Thursday, September 04, 2008

Trick or Treatment cont.

I’ve just finished reading Trick or Treatment. Since I’ve made it a little bit of a hobby to stay informed about the science or lack thereof behind many alternative treatments, I can’t really say that much of the information in the book surprised me. However, the thorough history of these treatments’ origins gave me a better understanding of why so many people choose to believe in these treatments even after the foundations that they are built on have shown to have no basis in fact or evidence.

Their evaluation was primarily limited to acupuncture, homeopathy, chiropractic and herbal medicines. Each was given a very good historical overview. Then they started looking into the actual trails to test each treatment. With most of them the treatments were found to have little to no effect beyond that of placebo. In evidence-based science research if you find an anomalous effect and to try to isolate that effect to test it the effect gets stronger as you increase your protocols and the test can be duplicated by other researchers. In nearly all of the tests of acupuncture, homeopathy and chiropractic the results were indistinguishable from placebo and any anomalous effects disappeared once the proper controls were in place. So clearly if these treatments are working at all they are not working because the water had a memory of the arsenic it used to contain, the innate intelligence can travel up and down the spine, or the chi’i can flow better along the meridians.

The one treatment they authors did find more effective than placebo was the herbal treatments. This was not, however, an endorsement. Unlike the other three treatments discussed in the book herbal treatments actually have active ingredients. Those active ingredients may indeed have positive effects. They also have side-effects. (I always get a kick out of the infomercials for homeopathic remedies that brag about having no side effects. Of course they don’t have any side effects. They have no effects at all.) The inconsistent dosages and lack of controls that would be put on these products otherwise make herbal treatments the most dangerous of the ones reviewed.

My personal concern is not that any of these treatments themselves would be harmful. The real danger comes from the fact that while the patient is busy trying these alternative treatments they are forgoing the evidence-based treatments that could really help them.

Rather than just seeming like a couple of guys who had an axe to grind the authors genuinely come across as open-minded seekers of evidence. In fact one of the authors used to be a practicing homeopath. He became disillusioned with his trade after he tried to recreate Hahnemann’s original experiment that was supposed to have cured malaria. After numerous trials he was forced to conclude that there must have been some mistake in Hahnemann's original work. Since that experiment was the foundational experiment in the whole “like cures like” philosophy of homeopathy, the author was forced to question the entire field. His research not only convinced him that homeopathy is just a placebo, it was a very expensive one to boot.

In the last chapters the book calls for stricter government control and labeling of all treatments that may take the place of traditional medicines. My libertarian views normally restrict me from endorsing big government solutions. However, these treatments clearly represent a danger to the taxpayers when they are taken in place of more tested, evidence-based treatments. I wouldn’t want the government to restrict them entirely, but I see no problem with stricter labeling laws.

Several years ago a guy I know was diagnosed with leukemia. He is an alternative medicine practitioner. He has gone to India to study several different forms of treatment. He is even a believer that the Earth has acupuncture meridians and that we can fix the climate problems by simply placing large needles in the Earth at exactly the right point. (I wish that last sentence was a joke, but it isn’t). As detached as his beliefs were I really though that he wouldn’t be around much longer once he was diagnosed with leukemia. The last time I spoke with him his leukemia was in full remission and it wasn’t because of any alternative treatment. It was because he took his doctor’s recommendation and had a very aggressive, mainstream treatment that included radiation treatment and chemotherapy. I am so thankful that he did not risk his own life with alternative treatments.

There are different ways to Romanize the pronunciation of the Chinese word . I’ve seen it spelled ki, qi, chi, and chi’i. for these posts I simply used chi’i because that was the one the authors chose. Technically it is pronounced 気.

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