I've been trying to convince my wife (who has a degree in dietetics and a minor in anthropology/archeology) to write about this subject for a while, but food and diet are such visceral topics for people that she finds discussions of the topics incredibly frustrating.
Food, language, gender norms, these are all fields of study where there is substantial research and a lot of resolute but unfounded claims by people with axes to grind, or products to sell.
All of which is to say, there's not a lot of skepticism, even amongst populations who claim to be generally analytical and skeptical.
My wife is the same way. She has a PhD in nutrition and is also a registered dietitian, but she just can't muster the energy to argue online with people that have read two articles on Pub Med.
and this is why I wish the paleo-fanatics would stop harping on the "evolutionary based" part.
I eat pretty much paleo. I avoid grains, I limit dairy consumption, I avoid a lot of sugar in my food. However, a lot of the "science" behind paleo is bullshit. The name & culture is the worst thing that could have happened to the diet.
Food is important to your health. I eat a lot of vegetables, high quality meat, and avoid high amounts of carbs & sugar now. How could I not feel better? It doesn't have anything to do with evolutionary adaptability.
edit: knowtheory below is referring to something I edited out regarding an attempt to double blind myself to ensure this wasn't all in my head.
See, that's just fine! It's awesome that you've found a diet that makes you feel better.
But here's the thing. You can't double blind yourself. That's the whole issue with blind trials. Double blind trials require that you do not and can not determine whether you are in the treatment group or not. Additionally, unless you're having an unrelated person prepare the food, w/o any knowledge of which foods are in the "paleo" group vs the control group, you're not operating double blind.
If it's just you and another person, it would be challenging to set up a double blind experiment (although i'd be interested to hear what you tried).
I removed that. I figured that I would get some flak. :P
I did have my roommate prepare the food. Another one of my roommates swapped/labeled the food and then went to class, no interaction. It was mostly because he didn't believe that I could feel it and that it was mostly in my head. (which I totally understand, I was pretty worried about that as well)
We switched out white flour for some almond flour. We also did another one where he sweetened something using honey and another using corn syrup. (I could totally taste the difference there though)
Certainly not rigorous, but enough to make me pretty sure it isn't entirely a placebo effect. I'm planning on getting a Celiac Sprue test at some point.
If you have adverse reactions to wheat products after provocation (even tiny amounts should trigger the effects), then it's indeed likely that you do have coeliac disease. About 1% of population have it, so it's not that surprising. Just remember that a test would require a proper, long provocation, otherwise you'll just get a negative from the biopsy because there's no intestinal damage anymore.
On the other hand, if a diet helps, and provocations after, say, a month (but without your knowledge) make things go downhill fast, you can be sure enough. Welcome to the wonderful life where you get to check yoghurt for trace amounts of wheat products, and pizza is a holy grail (one of my closest friends is coeliac, for people in Amsterdam area, Woodstone in Haarlem makes good gluten-free pizza).
I'll add to this that it is often (not always) possible to detect the presence of Coeliac Disease through a blood test. That should be the first step before going the colonoscopy route.
Some of the paleo-esque promoters like Gary Taubes have been making similar comments about most "mainstream" nutrition research.
That being said -- you don't need to find the optimal for the population. You only need to find the optimal for you. And so even un-blind testing is reasonably effective at that.
Mat Lalonde (PhD Organic Chemist, Harvard) does a good job of dispelling the bullshit Paleo arguments. At the end of the day though, he still follows a generally Paleo diet.
>But how does one determine what the prevalence of cardiovascular disease was in the ancient past? Time and the decomposition it brings are brutal on the flimsy meat of which we are made, and it is uncommon to have access to anything other than bones, much less bodies intact enough to be examined for signs of atherosclerotic disease. Even so, however, there have been indications that the idea that ancient humans didn’t suffer from atherosclerosis is a comforting myth, the most recent of which is a study published a week ago online in The Lancet by Prof. Randall C. Thompson of Saint Luke’s Mid America Heart Institute and an international team of investigators entitled Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations. Basically, it was a study of 137 different mummies from four different geographic locations spanning 4,000 years.
The whole time I was reading this I could only think, "science is great!" Thanks for posting this.
Paleo falls into the same trap as most ideologies. Some percent of True Believers become jerks about it ("but it's so obvious! Just look at [weakly correlated thing]!"), and end up making the whole group look bad.
It's unfortunate, because most ideologies don't seem to be made to alienate. We get along fine as long as we don't bring up our pet beliefs.
Calling the "naturalistic fallacy" a fallacy is a bit of an overstretch IMO, sure natural=better is not a rule true 100% of the time, but nevertheless until sufficient evidence has not been accumulated that some of the adjustments we make to our lifestyle are not harmful to us health-wise avoiding them is not an unreasonable heuristic to follow. One example is how it became clear in the last years in nutritional science that in general the more processed the food is the more harmful it is for us.
There is also the reverse problem, illustrated by the condescending attitude toward herbalism in this article, of people who idealize modernity, and for example believe only medicine in the form of pills can be effective, even though plants may contain exactly the same chemical compounds. I am not saying there is no fraud in herbalism, sure there is plenty of it, but herbs in general clearly can have strong both positive and negative effect on physiology, which is really quite obvious if you consider the variety of herbs existing and that they all contain lots of different chemical compounds.
In general I think it is ridiculous to ignore the thousands of years of experimentation and exploration of our ancestors just because it wasn't "science-based".
I think part of what the author sees as problematic is the loose definition of what "natural" means - to use your herbalism example, some people consider herbs to be automatically better than {mainstream_treatment_x} just because it is "natural", for a random value of "natural".
So you are probably saying the same / a similar thing as the author with slightly different emphasis.
edit: grammar, spelling mistakes, mainstream_treatment_x instead of "better tested"
I recently went to the doctor and got a recommendation to try one of three different medicines. Two were "supplements" and the third one was an off-label psychiatric medication. Each drug had its own set of side effects, and I chose one of the supplements because the off-label psychiatric drug required a prescription. I just didn't think "natural" versus "artificial" was relevant.
The things that concern me about herbalism are simple:
1. The compounds in herbs are not tested as rigorously as "modern" drugs, at least by the FDA in the US. Knowledge of side effects and safe dosage is more limited.
2. Herbs are often subject to variation in dosages from pill to pill, because the source plant matter is variable and the actual yields are difficult to determine.
It's not about ignoring thousands of years of experimentation, it's just that our standards are higher, and the old experiments were poorly conducted. We want to know the side effects and the interactions. We want to know the drug's mechanism. We want to know about the possible complications. We want to know the effective dose and the unsafe dose. And we want to be able to isolate things: herbs contain many chemicals: you might want one of the chemicals, but not want the side effects from one of the other chemicals.
It reminds me of the almond extract you can buy at the store. The natural almond extract tastes the same as artificial almond extract, but the natural almond extract contains more cyanide. People pay a premium for things labeled "natural".
The heuristic to use natural things works well for foods, but it's a harmful heuristic when considering drugs. It's also a bad heuristic for heating your home (wood fires), immunizing your children (let them die from whooping cough), family planning (pull out), et cetera.
It's funny you mention family planning, it's actually a great example for what I am saying. Pull out might not be the best strategy for avoiding kids, but also effectively avoiding kids isn't something too heavily promoted by evolution ;) and in a sense you wouldn't do bad to stick to it if survival is the ultimate goal. You mention how modern drugs are rigorously tested, but just recently there was a big affair about Bayers contraceptive pills used by millions of women worldwide causing blood clogs:
So, being so incredibly lucky to be part of several thousands of years old lineage of people who managed to survive, it isn't unwise to stick to the traditional ways of living, when the new way wasn't tested for sufficiently long and/or when the old way wasn't proved to be harmful - remember I am talking about using it as a heuristic in situations where we don't have full knowledge. I am not saying that every single aspect of it will be beneficial, just that you will be unlikely to do very badly when following this strategy, simply because it was tested over a very long timespan.
Nassim Taleb makes a similar point in his book "Antifragile". To be honest I hated the book and think much of it is crap, but this aspect I agree with.
Yes, you can name a drug with bad side effects. FDA isn't 100% effective, my point is that the standards for herbal remedies are comparatively worse than those for "modern" drugs.
Kava has been linked to liver failure, Comfrey causes liver damage, Chaparral causes liver damage, and Pennyroyal is basically toxic. St John's Wort has so many interactions it's basically unsafe to take in conjunction with anything. On top of this, herbal medicines are often poorly-sourced, and substitutions are made overseas. The regulations just aren't good enough.
Then when you talk about the pull-out method of family planning, you say it's a good technique because you'll have kids. That's some impressive double-speak. Next you'll tell me that Caffeine is a good sleep aid because evolution wants you to be more productive.
The FDA's regulatory tools simply work better on "modern" drugs. Look at how Thalidomide was never approved for sale in the US, because the FDA said that more studies were needed. By comparison, "dietary supplements" can only be removed from the market if they show "significant or unreasonable risk". If those standards had been applied to Thalidomide, the human cost would have been terrible.
(Note: Apologies for the over-use of quote marks. "Modern" isn't quite the right term here, some of these drugs are quite old, but I'm not sure what is the right term.)
Then when you talk about the pull-out method of family planning, you say it's a good technique because you'll have kids. That's some impressive double-speak. Next you'll tell me that Caffeine is a good sleep aid because evolution wants you to be more productive.
I didn't phrase it clear enough, I admit, but what I meant is only that avoiding contraceptive pills would free you from the exposure to the pretty bad side effect they turned out to have even though they were supposedly well tested. I just used it as an illustration of my point that being a bit sceptical towards the very new lifestyle approaches is not a bad rule of thumb in abscence of other considerations.
I also of course agree herbs can have serious side effects. You really seem to want to turn it into an X vs Y thing where there has to be one winner. I just want to say that despite all the bad press science seems to indicate using herbs in some particular situations in particular ways might be very beneficial.
> You really seem to want to turn it into an X vs Y thing where there has to be one winner.
The only X versus Y here is scrutiny. Read my posts a little more carefully: my criticism of herbal remedies is not about the fact that they are herbal, but the fact that they are understood little and regulated poorly. That's not a problem with the remedies themselves, but with the laws and systems of incentives driving scientific research.
The problem with herbalism is that it's the first place science-based medicine went looking for drugs. For basically any herb and effect someone ascribes to it, there have already been twenty rigorous studies, and either no statistical effect was found or the responsible chemicals were extracted, purified, concentrated, and synthesized and are now marketed under two brand names and three generics.
Going to herbs directly isn't going where no science has been before. At best you're getting a known drug which is poorly dosed and mixed with a shotgun of other chemicals which may be harmful. At worst you've just got a cocktail of potentially harmful (remember, even most of the "good" effects come from poisons the plants produce to keep things from eating them) chemicals with no actual benefit.
Yours is a very common response I get to this - I wonder why, since there is absolutely no evidence for it. You vastly underestimate the number of plants in existence and vastly overestimate the fraction we have been able to study rigorously. You also hugely simplify the chemistry of it all, the main advantage of plants over modern medicine in its typical form is that they contain complex compounds of chemical substances which show a synergy in a certain direction e.g. they interact with the body in a different way when they are administered together than if they would be ingested separately. Analyzing such compounds and the interactions between them is still often beyond the current state of science and is also not as well funded as traditional drug research, simply because traditional drugs are easier to sell.
Please don't have the impression that I am somehow advocating herbs over traditional medicine, I don't, and there are surely problems with using herbs, but those are different problems that the one most often mentioned. The material you use has to be rather fresh because the concentration of active substances degenerates with time very quickly, the concentration also varies a lot from one area of growth to another so it might be difficult to come up with dosages, they can have serious side effects just like traditional medicine, they are inconvenient to store and use etc.
You can find scientific references for most of what I said and anyway it would come to no surprise to a second-year biology undergraduate. Just reading the wikipedia page about herbalism would clarify a lot of misunderstanding on the topic:
"the main advantage of plants over modern medicine in its typical form is that they contain complex compounds of chemical substances which show a synergy in a certain direction"
This is such unutterable nonsense.
Take Aspirin vs. Willow Bark.
Aspirin is derived from substances found in willow bark. Aspirin will cure your headache with a known dose of a substance with a well documented harm profile.
Willow bark will cure your headache with a slightly less effective form of the compound, and if used often enough will harm your liver and kidneys because of all the other stuff that's in there.
Plants are not 'designed' to cure you, the 'spirit of the plant' does not lean in one way or other. This is animistic nonsense.
You are very aggressive while you clearly do not know what I am talking about and doing a complete straw men. In fact the very same page referenced in this post confirms what I said:
Cool, you found one example where the compounds in plant potentiate each other in a useful way. I gave you an example of where this is absolutely not true, and there are likely many more on both sides.
This absolutely does not support the statement "the main advantage of plants over modern medicine in its typical form is that they contain complex compounds of chemical substances which show a synergy in a certain direction ".
In fact it doesn't support that there is an advantage at all, and it shows that by scientifically studying the plant we can figure out the substances responsible for the effect (if it's reproducible), purify them and make use of them in preparations that can be applied more effectively than a poultice.
I'm not sure how you think this is a straw man either.
What I mean is that _in cases where plants could have advantage over modern medicine_, they often do so because of their complex chemical constitution that can produce those kinds of synergies, where modern medicines are most often based on at most 2-3 active substances because we have trouble analyzing more complex interactions.
No, it was a poke at magical thinking. It may also have been unwarranted snark...
I'll agree that where it can be shown that a plant has an effect that modern medicine can't explain, complex interactions may well be at work. You gave me the impression that you think this is a general rule, where really it seems to be an exception.
Following the reference through from the "clinical trials" section, the Wikipedia article is a little misleading. It makes it sound like only 356/1000 random plants have been studied, but in the paper [1] the breakdown is actually:
15.7% had been tested in clinical trials; 50.9% had been tested in vitro or in vivo; 20.8% had been subject to a phytochemical study; 12.1% had no studies found in the literature search; 0.5% were "dangerous".
That's not saying only 1/3 of plants had been studied. That is saying that 87% of plants have been studied.
I was thinking we are talking about all plants in existence, this is a study of 1000 most commonly used herbs, still, I learned something new, so thanks. Still it doesn't prove your more bold claim that somehow all the potential benefits of using them are already available in a very safe to use pill.
My overconfidence is mostly coming from the long tail.
Even if there are millions of distinct plant chemistries out there, a small number (say, 100) will account for 90% of the herbal remedies prescribed and taken. These will have been studied by scientific methods exhaustively. The next most common chunk will have received some cursory attention, and then you enter into the vast fields of the unknown.
But the fields aren't unknown to just science: they're unknown to cultural practitioners as well. I'm willing to believe that, even without double-blind clinical trials, people were able to find effective treatments with enough trial and error. But "enough trial and error" means "not the long tail". So once you start talking the 1000th most common plant used for medicinal properties, the amount of experience pre-scientific practitioners have accumulated is negligible, and handful of anecdotes at best. Not even enough to ascribe correlation, let alone causation.
So on the head of plants of potential value, I'm betting that they've all been studied exhaustively. On the tail, there are countless plants which could have countless benefits, but essentially no evidence to do anything but pick one at random and hope it cures what ails you. The middle, of enough evidence to suspect or know a plant does something, but not how, is going to be fairly small.
I agree with your reasoning, but you assume that the outcome of the research on a given plant will very quickly lead to a total understanding of its ingredients and effects and that it will always be feasible to develop a technological process to deliver the same complex of ingredients in the form of a pill, neither of which has to be the case.
For something to be interesting the outcome of research on a given plant should at the very least be that there is an effect to study, or it's not worthwhile. Nobody says "we don't understand how it works, therefore it doesn't work and we should throw it away".
The idea that plants can always be reduced to merely one of their components is an oversimplification. Ask anyone who smokes marijuana why different 'strains' of the plant have different effects, or why Marinol (the pharmaceutical name for THC) is perhaps more dangerous and less helpful or pleasant than the complex cocktail of cannabanoids in their natural delivery[1]. It's also why I'll drink green tea over taking green tea extract any day.
I am surprised you think this is a point in your favor. Yes, the primary active ingredient in marijuana is not sufficient. But you just said different strains of marijuana have different effects.
Which strain is most effective for glaucoma? Which strain is most effective for pain management during chemotherapy? Which strain doesn't help with either of those things? The same questions can be asked for any plant.
Medicines extracted from plants may not have the exact same effect as those plants, but they are much more predictable. The dose, the benefit, and the side effects can be studied and known. (And there is no reason to think the effect will be worse or weaker: the extra cocktail of chemicals in the plant could either amplify or dampen the primary active ingredients.)
I don't see how it fails to support my argument that by reducing a plant to one or a handful of alkaloids that represent a fraction of the body of the plants chemical makeup, we risk losing out on some of what the plant has to offer. I don't disagree that sometimes, that can be a good thing. However, it's not always; in the case of Marinol "While there has never been a documented human fatality from overdosing on tetrahydrocannabinol or cannabis in its natural form,[86] Marinol can lead to death"
Additionally, the process of isolating and combining the individual components of a plant in order to reproduce observed health benefits of the plant consumed as a whole can be a long and tedious process. Marinol's failure as a good substitute for most people who desire the effects of marijuana is a pretty good example of why, even in this age of science, it is still sometimes better to go back to the source. Green tea extracts, which I also mentioned, frequently consist of Green Tea Catechins, without including, or mentioning whether they contain, L-Theanine, an amino acid in Green tea that has been observed to have nootropic and mood-elevating effects. For someone who wants to reproduce the documented benefits of GTC, by all means go ahead and take the extract. But the benefits of green tea consumed in the traditional way have been enjoyed and observed both in studies over the last few decades, as well as by millions of people over the last thousands of years. Until we've rigorously studied every alkaloid contained in the plant individually, as well as the countless combinations and permutations of those alkaloids (also taking into account the innumerable relative concentrations in which they can be delivered and balanced), it will be hard for science to say whether the components of green tea are present in the most optimal way for X Y Z desired effects
>sure natural=better is not a rule true 100% of the time
It isn't even a loose correlation. It is no better than random.
>One example is how it became clear in the last years in nutritional science that in general the more processed the food is the more harmful it is for us.
That has not become clear at all, that is something people like to repeat, but is simply a misinterpretation of the recommendation that people "eat mainly unprocessed foods" to maintain a healthy weight. The recommendation is not due to some magical pixie dust inherent in unprocessed food, it is because processed foods are often very high in calories.
>There is also the reverse problem, illustrated by the condescending attitude toward herbalism in this article, of people who idealize modernity, and for example believe only medicine in the form of pills can be effective, even though plants may contain exactly the same chemical compounds.
Except the article had no such attitude, and said nothing like what you are suggesting it says.
>In general I think it is ridiculous to ignore the thousands of years of experimentation and exploration of our ancestors just because it wasn't "science-based".
It isn't ignored. It is studied, and if it is found to actually be effective, it is used. If it is found not to be effective, it is not used. The quack/fraud "medicine" crowd really need to grow out of lying about this. Scientists do not ignore old herbal remedies, they study them.
It isn't even a loose correlation. It is no better than random.
It depends what you mean by natural, I guess. Please read this in context, I am mostly talking about early adopting radical lifestyle changes vs. sticking to the status quo your ancestors followed, and the effects of doing so when employing exclusively one or the other strategy to all the choices.
That has not become clear at all, that is something people like to repeat, but is simply a misinterpretation of the recommendation that people "eat mainly unprocessed foods" to maintain a healthy weight. The recommendation is not due to some magical pixie dust inherent in unprocessed food, it is because processed foods are often very high in calories.
Oh yes, ridicule what I said to make your point, introduce the pixie dust despite me basing most of what I say on at least some evidence, this will make your reply so much more valuable. You are also actually only partially right, it is the amount of calories and the absence of fiber and vitamins and micronutrients (while those are used up during digestation) that makes processed foods unhealthy. I don't see how any of this has to do with what I said.
Except the article had no such attitude, and said nothing like what you are suggesting it says.
...
It isn't ignored. It is studied, and if it is found to actually be effective, it is used. If it is found not to be effective, it is not used. The quack/fraud "medicine" crowd really need to grow out of lying about this. Scientists do not ignore old herbal remedies, they study them.
I didn't say any of this, this was a comment on the general attitude of some people.
There's a tremendous amount of baggage in the loaded term "natural". But I think there might be a shred of reason to underlying the naturalistic fallacy if you interpret natural to mean "previously present in our evolutionary environment and therefore has previously exhibited evolutionary selective pressure on the development of our immune system and biochemistry."
In other words, novel, isolated chemicals and processes have more opportunity to present our bodies with circumstances their evolution has not "tuned" them for.
What I am stating is limited in scope, and your response is as disingenuous as it is snarky.
Your example likely demonstrates selective pressure within species--specifically urushiol in plants as a protective mechanism against herbivores. But you are arguing against the relevance of selective pressure. So you have beat up a straw man in which all things natural are better, but of course, I never argued that.
Do you believe in selective pressure? Do you think digesting cow milk conferred no evolutionary advantage?
There ARE studies on the prevalence of the genes for digesting dairy milk, and I think they back me up.
On a different note. I'm interested in a link to the study where where they studied my hypothesis and disproved it like you say. I've never seen a serious study attempt to disprove this. So, citation please?
Thanks for all the downvotes, aggressive trolling, comments on "pixie dust", "spirit of the planet", "poultices" etc., very constructive discussion, very scientific...
I have a friend who's into homeopathy and such, and I normally keep my mouth shut. But I have done some thinking about why. This friend is very smart, very intellectual, very curious, and not overly credulous. She's really a bit of a nerd.
From my few conversations on the matter, the thing that's jumped out at me is this:
She's drawn to alternative medicine because it's open source. Like many nerds, she hates closed proprietary systems and loathes bureaucracy.
If alt-med worked, it would be vastly superior to conventional "industrial" medicine. The latter is bureaucratic, run by closed guilds, closed source, and radiates this standoffish "you are an idiot, do not ask questions" mentality.
By contrast alt-med is open. Anyone can learn about it. Anyone can become a practitioner. Anyone can experiment. It's tolerant of differences of opinion to a much greater extent than conventional medicine. It comes off as welcoming, inviting, and engaging.
Of course, I understand some of the reasons medicine is the way it is. Unlike hacking code on a computer, screwing up medicine can really hurt people. (Code on a computer generally can't, unless you're talking about certain kinds of specialized areas.) But it does seem to me that this is part of the appeal of alt-med.
The other appeal, I think, is escape from the bureaucratic hell that is conventional medicine. Alt-med is actually more free-enterprise. There is more patient choice. It's less expensive. My wife and I just had a baby, and dealing with the insurance company has been a living hell.
Edit: one more observation.
We've tried a little bit of alt-med type stuff to varying degrees of success. I think I can also say this, and I think it goes a long way to explaining alt-med's popularity.
The bedside manner you get with "alternative" practitioners is vastly better. I mean huge orders of magnitude better.
We have a pretty good doctor and a pretty good hospital, and even then we occasionally feel like meat. And ours is really above average in terms of doctor-patient relations and comfort. I've heard some real slaughterhouse horror stories, particularly around women giving birth in ordinary hospitals. I have a relative who has such a story. She really felt like a piece of beef, and the doctor was a real jerk.
The physical design of the spaces is better too. Go into an alt-med clinic and it feels warm, welcoming, calming. Go into a hospital or a conventional doctors' office and it looks like a car repair shop. Again -- to draw an analogy to the computer industry -- Apple has proven just how much aesthetics matter. Apple's products are generally not technically superior, but they are often vastly superior aesthetically and in terms of usability.
>> The physical design of the spaces is better too. Go into an alt-med clinic and it feels warm, welcoming, calming. Go into a hospital or a conventional doctors' office and it looks like a car repair shop.
I'm sure the feel could be improved, but I bet the main design goal in conventional offices is "surfaces that can be easily cleaned." Not very unlike a car repair shop, really.
> I have a friend who's into homeopathy [...] she's drawn to alternative medicine because it's open source. Like many nerds, she hates closed proprietary systems and loathes bureaucracy
If your friend, or anyone else that way inclined, dislikes modern medicine because of its insular, closed nature then I urge them to support campaigns such as alltrials.net, which advocate open research across medicine. There are a number of people in the industry who truly support an open approach to pharma, and the more people generally shouting about it the better.
I say this because it seems very strange to advocate homeopathy based on its "open source" credentials when the people practising it won't tell you that it patently and demonstrably simply doesn't work outside of the placebo effect. Some alternative medicines do have proven benefits: homeopathy is not one of them.
There is a strong history of alternative medicine medicine practitioners using libel and defamation laws to silence their critics. See, for example, BCA v Singh[1]. Alternative medicine is not open. It is a highly insular community that reacts very badly to criticism, more so than modern medicine.
Let me put it another way: if alternative medicine (and I'm particularly thinking of homeopathy in this case) was so open you would expect people going to receive homeopathic treatment to be told the field was totally discredited by modern science and numerous double blind studies. But they're not. A homeopathic practitioner will not direct you to these studies, or tell you. I don't know how this can be considered open.
Well I know several people for whom the Paleo diet has worked, and also alt medicine. I don't know why it works but it's unscientific to ignore the evidence simply because you don't understand it.
It's unscientific to elevate your anecdotes above actual studies because you subjectively feel there's something there. This is why we have studies.
I don't know why it works but it's unscientific to ignore the evidence simply because you don't understand it.
Classic. Homeopathy enthusiasts always wheel this out and it's hilarious. "Just because you don't understand how it works you shouldn't ignore it!". I don't understand how it works because it doesn't! And this has been shown over and over again!
I have no idea about the paleo diet, but if it seems to do good things for people we should first establish whether that is true and then find out how it's true. Alt med always misses step 1.
I'm sorry but anecdotes are evidence, just with a very small sample size. You can keep saying "it doesn't work" as many times as you like but you'll still be wrong.
I'm sorry but anecdotes are evidence, just with a very small sample size.
OK, anecdotes are not good evidence, and cannot be used as evidence because they suffer from nearly all the problems that a good study accounts for and real evidence gathering processes account for and mitigate. Anecdotal data suffers from confirmation bias, from selection bias, it has a small enough sample size to be meaningless, and is as a result worthless.
Better?
You can keep saying "it doesn't work" as many times as you like but you'll still be wrong.
Right, but if you've tried doctors and they haven't been able to help, and if you have heard of a treatment which anecdotally works, and has no reported side effects, then why wouldn't you try it.
If it works for you then you still have a sample size of one but this would be good enough.
That depends on what the condition is, how trustworthy the anecdotes are and how much someone was trying to charge me for it.
For instance in the case of terminal cancer, some people get ripped off by charlatans to the tune of hundreds of thousands of dollars. The anecdotal data around these assholes is all overwhelmingly positive and claims no side effects, because people who are ripped off and then die tend not to talk about it but the very few who survive for reasons unknown shout a lot. The reason you might not try it is because you'd be bankrupting the family you're going to leave behind, or funneling good-will donations to a conman.
There are numerous examples of alt-med 'cures' that are dreadfully harmful (black salve, sodium hypochlorite enemas). This idea that CAM is fine to try if you're out of options because it has no side effects is itself very dodgy. Hell, even acupuncture carries some elevated risk of infection because you're pushing needles through the skin.
But if it was something minor, cheap and there really were no side effects, sure - why not?
--edit--
But telling if there really are no side effects does require some basis in provable fact, or you're just necking unknown quantities of unknown stuff, which may not be a great plan.
"That depends on what the condition is, how trustworthy the anecdotes are and how much someone was trying to charge me for it."
This is true for any medical treatment. You weigh up the costs, risks, benefits and then you decide if you want to go ahead with it.
There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,
"This is true for any medical treatment. You weigh up the costs, risks, benefits and then you decide if you want to go ahead with it."
Absolutely, but medical treatments should have reliable data available (not saying they always do). In contrast alt med never does (that's what makes it alt), but instead has cheerleaders and woo.
"There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,"
Yup, and now we know the harms and don't use these things. (What's your point?). Whereas with alt-med this doesn't seem to happen.
"There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,"
I also want to say that this is pretty disingenuous as a statement because I named harmful CAM treatments in response to your question "if you have heard of a treatment which anecdotally works, and has no reported side effects, then why wouldn't you try it?". I was pointing out that alt med really cannot claim to have no side effects. It often does claim this, but it cannot.
Many medicines have dreadful side-effects, yes, even the ones we still use, but these are measured and quantified and (in theory) the treatments are only used if the main effect is worth it.
With alt med there often are side effects and there is no proof that any of it works, by definition.
"Available scientific evidence does not support claims that naturopathic medicine is effective for most health problems."
I wouldn't call that supporting evidence that CAM works, in fact I'd say that whole page doesn't give it any support at all, nor does it excuse naturopathy from having harmful effects -
"Substances used in alternative medical practices may have not been thoroughly tested to find out how they interact with medicines, foods, or dietary supplements. Even though some reports of interactions and harmful effects may be published, full studies of interactions and effects are not often available. There may also be lesser-known methods used, other than the ones discussed here, which could potentially cause harm. Because of these limitations, any information on ill effects below should be considered incomplete."
"Other aspects of naturopathic medicine, like healthy nutrition, have been shown to lower the risk of illnesses such as heart disease and cancer. Some aspects of naturopathic medicine may be useful when used along with conventional medical treatment."
Like I said, you're simply choosing to ignore the evidence. If you'd like to stay ignorant of it then that's your right and your privilege.
Claiming decent nutrition or exercise as an aspect of CAM is disingenuous at best, and at worst a way to propagate charlatanry.
"Look, we do this common sense thing, therefore the rest of our stuff must be true!"
Eating well, getting rest and exercise, these things are not alt med, not naturopathic, not 'integrative', they are well supported aspects of evidence based medicine.
I'm not American, so it's not really for me to bother them. Also it's not really false, is it?
"Other aspects of naturopathic medicine, like healthy nutrition, have been shown..."
Perfectly true information. Just irrelevant because those are aspects of mainstream medicine too.
--edit-- but were I american and had medical credentials to my name, yes I absolutely would be writing to them to protest the existence of that page in its entirety. As it stands I'm just a British skeptic.
Just to be clear, your primary reference is The American Cancer Society, which is a non-profit charity. You know it's not a scientific research organization, right? And one which has a rather mediocre rating, as charities go?
Why do you pick specifically that reference, which sits very carefully on the fence in order to find something good about naturopathic therapies? ("good diet" and "counseling" are, of course, quite common recommendations of any doctor)
Why not reference an actual research organization which also has patient outreach? I'm thinking specifically of The National Center for Complementary and Alternative Medicine, of the NIH, at http://nccam.nih.gov/health/cancer/camcancer.htm . They've gotten into political hot water because it was started and funded to find how if CAM is useful, only to report that no, it nearly isn't useful at all.
That site NCCA describes only on the treatments which are specific to CAM, and not shared with standard medical practice.
I did a quick google search and it was one of the first references that came up. I only have to provide a citation that CAM sometimes works to disprove Nursies assertion that CAM "doesn't work".
Nursie did not assert simply that all of CAM "doesn't work". Nursie pointed out that those aspects of CAM which do work are shared with traditional medicine, and have been part of traditional medicine for a long time. They are not specific to CAM.
A naturopath may suggest that you always wear a seatbelt when driving a car. That doesn't make the suggestion part of naturopathy.
A naturopath may suggest that you keep the safety on when carrying a firearm. Again, that's a good suggestion, but it's not something specific to naturopathy.
The examples you pointed out on the Cancer Society web page are not unique to naturopathy. I interpret them as trying to say something good about naturopathy, probably because of so many complaints about how naturopathy is being 'suppressed by Western thought', or something like that.
The NIH site I pointed you to reports on the CAM practices which are specific to CAM. Very few of them "work" in any fashion, and none of them are treatments.
"It" refers to the part of alt.med which isn't part of med. That's the part that makes it "alt."
At least, that's how I interpret it. The full context is:
analog: "Paleo diet has worked, and also alt medicine", followed by Nursie: "I don't understand how it works because it doesn't!"
The immediate context for 'it' is homeopathy, but I think, based on Nursie's other statements, that it should apply to all of alt.med. It doesn't apply to (to coin an abbreviation), "std.med", because it seems that Nursie finds convincing evidence that std.med does work.
So the question to you is, what puts the "alt." in "alt.med"? If practice X is part of "alt.med" and is part of "std.med" then is how is X "alt"?
It's possible that something started as alt.med and became part of std.med, but the practices listed on the ACS page have been part of std.med since pretty much since the dawn of evidence-based medicine, so it's not like std.med recently took those parts from alt.med.
Therefore, you should interpret those quote of Nursie to mean:
"[The part of alt.med which is specific to alt.med] doesn't [work]" and "I don't understand how [the alt. part of alt.med] works because [the alt. part of alt.med] doesn't [have any demonstrated effectiveness]".
Rather, what do you mean by "work"? If people who pray feel more relaxed, then yes, it works for some people. So does meditation. So does reading a book, or watching a movie. Or playing cards, or talking with friends.
If by "effective" you mean that people who pray have a higher longevity, higher rate of being cured, etc. then no, it doesn't work. This type of prayer is usually called intercessory prayer.
> Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. ...
> CONCLUSIONS: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.
> OBJECTIVES: To review the effects of intercessory prayer as an additional intervention for people with health problems already receiving routine health care.
> AUTHORS' CONCLUSIONS: These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
Reduced stress is an important quality of life factor. It has been shown to provide this, therefore it works.
"Spiritual well-being and coping. An analysis of 43 studies on people with advanced cancer noted that those who reported spiritual well-being were able to cope more effectively with terminal illnesses and find meaning in their experience. Major themes of spiritual well-being included self-awareness, coping with stress, connectedness with others, faith, empowerment, confidence, and the ability to live with meaning and hope."
Palliative care, which is what we are talking about now, is different than treating a disease. Standard medicine is well aware that tending to the emotional needs of the patients, including providing an on-call chaplain at some hospitals, helps make some patients feel better. Hospital chaplains have been around for a long time, and are not specific to alt.med, nor did the practice of providing access to religious support derive from alt.med.
That said, it's interesting that the paragraph you quoted doesn't mention the word "prayer" at all. It refers to "spiritual well-being." Earlier in that page it pointed out that spirituality "is often expressed through religion and/or prayer"", but it doesn't say that it's the prayer which leads to any change.
More specifically, it also says that "Meditation, twelve-step work (as practiced in Alcoholics Anonymous and similar groups), and seeking meaning in life all involve spirituality. Even simple practices such as silent observation, listening, or gratitude can become part of an open-ended spirituality that can infuse everyday life. Some people express their spirituality by spending time with nature, doing creative work, or serving others."
It notably doesn't say (as you suggest) that prayer is an effective method to reduce stress, nor does it say that prayer is any more effective than 'spending time with nature' or 'doing creative work.' (To that list I'll add 'talking with a counselor.')
So I don't understand your point. That page doesn't show that prayer "works", except perhaps as pallative treatment for those who already believe that prayer is effective. But then that's not very surprising, is it? And other forms of palliative care would also be effective. Perhaps even more effective?
You must certainly acknowledge that "spiritual well-being" as given on that page is a rather broad term. Telling a patient to spend time relaxing in the mountains, as an example of spending time with nature, is not specific to alt.med. Indeed, a century ago, going to a spa in the countryside, where one could get away from the stresses of life was the common treatment for well-off people with tuberculosis, 'consumption', and other hard-to-cure diseases. So it's not like these suggestions are foreign or even recent to standard medicine.
(Though once we figured out how to cure tuberculosis, this treatment for tuberculosis disappeared. That's why palliative care is different than treatment.)
Also, don't you find the circular reasoning rather odd? As you quoted, "those who reported spiritual well-being were able to cope more effectively with terminal illnesses and find meaning in their experience", but as I quoted in the second paragraph, "seeking meaning in life [involves] spirituality." In a rather direct sense it says that those who seek meaning are more able to find meaning in their experience. Should anyone be surprised about that?
I also think the idea that one should "find meaning in their experience" is a biased term. What meaning is there in going through cancer treatment? Other than the obvious - a combination of genetic and environmental factors, plus random chance lead to having cancer, and it's pain in the ass to get cancer treatments - why should anyone seek a deeper meaning?
Of course, if you think the universe is constructed around you, perhaps because there's a God or universal spirit who intercedes on your behalf and 'works in mysterious ways', then perhaps thought, prayer, and reflection might help revel that hidden meaning, or perhaps help you accept that it's all for the best. But then it's rather biased metric, because those who don't think there is meaning to cancer will also tend be those who don't have a religious or spiritual faith.
Ok, if that's not good enough for you then pick one of the other examples that the ACS provide. Or continue attacking the ACS as a reputable source, whatever.
Or go and look up the examples that the med student provided, Inositol or Theanine. I expect you'll find reasons to ignore the evidence there too though, that's the problem with zealotry.
I don't understand your argument. You said that alt.med methods are effective. I and Nursie point out that the methods which are effective for alt.med are also part of std.med. They are not unique to alt.med and therefore cannot be used to justify the validity of other alt.med practices which are not part of std.med.
Do you agree with this argument? If not, why not? If both std.med and alt.med make the same recommendation then what's "alt" about alt.med? Otherwise I continue.
You point out that prayer is effective. I respond that intercessory prayer has not been shown to be effective, despite several large-scale experiments. Yes, prayer can be part of palliative care, since it might make some people feel better. But palliative care is not treatment.
It also leads to questions like, is reading a good book on the topic of death or dealing with terminal cancer (as with http://en.wikipedia.org/wiki/Bibliotherapy) a better, more effective palliative care than telling people to read the Good Book?
You point out that the ACS says that prayer is effective. I point out that you've misread the page, because the ACS page does not say that prayer is effective. It only says that prayer is a visible aspect of how some people carry out their 'spiritual life', and that a spiritual life may help some people feel better.
Furthermore, the definition of 'spiritual life' on that page is so ill-defined that it includes, say, the hobbies of a dyed-in-the-wool hard-core reductionist, atheist, anti-CAM person. Which might also be hobbies that a std.med practitioner would suggest. There is nothing "alt" about a doctor suggesting that someone relax by taking a holiday in the countryside, away from computers and phones.
So no, it's not good enough me as evidence that alt.med is effective. Nor should it be good enough for you.
Yes, there are perhaps a dozen dietary supplements and herbs which might be useful. These are overshadowed by the array of supplements on the market that have no redeeming quality except perhaps to enrich the pockets of the multi-billion dollar supplement manufacturing industry.
Which means that yes, Nursie and I are wrong in that there is a thin sliver of possibly useful treatments to come from alt.med. Most interestingly, these tend to be for anxiety and depression, where effectiveness is much harder to evaluate than "can cure a staphylococcus infection." Thin evidence, I say, but I'll concede that sliver.
Your argument though is that those dozen possible treatments justify the entire alt.med industry? Color me doubtful.
You say that I ignore the evidence. What I ask is that you present the evidence. The ACS page does not seem to provide the evidence that you say it does. The ACS page is, of course, a summary and cannot be held up to full scrutiny, which is why, in order to strengthen my argument, I've made references to some of the experimental research papers on the topic, and they concur with my position.
Surely if there is the good evidence that you say there is then you can either find more experimental research with conclusions that strengthen your viewpoint, or can highlight the flaws in the papers I cite, yes?
That was rhetorical. You point out that there's perhaps a dozen herbs and nutritional supplements which might .. and I do stress the might .. be a useful treatment. Does that justify the entire herbal and diet supplement industry? Since your argument does seem to be that Nursie is wrong for saying that 100% of alt.med is useless as a treatment, when the actual number is 99.9+%. Do you really want to get that fraction of a mil? Because I'll grant you that <0.1%, and wonder why it's so important to you.
Again I ask you the question, what puts the "alt." in "alt.med"?
If a practice is common to both std.med and alt.med, when should we attribute its discovery or common use to alt.med?
Obviously you shouldn't say that open heart surgery is part of natropathy, but why not? It works, so why doesn't alt.med claim it as its own?
You can't, for example, say that food supplements are only part of alt.med because fluoride in (some) water systems, vitamin D in milk, and iodine in salt are three food supplements that medical researchers successfully insisted be part of the standard food supply, in order to improve public health.
What makes 'alt.med' alt?
But in some sense you're right. The old canard is that we have a name for alt. medicine that works - it's called "medicine." Because fundamentally, modern medicine is based on trying to find what works. The thing is, very little of alt.med "works", by almost any definition except palliative care, and even then, no more helpful than other forms of care.
Take a look at any of the research papers on the subject, where the alt.med methods were put to a test, and you'll see that any signal that is there is about as strong as the noise.
Compare that to the first people who were treated with penicillin. Compare that to the children who no longer got polio. Those are examples of clear, strong signals of effective treatments.
Just to clarify - my assertion is that CAM doesn't work because if it works, and we have evidence to show that it works, it's not CAM it's part of the body of evidence-based medicine.
If we don't have scientific evidence that something works then pretty much by definition we can't say it works because we don't have the proof. It's sort-of tautological.
The other comment "I don't understand how it works because it doesn't" was specifically in reference to Homeopathy, which has been shown over and over again to be no better than placebo (i.e. doesn't work). The example was to show that there's no point in investigating how something works, and it's silly to chastise people for not understanding how something works, unless we can first show that something works and that there is even something to investigate.
Apply this to paleo - I have no reason to suspect it works or not. Before investigating this miraculous diet, lets do a proper study to see if it actually is of benefit to the general population, or just to a subset, or if actually the benefits reported are by a tiny number of self-selected people and not really significant at all.
When we actually know (rather than suspect from anecdote) that it does something, then is the time to look at how.
"I only have to provide a citation that CAM sometimes works to disprove Nursies assertion that CAM "doesn't work"."
It helps to pick something that is actually CAM then, and not part of mainstream health advice that has been coopted by CAM. Eating well and getting lots of exercise isn't exactly revolutionary, outside-the-box, non-mainstream thinking.
You do realize that many doctors who don't follow naturopathic medicine also recommend "healthy nutrition", right? And that many also recommend "counseling"? These are not the sole provenance of naturopathic medicine.
They all probably recommend getting enough sleep and drinking enough water.
In a related question, what is "healthy nutrition"?
When Ayurveda says that onions "stimulate the central nervous system, and can disturb vows of celibacy" and should not be eaten as food (at least not by yogis), while nutritionists and researchers find no evidence that onions have those non-nutritional effects on the body and recommend that you can eat them if you like the taste, then whose advice should be followed, and why?
Let's say that 10% of the people who switched to a paleo diet found that it "worked". (Without knowing what "worked" means, I'll assume it's "lose weight.")
If you talk to those people for whom it worked, then great! there may be evidence there.
However, let's say that of the people who decided lose weight through other means (a low calorie diet, more exercise, gastric bypass, whatever), 10% were successful.
With this additional information, it's hard to conclude that choosing a paleo diet makes a strong difference.
In other words, looking at the success cases doesn't give a conclusion, only a possible path for followup investigation. It's unscientific to say that something "works" by only looking at the successful cases. You also need to track the failure cases (those who tried paleo but where it didn't work), and the success and failure cases for other methods.
The same for medicine. If someone tries X (aspirin, herbs, whiskey, zinc, penicillin, etc.) for the flu then gets better within a couple of days, then it doesn't mean that X actually "worked". There could be other reasons for why the person got better, like the person's own immune system. (For the record, none of those 'medicines' will work against the flu, though a few of them will help relieve some of the symptoms.)
That's why these anecdotal accounts, while true and even heart-felt, don't suffice to make a scientific conclusion.
Some things do work and are not yet accepted in medicine. Herbal medicine etc.pp.
Often it's just hard to patent and/or isn't financially lucrative to get FDA approval.
Also lifestyle in general is terribly handled in medicine. MDs know nearly nothing about what matters and what they should recommend. They are decades behind the available evidence.
Some herbal medicine may work. Without proper studies we don't know.
I agree that lifestyle stuff is important, can be handled by none MD folks, and can have a huge impact on life and health in general. What gets my goat is the CAM proponents who claim they can cure anything and everything with their woo.
But there are a bunch of studies on useful stuff. Inositol, Theanine etc. And we still don't do studies because interests don't align well for it to happen quickly.
My point being that some Alt Med Practitioners actually help. I don't like it, because I heavily dislike the widespread incompetence about science/medicine in Alt Med circles. But it's still true.
Well the MDs do give you lifestyle advice. And the "professionals" that should care about this stuff (esp. dieticians) also suck badly. They often just regurgitate the food pyramid.
I am on my way to my MD, I know. But in the real world people do use "Alt Med" for treatments that have shown efficacy already. It takes far longer than expected until this stuff becomes part of practiced medicine though. In the end I don't care about the label, but the evidence/science and the results.
"But in the real world people do use "Alt Med" for treatments that have shown efficacy already."
You're investing in their false modality by using it to define actual medicine, in the same way that people market "homeopathic" OTC based on actual ingredients and not "water memory".
I don't disagree much on fact, but the attitude on display here is not helpful. It turns people off.
There was a time when people were willing to trust authority figures and accept the advice of credentialed experts without question. That time is over. If you talk this way to people, they tune you out.
Part of the reason for this is the Internet itself, and the general displacing of one-to-many communications with many-to-many communications. The medium is the message, and the message of this medium is "information is liquid, and there are no privileged points of view."
But more significantly, I think people have grown fatigued with the errors and lies of experts. Experts with all the right credentials once told women to smoke. It's a great way to lose weight. Margarine was once good for you. In 2006, the worst time to buy a house in 100 years, the President of the United States stood up on stage and encouraged more people to buy homes. People are sick of it, and they're not listening anymore.
It doesn't matter if you're right or wrong. The only way to get peoples' attention now is to speak to them like equals and explain yourself. Opaque statements that appeal to authority tend to be tossed in the waste basket by most educated, thinking people. The only people who are willing to "just believe" anymore are fanatics, and they tend to be followers of the most idiotic bullshit imaginable.
I'm not really sure I make appeals to authority, and the fact that I rip into stuff is me treating people as equals, not as fragile china dolls that need to be cosseted and persuaded with allusions to reality to persuade them down from their weird views.
I'm also pretty sure you're right that it puts a lot of people off, and I'm not the right person to talk to them :)
Oh and I absolutely agree that the days of listening to experts and authority figures are over. I'm not one.
You'll find me the last person to say that the medical establishment has everything right, or that we should always listen to doctors because they're just so clever. I just think that most of the thought behind alt-med in its various forms is nonsense too.
There was an interesting study done - and written up on SBM - that suggests that the theraputic effect of Alt-med, at least with acupuncture, is entirely due to patient-practitioner interaction.
As someone on the cusp of becoming a Doctor, I understand this. I even understand why traditional medicine fails at it (and it is many of the reasons you mention). And I understand why Alt-med succeeds here.
I think it's great that alt-med can deliver a measurable placebo through the clinical effect.
HOWEVER
this does not excuse the intellectual dishonesty of alternative medicine practitioners.
Please anyone who replies to this suggesting that 'We don't know enough about alt med, bla bla bla, big pharma won't study it because it can't be milked for the elixir of life, money/human blood, etc' - Stop now. There's 3 types of treatments. Medicine proper, Stuff that has been tested and found wanting, and stuff that hasn't been tested. The second category is almost exclusively the whole of alternative medicine.
please excuse my divergence as I return to the train of thought:
We should continue to deny alternative medicine practitioners legitimacy. As I argue in the SMH article (3rd contribution in the article) referenced at the bottom of this post, it causes an economic misallocation of resources away from real, practical science towards, for want of a better word, magic.
What we should also do, I now believe, is actively encourage these people to become 'Lifestyle practitioners'. They don't practice a form of medicine, or at least drop the pretence that what they are doing has any scientific backbone, and instead do what they are doing now - that is, interacting with patients, talking with them about their lives, encouraging positive lifestyle interventions (cutting out smoking, drinking, increasing exercise, etc) in an environment that it seems they are more responsive to these interventions.
You can't have both. It is false and misleading for Alt-med practitioners to continue to pretend and/or believe that what they are doing has a real scientific basis in the same way as taking a drug that has been through a RCT does.
But you allude to the root of the problem when you talk about the shabby operation of many hospitals etc.
The difference is, they are built for really sick (or in your example, pregnant) people. Lots of them. Because there are lots of them. And alt-med practitioners will kill them by the bucketload if we were to get rid of hospitals and doctors tomorrow. and then society would go through the process of re-inventing something similar
What percentage of Conventional medicine practices are evidence based?, ie what percentage of what you as a conventional MD practice has been subjected to RCT?
I have a friend who is a Internal Medicine MD who claimed it was less than 50%. If thats the case then every conventional MD continues "to pretend and/or believe that what they are doing has a real scientific basis".
Please give me a % of what you do in a clinical setting that has been subjected to RCT otherwise you are setting a standard for CAM that even you cannot meet.
I'm not an American and I won't practice there. I'm Australian and we score an improved 19th on that league table. However I recently had the opportunity to study/work in a hospital in the states and these are some of my observations.
- The US healthcare system is fucked.
- there is a major disparity of care by region and neighbourhood (from my experience)
- poor people are discriminated against by the healthcare system
- these inequalities of care and resources are perpetuated down the line by a social system which doesn't support the most needy n society
In comparison,
Cuba has one of the highest rates of doctors per capita and a healthcare system that performs astoundingly well, especially when compared on a dollar basis. You don't need high tech to perform life saving basic medical treatment, such as that which infant mortality measures.
I feel that the US healthcare system over-emphasises technology to deliver solutions, when what is actually needed are people on the ground in places where they are needed. Unfortunately for those people, they are unable to pay so no-one is going to go to them.
Now to the meat and potatoes of your claim. Firstly let me say that it strikes me as a bit aggressive. I said * in the same way as taking a drug that has been through a RCT does.*
If I am to respond to your whole query, then really I am throwing open the whole of medicine. And it's a big area. Everything from the correct techniques for birthing to height projection charts for children, through immunisations and treatment for common illnesses, to whole specialties of cardiology, renal medicine, .... Many many more.
But let me give you some anecdotes to show you how much of medicine HAS been studied. Maybe You will cry 'liar, deceiver!'. Or maybe I will be able to convey to you a bit of the never-ending torrent of information every doctor is swimming in (and I will admit, there are some that simply stop looking at it all).
Firstly. We have to do assignments called PEARLS. basically, w come across a clinical question and go and try and find evidence for it. As (at the time) a 3rd year med student, I still didn't really have much idea what was going on in the hospital, let alone how to formulate a clinical question and find an answer.
My question involved an elderly patient who had been transferred to the service I was on. He was on an ace inhibitor and an Angiotensin-receptor blocker. That is, 2 types of drugs which supposedly do the same thing.
This was a bit weird to me but it turned out there is some plausible science behind it - combination treatment might lead to being able to use lower doses, which can mean less side effects, as well as more effective RAAS blockade which might lead to better control of blood pressure.
Well it turned out that for this question I thought was stupid and pointless there had been a recently completed RCT, The ONTARGET Study, which proved that dual blockade is worse than single drug use.
My housemate is currently doing his, and his clinical question is whether an infected abdominal surgical wound should be closed or left open.
Also seems like a Bizzare question but turns out there are several papers on this, and they say that the wound must be left open.
No RCT this time, but it is notoriously hard to do RCTs in surgical patients for reasons I'm sure you can understand.
A thir anecdote: when we start med, they tell us that 50% of what we learn will be obsolete at the end of 4 years of study, the problem is we don't know which 50%. Such is the rate of scientific advancement.
When I first heard this I just thought it was an embellishment, a story designed to boast of the speed of discovery.
Turns out its true. Some significant changes have occurred since I've started studying that have overturned long-held practices.
An example would be the use of lidocaine and adrenaline/epinephrine in local anaesthetic for closing a wound in the extremity.
It was thought that the adrenaline would cause vasoconstriction whi...
His studies comparing fakes strike me as the most innovative thing I've heard about in medicine in years.
A big problem with "conventional" medicine is this: the mind is off limits. This legacy I think goes back to the suppression of deep mind research following the psychedelics moral panic in the late 1960s/early 1970s. They were doing really interesting stuff back then, but the societal effects of probing deep into the mind caused the entire academy to purge itself of really challenging, imaginative research in these areas. Our society is really terrified of that stuff. We like our doors of perception safely nailed shut.
I also think this comes from the mind/body dichotomy. The mind and body are not disconnected entities. The mind is a part of the body. As such, the mind is going to have a profound influence over the body. The placebo effect itself proves this, as do the studies you cite and numerous others.
I agree that the mind's contribution has been shut out of things. I don't think it's right but I do think there has been sound reason not to: we just don't understand enough about how the interaction works.
We are entering into a really interesting new era as investigation into these areas begins again
The "set and setting" hypothesis is strongly supported by the fact that in the studies I linked fake acupuncture outperformed a fake pain pill for the treatment of pain.
My current hypothesis on homeopathy is that it's a placebo surrounded by some interesting mythology and a good story that serves to enhance its placebo effect by priming the subject.
THAT is what really needs to be studied. If this could be understood, we could have a genuine complimentary medicine rooted in science that addressed the mind side of the equation coincidentally with conventional medicine addressing the body. I was ecstatic to learn about that Harvard Medical School program, which is looking at just those kinds of hypotheses.
The other thing though -- and this is the hard thing for skeptics -- is that if this is true, it means these things may not be 100% quackery and fraud. There is something happening here, just not what the practitioners think is happening. It's in the patient's head, but also "real" in the sense that front-loaded placebo outperforms a null treatment.
Do you mean it has been tested and found to work, even if it has nothing to do with medicine (some herbal supplement or meditation) or just medical approved/ordered?
I don't buy into much of the alt-med areas (homeopathy, acunpunture, etc, just not my cup of tea) but I do research a lot about natural 'supplements' and many have been proven quite useful for human health. In what category would you put this?
The other part of the problem is the influence medical staff have. One example is the food advice we have been getting the last couple decades.
'No fats, a lot of cereal. That's the way to live.' which still today doctors here advise (my dad is pre-diabetic, his doctor recommended to change to wholegrain bread and stop eating animal fat, and take his medicine, can't forget that along with his statins for the cholesterol!) which we all know now that isn't the way to go, but many doctors are still making their informed decisions by things they learned 40 years ago in medical school.
Open source is more than just open information. It's accessible information, accessible tools, and accessible discourse.
Also: most of the replies on this thread have misunderstood my original post. I was not arguing for homeopathy or alt-med at all, and I do think quite a bit of it is baloney. I was explaining why people are into it, from a sociological point of view.
How is evidence-based medical information less accessible than alt-med? There's books about it at bookstores, libraries, and online, ranging from the AMA's "Family Medical Guide" up to specialized texts on just about every topic. Plus, at least some of the literature is available for free online.
Somewhat to your point, I've found that people arguing alternative vs modern western medicine are often arguing two sides of different issues. Those in favor of modern, evidence based medicine, explain why the scientific method works, and why is superior to superstition. However, those on the other side, having often spent a lot of time among doctors of all types trying to find help for some chronic condition, are arguing how horrible modern medicine has been to them in practice.
And if you look at the debate like this, it is possible to support both sides simultaneously.
The only problem I have with that is that "modern medicine has been horrible to me" doesn't (if thinking rationally rather than emotionally) automatically lead me to thinking "therefore this other stuff must be better".
I guess that's why I find it so hard to understand.
"it is possible to support both sides simultaneously"
It's really not in practice. Skepticism of evidence-based medicine is done through the prism of having bad or not enough medicine. "Alt-med" throws all evidence away but "it works for me". Some emulate studies, but they exist for marketing and potential Federal funding, not for any actual interest in success.
"She's drawn to alternative medicine because it's open source. Like many nerds, she hates closed proprietary systems and loathes bureaucracy."
Granted, the same can be said for truthers, UFO and Bigfoot aficionados. They're all nerds, but it doesn't take a great deal of skill to be any of the above.
I agree with a lot of what this article says regarding the "naturalistic fallacy",etc.
However, this quote is an example of shallow thinking that drives me nuts:
"Of course, it’s hard not to note that cancer and heart disease are primarily diseases of aging, and life expectancy was so much lower back in the day that a much smaller percentage of the population lived to advanced ages"
Life expectancy FROM BIRTH has risen dramatically, but if you rule out those who died before they reached 5 years old, and rule out violent deaths and/or viral/bacterial plagues, you begin to realize that life expectancy is not much higher today.
The point is that if cancer and heart disease are disease of aging, but were rare in paleolithic times, then a life expectancy lower than the age at which they are expected to strike does not preclude the possibility that there were other factors than early death that reduced their incidence.
If a disproportionate number of people died before the age of 5, a life expectancy of 40 means that many lived beyond that age, and would be expected, all things being equal, to have contracted cancer and/or heart disease.
Life expectancy FROM BIRTH has risen dramatically,
Check more sources, and you will learn that life expectancy is rising at all age levels throughout the developed world. I've posted all of these links before here on Hacker News, and I don't mind posting them again.
Girls born since 2000 in the developed world are more likely than not to reach the age of 100, with boys likely to enjoy lifespans almost as long. The article "The Biodemography of Human Ageing" by James Vaupel,
originally published in the journal Nature in 2010, is a good current reference on the subject. A comparison of period life expectancy tables and cohort life expectancy tables for men and women in Britain
helps make the picture more clear. ("Period life expectancy" is what is usually reported for a whole country. But cohort life expectancy provides a better estimate of future lifespans of young people today,
and is still steadily on the rise around the world.) Life expectancy at age 40, at age 60, and at even higher ages is still rising throughout the developed countries of the world.
I came here to post the same thing. This is its own fallacy.
It was used to market estrogen supplementation, among other spurious remedies, to post-menopausal women. "Women didn't used to live very long after menopause--the life expectancy was only about 50. You need to take estrogen pills to keep you healthy into old age."
This of course was people using statistics to lie. The average life expectancy was lower primarily due to high infant mortality. Life expectancy is NOT the average age at death.
But then they found out that the estrogen pills were causing breast cancer, so that put a stop to that.
> This of course was people using statistics to lie. The average life expectancy was lower primarily due to high infant mortality. Life expectancy is NOT the average age at death.
Just because lower infant mortality raises the life expectancy, doesn't mean that the average age at death hasn't gone up. I agree with your life expectancy claim do, but it doesn't mean the opposite is true either.
That's a true statement--infant mortality has declined and average age at death has also increased, but the increases in average life expectancy are much more greatly attributable to the former than to the latter.
The fallacy is "{disease} is a disease of old age, and people didn't used to live past {average caveman life expectancy}. Therefore humans almost never experienced {disease} until modern times." This is very far from the truth, and is usually delivered as part of a sales pitch. I was surprised to see it repeated in the OP almost verbatim. The article debunks several other fallacies but, disappointingly, perpetuates this one.
I'm pretty sure that life expectancy figures generally discount infant mortality as a separate issue.
People did not live all that long in prehistory. Infections and diseases were more fatal more often. It's not like if you made it to ten you'd be as likely to live to 70 as someone is today, no sir.
>Life expectancy FROM BIRTH has risen dramatically, but if you rule out those who died before they reached 5 years old, and rule out violent deaths and/or viral/bacterial plagues, you begin to realize that life expectancy is not much higher today.
That is a myth. Life expectancy is much higher at all ages. In ancient Rome, the life expectancy for a 15 year old was 52. In modern first world nations, life expectancy at birth is 80. That is a huge extension of adult lifespan. Just because infant mortality was part of the reason lifespans were lower in ancient times, doesn't mean it was the whole reason.
And you don't think the life expectancy for a 15 year old being 52 didn't have to do with deaths due to disease/violence?
Let's look at a familiar group of people who had zero access to antibiotics nor modern medicine. America's founding fathers:
"For their era, the 1787 delegates (like the 1776 signers) were average in terms of life spans.[15] Their average age at death was about 67. The first to die was Houston in 1788; the last was Madison in 1836.
Secretary Charles Thomson lived to the age of 94. Johnson died at 92. John Adams lived to the age of 90. A few—Franklin, Jefferson, Madison, Williamson, and Wythe—lived into their eighties. Either 15 or 16 (depending on Fitzsimons's exact age) died in their seventies, 20 or 21 in their sixties, eight in their fifties, and five only in their forties. Three (Alexander Hamilton, Richard Dobbs Spaight and Button Gwinnett) were killed in duels."
No, its not the point. Did you even read the article? The article is making a claim that the specific "diseases of civilization" (heart disease, cancer, diabetes) would have been equally prevalent in primitive societies IF people had actually made it to old age.
There is zero discussion or argument about the fact that people died of random shit that is today easily cured. The argument is due to the fact that the people that DIDN't die due to random pathogens/violent acts/etc DID live to comparable levels of old age, and the author doesn't get that. When more than half of children die before age 5, it skews the life expectancy statistic the author is citing to claim that there were no old people around to get heart disease or cancer. This is completely incorrect.
>The article is making a claim that the specific "diseases of civilization" (heart disease, cancer, diabetes) would have been equally prevalent in primitive societies IF people had actually made it to old age
Right. And you pretended that they did make it to old age and infant mortality was the cause of lower lifespans. I corrected that misconception. I honestly have no idea how you got this confused.
>DIDN't die due to random pathogens/violent acts/etc DID live to comparable levels of old age
No, they didn't. That's the point. Hitting 80 was exceptionally rare. Rare like hitting 110 is now.
I'm getting kind of an asshole reputation for always arguing with friends who are deeply into C/AM. But I'm also starting to realize it's exactly like arguing with a religious person - there is absolutely nothing you can say to make them realize their faith is based on fallacies. There is absolutely no correlation between the general intelligence of a person and the ridiculousness of their belief claims. You could be talking astrophysics one minute and the next you're into a strange shamanistic wonderland where science doesn't exist. I really do think it's a faith-like mental virus.
On the whole, it doesn't worry me too much - everyone is entitled to their little domains of craziness and I know I have my own.
But what does worry me is the observation that C/AM believers in my environment are almost always women. It feels like a big gaping hole in everything we achieved with women's rights and education. Within my extremely limited horizon of living in a western industrial society, this is in fact the single most worrying trend. It's like a large part of our women went to a parallel universe "girls school", whereas the men in the mean time learned about science and reasoning.
I'm at a total loss as to where this gender disparity comes from, but there has to be a vector somewhere. If anyone has any ideas, I'm looking forward to hearing them. If there is anything to be done about this, I'd like to volunteer my time for it.
I've found that, at least amongst 20 and 30 something age groups, women tend to be more religious too. Now that is my crappy anecdotal observation. It would be interesting to see some real data on that.
I'm convinced that the whole C/AM thing taps into an instinctive love of purity. We are wired to care about cleanliness and purity in our food sources. Perhaps women are wired even more this way (the fact that they have superior senses of smell to men might also explain it). The Nazi movement took advantage of many people's innate belief that purity of anything (in their case genetics) is a good thing no matter what.
There was an article posted not too long ago about fireplaces, and how bad for you they really are. There are two kinds of people: those who will readily evaluate facts which contradict their pre-conceived beleifs, and those who will immediately dismiss them.
I really refuse to accept that women are just "wired for faith", it sounds too similar to the Victorian notion that somehow women are naturally wired for irrationality. There has to be a social reason why this spreads among women, there is a gap somewhere in science education that leaves women more vulnerable to this.
And I actually watched it spread. The transmission seems to be helped by exploiting trusted relationships among network nodes, so to speak. But that still doesn't explain why someone is susceptible to the attack in the first place.
I'm also skeptical about the purity idea, because it's an arbitrary (and wrong) definition of purity to begin with and there is really no reason why women should be hard-wired to fall for these things. This is traditionally the moment where completely made-up cavemen analogies are introduced, but those are exactly as unscientific as C/AM itself.
Women are more prone to fall for BS because we enculturate them to believe that emotions and warm fuzzy feelings are a more reliable guide than science and logic. Third-wave feminism is partly to blame; the notion that science and logic are "patriarchal" and that not oppressing women entails a warm and fuzzy "feminine" replacement for disciplined thought is the third wave's doing.
Thinking logically, critically, and skeptically is an ungendered activity. Women are as capable of and welcome to it as men are; we should be encouraging the females of our kind to apply reason and evidence to their judgements! Sadly, we're the culture that produced Oprah and turned her into a media mogul powerful enough to make the foundations of the earth tremble.
This is purely an image problem for science education, then. Because there is absolutely nothing warm and fuzzy about the "natural state" or whatever romanticized notion we're entertaining about nature. Applied science, and more importantly, the ability to apply science, enables people to build, cure, protect, predict, ensure, improve, discover, and many other things that are intrinsically more warm and fuzzy than, say, naturally dying of a curable disease.
Both religious and C/AM people usually have an approachable simple, clear way of presenting their (irrational) thesis to an average person. Just like salesmen, they appeal to trust, basic needs, use the right words like (clean, pure, natural) for their approach and the right words for the opposite approach (chemical, poisonous, toxic). For homeopathy, stupid little slogans for disease models work "fight fire with fire", "fight like with like" and so on. Makes sense right...
> The transmission seems to be helped by exploiting trusted relationships among network nodes,
I understand your reaction against GP's opinion that he noticed more women in his circles are susceptible to this. I don't know what to tell you, I have the same observation. I would characterize not as "women are wired for irrationality" but maybe women are wired better for communication and for building trusting relationships.
Again, maybe I am making shit up here, this is just my silly observation. But I have noticed that women (in my circle) more so once they establish their trust in respect to other women they we more willing to accept advice such as "so and so told me homeopathy work and I trust".
Also to hammer more on the dangerous topic. I think there is self-fulfilling circular dependency between the idea that women are wired to be irrational and girl acting that way because the society already has that belief.
> I understand your reaction against GP's opinion that he noticed more women in his circles are susceptible to this.
Yeah, I am the GP though.
I cede that I'm always very skeptical about this "X are just wired for Y" stuff. Historically, this has always been used to discriminate against groups of people, and also historically these assertions have so far always turned out false. This is why I'm assuming a cultural background to this problem, not a physiological one. Just because something happens a lot doesn't mean the reasons are not cultural.
> I think there is self-fulfilling circular dependency between the idea that women are wired to be irrational and girl acting that way because the society already has that belief.
> I'm at a total loss as to where this gender disparity comes
> from, but there has to be a vector somewhere. If anyone has
> any ideas, I'm looking forward to hearing them. If there is
> anything to be done about this, I'd like to volunteer my
> time for it.
I'm not sure, but I think a lot of it is marketing. I'm not sure about the numbers but I have a feeling there are more stay at home moms then there are dads. Commercials during the day are highly targeted at this demographic and its possible that this is where most of the misinformation comes from.
Also, I know women are proven more emotional than men. Does this also encompass the "spiritual" side of things (a trait which a lot of alternative medicines have)?
The stay at home mom thing does make a lot of sense, there's a strong homeschooling mindset among extremely left-wing moms and extremely right-wing moms, and both tend to be very into CAM.
I am someone totally open to the idea that there are herbs/food/whatever out there that have health benefits. What I never get about people into 'herbalism' is that they just say things and expect everyone to know them to be true. "X herb is good for digestion!" "X herb is good for relaxation!" How do they know this? Never once has one of them showed me a double blind study done that shows this to be true. In America, the process to get something approved by the FDA is long and expensive. If some common herb like basil cured cancer no drug company is going to spend hundreds of millions of dollars to prove it just so you can grow it in your back yard and not pay them for their trouble. However, certainly there has to be people willing to do studies on these herbs and I've never been giving one. The most disturbing thing is that this doesn't ever bother these people. Not once have a friend who is into herbs voluntarily provide any study done on any one of these herbs to prove a point. It's always just, "X herb helps with stress!" How do you know that to be true?!?!?
the FDA method of approving poisons like modern medicines may not be a relevant methodology for herbs.
Before you get all upset I called your favorite prescription medicine a poison, think about what it really is. A poison if taken in high doses. Ayurveda states there are 3 ways to cure disease. Food, herbs and poisons. Modern allopathy is only the third, poisons. It has very little information on how to cure through food and herbs.
Everything in 'high doses' is a poison, even pure, distilled water.
Herbs either contain active chemicals or they're a placebo.
If they're a placebo they're as good as taking a sugar pill.
If they contain active chemicals they contain unstandardised amounts and probably in concert with all sorts of other things that may or may not be helpful or harmful.
My wife is an Ayurvedic practitioner, so yes I am biased, but I dont believe in every aspect of it. I can definitely say it is not "bullshit" and it is indeed helping many of her clients.
She has people who come to her, that conventional docs have literally given up on. "We cant figure out what is wrong with your digestion, theres nothing more we can try" she hears stories like that all the time.
People ARE being helped. Whether it is all placebo I dont know for sure. but people who literally have no other options in conventional medicine are seeing real results.
They are sleeping better w/o medication, they are not having anxiety attacks anymore, I could go on and on with her stories.
My wife is pretty humble about it and not selling snake oil etc. People are seeing real results.
If there is an effect that's measurable above placebo we should absolutely find out what it is and why it works. Otherwise it's just like the rest of these things.
My statement, however, was not about whether your wife can make people feel better in ill-defined ways, it was about the ludicrous claims above on herbs and 'poison'.
It doesn't follow the western model of logic, which is why uninformed people who cannot understand subtleties insist on displaying their boarishness.
For instance ayurveda says the stomach has digestive fire, it does not give you a list of chemicals which break down food. Rather it seeks to strengthen that digestive fire. If you want to peek in there with a catheter and say "Nope, there is no fire, ayurveda is bullshit" Well then, best of luck with your clinical trials trying to experiment on the newest medicines. There is value in that.
It is not based on an inductive experimental approach so it does not fit with most western scientists. The idea is it is like an instruction manual, not reverse engineering. The human body was not evolved from some random processes for us to reverse engineer, rather there is an inherent design and ayurveda explains it. People may not agree with those depths of it, but that is the origin and philosophy.
You ascribe an overly reductionist viewpoint on scientific thought.
The scientific analysis would be to note that 'digestive fire' might not literally be a fire (just like 'I've got the runs' doesn't mean that I want to run).
The corresponding experiment would be "if person X is treated with Y1 then does outcome Z occur with any statistical difference compared to treatment with Y2", where "Y2" can be "doing nothing."
This has nothing to do with peering inside the body, only with outcomes.
Once a difference has been identified, then it's reasonable to try to identify how 'digestive fire' might map to aspects of the body.
There are well more than trillions of possible treatments, so as a strategy a scientist will use a model of how the body works in order to prioritize the investigation. For example, the presence of a single butterfly between 50 and 100 meters away certainly does not affect most people's digestion, and can be put very low on the list of parameters to explore.
The only part of the "western model of logic" which applies is determining if the treatment had an beneficial effect. If you say that that doesn't apply, then you also throw out the possibility of determining if a treatment isn't actually effective.
Yes there can be scientific determinations done on ayurvedic treatments and some are done. I should not through the baby with the bathwater as they say. Ayurveda is largely about lifestyle and diet. But varies from person to person. I am sure there will be more sophisticated tests done which can show efficacies of the results. A gross example is heartburn. if you have heartburn do you just take a pill for it or adjust your lifestyle and diet? I am sure there can be more sophisticated experiments done which can show efficacies of treatments. You are right that we cannot through out logical thinking.
I looked for those scientific determinations. I couldn't find anything substantial. Mostly I saw a bunch of "ayurvedic treatments suggest X for Y, X contains A, B, and C, and C is seems to affect Q, which may be related to Y, so if there's an effect then that effect might be mediated through Q. But we need more studies to be sure."
As to your heartburn example, here's what Western medicine suggests.
1) While true for <1% of the population, the heartburn could be caused by ischemic heart disease.
An adjustment of diet or lifestyle won't make a big difference at this point.
Diet and lifestyle makes a much bigger difference in the decade leading up to the problem, but you chose an example of treating heartburn, not of general health.
2) If it's caused by an H. pylori infection, then proscribe an triple therapy of of amoxicillin, clarithromycin and a proton pump inhibitor. This not only treats the immediate disease but eradicates H. pylori from the body. Western medicine learned about this in the 1980s. A change of diet might help with the immediate disease, but patients must follow that diet in order to avoid a recurrence.
History shows that people don't like sticking to diets. If a patient can't follow the diet, and the heartburn comes back, is that a failure in the patient, for not following the treatment, or a failure in the treatment, for being hard for patients to follow through on? I place the blame more on the treatment than the patient. Especially when there's a two week treatment which will eradicate the bacteria.
3) If it's caused by GERD then patients might try lifestyle changes. But here's what Wikipedia says on the topic:
> Certain foods and lifestyle are considered to promote gastroesophageal reflux, however most dietary interventions have little supporting evidence.[23] Weight loss and elevating the head of the bed are generally useful.[24] Moderate exercise improves symptoms however in those with GERD vigorous exercise may worsen them.[23] Stopping smoking and not drinking alcohol do not appear to result in significant improvement in symptoms.[24] Avoidance of specific foods and eating before lying down should only be recommended to those in which they are associated with the symptoms.[19] Foods that have been implicated include: coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods.[19]
(Note: [23] from 2009 says "it is possible to hypothesize that GERD may be a curable condition through the control of body weight and, in particular, by reducing abdominal obesity." while [24] from 2006 says "Therefore, although weight loss seems to have a promising effect on pH measures and symptoms, further randomized controlled studies are warranted to determine its exact effect on GERD outcomes". I suggest that the Wikipedia summary, that weight loss being generally useful, is not backed up by the citation.)
So, three different causes of heartburn, but lifestyle and diet changes have at best little effect.
What is the ayurvedic treatment for heartburn? Does it distinguish between these different reasons for getting heartburn, each of which has a different set of treatments in Western medicine? Or is the answer for all cases to change diet and lifestyle, even where Western medicine has show that those changes aren't effective?
> They are sleeping better w/o medication, they are not having anxiety attacks anymore, I could go on and on with her stories.
I would definitely attribute sleeping and anxiety problems as mental issues; medication will try to mess with the body's (brain)chemistry to fix it, but, whilst not into alternative medicine, I do think non-chemical treatments - psychology, relaxation therapy, physical therapy - can help with that category of ailments.
I would add to my other response that your wife is probably a very caring and patient person, and by listening to people with trouble, taking time to understand them, and doing whatever it is she does with ayurveda, I have no doubt at all that she helps people.
I wouldn't even rule out that ayurveda itself is helping them as well as just spending time being listened to and relaxing as a result. I don't know much about it and if there are dietary, meditative and exercise aspects then it's probably doing her patients a power of good!
I just think the other poster's talk about poisons is rubbish :)
My 'bullshit' comment was a sort of a logical construction. If some of the 'facts' upon which Ayurveda is predicated can be shown to be wrong, Ayurveda as a thought system is wrong (it produces incorrect results). Doesn't mean everything about it is wrong, just that it doesn't always make good predictions/proclamations. A bit like... I don't believe in Jesus but the whole 'do unto others' line is awesome :)
Water is a poison therefore a system of health you don't understand is bullshit, great logic.
I am not going to bother arguing since you want to lump everything together in your clinical trials. "Well gee, if healthy food is good for you, let's extract the chemical from it, inject it into our body and test it, if it is really healthy we will see good effects, otherwise it must be a placebo"
You said that modern medicine is poison if taken in high doses. I pointed out that anything is a poison in high doses.
You said that Ayurveda prefers herbs over 'poison' and lumped all modern medicine in with 'poison'. So I pointed out that this is nonsense too.
If 'Ayurveda' makes these claims, then I'm sorry but it's full of bullshit.
I'm sorry if this offends you, but it really is that simple. Maybe there are other parts of what it teaches that are less fallacious, but what you've said here so far is demonstrably false.
I can see that is the limit of your intellectual presentation, good job. Nice to see your nuanced understanding of the health benefits of tylenol vs a bowl of hot cooked rice. I will remember that the next time I am munching on a bowl of tylenol.
"Ayurveda states there are 3 ways to cure disease. Food, herbs and poisons."
That, of course, is wrong. There are additional way to cure a disease. Unless of course that you're using "poison" as a catch-all term to mean anything which isn't food or herbs, in which case it it's a rather useless redefinition to mean simply 'neither food nor herb.'
For example, radiation therapy for cancer is neither a food nor herb, so by definition you place it into "poison", even though it doesn't act like any chemical poison. There's a certain logic to that assignment - radiation treatment is not something an otherwise healthy person would do - but it's a treatment that no traditional Ayurveda practitioner ever considered.
UVB exposure (ie, sunlight or phototherapy) can be an effective treatment for some people who are vitamin B deficient because of malabsorption syndromes (like Cystic fibrosis and short bowel syndrome) which prevent them from absorbing vitamin D through their diet.
Since UVB can cure a disease but is neither a food nor an herb, it must be a poison, right? But UVB is something that healthy people get all the time, so it wouldn't normally be considered a poison. In fact, it could be removed completely, so long as there were other source of vitamin B. Still, you might say that UVB is a food instead of a poison. The problem there is that too much exposure to UVB increases the risk of cancer. Is it both a food and a poison?
Oxygen therapy is useful as part of many treatments, including aborting cluster headache attacks. Perhaps oxygen is also a food? Bu too much oxygen leads to oxygen toxicity. So it is definitely a poison, right? Interesting that we require poison in order to breath.
The issue is, as Nursie stressed, that "the dose makes the poison". Paracelsus said that almost 500 years ago, and it's still true. Even in Ayurvedic assignments of different treatments.
Ayurveda says that nutmeg is an herb, right? It's used as a medicine because of its sedative properties. But eat 10 or so of the seeds and there's a good chance you will die. So, an herb can also be a poison?
Obviously then the three categories are not that distinct. I would argue that they are blurry enough as to be unusable. Life is not so simple as to classify treatments into three distinct groups.
And I don't know what you mean by "Modern [medicine] ... has very little information on how to cure through food." Beriberi, rickets, scurvy, pellagra, kwashiorkor, Korsakoff's syndrome, and Wernicke's encephalopathy are just some of the diseases which modern medicine has cured through food. For several thousand years, beriberi was endemic in Asia, because polished white rice was a staple food.
What is the Ayurveda treatment for handle that disease, and was it developed before or after modern medical researchers identified that it was nutrition deficiency? (Hint: it was after.)
(PS: ultrasonic waves are used to break up kidney stones. That's cure for a disease, no? Are ultrasonic waves food, herb, or poison?)
You bring up interesting points, i am sure the lines are blurry. My point was only there is a lot of knowledge of curing through herbs and food in ayurveda. Treatment of diseases of malnutrition which you brought up are certainly achievements of modern science, but if someone was following a ayurvedic recommendations for diet, would such malnutrition have taken place? That is again the western model of finding and curing diseases, not concentrating on health.
You made a specific statement that modern medicine is a "poison", according to the logic of ayurveda, because it is a treatment which is neither food nor herb.
Do you still regard modern medicine as "poison"? If so, does that word have any meaning other than "a treatment which isn't a food or an herb"? Are ultrasound treatments poison? And, are the ayurvedic categories useful for anything other than arbitrary labels? If so, how does knowledge of the categories affect treatment outcomes?
Western medicine doesn't reduce things into three different categories. Each type of molecule, and each combination of types, and each dosage, can have a different effect on different people. I am aligned with that more complicated view, and believe that those three labels you mentioned are worthless when it comes to categorizing treatments.
As to beriberi in Asia, I researched it before I posted my comment which is why I wrote, "For several thousand years, beriberi was endemic in Asia, because polished white rice was a staple food."
Here's one of the references I used: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889456/ , in looking specifically on the history of beriberi in India. It's a complicated history, mixed in with colonialism, and racism between English, Indian, and Chinese populations. But you'll have to tell me - what was the pre-1900 ayurvedic treatment for beriberi in India, where definitely there were many people in India who suffered from the disease, but before Western medicine found that it was a vitamin deficiency? My prediction is that ayurveda had no effective treatment for beriberi.
I disagree quite strongly with your claim that the western model is "finding and curing diseases, not concentrating on health."
How are fluoridated water, vitamin D in milk, iodine in salt, and enriched flour not prime examples of 'western medicine' using diet supplements to improve public health by preventing disease through improved diet?
Let's take rickets as an example. What's the historical ayurvedic treatment for rickets, and how does it distinguish between the different types of rickets? (I have to say 'historical' since it doesn't mean much if the ayurvedic treatment derived from Western knowledge, would it?)
which offers some medical advice, but it's wrong advice. Those oil massages (well, it is a massage book) don't appear to contain vitamin D, and in any case, vitamin D must be ingested to work. Also, while it suggests exposure to sunlight, which is one valid treatment, it suggests infra-red light as an alternative, which is wrong. Vitamin D production in the skin requires UV, not infrared.
I also found http://india.mapsofindia.com/indian-medicines/ which suggests Arbindasava - "Effective in rickets and other diseases like fever, cough and constipation" Arbindasava seems to be a general tonic. Or what I'll say is snake oil, given the diseases it claims to cure.
A problem, of course, is that there are several different ways to get rickets. Vitamin D diet deficiency is one, but some people can't process vitamin D from the diet so need exposure to sunlight. (Which I mentioned earlier.) What are the ayurvedic recommendations for these different types of rickets? Are those types based on Western research knowledge or were they known pre-1900?
You say there's "a lot of knowledge of curing through herbs." (Incidentally, I see that "curing" is now important, when you wrote that we should concentrate on health.) The Ancient Greeks had a lot of knowledge about curing. That d...
This comment comes off as sexist to me. I don't think that more women being involved with C/AM means that a larger proportion of women are irrational. Different things are popular with women and men. A large portion of both men and women are irrational. Just because a larger group of irrational women like C/AM compared to men does NOT mean that there is a larger group of irrational women.
Conspiracy theories are irrational too, and seem to be much more popular with men. That doesn't mean that there are more irrational men than women.
I'm not sure if you're just trolling or whether you're actually responding to the same comment I wrote.
> I don't think that more women being involved with C/AM means that a larger proportion of women are irrational.
At no point did I say or even imply that. In fact, I explicitly countered that notion as it was presented by another commenter.
So my position is kind of the opposite of what you're alleging. Please take the time, go back and read what was actually written.
As an aside, does a maneuver still count as Strawman Argument if the position of the original post is exactly reversed, or is there another term for it in that case?
This is the part of your comment where I thought you were implying a more general irrationality of women:
>It feels like a big gaping hole in everything we achieved with women's rights and education. [. . .] It's like a large part of our women went to a parallel universe "girls school", whereas the men in the mean time learned about science and reasoning.
If you're not implying that a large portion of women are less rational than men, what does this section of your comment mean? That is how I interpret it. I guess I interpreted it differently than you intended.
Edit: Note that I am not saying you implied that women are inherently less rational than men, which is what I think you countered in another comment. Just that you said they are currently, due to some as-yet unknown reason. I'm trying to dispute this assumption.
If you read my other comments it should be abundantly clear what I mean. And I don't see how you somehow extract the exact opposite of it from my text.
> It feels like a big gaping hole in everything we achieved with women's rights and education.
I said that because it is. It feels like a giant setback. There is absolutely nothing in here to remotely suggest I could be thinking that women are less rational than men.
> It's like a large part of our women went to a parallel universe "girls school", whereas the men in the mean time learned about science and reasoning.
That's an analogy. Let's assume for a second that I actually literally meant to say that all women go to special girls schools while men are getting the real education (which, again, I am not), then it still means that I assert it's a failure of the education system. So even if you went out of your way to be offended by that analogy, and take it in the most literal meaning possible, it still does not say in any way that women are somehow predisposed for less rationality than men. It does, however, imply the contrary.
This really, really frustrates me - and you have my apologies for the symptoms of this frustration - I'm not sure if words are actually getting across here. Clearly you see something completely different in sentences that are not even remotely similar to your perception. I'm really sorry if I triggered something here, but please do not repost my own position as yours while at the same time asserting that I don't hold it. It's unbelievably rude. And worse, it's a dirty discussion tactic.
I did not mean to accuse you of saying that women are predisposed for less rationality than men. Sorry for the confusion.
With that said, you still, to me, seem to be saying that women are currently employing less rationality than men, due to failure in education, culture, or something else. This is what I want to dispute. I disagree that alternative medicine being more popular with women means that women as a whole have been given less critical thinking skills. I think it's just because some things are more popular with women, and some with men. Alternative medicine appears to me to be something that is more popular with women, and it also happens to be irrational.
> I disagree that alternative medicine being more popular with women means that women as a whole have been given less critical thinking skills
Well, we're failing women here somewhere and my first guess would indeed be the education system in general, and maybe the image of science education in particular. I'm not saying that women generally employ less critical thinking skills (hence my original comment about astrophysics in that context), but at the same time there is very clearly something wrong that makes women more susceptible to this C/AM bullshit. There are clearly antibodies missing here, the question then becomes why are we giving those antibodies to men and denying them to women?
> I think it's just because some things are more popular with women, and some with men.
Sure, though as I said in other comments, by default I tend to attribute these things overwhelmingly to culture, not physiology. Being susceptible to C/AM and other crap is not a cute little boy-girl difference, however. It's a massive problem, because having a mind with this faith-based nonsense in it is clearly a disadvantage that precludes victims from actually understanding the world. Not to mention it's a risk whenever "alternative medicine" is favored over actual treatment in critical situations.
> Alternative medicine appears to me to be something that is more popular with women, and it also happens to be irrational.
My point is, that needs to change. It's not an innocent phenomenon. There is something deeply wrong here. To shift the focus a little, do you know which group is also extremely susceptible to non-scientific bullshit? Medical doctors. It's a huge problem. We're currently addressing this issue both in medical school and in hospital culture, but it's still an uphill battle. We need to do the same for women.
I wonder if this disparity only arises at the high end of intellect/education. Below that, I find men and women to be indistinguishable in terms of what kind of beliefs and thoughts they will hold (gender-related issues aside).
But, it does seem that well-educated men are more likely to develop a hardline obsession with science and rationality. I think emotion and sentiment have a lot to do with it. It's easier for us to take that detached, analytic viewpoint.
Disclaimer: This is a big generalization, and there are many people to whom it does not apply, but I do believe it to hold in aggregate.
One theory that I've read (unfortunately, even though this is a science thread, I have no studies backing or rejecting this) is that as men are evolutionarily less valuable than women (for reproduction), the genetic variations are more pronounced in men than in women. This would mean that at the high end of intellect, more men are smarter/more rational than women, but the reverse happens at the low end; more men are also stupider than women. In statistical terms, IQ (even though intelligence is not linear) has mean 100 for both sexes, but s1 > s2, where s1 is standard variation for men, and s2 is standard variation for women.
My anecdotal evidence confirms this, but unfortunately only on the high end (my male classmates got more top grades than women, though one of the smartest people I know is a female) and in a single dimension of intelligence (I'm a mathematician).
I think that you miss the point here: If paleo diet is not the silver bullet than what diet should I have? I'm not a paleo advocate by the way. I tried it out but I'm not having a paleo diet at the moment. I'm still trying to find some alternate diet which is proven to be healthy. It seems that this may be one of the most difficult endeavor I've ever undertaken. Any suggestions?
Has anyone claimed that the Paleo diet is unhealthy? From what I've seen the only complaints against it are that the claimed reason for it's effectiveness are not well supported.
I don't have any studies but it certainly seems healthier than the high-carb, low-fat diet which was promoted by the medical establishment for so long.
For what it's worth, U.S. World & News Report annualy assembles a panel of diet and health experts (http://health.usnews.com/best-diet/experts) to judge a variety diets. In 2011 and 2012, the paleo diet ranked as the worst. The criteria were health, weight-loss, and ease of following. In terms of nutrition, safety, rating for diabetes, and rating for heart health, it scored a 2/5, 2.3/5, 2.1/5, and 2/5 respectively.
Although, many of the individuals are nutritionists at reputable scientific institutes, so hopefully their opinions are informed by scientific studies. There's no guarantee of that, of course, but at least their credentials are stated up front (unlike the many nutrition experts you'll find in any given message board).
1. Most or all of the mummies studied were from neolithic societies, not paleolithic. The only one that might be considered paleolithic is the Unangan, but even these are from decades after they were conquered by the Russians. So they may very well have had white flour and processed sugar in their diet. I couldn't find information about their diet during this period.
2. The time needed for natural selection to work. I'm not convinced by this one. The examples that were given would have had higher selection pressure on the young during their child-bearing years. I would guess that the selection pressure from diseases of old-age would be much less, and would take many more generations to be felt.
Still some good points to be made about the naturalistic fallacy.
Seems like even scientists don't have a good understanding of diet. I just watched a show that mentioned Henry VIII's diet. They mentioned how it made him fat because of all the meat he ate. I thought "that doesn't sound right" and looked it up. He didn't eat vegetables (considered peasant food at the time) and ate a lot of meat. What probably made him fat though was all the bread, desserts, ale, and wine mixed with sugar. If he stuck to meat and added some vegetables, he would have been fine.
Does anyone know the claims regarding saturated fat and coconut oil? I have some friends who in the last 2 months have become zealots and they encourage "high quality" fats (coconut oil) and denounce canola oil.
It is well known in cardiovascular surgery circles that islander diets (which have high levels of coconut oil) have vey high levels of atherosclerosis. I have heard this comment many times in 4 years of medical school, and seen many islander patients (Australia has a deal with the French Government to perform tertiary care of New Caledonians) however have yet to come across a source for it
I think the Paleo argument is that it is the interaction of certain saturated fats and insulin response from high glycemic index foods that oxidize LDL cholesterol (?). I don't know any of the science here, so i could be paraphrasing wrong, but I'd love understand if this is as fringe as it sounds.
Ah I see your point.
I have some time tomorrow (bt 12-18 hrs from now) so will see what I can find specifically regarding this if you'd care to check back here,
In the meantime here's some science of atherosclerosis -
high glycemic index foods - scrap that - glucose and fructose in general is are reactive molecules - they are often drawn as a 6-carbon circle in organic chem but are actually moving in and out of a ionically bonded circle and a linear structure which is very reactive.
It is relatively well understood that the 6 carbon carbohydrates are reactive enough to be capable of causing endothelial damage which can set off the inflammatory cascade that leads to atherosclerosis and high LDL levels will further exacerbate the problem.
Come to think of it, maybe this answers your question?
The problem with "Evidence Based Medicine" vs CAM are two-fold, according to my friend who is an MD in internal medicine at the local VA.
1. 'Evidenced based' medicine is not really 'Evidenced based' because (again this is according to an MD) 50% of what they practice has not been subjected to scientific study.
2. Also there is not the time nor funding to test every aspect and modality of CAM. So some CAM practice might really be working for patients but there is not time nor funding to discover why.
This seems like yet another rant by some Physician whose 'religion' is actually evidence-based medicine.
You're really going to base your entire argument around the purported statements of your doctor friend whose identity, statements, and views cannot be verified?
You'ved made multiple comments in this thread that amount to exactly "nuh-uh! my doctor friend said!"
In the spirit of yesterday's fallacy thread, this is both a (bad) appeal to authority and using anecdote as data.
"The number of reviews indicating that the modern biomedical interventions show either no effect or insufficient evidence is surprisingly high. Intterrater disagreements suggest a surprising degree of subjective interpretation involved in systematic reviews. Where patterns of disagreement emerged between authors and readers, authors tended to be more optimistic in their conclusions than the readers."
Just because current conventional medicine isn't entirely evidence-based does not excuse the claims of CAM from the requirement for evidence.
Note that when an MD gives this statement: "take these antibiotics, then get some bed rest and take plenty of fluids", 2/3rds of the advice given is likely not based on evidence, yet there is a huge difference between that and a recommendation not based on any evidence at all.
> Just because current conventional medicine isn't entirely evidence-based does not excuse the claims of CAM from the requirement for evidence.
Who says CAM practitioners do not want to be subjected to RCT? Bring on the money and the time to do it!! Fact is very little money nor time has been spent on RCT for CAM. My wife who practices Ayurveda, is dying for there to be more studies.
Plus, your statement is fallacious since you are claiming it is OKAY for conventional docs to conduct "unscientific" practices and procedures, which is at least 50% of what they do, but it is NOT OKAY for CAM practitioners to do the same.
I did not say that CAM practitioners do not want to be subjected to RCT, nor did I claim that it is acceptable for conventional medical practitioners to recommend practices and procedures that are not evidence-based.
Make no mistake, I'm not conflating conventional medicine with evidence-based medicine (EBM). Statements like "get some rest and drink some fluids" must be backed up by evidence to be considered EBM, and there have been cases where that very statement was proven false.
In medicine there are also assertions and predictions based on theory instead of direct evidence, lest we be hamstrung by cases not specifically studied. Conventional medicine has an advantage here, because the many theories it collectively adopts on the human ecosystem (physiology, biochemistry, germs, and others) are generally backed by scientifically rigorous studies. This leads to a model that is very well described, often down to the molecular level, and correlates well with other branches of science. This makes its assertions a lot more plausible, if only indirectly evidence-based. Compare that with the theories of the schools of CAM, many of which are based on nothing but tradition, with many others already having been debunked. This lack of plausibility plays a part in limiting the resources available for CAM research, and is the cause of the general sense of incredulity at the CAM community's claims by the scientifically literate.
This relates to the OP, where a theory poorly backed-up by evidence is used to create a large body of assertions, leading to doubt and incredulity over its claims.
I'm not a Paleo dieter, but I am familiar with the gist of their claims. I do not understand how this study is a response to those claims. The 137 mummies studied are from "Individuals from ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands were imaged." Of those we have 3 agricultural civilizations (Egytp, Peru, Pueblo) and one hunter gatherer (Aleutian). So 3/4 of the studied civilizations don't argue agains the basic Paleo claim at all. I can't see from looking the the links what the results from the Aleutian cohort were.
Not at all. The point OP was making is that these 3 cultures are decidedly NOT paleolithic, and it's disingenuous to use them as examples of the effects of the paleolithic diet on cardiovascular health.
The no-true-scotsman fallacy implies a shifting or pedantically narrow definition. That's not applicable here.
Paleo fans are very clear that they're trying to emulate pre-agricultural diets. That's the sine qua non of the Paleo fad. So it's totally legitimate that they would object to evidence about agricultural societies.
>Probable or definite atherosclerosis was noted in 47 (34%) of 137 mummies and in all four geographical populations: 29 (38%) of 76 ancient Egyptians, 13 (25%) of 51 ancient Peruvians, two (40%) of five Ancestral Puebloans, and three (60%) of five Unangan hunter gatherers (p=NS).
I think the point is that atherosclerosis was just as prevalent in the hunter gatherer society as it was in the agricultural ones. Sample size is admittedly small though.
I'm not a Paleo dieter, but I am familiar with the gist of their claims. I do not understand how this study is a response to those claims. The 137 mummies studied are from "Individuals from ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands were imaged." Of those we have 3 agricultural civilizations (Egytp, Peru, Pueblo) and one hunter gatherer (Aleutian). So 3/4 of the studied civilizations don't argue agains the basic Paleo claim at all. I can't see from looking the the links what the results from the Aleutian cohort were.
It is not about the paleo. First - while atherosclerosis may be a normal part of aging, does it say anything about ancient heart attacks and strokes? I don't care of the plaques in my arteries I care about not being dead from a heart attack.
Also the influx of refined carbohydrates in our diet is a big change. So maybe we have not evolved yet to cope with them in the current amounts and purity.
I think most fad diets have the following problems:
1. Little and improper science - so even if they work they can't explain why or how.
2. One size fits all - I invented the paleo diet without ever heard of it - once I decided to quit sugar and starches cold turkey - I have always loved raw nuts and vegetables, grilled meat and cheese. But this is not for everyone - alot of people will not find it tasty. So they eat something they hate - the result is they have problems adhering to eat and abandon it.
3. Government has failed to do its job on the nutrition front. Every recommendation is fought by the losing industry lobbyists, there is little exploitative science done etc. While every person should have the choice they also have to have access to transparent, true and scientifically proved nutritional information - otherwise we will always have the next wonder diet on which sizable portion of the population will be on. A lot of people will hurt themselves taking it to the extremes and so on ...
I recently lost 30lbs by adopting a low-carb/real-food/paleo way of eating. As a result, I feel much better, sleep better, and have increased energy. My moods seem to be stabilizing and I feel more confident than ever. The decrease in weight has enabled me to exercise more comfortably, which in turn has resulted in an increased frequency of exercise, as it's now enjoyable. I can appreciate that the science behind the Paleo movement is not perfect, but the benefits I've realized from it far outweigh any questionable science employed to sell a few books by Loren Cordain along the way. It all basically boils down to application of the 80/20 rule to diet anyway.
I skimmed the article but it seems to me it misses a key component of why people choose "alternatives". Both "naturalistic" and "old school" (as in 18th century and earlier probably) today seem to me to be a reaction against years of uncontrolled abuse, dangerous drugs, uncontrolled trials in the past, poisoning and dumping chemicals in the environment (ddt and such) without any regard for consequences. It is kind of this cavalier attitude towards human bodies and environment during an accelerated progress in the last century that made some (unfortunately) think twice and reject everything that modern medicine stands for.
Another aspect of this "integrative" medical approach is basic psychology. Patients want to be understood and paid attention to. They want doctors to also ask them what they had for breakfast and how their son is doing. They'd want doctors to come to their house, put the hand on their head and say "you'll get better don't worry". All that is in contrast to a cold and robotic 5 minute chart check visits that are billed at $594.00/hour.
Ancient Egypt certainly was a culture with agriculture so citing mummy studies to debunk paleo diets does not make much sense. Also ommitting the studies about actual living hunter gatherer tribes does not lend the argument much credibility.
I think paleo diet books should be scrutinized, but not be confused with actual science.
I heartily recommend people check out "The Heretics" by Will Storr.
The book points out, amongst other insights, the tendency of scientists to react irrationally to alternative medicine and other such phenomena. Whilst the scientific community is usually right on such things, we (I'm a scientist) do have a tendency to be very dismissive and even contemptuous of people who believe in alternative therapies (or religion, or a whole host of subjects that contradict scientific thinking).
Seems scientists can be as dogmatic as their opponents. Thought-provoking stuff.
No one is immune to dogma. All our beliefs eventually trace back to some foundation, including the belief that logic is the only fount of truth. The question is whether we can be comfortable with that, or we have to project our own insecurities about it onto others. Can we tolerate the unbelief of other people, and treat them well?
Or do we need everyone to be exactly like us? A lot of the screeds on the Internet reek of this tribalism. It's utterly tiring to read.
False equivalencies aren't particularly convincing, though. Discussing flaws in thinking is much preferable to saying "some scientists can be dogmatic!" yes, of course?
That doesn't make non-evidence based medicine useful.
My objection to this article is that it's posing a false dichotomy. Choosing our diet based purely on good solid science is not an option, because our scientific knowledge is still too limited. Any honest scientists will admit there's still a lot of complexity we don't fully understand. Which is precisely why there's so much exciting research going on right now (example: https://twitter.com/whsource)
Wherever we have solid evidence it absolutely needs to win out. But that's not the issue here. What we have here is a lot of fuzzy, plausible ideas that are extremely difficult to prove via experiment.
If you want to say categorically that "the paleo diet" (or almost any other) is good or bad, then you need to do a gigantic, long-term, prospective, randomized study of actual human beings. Which is not practical.
So we're left doing the best we can. We rely on heuristics to fill in the gaps. Eating the same things that your ancestors ate is not a bad start. (Granted, that's not necessarily "paleo").
The paleo movement has long since moved away from "eat what paleoliths ate" to focus on "nothing in biology makes sense except in light of evolution".[1] Multiple thought leaders (e.g. Chriss Kresser[2] and Robb Wolf) have acknowledged genetic changes such as lactase persistence and changes in iron metabolism that have arisen in the last 10,000 years. Succesful inclusion of dietary grains however, requires fundamental changes in our digestive tract. From Paul Jaminet's "The Perfect Health Diet" pg 196:
"Grasses evolved in concert with grazing mammals: both originated at the same and they became common together. [...] To reproduce successfully despite being regularly eaten, grasses evolved [...] toxic compounds specifically designed to sabotage digestion in mammals. [...] Grazing mammals have evolved defenses for these toxins-for instance, digestive organs such as rumens that allow the brunt of the toxins to be taken by bacteria." [3]
So things like gluten, opioids, agglutinin, and adiponectin trigger autoimmune reactions, neuropathy, accelerate degenerative diseases, and prevent absorption of micronutrients.
I find it ironic OP admits the studies of mummified remains were agricultural societies and then asserts "certainly atherosclerosis was common even among hunter-gatherers." Analysis of modern hunter gatherers and the most reliable accounts of hunter gatherer populations (researchers that actually lived among those they studied) attest to remarkably low occurrences of diseases of civilization while eating diets devoid of grains and high in saturated fat. [4] Rather than a "fascination with the noble savage", paleo eating is about optimizing food quality (i.e. low toxins) and approximating the macronutrient ratios of hunter-gatherer populations. Certainly a segment of the population may thrive on a grain based diet of 70-80% carbohydrate, but that isn't the case for many.
As far as 'science based medicine' is concerned regarding paleo, there is one meaningful study I'm aware of. [5] However, I highly encourage a look at Robb Wolf's recent post,[1] a fantastic summary of the strengths EMB has (antiviral, trauma) compared to the weaknesses (degenerative diseases) and nutrition. He writes that most of what happens in medical practice is based off observation anyway, not double blind placebo controlled RCTs. I'm not against "evidence based" but it's not the only thing out there. Manipulating statistics [6] [7] and noncontextual studies are easily misleading. After experimenting (including a brief bout of vegetarianism) I've been eating paleo for about two years and am the leanest and most energetic I've ever been. The best way to solve the nutrition challenge is to change variables until you are happy with your health.
[7] "The Great Cholesterol Con" by Malcolm Kendrick and "Good Calories Bad Calories" by Gary Taubes are thorough analyses of the problems in the field of nutrition.
My paternal-grandfather, who lived to 102, when asked about diet responded, "eat variety, eat in moderation, have lots of colors on your plate"
Anecdotally, the folks I know who practice some kind of extreme diet, seem to spend an inordinate amount of time thinking about their diet. All that planning, charts, dietary interactions, classes, support groups, supplements, and books books books...it never sticks, they end up sick and it all seems to be just a giant waste of time and energy and potential.
Now I'm going to say something that's going to be offensive to many folks out there, but it's coming from a similarly personal place and it's about how people use their control of food as a proxy to control their lives.
This mechanism seems to show up in a wide variety of ways, extremely picky eaters, binge eating, anorexia, etc. Some rise the level of psychological or health disorder, some are just patterns and habits. One pattern that seems to show up over and over (and over) again is highly specialized diets for no specific health disorder.
My mother jogs from diet to diet every few years, she dives deep into the diet she's currently landed on: Atkins, Paleo, Gluten-free, Vegetarian, etc. buys and reads dozens of books, finds food sources, and restocks the entire house. Growing up I was fed under probably no less than 6 or 7 diets of this sort. My mother is a treasure trove of semi-scientific nutritional information and alternative medicinal practices.
My mother had a very out of control young childhood. She uses food and her diet as a mechanism to try and bring control to her life because that's something she can control.
I've found a similar pattern in my friends who also practice a similar relationship to food. Divorced parents, absent fathers, attention draining mentally-ill siblings, alcoholic parents, long lists of childhood illnesses, etc. all seem to be the backstories of the people I know who have intense desires to control their foods.
Anecdotally, it seems to be that these diets speak to a deep place in people. These diets, and the endless books and "information" available in these dietary communities seems to make them feel like if they can just learn the information in the diet, they can achieve some kind of control over that aspect of their life. It's like a complex OCD tick that's only satiated in this way.
There's some endless justification for it, ethics, or evolution, or morals, or health or whatever. But it usually seems to just boil down to people who want and need to bring what they feel is order to a life that's careening out of control.
It usually ends, like it does with all of my friends and family who go down this route, with some mysterious health problem that they try and solve by first doubling down on their diet, then is miraculously solved by just eating like a normal person for a few months.
And inevitably they'll start to overthink their diet, and find some other direction to go and the cycle will repeat. Because their feeling of wellbeing can't overwhelm their feeling of establishing control.
I've heard almost this exact story [1], word for word, dozens of times over the years.
Eating healthy is not that hard, and it doesn't really require that much thought or time. You don't really have to read lots of books on the subject, or adhere to an ideology, write blogs, or read food manifestos.
Just "eat variety, eat in moderation, have lots of colors on your plate".
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[ 3.3 ms ] story [ 239 ms ] threadI've been trying to convince my wife (who has a degree in dietetics and a minor in anthropology/archeology) to write about this subject for a while, but food and diet are such visceral topics for people that she finds discussions of the topics incredibly frustrating.
Food, language, gender norms, these are all fields of study where there is substantial research and a lot of resolute but unfounded claims by people with axes to grind, or products to sell.
All of which is to say, there's not a lot of skepticism, even amongst populations who claim to be generally analytical and skeptical.
http://www.badscience.net/books/bad-science/
I eat pretty much paleo. I avoid grains, I limit dairy consumption, I avoid a lot of sugar in my food. However, a lot of the "science" behind paleo is bullshit. The name & culture is the worst thing that could have happened to the diet.
Food is important to your health. I eat a lot of vegetables, high quality meat, and avoid high amounts of carbs & sugar now. How could I not feel better? It doesn't have anything to do with evolutionary adaptability.
edit: knowtheory below is referring to something I edited out regarding an attempt to double blind myself to ensure this wasn't all in my head.
But here's the thing. You can't double blind yourself. That's the whole issue with blind trials. Double blind trials require that you do not and can not determine whether you are in the treatment group or not. Additionally, unless you're having an unrelated person prepare the food, w/o any knowledge of which foods are in the "paleo" group vs the control group, you're not operating double blind.
If it's just you and another person, it would be challenging to set up a double blind experiment (although i'd be interested to hear what you tried).
I did have my roommate prepare the food. Another one of my roommates swapped/labeled the food and then went to class, no interaction. It was mostly because he didn't believe that I could feel it and that it was mostly in my head. (which I totally understand, I was pretty worried about that as well)
We switched out white flour for some almond flour. We also did another one where he sweetened something using honey and another using corn syrup. (I could totally taste the difference there though)
Certainly not rigorous, but enough to make me pretty sure it isn't entirely a placebo effect. I'm planning on getting a Celiac Sprue test at some point.
On the other hand, if a diet helps, and provocations after, say, a month (but without your knowledge) make things go downhill fast, you can be sure enough. Welcome to the wonderful life where you get to check yoghurt for trace amounts of wheat products, and pizza is a holy grail (one of my closest friends is coeliac, for people in Amsterdam area, Woodstone in Haarlem makes good gluten-free pizza).
That being said -- you don't need to find the optimal for the population. You only need to find the optimal for you. And so even un-blind testing is reasonably effective at that.
One of his talks: http://vimeo.com/27570335
The whole time I was reading this I could only think, "science is great!" Thanks for posting this.
It's unfortunate, because most ideologies don't seem to be made to alienate. We get along fine as long as we don't bring up our pet beliefs.
There is also the reverse problem, illustrated by the condescending attitude toward herbalism in this article, of people who idealize modernity, and for example believe only medicine in the form of pills can be effective, even though plants may contain exactly the same chemical compounds. I am not saying there is no fraud in herbalism, sure there is plenty of it, but herbs in general clearly can have strong both positive and negative effect on physiology, which is really quite obvious if you consider the variety of herbs existing and that they all contain lots of different chemical compounds.
In general I think it is ridiculous to ignore the thousands of years of experimentation and exploration of our ancestors just because it wasn't "science-based".
So you are probably saying the same / a similar thing as the author with slightly different emphasis.
edit: grammar, spelling mistakes, mainstream_treatment_x instead of "better tested"
The things that concern me about herbalism are simple:
1. The compounds in herbs are not tested as rigorously as "modern" drugs, at least by the FDA in the US. Knowledge of side effects and safe dosage is more limited.
2. Herbs are often subject to variation in dosages from pill to pill, because the source plant matter is variable and the actual yields are difficult to determine.
It's not about ignoring thousands of years of experimentation, it's just that our standards are higher, and the old experiments were poorly conducted. We want to know the side effects and the interactions. We want to know the drug's mechanism. We want to know about the possible complications. We want to know the effective dose and the unsafe dose. And we want to be able to isolate things: herbs contain many chemicals: you might want one of the chemicals, but not want the side effects from one of the other chemicals.
It reminds me of the almond extract you can buy at the store. The natural almond extract tastes the same as artificial almond extract, but the natural almond extract contains more cyanide. People pay a premium for things labeled "natural".
The heuristic to use natural things works well for foods, but it's a harmful heuristic when considering drugs. It's also a bad heuristic for heating your home (wood fires), immunizing your children (let them die from whooping cough), family planning (pull out), et cetera.
http://en.wikipedia.org/wiki/Drospirenone#Adverse_effects
So, being so incredibly lucky to be part of several thousands of years old lineage of people who managed to survive, it isn't unwise to stick to the traditional ways of living, when the new way wasn't tested for sufficiently long and/or when the old way wasn't proved to be harmful - remember I am talking about using it as a heuristic in situations where we don't have full knowledge. I am not saying that every single aspect of it will be beneficial, just that you will be unlikely to do very badly when following this strategy, simply because it was tested over a very long timespan.
Nassim Taleb makes a similar point in his book "Antifragile". To be honest I hated the book and think much of it is crap, but this aspect I agree with.
Kava has been linked to liver failure, Comfrey causes liver damage, Chaparral causes liver damage, and Pennyroyal is basically toxic. St John's Wort has so many interactions it's basically unsafe to take in conjunction with anything. On top of this, herbal medicines are often poorly-sourced, and substitutions are made overseas. The regulations just aren't good enough.
Then when you talk about the pull-out method of family planning, you say it's a good technique because you'll have kids. That's some impressive double-speak. Next you'll tell me that Caffeine is a good sleep aid because evolution wants you to be more productive.
The FDA's regulatory tools simply work better on "modern" drugs. Look at how Thalidomide was never approved for sale in the US, because the FDA said that more studies were needed. By comparison, "dietary supplements" can only be removed from the market if they show "significant or unreasonable risk". If those standards had been applied to Thalidomide, the human cost would have been terrible.
(Note: Apologies for the over-use of quote marks. "Modern" isn't quite the right term here, some of these drugs are quite old, but I'm not sure what is the right term.)
I didn't phrase it clear enough, I admit, but what I meant is only that avoiding contraceptive pills would free you from the exposure to the pretty bad side effect they turned out to have even though they were supposedly well tested. I just used it as an illustration of my point that being a bit sceptical towards the very new lifestyle approaches is not a bad rule of thumb in abscence of other considerations.
I also of course agree herbs can have serious side effects. You really seem to want to turn it into an X vs Y thing where there has to be one winner. I just want to say that despite all the bad press science seems to indicate using herbs in some particular situations in particular ways might be very beneficial.
The only X versus Y here is scrutiny. Read my posts a little more carefully: my criticism of herbal remedies is not about the fact that they are herbal, but the fact that they are understood little and regulated poorly. That's not a problem with the remedies themselves, but with the laws and systems of incentives driving scientific research.
Going to herbs directly isn't going where no science has been before. At best you're getting a known drug which is poorly dosed and mixed with a shotgun of other chemicals which may be harmful. At worst you've just got a cocktail of potentially harmful (remember, even most of the "good" effects come from poisons the plants produce to keep things from eating them) chemicals with no actual benefit.
Please don't have the impression that I am somehow advocating herbs over traditional medicine, I don't, and there are surely problems with using herbs, but those are different problems that the one most often mentioned. The material you use has to be rather fresh because the concentration of active substances degenerates with time very quickly, the concentration also varies a lot from one area of growth to another so it might be difficult to come up with dosages, they can have serious side effects just like traditional medicine, they are inconvenient to store and use etc.
You can find scientific references for most of what I said and anyway it would come to no surprise to a second-year biology undergraduate. Just reading the wikipedia page about herbalism would clarify a lot of misunderstanding on the topic:
http://en.wikipedia.org/wiki/Herbalism
This is such unutterable nonsense.
Take Aspirin vs. Willow Bark.
Aspirin is derived from substances found in willow bark. Aspirin will cure your headache with a known dose of a substance with a well documented harm profile.
Willow bark will cure your headache with a slightly less effective form of the compound, and if used often enough will harm your liver and kidneys because of all the other stuff that's in there.
Plants are not 'designed' to cure you, the 'spirit of the plant' does not lean in one way or other. This is animistic nonsense.
http://www.sciencebasedmedicine.org/index.php/scientific-evi...
This absolutely does not support the statement "the main advantage of plants over modern medicine in its typical form is that they contain complex compounds of chemical substances which show a synergy in a certain direction ".
In fact it doesn't support that there is an advantage at all, and it shows that by scientifically studying the plant we can figure out the substances responsible for the effect (if it's reproducible), purify them and make use of them in preparations that can be applied more effectively than a poultice.
I'm not sure how you think this is a straw man either.
What I mean is that _in cases where plants could have advantage over modern medicine_, they often do so because of their complex chemical constitution that can produce those kinds of synergies, where modern medicines are most often based on at most 2-3 active substances because we have trouble analyzing more complex interactions.
I'll agree that where it can be shown that a plant has an effect that modern medicine can't explain, complex interactions may well be at work. You gave me the impression that you think this is a general rule, where really it seems to be an exception.
15.7% had been tested in clinical trials; 50.9% had been tested in vitro or in vivo; 20.8% had been subject to a phytochemical study; 12.1% had no studies found in the literature search; 0.5% were "dangerous".
That's not saying only 1/3 of plants had been studied. That is saying that 87% of plants have been studied.
[1] http://onlinelibrary.wiley.com/store/10.1111/j.1365-2710.200...
Even if there are millions of distinct plant chemistries out there, a small number (say, 100) will account for 90% of the herbal remedies prescribed and taken. These will have been studied by scientific methods exhaustively. The next most common chunk will have received some cursory attention, and then you enter into the vast fields of the unknown.
But the fields aren't unknown to just science: they're unknown to cultural practitioners as well. I'm willing to believe that, even without double-blind clinical trials, people were able to find effective treatments with enough trial and error. But "enough trial and error" means "not the long tail". So once you start talking the 1000th most common plant used for medicinal properties, the amount of experience pre-scientific practitioners have accumulated is negligible, and handful of anecdotes at best. Not even enough to ascribe correlation, let alone causation.
So on the head of plants of potential value, I'm betting that they've all been studied exhaustively. On the tail, there are countless plants which could have countless benefits, but essentially no evidence to do anything but pick one at random and hope it cures what ails you. The middle, of enough evidence to suspect or know a plant does something, but not how, is going to be fairly small.
[1]http://en.wikipedia.org/wiki/Marinol#Marinol
Which strain is most effective for glaucoma? Which strain is most effective for pain management during chemotherapy? Which strain doesn't help with either of those things? The same questions can be asked for any plant.
Medicines extracted from plants may not have the exact same effect as those plants, but they are much more predictable. The dose, the benefit, and the side effects can be studied and known. (And there is no reason to think the effect will be worse or weaker: the extra cocktail of chemicals in the plant could either amplify or dampen the primary active ingredients.)
Additionally, the process of isolating and combining the individual components of a plant in order to reproduce observed health benefits of the plant consumed as a whole can be a long and tedious process. Marinol's failure as a good substitute for most people who desire the effects of marijuana is a pretty good example of why, even in this age of science, it is still sometimes better to go back to the source. Green tea extracts, which I also mentioned, frequently consist of Green Tea Catechins, without including, or mentioning whether they contain, L-Theanine, an amino acid in Green tea that has been observed to have nootropic and mood-elevating effects. For someone who wants to reproduce the documented benefits of GTC, by all means go ahead and take the extract. But the benefits of green tea consumed in the traditional way have been enjoyed and observed both in studies over the last few decades, as well as by millions of people over the last thousands of years. Until we've rigorously studied every alkaloid contained in the plant individually, as well as the countless combinations and permutations of those alkaloids (also taking into account the innumerable relative concentrations in which they can be delivered and balanced), it will be hard for science to say whether the components of green tea are present in the most optimal way for X Y Z desired effects
It isn't even a loose correlation. It is no better than random.
>One example is how it became clear in the last years in nutritional science that in general the more processed the food is the more harmful it is for us.
That has not become clear at all, that is something people like to repeat, but is simply a misinterpretation of the recommendation that people "eat mainly unprocessed foods" to maintain a healthy weight. The recommendation is not due to some magical pixie dust inherent in unprocessed food, it is because processed foods are often very high in calories.
>There is also the reverse problem, illustrated by the condescending attitude toward herbalism in this article, of people who idealize modernity, and for example believe only medicine in the form of pills can be effective, even though plants may contain exactly the same chemical compounds.
Except the article had no such attitude, and said nothing like what you are suggesting it says.
>In general I think it is ridiculous to ignore the thousands of years of experimentation and exploration of our ancestors just because it wasn't "science-based".
It isn't ignored. It is studied, and if it is found to actually be effective, it is used. If it is found not to be effective, it is not used. The quack/fraud "medicine" crowd really need to grow out of lying about this. Scientists do not ignore old herbal remedies, they study them.
It depends what you mean by natural, I guess. Please read this in context, I am mostly talking about early adopting radical lifestyle changes vs. sticking to the status quo your ancestors followed, and the effects of doing so when employing exclusively one or the other strategy to all the choices.
That has not become clear at all, that is something people like to repeat, but is simply a misinterpretation of the recommendation that people "eat mainly unprocessed foods" to maintain a healthy weight. The recommendation is not due to some magical pixie dust inherent in unprocessed food, it is because processed foods are often very high in calories.
Oh yes, ridicule what I said to make your point, introduce the pixie dust despite me basing most of what I say on at least some evidence, this will make your reply so much more valuable. You are also actually only partially right, it is the amount of calories and the absence of fiber and vitamins and micronutrients (while those are used up during digestation) that makes processed foods unhealthy. I don't see how any of this has to do with what I said.
Except the article had no such attitude, and said nothing like what you are suggesting it says. ... It isn't ignored. It is studied, and if it is found to actually be effective, it is used. If it is found not to be effective, it is not used. The quack/fraud "medicine" crowd really need to grow out of lying about this. Scientists do not ignore old herbal remedies, they study them.
I didn't say any of this, this was a comment on the general attitude of some people.
In other words, novel, isolated chemicals and processes have more opportunity to present our bodies with circumstances their evolution has not "tuned" them for.
Your example likely demonstrates selective pressure within species--specifically urushiol in plants as a protective mechanism against herbivores. But you are arguing against the relevance of selective pressure. So you have beat up a straw man in which all things natural are better, but of course, I never argued that.
Do you believe in selective pressure? Do you think digesting cow milk conferred no evolutionary advantage? There ARE studies on the prevalence of the genes for digesting dairy milk, and I think they back me up.
http://www.nytimes.com/2006/12/11/science/11evolve.html?_r=0
No, I am arguing against pretending there is a correlation between "natural" and "good" when there is not. Like I very clearly said.
From my few conversations on the matter, the thing that's jumped out at me is this:
She's drawn to alternative medicine because it's open source. Like many nerds, she hates closed proprietary systems and loathes bureaucracy.
If alt-med worked, it would be vastly superior to conventional "industrial" medicine. The latter is bureaucratic, run by closed guilds, closed source, and radiates this standoffish "you are an idiot, do not ask questions" mentality.
By contrast alt-med is open. Anyone can learn about it. Anyone can become a practitioner. Anyone can experiment. It's tolerant of differences of opinion to a much greater extent than conventional medicine. It comes off as welcoming, inviting, and engaging.
Of course, I understand some of the reasons medicine is the way it is. Unlike hacking code on a computer, screwing up medicine can really hurt people. (Code on a computer generally can't, unless you're talking about certain kinds of specialized areas.) But it does seem to me that this is part of the appeal of alt-med.
The other appeal, I think, is escape from the bureaucratic hell that is conventional medicine. Alt-med is actually more free-enterprise. There is more patient choice. It's less expensive. My wife and I just had a baby, and dealing with the insurance company has been a living hell.
Edit: one more observation.
We've tried a little bit of alt-med type stuff to varying degrees of success. I think I can also say this, and I think it goes a long way to explaining alt-med's popularity.
The bedside manner you get with "alternative" practitioners is vastly better. I mean huge orders of magnitude better.
We have a pretty good doctor and a pretty good hospital, and even then we occasionally feel like meat. And ours is really above average in terms of doctor-patient relations and comfort. I've heard some real slaughterhouse horror stories, particularly around women giving birth in ordinary hospitals. I have a relative who has such a story. She really felt like a piece of beef, and the doctor was a real jerk.
The physical design of the spaces is better too. Go into an alt-med clinic and it feels warm, welcoming, calming. Go into a hospital or a conventional doctors' office and it looks like a car repair shop. Again -- to draw an analogy to the computer industry -- Apple has proven just how much aesthetics matter. Apple's products are generally not technically superior, but they are often vastly superior aesthetically and in terms of usability.
I'm sure the feel could be improved, but I bet the main design goal in conventional offices is "surfaces that can be easily cleaned." Not very unlike a car repair shop, really.
Except, car repair shops (at least the ones I know) are rarely clean, ;)
If your friend, or anyone else that way inclined, dislikes modern medicine because of its insular, closed nature then I urge them to support campaigns such as alltrials.net, which advocate open research across medicine. There are a number of people in the industry who truly support an open approach to pharma, and the more people generally shouting about it the better.
I say this because it seems very strange to advocate homeopathy based on its "open source" credentials when the people practising it won't tell you that it patently and demonstrably simply doesn't work outside of the placebo effect. Some alternative medicines do have proven benefits: homeopathy is not one of them.
There is a strong history of alternative medicine medicine practitioners using libel and defamation laws to silence their critics. See, for example, BCA v Singh[1]. Alternative medicine is not open. It is a highly insular community that reacts very badly to criticism, more so than modern medicine.
Let me put it another way: if alternative medicine (and I'm particularly thinking of homeopathy in this case) was so open you would expect people going to receive homeopathic treatment to be told the field was totally discredited by modern science and numerous double blind studies. But they're not. A homeopathic practitioner will not direct you to these studies, or tell you. I don't know how this can be considered open.
[1]: http://en.wikipedia.org/wiki/BCA_v._Singh
http://www.straightdope.com/columns/read/3085/do-antidepress...
I really wonder what percentage of all medicine -- alternative, complimentary, mainstream, scientific, pseudo-scientific, and so on -- is placebo.
It's also unmitigated bullshit. It's tolerant of different views and opinions because none of them are based on evidence.
Alt-med is actually more free-enterprise. There is more patient choice. It's less expensive.
The 'choice' is an illusion. None of it works so sure, choose what you like. It's less expensive because it's nonsense.
The bedside manner you get...
Because it's a con game and that's all they have to offer.
Do you know what we call alternative medicine that works? Medicine.
It's unscientific to elevate your anecdotes above actual studies because you subjectively feel there's something there. This is why we have studies.
I don't know why it works but it's unscientific to ignore the evidence simply because you don't understand it.
Classic. Homeopathy enthusiasts always wheel this out and it's hilarious. "Just because you don't understand how it works you shouldn't ignore it!". I don't understand how it works because it doesn't! And this has been shown over and over again!
I have no idea about the paleo diet, but if it seems to do good things for people we should first establish whether that is true and then find out how it's true. Alt med always misses step 1.
OK, anecdotes are not good evidence, and cannot be used as evidence because they suffer from nearly all the problems that a good study accounts for and real evidence gathering processes account for and mitigate. Anecdotal data suffers from confirmation bias, from selection bias, it has a small enough sample size to be meaningless, and is as a result worthless.
Better?
You can keep saying "it doesn't work" as many times as you like but you'll still be wrong.
[Citation Needed]
If it works for you then you still have a sample size of one but this would be good enough.
For instance in the case of terminal cancer, some people get ripped off by charlatans to the tune of hundreds of thousands of dollars. The anecdotal data around these assholes is all overwhelmingly positive and claims no side effects, because people who are ripped off and then die tend not to talk about it but the very few who survive for reasons unknown shout a lot. The reason you might not try it is because you'd be bankrupting the family you're going to leave behind, or funneling good-will donations to a conman.
There are numerous examples of alt-med 'cures' that are dreadfully harmful (black salve, sodium hypochlorite enemas). This idea that CAM is fine to try if you're out of options because it has no side effects is itself very dodgy. Hell, even acupuncture carries some elevated risk of infection because you're pushing needles through the skin.
But if it was something minor, cheap and there really were no side effects, sure - why not?
--edit-- But telling if there really are no side effects does require some basis in provable fact, or you're just necking unknown quantities of unknown stuff, which may not be a great plan.
This is true for any medical treatment. You weigh up the costs, risks, benefits and then you decide if you want to go ahead with it.
There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,
Absolutely, but medical treatments should have reliable data available (not saying they always do). In contrast alt med never does (that's what makes it alt), but instead has cheerleaders and woo.
"There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,"
Yup, and now we know the harms and don't use these things. (What's your point?). Whereas with alt-med this doesn't seem to happen.
I also want to say that this is pretty disingenuous as a statement because I named harmful CAM treatments in response to your question "if you have heard of a treatment which anecdotally works, and has no reported side effects, then why wouldn't you try it?". I was pointing out that alt med really cannot claim to have no side effects. It often does claim this, but it cannot.
Many medicines have dreadful side-effects, yes, even the ones we still use, but these are measured and quantified and (in theory) the treatments are only used if the main effect is worth it.
With alt med there often are side effects and there is no proof that any of it works, by definition.
You'd be crazy to only use alt med for cancer treatment, but as an addition studies have shown it to be effective.
http://www.cancer.org/treatment/treatmentsandsideeffects/com...
I wouldn't call that supporting evidence that CAM works, in fact I'd say that whole page doesn't give it any support at all, nor does it excuse naturopathy from having harmful effects -
"Substances used in alternative medical practices may have not been thoroughly tested to find out how they interact with medicines, foods, or dietary supplements. Even though some reports of interactions and harmful effects may be published, full studies of interactions and effects are not often available. There may also be lesser-known methods used, other than the ones discussed here, which could potentially cause harm. Because of these limitations, any information on ill effects below should be considered incomplete."
"Other aspects of naturopathic medicine, like healthy nutrition, have been shown to lower the risk of illnesses such as heart disease and cancer. Some aspects of naturopathic medicine may be useful when used along with conventional medical treatment."
Like I said, you're simply choosing to ignore the evidence. If you'd like to stay ignorant of it then that's your right and your privilege.
"Look, we do this common sense thing, therefore the rest of our stuff must be true!"
Eating well, getting rest and exercise, these things are not alt med, not naturopathic, not 'integrative', they are well supported aspects of evidence based medicine.
http://www.cancer.org/aboutus/howwehelpyou/contactus/index
"Other aspects of naturopathic medicine, like healthy nutrition, have been shown..."
Perfectly true information. Just irrelevant because those are aspects of mainstream medicine too.
--edit-- but were I american and had medical credentials to my name, yes I absolutely would be writing to them to protest the existence of that page in its entirety. As it stands I'm just a British skeptic.
Why do you pick specifically that reference, which sits very carefully on the fence in order to find something good about naturopathic therapies? ("good diet" and "counseling" are, of course, quite common recommendations of any doctor)
Why not reference an actual research organization which also has patient outreach? I'm thinking specifically of The National Center for Complementary and Alternative Medicine, of the NIH, at http://nccam.nih.gov/health/cancer/camcancer.htm . They've gotten into political hot water because it was started and funded to find how if CAM is useful, only to report that no, it nearly isn't useful at all.
That site NCCA describes only on the treatments which are specific to CAM, and not shared with standard medical practice.
A naturopath may suggest that you always wear a seatbelt when driving a car. That doesn't make the suggestion part of naturopathy.
A naturopath may suggest that you keep the safety on when carrying a firearm. Again, that's a good suggestion, but it's not something specific to naturopathy.
The examples you pointed out on the Cancer Society web page are not unique to naturopathy. I interpret them as trying to say something good about naturopathy, probably because of so many complaints about how naturopathy is being 'suppressed by Western thought', or something like that.
The NIH site I pointed you to reports on the CAM practices which are specific to CAM. Very few of them "work" in any fashion, and none of them are treatments.
At least, that's how I interpret it. The full context is:
analog: "Paleo diet has worked, and also alt medicine", followed by Nursie: "I don't understand how it works because it doesn't!"
The immediate context for 'it' is homeopathy, but I think, based on Nursie's other statements, that it should apply to all of alt.med. It doesn't apply to (to coin an abbreviation), "std.med", because it seems that Nursie finds convincing evidence that std.med does work.
So the question to you is, what puts the "alt." in "alt.med"? If practice X is part of "alt.med" and is part of "std.med" then is how is X "alt"?
It's possible that something started as alt.med and became part of std.med, but the practices listed on the ACS page have been part of std.med since pretty much since the dawn of evidence-based medicine, so it's not like std.med recently took those parts from alt.med.
Therefore, you should interpret those quote of Nursie to mean:
"[The part of alt.med which is specific to alt.med] doesn't [work]" and "I don't understand how [the alt. part of alt.med] works because [the alt. part of alt.med] doesn't [have any demonstrated effectiveness]".
The use of prayer is definitely part of alt med, and has been shown to work, therefore Nursie is incorrect when he says "alt med does not work".
Rather, what do you mean by "work"? If people who pray feel more relaxed, then yes, it works for some people. So does meditation. So does reading a book, or watching a movie. Or playing cards, or talking with friends.
If by "effective" you mean that people who pray have a higher longevity, higher rate of being cured, etc. then no, it doesn't work. This type of prayer is usually called intercessory prayer.
Take for example http://www.ncbi.nlm.nih.gov/pubmed/16569567 .
> Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. ...
> CONCLUSIONS: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.
Take for another example http://www.ncbi.nlm.nih.gov/pubmed/19370557 .
> OBJECTIVES: To review the effects of intercessory prayer as an additional intervention for people with health problems already receiving routine health care.
> AUTHORS' CONCLUSIONS: These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
"Spiritual well-being and coping. An analysis of 43 studies on people with advanced cancer noted that those who reported spiritual well-being were able to cope more effectively with terminal illnesses and find meaning in their experience. Major themes of spiritual well-being included self-awareness, coping with stress, connectedness with others, faith, empowerment, confidence, and the ability to live with meaning and hope."
http://www.cancer.org/treatment/treatmentsandsideeffects/com...
That said, it's interesting that the paragraph you quoted doesn't mention the word "prayer" at all. It refers to "spiritual well-being." Earlier in that page it pointed out that spirituality "is often expressed through religion and/or prayer"", but it doesn't say that it's the prayer which leads to any change.
More specifically, it also says that "Meditation, twelve-step work (as practiced in Alcoholics Anonymous and similar groups), and seeking meaning in life all involve spirituality. Even simple practices such as silent observation, listening, or gratitude can become part of an open-ended spirituality that can infuse everyday life. Some people express their spirituality by spending time with nature, doing creative work, or serving others."
It notably doesn't say (as you suggest) that prayer is an effective method to reduce stress, nor does it say that prayer is any more effective than 'spending time with nature' or 'doing creative work.' (To that list I'll add 'talking with a counselor.')
So I don't understand your point. That page doesn't show that prayer "works", except perhaps as pallative treatment for those who already believe that prayer is effective. But then that's not very surprising, is it? And other forms of palliative care would also be effective. Perhaps even more effective?
You must certainly acknowledge that "spiritual well-being" as given on that page is a rather broad term. Telling a patient to spend time relaxing in the mountains, as an example of spending time with nature, is not specific to alt.med. Indeed, a century ago, going to a spa in the countryside, where one could get away from the stresses of life was the common treatment for well-off people with tuberculosis, 'consumption', and other hard-to-cure diseases. So it's not like these suggestions are foreign or even recent to standard medicine.
(Though once we figured out how to cure tuberculosis, this treatment for tuberculosis disappeared. That's why palliative care is different than treatment.)
Also, don't you find the circular reasoning rather odd? As you quoted, "those who reported spiritual well-being were able to cope more effectively with terminal illnesses and find meaning in their experience", but as I quoted in the second paragraph, "seeking meaning in life [involves] spirituality." In a rather direct sense it says that those who seek meaning are more able to find meaning in their experience. Should anyone be surprised about that?
I also think the idea that one should "find meaning in their experience" is a biased term. What meaning is there in going through cancer treatment? Other than the obvious - a combination of genetic and environmental factors, plus random chance lead to having cancer, and it's pain in the ass to get cancer treatments - why should anyone seek a deeper meaning?
Of course, if you think the universe is constructed around you, perhaps because there's a God or universal spirit who intercedes on your behalf and 'works in mysterious ways', then perhaps thought, prayer, and reflection might help revel that hidden meaning, or perhaps help you accept that it's all for the best. But then it's rather biased metric, because those who don't think there is meaning to cancer will also tend be those who don't have a religious or spiritual faith.
Or go and look up the examples that the med student provided, Inositol or Theanine. I expect you'll find reasons to ignore the evidence there too though, that's the problem with zealotry.
Do you agree with this argument? If not, why not? If both std.med and alt.med make the same recommendation then what's "alt" about alt.med? Otherwise I continue.
You point out that prayer is effective. I respond that intercessory prayer has not been shown to be effective, despite several large-scale experiments. Yes, prayer can be part of palliative care, since it might make some people feel better. But palliative care is not treatment.
It also leads to questions like, is reading a good book on the topic of death or dealing with terminal cancer (as with http://en.wikipedia.org/wiki/Bibliotherapy) a better, more effective palliative care than telling people to read the Good Book?
You point out that the ACS says that prayer is effective. I point out that you've misread the page, because the ACS page does not say that prayer is effective. It only says that prayer is a visible aspect of how some people carry out their 'spiritual life', and that a spiritual life may help some people feel better.
Furthermore, the definition of 'spiritual life' on that page is so ill-defined that it includes, say, the hobbies of a dyed-in-the-wool hard-core reductionist, atheist, anti-CAM person. Which might also be hobbies that a std.med practitioner would suggest. There is nothing "alt" about a doctor suggesting that someone relax by taking a holiday in the countryside, away from computers and phones.
So no, it's not good enough me as evidence that alt.med is effective. Nor should it be good enough for you.
Yes, there are perhaps a dozen dietary supplements and herbs which might be useful. These are overshadowed by the array of supplements on the market that have no redeeming quality except perhaps to enrich the pockets of the multi-billion dollar supplement manufacturing industry.
Which means that yes, Nursie and I are wrong in that there is a thin sliver of possibly useful treatments to come from alt.med. Most interestingly, these tend to be for anxiety and depression, where effectiveness is much harder to evaluate than "can cure a staphylococcus infection." Thin evidence, I say, but I'll concede that sliver.
Your argument though is that those dozen possible treatments justify the entire alt.med industry? Color me doubtful.
You say that I ignore the evidence. What I ask is that you present the evidence. The ACS page does not seem to provide the evidence that you say it does. The ACS page is, of course, a summary and cannot be held up to full scrutiny, which is why, in order to strengthen my argument, I've made references to some of the experimental research papers on the topic, and they concur with my position.
Surely if there is the good evidence that you say there is then you can either find more experimental research with conclusions that strengthen your viewpoint, or can highlight the flaws in the papers I cite, yes?
"Your argument though is that those dozen possible treatments justify the entire alt.med industry?"
Again I ask you the question, what puts the "alt." in "alt.med"?
If a practice is common to both std.med and alt.med, when should we attribute its discovery or common use to alt.med?
Obviously you shouldn't say that open heart surgery is part of natropathy, but why not? It works, so why doesn't alt.med claim it as its own?
You can't, for example, say that food supplements are only part of alt.med because fluoride in (some) water systems, vitamin D in milk, and iodine in salt are three food supplements that medical researchers successfully insisted be part of the standard food supply, in order to improve public health.
What makes 'alt.med' alt?
But in some sense you're right. The old canard is that we have a name for alt. medicine that works - it's called "medicine." Because fundamentally, modern medicine is based on trying to find what works. The thing is, very little of alt.med "works", by almost any definition except palliative care, and even then, no more helpful than other forms of care.
Take a look at any of the research papers on the subject, where the alt.med methods were put to a test, and you'll see that any signal that is there is about as strong as the noise.
Compare that to the first people who were treated with penicillin. Compare that to the children who no longer got polio. Those are examples of clear, strong signals of effective treatments.
If we don't have scientific evidence that something works then pretty much by definition we can't say it works because we don't have the proof. It's sort-of tautological.
The other comment "I don't understand how it works because it doesn't" was specifically in reference to Homeopathy, which has been shown over and over again to be no better than placebo (i.e. doesn't work). The example was to show that there's no point in investigating how something works, and it's silly to chastise people for not understanding how something works, unless we can first show that something works and that there is even something to investigate.
Apply this to paleo - I have no reason to suspect it works or not. Before investigating this miraculous diet, lets do a proper study to see if it actually is of benefit to the general population, or just to a subset, or if actually the benefits reported are by a tiny number of self-selected people and not really significant at all.
When we actually know (rather than suspect from anecdote) that it does something, then is the time to look at how.
It helps to pick something that is actually CAM then, and not part of mainstream health advice that has been coopted by CAM. Eating well and getting lots of exercise isn't exactly revolutionary, outside-the-box, non-mainstream thinking.
They all probably recommend getting enough sleep and drinking enough water.
In a related question, what is "healthy nutrition"?
When Ayurveda says that onions "stimulate the central nervous system, and can disturb vows of celibacy" and should not be eaten as food (at least not by yogis), while nutritionists and researchers find no evidence that onions have those non-nutritional effects on the body and recommend that you can eat them if you like the taste, then whose advice should be followed, and why?
If you talk to those people for whom it worked, then great! there may be evidence there.
However, let's say that of the people who decided lose weight through other means (a low calorie diet, more exercise, gastric bypass, whatever), 10% were successful.
With this additional information, it's hard to conclude that choosing a paleo diet makes a strong difference.
In other words, looking at the success cases doesn't give a conclusion, only a possible path for followup investigation. It's unscientific to say that something "works" by only looking at the successful cases. You also need to track the failure cases (those who tried paleo but where it didn't work), and the success and failure cases for other methods.
The same for medicine. If someone tries X (aspirin, herbs, whiskey, zinc, penicillin, etc.) for the flu then gets better within a couple of days, then it doesn't mean that X actually "worked". There could be other reasons for why the person got better, like the person's own immune system. (For the record, none of those 'medicines' will work against the flu, though a few of them will help relieve some of the symptoms.)
That's why these anecdotal accounts, while true and even heart-felt, don't suffice to make a scientific conclusion.
Often it's just hard to patent and/or isn't financially lucrative to get FDA approval.
Also lifestyle in general is terribly handled in medicine. MDs know nearly nothing about what matters and what they should recommend. They are decades behind the available evidence.
I agree that lifestyle stuff is important, can be handled by none MD folks, and can have a huge impact on life and health in general. What gets my goat is the CAM proponents who claim they can cure anything and everything with their woo.
Well the MDs do give you lifestyle advice. And the "professionals" that should care about this stuff (esp. dieticians) also suck badly. They often just regurgitate the food pyramid.
I completely agree otherwise.
Herbal medicine is medicine. "Alt-med" is reserved for treatments that are not and will not ever be evidence-based.
You're investing in their false modality by using it to define actual medicine, in the same way that people market "homeopathic" OTC based on actual ingredients and not "water memory".
There was a time when people were willing to trust authority figures and accept the advice of credentialed experts without question. That time is over. If you talk this way to people, they tune you out.
Part of the reason for this is the Internet itself, and the general displacing of one-to-many communications with many-to-many communications. The medium is the message, and the message of this medium is "information is liquid, and there are no privileged points of view."
But more significantly, I think people have grown fatigued with the errors and lies of experts. Experts with all the right credentials once told women to smoke. It's a great way to lose weight. Margarine was once good for you. In 2006, the worst time to buy a house in 100 years, the President of the United States stood up on stage and encouraged more people to buy homes. People are sick of it, and they're not listening anymore.
It doesn't matter if you're right or wrong. The only way to get peoples' attention now is to speak to them like equals and explain yourself. Opaque statements that appeal to authority tend to be tossed in the waste basket by most educated, thinking people. The only people who are willing to "just believe" anymore are fanatics, and they tend to be followers of the most idiotic bullshit imaginable.
I'm also pretty sure you're right that it puts a lot of people off, and I'm not the right person to talk to them :)
Oh and I absolutely agree that the days of listening to experts and authority figures are over. I'm not one. You'll find me the last person to say that the medical establishment has everything right, or that we should always listen to doctors because they're just so clever. I just think that most of the thought behind alt-med in its various forms is nonsense too.
As someone on the cusp of becoming a Doctor, I understand this. I even understand why traditional medicine fails at it (and it is many of the reasons you mention). And I understand why Alt-med succeeds here.
I think it's great that alt-med can deliver a measurable placebo through the clinical effect.
HOWEVER
this does not excuse the intellectual dishonesty of alternative medicine practitioners.
Please anyone who replies to this suggesting that 'We don't know enough about alt med, bla bla bla, big pharma won't study it because it can't be milked for the elixir of life, money/human blood, etc' - Stop now. There's 3 types of treatments. Medicine proper, Stuff that has been tested and found wanting, and stuff that hasn't been tested. The second category is almost exclusively the whole of alternative medicine.
please excuse my divergence as I return to the train of thought:
We should continue to deny alternative medicine practitioners legitimacy. As I argue in the SMH article (3rd contribution in the article) referenced at the bottom of this post, it causes an economic misallocation of resources away from real, practical science towards, for want of a better word, magic.
What we should also do, I now believe, is actively encourage these people to become 'Lifestyle practitioners'. They don't practice a form of medicine, or at least drop the pretence that what they are doing has any scientific backbone, and instead do what they are doing now - that is, interacting with patients, talking with them about their lives, encouraging positive lifestyle interventions (cutting out smoking, drinking, increasing exercise, etc) in an environment that it seems they are more responsive to these interventions.
You can't have both. It is false and misleading for Alt-med practitioners to continue to pretend and/or believe that what they are doing has a real scientific basis in the same way as taking a drug that has been through a RCT does.
But you allude to the root of the problem when you talk about the shabby operation of many hospitals etc.
The difference is, they are built for really sick (or in your example, pregnant) people. Lots of them. Because there are lots of them. And alt-med practitioners will kill them by the bucketload if we were to get rid of hospitals and doctors tomorrow. and then society would go through the process of re-inventing something similar
Maybe one day hey?
* - http://www.sciencebasedmedicine.org/index.php/legislative-al...
* - http://www.smh.com.au/opinion/the-question/should--universit...
I have a friend who is a Internal Medicine MD who claimed it was less than 50%. If thats the case then every conventional MD continues "to pretend and/or believe that what they are doing has a real scientific basis".
Please give me a % of what you do in a clinical setting that has been subjected to RCT otherwise you are setting a standard for CAM that even you cannot meet.
Can you explain, why, with all our advanced conventional medicine etc the USA still ranks 35 in the world for infant mortality, below even Cuba, Slovakia and Brunei? http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor...
EDIT: Okay, I did my own research into my question above. I am sure this is just scratching the surface here.
See here: http://journals.cambridge.org/action/displayAbstract?fromPag...
I'm not an American and I won't practice there. I'm Australian and we score an improved 19th on that league table. However I recently had the opportunity to study/work in a hospital in the states and these are some of my observations.
- The US healthcare system is fucked.
- there is a major disparity of care by region and neighbourhood (from my experience)
- poor people are discriminated against by the healthcare system
- these inequalities of care and resources are perpetuated down the line by a social system which doesn't support the most needy n society
In comparison, Cuba has one of the highest rates of doctors per capita and a healthcare system that performs astoundingly well, especially when compared on a dollar basis. You don't need high tech to perform life saving basic medical treatment, such as that which infant mortality measures.
I feel that the US healthcare system over-emphasises technology to deliver solutions, when what is actually needed are people on the ground in places where they are needed. Unfortunately for those people, they are unable to pay so no-one is going to go to them.
Now to the meat and potatoes of your claim. Firstly let me say that it strikes me as a bit aggressive. I said * in the same way as taking a drug that has been through a RCT does.*
If I am to respond to your whole query, then really I am throwing open the whole of medicine. And it's a big area. Everything from the correct techniques for birthing to height projection charts for children, through immunisations and treatment for common illnesses, to whole specialties of cardiology, renal medicine, .... Many many more.
But let me give you some anecdotes to show you how much of medicine HAS been studied. Maybe You will cry 'liar, deceiver!'. Or maybe I will be able to convey to you a bit of the never-ending torrent of information every doctor is swimming in (and I will admit, there are some that simply stop looking at it all).
Firstly. We have to do assignments called PEARLS. basically, w come across a clinical question and go and try and find evidence for it. As (at the time) a 3rd year med student, I still didn't really have much idea what was going on in the hospital, let alone how to formulate a clinical question and find an answer.
My question involved an elderly patient who had been transferred to the service I was on. He was on an ace inhibitor and an Angiotensin-receptor blocker. That is, 2 types of drugs which supposedly do the same thing.
This was a bit weird to me but it turned out there is some plausible science behind it - combination treatment might lead to being able to use lower doses, which can mean less side effects, as well as more effective RAAS blockade which might lead to better control of blood pressure.
Well it turned out that for this question I thought was stupid and pointless there had been a recently completed RCT, The ONTARGET Study, which proved that dual blockade is worse than single drug use.
My housemate is currently doing his, and his clinical question is whether an infected abdominal surgical wound should be closed or left open. Also seems like a Bizzare question but turns out there are several papers on this, and they say that the wound must be left open.
No RCT this time, but it is notoriously hard to do RCTs in surgical patients for reasons I'm sure you can understand.
A thir anecdote: when we start med, they tell us that 50% of what we learn will be obsolete at the end of 4 years of study, the problem is we don't know which 50%. Such is the rate of scientific advancement.
When I first heard this I just thought it was an embellishment, a story designed to boast of the speed of discovery. Turns out its true. Some significant changes have occurred since I've started studying that have overturned long-held practices.
An example would be the use of lidocaine and adrenaline/epinephrine in local anaesthetic for closing a wound in the extremity.
It was thought that the adrenaline would cause vasoconstriction whi...
http://programinplacebostudies.org/
http://harvardmagazine.com/2013/01/the-placebo-phenomenon
His studies comparing fakes strike me as the most innovative thing I've heard about in medicine in years.
A big problem with "conventional" medicine is this: the mind is off limits. This legacy I think goes back to the suppression of deep mind research following the psychedelics moral panic in the late 1960s/early 1970s. They were doing really interesting stuff back then, but the societal effects of probing deep into the mind caused the entire academy to purge itself of really challenging, imaginative research in these areas. Our society is really terrified of that stuff. We like our doors of perception safely nailed shut.
I also think this comes from the mind/body dichotomy. The mind and body are not disconnected entities. The mind is a part of the body. As such, the mind is going to have a profound influence over the body. The placebo effect itself proves this, as do the studies you cite and numerous others.
I agree that the mind's contribution has been shut out of things. I don't think it's right but I do think there has been sound reason not to: we just don't understand enough about how the interaction works.
We are entering into a really interesting new era as investigation into these areas begins again
My current hypothesis on homeopathy is that it's a placebo surrounded by some interesting mythology and a good story that serves to enhance its placebo effect by priming the subject.
THAT is what really needs to be studied. If this could be understood, we could have a genuine complimentary medicine rooted in science that addressed the mind side of the equation coincidentally with conventional medicine addressing the body. I was ecstatic to learn about that Harvard Medical School program, which is looking at just those kinds of hypotheses.
The other thing though -- and this is the hard thing for skeptics -- is that if this is true, it means these things may not be 100% quackery and fraud. There is something happening here, just not what the practitioners think is happening. It's in the patient's head, but also "real" in the sense that front-loaded placebo outperforms a null treatment.
Do you mean it has been tested and found to work, even if it has nothing to do with medicine (some herbal supplement or meditation) or just medical approved/ordered?
I don't buy into much of the alt-med areas (homeopathy, acunpunture, etc, just not my cup of tea) but I do research a lot about natural 'supplements' and many have been proven quite useful for human health. In what category would you put this?
The other part of the problem is the influence medical staff have. One example is the food advice we have been getting the last couple decades.
'No fats, a lot of cereal. That's the way to live.' which still today doctors here advise (my dad is pre-diabetic, his doctor recommended to change to wholegrain bread and stop eating animal fat, and take his medicine, can't forget that along with his statins for the cholesterol!) which we all know now that isn't the way to go, but many doctors are still making their informed decisions by things they learned 40 years ago in medical school.
> conventional "industrial" medicine [is] closed source
Absolutely false. Conventional medicine was "open source" before "open source" was a thing.
It has peer reviewed journals exactly because of the benefits that being open brings.
> [alt-med is] tolerant of differences of opinion to a much greater extent than conventional medicine.
Conventional medicine welcomes with open arms anything that can be proven to work. Alt-med welcomes with open arms anything. I prefer the former.
Also: most of the replies on this thread have misunderstood my original post. I was not arguing for homeopathy or alt-med at all, and I do think quite a bit of it is baloney. I was explaining why people are into it, from a sociological point of view.
And if you look at the debate like this, it is possible to support both sides simultaneously.
I guess that's why I find it so hard to understand.
It's really not in practice. Skepticism of evidence-based medicine is done through the prism of having bad or not enough medicine. "Alt-med" throws all evidence away but "it works for me". Some emulate studies, but they exist for marketing and potential Federal funding, not for any actual interest in success.
Granted, the same can be said for truthers, UFO and Bigfoot aficionados. They're all nerds, but it doesn't take a great deal of skill to be any of the above.
"to form the basis or foundation of : strengthen, support <facts and statistics subtly undergird his commentary"
However, this quote is an example of shallow thinking that drives me nuts: "Of course, it’s hard not to note that cancer and heart disease are primarily diseases of aging, and life expectancy was so much lower back in the day that a much smaller percentage of the population lived to advanced ages"
Life expectancy FROM BIRTH has risen dramatically, but if you rule out those who died before they reached 5 years old, and rule out violent deaths and/or viral/bacterial plagues, you begin to realize that life expectancy is not much higher today.
If a disproportionate number of people died before the age of 5, a life expectancy of 40 means that many lived beyond that age, and would be expected, all things being equal, to have contracted cancer and/or heart disease.
Check more sources, and you will learn that life expectancy is rising at all age levels throughout the developed world. I've posted all of these links before here on Hacker News, and I don't mind posting them again.
Girls born since 2000 in the developed world are more likely than not to reach the age of 100, with boys likely to enjoy lifespans almost as long. The article "The Biodemography of Human Ageing" by James Vaupel,
http://www.demographic-challenge.com/files/downloads/2eb51e2...
originally published in the journal Nature in 2010, is a good current reference on the subject. A comparison of period life expectancy tables and cohort life expectancy tables for men and women in Britain
http://www.ons.gov.uk/ons/rel/lifetables/period-and-cohort-l...
helps make the picture more clear. ("Period life expectancy" is what is usually reported for a whole country. But cohort life expectancy provides a better estimate of future lifespans of young people today,
http://www.time.com/time/specials/packages/article/0,28804,1...
and is still steadily on the rise around the world.) Life expectancy at age 40, at age 60, and at even higher ages is still rising throughout the developed countries of the world.
http://www.scientificamerican.com/article.cfm?id=longevity-w...
It was used to market estrogen supplementation, among other spurious remedies, to post-menopausal women. "Women didn't used to live very long after menopause--the life expectancy was only about 50. You need to take estrogen pills to keep you healthy into old age."
This of course was people using statistics to lie. The average life expectancy was lower primarily due to high infant mortality. Life expectancy is NOT the average age at death.
But then they found out that the estrogen pills were causing breast cancer, so that put a stop to that.
Just because lower infant mortality raises the life expectancy, doesn't mean that the average age at death hasn't gone up. I agree with your life expectancy claim do, but it doesn't mean the opposite is true either.
The fallacy is "{disease} is a disease of old age, and people didn't used to live past {average caveman life expectancy}. Therefore humans almost never experienced {disease} until modern times." This is very far from the truth, and is usually delivered as part of a sales pitch. I was surprised to see it repeated in the OP almost verbatim. The article debunks several other fallacies but, disappointingly, perpetuates this one.
People did not live all that long in prehistory. Infections and diseases were more fatal more often. It's not like if you made it to ten you'd be as likely to live to 70 as someone is today, no sir.
That is a myth. Life expectancy is much higher at all ages. In ancient Rome, the life expectancy for a 15 year old was 52. In modern first world nations, life expectancy at birth is 80. That is a huge extension of adult lifespan. Just because infant mortality was part of the reason lifespans were lower in ancient times, doesn't mean it was the whole reason.
Let's look at a familiar group of people who had zero access to antibiotics nor modern medicine. America's founding fathers:
"For their era, the 1787 delegates (like the 1776 signers) were average in terms of life spans.[15] Their average age at death was about 67. The first to die was Houston in 1788; the last was Madison in 1836.
Secretary Charles Thomson lived to the age of 94. Johnson died at 92. John Adams lived to the age of 90. A few—Franklin, Jefferson, Madison, Williamson, and Wythe—lived into their eighties. Either 15 or 16 (depending on Fitzsimons's exact age) died in their seventies, 20 or 21 in their sixties, eight in their fifties, and five only in their forties. Three (Alexander Hamilton, Richard Dobbs Spaight and Button Gwinnett) were killed in duels."
Right. And you pretended that they did make it to old age and infant mortality was the cause of lower lifespans. I corrected that misconception. I honestly have no idea how you got this confused.
>DIDN't die due to random pathogens/violent acts/etc DID live to comparable levels of old age
No, they didn't. That's the point. Hitting 80 was exceptionally rare. Rare like hitting 110 is now.
On the whole, it doesn't worry me too much - everyone is entitled to their little domains of craziness and I know I have my own.
But what does worry me is the observation that C/AM believers in my environment are almost always women. It feels like a big gaping hole in everything we achieved with women's rights and education. Within my extremely limited horizon of living in a western industrial society, this is in fact the single most worrying trend. It's like a large part of our women went to a parallel universe "girls school", whereas the men in the mean time learned about science and reasoning.
I'm at a total loss as to where this gender disparity comes from, but there has to be a vector somewhere. If anyone has any ideas, I'm looking forward to hearing them. If there is anything to be done about this, I'd like to volunteer my time for it.
I'm convinced that the whole C/AM thing taps into an instinctive love of purity. We are wired to care about cleanliness and purity in our food sources. Perhaps women are wired even more this way (the fact that they have superior senses of smell to men might also explain it). The Nazi movement took advantage of many people's innate belief that purity of anything (in their case genetics) is a good thing no matter what.
There was an article posted not too long ago about fireplaces, and how bad for you they really are. There are two kinds of people: those who will readily evaluate facts which contradict their pre-conceived beleifs, and those who will immediately dismiss them.
And I actually watched it spread. The transmission seems to be helped by exploiting trusted relationships among network nodes, so to speak. But that still doesn't explain why someone is susceptible to the attack in the first place.
I'm also skeptical about the purity idea, because it's an arbitrary (and wrong) definition of purity to begin with and there is really no reason why women should be hard-wired to fall for these things. This is traditionally the moment where completely made-up cavemen analogies are introduced, but those are exactly as unscientific as C/AM itself.
Thinking logically, critically, and skeptically is an ungendered activity. Women are as capable of and welcome to it as men are; we should be encouraging the females of our kind to apply reason and evidence to their judgements! Sadly, we're the culture that produced Oprah and turned her into a media mogul powerful enough to make the foundations of the earth tremble.
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
can just, like, the word "woman" land on an HN thread without it becoming an embarrassment?
> The transmission seems to be helped by exploiting trusted relationships among network nodes,
I understand your reaction against GP's opinion that he noticed more women in his circles are susceptible to this. I don't know what to tell you, I have the same observation. I would characterize not as "women are wired for irrationality" but maybe women are wired better for communication and for building trusting relationships.
Again, maybe I am making shit up here, this is just my silly observation. But I have noticed that women (in my circle) more so once they establish their trust in respect to other women they we more willing to accept advice such as "so and so told me homeopathy work and I trust".
Also to hammer more on the dangerous topic. I think there is self-fulfilling circular dependency between the idea that women are wired to be irrational and girl acting that way because the society already has that belief.
Yeah, I am the GP though.
I cede that I'm always very skeptical about this "X are just wired for Y" stuff. Historically, this has always been used to discriminate against groups of people, and also historically these assertions have so far always turned out false. This is why I'm assuming a cultural background to this problem, not a physiological one. Just because something happens a lot doesn't mean the reasons are not cultural.
> I think there is self-fulfilling circular dependency between the idea that women are wired to be irrational and girl acting that way because the society already has that belief.
I agree absolutely.
> from, but there has to be a vector somewhere. If anyone has
> any ideas, I'm looking forward to hearing them. If there is
> anything to be done about this, I'd like to volunteer my
> time for it.
I'm not sure, but I think a lot of it is marketing. I'm not sure about the numbers but I have a feeling there are more stay at home moms then there are dads. Commercials during the day are highly targeted at this demographic and its possible that this is where most of the misinformation comes from.
Also, I know women are proven more emotional than men. Does this also encompass the "spiritual" side of things (a trait which a lot of alternative medicines have)?
Before you get all upset I called your favorite prescription medicine a poison, think about what it really is. A poison if taken in high doses. Ayurveda states there are 3 ways to cure disease. Food, herbs and poisons. Modern allopathy is only the third, poisons. It has very little information on how to cure through food and herbs.
Herbs either contain active chemicals or they're a placebo.
If they're a placebo they're as good as taking a sugar pill. If they contain active chemicals they contain unstandardised amounts and probably in concert with all sorts of other things that may or may not be helpful or harmful.
Ayurveda is bullshit. QED.
My wife is an Ayurvedic practitioner, so yes I am biased, but I dont believe in every aspect of it. I can definitely say it is not "bullshit" and it is indeed helping many of her clients.
She has people who come to her, that conventional docs have literally given up on. "We cant figure out what is wrong with your digestion, theres nothing more we can try" she hears stories like that all the time.
People ARE being helped. Whether it is all placebo I dont know for sure. but people who literally have no other options in conventional medicine are seeing real results.
They are sleeping better w/o medication, they are not having anxiety attacks anymore, I could go on and on with her stories.
My wife is pretty humble about it and not selling snake oil etc. People are seeing real results.
My statement, however, was not about whether your wife can make people feel better in ill-defined ways, it was about the ludicrous claims above on herbs and 'poison'.
For instance ayurveda says the stomach has digestive fire, it does not give you a list of chemicals which break down food. Rather it seeks to strengthen that digestive fire. If you want to peek in there with a catheter and say "Nope, there is no fire, ayurveda is bullshit" Well then, best of luck with your clinical trials trying to experiment on the newest medicines. There is value in that.
It is not based on an inductive experimental approach so it does not fit with most western scientists. The idea is it is like an instruction manual, not reverse engineering. The human body was not evolved from some random processes for us to reverse engineer, rather there is an inherent design and ayurveda explains it. People may not agree with those depths of it, but that is the origin and philosophy.
Hooray, you've admitted you're peddling religion, and creationism at that. Well done.
The scientific analysis would be to note that 'digestive fire' might not literally be a fire (just like 'I've got the runs' doesn't mean that I want to run).
The corresponding experiment would be "if person X is treated with Y1 then does outcome Z occur with any statistical difference compared to treatment with Y2", where "Y2" can be "doing nothing."
This has nothing to do with peering inside the body, only with outcomes.
Once a difference has been identified, then it's reasonable to try to identify how 'digestive fire' might map to aspects of the body.
There are well more than trillions of possible treatments, so as a strategy a scientist will use a model of how the body works in order to prioritize the investigation. For example, the presence of a single butterfly between 50 and 100 meters away certainly does not affect most people's digestion, and can be put very low on the list of parameters to explore.
The only part of the "western model of logic" which applies is determining if the treatment had an beneficial effect. If you say that that doesn't apply, then you also throw out the possibility of determining if a treatment isn't actually effective.
As to your heartburn example, here's what Western medicine suggests.
1) While true for <1% of the population, the heartburn could be caused by ischemic heart disease. An adjustment of diet or lifestyle won't make a big difference at this point.
Diet and lifestyle makes a much bigger difference in the decade leading up to the problem, but you chose an example of treating heartburn, not of general health.
2) If it's caused by an H. pylori infection, then proscribe an triple therapy of of amoxicillin, clarithromycin and a proton pump inhibitor. This not only treats the immediate disease but eradicates H. pylori from the body. Western medicine learned about this in the 1980s. A change of diet might help with the immediate disease, but patients must follow that diet in order to avoid a recurrence.
History shows that people don't like sticking to diets. If a patient can't follow the diet, and the heartburn comes back, is that a failure in the patient, for not following the treatment, or a failure in the treatment, for being hard for patients to follow through on? I place the blame more on the treatment than the patient. Especially when there's a two week treatment which will eradicate the bacteria.
3) If it's caused by GERD then patients might try lifestyle changes. But here's what Wikipedia says on the topic:
> Certain foods and lifestyle are considered to promote gastroesophageal reflux, however most dietary interventions have little supporting evidence.[23] Weight loss and elevating the head of the bed are generally useful.[24] Moderate exercise improves symptoms however in those with GERD vigorous exercise may worsen them.[23] Stopping smoking and not drinking alcohol do not appear to result in significant improvement in symptoms.[24] Avoidance of specific foods and eating before lying down should only be recommended to those in which they are associated with the symptoms.[19] Foods that have been implicated include: coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods.[19]
(Note: [23] from 2009 says "it is possible to hypothesize that GERD may be a curable condition through the control of body weight and, in particular, by reducing abdominal obesity." while [24] from 2006 says "Therefore, although weight loss seems to have a promising effect on pH measures and symptoms, further randomized controlled studies are warranted to determine its exact effect on GERD outcomes". I suggest that the Wikipedia summary, that weight loss being generally useful, is not backed up by the citation.)
So, three different causes of heartburn, but lifestyle and diet changes have at best little effect.
What is the ayurvedic treatment for heartburn? Does it distinguish between these different reasons for getting heartburn, each of which has a different set of treatments in Western medicine? Or is the answer for all cases to change diet and lifestyle, even where Western medicine has show that those changes aren't effective?
I would definitely attribute sleeping and anxiety problems as mental issues; medication will try to mess with the body's (brain)chemistry to fix it, but, whilst not into alternative medicine, I do think non-chemical treatments - psychology, relaxation therapy, physical therapy - can help with that category of ailments.
I wouldn't even rule out that ayurveda itself is helping them as well as just spending time being listened to and relaxing as a result. I don't know much about it and if there are dietary, meditative and exercise aspects then it's probably doing her patients a power of good!
I just think the other poster's talk about poisons is rubbish :)
My 'bullshit' comment was a sort of a logical construction. If some of the 'facts' upon which Ayurveda is predicated can be shown to be wrong, Ayurveda as a thought system is wrong (it produces incorrect results). Doesn't mean everything about it is wrong, just that it doesn't always make good predictions/proclamations. A bit like... I don't believe in Jesus but the whole 'do unto others' line is awesome :)
I am not going to bother arguing since you want to lump everything together in your clinical trials. "Well gee, if healthy food is good for you, let's extract the chemical from it, inject it into our body and test it, if it is really healthy we will see good effects, otherwise it must be a placebo"
You said that Ayurveda prefers herbs over 'poison' and lumped all modern medicine in with 'poison'. So I pointed out that this is nonsense too.
If 'Ayurveda' makes these claims, then I'm sorry but it's full of bullshit.
I'm sorry if this offends you, but it really is that simple. Maybe there are other parts of what it teaches that are less fallacious, but what you've said here so far is demonstrably false.
I can see that is the limit of your intellectual presentation, good job. Nice to see your nuanced understanding of the health benefits of tylenol vs a bowl of hot cooked rice. I will remember that the next time I am munching on a bowl of tylenol.
Seriously, just because "Anything is poison in high doses", it doesn't follow that a "high dose" is the same for everything.
Christ almighty you're dumb.
I find it amusing that persons who abuse the word "toxins" project their own confusion on others.
That, of course, is wrong. There are additional way to cure a disease. Unless of course that you're using "poison" as a catch-all term to mean anything which isn't food or herbs, in which case it it's a rather useless redefinition to mean simply 'neither food nor herb.'
For example, radiation therapy for cancer is neither a food nor herb, so by definition you place it into "poison", even though it doesn't act like any chemical poison. There's a certain logic to that assignment - radiation treatment is not something an otherwise healthy person would do - but it's a treatment that no traditional Ayurveda practitioner ever considered.
UVB exposure (ie, sunlight or phototherapy) can be an effective treatment for some people who are vitamin B deficient because of malabsorption syndromes (like Cystic fibrosis and short bowel syndrome) which prevent them from absorbing vitamin D through their diet.
Since UVB can cure a disease but is neither a food nor an herb, it must be a poison, right? But UVB is something that healthy people get all the time, so it wouldn't normally be considered a poison. In fact, it could be removed completely, so long as there were other source of vitamin B. Still, you might say that UVB is a food instead of a poison. The problem there is that too much exposure to UVB increases the risk of cancer. Is it both a food and a poison?
Oxygen therapy is useful as part of many treatments, including aborting cluster headache attacks. Perhaps oxygen is also a food? Bu too much oxygen leads to oxygen toxicity. So it is definitely a poison, right? Interesting that we require poison in order to breath.
The issue is, as Nursie stressed, that "the dose makes the poison". Paracelsus said that almost 500 years ago, and it's still true. Even in Ayurvedic assignments of different treatments.
Ayurveda says that nutmeg is an herb, right? It's used as a medicine because of its sedative properties. But eat 10 or so of the seeds and there's a good chance you will die. So, an herb can also be a poison?
Obviously then the three categories are not that distinct. I would argue that they are blurry enough as to be unusable. Life is not so simple as to classify treatments into three distinct groups.
And I don't know what you mean by "Modern [medicine] ... has very little information on how to cure through food." Beriberi, rickets, scurvy, pellagra, kwashiorkor, Korsakoff's syndrome, and Wernicke's encephalopathy are just some of the diseases which modern medicine has cured through food. For several thousand years, beriberi was endemic in Asia, because polished white rice was a staple food.
What is the Ayurveda treatment for handle that disease, and was it developed before or after modern medical researchers identified that it was nutrition deficiency? (Hint: it was after.)
(PS: ultrasonic waves are used to break up kidney stones. That's cure for a disease, no? Are ultrasonic waves food, herb, or poison?)
Do you still regard modern medicine as "poison"? If so, does that word have any meaning other than "a treatment which isn't a food or an herb"? Are ultrasound treatments poison? And, are the ayurvedic categories useful for anything other than arbitrary labels? If so, how does knowledge of the categories affect treatment outcomes?
Western medicine doesn't reduce things into three different categories. Each type of molecule, and each combination of types, and each dosage, can have a different effect on different people. I am aligned with that more complicated view, and believe that those three labels you mentioned are worthless when it comes to categorizing treatments.
As to beriberi in Asia, I researched it before I posted my comment which is why I wrote, "For several thousand years, beriberi was endemic in Asia, because polished white rice was a staple food."
Here's one of the references I used: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889456/ , in looking specifically on the history of beriberi in India. It's a complicated history, mixed in with colonialism, and racism between English, Indian, and Chinese populations. But you'll have to tell me - what was the pre-1900 ayurvedic treatment for beriberi in India, where definitely there were many people in India who suffered from the disease, but before Western medicine found that it was a vitamin deficiency? My prediction is that ayurveda had no effective treatment for beriberi.
I disagree quite strongly with your claim that the western model is "finding and curing diseases, not concentrating on health."
How are fluoridated water, vitamin D in milk, iodine in salt, and enriched flour not prime examples of 'western medicine' using diet supplements to improve public health by preventing disease through improved diet?
Let's take rickets as an example. What's the historical ayurvedic treatment for rickets, and how does it distinguish between the different types of rickets? (I have to say 'historical' since it doesn't mean much if the ayurvedic treatment derived from Western knowledge, would it?)
I easily found http://books.google.com/books?id=qbNK6dn_FKIC&pg=PA98...
which offers some medical advice, but it's wrong advice. Those oil massages (well, it is a massage book) don't appear to contain vitamin D, and in any case, vitamin D must be ingested to work. Also, while it suggests exposure to sunlight, which is one valid treatment, it suggests infra-red light as an alternative, which is wrong. Vitamin D production in the skin requires UV, not infrared.
I also found http://india.mapsofindia.com/indian-medicines/ which suggests Arbindasava - "Effective in rickets and other diseases like fever, cough and constipation" Arbindasava seems to be a general tonic. Or what I'll say is snake oil, given the diseases it claims to cure.
A problem, of course, is that there are several different ways to get rickets. Vitamin D diet deficiency is one, but some people can't process vitamin D from the diet so need exposure to sunlight. (Which I mentioned earlier.) What are the ayurvedic recommendations for these different types of rickets? Are those types based on Western research knowledge or were they known pre-1900?
You say there's "a lot of knowledge of curing through herbs." (Incidentally, I see that "curing" is now important, when you wrote that we should concentrate on health.) The Ancient Greeks had a lot of knowledge about curing. That d...
Conspiracy theories are irrational too, and seem to be much more popular with men. That doesn't mean that there are more irrational men than women.
> I don't think that more women being involved with C/AM means that a larger proportion of women are irrational.
At no point did I say or even imply that. In fact, I explicitly countered that notion as it was presented by another commenter.
So my position is kind of the opposite of what you're alleging. Please take the time, go back and read what was actually written.
As an aside, does a maneuver still count as Strawman Argument if the position of the original post is exactly reversed, or is there another term for it in that case?
>It feels like a big gaping hole in everything we achieved with women's rights and education. [. . .] It's like a large part of our women went to a parallel universe "girls school", whereas the men in the mean time learned about science and reasoning.
If you're not implying that a large portion of women are less rational than men, what does this section of your comment mean? That is how I interpret it. I guess I interpreted it differently than you intended.
Edit: Note that I am not saying you implied that women are inherently less rational than men, which is what I think you countered in another comment. Just that you said they are currently, due to some as-yet unknown reason. I'm trying to dispute this assumption.
> It feels like a big gaping hole in everything we achieved with women's rights and education.
I said that because it is. It feels like a giant setback. There is absolutely nothing in here to remotely suggest I could be thinking that women are less rational than men.
> It's like a large part of our women went to a parallel universe "girls school", whereas the men in the mean time learned about science and reasoning.
That's an analogy. Let's assume for a second that I actually literally meant to say that all women go to special girls schools while men are getting the real education (which, again, I am not), then it still means that I assert it's a failure of the education system. So even if you went out of your way to be offended by that analogy, and take it in the most literal meaning possible, it still does not say in any way that women are somehow predisposed for less rationality than men. It does, however, imply the contrary.
This really, really frustrates me - and you have my apologies for the symptoms of this frustration - I'm not sure if words are actually getting across here. Clearly you see something completely different in sentences that are not even remotely similar to your perception. I'm really sorry if I triggered something here, but please do not repost my own position as yours while at the same time asserting that I don't hold it. It's unbelievably rude. And worse, it's a dirty discussion tactic.
With that said, you still, to me, seem to be saying that women are currently employing less rationality than men, due to failure in education, culture, or something else. This is what I want to dispute. I disagree that alternative medicine being more popular with women means that women as a whole have been given less critical thinking skills. I think it's just because some things are more popular with women, and some with men. Alternative medicine appears to me to be something that is more popular with women, and it also happens to be irrational.
Well, we're failing women here somewhere and my first guess would indeed be the education system in general, and maybe the image of science education in particular. I'm not saying that women generally employ less critical thinking skills (hence my original comment about astrophysics in that context), but at the same time there is very clearly something wrong that makes women more susceptible to this C/AM bullshit. There are clearly antibodies missing here, the question then becomes why are we giving those antibodies to men and denying them to women?
> I think it's just because some things are more popular with women, and some with men.
Sure, though as I said in other comments, by default I tend to attribute these things overwhelmingly to culture, not physiology. Being susceptible to C/AM and other crap is not a cute little boy-girl difference, however. It's a massive problem, because having a mind with this faith-based nonsense in it is clearly a disadvantage that precludes victims from actually understanding the world. Not to mention it's a risk whenever "alternative medicine" is favored over actual treatment in critical situations.
> Alternative medicine appears to me to be something that is more popular with women, and it also happens to be irrational.
My point is, that needs to change. It's not an innocent phenomenon. There is something deeply wrong here. To shift the focus a little, do you know which group is also extremely susceptible to non-scientific bullshit? Medical doctors. It's a huge problem. We're currently addressing this issue both in medical school and in hospital culture, but it's still an uphill battle. We need to do the same for women.
But, it does seem that well-educated men are more likely to develop a hardline obsession with science and rationality. I think emotion and sentiment have a lot to do with it. It's easier for us to take that detached, analytic viewpoint.
Disclaimer: This is a big generalization, and there are many people to whom it does not apply, but I do believe it to hold in aggregate.
My anecdotal evidence confirms this, but unfortunately only on the high end (my male classmates got more top grades than women, though one of the smartest people I know is a female) and in a single dimension of intelligence (I'm a mathematician).
That's a little harsh. The point of the article is ruling out a diet, so your search is easier knowing it is based on bad science.
I don't have any studies but it certainly seems healthier than the high-carb, low-fat diet which was promoted by the medical establishment for so long.
It also completely ignores the very personal nature of a diet. What's easy to follow for one person will be very difficult for another.
And if you're rating a diet for heart health I'd like to actually see the rates of heart related illnesses for those following the diets.
Although, many of the individuals are nutritionists at reputable scientific institutes, so hopefully their opinions are informed by scientific studies. There's no guarantee of that, of course, but at least their credentials are stated up front (unlike the many nutrition experts you'll find in any given message board).
1. Most or all of the mummies studied were from neolithic societies, not paleolithic. The only one that might be considered paleolithic is the Unangan, but even these are from decades after they were conquered by the Russians. So they may very well have had white flour and processed sugar in their diet. I couldn't find information about their diet during this period.
2. The time needed for natural selection to work. I'm not convinced by this one. The examples that were given would have had higher selection pressure on the young during their child-bearing years. I would guess that the selection pressure from diseases of old-age would be much less, and would take many more generations to be felt.
Still some good points to be made about the naturalistic fallacy.
In the meantime here's some science of atherosclerosis -
high glycemic index foods - scrap that - glucose and fructose in general is are reactive molecules - they are often drawn as a 6-carbon circle in organic chem but are actually moving in and out of a ionically bonded circle and a linear structure which is very reactive.
It is relatively well understood that the 6 carbon carbohydrates are reactive enough to be capable of causing endothelial damage which can set off the inflammatory cascade that leads to atherosclerosis and high LDL levels will further exacerbate the problem.
Come to think of it, maybe this answers your question?
1. 'Evidenced based' medicine is not really 'Evidenced based' because (again this is according to an MD) 50% of what they practice has not been subjected to scientific study.
2. Also there is not the time nor funding to test every aspect and modality of CAM. So some CAM practice might really be working for patients but there is not time nor funding to discover why.
This seems like yet another rant by some Physician whose 'religion' is actually evidence-based medicine.
You'ved made multiple comments in this thread that amount to exactly "nuh-uh! my doctor friend said!"
In the spirit of yesterday's fallacy thread, this is both a (bad) appeal to authority and using anecdote as data.
"The number of reviews indicating that the modern biomedical interventions show either no effect or insufficient evidence is surprisingly high. Intterrater disagreements suggest a surprising degree of subjective interpretation involved in systematic reviews. Where patterns of disagreement emerged between authors and readers, authors tended to be more optimistic in their conclusions than the readers."
Note that when an MD gives this statement: "take these antibiotics, then get some bed rest and take plenty of fluids", 2/3rds of the advice given is likely not based on evidence, yet there is a huge difference between that and a recommendation not based on any evidence at all.
Who says CAM practitioners do not want to be subjected to RCT? Bring on the money and the time to do it!! Fact is very little money nor time has been spent on RCT for CAM. My wife who practices Ayurveda, is dying for there to be more studies.
Plus, your statement is fallacious since you are claiming it is OKAY for conventional docs to conduct "unscientific" practices and procedures, which is at least 50% of what they do, but it is NOT OKAY for CAM practitioners to do the same.
Make no mistake, I'm not conflating conventional medicine with evidence-based medicine (EBM). Statements like "get some rest and drink some fluids" must be backed up by evidence to be considered EBM, and there have been cases where that very statement was proven false.
In medicine there are also assertions and predictions based on theory instead of direct evidence, lest we be hamstrung by cases not specifically studied. Conventional medicine has an advantage here, because the many theories it collectively adopts on the human ecosystem (physiology, biochemistry, germs, and others) are generally backed by scientifically rigorous studies. This leads to a model that is very well described, often down to the molecular level, and correlates well with other branches of science. This makes its assertions a lot more plausible, if only indirectly evidence-based. Compare that with the theories of the schools of CAM, many of which are based on nothing but tradition, with many others already having been debunked. This lack of plausibility plays a part in limiting the resources available for CAM research, and is the cause of the general sense of incredulity at the CAM community's claims by the scientifically literate.
This relates to the OP, where a theory poorly backed-up by evidence is used to create a large body of assertions, leading to doubt and incredulity over its claims.
Paleo fans are very clear that they're trying to emulate pre-agricultural diets. That's the sine qua non of the Paleo fad. So it's totally legitimate that they would object to evidence about agricultural societies.
I think the point is that atherosclerosis was just as prevalent in the hunter gatherer society as it was in the agricultural ones. Sample size is admittedly small though.
Also the influx of refined carbohydrates in our diet is a big change. So maybe we have not evolved yet to cope with them in the current amounts and purity.
I think most fad diets have the following problems:
1. Little and improper science - so even if they work they can't explain why or how.
2. One size fits all - I invented the paleo diet without ever heard of it - once I decided to quit sugar and starches cold turkey - I have always loved raw nuts and vegetables, grilled meat and cheese. But this is not for everyone - alot of people will not find it tasty. So they eat something they hate - the result is they have problems adhering to eat and abandon it.
3. Government has failed to do its job on the nutrition front. Every recommendation is fought by the losing industry lobbyists, there is little exploitative science done etc. While every person should have the choice they also have to have access to transparent, true and scientifically proved nutritional information - otherwise we will always have the next wonder diet on which sizable portion of the population will be on. A lot of people will hurt themselves taking it to the extremes and so on ...
Another aspect of this "integrative" medical approach is basic psychology. Patients want to be understood and paid attention to. They want doctors to also ask them what they had for breakfast and how their son is doing. They'd want doctors to come to their house, put the hand on their head and say "you'll get better don't worry". All that is in contrast to a cold and robotic 5 minute chart check visits that are billed at $594.00/hour.
I think paleo diet books should be scrutinized, but not be confused with actual science.
The book points out, amongst other insights, the tendency of scientists to react irrationally to alternative medicine and other such phenomena. Whilst the scientific community is usually right on such things, we (I'm a scientist) do have a tendency to be very dismissive and even contemptuous of people who believe in alternative therapies (or religion, or a whole host of subjects that contradict scientific thinking).
Seems scientists can be as dogmatic as their opponents. Thought-provoking stuff.
Or do we need everyone to be exactly like us? A lot of the screeds on the Internet reek of this tribalism. It's utterly tiring to read.
That doesn't make non-evidence based medicine useful.
Wherever we have solid evidence it absolutely needs to win out. But that's not the issue here. What we have here is a lot of fuzzy, plausible ideas that are extremely difficult to prove via experiment.
If you want to say categorically that "the paleo diet" (or almost any other) is good or bad, then you need to do a gigantic, long-term, prospective, randomized study of actual human beings. Which is not practical.
So we're left doing the best we can. We rely on heuristics to fill in the gaps. Eating the same things that your ancestors ate is not a bad start. (Granted, that's not necessarily "paleo").
"Grasses evolved in concert with grazing mammals: both originated at the same and they became common together. [...] To reproduce successfully despite being regularly eaten, grasses evolved [...] toxic compounds specifically designed to sabotage digestion in mammals. [...] Grazing mammals have evolved defenses for these toxins-for instance, digestive organs such as rumens that allow the brunt of the toxins to be taken by bacteria." [3]
So things like gluten, opioids, agglutinin, and adiponectin trigger autoimmune reactions, neuropathy, accelerate degenerative diseases, and prevent absorption of micronutrients.
I find it ironic OP admits the studies of mummified remains were agricultural societies and then asserts "certainly atherosclerosis was common even among hunter-gatherers." Analysis of modern hunter gatherers and the most reliable accounts of hunter gatherer populations (researchers that actually lived among those they studied) attest to remarkably low occurrences of diseases of civilization while eating diets devoid of grains and high in saturated fat. [4] Rather than a "fascination with the noble savage", paleo eating is about optimizing food quality (i.e. low toxins) and approximating the macronutrient ratios of hunter-gatherer populations. Certainly a segment of the population may thrive on a grain based diet of 70-80% carbohydrate, but that isn't the case for many.
As far as 'science based medicine' is concerned regarding paleo, there is one meaningful study I'm aware of. [5] However, I highly encourage a look at Robb Wolf's recent post,[1] a fantastic summary of the strengths EMB has (antiviral, trauma) compared to the weaknesses (degenerative diseases) and nutrition. He writes that most of what happens in medical practice is based off observation anyway, not double blind placebo controlled RCTs. I'm not against "evidence based" but it's not the only thing out there. Manipulating statistics [6] [7] and noncontextual studies are easily misleading. After experimenting (including a brief bout of vegetarianism) I've been eating paleo for about two years and am the leanest and most energetic I've ever been. The best way to solve the nutrition challenge is to change variables until you are happy with your health.
[1] http://robbwolf.com/2013/03/15/evidence-based-medicine-fraud... My favorite line from this post is "based of this wacky stuff called the best data we had at the time"
[2] http://chriskresser.com/rhr-what-science-really-says-about-t...
[3] http://perfecthealthdiet.com/notes/#Ch19
[4] http://perfecthealthdiet.com/notes/#Ch2
[5] http://www.staffanlindeberg.com/DiabetesStudy.html
[6]http://www.zoeharcombe.com/2013/03/meat-consumption-and-mort...
[7] "The Great Cholesterol Con" by Malcolm Kendrick and "Good Calories Bad Calories" by Gary Taubes are thorough analyses of the problems in the field of nutrition.
Anecdotally, the folks I know who practice some kind of extreme diet, seem to spend an inordinate amount of time thinking about their diet. All that planning, charts, dietary interactions, classes, support groups, supplements, and books books books...it never sticks, they end up sick and it all seems to be just a giant waste of time and energy and potential.
Now I'm going to say something that's going to be offensive to many folks out there, but it's coming from a similarly personal place and it's about how people use their control of food as a proxy to control their lives.
This mechanism seems to show up in a wide variety of ways, extremely picky eaters, binge eating, anorexia, etc. Some rise the level of psychological or health disorder, some are just patterns and habits. One pattern that seems to show up over and over (and over) again is highly specialized diets for no specific health disorder.
My mother jogs from diet to diet every few years, she dives deep into the diet she's currently landed on: Atkins, Paleo, Gluten-free, Vegetarian, etc. buys and reads dozens of books, finds food sources, and restocks the entire house. Growing up I was fed under probably no less than 6 or 7 diets of this sort. My mother is a treasure trove of semi-scientific nutritional information and alternative medicinal practices.
My mother had a very out of control young childhood. She uses food and her diet as a mechanism to try and bring control to her life because that's something she can control.
I've found a similar pattern in my friends who also practice a similar relationship to food. Divorced parents, absent fathers, attention draining mentally-ill siblings, alcoholic parents, long lists of childhood illnesses, etc. all seem to be the backstories of the people I know who have intense desires to control their foods.
Anecdotally, it seems to be that these diets speak to a deep place in people. These diets, and the endless books and "information" available in these dietary communities seems to make them feel like if they can just learn the information in the diet, they can achieve some kind of control over that aspect of their life. It's like a complex OCD tick that's only satiated in this way.
There's some endless justification for it, ethics, or evolution, or morals, or health or whatever. But it usually seems to just boil down to people who want and need to bring what they feel is order to a life that's careening out of control.
It usually ends, like it does with all of my friends and family who go down this route, with some mysterious health problem that they try and solve by first doubling down on their diet, then is miraculously solved by just eating like a normal person for a few months.
And inevitably they'll start to overthink their diet, and find some other direction to go and the cycle will repeat. Because their feeling of wellbeing can't overwhelm their feeling of establishing control.
I've heard almost this exact story [1], word for word, dozens of times over the years.
[1] - http://kristensraw.com/blog/2013/03/17/my-vegan-diet-caused-...
Eating healthy is not that hard, and it doesn't really require that much thought or time. You don't really have to read lots of books on the subject, or adhere to an ideology, write blogs, or read food manifestos.
Just "eat variety, eat in moderation, have lots of colors on your plate".