Wednesday, June 30, 2010

Medical Controversy: Much Ado About Nothing...

No... this is not a post about the placebo effect. That's not the nothing I'm talking about. Well actually I may end up talking about placebos but that's not the nothing I want to start with. The nothing I want to start with is homeopathy.

I mentioned quickly in Anatomy of a Comment about the homeopathy debate going on in the UK. I mentioned one of the groups that is fighting the pseudoscience and quackery of homeopathy is 1023.org.uk. But a much simpler description of homeopathy and the lack of good science behind it is a long comic strip by Darryl Cunningham called simply Homeopathy. Which not only covers the lack of science behind homeopathy but covers some of the reasons it may work. Reasons that have nothing to do with the dilutions themselves. This may be a case of things working but not for the reasons expected by the practitioners. It ends with some scary reasons why homeopathy, and especially its practitioners, may be very bad for people instead of just merely harmless.

Still it seems like reason and evidence is winning this battle. It's getting harder for practitioners to make unproven claims. This makes sense. People who make claims have to be able to show the claims are valid. All the hard science seems to disprove the claims of homeopaths. Most, if not all, of the basic claims as to how homeopathy work have been repeatedly shown to be false.

But even without digging too deeply the pseudoscience behind homeopathy doesn't make any sense. If water could have a memory of what is was in it at one time and later diluted away then how do you delete the memory? How do you reset water to not have the memory of anything? And wouldn't that mean that tap water would have the memory of every chemical used to make it safe? And wouldn't every stream or lake have the memory of every chemical or agent that had been diluted in it?

Of course many people swear by homeopathy. They're convinced it works and they are convinced it helped them in some meaningful way. As I mentioned the cartoon covers some of the reasons it may be helpful to visit a practitioner. It also covers the reasons going to the practitioners may be harmful to your health as well. He gives good examples of how practitioners have been repeatedly shown to not suggest mainstream medicine in conjunction with their homeopathic remedies. The specific case he mentions of Penelope Dingle is very disturbing on several levels.

Alternatives as a supplement to mainstream medicine is one thing. Alternatives that exclude proven medical treatments are another thing altogether.

Yet what also caught my eye in the cartoon was the line:
There have been many attempts to reproduce Benveniste's experiments. But any positive results have been neither consistent or convincing. All evidence points to homeopathic remedies being inert and no more effective than a placebo or just letting the illness run its course.
Which got me thinking about all the intangibles that effect each and every one of us when it comes to illness and health. The placebo effect is one of those. Attitude and outlook are also mentioned repeatedly as being important - even by mainstream medical practitioners. But not every placebo works. Not everyone with the right attitude survives and people who are pessimistic about their chances aren't always proven right. These are effects that are hard to quantify and hard to measure. How do you measure a patient's outlook? How do you tell if they are feeling depressed with their situation or if they have an overall positive feeling instead? How do we begin to quantify and understand the more intangible factors?

And if, for example, you have some sort of measurable sense of how a certain attitude affects outcomes in positive ways for certain diseases... how do you prescribe an attitude?

2 comments:

Lene Andersen said...

I would love to see well-designed, thoughtful research on the placebo effect itself. Instead of just leaving it out there hanging, why not study exactly what it is, what it does and why it can make so many people feel better.

It says something about our mental powers, consciousness or whatever you want to call it that we can affect our own body in such a way - the mind- body connection is powerful and could be a valuable tool in fighting disease, but only if people would start studying it. And by "people" I mean the medical profession - there's a lot of work on the mind-body connection in the "flakier" areas, but the medical profession tends to not consider those fields anything but ridiculous, yet inexplicably (so far), the placebo effect works.

David Govoni said...

You're more than a little ahead of me a little. There has been a lot of research on what I ended up calling the intangibles. Not just the placebo effect but also the impact of outlook and attitude and the impact of prayer and belief for example.

I didn't cover that work here because I wanted to look at homeopathy and save the rest for later. I don't always foreshadow well.

Yes the 'flakier' side has put a lot of writing into the mind-body connection. Some of it may be considered research but much of it isn't. And, as I hinted, I keep reading where members of the orthodox medical community admit that attitude and outlook are an important part of health and well being. Much of the mainstream isn't against those ideas at all. It may be against the pseudoscientific explanations but it isn't turning a blind eye to something that seems to work. Still... (and this is my point and not one from any medical professional) how do you prescribe someone to be upbeat about their chances?

I'm still collecting articles and links that look at the more intangible pieces in the puzzle. There are a number of controversies that rage in those areas. One in particular deals with prayer. In some studies prayer has been shown to have no significant influence on outcomes. I find it telling that research has been done honestly and openly on the topic and yet when the results don't match the expectations of those that promote prayer... well... you can imagine how they react.

However I'm still looking for the best summaries and syntheses of those types of research.

As usual you're two steps ahead of me.