Poll - Integrate Alternatives???

[Eos of the Eons]

http://www.ireland.com/head2head/

Should alternative medicine be integrated into the health system?

There's a claim about "gaps" in medicine, and how rubbish can fill it. Rubbish that fills gaps should be washed away. The poll is to the right, with the "your vote" heading.

So far, the results are depressingly predictable.

OHHH well.

[murphyr]

Evidence from studies in the UK indicates that some complementary and alternative therapies are successfully filling in the gaps in effectiveness recognised in the National Health Service.If the gap is "there are no aromatherapy treatments offered", then sure. Awesome that she doesn't cite anything other than vague authority.

Studies show that people who consult complementary practitioners usually have long-standing conditions for which conventional medicine has not provided a satisfactory solution.I'm willing to grant that people who go to complementary practitioners are usually desperate for a cure to whatever ails them. I don't see how hoping these other people have a cure makes them have one.

As Ireland is in a similar position, why don't we integrate the two systems and increase efficacy of health care as a whole?I love that she goes from "people get desperate when they're sick for a long time and go to complementary practitioners" to "alternative medicines clearly work and integrating them into the health care system would increase it's efficacy, rather than either doing nothing by providing ineffective 'cures' or harming the public by wasting time on cures which haven't been shown to actually do anything."

. In many cases this is untrue - there is much evidence that cancer and heart disease respond well to, and can be prevented by, nutritional therapy, herbal medicine and other complementary therapiesI'd believe that "good nutrition" could have an effect, as shoving Big Macs in yourself for hours on end might not be too good for the heart, but it'd be great if there were citations. Like at all.

When we consider the known side effects that often come with prescription drugs, should we not be utilising the power of mind the placebo effect demonstrates alongside less aggressive complementary forms of treatment and save the drugs for only those who really need them?Holy mother.

I...

Wow.

Is she seriously suggesting we give people sugar pills in lieu of actual treatment without informing them that they're in a study? Is it just me, or is that massively unethical?

The delivery of a purely conventional healthcare service is becoming financially unsustainable. Clearly the proper response is to have more things that the healthcare service will pay for. Clearly.

Poor nutrition and unhealthy lifestyles are killing the nation.Sweet. That means we can poke holes in people. Apparently.

As the common purpose in healthcare is to promote and maintain optimum health, it is important for all parties to make room for each other.You know what I think the healthcare might be able to to promote and maintain optimal health? Cover things that work and that have evidence that supports that it works, while not wasting money on junk or misunderstandings of the placebo effect.

[Slimething]

So far, the results are depressingly predictable.

OHHH well.

Don't be so glum, Eos. This is what natural selection is made of! :biggrin:

[Michael Redman]

"Poor nutrition and unhealthy lifestyles are killing the nation."

Killing the nation? Wow, I was just in Ireland 4 months ago, and it didn't even look sick!

[Ben Tilly]

For giggles and grins, I'll take the contrary point of view.

The placebo effect is real. It is proven. It is significant enough that we have to control for it very carefully in research. In fact in our studies we try to make sure that the people treating the patient are not aware of whether the patient is receiving the experimental treatment or the placebo because it has been shown that patients will respond differently. (It is likely that they pick up on subconcious cues from body language.)

As another data point, conventional doctors are not taught to effectively apply the placebo effect. Quite the opposite in fact, doctors are taught to process patients effectivly and not establish the kind of contact that the placebo effect requires.

So we have this real effect that we know is beneficial. We know that it is most likely to be beneficial if the person who provides it really is convinced that their sugar pills make a difference. We know that doctors are not effective at producing this effect.

If we have a patient whose world view will let them respond to this garbage, why not allow it? I'm not saying that we let them deny themselves conventional treatment. I'm saying that we allow them the option of seeking out additional treatment that we know can make a difference for some things. (Even though it is based on garbage.)

(A random note. The argument for the "no" side included acupuncture as something that doesn't work. We don't know exactly why it works, but studies have shown that it really does help for handling nausea and acute pain. While acupuncture doesn't work for a lot of what proponents claim it will, it does have some demonstrated effectiveness above and beyond a straight placebo effect.)

Cheers,
Ben

[Tricky]

http://www.ireland.com/head2head/

Should alternative medicine be integrated into the health system?

There's a claim about "gaps" in medicine, and how rubbish can fill it. Rubbish that fills gaps should be washed away. The poll is to the right, with the "your vote" heading.

So far, the results are depressingly predictable.

OHHH well.
To paraphrase Dorothy Parker, "Alternative medicine fills a much needed gap in health care."

[Michael Redman]

As another data point, conventional doctors are not taught to effectively apply the placebo effect. Quite the opposite in fact, doctors are taught to process patients effectivly and not establish the kind of contact that the placebo effect requires.Deceiving patients about the treatment they are receiving prevents informed consent, and is therefore unethical as well as illegal.

Other than that, though, it's a great idea.

[~enigma~]

Geez - from the thread title I thought you were saying you invented a way to avoid integrating in Calculus.

[Michael Redman]

I though it was an anti-Polish immigrant thread.

[murphyr]

So we have this real effect that we know is beneficial.The reason the placebo effect is the placebo effect is that it is not a real effect. It's an artifact of paying attention to one's health more carefully, more carefully following guidelines and deluding one's self into thinking one is improving a condition. Sugar pills don't do anything to, say, kill cancer, but if you're giving them a treatment for their cancer, they're not going to get treatment that will actually help them.

You could achieve the same effects by just telling people to pay better attention to their health.

We know that doctors are not effective at producing this effect.Yes, but their job isn't "lie to the patients". And I'm not sure I want advertising executives involved in healthcare.


If we have a patient whose world view will let them respond to this garbage, why not allow it? Either because the national healthcare shouldn't be unnecessarily burdened with feel-good remedies that have been shown to be ineffective (people can spend all they want on stone therapies, as long as it's not my money) or because government endorsement of things like homeopathy affords them a sense of credibility and effectiveness which is directly contradicted by the evidence.

I'm not saying that we let them deny themselves conventional treatment. I'm saying that we allow them the option of seeking out additional treatment that we know can make a difference for some things.1. People are more likely to cling to alternative therapies than conventional medicines if the reason that they're taking the alternative therapies is because conventional medicine has not helped them. They're likely to abandon it entirely.

2. They can seek out therapies on their own without the national healthcare system paying for it.

I should probably mention that I have no clue how the Irish Healthcare system operates.

[wwitzke]

Geez - from the thread title I thought you were saying you invented a way to avoid integrating in Calculus.

Same here. I thought it was some sort of woo alternative to integration (like, maybe wishing really hard to find the area under the curve would make it happen, no integration required). I was intrigued, and wondered if this was somehow related to Scientology. :D

[Mojo]

Should alternative medicine be integrated into the health system? [/B]Sure it should: but only the bits that work.

;)

[pvt1863]

Did they mean for the pictures of the debaters to look like mug shots?

[Ben Tilly]

Deceiving patients about the treatment they are receiving prevents informed consent, and is therefore unethical as well as illegal.

Other than that, though, it's a great idea.

I think that patients who take alternative treatments are well aware that they are alternative and are not scientifically proven. If they know that and remain convinced that the treatments will work, then they might..for those patients.

I fail to see either the legal or the ethical dilemma as long as alternative treatments must be clearly labelled as such.

Cheers,
Ben

[Eos of the Eons]

I think that patients who take alternative treatments are well aware that they are alternative and are not scientifically proven. If they know that and remain convinced that the treatments will work, then they might..for those patients.

I fail to see either the legal or the ethical dilemma as long as alternative treatments must be clearly labelled as such.

Cheers,
Ben


Nach. Most people who take alternatives take them for the reason the nutty lady at the link figures they are needed. Because they figure they work better than real medicine.

Altie labels don't say anything. The literature is elsewhere, then people seek the product for the lies that were told about the products.

[Ben Tilly]

The reason the placebo effect is the placebo effect is that it is not a real effect. It's an artifact of paying attention to one's health more carefully, more carefully following guidelines and deluding one's self into thinking one is improving a condition. Sugar pills don't do anything to, say, kill cancer, but if you're giving them a treatment for their cancer, they're not going to get treatment that will actually help them.

Sorry, you're wrong. There are many examples where placebo effects have clearly made a difference in very concrete problems. The placebo effect won't cure a bullet to the head. But it may help you recover function after that incident.

You could achieve the same effects by just telling people to pay better attention to their health.

Unfortunately you can't. In many cases, if the patient believes they will die, they will. If they believe they'll survive, they just might.

Back in the 90s I remember reading an article that in Germany it was considered unethical to tell a patient who was dying that they were not expected to survive. Because the act of telling them that could be a self-fulfilling prophecy. In the USA, of course, the opposite is considered unethical. The ethics of the situation are not clear to me. I think it is wrong to lie. But it is also wrong to take action that can cause death. If telling the truth is literally lethal, is it better or worse to tell that truth?

Yes, but their job isn't "lie to the patients". And I'm not sure I want advertising executives involved in healthcare.

Either because the national healthcare shouldn't be unnecessarily burdened with feel-good remedies that have been shown to be ineffective (people can spend all they want on stone therapies, as long as it's not my money) or because government endorsement of things like homeopathy affords them a sense of credibility and effectiveness which is directly contradicted by the evidence.

This is a tricky problem.

1. People are more likely to cling to alternative therapies than conventional medicines if the reason that they're taking the alternative therapies is because conventional medicine has not helped them. They're likely to abandon it entirely.

That I would not support. I'm willing to be supportive of alternative therapies as a supplement. But not as a replacement. (Except, of course, for the terminally ill who are likely to die in either case. I'm a big believer in making death as gentle as feasible.)

2. They can seek out therapies on their own without the national healthcare system paying for it.

I should probably mention that I have no clue how the Irish Healthcare system operates.

Good point, and me neither.

However when I lived in Canada, I went to a chiropractor for neck problems. (Which were due to a bad fall while roughhousing with my brother.) That was covered by BC Med, and the treatment helped me. Even though a chiropractor is considered "alternative treatment", I was convinced that it could help my neck injury, and I'm glad that I had that option available.

Cheers,
Ben

[murphyr]

There are many examples where placebo effects have clearly made a difference in very concrete problems.
Are there?
But it may help you recover function after that incident.How? Power of positive thinking?
In many cases, if the patient believes they will die, they will. If they believe they'll survive, they just might.It seems that whether they live or die is independent of whether they think they'll live or die, all else being equal. If they think they'll die, they might cease treatment, which would hasten that along, of course.

But it is also wrong to take action that can cause death.Well, if they're terminally ill, telling them so isn't what's killing them, it's their terminal illness. Of course, you'd also have to provide a bit of evidence that telling them that they've got an illness hastens death faster than can be explained by the natural progression of the illness.

That I would not support. But it's a tricky situation, isn't it? You certainly can't force people to continue conventional treatment, can you?

Even though a chiropractor is considered "alternative treatment", I was convinced that it could help my neck injury, and I'm glad that I had that option available.What was the philosophy of the chiropractor? Was it presented as essentially licensed massage and physical therapy or was it presented as an adjustment to restore your innate intelligence? There's a difference.

[Michael Redman]

I think that patients who take alternative treatments are well aware that they are alternative and are not scientifically proven. If they know that and remain convinced that the treatments will work, then they might..for those patients.

I fail to see either the legal or the ethical dilemma as long as alternative treatments must be clearly labelled as such.

Cheers,
BenWe're not talking about labels. You're suggesting that physicians prescribe alternative treatments. In order to do so legally and ethically, they would have to inform the patient that there is no rational reason to believe that the treatment works. Suggesting that the treatment is effective would be fraud. The only way to have informed consent would be for the doctor to explain that the placebo effect was the only way the treatment could possibly be beneficial, and, as far as I understand, that kind of ruins the effect.

Of course, if there was any chance the treatment could do harm to the patient, it would be unethical to prescribe, no matter how informed the patient.

[Ben Tilly]

We're not talking about labels. You're suggesting that physicians prescribe alternative treatments. In order to do so legally and ethically, they would have to inform the patient that there is no rational reason to believe that the treatment works. Suggesting that the treatment is effective would be fraud. The only way to have informed consent would be for the doctor to explain that the placebo effect was the only way the treatment could possibly be beneficial, and, as far as I understand, that kind of ruins the effect.

No. I'm suggesting that medical insurance should cover some alternative treatments. I'm not suggesting that doctors should be prescribing them.

Of course, if there was any chance the treatment could do harm to the patient, it would be unethical to prescribe, no matter how informed the patient.

Obviously true. However many alternative treatments are clearly non-harmful.

Cheers,
Ben

[Ben Tilly]

There are many examples where placebo effects have clearly made a difference in very concrete problems.
Are there?
Yes. See http://www.fda.gov/fdac/features/2000/100_heal.html, or http://pubs.acs.org/hotartcl/mdd/99/aug/mysterious.html for an overview of the placebo effect which includes examples of conditions where it has been proven to help.
But it may help you recover function after that incident.
How? Power of positive thinking?
The how is the placebo effect is unclear. The fact that it exists is not. In this case I'd suggest that it might help convince the patient to exert themselves in their treatment.
In many cases, if the patient believes they will die, they will. If they believe they'll survive, they just might.
It seems that whether they live or die is independent of whether they think they'll live or die, all else being equal. If they think they'll die, they might cease treatment, which would hasten that along, of course.
Unfortunately all else is seldom equal.
But it is also wrong to take action that can cause death.
Well, if they're terminally ill, telling them so isn't what's killing them, it's their terminal illness. Of course, you'd also have to provide a bit of evidence that telling them that they've got an illness hastens death faster than can be explained by the natural progression of the illness.
I didn't say that your message is the proximate cause of death. Merely that it might make the difference between life and death.
But it's a tricky situation, isn't it? You certainly can't force people to continue conventional treatment, can you?
No. But you can try to make them feel better about it, which helps compliance.
Even though a chiropractor is considered "alternative treatment", I was convinced that it could help my neck injury, and I'm glad that I had that option available.
What was the philosophy of the chiropractor? Was it presented as essentially licensed massage and physical therapy or was it presented as an adjustment to restore your innate intelligence? There's a difference.
Not exactly either, but it was closer to licensed massage and physical therapy.

Cheers,
Ben