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Extraordinary claims require extraordinary evidence.

I read a very good article on Science-Based Medicine which really puts the whole idea of "Complementary and Alternate Medicine" into perspective.

For skeptics of CAM, of course, this gives a straightforward way of pointing out the flaws in ideas like homeopathy and chiropractic. For those who are unsure about the facts, it gives an easy way to understand why some things these therapies claim are implausible or impossible. For the believers in these modalities who may be mislead or misinformed by their practitioners, it gives a bit of critical thinking in a world of irrationality.



Sep. 12th, 2008 05:38 am (UTC)
Thanks for the link! I'll be adding Science-Based Medicine to my blog-check list.

It reminds me, though, that I need to do some homework on chiropractic treatments and acupuncture. A lot of skeptics dismiss both completely, but I have an inkling that there's actually a seed of scientific truth in both, but I'd like to back it up with some actual research.

Just from personal experience, I think both chiropractic treatments and acupuncture work... on a very top-level, limited basis. I'd need extraordinary and repeatable evidence to believe that cracking a back or sticking needles in the skin can treat lumbago or whatever. However, I do recall running across actual studies regarding acupuncture in that it can be effective in treating pain. (This I find plausible, as I could easily believe that the needles cause an endorphin release in the body, which in turn dull pain.) I've seen little in the way of unbiased studies on chiropractic medicine, but I could also buy that the most basic chiropractic treatments (i.e., cracking the neck, working the muscles to relax, etc.) help treat back pain just because it helps the muscles relax, which in turn allow the bones to return to proper alignment, which in turn allows the muscles to stay relaxed instead of reacting to a poor posture.

I have an old neck injury (car crash) and an aunt who is a chiropractor. About once every six months to a year, I do something stupid to my back (i.e., lift something too heavy, dislocate a rib, etc.). Taking painkillers until the pain goes away just makes my stomach upset and tries my patience. If I go to see my aunt instead, though, for the price of $20, she'll stick some needles in my back, crack my neck and pop a couple vertebrae, and I walk out an hour later feeling like a million bucks. A day later, I'll usually feel a twinge where the pain originally was, but it's a ghost of what it used to be, and is soon gone.

I'd never say that chiropractic treatments were a permanent solution for my back pain, but they really do feel good. And there's nothing on the planet (including alcohol) that relaxes me like having acupuncture needles in my back. I almost always fall asleep on the table while the needles are in.

I'm with the SBM writer, though, when it comes to claims that either treatment can do anything other than have an effect beyond the skin, surface muscles, and the occasional dislocated bone. I just think that these two practices are suffering the same thing as American politics these days: there are the true believers on one side, complete unbelievers on the other, and nobody in the middle ground sifting through the chaff to see if there are a couple grains of truth.

Sorry, I'll go post in my own journal... !
Sep. 12th, 2008 06:16 am (UTC)
No, I really appreciate you commenting.

One problem with testing acupuncture is that it's very hard to properly blind a trial. The person putting the needles in is going to know if it is "real" or "sham" acupuncture (as far as if the needles are going in the proscribed points). The best that's been done is showing that "sham" acupuncture is actually slightly better than "real" acupuncture for pain relief. I think that a lot of the effect on pain is as you described: endorphin release. I would be curious to see what effects acupuncture has on subjects with a local anesthesia of the puncture area. Controls could be told that they would be receiving a "real" treatment and get no needles, and two variable groups could receive needles in the proscribed and random points. Again, there is the double blinding problem, but it would be a better design for a control.

My big problem with chiropractic is that there are many chiropractors out there who subscribe to the idea of subluxation, that there is a blockage of energies or whatever causing health problems due to misalignment of the vertebrae. I can totally get behind the idea of skeletomuscular adjustment for physical therapy, but if there's a ruptured disk involved or the problem is completely unrelated to the spine, like deafness or diabetes, that is something I'm very skeptical of. I don't see it as at all plausible. Of course, there are a lot of scam artists in the biz. Just take a look at the chiropractic tag on the SBM site and you'll get to see a lot of the reasons I'm not impressed with chiro as a whole. Especially if you search for "stroke" in those articles. It's really tragic. I might be biased since my dad died of a (non-chiro related) stroke.

But here I have gone off on a bit of a rant. ~_^ The SBM site was pointed out to me by Phil Plait (or PZ... one of the two).
Sep. 12th, 2008 06:42 am (UTC)
I did hear about the "sham" acupuncture test; I gotta go read it, as I'm really curious about their study design. But yeah, you're right... how does a double-blind test happen there?

I think the most telling thing regarding acupuncture is the recent S&M fad of back piercing. (A couple photos on the page are NSFW, but it's generally pretty tame.) Advocates of the practice that I know personally describe it as being very relaxing. I know several folks who found getting tattoos to be a relaxing experience as well. Neither practice claims to be anything but decorative or perhaps counter-cultural; there are no medical claims or a "system of meridians"; yet there's a similarity in physical reactions.

As for chiropractic arts... yeah, it's stuffed full of charlatans and (for lack of a better term) witch doctors, that's for certain. If Aunt Mari couldn't work on me anymore, I'd be incredibly wary of even looking for a new chiropractor. I wish there was a certification board or something that could evaluate and rank chiropractors according to their level of whacknuttery.

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