The Never-Ending Story

I`m sorry, but the author seems to be a real loser. First of all, she writes as if its natural for freshies from Pakistan to get involved in drugs and alcohol. I`m not saying they don`t, they do, and its during the whole wannabe phase so that they can get socially accepted into this gora environment. I was born and raised in California, and I moved to Karachi to do my high school and I saw what goes on in Pakistan. Ya I could name a lot of people who got into the drug/alcohol scene, but I could also name a lot who didn`t, myself included. The main reason why the kids in Karachi get into this stuff is to look cool. And the fact that you had to trade your virginity for a joint just shows your level of self value and morals.

No, I don`t mean to kick you while you`re down. I`m just saying, when you mess up, own up to it. Don`t blame society and the religion you so obvioulsy choose not to follow. Pointing fingers just shows that you still haven`t woken up from one of your drug induced states of ignorance. Don`t bring the rest of us down either. We all only have ourselves to blame.

As Salaamu Alaikum

guess im still in denial about my state or something or maybe i am immune..who knows..but do we really care about what ppl think?i know i say this as a man and cannot begin to comprehend what the other sex goes thru..but we try.

REQUEST TO MODERATORS: IF YOU LET THIS POST THROUGH, KEEP THE ARTICLE ON THE FRONT PAGE FOR A FEW MORE DAYS.

Re: Juanita (Reply 111)

I will proceed to discuss primarily herbal remedies, to keep this interact focused. A similar argument can be made for other alternative therapies such as homeopathy, acupuncture, etc.

``[Referring to efficacy of Alternative therapies] the overwhelming majority investigated so far do not [work]`` (brackets mine)

By the way your bias is fully evident in that you quote four examples (Reply 107) on Alternative agents/procedures, all of which are negative. In your hurry to glean negative results you may have MISSED any positive result studies, but I will assume this was not INTENTIONAL ! You may have been inhibited by your resource base, since very little evaluation of herbal agents has occurred in the US. In Europe, and particularly Germany, hundreds of herbs have been evaluated, and many have yielded - surprise, surprise! - positive results. Saw Palmetto was shown in a study to be as effective for treating enlarged prostate as the expensive/risky drug Proscar. Lets take Milk Thistle, which guards the liver against toxins and has even been shown to support the regeneration of new liver cells; the active compound here is silymarin. Now if you conduct a test on Milk Thistle to see if it cures liver cancer, your results may be negative, but that`s not the conclusion an honest scientist would put out there, to discredit any curative properties the herb may have. This is what you end up doing. Your bias in only presenting one-side of the picture to win an argument surely doesn`t establish credibility with me.

Lets consider your example of garlic extract for cardio-vascular risk. You don`t say how ``cardio-vascular risk`` was defined in this experiment. Garlic has been shown to be active against parasites, fungi and viruses. It also lowers cholesterol and acts as an inhibitor of blood clot formation, both of which can prevent heart attacks. When you crush a clove of fresh garlic, there are enzymes which convert the chemical alliin to allicin, which is quite a strong natural antibiotic. For you to just throw out there a placebo study, which shows ``no difference in results``, only makes one wonder what the observed parameter was. Shouldn`t YOU be asking this question as a scientist, rather than a layperson like myself ? Are you attempting to discredit garlic, or herbs in general, or what?

Another example you give is Echinacea as an immunity enhancer against colds. Once again you do not define how increased immunity was measured. Echinacea shortens the INTENSITY and DURATION of flus and colds. Its also effective against urinary tract infections, and as a `marham patti` for external wounds. It helps the immune system better defend itself against foreign organisms, but this process is not fully understood. This evidence should suggest, even to the most skeptical researcher, an opportunity to further explore Echinacea, and better understand how it works on the immune system. Isolating an active agent only gives us part of the picture, because we look for a specific compound, which affects the observed parameter, to establish direct causality. But at least, it`s a start. Unfortunately, for some researchers the isolation of an active compound is an end in itself. Now, once again, I think your objective is to flout Echinacea as a herb, thereby attempting to discredit the larger case for herbal remedies.

For completeness I must give examples of herbs that have curative properties but are not prescribed because of unacceptable side effects. Belladonna is effective against gastro-intestinal cramps, but also contains toxic alkaloids, which prohibit its use. Chaparral can be used for arthritis, cancer, pains, colds, but can also cause severe hepatitis and liver failure. Kombuchatea can be used for AIDS, insomnia and acne, but can also cause liver damage, intestinal problems and even death. Again, this does not discredit herbal remedies in general, as you attempt to do.

One must dig deeper and see whether the models may be flawed, not just parrot the conclusions. Are there secondary or tertiary effects on the body that are not being observed? Does the agent being evaluated act on a completely different organ or system (nervous vs. cardiovascular) which in turn effects the immune system, which then effects the observed parameter? Is the observed parameter being defined too rigidly to compensate for the inadequacy of current theoretical models and experiment hardware, or due to limitations of funding and time constraints?

A discussion of research would be incomplete without a mention of the politics and money, which feeds it. Funding is disproportionately directed towards diseases with high media visibility (read high incidence in white males) and the public is conditioned into salivating for the one BIG CURE for heart disease, or cancer or now belatedly AIDS. Here the blame rests with approval-seeking politicians and the attention-grabbing media. Scientists have continued to warn that there will not be one big cure for cancer, but the media has to dumb it down so they keep fixating on a simplistic articulation of disease and cures. It is common knowledge for those who care about these issues, that AIDS research funding was finessed for many years by characterizing the disease as a GAY problem. This was useful in reducing the disease to an issue of life-style choice and concomitant risks. Only recently have powerful gay white men in the fashion and entertainment industry raised public awareness to the point that wearing red ribbons is cool.

If you wait till the mainstream is convinced before taking action, you`re always going to be late. Anyway, funding and politics is a separate issue, but I bring it up to show how politics and the media can influence where funds are directed, and what results are sought. Would you uncritically swallow a study on fetuses funded by the Heritage Foundation, or Americans for the Family Way? Pay the piper and call your tune. Vested interests (politicians, business, doctors and scientists trained in Western medicine, etc.) generally fund research done with `acceptable lenses` because those parameters can be set up by them, and the results by definition won`t rock the boat too much. Not all research may be so tarnished, but these are factors we must bear in mind.

Think about it. The vast majority of doctors treat medicine as an assembly line profession (I know you will want to take this personally but try and resist the impulse). Go through a checklist, hit bullet point symptom observations, form hypothesis, prescribe medication, if patient doesn`t come back they were cured. Who would want to go through an educative process where they have to further learn a bunch of crap about various mumbo jumbo third-world remedies with herbs, acupuncture and voodoo magic. Easier to say, I`m the doctor, I`m more educated about your health, you`re paying me, so trust me.

Most doctors get defensive when they are questioned about anything related to the practice of their craft on YOUR body. Maybe they are in a hurry to maximize the number of patients. Maybe they think every patient is stupid. Maybe they don`t like being questioned on topics which are their domain. Maybe preserving this domain and limiting the terms of debate is the best way to perpetuate their stranglehold on the practice of medicine?

There is obviously a resistance to accepting alternative medicine, but the momentum and the evidence is building up, when you look in the right place and with the correct lenses. To quote negative results in some placebo studies as the death knell for herbal remedies is ridiculous. Unless the underlying assumption is, and this is more sinister, that anyone who argues for herbal remedies is by definition this fuzzy, dimwitted, gullible, uneducated, commune-dweller who jumps onto every trendy bandwagon. As a matter of fact, you have tried to characterize support for alternative remedies as synonymous with this mindset. This again is disingenuous because it serves to discredit the arguments for alternative remedies by conflating them with an alternative lifestyle mind-set, to elicit all the negative emotions which one may have for such people.

To your credit you state:

``Physicians and medical scientists clearly should accept much of the responsibility for the creation of this huge `information failure`... they must become better at communicating with the lay public about their health in a language they can understand.`` (you go on to give examples of your extensive writeups and followup)

But the stance you adopt on chowk of ridiculing opposing points of view, the people who propose them, and the examples you offer in support of your viewpoint, all show that you are not interested in resolving this ``information failure``. Instead you resort to attempts at exposing your detractors as illogical and misinformed.

Agree with your point about unscrupulous, unregulated herbal remedy manufacturers, with dubious claims. I don`t recall anyone advocating a widespread embrace of all herbal remedies. Maybe this is ``counter-acting with subterfuge``, because its easier to discredit an argument by first misrepresenting it. Again begs the question, do you want to win an argument that badly?

``poorly conceptualized misinformation``

Make up your mind. Is it poorly conceptualized or is it misinformation? Because its not going to be very effective as misinformation if its poorly conceptualized to start with.

And your rebuttals to my ``misinformation`` are very easily dismissed. Here goes:

``1) double-blind studies DO NOT INVARIABLY involve continuos curves. It depends on the parameter of interest under study. Examples include cancer cured versus not cured, patient lived versus died, number of colds reduced versus not reduced. In pain studies, the patients own subjective assessment of pain is often used - i.e if the patient says pain was reduced, we`ll accept that.``

WRONG. It DOES all fall on a multi-variable continuous `surface`. However, scientists arbitrarily define a binary overlay by setting up the hypothesis H1 and its negation H0. The experimenter then proceeds by forcing complex, multi-variable and continuously distributed outcomes, into 2 data buckets - H1 and H0. My criticism is of the way H1 is defined in a limited fashion such as ``cancer cured`` or ``patient died``. ``colds reduced`` is even more ambiguous. What does ``cancer cured`` mean? Is the cancer reduced in size, is it surgically removed, does it simply disappear. If you remove half the intestine with a tumor, is that the same thing as spontaneous regression? As for ``patient died``, if X dies in 5 months, Y lives for 2 years on a respirator, and Z dies a slow and painful death in 5 years. Would it be fair to lump them all as ``patient died``? Or even patient lived? What kind of life would that be? Science is based on assumptions, theories, and limited knowledge, which lead us to a limited understanding of reality. This does not mean that what we cannot measure, what we do not know, what we cannot isolate -- does not exist or is irrelevant. A little humility on the part of scientists is not misplaced.

If the agent (whether its an herb or some other chemical) does not have direct and obvious results, should it be dismissed? How about setting up the experiment differently. Why not look at the results on the whole body, and draw conclusions for subsequent investigation? Maybe isolating an active ingredient from the herbal extract is not as effective as using the herb itself. Maybe there are other chemicals in the extract which act as catalysts for the active agent. Maybe two compounds appearing together in an herb cancel each other out. Or maybe one introduces a hazard while the other has curative properties. Usually the compounds in plants are in dilute form, they have milder effects compared to one concentrated chemical in a synthetic drug. Maybe the experimenter is ONLY looking for a kick-ass ``cancer cure``, and will ignore other salutary side effects. Chinese herbal remedies are always prescribed as a combination of multiple herbs in measured ratios, because they have a combined effect.

Pharmaceutical drugs are already hitting efficacy limits as bacteria develop resilient strains to the strongest antibiotics. The future will draw heavily on herbal, least of all because this research is cheaper. The correct lenses will THEN be developed.

``2) An alpha level (blah, blah, blah) ... causality ... biological plausibility and coherence, strength of an association, consistency of the association from population to population, temporality of cause and effect, existence of biological gradients, results from animal experiments, and much more.`` (blah, blah, blah)

I know what alpha is. You just reproduce info off the shelf, for the heck of it. I can`t believe all the medical jargon you throw up as a smoke screen. Who ever denied or dismissed all this? The point, which you conveniently dissemble on, is that you need to modify or change the current methodology in order to evaluate alternative therapies effectively. And this IS happening, whether you agree with it or not.

``3) Keeping an open mind should apply equally to you...instead of stubbornly clinging to your alternative worldview.``

I don`t think you care to elicit my worldview. My worldview is that since our knowledge is limited we must be open to ALL alternatives, with western medicine as a de facto inclusion.

``Btw, nicely timed response with Bad Girl to my ``falsely malign`` statement!!``

Nicely timed ``lunacy`` ruling by Godot in (Reply 117) ?

``I am still waiting for that Gary Null data you were going to edify us with`` (Reply 113)

Permit me to put you on a gingko baloba regimen for a couple of months, as a prelude to sharing this data. Otherwise, I`m afraid the effort will prove futile.

``You deny hostility, but I feel that this hostility is expressed through Random.``

So....? Here`s a thought. Maybe you should address Random as to this perceived ``hostility``.

In conclusion, traditional and specifically herbal medicine was the main therapy for centuries, until concentrated pharmaceutical drugs were developed. Now, as the disillusionment with modern western medicine grows, as a result of costs and consequences of modern drugs, more people are turning to alternative remedies as a way to take back control over their own health.

As correctly pointed out by you, this leaves the field wide open for quacks, because this segment is unregulated. However, you go the other extreme to present selective evidence against alternative therapies, with a view, in my opinion, to dismiss any discussion of it as simple-minded.

Currently about a third of Americans use dietary supplements (herbal remedies are categorized as such) which shows a growing dissatisfaction with the present state of modern medicine. Many patients don`t tell their doctors they use herbal drugs for fear of being ridiculed, sentiments you have amply exhibited on chowk. For your professional sake you would be advised to be more open about herbal remedies, because if your patient does not tell you they use a herbal drug, and your prescription dangerously interacts with the herbal drug, you could have a problem on your hands.

All German physicians are required to take courses on herbal therapies, but there are only a handful of American schools, which even offer courses in it, let alone requiring it. Germany`s Commission E tested 380 botanicals and approved 254 as ``safe and reasonably effective``, and rejected 126 as ``ineffective, unsafe or both``. Hardly supports your statement ``the overwhelming majority investigated so far do not [work]``. Even the FDA is succumbing to the evidence, as Dr. Robert Temple, director of its Center for Drug Evaluation said in June 1996, that they would be willing to consider a lower bar for approving herbs, ``A long history of safe use might provide sufficient safety information ... for short term use.``

For a scientist who claims to walk the same halls as Judah Folkman, you have some remarkably convenient blind-spots. For the sake of your career, you better make it clear you`re only sparring with me, or deliberately ``counter-acting with subterfuge`` (SR). Even though you are attempting to argue the case for scientists and the medical profession, if Dr. Folkman were to read your responses here, he would cringe at your efforts to argue a position that even he would not take. I assume you think of him as a heavy-hitter in his field, since you brought him up. Incidentally, Dr. Folkman reported his results in 1997 but they were not reproduced by anyone until now, when the National Cancer Institute reported duplicating his findings (NYT 2/12/99). For those who don`t know about this study, Dr. Folkman was able to give certain drugs to mice with cancerous tumors, which cut off blood supply to the tumors and destroyed them. It`s a bit unusual to have been prematurely proposing his findings as an example, when they had not been duplicated in another lab. This in the light of your continued resistance to any evidence supporting alternative therapies.

Just some macrobiotic, organic, conceptual food for thought.

Random (Juanita-inhibitor) Gekko

Sources: (1) The Physicians` Desk Reference for Herbal Medicines; (2) The Complete German Commission E Monographs; (3) ``Tyler`s Honest Herbal`` by Dr. Varro E. Tyler with Steven Foster; (4) ``Tyler`s Herbs of Choice`` by Dr. Tyler with James Robbers; (5) Journal of the American Dietetic Association, October 1997; (6) The Mayo Clinic Health Letter, June 1997. Dr. Tyler is Emeritus Professor of Pharmacognosy ( the study of active ingredients in plants). Most of the evaluations in (1) and (2) are based on studies conducted in Germany. There is an NIH website too- www.nal.usda.gov/fnic/IBIDS/.

hey everybody...

just thought i`d drop in and say a quick hello.

HIIIIIII

shandana

Re: Godot

``...you are wasting your time with a couple of people. Save your energy for those whose ideas do not border on lunacy.``

You know Godot - I think I`ll take your advice!!

Anita

re anita

for the benefit of those who dont have to be subject to ``this`` never ending story, i am going to respond to you directly by email.

Re: Anita Zaidi

Anita, it is quite obvious to me that you are a very intelligent, sane, and nice woman (lucky Saad!). It is also quite apparent to me, then, that you are wasting your time with a couple of people. Save your energy for those whose ideas do not border on lunacy.

Re: Bad Girl,

In case I still haven`t made my point clear -

You deny hostility, but I feel that this hostility is expressed through Random. You refuse to admit or deny a relationship. If you did, we could talk about it like adults, resolve this once and for all, and move on.

Anita

Oh, and Random,

I am still waiting for that Gary Null data you were going to edify us with.

Anita

Re: Bad Girl

Thank you for your response. I wasn`t really expecting you to be candid.

I am glad that Random was conveniently able to speak for himself just at the right time.

So long,

Anita

Re: Random

``One of the main limitations to our science is a closed mind. The person who brings about a `paradigm shift` is not merely brilliant, but is willing to step outside the prevailing set of beliefs --- to open her mind to regimes that may not be definable by current science.. The danger arises when scientists resist this, convinced about the completeness and internal consistency of the ACCEPTED FRAMEWORK, and worse - slander those that propose ALTERNATIVE FRAMEWORKS``

You have made some very valid comments about keeping an open mind. That is undoubtedly the road to progress. And scientists have kept an open mind about alternative therapies. There is much activity here, in the scientific world, in an effort to finally resolve which, if any, of the thousands of alternative therapies in vogue work. Unfortunately, the overwhelming majority investigated so far do not.

You say:
``Double-blind studies invariably involve a continuous curve with arbitrarily defined confidence intervals. Researchers have decided that for placebo studies they feel comfortable with an alpha of 5%, or 1% or 0.1%. This may be reasonable, but the objective is to ascertain a binary result from a continuous data set, e.g., Ibuprofen measurably reduces the sensation of pain. For the purposes of establishing reasonable causality, this may suffice, but to cling to such body of studies as the holy grail is hubris.``

There is a lot of poorly conceptualized misinformation here.

1) double-blind studies DO NOT INVARIABLY involve continous curves. It depends on the parameter of interest under study. Examples include cancer cured versus not cured, patient lived versus died, number of colds reduced versus not reduced. In pain studies, the patients own subjective assessment of pain is often used - i.e if the patient says pain was reduced, we`ll accept that.

2) An alpha level indicates the probability that the same result would be obtained if the experiment was repeated multiple times. An alpha level of 1% for example means that if an experiment was repeated 100 times, 99 times the same result would be obtained - a pretty exacting standard. This prinicple is the basis of interpreting epidemiological studies. But no scientist accepts this as proving causality. The bar for proving causality is set much higher, and has to do with showing biological plausibility and coherence, strength of an association, consistency of the association from population to population, temporality of cause and effect, existence of biological gradients, results from animal experiments, and much more.

3) Keeping an open mind should apply equally to you. If experimental data go against your alternative framework, at least have the intellectual honesty to accept it as such, and move on, instead of stubbornly clinging to your alternative worldview.

Btw, nicely timed response with Bad Girl to my ``falsely malign`` statement!!

Anita

re: anita

``1. Acupuncture versus sham control procedure ...
2. Acupuncture versus sham control procedure ....``

hmmm. interesting, but many younger GP`s in britain are including acupuncture as part of the treatment they offer, especially in cases where medication doesn`t work or is not advisable (like pregnant or nursing mothers). and in china, many physicians are trained in both western medicine and traditional chinese medicine and often use the synergy of both types of training. (ditto for my herbalist). i`m sure the doctors in britain have evidence that supports their openness to acupuncture. maybe we can find studies from there?

`` despite the underlying hostility on both sides, I think this has been a useful discussion.``

anita, there has been no hostility from my side, probably just frustration in the face of the over-use of adjectives. as i pointed out its hard for me to have a discussion if it gets personal. however, its good to know that this discussion has been useful for you.

``The message is that science has become too complex to understand``

that is certainly part of the message, but my argument cannot be reduced to this. to reiterate, this is a part of a larger ideological feminist critique of science and positivist epistemology in general (a critique that i have found quite informative).

``However, from a lay person`s health perspective this is a very dangerous pit to fall in, if it leads them towards finding simple solutions to very complicated problems, when no simple solutions in fact exist.``

i agree with you. i never meant to imply that it is. and as i said before, i don`t go to the local health store and self prescribe herbs. don`t recommend that others do it either. i research alternative practitioners thoroughly, find out their background, and then try them out. i am aware both of the faddishness and the abuse/quackery that exists in this field. (also, my pcp is always consulted.) this argument cuts both ways and medical doctors should be aware of this fact also.

``I see fewer patients so that I can spend an hour with each one going over all their concerns/questions.``

this is indeed remarkable and admirable and i`m sure all the extras you provide help your patients as much, if not more, than the medication you dispense.

``While I would like to attribute these negative reactions to a) thinking that you have used Random to falsely malign me, and b) irritation at your inaccurate statements regarding scientific medicine,``

as for a) random speaks for her/him self.
as for b) the jury is still out whether my statements are inaccurate.

``I sincerely apologize if I have hurt your feelings.``

no, you have not hurt my feelings at all. can`t speak for anyone else, but i come to chowk to learn, get challenged, clarify my own ideas, shoot the breeze and get entertained. hostility is only problematic because it comes in the way of having a sincere and meaningful discussion. but, the best of us are guilty of it at times and if we can move beyond it, its to our credit.

This post may get through, but the last one was CENSORED, unfairly in my opinion.

Re: Saima (Reply 97)

``whether the human race will ever develop beyond the scientific method as its greatest thought system. Reason is a product of centuries of fumblings and searchings, It is not the end of thought; rationality as we know it is not the last end of this continuum.``

Saima, great points. A holistic approach IS what`s needed, not only towards the microsystem called the human body but towards the larger environmental balance and our duty to tread lightly. This means that in the case of medicine, we must study all the Alternative `branches` to better understand the human body and how it interacts with its environment. Not just study diseases and cures. However, I don`t agree with your logic above. Our science is a result of rationality and its need to predict and verify through empiricism. Science is just a tool. If there are flaws in the tools, or more importantly, if we contrive our experiments within one paradigm, they will (i) yield limited results, (ii) these results will be interpreted within that same paradigm. We cling to our paradigms for the same reason we cling to religion. A flawed or incomplete paradigm does not negate rationality or reason. Rationality MAY not be the end of thought, but our current science DEFINITELY is not. That is the only thing we can be certain about. Discussions on IQ always amaze me, but that`s fodder for a whole new piece.

One of the main limitations to our science is a closed mind. The person who brings about a `paradigm shift` is not merely brilliant, but is willing to step outside the prevailing set of beliefs --- to open her mind to regimes that may not be definable by current science. To ask why these other regimes work. To modify our science, our instruments, so that they may be able to measure parameters we don`t yet look for. The danger arises when scientists resist this, convinced about the completeness and internal consistency of the ACCEPTED FRAMEWORK, and worse - slander those that propose ALTERNATIVE FRAMEWORKS.

Double-blind studies invariably involve a continuous curve with arbitrarily defined confidence intervals. Researchers have decided that for placebo studies they feel comfortable with an alpha of 5%, or 1% or 0.1%. This may be reasonable, but the objective is to ascertain a binary result from a continuous data set, e.g., Ibuprofen measurably reduces the sensation of pain. For the purposes of establishing reasonable causality, this may suffice, but to cling to such body of studies as the holy grail is hubris.

Re: Anita (Reply 107)

``you have used Random to falsely malign me``

You impute the weirdest motivations to other people. As for ``falsely malign`` - I have simply CALLED YOU OUT.

No one ``used`` or can use Random for anything. I`m not a condom even though I may rhyme with it.

Random (Claritin) Gekko

Re: Saima Shah

Saima, as usual interesting comments.

You say: ``Let`s jsut get the point of view across that relegating control to others is not the best way to deal with disease``

Agreed. I have addressed this some in an earlier comment to BG (#107).

You say: ``That disease is not just the effect of a few germs which must be killed. Those germs are a part of this great eco system we inhabit and killing these may not be the best long-term answer``

Absolutely agreed! Ninety percent of the antibiotics currently used are unnecessary. This is especially true in animal husbandry. The problem is of mega proportions, and will come back to haunt us - in fact is already haunting us.

You say: ``I want to know whether the human race will ever develop beyond the scientific method as its greatest thought system. Reason is a product of centuries of fumblings and searchings, It is not the end of thought; rationality as we know it is not the last end of this continuum``

Hmmm. Scientific method is the best we’ve got so far. Right now I cannot conceive of much beyond rational thought, but I am tired and hungry, and it is past one am :) But at least let’s not go backwards into the pre-reason era.

You say: ``Our ignorance in the face of evolving and new diseases is heartening. It means we may have more time with the the forests and flaura and fauna which our continued procreation and plunder is depleting at a rapid pace``

To me, it is scary. In fact, Saima, I am shocked !!!Are you really saying that you’d welcome some new bug that will come and decimate people to reduce their numbers. Surely, there are other ways to preserve the environment and reduce population growth rates which are not so painful, and patently unjust (remember, its the poor that always die). How about more equitable sharing of environmentally-friendly resources between the rich and poor countries, education, poverty alleviation, and so on.

You say: ``Why don`t doctors look at the entire ecosystem?``

An entire branch of public health, called Environmental Health/Medicine is devoted to this field. These are the guys/gals who describe all the environmentally-toxic health substances that you hear about.

You say: ``What is wrong with holistic as a concept?``

Nothing. That is why I love Infectious Disease. It looks at the whole person (their immune system, their nutritional status, their general health), the germ, the environment, how they come together …only I do it keeping scientific principles in mind, instead of mumbo jumbo.

You say: ``what is so mumbo jumbo about herbal cures or methods? it does not kill fishes and is not a by-product of petroleum and gets the job done in many many cases.

If they are proven to work, then of course they are not mumbo jumbo, but the problem is that most, when studied scientifically work no better than placebo (see earlier reply to BG). Many are probably harmless to health, especially if cost is not a big factor. The problems occur when, they include substances that are good in the short-term, but harmful in the long-term (example many homeopathic medicines include steroids), when they have interactions with other allopathic drugs a patient might be on, since many herbal medicines have patented and secret recipes (several deaths have occurred due to fatal interactions), and when a person such as BG might choose them to treat breast cancer, over conventional, proven methods of treatment, in the mistaken belief that the alternative is better.

You say: ``Your views are edifying, but then what`s next in terms of optimum solutions rather than cures``

The answer is to keep searching …

Regards,

Anita

Re: Umair

``To the inequity of death (Hakim Said dies, Zardari lives) and of birth, may we add the inequity of retribution for intelligence as the third biggest irony of life?``

So true...

Anita

Bad Girl,

In response to your request for data some quick info on alternative therapies. This is only the data I have at home. There is much more, may be I’ll write an article.

1. Acupuncture versus sham control procedure for nicotine withdrawal (patients didn’t know what they were getting)- no difference in results (Archives of Internal Medicine Nov 9, 1998).

2. Acupuncture versus sham control procedure for low back pain - no difference in results (ibid).

3. Garlic extract versus placebo for cardiovascular risk - no difference in results (Archives of Pediatric and Adolescent Medicine - Nov 1998).

4. Echinacea extracts versus placebo for boosting immunity against colds - no difference in results (Archives of Family Medicine, Dec 1998).


Bad Girl, despite the underlying hostility on both sides, I think this has been a useful discussion. An important underlying message can be gleaned from your comments such as (probably slightly paraphrased, but the essence I think stands), ``modern medicine disempowers patients``, ``patients feel powerlessness``, ``the distant expert in the white coat``, ``science is too focused on lab experiments and quantification rather than on people…etc``

The message is that science has become too complex to understand and decipher for many lay people so that they increasingly feel alienated and disempowered. Physicians and medical scientists clearly should accept much of the responsibility for the creation of this huge‘information failure’. However, from a lay person’s health perspective this is a very dangerous pit to fall in, if its leads them towards finding simple solutions to very complicated problems, when no simple solutions in fact exist. Charlatans have exploited this need of people to understand their physiologic and pathologic processes by convincing them into thinking they have easy solutions when the reality is far different. Therefore, some members of the lay public are doing themselves a huge disservice by shunning a scientific understanding of their health, instead of spending time understanding the complexities.

From the medical scientists and physicians perspective, clearly if they are to help people they must become better at communicating with the lay public about their health in a language they can understand. For me personally this has meant that I see fewer patients so that I can spend an hour with each one going over all their concerns/questions. I make it a point to mail the parent/s a copy of my extensive typed note, sharing all my thoughts that went into caring for their child. For a particularly challenging health problem, I also mail up to date reviews/latest scientific info, along with a lay summary. In addition, I give them my e-mail and pager number for follow-up questions. I find that these extra steps go a long way in informing my patients about their health and making them active participants and decision-makers, and we all benefit in the process.

One hopes that as people become more knowledgeable about their health, it will force the physician-patient relationship to become less passive. Only by this process can patients make INFORMED decisions about their health that are rational, based on scientific principles, health-promoting, and take into account their own preferences.

In the end, an explanation and an apology. In examining my own reactions, I realize that I have been unnecessarily harsh in addressing you. While I would like to attribute these negative reactions to a) thinking that you have used Random to falsely malign me, and b) irritation at your inaccurate statements regarding scientific medicine, that is in fact no excuse for my insulting tone. I sincerely apologize if I have hurt your feelings.

Anita

Re: Iconoclast and my preachiness.

I stand reprimanded! I know the above is also terribly preachy. I suppose it has something to do with being the eldest of 5 siblings, the eldest of 18 cousins, many years of teaching, and being a mother!! Count it among my biggest faults.

Anita

Re Fauzan:

Both your replies, as you say, comply with the guidelines and so both, as you can see, are on. I think the ``tape delay`` in posting replies threw you off. Hope you dont jump quite so quickly to ``hypocritical controlled society`` conclusions :).

Keep interacting.

Cheers,

Umair Khan