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lonely persuader
= Cult of Ray =
Ireland
488 Posts |
 Posted - 05/26/2006 : 09:04:05
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quote:
Originally posted by starmekitten
LP -I don't really see what you're arguing if I'm honest. You seem to be saying all such things are bad because no one knows if they really work or how they really work... I think a lot can be said for many straight medical treatments too. You've lost me.
forum ebook: end of miles
Im just arguing that any new treatment (be it plausable or not) must be proven to have an effect to be considered a proper treatement. Alot of the aforementioned treatements (homeopathy included) are not proven and any effect could be due to sampling error. If it is not proven I would not have much time for it, to be honest.
If someone said that wearing blue socks lessened your chances of cancer and they ran a trial with a proper sample size etc and proved it empirically, it would be fine by me (even thought it sounds ridiculous).
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Newo
~ Abstract Brain ~
Spain
2674 Posts |
Posted - 05/26/2006 : 09:18:29
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quote:
mosleyk Posted - 05/26/2006 : 07:53:41
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quote:
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Originally posted by Newo
quote:
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mosleyk
= Cult of Ray =
USA
506 Posts
Posted - 05/25/2006 : 10:37:34
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They used the scientific method to test the power of thought/prayer....I don't want to give away some of the results in the book, but they aren't exactly what you would expect.
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A Japanese physicist called Masaru Emoto experimented with exposing water to various words and emotions then froze it and photographed the crystals. When he said words with loving intention behind them, the water molecules rearranged themselves into beautiful symmetrical snowflake shapes and with words spoken with malevolent intent the molecules turned scattered and knotted and chaotic.
To go back offtopic, Oregon is a place IŽve always wanted to visit, IŽve had notions about it since reading lots of Ken Kesey and Raymond Carver when younger. A Californian friend here sez one town sheŽd like to live in at some stage is Eugene, and she told me about in Portland a cyclist got killed at an intersection so somebody painted a mandala over it to make cars slow down and drive around, which worked so well many intersections have them now.
Gravy boat! Stay in the now!
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I am familiar with that experiment. Ever hear of the movie "What the beap do we know" Um.....I might also add it was filmed in Oregon, and they also filmed scenes in the most awesome $2 movie house in Portland...the bagdad. http://www.mcmenamins.com/index.php?loc=9&id=177 ...anyway they cited the experiment in the movie
I havenŽt seen though I do have it on disc, a friend of a friend is giving me his old laptop so IŽll be having a look soon.
Llama, here for you:
Thank You
You Make Me Sick I Will Kill You
http://www.masaru-emoto.net/english/eprofile.html
--
Gravy boat! Stay in the now! |
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dr.Evil
- FB Fan -
63 Posts |
Posted - 05/26/2006 : 11:30:49
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quote:
Originally posted by lonely persuader
I would like to know if your doctorate is medical or philosophical in nature Dr. Evil.
If you have any other methodology to measure causality, I would like to hear it. Evidence-based medicine may have flaws due to how its conducted (they're are people involved who make mistakes etc) but the concept is sound and the best available. Lets go back to the witch-doctor and voodo ages.
> the best evidence today suggests that most of the evidence in existence is plagued and flawed
What a contradictory sentence!! Lovily paradoxical argument.
I really don't see how or why my background should matter. I assume mine is better than yours. The arguments against evidence based medicine are many, but I will try to be brief (but I failed:).
First off, when one is discussing evidence based medicine one is not discussing a paradigm that wants to provide the best possible treatment (every treatment paradigm wants to provide the best possible treatment), but a paradigm that has a quite specific opinion about what evidence is and how it should measured. It has basically taken the "evidence" concept and methodology from the natural sciences and applied them to health-care. Thus, I am not againts providing good treatment - I am against excluding treatment paradigms/modalities just because they do not suit "the evidence based guys".
For instance; the randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition (let's call it RCT) is the gold standard regarding methodology, and the results are the evidence. However, as anyone remotely familiar with health-care would be aware of, the patients that would be suited for such trials are rarely the same patients that exist in health care.
Thus, when testing antidepressants, one excludes patients with alcohol or drug abuse, maybe patients with psychotic symptoms, severe anxiety - and let's exlude the severe personality disorders as well. Do the remaining patients represent the patients that receive the treatment? Sometimes, but most often not.
What kind of evidence then do these studies provide? Again, look at the drug-trials - patients improve 1-2-3 or whatever points on a GAF-scale or maybe on Becks depression inventory. Is that clinically significant? Well, evidence based medicine does not seem to care. But the government, who pays for treatment, cares. That's why NIMH started a huge multicenter study (STAR*D) to investigate how SSRI's work for real patients, and if they achieve the wanted results (get well and back to work basically) - which they for 75% don't.
To summarize: the method is poorly suited for many kinds of medicine, and there is evidence to back that statement up.
Second: the way trials are published today provide no way of checking wether what's written actually reflects what is done. Trust the author - basically. Which sounds like a bad idea regarding
1) authors that subscribe to a paradigm almost never publish negative results regarding their own paradigm
2) pharmaceutical companies never publish negative results regarding their own products (how strange)
3) the effect of certain pharmaceutical products totally disapears when including only neutrally funded investigations
4) It is easier to get a study with a positive result published than a negative one.
5)2 thirds of all the pharmaceutical studies are never published. And you may only wonder what the results were.
6) pharmaceutical companies have the last years been caught lying, hiding vital information both from government agencies and the journals in which they published the articles. I give you no references - you should know where to look. This has been published as editorials in most (perhaps all) of the medical journals the last years.
This is the system that produce your "evidence". The system is flawed - again a well documented fact. Do a little search in the major journals and you'll find plenty of studies.
3) Evidence based medicine is at odds at the "consumer"/patient's rights movements which has, in most western countries, resulted in laws that now state that patients must be allowed to influence treatment - especially in psychiatry. There is little room for this in evidence based medicine.
There are many more points, but I believe these represent valid objections against this paradigm. Is it the best we got? I don't think so. This far it has been used to make governments spend money on drugs that did not have their so-called effect, on drugs that had effects we never asked for, on drugs that were no better than cheaper and older drugs, on drugs instead of human resources, on drugs instead of different treatment modalities (psychotherapies, chiropractors) and much, much more.
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Edited by - dr.Evil on 05/26/2006 13:09:45 |
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Llamadance
> Teenager of the Year <
United Kingdom
2543 Posts |
Posted - 05/26/2006 : 11:48:32
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Nicely written dr.Evil, and having worked for several major pharmaceutical companies, I too question their ethics.
A couple of questions though. How best to compare results if not with standardised, homogenised populations? You have to have a frame of reference. How should it be judged?
Many drugs that treat chronic, long term diseases aren't cures. All they can do is limit the symptoms/provide temporary relief. eg. as you mentioned, drugs for blood pressure and depression. Both of these would be better dealt with - if possible - in a non-chemical way. What unwanted effects have blood pressure drugs brought....and if they're positive, is that really a problem?
In the UK, while a patient is open to saying what treatment they might like, the final decision is with the GP. If the patient disagrees, the GP can refuse to treat them citing breakdown in the patient-doctor relationship - thus passing them onto another GP.
The internet gives patients a lot more information (much misleading) which means they can discuss treatment options with their doctor. It also puts a responsibility on the doctor to be more transparent in their reasons for prescribing. Often doctors fail to live up to this responsibility.
Pain is temporary, quitting is forever.
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mosleyk
= Cult of Ray =
USA
607 Posts |
Posted - 05/26/2006 : 12:12:58
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Here are some more fun facts
...in the US approximately 80% of all "new FDA approved drugs" are actually just reforumlated older drugs.
The FDA DOES NOT dictate the black box warning when a drug is approved. Black box warnings are strangely enough only present in about 10% of all package inserts.
Top three government lobbists (ones that spend the most) are pharmacueticals.
FDA is absolutely too understaffed to properly review all safety reports from clinic trials. Case in point...vioxx. When studies were still being conducted prior to approval I was working in the IRB. We immediately recognized the risks and had all investigators add this risk statement into the consent form and re-consent.
"Some researchers believe COX-2 inhibitor type drugs might increase the risk of heart attack, stroke, chest pain (angina), blood clots, and death. We are not sure this is true but we want to be careful. To help keep you safe in this study, we will closely watch you for these side effects by [describe monitoring plan here]."
Remember this was BEFORE FDA approval. All related adverse events were forwarded to the sponsor who is required to forward them to the FDA.
so....what happened to these risks after it was approved. How could Merck say they didn't know?
this is what scares me about research.... |
Edited by - mosleyk on 05/26/2006 12:13:34 |
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dr.Evil
- FB Fan -
63 Posts |
Posted - 05/26/2006 : 13:08:46
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quote:
Originally posted by Llamadance
Nicely written dr.Evil, and having worked for several major pharmaceutical companies, I too question their ethics.
A couple of questions though. How best to compare results if not with standardised, homogenised populations? You have to have a frame of reference. How should it be judged?
Many drugs that treat chronic, long term diseases aren't cures. All they can do is limit the symptoms/provide temporary relief. eg. as you mentioned, drugs for blood pressure and depression. Both of these would be better dealt with - if possible - in a non-chemical way. What unwanted effects have blood pressure drugs brought....and if they're positive, is that really a problem?
In the UK, while a patient is open to saying what treatment they might like, the final decision is with the GP. If the patient disagrees, the GP can refuse to treat them citing breakdown in the patient-doctor relationship - thus passing them onto another GP.
The internet gives patients a lot more information (much misleading) which means they can discuss treatment options with their doctor. It also puts a responsibility on the doctor to be more transparent in their reasons for prescribing. Often doctors fail to live up to this responsibility.
Pain is temporary, quitting is forever.
First of all - regarding your second question, I wrote a clumsy sentence describing a side-effect (blood pressure) - but it came out all wrong and looked like i was describing a blood pressure drug. Sorry about that, I have edited the response.
Regarding your first question, I believe decisions regaring treatment should be based upon studies conducted through a multitude of methods that are able to reflect clinical reality - funded and run by neutral institutions (universities for instance). It is a complex reality and it should be reflected in the multitude of methods. If our governments have the money to pay for these drugs, they should have the money to test them properly. They should also spend a little more time describing and defining the the concepts they whish to study - everything can't be "empirical" and meta-analysis.
Patient rights exist on paper - which is better than nothing. There is a long way to go, but the fact alone that they now exist as laws make it possible to refer to them in debates, to refer to them when quarreling with officials, to refer to them when other practices that deny people their rights are proposed etc. We should all get down and dig patient rights.
I would also say that if it is completely impossible to come to a satisfying agreement with your GP, maybe it is better to switch after all?
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Edited by - dr.Evil on 05/26/2006 13:10:48 |
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lonely persuader
= Cult of Ray =
Ireland
488 Posts |
Posted - 05/27/2006 : 09:22:08
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quote:
Originally posted by dr.Evil
quote:
Originally posted by lonely persuader
I would like to know if your doctorate is medical or philosophical in nature Dr. Evil.
If you have any other methodology to measure causality, I would like to hear it. Evidence-based medicine may have flaws due to how its conducted (they're are people involved who make mistakes etc) but the concept is sound and the best available. Lets go back to the witch-doctor and voodo ages.
> the best evidence today suggests that most of the evidence in existence is plagued and flawed
What a contradictory sentence!! Lovily paradoxical argument.
I really don't see how or why my background should matter. I assume mine is better than yours. The arguments against evidence based medicine are many, but I will try to be brief (but I failed:).
First off, when one is discussing evidence based medicine one is not discussing a paradigm that wants to provide the best possible treatment (every treatment paradigm wants to provide the best possible treatment), but a paradigm that has a quite specific opinion about what evidence is and how it should measured. It has basically taken the "evidence" concept and methodology from the natural sciences and applied them to health-care. Thus, I am not againts providing good treatment - I am against excluding treatment paradigms/modalities just because they do not suit "the evidence based guys".
For instance; the randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition (let's call it RCT) is the gold standard regarding methodology, and the results are the evidence. However, as anyone remotely familiar with health-care would be aware of, the patients that would be suited for such trials are rarely the same patients that exist in health care.
Thus, when testing antidepressants, one excludes patients with alcohol or drug abuse, maybe patients with psychotic symptoms, severe anxiety - and let's exlude the severe personality disorders as well. Do the remaining patients represent the patients that receive the treatment? Sometimes, but most often not.
What kind of evidence then do these studies provide? Again, look at the drug-trials - patients improve 1-2-3 or whatever points on a GAF-scale or maybe on Becks depression inventory. Is that clinically significant? Well, evidence based medicine does not seem to care. But the government, who pays for treatment, cares. That's why NIMH started a huge multicenter study (STAR*D) to investigate how SSRI's work for real patients, and if they achieve the wanted results (get well and back to work basically) - which they for 75% don't.
To summarize: the method is poorly suited for many kinds of medicine, and there is evidence to back that statement up.
Second: the way trials are published today provide no way of checking wether what's written actually reflects what is done. Trust the author - basically. Which sounds like a bad idea regarding
1) authors that subscribe to a paradigm almost never publish negative results regarding their own paradigm
2) pharmaceutical companies never publish negative results regarding their own products (how strange)
3) the effect of certain pharmaceutical products totally disapears when including only neutrally funded investigations
4) It is easier to get a study with a positive result published than a negative one.
5)2 thirds of all the pharmaceutical studies are never published. And you may only wonder what the results were.
6) pharmaceutical companies have the last years been caught lying, hiding vital information both from government agencies and the journals in which they published the articles. I give you no references - you should know where to look. This has been published as editorials in most (perhaps all) of the medical journals the last years.
This is the system that produce your "evidence". The system is flawed - again a well documented fact. Do a little search in the major journals and you'll find plenty of studies.
3) Evidence based medicine is at odds at the "consumer"/patient's rights movements which has, in most western countries, resulted in laws that now state that patients must be allowed to influence treatment - especially in psychiatry. There is little room for this in evidence based medicine.
There are many more points, but I believe these represent valid objections against this paradigm. Is it the best we got? I don't think so. This far it has been used to make governments spend money on drugs that did not have their so-called effect, on drugs that had effects we never asked for, on drugs that were no better than cheaper and older drugs, on drugs instead of human resources, on drugs instead of different treatment modalities (psychotherapies, chiropractors) and much, much more.
Firstly, my comment about your doctorate was a joke about being called Dr. Evil. Chill.
>I really don't see how or why my background should matter. I assume >mine is better than yours.
Your assumption may or may not be valid. You have no "evidence" to base your assumption on. This tells me something about your deductive skills. Enough.
Anyways, your responses (1-6) do not say anything about evidence based medicine.
eg.
1) authors that subscribe to a paradigm almost never publish negative results regarding their own paradigm.
Maybe this is true, this is a problem of ethics for the individual scientist to deal with. It does not invalidate evidence based medicine.
I believe our argument is at different levels. Mine being at a lower level, dealing with the scientific paradigm/methodologies, while your dealing with problems within the real world (manifestation of the paradigm) of what happens.
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starmekitten
-= Forum Pistolera =-
United Kingdom
6370 Posts |
Posted - 05/27/2006 : 11:47:14
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Lonely P, I can't really see that you're arguing anything to be honest...
Scientific methodologies, is it fair to say when it comes to therapeutics first hand research is usually done via academic agencies such as charities or universities and then the pharmaceutical companies pick up on these and develop them into commercial use? Right?
What has this got to do with homeopathy? there's a ton of stuff out there both medical and non medical where it works but the action isn't fully understood, this doesn't invalidate anything does it?
forum ebook: end of miles |
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Ziggy
* Dog in the Sand *
United Kingdom
2494 Posts |
Posted - 05/27/2006 : 13:41:54
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| Yeah, the thing you have to be careful of is that if a flaw with conventional scientifically based medicine is discovered, this doesn't just mean that it can be used to to support homeopathy or suchlike. |
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Alternative Therapies
