Angry Doctor

Wednesday, May 31, 2006

Medicine And The 'Dilute-Down' Myth

This article on the International Herald Tribune was published in Today yesterday, with the title of "Business And The 'Trickle-Down' Myth".

It should come as no surprise to you that angry doc liked the pro-labour, anti-globalisation stance of the article. However, that is not the point of this post.

The point I want to make is about alternative medicine.

I was actually planning a post on homeopathy, after Blinkymummy asked me about this mode of therapy. I looked up several sites, dug up the
2005 Lancet article which discredited homeopathy, and the rebuttal from the National Centre of Homeopathy.

Enough material to make a point, I thought.

But the more I thought about it, the more I realised it didn't really matter how much background material I had, or what authority they came from.

The two sides cannot hope to convince each other or convert each other's adherents, because the very bases of their disciplines are not the same.

How can you have a productive debate when you cannot even agree on how a therapy is to be tested?

How can you discuss what is real, when you do not have the same interpretation of 'reality'?

I found it impossible to write an argument that will convince a reader what was 'right' or 'wrong'.

You see, how you decide which side is 'right' will depend on whose paradigm you buy into, and that in turn will probably be decided by what you have already decided about the two modes of therapy, which will in turn probably be determined by your personal experiences with these two modes of therapy.

In other words, one probably decides which way of looking at the world is valid based on subjective experiences, and the outcomes one hopes will realise.

Which pretty much describes angry doc reading the William Pfaff article, really.


He agrees with the author's description of the modern globalised economy, the effects it has on the workforce and populace of the 'home' country, the eventuality of the foreign labour force being dumped when they have out-lived their usefulness, and the prediction that this whole system is not sustainable.

All that is not based on having studied Economics at 'A' Levels or reading The Business Times daily, or on concepts and theories of economics like comparative advantage or 'the invisible hand', but his observations on the economic conditions of his patients, both locals and foreigners, and his limited travels around the region.

Now if you are a supporter of globalisation, you may think that the article is too simplistic and full of inaccuracies, and the author lacks an understanding of how the economy really works, and that angry doc is just choosing to see one side of the story and indulging in wishful thinking.

Some of you may agree with the author, like angry doc does.

Nevertheless, we all live in the same global economy. We all have physical bodies. We all live in the same reality.

We can't both be right now, can we?

Or are we both wrong?

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9 Comments:

  • Ah! So in some way I hope you understand why I said it was going to be highly unlikely that TCM was going to be "proven" or translated into the same language. Different paradigms.

    It's not based on the one that built the computer :wink:

    Whether it's right or not is difficult because it's just a different language, culture, country, race, and paradigm.

    But I can see the problem with Homeopathy as well.

    Personally I think the "idea" is plausible, but the "energy medicine" based on like cure like diluted to several million parts retaining the "energy signature" that heals....well I think TCM has a much better and more refined philosophy similar to that.

    I'd go with TCM more than Homeopathy on this "paradigm"

    But that's just me. No offence to Homeopathy practitioners.

    At the end of the day, whatever works for the patient, but we have to acknowledge it aint easy to practice so many different schools of alternative medicine and be good at it. We have to choose a few.

    By Blogger Dr Oz bloke, At May 31, 2006 9:37 pm  

  • Just because something has its own paradigm doesn't mean it is true or right.

    By Blogger angry doc, At May 31, 2006 10:09 pm  

  • knowing how things work and for the paradigm to work are two different things. The explanation for the 'paradigm' might be wrong but a cure is a cure.

    I can drive a car without knowing how the engine works.

    The problem with alternative medicine is consistency. Without a proper theoretic framework to explain things in biological sense it is difficult to reproduce things consistently. Using abstract terms can be difficult to understand.

    Just like homeopathy. If they can find an energy pattern or show some pattern with mass spectrometer or something, people probably be more convince. Usining these patterns then to treat dieseases. Still a long way to go but at least people don't have to go by faith! :) To me I feel like I am drink water. Even cynide present in this amount is probably harmless! hahaha.

    Of course if you believe in ghost and spirits then alternative medicine might sometimes target the spiritual body and not the physical to bring about healing. Now we don't know much about the spiritual body and probably cannot come out with something to explain what we don't really know. :)

    I don't know much about TCM or alternative medicine but the lack of explanation does change the fact that it can work. Of course a deeper understanding in biological terms as oppose to abstract ideas improves the way the technique is applied. Imagine if we understand the secret of meridians and all that in biological terms. It is definitely useful to constantly dissect alternative medicine with modern science. Just need to find people who are trained and are willing to do that. Some are just contented with driving the car while others wants to know how it actually works. A simple latent energy from fossil fuel is transformed into mechanical engery in the car don't satisfy or contribute to newer and better cars. :)

    By Anonymous Anonymous, At June 01, 2006 9:29 am  

  • Quote:'How can you discuss what is real, when you do not have the same interpretation of 'reality'?'
    exactly, that's why I feel the two systems of medicine will never be reconciled. the few 'alternative' therapies that have been accepted into mainstream medicine are those which have been 'proven' thru evidence-based medicine. those about 'heat' and 'wind', how to assess?

    By Blogger huajern, At June 01, 2006 12:46 pm  

  • Homeopathy? Let's just say a 200 year old discipline has 200 year old outcomes.

    Actually we all agree on the outcomes. Survival, relief of disease, quality of life etc.

    Complementary/alternative medicines do OK with QOL in the clinic, but with regards to survival/curing disease, the results aren't quite so good. This is consistent with my clinical experience. I daresay 60-70% of my patients are taking some sort of complementary treatment.

    Quite honestly, in my line, TCM doesn't work well as a treatment by itself. Unfortunately, that's not how our locals see it. So the lots of patients initially consult me, decide to progress through TCM before showing up at my clinic after a few months' hiatus when their disease has worsened deciding that Western medicine perhaps has something to it after all.

    So while I don't disagree that there is some good e.g. artemesin for malaria, even from a scientific perspective, artemisin was used for 2000 years as a relief from fever. The peripheral blood film for malaria however was developed by Western practitioners, so the clinical benefit was still highly influenced by the developments of "Western medicine", long before data dredging/subgroup analysis.

    So unfortunately, I don't think there's room for more than one paradigm. And rightly so.

    By Anonymous Anonymous, At June 03, 2006 2:31 pm  

  • Dear Anon,

    Just something to ponder about.

    What about the ones who took alternative or TCM and recovered and DID NOT see you?

    In some way your perspective might be skewed because you only see the failed cases? Or are you saying that there are no TCM/alternative successful cases at all out there? Or that those cases treated by TCM/alternative are all "psychosomatic"?

    You do sound like a specialist of some sort. Personally I do not think that western medical specialists would have much use for alternative medicine.

    The ones who might use it more often would be the primary care physicians. Especially when they see patients who are clearly not well but there is no nice diagnosis to put on them.

    There has been a big increase in the number of "functional diseases" in the various disciplines.

    Ask yourself why.

    By Blogger Dr Oz bloke, At June 05, 2006 10:08 am  

  • 'Especially when they see patients who are clearly not well but there is no nice diagnosis to put on them.'
    I know this sounds paternalistic, but could it be they truly have nothing wrong with them? Or could it be just us medicalizing aging? As we grow older, backs ache, effort tolerance declines, memory deteriorates, bowel movements slow down etc. Are these symptoms just part of aging or are they diseases?
    since you are a allopathic doctor interested in TCM, maybe you can do a small trial for something simple, like 'tiredness'. 3 arms: placebo, multivitamins, herbal concoction. see which comes out better after a month. i'll bet on the placebo. :)

    By Anonymous huajern, At June 05, 2006 10:58 am  

  • Well MOH has recognized TCM. There is a registration body for TCM.

    Like it or not, it's legitimized.

    At the end of the day, everyone is entitled to their own opinions.

    As my friend says "As long as it works"

    So what if it's the placebo? It worked!

    For all you know, a lot of our medicines work as "placebos" too!

    I remember reading a trial which found that between patients taking a lump of sugar and loratidine, the difference was not statistically significant.

    Whatever works. But there are cases where patients have had distinct problems. (Not aging symptoms and not old patients) and they recovered after taking alternative medicine, or western medicine applied via alternative principles....

    I remember one of the senior doctors in my group saying that in Singapore, we western doctors are very closed minded. Strangely we live in a society that is open and culturally accepts TCM for instance, yet we condemn it.

    Trials are certainly a way to go. But why pass judgement even before the trial begins?

    By Blogger Dr Oz bloke, At June 05, 2006 2:53 pm  

  • 'Whatever works' may be all that matters to the patients, but the medical profession would also like to know why it works and how it works.

    The problem is when one equates the effectiveness of one type of treatment with the effectiveness of the whole discipline of medicine.

    Of course, the reverse can also happen, which is why I believe we should subject all forms of treatment to the same test, which is the thinking behind Evidence-based Medicine.

    By Blogger angry doc, At June 10, 2006 6:41 pm  

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