The Evolution of Alternative Medicine(theatlantic.com)
theatlantic.com
The Evolution of Alternative Medicine
http://www.theatlantic.com/health/archive/2015/06/the-evolution-of-alternative-medicine/396458/?single_page=true
5 comments
Also on the other side:
A family member of mine was in the hospital giving birth. She was having a rough time (it later turned out she needed a C-section), and was really in pain. The doctor looked at her, annoyed, and said "you're not very good at this are you?"
That's an extreme example, but it illustrates a major problem with scientific/Western/whatever you want to call it medicine: it considers aesthetics and emotions to be irrelevant frivolities. Visit the inside of a hospital. Most look not terribly unlike prisons. In fact, I've seen prisons that are aesthetically more pleasing.
To the extent that we have data on this -- and assuming it's not untrue -- the data shows that aesthetics and emotions do matter.
Alternative medicine in my experience gets this. The alt-med oriented offices I've seen are beautiful. People are treated like they are sentient beings, not slabs of meat.
A family member of mine was in the hospital giving birth. She was having a rough time (it later turned out she needed a C-section), and was really in pain. The doctor looked at her, annoyed, and said "you're not very good at this are you?"
That's an extreme example, but it illustrates a major problem with scientific/Western/whatever you want to call it medicine: it considers aesthetics and emotions to be irrelevant frivolities. Visit the inside of a hospital. Most look not terribly unlike prisons. In fact, I've seen prisons that are aesthetically more pleasing.
To the extent that we have data on this -- and assuming it's not untrue -- the data shows that aesthetics and emotions do matter.
Alternative medicine in my experience gets this. The alt-med oriented offices I've seen are beautiful. People are treated like they are sentient beings, not slabs of meat.
That is an extreme and unfortunate example (and there is an entire additional set of issues around bedside manner and how our current training and practice environments select against it). However, establishment medicine is, in general, getting much better at this -- see for example some of the suites in the new Benioff Children's Hospital in SF which have been extensively designed for patient comfort (although lacking in some other areas...).
Patient comfort can be a problem when it's prioritized over treatment, as is often the case in alternative medicine and increasingly so in patient comfort-centered establishment medicine. A good example of this can be found in hospital food -- some medical centers have discovered that patient satisfaction increases dramatically when they're given the food they want/request, even when this food is explicitly counter to nutritional recommendations for their health conditions.
A secondary interesting externality of the recent focus on patient satisfaction is the construction of parking near hospitals. Several studies over the last decade have identified ease of parking as a primary factor in increasing patient satisfaction, so many new facilities are prioritizing this, which only amplifies the already-negative effects healthcare facilities have on their surrounding neighborhoods.
Aesthetics and emotions do matter, and almost all doctors realize this. However, their incentives and the incentives of the facility administrators are rarely aligned towards prioritizing them, and when they are they're often at the expense of the care itself. Alternative medicine is no exception to this phenomenon.
Patient comfort can be a problem when it's prioritized over treatment, as is often the case in alternative medicine and increasingly so in patient comfort-centered establishment medicine. A good example of this can be found in hospital food -- some medical centers have discovered that patient satisfaction increases dramatically when they're given the food they want/request, even when this food is explicitly counter to nutritional recommendations for their health conditions.
A secondary interesting externality of the recent focus on patient satisfaction is the construction of parking near hospitals. Several studies over the last decade have identified ease of parking as a primary factor in increasing patient satisfaction, so many new facilities are prioritizing this, which only amplifies the already-negative effects healthcare facilities have on their surrounding neighborhoods.
Aesthetics and emotions do matter, and almost all doctors realize this. However, their incentives and the incentives of the facility administrators are rarely aligned towards prioritizing them, and when they are they're often at the expense of the care itself. Alternative medicine is no exception to this phenomenon.
"Hey, how about we design this place for function, rather than form?"
'... Brilliant!'
'... Brilliant!'
I'm bothered by the dilution/misuse/pollution of the word "holistic".
"Holism" is an important notion, held even by stodgy professores like WVO Quine. It stands in contrast to "reductionism", the alternate notion that things "boil down" to fundamental elements.
It's related to "emergentism", but much less bold: while emergentism has to argue for novel properties in wholes, holism is simply saying that wholes exist. Emergentism is much easier to knock down -- as is naïve reductionism.
"Holism" is an important notion, held even by stodgy professores like WVO Quine. It stands in contrast to "reductionism", the alternate notion that things "boil down" to fundamental elements.
It's related to "emergentism", but much less bold: while emergentism has to argue for novel properties in wholes, holism is simply saying that wholes exist. Emergentism is much easier to knock down -- as is naïve reductionism.
What is Alternative medicine that works is called? Medicine.
Yes, but a lot of people forget the other side of that.
You know what they call it when a doctor gives a treatment based on an unjustifiable hunch (or prodding from a pharma rep) that never gets reviewed because of privacy and unwillingness to criticize other doctors? Medicine.
Just because typical altmed lacks a sound epistemology, doesn't mean the typical doctor has it.
You know what they call it when a doctor gives a treatment based on an unjustifiable hunch (or prodding from a pharma rep) that never gets reviewed because of privacy and unwillingness to criticize other doctors? Medicine.
Just because typical altmed lacks a sound epistemology, doesn't mean the typical doctor has it.
Sometimes alternative medicine = more care
and evidence based medicine = less care
"Researchers find placebo combined with more care is better than a drug alone." http://arstechnica.com/science/2015/04/a-tale-of-two-placebo...
and evidence based medicine = less care
"Researchers find placebo combined with more care is better than a drug alone." http://arstechnica.com/science/2015/04/a-tale-of-two-placebo...
That or Placebo. https://en.wikipedia.org/wiki/Placebo
IMO, if doing a 'pointless' ritual reduces someones dependance on pain medication then it's useful.
IMO, if doing a 'pointless' ritual reduces someones dependance on pain medication then it's useful.
All anyone should care about is results. If a ritual somehow reduces pain then it can hardly be called "pointless."
The problem is when there are no results. From homeopathic "medicine" that's nothing but water to chiropractors claiming that they can treat allergies, there's a ton of alternative medicine that's just completely baseless.
Pain is an area where weird things can help, because it's ultimately a matter of perception. But that doesn't in any way legitimize the sorts of folks who say they can treat cancer by manipulating your spine.
The problem is when there are no results. From homeopathic "medicine" that's nothing but water to chiropractors claiming that they can treat allergies, there's a ton of alternative medicine that's just completely baseless.
Pain is an area where weird things can help, because it's ultimately a matter of perception. But that doesn't in any way legitimize the sorts of folks who say they can treat cancer by manipulating your spine.
I'm happy to heap scorn on homeopathy too, but, as you say initially, if results are what we're after, than placebo effect is potentially just as good as allopathic medicine. But yes, it would be asking a lot of placebo effect to cure cancer...
Exactly. You should really stop and do a re-think if you ever find yourself saying, "no, that didn't relieve your pain, it just produced a state observationally indistinguishable from lacking pain!"
Kinda like the people who say "shaving hair doesn't make it come back darker. That's a misconception. It just looks like it does ... when what you care about is looks."
Kinda like the people who say "shaving hair doesn't make it come back darker. That's a misconception. It just looks like it does ... when what you care about is looks."
That assumes there is some systematic process in which established medicine adopts alternative methods once they have been validated.
However, this is a simplistic view that is quite far from reality. First, the practices are totally different in principled approaches. Medicine generally is focused on treatment and management of illness and conditions. Alternative medicine is generally focused on prevention or reversal of conditions.
Medicine doesn't have much incentive to adopt alternative practices even when they do work. You can't patent them. Lot's of research often goes into taking a natural substance and turning it into a drug just so it can be patented to make it profitable. However, often in the effort to create a drug version, the drug version must be a modified structure which doesn't exist in nature in order for it to be patentable, but this is what leads to the problem of side effects or complete failures of medications.
Just look at recent revelations of medicine such as anti-depressants which perform no better than placebo. Effectiveness of statins are being called into question and then there is monumental disaster Vioxx that killed something like 55k after successfully completing the FDA approval process.
Simply saying medicine works and alternative doesn't is quite an unfair view. Reality is there is both good and bad on both sides.
However, this is a simplistic view that is quite far from reality. First, the practices are totally different in principled approaches. Medicine generally is focused on treatment and management of illness and conditions. Alternative medicine is generally focused on prevention or reversal of conditions.
Medicine doesn't have much incentive to adopt alternative practices even when they do work. You can't patent them. Lot's of research often goes into taking a natural substance and turning it into a drug just so it can be patented to make it profitable. However, often in the effort to create a drug version, the drug version must be a modified structure which doesn't exist in nature in order for it to be patentable, but this is what leads to the problem of side effects or complete failures of medications.
Just look at recent revelations of medicine such as anti-depressants which perform no better than placebo. Effectiveness of statins are being called into question and then there is monumental disaster Vioxx that killed something like 55k after successfully completing the FDA approval process.
Simply saying medicine works and alternative doesn't is quite an unfair view. Reality is there is both good and bad on both sides.
It's harder than that. Acupuncture works better than a placebo, but it doesn't matter where you stick the needles, or if you use fake needles.
Acupuncture isn't medicine. It's a super-placebo.
Acupuncture isn't medicine. It's a super-placebo.
> Acupuncture works better than a placebo
IIRC, it works better than a sugar-pill placebo, but not better than injection-based placebo. Magnitude of the placebo effect is different by delivery mechanism.
IIRC, it works better than a sugar-pill placebo, but not better than injection-based placebo. Magnitude of the placebo effect is different by delivery mechanism.
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So it turns out that there are several biological processes that allow for the human body to heal itself. These include our endogenous opioid system (which releases dopamine, etc). The placebo effect (which is much of alternative medicine) relies on this process.
In short, the placebo (or acupuncture, or holistic tinctures, or voodoo) allow your body to heal itself. For this to work there need to be at least 2 of the 3 following criteria in place:
A) Prior Conditioning (i.e. if you take tylenol and it helps, then one day you take a sugar pill, that you believe is tylenol, then the pain should still be reduced some).
B) Rational Beliefs around effectiveness (i.e. if it is painful or unpleasant it must be working. This is part of the reason medicine taste like medicine, when it could taste like candy)
C) Authority (Turns out, you can just give placebos to yourself. Someone must give the placebo permission for it to work. Further proof, that humans are weird).
Alternative medicine normally touches on all three of these criteria.
In short, the placebo (or acupuncture, or holistic tinctures, or voodoo) allow your body to heal itself. For this to work there need to be at least 2 of the 3 following criteria in place:
A) Prior Conditioning (i.e. if you take tylenol and it helps, then one day you take a sugar pill, that you believe is tylenol, then the pain should still be reduced some).
B) Rational Beliefs around effectiveness (i.e. if it is painful or unpleasant it must be working. This is part of the reason medicine taste like medicine, when it could taste like candy)
C) Authority (Turns out, you can just give placebos to yourself. Someone must give the placebo permission for it to work. Further proof, that humans are weird).
Alternative medicine normally touches on all three of these criteria.
We will get real medicine if we can figure out how to make health profitable. Now disease is profitable.
How do you incentivize a healthy lifestyle in which you don't need pharmaceutical companies?
How do you incentivize a healthy lifestyle in which you don't need pharmaceutical companies?
You focus on not just making people healthy, but making them optimally so.
In the more narrow field of life extension within alternative medicine there is quite a bit of good research and the Life Extension organization would be an example of what the greater health industry might would look like if it wasn't focused on disease care. http://www.lef.org/welcome
In the more narrow field of life extension within alternative medicine there is quite a bit of good research and the Life Extension organization would be an example of what the greater health industry might would look like if it wasn't focused on disease care. http://www.lef.org/welcome
thelancet: "Offline: What is medicine's 5 sigma?"
http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
"The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. As one participant put it, “poor methods get results”. The Academy of Medical Sciences, Medical Research Council, and Biotechnology and Biological Sciences Research Council have now put their reputational weight behind an investigation into these questionable research practices. The apparent endemicity of bad research behaviour is alarming. In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours. Our acquiescence to the impact factor fuels an unhealthy competition to win a place in a select few journals. Our love of “significance” pollutes the literature with many a statistical fairy-tale. We reject important confirmations. Journals are not the only miscreants. Universities are in a perpetual struggle for money and talent, endpoints that foster reductive metrics, such as high-impact publication. National assessment procedures, such as the Research Excellence Framework, incentivise bad practices. And individual scientists, including their most senior leaders, do little to alter a research culture that occasionally veers close to misconduct."