Naturopathic Physicians teaching PA's?

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Complaints regarding the qualifications of faculty to teach their assigned subjects should be sent to the PA accrediting body. On another thread there was discussion of the ND curriculum's similarity to MD/DO training - I have no idea if that is true, but if it is, then one cannot assume that an ND's training in anatomy is by definition inadequate.
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Blue Dog said:
And you know this because...you've attended med school? So, what are the "blow off" courses in med school?
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It could be a lot of them if you believe Dr. John Ioannidis and his team who found:

1. 80% of non-randomized studies turned out to be wrong
2. 25% of gold-standard randomized trials turned out to be wrong
3. 10% of platinum-standard large randomized trails turned out to be wrong.

I could be wrong though when I say you might want to keep this info in the back of your head somewhere.
 
zenman said:
It could be a lot of them if you believe Dr. John Ioannidis and his team who found:

1. 80% of non-randomized studies turned out to be wrong
2. 25% of gold-standard randomized trials turned out to be wrong
3. 10% of platinum-standard large randomized trails turned out to be wrong.

I could be wrong though when I say you might want to keep this info in the back of your head somewhere.
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Does this data not further legitimise the case for evidence based medicine however? Also, what constitutes wrong and is there a better method? You attempt to randomise, you try to collect good data, you have other studies reproduce results and you have it all peer reviewed. Not perfect, but there is no such thing as determinism in this world, so we go off the highest probability. That is as good as it gets, yet I see no need to embrace unproven therapies until they have passed the test so to speak.
 
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Paseo Del Norte said:
Not perfect, but there is no such thing as determinism in this world, so we go off the highest probability. That is as good as it gets, yet I see no need to embrace unproven therapies until they have passed the test so to speak.
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Exactly. The fact the the scientific method fails to produce perfect results 100% of the time is no reason to throw it out the window.

Besides, Ioaniddis's complaint has always been against "bad science" (poorly conducted research), not the scientific method itself.

http://scienceblogs.com/insolence/2007/09/the_cranks_pile_on_john_ioannidis_work_o.php
 
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Starpower said:
Gee, I wonder if proven dissolution of beta-amyloid plaques might actually have the "potential" to deliver any "beneficial effects" to humans. Hmmm, who can I call and ask? Because I really just can't seem to figure that one out on my own.

Further (and I'm tiring of this 'discussion'), you should probably read articles past their titles, before you start spouting the words "theoretical and unproven".
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I spent about an hour this morning reading over those studies you posted - well, the ones I could get access to. Here's my take on it...

All of the studies do show good potential, there's no denying that. Even the in vitro studies look pretty darn good. That being said.... its not good enough. We all know, or should, that things behave differently in the body than they do in the lab. In addition, just because a drug does something in the body doesn't mean it will have the effect desired. Allow me an example:

Zetia, a cute little drug marketed by Merck for lowering LDL cholesterol. In studies, it does indeed lower LDL. It even has been shown to reduce the thickness of atherosclerotic plaques. This is all well and good... but there are no studies showing that it actually has any patient-oriented outcomes. It doesn't prevent CV disease as far as we can tell. No reduction in MI or stroke. So, while zetia looks good on paper, it hasn't yet been shown to do influence outcomes.

Your wonder drug needs more research. That's all we're saying.
 
VA Hopeful Dr said:
Your wonder drug needs more research. That's all we're saying.
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I see. And which articles were you able to acess?

What about ... this one?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781139/

The AD patients, whose macrophages were treated with curcumin, when compared with patients whose macrophages were not treated with curcumin, showed an improved uptake and ingestion of the plaques.
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I'd also really like to read this one:

http://journals.lww.com/psychopharm...Month_Randomized,_Placebo_Controlled,.25.aspx

but I don't have access.I did just lance an abscess, tho.
 
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Starpower said:
I see. And which articles were you able to acess?

What about ... this one?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781139/



I'd also really like to read this one:

http://journals.lww.com/psychopharm...Month_Randomized,_Placebo_Controlled,.25.aspx

but I don't have access.I did just lance an abscess, tho.
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That's a pretty neat review. Problem is, it doesn't really prove your point. All of the biochemical studies (macrophages, glial cells, and so on) are all in vitro studies. In addition, the few studies on humans are all retrospective studies.

Again, looks promising but its not ready for full acceptance yet.
 
VA Hopeful Dr said:
I spent about an hour this morning reading over those studies you posted - well, the ones I could get access to. Here's my take on it...

All of the studies do show good potential, there's no denying that. Even the in vitro studies look pretty darn good. That being said.... its not good enough. We all know, or should, that things behave differently in the body than they do in the lab. In addition, just because a drug does something in the body doesn't mean it will have the effect desired. Allow me an example:

Zetia, a cute little drug marketed by Merck for lowering LDL cholesterol. In studies, it does indeed lower LDL. It even has been shown to reduce the thickness of atherosclerotic plaques. This is all well and good... but there are no studies showing that it actually has any patient-oriented outcomes. It doesn't prevent CV disease as far as we can tell. No reduction in MI or stroke. So, while zetia looks good on paper, it hasn't yet been shown to do influence outcomes.

Your wonder drug needs more research. That's all we're saying.
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In fairness, I think it could be argued that the same is true for statins, particularly when it comes to primary prevention. In that case, we've got a multibillion dollar drug class prescribed to many millions of people.
 
facetguy said:
In fairness, I think it could be argued that the same is true for statins, particularly when it comes to primary prevention. In that case, we've got a multibillion dollar drug class prescribed to many millions of people.
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Maybe you should review the results of the JUPITER trial studying rosuvestatin 20 mg versus placebo in patients with elevated CRP but normal LDLs.
 
facetguy said:
In fairness, I think it could be argued that the same is true for statins, particularly when it comes to primary prevention. In that case, we've got a multibillion dollar drug class prescribed to many millions of people.
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True, but secondary prevention numbers are outstanding for all statins (except crestor). I should have phrased my original post better.
 
bradt9881 said:
Maybe you should review the results of the JUPITER trial studying rosuvestatin 20 mg versus placebo in patients with elevated CRP but normal LDLs.
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I think you should look at that trial a bit more closely, the exclusion criteria they used are pretty crazy.
 
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Blue Dog said:
Exactly. The fact the the scientific method fails to produce perfect results 100% of the time is no reason to throw it out the window.

Besides, Ioaniddis's complaint has always been against "bad science" (poorly conducted research), not the scientific method itself.

http://scienceblogs.com/insolence/2007/09/the_cranks_pile_on_john_ioannidis_work_o.php
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I have no trouble with the scientific method. However since humans run the trials, I not standing on any soapbox and screaming EBM is God, since we know many studies are not worth the glossy paper they are published on.
 
VA Hopeful Dr said:
Again, looks promising but its not ready for full acceptance yet.
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Well, at least there's likely no harm in giving it a whirl, unlike Prozac which can cause depression and suicidal ideation yet we prescribe it en masse daily ... effect of Prozac also can't be accurately evaluated scientifically other than clinical observatiuon.
 
Starpower said:
Seen any curry overdoses lately, Doctor?
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There are more kinds of harm than overdose. The most common harm with quack therapy is forgoing more effective conventional therapy based on the belief that the quack therapy alone will be effective.

The point is, your "treatment" has not been demonstrated to be safe or effective, and neither should be presumed in the absence of evidence.
 
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Starpower said:
Well, at least there's likely no harm in giving it a whirl, unlike Prozac which can cause depression and suicidal ideation yet we prescribe it en masse daily ... effect of Prozac also can't be accurately evaluated scientifically other than clinical observatiuon.
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We prescribe it because its been shown to make a big difference. Yes, there are cases of suicide ideation after starting SSRIs. That's why you have caregivers observe the patient a little more closely for the first month or so until its had a chance to take effect.

By the way, how would you measure the efficacy of psych drugs other than clinical observation? We don't exactly have a lab test or radiology exam we can do to quantify this.
 
Blue Dog said:
There are more kinds of harm than overdose. The most common harm with quack therapy is forgoing more effective conventional therapy based on the belief that the quack therapy alone will be effective.
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I'll agree with you there. I see patients in my clinic regularly, who are ill-informed and leaning towards 'quack' treatments recommended by family members.

Blue Dog said:
The point is, your "treatment" has not been demonstrated to be safe or effective, and neither should be presumed in the absence of evidence.
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Until you read the studies and the pdf posted above you are in absolutely no position to make such a statement. Once you take the time to review, I welcome you to return and further discuss the issue.
 
VA Hopeful Dr said:
By the way, how would you measure the efficacy of psych drugs other than clinical observation? We don't exactly have a lab test or radiology exam we can do to quantify this.
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My point exactly. Yet curcumin is to be penalized for quantifically affecting beta-amyloid levels? Doesn't make any sense.

Although serum A-beta40 levels did
not differ significantly among doses,

serum A-​
beta40 tended to rise on curcumin,

possibly reflecting an ability of curcumin

to disaggregate A-​
​
beta deposits in the​


brain, releasing the A-beta for circulation


and disposal.7,8​
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​
 
Starpower said:
Until you read the studies and the pdf posted above you are in absolutely no position to make such a statement. Once you take the time to review, I welcome you to return and further discuss the issue.
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None of those are outcomes studies.

Until circumin is repeatedly shown to result in statistically significant clinical improvement in Alzheimer's disease, it cannot be accurately referred to as a "treatment."
 
Starpower said:
My point exactly. Yet curcumin is to be penalized for quantifically affecting beta-amyloid levels? Doesn't make any sense.

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This is exactly what we're talking about. SSRIs have shown to improve the symptoms that patients are having - what we call patient-oriented outcomes.

As soon as this cumin stuff can be shown to do the same, I'll be glad to advocate it to my patients.
 
VA Hopeful Dr said:
This is exactly what we're talking about. SSRIs have shown to improve the symptoms that patients are having - what we call patient-oriented outcomes.

As soon as this cumin stuff can be shown to do the same, I'll be glad to advocate it to my patients.
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Then it seems both drugs are lacking in data of some sort, doesn't it. And it's curcumin, not cumin ... curcumin is a root, cumin is a seed.
 
Starpower said:
Then it seems both drugs are lacking in data of some sort, doesn't it. And it's curcumin, not cumin ... curcumin is a root, cumin is a seed.
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That's one way to look at it. Another, more applicable way, would be to say that prozac has been proven to help patients with conditions X, Y, and Z while curcumin has only been shown to have efficacy in the lab.

One of those is applicable to medicine, one is not.
 
VA Hopeful Dr said:
That's one way to look at it. Another, more applicable way, would be to say that prozac has been proven to help patients with conditions X, Y, and Z while curcumin has only been shown to have efficacy in the lab.

One of those is applicable to medicine, one is not.
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I think what you mean is that curcumin has only been shown to have efficacy in the lab, thus far. Still, note that the retrospective study did indicate some improvement in cognitive function. Regardless, more work has still yet to be done ... but you can bet your bottom dollar that I still mention it in passing. I'm not going to sit on my fat ass to suppress something which could possibly hold benefit for a patient. If they decide to follow through on it, that's their business. This mentality was instilled in me by a MD who trained me for my second Hospice position.
 
Oh hey, here's the 2011 article from the International Immunopharm journal, most interesting ...
 

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Starpower said:
I think what you mean is that curcumin has only been shown to have efficacy in the lab, thus far. Still, note that the retrospective study did indicate some improvement in cognitive function. Regardless, more work has still yet to be done ... but you can bet your bottom dollar that I still mention it in passing. I'm not going to sit on my fat ass to suppress something which could possibly hold benefit for a patient. If they decide to follow through on it, that's their business. This mentality was instilled in me by a MD who trained me for my second Hospice position.
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Key word there is retrospective. You don't base clinical decisions off of retrospective data, which comes with a huge share of pitfalls.

I've looked at your other studies and they are all basic science work, not clinical data (except for the last study you linked, which came with several flaws...the biggest being, IMO, that it was just a 6 month long study). Basic science =/= clinical data. There are many, many, many instances where robust basic science data has been shown to be of little or no benefit (or even harmful) in the clinic. IMO, no clinician should be basing their clinical decisions on preclinical data and/or very weak clinical data.

The fact is that there aren't any conclusive clinical studies suggesting that curcumin is useful in the clinic. It doesn't matter if there are a million preclinical studies if there isn't solid clinical data suggesting that it should be used in the clinic.

Edit: Pretty much every piece of clinical evidence mentioned in the review article you last posted is a phase I trial (with the exception of the 6-month-study you linked earlier, which comes with its own share of methodological flaws). Success in phase I (or II) trials don't necessarily translate over to success in a phase III.
 
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You don't base clinical decisions off of retrospective data

sorry many clinical decisions and guidlines are based on retrospective data.
 
clubcantholdme said:
You don't base clinical decisions off of retrospective data

sorry many clinical decisions and guidlines are based on retrospective data.
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Only when we don't have anything better, and often those are peds/ob studies where doing proper research is almost impossible.
 
oh, like large parts of the position statments or guidlines for regional anesthesia, or the AHA guidlines on perioperative cardiac evaluation, yes almost never, the truth is the most of what we do is based on retrospective studies.

not saying it the best evidence it is just usually the best we have it is not possible to conduct prospective studies of sufficient power for the myriad facets of healthcare.
 
i took a CAM course and shadowed a chiropractor and naturopath during my first two years just for kicks, they exist and your patients will be going to them, so know them. i also take a number of vitamins and get massages from chiropractors every now and then and attend yoga with an ayurvedic practitioner. just 'cause it's not scientific, doesn't mean it's evil, so relax.

i plan to be a radiologist. i feel like a bunch of stuff in medicine is just expensive placebo anyways
 
Starpower said:
My point exactly. Yet curcumin is to be penalized for quantifically affecting beta-amyloid levels? Doesn't make any sense.

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"quantifically" ?:confused:
 
facetguy said:
re: curcumin in oncology, new in vitro study

Study abstract: http://archotol.ama-assn.org/cgi/content/short/137/5/499

Media: http://www.medicalnewstoday.com/releases/225945.php
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Those kinds of studies are a dime a dozen; the literature is littered with them. No one cares about such studies unless they've been well-validated in in vivo models. You can do many things in vitro that end up completely failing in vivo. Just like many things that have the basic science data to back them up fail in a clinical setting.

Specifically regarding the study you linked, I don't know if that would actually work in an in vivo setting. The tumor microenvironment plays a crucial role in tumorigenesis and progression. The multiple paracrine/autocrine cytokine loops, etc, that activate the STAT pathways are unlikely to be significantly affected by the treatment used in this study. You must understand that in vitro studies are mainly (for the most part) good for piecing out the mechanistic details behind something; that doesn't mean that what you see in vitro will actually work in vivo or in the clinic.
 
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Kaushik said:
Those kinds of studies are a dime a dozen; the literature is littered with them. No one cares about such studies unless they've been well-validated in in vivo models. You can do many things in vitro that end up completely failing in vivo. Just like many things that have the basic science data to back them up fail in a clinical setting.

Specifically regarding the study you linked, I don't know if that would actually work in an in vivo setting. The tumor microenvironment plays a crucial role in tumorigenesis and progression. The multiple paracrine/autocrine cytokine loops, etc, that activate the STAT pathways are unlikely to be significantly affected by the treatment used in this study. You must understand that in vitro studies are mainly (for the most part) good for piecing out the mechanistic details behind something; that doesn't mean that what you see in vitro will actually work in vivo or in the clinic.
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Take a deep breath. Everyone knows that in vitro is in vitro. I'm not trying to say this curcumin-derived substance is ready for prime time. I was clear to point out that the study is in vitro. The sequence of events was simple: I happened upon the curcumin study, I recalled some discussion in this thread about curcumin (discussion to which I hadn't even contributed), so I posted the links. I also recall having seen something a year or two ago about studies on curcumin from MD Anderson. Clearly, some oncology researchers see something in curcumin. Time will tell. Until then, we wait.
 
jwk said:
"quantifically" ?:confused:
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HAhaha, and here I thought overriding the spellcheck feature meant I was smart. Give me a break ... I'm just a PA! ;)

QUANTIFIABLY then ...

... now go get me a Coke from the fritter-fritter, will ya? :D
 
facetguy said:
I also recall having seen something a year or two ago about studies on curcumin from MD Anderson. Clearly, some oncology researchers see something in curcumin.
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Turmeric is on several of the dishes offered in the various cafeterias at MD Anderson and not by coincidence.
 
I sent an email to University of Bridgeport asking about some of the allegations about their new PA program. After about 6 weeks I finally got a response saying that UB has been and continues to be very proud of its "non-traditional" CAM programs such as its ND, DC and acupuncture schools and that these programs and their professors are highly qualified and have much to offer the PA program.

Well that about sums it up for me! Quackery!
 
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