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Dave W.
Info Junkie

USA
26015 Posts

Posted - 08/09/2004 :  10:17:19   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message
Tom wrote:
quote:
For back pain, often physiotherapy is prescribed by physicians. However, whereas giving practice routines to strengthen your back do give some beneficial results, often massage therapy is used. Massage therapy has in clinical trials been shown to do nothing except relieve pain for the duration of the massage and a few hours afterwards.
Actually, I don't have enough specific knowledge to either agree or disagree with any of your examples, but I would like to ask, in relation to what I've quoted above, is this a case where the patients often decide that "physiotherapy" means "massage," or is it actually the doctors (or worse: orthopaedists) prescribing massage instead of physiotherapy?

My experience in this matter is small, but none of my wife's back problems have ever led to a "you should get a massage" suggestion. And she actually went to her therapy sessions, learned the exercises, and got the photocopied pages of reminders for a strong back.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
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tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 08/09/2004 :  15:55:05   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message
Massage has been an often used therapy for back pains IIRC. Practices may have improved since I studied it, and it may have been a dutch thingie, I don't know.

However, the problem is twofold. The patient today often demands a therapy which won't be effective for him, you are right in that. But on the other hand, physicians often don't have the scientific expertise or the time to be able to make a good estimate on what the current state of the art is in medicin. I know quite some people who actually provided their physician with a good alternative to their treatment (I admit that they were trained in interpreting (scientific) sources).

Also, to make matters worse, a lot of problems presented to physicians aren't standard anymore (like a broken bone). Physicians often have to deal with vague complaints, so-called 'fashion diseases' and psychological problems which express themselves physically. For these complaints, prescribing the correct medication can be nearly impossible and a placebo effect can be enough to diminish the problems. In general it seems to me that we thought we knew a lot about the human body, but the more we know, the more it becomes clear that we actually don't know all that much.

And before people start making the wrong conclusions from what I say. Go to a physician in stead of alternative medicinman and trust his judgement. Despite the problems with which a physician is faced, he is still the expert. Alternative medicin can be good if used as a complementary therapy, but using it as a therapy on its own mostly won't help you much further and has not yet been shown to be effective (at least not in studies I've seen).

Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 08/11/2004 :  01:50:57   [Permalink]  Show Profile Send beskeptigal a Private Message
quote:
Originally posted by Dave W.

Tom wrote:
quote:
A good deal of the cures prescribed by physicians are bogus, and physicians often don't have the chance to read up on this.
Well, at this point I think it's important to talk about what you mean by "cures" and "bogus." I mean, you won't find double-blind clinical trials testing the hypothesis that casts help broken bones heal, since with what we already know, not casting them would be considered unethical.

So, what is an example of a "bogus cure" commonly prescribed by a physician?
Well, I can find hundreds for you with enough time. Here are two to start with.

Clinical Trials Show Surgical Interventions To Be No Better Than Placebo I don't think they've stopped this surgery on this study alone. Trouble is, there are not many studies showing the effects of this procedure done with controls. In other words, all the evidence the surgery helps can be explained by placebo effect. While there may be benefit, there is no good evidence.


If you read this one all the way through, you'll see that a tonsillectomy might reduce your incidence of sore throats by a few for a year or two. Is that worth the cost/risk?
Tonsillectomy for sore throats Yet tonsillectomies are "the second-most common surgery of childhood, but is less commonly performed in adults. Tonsillectomy accounts for 25% of all operations performed by otolaryngologists (ear, nose and throat surgeons)."

Want more?
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statuscrow
New Member

1 Post

Posted - 09/08/2004 :  16:47:05   [Permalink]  Show Profile Send statuscrow a Private Message
quote:
Originally posted by tomk80

I would agree. However, for example in the case of chronical fatigue syndrom, real medicine does not offer hope, since it does not offer treatment. Thus, the people will try to find hope in delusion, and think to benefit from it. I know (or at least, strongly suspect) that they put their hope in delusion, but fighting the fight against it is presently an experience I find too hard.



provigil? i think that is prescribed for cfs sometimes in the us. there are definitely drugs for CFS, but doctors are wary to give them for whatever reason.
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tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 09/09/2004 :  02:49:23   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message
quote:
Originally posted by statuscrow
provigil? i think that is prescribed for cfs sometimes in the us. there are definitely drugs for CFS, but doctors are wary to give them for whatever reason.



I don't know. My friend is going to a new doctor soon (one who actually has a degree in medicin and combines regular and alternative medicin). Maybe something better will come of it than she got from the alternative medicin till now (finding new virusses, infections etc every month).

Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
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Dave W.
Info Junkie

USA
26015 Posts

Posted - 09/09/2004 :  07:23:23   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message
beskeptigal wrote:
quote:
Well, I can find hundreds for you with enough time. Here are two to start with.
I apologize for missing this, before. Thankfully, the thread got bumped.

While I don't want to spend much time defending the procedures in your examples, it seems to me that they aren't offered as cures of anything. In other words, tonsillectomy is offered as a method of reducing the incidence of throat infections (which it does for two years, if that single three-year study is correct), and I really think that anyone who offers arthroscopic surgery for osteoarthritis as any sort of permanent fix should lose his/her license to practice. Also, on the latter, the article you provided clearly says that it's way too early to conclude that the procedures really are bogus.

So, your examples represent procedures of which may be of some value, and a benefit/risk determination is really up to the patient and doctor(s). I was hoping for something more clear, like colon hydrotherapy, for which there is no known therapeutic benefit but a greater-than-zero risk, making anyone who uses it as a treatment a dangerous quack.

Of course, medical knowledge, like other sciences, advances. Used to be that lower-back pain was treated with bedrest, and lots of it. Now, doctors want people out of bed and exercising after the worst of the pain is over, no more than a couple of days. So far as I know, tonsillectomy is much less used these days than back when I was a kid (and I came real close to having the procedure, getting tonsillitis like clockwork), as a result of doctors realizing that there's less of a benefit than once thought. But, how many is 25%, anyway? What percentage of all surgical procedures are performed by otolaryngologists? The statistic is fairly meaningless without such context.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 09/10/2004 :  13:53:54   [Permalink]  Show Profile Send beskeptigal a Private Message
I can't get you more sources until later this weekend, Dave, but I will make an effort.

Tonsillectomy was done up until the late 60s to decrease recurrent throat infections like streptococcal disease. Today, the accepted criteria is after a tonsil abscess to prevent recurrence, or, for airway obstruction. Decreasing sore throat frequency, even for a few years is no longer considered more beneficial than the risk surgery incurs.

As far as the knee surgery research, it was a pioneering study because it used sham surgery, previously not considered ethical in human medical trials. Prior to that study, if a surgeon tried a new technique, such as removing tissue around a joint that might be the cause of pain, the result was judged by the patient's perceived benefit. The study's intent was twofold, one to test the specific surgical intervention, and two, to question the current method of evaluating the success of a surgical intervention without adequate controls.

I didn't use that example because of the specific procedure, I used it to present the concept that not everything done in Western medicine has a clear basis in evidence.

I'm not sure why you are distinguishing cure vs improvement in a condition. Sometimes living with a condition for which there is a risky cure is a decision between the doctor and patient as well.

Colon hydrotherapy is not Western medicine. So are you asking for a treatment in Western medicine that is totally bogus? I presume you mean since the days of bloodletting? Or since the early 1900s when hysterectomies were done for hysterical women, or, nitrous oxide was given for "scolding wives"? Or as recently as the 1950s when TB was treated with 'fresh air', (no harm no benefit), or temporary lung collapse, or partial or complete lung removal, [no benefit(I have to confirm that), lots of harm]?

I'll see if I can find you some more recent examples for you this weekend.
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 09/14/2004 :  12:53:36   [Permalink]  Show Profile Send beskeptigal a Private Message
I had a busy weekend and didn't look anything up. Here's a medical fallacy that came to mind though. Ulcers. Always thought to be from excess stomach acid and/or stress.

Turns out 95% of ulcers have a sole bacterial cause. This one took years to convince MDs. In fact, the CDC still has an 'educate the doctors' campaign on it.

All those profitable H2 blockers to treat ulcers had to find a new market. So now they are heavily marketed as over the counter treatments for 'acid reflux disease'.
Edited by - beskeptigal on 09/14/2004 12:55:28
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Dave W.
Info Junkie

USA
26015 Posts

Posted - 09/14/2004 :  18:42:21   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message
beskeptigal wrote:
quote:
I didn't use that example because of the specific procedure, I used it to present the concept that not everything done in Western medicine has a clear basis in evidence.
Oh, I'm well aware of that, but it's a far cry from having an unclear evidenciary basis to "bogus."
quote:
I'm not sure why you are distinguishing cure vs improvement in a condition. Sometimes living with a condition for which there is a risky cure is a decision between the doctor and patient as well.
I'm well aware of that, too. Benefit/risk analyses are very important, and too many people leave them solely to their doctors (and a few deny their doctors any input - either extreme is bad). With the amount of psoriasis I have now, if I were to meet a doctor who suggested cyclosporin, methotrexate or even retinoids, I'd leave the office ASAP (and if they tried to bill my insurance company for the visit, I'd rat 'em out to the review board). Too much risk involved with those treatments, for not enough benefit.
quote:
Colon hydrotherapy is not Western medicine.
Tell that to the people who offer it in walk-in clinics. They've got doctors and nurses, and lots of shiny steel equipment. They obviously want the world to think that they are compentently practicing modern, Western medicine, and that what they do can "cure" you of something.
quote:
So are you asking for a treatment in Western medicine that is totally bogus? I presume you mean since the days of bloodletting?
What I was asking Tom for an example of was a "bogus cure" which is commonly prescribed by physicians. Present tense. I understand that medicine advances - that's a good thing, indeed.

Look, Tom wrote:
quote:
A good deal of the cures prescribed by physicians are bogus, and physicians often don't have the chance to read up on this.
I replied with my question, and Tom backed off the implied extremes in his statement. I don't know whether you saw that or not, but you replied directly to my question with this:
quote:
Well, I can find hundreds for you with enough time.
And so I thought you were answering the question as first stated.

I'm well aware that there's plenty of medicine going on which is not clinically tested. As I already pointed out (and you quoted), there are no double-blind studies on whether casts help heal broken bones, and there probably will never be any such studies. Does that mean that casting a broken bone is a "bogus cure?" Of course not.

The story of Heliobacter pylori is also well-known to me. It sits as another shining example of science overcoming the inertia of the experts, along with continental drift, natural selection and geocentrism. H2 blockers are still a part of the treatment of peptic ulcers, but only as an adjunct to antibiotic therapy, as H2 blockers will help to reduce the symptoms while the real cure is taking effect.

Having 100% of all medical procedures be strongly evidence-based is an unrealistic expectation. But the idea that doctors are commonly - and currently - dishing out completely worthless remedies just because they haven't read the research yet is at the opposite extreme. Again, both extremes are bad news for those, like myself, who strive for critical thought in medicine, on the part of both patients and doctors. Yes, there have been mistakes in medicine, but to come anywhere close to implying that those mistakes are on-going and prevalent is to give the "alternative medicine" fanatics (and I'm only referring to the extremists, here) more ammunition with which to win over the opinion of the general population. Your three examples give just that sort of impression when offered in response to a question about "bogus cures" being commonly used, especially if one doesn't look deeper to see that the knee surgery hasn't yet been definitively debunked, or that tonsillectomy is no longer used to treat simple recurrent sore throats, or that ulcers are now commonly and successfully treated with antibiotics.

Just like the leaders of the "creation science" movement regularly ignore vast quantities of detail in order to sway public opinion, so do the people who claim that all pharmaceuticals are nothing more than poisons, or that doctors don't care about anything but their yachts. Therefore, precision in discussing things medical is important. Tom was less than precise in his characterization of medicine, and my question was meant either to find out something I didn't know, or to get Tom to see what I'm talking about now. The latter occured, but either would have been good.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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H. Humbert
SFN Die Hard

USA
4574 Posts

Posted - 09/14/2004 :  19:18:15   [Permalink]  Show Profile Send H. Humbert a Private Message
quote:
Originally posted by beskeptigal
So are you asking for a treatment in Western medicine that is totally bogus? I presume you mean since the days of bloodletting?

Interestingly enough, a new study shows bloodletting may not have actually been entirely bogus.
quote:
Their [University of Chicago scientists] research, reported in the journal Science, suggests that in the days before antibiotics, bloodletting might have slowed staph infections -- a leading cause of pneumonia -- and other infections by starving the germs of iron.

http://www.suntimes.com/output/health/cst-nws-bloodlet11.html

http://www.cbsnews.com/stories/2004/09/10/health/main642559.shtml

Reminds me of how the medical practice of applying leeches has been redeemed to some extent.


"A man is his own easiest dupe, for what he wishes to be true he generally believes to be true." --Demosthenes

"The first principle is that you must not fool yourself - and you are the easiest person to fool." --Richard P. Feynman

"Face facts with dignity." --found inside a fortune cookie
Edited by - H. Humbert on 09/14/2004 19:29:31
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 09/14/2004 :  22:22:22   [Permalink]  Show Profile Send Dude a Private Message
"bleeding" is unlikely to make a comeback..... and the negative effects would have been just as bad (or more likely worse) than the benefit....

Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
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H. Humbert
SFN Die Hard

USA
4574 Posts

Posted - 09/14/2004 :  22:34:55   [Permalink]  Show Profile Send H. Humbert a Private Message
quote:
Originally posted by Dude

"bleeding" is unlikely to make a comeback..... and the negative effects would have been just as bad (or more likely worse) than the benefit....



Very true, and the researchers say as much. No one is recommending people be bled. Rather, the aim of the study was to understand a mystery. As one said, "How could a procedure popular for 2,500 years have really been completely worthless?"

Hehe, don't answer that. I can already think of several ways how.


"A man is his own easiest dupe, for what he wishes to be true he generally believes to be true." --Demosthenes

"The first principle is that you must not fool yourself - and you are the easiest person to fool." --Richard P. Feynman

"Face facts with dignity." --found inside a fortune cookie
Edited by - H. Humbert on 09/14/2004 22:38:33
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furshur
SFN Regular

USA
1536 Posts

Posted - 09/15/2004 :  05:39:01   [Permalink]  Show Profile Send furshur a Private Message
I'll answer it anyway with a question (if that is possible).
quote:
As one said, "How could a procedure popular for 2,500 years have really been completely worthless?"

How could a procedure (human sacrifice) popular in so many new world societies (Axtec, Mayan, etc.) have really been completely worthless?



If I knew then what I know now then I would know more now than I know.
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tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 09/15/2004 :  08:36:09   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message
quote:
Originally posted by statuscrow
provigil? i think that is prescribed for cfs sometimes in the us. there are definitely drugs for CFS, but doctors are wary to give them for whatever reason.



I did some additional searches for provigil, and it seems a promising medicin. It's working component is modafinil, and it is also used in the treatment of other illnesses with comlaints of fatigue. However, there are few reports on the topic, which may be a reason for the wariness of doctors to prescribe the treatment.

In general, physicians are wary to diagnose and subsequently treat syndroms like CFS. The main reason is that no consistent ethiology and pathology have been described. There is even the suspicion that the syndroms might be mainly psychological in origin, in which case diagnosing the syndrom would lead to a reinforcement of the sick role of the patient and could actually make things worse.

edited to add: another reason why physicians may be wary of prescribing modafinil and similar medicins is that it takes effect in the central nervous system of the patient. Hence, it might alter judgement, thinking or motor skills.

Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
Edited by - tomk80 on 09/15/2004 08:41:41
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 09/15/2004 :  12:43:03   [Permalink]  Show Profile Send beskeptigal a Private Message
Oh, sorry Dave, I thought all the responses I was replying to of yours were to my posts.

No, we can't test every medical intervention before using it. But there is more emphasis on evidence now than in the past. My main point was that sometimes what look like obvious cause and effects in medical interventions need a certain amount of skepticism applied.

We have to use the interventions that are based on what we know at the time because decisions have to be made. Science marches on.

Actually, casting broken bones is based on observation. There is more than sufficient evidence from the past, but also from the results of persons whose fractures weren't casted. But I understand the concept of the example.

As to the enemas as therapy, 'Western medicine' for lack of a better term, is not defined as how the clinic looks nor what the practitioners present themselves as. It is defined as the practice of medicine usually taught in medical schools. Alternative medicine is taught in naturopathic schools. There is overlap. Some of the rest is just plain quackery.

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