled trials before the drugs were yanked from the market as unsafe or not so effective, or both
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I was just studying this - Vioxx was never found to be safe and effective in randomized controlled trials. In the VIGOR trial, Vioxx was found to cause MIs at 4-5 times the rate of naproxen. So Merck sold the FDA on the notion that it's not because Vioxx was so bad: it's because naproxen was actually cardioprotective. Other scientists were warning the FDA that this was implausible, as it would mean that naproxen was more cardioprotective than aspirin. But Merck got away with this and other misdeeds and Vioxx stayed on the market for years. It wasn't a failing of the RCT - the data were there - but how it was interpreted.

Baycol, on the other hand, was found to be safe, but that wasn't a failing of RCTs, which aren't powered to find rare AEs. And the rhabdomyolysis from Baycol was rare. Though Baycol caused rhabo up to 80 times the rates of other statins, the rate of rhabdo with Baycol still worked out to about 4 per 100,000 prescriptions - too rare an event for RCTs to generally find. It's the post-marketing surveillance that found the problems with Baycol.

(Zelnorm I don't know about.)
 
Pharmavixen said:
The Atlantic article is good, though short on details. A quibble:



I was just studying this - Vioxx was never found to be safe and effective in randomized controlled trials. In the VIGOR trial, Vioxx was found to cause MIs at 4-5 times the rate of naproxen. So Merck sold the FDA on the notion that it's not because Vioxx was so bad: it's because naproxen was actually cardioprotective. Other scientists were warning the FDA that this was implausible, as it would mean that naproxen was more cardioprotective than aspirin. But Merck got away with this and other misdeeds and Vioxx stayed on the market for years. It wasn't a failing of the RCT - the data were there - but how it was interpreted.

Baycol, on the other hand, was found to be safe, but that wasn't a failing of RCTs, which aren't powered to find rare AEs. And the rhabdomyolysis from Baycol was rare. Though Baycol caused rhabo up to 80 times the rates of other statins, the rate of rhabdo with Baycol still worked out to about 4 per 100,000 prescriptions - too rare an event for RCTs to generally find. It's the post-marketing surveillance that found the problems with Baycol.

(Zelnorm I don't know about.)
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Bottom line: Busy clinical physicians were led to believe these meds were safe and they turned out to not be. That it was known by researchers early on (and the same was true for Celebrex too) makes it even worse.
 
from the Atlantic article

80 percent of non-randomized studies [...] turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials
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David Gorski, a surgeon and researcher at Detroit's Barbara Ann Karmanos Cancer Institute, noted in his prominent medical blog that when he presented Ioannidis's paper on highly cited research at a professional meeting, "not a single one of my surgical colleagues was the least bit surprised or disturbed by its findings."
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His PLoS Medicine paper is the most downloaded in the journal's history
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if all this is commonly known, then why isn't more being done to change that?
 
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bigmike7104 said:
from the Atlantic article







if all this is commonly known, then why isn't more being done to change that?
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Well, there's just not that much you can do to change it. The reality is that most of the stuff we study is multifactorial and has tons of confounders. We accept P=0.05 as statistical significance, but that means that 5% of significant results were caused just by random chance. Think about that, even if the studies WERE perfect, we would still have 5% of them being wrong. The only way to be truly confident in a conclusion is to verify it multiple times with high quality studies. It's the nature of the beast.

This isn't as bad as it sounds, because people have this in mind when we make treatment decisions. Something doesn't become standard of care by the evidence of one poor quality study. There are systems out there to measure the quality of data so that you can weigh options accordingly.
 
Just out today in Scientific American:
http://www.scientificamerican.com/article.cfm?id=demand-better-health-care-book

This topic seems to be getting quite a bit of attention recently. It's sobering.

The authors state several times something along these lines: "The gap between what is proven to work and what physicians actually do poses a serious threat to the health and well-being of all of us."

On page 4, the authors mention the US gov't AHCPR guidelines for acute low back pain, published way back in 1994. They point out that back surgery wasn't given the greatest of reviews, and how consequently the surgeons revolted and ultimately had the agency that published the guidelines essentially wiped off the map. What the authors don't mention is that the treatment that was recommended as first-line treatment of acute low back pain, based on the evidence, was...wait for it...spinal manipulation. I remember the publication of this 1994 guideline because I was just entering practice at that time. Imagine: a government agency reviewing all the evidence giving a thumbs up to spinal manipulation (we might as well say chiropractic) and a thumbs down to most back surgery. :scared: Here's the link to that 1994 report: http://www.ncbi.nlm.nih.gov/books/NBK16662/
 
facetguy said:
Just out today in Scientific American:
http://www.scientificamerican.com/article.cfm?id=demand-better-health-care-book

This topic seems to be getting quite a bit of attention recently. It's sobering.

The authors state several times something along these lines: "The gap between what is proven to work and what physicians actually do poses a serious threat to the health and well-being of all of us."

On page 4, the authors mention the US gov't AHCPR guidelines for acute low back pain, published way back in 1994. They point out that back surgery wasn't given the greatest of reviews, and how consequently the surgeons revolted and ultimately had the agency that published the guidelines essentially wiped off the map. What the authors don't mention is that the treatment that was recommended as first-line treatment of acute low back pain, based on the evidence, was...wait for it...spinal manipulation. I remember the publication of this 1994 guideline because I was just entering practice at that time. Imagine: a government agency reviewing all the evidence giving a thumbs up to spinal manipulation (we might as well say chiropractic) and a thumbs down to most back surgery. :scared: Here's the link to that 1994 report: http://www.ncbi.nlm.nih.gov/books/NBK16662/
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Of course the surgeons revolted, they don't have to deal with these patients after they say "not a surgical candidate". As a PCP, I'd love to have a few DCs in my area that I knew were sticking to regular MSK (hell even dietary stuff). Its just hard for me to know who's like that and who thinks they can cure diabetes.
 
VA Hopeful Dr said:
Of course the surgeons revolted, they don't have to deal with these patients after they say "not a surgical candidate". As a PCP, I'd love to have a few DCs in my area that I knew were sticking to regular MSK (hell even dietary stuff). Its just hard for me to know who's like that and who thinks they can cure diabetes.
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I don't want to make this thread about chiropractic; I just remember that AHCPR story from when it happened. Chances are good that there are indeed chiros in your area that you can rely on.

You mention diabetes. This could actually be one example where a chiro (or anyone else) could approach a cure (assuming we're talking T2DM). I just posted this small study in another thread: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/?tool=pubmed

After 6 months, 95% of the low-carb subjects had reduced or eliminated their diabetes meds. This is the diet that Duke, as one example, uses for their 'diabesity' patients. Something to think about.
 
facetguy said:
After 6 months, 95% of the low-carb subjects had reduced or eliminated their diabetes meds. This is the diet that Duke, as one example, uses for their 'diabesity' patients. Something to think about.
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The influence of diet on DM2 is exhaustively studied and documented. Pts who have successfully managed to lose massive amounts of weight and maintain this wt loss effectively "cure" their DM2. Trouble is, as found in clinical trials and clinical experience, most patients find it extremely hard to maintain wt loss. Even when people are educated about the risks, blindness, loss of limbs, CKD, the influences of culture/lifestyle are too pervasive. The folks who do manage to do it are basically unusually tough-minded. The rest are more like, "I just don't have any self-discipline, tee hee," picking up their metformin along with the 2L bottles of pepsi.

Think of the life-long smokers, post-cancer surgery, holding their ciggys up to their trach. Most people are like this when it comes to food.
 
Pharmavixen said:
The influence of diet on DM2 is exhaustively studied and documented. Pts who have successfully managed to lose massive amounts of weight and maintain this wt loss effectively "cure" their DM2. Trouble is, as found in clinical trials and clinical experience, most patients find it extremely hard to maintain wt loss. Even when people are educated about the risks, blindness, loss of limbs, CKD, the influences of culture/lifestyle are too pervasive. The folks who do manage to do it are basically unusually tough-minded. The rest are more like, "I just don't have any self-discipline, tee hee," picking up their metformin along with the 2L bottles of pepsi.

Think of the life-long smokers, post-cancer surgery, holding their ciggys up to their trach. Most people are like this when it comes to food.
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It's true that long-term weight management isn't easy for many. But I don't think we shouldn't try. The Westman study I linked showed that T2DM benefits began even before weight loss, suggesting a metabolic effect to this way of eating outside of weight loss alone. This effect has also been seen in gastric bypass patients, almost immediately in some cases, well before any weight loss occurred.
 
facetguy said:
I don't want to make this thread about chiropractic; I just remember that AHCPR story from when it happened. Chances are good that there are indeed chiros in your area that you can rely on.

You mention diabetes. This could actually be one example where a chiro (or anyone else) could approach a cure (assuming we're talking T2DM). I just posted this small study in another thread: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/?tool=pubmed

After 6 months, 95% of the low-carb subjects had reduced or eliminated their diabetes meds. This is the diet that Duke, as one example, uses for their 'diabesity' patients. Something to think about.
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I actually meant that as a slight towards surgeons, little more.

You know what I meant about curing diabetes. Good diet, weight loss, and exercise seems more management to me. We do have diet-controlled diabetics, after all.
 
VA Hopeful Dr said:
I actually meant that as a slight towards surgeons, little more.

You know what I meant about curing diabetes. Good diet, weight loss, and exercise seems more management to me. We do have diet-controlled diabetics, after all.
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I'm with ya. :thumbup:
 
facetguy said:
Just out today in Scientific American:
http://www.scientificamerican.com/article.cfm?id=demand-better-health-care-book

This topic seems to be getting quite a bit of attention recently. It's sobering.

The authors state several times something along these lines: "The gap between what is proven to work and what physicians actually do poses a serious threat to the health and well-being of all of us."

On page 4, the authors mention the US gov't AHCPR guidelines for acute low back pain, published way back in 1994. They point out that back surgery wasn't given the greatest of reviews, and how consequently the surgeons revolted and ultimately had the agency that published the guidelines essentially wiped off the map. What the authors don't mention is that the treatment that was recommended as first-line treatment of acute low back pain, based on the evidence, was...wait for it...spinal manipulation. I remember the publication of this 1994 guideline because I was just entering practice at that time. Imagine: a government agency reviewing all the evidence giving a thumbs up to spinal manipulation (we might as well say chiropractic) and a thumbs down to most back surgery. :scared: Here's the link to that 1994 report: http://www.ncbi.nlm.nih.gov/books/NBK16662/
Click to expand...

Although back surgery is oversold (however it can be hard to predict who will benefit and who wont) "subluxation" manipulation is not necessarily the answer, there are cheaper and less dishonest management strategies.
http://www2.cochrane.org/reviews/en/ab000447.html
 
Frozen said:
Although back surgery is oversold (however it can be hard to predict who will benefit and who wont) "subluxation" manipulation is not necessarily the answer, there are cheaper and less dishonest management strategies.
http://www2.cochrane.org/reviews/en/ab000447.html
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You're a bit off topic here, no? But since you brought it up, what does that Cochrane review say? This particular Cochrane review was VERY selective in the studies reviewed and arguably presents the worst possible assessment of spinal manipulation for LBP. And still, what does it say? It says SMT is no less effective than all the treatments you will someday order for your LBP patients.

Let me ask you, Frozie, if you're the objective, evidence-based soon-to-be physician that I'd guess you'd claim to be, can you continue to say that spinal manipulation for LBP is bogus despite it being proven time and again to be just as effective as anything else out there for these patients? Be the scientist you want us to believe you are and accept the evidence for what it is, even if it shatters your preconceived notions and prior biases.

And when you say cheaper, do I also have to post links to cost-effectiveness studies for you, or will you do your homework and actually read the literature?

Now go home and get your shinebox. (Can anyone name the movie?)
 
facetguy said:
You're a bit off topic here, no? But since you brought it up, what does that Cochrane review say? This particular Cochrane review was VERY selective in the studies reviewed and arguably presents the worst possible assessment of spinal manipulation for LBP. And still, what does it say? It says SMT is no less effective than all the treatments you will someday order for your LBP patients.

Let me ask you, Frozie, if you're the objective, evidence-based soon-to-be physician that I'd guess you'd claim to be, can you continue to say that spinal manipulation for LBP is bogus despite it being proven time and again to be just as effective as anything else out there for these patients? Be the scientist you want us to believe you are and accept the evidence for what it is, even if it shatters your preconceived notions and prior biases.

And when you say cheaper, do I also have to post links to cost-effectiveness studies for you, or will you do your homework and actually read the literature?

Now go home and get your shinebox. (Can anyone name the movie?)
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I will not have a rational debate with someone who is rude and insulting. Post all you want, I won't bother reading anymore.
Frozen
 
Frozen said:
Although back surgery is oversold (however it can be hard to predict who will benefit and who wont) "subluxation" manipulation is not necessarily the answer, there are cheaper and less dishonest management strategies.
http://www2.cochrane.org/reviews/en/ab000447.html
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Frozen said:
I will not have a rational debate with someone who is rude and insulting. Post all you want, I won't bother reading anymore.
Frozen
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Sorry if I hurt your feelings. But I think it's clear you threw the first stone with your comments and by linking to a study that you misinterpreted to mean spinal manipulation has no value. And you did it in a thread that has nothing to do with spinal manipulation.

(And were my comments really that harsh? Did you think I wouldn't respond to your wisecrack?)
 
From Boston Globe, few days ago:
"Trial and Too Many Errors: Evidence-Based Medicine Can Be Built on Opinion and Selective Evidence"
http://www.boston.com/bostonglobe/e...11/04/17/trial_and_too_many_errors/?page=full

"Drug manufacturers tend to be the sponsors of the largest and most expensive randomized clinical trials. As such, they are the gatekeepers of a significant percentage of the gold-standard medical evidence used to determine the best treatments.
Yet troubling examples have surfaced of companies keeping “adverse events’’ data — such as painful side effects — hidden, or of publishing only studies that are positive for a drug, while burying the negative results."

"Journals won’t take easily to such a watchdog role, because they are dependent on the industry to survive. In addition to advertising, sales from reprints are a significant source of revenue for journals. Publishing a major study can mean up to $1 milllion in reprint sales — much of that coming from the companies themselves, which buy copies to distribute to doctors."

Again, just a reminder that what we read as 'evidence' isn't always what it seems.
 
The question, of course, is always: as opposed to what?
 
facetguy said:
"Nobody gets a promotion from publishing a negative study." In other words, design the study and manipulate the data so that you assure the outcome you want. Not very science-based.
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I think the article misinterpreted what is actually publication bias, where positive trials get published while negative trials go in the bin. You can't get away with manipulating the data to ensure a positive outcome.
 
I think the number should be lesser than 80, I am a Pharma Student & best according to my knowledge science based medicines are the only one with high rate of success in compared to Ayurveda or other Chinese Evolved Medicines. Eight percent were as likely to be harmful as beneficial this statement is totally wrong and can't be justified. This left the largest category, 46 percent, as unknown in their effectiveness is true & moreover the SSRI drugs are the new face of Science based medicine as most of the people have shifted to it for routine sickness like influenza & etc.
 
Pharmavixen said:
I think the article misinterpreted what is actually publication bias, where positive trials get published while negative trials go in the bin. You can't get away with manipulating the data to ensure a positive outcome.
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Through the miracle of statistics, you can most definitely manipulate data to generate a p value <0.05.
 
BMJ: "Scientific Misconduct Is Worryingly Prevalent"
http://www.bmj.com/content/344/bmj.e377

"One in seven UK based scientists or doctors has witnessed colleagues intentionally altering or fabricating data during their research or for the purposes of publication..."

Does this instill confidence in the medical literature that you read and upon which practice guidelines/policies are based?
 
Fraud in published drug studies:
http://www.newswise.com/articles/facts-in-scientific-drug-literature-may-not-be-study-finds

"A growing concern with fraud and misconduct in published drug studies has led researchers at the University of Illinois at Chicago’s Center for Pharmacoeconomic Research to investigate the extent and reasons for retractions in the research..."We were surprised to find the proportion of retractions due to scientific misconduct in the drug literature is higher than in general biomedical literature," said Simon Pickard, associate professor of pharmacy practice and senior author of a study published in the journal Pharmacotherapy."

"These studies can affect the treatment of thousands of patients, since scientific publications are often printed months in advance. There is an average lag in time of 39 months between the original publication and a retraction notice, Pickard said.
"Once a health care professional changes treatment options, it’s not easy to reverse," said Jennifer Samp, a fellow in Pickard’s research group and lead author of the study. "
 
I'm often surprised at how little evidence there really is to support many conventional medical treatments.
 
"But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders. "

- Regardless the motive/s behind the argument in this post I think that the very last sentence is a bold message to us all. Alternative medicine is infact a reality and should not be taken lightly. There is nothing when we accept that reality as long as well still stick to what we perceive as fact and true!

piece ya'll:)
 
picture.php
 
What I take from this is that 46% of medicine being unknown in conventional practice vs probably around 90% unproven/debunked in alternative medicine still leaves conventional in a better position by a mile. Remember a lot of alt med is garbage, vertebral subluxation adjustment, aruveda's kappa/pitta classification system, traditional chinese medicine, naturopathy's adoption of woo like homeopathy but we don't see the alt meder's throwing out tradition to keep improving their practices so MDs have good cause to be careful. Granted medicine is way too political and lobbiest influenced. Because the strong drug and food industry bias does limit medical education MDs should read supplement research and not hesitate to recommend standardized supplements when they may help a condition. The correct course of action is to teach evidence based courses on supplements and other useful practices and to work to minimize industry influence. But endorsing woo unconditionally under the banner of alt med like Andrew Weil does is a big mistake that only benefits the woo pushers.
 
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NY Times article from today on the Celebrex story/scam:
http://www.nytimes.com/2012/06/25/h...ns-of-doubt-and-deception.html?pagewanted=all

"A research director for Pfizer was positively buoyant after reading that an important medical conference had just featured a study claiming that the new arthritis drug Celebrex was safer on the stomach than more established drugs. “They swallowed our story, hook, line and sinker,” he wrote in an e-mail to a colleague.
The truth was that Celebrex was no better at protecting the stomach from serious complications than other drugs. It appeared that way only because Pfizer and its partner, Pharmacia, presented the results from the first six months of a yearlong study rather than the whole thing."

"The documents suggest that officials made a strategic decision during the early trial to be less than forthcoming about the drug’s safety. They show that executives considered attacking the trial’s design before they even knew the results and disregarded the advice of an employee and an outside consultant who had argued the companies should disclose the fact that they were using incomplete data."

And you gotta love this:

"Some of the Celebrex’s detractors contend that its risks are still not fully understood, and argue that Pfizer is dragging its feet on a study — now nearly six years old — evaluating the drug’s heart risks. The study is scheduled to end in May 2014, the same month that Celebrex loses its patent protection and sales of the drug are expected to plunge."

In other words, we'll let y'all know whether our drug is killing your patients...just as soon as we're done reaping huge profits from it.
 
That Celebrex trial story is kinda old news, considering it was published in the late 90s. In my post-graduate pharmD course, it was used as a teaching tool for how statistics can be misused to cast a drug in a more favourable light.

But it's the modalities of science-based medicine that exposes these kinds of fraud. If you apply this same level of rigour to the Complementary and Alternative Medicine field, you reveal it as the sCAM that it is. Homeopathy violates basic laws of physics. Chiropractic subluxations don't exist. Ayurvedic medicines are frequently found to be full of toxic heavy metals. Traditional Chinese medicine not only doesn't work, but also devastates populations of endangered species. The "vitalism" that is the basis of naturopathy is complete nonsense. Etc.

But practitioners of sCAM don't want scientific methods used to scrutinize their lucrative and widespread fraudulence. So that's why we see folks using scientific methods to discredit scientific methods. If people swallow that basic logical contradiction, they'll be more likely to fall for your sCAM.
 
Pharmavixen said:
That Celebrex trial story is kinda old news, considering it was published in the late 90s. In my post-graduate pharmD course, it was used as a teaching tool for how statistics can be misused to cast a drug in a more favourable light.
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Some documents related to the case were just released, that's why it was in the Times last week. I'm glad to hear that case is used as an example, a large example, in your course. But I'm sure you guys studied other cases as well, because this is obviously not the only example of statistics being misused to cast a drug in a more favorable light.

Pharmavixen said:
But it's the modalities of science-based medicine that exposes these kinds of fraud. If you apply this same level of rigour to the Complementary and Alternative Medicine field, you reveal it as the sCAM that it is. Homeopathy violates basic laws of physics. Chiropractic subluxations don't exist. Ayurvedic medicines are frequently found to be full of toxic heavy metals. Traditional Chinese medicine not only doesn't work, but also devastates populations of endangered species. The "vitalism" that is the basis of naturopathy is complete nonsense. Etc.

But practitioners of sCAM don't want scientific methods used to scrutinize their lucrative and widespread fraudulence. So that's why we see folks using scientific methods to discredit scientific methods. If people swallow that basic logical contradiction, they'll be more likely to fall for your sCAM.
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I can't speak for all of CAM, but the chiropractic profession has been doing research for decades now, even using scientific methods. ;) Now, I could only wish we had the kind of research dollars available as other areas of science, but oh well.

But anyway, you mentioned chiropractic subluxations and that they don't exist. Yes, the term subluxation is still used in the profession, I won't deny that. Nor will I deny that that term causes confusion. But much of the profession feels as though that term represents more of a historical concept. So, would you be willing to say that the chiropractic profession, minus the term subluxation, isn't quite so bad?
 
facetguy said:
I can't speak for all of CAM, but the chiropractic profession has been doing research for decades now, even using scientific methods. ;) Now, I could only wish we had the kind of research dollars available as other areas of science, but oh well.
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What would you like to research? DCs are masters of deception. You use outdated false biomechanics and push it by making outrageous therapeutic claims that are not supported by science.

Like pharmaceutical research, most of what comes out of chiropractic is self serving and doesn't advance the knowledge base. Any lack of funding is likely a reflection of the implausibility of the field.

But anyway, you mentioned chiropractic subluxations and that they don't exist. Yes, the term subluxation is still used in the profession, I won't deny that. Nor will I deny that that term causes confusion. But much of the profession feels as though that term represents more of a historical concept. So, would you be willing to say that the chiropractic profession, minus the term subluxation, isn't quite so bad?
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Nonsense. Most chiropractors sell subluxation as being real and manipulation as curing osteoarthritis. It is quackery. Your unwavering denial of this really is pathetic.
 
Pharmavixen said:
But it's the modalities of science-based medicine that exposes these kinds of fraud. If you apply this same level of rigour to the Complementary and Alternative Medicine field, you reveal it as the sCAM that it is. Homeopathy violates basic laws of physics. Chiropractic subluxations don't exist. Ayurvedic medicines are frequently found to be full of toxic heavy metals. Traditional Chinese medicine not only doesn't work, but also devastates populations of endangered species. The "vitalism" that is the basis of naturopathy is complete nonsense. Etc.

But practitioners of sCAM don't want scientific methods used to scrutinize their lucrative and widespread fraudulence. So that's why we see folks using scientific methods to discredit scientific methods. If people swallow that basic logical contradiction, they'll be more likely to fall for your sCAM.
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I think many CAM people would love rigorous research but where's the $$? The research scientist Oakley Gordon says forget trying to apply western scientific research to some CAM as it just won't work. Victoria Sweet, M.D and with a Ph.D. in the history of medicine, went back and studied the medicine of the medieval German nun Hildegard and actually used it successfully. Don't discount everything...
 
zenman said:
I think many CAM people would love rigorous research but where's the $$? The research scientist Oakley Gordon says forget trying to apply western scientific research to some CAM as it just won't work. Victoria Sweet, M.D and with a Ph.D. in the history of medicine, went back and studied the medicine of the medieval German nun Hildegard and actually used it successfully. Don't discount everything...
Click to expand...

The big money is almost always in the latest and greatest, and so that's what gets pushed hardest. Anything old falls by the wayside. Sometimes this is a good thing, but not always. Now, your example does take this to the next level of old, but it's an interesting lesson nonetheless.
 
zenman said:
I think many CAM people would love rigorous research but where's the $$?
Click to expand...

When I was in the post-grad pharmD course and had full access to medical databases, I was surprised to discover that there was all sorts of research on sCAM modalities. For instance, vitamin C for cancer has been extensively investigated, and there have been lots of papers published on homeopathy. There was even a Cochrane review of homeopathy, though it has since been withdrawn.

There's also tons of research on herbal remedies for all sorts of things, and the Chinese government sponsors lots of work looking at traditional Chinese medicine remedies. Mostly negative, though any weakly positive results approaching or barely breaching statistical significance are leapt upon with great zeal and fanfare.

The sCAMmers insist that there hasn't been enough research. But actually, there has been lots, though for people looking to validate their useless remedies, there will never be enough.

Research is expensive and there's the whole ethical problem of investigating treatments with nothing to recommend them other than folklore.
 
Pharmavixen said:
When I was in the post-grad pharmD course and had full access to medical databases, I was surprised to discover that there was all sorts of research on sCAM modalities. For instance, vitamin C for cancer has been extensively investigated, and there have been lots of papers published on homeopathy. There was even a Cochrane review of homeopathy, though it has since been withdrawn.

There's also tons of research on herbal remedies for all sorts of things, and the Chinese government sponsors lots of work looking at traditional Chinese medicine remedies. Mostly negative, though any weakly positive results approaching or barely breaching statistical significance are leapt upon with great zeal and fanfare.

The sCAMmers insist that there hasn't been enough research. But actually, there has been lots, though for people looking to validate their useless remedies, there will never be enough.

Research is expensive and there's the whole ethical problem of investigating treatments with nothing to recommend them other than folklore.
Click to expand...

Does this not happen with pharmaceuticals? Of course it does, and frequently. Some of the absolute risk numbers are a joke, which is why we usually see things spun in terms of relative risk. Data gets tortured all the time.

I'm not disagreeing with you in total, I'm just saying we need to be fair and objective about some of the data thats out there for drugs (which carry risk in every case) that lots of people end up taking.

I do have to say I disagree with your pejorative tone, particularly your use of "sCAMmers".
 
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