Health Freaks – New Programme on C4

Waking-Dreams

Caught the end of this programme the other night. It puts home remedies to the test whereby members of the public bring their anecdotal evidence to a panel of 3 doctors in an effort to convince them to bring it to trial (to see whether the science will back up their claims).

It’s great to see home remedies and the whole alternative medicine malarkey being put to the test.

https://www.youtube.com/watch?v=hEGH4hfxMfU

Iwannahurl

I wonder whether they're going to do the same for 'conventional' medicine?

Some suitable areas for scrutiny:

• Psychiatry
• Screening (eg mammography)
• Lumbar fusion
• RCTs in Oncology

I could add more I'm sure, but I'm a bit out of touch with the issues, and biomedicine is always evolving.

A 2001 review of 160 Cochrane Systematic Reviews found a "surprisingly high" number of biomedical interventions which had no beneficial effect or for which there was only inconclusive evidence. Has that situation changed much?

Waking-Dreams

I doubt they would.

Given that it’s a TV show (and the manner in which it’s presented) I’d imagine it is being aimed at the general population who are either using or have heard of various different home remedies for various ailments.

Iwannahurl

Why should mainstream medical malarkey get a free ride?

Other possible topics: benzodiazepine misprescribing and misuse of antiobiotics.

Vivisectus

Actually, mainstream medical medicines or procedures already have to be tested before people start using them. This is not the case with "alternative" remedies.

That said, there is a growing awareness these days in scientific circles of the problems caused by publication bias, among other problems. This is especially strong in areas of medical science where it is hard to avoid subjectivity. Psychiatry is especially vulnerable to this, for obvious reasons.

Iwannahurl

Vivisectus wrote: »

Actually, mainstream medical medicines or procedures already have to be tested before people start using them. This is not the case with "alternative" remedies.

That said, there is a growing awareness these days in scientific circles of the problems caused by publication bias, among other problems. This is especially strong in areas of medical science where it is hard to avoid subjectivity. Psychiatry is especially vulnerable to this, for obvious reasons.

I'm not aware of any particular link between publication bias and "subjectivity". Why would there be? Is publication bias not a potential problem across all scientific disciplines?

As for your statement that mainstream medicines or medical procedures have to be tested "before people start using them", can you point to any authoritative source which demonstrates conclusively that most if not all medical practices (drug prescribing, surgery and other interventions) have been subjected to clinical trials and shown to be effective in terms of real-life patient outcomes, such as decreased mortality, reduced hospitalisation or improved Quality of Life?

I'm not at all convinced that the canonical RCT is delivering what it's supposed to in terms of dependable evidence, and neither am I confident that clinical trials are a guide to what happens in real life.

Many clinical trials have problems with enrolment and end up being under-powered and hence unreliable in the clinical context, many illnesses are treated with therapies that have never been tested in any type of clinical trial, and many treatments that come into general use have only been tested on an unrepresentative sample of patients. Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127439/

Four more areas where modern medical practice -- often in close association with the pharmaceutical industry -- is highly questionable:

1. The widespread and systematic prescribing of branded drugs instead of generics.
2. The prescribing cascade.
3. Co-morbidity and polypharmacy.
4. Disease mongering.

I doubt these will get a look in on C4 either.

Vivisectus

Iwannahurl wrote: »

I'm not aware of any particular link between publication bias and "subjectivity". Why would there be? Is publication bias not a potential problem across all scientific disciplines?

In areas where it is harder to objectively measure outcomes, the effects of such biases as publication bias are more pronounced. There is simply more scope for interpretation, and hence bias. I am not saying any field is immune.

As for your statement that mainstream medicines or medical procedures have to be tested "before people start using them", can you point to any authoritative source which demonstrates conclusively that most if not all medical practices (drug prescribing, surgery and other interventions) have been subjected to clinical trials and shown to be effective in terms of real-life patient outcomes, such as decreased mortality, reduced hospitalisation or improved Quality of Life?

Well, yes. Drugs are subjected to clinical trials. SO are medical procedures. It is the law. Not to do so leaves you open to massive liability to lawsuits, in fact. Due to my rather nomadic life I may be more knowledgeable with the US system than the Irish one, but that is indeed my understanding. Am I perhaps misunderstanding the question?

I am sure some things are not tested enough, or well enough, and I have no doubt bias and corruption rear their ugly head as well. But just like I do not consider all politics utterly useless, I do not disregard clinical testing either.

I'm not at all convinced that the canonical RCT is delivering what it's supposed to in terms of dependable evidence, and neither am I confident that clinical trials are a guide to what happens in real life.

So now clinical trials are useless anyway? Some of the things you are saying seem contradictory at this point. You were just asking me for evidence of them.

What do you propose to use as a guide to "what happens in real life"? Anecdotal evidence you like?

Many clinical trials have problems with enrolment and end up being under-powered and hence unreliable in the clinical context, many illnesses are treated with therapies that have never been tested in any type of clinical trial, and many treatments that come into general use have only been tested on an unrepresentative sample of patients. Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127439/

Oh so ther are clinical trials, but you do not trust them? You just asked me for evidence of them...

Four more areas where modern medical practice -- often in close association with the pharmaceutical industry -- is highly questionable:

1. The widespread and systematic prescribing of branded drugs instead of generics.
2. The prescribing cascade.
3. Co-morbidity and polypharmacy.
4. Disease mongering.

I doubt these will get a look in on C4 either.

I think I can see where this is going.

Waking-Dreams

Iwannahurl wrote: »

Why should mainstream medical malarkey get a free ride?

Who’s suggesting it should? This is just ONE television programme which looks at common alternative remedies; y’know, the kinds that people seem to pick up from various different sources or which have probably been passed down through generations, etc. “Granny’s old liver tonic”…

I really fail to see how not looking at some of the faults of mainstream medicine invalidates the findings that alternative treatments (in general) seldom work in the way the person claims they work or that they are no more effective than chance/placebo/using nothing.

Plenty of reputable people have written about both alternative quackery AND mainstream medicine’s shady underbelly, such as Ben Goldacre (Bad Science/Bad Pharma).

Maybe he’ll get a TV show one day?

Iwannahurl

Vivisectus wrote: »

That said, there is a growing awareness these days in scientific circles of the problems caused by publication bias, among other problems. This is especially strong in areas of medical science where it is hard to avoid subjectivity. Psychiatry is especially vulnerable to this, for obvious reasons.

Vivisectus wrote: »

In areas where it is harder to objectively measure outcomes, the effects of such biases as publication bias are more pronounced. There is simply more scope for interpretation, and hence bias. I am not saying any field is immune.

I'm sure no field is immune from publication bias, but perhaps the stakes are higher in biomedicine? However, I'm not following your line of reasoning here regarding publication bias and difficulties in "objectively measuring outcomes". What exactly is the association between "subjectivity", "objective outcome measures" and publication bias specifically?

Vivisectus wrote: »

Well, yes. Drugs are subjected to clinical trials. SO are medical procedures. It is the law. Not to do so leaves you open to massive liability to lawsuits, in fact. Due to my rather nomadic life I may be more knowledgeable with the US system than the Irish one, but that is indeed my understanding. Am I perhaps misunderstanding the question?

I am sure some things are not tested enough, or well enough, and I have no doubt bias and corruption rear their ugly head as well. But just like I do not consider all politics utterly useless, I do not disregard clinical testing either.

Would you care to address the limitations of clinical trials as discussed in the paper I linked to above?

Since you're familiar with the situation in the USA, you will no doubt know of the Vioxx saga. The story of that particular drug and its manufacturer Merck makes a good case study of the power of pharmaceuticals for good or ill, potentially affecting large populations.

A key issue with regard to clinical trials is the fact that potential hazards do not become apparent until years after formal approval based on limited investigations over much shorter time periods.

Unfortunately for citizens, it turns out that even generics may not be safe and that patients are afforded little protection by the state.

Your reference to politics reminds me of Winston Churchill's famous comment that democracy is the worst form of government except for all the others. I feel the same about science.

Vivisectus wrote: »

So now clinical trials are useless anyway? Some of the things you are saying seem contradictory at this point. You were just asking me for evidence of them.

What do you propose to use as a guide to "what happens in real life"? Anecdotal evidence you like?

Oh so ther are clinical trials, but you do not trust them? You just asked me for evidence of them...

Where did I say that clinical trials were "useless"? My point regarding "real life" is as outlined in the Journal of Clinical investigation paper above: clinical trials as currently constituted (in medicine and law) are often remarkably limited, and the real effects of medical interventions are often not revealed until large numbers of people have been treated over time. Then the court cases begin, in some instances. You could call real life a Stage 4 (uncontrolled) Clinical Trial perhaps, with the average patient enrolled as an unwitting participant in a mass experiment.

What I'm saying is that even the combined apparatus of science, clinical trials and the state regulation of biomedicine does not necessarily produce effective and sustainable outcomes in healthcare, and that we need much more rigorous and open public scrutiny of the issues.

Given the vast scale of biomedicine and "health" services compared to the so-called "alternative" community, which sector is worthy of the greater attention? The answer is obvious, I would suggest. Of course it's much easier to make programmes patronising the average citizen and rubbishing "home remedies and the whole alternative medicine malarkey", also for obvious reasons.

Vivisectus wrote: »

I think I can see where this is going.

Me too. It's not uncommon on Boards, in my experience.

Waking-Dreams wrote: »

This is just ONE television programme which looks at common alternative remedies; y’know, the kinds that people seem to pick up from various different sources or which have probably been passed down through generations, etc. “Granny’s old liver tonic”…

I really fail to see how not looking at some of the faults of mainstream medicine invalidates the findings that alternative treatments (in general) seldom work in the way the person claims they work or that they are no more effective than chance/placebo/using nothing.

I haven't suggested that media failure to place biomedicine under greater scrutiny somehow invalidates scientific study of "alternative" medicine. To repeat, my basic point is that since biomedicine is vast compared to "alternative" therapies, the level of public scrutiny should correspond. Are you aware of any TV series of a similar nature, say within the last five years, that subjected biomedicine to the same 'test'? I'm not saying that such programmes do not exist, just that I haven't seen them and that there aren't as many of them, imo, as the scale of biomedicine would seem to warrant.

EDIT: by way of illustration, I see eight threads about "alternative medicine" on the first page of this forum. Why is so much sceptical enquiry directed towards the alternatives and not towards established biomedicine, which is not always based on good science and affects both the citizen and the state to a far greater extent? What is so attractive about debunking "alternative" pseudoscience as opposed to critical analysis of biomedicine?

.

Vivisectus

I'm sure no field is immune from publication bias, but perhaps the stakes are higher in biomedicine? However, I'm not following your line of reasoning here regarding publication bias and difficulties in "objectively measuring outcomes". What exactly is the association between "subjectivity", "objective outcome measures" and publication bias specifically?

The wider scope for interpreting a test as successful. An example is the reported success of a batch of new anti-psychotic medicines in the nineties - I forget their names, but I will have a look later today for the article about it. They were reported as having greater benefits with fewer side-effects in quite a few studies.

This in turn had a knock-on effect where people reviewing groups of these medicines were also reporting them as more successful.

It was not until 15 years later that people found out they were unable to replicate the results, and that studies had in fact been done but not published that produced neutral results.

Would you care to address the limitations of clinical trials as discussed in the paper I linked to above?

I am not denying they have limitations.

Since you're familiar with the situation in the USA, you will no doubt know of the Vioxx saga. The story of that particular drug and its manufacturer Merck makes a good case study of the power of pharmaceuticals for good or ill, potentially affecting large populations.

And a few others, sure. Like I said: I am sure plain old greed and incompetency rear their ugly heads on a regular basis.

A key issue with regard to clinical trials is the fact that potential hazards do not become apparent until years after formal approval based on limited investigations over much shorter time periods.

Unfortunately for citizens, it turns out that even generics may not be safe and that patients are afforded little protection by the state.

Your reference to politics reminds me of Winston Churchill's famous comment that democracy is the worst form of government except for all the others. I feel the same about science.

I am still curious what you would like to substitute.

Where did I say that clinical trials were "useless"? My point regarding "real life" is as outlined in the Journal of Clinical investigation paper above: clinical trials as currently constituted (in medicine and law) are often remarkably limited, and the real effects of medical interventions are often not revealed until large numbers of people have been treated over time. Then the court cases begin, in some instances. You could call real life a Stage 4 (uncontrolled) Clinical Trial perhaps, with the average patient enrolled as an unwitting participant in a mass experiment.

Clinical tests can not screen out all possible effects. We need to try and strike a balance between the need for the new drug, the benefits, the potential risks, the cost, etc.

I take it you feel we are not currently doing a very good job at that. Do you have anything substantial to show just how good / how bad?

I was under the impression that you were saying that clinical trials are unable to detect positives, like many of the homeopathy fans do - I see now that you meant they are limited in what they can detect, and I think no-one can disagree with that.

What I'm saying is that even the combined apparatus of science, clinical trials and the state regulation of biomedicine does not necessarily produce effective and sustainable outcomes in healthcare, and that we need much more rigorous and open public scrutiny of the issues.

Nope - not all risks are screened out. Sometimes big ones. That said, comintg fresh out of some highly entertaining anti-vax discussions, I really wonder what form these would have to take and I shudder to think what some people would do with it.

Given the vast scale of biomedicine and "health" services compared to the so-called "alternative" community, which sector is worthy of the greater attention? The answer is obvious, I would suggest. Of course it's much easier to make programmes patronising the average citizen and rubbishing "home remedies and the whole alternative medicine malarkey", also for obvious reasons.

Yup - because they are pretty darn silly. And a program about the biomedical industry would probably become pretty technical pretty quickly and not make good TV.

Iwannahurl

Vivisectus wrote: »

a program about the biomedical industry would probably become pretty technical pretty quickly and not make good TV.

That's entertainment, not sceptical enquiry, imo.

We should be putting our critical faculties to better use, engaging and educating the public in the process.

Vivisectus

Iwannahurl wrote: »

That's entertainment, not sceptical enquiry, imo.

We should be putting our critical faculties to better use, engaging and educating the public in the process.

Hey I'd happily watch it. But I would be very worried about being immediately inundated by medical alarmists such as the anti-vaxx movement and health-woo merchants.

Iwannahurl

I'm not a fan of light entertainment myself.

With regard to publication bias, here are two links you might find interesting:

http://www.hta.ac.uk/fullmono/mon1408.pdf

http://www.cochrane-net.org/openlearning/html/mod15-2.htm


.

Vivisectus

Iwannahurl wrote: »

That's entertainment, not sceptical enquiry, imo.

We should be putting our critical faculties to better use, engaging and educating the public in the process.

Hey I'd happily watch it. But I would be very worried about being immediately inundated by medical alarmists such as the anti-vaxx movement and health-woo merchants.

Waking-Dreams

Iwannahurl wrote: »

I haven't suggested that media failure to place biomedicine under greater scrutiny somehow invalidates scientific study of "alternative" medicine.

Good to hear because your first two posts in this thread didn’t give that impression. Just saying.

Iwannahurl wrote: »

To repeat, my basic point is that since biomedicine is vast compared to "alternative" therapies, the level of public scrutiny should correspond. Are you aware of any TV series of a similar nature, say within the last five years, that subjected biomedicine to the same 'test'? I'm not saying that such programmes do not exist, just that I haven't seen them and that there aren't as many of them, imo, as the scale of biomedicine would seem to warrant.

TV programmes don’t always get made on the basis of being warranted but because of public interest, ratings, etc. While I have no objection to such programmes looking at biomedicine, I would hazard a guess and say that a show about alternative therapies will draw more viewers than about biomedicines, RCT and many of the other things you mentioned.

Personally, I would like to see some sort of TV programme (even a one off show) examining anti-depressants, especially after reading The Emperor’s New Drugs by Irving Kirsch. And given the prevalence of depression in society I’d imagine it would appeal to many viewers.

Iwannahurl wrote: »

What is so attractive about debunking "alternative" pseudoscience as opposed to critical analysis of biomedicine?

Perhaps because pseudoscience is just so prevalent in the public arena that it calls for a, somewhat, equal measure of sceptical enquiry. It’s hard not to open a magazine or turn on the TV without encountering some celebrity hawking a natural remedy or some nutritionist talking about “detoxing” their livers and the benefits of coffee enemas. Moreover, there are a lot of hucksters out there who profit off of selling snake oil. Endangered species are facing extinction so that Traditional Chinese Medicines continue and some alternative medicine practitioners are so bonkers they recommend people abandon conventional medicine altogether.

Iwannahurl wrote: »

Of course it's much easier to make programmes patronising the average citizen and rubbishing "home remedies and the whole alternative medicine malarkey", also for obvious reasons.

Patronising? These shows appear to be educational. Granted, the people who are promoting the remedies in question might feel slighted or spoken down to when they’re told it doesn’t work but the benefit is for others on the fence who might have considered it but will now know better and not waste their time.

I get your point about conventional medicine not being the beacon of perfection. But to go easy on alternative medicine just makes no sense, even if you consider it patronising to do so.

Iwannahurl

What was in my first two posts that would give such an impression? There remains much malarkey in modern healthcare, none of which has anything to do with "alternative" pseudoscience. My first post also included the following: "A 2001 review of 160 Cochrane Systematic Reviews found a "surprisingly high" number of biomedical interventions which had no beneficial effect or for which there was only inconclusive evidence. Has that situation changed much?" What impression does that statement give, and what do you suppose the answer to that question is?

Shows such as these seem to be little more than a mild amusement for some (not that I've watched it, mind you). I also have the impression that Sceptics' debunking of 'alternative malarkey' is a bit of a blood sport. It's also the line of least resistance, since it conveniently avoids the tougher and trickier task of challenging more powerful and established vested interests. It is much easier to laugh at the delusions of people with much lower levels of educational attainment than to persist in asking awkward questions of those higher up the food chain. I should acknowledge, however, that there is at least one Irish Sceptic who is not at all averse to debunking mainstream medical malarkey, and frequently does exactly that on his excellent blog.

That reminds me of a public seminar I attended several years ago at which two leading Irish Sceptics, prominent at the time, gave a presentation on "alternative" medicine. Their entertaining double act consisted of ridiculing the notions propounded by the the usual rogues gallery of quacks, gurus and snake oil salesmen. At one stage they put up a slide listing some scientific fallacies. Prominently displayed were the words "post hoc ergo proctor hoc" (sic). I hadn't the heart to correct them.

Waking-Dreams

It just came across as: there’s bigger fish to fry than alternative medicine. I don’t see why both endeavours can’t be pursued simultaneously. Why should one take precedence over the other? You say there are more problems in biomedicine. Well, alternative medicine is also a billion dollar industry too, so there are powerful and established vested interests there which would like to see it protected from widespread analysis. People also die from some of these treatments too.

http://whatstheharm.net/

If you see all this debunking as blood sport, perhaps this says more about your own attitudes towards alternative medicine. Are you a supporter of certain alternative medicines?

Look, there are plenty of people who support scientific enquiry yet also think that pointing out the delusions of others is strident, arrogant, or “misses the bigger picture”. I’m reminded of agnostics and certain atheists who “believe in belief” and consider it a bad idea for people to have their beliefs exposed to scrutiny. Fair enough. We’ll just have to leave it there I suppose.

Iwannahurl

Waking-Dreams wrote: »

1. I don’t see why both endeavours can’t be pursued simultaneously.

2. Why should one take precedence over the other?

1. Can you show me where that is happening in the Irish Skeptics forum? Can you link to, say, five notable threads over the last year in which some important aspect of biomedicine was subjected to critical analysis? My search for a thread with "Psychiatry" in the title drew a blank, btw.

2. It's a question of proportionality. In Ireland we spend about 9% of our GDP on "health" services. Are you seriously suggesting that spending on "alternative" medicine is anywhere near that?

Waking-Dreams

1. The Irish Skeptics Forum has to be one of the least frequented forums on boards. There are only 7/8 threads from 2013 and it’s now almost halfway through November! I really don’t see that as evidence of there being a dearth of people in Ireland who have questions about conventional medicines, do you? As pointed out earlier, alternative medicines are all around us, hence the popularity of debunking them. FYI, the Psychology forum might be of use for looking into criticisms of Psychiatry.

2. Hang on a sec: you’re comparing 9% of GDP spent on “health” services which would include ALL kinds of services and treatments (many of which actually work) to then asking for what amount of money is spent on alternative medicines (which do not work) and are not tax payer funded either (but are often paid for privately by citizens). I am not aware of any reports documenting the expenditure on alternative medicines in Ireland, but approx. $33 Billion is spent on them in the USA.

Now, somehow across Irish towns and cities, Traditional Chinese Medicine shops, health food stores i.e. Holland & Barrett are still staying in business. Of course, the latter do sell vitamins and other useful supplements but homeopathic remedies are not being put on their shelves for decoration. Also, how many different books will you find on the shelves in Easons and Waterstones about alternative medicines, etc? Not to mention, the “private” practitioners who take cash in hand for their services.

So, I dare say we may never get a true picture on how much is being spent on placebo medicine in this country but going by the overall trend in the USA, I think it warrants the current level of scepticism here.

That’s all I have to say on the matter. This is beginning to get repetitive.

Iwannahurl

There are no critiques of biomedical practices in the IS forum because the (few) regular posters prefer softer targets perhaps.

References to GDP etc are about proportionality.

$33 billion may be spent on "alternative" medicines in the US, but it is also true to say that Americans spend larger sums on conventional medical treatments and are not necessarily healthier as a result.

They also waste massive amounts of money on aspects of "health care" which have nothing to do with health at all. I recall a ?Harvard study some years ago which found that the amount of money wasted by HMO's "administration" practices could provide health insurance for every single uninsured US citizen.