The National Center for Complementary and Alternative Medicine was tacked forcibly onto the National Institute of Health after Tom Harkin (D-Iowa) and Orrin Hatch (R-Utah) thought more attention ought to be paid to beeswax.
As a curative agent, I mean. Those two, and others in charge of us, thought it would a fine idea if we paid to put alternative therapies to the test.
And they’re right: it is a good idea. Some potential palliatives can be dismissed immediately—for example, massive doses of arsenic to treat toenail fungus. But most cannot be brushed off without some evidence, because even the most ludicrous sounding treatment might be helpful.
Have a claim? Put it to a controlled test. Pass that test and all benefit. Flunk it, then admit defeat; or at least keep quiet and move on (which never happens, naturally).
The three treatments that have received the most exhaustive testing are acupuncture, chiropractic, and homeopathy. They have been subject to endless experiments, found wanting, but never found lacking proponents.
I worked for several years at Cornell Medical School’s Center for Complementary and Integrative Medicine, where I read over a hundred papers that made extraordinary claims. The best evidence for the efficacy of any of these treatments is statistical. But the more experiments any treatment undergoes, the more its signal fades into the noise. You have to wear cheap statistical magnifying glasses to see positive effects.
However, I do not say, and it is not true, that these treatments have no benefit. They surely do. But so do sugar pills. But with chiropractic, there is a real, documented chance of physical harm. Acupuncture and homeopathy are harmless. The later is guaranteed to be.
In case you are one of the few people left who don’t know, a homeopathic “drug” is made in the following manner.
Water—somehow this is “pure” water, but how it’s made, we’re never told—is dosed, tea-bag style, with some substance, usually some plant extract. The doped water is successively diluted until the probability that even one molecule of the substance remaining is about equal to you having the ability to jump to the moon.
This is boasted of. The water—by a mysterious process unknown to anybody—is able to memorize that it once knew the substance. When you eat that water in the form of a pill composed of miscellaneous ingredients that were soaked in the diluted water, it is supposed to help your body fix itself by releasing vibrations.
It’s always vibrations!
Nobody knows how homeopathy works. Because it doesn’t. We know a lot of science with varying degrees of accuracy, and there are few things we know so well that homeopathy and most other complementary procedures are groundless. Yet some insurance companies still pay for these treatments.
The actuaries who investigate these therapies are good enough statisticians to know that the therapies don’t perform as stated (biologically, physically), but they also know that they work in the following way: some people who would otherwise see an expensive physician will chose a cheap complementary procedure instead.
Usually, these people needn’t have gone to a physician anyway. They have colds, minor aches and pains, or other maladies that will self correct.
If complementary procedures were just as expensive as standard ones, insurance companies would surely not cover them. But since they are cheaper, actuaries can estimate how many people will use a placebo therapy that would have instead gone to a physician. Perhaps oddly, if the number that would opt for, say, homeopathy (if it were covered) is large, then the insurance company will cover homeopathic treatments. This saves them money.
When the government takes over medical care, they will have to legalize these kinds of actuarial calculations. It must decide what will be paid for and what won’t. For example, if I set up shop as a quack—I cure with taps of my healing hammer–the government will have to legislate whether it will pay me. Just as insurance companies do now.
Therefore, if there is any rationality left in government, they will probably come to the same conclusions that insurance companies have, and they will fund homeopathic and other integrative therapies.
It’s worse. Governments cave more readily to special interests than do insurance companies. “You cover homeopathy? You should also cover wymen-centered Wiccan magick!” The actuarial tables will be tossed and votes will take their place.
Incidentally, Wiccan “cures” are cheaper than, say, new chemotherapies. And who are we to say which is better?
Just wait and see.
Note I’m traveling today and will be away from the computer.
1. Medicine is hard.
2. Medicine is an inexact science.
3. Most minor illnesses, aches and pains go away (get better) without any treatment.
4. If people want to buy Miracle Mouse Milk Snake Oil Additive for their car, that’s fine with me. If they want me to pay for the medical equivalent, the answer is, “No!”
I’ve always thought that I should have gone into homeopathy as an easier way to make money. Unfortunately, I apparently have some sort of personal integrity which prevents me from making money off the gullible. Is there any way I can have that surgically removed, and maybe kept in a jar in case I need it later?
gcb,
Yes. You can run for office.
“Some potential palliatives can be dismissed immediately—for example, massive doses of arsenic to treat toenail fungus.”
I thought that after a massive dose of arsenic your toenail fungus would never bother you again.
Matt:
I don’t know about Homeopathy, but a nice hot cup of tea (Darjeeling preferably) always makes me feel better when I am getting a cold. A beer does as well when my throat is dry and itchy. Can we get these covered?
Mr. Briggs
I don’t know whether you have seen this, but if you would like a little lighthearted cure for whatever might ail you go here and follow the links to Tamino etc: except the later link doesn’t seem to work.
http://bishophill.squarespace.com/
it is an interesting view of the statistical art.
Who was it who said laughter is the best medicine?
Kindest Regards
a jones:
I visited. It was very interesting until a bunch of yahoos showed up. VS and Alex appear to be savvy statisticians. Having the input of statisiticans always helps when you are making empirical assertions of which many are skeptical – so long as they do not have a dog in the fight, e.g., tamino.
These cures always involve “vibrations”– or magnetism. My wacky sister-in-law once gave to me some magnetic insoles for my shoes that were supposed to cure whatever. They were heavy. I figured some health benefit from just wearing the extra weight all day as I walked.
But Kevin, the other benefit was you never got lost. You always knew which way was North.
I wonder if my first physics prof could get funded?
http://www.amitgoswami.org/quantum-activism-health-healing/
In humor – truth:
http://www.youtube.com/watch?v=HMGIbOGu8q0&feature=player_embedded
Alas, the insoles where N-S on the upper and lower surfaces. I only knew up from down.
“The three treatments that have received the most exhaustive testing are acupuncture, chiropractic, and homeopathy. They have been subject to endless experiments, found wanting, but never found lacking proponents. ”
That is strange, because chiropractic helped me. I used to get extremely powerful and long lasting migraines. They always started at the base of my head and progressed to form a cap. From 1993 until around 1998 they consumed nearly 40% of my life. The only drugs that worked on them were narcotics which doctors refuse to prescribe for migraines. I went to a chiropractor from 1998 until 2000, and my migraines became less frequent and less severe. For about 6 years after that I only had a migraine every few months instead of a couple every month, the duration dropped from about 6 days on average to about 3 days on average, and the level of pain went from a frequently 9 and 10 to 7 and 8. Since I stopped going, my migraines have slowly started progressing back to the level they were before I went. Now I usually have 2 migraines per month that last 3 to 5 days and reach a typical pain level of 8 or 9.
I was very specific about what I wanted my chiropractor to do, and I usually went two times in one day 3 times a week. The targeted goal was to accustomize my neck to be in a neutral state. I think he accomplished this very well, and if I was not such a slouch, I would probably still be benefiting from the time I spent under his care.
I will agree, however, that there are many quack chiropractors out there. Even so, when a chiropractor knows what he is doing, has the physical skill to do it, there can be healing for certain problems, and for others there can be a delay in the eventual outcome.
astonerii
You cannot surmise a physiological trigger mechanism for both the onset and the relief of your migraines?
Mine are caused by strong sunlight and tanins in some red wines. Alas my days of consuming Port are no more.
Bernie;
Bright lights, particularly the types used in manufacturing places where the government sets minimum luminosity are a certain trigger, it takes less than 10 minutes in an area like that to start the migraine.
Places with fluorescent lighting, particularly areas with large numbers of bulbs regardless of brightness seem to trigger a migraine after about 2 hours of exposure.
Other times, I will get a visual effect of dark spots with a blue-white halos any where from 6 to 12 hours before the onset of a migraine. When I get this visual effect it is about a 50/50 chance that I will get a migraine within that time frame.
When I was in the military, I got malaria, and a psychologist from the VA says that if it was the brain attacking variety, it could have damaged my brain in some way. When I had malaria, I was on a force march when I got one of my first bouts of fever, and I became disoriented and fell down a 25 foot ravine and may have injured my neck. My best guess, for my trigger is that the injury to my neck gets irritated and tightens my muscles at the base of my head, which then leads to pressure in the brain, which then leads to irritation of the damaged part of my brain from the malaria. But doctors have not found anything definitive. I got the idea based on what my VA neurologist told me, that my migraines resemble a tension triggered migraine.
Those are the only triggers I can come up with. I do not think my repetitive diet would be the cause.
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Dr. Briggs,
Thank you for the article. You are correct in stating that most chiropractic research is annecdotal at best. There is however, one group in the profession that has over 100 index medicus articles, including mathematical modeling, statistical studies, controlled trials and numerous cohort studies and case reports. Dr. Don Harrison PhD has striven to utilize his finite element mathematical modeling and engineering background to validate the work that is done by this particular group of chiropractors, which is totally different from the traditional “Rack and Crack” perpetuated by most chiropractors. http://www.idealspine.com will direct you toward this small but growing body of peer-revied evidence for this subset of chiropractic.