dras knowledge

Friday, April 29, 2005

"It works for Me" is the definitive argument for alt med

"It works for me" may be the ultimate and definitive CAM arguemnt.

"I don't care if it is a placeboeffect, it works for me" is a usual comeback.

"What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?" Kaptchuk: Ann Intern Med.2002 Jun 4;136(11):817-25

So-called Integrative Medicine will continue to make inroads into mainstream medicine using justifications that maybe placebo is not well-understood, but itworks.

"…rather than debunking the placebo as a myth, it might be time to suggest that there is no need to abjure “pleasure” as a degradation of scientific principles and that medicine might well want to adopt an “ethic of pleasing” as one of its most valuable assets. Offering an explicit appeal to a patient’s desire (instead of covertly denying and disavowing its existence in the name of a “scientific” practice) might open up a collaborative dynamic in which we could begin to investigate more creative and effective ways to invoke the human imagination to healing ends." Ed Cohen. The Placebo Disavowed: Or Unveiling the Bio-Medical Imagination. The Yale Journal for Humanities in Medicine. Published: November 26, 2002

In academic circles, you'll recognize T. Kaptchuk as one of more prominently published and opinned on a placebo effect being used in mainstream medicine. D.Eisenberg and D. Moerman and others also should not be left out.

My simple opinion, and possibly a refute to the "it works for me" argument is:

Great! How much does it cost, and who should be paying for it? The individual, nor society has the resources to carry forward any and all things that are merely reported to "work." The best we can do is use science to fish out and predict physiological impacts of interventions, while at the same time, try to understand and advocate the kinds of things that influence an individual's perception of feeling better.

In summary, we need to be wise in order to discover which things truly are the best value.

dras

Saturday, April 09, 2005

Personal reply to anti-vaxer

you wrote:
"It's not in your best interest to see mainstreammedicine take a huge blow when people realize that ourchildren have been exposed to large amounts of toxicmercury which caused a genetically susceptible subsetof our children to become autistic, as a result ofmandated vaccines."

"It's not in your best interest to see mainstream medicine take a huge blow..."

Why would I be worried about mainstream medicine taking a blow? What interests could I have outside avoiding some kind of cognitive dissonance at being wrong? What is really at stake over the vaccine=autism issue. What can be won, personally and realistically, by individuals advocating either side? I have nothing personally at stake, unless it's the real risk to my progeny no longer having the benefit of herd immunity against some very real, very deadly childhood diseases if/when enough are frightened into abstaining from vaccines.

"...our children have been exposed to large amounts oftoxic mercury..."

Even if we all concede on this one, overly-stretched point, it no where near validates anything in the rest of the bigger-issue statement. The fact that the point is disputed suggests there is not clear evidence for it.

"...mercury which caused a genetically susceptiblesubset of our children to become autistic..."

I speculate if one focuses efforts strictly to finding a relationship of mercury with genetic susceptibility with autism, that a clear association will evolve. But, it will be one that remains weak when placed among all that we know, and do not know, about these things separately. What about all the other countless, specutively harmful compounds and substances that are ending up in our man-made ecosystem? Traces of these elements used in the food manufacturing process, for example. What are these doing genetically to our children? I bet all kinds of correlations and associations can be scientifically made. Is something different, or are these next? There are traces of "poisons" all over the place. Shouldn't we then be able to trace ANY malady or health/developmental circumstance to a trace of poison somewhere? We could dig-up and find all kinds of associations and be able to blame someone, somewhere. Some Alt-med advocates champion this global theory ofdisease, but in reality, there is scant support outside pseudoscience.

"...autistic, as a result of mandated vaccines."

This statement clearly infers blame for autism. Would it matter as much if someone could not be made at fault? What can it change now that mercury is no longer used in vaccines like it was? Could it be that it's all about trying to get somebody to be made to pay? If so, it is unfortunate, because it takes away from sincere efforts of caretakers, clinicians and researchers who only want to make their loved ones, their patients, and the world better.

To me, it looks like the scientific community is trying to understand any vaccine=autism link. But, it's becoming increasingly difficult to be objectivebecause of the stakes involved. Stakes that Wakefield bared for all to see. As a result, and this is the sad part, it's become an issue of passion and politics.

dras

Thursday, April 07, 2005

Cancer testing causes cancer? AHRQ U.S. healthcare quality report

AHRQ has a new site where there are healthcare quality reports and rankings for all 50 states.

I opened the page for my home state of Utah and looked at the information for the first quality measure: Cancer http://www.qualitytools.ahrq.gov/qualityreport/state/srt.aspx?state=UT

Percent of adults 50 and older with fecal occult blood test in last 2 years
National: 31.5%
Utah: 21.0%
Rank: 50

Colorectal cancer deaths per 100,000 population per year
National: 19.8
Utah: 13.5
Rank: 1

It's pretty obvious to me that if I don't get checked for colon cancer, my chances are better that I won't die from it.

dras

P.S. More meaningful discussion about this anomaly should first look at factors around how the data was derived, the math behind whether differences or "ranking" are meaningful, and other influences behind an apparent geographic disparity. Perhaps this can add fuel to a current debate as to whether fecal occult blood testing is even worthwhile. Which leads to discussions about Mail Order stool-DNA testing and virtual colonoscopies (neither of which currently carry endorsement from American College of Physicians, the American College of Colorectal Surgeons, and the National Cancer Institute.)

Wednesday, April 06, 2005

Hyperbaric, I must be psychic

I must be psychic. I posted the last 2 paragraphsbelow to the list exactly 3 years ago. Follow the below link for the authority on hyperbaricmedical treatment. HBO is now big business and bigmoney. Despite the business generating hype, I'm sureyou'll find little scientific evidence for HBOtreatment of CP, Alzheimer's, headache, stroke,autism, MS, PAD, Lyme disease and anything else notlisted at the UHMS site.I will suggest therapy is not too dangerous, except tothe pocket book. There is some danger in a lab notbeing certified, not using well-trained andknowledgeable technicians, and not having pulmonary MDspecialist oversight. If the lab has all of this, isa Medicare provider and affiliated with a hospital orwound clinic, chances are better that it is legitimateand safe in the care provided.DaleHyperbaric oxygen pressurization has well establisheditself in the successful treatment of “the bends”(decompression sickness), some of the more awful skininfections, CO poisoning, cerebral edema and a few other very specific conditionshttp://www.uhms.org/Indications/indications.htm). Ten years ago, you would find only one chamber in alarge metro area. Nowadays, tertiary hospitals partnerto build them in their parking lots and entrepreneursbuild free-standing chambers in the burbs. Theundersea and Hyperbaric Medical Society will certifyboth lab and technician, but certification is notrequired for them to operate. Treatments, if donecorrectly, are benign and probably don’t hurtanything. If you build it, they will come. I’msuspicious the hyperbaric empire is on its way.