Applying Science to Alternative Medicine

[SteveGrenard]

There was a review in the NY Times on alternative medicine and how science is or should be applied to validating or disproving its claims.

http://www.nytimes.com/2008/09/30/he...ce&oref=slogin

Quote:

Applying Science to Alternative Medicine

·

By WILLIAM J. BROAD
Published: September 29, 2008


<snipped>
More than 80 million adults in the United States are estimated to use some form of alternative medicine, from herbs and megavitamins to yoga and acupuncture. But while sweeping claims are made for these treatments, the scientific evidence for them often lags far behind: studies and clinical trials, when they exist at all, can be shoddy in design and too small to yield reliable insights.

Now the federal government is working hard to raise the standards of evidence, seeking to distinguish between what is effective, useless and harmful or even dangerous.

<snipped>

[Eos of the Eons]

About time. Enough people have died from the propaganda that the sCAM industry has flooded all lines of communication with. Make them put those billions of dollars where their mouths are and prove that their products are OH so much better than real medicine.

[my_wan]

It's true that alternative medicines often don't have the funding needed to establish efficacy. The alternative medicine industry wants no part of real facts and it simply not profitable enough for the drug industry due to lack of patent protections. When science does find something useful it's generally distilled into a pill. The alternative medicine industry doesn't want the cost or accountability, which is the problem with the industry to begin with. It's far more profitable to talk about how evil the medical industry is while selling snake oil with no accountability. Far too often even killing their clients by application of the belief system and/or the snake oil itself.

I've often thought it might be reasonable to create a wing of the FDA that financed trials on some of these things with tax dollars, much like the Orphan Drug Act of 1983. We could then loosen up on the rules about what the alternative industry could claim in light of the evidence and tighten down on those rules with regard to unsubstantiated claims. At the very least require MSDS sheets (or similar) come with every sale.

The fact is actual information is the last thing the alternative medicine industry wants. They are in fact the industry that they accuse conventional medical industry of being. That's not to says wrongs aren't done within conventional channels.

[Eos of the Eons]

Alt med is a BILLION dollar industry. They simply don't want to be bothered with wasting money on proving there is anything to their products. They don't work anyways, or they would have to follow the rules in the first place.

Real meds are Distilled? NOT. The active ingredient is isolated and then standardized into a safe and effective dose that is TESTED for safety and efficacy.

Not so with alt med. Everything is willy nilly. A tree branch is crushed into a capsule. Ashes are mashed into pill form. Nothing is standardized, there is often no active ingredient that is safe or effective.

They need to spend their OWN money or shut up about how GREAT their products are.

They get around the rules by not making actual claims on the product labels. They put on the bottles that they aren't for treating anything. We know how they get their messages out though. Too bad they don't have to prove what they are saying in those other channels.

[Asolepius]

Originally Posted by my_wan

I've often thought it might be reasonable to create a wing of the FDA that financed trials on some of these things with tax dollars, much like the Orphan Drug Act of 1983. We could then loosen up on the rules about what the alternative industry could claim in light of the evidence and tighten down on those rules with regard to unsubstantiated claims. At the very least require MSDS sheets (or similar) come with every sale.

This function already exists - it's NCCAM. It has indeed spent $billions with almost nothing to show for it.

[Mojo]

Originally Posted by my_wan

When science does find something useful it's generally distilled into a pill.

If you look at sCAM, many part of it are concerned entirely with solving problems with pills. In particular look at the "nutritional medicine"/supplements industry. They even claim that they can solve, for example, complex behavioural problems with pills.

[Mojo]

Originally Posted by Eos of the Eons

They get around the rules by not making actual claims on the product labels. They put on the bottles that they aren't for treating anything. We know how they get their messages out though.

I have a classic example on the desk in front of me. It's a packet of valerian tea. It doesn't quite make any medicinal claims. On the other hand, it has warnings such as "can cause drowsiness" and instructions "Dosage - one sachet one hour before retiring".

[fls]

Originally Posted by SteveGrenard

There was a review in the NY Times on alternative medicine and how science is or should be applied to validating or disproving its claims.

http://www.nytimes.com/2008/09/30/he...ce&oref=slogin

This was maybe a good idea 20 years ago, but it has demonstrated that it's not a fruitful and useful way to spend our money.

http://www.quackwatch.org/01Quackery...ics/nccam.html

Linda

[Gord_in_Toronto]

Originally Posted by fls

This was maybe a good idea 20 years ago, but it has demonstrated that it's not a fruitful and useful way to spend our money.

http://www.quackwatch.org/01Quackery...ics/nccam.html

Linda

Every now and again I used to go to the National Center for Complementary and Alternative Medicine web site to see what they had discovered (I admit I have not done this recently).

The site is so "organized" such that it is impossible to see what they had studied, what they are studying, and what the results are. Something so ****** obvious to provide unless the results are essentially worthless which is my uneducated guess. If you do track down the trials they have run, the conclusions are, almost universally, that there might be a slight positive effect and that more testing is required.

Dr Barrett is correct. But it's your tax dollars not mine.

[JJM]

There is considerable discussion of "prior probability" in research on "CAM" at http://www.sciencebasedmedicine.org/ As I understand it, the likelihood of invalid, apparently-positive research results increases greatly for irrational ("low-probability") methods. Therefore, such projects are not worth funding.

On a more practical basis, a regular application to the NIH has to be supported by extensive referral to the high-quality, basic, science literature (that is, what we know with considerable confidence). Consider a proposed, HIV-protease inhibitor. An application to the NIH must include demonstrated knowledge of the protease, what is known about the chemistry of compounds related to that which is proposed which would make it a reasonable thing to study, and evidence that one has the facilities to make and test the new compound.

AltMed researchers cannot provide such support for their ideas. They rely on ancient superstitions, and anecdote/testimonial. Since they cannot write grant applications that are competitive with scientific research, some of their supporters in Congress (USA) invented the NCCAM to support low-quality research.

While it might seem ideal to study AltMed, the notion fails because the research is not on the same rigorous basis as mainstream proposals. I fully support AltMed research that is as well-founded as normal NIH research, such does not exist.

[KingMerv00]

Originally Posted by my_wan

The alternative medicine industry wants no part of real facts and it simply not profitable enough for the drug industry due to lack of patent protections.

That is a common misconception. Under the right conditions, it is possible to get a patent on an alternative medical treatment. Even if a patent is not possible, huge profits can be and are made. For example, Coca-Cola is not patented and I doubt it ever will be because it would actually be bad for business.

[Gord_in_Toronto]

Originally Posted by JJM

There is considerable discussion of "prior probability" in research on "CAM" at http://www.sciencebasedmedicine.org/ As I understand it, the likelihood of invalid, apparently-positive research results increases greatly for irrational ("low-probability") methods. Therefore, such projects are not worth funding.

On a more practical basis, a regular application to the NIH has to be supported by extensive referral to the high-quality, basic, science literature (that is, what we know with considerable confidence). Consider a proposed, HIV-protease inhibitor. An application to the NIH must include demonstrated knowledge of the protease, what is known about the chemistry of compounds related to that which is proposed which would make it a reasonable thing to study, and evidence that one has the facilities to make and test the new compound.

AltMed researchers cannot provide such support for their ideas. They rely on ancient superstitions, and anecdote/testimonial. Since they cannot write grant applications that are competitive with scientific research, some of their supporters in Congress (USA) invented the NCCAM to support low-quality research.

While it might seem ideal to study AltMed, the notion fails because the research is not on the same rigorous basis as mainstream proposals. I fully support AltMed research that is as well-founded as normal NIH research, such does not exist.

Why do you think that NCCAM does "low-quality research"?

They don't seem to think this is so.

However, I did visit their website for the first time in sometime and find that it has been revised but still does not make it easy to get a summary of what they are doing and what their results are.

Now, if you select an area of study from the http://nccam.nih.gov/clinicaltrials/alltrials.htm page you can select an area of clinical trial and see what studies have been done and are proposed in that area. Selecting a trial brings up a page with a detailed description and on that page is a tab labeled "No Study Results Posted". I presume, if there were any study results posted it would point to them. But I have not found such a tab on any of the dozen or so completed studies (some completed four or more years ago) I picked.

If you click on the "No Study Results Posted" tab you get a page that says, in part, "Note that some studies will not have results posted for various reasons, including the following: the trial is not yet completed; the results data are being analyzed for future posting; mandatory submission requirements do not apply; or the deadline for results reporting has not been reached."

Am I allowed to say, "Ha. Ha."? I think they missed "or the results did not prove what we wanted and are thus not worth publishing".

[my_wan]

Many good arguments were made here against the ideas I mentioned. I'm left with a rare situation where I can't mount an effective defense of those proposals. Not the least of my inadequacies was an ignorance of NCCAM.

Looking over the literature some troubling issues became obvious with NCCAM itself. Their synopsis contain nearly all, or even all, fluff as if ultimately they have no intention of making any difference in any policy based on the effectiveness of anything. Quackwatch confirmed this:

Originally Posted by http://www.quackwatch.org/01QuackeryRelatedTopics/nccam.html

NCCAM recently awarded $15 million to nine medical schools to develop teaching of these subjects—all by advocates of "CAM." It gave no funds to the five medical school courses with curricula already developed that teach about the subject rationally.<snipped characterization>

NCCAM appears to extend their goals well beyond simply providing fact based information useful to a reasoned policy issue. Even their findings spend more time coddling CAMs than providing findings good or bad. Unfortunately this sham does not meet the mission standards I would have hoped.

I'm prepared to simply support tightening the legal screws on the claims of those in the industry.

[Eos of the Eons]

Tighten that screw, and woo woos find money in their pockets to take out ads and put up websites about how "they" are tramping on your HEALTH FREEDOM. They get the layperson who has no clue to vote down any laws.

Seriously twisted. The power they have and say that they don't have. The power they have and say that BIG PHARMA is wielding over them. Ugh.

Hypocrites. Rich unethical hypcorites. I marvel at how they get away with it.

[krazyKemist]

Originally Posted by JJM

There is considerable discussion of "prior probability" in research on "CAM" at http://www.sciencebasedmedicine.org/ As I understand it, the likelihood of invalid, apparently-positive research results increases greatly for irrational ("low-probability") methods. Therefore, such projects are not worth funding.

This remembers me of a discussion on Orac's Respectful Insolence about the faults of Evidence Based Medicine, in which he was deploring the low level of priority that is given to basic science, which constitutes most of prior probability.

Evidently, we got into a tusle with none other that two homeopaths (yes, one of them was Dana Ullman), first congratulating Orac for finding fault in EBM, then trying to push the usual trope about Milgrom, Elia, Rustum Roy, memory of water, ect.

Then, when we started laughing at this, the goalposts shifted. One of the guys gave us the reference for a paper that he said was "homeopathy-skeptical" (except its first author works at Boiron labs and it was funded by an homeopathy association) and made full use of the ability of statistics to amplify noise.

All of those papers have the same feel to them. The data is twisted and shaped into whatever form it takes for the author to confirm what they want to hear. And the tool they use to that effect is statistics. Which makes me often repeat this : I like my data like I like my steak : minimum cooking, please !

[Soapy Sam]

While in no way supporting SCAM, I think we should bear in mind that "real medicine" kills people too- possibly rather more than "pretend" medicine does.

[Gord_in_Toronto]

Originally Posted by Soapy Sam

While in no way supporting SCAM, I think we should bear in mind that "real medicine" kills people too- possibly rather more than "pretend" medicine does.

Possibly you might just see that, unlike SCAM, real medicine actually cures one Hell of a lot more people too. Had any smallpox recently?

[jimtron]

Originally Posted by Soapy Sam

While in no way supporting SCAM, I think we should bear in mind that "real medicine" kills people too- possibly rather more than "pretend" medicine does.

Probably true, but there are no alt med emergency rooms or alt med open heart surgery techniques. When push comes to shove, anti-"Western" medicine folks usually go to real doctors. And of course there are risks and mistakes and accidents. But where can one go for truly efficacious treatment without risks? Homeopathy has zero side effects, and also zero effectiveness. Real treatments often have risks.

[Ivor the Engineer]

Originally Posted by jimtron

Probably true, but there are no alt med emergency rooms or alt med open heart surgery techniques. When push comes to shove, anti-"Western" medicine folks usually go to real doctors. And of course there are risks and mistakes and accidents. But where can one go for truly efficacious treatment without risks? Homeopathy has zero side effects, and also zero effectiveness. Real treatments often have risks.

Sometimes doing nothing is the best medicine. Homoeopathy is useful in this regard because it satisfies the patient's desire for intervention while not running the risk of causing additional problems due to pointless medication.

[Asolepius]

Originally Posted by Ivor the Engineer

Sometimes doing nothing is the best medicine. Homoeopathy is useful in this regard because it satisfies the patient's desire for intervention while not running the risk of causing additional problems due to pointless medication.

A common fallacy. I really think we need to look at homeopathy more `holistically'. The individual `worried well' patient finds it useful when no conventional medicine has worked. This is because there was nothing wrong with them in the first place. All well and good so far. But have you read any homeopathy teaching material? I have started a library of this, and it really is an education. It is a terrifying testimony to how a staggeringly huge edifice of belief, very highly complex and apparently well organised, can be built on no more than assertions. One of my books starts with the assertion that health depends on the flow of vital force, and then refers to this throughout the rest of the book as if it were established scientific fact. This is very similar to the Nazis' re-engineering of German science in the 1930s. They said that all that mattered was the will, and that if the science disagreed with personal will then the science was wrong. This is an extremely dangerous thing for society.

Sorry for the reductio ad Hitlerum, but I think it's appropriate in this case.

[Mojo]

Originally Posted by Ivor the Engineer

Sometimes doing nothing is the best medicine. Homoeopathy is useful in this regard because it satisfies the patient's desire for intervention while not running the risk of causing additional problems due to pointless medication.

And this is one of the reasons why homoeopathy appeared to be effective in the 19th century. Most medicine available at the time was ineffective, and much of it was harmful, so doing nothing was often the best option. But doing nothing is not really an acceptable option in the case of conditions for which effective treatments exist:

http://forums.randi.org/showthread.php?t=125703

[jon]

Originally Posted by Mojo

I have a classic example on the desk in front of me. It's a packet of valerian tea. It doesn't quite make any medicinal claims. On the other hand, it has warnings such as "can cause drowsiness" and instructions "Dosage - one sachet one hour before retiring".

To be fair, in that type of situation I'm more worried when valerian *doesn't* come with any warnings, or is just sold as a 'relaxing' drink: these can be active ingredients, and there are times when drowsiness can be a real problem...

[krazyKemist]

Originally Posted by Mojo

I have a classic example on the desk in front of me. It's a packet of valerian tea. It doesn't quite make any medicinal claims. On the other hand, it has warnings such as "can cause drowsiness" and instructions "Dosage - one sachet one hour before retiring".

I think we should separate herbalism from nonsense such as homeopathy, therapeutic touch and reiki. After all, herbs can contain active principles and are at the basis of the modern pharmacy, even if their qualities may vary widely in the absence of correct standardisation (which is almost impossible to find in herbal medicines today, except maybe in Germany).

Claims of efficacy for herbs and other natural extracts can initiate fairly good drug research, which can make it outside a CAM setting. The whole NCCAM business in my opinion has tainted good research on natural products (extract testing, natural product isolation and synthesis) by using its successes as a camouflage for less worthy ideas, like for example, testing therapeutic touch on in-vitro grown cells (yes, my friends, this was funded by the NCCAM dollar ).

Natural product research, in my opinion, shouldn't even be included in CAM.

[fls]

Originally Posted by krazyKemist

I think we should separate herbalism from nonsense such as homeopathy, therapeutic touch and reiki. After all, herbs can contain active principles and are at the basis of the modern pharmacy, even if their qualities may vary widely in the absence of correct standardisation (which is almost impossible to find in herbal medicines today, except maybe in Germany).

Claims of efficacy for herbs and other natural extracts can initiate fairly good drug research, which can make it outside a CAM setting.

I don't think this is true. Testing on the basis of traditional use for specific conditions seems to have very low yield and misses important effects. For example, testing traditional Chinese herbs used to treat maleria found only one that was effective out of about 200. And yew (the source of taxol) was not traditionally used as a cancer treatment. Herbalism seems to fall squarely under CAM in that traditional use depends upon the same unreliable and invalid methods of determining usefulness as the rest of the CAM therapies. Which makes it a poor source of inspiration.

Quote:

The whole NCCAM business in my opinion has tainted good research on natural products (extract testing, natural product isolation and synthesis) by using its successes as a camouflage for less worthy ideas, like for example, testing therapeutic touch on in-vitro grown cells (yes, my friends, this was funded by the NCCAM dollar ).

Natural product research, in my opinion, shouldn't even be included in CAM.

But it's not. Natural product research has always been a part of regular research, rather than research targetting CAM.

Linda

[krazyKemist]

Originally Posted by fls

I don't think this is true. Testing on the basis of traditional use for specific conditions seems to have very low yield and misses important effects. For example, testing traditional Chinese herbs used to treat maleria found only one that was effective out of about 200.

One out of 200, even if it seems like very poor success, still represents a fair enrichment compared with the yield of conventional drug screening. But of course, the economy depends on the testing method. I'm not advocating testing them in a costly double-blind clinical test.

Quote:

And yew (the source of taxol) was not traditionally used as a cancer treatment. Herbalism seems to fall squarely under CAM in that traditional use depends upon the same unreliable and invalid methods of determining usefulness as the rest of the CAM therapies. Which makes it a poor source of inspiration.

Of course not. Traditional treatment of cancer was to wait till you die. The only objection I have with treating herbalism as CAM is that it doesn't have the same prior probability as nonsensical methods. Some of it can actually work according to the basic science. That's why I cringe when I see it included with tinfoil hat stuff like homeopathy, reiki and chiropractic.

[blutoski]

dp

[blutoski]

Originally Posted by Ivor the Engineer

Sometimes doing nothing is the best medicine. Homoeopathy is useful in this regard because it satisfies the patient's desire for intervention while not running the risk of causing additional problems due to pointless medication.

In principle, I agree, as does Dr. Harriet Hall.

However, in practice, I disagree with yourself and Dr. Hall because of the reality on the ground: homeopathy has two grave risks as actually practiced.

• adulteration is too common. Dr. Grollman's research on the East Coast of the US suggests that about a third of off-the-shelf homeopathic remedies contain undeclared active ingredients in normal concentrations. Some of these ingredients are prescription drugs.
  
• homeopaths too commonly treat conditions that require medical attention, or advise that patients discontinue their medicines when it is not justified.

So, while homeopathic remedies may be harmless, homeopathy is not harmless.

[fls]

Originally Posted by krazyKemist

One out of 200, even if it seems like very poor success, still represents a fair enrichment compared with the yield of conventional drug screening. But of course, the economy depends on the testing method. I'm not advocating testing them in a costly double-blind clinical test.

I agree in that they probably represent a collection of plants that are more likely to have pharmacological activity and less likely to be overtly toxic than a random sample of plant extracts. I think the usefulness of traditional use stops there, though.

Quote:

Of course not. Traditional treatment of cancer was to wait till you die.

Traditional medicine doesn't consider certain conditions exempt from potential treatment.

Quote:

The only objection I have with treating herbalism as CAM is that it doesn't have the same prior probability as nonsensical methods. Some of it can actually work according to the basic science. That's why I cringe when I see it included with tinfoil hat stuff like homeopathy, reiki and chiropractic.

I agree that there is a smattering of information that is useful mixed in with the useless. But traditional use doesn't tell us which is which. I guess I cringe when I see natural product research included under herbalism.

Linda

[GreyICE]

Originally Posted by Mojo

If you look at sCAM, many part of it are concerned entirely with solving problems with pills. In particular look at the "nutritional medicine"/supplements industry. They even claim that they can solve, for example, complex behavioural problems with pills.

Since many behavioral problems are caused by psychological reasons, I imagine they have smashing success. Psychological problems are exactly where placebos do the most good (they tend to suck at curing, say, cancer, which doesn't really give a crud whether you think its curing itself magically or not).

[krazyKemist]

Originally Posted by fls

I guess I cringe when I see natural product research included under herbalism.

I think the problem is that "herbalism" has become a loaded term, what with all the people who have made considerable misuse of it. Maybe it would be better to use "pharmacognosy" (until that too gets usurpated by the woo-woos).

[JJM]

Originally Posted by krazyKemist

... After all, herbs can contain active principles and are at the basis of the modern pharmacy, even if their qualities may vary widely in the absence of correct standardisation (which is almost impossible to find in herbal medicines today, except maybe in Germany).

The German Commision E promotes standardization; but that is an illusion since they don't know what the active ingredients, if any, are. Moreover, the supporting data is mostly not in peer-reviewed literature.

Originally Posted by krazyKemist

Claims of efficacy for herbs and other natural extracts can initiate fairly good drug research, which can make it outside a CAM setting. {snip}

Natural product research, in my opinion, shouldn't even be included in CAM.

Originally Posted by fls

I don't think this is true. Testing on the basis of traditional use for specific conditions seems to have very low yield and misses important effects. For example, testing traditional Chinese herbs used to treat malaria found only one [artemisinin] that was effective out of about 200. {snip}
Linda

Originally Posted by krazyKemist

One out of 200, even if it seems like very poor success, still represents a fair enrichment compared with the yield of conventional drug screening. {snip}

Yes, and no. When it comes to drug discovery, a 0.5% success rate is great. When it comes to herbal treatment, 99.5% inactive is not good. But, it is not typical: Ethnobotany and the Search for New Drugs – No. 185 (CIBA Foundation Symposia Series)
http://www.amazon.com/Ethnobotany-Search-New-Drugs-Foundation/dp/0471950246/ref=sr_1_1?ie=UTF8&s=books&qid=1219583435&sr=1-1
John Wiley & Sons (December 1994) RS 164.E84 1994

There is contradictory data and interpretation concerning the usefulness of ethnobotany. My, initial take on this is that large ethnobotanical collections are not much better, or worse, than random samples of herbs.

Originally Posted by fls

I agree in that they probably represent a collection of plants that are more likely to have pharmacological activity and less likely to be overtly toxic than a random sample of plant extracts. {snip}
Linda

The key word is "overtly." I just looked up the hundreds of ethnic uses for species of Aristolochia. When people take it for months/years, and then die of kidney failure, the local herbalist does not associate aristolochic acid with the death because the death does not immediately attend use of the herb. The same goes for Kava and liver failure.

[fls]

Originally Posted by JJM

Yes, and no. When it comes to drug discovery, a 0.5% success rate is great. When it comes to herbal treatment, 99.5% inactive is not good. But, it is not typical: Ethnobotany and the Search for New Drugs – No. 185 (CIBA Foundation Symposia Series)
http://www.amazon.com/Ethnobotany-Search-New-Drugs-Foundation/dp/0471950246/ref=sr_1_1?ie=UTF8&s=books&qid=1219583435&sr=1-1
John Wiley & Sons (December 1994) RS 164.E84 1994

Don't leave us in suspense! What does it say?

Quote:

There is contradictory data and interpretation concerning the usefulness of ethnobotany. My, initial take on this is that large ethnobotanical collections are not much better, or worse, than random samples of herbs.

The key word is "overtly." I just looked up the hundreds of ethnic uses for species of Aristolochia. When people take it for months/years, and then die of kidney failure, the local herbalist does not associate aristolochic acid with the death because the death does not immediately attend use of the herb. The same goes for Kava and liver failure.

Yeah, I probably should have emphasized that.

Linda

[JJM]

Originally Posted by fls

Don't leave us in suspense! What does it say?

Linda

Inre the ethnobotany symposium volume I cited; as I wrote:

Quote:

There is contradictory data and interpretation concerning the usefulness of ethnobotany. My, initial take on this is that large ethnobotanical collections are not much better, or worse, than random samples of herbs.

Not much else of interest to me. Topics included how particular collections were made, preservation of native species and remunerating the locals for adoption of their herbs. There has been a problem with the fact that ethnobotanists were botanists who did not recognize what diseases were being treated by particular herbs, and who paid insufficient attention to how the herbs were prepared and administered.

Most of the concrete examples concerned anti-cancer and anti-HIV compound discovery by in vitro testing, with a few compounds in clinical testing or approved for use. One usually expects to test 10,000 compounds along the way to one approved drug. It looks like ethnobotany is either worse than that; or, assuming multiple assays of the same material (over three decades, and inferior assays in the early days), to bring it down to 8,000 assays to one drug.

If the assumptions are correct, that is an improvement; but not so much that I would rule-out random collection and screening (especially, if the testing is cheap). I also doubt this is representative of the promise of ethnobotany since the "ancients" would not have recognized most cancers as such, nor would they have any experience with HIV (which jumped to humans relatively recently).

[Eos of the Eons]

Doing nothing can kill people. You won't cure cancer by taking homeopathy. Type 1 diabetics will die if they opt only for homeopathy.