How do *****s become doctors?

[turkeyjerky]

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Nothing alternative has stood up to the light of day? How do you know? Do you know the outcomes of all the studies that have ever been done on alternative therapies? Try telling that to the hundreds of people I know who have healed from cancer with a completely alternative approach- no chemo, no surgery, no radiation. I'm not saying that conventional things are wrong and I'm not saying there are not cases where they are necessary. I'm just saying there's more out there.

Do you know that researchers have been banished from the country upon discovery of cures for certain kinds of cancer? Do you know about the Hoxsey Cancer Clinics and the persecution that Hoxsey himself was subject to at the hands of the government? Do you know about the other researchers, like the one who studied at a very renowned school where one of my professors was a postdoc? He was working on a cure for cancer and was banished from the United States as a result? Do you know that the American Cancer Society has to disband once a cure is found?

Looks like we have more than one ***** on this thread

 

[bkz]

... learn now to think for yourself rather than parrot what you've been told. Learn to examine the evidence and make your own decisions or stay the hell out of medicine.

You've posted a lot of valuable things here and this is one of the best.

Your status as a school admin doesn't give you privileges to be abusive to applicants.

rkaz there is more than a little irony in condemning LizzyM for her views as an authority figure when her POINT is about questioning authority.

 

[Hyperstudyosis]

No, I don't. I delete them unread. I don't read SDN PSs.


Also, in terms of teachers and parents being authorities... learn now to think for yourself rather than parrot what you've been told. Learn to examine the evidence and make your own decisions or stay the hell out of medicine.

I didn't send you my PS, but rather the general idea of what I wanted to talk about and you sent me a message back, so I know you read it. As for thinking for myself....I am learning to do that. Life is a learning process. You're right that I should read the ACS Constitution for myself instead of trying to quote it from what someone else (actually, an MD) told me. But your comment about the tin hat wasn't necessary. And what if I do examine the evidence and make a decision you don't agree with? Will you still tell me to stay the hell out of medicine?

Thank you, rkaz for reminding me not to conform. I need constant reminders of that, as it is very difficult for me to accept my vulnerability enough to be my own person. It sounds like you've been studying alternative medicine for quite some time. Me too. I've been independently studying all different aspects of it since I was 14. I'm glad that you are going to medical school, rkaz.

Shaptown, I have personally witnessed people with stage IV metastatic cancer recover without the use of Western medicine. I will be the first to say that we need Western medicine, however I would like people to remain open-minded because our way is not the only way. Do you know from personal experience or research that Eastern medicine will do NOTHING for stage IV metastatic melanoma?

And Lizzy, I'm not a complete conspiracy theorist- I don't think the whole world is going to hell in a handbasket because of the government. But I do think that the government is foolish sometimes and thinks more about its own agenda than what will really make a differnce in society...and more about the short term than the long term.

 

[bkz]

As for thinking for myself....I am learning to do that. Life is a learning process. You're right that I should read the ACS Constitution for myself instead of trying to quote it from what someone else (actually, an MD) told me. But your comment about the tin hat wasn't necessary.

*puts moral superiority hat on* 😛 You shouldn't whine about constructive criticism when someone is trying to teach you something. If they were truly trying to insult you or didn't want you to succeed they wouldn't say anything at all.

 

[Hyperstudyosis]

Looks like we have more than one ***** on this thread

Oh, I'm sure there are lots of us! I don't mind being associated with them though. After all, isn't that what they called Christopher Columbus, Isaac Newton, Galileo, Patch Adams?

 

[Hyperstudyosis]

*puts moral superiority hat on* 😛 You shouldn't whine about constructive criticism when someone is trying to teach you something. If they were truly trying to insult you or didn't want you to succeed they wouldn't say anything at all.

They would if they were angry. After all, isn't that what we do in these forums...call people idiots and *****s? Do I fool myself into thinking anyone really cares about my personal development? Ha, that's funny.

 

[bkz]

They would if they were angry. After all, isn't that what we do in these forums...call people idiots and *****s? Do I fool myself into thinking anyone really cares about my personal development? Ha, that's funny.

😕 You're being sarcastic but c'mon, think about it--we come here to learn and get to know our future colleagues. If you get a reputation for being sensitive to everyone who disagrees with you, you will miss out on a lot of valuable advice.

 

[Hyperstudyosis]

😕 You're being sarcastic but c'mon, think about it--we come here to learn and get to know our future colleagues. If you get a reputation for being sensitive to everyone who disagrees with you, you will miss out on a lot of valuable advice.

I don't think I'm the one being sensitive. I'm okay with people disagreeing with me. I don't judge anybody else for having a different point of view. But they are judging me for having a different point of view. That is the thing. I embrace diversity in medicine. If we were all the same we wouldn't be able to meet everyone's needs, right? Because our patients are going to be diverse and they are going to come to us with diverse needs. I would just prefer that all the name calling could stop and I would prefer not to be rejected on the basis of my personal opinions.

 

[Shaptown]

the analogy of the old man who thinks everyone else is driving the wrong way on the freeway comes to mind...

 

[LizzyM]

I didn't send you my PS, but rather the general idea of what I wanted to talk about and you sent me a message back, so I know you read it.

I got 30 PMs this week. I don't remember the details of any of them. It is highly unlikely I'd recognize anyone based on a PM about a PS. (I've only recognized one person and that was a frequent poster and non-trad who had very unusual career before applying to med school.)

 

[Kaustikos]

I got 30 PMs this week. I don't remember the details of any of them. It is highly unlikely I'd recognize anyone based on a PM about a PS. (I've only recognized one person and that was a frequent poster and non-trad who had very unusual career before applying to med school.)

I was the guy who watched you in the crowds, who stood in your lawn staring. Who watched you as you took a shower...always with the most sincere of intentions. Who recorded your interviews and uploaded them on youtube.

I LOOOOOOOOOOOOOOOOOOOOOOOOOVE YOU

 

[circulus vitios]

A misunderstanding of the word 'double-blind' completely undermines 4 years of medical school, 3+ years of residency, and a fellowship.

 

[GoSpursGo]

Dangit, I hate to put on my moderator hat.

It makes me look very silly.

Let's try to avoid insulting other members and keep things civil, shall we? Thanks! *hat off*

 

[Forthegood]

Acupuncture is a sham. Period. You can't necessarily (there are always exceptions) group all the CAM as placebo, but the vast majority are. And acupuncture is no different.

Saying "tell that to such and such who felt better after acupuncture" is about as valid as saying giving a kid with cancer a popsicle and him feeling better means that the popsicle is an effective therapy. Except for the fact that acupuncture has been well studied and is not effective, while the verdict is still out on said popsicle.

Premed or not, the value is in the reading the primary literature and books on the subject and not on the degree in progress.

SDN has a bad habit of trying to discredit people because they don't have a degree, rather than on the content and validity of their argument.

 

[phospho]

A misunderstanding of the word 'double-blind' completely undermines 4 years of medical school, 3+ years of residency, and a fellowship.

👍

Again, this has nothing to do whether the OP was correct in identifying the mistake, or bringing it up. In fact, the OP demonstrated an important trait most premeds should have - the ability to think critically. What bothers me is the arrogance presented in the original post.

I would hate to think that in 15 years from now, after I finish medical school, residency, and fellowship, some 20 year old premed would actually have the audacity to call me a "*****" on a public forum because of a mistake I made (and we will ALL make mistakes at one point or another).

If this isn't downright arrogant/rude/off base/unnecessary/bad form/over the top, I don't know what the hell is.

 

[TehDoc]

Looks like this thread backfired on you OP.

 

[Depakote]

Recently I attended a short presentation by an oncology fellow who was doing her project in acupuncture (and its applications in oncology).

I should have to end this post here. The fact that she's wasting her time on long "disproven" nonsense should be enough.

However, her study design was also horribly flawed. She performed both the real acupuncture and sham (fake) acupuncture. So at the end, during the question and answer, I asked her how it's double blind if she's doing both arms and she knows what her patients are receiving. She said she doesn't perform the stats, so it's double blind. WHAT?

She obviously has never heard of investigator bias. This is something she should have learned in first year of UNDERGRADUATE (possibly even in high school).

So my question is, how do people like this become doctors?

I hate to get involved in a thread like this, but there are a few ways I could see this being double blind.

If she was the person actually performing the acupuncture (which seems odd I don't know where a fellow would have had the time to pick up extra acupuncture training), she could have done real and sham acupuncture on randomly assigned cohorts of patients. The patient would be blinded to their treatment assignments. The data collection and analysis (the "stats") would be performed by a third party, also blinded to type of acupuncture performed by the fellow.

The integrity of the study is maintained as the investigator is not privy to the data prior to collection and analysis and neither the patient nor the data collector/analyst is privy to the treatment assignment.

The other possibility is that the IRB reviewing the study, the PI and the fellow running the study are all *****s for not understanding this as well as a pre-med.

 

[bonoz]

Fread backfire ftmfw!

 

[Longshanks]

Had to jump in here now that I came across this... absolutely ridiculous. Let's point out all of the fallacies of the OP one by one, let this be a lesson here...
1.) How is acupuncture long disproven? Where is the evidence supporting this claim? Is it standardized western medicine? No, it is not, however it has been practiced for quite a long time and there is a sizeable population who apparently reap benefit from it. In fact, more and more schools are at least introducing their students to what various forms of alternative medicine are out there, both as possible alternative regimens and to better understand what quackery is out there and better educate patients. Now, what unbiased peer reviewed study to we have eliminating acupunture as a viable supplemental treatment regimine?

2.) In a double blind study a research term can perform both arms so long as you analyzed the data in a blinded fashion. Maybe this is something that hasn't come across in your training or schooling, however we can use an actual published example here: a research term treat mice with with a gene defect with bacteria A or control. After 30 days mice are sacrificed and organ samples are taken for histology, the pathology department returns the samples to the PI whom then looks at each slide unknowing which slide came from which group. The study was therefore performed in a blinded fashion. How does this relate to this scenario? I highly doubt the oncologist performed the acupuncture, rather acupuncturists performed the therapy under the oncologist's direction and supervision in accordance to her experimental protocol, which then she analyzed the data afterwards - the study was blinded.

3.) To return a question of yours, how do people like you come on to SDN and call attendings idiots when you're still but a lowly pre-med like the rest of us?

 

[Suenya]

Acupuncture for pain management, at least, is still very much in the aether between being validated or not. The ridiculous individual anecdotes aside (that's exactly what you would expect with a strong placebo, please realize that. It's not particularly strong evidence), the body of evidence still leans toward acupuncture outperforming placebo.

I think it is probably type 1 error, and that eventually evidence will mount that acupuncture does not work more than placebo, but an honest evaluation of the state of the field shouldn't leave anyone with a strongly settled opinion that that is the case. It's nowhere near that clear, and anyone who thinks it is likely to have already made their decision prior to viewing the data.

 

[hopefuldoc87]

SDN has a bad habit of trying to discredit people because they don't have a degree, rather than on the content and validity of their argument.

The problem isn't in the content or validity of the argument. It was the way the OP presented it. It's called showing a little respect for someone who has gone through the gauntlet of medical school, residency, and fellowship. That in itself is no easy task. I'm not trying to look oversensitive, but it's the equivalent of a high school student who is thinking of becoming pre-med insulting a medical school student (who has accomplished the difficult task of getting IN to a medical school). Now if the medical school student says something stupid or *****ic, then OK, fair game. But to call someone a ***** for using double-blind wrong (which was debatable according to some previous posters), was a little crass.

I have no problem with the OP critically thinking and questioning the doc. Calling him/her a ***** on the other hand was uncalled for, especially when the OP hasn't proven he/she is capable of getting into a medical school.

 

[Chuck's Right Foot]

I hate to get involved in a thread like this, but there are a few ways I could see this being double blind.

If she was the person actually performing the acupuncture (which seems odd I don't know where a fellow would have had the time to pick up extra acupuncture training), she could have done real and sham acupuncture on randomly assigned cohorts of patients. The patient would be blinded to their treatment assignments. The data collection and analysis (the "stats") would be performed by a third party, also blinded to type of acupuncture performed by the fellow.

The integrity of the study is maintained as the investigator is not privy to the data prior to collection and analysis and neither the patient nor the data collector/analyst is privy to the treatment assignment.

The other possibility is that the IRB reviewing the study, the PI and the fellow running the study are all *****s for not understanding this as well as a pre-med.

I think with the mice population, the possible placebo effects aren't influenced by doctor/subject interaction, but in the case of accupuncture, this interaction could be an issue, most likely in self-report measurements of pain, nausea, etc.

 

[235009]

People on SDN should really read the whole thread before they post something *****ic. I pointed out the same exact thing (that OP is completely wrong in calling the attending a ***** and that she was actually right) in post FIVE and yet people kept jumping on his bandwagon until LizzyM posted the same exact reasoning a couple dozen posts later:

she's not wrong IF she preforms all the procedures but isn't the one who is asking the patients how they feel afterwards. If the person asking the patients how they feel is blinded to which procedure the patient got then it is double blinded.

Double blind means that neither the subject nor the person measuring outcomes knows whether the subject receives the real therapy or the placebo(or in this case, sham procedure).

...it's pretty obvious that people believe LizzyM only because she's a school admin, even in matters where she isn't necessarily an expert (like this). I think i'm going to go ahead and change my status to "medical student" because apparently that automatically gives you authority on SDN....even though it is my degree and experience that gives me authority in this subject and definitely not the fact that i got into med school.

👍👍 My dad is a professional statistician (for clinical trials), and double-blind means the person providing treatment does not know if the patient receives the real treatment or a placebo. The person/people who do know should never be meeting the patients at all.

keep in mind that your dad's degrees and experience do not magically transfer to you through osmosis. it would've been pretty smart of you to go seek out your dad and ask him about this so you could further your knowledge rather than using "my dad is a professional statistician" as a way to try and give more credibility to your incorrect guess.

Medical students(and yes "premeds") are trained to possess an independent thought accompanied with critical thinking. Calling the doctor a ***** might be out-of-line but questioning her work is not.Blind submission to authority won't get you very far as a scientist. I can't tell you the number of times residents have called out their attendings for the good of the patients at the hospital where I work.

the way OP approached this is ridiculously arrogant and goes to show that he doesn't really care much about actually learning. it's perfectly fine to question this attending and it's great that he asked a question during her presentation. she probably didn't answer his question sufficiently because she assumed (incorrectly) that he was well versed in study design. rather than arrogantly posting on here a diatribe about this attending physician being a "*****" he should have made a thread asking higher authorities (people with greater understanding of study design than he has) on SDN who was right. if he is in fact justified in his criticism then he can knock himself out and call the attending a *****. but alas he instead chose to make a fool of himself.

A premed calling a doctor a ***** is not "out of line" - he's a *****.

again if he had posed his concern to someone who is well versed in experimental design who can tailor the explanation down to his level and finds that he is right he can knock himself out and call the attending a ***** all he wants.

 

[Chuck's Right Foot]

doing the stats doesn't mean measuring the outcome, hence the OPs discussion of investigator bias.

If the physician was the one collecting the data, there could be issues.

 

[BennieBlanco]

answer:

1. They take the pre-reqs and MCAT with strong stats
2. Have other good ECs
3. Apply to medical school
4. Graduate and find a good residency or enter PC

Done.

 

[softmed]

(that OP is completely wrong in calling the attending a ***** and that she was actually right)

She was wrong. I am right. You obviously need to refresh yourself on what double blind means. Quoted from the skeptic dictionary: "The evaluator is kept blind to the controls to prevent him or her from subtly tipping off the subject, either knowingly or unknowingly."

http://www.skepdic.com/control.html

I also enjoy the fact that everyone is calling me arrogant, then going on to act as if I know nothing about experimental design. I'm in graduate school. All I do is read about experiments, design them, and perform them all day.

I'm not sure why everyone is up in arms about me calling her a *****. This is a message board. That makes it probably the most informal media possible. Perhaps she is well trained as a doctor, but the fact that she believes in ancient Chinese nonsense medicine is a bit scary.

That brings up another point. At least twice people have criticized me for calling acupuncture nonsense. To those people: have you ever read the meta studies on acupuncture? I assure you, the science agrees with me. Sham acupuncture and real acupuncture both work equally well.

 

[Forthegood]

1.) How is acupuncture long disproven?

It is not. It is RECENTLY disproven.

Where is the evidence supporting this claim?

Pubmed. Mainly.

Is it standardized western medicine? No, it is not, however it has been practiced for quite a long time and there is a sizeable population who apparently reap benefit from it. In fact, more and more schools are at least introducing their students to what various forms of alternative medicine are out there, both as possible alternative regimens and to better understand what quackery is out there and better educate patients.

Excellent. But if you would read, rather than assume you are just naturally always right, you would see that this is education on placebos.

Now, what unbiased peer reviewed study to we have eliminating acupunture as a viable supplemental treatment regimine?

The Cochrane reviews does a pretty good job.

But what the hell, let's ask someone who has dedicated their whole life to it. Barker Bausell was the Research Director at the NIH Complementary and Alternative Medicine Research Center. His book "Snake Oil Science" does takes a firm stand against the validity of CAM therapy and in his own opinion is convinced the effects seen are placebo effects. Here is a quote from p275,

"No CAM therapy has a scientifically plausable biochemical mechanism of action over and above thos proposed for the placebo effect."

and later...

"Unfortunately, the results from high-quality randomized, placebo controlled trials (chapter 11) and systematic reviews (chapter 12) have demonstrated that CAM therapies don't do so, which regretfullly leads me to conclude that: CAM therapies are nothing more than cleverly packaged placebos."

This is what is great about science. You really can show that through math, something does not work.

2.) I highly doubt the oncologist performed the acupuncture, rather acupuncturists performed the therapy under the oncologist's direction and supervision in accordance to her experimental protocol, which then she analyzed the data afterwards - the study was blinded.

Not blinded. Still, even if what you said is correct, you would have to make sure the Acupuncturist in NO WAY showed the patient that the acupuncture was real or fake. Obviously, there are also problems dealing with controlling whether those patients had experienced accupuncture before, or if they knew enough about it to decide whether they were placebo or not. I could go on, but it would take a book, this is in NO WAY adequately controlled.

3.) To return a question of yours, how do people like you come on to SDN and call attendings idiots when you're still but a lowly pre-med like the rest of us?

Attendings can be idiots as well. In fact, most of the crappy studies that you will read (if you bother to do the work yourself, my money is you won't), are done by attendings. Yes, the vast majority are excellent at what they do and deserve much respect. But just because you think they are well trained is no excuse to stop thinking.

Acupuncture for pain management, at least, is still very much in the aether between being validated or not.

No.

The ridiculous individual anecdotes aside (that's exactly what you would expect with a strong placebo, please realize that. It's not particularly strong evidence), the body of evidence still leans toward acupuncture outperforming placebo in poorly conducted studies.

I fixed it so you won't have to.

I think it is probably type 1 error, and that eventually evidence will mount that acupuncture does not work more than placebo, but an honest evaluation of the state of the field shouldn't leave anyone with a strongly settled opinion that that is the case.

Yes, there should be better studies performed. However, there already is a LOT of well-conducted studies out there. They are hard to find because the great number of overall studies in this field are awful.

It's nowhere near that clear, and anyone who thinks it is likely to have already made their decision prior to viewing the data.

I didn't. In fact, until I went through it myself, I was pretty convinced that Chiro and other CAM worked. Fortunately, numbers don't lie. Science can (if allowed) correct even the most closely held beliefs.

 

[caniac]

Be sure to wear a tinfoil hat with your interview suit. I want to recognize you when you come in.

wait, so is it not a good idea to sport my stylish, faux-fur tinfoil hat when I show up at interviews? I mean, it insulates in the winter, is a great accessory for my duct-tape clutch, and keeps both the aliens and the government out of my head. It's just fabulous!!! 😍😍

but if it makes me look like a quack, I guess I'll just have to accessorize differently 🙄

As for the OP's question, 1) unless there's been studies shown that acupuncture is actually harmful, I see no reason to knock it--whatever works to alleviate pain seems valid to me. 2) idiots get in to all schools (and professions) all the time. Eventually, people learn to neither work with these individuals nor trust what they say.

EDIT: I know very little about acupuncture (and don't have PubMed access), so there may have been studies proving it harmful. I'm just saying that if cancer patients choose to believe that it helps alleviate their pain, I see no reason to take it away from them.

 

[smash]

EDIT: I know very little about acupuncture (and don't have PubMed access), so there may have been studies proving it harmful. I'm just saying that if cancer patients choose to believe that it helps alleviate their pain, I see no reason to take it away from them.

Pubmed is a free search engine. I don't know specifically what articles were being referred to, so I don't know if the full text was available from Pubmed or not, but you don't have to have a subscription to use the database search.

 

[235009]

(that OP is completely wrong in calling the attending a ***** and that she was actually right)

She was wrong. I am right. You obviously need to refresh yourself on what double blind means. Quoted from the skeptic dictionary: "The evaluator is kept blind to the controls to prevent him or her from subtly tipping off the subject, either knowingly or unknowingly."

http://www.skepdic.com/control.html

do you really think that everything is as simple as a dictionary definition? Both LizzyM and myself told you why this study is still considered double blinded and all you can to is come back with a dictionary definition and more stubbornness. that's absolutely ridiculous and goes to show that you aren't interested in learning and only interested in being right (even though u aren't). In the study you described SOMEONE had to do the surgery...whether it is the PI or another doctor is completely irrelevant as long as they are not the one collecting the data (in this case asking the patient how they feel after the acupuncture).

it has become blatantly obvious that your problem with this doctor is not that her study design was flawed...we've already told you it isn't...it's that she is studying something you vehemently believe is snake oil and because of your inherent bias you are trying to look for any reason to discredit her study just in case its results don't conform to your belief.

i would direct you to go back and read post 5 and post 27 (which explain to you why you are wrong) but i know you won't so i've included them here:

she's not wrong IF she preforms all the procedures but isn't the one who is asking the patients how they feel afterwards. If the person asking the patients how they feel is blinded to which procedure the patient got then it is double blinded.

i'm assuming this is what happened. so in fact she isn't the *****, you are. in addition to being arrogant.

Double blind means that neither the subject nor the person measuring outcomes knows whether the subject receives the real therapy or the placebo(or in this case, sham procedure).

Obviously, with sham procedures, someone who knows which treatment the subject is getting has to meet the subject to administer the treatment (e.g. how do you do sham surgery studies without having someone meet the subject.) The key is, the person measuring the outcome of interest should not know the subjects' group assignment.

This is a fine point of clinical trial design and one that gets overlooked in placebo controlled drug trials where it is easy to blind the phyisican-investigator who dispenses the study drug and measures outcome. The drug comes in a numbered vial and someone apart from the physician-investigator randomizes the subject and tells the doc which numbered packet to use for that subject.

 

[softmed]

"do you really think that everything is as simple as a dictionary definition? Both LizzyM and myself told you why this study is still considered double blinded and all you can to is come back with a dictionary definition and more stubbornness."

It's funny because I thought LizzyM's post full agreed with what I was saying. Rereading it, I see that it does agree with what I said.

There is a problem with the study design because she's doing both the sham and real procedure. There are many ways the investigator could be blinded to which procedure they're doing. She could easily train a person that knows nothing about acupuncture in both techniques and not tell them which is the real one. Or she could train multiple people. If you look at the study designs of other acupuncture papers this is how they usually accomplish the double blindness.

 

[LizzyM]

"do you really think that everything is as simple as a dictionary definition? Both LizzyM and myself told you why this study is still considered double blinded and all you can to is come back with a dictionary definition and more stubbornness."

It's funny because I thought LizzyM's post full agreed with what I was saying. Rereading it, I see that it does agree with what I said.

There is a problem with the study design because she's doing both the sham and real procedure. There are many ways the investigator could be blinded to which procedure they're doing. She could easily train a person that knows nothing about acupuncture in both techniques and not tell them which is the real one. Or she could train multiple people. If you look at the study designs of other acupuncture papers this is how they usually accomplish the double blindness.

You misread me. There is no problem with the investigator doing the procedures as long as she has someone else measuring the outcomes. You haven't even told us what the outcome of interest is or how it is measured.

Training a person who knows nothing about acupuncture to do it for the study would be fraught with problems as professional accupuncturists are sure to say that the person administering the treatment was poorly trained and didn't do it properly.

 

[softmed]

You misread me. There is no problem with the investigator doing the procedures as long as she has someone else measuring the outcomes. You haven't even told us what the outcome of interest is or how it is measured.

Training a person who knows nothing about acupuncture to do it for the study would be fraught with problems as professional accupuncturists are sure to say that the person administering the treatment was poorly trained and didn't do it properly.

The outcome of interest is pain relief. She gives them a survey when they come back.

It's worth noting that her study so far had shown no difference between the sham (with no needle puncture) and real acupuncture. For some reason that didn't seem to discourage her as she still has a practice where she uses acupuncture to treat obesity, anxiety, and depression. Perhaps that should have been what I wrote about the OP.

 

[LizzyM]

Don't knock placebos... they work about 33% of the time! 🙄

Check this out... just as funny as the day it was published; and it has that grain of truth in it.

http://www.theonion.com/content/node/39082

Also, check out this article on acupuncture & IVF. "Never mind the evidence, it's cheap and people like it...."

http://www.reuters.com/article/healthNews/idUSTRE53F6A720090416

 

[mvenus929]

lol!! I don't really care if the doc was practicing voodoo magic.

you're a premed calling an oncologist a *****...

enough said...

To be fair, there are a number of things that doctors do that 'lowly' techs can see as wrong, because they have a slightly different background. We have a doctor at the hospital I work at who, when putting in ART lines, will order 2 sets of blood cultures.. on the same exact blood. This despite being told by countless phlebs and med techs that you can't charge a patient twice for the exact same procedure.

Granted, I'm not calling him a ***** or idiot, but still... us lowly sometimes less than college educated people can see something wrong about what he orders.

 

[MegaProjectile]

I can't care less if he wants to argue about experimental design (or whatever the hell he's trying to argue about). I'm all for independent thinking, and I'm definitely not condoning "blind submission".

A premed calling a doctor a ***** is not "out of line" - he's a *****.

So it's ok for a doctor to call a fellow doctor a *****? Personal attacks/name-calling is uncalled for regardless if it's coming from a premed or a fellow doctor. You seem to be drawing the line when a premed does it.

 

[Chuck's Right Foot]

Regardless of the terminology, and given the outcome measure, the study sounds far from above reproach.

I believe the term where the practitioner is also blind to sham vs. real treatment is "Triple Blind".

 

[LizzyM]

Recently I attended a short presentation by an oncology fellow who was doing her project in acupuncture (and its applications in oncology).

I should have to end this post here. The fact that she's wasting her time on long "disproven" nonsense should be enough.

However, her study design was also horribly flawed. She performed both the real acupuncture and sham (fake) acupuncture. So at the end, during the question and answer, I asked her how it's double blind if she's doing both arms and she knows what her patients are receiving. She said she doesn't perform the stats, so it's double blind. WHAT?

She obviously has never heard of investigator bias. This is something she should have learned in first year of UNDERGRADUATE (possibly even in high school).

So my question is, how do people like this become doctors?

Getting back to the original question....
This is why we do like students to have some experience with research during undergrad & medical school and residency. To learn some scientific method. However, clinical research poses different challenges than the challenges faced in with animal models, and bench research. There are training grants and opportunities to learn these research methods (clinical and translational research and T-32 are your key words) in some fellowship programs -- after residency but obviously, not everyone has access to that type of training and they go on & make fools of themselves. 🙁

 

[Brent8927]

I'm not going to comment about the initial post, I'm sure that he/she could have commented about the oncologist in a better way. However, I am dismayed by the comments about all of this alternative medicine woo. Modern medicine has to depend on well designed clinical studies or else its no better than everything from the 19th century backwards (maybe even later). It's difficult to design good studies that pass statistical and scientific norms, but almost all of the research (I really don't know one study that was either not challenged as poorly designed or just disproved the point) that has come out of the NCCAM (http://nccam.nih.gov/) has shown alternative/complementary medicine to be terribly useful beyond a placebo effect. For instance, the latest study about acupuncture that came out is discussed on the blog Evidence Based Medicine (http://www.sciencebasedmedicine.org/?p=492). Another post by Orac (http://scienceblogs.com/insolence/2009/05/another_acupuncture_study_misinterpreted.php), basically takes apart the study and shows that acupuncture does nothing beyond a possible placebo effect.

It would be great if any of these things worked, but they really don't. I can come up with as many anecdotal stories as the next person about random remedies and procedures, but when you try to test the cases in a scientific study all of the Alt-med fails. And we spend a lot of money and time in medical schools pushing them instead of proven treatments. We should be careful in legitimating nonsense in the medical arena.

I don't know how you can say with confidence that acupuncture doesn't work. Consider:

An old statement (1997) by the NIH:

"There is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value."

A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective.

Also see:
http://www.mayoclinic.com/print/acupuncture/SA00086/METHOD=print
The Mayo Clinic says acupuncture can help.

Now, the statement by the NIH is a bit outdated, and we don't exactly know too much about the specifics of the poll, but certainly when the Mayo Clinic says acupuncture may help then I think that carries some weight.

I'm just a soon-to-be medical student, so I know very, very little compared to physicians at the Mayo Clinic. But if they say there may be some merit, then I believe there very well may be.

It seems to me that many people who are against CAM are so because it isn't "scientifically proven" or understandable. Just keep in mind that Western medicine evolved from a similar mindset of CAM. At some point it was a bit more "witchcraft" than science. Now it's all about evidence-based medicine, but you can be sure plenty of folk/herbal remedies used in the medieval era have found their way into modern pharmaceuticals--only now we focus on the active ingredient and make it a pill rather than using the leaf and making a tea.

I understand there are many sham treatments/remedies out there (when people say, "it's safe because it's natural" I like to respond that "well, so is radioactive uranium and rattlesnake venom!"

When it comes down to it, CAM seems popular because everyday middle-class Americans like it. I think this is largely because A) People love magic teas! and B) People get more attention and care, or at least feel like they do, with a practitioner of alternative medicine than a western physician. They seem to get hope--which is one of the most powerful medicines out there (just look at a placebo for proof).

I think we should take some of this to heart--people trust doctors a bit less than they used to, and generally feel their physician isn't devoting enough time to taking care of them. We should be a little concerned about this because to heal our patients we need their trust and confidence. If they don't believe in us, they stop coming to us, and if that happens, it doesn't matter if we're right, because we won't have a patient to treat.

 

[unsung]

(that OP is completely wrong in calling the attending a ***** and that she was actually right)

She was wrong. I am right. You obviously need to refresh yourself on what double blind means. Quoted from the skeptic dictionary: "The evaluator is kept blind to the controls to prevent him or her from subtly tipping off the subject, either knowingly or unknowingly."

http://www.skepdic.com/control.html

I also enjoy the fact that everyone is calling me arrogant, then going on to act as if I know nothing about experimental design. I'm in graduate school. All I do is read about experiments, design them, and perform them all day.

I'm not sure why everyone is up in arms about me calling her a *****. This is a message board. That makes it probably the most informal media possible. Perhaps she is well trained as a doctor, but the fact that she believes in ancient Chinese nonsense medicine is a bit scary.

That brings up another point. At least twice people have criticized me for calling acupuncture nonsense. To those people: have you ever read the meta studies on acupuncture? I assure you, the science agrees with me. Sham acupuncture and real acupuncture both work equally well.

Like you noted, there's a dearth of properly executed double blind studies on acupuncture at the moment. But it would clearly be premature to conclude that acupuncture works purely through a placebo effect (I think we can all at least agree that it DOES work in many situations).

More than anything else, your arrogance is rank and off-putting.

Modern science would do well to turn its eye toward traditional medicines and therapies, as many have a long history of being effective. (Exactly how effective? More effective than a placebo? Why is it effective? Those are all good Qs that need to be asked... but the point is, many of them do seem to work. And all of us would lose out if scientists actually agreed with your viewpoint and decided to not even study these practices, because of some automatic assumption that they "can't" work, because they didn't develop through the paradigm of modern science.)

Take the example of the anti-malarial drug artemisinin, which was recently isolated from an herb artemisia used in Traditional Chinese Medicine to treat malaria. Back in 200 BCE, the Chinese were already using artemisia to treat malaria. This is to say, long long before science had progressed to the point of isolating the drug or understanding its mechanism of action, people were using the herb and getting better through using it. Acupuncture has been around even longer, since 3000 BCE.

There's a portion of "sham" in traditional practices, but there's also a significant portion of practices with a long history of being effective, which merits careful examination through the lens of modern science.

Importantly, just because we don't understand WHY or HOW something works *yet*, does not mean it does not work or cannot work.

Btw, being open and receptive to new (and sometimes seemingly outlandish) ideas is a valuable quality to have, if you ever want to conduct useful, innovative research.

Some of you in this thread seem to need to have this repeated:

Just because we don't understand WHY or HOW something works *yet*, does not mean it does not work or cannot work... or worse yet, should not even be studied further, which is what some of you appear to be suggesting.

Arrogant dismissal is one of the quickest ways to kill scientific innovation. Not to mention it will probably make you a horrible physician... but that's a different story.

 

[unsung]

I don't know how you can say with confidence that acupuncture doesn't work. Consider:

An old statement (1997) by the NIH:

"There is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value."

A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective.

Also see:
http://www.mayoclinic.com/print/acupuncture/SA00086/METHOD=print
The Mayo Clinic says acupuncture can help.

Now, the statement by the NIH is a bit outdated, and we don't exactly know too much about the specifics of the poll, but certainly when the Mayo Clinic says acupuncture may help then I think that carries some weight.

I'm just a soon-to-be medical student, so I know very, very little compared to physicians at the Mayo Clinic. But if they say there may be some merit, then I believe there very well may be.

It seems to me that many people who are against CAM are so because it isn't "scientifically proven" or understandable. Just keep in mind that Western medicine evolved from a similar mindset of CAM. At some point it was a bit more "witchcraft" than science. Now it's all about evidence-based medicine, but you can be sure plenty of folk/herbal remedies used in the medieval era have found their way into modern pharmaceuticals--only now we focus on the active ingredient and make it a pill rather than using the leaf and making a tea.

I understand there are many sham treatments/remedies out there (when people say, "it's safe because it's natural" I like to respond that "well, so is radioactive uranium and rattlesnake venom!"

When it comes down to it, CAM seems popular because everyday middle-class Americans like it. I think this is largely because A) People love magic teas! and B) People get more attention and care, or at least feel like they do, with a practitioner of alternative medicine than a western physician. They seem to get hope--which is one of the most powerful medicines out there (just look at a placebo for proof).

I think we should take some of this to heart--people trust doctors a bit less than they used to, and generally feel their physician isn't devoting enough time to taking care of them. We should be a little concerned about this because to heal our patients we need their trust and confidence. If they don't believe in us, they stop coming to us, and if that happens, it doesn't matter if we're right, because we won't have a patient to treat.

Yep! "Real" modern evidence-based medicine did not evolve from thin air. Like I mentioned in the post above, in 200 BCE, Chinese may have used the herb artemisia to treat malaria (devoid any understanding of its mechanism of action, but observing that it works). Now in in present-day 2009 CE, western scientists have isolated an anti-malarial compound in the herb explaining how it works. But really, there's nothing magical about condensing the effective component of an herb down into a pill... sometimes the herb might even work better due to synergistic effects. But a lot of misguided souls seem to place more stock in a pill just because it's a pill.

Even if the pill is something like Prozac. 🙄

Which brings up the issue that a lot of modern day medicine is heavily "voodoo", in the sense that we really have no clue how it works! Take psychiatry. Why exactly do physicians use lithium for bipolar? How does ECT work, that people trust their physicians to repeatedly shock them to "treat" depression?? (Answer: No one knows how it works. And studies are mixed as to whether it works at all! Some physicians will not use the treatment, while others love to use it on most to all of their patients!)

Also, do anti-depressants actually work, even ? Do they work better than placebo? The evidence coming out recently is pretty alarming, I must say. Yet has there been a dramatic change amongst physicians to stop prescribing these things? Hmm. I hope you alt-medicine skeptics are aware that a lot of "traditional" medicine is not nearly as firmly based in evidence-based medicine as you might like to think!

Yeeeeaaaaah. But we have far fewer people objecting to these treatments as "shams" than we do people who object to treatments like acupuncture as "shams".

Why? 'Cuz those psychiatric treatments are under the arbitrary mantle of "modern science".

(Btw the whole construct of psychiatry as a separate field from neurology is quite amusing. People like to think of western science as being so purely logical and evidence-based, when it is often quite illogical and arbitrary. It is definitely not this objective bastion of pure reason as some of you guys seem to think.)

 

[Forthegood]

When you restart your computer because it was not working, is that vodoo? Yes, people may not know exactly why it works because there are so many ways it could, so many processes restarting. Of course, no one in their right mind would say it works because invisible streams of energy flowing through invisible circuitry make up a "life-force" that can be tinkered with until the computer starts to feel better.

Accupuncture is a sham. I can't say it enough. The other things you brought up, all have several excellent physiologically sound theories. Accupuncture has NONE. You take gross anatomy and tell me where you find these secret vessels that have been overlooked carelessly.

 

[AmoryBlaine]

Studies are hard to design, harder to troubleshoot, and even harder to pull off. It sounds like this person's study may not have been well-designed but hell, open up a journal at random and you'll see flaws in every study.

Med schools, residencies, universities have so fetishized research and publication that there is a huge drive to do stuff just to try to get it in somewhere. What does the average pre-med or med student say when it comes to research? Do they identify a question that they find to be compelling and interesting or do they try to hitch on board with someone who will get them the best chance of having their name on something?

 

[Brent8927]

When you restart your computer because it was not working, is that vodoo? Yes, people may not know exactly why it works because there are so many ways it could, so many processes restarting. Of course, no one in their right mind would say it works because invisible streams of energy flowing through invisible circuitry make up a "life-force" that can be tinkered with until the computer starts to feel better.

Accupuncture is a sham. I can't say it enough. The other things you brought up, all have several excellent physiologically sound theories. Accupuncture has NONE. You take gross anatomy and tell me where you find these secret vessels that have been overlooked carelessly.

From the May Clinic article I referenced:

In contrast [to the traditional Chinese explanation of why acupuncture works], the Western explanation of acupuncture incorporates modern concepts of neuroscience. Many practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body's natural painkillers and increase blood flow.

Just because something isn't understood, it doesn't mean it doesn't work. But it most definitely means we should look into it more--perhaps acupuncture just has a larger placebo effect because it's "traditional Chinese medicine" and people are more likely to put faith in a very very old procedure?

Acupuncture might be a sham. But it might not be. We should really keep an open mind until it has been proved one way or another. Right now people are divided because the research appears conflicting. I think that definitely merits more research, and I plan to keep an open mind and be receptive to whatever research is able to definitively state.

 

[Forthegood]

Many practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body's natural painkillers and increase blood flow.

No. Has not been shown and there is no physiologic mechanism that would support this. Increasing blood flow? You have to be joking right. Well then, we have whole classes of drugs that should be MORE effective than accupuncture. Stimulating nerves and muscles and connective tissue? That may sound good, but it means nothing. I just stimulated dozens of nerves, muscles, and connective tissure typing... but I don't feel any better because that has NOTHING to do with nociception.

perhaps acupuncture just has a larger placebo effect because the people who publish studies showing an effect make their income of the effect and studies that show no effects are much less likely to be published.

Fixed it, you're welcome.

Rght now people are divided because the research appears conflicting.

The research only appears conflicting if you just read abstracts and from any old journal. The well-controlled studies all line up very nicely.

I think that definitely merits more research, and I plan to keep an open mind and be receptive to whatever research is able to definitively state.

Good, but I have no idea what you are waiting for. Several very well done studies are out there. Use your brain, read through their methods in great detail, and see for yourself.

More is not always better. Often, it is just more.

 

[foolz0r]

It seems like you have a real problem with acupuncture. Who stuck a needle up your butt?

 

[Brent8927]

No. Has not been shown and there is no physiologic mechanism that would support this. Increasing blood flow? You have to be joking right. Well then, we have whole classes of drugs that should be MORE effective than accupuncture. Stimulating nerves and muscles and connective tissue? That may sound good, but it means nothing. I just stimulated dozens of nerves, muscles, and connective tissure typing... but I don't feel any better because that has NOTHING to do with nociception.

You have a right to believe what you would like, and you are welcome to dismiss the opinions and research of the Mayo Clinic and other researchers. Unless you give me a good reason why I should take your word over the word of some of the world's best physicians and researchers, I will continue to keep an open mind.

 

[NonTradMed]

I don't know enough about acupuncture to know whether it works or not but I get frustrated by dogmatic followers on both sides of the CAM debate. As scientists, we cannot say accept or dismiss out of hand medications simply because it's labeled with 'alternative' or 'modern' in it.

As an above poster pointed out, an ancient antimalarial drug was found to have real pharmaceutical properties. Sadly, some people would dismiss such a drug merely because it is "ancient Chinese nonsense". Interestingly, ephedrine was also used by the ancient Chinese, it's properties were written down by physicians at the time---but I doubt many people would now call ephedrine "ancient ", "Chinese" or "nonsensical". 😉

Myself, I take a more moderated approach. Just as I think it's foolhardy for some people to assume ALL natural or 'ancient' remedies must be good (because they have some mystical properties), I won't close my eyes to nonproven medicines simply because it has not been studied----that isn't to say I'd prescribe it, but I wouldn't dismiss out of hand if a patient says it works for them. It is the height of arrogance to assume modern scientists is the sole repository of pharmaceutical knowledge.

 

[Handy388]

When you restart your computer because it was not working, is that vodoo? Yes, people may not know exactly why it works because there are so many ways it could, so many processes restarting. Of course, no one in their right mind would say it works because invisible streams of energy flowing through invisible circuitry make up a "life-force" that can be tinkered with until the computer starts to feel better.

Accupuncture is a sham. I can't say it enough. The other things you brought up, all have several excellent physiologically sound theories. Accupuncture has NONE. You take gross anatomy and tell me where you find these secret vessels that have been overlooked carelessly.

I am sure you can find ridiculous mechanism proposed for allopathic therapies as well, sure you can not find anything STRUCTRUAL at those spots, but perhaps they are major axis of FUNCTION? Remember anatomy usually only teaches you structural. I have not heard of study where they investigate the physiological change around the needle site when it goes down.

Additionally, it's diffcult to design a "sham needle" because many spot does not even need to be penetrated, mere pressure can have an effect. when I was taught to press a certain spot to combat nausea, I merely pressed that spot very hard, and it works for me, personally.

Don't get me wrong, I called bull**** in the face of many acupture points (one such point claim that it fixes heart failure in its acute stage and I literally burst out laughing at the person who's telling me about it. "So you are telling me all those allopathic measures, surgeries and medications are not necessary, all I need to do is press a botton on the human Ipod?)

But I think some points are located in very functional places and could potentially have an impact on function.

Please keep an open mind.

 

[Handy388]

Nothing alternative has stood up to the light of day? How do you know? Do you know the outcomes of all the studies that have ever been done on alternative therapies? Try telling that to the hundreds of people I know who have healed from cancer with a completely alternative approach- no chemo, no surgery, no radiation. I'm not saying that conventional things are wrong and I'm not saying there are not cases where they are necessary. I'm just saying there's more out there.

Do you know that researchers have been banished from the country upon discovery of cures for certain kinds of cancer? Do you know about the Hoxsey Cancer Clinics and the persecution that Hoxsey himself was subject to at the hands of the government? Do you know about the other researchers, like the one who studied at a very renowned school where one of my professors was a postdoc? He was working on a cure for cancer and was banished from the United States as a result? Do you know that the American Cancer Society has to disband once a cure is found?

please enlighten us on this alternative treatment that you know and WHY it works? I mean, we aren't talking about pain relief here, we are talking about complete differentiation of un or underdifferentiated cells, that's something that calls for an explaination.