Talk:Alternative medicine

Previous discussions are archived here:

• Talk:Alternative medicine/Archive 1
• Talk:Alternative medicine/Archive 2
• Talk:Alternative medicine/Archive 3
• Talk:Alternative medicine/Archive 4
• Talk:Alternative medicine/Archive 5
• Talk:Alternative medicine/Archive 6
• Talk:Alternative medicine/Archive 7 (May 17, 2004 - May 28, 2004)
• Talk:Alternative medicine/Archive 8
• Talk:Alternative medicine/Archive 9
• Talk:alternative medicine/archive 10
• Talk:alternative medicine/archive 11
• Talk:alternative medicine/archive 12

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Major revisions to Alternative Medicine article

As discussed previously, some feel that this article is a mess and needs major reorganization and editing. The amount of information dedicated to defending and critiquing alternative medicine as a whole is inordinate. Since the validity of alternative medicine inherently depends upon the validity of the various methods and treatments that fall under its heading, most of the information defending and critiquing the broader alternative medicine category should be moved to those specific articles. Does anyone agree? Does anyone disagree? Are there suggestions on what we can trim or move while keeping a NPOV? Edwardian 2 July 2005 00:01 (UTC)

I don't think the amount of information is inordinate. It should just be presented more clearly; I agree that the article could use major reorganization and editing. Most of what's specific to a particular therapy should be in that particular article, but this article doesn't devote excessive space to such material. Occasional citation of a study, as an example of how practitioners and opponents assess alternative medicine, is a reasonable way of illustrating some points, even though most such studies necessarily examine only one form of AM. JamesMLane 4 July 2005 04:58 (UTC)

Edwardian, I disagree. I think that it is important to include these defences and criticisms in this article about a highly controversial topic. Axl 7 July 2005 07:42 (UTC)

Alternative medicine and the law

This is from the section entitled "Alternative medicine and the law": Legal jurisdictions differ as to which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service. Regulation does not, however, necessarily reflect the effectiveness of the methods used. Some practitioners and branches of alternative medicine have been investigated by governmental agencies for health fraud, and in a few cases criminal charges have been brought. I am going to remove the last sentence. Fraud is not unique to a practitioner of alternative medicine, and if certain branches are more likely to be investigated I suggest that we discuss that within their specific articles.Edwardian 4 July 2005 06:47 (UTC)

Testing and studies

This is from the section entitled "Testing and studies": The scientific community argues that many studies carried out by alternative medicine promoters are flawed, as they often use testimonials and hearsay as evidence, leaving the results open to observer bias. They argue that the only way to counter observer bias is to run a double blind experiment, where neither the patient nor the practitioner knows whether the real treatment is being given or if a placebo has been administered. This research should then be reviewed by peers to determine the validity of the research methodology.

Testimonials are especially useless in this procedure, because by chance alone some people will get cured and will be able to testify that the method really helped them - this can be explained by post hoc reasoning of the regressive fallacy. Furthermore, if the majority of people using a method do not notice any benefit or even get worse, there will still be a minority that can testify that the method really helped for them. [2]

I reworded the first sentence then deleted the rest. It is beyond the scope of this article to explain proper study design. The main section is entitled "Critcism" so it should suffice to say that critics contend that there are few well designed studies to support alternative therapies... or something like that. Edwardian 4 July 2005 07:41 (UTC)

I think the former language was too wordy but truncating it to only the first sentence errs in the opposite direction. We shouldn't just say that some people don't accept the evidence offered by AM proponents; we should give some further explanation of the grounds adduced by the critics. (Some AM proponents ascribe all criticism to greed on the part of orthodox doctors and scientists who don't care about truth and seek only to protect their lucrative turf.) We don't need to provide a complete primer on study design. Certain recurring issues are common to many forms of alternative medicine: Testimonials are useless because of observer bias and selective memory, and valid tests must rule out the placebo effect. A short explanation of these issues can link to Observer effect#Observer bias, Placebo effect, and Randomized controlled trial. At present some links are there, but the linking is spotty, a symptom of the need for improved organization. JamesMLane 4 July 2005 09:24 (UTC)

I am removing the following sentence as itNearly all mainstream doctors and scientists are open to revising their views of any specific new treatment, if new peer-reviewed evidence comes available. And many have, such as the physicians quoted above. We don't know for sure what "nearly all mainstream doctors and scientists" think, however, the fact that "[t]he boundaries of alternative medicine have changed over time as a number of techniques and therapies once considered to be 'alternative' have been accepted by mainstream medicine" makes the comment unnecessary. Edwardian 6 July 2005 00:36 (UTC)

references

I have changed the references list to now be in alphabetical order. I have also made them all have the same format, a commonly used one that you can find in journals like the annals of internal medicine. The key thing now is consistency. Please could anyone who adds a reference use this following format:

Author Initials, second author initials. "title" journal name, year; volume(issue): pages.

The date is irrelevant except for the year. No links in the reference except at the end of the reference.

This is really important for the professional organisation of an article which cites references and not is not me nitpicking.

I have also altered the contemporary use section.

PhatRita 8 July 2005 13:23 (UTC)

Section entitled "Medical education"

Regarding today's addition: Skeptics would argue, however, that it has acupuncture has never been shown to be effective in healing anyone of anything, though some people have been hurt by it by either the practice itself directly or indirectly by subsequent avoidance of conventional medicine. It is notable that the aforementioned British Medical Acupunture Society fails to mention the metaphysical implications of acupuncture on their website, and actually makes a conspicuous error in effectively denying them. The section is entitled "Medical education", not "Criticism of accupuncture". The points in the first sentence regarding concerns about efficacy, direct harm, and indirect harm have already been stated previously in the article (see Alternative_medicine#Criticism_of_alternative_medicine). I assume that the "British Medical Acupunture [sic] Society" was offered only as an example of education offered in alternative medicine, so it's a bit irrelevant to rebut acupuncture claims here. Can an someone suggest why these comments should stay here and not be moved to acupuncture? Edwardian 21:54, 18 July 2005 (UTC)

they don't belong in acupuncture either: see the section below.PhatRita 18:59, 19 July 2005 (UTC)

I'm OK with that, too. I wanted them out of here and thought I could "pass the buck". Edwardian 07:32, 20 July 2005 (UTC)

Maprovonsha172's edits

In the UK no medical schools offer courses teaching courses in clinical practise of alternative medicine. However, alternative medicine is taught in several schools as part of the curriculum. Teaching is based mostly on theory and understanding alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. To obtain competence in practising clinical alternative medicine, qualifications must be obtained from individual medical societies. The student must have graduated and be a qualified doctor. The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example. Skeptics would argue, however, that it has acupuncture has never been shown to be effective in healing anyone of anything, though some people have been hurt by it by either the practice itself directly or indirectly by subsequent avoidance of conventional medicine. It is notable that the aforementioned British Medical Acupunture Society fails to mention the metaphysical implications of acupuncture on their website, and actually makes a conspicuous error in effectively denying them.

I removed Maprovonsha172's edits in bold. "Never been shown to be effective in healing anyone of anything" is false. (See acupuncture.) "Conspicuous error" is decidedly POV. And it is not particularly notable that the BMAS fails to mention the metaphysical aspects, as they are not relevant to Western science. --Dforest 02:23, 19 July 2005 (UTC)

I beg to differ on all counts. If you take the metaphysical "aspects" out of acupunture you're taking away the essential element. In effect, you would just be poking people with needles. Acupuncture is the practice of placing needles in certain key points in order to unblock Chi, a non-physical force which certain pre-scientific people believe pervades all things. It is a conspicuous error to fail to mention the metaphysical basis for this practice, and effectively deny it. Moreover, it is a fact that acupuncture has never been shown to be effective in healing anyone of anything and if you think otherwise you ought to tell James Randi and he'll give you $1,000,000, or £574,538.69 for our British friends. To show that acupunture heals to show that unblocking Chi heals, but few people believe Chi exists.

Needless to say, I'm going to change it back. Maprovonsha172 19:59, 20 July 2005 (UTC)

acupuncture may have started out with such theroetical bases but it has certainly changed and evolved. Western acupucnture involved the idea of needles inserted into certain junctional areas of nerves which mediates a descending pathway activation of nervous release of endogenous analgesiacs in the brain. The theory is consistent with Melzack & Wall's theory of pain (1960), the widely accpeted portrayal of pain by the medical community. The fact that fMRI studies show what my lecturer calls lines "like a christmas light" which go off, that acupuncture alters firing rate, not to mention the systematic reviews quoting its efficacy in at least osteoarthritis (see main text).

so the Moreover, it is a fact that acupuncture has never been shown to be effective in healing anyone of anything comment is disputed at the least and more likely, false.

The "essential element" that you suggest is merely a starting point for a different kind of understanding for modern medical acupuncturists who adhere to the western principle of nerve junctions, of which the BMAS is the statutory body for. Ie in one form of acupuncture the basis for diagnosis may be metaphysical, but in another form, the western form, it has credible mechanisms and a whole different philosophy.

In short, in eastern, the acupoints lie on meridians, in western, the acupoints lie on certain nerves. The points are the same.

I resent the comments about pre-scientific, it is totally not necessary and I would imagine to be somewhat offensive to TCM practitioners and other alternative practioners. Please excuse the poor Chinese people who did not have immunohistological staining techniques and electron miscroscopes back in the 30th century BC to make sure that QI not chi exists.

and finally if you have points to debate about acupuncture in particular, please put it in the actual acupuncture entry.

Ps James Randi is there to prove supernatural things. Western acupuncture is not supernatural. But if you are offering, send the cheque for £574.5K to

PhatRita 21:53, 20 July 2005 (UTC)

Again, I don't think you have the right information. Here's what Robert Todd Carroll says on his website: "There is no correlation between the meridians used in traditional Chinese medicine and the actual layout of the organs and nerves in the human body."

And I'm not just looking to debate pro-acupuncture POV, I'm up for arguing against any POV. Unfortunetely, however, there seems to be several topics which wikipedians generally accept POV, and will look the other way when they encounter it. New Age beliefs, from "magick" to alternatives to medicine, seem to be widely accepted here and are allowed. Well, acupuncture is defined by the metaphysical notion of Chi, and cannot thus be understood as medical or scientific in any context. The only findings for acupuncture by actual physicians are that patients feel better. But pain is largely subjective. It's hard to pin one thing down as a cause of feeling better, and it often comes down to post hoc reasoning. Also, there is the placebo effect.

Prof. Carroll continues: "Finally, acupuncture is not without risks. There have been some reports of lung and bladder punctures, some broken needles, and some allergic reactions to needles containing substances other than surgical steel. Acupuncture may be harmful to the fetus in early pregnancy since it may stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin, which affect labor. There is always the possibility of infection from unsterilized needles.* And some patients will suffer simply because they avoided a known effective treatment of modern medicine."

So acupuncture is a dangerous antiquated practice and it would be irresponsible for us to present it any other way. Maprovonsha172 01:50, 21 July 2005 (UTC)

here in the world of medicine, we use this little thing called evidence based medicine (EBM). It aims to get the most impartial view of any subject. One idea in this EBM is that there is an evidence pyramid at the top of which is a meta analysis. The general gist that applies here is, websites are not reliable, and that medical journals are more reliable. Websites are not peer reviewed, but journals are. It may very well be that this website has references, but it is still written with whatever agenda there is and no peer reviewing nor editing has been committed by external, impartial sources. In my experience, you can probably write an article in CAM which could prove almost anything provided you select the right journals to back up your argument since so many contradict.

Acupuncture, on the other hand, has studies into basic mechanisms look at Vickers and Zollman's introductory article on acupuncture published in the BMJ here

regarding your points about meridians - even if this is true, which you have yet to prove with a quoted review or analysis in a reputable journal, meridians don't necessarily mean routes of nerves, but maybe intersection points between meridians and nerves. There is always another argument you have to defeat. So if you cannot convince me, a CAM skeptic, on your edits, there must be very little hope of you winning over others.

lastly regarding your point about safety. This is ridiculous. Do you know the incidence of such things happening? these are mostly isolated incidents. Acupuncture is much much safer than most convetional medical treatments. Just watch ER and you'll see what I mean. People make mistakes, and that includes acupuncturists and doctors. Getting all worked up about it is alarmist only because you have a distinct inclination against acupuncture, imho.

in the spirit of EBM, I can certainly quote significant evidence for the safety of acupuncture:

here, an major study (BMJ) of 34 000 acupuncture treatments which says "Comparison of this adverse event rate for acupuncture with those of drugs routinely prescribed in primary care suggests that acupuncture is a relatively safe form of treatment.".

looking forward to your reply.

PhatRita 10:48, 21 July 2005 (UTC)

I'm glad we're on the same page that medicine should be evidence-based, indeed everything properly called medicine is evidence-based, and evidence is researched and presented in medical journals. Acupuncture, however, is not evidence-based medicine. I never said that acupuncture is VERY dangerous, there are more dangerous medical procedures. However, medical procedures do good, and acupuncture has never been shown to do any good. It is one thing to show that acupuncture doesn't hurt too many people, it's another to show that it actually helps anyone. Maprovonsha172 23:55, 21 July 2005 (UTC)

you know, for all that wording, you seem to have skirted the actualy points that I have made in reponse to your points. Firstly, you say that acupuncture is "dangerous" and when I reply with evidence to the contrary, you say that you never said it was "VERY dangerous". So what was your actual point in the first place?

secondly, you say that acupuncture is inefficacious. You provide no evidence to support this, other than a website. There is already sufficient references quoted on the main wiki article anyway to suggest otherwise. Then you say that you are indeed a strong proponent of EBM, and yet, you do not quote references of journals, analyses etc etc, which is the essential embodiment of EBM.

Then you say that acupuncture is NOT evidence based medicine. What do you form your basis on for that remark? does a medciine get born with the status of evidence based medicine? How is acupucnture different to the latest cancer drug? Because it wasn't developed in the lab? Because we don't know the mechanisms? How many techniques in medicine, eg the abdominal thrust (heimlich's manoevre) do YOU know that is evidence based and developed in the lab? And you'd be surprised how many drugs we have no idea what mechanisms they act thru, such as ASPIRIN.

then I see this quote: "however medical procedures do good, and acupuncture has never been shown to do any good". Just what on earth supports this statement? Where is the evidence? I bet you there has probably never been any studies conducted to show whether lancing a cyst for pus exists. But doctors do it anyway. And don't give me that "oh but it works for people" because that is anecdotal. The same argument can be made for acupucnture. You must make a choice between supporting EBM, which would mean you have to accept evidence EBM throws up, or not accepting EBM and base your arguments on unsupported works, hear say and narrow mindedness.

PhatRita 09:44, 22 July 2005 (UTC)

Acupuncture cannot be evidence-based by definition, because it is by definition metaphysical. Acupuncture is a practice of placing needles along certain meridians, by practicioners who believe this will unblock Chi. Show me a journal that discusses the qualities of Chi. The anecdotal post hoc reasoning you say is made for acupuncture, that "it works for people," is the only thing anyone has said for acupuncture that I know of. When it's shown that unblocking Chi heals people, then you can call it evidence-based. Maprovonsha172 01:18, 23 July 2005 (UTC)

You are confusing evidence base with mechanisms of action. Evidence based medicine does not exclude metaphysical medicine as something to test. In fact, contrary to that, it is here that EBM shines the most. Therapies such as homeopathy (which has metaphysical roots, im sure you'll agree), are tested via the EBM principle of clinical efficacy. Journals do not have to discuss whether Qi is unblocked or anything, but whether it can give a greater effect than placebo. "Acupuncture cannot be evidence-based by definition", I have no idea how you can defend yourself against this. Acupuncture can, and is, consistently proven by EBM as efficacious. In short, I just don't see the mutual exclusivity between metaphysical therapies and EBM.

There were some interesting funnel plots published a while back[1]. In the light of this paper I would suggest that claiming that acupuncture is supported by EBM is going a little far.Geni 09:43, 25 July 2005 (UTC)

The study you quote is one of a metaanalysis of trials in China. I do not see how this is relevant to the discussion at hand. Anyway, the study shows most of the trials are in favour of acupuncture over control. The problematic "trials needs more rigour" conclusion is present in most systematic reviews if not all of them. Acupuncture is supported by EBM, probably not as consistenly as I may have suggested, but it is shown to be efficacious above placebo for some conditions, which makes it a viable therapy. Check out the Cochrane collaboration on acupuncture:

here

PhatRita 14:01, 25 July 2005 (UTC)

also you don't seem to have replied to any of the points I have raised regarding such things such as your safety remarks, the lack of credible evidence you can present and justification for your POV.

PhatRita 21:22, 24 July 2005 (UTC)

It cannot by definition be tested because Chi is the essential element and it cannot be tested. As to the safety remarks, I thought we had sorted that out. I said that acupuncture may be dangerous. That's true not only because people have been hurt by the insertian of needles but also because some people avoid medical treatment after being treated by an acupuncturist. As for credible evidence:

"Chi is defined as being undetectable by the methods of empirical science." --Robert Todd Carroll, Ph.D. http://skepdic.com/acupunc.html Maprovonsha172 01:06, 27 July 2005 (UTC)

again we reach an impasse on this matter. Firstly, your comments on safety. Again, where is your evidence? You say that people avoid medical treatment after acupuncture. How many? what % of the population? Says who? again, you quote Dr. Robert Carroll, from the Skepdics website, with which I'm all too familiar. This is not EBM, as much as www.crystalhealing.com is not EBM. The words you want be looking for are "lancet", "bmj", "jama" ,"nejm", "peer review", "randomised", "control" and "trial".

again you say that chi is untestable. I do not disagree with you on this matter. However, testing chi (Qi is the preferred written form as it reflects the Chinese pinyin system) is certainly not EBM. The fact of the matter is that acupuncture and other therapies can be tested for their clinical efficacy and THAT is EBM. This efficacy does not necessitate in a viable theory of practise. If we follow your logic, tender loving care is as much untestable as qi is. And incidentally, western acupuncturists do not consider qi as part of their diagnosis.

PhatRita 12:49, 27 July 2005 (UTC)

Then why don't you provide some evidence that acupuncture, whether in the traditional sense or in the sense you speak of, heals people? Pain is one thing(placebo effect), irradicating disease is another. Maprovonsha172 19:50, 28 July 2005 (UTC)

my god, it continues! I'm afraid, that the onus is on YOU to provide evidence. I have quoted at least 5 or six studies, journals or systematic reviews to back up my points, and you are asking me to provide evidence base?! ridiculous. The only evidence you have provided comes from the skepdic's website.

However, I shall continue my pursuit of this argument via evidence based discussion. There are very few full articles you can read, for example, on a systematic review (and full reviews are quite boring, I can assure you.) If you know what the Cochrane database of systematic reviews, then skip the following paragraph.

Professor Archie Cochrane was a well respected and brilliant doctor living in Scotland. Basically he was the pioneer of the cochrane collaboration which sought to provide highly reliable reviews on what is effective and what wasn't. Nowadays, the cochrane collaboration is one, if not the most respected authority in clinical medicine. They publish their findings on the prestigious journal, "the cochrane database of systematic reviews". Their databases are as good as pubmed and you have heard of the following: DARE (Database of Abstracts of Reviews of Effects ), CENTRAL (Cochrane Central Register of Controlled Trials), and others such as NHS EED, HTA and more.

Take a look on their website, and they allow access to abstracts of their systematic reviews. Looking up on acupuncture gives this:

here

(informedhealthonline is the public domain name for the cochrane.)

Acupuncture for lateral extensor (tennis elbow) pain: "Acupuncture might be able to provide short-term relief from tennis elbow, but more research is needed"

Acupuncture for idiopathic migraines: "Acupuncture seems to be able to help relieve headaches and migraine, but more reliable research is needed"

Acupuncture and TENS for dysmennorhoea (painful periods): "TENS and acupuncture might help relieve painful menstrual cramps"

Acupuncture on rheumatoid arthritis: "One study shows electroacupuncture decreased pain in patients with rheumatoid arthritis"

Acupucnture for labour induction: "Acupuncture may help to induce labour but more research is needed"

Acupucnture safety: "Acupuncture with disposable needles and clean needle techniques causes few serious adverse effects"

Do you see a repeat pattern emerging? research is needed, and yet the results seem to be in favoiur of acupuncture. Therefore I don't see how you can justify any of your comments from the past 2 weeks.

I also read this in an old copy of the journal of alternative and complementary medicine the other day:

"there is now general internal agreement that acupuncture is effective for the following coditions: dental pain, postoperative nausea and vomiting and chemotherapy induced nausea and vomiting. Some conditons are seen to be effective by some and difficult to interpret by others: migraine, low-back pain, and TMD." (Birch et al 2004)

PS please dont even THINK about dragging placebo into this argument or I'm gonna have a field day. EBM is a serious business and relating everything to the placebo whenever someone quotes "alternative medicine" will lose their argument credibilty from the word go.

pps. This argument reminds me of my friend at school trying to argue with the teacher that a cold is caused by bacteria.

ppps "irradicating [sic] disease?" what the hell are you talking about?

references:

• Birch S, Hesselink J, Jonkman FA et al (2004) "Clinical research on acupuncture: part 1. What have reviews of the efficacy and safety of acupuncture told us so far?" JACM; 10(3):468-480

PhatRita 23:13, 29 July 2005 (UTC)

None of those examples you gave are what I asked for. They all refer to pain, which is a very tricky thing to measure. Pain is quite subjective, and affected by suggestion. I don't know why you mean to dismiss the placebo effect so crassly, (PS please dont even THINK about dragging placebo into this argument or I'm gonna have a field day.) the fact is there exists a placebo effect and it is visible in all sorts of alternative-to-medicine-therapies from faith healing to acupuncture.

And by irradicating disease I mean that it gets rid of disease, as anti-biotics do. Maprovonsha172 20:00, 2 August 2005 (UTC)

So what is the purpose of alternative medicine? You have yet to state what exactly you would like to see proven? That acupuncture is a miracle cure for everything? Well it isn't. Like antibiotics cannot eradicate disease - they are bacteriostats, which means they limit bacteria growth. You have no valid argument.

You are quite right, pain is subjective, but how does that affect your reasoning that acupuncture is ineffective? Placebo is a valid argument, only if you back it up with randomised control trials stating that there is no efficacy over placebo. The studies I have quoted are all randomised and controlled, or meta analyses of such studies. Also, most healthcare professionals use the placebo to their advantage. It is said that the placebo is used by the most eccentric quacks and the wisest physicians. Bedside manners, the white coat, clean hospitals, fresh air, flowers, allowing supporting families to visit etc are all examples of the placebo. PhatRita 14:10, 4 August 2005 (UTC)

The National Council Against Health Fraud has shown that:

1. Acupuncture is an unproven modality of treatment;

2. Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge;

3. Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease;

4. Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter- irritation, operant conditioning, and other psychological mechanisms;

5. The use of acupuncture should be restricted to appropriate research settings;

6. Insurance companies should not be required by law to cover acupuncture treatment;

7. and Licensure of lay acupuncturists should be phased out.

They explain that "Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease" and that "the perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms." In short, most of the perceived beneficial effects of acupuncture are probably due to mood change, the placebo effect, and the regressive fallacy.

Also, anti-biotics don't only limit bacterial growth, they kill bacteria. The first sentence of the wikipedia article for anti-biotics is, "An antibiotic is a drug that kills or slows the growth of bacteria." That sentence isn't disputed, and if you want an example, look up penicillin.

Your use of the word placebo is rather strange, as well. The placebo effect is generally defined as measurable, observable, or felt improvement in health not attributable to treatment, resultant of a practice or the administering of something (sugar or starch pill) should be ineffective. A placebo (Latin for "I will please") is apposed to a nocebo (Latin for "I will harm") which is something which should be ineffective but which causes symptoms of ill health. Acupucture is an example of a placebo, I'm not denying that, but if we agree that it is a placebo we're agreeing that it is effective only because "patients" expect it to be.

Furthermore, what I've said about anti-biotics stands against the true effectiveness of acupuncture, because though anti-biotics irradicate disease, acupuncture has never been shown to heal anyone of anything.

Maprovonsha172 19:45, 5 August 2005 (UTC)

1)The NCAHF is one of the keystones in the ring which includes quackwatch, chirowatch etc. Are you honestly telling me that this is IMPARTIAL and undisputed evidence!?

2)Penicillin, is known as a bacteriostat, like many of its derviatives and future versions. They act to SLOW bacterial growth and so let the immune system take over. Their role in actually killing bacteria is very limited. Allopathic medical training has got me well versed in this knowledge. Penicillin is a cell wall disruptor. However, others such as rifampicin etc can affect RNA synthesis, etc. They do not KILL bacteria. They decrease the numbers of bacteria reproducing or limit growth. I would choose my wording more carefully next time, if I were you.

3)Placebo. This is a whole can of worms. Firstly, consider the ethical side of the argument. If it does seem to be efficacious, EVEN IF, and only IF, acupuncture is purely placebo, what is wrong with using it? It seems to please patients who use it, and it is safer than conventional medicine. Besides, acupunture is more effective than a placebo. Secondly, consider your sentence "not attributable to treatment". Placebo relies on treatment - the longer the treatment (and more empathically given), the higher the placebo effect (Brody 2000), even if this treatment has no conceivable effect on the body's physiology. This basically boils down to how the pill or treatment is administered.

4)thank you for your latin lesson. I am quite aware of what placebo means.

5)Have you ever read a systematic review on acupuncture? Have you ever even read a medical journal? Try it sometime before you bombard this talk page with useless quotes from a seriously biased and unpublished web source. For all your wording, you have yet to prove with a single medically published source, that acupuncture is ineffective.

6)Futhermore, you have insisted on launching a crusade against acupuncture, the most scientifically proven form of CAM, and insisted on adding negative input into the CAM main page (including after we started out little debate, without notifying me nor other members) which is neither the right information NOR the right place to put it. This amounts to little more than vandalism. If you wish to prove yourself more than a vandal, I suggest you go and acquaint yourself with how EBM works. You may say you know and agree with EBM, but you certainly do not follow its methodology and practice.

PhatRita 12:11, 7 August 2005 (UTC)

1. I hardly think being in an anti-quackery ring makes a website untrustworthy.

2. Let me choose my words quite carefully. Here's what the FDA says:

For example, penicillin kills bacteria by attaching to their cell walls, then destroying a key part of the wall. The wall falls apart, and the bacterium dies.

http://www.fda.gov/fdac/features/795_antibio.html

3. You ask...

"If it does seem to be efficacious, EVEN IF, and only IF, acupuncture is purely placebo, what is wrong with using it?"

What is the point of using it? Some people are hurt by needles, yet needles have never irradiated disease like anti-biotics. If you were injured on the battlefield in the Second World War, I'm sure you'd rather have penicillin than any herbs or crystals or whatever, and the only needle you'd want is one with morphine in it.

4. Anytime. You say you've been trained in allopathy, but do you know the etymology of the word? Hahnemann, the creator of homeopathy, conjoined the words allos and pathos or opposite and suffering. It refers to the ancient Greek humoral practices which modern science no longer uses. So it is a false term at best, and perhaps even a tacit slander. Perhaps you ought to choose your wording more carefully next time. http://www.ncahf.org/articles/a-b/allopathy.html

5. Well it depends on how you mean "ineffective." We've agreed that it is merely a placebo, which is something which eases pain but is generally ineffective outside of the subjective nature of perceived pain. Acupuncture doesn't heal anyone of anything, and never has, and that's all I want in the article. It may ease some pain in some people, but so do false beliefs. We should promote science and rationality, not try to adapt old Eastern Metaphysics to our sensibilities.

6. You say...

"If you wish to prove yourself more than a vandal, I suggest you go and acquaint yourself with how EBM works. You may say you know and agree with EBM, but you certainly do not follow its methodology and practice."

I suggest you lose your condescending tone, and argue the issue if you can. You say I'm not posting the "right information" instead of attack the information I've presented, and you say I should acquaint myself with the way evidence-based medicine works instead of pointing out where you've found me ignorant. You make the ridiculous claim that I don't follow the methodology and practice of evidence-based medicine, as if I should. I'm not an M.D. I'm a philosopher, we're bound by the laws of logic and our method is analysis. In philosophy, we call all these little jabs red herrings. If you want to argue an issue, do so. You've so avoided the issues at hand I don't even know what you mean to accomplish. I've said that I want it said in this article that acupuncture has never been shown to heal anyone of anything, and is merely a placebo utilizing the body's susceptibility to suggestion. If you disagree with that, argue against it. Furthermore, the NCAHF is a well-respected organization, you can't just make such an irrational statement that because they belong to a certain web-ring they can't be trusted. Even if they were a fringe organization, and nothing they say could be trusted, you should be able to point out where you disagree with them. So, in addition to what I want to add into the article that you should argue against, you may argue against the following points made by the NCAHF:

1. Acupuncture is an unproven modality of treatment;

2. Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge;

3. Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease;

4. Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter- irritation, operant conditioning, and other psychological mechanisms;

5. The use of acupuncture should be restricted to appropriate research settings;

6. Insurance companies should not be required by law to cover acupuncture treatment;

7. and Licensure of lay acupuncturists should be phased out.

They explain that "Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease" and that "the perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms." In short, most of the perceived beneficial effects of acupuncture are probably due to mood change, the placebo effect, and the regressive fallacy. Maprovonsha172 16:53, 7 August 2005 (UTC)

Ok this whole issue has spun way out of control, which was not my original intention.

In response to your points,

1)being an anti quackery site does not, conversely, make it a trustworthy site either. That is the whole reason I have been arguing with you about this issue. These websites can say anything they want and it would not be moderated or corrected. Yes, they MAY have correct information, but equally, they MAY NOT. And when someone or a group have an agenda, ie, anti quackery, the information may be, and is often distorted or manipulated. Compare this, for example with the evidence based process whereby scientific enquiry into reputable journals results in balanced and peer reviewed articles which are edited by independant people working for those journals.

2) Penicillin DOES kill bacteria, but not in as much a great quantities as you may think. They do disrupt cell walls etc like you state. However, considering that the body's immune system will do most the work, and their effect is not as great as you may think. It is true that someone with a dnagerous infection, antibiotics are the life saving force, but you have to be careful in simply stating that they kill bacteria, for their role in fighting infection is a little more complex. Basically it boils down to a numbers game - antibiotics stop the growth of the colony so much that the immune system can overcome, and not as many people think, they dont just simply quickly eradicate all bacteria.

3)the point you have made is that acupuncture is not as efficacious as say morphine for killing pain? Or it is not relatively good as say antibiotics for treatment. Well this is obviously true and is not a point of which I am arguing. Of course morphine is more efficacious than acupucnture in most cases. However, morphine is more efficacious than paracetamol or aspirin for pain killing in most cases, isn't it? You have to look at what acupuncture is used for and whether it is efficacious for that.

4)your comments have created some offence to me (part of the reason for the severity of my reply, which I apologise for in retrospcet) because I take my alternative medicine very seriously. Your reply seemed to me very patronising. If you take a look at history of the homeopathy page and talk:homeopathy page, you will find my name in abundance there. I am well aware of who Hahnemann is and where allopathy comes from.

5)We have not agreed it is MERELY a placebo. My point was that IF and only IF acupuncture was a placebo, there would still be considerable ethical use for it as it is SEEMINGLY efficacious. From what research shows, it is much more efficacious than acupucnture.

I think also you should be careful when you say that acupucnture has never healed anyone of anything. What do you mean by heal? Acupucnture is effective for short term pain relief amongst other conditions. This alone makes it a viable medical therapy. I completely disagree with your statement there. If you are referring to healing as for example, CURING, then you MAY be right. However, most medical techniques don't CURE diseases. Morphine, for example is a pain killer, but what does it cure? Certainly not the debilitating multiple scelerosis nor the excruciating supracondylar fracture it was prescribed for. Acupucnture is effective for what is was prescribed for and that is it.

"so do false beliefs" - well my quotes from studies have shown that acupucnture is ABOVE placebo. This comment may be true but so is this comment: "acupuncture is better than false beleifs for that pain relief"

6)I have been, for the past 2-3 weeks trying to argue with you about your comments. Everytime I do, you make another comment but do not answer my replies. And yet I am the one trying to "avoid the issue"?

EBM is the methodology by which medical personnel make warrants of arguments for whether a theory is effective or not. Your points are attacking the core of the efficacy of a treatment. If you wish to argue that it is effective or not, you do not attack its theory or scientific foundation, you attack its SCIENTIFIC evidence. You must attack whether it is effective above the placebo effect in the clinic, because that is what matters.

You refuse to believe that there may be nerves involved in endogenous analgesiac relief. Yet how do you know? Not even the best scientific minds can be sure of this conclusion.

you one solid line thus far: "acupuncture has never been shown to heal anyone of anything, and is merely a placebo utilizing the body's susceptibility to suggestion"

I will argue against this point. What you are in effect is saying that acupuncture is not effective over placebo.

The studies which I have quoted above, all of them show other wise. These are scientific studies with randomisation and double blind and so on, which show otherwise. These are studies which composed of blinded randomised trials which have one group on placebo and one group with acupucnture. These are also systematic reviews of tens, if not hundreds of these trials and group them together to form a conclusion. If even one randomised control trial came out for a "normal" pharmaceutical drug which showed such effects, it would be sold on the market.

It is your job to prove that acupuncture is INEFFECTIVE.

Acupucnture has not been proved conclusively as efficacious becuase skeptics just refuse to beleive in CAM therapies. Not any amount of evidence will convince them.

Again, this point about the NCAHF. They may be respectable, but I can say that the Research council for complementary medicine (RCCM), is respecatble (which it is). I could say that holistichealth.com is respectable. I could say that chirohealthweekly is the lord's scriptures. But it is not tenable in the medical world, of which acupuncture belongs to.

In response to NCAHF's six points:

1 - At what point is there enough "proof"? There is already siginificant evidence, but probably there will never be enough for hardcore skeptics.

2 - Its theory may be based on primitive practises. So? The same could be said for using herbs, but 30% of all drugs are derived from them. It does not matter where it comes from, but that it is effective.

3 - This is wrong. There is plenty of research evidence to show that acupucnture is effective above placebo.

4 - Every treatment has some kind of placebo effect. When the point says "Percieved effects of acupuncture...", you can replace with almost anything. "the perceived effects of Paracetamol...." You could say the same about every one of those treatments.

5 - what are these research settings?

6 - American medical insurance is beyond me. I know nothing about it.

7 - Well of course they should be. The licensing of lay doctors should be phased out, the licensing of lay nurses should be phased out. What a ridiculous comment. Of course alternative medicines need a strong professional internal discipline and organistion like the AMA and the BMA/GMC does. This step is already moving in the UK. Chiro + osteopathy are under parliament legislation to be under the GMC. Acupuncture is well on its way.

ps , Again I apologise for wording in the previous reply. Although I do feel offended from your remarks, especially "prescienfic".

PhatRita 14:43, 8 August 2005 (UTC)

I retract my apology dated 08/08/05, above. the user in question, Maprovonsha172, insists on altering the main article page to add POV comments to suit his negative view of alternative medicine. There are many comments regarding acupuncture which he refuses to argue for with actual medical evidence and runs around rings to avoid. He uses unreliable evidence from a known anti cam website which clearly breaches the neutral point of view policy of wikipedia. He has also made several comments which adds offense to me and alternative medical practioners alike. PhatRita 19:40, 11 August 2005 (UTC)

You haven't shown that acupuncture is effective. That some studies show acupuncture is more effective than a placebo doesn't mean anything if the majority of studies don't indicate anything more than a placebo effect. And please, let's argue about what's true, not whether a website I'd link to is NPOV, or whether things I have said have offended you. The Supreme Court said that you can't prosecute emotional distress cases because no one can be the judge of it, I think that speaks volumes to this discussion. You said my posts have offended you, but we can't be sure, people feel better with acupuncture, but are they better? We can't be sure. It's the placebo effect. We see it in faith healing, as well, the placebo effect provides the illusion of being healed, but in time the disease persists whether or not pain resumes. I wonder if you've seen the documentary A Question of Miracles, in it the documentarian followed people who were going to faith healers, and faith healers themselves. People who couldn't walk got up and danced around, people who couldn't step out of a wheelchair got up and ran around. It doesn't mean these faith healers cured them. All that happened was a temporary stimulation of neurochemicals which masked pain, unfortunately, it doesn't mask one from the cancer or whatever is killing you and you die just the same. The same is true for acupuncture.

And I'm sorry (and you don't have to worry about any retractions of courtesy from me) if you were earnestly offended by my saying acupuncture is prescientific, but I don't feel bad because acupuncture is prescientific. It's a paradigm case. If you think Chi is anything but prescientific you should find a dictionary and look up the word. Maprovonsha172 01:50, 21 August 2005 (UTC)

I have not replied for a while, being away for holiday. To reply to your point:

That some studies show acupuncture is more effective than a placebo doesn't mean anything.... - metaanalyses that I quote are ones which cover every credible trial of that time and amalgamate the results. These studies which I quote, therefore, cover literlly hundreds of trials.

...if the majority of studies don't indicate anything more than a placebo effect - have you counted all the studies which have been conducted? You will find that this is again, a false statement. Studies which show effect above placebo, in my experience, outnumber ones that dont at least 2 to 1. Although there may be some other reasons such as publication bias, this still contradicts your statement. It is time you stopped running rings and come up with some hard answers. These answers include hard facts of published peer reviewed trials in medical journals, not Dr Stephen Barrett's Quackwatch ring nor the Skepdics site.

My offense is mild, and is probably a little more than annoyance that you refuse to engage the argument with reliable facts.

PhatRita 16:48, 24 August 2005 (UTC)

ps its QI not CHI!

Most studies just don't show what you're suggesting. And I don't know what you're implying about Robert Todd Carroll or Stephen Barrett, who are both highly respectable people.

Studies which favor acupuncture are often bias, resulting from poor methological quality and the desire to see these things approved. There is a LOT of money in acupuncture and other so-called "alternative" medicines so of course MANY people want these good results.

Here's an example of poor metholodology: http://www.jr2.ox.ac.uk/bandolier/booth/alternat/AT005.html

Here's a good explanation of acupuncture and its metaphysical implications: http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html

P.S. The purpose of transliteration is so that we read a word as we would write it. So, since its pronounced Chi, I'm going to keep calling it Chi. Maprovonsha172 21:28, 25 August 2005 (UTC)

Im not implying anything about those two people. However, the content that you quote are simply not reliable, however true they are. You have a distinctly awry sense of what evidence based medicine actually is. Articles by non peer reviewed, unpublished sources are just not something which is admissible as evidence in the EBM courtroom. I have stated this several times and yet you refuse to acknowledge this point. There may be nothing wrong with the article, but HOW ARE WE TO KNOW?

Im sure those are both highly respectable people. Stephen Barrett is a medical director somewhere, with a life master rank in bridge and eagle scout or whatever. Great.

I agree with you that many studies, in areas such as homeaopthy and other alternative medicines are severely flawed. However, many studies are not. Reversely, studies can be biased against acupuncture, say by someone like Stephen Barrett...MD.

This is why we even have EBM and organisations such as the cochrane. Reviews, such as those performed by the cochrane are the best answer we can derive from the evidence we have.

The single review you have quoted (the first credible source I have ever seen you quote) is probably true. But you have picked a single example of trials of bad methodology out of the hundreds of trials out there. I can equally pick out good evidence from the hundreds too.

I have read the quackwatch acupuncture article before. It contains selective evidence, like all of quackwatch's articles, to be honest. You can prove almost anything with the right studies in CAM related subjects.

I also ask you to write qi instead of chi not because whether it suits you, but for the same reason that peking is no longer used and beijing is - it is out of respect for the culture that originated the name and their wish to use the way that they write it with (the pinyin system).

PhatRita 23:41, 27 August 2005 (UTC)

Section entitled "Contemporary use of alternative medicine"

I suggest combining the subsections entitled "In the US and UK", "Around the world", and "Rising use of alternative medicine" (a total of 7 sentences) into one section, then moving that section to immediately before or immediately after the section entitled "Legality and regulation". Thoughts? Objections? Edwardian 06:38, 26 July 2005 (UTC)

Well wikipedia english is mainly uk and us and rising use of alternative medicine is a different topic heading in itself, so I disagree with that idea. I do agree with placing it after legality and regualtion PhatRita 14:33, 26 July 2005 (UTC)

My thought was that the three subsections each reflect "usage of alternative medicine", and could easily be combined into one concise paragraph. I'll leave them as subsections, but move them as noted above. Edwardian 04:48, 27 July 2005 (UTC)

Suggestion change in section entitled "Safety issues"

From: This can be a particular issue in the treatment of children and individuals whose capacity to evaluate the treatment is impaired, and of animals. To: This can be a particular issue in the treatment of individuals whose capacity to evaluate the treatment is impaired. Reason: The issue of children (and animals!) not being able to make an informed decision is not unique to alternative therapies. Are there any objections to this change? Edwardian 00:23, 30 July 2005 (UTC)

yes your reason does not appear to make a case.Geni 01:42, 30 July 2005 (UTC)

Edwardian, I don't get your point? The current wording does not imply: that children not being able to make an informed decision is unique. It is saying "children AND individuals whose capacitiy . . . etc... ". Note the use of the word "AND". dave 07:43, 15 August 2005 (UTC)

Trauma

I don't think I'm qualified to edit the article, and it's probably been said before, so I'll just post this here. For some reason, I have never heard of an "alternative" treatment used to treat trauma. Why is this? Am I missing something? Alternative medicine only seems to address the rather nebulous issue of disease. When did the last N.D. fix up a gunshot wound or a lacerated, bleeding liver from a car accident victim? Can a chiropractor reassemble a compound-fractured leg or remove an icepick from someones brain? etc. etc. etc. It is the 21'st century, after all. Surely there's "natural" "cures" for these traumas, are there not??

If they could actually do anything they wouldn't be called "alternative;" "alternative" is a euphemism for all these quacks thatthe Establishment won't endorse because they can't prove them effective, but people flock to because they can't be proven ineffective. Then in this case "alternative" is a euphemism for "fringe." It's fringe versus mainstream, pseudoscience versus science. If alternative medicine could be shown effective, it would become mainstream and cease to be "alternative" even though it would be "an alternative" in the proper sense of the word, which is to say an different yet equally valid option. The trouble is these pseudo/pre-scientific practices aren't equal, they are often ineffective and/or directly or indirectly harmful. Maprovonsha172 01:34, 21 August 2005 (UTC)

ahh, maybe a good ole non sequitur, but hey... That's all I got :) --Kvuo 23:47, 17 August 2005 (UTC)

What non sequitur? Maprovonsha172 18:43, 22 August 2005 (UTC)

My original comment. I didn't reply to your reply until now --Kvuo 22:13, 24 August 2005 (UTC)