Monday, December 21, 2009

Jimmy's Rants: Complementary/alternative/quack medicine

Let me make one thing clear right before I start - this is not meant to be a fair or scientific appraisal of complementary, alternative, holistic, whatever new age term people use for non-science based, medicine. There's so much of that out there it is frankly baffling that people still try it or claim it works. Try looking on Pub Med or any of the many skeptical and critical thinking websites (Steven Novella's NeuroLogica blog, Science Based Medicine and Orac's Respectful Insolence being some of the best) that have over many years carefully demolished the claims of the alt-med crowd.

This is just me, ranting about alt-med nonsense.

Let me start here, with something you may have heard many times from fans of the alt-med industry (let's call it what it is people, it is an industry):

"Big pharma is just in it for the money/to make money."
You may have heard a different variant of it, the point is that the alt-med lover (I need to come up with a better term and woo is over used) is saying you can't trust modern medicine because pharmaceutical companies make money.

OK. My first response is "So what?" That really doesn't prove anything other than that deep down everyone is suspicious of people or companies that make money - everyone seems to think that there's something inherently wrong with being good at making money.

Second response is - "And what do you think purveyors of alt-med are in it for?" The implication from your altie is that clearly alt-med companies or supporters are in it for purely altruistic reasons.


Bull-fucking-shit to the tune of approximately $39,000,000,000. Plus the $1,900,000,000 U.S. practitioner supplements market (I confess I have no idea what that last one is - probably shit like Airbourne).

Really, they're not in it for the money? Just exactly how hopelessly naïve and blinkered can you be? Or is there a dollar limit below which you can trust a company or person, and above which people become as untrustworthy as Chris the crafty Cockney.

I'm sure that you've also heard this or something similar from an altie:
"You can't trust X because they are a doctor/shill for Big Pharma"
This is usually right before they start telling you about their favourite Big Altie (someone famous for pushing this crap). The implication is clear - you can't trust qualified medical professionals because, well, Big Pharma. However, clearly you can trust Big Altie because they have nothing to gain from promoting the alt-med industry. And if it isn't Big Altie (or BA) that they mention it is usually Friend Who I Know And Whose Account I Trust More Than My Own Mother (or FWIKAWAITMTMOM for short - imagine the Fresh Prince saying it).

Of course, the fact that random or famous BA has made millions from promoting alternative or complementary medicine seems to have passed your altie by. In fact, the very notion that Big Altie might be promoting something that directly makes them money seems to have passed your altie by. They're not Big Pharma or a doctor, so they must be trustworthy, right? It's not like they make any money charging $25,000 per lecture and selling millions of books filled with lies or promoting organisations they are intimately involved with or anything.

So, why should I trust Big Altie or FWIKAWAITMTMOM if I shouldn't trust a doctor or Big Pharma? Exactly for how long and at which school did FWIKAWAITMTMOM study to 'just know' that some crank sticking needles in them cured their back problem?

And while we are vaguely in the vicinity of this, just exactly how much government regulation is there of the alt-med industry? The answer, and don't just take my word for it go check for yourself, is not fucking much. In fact, why don't you do some reading on just how angry the alt-med industry gets when regulation that isn't even close to that which Big Pharma endures is suggested. Big Pharma on the other hand relies on everything we know in modern science and medicine and (quite rightly) jumps through hoops and spends millions of dollars on each thing it introduces (and yes I know they still get it wrong sometimes - but the medical field is also clearly self correcting and accountable). But your altie would rather we believe an industry whose R&D almost certainly began with and has since been limited to, "Right, what do you think will happen if I stick this needle here? What about if you drink this? Well, now what if I twist your spine this way?"

Really? Are they fucking insane?

Because, and here is really the crux of why the alt-med industry should be treated with horror and disdain in equal measure, alt-med ignores EVERYTHING we know about modern science and scientific medicine. Germ theory? Ignored. Immune system? Ignored. Viruses? Ignored. Bacteria? Ignored. Human physiology? Ignored. Genetics? Ignored. Physics? Ignored. Chemistry? Abused.

If you believe that anything that comes from Traditional Chinese Medicine (TCM) works then you believe that there is an invisible, undetectable lifeforce called Qi flowing through your body via an invisible and undetectable means and that this is what causes illness or pain in the human body. This means you reject everything we know about modern medicine.

You might not think you do - but you do. If a blockage of Qi is causing the illness and sticking a needle somewhere unblocks this Qi and that cures the illness (yes - that is what acupuncture claims) then it can't be whatever it is that modern medicine says it is. It can't be both. You might be able to compartmentalise them in your mind via some mental gymnastics but the fact is you are just wasting time and money - you've chosen pseudoscience, ancient mysticism and spiritualism over modern medicine.

You believe in something that no-one can prove to exist over something we can show exists.

And no, just because it has been practised for thousands of years doesn't mean there is something to it. If it was so effective then why were lifespans so short until the 20th century? If it was so effective for those thousands of years, why did it take the acceptance of germ theory to all but eradicate small pox? Why have almost all leaps forward in medicine taken place in the last 200 years?

And have you ever wondered why the anecdotal evidence you have about why things like acupuncture work is invariably in reference to muscle and joint pain? What is common with those things? Well, the fact that muscle and joint pain comes and goes at irregular intervals would be the main one. Just because your pain went away after your alt-med treatment doesn't mean it was cured by the alt-med treatment - these things are cyclical and are almost certain to come back - but when they come back I can guarantee you won't be thinking that the alt-med didn't work just like you would if it did after conventional medical treatment. We all get back pain - it's because we're not supposed to be standing upright, but it comes and goes for all of us.

If it doesn't work then why do health insurance companies and some national health services offer alternative medicine treatments I hear you ask? Because they are cheaper. What costs more - going to specialists, having tests, recieving expensive medical treatments or having a quack poke you with needles or manipulate your spine?

But what about scientific studies that show it works? Well, good question. First and foremost, pay attention to the studies themselves. Invariably they are poorly controlled and with poor methodology - usually they are not double blinded (which means the test subjects and those evaluating the results don't know who is recieving the actual treatment and who is in the control group). Often the test subjects are still recieving conventional medical treatments as well, but results are immediately assigned to the alternative treatment rather than the conventional one. Control groups are often lacking or the results for them are played down - many studies that show a possible result for acupuncture (for instance) will also show a result for sham acupuncture (where needles are not inserted according to the principles of acupuncture or they are not inserted at all but patients think they are). For a truly blinded test the people giving the treatment should not know if they are giving the actual treatment, the placebo, or the control as well.

Second, don't rule out the placebo effect. I remember reading a study that showed acupuncture may have had an effect on adults for reducing post operative nausea - but the same study suggested it had no effect on children. It doesn't take a genius to figure out why - kids don't know that needles are supposed to make them feel better and kids aren't as good at suppressing the urge to be sick.

Read the studies claiming a positive effect for alternative medicine carefully. Then make sure you read the many studies that show a non-existent or even negative effect. For instance, check out the adverse effects of chiropractic manipulation.

Almost all well controlled, well designed and carefully run studies show that alternative medicine has no effect better than placebo, if any positive effect is shown at all. That isn't because modern medicine and science are biased against alternative treatments, it's because alternative treatments probably don't work.

There are all sorts of psychological reasons why people think alt-med works as well: Confirmation bias. Selective thinking. Hindsight bias. Cognitive dissonance. Wishful thinking. Affect bias. Believing correlation is causation. Communal reinforcement. Placebo effect. Selection bias. Self-deception. Can your typical altie really say none of these apply to them? That would be impressive if they can, it means they aren't human.

Come on people, think. It's much better than the alternative.


  1. The placebo effect is strong. Our brain is wired to make the body and its component parts produce certain pharmaceutials (in fact, a huge array of them) and the placebo effect is so strong that it can trigger the brain into producing an excess of the desired pharmaceutical for a SHORT TIME. However, the placebo effect is short lived and longer term studies have show its effect to be real, on occasion stronger than the 'true' medicine but ultimately temporary.

    I actually use this theory to SUPPORT acupuncture in certain cases, for a reason I think you may find interesting.

    If you are one of the naive people who believe that acupuncture will work for you then, by all means go ahead and have a session. You'll be taken in by the hype, your quack will go at you with the pointy sticks and, guess what, your brain will tell you that you've done something good for your body and will trigger your body's very own Pfizer to start making pharma.

    In this respect, for minor aches and pain, the acupuncture has 'worked'. Fair enough, you would have got a similar effect if I had told you (and you believed) that back pain could be cured while pleasuring yourself while watching teletubbies DVDs, but my point remains. Acupuncture 'worked' and there is a scientific mechanism to show why it did work. Whether the patient believes the basis of it working is almost irrelevant.

    Now when it comes to using acupuncture for such things as cancer, HIV, Parkinsons etc, I have a quite different view. Quacks who purport to be able to use acupuncture or healing herbs to 'cure' these diseases should be jailed for fraud a la Bernie Madoff. They are killing people.

    You and I, Jimmy, know better than to stick pins in ourselves with the hope of curing that which should be better left to Merck, but for minor afflictions of the science-blind, sometimes acupuncture may not be such a bad thing.

  2. Mark:

    I wouldn't disagree with you on that score actually, in that context at least.

    What I forgot to write in the rant but had intended to was that there is some limited scientific evidence to suggest acupuncture helps with temporary pain relief - almost certainly something related to the fact that some quack is jabbing the body with needles in some of its most sensitive areas no doubt.

    But proponents of acupuncture don't claim only that it might help you with pain, temporarily. In fact, one acupuncturist I know used to advertise her services with an A4 sheet of paper filled with ailments that she claimed acupuncture could fix (I think the list actually and unfortunatey also came from the WHO). It included everything from skin irritations to infertility and a lot inbetween, including some serious conditions people should seek real medical help for.

    So in that context, I am not going to agree even that acupuncture works only as a placebo instigator, because it isn't doing what its proponents claim.

  3. Haha - true, true - quacks and charlatans do tend to over-hype and under-deliver in the long term. I'm off to watch my teletubbies DVD. My back hurts.

    Have a happy state-mandated religious break from work and secular greetings to you and yours.