The point he is saying is back pains can often be a mental/subjective phenomena rather than having physiological cause. I don't see CK "dismissing it out of hand" the fact you think he is is just bizarre.
I re-read my post and I can't see anywhere where I suggest dismissing anything. All I can see is me clarifying what I think Tarvotski was talking about in relation to the medicalisation of 'back pain' i.e. I suspected he was making a distinction between back pain that can be shown to have some physiological cause and backpain where such a cause is conspicuously absent which as we both agree is more prevalent in urban settings. You are right by the way people hunched over computers isn't good for posture yet to be fair I'd say carrying heavy equipment around on your back for years is probably worse. So I suspect we are dealing with an ultimately social/pyschological rather than physiological ailment which still doesn't mean it is not an issue. In fact to be clear I wasn't saying it wasn't a problem or that it doesn't need to be addressed. As for how I would propose dealing with recurrent back pain that seems to have no physiological cause? Physio therapy, exercise, massage, relaxation treatments, swimming or maybe... if the person is so inclined some sort of counselling to see if it is stress related and if it can be addressed that way.
The fact that a physical cause cannot be found does not mean that one does not exist. It just means that no reliable test exists or if they do that they are too expensive to be considered for use on a large scale. A sprained muscle is an example of such a cause.
By "medicalisation" I was referring to the idea that things always have a reductionist simple cause and effect, and therefore can be treated simply like that. eg you contract an infection, therefore you take antibiotics to cure it. With the case of back pain, as people have pointed out there are all sorts of factors that influence it, so going to the doctor expecting a miracle cure is unrealistic as is thinking that one pill/one treatment of accupunture/whatever will sort it out, when probably what is needed is a realistic assesment of lifestyle and certain changes to that. Ben Goldacre makes very good points about how in australia they managed to reduce instances of days off caused by back pain... how? By educating people about the issue and saying how it's not a serious medical issue: http://www.badscience.net/?p=542#more-542
This seems to be implying that everything must have a physical cause, is that what you meant? You also say "sprained muscle", which is confusing at best since you can get "strained muscle" or a "sprained ligament", but not a "sprained muscle". I'd of thought you'd have known that... Anyway, both are quite simple to diagnose. I've had it done many times in my life, so either you are talking about something different or are you reffering to the use of MRI's for determining the level of ligament sprain is too costly??
Remember in the UK we have the NHS... if someone was suffering from chronic backpain for a number of years I'm quite certain they would undergo a battery of tests. When I damaged my leg and was finding it difficult to walk I was given an X Ray which didn't reveal what the doctors expected now in the picture your painting I'd have been told it's all in my head and given some pain pills. Instead I was sent to see a consultant and a physio and it was quite quickly discovered I'd ruptured my quadriceps. Anyway, that's just a personal anecdote but my point is that mystery illnesses aren't just dismissed when the cause isn't apparent. However, if after in depth examination no physiological cause can be found it's not really all that daft to conclude it's probably mental. Your point that a physiological cause not being found doesn't mean it's not there is valid but conversely I would argue just because someone has symptoms doesn't necessarily mean they have a physiological based problem.
One treatment for psychosomatic pain that I’ve heard good anecdotes about is to educate and raise the awareness of the person experiencing the pain as to how the mind can restrict blood flow to muscles as a response to stress ect. It worked for my dad when he had a frozen shoulder. It was surprisingly effective. I also new a student in Canada who had some back pain and she did some visualization during breathing meditations, I think visualizing things like white light or blood flowing to the area where the pain was and dark energy or pain flowing away from said area. Apparently it worked for her. I’d take a wild guess and say she probably increase blood flow to the painful area. I also had a friend a while ago with a suspected psychosomatic stomach complaint and as soon as someone explain psychosomatic symptoms to him said he felt like a light bulb went on and he felt a lot better. Admittedly these where all people that I'd describe as a high natural capacity for understanding psychological phenomena. i.e. reflective types This link is a book on psychosomatic pain my dad says really helped him with his frozen shoulder http://www.amazon.co.uk/Healing-Bac...=sr_1_1?ie=UTF8&s=books&qid=1201743987&sr=1-1 PS. I woun't be offended if anyone says it's rubbish
The suggestion that 'science' provides conflicting information and is therefore unreliable suggests a fundamental misunderstanding of how science operates. As you know Taoquan science updates with new evidence and as you also know different studies focus on different things. Take for example the issue of whether wine is good or bad for you... if you only read newspapers it sounds like 'science' has no idea and changes it's mind every week. This isn't true however if you actually look at the studies you get a very different picture... a glass of wine may be good for some things and bad for others and in fact it can be. 'Science' doesn't have one single voice it has many all vying for attention and the ones with the best evidence are the ones that become part of the consensus. However, in most cases thats not even relevant as the studies don't contradict when you actually read them. In cases where they do then the methodology of the studies needs to be considered closely- whose evidence is more compelling? The fact that the mainstream press doesn't provide such an analysis or presentation is not a failing of the scientific method its a failing of the mainstream media and occasionally of boastful or careless statements from specific scientists. Now as to the quote above... there seem to me to be quite a lot of problems with the arguments you make. I'll number them so you can respond without having to requote me and because it makes it tidier. 1. There are theories as to why acupuncture may produce beneficial effects. The point as Topher has highlighted is that such theories usually predict that it's the actual act of sticking a needle in which causes the effect not the claimed method of unblocking chi and whatnot. These theories seem to be quite well supported by the fact that sham acupuncture frequently performs just as well as real acupuncture in trials which demonstrate an effect. 2. Next the percentages; well first of the 35% as discussed already is not really a scientific figure it's been discredited. Next, even if this was the magic figure of placebo response that would mean that out of a 100 we should expect 35 to claim an effect even if treated with a placebo. Your claim that this figure cannot account for the other 65% would only make sense if we accepted that acupuncture worked 100% of the time. We don't accept this as the evidence isn't there... 3. As for the 'keeping an open mind' and 'worth looking into' because of a possible statistically small effect these are the same kind of arguments made for psychic research which should ring alarm bells. As Topher has pointed out in better designed trials the statistical effect tends to decrease or at least be on a par with the sham treatment which is what we should expect to see if the claimed treatment is actually not the reason for the effect. I'm not saying acupuncture trials shouldn't be done by the way I am just saying that your argument as to why they should be done doesn't hold up. Flip it around for a second... is there any clinical evidence that would convince you acupuncture was not an effective treatment or at least not effective for the reasons you thought? I doubt there is because you will, I imagine, always place your experience of helping people above what any trial says. Thats fair enough (and if I'm characterising your position wrongly then please correct me) but then I think it's worth realising that your only interest in clinical trials is to prove what you already have concluded and not because thats what the clinical evidence is suggesting. Taoquan this seems to be taking an absurd position about environmental effects on drugs. Drugs work on the body in specific ways. Yes no two individuals are the same however why do you think penicillin works in every environment in the world? People have different diets, different jobs and different exposure to 'toxins' so how could the drug possibly work if environments are as powerful as you are arguing. Diet and such can be important factors but were they are they are taken into account... how do I know? The medical trial I took part in involved different diets to measure how it effected the absorbtion and effects of the drug. Using Mao's support as an argument for TCM I didn't think I would see such a thing from you. Settting Mao aside for a minute the problem of accepting the 2000+ years of empirical evidence for Chinese medicine is the same problem with accepting any ancient 'empirical evidence'. To name but a few: 1. Many long practiced and well supported treatments we know to be harmful or useless. If we relied on numbers of historical testimonials then blood letting should certainly be a major Western and TCM technique. 2. Medical accounts from long ago are notoriously difficult to verify and frequently contaminated by the desire of the recorder to promote their brand of treatment. 3. Following your logic supernatural based healing is probably the most well attested treatment in accounts. So surely all those cultures with all those testimonials must prove that various Gods do in fact heal people! Right? Now to get back to Mao. Mao is I think we could all agree not a man with a famous sense of good judgement (remember the great leap forward responsible for many millions starving to death?) so why his opinion on acupuncture should be valued is certainly an issue. However, regardless of this one needs to look at the context of Mao advocating TCM and when you do you see quite clearly that he was trying to big up Chinese culture as being unique and just as advanced as it's Western counterparts. The 'scientific' agencies he set up to investigate TCM are known to have been mostly sham-arific and to just publish pseudoscientific results that pleased the party. In summary I really doubt that Mao being a patron of TCM is a point in it's favor. Taoquan what if not Qi and meridans may I ask is the essential logic for acupuncture then? Your not pushing the needles into the circulatory system (veins and arteries) as far as I'm aware so it doesn't seem likely it's based on blood flow. The issue I take with your arguments is that if you look into the evidence you are using to arrive at them you come to a very different conclusion... looking at the example you yourself chose to highlight: It is about a total over the space of a year of three very young babies (under 6 months old!) dieing most likely from taking cold medicine. The fact that their autopsies showed a drug compound "in amounts nine to 14 times the levels recommended for children 2 to 12 years old" suggests that perhaps this is not a case of effects not being known and more a case of people not using medicine as directed! Next is the fact that all the people critical of using such medication on children are doctors who clearly state that there is no evidence for its beneficial effect "Cold and cough medications, especially medications containing pseudoephedrine, have never been shown to have any beneficial effect on children less than 2 years of age, yet they clearly can have significant harmful effects". So again what you this article supports is an argument for stricter controls on drug and better education for parents about what medicine is suitable for young children it does not support that drug effects are mostly unknown. The other thing you post is simply a web search and is not really that useful for illustrating your point; if I type in acupuncture and pseudo science and get 4 million hits does that prove to you that acupuncture is a pseudoscience? If I'm making an argument I should do the legwork and provide you with evidence that supports my argument not simply state the evidence is out there and post a google search. No it doesn't not when read in context. In context it is clear that the FDA is agreeing on principle that in extreme cases say terminally ill cancer patients that if the potential for benefit outweighs the risk it will not prevent people from having access to new drugs. That's not sinister. This is such a silly argument! And under these grounds most alternative medicine is much worse off than mainstream medicine as such studies are usually much smaller and show very statistically small effects. You were just earlier in this post claiming that if there was a 10% benefit in a study it's worth looking into and now because it suits your argument your arguing a 40% effect in a large study is worthless. It's a very inconsistent argument overall. Your belief that studies in a number of hundred or thousands of people are useless because they don't compare to the number of people in the US is a really, really silly argument. It seems to me also that you can't honestly believe it and are just making it so that you can continue to argue that A) environmental factors make drug studies useless and B) alternative medicine is just as likely to be effective as mainstream medicine as clinical trials can't be done on the entire population. In a very real sense this argument is anti-science i.e. promoting uncertainty as the basis for the validity of treatments. Your showing the facts by taking quotes out of context and making understandable things sound sinister. Which is in keeping with seeing the FDA as part of the big, bad corporate medical establishment. I would also contend that the common view of the FDA is not actually as uncritical as you claim as it does seem quite apparent to me that almost everyone is critical about some aspects of the FDA. Which I think is related to it's role.
I would if I had access to it. I've only read it from the various online sources many of which I posted. I was referring to the testing stage where there might be conflicting data. Once a drug has been approved there will be enough data to ensure that a) it is safe and b) it works. I find it hard to believe that a drug so dangerous that it can kill a person manages to slip though the rigorous clinical trials. As I said before, if that has happened then it may be due to an individuals reaction to the drug rather than a danger to the majority or like the cough medicine, a failure to follow directions. Well since something psychical is taking place it isn't impossible that sometimes, in some cases, an effect beyond a placebo is taking place (e.g. the needles may actually do something positive) however I've not read anything that would convince me. I'm not just dismissing it, I hold this view since pretty much every well designed study suggests it is nothing more than a placebo triggered by the process of acupuncture. Could the insertion of the needles be causing an actual effect? Maybe. However I've not read any mechanism explaining how the needles could cause such an effect. In trials they will ensure for all sorts of variables so they can be sure the results are due to the drug and not something else. It's why they include the likes of control groups. It's why patients are randomised. It's why larger studies are better than smaller studies. In the end, if the drug is having an actual objective effect on someone then they will know. The trials are designed for specifically that reason. When a trial is poorly designed it means the design and methodology of the trial cannot ensure an objective effect. Well I get the impression that you and many others alternative medicine advocates wonder how a doctor or advocate of scientific medicine can be critical of CAM when there are 'problems' with 'western' medicine. Why else would the so-called problems with scientific medicine be raised? Since we're taking about the efficacy of herbs and now acupuncture I don't see the relevance unless of course the CAM crowd are trying to suggest the 'western' doctors need to get their own house in order first. Appeal to tradition & numbers in the same line! The fact TCM is old and lots of people think there was a real effect doesn't mean anything. Numbers don't mean anything. 'Western' medicine may not be as old, but it has achieved far far more. Because they believed it worked. By your logic, there must be something to every religion otherwise why didn't people "throw it out". But it's basically the root philosophy of it. Other stuff/terms are just added into the philosophy later in order to try and square it with new medical knowledge but it still rooted in chi! Can you link me to the 2000+ year old theories of the cardiovascular system and blood flow movement? Much appreciated. Simply directing me to generic search engines results doesn't really help. I could have done that myself. This sounds like it was the fault of the parents who gave medicine designed for 2-12 year olds to 6 month old babies! "Cough and cold medicines can be harmful, and even fatal, and should be used with caution in children under 2 years of age," said the study's lead author, Dr. Adam Cohen of the Epidemic Intelligence Service at the U.S. Centers for Disease Control and Prevention. "They are drugs, so they have risks as well as benefits." That sounds like good advice to me. The article states that "medications containing pseudoephedrine, have never been shown to have any beneficial effect on children less than 2 years of age" In any case, it looks like someone wasn't following the instructions: "Autopsies of the three deceased infants revealed that cold medications were the cause of death. All three infants' medical examinations showed high levels of pseudoephedrine -- the nasal decongestant ingredient in cold medications that can be used to make meth and was recently removed from many cold products -- in amounts nine to 14 times the levels recommended for children 2 to 12 years old." Well this is just a clear misunderstanding of the process. You do realise that clinical trials can potentially take *decades* to complete? The six months you mentioned is to review the results of the trial, which as I mentioned is a long time compared to Europe. How can you say that they know little about the drugs when they spend years if not decades understanding them. Most drugs don't actually make it to an FDA review because they don't make it passed the trial itself! It's large enough to ensure the drugs works. That would however only be one stage. The drug/treatment would have gone through chemical testing, then animal testing, then a few small scale trials, before the final large trial (should it even make it that far).
CK, As always I enjoy that you keep it simple and respectful. I do enjoy that you are able to point out holes in my arguments, cause it helps me learn. As I mentioned I am not a "science person" but when I get in good discussions with people like you, topher etc. that keep it civil it is nice that I can learn from you. Thank you.
Topher, please see my explanation to CK about how much "rooted in Qi" it is. also sorry but I will try to find an internet source for TCM explaining blood flow etc. but I have not come across any. It is more found in the classical writings of TCM such as the Nan Jing, Nei Jing, even some in the Jia Yi Jing and Mai jing. so aside from recommending the books I am not sure I can provide a link for you sorry.
Thanks for the reply Taoquan I'll get round to looking at it properly later and I feel the need to mention again that although it may not always come across in my replies I do respect your ability to have thorough and well thought out debates. And it's not just you either in light of this discussion I've found myself researching alot I hadn't looked at before... so my thanks to everyone involved. Even when I'm calling an argument silly it does make me have to think hard about how to explain 'why' exactly I think it is silly. Anyway, appreciating the civil responses and hope you can all put up with the occasionally heated tone in my posts if it helps I can assure you I'm not ever actually properly annoyed.
I wonder whether it is worth continuing the discussion then? I mean, if no clinical evidence can convince you that acupuncture doesn't work! Even spending a month with a TCM practitioner wouldn't be anywhere near as good or worthwhile as well-designed large-scale clinical trial. Not only can people be fooled, they also fool themselves. Everyone does. For that reason subjective, personal experiences really are a poor basis for claiming an actual objective phenomena is taking place. In clinical trials it doesn't matter what you or the researchers believe because the trials are designed in such a way so to minimise the influence the variables will have on the outcome. WOW! I don't even know where to begin here. Science is not just a show of hands! Because how can you design a treatment when you have no clue what is actually happening? I would question the ethics of providing a treatment and relying purely on a placebo effect taking place (especially if it's claimed to be something which it clearly isn't). If it is something other than a placebo then I would question it being offered to patients when you don't know how or why it works. Also, whether it works should precede how it works. If you think testimonials are proof then what happens when the testimonials are contradictory? How do you decide, which of course you must do, since you can't hold both as true. A clinical trial can find this out quite easily. Give one group real acupuncture at the points described above and give second group sham acupuncture (e.g. placing the needles at 'points' not near arteries and not as deep). A quick test can then see if the blood circulation has increased in either group. If what your are suggesting is true the real acupuncture group should see positive results while the sham acupuncture should see negative results, however if there is no significant difference then it would suggest placebo (i.e. that it doesn't matter there the needles go, which would be in line with other trials). I was assuming you had something in mind when you made the claim. I completely agree with the criticisms of the US medical system. I find it repulsive that profit making should have anything to do with health. I much prefer the UK system. For instance, my stepdad has some health problems (diabetes, angina); he receives free medication, doesn't pay for any doctor visits and gets free equipment such as electric arm chairs. I'd rather pay higher taxes for a national health service and if I don't use it much, well then I know my contribution is being used by other in need rather than going into the pockets of corporations. In any case, for all the faults of the US healthcare system such as those you've highlighted above, it doesn't speak of the effectiveness of the medical research side of it. No worries I'll see if I come across anything.
I'd say it's a pretty fair assesment. Some trials have shown some positive effect and in these kind of cases I think A) further studies should be done to see if the findings are replicated in subsequent trials and B) it's fair enough to promote Acupuncture/TCM as a theraupeutic treatment were a positive effect is established. I'm by no means agains Acupuncture or TCM as a treatment when the evidence supports it. As for scientists you are correct that there are multiple voices on the topic there are some who are staunch supporters of TCM but as I also pointed out in the last post when scientific opinion differs it is the strength of the evidence that should cast the deciding vote. Ack... gotta go out again. Continue later.
Oh, one thing you may find with looking into that is a quick line I can offer you about TCM and cardiovascular: "The heart is the governor of the blood, it moves the blood and nourishes the blood. The liver stores the blood and purifies the blood." Sounds familiar to Western medicine doesn't it? Some discussions like this is found in the Nei Jing and Nan jing, written (estimated) about 250 B.C. Thanks again for your replies.
CK, I am in agreement with you. It seems that you are saying that your problem with acupuncture (or any other forms of treatment for that matter) is that they are making claims that are not true? Would this be fair to say? If you are saying this I too am in agreement with you.
Well it seems futile talking about clinical trials and the evidence against acupuncture if nothing can change your mind. Who said the people doing the research doing the trial don't know about acupuncture? The point is spending time with an acupuncturist may be useful in understanding the practice/process but it is absolutely useless for demonstrating an actual effect. What does my knowledge or lack of knowledge acupuncture have to do with the outcomes of the trials? Nothing! I know enough to understand the philosophy and claims being made even if they are wrapped in scientific sounding buzzwords. I also know enough to review the data of the trials. This is more than enough to come to a conclusion on the objective nature of acupuncture. I can send my entire life researching it yet it still won't change the outcome of the trials. Clinical trials are a far bit more than a chat around the water cooler! It seems you're simply assuming I lack knowledge of acupuncture due to the fact I am critical of it. The reason I am critical of it because there is no evidence it works. And I find it a bit rich for you to criticise me about researching and understanding when you've exhibited quite a lack of understand about basic science (i.e. saying science is "quite frankly is a social consensus") and you've basically admitted just a few posts back that don't care about outcomes of the trials. It depends what you're implying when you say agreement. Scientific consensus (i.e. agreement among scientists) is an informed judgement based on EVIDENCE, and the evidence is what it is. The scientific consensus will gradually start to form while the evidence is building, as more and more data arrives that consensus becomes stronger (climate change is a very good recently example of this). Plausibility, the law of parsimony and how a hypothesis fits in with other well established theories also play a key role in a consensus. It is not however an agreement based on desire, or personal belief, etc. http://en.wikipedia.org/wiki/Scientific_consensus No, you think you know how and why, based on the philosophy behind it, but it consistently fails in the trials. If science cannot show it then it is probably because there is no effect. I can't think of anything other than the rigour of the scientific method which can establish a actual objective phenomena. Yet the methods of science are the best to establish if it is true. It has been tested. It doesn't do well. The root ideas of TCM are pseudoscientific and are contrary to what the the evidence says. As we've repeated numerous times already, virtually all of the well designed studies suggest it is a placebo. And as I've also said, since something psychical is taking place it's possible that there is something beyond a placebo as a result of the needles however so far there is no convincing evidence of this. In any case, what does it matter since the studies are irrelevant to you, right? Two problems: 1. What relevance is this? 2. Drugs offered to the public would have had the placebo ruled out. A drug that was just a placebo would never ever get passed. 3. Even if your comment was true (it isn't) why is it relevant to whether acupuncture works? I can only conclude you're trying to make an tu quoque fallacy here. No. I can't remember the details but I have read of GPs giving placebos (i.e. sugar pills) to patients who kept returning for I think conditions which are so minor that they didn't need medicine or where the patient becomes dependent on a drug. Perhaps the ethics of that is somewhat questionable. I'll try to find the original article. Well you think testimonials are suitable evidence, right? Well what if there are a bunch of testimonials for a particular event, but also another bunch of contradictory testimonials for the same event. Clearly, both cannot be true. Example: there are testimonials from people in the lifeboats at the sinking of the Titanic who were quite convinced that she split in two before she sank. There were testimonials from others who were also in the lifeboats who were quite sure she sank whole, thus illustrating why testimonials are not a good basis for evidence. So, given two or more contradicting testimonials, how do you decide which are true? Here's a video lecture on critical thinking, including why testimonials are not good: http://www.skepticscorner.com/Mental Muscle.m4v (it's quite a big file at 235MB however it's worth the watch). It's more than sufficient. If inserting the needles into points near arteries did what you say it should the only the group which received that treatment should get the results. If there is no significant difference between the two groups then it disproves that hypothesis and suggests that simply inserting needles into the body it sufficient to produce an effect (be it a placebo or something physiological/real). In any case, simply sticking needles into the body isn't acupuncture is so the result would not be a 'win' for acupuncture. This is a fallacy of arguing from inductive uncertainty. While it could be an actual physiological effect resulting simply from the needle insertions, as I said above that alone isn't what acupuncture is about is it. That be said, since there is no current evidence that it is a physiological effect the most probable explanation is placebo. Of course... it isn't impossible... but just realise that no acupuncturist want's to be hyping-up that conclusion. If it doesn't matter where you stick the needles (i.e. they're random) as the evidence suggests is the case, then it actually discredits acupuncture. Unless acupuncture receives positive claims for exactly what acupuncture states will happen, it can't be regarded as a 'win'. Well clearly these people should be tried and jailed for fraud and endangering the public! Do you have any any specific cases in mind? These are just corporate suits looking for a profit which as I mentioned I find repulsive. I'm not entirely sure how it would work anyway since as far as I'm aware drugs are not passed to the FDA for approval unless they pass all the clinical trial phases (i.e. for a drug to get a final large-scale trial it must have been successful in the previous trials). I find it unlikely that the clinicians would be willing to participate in such frauds.
