Why isn’t CAM mainstream?

[Yuri Nalyssus]

What is the reason, historically, that orthodox medicine has risen to predominance?

I hear frequent assertions that the predominance of orthodox medicine is political and as a result of lobbying by powerful, self protecting groups from about the middle of the 19th century as the primordial medical mish-mash which existed then started to diversify into what we now know as CAM and conventional medicine.

Now, I’m not sure what the state of medical science was in the 1800’s but it can’t have been anywhere near as advanced as we are used to today. So I am curious as to what criteria would have been used back then by medics, surgeons and pharmacists (apothecaries) to ensure their disciplines became predominant over other emerging fields such as homeopathy, mesmerism and phrenology. Was it ‘primitive science’ including clinical trials or was it politics and toadying influence in the corridors of power.

How could the science that existed then have been able to distinguish between the genuine effect of aspirin and the apparent effect of homeopathy?

Yuri

[Miss_Kitt]

Yuri -- While the level of knowledge possessed by the scientific community was lower in the 1800's, the method of science was the same. Test, test, test; examine the results; draw tentative conclusions; do more tests.

The standard of "orthodox medicine" is that efficacy is what determines what is orthodox. Nobody has a particular interest in ensuring that their disciplines become predominant, as you put it. The discipline isn't the concern; what the concern of any doctor, pharmacist, dentist, or field medic is, is What Works.

Phrenology and mesmerism have faded because they clearly didn't work in even simple trials. Homeopathy, however, has special legal protection (at least in the US) because of exactly that "toadying influence in the corridors of power". A prominent doctor and US Senator (Royal Copeland) was also a believer in homeopathy, and he made sure that the emerging legislation of 1938 to define drugs versus supplements, etc. included homeopathic remedies as "drugs". You can check the history of homeopathy at any number of websites and in the encyclopedia as well. Since hundreds of homeopathic remedies already were listed at that time, they all became established drugs at the stroke of a pen.

As more stringent testing standards of effectiveness for drugs have been brought into law, older drugs have been "grandfathered in" since were already long in use and presumed therefore to be harmless. And that is what a homeopathic remedy is, just water or a sugar (or starch) tablet, totally harmless in its effect on the body. But they consistently fail in double-blinded tests, and rational people don't use them unless they're ignorant of those tests.

Just my thoughts, MK

[Rolfe]

The History of Medicine is quite a sizeable discipline in itself, so somebody has probably studied the topic.

I think that most doctors in the 19th century weren't adherents of any particular discipline. They'd go with what appeared to be rational and appeared to be beneficial. This would give "stuff that works" an inherent edge. Homoeopathy was obvioulsy struggling on the "rational" criterion right form the get-go, and again that probably militated against its being perceived as working, because if you think something is unlikely to work, you'll be less inclined to give it credit for any little improvement.

Rolfe.

[Darat]

What is the reason, historically, that orthodox medicine has risen to predominance?

...snip...

It worked better than the alternatives.

[T.A.M.]

It worked better than the alternatives.

beat me to it!

Doh!

TAM:)

[arthwollipot]

It worked better than the alternatives.Fixed it for you.

[Mojo]

What is the reason, historically, that orthodox medicine has risen to predominance?

I hear frequent assertions that the predominance of orthodox medicine is political and as a result of lobbying by powerful, self protecting groups from about the middle of the 19th century as the primordial medical mish-mash which existed then started to diversify into what we now know as CAM and conventional medicine.


The basic problem with this argument being that the rise of "orthodox" medicine has to a large extent coincided with the rise of medicine as a science rather than as a ragbag of traditional ideas. The development of things like the germ theory of disease etc.

Darat put it much more succinctly.

[fls]

I suspect much of it can be traced to the reform of medical education around the turn of the century (1900). There were a plethora of medical schools, teaching various models (including homeopathy and osteopathy), of highly uneven quality, producing these physicians. This allowed non-scientific practices to be easily incorporated within medicine. By the end of the first quarter of the 20th century, most of these schools were shut down, as they didn't conform to the new standards of medical education which was supportive of science-based practices. And with that, SCAM practices became marginalized.

Linda

[Cuddles]

Now, I’m not sure what the state of medical science was in the 1800’s but it can’t have been anywhere near as advanced as we are used to today. So I am curious as to what criteria would have been used back then by medics, surgeons and pharmacists (apothecaries) to ensure their disciplines became predominant over other emerging fields such as homeopathy, mesmerism and phrenology. Was it ‘primitive science’ including clinical trials or was it politics and toadying influence in the corridors of power.
How could the science that existed then have been able to distinguish between the genuine effect of aspirin and the apparent effect of homeopathy?

I was going to post something along the lines of all the others, but actually it's a fair question. The interesting thing is, homeopathy was actually largely responsible for the rise of real medicine and the realisation of the importance of blinded, controlled trials. Before then, as Rolfe says, people tended to go with what seemed to make sense and what seemed to work. This led to all kinds of nonsense such as bloodletting, trepanning and so on. However, when homepathy came along, even people who engaged in such current "treatments" could mostly see what obvious nonsense it was. The problem they had was that it actually worked better than many existing treatments, since although it couldn't actually help anyone, it wasn't actively harmful as many other things were.

People therefore realised that there must be something else going on. Since homeopathy could not be responsible, perhaps patients were just getting better by themselves, or ever just thought they were getting better. As we now know, it's both, along with various other effects. In order to find this out, sensible scientific trials were required, rather than just relying on anecdotes and the say-so of doctors.

So to answer the question, the reason real medicine rose to predominance over quackery is because of the quackery itself. Since pretty much any idea could be tried and accepted, it was inevitable that eventually there would come along ideas that were so silly that practically everyone could recognise them as nonsense. Since the obviously silly appeared as succesful as accepted ideas, proper testing was forced into being, and real medicine was born.


Another point more related to the present is that there is no such thing as "orthodox medicine". There is just medicine that works. Anything that works is accepted by real doctors. Real doctors don't care where a drug came from or whose ancestors thought of it first, all they care about is what it does. The reason that all the various "alternative" quackeries are not accepted is, quite simply, because they don't work.

[Yuri Nalyssus]

I suspect much of it can be traced to the reform of medical education around the turn of the century (1900). There were a plethora of medical schools, teaching various models (including homeopathy and osteopathy), of highly uneven quality, producing these physicians. This allowed non-scientific practices to be easily incorporated within medicine. By the end of the first quarter of the 20th century, most of these schools were shut down, as they didn't conform to the new standards of medical education which was supportive of science-based practices. And with that, SCAM practices became marginalized.Were they forcibly shut down by a politically entrenched medical elite? Did they fail because of lack of funding, and was funding obtained for conventional medicine by means of personal influence rather than based on science?

My point is that at that time (1850 to 1900ish) science was in its infancy, we didn't have any of the obvious, self evident, 'wonder drugs' we have now (antibiotics, insulin, glucocorticoids etc), anaesthetics and consequently surgery were crude butchery by today’s standards. What I am curious about is exactly what things were tested and how - when was rational scientific method systematically applied to the field of medicine?

Yuri

[Soapy Sam]

I'm going to guess January.

[HansMustermann]

Well, actually the way I see it, what really happened was that "orthodox" medicine started having much better results at various points.

E.g., a big turning point was penicilin. Before the 30's, if you got syphilis or tuberculosis you'd eventually die. After that, you'd get a few shots and lived. Sulpha was discovered in the early 30's, too, and it was pretty much a wonder drug. Etc.

At one point there simply was plenty of evidence that you have more chances of living when you go to a real doctor than when you go to a witch-doctor, so people started going to a real doctor.

Nowadays we see a return of the woowoo because most of the formerly deadly diseases have been all but eradicated. (Though thanks to idiots avoiding vaccines, some are making a return.) Most people ever get to see a doctor with at most a flu, or with chronic problems which can't be cured one way or another.

But the thing is, we're still lousy at curing viruses. Anti-virals do far more damage than a flu, so you don't get them unless you have AIDS or bird flu. Usually the real doctor gives you a placebo anyway, whether you realize it or not. Antibiotics for a flu or a cold _are_ a placebo. They don't even vaguely inconvenience the virus. Whether you take the latest antibiotics, or a homeopathic remedy, or pray to your favourite deity, or just drink tap water, in the end it's still just your own immune system that cures a flu or a cold.

So to make the story short, _nowadays_ people start noticing again that for most of their diseases, a real doctor is about as effective as a quack. And they start going to quacks again. (Then eventually get something which actually is deadly, and die.)

But way back when it mattered, death by disease was a huge problem. Just see the plagues in the middle ages for a nasty example. Tuberculosis killed millions all the way into the early 20'th century. Smallpox was a real killer until cowpox started being used as a vaccine. Malaria _still_ kills millions in Africa. Or as a soldier, all the way to the late 19'th century, you'd be more likely to die of dysentery than in actual combat. There were even kings who died of it while campaigning. Etc.

There were real deadly diseases around, not just "oh, johnny got a cold again" like these days. I'd say that makes one think twice about whether they want to try the woowoo stuff or go to those guys who actually cure it, no?

[Yuri Nalyssus]

The History of Medicine is quite a sizeable discipline in itself, so somebody has probably studied the topic.

I think that most doctors in the 19th century weren't adherents of any particular discipline. They'd go with what appeared to be rational and appeared to be beneficial. This would give "stuff that works" an inherent edge. Homoeopathy was obvioulsy struggling on the "rational" criterion right form the get-go, and again that probably militated against its being perceived as working, because if you think something is unlikely to work, you'll be less inclined to give it credit for any little improvement.

Rolfe.
But things that look rational or irrational to our modern eyes wouldn't have necessarily appeared that way to people of that age.

Bleeding might have appeared very rational - someone is red faced and agitated, you draw off a bucket of blood and hey presto they turn pale and calm down - instant result.

Was giving lemons to sailors with scurvy or injecting exctract of cow pus into people to prevent small pox any more rational than dosing with very dilute camphor to treat cholera, especially when the results of homeopathy in epidemics were several orders of magnitude more impressive that the conventional medicine of the day? If it was solely about what works then everyone ought to have been a homeopath after the cholera outbreaks in the 1830's and 50's (http://homeoint.org/morrell/londonhh/outbreak.htm) but instead the medical orthodoxy of the day tried to supress homeopathy by blocking parliamentary debate about the outcomes of treatment during the epidemics. Why did the docs of the day persist in believing their stuff was better when plainly it wasn't?

I really need to work this through :boggled:.

Yuri

[fls]

Were they forcibly shut down by a politically entrenched medical elite? Did they fail because of lack of funding, and was funding obtained for conventional medicine by means of personal influence rather than based on science?

My point is that at that time (1850 to 1900ish) science was in its infancy, we didn't have any of the obvious, self evident, 'wonder drugs' we have now (antibiotics, insulin, glucocorticoids etc), anaesthetics and consequently surgery were crude butchery by today’s standards. What I am curious about is exactly what things were tested and how - when was rational scientific method systematically applied to the field of medicine?

Yuri

Well, what did we have at the time that made a difference. Big differences were made in surgery with the use of anti-septic practices and ether. Drugs came later with things like insulin and penicillin. Initial testing probably led to the discovery that things didn't work, rather than discovering things that did work. You didn't need testing for the early drugs - the results spoke for themselves.

Medical schools were shut down because of lack of accreditation. You can't practice medicine unless you have a recognized medical degree, which means you don't have access to a hospital and you can't prescribe drugs. I'm not sure to what extent this inhibited homeopaths, etc., since as you mentioned, there wasn't a lot that we were accomplishing with drugs and hospitalization anyway.

I think there was a lag period from the application of the scientific method to medicine until effective therapies became available, so what were we basing the distinction on in the meantime, and how was it sold to the public? Maybe it rode in on the coat-tails of the benefits from science people were enjoying otherwise - electric lights, automobiles, radio. The food and drug laws had an influence on removing snake oil, but again the main focus was safety, rather than efficacy, and that will have less of an effect on noticeable outcomes.

I think ultimately, regardless of whether these changes were driven by an entrenched medical elite (which may have been the case), the reason that they persisted and were strengthened is because (as everyone has pointed out), we began to obtain dramatic results which won over hearts and minds. And I think HansMustermann's post makes a good point - that the reason for the resurgence in SCAM is because the dramatic changes are now taken for granted and we're back to fighting over the scraps.

Linda

[fls]

If it was solely about what works then everyone ought to have been a homeopath after the cholera outbreaks in the 1830's and 50's (http://homeoint.org/morrell/londonhh/outbreak.htm) but instead the medical orthodoxy of the day tried to supress homeopathy by blocking parliamentary debate about the outcomes of treatment during the epidemics. Why did the docs of the day persist in believing their stuff was better when plainly it wasn't?

I really need to work this through :boggled:.

Yuri

Was this really the case, though? I know the homeopaths make a huge deal about this, but when you look into it, the homeopaths treated a tiny number of people compared to the tens of thousands treated in orthodox hospitals. Did their results get any real notice among other doctors or the general public? We all know that you cannot depend upon information coming from homeopaths to be an accurate representation of the state of affairs (you're usually better off assuming that it isn't). And I'm not sure that a doctor would conclude that their own stuff wasn't better on the basis of the homeopaths' results. Drawing from a highly selective population could easily account for differences in outcome without the need to conclude that orthodox medicine was actually harming people.

ETA: Also quotes from doctors of the day, such as Osler or Holmes, show that the results from homeopathy did contribute to the idea that orthodox medicine may be harmful, so that the application of the scientific method first led to discarding harmful practices (rather than discovering helpful practices).

Linda

[Yuri Nalyssus]

Well, actually the way I see it, what really happened was that "orthodox" medicine started having much better results at various points.

E.g., a big turning point was penicilin. Before the 30's, if you got syphilis or tuberculosis you'd eventually die. After that, you'd get a few shots and lived. Sulpha was discovered in the early 30's, too, and it was pretty much a wonder drug.
So could it be said that orthodox medicine started with the development of antibiotics and effective pharmaceuticals? Or were there other, earlier 'points'. When were anaesthetics first devised?

So to make the story short, _nowadays_ people start noticing again that for most of their diseases, a real doctor is about as effective as a quack. And they start going to quacks again. (Then eventually get something which actually is deadly, and die.)
Excellent summation, consider it stolen!

Yuri (must get a decent medical history book)

[HansMustermann]

Well, every bit helped, and some goes all the way to IIRC the 18'th century. E.g., the cowpox vaccine. But basically when medicine really had its golden age was when antibiotics were discovered. IMHO.

[Yuri Nalyssus]

Was this really the case, though? I know the homeopaths make a huge deal about this, but when you look into it, the homeopaths treated a tiny number of people compared to the tens of thousands treated in orthodox hospitals.
Do you have a reference for this Linda?

Did their results get any real notice among other doctors or the general public?
Well, they got noticed by parliament and the House of Lords in the UK (or whatever acronym our country was at that point):

Now, a circular was addressed by the President of the Board of Health to various Metropolitan hospitals and to qualified practitioners, requesting returns of cholera cases... to determine by comparison, for the public good, what treatment experience showed to be the best for the new plague. Returns were sent in from the London Homœopathic Hospital, giving the names and addresses of the patients treated, the symptoms, remedies, and result in each case, and a summary of those results. This was not a question of theory, or of any particular school; it was a question of facts and statistics affecting the public health. But the report of the Board of Health was presented to Parliament without the slightest reference to the London Homœopathic Hospital or to the brilliant results which its physicians had achieved... The perversity was too plain, and Lord Robert Grosvenor... moved on May 17, 1855, in the House of Commons for "Copies of Letters addressed to the General Board of Health complaining of the omission of any notice of certain returns in relation to the treatment of cholera and correspondence between the President of the Board and the Medical Council, with copies of the returns which have been rejected by the Medical Council." The House of Commons, which was more anxious for the "progress of science" and the "value and utility of averages" than for "the operation of known remedies," to say nothing of its great duty to the people it represented, forthwith ordered a special return of the ignored homœopathic statistics, which was in due course made by the Board of Health, and these returns were ordered by the House to be printed on May 21, 1855.

Also quotes from doctors of the day, such as Osler or Holmes, show that the results from homeopathy did contribute to the idea that orthodox medicine may be harmful, so that the application of the scientific method first led to discarding harmful practices (rather than discovering helpful practices).
According to this account (http://www.angelfire.com/mb2/quinine/cholera1830.html)orthodox medicine was extremely harmful:

Treatment usually followed traditional lines. In the first stage the diarrhea was treated with Opium 1½ grains, twice in 24 hours. Calomel was added if the bowels continued to be purged, but no emetics were administered for vomiting. ‘Cautious’ bleeding should have relieved headaches and muscle cramps... Most doctors stressed total abstinence from all liquids... occasional mustard emetics ‘comforted’ the patient. Galvanism was tried without success, as were rectal injections of 4 to 6 oz of turpentine. If patient survived into the third stage, the milder cases only required a few leeches or a blister. Moderate cases had small amounts of blood removed by venesection from the arm.

The seriously ill were kept warm with mustard plasters... brandy, aromatic tinctures and camphor were administered, as well as more purgatives to clear out poisons...


Yuri

[fls]

Do you have a reference for this Linda?

I did. I spent a lot of time trying to track down the details of this story from primary sources. Most of my searches led back to the homeopathic source, but I did find the reports of cases and mortality statistics from the hospitals including the London Homeopathic hospital. I will see if I can recreate my search for that information and provide the links.

Well, they got noticed by parliament and the House of Lords in the UK (or whatever acronym our country was at that point):

I could not confirm this information.

Linda

[jj]

[COLOR=black][FONT=Verdana]What is the reason, historically, that orthodox medicine has risen to predominance

Because it works.

[Skeptic Guy]

IMO, modern medicine began the day it accepted the scientific method to determine the efficacy of its treatments, procedures, and medicines. Medicine had always had 'medicines' it considered effective, but had no system to prove it until science came along.

And I always dislike calling it 'Orthodox medicine'. There's only medicine. It either works (medicine) or doesn't work (homeopathy, etc).

[blutoski]

Well, they got noticed by parliament and the House of Lords in the UK (or whatever acronym our country was at that point):

When I read through this, the only thing that's clear is that a politician forced a committee of medical professionals to include homeopathic submissions despite their expert judgement. ie: homeopathy seems to have benefitted from a beguiled a politician, who overruled the professionals and rammed it down their throats.

This is how healthfraud thrives in many countries today. Homeopathy and chiropractic are specifically protected in the US and Canada by special political exclusions from the requirement to demonstrate efficacy.

[Yuri Nalyssus]

When I read through this, the only thing that's clear is that a politician forced a committee of medical professionals to include homeopathic submissions despite their expert judgement. ie: homeopathy seems to have benefitted from a beguiled a politician, who overruled the professionals and rammed it down their throats.

This is how healthfraud thrives in many countries today. Homeopathy and chiropractic are specifically protected in the US and Canada by special political exclusions from the requirement to demonstrate efficacy.
The original source was pro-homeopathic but it is a claim that I have heard and read with great frequency and which has the ring of truth (whatever that means) although I will have to check the parliamentary records (don't even know if they're on-line).

The point that is being made when this sort of thing is repeated is that even though cholera patients treated homeopathically had a far better recovery rate than those treated conventionally (the reasons being, we now realise, that a/ current medical treatments were so noxious they actually made patients worse and b/ Patients in homeopathic hospitals were from a better social class and given a better plane of nutrition - no references, just something I read somewhere, all contributions welcome). But, despite this difference the conventional medics of the day tried to have the statistics suppressed; what reason could they have had to have wanted to exclude the homeopathic figures other than to protect their own turf and prevent people seeking the homeopathic option?

Do you have a reference to anything confirming that homeopathy and chiro don't have to prove efficacy?

Yuri

[skeptigirl]

What is the reason, historically, that orthodox medicine has risen to predominance?It works.

[skeptigirl]

...
Do you have a reference to anything confirming that homeopathy and chiro don't have to prove efficacy?

YuriQuackWatch (http://www.quackwatch.org/) has concise summaries if you have failed to read the thousands of threads on these failed alternatives.

[skeptigirl]

This brings up an important point. If any of you have access to getting into these Obama Health Care Forums, we need a voice to speak out against bad medicine.

[Rolfe]

QuackWatch (http://www.quackwatch.org/) has concise summaries if you have failed to read the thousands of threads on these failed alternatives.


I don't think Yuri Nalyssus, VetFFVoo, is really in much doubt about all that. I think his point was perhaps subtly different.

Rolfe.

[Yuri Nalyssus]

QuackWatch (http://www.quackwatch.org/) has concise summaries if you have failed to read the thousands of threads on these failed alternatives.
Ouch!

What I was asking for was evidence that, in law, these modalities are not obliged to prove efficacy yet are allowed to practice under state patronage. Thanks for the reminder about quackwatch though.

Yuri

[Yuri Nalyssus]

I think I’m starting to see a pattern emerging:
It worked better than the alternatives.
beat me to it! Doh!TAM
It worked better than the alternatives.Fixed it for you.
Because it works.
It works.
Sigh, I really, really wish I’d put the phrase, “By the way, I know it works better, that's not my point” in the opening post! :cool:

Yuri

[Rolfe]

It really is an interesting question. Until the mid-20th century there wasn't an awful lot of stuff that actually "worked" at a self-evident level. Certainly not as far as therapeutics were concerned, though I'll grant you gaseous anaesthetics and antiseptic surgery and vaccination.

I still think prior probability had quite a lot to do with it. You could try asking Abigail Woods (http://www3.imperial.ac.uk/people/a.woods). She's a vet, and the only expert I know in the history of veterinary medicine. She might have some useful insights.

Rolfe.

[Dr. Trintignant]

Was giving lemons to sailors with scurvy or injecting exctract of cow pus into people to prevent small pox any more rational than dosing with very dilute camphor to treat cholera

Yes, it was more rational. Citrus was found to cure scurvy in one of the very earliest clinical trials. It was not a very good trial by modern standards (not blinded; missing a control group), but for such an obvious and otherwise irreversible disease as scurvy, those aspects were not such a big deal. Likewise, injection of cow pus was a result of a scientific test--a verification of a hypothesis based on the observation that milkmaids rarely got smallpox. Again, the test was crude by modern standards, but both the conclusions and the way they were arrived at were basically correct.

- Dr. Trintignant

[T.A.M.]

I think I’m starting to see a pattern emerging:


[COLOR=black][FONT=Verdana]


Sigh, I really, really wish I’d put the phrase, “By the way, I know it works better, that's not my point” in the opening post! :cool:

Yuri

Yuri;

I know you know it works. My comment (that it works) is not to you, but to answer the reason why it came to be the dominant form of health care, as opposed to the "alternative" medicines.

TAM:)

[Rolfe]

But I think Yuri's point was that the effect seems to have been evident before there were any self-evident therapeutic techniques available to "mainstream" medicine.

Rolfe.

[balrog666]

I guess I missed it - what the hell is CAM? And why would any rational person give a Flying Fickle of Fate about it?

[Rolfe]

There's a reason why you decided to post in this thread when you have no idea what it is about and care less?

Rolfe.

[Ysidro]

One big question you seem to be missing is "how and when are you defining the start of modern medicine?" I'd say that's a doctoral thesis in and of itself!

[skeptigirl]

Ouch!

What I was asking for was evidence that, in law, these modalities are not obliged to prove efficacy yet are allowed to practice under state patronage. Thanks for the reminder about quackwatch though.

YuriI was sort of wondering why you were seeming to be asking for evidence woo was woo. Sorry for the misunderstanding. I think the thread title is confusing, "why isn't CAM mainstream?"

It's political and appalling at the same time. I am beginning to mount a campaign about this very thing. In fact, I suggest skeptics of bad medicine make an effort to get in on these town meetings Obama plans to hold regarding health care reform. I am going to see about getting in on WA State's meeting. Apparently the Gov is in charge of who attends.

In this state, the woo believers have been actively lobbying our state legislature and they have gotten bad laws passed. We need skeptics and scientists more passionate about countering this bad trend. It has been going on under the radar.

As for the infomercials and that mess, I think either a pro-business, and/or pro-free speech is clouding the judgment of regulators. We need to lobby federal legislators for stronger consumer protection laws.

And in England they apparently have a few members of the royal family who are convinced homeopathy works. That needs addressing, for sure.

(Sorry for repeating myself there about the Obama health care reform meetings.)

[skeptigirl]

One big question you seem to be missing is "how and when are you defining the start of modern medicine?" I'd say that's a doctoral thesis in and of itself!While lots of people think of Hippocrates as an early pioneer in medicine, modern medicine actually began closer to 150 years ago. Prior to that, there was a lot of scientific exploration of the anatomy of the human body, and some successful though crude surgery was developed like amputations. But there was very little in the way of systematic testing of remedies and cures.

Many people are unaware but Florence Nightingale was a pioneer (http://www.agnesscott.edu/Lriddle/WOMEN/nitegale.htm) in evidence based medicine in the 1850s. She developed the "polar-area diagram" to dramatize the needless deaths caused by unsanitary conditions and the need for reform. With her analysis, Florence Nightingale revolutionized the idea that social phenomena could be objectively measured and subjected to mathematical analysis. She was an innovator in the collection, tabulation, interpretation, and graphical display of descriptive statistics.


John Snow (http://geography.about.com/cs/medicalgeography/a/cholera.htm) is credited as being the first successful epidemiologist. He mapped cholera cases and found they were clustered around one particular town water pump.

Then there was the case of the nurse midwives who discovered hand washing (http://en.wikipedia.org/wiki/Germ_theory_of_disease#cite_note-1).Microorganisms were first directly observed by Anton van Leeuwenhoek, who is considered the father of microbiology. Ignaz Semmelweis was a Hungarian obstetrician working at Vienna's Allgemeines Krankenhaus in 1847, when he noticed the dramatically high incidence of death from puerperal fever among women who delivered at the hospital with the help of the doctors and medical students. Births attended by the midwives were relatively safe. Investigating further, Semmelweis made the connection between puerperal fever and examinations of delivering women by doctors, and further realized that these physicians had usually come directly from autopsies. Asserting that puerperal fever was a contagious disease and that matter from autopsies were implicated in its development, Semmelweis made doctors wash their hands with water and lime before examining pregnant women, thereby reducing mortality from childbirth to less than 2% at his hospital. Nevertheless, he and his theories were viciously attacked by most of the Viennese medical establishment.That Wiki entry needs editing. They left out the fact handwashing was practiced by the midwives before Semmelweis realized it mattered, and only mentioned the doctors attending births directly after performing autopsies.



To my surprise, that same Wiki entry notes The Atharvaveda, a sacred text of Hinduism, is the first ancient text dealing with medicine. It identifies the causes of disease as living causative agents such as the yatudhānya, the kimīdi, the kṛimi and the durṇama. The atharvāns seek to kill them with a variety of drugs in order to counter the disease (see XIX.34.9). One of the earliest western references to this latter theory appears in On Agriculture by Marcus Terentius Varro (published in 36 BC), wherein there is a warning about locating a homestead in the proximity of swamps:
“ ...and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases.[2]I'm going to have to investigate that. It sounds very interesting.

[Yuri Nalyssus]

Yuri;

I know you know it works. My comment (that it works) is not to you, but to answer the reason why it came to be the dominant form of health care, as opposed to the "alternative" medicines.

TAM:)
:hug2

[Yuri Nalyssus]

I guess I missed it - what the hell is CAM? And why would any rational person give a Flying Fickle of Fate about it?
CAM in this context stands for Complementary and Alternative Medicine, an eclectic group of therapeutic and diagnostic modalities which claim to provide health benefits outside those offered by conventional, science based medicine. As a rule they have little real science to support their claims but proponents tend to point to the general high level of satisfaction amongst users as evidence that it is useful.

People should care about it for several reasons. Some (not many) of the techniques are directly harmful but the biggest concern is that these, essentially ineffective practices are used in place of real medicine and the patient suffers as a result of delayed diagnosis.

Welcome to science, maths and medicine!

Yuri

[Yuri Nalyssus]

I was sort of wondering why you were seeming to be asking for evidence woo was woo. Sorry for the misunderstanding. I think the thread title is confusing, "why isn't CAM mainstream?"
Well, I was sort of going for "cleverly provocative"; and got a bit more than I bargained for!

Thanks for the info, I'd forgotten about Florence Nightingale. One of my children did a project at school on her and showed me the graph that she used for her studies - I may have to steal their homework, should be about my level of understanding.

And in England they apparently have a few members of the royal family who are convinced homeopathy works. That needs addressing, for sure.
The French had the answer to that one (http://en.wikipedia.org/wiki/French_Revolution).

Yuri

[Yuri Nalyssus]

One big question you seem to be missing is "how and when are you defining the start of modern medicine?" I'd say that's a doctoral thesis in and of itself!
I'm coming to realise that's the question I was really asking, and by extension when did modern science start as the two go hand in hand. When did scientific testing get clever enough that we were really able to say that blood letting is nonsense whereas injecting cow pox extract to confer immunity is good when both of them must have appeared equally sensible or bizarre by the standards of the day depending on your point of view (in fact bleeding was probably regarded as the more rational of the two).

As Linda and others have pointed out the effects of some of the earliest bits of modern medicine (eg. anaesthetics and antiseptics) were so obvious, given the incredibly low starting point that double blind trials would have been OTT; something I hadn’t really got straight in my head - it is ok to judge things on their direct effects if that effect is strong enough.

Yuri

[Yuri Nalyssus]

You could try asking Abigail Woods (http://www3.imperial.ac.uk/people/a.woods). She's a vet, and the only expert I know in the history of veterinary medicine. She might have some useful insights.

Rolfe.
Thanks Rolfe, I'll try to contact her. I've been interested for some time to know if any proper trials were ever done on the firing of horses; I've always thought firing was the veterinary equivalent to bleeding (I know vets bled as well) - a dangerous, noxious and useless practice, as opposed to homeopathy, a cuddly, fluffy and useless practice, much more suited to the modern age.

Yuri

[arthwollipot]

I guess I missed it - what the hell is CAM? And why would any rational person give a Flying Fickle of Fate about it?"CAM" = "Complementary/Alternative Medicine".

And why anyone should give a Fickle Frisbee of Fate (flies forth felling foes) is that a lot of people trust their lives to it.

[balrog666]

"CAM" = "Complementary/Alternative Medicine".

And why anyone should give a Fickle Frisbee of Fate (flies forth felling foes) is that a lot of people trust their lives to it.


Thanks. I was wondering what that "C" was.

And I guess I left out "Finger" as well.

[Rolfe]

Yuri is being polite.

Supplementary, Complementary and Alternative Medicine.

Rolfe.

[gentlehorse]

I guess I missed it - what the hell is CAM? And why would any rational person give a Flying Fickle of Fate about it?

http://nccam.nih.gov/health/whatiscam/

[Yuri Nalyssus]

http://nccam.nih.gov/health/whatiscam/

Alternative medicine is used in place of standard medical care. An example is treating heart disease with chelation (pronounced "kee-lay-shen") therapy (which seeks to remove excess metals from the blood) instead of using a standard approach.
Just one small omission there, they forgot to mention that doing this is likely to kill you (http://www.gmc-uk.org/concerns/hearings_and_decisions/ftp/20080611_ftp_panel_viegas.asp) :cool:.

Still, just so long as everyone is being nice and non-judgemental; wouldn't want to get anyone upset. Dead maybe, but definitely not upset.

Yuri

[Eos of the Eons]

I guess I missed it - what the hell is CAM? And why would any rational person give a Flying Fickle of Fate about it?
They focus on marketing and villifying legitimate medicine.
Every woman I know in my area (I can't say "every woman I know" since I know me and a few other skeptical women who don't live in my area) is into SCAM because of magazines, news articles, and other SCAM marketing. Their mantra is that what THEY offer are "all natural", safe, non-chemical, non-toxic, effective, and therefore TOTALLY BETTER for you and won't poison you to death. When I took my medical office admin courses my teacher drilled it all into our heads how nasty doctors are and how they are only driven to profit by causing only more suffering, while blood readers, chiros, homeopathy, etc. were warm and fuzzy and only had your best interests in mind and would be the only way to be drug free and totally healthy.
Every time I start to make a new friend they start going on about their naturopath and woo woo junk like their magnetic bracelets, and I am left trying to change the subject. But, if you don't join em in their embracement of woodom, they figure you are nuts and don't want to be your friend. Especially *gasp* if you've vaccinated your kids, cuz your kids can "spread" the NASTY vaccine to theirs omigosh.

Everyone gives a flying fickle fate because it is the new thing to do if you are smart and want to be doing the "in" thing. If you don't do it, then you are STUPID AND CRAZY. Cuz flower remedies have their molecules in flowery shapes and that makes you magically perfect in every way! If you take drugs with NASTY CHEMICALS, well you are tainted and brain damaged and STUPID. If you allow your kids to be vaccinated then you're a BAD parent who has caused them to brain damaged, stupid, more prone to being sick, and now a threat to the health of other children.

You just have to read the letters to the editor, the news articles, magazines, go online, etc. to become part of the SCAM fan club that has taken over in large parts. Our local women's magazine will fill you in quite well with just one month's publication. It's a woman thing afterall, to be in tune with your body and following your intuition about what is best for you and everyone else on the planet because those uneducated magazine writers say so.

Try to find one article anywhere in local media that will explain the science and why MDs aren't all bad, too bad. Doctors are the evil ones, drugs are ALL bad. You must turn to a naturopath to ween off of toxic chemicals and become totally healthy again.

Why did the local folks give money to a family whose son was in hospital with cancer? To buy mannatech and other SCAM stuff. Why did the boy still die? The family ran out of the SCAM stuff that was keeping him alive, so that is why he died. Seriously, this is a huge story, mouth to mouth in my city. When I actually read the fundraising ad though, from another town, it was to raise money for experimental drugs at a legitimate hospital though, and he didn't die because he ran out of SCAM products to take. argh.
http://img.photobucket.com/albums/v124/sueandray99/brandonreis.gif

I had to dig to find the truth, or just believe what people told me at work. Everyone knew the kid's name, but someone sure twisted the story to fit the SCAM is the only thing that can save you line, and you have to keep taking it to live, which is good for SCAM, since SCAM is non toxic, but if you have to keeping taking nasty drugs to live they will end up killing you because they are toxic. ugh. Well, the kid still died... because he didn't have enough SCAM to keep him alive... *headpalm* Well, the kid had a rare killer cancer that no amount of SCAM could have saved him from, but you are not to believe that, nope nope. Instead you need to believe that taking SCAM would have saved him if he hadn't run out of it. Gah.

So, no matter where I turn there is someone justifying why SCAM is good and regular medicine is bad, to the extreme, even using this boy's tragic story for the spin. It's beyond ridiculous.


Oh, and I have to read this tripe from a local antivaccine crusader nearly every month in the newspaper:

http://www.albertalocalnews.com/reddeeradvocate/letters/Court_wrong_to_dismiss_vaccine-autism_link.html


As a result, toxins can remain like a time-release capsule and this toxic buildup can prevent the brain from functioning properly, leading to autism and ADHD. Support for this claim has been found in primates being injected with vaccines.


I've given up trying to respond. It just gets me fired anyways, since I'm the stupid one to disagree with the local antivaccine nutters. There is a reason why our vaccine rates are falling, especially for MMR. Oh, and flouride is causing autism too, so the antiflouride rants on the local radio were flowing every 1/2 hour recently. Drove me up a wall. Every 1/2 hour all day were hysterical sounding sound bites of people ranting how flouride cause Alzheimer's, autism, ADD, ADHD, cancer. I listened, mesmerized by their whole hearted convictions. There was one solitary soundbite by teh evil dentist saying scientific studies showed no causation. He sounded very very boring and unconcerned about the health of your children compared to the other layperson rants.

[Mojo]

Many people are unaware but Florence Nightingale was a pioneer (http://www.agnesscott.edu/Lriddle/WOMEN/nitegale.htm) in evidence based medicine in the 1850s.


Sorry, but Dana Ullman has already claimed her for homoeopathy (http://74.125.47.132/search?q=cache:jkKu3UsqP0wJ:www.amazon.co.uk/Homeopathic-Revolution-Famous-Cultural-Homeopathy/dp/1556436718+%22florence+nightingale%22+%22homeopath ic+revolution%22&hl=en&ct=clnk&cd=4&gl=uk).

[Mojo]

Thanks. I was wondering what that "C" was.


The word "complementary" was introduced for marketing purposes to imply that "alternative" medicine would be practised alongside real medicine, rather than instead of it. A pity that most of the proponents of CAM appear to hold views on medicine rather like those expressed in this book review (http://www.amazon.co.uk/review/R2G19D5YM38PJ1/ref=cm_cr_rdp_perm).

[balrog666]

Yuri is being polite.

Supplementary, Complementary and Alternative Medicine.

Rolfe.


Yes, yes, thanks all.

However, one of the reasons I asked is that I have seen several threads with acronyms in the title that are never referenced later - I find that annoying. ;)

[Toke]

This is an incredible book which centres around the fraudulent biomedical paradigm that has fooled so many people for so long. McCumiskey shreds all the Medical Myths one by one - Germ Theory, Vaccination, AIDS, Bird Flu as well as the non-existence of viruses! He states that we have not been given any true scientific evidence to prove viruses even exist and quotes the work of Dr. Lanka.

Unbelivable.