A moon in the dark night-Science based medicine-part 2- complementary and alternative medicine
CAM was once defined as “stuff that isn’t taught in medical schools.”
CAM is a shortcut from idea to bedside, bypassing good science.
The growing popularity of CAM may be attributed to multiple factors, including misunderstandings about science and a distrust of the medical establishment You can watch the video here video
Transcript
I’m dr. Harriet all and this is lecture 2 in a series of ten lectures on
science-based medicine in the first lecture I talked about what sites based
medicine is now all talk about what it isn’t alternative medicine today it’s more commonly referred to as complementary and alternative medicine and that’s a mouthful its easier to cut it down to one syllable and just call it by its acronym cam sometimes Kim rejects so
it’s entirely sometimes it tries to use so I it’s and fails even when camp
claims to have scientific evidence to support its claims that evidence doesn’t
measure up to the rigorous standards of good science this lecture will be general discussion of cam and in future lectures I’ll cover specific areas of
CAM like acupuncture chiropractic and homeopathy what is Kim and old
definition of alternative medicine was stuff that isn’t taught in medical
schools that definition doesn’t really work anymore since camp has been
sneaking into our medical schools more about that later but here’s a list of
some of the things that we’re taught in medical school in fact I’ve never even
heard of most of the things on this list when I graduated back in nineteen
seventy I had heard you the things on this list like chiropractic and
acupuncture but I didn’t understand enough about them to have formed an
opinion and I’ve never heard the term alternative medicine then we would have
just missed most of the things on this list as folk medicine or superstition or
quackery some of them still more reasonable than others like herbal
medicine after all herbal medicine was the beginning of scientific pharmacology
purchased batshit crazy like sticking lighted candles in your ears or drinking
your own urine or diluting all the active ingredient out of a remedy to
make it stronger
you know about the time I graduated a new term was coined alternative medicine
it was an umbrella term that loved all the things on that list together the impossible right along with a more plausible the untested right along with the ones that had already
been tested and proven not to work later in the nineteen eighties in nineteen
nineties we started to hear term the terms complementary medicine and
integrative medicine alternative medicine may be used alone as an
alternative to conventional medicine where people may hedge their bets by
using both alternative and conventional medicine at the same time
complementary medicine by definition is never used alone it’s used along with
conventional medicine to complement the conventional treatment integrative
medicine implies that you don’t just use alternative medicine along with
conventional medicine you somehow integrate the two into one unified
coherent system of practice I want to larger protest here there’s really no
such thing as alternative medicine here only treatments that have been tested
and proven to work and treatments that have it if a treatment had been proven
to work we wouldn’t call it alternative we just call it medicine my colleague
Steven novella explains the campus of political ideological entity not a
scientific one it’s an artificial category created for the purpose of
promoting a diverse set of dubious untested or fraudulent health practices
it is an excellent example of the successful use of language is a
propaganda tool so people prefer to call it so-called complementary and
alternative medicine or supplements + cam either those gives the convenient
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acronym science-based medicine starts with an idea
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tests it and if it passes the test that it applies it to patients cam bypasses
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the step of adequate testing it’s a shortcut from idea to bedside let’s look
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at this list again the real question is not what to call us things but they work
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I don’t think anyone believes that everything on this list work if they do
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they’re not be irrational because some of these things
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compatible with each other that for every item on this list there are people
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who are convinced that it works it’s curious that they never seem to fight
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among themselves
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you never hear of debates between acupuncturists in homeopathic
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practitioners of one system sometimes incorporate the practices of another
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system like actress who adopt acupuncture or who recommend homeopathic
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remedies we never seem to care that if the beliefs behind the other system were
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right he believes behind their own system would have to be wrong
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typically attributes all disease 21 imaginary cause chiropractic claims that
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all disease is caused when spinal bones get out of alignment and interfere with
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nerve function homeopathy is inventor Samuel Hahnemann believe that all
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disease was caused by my assumption explain about that in lecture 5
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acupuncture attributes all disease to disturbances in the flow of a mythical
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life force Kochi Ayurveda attributes disease to improper digestion being out
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of harmony with the environment and due to aggravated Duchess who don’t think of
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aggravated tortious I can’t help imagining an angry vicious cartoon beast
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like the Tasmanian Devil christensen says that all diseases merely an
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illusion due to a lack of faith a few years ago I did an internet search for
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the one true cause of all disease sixty seven of them were probably a lot more
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but I get tired of looking at that point here is just a few of them
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allergies are sergeant deficiency toxins good acidity parasites of congested
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colon yeast free radicals inadequate nutrition the list goes on and on and
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got sillier and sillier perhaps the silliest was the United KKK States of
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America is the one true cause of all disease I don’t know what that means and
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I don’t think I want to know so there are at least 60 71 true causes in all
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this
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new math 467 equal to one if all diseases caused by taxes it could very
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well be caused by parasites its parasites you can’t be a congested goal
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in order to mutually exclusive claims it bothers them the experience cognitive
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dissonance in the Tri diligently to find evidence to reject one of the competing
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hypotheses eventually reach a consensus no alternative medicine pseudo scientist
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don’t seem to be bothered by cognitive dissonance your content to look for
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evidence to support their own chosen treatment they blithely disregard any
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computer competing claims they don’t want to look for evidence that something
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doesn’t work well each claims to know the one cause of disease they don’t seem
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interested in looking for the one reality often they don’t believe there
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is one truth as one woman said to me it could be true for you but that doesn’t
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mean it’s true for me in his book voodoo so here’s how bob part described a press
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conference held by representatives of the office of alternative medicine 1
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insisted that the number one health problem in the united states is
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magnesium deficiency another was convinced that the expanded use of
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acupuncture could revolutionize medicine and so it went around the table with
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each touting his or her preferred therapy there was no sense of conflict
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or rivalry as each spoke the others would not in agreement with purposes I
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began to realize was to demonstrate that these disparate therapies all work it
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was my first glimpse of what holds alternative medicine together there is
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no internal dissent in a community that bills itself the siege from the outside
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each camera organizes its all in a single cause of all disease single cause
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that is wrong
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science recognizes that there are many causes of disease and it organizes them
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into these nine categories and do the acronym
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indicate vie for vascular eicher infectious or inflammatory in
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preneoplastic D for drugs and toxins I for interventional or iatrogenic other
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words caused by treatment for congenital and develop developmental a for
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autoimmune teacher trauma endocrine and metabolic and so it’s recognizes that a
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single illness could involve more than one cause for instance when a traumatic
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injury becomes infected we’re seeing a trend were obsolete treatments are
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making a comeback the top picture is the Royal London homeopathic hospital
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founded in 1849 it’s still in business but it recently changed its name from
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homeopathic to integrative the bottom picture is the Massachusetts homeopathic
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hospital around 1960 now back in in 1979 homeopathic hospitals in the us- the
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last one closed in nineteen fifty so homeopathy was almost extinct in the USA
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but recently it seems to be reviving some health care providers are
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recommending homeopathy homeopathic remedies are being sold over the counter
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in pharmacies so what happened why did those old discredited treatment methods
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that almost disappeared start to come back in the nineteen eighties and
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nineties in 1994 the U S Congress passed the diet supplement helps and Education
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Act
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herbal herbal medicines from FDA regulation under the pretense that they
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were diet supplements intended to be used as food medicines in 1998 and I
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founded the National Center for Complementary and Alternative Medicine
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studies on alternative medicine insurance companies began paying for
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things like acupuncture and chiropractic and some of these formerly discredited
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treatments were introduced into hospitals and medical schools in a
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movement that we call
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academic medicine I’ll be coming back to these issues in lecture 10 how did it
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change wise camp certainly so popular there’s no simple answer but I think
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there are several reasons for the trend for one thing
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etc of outstanding successes antibiotics cure W eradicated smallpox we
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transplanted kidneys are expected science to go on to cure cancer and
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every other disease and when that didn’t happen we got frustrated we’re healthier
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than we’ve ever been and now the absence of disease is no longer enough for us we
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want something more we want some elusive state of perfect health instead of dying
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of infections we live into old age and we develop the diseases of aging like
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arthritis heart disease and cancer
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prosperity is increasing people have to worry about where their next meal is
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coming from the worried well have the luxury of being concerned about every
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little more everyday life been reinterpreted as symptoms requiring
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treatment who have been invented imaginary diseases like chronic
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candidiasis and the need for detoxification science isn’t perfect
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drugs have side effects people distrust the establishment the government Big
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Pharma AMA they perceive the scientific method is artificially unnatural people
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don’t really understand the scientific method has always been an
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anti-intellectual tendency in america throughout history americans value
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quality self-help individualism in the democratic idea that everyone’s opinion
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counts we have derogatory names for people who know stuff like geeks and
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nerds and kids and hydros modern medicine is seen as impersonal it
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obsessed with technology and its perceived as not responding to the
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patient’s experience of illness on a human level one of the commenters on the
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same space medicine blog said this public demand for scam is due to only
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one factor the deplorable widespread lack of critical thinking skills I tend
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to agree just how widespread is cam well that depends on how you ask the question
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this is from a 2002 CDC study that shows the percentage of people who reported
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using
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each campbell biology in the previous 12 months look at the bottom to identify
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sixty-two percent said they used CAM but when they excluded prayer only about 36
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percent said the camp the most popular cam was natural products at 19% and
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leading the list of natural products recordation ginseng ginkgo and garlic
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supplements breathing exercises came next 12 percent chiropractor followed at
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7.5% then meditation yoga massage and diet based therapies noticed that
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acupuncture homeopathy didn’t even make the list there were only used by one
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percent 1% each in the United States they’re more popular in other countries
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but they’re still not very widespread 10 percent of the people in the UK is
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homeopathy and only 6 percent of people in taiwan use acupuncture ur here is
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what people answered when they were asked why they used CAM
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combining it with conventional treatment would help 50 percent thought that it
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would be interesting to try 26 per cent soda medical professional had suggested
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it
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28 percent believe conventional medicine wouldn’t help them in thirteen percent
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said conventional medicine was too expensive and what health conditions did
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they use it for a while back pain was by far the most common conditions treated
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with alternative medicine
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the top three were back in musculoskeletal pain goals and anxiety
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or depression at 50% 9.5% and 4.5% respectively
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a smaller percentage used it for gastrointestinal problems for headache
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insomnia here is still used it for sinusitis cholesterol asthma blood
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pressure and menopause around 1% each and what kind of people use cam cam
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users were more likely to be women than men
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in there were the oldest or youngest you’re most likely to be asians and
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least likely to be african-americans were likely to be better educated have a
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higher income to have private health insurance to live in urban areas
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particularly west coast to drink alcohol to be former smokers into a bit recently
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hospitalized so I think we can conclude that there is no one simple answer to
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who is likely to use cam and why what sets him apart from science-based
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medicine is basically a lack of testing really by definition camp consists of
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treatments that are not supported by enough evidence to have earned a place
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in mainstream medicine quite often camp denies that there is a need for testing
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their content with testimonials and poorly documented anecdotes in contrast
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to say it’s based medicines rigorously documented case reports in clinical
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studies on campus just treatments it tries to prove that something weird
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other than to ask if it works and many of the studies it does or poorly
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designed to the substandard cams ideology tends to ignore biologic
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mechanism to disparage modern science to rely on a chat and natural remedies my
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friend carol is very intelligent well-educated and skeptical about most
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things but here’s her she decides to put their to use a camp treatment will try
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pretty much anything as long as it meets these three criteria friends so that
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helped them it sounds plausible to her
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doesn’t sound horrible she’s willing to go by anecdotal evidence when a friend
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says it worked for me
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sciences if you’ve been on her list of criteria she doesn’t bother to ask if
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testing shows work she says science doesn’t know everything she told me that
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when she feels a cold coming on she takes echinacea and she hasn’t had a
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cold is seven years I told her when I feel a cold coming on I don’t take
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echinacea and I haven’t had a cold in seven years either so if she accepted
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her own experiences prove that echinacea work to predict goals he ought to accept
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my experience that
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not taking echinacea works to prevent calls she decided we just have to agree
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to disagree
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cameras considered more natural than conventional medicine and people find
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this very appealing but the appeal to nature is a logical fallacy called
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argument and Matt natural natural isn’t always good there’s really nothing
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natural about many of the treatments camera offers like sticking needles in
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the year his excellent book snake-oil science the truth about complementary
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and alternative medicine are burger bustle refuse reviewed the published
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evidence for cam and concluded there is no compelling credible evidence to
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suggest that any camp there are few benefits any medical condition or
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reduces any medical symptom pain or otherwise
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better than a placebo this is my friend has ordered an MBA from Germany early in
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his career he was involved with several kinds of cancer including homeopathy
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acupuncture herbalism and manipulation but as time went on he began to question
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them he got a PHD in set up to research p.m. treatments and find out what worked
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and what didn’t you found that most of them didn’t work he became the world’s
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first professor of complementary medicine at the University of Exeter in
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the UK he and his team were published over 700 scientific papers evaluating
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cam book trigger treatment undeniable facts about alternative medicine after
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reviewing all the undeniable fact they concluded while there is evidence that
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acupuncture might be effective for some forms of pain relief the nausea it fails
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to deliver any medical benefit in any other situations and its underlying
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concepts are meaningless qualifications tentative might with respect to
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homeopathy the evidence points towards a bogus industry that offers period that
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offers patients nothing more than a fantasy chiropractors on the other hand
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might compete with physiotherapist in terms of treating some back problems but
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all the other claims are beyond belief
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and can carry ranges significant risk herbal medicine and utterly offers some
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interesting remedies but they are significantly outnumbered by the
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unproven disproven and dangerous herbal medicines on the market
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well that’s not very impressive i’ll be covering each of those in separate
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lectures there’s a spectrum of plausibility and cam the plausibility of
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homeopathy is essentially zero acupuncture has some plausibility the
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underlying oriental concepts are implausible but it is plausible that
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inserting needles in this can should could possibly cause disease illogical
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affects the plausibility of herbal medicine is high after all the whole
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science of Pharmacology developed out of studying plants in about half of all the
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drugs are used today are derived from plants so herbal remedies might work but
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they need to be individually tested just like any other drug is better than
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conventional medicine they constantly criticized doctors with a cute
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accusations like these doctors cut Bergen poison referring to surgery
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radiation and chemotherapy well conventional treatments have thought of
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pics
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also save lives which cam doesnt the third doctors only treat symptoms not
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the underlying cause that’s an outright lie if you have pneumonia doctors doing
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just treat your symptoms of fever and cough with aspirin and cough syrup
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identify the causative bacteria that kill it with antibiotics in the street
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real underlying causes camp treats imaginary ones they say doctors are only
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in it for the money so it’s cam doctors have to make a living and so do care
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practitioners they don’t offer their services for free and they say that most
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of conventional medicine isn’t a bit evidence-based either but it is too
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that’s another lie will tell you that only ten to twenty percent of what
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conventional doctors do is based on evidence but that’s a myth based on
