Thursday, November 27, 2008

Complimentary and Alternative Medicine at the University of Toronto

 
The Faculty of Arts & Science at the University of Toronto offers a program called "Human Biology." Students who complete the program will graduate with an Honours B.Sc. degree. One of the courses is HMB434H1: Complementary and Alternative Medicine.

The textbook for the course is Fundamentals of Complementary and Integrative Medicine by Marc S. Micozzi.

Here's the course description.
Complementary/ alternative medicine (“CAM”) is used in health care systems not only in North America, but also in countries such as China, India, and Vietnam (WHO, 2002). It involves the use of non-biomedical, “holistic” and/or culturally-specific health services and practices in the treatment of illness and disease (such as Chinese acupuncture), and an expanded concept of health, illness, and wellness. This course provides an introduction to the concepts, theoretical basis, evidence-based analysis, and pressing challenges and issues in CAM today. Specific topics include introductions to: complementary/ alternative medicine in industrialized countries and commonly used modalities such as homeopathy and naturopathic medicine; traditional medicine (TM) and primary health care (PHC); traditional Chinese Medicine (TCM) and China; Ayurvedic medicine in India; Canada’s First Nations; and integrative health systems and models. Course format includes lectures, guest-presentations, films/documentaries, and inter-active class discussions/exercises. Students will also have the opportunity to analyze CAM systems and modalities.
I've been pretty nervous about this course ever since one of our students blogged about it last year [U of T has a course in complementary and alternative medicine]. I was hoping that the course would present both sides of the story.

That idea was just blown out of the water at a meeting that I just returned from. I got a chance to talk to one of the instructors, Daniel Hollenberg. What I was hearing was not good so I steered to conversation around to homeopathy thinking that this might relieve my fears. It didn't.

Here, without comment, is what I was told by a man who teaches science students at my university.
  • Philosphers of science recognize that there are several different kinds of evidence—not just the reductionist evidence of traditional medicine. In particular, epistemologists talk about holistic evidence. Alternative medicine is supported by holistic evidence not reductionist evidence.

  • Evidence in support of homeopathy has been published in Lancet, and he teaches that to his students.

  • While there may be examples of some homeopathic medicines that don't work, the theory of homeopathic medicine is understood and supported by physicists who have published papers explaining how water retains the memory of molecules that used to be dissolved in it. He mentioned Ursala Franklin as a supporter of homeopathy.


17 comments:

  1. So water retains the memory of molecules that used to be dissolved in it more than half a microsecond ago? Then it must retain the memory of just about every molecule in existence! I'm not sure whether to laugh or cry.

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  2. So water retains the memory of molecules that used to be dissolved in it more than half a microsecond ago? Then it must retain the memory of just about every molecule in existence!

    Um, you mean my drinking water retains the memory of the being in someone's toilet in some town up-river? Eeww. And worse: by the time it gets here it's been diluted eleventy bazillion times -- which according to the principles of homeopathy, means it increases in potency!

    It's a wonder we didn't all die of gastro-enteritis long ago.

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  3. This is both ridiculous and very disturbing at the same time... Does he mention the studies that pretty much falsify homeopathy? Or is he ignoring all evidence that opposes his beliefs?

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  4. So much for sending my son to U of T

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  5. Alternative medicine is supported by holistic evidence not reductionist evidence.

    I dont even know what this means.

    It's very simple: take a group of people with ailment X and treat them with "alternative therapy" or placebo. If the number of people who recover from ailment X is larger in the group receiving "alternative therapy" than the group receiving placebo, then you might have a therapy that does something (assuming all variables are properly controlled for and the samples are large enough). If there's no difference, there's likely no effect (same assumptions as above, since experimental bias can go both ways).

    Plenty of "alternative therapies", including, most famously, the chewing of the bark of the willow (to get salicylic acid) to cure pain, have made their way to "actual therapy" through similar processes.

    What the heck is so hard to grasp about that concept?

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  6. "shrug" I think homeopathy is about placebo effect. And for some diseases, placebo effect works; the catch is, there HAS to be a lie. Say the truth, and the placebo won't work. It's a puzzler,: some people say this is unethical. I'm not sure...

    There are too many stupid doctors that simply don't ask enough about several biologically relevant aspects of their patients, with the result of negligence and suffering of their patients. AND they act all along with "scientific" arrogance.

    Ask yourself how many patients have been screwed by negligent and careless doctors in whom they placed their trusted because of the abundant lip-service to "science" and "traditional medicine".It's full of victims out there. I doubt any of you are not acquainted with a victim of such negligence.

    If people are asked to blindly place faith in "official" medicine and science, and then everything turns awful wrong, the problem is NOT that people are not trusting science, isn't it. It's that bad doctors full of lip-service to science are eroding the confidence of people in science.

    There are millions of de-humanized, careless doctors and various pill-sellers that are out there only to make a profit. And they do so in the name of science. I think just blaming the homeopathy practitioners for everything is an incomplete and stupid view of the problem.

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  7. the problem is NOT that people are not trusting science, isn't it. It's that bad doctors full of lip-service to science are eroding the confidence of people in science.

    I think the problem isn't so much with bad doctors, but with people who don't understand basic science. Almost everyone has had a bad experience with a shitty doctor. I have, you probably have, and most of my family and acquaintances have. But, in my experience, the majority of the people that end up going to serious woo are people who don’t know the first thing about science. They trust their doctor not because she/he talks about “traditional medicine” or “science”, but because they’ve been told that doctors know what they are doing. When something goes wrong, rather than chalking it up to either a mistake or a bad doctor they begin to blame the entirety of modern medicine and/or science. And when that type of person meets a CAM conman who tells them that CAM is not like that nasty medicine that failed them, it’s not difficult to see why they would fall for it. Especially since to someone who has no clue about science CAM may seem not only plausible, but very common sense.

    The problem with people falling for CAM is not simply bad doctors inspire a loss of confidence in science. The naively high expectations of medicine and ignorance of science shown by some people, I feel, is a bigger problem. Even if all the doctors in the world were top-notch, we’d still have mistakes and science would still be wrong on occasion. In this situation people would still go for CAM because they want to believe the person with the big promises and the explanation that makes sense to them.

    Back onto the topic of the CAM course at UofT. I’m in a Human Bio program here and I think it’s pretty sad that they teach this kind of course. Is there any way to get the department to reconsider offering this class? Would enough students objecting to it be meaningful?

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  8. Ha!

    Don't all you suckers from UofT who got your B.Sc by studying a real subject feel silly now!

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  9. Science and medicine are separate concerns. Medical doctors are acting with medical arrogance, not "scientific" arrogance.

    There is no scientific method in the general craft of patient diagnoses. It's a craft, just like other repair and support positions like computer techs and auto mechanics. Once you get into surgery and the like, it's higher-level, but it's only medical research that touches on the scientific. Most everything else is a craft (albeit highly skilled in some cases) or at "best" an applied science like engineering would be.

    The prevalence of bad doctors and bad diagnoses are due to doctors who are underqualified, uncaring, burnt-out and/or delightfully devoid of troubleshooting skills. Some enjoy the power of pronouncing things true and not being contradicted, others just want you out of their hair, others just want to get as many visit fees as possible by making for a short diagnosis.

    Some people enjoy seeing naturopaths for exactly that reason, though it doesn't take long for some of them to wander off into questionable medication.

    I had a swollen leg, went to one doctor who prescribed diuretics. That didn't work, so they prescribed another kind. Went to another doctor who depressedly just said "oh, it's part of getting old". The third doctor noted the symptoms and sent me for an X-ray, discovering the hairline fracture in my foot. That last doctor is now my go-to doctor, and has shown consistently superior troubleshooting skills.

    I don't think that the poor doctor performance would be traced to a journal paper entitled "All Leg Swellings Curable By Diuretics".

    I wouldn't blame homeopathic doctors for "everything". It is, however, an endeavour based on a complete crock, and not a particularly ancient crock, either. The "failed" homeopathic suicide stunt should have given people pause.

    Am I supposed to believe that $17.50 for a bottle of water to "treat" gout is a justifiable endeavour?

    By all means, call out those peddling normal meds when they shouldn't be, people asking for meds they don't need and can't use, and meds that just don't work.

    Just don't exempt any substances from standards of truth, or exempt those who push them.

    Normal research can account for the placebo effect. Making up new definitions of evidence because something cannot actually withstand the rigour is the mark of charlatans.

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  10. I imagine the lancet paper to which he refers is:

    K Linde, N Clausius and G Ramirez, Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials, Lancet 350 (1997), pp. 834–843.

    However, as Ben Goldacre points out in a letter to the Lancet, responding to a homeopathy proponent who attempted to critique him:

    Fisher cites one meta-analysis from 1997,2 which is frequently quoted by homoeopaths as proof of efficacy. However this positive finding is perhaps weak: the odds ratio for the 26 good-quality studies, corrected for publication bias, was 1·78 (95% CI 1·03–3·10). The same trials from this meta-analysis have been reanalysed extensively3 and significant doubt has been cast on the initial analysis. Most notably the same researchers, working on the same set of 89 trials4 in 1999 concluded that their own reanalysis “weakened the findings of our original meta-analysis… it seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.”

    The further references are:

    E Ernst, A systematic review of systematic reviews of homeopathy, Br J Clin Pharmacol 54 (2002), pp. 577–582.

    and

    K Linde, M Scholz, G Ramirez and N Clausius, Impact of study quality on outcome in placebo-controlled trials of homeopathy, J Clin Epidemiol 52 (1999), pp. 631–636.

    Ben's letter is:

    Goldacre, B. (2008) Meta-analyses of homoeopathy trials – Author's reply, Lancet, 371, 985-986.

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  11. ... and I was considering the U. of T. for a Ph.D in science, oh well ...

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  12. To be fair, depending on the focus that kids in the human biology program take, they normally don't get lots of science. A lot of what they learn is anthropological/sociological stuff with regard to human health. It's too bad that they're not limiting themselves to a critical sociological exercise (which may be rigorous, I don't know), but instead are making retard scientific claims.

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  13. should be a first year humanities course

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  14. How disappointing.

    I just finished reading Snake Oil Science. There is a blog entry about the book here. Basically it seems CAM modalities are nothing but ways to attempt to trigger placebo effects.

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  15. Seriously though, can anyone explain the difference between 'holistic evidence' and 'reductionist evidence'?

    Moreover, can anyone explain why the Nobel committee has not yet recognized the extraordinary contribution of those "physicists who have published papers explaining how water retains the memory of molecules that used to be dissolved in it"?

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  16. When people start believing that doctors don't know how to cure, they start visiting a shaman.

    Lost Marbles seems to think it's the "public" that should know more about science, thus they could tell bad doctors becuase they don't make sense. If not, "it's their own fault".

    That is quite plain silly. We need specialists. We cannot study everything or develop every CRAFT. Even for your plumbing, you decide to place trust.

    People should not be required to become self-doctors. It's the Doctors that must be required to be good at what they do. Focusing attacks only on chiropractors and herb-selling hippies while assuming that all traditional medicine is good practice is simply a superficial look at the problem (many think all they have to do to make this a better world is go around life "championing science").

    The focus should be in improving the academic formation and practice of the specialist, that is, the doctors. It is the failure of doctors, as I pointed out above, their inhumanity and money-driven customs, ignorance, refusal to research or update their practice, etc that produces much suffering and resentment with "traditional" medicine

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  17. Wait, is does it mean that homeopathy is the same and holistic approach to cancer treatments are the same or is it just part of the therapy? I'm confused, sorry. I'm doing a thesis for our finals; I'm not doing really well on our biology subject so I chose a difficult topic. So far I found out that alternative therapy doesn't really cure cancer but rather helps the immune system get stronger so that it can endure cancer's presence on the body. So far, I haven't found anything about it, except now. I hope you can help me out with this. Your insights will be very much appreciated!

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