Aging Capriciously

This is the second of the ten perspectives I am going to discuss about medical care in the United States in the 21^st Century.  My caveat this week is that if you truly think witch doctors, fortune tellers, bizarre untested treatments, herbal cures, doctors in foreign countries, prayers and numerous kinds of quack medical treatments can cure your sainted mother’s cancer or your father’s heart condition, then by all means “go for it.”  Much of what passes for medicine in the USA is not based on science but is based on hopes and wishes and dreams.  Far be it for me to destroy your last hope.

On the other hand, if you want to be rationale and logical about it, then evidence based medicine with a feedback loop based upon open scientific investigation and testing is the best way to truly establish cause and effect in medical practice.  Let me tell you an often heard story.

Mary Jane was 31 years old and was diagnosed with terminal brain cancer.  After ongoing chemotherapy and radiation therapy, she continued to decline physically.  There appeared to be no other options for her.  However, her 39-year-old brother Bill had heard of a treatment being used by some people in a village in the Alps which they claimed could cure cancer.  A doctor Kowalski had written a book extolling the virtues of this treatment and Bill had bought the book.  Bill convinced Mary Jane to give it a try.  She stopped her chemo and radiation treatments and started following the treatment regimen.  Within four weeks Mary Jane was looking a lot better and feeling better as well.  After two months on the regimen, she visited her oncologist.  He took some tests and “would you believe it?”  There was no sign of the cancer any more.  This treatment regimen (unknown to modern science) had totally cured Mary Jane. 

Wow, what a story!  Is that fantastic!  Makes you want to kick all those mainstream traditional doctors right in the butt. 

Epilogue:

Three months later, Mary Jane became quite ill.  Further tests showed her cancer had returned or perhaps never left.  Mary Jane died in another six weeks.

Raise your hands please, if you have heard this story or a similar story before.  I am sure most of you have.  Hope springs eternal in the human breast.  I can’t blame anyone for that.  I can blame those who promote untested and unscientific treatments and get poor suffering people to buy into their schemes.  It is one thing to find a new cure that perhaps may be proven to have medicinal value.  That kind of discovery happens all the time.  It is quite another thing to put down traditional medical science as useless.  Furthermore, there are indeed negative consequences of many alternative medical practices.

Dr. Paul A. Offit, a noted medical researcher and pediatrician (Wiki) has proposed four ways in which alternative medicine “becomes quackery”:

1. By recommending against conventional therapies that are helpful.
2. By promoting potentially harmful therapies without adequate warning.
3. By draining patients’ bank accounts.
4. By promoting magical thinking.

What is a Quack? 

Quacks are often well meaning but “the road to hell is paved with good intentions.”  We have people who believe vaccines are harmful.  We have people who believe poisonous snakes can be handled safely if you only believe in Jesus.  We have people who believe that disease is caused by negative thinking.  We sometimes confuse these people with the old “snake oil” salesman.  The distinction between the quack and the “snake oil” salesman is quite important.

The “snake oil” salesman is probably a fraud, a cheat and a con-artist.  The friend who is trying to convince you that you should not go to a regular doctor is probably well intended.  This makes them even more dangerous than the “snake oil” salesman.  You may instinctively distrust the salesman but you trust your friend.  Such unfounded trust can kill you.  Your friend is pedaling an idea which may be dangerous and have no scientific merit.

“But wait,” you say.  “Why does everything have to be approved by the FDA or the AMA or some other authorized group?  What makes them superior to my witchdoctor or acupuncturist?”  The answer to this question if very difficult to explain.  Studies show that less than 30 percent of Americans are scientifically literate.  Trying to explain why science is more trustworthy than hope and intuition is very difficult to people lacking scientific literacy.  It is even more difficult since the search for empirical evidence is a journey and not a destination.  No one can say that science is 100 percent accurate or 100 percent certain.  Furthermore, we can find many anomalies wherein science was at first wrong or where the scientific evidence was premature.  This leads many who are intimated by science to be even more skeptical of its results and processes.

[For an excellent article on understanding scientific medicine and avoiding quacks, read: Tooth Fairy Science and Other Pitfalls: Applying Rigorous Science to Messy Medicine, — by Dr. Harriet Hall]

Homeopathy, Acupuncture and Pseudo Science

Homeopathy, acupuncture as well as creation theory, alchemy, parapsychology and many occult practices are labeled as pseudosciences.  The definition of pseudoscience is:

“Pseudoscience consists of claims, beliefs, or practices presented as being plausible scientifically, but which are not justifiable by the scientific method.   A topic, practice, or body of knowledge can reasonably be considered pseudoscientific when it is presented as consistent with the norms of scientific research, but it demonstrably fails to meet these norms.” — Pseudoscience, Wikipedia

I had intended to start this section off as a critique of homeopathic remedies but I decided to extend it to include the broader issue of pseudoscientific remedies.  I was going to discuss the fact that homeopathy no doubt relies on the well-known phenomenon of the “placebo effect.”  A placebo is a “fake” pill or medical treatment to which no known curative properties can be attached.  Nevertheless, people given such treatments often report “miraculous” cures.  I have even known people to get drunk while drinking colored water that they thought was wine or liquor.

“In many conditions, placebo effect is a big part of the effect of the drug,” said study researcher, Ted Kaptchuk, a professor of medicine at Harvard Medical School.  In the new study, 50 percent of the drug’s effect could be attributed to the placebo effect, he said. — Live Science, 2014

When it comes down to the efficacy of homeopathic pills, the evidence is just as damming.   Homeopathic treatments simple do not work any better than a placebo.

Homeopathic preparations are not effective for treating any condition; large-scale studies have found homeopathy to be no more effective than a placebo, suggesting that any positive effects that follow treatment are only due to the placebo effect and normal recovery from illness. —  Ernst, E. (2002). “A systematic review of systematic reviews of homeopathy”. British Journal of Clinical Pharmacology. 54 (6): 577–82. —- Wikipedia, Homeopathy

A little earlier in this paper, I briefly gave a testament to the scientific method over methods of pseudo-science that we have been discussing.  But, you may well ask, “What is the difference between science and pseudoscience?”   A second question might be “Well, how much faith can I put into the scientific method?”  Let’s take the first question.

What is the difference between science and pseudoscience?

A simple answer to this question is that science is based on objective repetition of results.  It uses evidence based analysis to determine the strength of the relationship between cause and effect variables.  Science must be transparent and the process used to determine cause and effect must be readily available to other scientists.  Numerous examples can be cited wherein faulty scientific research led to erroneous conclusions.  However, unlike pseudoscience, where there are no checks on the process, scientific faults will eventually be discovered and admitted.  This is often to the chagrin of the scientists who were either foolish or biased in their calculations.

In science, you have theories or hypothesis which are open to testing and ultimately being found either true or false.  There is a great range in the power of a hypothesis which renders some more important than others.  For instance, anyone can predict it will snow in Minnesota but the ability to predict exactly when and how much it will snow on any given day would be evidence of a very strong theory.

In pseudoscience, hypothesis and theories are either untestable or often non-existent.  For example, if I gave you a homeopathic pill of aconite (also known as wolf’s bane) as a remedy for your cold and you got better, does this mean the aconite cured you?  Without some type of controlled study, there is no way to know.  Perhaps, you would have gotten better without it anyway.  Many homeopathic practitioners recommend this substance as a means of alleviating cold symptoms.

(Click here for an excellent analysis of some of the many treatments recommended as cold remedies)

There are literally dozens if not hundreds of such substances that you can find recommended by alternative medicine practitioners.  The problem is not that they do not work, since for some people, some of the time, some of these substances might be very effective.  The problem is that often little is known about their effectiveness, their method of working or potential side effects that might be harmful.  Furthermore, as opposed to the scientific method, pseudoscience will make extravagant claims without more than anecdotal evidence that some treatment regimen was indeed effective.

Forbes (2014) published this list of the top five cold remedies to avoid since there is no evidence to support their effectiveness:

1. Zicamcontains zinc as its active ingredient. There has been some evidence to suggest that taking zinc right at the onset of a cold might shorten its duration a little bit, from 7 days to 6. But as Dr. Terence Davidson from UC San Diego explained, if you look at the more rigorous studies, the effect vanishes. Zinc turns out to have some worrisome side effects, too.

2. Airborne. You can find this in the cold remedy section many pharmacies but Airborne doesn’t cure anything. It’s a cleverly marketed vitamin supplement with no scientific support for any health benefits.

3. Coldcalmis a homeopathic preparation sold by Boiron, one of the world’s largest manufacturers of homeopathic remedies (including Oscillococcinum, an almost laughably ineffective flu remedy). It claims on the package to relieve cold symptoms. What’s in it? A dog’s breakfast of homeopathic ingredients, including belladonna, about which NIH says: Belladonna is UNSAFE when taken by mouth. It contains chemicals that can be toxic.
4. Umckais another homeopathic preparation that claims to “shorten the duration of common cold” and “reduce severity of cold symptoms.” Sounds pretty good—if only it were true. Umcka’s active ingredient is a plant extract called pelargonium sidoides, an African geranium. Interestingly, there have been a few experiments on this extract, some of which showed a small positive effect.

5. Antibiotics. Even if you cannot buy them, many people take them to treat a cold.  The problem is that antibiotics do not work for colds.

It would be interesting to see how much Americans spend each year on medicinal preparations that have little or no value.  There is so much superstition out there based on anomalies and anecdotes that people put their faith in.  Which brings us to the next question.

How much faith can I put into the scientific method?

The easy answer is that it depends.  What makes a good theory is the question we need to answer before we can know how much faith we should put into science.  Here is one answer as to what makes a good theory:

1. A good theory should explain the observations or results of an experiment or phenomena.
2. A good theory should allow for testing. 
3. A good theory can be tested against an independent objective criteria.
4. A good theory should be frugal in its nature so others can test it.
5. A good theory should be predictive.

Thus, if you are looking for the truth and you get a truth, be it from a scientist or from a witchdoctor, you can ask yourself how well the “truth” meets the four criteria above.  Let’s take some hypothetical examples.

• My good friend Dick says that Fords are better than Chevies? Do any of the above criteria apply to his belief?  I think not.  If so, I cannot see how.  Thus, I would call this a weak theory or more accurately, an opinion.

• Another friend of mine says it will be very cold next week. This assertion can be validated. Criteria 2, 3, 4 and 5 might all apply.  If he turns out to be right, he would only have to satisfy criteria number 1 to have a very strong theory.  In other words, he would have to provide some logic or rationale for his theory.  Subsequently, we could continue to test his theory and see if he can continue to accurately predict the weather.  The more his predictions come true and can be validated against some external criteria, the stronger his theory is. (We will assume he is not just reporting from the local weather station.)

So, we are now back to the issue of how much faith can be put into the scientific method.  I hope you will see from the above discussion that this will depend on whether the outcomes of the method are indeed subject to some rigorous external validation and criteria.  Without these factors, I would not trust my local scientist any more than my local witch doctor.

Time for Questions:

Why do you think people go to quacks?   Have you ever been to someone you thought might be a quack?  What results did you get?  What can people do when they are not helped by medical practitioners?  What other recourse do they have?

Life is just beginning.

“The claim of alternative practitioners to not treat disease labels but the whole patient…allows alternative practitioners to live in a fool’s paradise of quackery where they believe themselves to be protected from any challenges and demands for evidence.”  — Edzard Ernst