Angry Doctor

Thursday, July 12, 2007

Cow Dung 3

angry doc: Well, you have cancer.

patient: Cancer? Are you sure, doctor?

angry doc: Quite.

patient: But how did you know? Isn't there like some sort of test you should do to prove that I really have cancer?

angry doc: Well, what you can't prove does not equate to not existing.

patient: OK... but there's a treatment for this, right?

angry doc: Sure; just rub cow dung on your forehead every morning.


patient: Cow dung? I'm sorry doctor, but that sounds like vodoo medicine to me!

angry doc: Well, we shouldn't so quick to dismiss everything non-mainstream as voodoo.

patient: OK, maybe it's not voodoo, but is there evidence to show that it works?

angry doc: While I understand the importance of evidence-based medicine, I thought it would be good once in a while to be more open to hypothesis that are not proven.

patient: But doctor, this is my life and my health we are talking about here!

angry doc: It's always about you, isn't it?


Well, that conversation didn't really happen. In fact, much of what angry doc said didn't actually come from angry doc, but from readers' comments in two previous posts (here and here).

The truth is, we all require evidence of one sort or another when we deal with people in our daily lives; we just happen to have less stringent criteria for accepting someone's claims as valid evidence when we want or wish for them to be true, and vice versa.

You wouldn't let angry doc get away with diagnosing and managing a patient in the manner as in the scenario above, so why should you make an exception for people who make claims they do not have valid evidence for?

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22 Comments:

  • angry doc: Well, what you can't prove does not equate to not existing.

    Darn right!

    Cow dung works in curing any and ALL ailments. Used appropriately you can even get the Universe to deliver anything you want.

    If consciousness precedes existence - as can be verified with Quantum Mechanic's observer observing the Schrodinger Cat thereby causing wave particle duality and creating multiple Universes - so cow dung works at the atomic and sub atomic levels and works its up way to Classical Newtonian reality. We are unable to measure it just yet but please don't knock QM ok?

    If you have any queries I shall be happy to explain Quantum Entanglement for Dummies.;-)

    PZ

    By Blogger PZ, At July 13, 2007 1:16 pm  

  • The failure to understand logical fallacies makes many part with their money. :)

    By Blogger I must be stupid, At July 13, 2007 8:26 pm  

  • PZ, why are you trying to argue the case for not disproving efficacy? At the end of the day, a patient has cancer and will possibly die if not treated optimally. We want to use what we know that can improve the patient's condition (e.g. chemotherapeutic regimens demonstrated to be effective in RCTs), and not fiddle with using something for which its inefficacy has not been proven (cow dung has not been demonstrated to be ineffective). If and when cow dung is demonstrated to improve parameters such as disease-free survival as much as or more than current therapies, it will be accorded due credibility.

    By Anonymous igakunogakusei, At July 14, 2007 11:05 pm  

  • Hmmm I am surprised a brilliant guy like you can make an error in logic.

    "angry doc: Well, what you can't prove does not equate to not existing.

    Palmist: Well, it also doesn't prove that it exist either."

    "angry doc: While I understand the importance of evidence-based medicine, I thought it would be good once in a while to be more open to hypothesis that are not proven."

    I am sure you know this a
    "A hypothesis (from Greek ὑπόθεσις) consists either of a suggested explanation for a phenomenon or of a reasoned proposal suggesting a possible correlation between multiple phenomena." (taken from wiki) It does not make it a fact or a theory. My suggestion for you to be open to other forms of therapy not accept them wholesale. There are many areas where you cannot put it in terms that you could understand therefore you dismiss it. I think that is not open. To me how antidepressant works it just as fuzzy as how the TCM term things as heaty or liang. The only difference is the pharmacodynamics of antidepressant has a semblance of science. The truth is they don't really know how it works. However what they know is it works. Same as in TCM. They might not have the most scientific term to explain their theories but some of their theories do work. Anyway it is just my opinion.

    When I refer to evidence I mean scientific evidence as we know today. Let me ask you what are the chances or a person who turned vegetable return back to normal. The doctors says no hope. A blood letting new age practitioner managed to bring my grandmother back to normal. Can you explain that scientifically?

    By Blogger palmist, At July 15, 2007 2:09 am  

  • Eh, palmist, I think angry doc was merely raising a hypothetical conversation as an allegory to reinforce how ridiculous some of the comments previously made actually are. It's meant to be sarcastic rhetoric so I think you might have taken it the wrong way. I'm sure I'm right but we'll wait to hear it from the horse's mouth.

    By Anonymous igakunogakusei, At July 15, 2007 4:17 am  

  • igakunogakusei said...

    PZ, why are you trying to argue the case for not disproving efficacy?

    I was being sarcastic towards the Bleevers*, hence I emulated the QM reference justifying mumbo-jumbo, "new-age" quackery from Law of Attraction, to TAR and what-not codswallop and gibberish that wackos and the Bleevers* like to use for obvious reasons.

    PZ

    * - "Bleevers"(believers of "What the Bleep", "The Secret," TAR and their ilk)

    By Blogger PZ, At July 15, 2007 1:05 pm  

  • igakunogakusei said...

    It's meant to be sarcastic rhetoric so I think you might have taken it the wrong way.I'm sure I'm right but we'll wait to hear it from the horse's mouth.

    Well "angry doc" was actually using a big dollop of parody with a touch of sardonic wit and a hint of sarcasm to make his point.

    He then went on to further explain his point in clear prose.

    That anyone should misunderstand his post really boggles the mind.

    PZ

    By Blogger PZ, At July 15, 2007 3:08 pm  

  • Actually, palmist, I believe my point stands even if you replace 'cow dung' with 'TCM' or 'chemotherapy'; you and I naturally assume cow dung as a non-valid mode of treatment for cancer, whereas (I assume) some cattle-raising culture (maybe in Subsaharan Africa) will see it as a valid form of therapy. We will find it strange if I have used 'chemotherapy' instead of cow dung in my story, but the fact remains that an unproven form of chemotherapy is as unproven as cow dung when it comes to treating cancer. Cultural bias, I think. But never mind that.

    "My suggestion for you to be open to other forms of therapy not accept them wholesale. There are many areas where you cannot put it in terms that you could understand therefore you dismiss it. I think that is not open."

    Say you have cancer, and I recommend cow dung as a form of treatment to you: do you think that's OK because we shouldn't dismiss things we cannot understand and that we should be open?

    "To me how antidepressant works it just as fuzzy as how the TCM term things as heaty or liang. The only difference is the pharmacodynamics of antidepressant has a semblance of science. The truth is they don't really know how it works."

    We do have a rather coherent idea of how antidepressants work. We also know about neurons, and we can measure the levels of neurotransmitter objectively. To say that antidepressants are equivalent to TCM because you don't know how they work would be like me saying that astrophysics and astrology are equally valid because I don't know how either one of them works.

    "However what they know is it works. Same as in TCM. They might not have the most scientific term to explain their theories but some of their theories do work."

    Actually, that is not true.

    Certain herbs used in TCM have been shown to have efficacy, but this is dependent on the properties of the active compound contained in the herb and not a single 'cooling' chemical or a single 'heaty' chemical. Likewise, sticking needles into people have been shown to relieve pain, but it doesn't matter whether you stick them into acupoints or non-acupoints. This suggests that the theories of TCM do not accurately explain the observed phenomenon.

    We should be open to hypotheses, but we should also be open to the possibility that a hypothesis is wrong when it does not adequately explain what is observed.

    "Anyway it is just my opinion."

    You may choose to have that luxury; I can't.

    By Blogger angry doc, At July 15, 2007 4:26 pm  

  • To PZ:

    Firstly, HUH? :P I gather we both agree with angrydoc on this one then.

    Secondly, someone clearly did misunderstand! So people make mistakes - be polite.

    By Anonymous igakunogakusei, At July 15, 2007 5:39 pm  

  • igakunogakusei said...

    To PZ:

    Firstly, HUH? :P I gather we both agree with angrydoc on this one then.


    An outrageous and ridiculous proclamation that cow dung can cure ANY and ALL ailments and even get the Universe to deliver anything you want, did not give you any clue that this was a sarcastic remark? Do you know of any person who would ever make such a claim and actually mean it?

    Secondly, someone clearly did misunderstand! So people make mistakes - be polite.

    I expressed an honest opinion. It does boggle the mind. And it wasn't meant to be rude. I could argue that anyone who think otherwise is being most naive, hypocritical or dishonest but won't.

    PZ

    By Blogger PZ, At July 15, 2007 6:40 pm  

  • pz said...

    "Do you know of any person who would ever make such a claim and actually mean it?"

    Actually, I do. I don't know them personally but I've come across people who come by GP surgeries who actually think in that way. You could well have been one such person.

    By Anonymous igakunogakusei, At July 15, 2007 6:53 pm  

  • I confess that I sometimes have difficulty deciding whether people are being sarcastic or if they genuinely believe when reading their blog posts or comments.

    Not in this case, of course, since I knew about PZ from Mr Wang's blog; but some of the commentors over there leave me wondering...

    By Blogger angry doc, At July 15, 2007 7:14 pm  

  • igakunogakusei said...

    I don't know them personally but I've come across people who come by GP surgeries who actually think in that way.

    AND use Quantum Mechanics to justify it?

    Still clueless??

    What about "I shall be happy to explain Quantum Entanglement for Dummies and with a smiley WINK ;-)"

    Still no clue that these remarks are meant tongue-in-cheek and not to be taken seriously???????

    I suppose next time, I need to preface such posts with a DISCLAIMER that the following is meant as a joke and tongue-in-cheek.

    But it kinda take the fun out of things you think?

    PZ

    By Blogger PZ, At July 15, 2007 7:22 pm  

  • pz, I'd be happy to introduce you to the particular patient I have in mind - I think you might be quite entertained. :) Quantum Mechanics, astrophysics, the works!

    By Anonymous igakunogakusei, At July 16, 2007 1:47 am  

  • angry doc: Well, we shouldn't be so quick to dismiss everything non-mainstream as voodoo.

    angrydr, I see that you've taken my statement out of context with an inane knee-jerk reaction of a response. I find your mockery to be quite unbecoming and misplaced.

    Something "non-mainstream" does not automatically mean that it's been disproven or invalid. It could be something not yet explored, entered into the current psyche or that current science cannot adequately explain.

    Bear in mind, acupuncture was totally rubbished yet now it's a modality of "western" medical practice. It helps to keep an open mind, really.

    Wonder if you know of the history of when doctors had to be convinced of the benefits of handwashing? Turned out that the iatrogenic deaths were not caused by "miasma" as the medical "experts" of the day claimed but by cross-infections from germ-ridden hands. The trail-blazing colleagues who spouted these "heresies" faced the kind of ridicule probably not unlike the closed-minded sanctimony you appear to conjure up here from time to time. Nothing changes, yes?

    So lets compare apples with apples here - I was talking about the concept of "heatiness" & "cooling". Poorly chosen words but I still believe these phenomenons can be explained away. The actual aetiologies behind the 2 "cow-dung" concepts might be more complex than presented by old wives. Nevertheless, I suspect we have equivalent medical terms for those conditions.

    Where the treatment of terminal patients are concerned, one would be derelict in one's duty if mainstream modalities (not necessarily cures) were not pursued or encouraged. This much I agree. The thing to keep in mind though, is there are more than enough pharmaceuticals that we haven't a clue as to their modes-of-action and how certain physiological effects are derived from them. What is "mainstream" can be pooed-pooed rather quickly as well when fortuity runs out and the Russian roulette games we play with the patients create unacceptably high casualties figures for the day. For now, they're sometimes acceptable "voodoo".

    By Anonymous unemployed, At July 16, 2007 6:42 am  

  • "angrydr, I see that you've taken my statement out of context with an inane knee-jerk reaction of a response. I find your mockery to be quite unbecoming and misplaced."

    unemployed, I have not taken your statement out of context, as we are discussing unproven therapies and theories of medicine. My response is knee-jerk because the same old flawed arguments employed by proponents of unproven therapies deserve the same old rational responses.


    "Something "non-mainstream" does not automatically mean that it's been disproven or invalid. It could be something not yet explored, entered into the current psyche or that current science cannot adequately explain."

    I'll come back to that later...


    "Bear in mind, acupuncture was totally rubbished yet now it's a modality of "western" medical practice. It helps to keep an open mind, really."

    As I have mentioned earlier (and in previous posts on the topic of acupunture), studies have shown that any effect produced by 'acupuncture' is independent of whether the needles are placed in acupoints or non-acupoints. This suggests that 'dermapuncture' has an effect, and that the theories of qi and meridiens behind 'acupuncture' are wrong.


    "Wonder if you know of the history of when doctors had to be convinced of the benefits of handwashing? Turned out that the iatrogenic deaths were not caused by "miasma" as the medical "experts" of the day claimed but by cross-infections from germ-ridden hands. The trail-blazing colleagues who spouted these "heresies" faced the kind of ridicule probably not unlike the closed-minded sanctimony you appear to conjure up here from time to time. Nothing changes, yes?"

    I'm glad you mentioned the miasma theory. We were able to progress because we were able to reject the miasma theory and adopt the germ theory because the former did not adequately explain observed phenomena. Now as I mentioned earlier, while TCM has been shown to have efficacy in certain areas, studies have shown that this was unrelated to the theories behind TCM. Should we not then reject the theories of TCM in favour of those which better describe observation?


    "So lets compare apples with apples here - I was talking about the concept of "heatiness" & "cooling". Poorly chosen words but I still believe these phenomenons can be explained away. The actual aetiologies behind the 2 "cow-dung" concepts might be more complex than presented by old wives. Nevertheless, I suspect we have equivalent medical terms for those conditions."

    Do you have any evidence to show that the concepts of 'heatiness' and 'cooling' can be explained consistently in a scientific/medical manner, or is it just something you 'suspect'?


    "What is "mainstream" can be pooed-pooed rather quickly as well when fortuity runs out and the Russian roulette games we play with the patients create unacceptably high casualties figures for the day. For now, they're sometimes acceptable "voodoo"."

    One feature of science is that it is willing to look at and evaluate new evidence, and one feature of pseudoscience is that it refuses to accept new evidence that is contrary to its claims, but continue to claim that it cannot be evaluated by the normal scientific method.

    By Blogger angry doc, At July 16, 2007 12:11 pm  

  • igakunogakusei said...

    pz, I'd be happy to introduce you to the particular patient I have in mind - I think you might be quite entertained. :) Quantum Mechanics, astrophysics, the works!

    Methinks me knowest whom thy mean. Perchance a *W* somewhere in his name?

    PZ

    By Blogger PZ, At July 16, 2007 12:49 pm  

  • Say you have cancer, and I recommend cow dung as a form of treatment to you: do you think that's OK because we shouldn't dismiss things we cannot understand and that we should be open?

    Would cow dung be first line treatment? Out of all the other possibilities, would you start with something that you are not sure about? I am open to cow dung working doesn't mean that I would use it as first line. It also doesn't mean that I do not do my investigate to find out about cow dung use in treatment of cancer. Besides I would be open to a type of therapy if there are positive feedback about that therapy.

    I find that just because TCM doesn't have a consistently reproduceable results you reject them. There are anecdotal evidence that it works. You are not willing to acknowledge a form of therapy just because you cannot explain in scientific terms. I thought that rejection of therapy is not justififed.

    To me the bottom line is more important than whether we know how it works.


    We do have a rather coherent idea of how antidepressants work. We also know about neurons, and we can measure the levels of neurotransmitter objectively.

    What they know is that there is correlation between the amines and depression. You increase the amines they have a better mood. But that's about it. I personally do not subscribe to the biological model of depression. No one knows why it doesn't work for some people on antidepressant.


    To say that antidepressants are equivalent to TCM because you don't know how they work would be like me saying that astrophysics and astrology are equally valid because I don't know how either one of them works.

    I am not saying they are equally valid. I am saying both have their merits. They work. If left with little choice I would not forsake using something just because I do not have full knowledge of how it works.

    Likewise, sticking needles into people have been shown to relieve pain, but it doesn't matter whether you stick them into acupoints or non-acupoints. This suggests that the theories of TCM do not accurately explain the observed phenomenon.

    Would you like to quote the study? I haven't read it before.

    We should be open to hypotheses, but we should also be open to the possibility that a hypothesis is wrong when it does not adequately explain what is observed.

    Of course I am open that the hypothesis could be wrong. What is not adequately explained might not be wrong. It might just be a lack of knowledge to explain.

    You may choose to have that luxury; I can't.

    Actually I think you do have the choice. If doctors can't be open to alternative therapies we wouldn't have acupuncture in our hospitals. You make the best decision for your patients but when you are in unchartered waters with no reference you've to take risk and be open to other forms of therapy. You might have to try a drug regimen that is not tested but might work. I believe you would also have discussed it with your patient the options.

    By Blogger palmist, At July 19, 2007 1:06 am  

  • palmist,

    I think our difference is in the level of evidence we require.

    I would like to think that in the event that I am diagnosed with a terminal illness that conventional medicine has no cure for, I will not use unproven, 'alternative', last-ditch, miracle treatment. But of course, we will never know the strength of my conviction until I do have a terminal illness. Until then, I know that these treatment are unproven, and that there are valid reasons why they are 'alternative', last-ditch, and called miracles.

    For any mode of therapy ('alternative' or 'conventional'), there are two issues: does it work, and does it work in the way it is said to work?

    'Acupuncture' works, but it doesn't work in the way it is said to work. By not questioning the theory and mechanism behind how something work, we lose the opportunity to learn a great deal more about how our bodies work, and we allow a lot quackery to hide under the same flawed theory.

    Here are some references for studies involving acupuncture and sham acupunture investigating respectively:

    knee pain: http://www.annals.org/cgi/content/abstract/145/1/12

    elbow pain: http://www.jr2.ox.ac.uk/bandolier/band126/b126-1.html

    headache: http://www.sciencedaily.com/releases/2005/05/050504101520.htm

    hypertension: http://hyper.ahajournals.org/cgi/content/abstract/48/5/838

    By Blogger angry doc, At July 19, 2007 5:16 pm  

  • 'Acupuncture' works, but it doesn't work in the way it is said to work. By not questioning the theory and mechanism behind how something work, we lose the opportunity to learn a great deal more about how our bodies work, and we allow a lot quackery to hide under the same flawed theory.

    I don't know much about acupuncture actually. I believe we should explore the theoretical basis and develop a better model fof explanation. The qi and meridian theory could be related to many other dimensions of human physiology we have yet to discover and therefore not able to fully explain. I guess like you say I need less evidence as long as I can achieve the bottom line I am looking for.

    There is also confounding factors with doing trials for acupuncture because I feel that the skill of the acupuncturist affects outcome. I am no expert in this but I have a feeling that there are many points they can use just to treat one disease and knowing which point to use requires skill and experience. I hear people telling how they recovered from various diseases when western medicine can only provide symptomatic relief. There must be something valuable in TCM to be able to provide that kind of relieve to the patients. I guess it depends a lot on the practitioner and the results are not easily reproduced.

    By Blogger palmist, At July 22, 2007 1:03 am  

  • "I guess it depends a lot on the practitioner and the results are not easily reproduced."

    So presumably if someone went to an acupuncturist and got better you would attribute his recovery to acupuncture and conclude that acupuncture works and that the acupuncturist was skilful, and if he didn't get better you would say that the acupuncturist was not skilful but still be convinced that acpuncture works (and that he just had to find a skilful acupuncturist)?

    If so, you are ignoring the evidence that acupuncture and sham acupunture have the same efficacy.

    Inter-operator variance is in fact controlled for in some studies, and this has no bearing on the outcome.

    palmist, I think you need to ask yourself what kind of evidence it would take for you to change your mind about the efficacy of a form of treatment. To just accept anecdotes that confirm our beliefs as evidence and dismiss anecdotes and evidence that do not confirm our beliefs is not scientific, and in the long term not helpful to our understanding of the world and ourselves.

    By Blogger angry doc, At July 22, 2007 8:28 am  

  • One more link, this one to an article titled "Point specificity of acupuncture in the light of recent clinical and imaging studies".

    http://www.acupunctureinmedicine.org.uk/servearticle.php?artid=579

    Now I freely admit that I am 'poisoning the well', but this article was written by a 'former consultant physician' at the Royal London Homeopathic Hospital, and published in "Acupuncture in Medicine", the journal of the British Medical Acupuncture Society, and even then the author does not claim that the traditional theory of acupuncture can stand in the face of evidence.

    It isn't about eastern or western medicine, but about science and how best to understand observed phenomena.

    By Blogger angry doc, At July 22, 2007 8:54 am  

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