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Alternative medicine part 3

My last post has created some controversy and some people were not happy with what I had written. I even got a couple of e-mails asking why I was so harsh with ¨alternative medicine¨. The senders said that, in their case, they had tried ¨alternative therapy¨ and it had worked for them, whereas ¨real medicine¨ had failed. And if their problem was one that had to do with pain or some other disease that is ¨subjective¨, I believe them. Yes, that´s right I believe them, but not for the reasons they think that the alternative therapy worked. I´ll use the example of pain and I will try to explain it.

In my last post (click here) I gave an example of an experiment which demonstrated that, subjectively, everything works. There wasn´t really any difference between any of the treatments, right? Well, pain is a very subjective feeling. We can´t measure pain. Some people have a small injury and lots of pain, while other people can have a huge injury and no pain. Pain is influenced by stress, anxiety, your beliefs, attitude, and a thousand other things. That is why pain is very complex, after all, pain is in the brain (click here). Your belief in a therapy can even influence pain, so if you belief something is going to help you with your pain then it probably will! And that may be the reason why sometimes alternative therapy helps these patients.
Now, when you have a disease that can be measured, for example diabetes, asthma, high blood pressure, etc. alternative therapy simply doesn´t work.  Because different trials have shown that  alternative  therapy is no better than placebo. A pill is horrible and I wish doctors would stop prescribing so many of them. But a pill is only released onto the market when it has been proven that is has a BETTER effect than placebo, while with alternative therapy that doesn´t happen. 
But not only this, if we look at the logic behind these alternative therapies we realize that there is no logic. For example, acupuncture bases itself on the principles that a ¨life force called qi flows through bodies along 12 channels or ¨meridians¨, and that illness and pain occur when qi cannot flow freely. Science cannot do a lot of things but it can measure energy, and ¨QI¨has never been found.
Homeopathy dilutes one drop of the original substance  in a hundred, thirty times over, meaning  that less than one part per million of the original solution is in the final product, but this doen´t matter because homoeopathist believe that ¨water has memory¨.
I will say, though, that most alternative therapists usually listen better to their clients, they create a greater bond than a doctor does with his client. If you are lucky the doctor will maybe give you 5 minutes and prescribes you something. I think this is horrible and something that should change. The best thing would be to combine both treatments, things that have been demonstrated to work in clinical studies, with the care and effort that alternative therapists treat their patients.
So in conclusion: I believe those patients 100% when they say that the alternative therapy worked for them… but it´s not for the reasons why they think it worked.
References
  1. Singh S, Ernst E. Trick or Treatment? Alternative medicine on trial. Transworld Publishers.2009
  2. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoepathy and allopathy. Lancet.2005
  3. Ernst E. Homeopathy: what does the ¨best¨evidence tell us? Med J Aust. 2010 Apr 19;192(8):458-60.
  4. Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011:152:755-64.
  5. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet.2005
  6. David Colquhoun (UCL) and Steven Novella (Yale). acupuncture is a theatrical placebo. Anesthesia & Analgesia, June 2013 116:1360-63
  7. Asbjørn Hróbjartsson, M.D., and Peter C. Gøtzsche, M.D. Is the Placebo Powerless?-An analysis of clinical trials comparing Placebo with no Treatment.N Engl J Med 2001; 344:1594-1602.

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Alternative medicine part 2: subjectively – objectively

Anyone who has followed me knows that I am not a big fan of alternative medicine. Not because I have anything against it, it is just because it doesn´t really work. Study after study has found that alternative medicine is just NO good (1-4), and when they have found that something really works, well, it stopped being called alternative medicine and started being called MEDICINE.

The thing is, sometimes when you visit one of these ¨alternative therapists¨, you may come out feeling better and thinking ¨his medicine or therapy is working¨. Now, a couple of factors may come into play why ¨his therapy may be working¨,  like the ones I mentioned  in one of my previous blogs (click here). But, people sometimes don´t understand this quite well so I want to explain it with an example.

Three years ago they did a study on asthma (5). Now, I first want to mention that we know how to treat asthma. If you have asthma and take your medication you probably won´t have any problems and can live a normal life. However, if asthma is not treated properly it can lead to complications and even death. annually 250,000 people worldwide die due to asthma (6).

Ok, so the experiment went like this: There were 4 groups of people with asthma. Each group was treated with a different technique. One group was given the real medicine (albuterol), another group was given fake medicine (fake albuterol or fake inhaler), another group received sham acupuncture (there is really no difference between sham acupuncture and real acupuncture (7-12)), and the last group received nothing, they were only controlled.

SUBJECTIVELY all 4 groups improved a lot. A visual analogue scale was used to measure this (with 0 indicating no improvement and 10 indicating complete improvement). The results went as follows:

  1. ALBUTEROL- 50% improvement
  2. FAKE ALBUTEROL- 45% improvement
  3. SHAM ACUPUNCTURE- 46% improvement
  4. NO INTERVENTION CONTROL- 21% improvement

This is so important because there was really no difference between the fake treatments and the real treatments. After the experiment the patients felt quite good.

Now, OBJECTIVELY, meaning they can measure it (they measured the percent change in Maximum Forced Expiratory Volume in 1 Second), they all improved!! And here are the results:

  1. ALBUTEROL- 20.1% improvement
  2. FAKE ALBUTEROL- 7.5% improvement
  3. SHAM ACUPUNCTURE- 7.1% improvement
  4. No-INTERVENTION CONTROL- 7.1% improvement

The real medicine worked 3 TIMES BETTER than all the fake medicines, even though subjectively there was barely any difference. This is important because, like I said before, if asthma is not treated properly it can lead to a lot of complications and even death!!  Subjectively you may go to an ALTERNATIVE THERAPIST and feel great, but objectively it probably isn´t helping you too much. Because alternative medicine is no better than Placebo (1-4).

Another thing to take into account from this study, is the power of the brain. Because even though the 3 ¨fake groups¨ are inefficient in treating asthma, they (objectively) improved the outcome of each patient. Even the group that was only being observed!!! This phenomenon is called Hawthorne effect and it means: Clinical improvement in a group of patients in a clinical trial that is attributable to the fact of being under study!!

Hoped you liked it

References

  1. Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011:152:755-64.
  2. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet.2005
  3. David Colquhoun (UCL) and Steven Novella (Yale). acupuncture is a theatrical placebo. Anesthesia & Analgesia, June 2013 116:1360-63
  4. Asbjørn Hróbjartsson, M.D., and Peter C. Gøtzsche, M.D. Is the Placebo Powerless?-An analysis of clinical trials comparing Placebo with no Treatment.N Engl J Med 2001; 344:1594-1602.
  5. Michael E. Wechsler, M.D., John M. Kelley, Ph.D., Ingrid O.E. Boyd, M.P.H., Stefanie Dutile, B.S., Gautham Marigowda, M.B., Irving Kirsch, Ph.D., Elliot Israel, M.D., and Ted J. Kaptchuk. Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma.N Engl J Med 2011; 365:119-126
  6. http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx
  7. Linde K, Streng A, Jürgens S, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes MG, Weidenhammer W, Willich SN, Melchart D. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;293:2118–25
  8. Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K. Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005;331:376–82
  9. Haake M, Müller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167:1892–8
  10. Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther HU, Melchart D, Willich SN. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366:136–43
  11. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858–66
  12. Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115

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Homeopathy- the truth behind it!!

It´s one of the fastest alternative therapies that exist out there. Annual sales  in the United States only are $300 million (1)!! But, is homeopathy really effective and if so how does it work?

The funny thing about homeopathy is that people really don´t know what it is or how it came about. So, let´s explain that a little bit.

Homeopathy was invented by a Geman named Samuel Hahnemann at the end of the 18th century. One day when he was healthy he decided to experiment with a drug called Cinchona, which is derived from the bark of a Peruvian tree. Cinchona contains quinine and was being used to treat malaria. When he took this drug, his health deteriorated to the point at which he developed the sort of symptoms usually associated with malaria. He experimented with other drugs that were being used for other diseases and obtained the same results, meaning he would always get sick. So by ¨logic¨ he came to the following conclusion: ¨that which can produce a set of symptoms in a healthy individual, can treat a sick individual who is manifesting a similar set of symptoms(1)¨. But, on top of that, he added that diluting the substance would produce greater effects in curing a person, while reducing its potential to cause side effects. !!Voila!!! There you have it,  the ¨science¨ behind homeopathy…..but it gets better ;). How do they dilutate the substance, you ask? Well let´s go ahead and explain that with an example.

They put a plant in a sealed jar with water or alcohol, which dissolves some of the plant´s molecules. After several weeks the plant or solid material is removed, the remaining water with its dissolved ingredients is called mother tincture. The mother tincture is then diluted to such an extent that there will be NO molecules of the original substance left in the dose you get.  The typical homeopathic dilution is 30C: this means that the original substance has been diluted by one drop in a hundred, thirty times over. This means that less than one part per million of the original solution is in the final product. But this is not important to homeopaths because (this is the best thing) they say that ¨water has memory¨. Ah, I almost forgot: it´s also very important to vigorously shake the homeopathic remedy at each dilution(1-2).

With all this said, you can imagine that all the serious(3-5) trials that have been done have shown that homeopathy is no better than placebo (homeopaths will defend themselves mentioning some poor quality trial). Even after explaining all this to some people, I will still get the typical homeopathy fan that says to me ¨All I know is, I feel better when I take it¨. So how do you answer that statement? Well, you could simply explain to them about placebo and the effect it causes. Or about ¨regression to the mean¨ (https://sports-diet-pain.com/2013/12/02/why-do-%C2%A8alternative%C2%A8-therapies-seem-to-work/), which basically means that all things have a natural cycle, meaning  you will have good days and bad days. It´s like with a cold. It´s going to get better after a few days, but at the moment you feel the worst, that´s when you will do dramatic things to try to get better, like taking a homeopathic remedy. Then, when you get better ( as you surely will from a cold), you will naturally assume that the homeopathic remedy must be the reason for your recovery.

Here are couple of videos that talk about homeopathy. The first video is a MUST SEE!!! It explains what homeopathy is and how scientific trials work.

Until next time!

http://www.youtube.com/watch?v=iUt15WbF1_4       It´s called Homeopathy: The Test (BBC Documentary Films)

http://www.youtube.com/watch?v=YiwaGnj8kPU

http://www.youtube.com/watch?v=DHVVKAKWXcg&feature=share

References

  1. Goldacre B. Bad Science. Fourth Estate. London.2009.
  2. Singh S, Ernst E. Trick or Treatment? Alternative medicine on trial. Transworld Publishers.2009
  3. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoepathy and allopathy. Lancet.2005
  4. Ernst E. Homeopathy: what does the ¨best¨evidence tell us? Med J Aust. 2010 Apr 19;192(8):458-60.
  5. Wilson P. Analysis of a re-analysus of a meta-analysis: in defence of Shang et al. Homeopathy,2009 Apr;98(2):127-8.
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