Angry Doctor

Tuesday, February 13, 2007

Quackbuster: Singapore 4

The passage of the Health Products Bill is reported in Today today (emphasis mine).


Health Products Bill passed, with room to grow

AS PARLIAMENT yesterday passed the Health Products Bill, some members on the Government Parliamentary Committee (GPC) for Health called for health supplements and foodstuff to come under the new law, which will initially govern medical devices such as stents and pacemakers.

Madam Halimah Yacob, who heads the GPC for health, questioned the exclusion of food products from the Bill — a view echoed by Dr Fatimah Lateef, MP for Marine Parade GRC. Dr Fatimah noted that ginseng drinks, for example, claimed "to lower blood pressure", while Mdm Halimah said milk formulas also made health claims.

Responding, Health Minister Khaw Boon Wan said the Sale of Food Act, administered by the Agri-Food and Veterinary Authority (AVA), already included restrictions and requirements on food product claims.

He added that the Health Sciences Authority (HSA) works with the AVA on products that fall into the grey area between medicines and food.

There were also calls from some GPC members to hasten the regulation of health supplements. Mr Sam Tan, MP for Tanjong Pagar GRC, suggested more public education campaigns for consumers.

Mr Khaw said a decision on whether health supplements would be included under the Act has not been made.

Acknowledging their regulation to be a complex one, he said: "We should carefully discuss the pros and cons and, in particular, study the experience in other countries. It is not a straightforward subject."

Dr Lam Pin Min, MP for Ang Mo Kio GRC, and Dr Fatimah asked for greater emphasis on post-market surveillance, for robust regulation.

Yet, over-regulation was also a concern, said Mdm Halimah, as prohibitive fees and complex registration processes would act as a disincentive for small businesses and start-up initiatives.

Agreeing, Mr Khaw gave the assurance that a balance would be struck between consumer protection and business viability.

Beyond these concerns, GPC members welcomed the legislation, calling it timely and necessary.

The new Bill aims to consolidate, over time, all four separate pieces of legislation that currently govern medicines in Singapore — namely the Medicines Act, the Poisons Act, the Sale of Drugs Act and the Medicines (Advertisement and Sale) Act — under one framework.

The HSA is seeking public feedback on the Health Products Bill (Medical Devices) until April 3. Email hsa_feedback@hsa.gov.sg with your comments.


Does ginseng lower blood pressure? Well, it has been found to lower blood pressure in several studies angry doc looked up, but not in any meaningful manner on the long-term, according to the findings from this study. It's a small study with a high drop-out rate, and so by no means 'landmark' or conclusive, but I thought it was a well-designed study with attention to blinding. Had the study been larger and had the results shown a significant improvement in blood pressure in the subjects taking ginseng, it would certainly make the medical profession sit up and pay attention. But as it is, even some segments of the alternative and complementary medicine community don't think ginseng will help reduce your risk of getting a stroke or heart attack.

Perhaps this is the kind of study proponents of traditional medicine should be conducting instead of arguing that traditional medicine should be exempt from scientific studies and free to make unproven claims of health benefits.

In the mean time, angry doc finds few allies in his battle against health supplements of unproven efficacy even amongst his blogging-friends.

Labels: ,

25 Comments:

  • Release your anger and join the dark side !

    By Blogger DrFrappucino, At February 13, 2007 10:26 pm  

  • Never. I'll never turn to the Dark Side. You've failed, your highness. I am a Jedi, like my father before me.

    By Blogger angry doc, At February 14, 2007 9:15 pm  

  • Dear angry doc, I have written to you many times on the issue of TCM and alternative medicine. Talks about how for example diagnosis of TCM varies and thus treatment combinations vary thus making a double blinded randomized control trial difficult (hypertension in TCM might be due to different zangfu problems or Yin/Yang balances although to western medicine it is just an elevation of BP)

    In the same way, what are you so worried as far as these therapies are concerned? Do they cause harm?

    I think the authorities should look into the safety of supplements and also put disclaimers on the claims made.

    But the jury is still out on some of these treatments. It works for some it doesn't for some. Just like western medicine.

    Perhaps you do not see patients who are on such treatments. But if you do follow them up and see the improvement....well even if it just a placebo effect or whatever....it has still benefitted the patients. Seriously I doubt it is as simple as just a placebo effect.

    Whatever works as long as it causes no harm.

    By Blogger Dr Oz bloke, At February 15, 2007 2:51 pm  

  • Proponents of alternative medicine like to say that their system cannot or should not be subject to normal testing. But if it cannot be tested, how do you know it works?

    The fact is, if there is a system, it can be tested. If it works, it can be proven to work.

    We can for example take a population of patients with hypertension and let them be treated by TCM physicians, but randomise them into those who receive the treatment prescribed by the physician and a placebo, and blind both physician and patient to what the patient is given, then monitor the outcome.

    The same principle can be applied to acupuncture and homeopathy.

    Unproven therapy can do harm in several ways.

    They cost money to the patient for no proven benefit.

    They may delay the patient from seeking treatment which are proven.

    They promote a system of therapy that is not based on science, and allow other non-scientific, unproven, and potentially harmful therapies to hide under its banner.

    The blind acceptance of 'tradition' promotes complacency, while the scientific method promotes and allows new discoveries and developement.

    Morally, it is dishonest.

    I do see patients who are on TCM. Some do well, some do not. But I know you cannot just go by anecdotes since there can be many confounding factors to why some do well and some do not. That is why we need testing. That is why we need matched randomisation, placebo, and blinding.

    By Blogger angry doc, At February 15, 2007 4:55 pm  

  • "We can for example take a population of patients with hypertension and let them be treated by TCM physicians, but randomise them into those who receive the treatment prescribed by the physician and a placebo, and blind both physician and patient to what the patient is given, then monitor the outcome."

    I don't think any first world country's Bioethics committee would ever approve such a study design.

    Don't you think so? Medico-legal implications.

    Maybe you should look at it this way. Why aren't there such studies to completely show that alternative therapies don't work? No funding perhaps?

    Like you, I also don't agree that patients should delay the patient from seeking treatment which are proven ,but I won't object to patients who want to take both treatments. (as I am sure you practise the same way since you say you see patients taking TCM as well)

    Morally? Well the world is not as black and white. Even in western medicine is everything morally honest? Let's be honest with ourselves here.

    OSIM is today a huge company. What do they sell?

    Eu Yan Sang is growing.

    Morally dishonest? Well they are businesses. As are Pfizer, GSK, Roche etc.

    Let's not talk too much about morals shall we?

    We're doctors. Let the businessmen do the talking.

    If you talk about research, it works both ways. Nobody wants to do the research on alternative medicine for various reasons. But there is a demand for it.

    Well perhaps you subscribe to the philosophy that people in general are stupid and wouldn't be able to tell a scam when they see it.

    Well if that's the case.....:D

    By Anonymous Anonymous, At February 15, 2007 8:16 pm  

  • Same old flawed arguments.

    "I don't think any first world country's Bioethics committee would ever approve such a study design."

    Double-blind, placebo-controlled trials take place all the time, so there's no reason why one cannot apply the same to alternative medicine using inert placebos. Patients are monitored, and the trial can be stopped if a dangerous trend is observed in either group.

    "Why aren't there such studies to completely show that alternative therapies don't work? No funding perhaps?"

    "Nobody wants to do the research on alternative medicine for various reasons."

    Just because no one has proved something doesn't work does not mean it works. The burden of proof is on those who claim alternative therapies work.

    Proponents of alternative therapies do conduct studies and publish them (and I have discussed several of them on this blog); they provide most of the evidence that there is no evidence that alternative medicine work.

    "Even in western medicine is everything morally honest?"

    Western medicine is not all moral and honest, but that is not the issue here. I rail against some practices in western medicine too, but this entry is not about them.

    That western medicine is not all honest does not change the fact that the scientific method is basically sound, and that most alternative therapies are not scientifically-based or have a basis that can be tested.

    Try not to confuse the issues here.

    "But there is a demand for it."

    That there is a demand for a service or commodity is no proof of its efficacy.

    By Blogger angry doc, At February 15, 2007 9:25 pm  

  • Proof of efficacy.

    Maybe the patients that I speak to are different from yours.

    But they don't care about that.

    Anyway, my point is not that I think alternative medicine works or does not work. The fact is we don't know. The onus IS on the practitioners of alternative therapy to prove that it works. However you should know the challenges they face.

    However, for western doctors to start campaigns to tell people that it does not work despite not having actual evidence to absolutely prove beyond doubt that it doesn't work....well what's the difference?

    In the end it is becoming more of a battle of faiths than anything else.

    And like it or not, alternative medicine won't be going away despite this.

    I've asked you many times. How much do you know about alternative medicine? Have you studied it formally? Why not give that a try and then see how you can do a study to prove that it doesn't work.

    I'm sure you'll say the same things. It's a bit like the conflict between certain religions but of course not so violent. Thank goodness! :)

    Actually I have personally stopped talking to patients about alternative medicine because the expectations from the patients of a western doctor are not to talk about these things. Put it this way, they expect western doctors to malign TCM and alternative medicine, say that it has not evidence that it works etc. By doing that without having any in depth knowledge about alternative medicine we are merely playing into their hands.

    To fight the enemy, you have to know the enemy. Frankly, your blog entries that condemn TCM for example would be far more convincing if you had proper knowledge of TCM. Critque it proper rather than just write seemingly fanboy angst.

    By Anonymous Anonymous, At February 16, 2007 9:31 am  

  • Hi angry doc,

    Just curious have you spoken to any TCM physicians about the use of Ginseng? From what I understand, Ginseng isn't used primarily for the treatment of hypertension.

    I did learn in my lectures that ginseng has a hypoglycemic effect. But Ginseng is primarily used more for its effects on cognitive function. I think there are quite a number of studies on this. But again sample sizes were small.

    I agree with anon that it is largely a case of faith at the moment.

    From what I gather at my TCM lectures, treatment of conditions is very varied. Of course this lends to the whole unscientific method argument and I agree it really isn't scientific at all.

    Would it help if TCM practitioners said that their treatments were not scientifically proven and that if you let them treat you it is at your own risk?

    Seems to me angry doc is more for the outright ban and crucifiction of all alternative medicine on the face of the earth? LOL!

    Cheers! Happy Chinese New Year to all! Gong Xi Fa Cai!

    By Blogger Dr Oz bloke, At February 16, 2007 10:08 am  

  • "Proof of efficacy.Maybe the patients that I speak to are different from yours.But they don't care about that."

    The patients may not care, but healthcare professionals who base their practice on science and evidence should.

    "Anyway, my point is not that I think alternative medicine works or does not work. The fact is we don't know."

    Do you believe there is a way of knowing? If so, why don't we know? If not, how do you know it works?

    "The onus IS on the practitioners of alternative therapy to prove that it works. However you should know the challenges they face."

    I know the excuses they make for not producing evidence. I also know they do produce studies, many of which we have discussed on this blog.

    "However, for western doctors to start campaigns to tell people that it does not work despite not having actual evidence to absolutely prove beyond doubt that it doesn't work....well what's the
    difference?"

    There are studies that show no evidence of efficacy for various forms of alternative therapies.

    "In the end it is becoming more of a battle of faiths than anything else."

    No it is not. Faith is believeing in something despite a lack of evidence. Science is based on evidence. Trying to confuse the two to discredit science and elevate unproven therapies is also a common tactic used by proponents of alternative medicine.

    "I've asked you many times. How much do you know about alternative medicine? Have you studied it formally? Why not give that a
    try and then see how you can do a study to prove that it doesn't
    work."

    Why does one have to study a particular discipline to know whether it works or not? One does not have to study electronics to know whether a radio works, but one knows a radio works because one can hear a radio.

    "I'm sure you'll say the same things."

    I will say the same thing because you utilise the same old flawed arguments. Do have a look at my Laksa entry.

    "It's a bit like the conflict between certain religions but of course not so violent."

    It is not. In religion one cannot prove which one is true in this life. In medicine one can prove efficacy of treatment. Again you try to confuse the issue and equate science and unproven therapies.

    "Frankly, your blog entries that condemn TCM for example would be far more convincing if you had proper knowledge of TCM. Critque it proper rather than just write seemingly fanboy angst."

    Ad hominem attack. I shall return the favour: Frankly your rabid defence of unproven therapies would be far more convincing if you had proper knowledge of logic and the scientific method. Defend them logically rather than just write seemingly fanboy raves.

    See how that contributes nothing to the discussion? Let's refrain from personal attacks in the future, shall we?

    By Blogger angry doc, At February 16, 2007 10:11 am  

  • "Seems to me angry doc is more for the outright ban and crucifiction of all alternative medicine on the face of the earth?"

    Am I that obvious? :)

    Actually, no. Frankly I am sure there are a lot of good stuff hidden in TCM. The question is finding out the good stuff and separating them from the useless stuff. Science is the way to do it, but as you can see proponents of alternative medicine are often reluctant to apply science to their practice.

    I believe the underlying reason is that they fear that the theories which they have based their whole practice on ('qi', 'like cures like', 'chakras', etc.) will be shown to have no relation to the actual mechanics of how their therapies work, and everything else will fall down like a house of cards.

    It happened to western medicine with its theories of humours, and I am not sure we are worse off after that.

    If there is a way to examine therapies and find out how they work, thus allowing you to separate the wheat from the chaff, why shouldn't we use it?

    By Blogger angry doc, At February 16, 2007 10:36 am  

  • Hi angry doc,

    Actually the Chinese in China have tried to conduct studies on chinese herbs as you mentioned. However the results all turned out poorly. I learned this from my lecturer.

    Apparently there is a problem in applying a certain herb for a certain condition because that is not how patients are treated in TCM. There is great variability in the choice and combination of herbs. The one size fits all model apparently is very poorly applied to TCM principles of treatment.

    Ironically the western doctors in USA are conducting studies that have complicated study designs. Where they would group patients according to the syndromes that they are diagnosed with and then within that sub group randomize and seperate them into study and control groups etc etc. But invariably that limits the study sample sizes. Very complicated. I haven't heard how the studies are like for those sort of studies.

    I did come across a SHARP study on use of acupuncture for hypertension in the Journal Hypertension.
    http://hyper.ahajournals.org/cgi/
    content/abstract/48/5/838

    I think that's the sort of study that you might be referring to angry doc? Something that proves without a doubt? But is the sample size of 192 patients big enough? I can't access the full text and the subsequent discussions, hope you can share with us if you do happen to be able to access it.

    As it is my TCM lecturer said that acupuncture was generally not used to treat hypertension anyway.

    So far my TCM lecturers sound rational. They do advise against using TCM to treat many conditions. They do however recommend TCM for various other conditions. It could be a case that TCM works in some cases and doesn't in other cases.

    Acupuncture for pain management is definitely proven. So it's not all that bad neither is it some miracle.

    What I found surprising is that again it is the west that is developing the research designs that prove or disprove TCM rather than the chinese themselves.

    By Blogger Dr Oz bloke, At February 16, 2007 11:23 am  

  • I can't get SHARP either, but the abstract reveals an interesting point about acupuncture.

    You mentioned that acupuncture is proven for pain-relief, but the fact is that it is not.

    What the studies show is that poking the skin with needles relief pain for patients above placebo, but they also show that there is no difference between 'real' acupuncture and 'fake' acupunture, where the needles are inserted into points which are not associated with a meridien point.

    This suggests that poking the skin with needles does cause pain relief through some function (physiological or psychological), and it also suggests that the theory of qi and meridien is wrong.

    By Blogger angry doc, At February 16, 2007 11:57 am  

  • The thing about meridians is that it is rather complicated.

    Meridians are not just points. They are pathways. The acupoints are points where the Qi is supposedly pooled in greater abundance. So it is advisable to poke in that point. How big is a point? 1cm? 5cm? All good questions that no one has a good answer.

    I'm still learning. Dr Yeo Sow Nam would be a giving us a lecture in the last module coming up about acupuncture and pain management. Maybe I can share more then.

    What is it exactly that you want angry doc? What kind of proof are you seeking? As you said, if you hear the music from the radio, the radio works.

    Needle goes in, pain relieved above placebo level.

    Research into HOW it works is another matter of course. But at least the first step is there.

    Reminds me of the patient who told me she has a discomfort in the right loin. And I asked her is it a pain? Is it a distension? And she said no but I can't describe it. And then she asked me why like that ar?

    Err you want me to explain a reason why your right loin is feeling what?

    I would like to ask you an honest question angry doc, and I hope you can answer honestly.

    Do you really frankly think that there is some good stuff in TCM at all? Seems to me you think more that TCM is all bull.

    From my perspective, I think the explanations of how TCM works via all those Yin Yang, Qi, etc theories are totally voodoo cos they were formulated at a time when scientific thoughts did not exist. They are all philosophical theories and have not developd from there. So yes if you try to EXPLAIN why acupuncture relieves pain by talking about Yin Yang and Qi flow in meridians...well that's really absurd in terms of talking scientifically.

    But let's go step by step. We first identify what works then we find out how it works then we might better understand how we can link other therapies and whether the philosophies can then be explained scientifically. Otherwise where do we start?

    Unless you are just out to design studies to prove how it doesn't work. That's easy lah.

    Who knows, maybe chinese herbs are pharmaceutical agents. And acupuncture is merely manipulation of gate theories of analgesia? Nothing TCM about it.

    Actually alternative medicine is a very BROAD term. Would angry doc consider nutritional therapies as alternative therapy?

    I am pretty big on nutrition myself but only for personal use and for family and friends. Patients in Singapore aren't ready for these things just yet.

    But at least the US is helping to make some of these nutritional supplements packaged into drugs. Makes it easier for me to prescrive in future.

    OMACOR and LIPITOR anyone? LOL!

    By Blogger Dr Oz bloke, At February 16, 2007 12:27 pm  

  • Here's an article on SHARP on Medscape:

    http://www.medscape.com/viewarticle/547428

    "As you said, if you hear the music from the radio, the radio works."

    Yes, but the other part here is the reason and theory behind why the radio works. Qi and meridien and acu points are used as the theory and reason behind why acupunctture works, but the evidence repeatedly shows that where 'acupuncture' works, it works even if the needles are not inserted into known acupoints. Does this not suggest that the theory behind acupuncture is inadequate?

    "Do you really frankly think that there is some good stuff in TCM at all?"

    Undoubtedly. Certainly poking the skin with needle offers pain relief for people who do not get sufficient pain relief from other modalities of treatment. Herbs used in TCM have been show to have active ingredients which may be used clinically some day. Studies are going on every day and new information is being churned out.

    What I am against is not the 'contents' of TCM, but the unscientific reasoning behind TCM and other forms of alternative medicine.

    By Blogger angry doc, At February 16, 2007 12:45 pm  

  • "What I am against is not the 'contents' of TCM, but the unscientific reasoning behind TCM and other forms of alternative medicine."

    I guess that's a bit unfair but I can understand your rationale. I too don't buy the whole oh the Liver is a wood element and that is why it control the earth element organs eg the Spleen....totally no science there.

    But unfair in the sense that we might want to look at TCM as we would have looked at western medicine in the early years of modern man. It takes time for the science part to develop. Possibly hundreds if not thousands of years.

    But for the moment, the only way we can move foward to unravel the truths and fallicies of TCM is to work together (ie western modern scientists with TCM practitioners).

    And that means being able to speak each other's language. ie TCM practitioners learn modern scientific methods and western scientists learn about TCM princples (think of it as a philosophy rather than a science).

    I would agree with you that the theory behind TCM is totally unscientific at all. It is pure philosophy.

    But you have to understand during 500 BC people understood little by way of science. So liver has something to do with spleen has something to do with blood etc....that's already quite a good start, but to explain why....they used philosophy. I guess the chinese could have gone the way of magic and spirits, but at least they didn't.

    Slowly lah. But cut some slack also.

    I do think that we should not allow alternative medicine practitioners to say that their therapies are scientitifcally proven when they are not.

    Call it as it is.

    By Blogger Dr Oz bloke, At February 16, 2007 2:17 pm  

  • Fair enough.

    Do ask Sow Nam what he makes of the studies which show that fake acupuncture offers pain relief for me please.

    By Blogger angry doc, At February 16, 2007 2:27 pm  

  • ok I will take note of that and ask him. I think that lecture is scheduled around April I think.

    This seems to be an area of growing interest in terms of medical research. I don't recall seeing that many journal articles on alternative medicine till rather recently.

    Maybe it's a way to get us thinking out of the box and creatively to find new directions?

    Only time will tell.

    By Blogger Dr Oz bloke, At February 16, 2007 2:41 pm  

  • Indeed. There are more organisations doing research in alternative medicine and alternative medicine is being introduced into the curriculum of some medical schools in America. Dr RW discusses this in his blog often:

    http://doctorrw.blogspot.com/

    My personal feel is that most of the research is done with a "Let's prove it works!" attitude rather than a "Let's see if it works, and if so how and why" attitude.

    All this is against the backdrop of an increase in consumer demand for alternative medicine. Why there is an increase in demand is perhaps another thread in itself...

    By Blogger angry doc, At February 16, 2007 5:16 pm  

  • hi angrydoc,

    We had a lecture on Saturday by Prof Lee Tat Leang from NUH.

    He did mention the research about sham needles and how both groups had statistically significant reduction in pain. He also covered the evidence that suggests that needling releases endorphins (approx 20mg of morphine per acupuncture treatment).

    But somehow the take home message I got was that acupuncutre works pretty much like a placebo.

    Just great. I paid $8500 to learn a system of a complicated placebo? But he did say that whether acupuncture works is based on belief. Especially as far as using acupuncture to treat diseases (not as analgesia). SO far they have not been able to prove whether the meridians, and TCM principles actually work or not.

    So from being a drug salesman now...I am moving on to be a con man? And I paid $8500 to learn how to do that?

    Sigh. Got to get that idea out of my head!

    By Blogger Dr Oz bloke, At February 26, 2007 11:32 am  

  • But what was emphasises is that placebo is not a bad thing.

    And many studies have shown the following :

    1) placebo is dose related and has long term effects

    2)Large capsules are better placebos than small capsules.

    3) Yellow placebos are most effective as stimulants

    4) White placebos are most effective as painkillers

    5) Green placebos are best for anxiety

    6) Injections are better placebos than pills


    Interestingly, the great Sir William Osler actually advocated acupuncture for Lumbago!

    "For lumbago, acupuncture is, in acute cases, the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet needles, sterilised, will do) are thrust into the lumbar muscles at the seat of pain, and withdrawn after fiver or ten minutes. In many instances the relief of pain is immediate, and I can corroborate the statements of Ringer, who taught me this practice, as to its extraordinary and prompt effect in many instances"

    Sir William Oselr 1912
    The principles and practice of Medicine, 8th edition, Appleton, NY P1131

    I think I'll need some time to get over this lecture from Prof Lee. Rather polarizing for me.

    By Blogger Dr Oz bloke, At February 26, 2007 11:39 am  

  • Acupuncture meets evidence-based medicine...

    I heard Prof Lee was a big fan of acupuncture; nice to know he acknowledges the current available evidence on it.

    Your post makes the point about what is 'wrong' with promoting acupunture in its current form: if the theory behind it seems to be wrong, or if all there is to acupuncture is placebo effect, then why spend time teaching and learning something which is wrong? Might as well just have a one-afternoon workshop on how to poke needles into people safely. Also, aren't we lying to patients when we tell them that acupuncture helps them clear blocked qi or whatever when the theory seems to be wrong?

    If, however, we can study the mechanism behind why poking people with needles relief pain, we stand to learn more about human physiology and maybe discover new ways to treating ailments.

    As it is, reinforcing the wrong theory behind acupuncture helps to reinforce the whole system of medicine founded on the concept of qi and balance, and discourages scientific thinking and discoveries.

    Still, I am inclined to believe dermapuncture works in some physiologic way beyond the placebo effect. Just have to wait for the evidence...

    By Blogger angry doc, At February 26, 2007 6:13 pm  

  • As you said. Just have to wait for the evidence.

    The thing is that there is a lot we don't know about acupuncture and TCM. In fact perhaps we know only 1% of it.

    So how to teach? Teaching sham methods would hardly be sensible.

    I guess in the meantime we continue to teach the principles of Qi and TCM until we find the evidence to explain the phenomenon? That's the best we can do.

    It is still possible that the Qi theories and all could be right. And if that is so, we certainly don't want to lose it.

    It's a poor justification, but what else can we do for the moment? Completely forget about TCM and acupuncture and let it die off?

    I think if doctors took that approach, then all forms of modern medicine today would not exist.

    I have given it some thought. And for me, I would keep trying until proven otherwise or proven right.

    In the end it is for the good of the patient. If there are better ways to treat a disease with proven EBM then I take that route. If not I look for the next best route.

    By Blogger Dr Oz bloke, At February 27, 2007 9:56 am  

  • "I guess in the meantime we continue to teach the principles of Qi and TCM until we find the evidence to explain the phenomenon?"

    A more scientific approach would be to try other hypotheses and see which one fits the observations.

    "And for me, I would keep trying until proven otherwise or proven right."

    The question you need to ask yourself then is: when will you be convinced that something does not work or that a theory is wrong?

    By Blogger angry doc, At February 27, 2007 5:52 pm  

  • "The question you need to ask yourself then is: when will you be convinced that something does not work or that a theory is wrong?"

    That's actually a very interesting question and very hard to answer.

    From a clinical perspective, if I treat 10 patients and not a single one of them has a good response but nobody died....I am inclined to stop using that treatment.

    On the other hand if I treat 10 patients and 9 of them have good responses but 1 died from a drug reaction.....I would use it less.

    Or if I treated 10 patients and 7 had good results and 3 had no improvement but no one died....then I would continue trying.

    I think most of us in clinical practice are not researchers and we go very much on what our patients feedback to us.

    So it really depends on the patients. Not so much me. If they do well, then the more I believe. If they don't then I know I tried and I am not so convinced. That's how it is for me. I dunno about you.

    But then there are other docs who only try anything only if it HAS ALREADY been proven to work by someone else etc. But then they might find that after using the treatment, not all would have good results (same old thing).

    The question is, who is the one to say "IT WORKS!" then everyone follows?

    By Blogger Dr Oz bloke, At February 28, 2007 1:32 pm  

  • "I think most of us in clinical practice are not researchers and we go very much on what our patients feedback to us."

    The problem with such an approach is that the strength of the evidence can be very weak. Without control and blinding, how can you know whether an improvement/adverse effect is due to the intervention?

    "The question is, who is the one to say "IT WORKS!" then everyone follows?"

    It's not the identity of the messenger that is important, but the message. :)

    People pay attention and alter their practice based on the strength of the evidence produced.

    In individual clinical practices the numbers are small and there are many confounding factors which may affect the results of therapy. Studies with good design and high power (large study population) help to overcome these limitations.

    By Blogger angry doc, At February 28, 2007 5:21 pm  

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