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224 thoughts on “A Skeptic In Oz

  1. Harriet Hall says:

    @Kulkarniravi,
    “I know a lot more about my body…. than anyone else.”

    Talk about arrogance!

    Do you know more about your internal anatomy than an anatomist? Do you know everything that a CT or MRI scan will show? Can you explain the Krebs cycle?

    By the way, you never answered my question about how you would go about developing new drugs by considering the whole person, not just the symptoms. I’m asking again: please give us an example of what you mean.

  2. Chris says:

    kulkarniravi! You are back! Now will you please answer my questions?

    You seem to be the arrogant one. You came here blasting away about things, and have not supported one item. I am also amused that you think you know more about your body than any healthcare provider.

    I had no clue that the rash on my hand was from a nickel allergy until my family doctor told me. Now I get fewer rashes by avoiding nickel, which is difficult when one of my hobbies is sewing. It is very hard to find hand sewing needles not coated with nickel (I found some from Japan).

  3. Josie says:

    Kulkarniravi,

    From your posts you seem to be a mostly reasonable person who just has some preconceptions about science that just don’t apply.

    Medical professionals do not seek to treat symptoms and not the whole person, use of antibiotics can’t be considered reckless before we understood resistance, and medical professionals don’t “know what’s best for everybody” –they have standards of care that work for many and they need their patients to provide the personal information you mentioned earlier.

    Science is simply formalized observation to minimize the subjective frailties of our own perceptions.

    As scientists we are constantly being critical of our own work and the work of others in an effort to get predictive conceptions of whatever system we’re looking at. When a concept is no longer predictive we abandon it and move to something better.

    What is conventional medicine anyway? If I go to the doctor today with a lump in my breast is she going to put me through the same diagnostic and treatment regime I would have received in 1970? I doubt it. So called conventional medicine is constantly changing as our good doctors scientist and their support staff strive to improve.

    If they seem imperious or arrogant or dismissive, maybe it’s because of you’re bringing them the same tired arguments and quack treatments they have been assaulted with their whole careers and that have been shown not to work many times over. Your doctor, if he or she is a good one, has moved on to better things to help you in a demonstrable physical way. Your doctor is not going to insult you or your body by trying to placate you with an ineffective treatment that is “alternative” just to make you feel special. I think most docs would like you to feel special because you are special on your own merits.

  4. kulkarniravi says:

    “Do you know more about your internal anatomy than an anatomist? Do you know everything that a CT or MRI scan will show? Can you explain the Krebs cycle? ”

    What you (the healthcare professional) know is a generic human body, not in specific like me. My body today is what it is, because of the choices I made and my genes. You may know more about how the food is digested in my body, or what specific signals are fired in my brain when I see something, but you certainly can’t claim you know how my body will react to a certain food or medicine. It is mostly guess work.

    On the other hand, I know exactly how I feel (or my body will react) if I eat a banana early in the morning. I may not know the long term consequences of eating a banana every day in as many details as you do, but I certainly can tell you more about what happens to me in the short term. I strongly advocate always doing your own research when it comes to healthcare. I am not proposing that everyone should self medicate (less medicines the better is my motto). There is no excuse today to do otherwise.

    BTW, it is a just few clicks to find out what’s Kreb’s cycle, if I were so inclined.

  5. Harriet Hall says:

    @ kulkarniravi,

    You seem not to understand that personal observations can be very misleading. You may reach a false conclusion because of the post hoc ergo propter hoc fallacy, because of conditioning, because of the natural course of disease, because of a placebo response, or because of many other considerations. The whole reason for science is that we can’t trust our personal observations.

    Just one example: some people “know” they get headaches from aspartame, but when tested under double blind conditions, they ingested aspartame without getting a headache and got headaches from a placebo.

  6. kulkarniravi says:

    Chris,

    It is easier to reply to one liners with my own one liners :)

    I will try to address your points soon, currently I am backlogged if you notice.

    -RK

  7. Chris says:

    Funny, I did not post a one liner last night. I saw no reason to repeat it since it is still above waiting for your answer. I assumed you could go up and read it again, and that you had actual incidences in mind of authors here claiming “healthcare is an exact science” that you could easily find.

    So I actually need to repeat it for you? Okay, here is the cut and paste (though the HTML has to be put back in):

    kulkarniravi said:

    Actually I am not against science. I am just questioning the claim that healthcare is an exact science. Only the clinical study part is “scientific” though even that depends upon incomplete science.

    Josie and other responded with variants of “Pretty sure no one here makes this claim.”

    To which, kulkarniravi responds with:

    I beg to differ. Arrogance and contempt for the lay people is quite common among the healthcare professionals.

    Please provide the evidence you used to make the statement that “healthcare is an exact science” was ever made by one of the authors on this blog. Post which article made that claim. Make sure it is the one with the most arrogance and contempt for the regular readers who are lay people (like me).

    You made a claim, now support it.

  8. kulkarniravi says:

    Chris,

    I didn’t mean you posted a one-liner. I was referring to other comments and said it is easier to respond to them. I promise I will get back.

    -RK

  9. weing says:

    “BTW, it is a just few clicks to find out what’s Kreb’s cycle, if I were so inclined.”

    That is true. But to truly understand it and its ramifications in health and disease, and to appreciate the beauty of it will certainly take more than a few clicks.

  10. Chris says:

    Thanks for clearing that up (the smiley was not helpful). Though in the future when you post a comment with accusations and assertions be sure to include the supporting evidence. You should not have to go and look for them after you are challenged.

    Many long eons ago back in the 20th century when we had our first phone modem I read some advice on a Compuserve forum: lurk on a forum before commenting.

    Get to know the place, because each blog, forum and even Usenet newsgroup has a certain culture. Find out what has been discussed, and what kind of questions will be asked and answered. For starters read the blurbs on each of the authors of this site by clicking on the list on the right hand side of this page under the word “Staff.”

    And for a quick way to understand the mindset and arguments from the fearless leader, Dr. Novella, go and download the Skepticism 101 podcasts from the Skeptics Guide to the Universe 5×5, which is five minutes with five skeptics.

  11. ryt74 says:

    “Apparently the millions of people around the world who have benefitted from acupunture, for example, have all imagined their improvements.”
    500 trillion flies can not be wrong. Eat poop!

  12. Daniel M says:

    kulkarniravi,

    Unless you are a member of the X-Men your body’s biochemistry is not much different than anyone else, and someone who has studied pharmacology and biochemistry, understands disease processes, and has read thousands of drug studies understands how you will respond to a drug much, much better than you do. I am baffled that you claim to know, based on your subjective feelings, how new drugs will affect your body better than a doctor.

    Maybe an analogy that you can appreciate better than the pilot and passenger is a lawyer and a client. Do you think a lawyer would be arrogant to act like they know more about the law than an average client? I’d argue that if they don’t think they know better than they shouldn’t be practicing; similarly if a doctor doesn’t think she knows medicine much better than her patients she should find a new career immediately.

    If I had a complicated law problem I would research the law corresponding to my case, share with the lawyer my research and the particulars of my case, and listen to his expert advice. I wouldn’t assume that since some basic law information was “two clicks away” or that the lawyer’s extensive training was in “generic law, but not my particular case” that we were on equal footing. The same is true in medicine. Of course you should research on your own and share your research and all the particulars of your case with the doctor, but that doesn’t mean you know more about medicine than she does. By the way, health histories are an integral part of modern medicine. Maybe you don’t have much experience with healthcare, but doctors are specifically trained to take their patient’s self-report and history extremely seriously.

    Please go to your library and borrow Robbins’ Pathologic Basis of Disease, a medical biochemistry book like Mark’s, Bates’ Guide to Physical Examinations and History Taking, Netters’ A&P, and Harrison’s Principles of Internal Medicine. If you read, or even just browse, those books I think you’ll see that doctors might be justified in “arrogantly” thinking they know more about how to treat medical problems than their average patient.

  13. trrll says:

    Kulkarniravi’s insistence that “I know people will protest and say they consider other factors, but for the most part, the entire focus is on the disease and not the whole person. ” tells me that is is just repeating what he has been told, and has not bothered to educate himself by reading the actual medical literature.

    If he had done so, he would know that a huge emphasis of modern medicine is in improving individualized treatment: identifying which individuals will most benefit from a particular therapy and which are likely not to benefit or to exhibit adverse effects. Clinical trials are full of subgroup analyses. Genome-wide association studies are being carried out to identify individual genetic factors which influence benefit and risk of medical therapies.
    Both the FDA and NIH are encouraging studies to improve understanding of the impact of individual differences. Even the pharmaceutical companies have embraced this concept, because if they can identify the particular subpopulations that will benefit from a particular drug, or that will exhibit adverse effects, they are more likely to get approval from the FDA and will reduce their exposure to liability.

    Of course, this is a huge task. There is great diversity of the human population, and people also differ in diet, behavior, and exposure to environmental factors. Of course, when CAM talk about “treating the whole person,” what they almost alway mean is “taking a guess” — when asked to justify how they individualize treatment, they are unable to cite any actual evidence that their approach to individualization is any better than flipping a coin. Oddly enough, CAM practitioners often accuse practitioners of science-based medicine of “arrogance,” yet it is science-based practitioners who are acutely aware of their lack of knowledge and the limitations of clinical trials, and it is the CAM practitioners who are so arrogant as to presume that they can individualize therapies based solely upon their own intuition, without any need for clinical trials to see whether intuitive choices are helping or harming their patients.

  14. kulkarniravi says:

    There are far too many replies here to my posting, and I simply don’t have time to respond to all of them. So I will try and reply to the most common themes and leave out the rest – especially those that target my ignorance. But I do thank you for engaging me in this dialog, I am learning quite a bit here.

    First off, is the modern medicine based on science? Perhaps choice of words “exact science” provided a great strawman for people to flog, so let me not use that anymore. My fundamental argument is that the modern medicine is not as efficacious as the proponents claim it is. The reason is quite simple: no one yet understands the human body well enough to create therapies and drugs that can heal every (or even one) chronic disease completely. Note the word chronic before you start attacking me. I am not talking about infectious diseases such as polio or tuberculosis, which I am aware can be cured with antibiotics or vaccines. I have great regard for vaccines and antibiotics when used judiciously.

    Human body is very robust and yet very fragile. It is not (yet) like an automobile where you can replace a part with impunity and not have many long term consequences. We understand automobiles well enough that we can fix things if they break. I will give you a very simple example: modern medicine is nowhere near curing even the common cold or the headache – the medicines are all about mostly suppressing the symptoms. Forget about treating cancers or heart disease. Do the drugs extend life – yes sure, but at what cost?

    So if modern medicine is based on science, it is based on incomplete science. As I said in the automobile example, it is easy to fix if your assumptions were wrong when you made a repair. In case of human bodies, it is not that simple. Reductionist approach to human health is a very short sighted approach. We need a more holistic approach – science based holistic approach. Intervention should be the last line of defense, not the first line of attack. I would love to see a break up of research $$ that goes towards prevention modalities. Without actually researching it, I will bet that it is a miniscule %. That tells you where the basic defect of modern medicine lies. The root cause lies elsewhere and we keep searching for the proverbial ring under the lamp because that’s where the light is.

    More to come…

  15. tmac57 says:

    kulkarniravi-It’s all well and good to wish for more research dollars to go to prevention,but would you rather that money go to homeopaths,reiki therapists,chiropractors,and acupuncturists,or to cutting edge conventional (western?) medical research facilities,to find what preventions are science based? I’d put my money on the latter,thank you.
    By the way,my sister is in her 13th year of remission of her breast cancer,due to modern cancer treatments,and I know a woman who is still alive after having being treated for cervical cancer in 1980.Do you think that they would be alive if they had trusted their lives to CAM instead?

  16. kulkarniravi says:

    Just look at this link:

    http://www.bizjournals.com/sacramento/stories/2008/11/24/story9.html

    $700 billion wasted! I wonder actually how much money is spent on conventional medicine in the US? Compare that to the amount spent on preventive methods – health food choices, exercise, lifestyle changes. I bet it will be an insignificant (in single digits, if that) percentage. As a society we have to focus on what is really important, not quibble on minutiae like supplements which are relatively harmless.

  17. Scott says:

    My fundamental argument is that the modern medicine is not as efficacious as the proponents claim it is. The reason is quite simple: no one yet understands the human body well enough to create therapies and drugs that can heal every (or even one) chronic disease completely.

    Complete and utter strawman. Indeed, it’s so egregious that the term “lie” is arguably appropriate. Nobody I am aware of, certainly nobody here, claims that modern medicine “can heal every (or even one) chronic disease completely.” That’s the very definition of chronic!

    So if this is your fundamental argument, then you are fundamentally, utterly, and completely divorced from reality.

  18. @kulkarniravi:

    Time for you to learn a little about your chosen topic:

    http://www.sciencebasedmedicine.org/?p=157

  19. Daniel M says:

    Kulkarniravi,

    I hardly know where to start. Of course modern medicine hasn’t cured any diseases that are currently chronic, or they wouldn’t still be labeled chronic any more. Medicine has cured many, many diseases that USED to be chronic. Syphilis and tuberculoses, to give just two examples of many, used to be chronic diseases that eventually killed people, but modern medicine has cured them. Also you seem to have a fundamental misunderstanding of preventative medicine, it is a huge part of modern medicine (although patients usually ignore it); preventative medicine is not alternative in any way. Doctors can even specialize and become board certified in preventative medicine, although it is a huge part of what all doctors do, especially primary care doctors. 10s of billions of dollars has gone into preventative medicine studies, just go to your library and read through all the current medical journals and you’ll see countless studies published every month.

    Have you visited a doctor in a developed nation? I’m genuinely curious because from your comments it doesn’t appear that you are familiar with how medicine works, not just the science, but even office visits. You claim that preventative medicine isn’t stressed, even though it is heavily stressed in just about every primary care visit I have seen with in my 6 years as a military medic. You claim that doctors don’t take into account a patient’s history, even though that is an integral part of the SOAP note that is used in just about every medical visit. You use buzzwords like “holistic” to describe your vision of medicine, yet you still haven’t explained how that is different than supposed “reductionist” medicine. Please understand that prevention, considering the patient’s expectations and culture, and taking into account a patients history and subjective report are all absolutely vital part of science-based medicine.

    It appears that you are dismissing much of medicine, misunderstanding how science works, and claiming that you are just as qualified to know what works medically for yourself as are doctors who have spent decades treating patients. I really am baffled that you would call doctors arrogant for thinking they know medicine better than their patients (would you say a lawyer was arrogant if they thought they knew more about the law than their clients?), but it appears to be because you aren’t familiar with the medical system. I’d really encourage you to leaf through those medical textbooks I pointed you to earlier, as well as reading a thorough book on the history of medicine, maybe even see if you can job shadow a primary care doc, and I think it would clear up a lot of your misconceptions about medicine.

  20. Chris says:

    Well I did suggest he lurk a bit more, figure out what this place was all about. But obviously he has not done that, and is making unsupported claims. Or else he would not have said “We need a more holistic approach – science based holistic approach. ”

    Okay, I know he has not read much of the subject: “I will give you a very simple example: modern medicine is nowhere near curing even the common cold or the headache – the medicines are all about mostly suppressing the symptoms.”

    The “common cold” is a collection of over two hundred viruses. Where would you start?

    Now how about answering my question? The one that required a link to an article on this site that claimed “Actually I am not against science. I am just questioning the claim that healthcare is an exact science.” Show us which article on this blog by which author, or just admit that you have not read that here.

  21. kulkarniravio
    “I wonder actually how much money is spent on conventional medicine in the US?”
    Lots!

    “Compare that to the amount spent on preventive methods – health food choices, exercise, lifestyle changes. I bet it will be an insignificant (in single digits, if that) percentage. As a society we have to focus on what is really important, not quibble on minutiae like supplements which are relatively harmless”

    Firstly, If you look at all the things in society that we do to keep us healthy; food consumption, food safety measures, shelter, shelter safety measures, public disease control measures (CDC activities, etc) public safety for transportation, public safety measures for air, water or soil contamination, etc. All those things that are done to prevent disease or accidental injury, I would be very surprised if the cost of those measure were insignificant in comparison to the cost of “conventional” medical interventions (medications, tests and surgery, I guess you mean).

    Secondly, what do you think that these costs indicate? For me, the cost of exercise is relatively low. I buy a pair of running shoes on sale occasionally. I buy some music on itunes. I buy exercise clothes at the Salvation Army. I jog or jump around the living room for 30 minutes several times a week, do some floor work in the living room, dig around in the garden and move stuff. There, an exercise program for under $200 a year.

    I’m sure I spend much more on my doctor and medication bills. I’m sure I spend more on my house than on medical bills, food, and exercise. Is my house more important than my health? Not necessarily. But the amount that you spend on something does not indicate it’s importance in your life or all your priorities. To some extent, it just indicates how much things cost.

    Also, you seem to be suggesting that medicine has no idea of the effectiveness of most medications. But that makes me wonder, why is it okay to spend money on supplements (which you believe to be harmless, why?) without any idea of their effectiveness and not okay to spend money on medications without any idea of their effectiveness?

  22. Harriet Hall says:

    @ kulkarniravi,
    I’ll try once more: you never answered my question about how you would go about developing new drugs by considering the whole person, not just the symptoms. I’m asking again: please give us an example of what you mean.

  23. Harriet Hall says:

    @kulkarniravi,

    “My fundamental argument is that the modern medicine is not as efficacious as the proponents claim it is.”

    Who are these proponents and what exactly are they claiming? If you are just saying medicine should improve, that is a truism: we all agree wholeheartedly. We all understand the limitations of medicine and science is constantly working to make it more efficacious. What exactly would you have us do? Is there some system that you think would work better than modern medicine?

  24. David Gorski says:

    Of course, when CAM talk about “treating the whole person,” what they almost alway mean is “taking a guess” — when asked to justify how they individualize treatment, they are unable to cite any actual evidence that their approach to individualization is any better than flipping a coin.

    Or, as I like to say, “individualization” or “personalized medicine” in CAM means, if you’ll excuse my French, so to speak, “Making shit up as you go along.” In actuality, as Harriet pointed out, much of what passes for “individualization” is actually ascribing One True Cause to All Disease. In the end, this fetish for “individualization” in alternative medicine is a sham. It’s invoked when it is convenient to do so, particularly in the cases of “treatments” like homeopathy, in which any therapeutic effect perceived is due to the placebo effect. Indeed, alternative medicine’s claims of “individualization” means the freedom to keep trying stuff until the patient’s symptoms get better on their own.

    kulkarniravi, begin your education:

    On the “individualization” of treatments in “alternative medicine”
    Certainty versus knowledge in medicine
    The One True Cause of All Disease
    Hope and hype in genomics and “personalized medicine”

  25. I too am beginning to wonder if kulkarniravi has actually used “conventional medicine” very much in the last 20 years.

    For instance the article they linked too talks about how businesses need to focus on weeding out ineffective medical care. It seems completely oblivious to the fact that health care insurance companies do have processes for the approval of medical procedures, medications, etc based on cost and effectiveness*.

    If they had experience dealing with insurance companies to get services paid for, they would realize this.

    This is not to say that to processes couldn’t be improved, but it makes no sense for, say a computer manufacturer’s HR staff to try to figure out the most effective treatment for diabetes.

    *Sometimes I think these media articles that talk about “Changes that need to happen!” just look at what’s already being done then act like they thought of it.

  26. kulkarniravi,

    Did you just give the common cold as an example of a chronic disease? Because it isn’t. It’s an acute, self-limiting infection.

    What do you mean when you say, “no one yet understands the human body well enough to create therapies and drugs that can heal every (or even one) chronic disease completely”?

    I dunno. If someone with Type II diabetes works with their doctor on the most-recommended, science-based approach to their chrinic disease, improves their diet, starts an exercise program, loses weight and is no longer diabetic, does that not count?

    What does “heal” mean exactly? If my wound heals it means that scar tissue forms. But if someone “heals me” that has religious overtones and suggests that they have somehow restored me to a pristine state. We all get old, die, wear out. Nobody is going to be restored to a pristine state. If I have mechanically worn out my knees from overuse or overweight, modern medicine has no magic wand to “heal” my knees and give me back the cartilage I had when I was seventeen. It can help — it can even give me an artificial knee — but even if I am very happy and mobile due to a medical intervention I’ve still left my youth behind. If we could actually be “healed” in this way we would be immortal. We aren’t, and there is a case to be made that mortality is a good thing.

  27. daedalus2u says:

    There are a lot of chronic diseases that conventional medicine does pretty well on, or at least many orders of magnitude better than CAM.

    Diabetes type 1,
    Kidney failure, there is dialysis and transplant.
    HIV
    Many cancers are now treatable.
    Depression
    Psychosis
    Hypertension

  28. adding to daedalus2u list,

    Hypo/hyper-thyroid disease
    Lyme disease
    Parasitic infections (Giardia and the like)
    Dehydration due to illness
    Asthma
    Many traumatic injuries
    Many congenital heart, limb or cranio-facial malformations that used to cause death or disability
    Other issues such as PKU, which can be controlled through diet or medication so as not to cause damage.

    The thing that bothers me is that all these things don’t really seem to count in kulkarniravi’s book.

    They seem more invested in getting a MD to confirm their random observations about diet and supplements than helping people who have significant health issues.

  29. weing says:

    So medicine is not effective because there are still chronic diseases that have not been cured (not even one)? You gotta be kidding me! Awright. Let me think. Not an infectious disease. How about PKU. We test at birth and if found, we eliminate phenylalanine from their diets throughout childhood and the patient is out of the woods as an adult and doesn’t even have to avoid phenylalanine any longer? Have you ever seen adults that weren’t treated so? I have. You can’t cure them, you can only prevent them from becoming disabled.

  30. weing says:

    Dang it, micheleinmichigan, you beat me to it.

  31. daedalus2u says:

    It is true that modern medicine doesn’t treat the “whole” person. Real doctors tend to not massage the ego as much as quacks do.

    I think that CAM is for people who don’t feel like a whole person until they get their egos puffed up by quacks telling them they have all these important bits to puff up that no one else can tell is there.

  32. kulkarniravi says:

    I have already granted that modern medicine has indeed helped in cases of infectious diseases. Without it, we would still be dying of simple infections in unconscionably large numbers, as we indeed still do in cases of Malaria and even TB. But we have understood many of the infectious diseases and found a cure. Ditto emergency cases such as accidental injuries. Can things be improved? Certainly, but it is a remarkable progress.

    I have lived in the United States for 15 years and therefore yes, I do know about the medical care here. Primary care physicians simply do not have time to talk about preventive care, and I do not blame them. It is more of a societal and policy issue rather than a medical issue as someone pointed out. Perhaps we need more dieticians and nutritionists.

    Many here have dismissed diet as a major cause of diseases – it is not surprising. And yet, we are what we eat. Diet may not be the only cause of disease, but it must be one of the top contributors other than genes. One can not do much about one’s genes, but we should be able to alter our diets to improve our health. I have personally followed a vegetarian diet with a lot of fibers and have seen a major improvement in my health. Anecdotal yes, but it has worked for me. My dentist told me my blood is thin and flows easy and asked me if I took aspirin. I haven’t had headaches, perhaps induced by hypoglycemia, in ages now. Reduced calorie intake has also helped.

    Diet is the low hanging fruit for most people. It may be habitually difficult to change, but once you are convinced it matters, it is possible. In my opinion, that one change, will completely alter the healthcare situation in the US. Even it contributes only 10% to overall health, it is still a major benefit for a small change. I would wager more like 50%, no scientific studies to back it up, but I strongly believe it is true. And yet, we see only a half hearted attempt at ensuring that everyone knows that a balanced diet is important. There is simply not enough money in making people healthy. It is much more rewarding (for the healthcare industry) to treat diseases than prevent them.

    I am not accusing any of you or the industry of any overt conspiracy. I am sure no doctors, insurance professionals and researchers sit around a table to discuss how to make people unhealthy. But even if a small percentage of the yearly budget on healthcare is spent on ensuring better diet for everyone, it will make a huge difference. Our genetics may determine what diseases we are prone to, but our genetic code is not written in stone. We can change our genetic destiny by our choices, and diet is an important one.

    On a personal note, for the last seven years, I have shifted to a 50% raw food diet. My lunch consists entirely of broccoli, bell peppers, cucumbers, carrots, beans, almonds, apples, pears and more vegetables. It has made a huge difference in my health. Anecdotal? Yes, but it works for me. I am not going to wait until some big pharma company does research into broccoli to find out why it is healthy. By then it would be too late for me even if they ever get around to it.

    And yes, I don’t take medicines most of the times. I have taken anti biotics, once in the last 15 years because of a tooth extraction. My children have never taken antibiotics and they are healthy.

  33. Harriet Hall says:

    Now it comes out! Kulkarniravi is a vegetarian/raw foodist whose beliefs about food go beyond the evidence. Forget about scientific studies of the effects of diet: he knows it works for him!

    And he still hasn’t answered my direct question (after what? 3 requests now?).

  34. Chris says:

    Not even the one that required a link to an article on this site that has “the claim that healthcare is an exact science.” He has not listed the article on this blog where read that claim. I thought it was an easy question.

  35. kulkarniravi says:

    Regarding developing new drugs. I don’t believe it is possible find/develop drugs that can cure complex diseases like cancer or diabetes. Cure as in, the person is no longer afflicted by it, no more medicines necessary. Not yet anyway. Perhaps one day our knowledge of human body will be so extensive, our knowledge of herbs and foods is so vast and our computing power so enormous that we will be able to design/develop a combination that will cure these diseases. I think that day is at least decades away.

    Clinical studies are carried out at the most a decade if I am not mistaken. Humans have a lifespan of around 70-80 years on average. So the long term impact of these medicines can only be known after 2-3 decades if not more. So it is a lottery if you must take some drugs for a long time especially if you are young.

    There are other complicating factors that make the drugs efficacy questionable. Protestations of innocence not withstanding, most major drug companies have been implicated in some malfeasance or the other during the last few decades. Falsifying evidence, not disclosing adverse events you name it they have done it. I don’t need to list them, I am sure you all are far more familiar with the events than I am. FDA is a revolving door for the pharma executives – so I am not sure FDA has the common interest at the top of their priority. I know I am preaching to the extreme hostile audience here, but you have heard this before and despite all the evidence you will probably continue to believe that the FDA is a paragon of virtue. There is clearly a conflict of interest when a pharma company does research, conducts its own clinical trials and then sells the resulting drugs for a profit. That’s the huge elephant in the room that nobody is willing to acknowledge.

    We need to rethink how we develop drugs in the first place. I totally believe in science, but drug discovery should be done with zero profit motive. Drugs should not be consumer items, they are sometimes essential to the very survival of people. Any research in drugs should be conducted as a long term investment rather than to advance shareholder value. There should be total transparency in the entire process and no patents should ever be awarded for drugs. Clinical trial should be conducted independent of the research team. I know it is too much to ask for in the current regime, but in my opinion truly effective drugs will be found only when the profit motive is taken out of the equation. Is it likely to happen in my lifetime? I doubt it, but the current open source movement in other spheres gives me some hope.

  36. kulkarniravi says:

    Harriet,

    Labeling people is counterproductive, but I will answer your implicit question – yes I am a vegetarian, by birth. I have tried “non-vegetarian” (as they call it in India) food but never developed a taste for it. I believe it is possible to eat meat and still be healthy.

    I am not a raw foodist either. What I believe is that we need a high fiber content in our diet. The best way to get that is to eat a significant portion of your food raw. High fiber content helps in elimination and reduction of toxins in your body. The fiber need not come from raw foods, you can eat cooked vegetables and still get a lot of fiber too, but it is hard to make so much food at home.

  37. kulkarniravi says:

    Regarding herbs and supplements (or CAM as you like to call it). I don’t believe all herbs or supplements work as well, or at all, as advertised. But can any of you say that turmeric is not a good anti inflammatory or anti septic agent? How many of you have advised your patients to consume more turmeric?

    I believe in doing my own research for health. Sure, I consult doctors on a regular basis. I don’t always follow their prescription without checking if there are natural alternatives to it. For example, if I have a backache and the doctor prescribed a pain medicine, I would rather take a herbal one. Supplements such as Inflameric work very well – perhaps a placebo effect as you would like to call, but it works for me.

    Years ago I developed PVC (premature ventricular contractions). After three years or so I consulted a cardiologist and after several tests he concluded it was benign. It was still uncomfortable to have them, so I did some more research and took Co-Q10 after reading about other’s experiences. I felt the difference in a day or two, and was completely free of them within a week. Anecdotal? Sure, but it worked for me.

    Perhaps (as a healthcare professional) your code of conduct prohibits you from mentioning these supplements, even if you feel that they may work. However, as a patient, I should do as much research into the issues I am facing before blindly accepting a doctor’s advice. I am not talking about emergency cases here – only those issues that are chronic and non-life threatening. If those alternatives include supplements or herbs, so be it. For the doctor I am just another patient, for me it is my life.

  38. weing says:

    kulkarniravi.
    Hey, I love broccoli too. It doesn’t mean it will cure whatever ails me, however. You eat raw food, I eat sashimi also. It’s a matter of taste. Claiming that your eating style is better than mine is a little like claiming that red is a better color than blue. Diet is very important but it is not a panacea. I am sure we all would be better off financially and health-wise if we took greater care in picking our parents. I am in primary care and practice preventative care and I educate my patients in lifestyle changes. I cannot make claims about diet and lifestyle that don’t have any backing in science. That would be like prescribing a medication for an off label use and claiming that it is indicated for his/her condition. I would be lying in both cases. I don’t like lying. It just feels wrong.

  39. weing says:

    “I don’t believe it is possible find/develop drugs that can cure complex diseases like cancer or diabetes. Cure as in, the person is no longer afflicted by it, no more medicines necessary.”
    Actually, some cancers have been cured by drugs. I have patients who are no longer taking medications for their cancers and they are doing well. We may not be able to cure diabetes but we can treat it, although some would make that claim for bariatric surgery. You might say that food doesn’t cure simple hunger because you have to continue eating it. Why is that a bad thing?

  40. kulkarniravi says:

    United States has the “best” healthcare in the world. The proof of the pudding is in the eating. Can Americans claim to be the healthiest people in the world? In the year 2000, 52% (by value) of all the medicines consumed in the world was in the US. (http://apps.who.int/medicinedocs/en/d/Js6160e/6.html). And yet, USA is ranked only 37th among the developed nations (http://www.photius.com/rankings/healthranks.html). What do you think is the root cause?

    So more drugs should make people healthier but that hasn’t worked out that way. One could argue that without those all those medicines, US would be even worse, though I doubt it.

  41. kulkarniravi says:

    Since when hunger became a disease?

  42. weing says:

    We are aware of the problems with pharma and the FDA. You seem to underestimate what it takes to get a new medication onto the market. It takes about a billion dollars and 10 years to get it approved and still you don’t have any guarantees. What do you propose? That drug companies just give us anecdotes instead of research and say try it and see if it works for you just like that CAMsters? They would love that.

  43. weing says:

    “Since when hunger became a disease?” It’s not.
    I would argue that you have a sicker population if the consumption of medication is greater than in another population. Drugs making someone healthier? If a drug allows me to function as a productive member of society instead of being confined to bed is it making me healthier? In that situation am I just as healthy as the guy who doesn’t need the medication? I don’t think so. Would you call Stephen Hawking healthy?

  44. kulkarniravi says:

    Weing,

    “It takes about a billion dollars and 10 years to get it approved and still you don’t have any guarantees.”

    That’s an overly inflated figure. I remember reading a blog on this forum that it is probably closer to $40 million.

  45. kulkarniravi says:

    Weing,

    “I would argue that you have a sicker population if the consumption of medication is greater than in another population. ”

    I totally agree with you. If Americans are sicker, then what made them sick in the first place? Can’t be their genes, as it is not a homogeneous population. Can’t be the environment as it is no better or worse than other advanced nations. Could it be the diet?

  46. kulkarniravi says:

    A question for all healthcare professionals here. How many of you have studied nutrition and diet as a course? If you have not studied it any detail, two questions arise:

    - How can you advise your patients on diet and nutrition?

    - How can you say diet is not a major contributor to health (if you say it)?

  47. weing says:

    “But can any of you say that turmeric is not a good anti inflammatory or anti septic agent? How many of you have advised your patients to consume more turmeric? ”

    I am not aware of any good studies of turmeric for these uses? I am aware of some population studies suggesting it may have a role in preventing Alzheimer’s. There are also some studies on possible mechanisms for this. Can I recommend its use with certainty? No. Can I tell patients that this is all preliminary? Yes. If they want to use it in their diets, I don’t know of any contraindication. I even tell them I add it to my cooking a couple times a month.

  48. weing says:

    “If Americans are sicker, then what made them sick in the first place? Can’t be their genes, as it is not a homogeneous population. Can’t be the environment as it is no better or worse than other advanced nations. Could it be the diet?”
    Not sure about the environment being better or worse. Why is multiple sclerosis more common in people who grew up in temperate climates as opposed to tropical? Doubt diet would be the cause here. How about more access to medicines that allow the sick to survive and reproduce?

  49. Wolfy says:

    @ kulkarniravi

    1. How can you advise your patients on diet and nutrition?

    It depends on what they are asking. In my patient with breast cancer:

    Is eating broccoli generally good for me? yes
    Will eating broccoli cure my breast cancer? no

    Usually referral to a registered dietitian is a good idea, regardless of one’s specific clinical practice.

    2. How can you say diet is not a major contributor to health (if you say it)?

    I don’t, but good nutrition, by itself, won’t cure or prevent every illness.

    “I am not going to wait until some big pharma company does research into broccoli to find out why it is healthy.”

    Good plan. By the same token, we really didn’t need to wait around for someone to research on strychnine or tetrodotoxin to know that these compounds are toxic, but it is kind of nice to know why.

  50. Daniel M says:

    kulkarniravion,

    I challenge your assertion that it is necessarily a bad thing that the US uses so many prescription drugs. Of course we use more prescription drugs than less developed nations, but that is because our population has a longer life expectancy and as people move into old age they are more likely to need medication, as well as the fact that people who would die of a disease elsewhere are able to have long, full lives through the use of medicine.

    Canadians have a healthier population than the US, and several studies show that they use more prescription drugs per capita. Also, by almost any measure Japan has one of the healthiest populations in the world and a great healthcare system (including the greatest life expectancy and way lower infant mortality rates than the US), yet according to Newsweek’s article “Japan’s Good, Cheap Healthcare” they visit the doctor 3 times as often as Americans and use TWICE as many prescription drugs per capita. Obviously medication usage is not negatively correlated with a nation’s health as you suggest.

    Again, nutrition, exercise, and preventative medicine are NOT alternative, they are vital parts of science-based medicine. Doctors can become board certified in preventative medicine, and every state has numerous public health officials whose full time job is preventative medicine. How long would it take if doctors were really expected to teach patients how to cook, design healthy meals for them, build entire exercise programs for patients, and teach them proper workout technique? It would take days, if not weeks, which is why doctors refer patients who want to learn about exercise and nutrition in detail to nutritionists and personal trainers. Like I’ve pointed out several times, general exercise and diet advice, pointers to good references on the subject, and answering any patient questions on the subject are all part of just about every primary care visit I’ve witnessed as a medic of 6 years. Of course it isn’t gone into in incredible detail, but that is why nutritionists and personal trainers are part of modern medicine.

  51. Daniel M says:

    kulkarniravion,

    You wrote, “I remember reading a blog on this forum that it is probably closer to $40 million [to develop a drug].”

    Where did you read that on Science Based Medicine? Dr. Gavura wrote a post on the subject on April 14th and he called this figure “implausibly small” and said of the $1.3 billion claim “New drugs could be hitting, or even exceeding this mark – it depends on what your assumptions are.” Can you point me to a post where someone on Science-Based Medicine actually claimed that it probably costs around $40 million to develop a drug?

  52. Harriet Hall says:

    @ Kulkarniravi,

    “High fiber content helps in elimination and reduction of toxins in your body.”

    What toxins do you mean? Citations, please.

  53. Draal says:

    @Daniel and Kulk

    It kinda depends on how one defines ‘develop a drug.’ The discovery phase of the research and development of a drug is probably in the 40-200 million dollar range. For example, a library of crude extracts of plants/bacteria are screened against specific targets (cost for developing assays should be included), those that hit, are further fractionated to separate the matrix of compounds, fractions that hit are further purified until a single compound is isolated. It then is characterized by a variety of means to define it’s structural properties, work goes into chemically synthesizing the compound and similar analogs, those are re-screened, maybe protein co-crystal structures are made, then animal models are tested, toxicology is determined, ect. It’s an iterative process so any step can be repeated many times. Pharma companies throw a lot of money into trying to figure out how their compounds work on a molecular level; it’s no trivial feat.

    None of that includes Phase I, II, and III clinical trials, plus marketing of a drug that jacks up the price of bringing a drug to market. (Plus, you have to pay off all the doctors who will prescribe the drug to the unsuspecting masses, that costs a lot of money to put those doctors in pocket of big pharma).

  54. Wolfy says:

    @ Dr. Hall with regard to references/citations for:

    “High fiber content helps in elimination and reduction of toxins in your body.”

    If I had to take a wild guess here, any of the writings of:

    1. Max Gerson
    2. William Kelley
    3. Nick Gonzalez

    :)

    1. Harriet Hall says:

      @ wolfy,

      I was hoping for a citation that would explain exactly what those “toxins” are and show evidence that they are indeed eliminated. I don’t think the authors you list have any clue.

  55. tmac57 says:

    “High fiber content helps in elimination and reduction of toxins in your body.” That literally sounds like a load of crap!

  56. Wolfy says:

    @ dr hall:

    i know. i’ve noticed that when people discuss removing “toxins” these quacks are usually cited. i was guessing our friend above might do the same. my bad, it was my poor attempt at snark ;)

  57. kulkarniravi says:

    Wolfy

    I was not familiar with the work of the gentlemen you have mentioned. Digestion produces some bi products and elimination removes them from one’s body. If the elimination process is incomplete or defective, they may accumulate in one’s body. More food one consumes, the more bi products there are. If they are not eliminated in a timely fashion they become toxic. This should be common sense, I am not sure if there are any studies done to verify this theory. One thing is obvious – you need proper elimination to ensure good health.

    There is also some indirect evidence. Reasonable calorie reduction extends life and improves health. More food one consumes, the more one is prone to a variety of diseases such as diabetes, heart disease etc. Eating more fiber tends to improve elimination and at the same reduces calorie intake (depends on the type of fiber, but most vegetable and fruit sources are naturally low calorie).

    I don’t know if there is any truth to toxins, but if the quality of life improves by consuming more fiber, I would do it. Here are a couple references:

    http://www.webmd.com/heart-disease/news/20060413/fiber-good-not-just-for-your-gut
    http://www.webmd.com/diet/fiber-health-benefits-11/fiber-cancer

    Do the doctors spend enough time educating their patients about the importance of getting enough fiber in their foods? Not the ones I have visited. But I am not taking saying that there no sensible doctors anywhere – just not enough of them.

  58. Harriet Hall says:

    @Kulkarniravi,

    What exactly accumulates and how does it become toxic? No one can say, but people keep repeating these outdated bowel myths. The idea of autointoxication has been discarded by science. See Whorton’s book Inner Hygiene: http://www.amazon.com/Inner-Hygiene-Constipation-Pursuit-Society/dp/0195135814/ref=sr_1_1?s=books&ie=UTF8&qid=1304283920&sr=1-1

    You don’t have any evidence to present to us, only your beliefs. Fiber in the diet has health benefits, but not as many as you think.

  59. Wolfy says:

    dr hall beat me to it.

  60. weing says:

    Kulkarniravi,

    It’s normal waste and your body gets rid of it. If it didn’t, you would quickly get sick and die as happens in bowel obstruction. Toxins building up is a fantasy. I recommend a high fiber diet all the time. I agree with decreased calorie consumption also. The studies in animals show increased lifespan if they are chronically underfed.

  61. pmoran says:

    K, all the important, proven dietary advice can be written on the back of an envelope, and should be taught in schools and homes and on TV. No one should have to pay anyone, not doctors and definitely not CAM practitioners, for it.

    In my experience CAM practitioners equate “good nutrition” to taking lots of supplements. It has now been fairly well established that supplements don’t work as well as a good varied diet. CAM has probably done a lot of damage through encouraging people to think they can survive unhealthy lifestyles so long as they use the right supplements.

    There are exceptions, which, revealiingly, managed to escape CAM notice altogether until mainstream medical journals started talking about them e.g. Vitamin D supplementation in certain populations .

  62. kulkarniravi says:

    Pmoran,

    Dietary advice can be written on the back of an envelope. Here are some that come to mind:

    Eat wholesome and fresh foods
    Avoid synthetic foods
    Get as much fiber as possible
    Avoid sugar and simple carbs
    Reduce calorie intake

    So I agree with you on many points. I also agree that not all supplements are necessary or even work. If we eat a balanced diet (not the one promoted by FDA) we don’t need supplements.

    But I disagree on one point. When faced with a non life threatening health issue, sometimes there are alternatives that people should consider. My own case of PVC was resolved with co-Q10. Some here will challenge that story, but the fact is that I had them for 3 years, and they stopped within a week after I started taking them. Co-incidence? Placebo effect? Perhaps, but I am mostly free of them for the last five years. I may experience them once or twice a year.

    There is no harm checking out these supplements when the conventional medicine either has no clue or is unable to resolve an issue. I would go so far as to say, try the supplements first, but that’s just me.

  63. weing says:

    “If we eat a balanced diet (not the one promoted by FDA) we don’t need supplements.”

    What is the diet that the FDA promotes? Have you ever looked at the dietary recommendations from HHS and USDA? If you haven’t, please do.

    When I was a little teenager, I used to go around kicking a lamp post to make the light go out. One day I kicked it and the light went out and so did all the lights on the street and in the houses. I was sure I caused the blackout of 1965. Coincidence? I haven’t kicked any lamp post since, and we have not had a blackout occur.

  64. kulkarniravi,

    Conventional dietary advice consistent with FDA recommendations have been elegantly summarized by Michael Pollan, as follows:

    “Eat food. Not too much. Mostly plants.”

    http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html

  65. kulkarniravi says:

    Weing,

    “When I was a little teenager, I used to go around kicking a lamp post to make the light go out. One day I kicked it and the light went out and so did all the lights on the street and in the houses. I was sure I caused the blackout of 1965. Coincidence? I haven’t kicked any lamp post since, and we have not had a blackout occur.”

    So it was a complete co-incidence that my PVCs died the week I started taking co-Q10? That must be an extraordinary one. This is why supplements continue to be popular inspite of the medical establishment’s desperate attempt at negating them. There have been numerous such experiences in my case alone and at least some of them repeatedly. You can deny it all you want, but at least some of the supplements work for me. This is the experience of a lot of people. This is also why conventional medicine loses some of its sheen.

  66. Harriet Hall says:

    @kulkarniravi,

    A friend of mine called a chiropractor’s office on a Friday and made an appointment for Monday to see if the chiropractor could help with his terrible persistent back pain that had not responded to any treatment he had tried. On Saturday, his pain disappeared never to return. If he had seen the chiropractor on Friday, he would have falsely believed the chiropractic treatment had cured him. Wasn’t that an extraordinary coincidence? Uncommon coincidences are in fact common.

    The fact that your PVCs disappeared after you took the supplement does not prove that they disappeared because you took the supplement. Post hoc ergo propter hoc is a logical fallacy.

    Another friend takes echinacea every time she feels a cold coming on, and she hasn’t had a cold in 7 years. Every time I feel a cold coming on, I don’t take echinacea, and I haven’t had a cold in 7 years either. So if she has proof that echinacea works, I have proof that avoiding echinacea works. Which of us is right?

  67. Jan Willem Nienhuys says:

    we have not had a blackout occur

    You mean the big blackout of 2003

    http://en.wikipedia.org/wiki/Northeast_Blackout_of_2003

    was not caused by you not hitting any lamp post? How can you be sure? :-)

  68. weing says:

    Jan,

    You can’t blame that one on me. I was in Florida at the time.

  69. weing says:

    kulkarniravi,

    Check out variable ratio and variable interval reinforcement and watch the rituals that baseball players go through at bat.

  70. kulkarniravi says:

    All,

    I agree that scientifically no studies have been conducted on Co-Q10 to determine if it is effective against PVCs. I don’t care. It is a benign supplement at low doses, it has apparently worked for some people, it worked for me and that’s all there is to it. I am not going to wait until someone conducts tests that conclusively proves the case. Ditto many other supplements such as those based on curcumin, guggulu and many other ayurvedic supplements as well.

    When your doctor does not offer you any choice, I don’t see what is so outrageous about looking for alternatives – especially if some people have said they work. It is better than waiting for the mercy of large pharma companies which may or may not do it. This is what scientific dogma is all about.

  71. kulkarniravi says:

    I meant to say, opposing all supplements because they have not been tested in a scientific study is a scientific dogma. Many ayurvedic preparations have thousands of years of history and at least in some cases they work (even modern medicines don’t work in all cases). There is very little incentive for pharma companies to test these preparations because they can’t get patents on them.

  72. “I meant to say, opposing all supplements because they have not been tested in a scientific study is a scientific dogma.”

    By “supplement” you mean “drug.” You understand that, don’t you? If it has an action on the body then it’s a drug. (If it doesn’t, then you might as well use homeopathy or reiki.)

    Let’s rewrite your statement a little. “Not promoting or prescribing drugs with unknown risk/benefit ratios is a basic element of ethical practice.”

  73. Oh, and kulkarniravi you might want to review these:
    http://www.sciencebasedmedicine.org/?p=9955
    http://www.sciencebasedmedicine.org/?p=6703

    Also, the “appeal to antiquity” is a logical fallacy. You can look it up. (Google it or search for “antiquity” on this site.)

  74. GLaDOS says:

    I meant to say, opposing all supplements because they have not been tested in a scientific study is a scientific dogma.

    Anecdotes are good enough for you, eh?

    I have this amazing Bridge to Total Freedom for sale at a deeply discounted price.

  75. kulkarniravi says:

    “If it has an action on the body then it’s a drug.”

    That’s another dogmatic statement. Even food has an impact on the body. Herbs people use on a daily basis have an impact on the body. Are they all drugs? Many of the Indian spices have medicinal effect as well. Some people use it as a spice on a daily basis and that is it not a drug – but when I have a cold and I use that same herb it suddenly becomes a drug? That’s the ridiculous stand put forward by FDA all the time.

  76. tmac57 says:

    kulkarniravi said-”it worked for me and that’s all there is to it. I am not going to wait until someone conducts tests that conclusively proves the case.”
    That pretty much sums up your lack of critical thinking.That is exactly the same thing that suckers people into using Homeopathy,Reiki,and distance healing,all of which have no plausible mechanism for working,and all of which have adherents that swear that “It works for me”.See ‘placebo effect’ and anecdote in your google results.Science is about unequivocal evidence.Wishful thinking is just another word for magic.

  77. kulkarniravi says:

    Weing,

    Even Allopathic drugs are not always safe and there have been issues even with US manufacturers. That does not invalidate all of allopathy.

  78. kulkarniravi,

    Potatoes contain proteins, carbohydrates, vitamins, minerals and glycoalkaloids. Green potatoes (and many traditional, high-altitude varieties) contain lots of glycoalkaloids. If you deliberately choose high-glycoalkaloid potatoes with the intention of giving yourself a headache, you are using potatoes as a drug.

    If you process potatoes and concentrate any of the components such that you can consume in pill form many times the amount you would ingest in a normal diet, you are using potato extract as a (potentially dangerous) drug.

    If you eat prunes to irritate your bowels, you are using prunes as a drug. If you process prunes to extract the dihydrophenylisatin so that you can consume 100 prunes’ worth in a single pill, you are using prunes as a source of a (potentially dangerous) drug.

    There is no hard line between food and drugs in chemical terms. There is a functional difference in that food is a relatively unprocessed plant or animal and there is a natural limit on how much you can consume. Licorice tea is a diuretic, but there’s a practical limit on how much licorice tea you can consume in a day.

    There are other practical limits. For instance, alkaloids are likely to be toxic and are also bitter, and we have evolved to reject bitter foods unless they form part of our diet from childhood. Bitter foods, likely to have a lot of drug in them, are not likely to form a large part of a freely-chosen diet.

    Because things we eat for food often contain drugs we are advised to eat a wide variety of foods. If there is something good for us in a particular food, the more different types of food we consume the more likely we are to get it. If there is something bad for us in a particular food, by diversifying our intake we are less likely to eat too much of it.

  79. kulkarniravi says:

    There are many reputed and proven manufacturers in India and their products are consumed regularly by a large number of people. Check out Himalaya Drugs for example.

  80. kulkarniravi says:

    Alison,

    In agreement with everything you say.

  81. kulkarniravi says:

    tmac57,

    What does critical thinking have to do with it? Modern medicine has no cure for PVC and I waited for three years. I took Co-Q10 and PVCs were gone, as at least some said they would. What do you expect me to do, nothing? No amount of critical thinking would have solved them for me.

  82. kulkarniravi says:

    Harriet,

    I have an interesting anecdote regarding backaches as well. For years I suffered from lower backaches. I went to a orthopedics doctor who gave me some cockamamie about one leg being longer than the others. He wanted me to go to some therapy. I then asked a friend (in India and he is also a orthopedics doctor) for a second opinion. He measured my legs and said they are within the normal variance for humans. Even he didn’t have a solution.

    Then I read somewhere that keeping your wallet in the back pocket could pinch a nerve and create backaches. And voila, I haven’t suffered from chronic backaches any more. I do get them occasionally, but I can live with those.

    Many of the supplements, including echinacea are fairly harmless if consumed in small quantities. So I don’t see what’s the hullabaloo all about – some people may find that they appear to work. Most headaches are not life threatening anyway.

  83. kulkarniravi says:

    The other side of SBM is that it will not accept that many of the synthetic additives (such as aspartame) could be dangerous to your health. Even if the risk is low, why bother taking such stuff as we are not deficient in aspartame or other additives anyway. Just because SBM/FDA say they are safe, doesn’t necessarily mean they are. Just remember what they said about tobacco.

  84. Scott says:

    Many of the supplements, including echinacea are fairly harmless if consumed in small quantities.

    To the extent that they’re “harmless” in the quantity consumed, they are also USELESS in the quantity consumed. They can only be harmless if they have no appreciable interesting biological effects.

    The wallet thing has nothing to do with pinched nerves, by the way. It’s got far more to do with the angle your pelvis is at.

    The other side of SBM is that it will not accept that many of the synthetic additives (such as aspartame) could be dangerous to your health.

    Aren’t you running out of straw yet? SBM certainly accepts that such can be dangerous, which is why testing is required.

    Just remember what they said about tobacco.

    The scientific consensus was that it was very dangerous. The tobacco companies which claimed otherwise were not given any scientific credence. Science worked.

    Indeed, tobacco’s an excellent analogy with CAM. The science says one thing very clearly. The people who make their living selling the stuff say something else.

  85. Kulkarniravi
    “I went to a orthopedics doctor who gave me some cockamamie about one leg being longer than the others. He wanted me to go to some therapy. [etc] I do get them occasionally, but I can live with those.

    I also suffered from lower backaches. My physical therapist determined one leg was longer than the another (very slight difference) that results in irritation of my SI joint. I went to the therapy recommended. The therapist and doctor gave me a set of exercises to do when my back acts up. I do them when I have pain or when I do activities that the doctor told me will aggravate the issue (pulling weeds, running, hiking) and they are very effective for preventing the pain. I seldom need to take anti-inflammatories for the issue (unless I forget my exercises) I never used a wallet, so I couldn’t blame it on that.

    All that just using conventional medical care.

  86. Josie says:

    Kula:

    It’s now buried in the comments above but i am surprised no one else hit on this:

    “Any research in drugs should be conducted as a long term investment rather than to advance shareholder value. There should be total transparency in the entire process and no patents should ever be awarded for drugs.”

    That’s what an investment is….risk to receive a greater reward, eg increased share value.

    You don’t think people should make money for their investments in successful goods and services? Or be able to protect that value through patents?

    As part of the BioTech industry working for a company still relying on venture capital I have to wrinkle my nose at you. Our investors have allowed us to make great strides in a stem cell therapy for diabetes. Why shouldn’t those folks make a little of their money back plus profit? Why shouldn’t I have a little cash every two weeks for my part of the work?

    Without long term investment there is no return -no drugs, no therapies, no help for those afflicted with disease.

  87. kulkarniravi says:

    Josie,

    My point is that healthcare is not optional for anyone. You can live without a car or a television. You can’t survive long term without access to healthcare. When the whole focus of research into healthcare is shareholder value, that focus is not always in alignment with the good of the humanity. I don’t believe in the argument that without a serious profit motive there can’t be innovation. Just look at the (computer software) open source community. Most people who contribute to it don’t derive a dime out of it. As a society we have to make a choice about what is really important for us. We have given up many freedoms to become civilized and I believe research into medicines and procedures should be above making profits.

    There is a lot of historical evidence that many herbs work just fine for many common ailments. And yet, most research dollars go towards finding patentable drugs. There is not a lot of evidence that guggulu (for example) works, not because it doesn’t work, but because no one is interested in developing it. You can’t obtain patents on herbs. True scientific research should be done without regard to profits. Otherwise it tends to become profit oriented rather than truth oriented. A good analogy is searching for a lost ring under the street lamp because there is light, not where you lost it.

  88. Harriet Hall says:

    @Scott,

    The wallet thing actually does have something to do with pinched nerves. It puts pressure on the sciatic nerve where you sit, causing the “wallet syndrome” similar to the piriformis syndrome. It causes pain radiating from the compression site down into the leg but not pain in the back above. See
    http://en.wikipedia.org/wiki/Piriformis_syndrome

  89. kulkarniravi,

    It’s nice to think that people who provide healthcare don’t need to eat, but they do.

    Your doctor gets paid. When you need medication with a defined risk and benefit, it gets paid for. Your Co-Q10 is free though, I guess, as is echinacea and Ayurvedic medicine. I presume that Ayurvedic practitioners are all volunteer as well.

  90. kulkarniravi,

    Since you agree that “supplements” are drugs — as is anything that is concentrated and taken in pill form — and you don’t believe in regulation for “supplements,” then I guess you don’t believe in regulation or testing or any kind of reasearch on drugs, period?

    Your “no research because no patent” argument is simply not true. There’s lots of research on things like antioxidant vitamin supplementation for cancer and heart disease. It’s also the reason NCCAM was created. It funds lots of things.

  91. Scott says:

    @ Harriet:

    Interesting. That’s not how it was explained to me the second time (the first time was by a chiropractor who claimed it caused subluxations, but we all know THAT doesn’t mean anything). But it does make sense. I’ll take a look – thanks for the link.

  92. Harriet Hall says:

    We are not making much progress with kulkarniravi. His attitude seems to be “I don’t need no stinkin’ science. I know when I feel better and I don’t care to find out why. My mind’s made up; don’t confuse me with skepticism and facts.”

    He seems not to have understood my examples of false attribution, because he counters with the anecdote about his wallet. If he had sciatica caused by a wallet, that would be a true attribution, one discovered by science-based doctors. But if it was the wallet that caused the pain, why is the pain still continuing to occur occasionally? Isn’t that more consistent with a back pain with a non-wallet etiology that is unpredictably fluctuating over time as most of these things do?

  93. kulkarniravi says:

    Allison,

    I was only referring to the drug research and approval process. Not to the entire healthcare industry.

  94. nybgrus says:

    Kul: Herbs cannot be patented? You can’t make money from their formulation? Medicine and drugs are under the rule of Lord Draconis of BigPharma? Really? Care to explain why supplements and herbals are a multi BILLION dollar industry in the US alone? Oh, right, because they have almost no oversight, you can take anything and call it an “herb” or “natural” and sell it for whatever the market will bear and have no need for costly trials to prove it works.

    Pharmaceutical companies aren’t interested in herbs and natural cures? Of course they are. Look up pharmacognosy. You claim that most natural things would be just as good and safer to use for some conditions. Ha! Let me ask you a question – would you eat a lobster, a slice of swordfish steak, and a seaweed salad? I would. Now, would you eat everything in 1 cubic kilometer of ocean water? No? But I’m sure there is a lobster, swordfish, and some seaweed in there! Oh right… there is all that other stuff too. So, would you take a statin, which is pure, precisely dosed, well studied in large populations at those doses and for that specfic compound or would you take red yeast rice? Well, red yeast rice has been shown to be effective. It certainly does lower your cholesterol. And it is natural. Why wouldn’t you take that instead of a statin? Well, it works because the yeast secrete a compound that is chemically in the same class as a statin! Yep. The whole reason that “natural” stuff works at all, is because you are taking essentially the same drug that doctors are trying to prescribe. The difference is you don’t know the potency, efficacy, or side effect profile of that specific statin. Nor do you know exactly how much is in a 600mg capsule of red yeast rice. Nor do you know what else is in the “natural” supplement. Is it cheaper? For now, sure. Is it worth it? Not in my book.

    You argue that drug companies should be non-profit, that money should be spent to further the goals of medicine in actually helping people, etc. Well, duh! I think you will find that most people here actually agree with that sentiment. I certainly do. In an ideal utopia, we could take all that money we spend on defense and war and put it towards health and research. But this is not an ideal world and the changes you propose require a massive restructuring of priorities and is simply not realistic. You are getting heat here because you are simply spouting off pie-in-the-sky sentiment and trying to claim that “natural” cures will fix the problem. We echo your sentiment, but are cognizant of the practical limitations. And we also don’t fall for the natural fallacy.

    And lastly, we also don’t fall for anecdote. You keep insisting that since modern medicine couldn’t “cure” your PVCs and that Co-Q10 happened to “cure” them that it is perfectly reasonable that “it works for you.” And then you get offended when we chime in and say you lack critical thinking. We, as science based practictioners, cannot endorse something we have no good reason to suspect actually works. The fact that it “worked for you” means very, very little. Even if it did actually work for you and cured your PVCs it still means nothing. Because having you be the one exception is not a position we can endorse. When systematically we find that, in general, something doesn not work, it is our ethical duty to say so. Even if it is relatively harmless, as you say, it is still a waste of money. And that is exactly the point – we are not trying to prohibit you from the possibility of taking Co-Q10 or any other supplement. We are simply saying that we don’t think it would work and would advise against it. And we don’t need a specific study on Co-Q10 to be able to give such advice. In medical school you learn mechanisms or drugs, physiology, biochemistry, etc and lacking studies you can use that knowledge to assign a probability of something working. That’s called “expert opinion.” What we do want to see is more regulation of these supplements so they are actually safer, and less wild claims about what they may or may not do. The latter is a marketing ploy and it always amazes me that people will rail against “BigPharma” and the money it makes and then happily go pay 20 cents a pill for Vitamin C and take it willy nilly thinking it will help their colds (it won’t)without stopping to think that instead of lining “BigPharma’s” pockets they are lining “BigSuppla’s.” But when we use science to tell you it won’t work, then we are Pharma Schills trying to watch our bottom line. Or maybe, we are just science based and telling you that it doesn’t work so save your money. Or it isn’t safe simply because it is natural, so spend your money on safer better stuff.

  95. kulkarniravi says:

    Allison,

    “Your “no research because no patent” argument is simply not true. ”

    Right, but what % of the healthcare expenditure. See below and do your own math.

    National Center for Complementary and Alternative Medicine

    FY 2010: $128.8 million
    FY 2009: $125.5 million
    FY 2008: $121.5 million
    FY 2007: $121.6 million
    FY 2006: $122.7 million
    FY 2005: $123.1 million
    FY 2004: $117.7 million
    FY 2003: $114.1 million
    FY 2002: $104.6 million
    FY 2001: $89.2 million
    FY 2000: $68.7 million
    FY 1999: $50.0 million

    http://nccam.nih.gov/about/budget/appropriations.htm

  96. tmac57 says:

    So, for all that money that NCCAM has received, what benefit has the U.S. tax payer gotten so far? (crickets chirping)

  97. kulkarniravi says:

    Nybgrus,

    No offense taken whatsoever. In fact I am saying pretty much what you are saying with some differences. I am not asking doctors to endorse any herbs or supplements. I am not against regulation either, but people should be free to take these supplements. I am also saying that healthcare professionals don’t understand about human as much as you say they do. It may be a lot more than a layman like me, but they can’t definitively say that a particular supplement works or doesn’t for everyone. Nor can they say the same about the medicine either.

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