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[Shaki]

Originally Posted by DJ Jo-D

I'd like to believe in most of these treatments and wonder if believing in it fully can add an element of placebo into the equation?

I'd like to believe in God and I'm sure if I did I would be able to see his work, feel his love and have a relationship with him like all those crazy Christians. Kinda the same thing?

Whatever makes you happy (.....at the same time as lining the pockets of these shysters)

Perhaps nullmouse will summarise the chapter on Reflexology for us also?

[Le Stu]

I don't know about God, but a guy who can take this has got to be on to something:

YouTube - Shaolin Kung Fu: Iron Testicles

[droid]

It's easy for someone to dismiss something they either don't understand or don't want to understand.I went to a TCM practitioner for treatment.Not only did he help me with that particular ailment,he also diagnosed symptoms of another ailment....that my doctor has been trying to treat for a year.In my opinion if it doesn't work for YOU,then don't go back.

[nullmouse]

Originally Posted by Shaki

Perhaps nullmouse will summarise the chapter on Reflexology for us also?

Got homeopathy and chiropracty to get through first

Ended up being busier than expected this weekend, only just finished the acupuncture chapter yesterday evening. Fascinating stuff, and there's a lot of contradictory evidence out there. For example, the World Health Organisation has twice stated that acupuncture works - but both times their methodology for concluding this was flawed: First time around the type of studies they gathered together were limited by not being randomized, controlled studies but instead just looked at two groups - Untreated or treated. Obviously, this type of design can't rule out the possibility of the placebo effect, but the results all looked in favour of acupuncture working.

The development of randomized, controlled studies meant better, more reliable data could be generated but the second WHO report that looked at this data was compiled by an active practitioner of acupuncture and is likely to be heavily biased. Indeed, the second report included many studies that originated from China and may have been fabricated or selectively positive due to no-one wanting to publish their negative results. The book made some interesting points about the vested interest of the Chinese goverment (Mao himself promoted acupuncture as a way of getting the cheap healthcare for all he promised, but did not believe it was an effective treatment himself), and generally dismissed the WHOs findings on this and several other grounds.

One of the major grounds the WHO reports were dismissed was due to the lack of proper weighting given to studies when bringing them all together to look at as a whole. The Cochrane Library (regarded as the definitive collaboration on these types of analysis, on any medical treatment or intervention) weights studies based on how well they were conducted, the numbers of patients used etc and gives them a score based on how reliable they are judged to be. Under this more definitive scrutinism, the majority of the claims about acupuncture were found to be unsupported. In two specific cases, where the evidence was too sparse to perform a full analysis on, the trend seemed to be towards an effect above a placebo effect. These cases were related to the relief of mild pain.

Part of the problem in looking at acupuncture is how to authoritatively rule out the placebo effect: How can you fake sticking needles in people so that (a) they don't know it's a sham and (b) the person performing the needling doesn't know it's a sham. There are clever ways around point (a), such as trick needles that don't penetrate but do stick to the skin with just enough pressure to give the sensation of being pricked, but (b) is an ongoing issue: The conviction of the person giving the treatment is just as crucial as the belief of the person receiving.

However, despite these problems, there seems to be no weight to the claims of acupuncture being any better than a placebo. That said, even the placebo treatments used often showed an improvement in the patient's condition. The ethical dilemma that ensues is interesting: Is it OK to promote a treatment that 'works' but not for the reasons stated? Open to discussion, but is a placebo treatment really a cure or is it just a mask that hides underlying conditions without resolving them?

[nullmouse]

Originally Posted by droid

It's easy for someone to dismiss something they either don't understand or don't want to understand.

I agree, but evidence-based medicine is fantastic as it gives us the tools to evaluate if these treatments work, even if we don't understand the mechanism why.

[droid]

Originally Posted by nullmouse

I agree, but evidence-based medicine is fantastic as it gives us the tools to evaluate if these treatments work, even if we don't understand the mechanism why.

Absolutely,the evidence for TCM is thousands of years old,funny how when you tell a doctor or consultant about TCM they look at you with a raised eyebrow.

[nullmouse]

Originally Posted by droid

Absolutely,the evidence for TCM is thousands of years old,funny how when you tell a doctor or consultant about TCM they look at you with a raised eyebrow.

Well, you have to look at the quality of the evidence: When I talk about evidence-based medicine I'm pretty much referring to the way in which current clinical data is gathered via carefully controlled trials. The thousands of years evidence for TCM is pretty much all anecdotal evidence, testimonials and such. This isn't to say that there can't be truth in these testimonials, but they're not scientific evidence.

If any TCM treatments work, then they can be tested used the principles of evidence-based medicine (proper controls, randomised groups, 'blinding' so patients and doctors don't know what treatment they're giving etc) and solid evidence gained without needing to understand the mechanism behind the effect.

[TheTickingTime-Bomb]

Originally Posted by droid

Absolutely,the evidence for TCM is thousands of years old,funny how when you tell a doctor or consultant about TCM they look at you with a raised eyebrow.

If it's evidence is thousands of years old, then it isn't good evidence. The more recent the study the better it is.

[droid]

Originally Posted by TheTickingTime-Bomb

If it's evidence is thousands of years old, then it isn't good evidence. The more recent the study the better it is.

I really don't get your logic or how you arrived to that conclusion,but it it is your opinion,which i respect!Totally agree Nullmouse,it's a pity Western medecine and TCM couldn't work as complementary treatments eh?

[nullmouse]

Originally Posted by droid

I really don't get your logic or how you arrived to that conclusion,but it it is your opinion,which i respect!Totally agree Nullmouse,it's a pity Western medecine and TCM couldn't work as complementary treatments eh?

I agree with The TickingTime-Bomb as the more recent the evidence the more likely it is to be carried out to the highest scientific standards. For example, our understanding of the placebo effect and how it can impact poorly controlled trials is relatively recent to medicine - Older trials will most likely be subject to inappropriate controls that make it hard to work out what is a true effect and what is placebo.

Just to be clear, I don't think we should recommend any treatment without evidence. That evidence should be gathered in the strongest, most robust way - But the ways in which we gather this evidence does not rely on the need to know the mechanism why a treatment works. For example, acupuncture is claimed to work due to insertion of needles into certain regions (meridians) that are specific to the ailments presented. We don't need to know how (or indeed, if) meridians work to understand that a good control would be to insert needles in to regions that weren't specific. We could then compare how well the two groups did, and make some observation on how effective the treatment was.