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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline

« Poor Equipment Revisited | Main | Lack of Experience, You Know »

January 12, 2009

An Alternative Prescription From Chopra, Roy, and Weil

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Posted by Derek

Update: a follow-up post is here, for those who want more on Qi Gong, placebo effects and the like.

Well, we don’t even know who the new FDA commissioner is going to be under the Obama administration, but people are already making their bid for a change in direction. In Friday’s Wall Street Journal, you can find Deepak Chopra, Rustum Roy, and Andrew Weil with an op-ed titled “Alternative Medicine is Mainstream”. I think you can go ahead and silently append “. . .And Deserves Serious Mainstream Funding”.

My hopes for this piece were not high – Deepak Chopra, for one, I consider to be an absolute firehose of nonsense. Both he and Andrew Weil should be whacked with sticks every time they say the word "quantum". But they manage to avoid that one here - the op-ed turns out to be a marbled blend of things that I can agree with and things that make me raise both eyebrows. Its general thrust is:

1. Chronic diseases related to lifestyle (diet, physical habits, etc.) account for a large percentage of health care costs. These could be ameliorated or downright prevented through changes that don’t involve medical procedures.

2. “Integrative medicine” (by which the authors mean, among other things, plant-based diets, yoga, meditation, acupuncture and herbal therapies, have been shown (they claim) to help with such lifestyle changes, and with less expense. The definition of integrative medicine is not provided, nor is the boundary line between it and "regular" (disintegrative?) medicine drawn.

3. Therefore, the incoming administration should make these a big part of the health care system as soon as possible. Did we mention the funding?

Now, I can’t argue with that first point. Cardiovascular disease and Type II diabetes could both be much smaller problems if people in the industrialized nations would just eat less food (and better food) and exercise more. The editorial makes it sound as if no one believes this or has ever heard of such a thing, but come on. No one’s heard anything else for decades. However, it seems equally clear that jawboning people about this issue does not do nearly as much good as one might hope.

Whether “integrative medicine” is any more effective is something that I would very much like to see someone prove. The authors seem to be familiar with a bunch of well-controlled studies that I haven’t heard about, and I invite them to trot out some data. But some of the statements in the op-ed make me think that my cardiovascular health won’t be able to stand it if I hold my breath while waiting for that. For example, we have:

”Chronic pain is one of the major sources of worker’s compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong. Herbs usually have far fewer side effects than pharmaceuticals”.

Studies show, do they? Is there really a believable study that shows that Qi-freaking-Gong, of all things, is good for chronic pain? Ancient hokum about “energy fields” and “life force” does the trick, does it? My idea of a good trial of Qi Gong would involve one group of patients getting the full hand-waving treatment according to the best practitioners of the art. The other cohort gets random hand motions from a system I will gladly invent on request, and which I will have to be forcibly restrained from naming Don Ki Kong. It’ll be full of talk about holistic energies and connections to the universal flow, don’t you doubt it, and I’ll round up some impressive-looking worthies to administer the laying on of hands. Their passes and taps will be carefully screened by the Qi Gongers beforehand to make sure that none of them, according to their system, have any chance of actually having any effects on the Qi (assuming that any of them can agree). We call that a controlled trial to investigate placebo effects.

And I hardly know where to start with those beneficial herbs. The literature I’ve been reading has been showing that many of the herbal treatments show no effects when they’re looked at closely – St. John’s Wort, Echinacea, and so on. The larger and more well-run the trial, the smaller the effects go, in too many cases. But I have no problem with the idea that plants and plant extracts can have medicinal effects, of course: they’re full of chemicals. My whole career is predicated on the idea that taking chemicals of various sorts can alter one’s health. Where I jump off the parade float is at the nature’s-bounty-of-beneficial-herbs stuff, the idea that things are somehow more benign because they come from natural sources. Vitalism, they used to call that. It’s hooey. Strychnine. Ricin. Come on.

The editorial is full of fountains of happy talk like this one:

Joy, pleasure and freedom are sustainable, deprivation and austerity are not. When you eat a healthier diet, quit smoking, exercise, meditate and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. Your brain may grow so many new neurons that it could get measurably bigger in only a few months. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- similar to the way that circulation-increasing drugs like Viagra work.

Calling Dr. Love! All I have to do is change one letter in my last name, and I'm in business, expanding brains and other useful body parts. Unfortunately, that first sentence typifies a lot of thinking in this area. It's one of those "isn't it pretty to think so" statements. As far as I can see, deprivation and austerity have been the norm for most people throughout most of human history, even though they were eating natural foods and getting lots of exercise and fresh air. And one of the big reasons that people put on weight is that they have the freedom to experience the joy of tasty food a bit too often. No, this is noble-sounding stuff, but there's nothing behind it.

Update: Orac's take, with more on those "studies".

Comments (70) + TrackBacks (0) | Category: Press Coverage | Snake Oil


COMMENTS

1. Anonymous on January 12, 2009 9:52 AM writes...

When's Michael Moore going to go after the alternative medicine industry?

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2. retread on January 12, 2009 9:54 AM writes...

One of the joys of being retired from medicine is that I no longer have to explain to patients why these things are unlikely to work. I find the stuff amusing now. It's always fun to shop at Whole Foods and watch the credulous in the health aisle (which is quite extensive -- for the same reason that makeup takes a lot of floor space in Macy's -- it's extremely profitable). The clientele is likely the most upscale and educated you are likely to find in a grocery store. Where is Ambrose Bierce when you really need him?

The profession, since at least the 60s, has been advising people to lose weight, stop smoking, exercise a bit, with neglible result -- see the various NHANES studies, so anything the holistic practitioners can do to promote it, is OK. The profession may have even caused some of this by telling people to cut out fat. Unfortunately we have to eat something and most people substituted carbohydrates, which bounces blood sugar around and (which some researchers think) increases appetite.

You might be amused by reading the following paper -- it really happened. [ J. Am. Med. Assoc. vol. 279 pp. 1005 - 1010 '98 ] A paper from a 10 year old girl demolishes therapeutic touch, a practice by which 'healers' of various persuasions are able to sense human energy fields (whatever they are) and use them to cure disease. The sad thing is that some 80 nursing schools teach it.

Cynical types, such as Derek or the readers of this blog would never have gotten into the door to do such an experiment.

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3. MarkySparky on January 12, 2009 10:05 AM writes...

"When you eat a healthier diet, quit smoking, exercise, meditate and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep."


If I lift weights regularly while listening to The Star Spangled Banner sung in Hindi, I bet I'll gain muscle mass. Any bets as to the mechanism?

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4. Max on January 12, 2009 10:15 AM writes...

If universal health care ever gets a grip on the U. S. you can bet these are the people who will make every effort to infiltrate the system and impose their ideas on all of us. Every country that has a national health care system also has lifestyle police. The offerred explanation is that costs can be better controlled if people live healthy lives.

Obama wants all medical records computerized.

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5. Anonymous on January 12, 2009 10:20 AM writes...

Content is content, and good content will get you read. But good writing is good writing and when combined with good content will get you read widely. This is a commentary with good content but "Firehose of nonsense..", "Don Ki Kong.."is well written. Kudos.

Zz
"Dying is easy, comedy is hard."

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6. Hap on January 12, 2009 11:08 AM writes...

The lack of data (and the appearance that the lack of data is not a problem) does not endear me to their position. Getting people to give up the things people like in the amounts they want them is the hard part, and it would be helpful to see if it works in populations not already unlikely to need the help.

I think it would help if Congress would repeal the portion of the act which allowed supplement makers to market without evidence of effect - the concept that if something claims to have an effect there should be evidence of such would be helpful to weed out the unuseful parts of holistic medicine and to get rid of the ones willing to use the lack of claims enforcement to sell their snake oil. I know you can't make people think, but getting rid of much of the haystack would make it easier to find the needles.

I don't think universal health care would impose the "holistic medicine" theory on everyone - it would more likely go the way of some companies to fine and preclude coverage if you do things whose consequences are expensive to treat, and that would be hard because many of your voters are in the set of people doing precisely that.

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7. daen on January 12, 2009 11:12 AM writes...

"If universal health care ever gets a grip on the U. S. you can bet these are the people who will make every effort to infiltrate the system and impose their ideas on all of us. Every country that has a national health care system also has lifestyle police. The offerred explanation is that costs can be better controlled if people live healthy lives."

Well, Max, I very much doubt you have the slightest idea what you're talking about. Universal health care does not imply having "lifestyle police". Does the NHS in the UK have "lifestyle police"? It does not. France? Wine. Denmark? Smokers' paradise. Spain? Wine AND smoking. I've lived under both the Danish and British health care systems, and my parents now live under the Spanish system, and we have very little to complain about. I think you should look forward to it, even though the costs will inevitably be high, but that's sort of implied by the word "universal". The knock-on economic benefits of not having a large proportion of the population unable to work through sickness and unable to afford treatment, on the other hand, will be significant.

My aunt, in the US, recently had a hip replacement which went wrong. It currently costs my aunt and uncle $2,000 per day for care, which they can ill afford, because of a mistake, which they will only be able to get back through legal recourse. Don't tell me your system is more efficient and/or better when so much money ends up in the hands of investors, administrators and lawyers instead of in hospitals, and don't knock other countries' systems until you've tried them, particularly if you're knocking them for the wrong reasons.

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8. Jose on January 12, 2009 11:15 AM writes...

Did the WSJ really put the phrase, "Your sexual organs receive more blood flow, so you may become more potent -- similar to the way that circulation-increasing drugs like Viagra work." into print? Where, exactly, are the flying monkeys?

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9. Lev on January 12, 2009 11:19 AM writes...

Qi Gong vs.Don Ki Kong study would need a "do nothing" third group. I bet that waiving hands regularly for 20 minutes a day (in absolutely any style or lack thereof) *would* do good things to one's health. ;-)

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10. gary2 on January 12, 2009 11:43 AM writes...

It's good to have a diverse critique of these issues. I do have a few questions. The mainstream approach to health, big pharma, has quite a few unanswered questions. From what I've read ..... big pharma spends twice as much on marketing as they do on R&D..... the people in the F.D.A. can hold stock in companies they pass judgement on ...... the number of lobbyists in D.C. representing big pharma (2005) was about 1,275, big pharma spent ( 2007 ) $190,000,000 on federal lobbying. A medical professor from John's Hopkins did a study that showed more people in the U.S. went to alternative medical practitioners than to allopathic physicians. People are not happy with our present form of medical treatment ...... most specifically chronic illness solutions.

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11. RB Woodweird on January 12, 2009 12:05 PM writes...

gary2 sez:
It's good to have a diverse critique of these issues. I do have a few questions. The mainstream approach to health, big pharma, has quite a few unanswered questions. From what I've read ..... big pharma spends twice as much on marketing as they do on R&D..... the people in the F.D.A. can hold stock in companies they pass judgement on ...... the number of lobbyists in D.C. representing big pharma (2005) was about 1,275, big pharma spent ( 2007 ) $190,000,000 on federal lobbying. A medical professor from John's Hopkins did a study that showed more people in the U.S. went to alternative medical practitioners than to allopathic physicians. People are not happy with our present form of medical treatment ...... most specifically chronic illness solutions.


Aaaaaaand..... what are your questions?

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12. Anonymous on January 12, 2009 12:09 PM writes...

Well, gary2, how much does big alternative medicine spend on marketting vs. R&D? Can FDA regulators (or congressmen) own stock in suplement companies? How many lobbyists are in Washington representaing alternative medicine? So more people went to alternative medicine practitioners - what was the proportion that actually got better compared to the mainstream medicine? You seem t be arguing that big pharma behaves badly, and alternative medicine providers will behave goodly. Alternative medicine is absolutely prone to the same abuses as big-pharma medicine (I bet your average Qi Gong practioner (whatever that is) would have no trouble prescribing a never-ending, ever-escalating regime of tests and treatments, if you let em; heck, my barber would be more than happy to keep taking money as long as I'm willing to give it to him). Big pharma, however, actually has to show some data to support their claims. Whether the data is right, relevant, true, is another problem entirely. Alternative medicine sellers need do NOTHING to support their claims. Maybe some do, more power to them, then we can use the scientific method to try to understand and perhaps improve the alternative methods.

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13. Steve on January 12, 2009 12:17 PM writes...

As far as the use of "quantum" these guys aren't the dangerous ones by any means. Most people realize they're using it as a buzz word. I'm more worried about the crazy physicist out there like Fred Wolf. Though I must admit I love Fred's books. It's like reading hard scifi.

Here are few that appeared in "What the Bleep"
* William A. Tiller
* Amit Goswami
* John Hagelin
* Fred Alan Wolf
* David Albert

Also Andrew Weil's medical advice as far as diet seems pretty sound.

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14. milkshake on January 12, 2009 12:25 PM writes...

It is not true that St Johns Wort does nothing - It can make your eyes hurt like hell! I was faintly aware that there is a photo-toxic compound in the herb, but only after two days of extreme eye photo-sensitivity I figured out that my "conjunctivitis" was caused by this natural organic supplement, taken in recommended doses. When you buy a dietary supplement/herb remedy, you are at the mercy of the manufacturer (potency, adulteration and contamination). FDA looks at it only after people get sick.

I am not worried that homeopaths and yogis will sway the new administration - Obama surrounded himself with people that are savvy and pro-science.

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15. MTK on January 12, 2009 12:33 PM writes...

I have no problem with any medical treatment that anyone else wants to use. Unless I have to pay for it. If I as a taxpayer do have to pay for it, then I want some hard data which will support it's use. I am in favor of investing in the health and well-being of our citizens. Investing, not just spending. So once again give me some legitimate data that supports that investment.

The catch-22 here, of course, once something is studied and verified, it would no longer be alternative and therefore lose some of it's "effectiveness".

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16. Sarah on January 12, 2009 1:14 PM writes...

And along those lines, the Chicago Tribune has an article today that basically advises the public to get rid of all body-care products. The reasoning behind this? The presence of trace amounts of carcinogens, or potentially carcinogen-forming molecules. The part that bothered me the most is that the author doesn't provide any sources other than the book from which she takes the claims.

http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/01/10-chemicals-to.html

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17. JSinger on January 12, 2009 1:15 PM writes...

I'm confident that a few tens of millions invested in rigorous studies of the more plausible "alternative" stuff would yield much more than would extending NIH paylines to fund a bit more borderline same 'ol, same 'ol. The problem is that NIH has been supposed to be doing that already with NCCAM and they've never taken it seriously enough to enforce real rigor there.

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18. RoadNotTaken on January 12, 2009 1:37 PM writes...

to be fair, Qi Gong as it is practiced by millions, is pretty simlar to Tai Chi or Yoga -- that is, it's basically a low-impact exercise routine. you can make as much fun of it as you want because of all the spiritual silliness, but i'd bet that most people that spend a half-hour per day doing breathing and stretching-type exercises will tend to be pretty healthy.

if you visit public parks in Asia (i've seen this in Thailand and Vietnam and heard similar stories about China) they're full of old people doing Tai Chi and Chi Gong-type stuff in the mornings. not so here in the US. there's plenty to take issue with in the article, but it's also probably pretty worthwhile to have public discussions about how to encourage exercise and healthy living. when you make fun of anything practiced by spiritualists you're being every bit as simplistic and close-minded as people who instinctively distrust anything that comes from pharmaceutical companies.

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19. emjeff on January 12, 2009 1:43 PM writes...

I remember about a year or two after DSHEA was passed (which insured that dietary supplements would be regulated as foods, and so could say almost anything in their advertising), my father calling me in a huff, asking how these "hucksters" could get away with their advertising. He was astounded when I told him how the law was basically slanted toward the "natural" supplements industry. Now the question: How did a 68 year old meat cutter from Baltimore end up seeing through this crap, while Andrew weil (M.D., Harvard) still buys it hook, line and sinker?

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20. emjeff on January 12, 2009 1:51 PM writes...

"Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle."

How is breast and prostate cancer preventable by "lifestyle" changes?

What f***ing nonsense...

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21. SRC on January 12, 2009 1:57 PM writes...

C'mon, guys, use some imagination!

Let's not fight 'em - let's join 'em!

Take a few mg of a statin, say, dissolve it in a swimming pool of water, and sell it to the dingalings as a homeopathic formulation. COGS...zip!

I know. It's a gift...

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22. RB Woodweird on January 12, 2009 2:32 PM writes...

Sarah, I followed the link and read the ChiTrib article. Now I think there has never been a funny chemical joke, and I kill on sight any chemist who makes a chemical pun, but this was the appropriate time to bust out a link to www.dhmo.org. So I did, Bob forgive me.

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23. BD on January 12, 2009 3:30 PM writes...

PS - of course I'm disappointed the WSJ author did not cite any sources. This practice is too often the norm in popular reports on topics in science or medicine. This problem is often (but not always) confounded by authors' lack of technical understanding, especially in hard sciences.

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24. AR on January 12, 2009 3:47 PM writes...

@emjeff:
DSHEA actually ended up providing _more_ regulation of the industry in many ways. It established 'Good Manufacturing Practices' set by the FDA to ensure the quality of the products, as well as commissions to analyze the claims made on labeling etc. It also provides for the director of health and human services to take any product off the market if it is posing a hazard. All of these were harder to do when dealing with supplements as 'food' items.

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25. Michael Tinkler on January 12, 2009 5:47 PM writes...

I decided that if I didn't get tenure I was going to move south to Ithaca and set up as a practitioner of Traditional Galenic Medicine. You know - lots of humors and temperament talk, herbal healing, hot baths, prescribing Thai food for phlegmatic constitutions and ice cream for the choleric.

I coulda made a fortune!

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26. Wavefunction on January 12, 2009 6:54 PM writes...

Ah...the mentally deficient Chopra and Weil and their followers. All that remains is for them to now team up with Kevin Trudeau. And let's also whack Larry King and CNN along with them who insist on calling upon Dr. Chopra and Dr. Phil as resident experts on all matters ranging from rat hair in your shampoo to serial killers and terrorists.

The WSJ is gradually descending into becoming a forum for quacks. First there was Karl Rove roving about how George is an intellectual who has read 196 books in two years. And now this.

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27. TFox on January 12, 2009 7:35 PM writes...

99% of so-called "alternative" medicine is alternative for a reason. But the molecules don't care whether they are sold under DSHEA or FDAMA, or were prescribed by a witch doctor or an MD, they have the same biological effects regardless of what we call them. I used to work for a biotech which, before collapsing, tried out the herbals business. One interesting feature of the regulatory environment is that, if a substance *can* be sold under DSHEA, there is no economic incentive available for doing the gold-standard clinical trials. The trial is expensive, the drug version is harder to sell, and your competitors can keep selling the identical stuff as an herb. As a result, any hypothetical effective herb will remain a DSHEA herb on the marketplace, where sellers are prohibited by law from mentioning any evidence of efficacy. Rational consumers therefore have to do a great deal of careful literature reading before reaching conclusions. My takes? Echinacea: probably garbage, just wash your hands and get more sleep. St John's Wort? Effective, but with enough side effects, including severe ones like drug interactions, that you really ought to be under a physician's care anyway. Once you're there, there's lots of choices, and SJW is unlikely to be best. And besides, should a depression med *ever* be OTC? Ginseng? Effective, but for about the same indications as coffee, and not as good. Antioxidants / polyphenols? Maybe, but no more so than eating more vegetables. The rest? Largely placebos, but some are actively harmful. Be careful...

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28. provocateur on January 12, 2009 7:44 PM writes...

If you beleive in it so much why dont you guys start an industry and prove it through clinical trials....nt difficult...and I am not being sarcastic!

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29. Marilyn Mann on January 12, 2009 9:31 PM writes...

Great post.

Here's a similar one by Orac:

http://scienceblogs.com/insolence/2009/01/the_three_musketeers_of_woo_meet_dartagn.php

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30. Marilyn Mann on January 12, 2009 9:32 PM writes...

Great post.

Here's a similar one by Orac:

http://scienceblogs.com/insolence/2009/01/the_three_musketeers_of_woo_meet_dartagn.php

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31. The Necromancer on January 12, 2009 10:51 PM writes...

You present some perfectly valid criticisms of the alternative healing paradigm. One quibble. Your use of the word "vitalism" is way off. It is more than just an idea of the healing power of natural remedies derived from plants. Vitalism has a long and under-appreciated history in the west, and was foundational in debates about the role of chemistry in understanding life. It has evolved, and forms of neo-vitalism are represented in the concept of holism and in an awareness of the inherent complexity of living things. True, it is also associated with notions of vital force and Qi, but that sells the concept short. It is a critical stance in the face of unbridled reductionism and mechanism and the complete dominance of modern molecular biology in understandings of the living.

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32. Zak on January 13, 2009 1:58 AM writes...

I completely agree with your opinion of "alternative medicine," and would love to see the outcome of a randomized double-blind trial with your Dong Ki Kong. However, to be fair, you have to give Chi Gong the same shot that the big pharmas have: the ability to perform any number of clinical trials, hide the results of ones that don't make the case, and only publicize the ones that happen to offer evidence they're looking for.

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33. john on January 13, 2009 4:45 AM writes...

Well - I hope you can find a scientifically verified cure for how sick this negative speil made me feel. What about the word 'integrative' do you not understand?
To call the work of Weil and Chopra nonsense, shows extreme uneducated bigotry. I guess Hippocrates was also wrong because he couldn't back his findings with laboratory tests? Why does every idiot feel that science is the new religion. Did you not hear that 150,000 deaths per year result from scientifically proven, licensed, prescribed medicines.

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34. daen on January 13, 2009 5:16 AM writes...

"I guess Hippocrates was also wrong because he couldn't back his findings with laboratory tests?"

Yes, Hippocrates was wrong. Illness is not caused by an imbalance in the four humours.

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35. Kitty on January 13, 2009 6:12 AM writes...

Qi Gong is a low impact exercise system and does not need any belief in woo to be of benefit. It actually means 'breath work' and uses controlled breathing synchronised with balance exercises.
As someone with arthritis, and a pathological hatred of public swimming pools, it has proved to be of immense benefit as a way to 'wake up and oil' stiff joints without causing pain.
After 4 years of Tai Chi and Qi Gong my balance and strength is much improved, I am maintaining hip and knee movement, I take less medication for pain and inflammation and as a bonus the breathing exercises have improved my lung function. (I am asthmatic and had an average peak flow of 220 4 years ago, it is now 450). My physiotherapist was impressed by my muscle tone, balance and rate of work (after operations on both feet).
As for the mystical energy Qi (Chi), I don't believe in it, it's not part of my exercise regime and doesn't need to be for me to gain a better quality of life. My teacher doesn't expect us to believe in it and never mentions it, preferring to concentrate on the practice. We even learn some self defence. I'm one of the youngest in the class and I'm 60.
While the idea of Don Ki Kong made me laugh you show some ignorance of just how much hard work is needed to benefit from this excellent exercise regime. It is much more than just 'hand waving'.
Perhaps you should join a class for a term, actually learn some of the exercises and then blog about it? You never know you might actually find yourself recommending it for the less mobile among us - we can't all go to the gym or run marathons.

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36. RB Woodweird on January 13, 2009 7:23 AM writes...

Derek's post is full of win. Some comments are full of fail.

The Necromancer alleges that organic chemists don't have a proper grasp of the concept of vitalism. He probably drives a car which has a phlogiston gauge.

Zak wishes that "Chi Gong" get the same treatment as a new drug. Using the phrases "clinical trial" and "Chi Gong" in the same sentence made me giggle like a little girl.

John made me think that, well, yes, I did not know what the hell the word "integrative" meant (in the context of medicine, I assume). So I googled it. Now I know. It literally means "to sing the children's song about the little train going up the hill - I Think I Can, I Think I Can - while billing the insurance company $100 a verse".

John also warns us that prescribed medications are the cause of the current genocide waged on the American populace by the medicoindustrial complex. Stamping out this threat will bring the average life expectancy up to 25, maybe even 26.

Finally, Kitty has discovered that movement is better for you than sitting inert. Stop the presses! I am forwarding this to JAMA directly. BTW, Kitty, learning self-defense in Tai Chi only works on muggers who will be stunned by slow, beautiful movements.

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37. Kitty on January 13, 2009 7:57 AM writes...

RB Woodweird

As you know nothing about me your comment is both fatuous and insulting and only shows you have an inflated sense of your own importance.
I have never sat inert or wanted to. I do, however, have osteoarthritis which benefits from taking exercise.
Your ignorance of the benefits of Tai Chi for this condition is your problem.
Oh and when two boys tried to take my bag from me before Xmas they were suitably impressed by my 'slow, beautiful movements' which resulted in one of them on the ground while the second gave up and ran. I carried on with my day rather than ending up injured and robbed.

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38. RB Woodweird on January 13, 2009 8:34 AM writes...

Kitty,

On the contrary. I have had private investigators on your tail for the past several years. They gave me a quite detailed account of your encounter with those ruffians. As a matter of fact, my men were about to step in when, as they reported: "some sort of energy wave seemed to emanate from the subject's hands which took the first attacker right off his feet and drove the other back some distance". So, kudos to you.

However, your powers have since been noted by several government organizations which I cannot name here.

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39. Mojo on January 13, 2009 9:05 AM writes...

Gary2 wrote, "From what I've read ..... big pharma spends twice as much on marketing as they do on R&D"

Anonymous wrote, "Well, gary2, how much does big alternative medicine spend on marketting vs. R&D?"

I've not seen figures for the whole sector, but Boiron, a very large French homoeopathy company, gave figures for marketing and R&D costs in its report for the first half of 2007. Marketing costs were €47,124,000 while R&D costs were €2,548,000.

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40. Kitty on January 13, 2009 9:53 AM writes...

RB Woodweird

I'm glad you appreciate my 'powers', but you're too late if you want to exploit me - MI5 have had their eye on me for some time!

Seriously though, the training I receive saved me from almost certain injury.
I didn't fall over when I was pushed as I have excellent balance and can move well. I was able to use my attacker's weight against him and, by compromising his balance, push him to the ground.
I then turned to the other boy, looked him in the eye and did the whole kung fu stance thing with the chopping hands. Priceless! That part I made up on the spot but it really unnerved him.
It's not all about magic energy and woo. If you find the right teacher it's about learning an exercise regime which is both gentle and practical.
My class is made up of (elderly) godless heathens (including 2 physics teachers, a science journalist, a doctor and biologist - all retired) who become quite militant if a substitute teacher even mentions woo-words.
All of us are fitter and more confident for it.
So I say again - try it before you dismiss it out of hand.
Now I must walk my dogs, a pleasure made easier by Tai Chi.

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41. former wonderdrug co friend on January 13, 2009 1:16 PM writes...

Qi Gong Works!

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42. vvhome on January 13, 2009 2:07 PM writes...

I am sure JAMA would not go anywhere near Deepak Chopra. If you don't know or remember why, see this for what he did to them in 1991: http://www.aaskolnick.com/naswmav.htm.

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43. bio-friend on January 13, 2009 2:31 PM writes...

I am a big fan of this blog but really disappointed about this post and the comments. Search for 'Qigong and pain' in pub-med and you will find several randomized clinical trials and a meta-analysis supporting qigong reducing pain in patients with fibromyalgia (e.g. J Pain. 2007 Nov;8(11):827-31).

I agree more hope than science supports the supplement industry but drug discovery suffers from the same over-promotion and self-aggrandizement. How many drugs are FDA approved based on statistical, but not clinical, improvements but then how are those improvements sold in advertising to consumers? Not as marginal improvements but as breakthroughs.

Diet and exercise do not work like small molecules so the research required is not in-vitro but must focus on more complicated solutions like how to efficiently overcome generations of incorrect lessons (think seat belts or drunk driving). Additionally, the changes have to scale from individual to corporate behavior, my insurance does not offer to cover all but a $10 co-pay at the gym or salad bar but I can get little pills for free.

My lesson taken from this post (and I always learn something here) is that putatively intelligent people react dumbly when they are scared or presented with problems they do not understand. How do we benefit from insulting alternative medicine by calling it "jawboning"? Let's provide guidance by supporting high quality clinical trials evaluating the benefits of plant-derived producets. So you are ready to burn all the St. Johns Wort, ready to do the same for Taxol?

I am really dissapointed in your post Derek, why did this topic make you respond so wickedly? Do you feel threatened by the supplement industry? Afraid plants can synthesize molecules in ways you never will? Me too.

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44. Cellbio on January 13, 2009 3:00 PM writes...

Ah bio-friend, it is you I am sure that is threatened by open discussions that demand evidence for claims of benefits. Taxol is an example of how a drug from a "natural" source can be proven to work with appropriate scientific support. As a counter example, vitamin c in nanoparticles (did your short hairs stand on end!) offered to maximize bioavailability is pure marketing hog wash. No data, no particle QC, pure snake oil salesmanship. There is a long history in this country of looking for the "cure to what ails ya". These have been purveyed from the back of wagons (the Wizard of Oz before the dream I think is just such a shuckster), in print and mostly by charismatic con men (hmm, who does that resemble, your average chemist/researcher, or Chopra et al?). There were sanitariums in western Michigan that offered radioactive enemas for colonic health. Would you sign up for that? No, didn't think so, but that was one of the treatments offered by the quacks of the day. Our day has new quacks and new offerings for megaquantumnano health.

Does the search for new medicinces continue to utilize natural sources, yes indeed. I just helped with a project that purified a component from a Chinese herb used to treat cancer for centuries. The active molecule has an interesting set of activities. It cause DNA damage, cross links extracellular proteins, cross-links and activates membrane receptors, activating signal transduction and rapidly initiates cell death. So this weed contains a very wickedly toxic "natural" compound that offers no real advantage over existing cytotoxic meds. Nice try, came up with nothing new, except perhaps an understanding that this extract should be regulated because it is pretty nasty stuff. Is a toxic activity ever considered a possibility, or are all "natural" compounds thought to be perfectly safe?

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45. zfin on January 13, 2009 3:14 PM writes...

#44 Cellbio - is it something from Tripterygium? Triptolide?

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46. Derek Lowe on January 13, 2009 3:48 PM writes...

Bio-friend, when I look through the literature for comparisons between qi gong and conventional therapies, I find things like this (a study of children with fibromyalgia, which admittedly is a tricky diagnosis):

"Significant improvements in physical function, FM symptoms, QOL, and pain were demonstrated in both exercise groups; the aerobics group performed better in several measures compared with the qigong group."

That said, I'm glad to have you as a reader - it's always good to know that I'm not just getting people who have favorable opinions about the drug industry (or just people who work for it!)

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47. Cloud on January 13, 2009 6:20 PM writes...

Derek, my reading of bio-friend's comment leads me to believe that he/she does work in science, and possibly even in pharma or biotech.

I, too, am a long time reader and fan who is a little disappointed, more in the comments than in your post. I have been debating whether to post a comment on this thread given the tone of some of the comments. I agree that these so-called “alternative medicines� have for the most part not been subjected to sufficient scientific tests, and that many of the studies that have been done are inadequate. I agree that herbs are just impure drugs.

However, it saddens me to see scientists refusing to consider the possibility that some of these therapies work, even if we don’t (yet) know why. We scientists should be skeptical of claims but open to learning, or at least getting some new research ideas, from some of these alternative practices. Lumping all “alternative� things together and laughing at them does no one any good.

I know that one anecdote does not equal statistical evidence, but I also know what works in my life. I have a repetitive strain injury that has been treated using “standard� methods- high doses of NSAIDs, steroid shots, physical therapy, etc. These therapies helped, but the injury kept flaring up and I was facing a forced career change. Finally, I tried yoga (I may be the last person in Southern California to try it). One yoga class a week keeps me from relapsing, whereas a battery of physical therapy stretches done 3 times a day did not. Do I believe this is because yoga is tapping into my chakras or some other such thing? No. I don’t know why yoga works and the physical therapy stretches didn’t. Maybe it’s the stress reducing effects of a weekly yoga practice- there is certainly a lot of solid scientific evidence about the negative effects of stress. Maybe the yogis stumbled onto some biomechanically optimal combination of stretches/poses. Too bad studies are unlikely to be done to try to understand what is going on. You can blame the alternative crowd for that, but frankly, if we scientists laugh at the very idea that practitioners of yoga, tai chi, or qi gong are experiencing real benefits and refuse to take seriously anyone who dares to try to investigate this, we bear some of the blame, too.

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48. Cloud on January 13, 2009 6:26 PM writes...

Sorry for the funny characters. #@$%*! MS Word....

And interesting that your previewer displays them properly but the main page does not.

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49. Anonymous on January 13, 2009 7:37 PM writes...

I think the problem with some of the alternative medicine enthusiast is that most people don't really know what the placebo effect is.

I expect that some of the people who claim a beneficial effect because they took herbal supplements really *did* have that beneficial effect, and it probably really *was* because they took the supplement (or engaged in some other alternative practice). However, that does not necessarily mean that it was due to an intrinsic property of the supplement. It could very well have been psychologically prompted. (This is not to say that none of these treatments can have intrinsic merit, I just think it is highly unlikely that most of them do.)

I do not mean to belittle the supporters of these medicines, but rather to emphasize the profound effect that our perceptions and thoughts have on our physical well-being. If people really believe that something will work, it has a greater chance of actually working for them. This is the danger of relying on anecdotal evidence to support claims of efficacy rather than scientific data.

In addition to the need for us to educate the public about such matters, and about what the pharmaceutical industry actually does, and about how clinical trials actually work (all vitally important things to communicate to a public that views us in about the same light as big-oil and big-tobacco), maybe us cynical sciencey types have something to learn from these practices. We shouldn't support supplements that have no scientific merit and may in fact be harmful, but maybe we should try to find more time for contemplative, spiritual exercise, or any other activity that we feel to be positive and therapeutic, since our bodies can clearly benefit.

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50. JSinger on January 13, 2009 11:18 PM writes...

You can blame the alternative crowd for that, but frankly, if we scientists laugh at the very idea that practitioners of yoga, tai chi, or qi gong are experiencing real benefits and refuse to take seriously anyone who dares to try to investigate this, we bear some of the blame, too.

I started yoga at an MIT Health class (and experienced benefits similar to yours) and the pharma for which I work offers weekly, heavily-attended yoga classes. Acupuncture is also pretty heavily used among scientists, and researchers who don't do either of those things don't disparage them. A (convincing; placebo-controlled) talk on the pharmacology of acupuncture drew a huge audience.

I don't think that most scientists dismiss acupuncture, herbs and the like as useless, let alone that they dismiss smoking cessation and exercise as "alternative". On the contrary, the effects of weight loss and exercise have been wildly oversold by the biomedical establishment, if anything.

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51. Cloud on January 14, 2009 12:46 AM writes...

@JSinger- I was reacting to the comments here more than the general climate amongst researchers, but even here in SoCal, I hear scientists dismiss yoga, etc, without allowing for the possibility that they might work as something more than just exercise even if it is not for the reason the true believers provide.

I, for one, would happily sign up for Derek's Don Ki Kong trial- I think it would be interesting to find out whether the specific movements of Qi Gong have any particular benefits. I was actually really surprised when yoga worked where the targeted stretches I'd been given by my physical therapist did not.

Since that experience I've tried to be more equitable in my skepticism- show me the evidence that these things work. But also show me the evidence that they DON'T work. Just because the practitioners have a completely incorrect mechanism doesn't mean that they don't work. There are plenty of drugs out there whose mechanism is different than was originally thought.

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52. Anonymous on January 14, 2009 9:51 AM writes...

Michael Moore will never go after anything as long as it is government funded and requires no personal responsibility.

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53. Mark Buehner on January 14, 2009 10:26 AM writes...

Look, its very simple- if a substance has any actual biological effect to any extent, it will be banned over the counter and made prescription. The logic is that anything that actually does anything will eventually kill somebody (law of big numbers) and the pharma lobby will team up with the nannystatists to get it off the open market. Witness Ephedra. The only substances that escape this have become so useful and common they can't get away with it. Like aspirin that kills hundreds of people a year, orders of magnitude more than a thousand other prescription meds ever could.

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54. Paul A'Barge on January 14, 2009 10:26 AM writes...

I've got 5 years of PhD studies in Geophysics, a BS in both Math and Physics and 30 years of experience as a recipient of acupuncture.

Given my very low tolerance level for bullshit, I can tell you that acupuncture works wonders.

I'm sure you'll find a way to snark all over my comments, but frankly it's your loss not mine.

Good luck with the open mind thing.

Oh by the way, I also think that Deepak is a fire hose of nonsense.

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55. Mark Buehner on January 14, 2009 10:38 AM writes...

A lot of studies have shown that sham acupuncture (the needles don't actually penetrate) are just as effective as the real thing. Its a combination of placebo and the simple fact that human contact releases endorphins etc that make you feel better. A therapeutic massage is just as likely to relieve pain.

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56. JorgXMcKie on January 14, 2009 10:46 AM writes...

I tend to regard acupuncture treatment for chronic pain the same way I regard electro-shock therapy for chronic depression: "Okay, okay, I feel all better now, really I do. Just stop shocking/stabbing me."

Lots of things help *some* people. Medicine to date is about helping most, if not all people with similar problems.

As someone who seriously damaged a knee 40+ years ago, I've been in chronic pain for 40+ years. I find that when I'm busy or being entertained (by reading or talking with friends or whatever) I don't feel much pain. When I'm sitting around alone or not doing anything, the pain is worse. Occasionally when I awake it's bad enough that I take a naproxen sodium pill. The pain appears to be inversely felt in relation to how much I'm paying attention to something more interesting.

Thus, I wouldn't be at all surprised that if one were to do qi gong or whatever in a group the pain would be lessened. I'd say, "go for it" but with the understanding of what is really going on.

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57. RJ on January 14, 2009 10:47 AM writes...

Studies have shown that obesity and smoking prevention does not lead to long term cost savings. The reason is obvious - when people live longer, their overall medical expenses tend to be higher. Most medical expenses are incurred in old age, particularly in the decline shortly before death.

Preventative measures can be a boon for increasing life expectancy and quality of life, but as a way to save money it's a non-starter.

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58. Bilwick on January 14, 2009 11:17 AM writes...

I don't believe any form of medicine should be subsidized by the taxpayer; but for what it's worth, I found St. John's Wort to be effective when I was going through a very depressing time of my life. One might jump to the conclusion, "Placebo effect!" but I had no great emotional investment in it. I was experimenting on a "what the heck" basis. I often find that in assessing medical verdicts on herbs, etc., to keep in mind Mark Twain's statement, "If you don't like the verdict, wait a while."

In any event, although I've always had the impression (and I stress "impression," although I have a good track record as being a judge of character) that Chopra is a mountebank, my impression of Weil, based on his writings and lectures, is much more positive. He seems to go out of his way to be circumspect and not get people's hopes up about miracle cures. I often find him writing or saying things like, "There's some evidence that this herb helps with. . . " or "I've tried it myself and it seemed to provide a beneficial effect."

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59. Jay Manifold on January 14, 2009 11:46 AM writes...

#19 emjeff - Weil ain't buying it, he's selling it.

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60. kevin on January 14, 2009 12:04 PM writes...

I bet the acupuncturists are overjoyed to be lumped in with Qi Gong witch doctors. Not.

I've a better experimental test of Qi Gong though: One group gets Qi Gong, the other Novocaine. Then we drill teeth.

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61. Anonymous on January 14, 2009 12:07 PM writes...

@Mark Buehner- for the most part I think you're right. But there are exceptions. Maybe they prove the rule.

The exception that comes most readily to my mind is fenugreek, an herb used in cooking but also taken in larger quantities by lots of lactating women to increase milk production. It is pretty clear that it works, but I'm not expecting to see any pharma spend the time/money to make a drug from the active ingredient, for the simple reason that enrolling for a clinical study of such a drug would undoubtedly be a nightmare.

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62. David Davenport on January 14, 2009 12:23 PM writes...

my impression of Weil, based on his writings and lectures, is much more positive. He seems to go out of his way to be circumspect and not get people's hopes up about miracle cures.

... while marketing Dr. Weil-branded vitamins.

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63. Anonymous on January 14, 2009 12:43 PM writes...

"Chronic pain is one of the major sources of worker’s compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong."

Bullshit. I know, my chronic back says so. I tried it all before the knife and that only made it slightly bearable with 'help'. Accupuncture and qi gong did not help. Well, it helped the "Oriental Doctor" to the tune of several thousand dollars.

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64. Robohobo on January 14, 2009 12:45 PM writes...

"Chronic pain is one of the major sources of worker’s compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong."

Bullshit. I know, my chronic back says so. I tried it all before the knife and that only made it slightly bearable with 'help'. Accupuncture and qi gong did not help. Well, it helped the "Oriental Doctor" to the tune of several thousand dollars.

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65. Trouble on January 14, 2009 2:31 PM writes...

57. RJ on January 14, 2009 10:47 AM writes...

Studies have shown that obesity and smoking prevention does not lead to long term cost savings. The reason is obvious - when people live longer, their overall medical expenses tend to be higher. Most medical expenses are incurred in old age, particularly in the decline shortly before death.

Preventative measures can be a boon for increasing life expectancy and quality of life, but as a way to save money it's a non-starter.

*******

True that. We had a whole unit on this in PharmD school back in the late '80s. Now the evidence basis is just catching up.

Don't tell the Lifestyle Police, though. You might get arrested for sedition.

Don Qi Gong - I giggled like a schoolgirl. We might also try Ban Gmai Gong.

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66. linda on January 14, 2009 2:49 PM writes...

Hey there -
I don't think you understand what Qi Gong is - you. yourself are doing the exercises, no one is waving hands over you (there are other types that do that, I'm not into that but do find it fascinating, but, like you, skeptical)
Qi Gong is an ancient form of exercise - it stretching really, done in slow (sometimes fast) but always rhythmic. Some people find it very easy to meditate while doing Qi Gong. That is proven to reduce BP. Tai Chi comes from Qi Gong, but has some Martial Arts applications, but can be healing as well.

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67. SteveSC on January 14, 2009 5:21 PM writes...

Clinical medicine is NOT science. In science you are looking for something repeatable with large 'N's. In clinical medicine the N is always one.

Now most physicians will look to science to provide direction on what to do first, but the fact is that, in many (if not most) cases, what you try first doesn't really work. This is especially true when dealing with anything related to the nervous system.

Concrete example: Acetaminophen is an excellent pain reliever, but it doesn't always work, even in the same patient with the 'same' pain that it worked on before.

Another example: No treating physician really expects the first antidepressant to work. He/she will hope it works, but is always ready with a backup, backup to the backup, etc. By the time you do get something to work, was it the antidepressant, or was it time, change in the patient's relationships or environment, diet, exercise, or who knows what else?

The dirty little secret about drug trials is that when the 'N' gets as large as the FDA requires, the result is statistically significant even if the response rate is only a few percent above placebo. So 45% of people get better with Drug X, but 'only' 40% get better with placebo, is that worth higher risks (not that placebos don't have side effects too).

Add to that the realization that 'placebo' is really a trash can for a host of unknown effects, especially in CNS drugs. The human CNS is a complex system that responds powerfully to very small changes in input. Any system that can completely change mood, cognitive capability, feelings of pain, habitual and episodic behaviors, etc., from a change in the pattern of dark and light dots in a fraction of a second visual scan during a certain time in the year cannot be wholly described by science. And if you think I am exaggerating, just try sending an email to your lover about one month from now that says "I don't want to spend Valentine's Day with you."

The bottom line clinically is that some alternative treatments work some of the time in some of the patients. Forcing everyone to use only 'proven' treatments would be like mandating that everyone give only roses for Valentine's. Very effective on average, but worse than useless if your spouse happens to like something else.

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68. Cellbio on January 14, 2009 6:57 PM writes...

zfin, nope not triptolide. But I get a kick out of these compounds that inhibit proliferation, kill cells, and are then pursued for their ability to modulate the immune system and inflammation. In my past life, we developed a broad screen of immune cell function, and most every time we tested licensing candidates that had amazing potency in vitro in the assay du jur (Its a small molecule TNF inhibitor, yeah!) we found that it would likely inhibit all biology tested. Triptolides look like that to me. Poison a cell and it isn't up to much of a response, especially lymphocytes that go through a burst of proliferation in many activation assays.

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69. David Davenport on January 14, 2009 10:17 PM writes...

Forcing everyone to use only 'proven' treatments would be like mandating that everyone give only roses for Valentine's.

Yes, there is a Darwinian rationale for letting people who want to use unproven medical treatments to do so, as long as taxpayers aren't paying the bills.

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70. Paul on January 27, 2011 4:54 AM writes...

I get so annoyed when I try to describe medchem research to the "average person", and they invariable say, " Oh, this alternative therapy is much better--more natural." I like to suggest to such people that they should try a natural brew of hemlock tea.

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