The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.
One side, mainstream medicine, promotes the notion that it alone should be considered "real" medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it's dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.
If a pill or surgery won't do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.
The British Medical Journal recently undertook an general analysis of common medical treatments to determine which are supported by sufficient reliable evidence. They evaluated around 2,500 treatments, and the results were as follows:
This left the largest category, 46 percent, as unknown in their effectiveness. In other words, when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial. This is remarkably similar to the results Dr. Brian Berman found in his analysis of completed Cochrane reviews of conventional medical practices. There, 38 percent of treatments were positive and 62 percent were negative or showed "no evidence of effect."
For those who have been paying attention, this is not news. Back in the late 70's the Congressional Office of Technology Assessment determined that a mere 10 to 20 percent of the practices and treatment used by physicians are scientifically validated. It's sobering to compare this number to the chances that a patient will receive benefit due to the placebo effect, which is between 30 percent and 50 percent, according to various studies.
We all marvel at the technological advances in materials and techniques that allow doctors to perform quadruple bypass surgeries and angioplasties without marveling that recent studies indicate that coronary bypass surgery will extend life expectancy in only about three percent of cases. For angioplasty that figure sinks to zero percent. Those numbers might be close to what you could expect from a witch doctor, one difference being that witch doctors don't submit bills in the tens of thousands of dollars.
It would be one thing if any of these unproven conventional medical treatments were cheap , but they are not. Angioplasty and coronary artery bypass grafting (CABG) alone cost $100 billion annually. As quoted by President Obama in his drive to bring down medical costs, $700 billion is spent annually on unnecessary tests and procedures in America. As part of this excess, it is estimated that 2.5 million unnecessary surgeries are performed each year.
Then there is the myth that this vast expenditure results in excellent health care, usually touted as the best in the world (most recently by Rush Limbaugh as he emerged from a hospital in Hawaii after suffering chest pain). But this myth has been completely undermined. In 2000 Dr. Barbara Starfield, writing in the Journal of the American Medical Association, estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes, or physician error, making this number three in the leading causes of death for all Americans.
In 2005 the Centers for Disease Control and Prevention reported that out of the 2.4 billion prescriptions written by doctors annually, 118 million were for antidepressants. It is the number one prescribed medication, whose use has doubled in the last ten years. You would think, therefore, that a remarkable endorsement is being offered for the efficacy of antidepressants. The theory behind standard antidepression medication is that the disease is caused by low levels of key brain chemicals like serotonin, dopamine, and norepinephrine, and thus by manipulating those imbalanced neurotransmitters, a patient's depression will be reversed or at least alleviated.
This turns out to be another myth. Prof. Eva Redei of Northwestern University, a leading depression researcher, has discovered that depressed individuals have no depletion of the genes that produce these key neurotransmitters compared to people who are not depressed. This would help explain why an estimated 50 percent of patients don't respond to antidepressants, and why Dr. Irving Kirsch's meta-analysis of antidepressants in England showed no significant difference in effectiveness between them and placebos.
You have a right to be shocked by these findings and by the overall picture of a system that benefits far fewer patients than it claims. The sad fact is that a disturbing percentage of the medicine we subject ourselves to isn't based on hard science, and another percentage is risky or outright harmful. Obviously, every patient deserves medical care that is evidence-based, not just based on an illusory reputation that is promoted in contrast to alternative medicine.
We are not suggesting that Americans adopt any and all alternative practices simply because they are alternative. These, too, must demonstrate their effectiveness through objective testing. But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders.
Also, I have one ear that has been slightly deafened since an ear doctor punctured my ear drum in order to drain a clogged up ear. I later read in a woman's magazine that the process works fine on children but usually (or always?) produces lessened hearing in adults! So much for "evidence." etc.
Talk about looking a gift horse in the mouth. Very foolish.
It's so ironic that there are people making comments IN THIS VERY FORUM who denigrate the work of scientists and yet ARE USING COMPUTERS to read this.
For shame, brothers and sisters, don't go back into the caves of our prehistorical past (for you will die pointlessly from a preventable disease), come into the light. And fine, if one doesnt want to take antibiotics -dont. But for crying out loud don't hold the rest of us back.
http://www.sciencedaily.com/releases/2010/01/100105170924.htm
Lead author Kevin Fiscella, M.D.: "Therefore, our study suggests that the next step would be to intervene to boost vitamin D levels safely, with supplements."
This is only the latest study drawing attention to the epidemic of vitamin D deficiency. Will all doctors start checking their patients' vitamin D levels? Probably not. Many who claim to worship at the alter of "Science-Based Medicine" loathe the idea a vitamin or any natural substance could be good for anything. This stance has nothing to do with science or health; it's an ideology, a belief system. They sense that once they admit the value of one vitamin their entire drug-centered paradigm starts to crumble. It can't happen soon enough.
This is also not a final study or even a firm conclusion. As Dr. Fiscella states later in the article:
"Fiscella cautions, however, that not all observational studies of vitamin deficiency are borne out by subsequent clinical trials. For example, previous observational studies of vitamin E and beta-carotene that were associated with poor heart health did not hold up in later clinical studies."
A clinical study may provide good evidence to a raising of the suggested vitamin D intake levels for all individuals if increased levels are shown to improve cadiovascular health. Where do you have evidence suggesting that doctors would not monitor vitamin D levels if they were shown to be strongly associated and causing cardiovascular problems?
"They sense that once they admit the value of one vitamin their entire drug-centered paradigm starts to crumble. It can't happen soon enough."
What you are suggesting is that vitamins alone are sufficient to cure any potential illness and replace phamaceuticals, but this article, nor any other research I'm aware of makes that conclusion. Your body can only process so much vitamin at one time, once you reach your maximum intake and absorption, any further vitamins will not have any further effect.
The latest I've heard is that Vitamin D tablets (made by Big Alternative or Big Phama's ownership of supplement makers) are not as effective as a short exposure to the sun.
My guess is that as the safe daily dosages of vitamin D supplements increases that doctors may not bother to get patients Vitamin D levels, they'll just tell them to either spend so much time in the sun each day or take a pill.
You see real medicine is like the English language, neither of them really care where a word or idea originated --- they just start using it when it is useful.
Having been trained in the rigorous field of rocket science, I am somewhat horrified at the lack of rigor in medical research, and the pathetic level of knowledge as to how the human body really functions. They have yet to figure out the causes of any of the major chronic illnesses, and are still looking for the origins of our immune system. It is arrogance and ignorance that seems to fuel the medical-industrial complex, and it is a travesty to compare the medical arts with science as I know it.
Primary prevention is all about avoiding the development of disease in the first place, thus also avoiding the medical community, except in the case of accidents or injury. In other words, the goal of primary prevention is that you never have to set foot in a doctor's office or a hospital or take a drug. Primary prevention is an anathema to the medical business model, so it is not taught in medical school. In fact, it is not even a recognized discipline.
For one example of a program of primary prevention (designed by nature, not the medical community), see "The Wellness Project" .
Roy Mankovitz, Director
http://www.MontecitoWellness.com
To what chronic illnesses are you referring? And how do you define "origins of our immune system".
I do not understand your point with those statements. You are basically saying that science doesn't yet know everything. Well, that is true. If science had all the answers, it'd stop. But does that mean that you, or any other member of the alternative medicine community, knows the causes behind chronic illness or the origins of the immune system?
What kind of illnesses are you capable of preventing with "primary prevention". All illnesses or only certain kinds? Can you please describe how you would prevent Huntington's disease with "primary prevention"? There is a lot to be said for some aspects of Wellness programs, including good nutrition and healthy lifestyles, but that doesn't mean that there aren't a multitude of diseases and disorders that require actual medical treatment.
The primary prevention approach to health is an experiment in its infancy, and when results are available, they will be made public. Should you wish to learn more about it, ask your librarian for a copy of "The Wellness Project." Some persons with a strong sense of self may choose to participate in the experiment. Others may opt to follow a more traditional approach. I wish the best of health to all.
Speaking of confused - From my original comment, it should be obvious to you that the last thing I have an interest in doing is giving medical advice. My comment was my personal opinion on health, its relationship to the medical community, and the role of primary prevention in wellness. I do not advise anyone to do anything they are not already doing.
I also clearly stated that the reason I am the one commenting on and funding research in the field of primary prevention is because nobody who makes a living in the medical industry has an interest in it - no money.
On your misinformed issue of profit, read the second to last paragraph in my HuffPo profile. You will see that I donate my books to libraries, self-fund university research (that might someday help you with your personal health issues), and use profits to continue research in illness prevention. While you are there, also read the last paragraph, where I advise that I will not correspond with someone who makes ad hominem remarks. Congratulations - that now includes you.
http://www.huffingtonpost.com/dr-larry-dossey/addendum-to-the-mythology_b_416518.html
http://www.eurekalert.org/pub_releases/2009-10/nu-wad102309.php
Professor Radei: "The medications have been focusing on the effect, not the cause," she said. "That's why it takes so long for them to work and why they aren't effective for so many people."
Treating the symptoms, not the cause: "Science-Based Medicine" in a nutshell.
Also, none of those drugs can get approved with animal testing alone and would have to be tested in people in order to be approved by the FDA. Therefore, this is more of a wakeup to the pharmaceutical industry that they may go forward into clinical with anti-depressant drugs that do well in pre-clinical models, but fail in the clinic. By changing their models they may be able to prevent the expense of millions of dollars pursuing a failed clinical trial.
Depression and neuropharmacology is quite a difficult field and is not as well understood as other physiological mechanisms. I would suggest reading Dr. Mendelson's post below about the efficacy of anti-depressants and how the authors are incorrectly stating the conclusions of the meta-analyses.
Statements like this illustrate that the authors do not understand the subject matter of the study they are quoting. No one has a "depletion of genes", depressed or otherwise. The issue is the function of the gene products or involvement of the genes in the functional physiology of neurons in brains of depressed vs. stressed people. I have a difficult time lending credence to commentaries made that clearly illustrate a misunderstanding of basic (remedial) biological concepts.
"Redei used microarray technology to isolate and identify the specific genes related to depression in these animals. She examined the genes in the brain regions -- the hippocampus and amygdala -- commonly associated with depression in rats and humans.
Then she took four genetically different strains of rats and exposed them to chronic stress for two weeks. Afterwards, she identified the genes that had consistently increased or decreased in response to the stress in all four strains in the same brain regions.
Redei now had one set of depression-related genes that came out of an animal model of depression and one set of stress-related genes that came our of her chronic stress study.
Next she compared the two sets of genes to see if there were any similarities. "If the 'stress causes depression theory' was correct, there should have been a significant overlap between these two sets of genes," she said. "There weren't." http://www.northwestern.edu/newscenter/stories/2009/10/redei.html
So as you can see, there are what Redei has labeled "depression-related genes" and there can be an increase or decrease of them relative to the number of "stress-related genes"
You really should check yourself before asserting others don't know what they are talking about.
And Josephius is correct. An author trying to write about science should know that "depletion" of genes is the incorrect terminology for what Redei was describing in her paper. Nowhere did she once mention "depletion of genes" in that article you quoted.
Furthermore, that paper didn't imply anything about people. The conclusion from that paper is that the animal model used to model the drug efficacy is incorrect. Gene array studies are interesting, but also highly variable and prone to error. They provide broad overviews and, especially for translation into humans, require human counterparts that show that the genes regulated between rat and human regarding depression and stress are similar. Given that neural pathway are quite different between humans and rats, that is a study that would need to be done before any firm conclusions about stress and depression in people could be made. But, if you're trying to cure depression in rats, it is great news!
They aren't, as the authors say at the end:
-"We are not suggesting that Americans adopt any and all alternative practices simply because they are alternative. These, too, must demonstrate their effectiveness through objective testing. But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders."
Has reading become a lost art?
http://scienceblogs.com/insolence/2010/01/the_three_musketeers_of_woo_attack_scien.php
Ah yes, reading has indeed become a lost art.
The hippocratic oath is "first do no harm", if herbs are part of a regimen that includes lifestyle changes and more optimism then the client has in aid of healing besides the herb whatever indefinable inspiration called the placebo effect that initiates the body's still imperfectly understood self-healing mechanisms, without the known harmful and body system stressing side effects of drugs. Usually the mainstream medicine approach to an herb like valerian is to try to identify its "active" ingredient (patentable), distill that out and basically try to change it into a drug and see if it is effective, removing phytophenols, trace minerals, other factors that mitigate or balance out side effects, and basically defeating the purpose of trying to provide a safe alternative.
But you can certainly patent drugs derived from herbs. And even if you can't patent it, there's money to be made selling extracts of herbs. Or did you think that those thousands of pills bottles found in health 'food' stores are made and sold at cost?
And you're ignoring the role of NCCAM in the US that has funded some useful but mostly useless research. But the results of the research work only way. If the conclusion supports a herb or a supplement --- that's ok. If the conclusion doesn't support a herb or a supplement, then there is always some excuse for the way the study turned out. See http://nccam.nih.gov/research/results/gait/ as a great example.
1) Racism (ethnocentricity) - specifically the cognitive dissonance of having to admit that perhaps we conquered and eliminated a superior culture (all over the world , not just in US).
2) Money (greed)
3) The racial consequences of having burned 300 years of healers in Europe during the burning times.
Yet, truth will out. Wisdom is rising.
No, ignorance of science and the scientific method is rising.
http://www.huffingtonpost.com/steven-newton/science-denial-on-the-ris_b_413848.html
I am not a science denialist. I am, in fact, married to a very mainstream cardiologist, and I practice in the mainstream community as a psychotherapist. Having said that, one needs to look very deeply into other cultures' healing practices in order to glean the wisdom that resides there. This requires using both hemispheres of your beautiful brain. We have deified the left hemisphere in a sense and excluded other ways of knowing, other realities. Until you experience this first hand my words will make no sense. Blessings.
Although the study is old, the information that needs to be included: DID THE PATIENT DEMAND a specific drug and for one of many reasons, it was prescribed, even if there was no efficacy.
If 43% of treatment is not efficacious and physicians only issued treatment drugs based on need, then one would expect a dramatic decrease in non-efficacious and iatrogenic deaths...but the drug companies would complain. One must also remember (and factor into the bottom line) that since the studies of 2000, supposedly pharmaceutical companies are no longer supposed to provide kickbacks to physicians, etc....would that decrease the overuse of non-efficacious medicine?
I would be interested to see the same report that the British journal did for medical treatments done for CAM treatments. Are the authors arguing that their treatments would be better proven? If so, where is that evidence? Or are they arguing that all treatments cannot be proven effectively, so just do whatever you want? At that point, would you even need a doctor anymore?
duh--that's precisely the point they make at the end.
If you read the article at :
http://scienceblogs.com/insolence/2010/01/the_three_musketeers_of_woo_attack_scien.php#more
you would see that the authors here make several incorrect assertions about medical procedure efficacy, one even noted below by Dr. Mendelson. Given that I do not have access to the journal they are referencing I am unable to verify the conclusions of the studies they refer to so it is difficult to corroborate their article and its conclusions.
Can we get assurances from these individuals that they aren't willing to play the lottery for the 3% chance of a bypass extending their lives, should they find themselves in need?