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21-Sept-15 PHYS 192 Lecture 4 1

Alternative Medicine


• “The morning ABC News had an a commercial for the Oprah Winfrey Show about a guest on her show today, an NFL player who had a serious injury and was told he would never walk again. He now walks fine. She said it was a "miracle." She uses the word a lot, but there are no miracles in science. The correct word is ‘misdiagnosis.’”– Bob Park, 1-Feb-08


Questions:

• How would you define “alternative medicine”?

• What are some examples of alternative medicine?

• Why do you think alternative medicine is popular?

Science in Medicine• Controlled studies

– Anecdotes are meaningless

• Plausibility– Does the claim make sense?

• Epidemiological studies– Large samples are hard to control

• Things to remember– We usually get better.

– The placebo effect is real.

– Correlation does not necessarily mean causation

– Scientific language does not make science.



Americans Pay Big Money For Alternative Medicine

“Americans spend $34 billion every year on forms of alternative medicine, says the first national study on this kind of spending.

Chiropractors, acupuncturists and other herbal remedies are making a lot of money as people look for simple care in a high-tech world, a report by the government indicates.

‘We are talking about a very wide range of health practices that range from promising and sensible to potentially harmful,’ wrote Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine, the agency that spearheaded the research.”


Science-based medicine

• How do you know if a treatment really works or not?

• How do you design a study to test whether or not a treatment works?

• What is an acceptable risk factor?

AcupunctureAcupuncture is a form of Traditional Chinese Medicine (TCM), one of the oldest continuous systems of medicine dating back 4,000 years. It is the most commonly used system of healing in the world.

TCM is based on the belief that what happens to one part of the body affects every other part of the body. Similarly, organs and organ systems are viewed as interconnected structures that work together to keep the body functioning.

One of the TCM concepts is qi (pronounced "chi"), which is considered a vital force or energy. Qi flows through the body via channels, or pathways, called meridians. Imbalances in the flow of qi cause illness; correction of this flow restores the body to balance.

Acupuncture restores the balance, thus allowing for the normal flow of qi throughout the body and restoring health to the mind and body.

from aurorahealthcare.org


Conditions treatedDiseases of the muscles, bones and joints

• Sprains

• Osteoarthritis

• Rheumatoid Arthritis

• Fibromyalgia

Diseases of the nervous system

• Strokes

• Neuralgia

Anxiety, depression and other nervous disorders

• Nerve paralysis

• Headaches/migraines

Digestive disorders

• Indigestion

• Stomach ulcers

• Gall stones

• Diarrhea

• Constipation

• Nausea and vomiting

• Irritable Bowel Syndrome

Diseases of the respiratory system

• Asthma/allergies

• Bronchitis

• Sinusitis

Diseases of the heart and blood vessels

• Angina

• High blood pressure

• Obesity

• Drug addiction

• Smoking

Obstetrics and gynecology

• Fetal malposition

• PMS

• Menopause symptoms (hot flashes)

• Dysmenorrhia

• Amenorrhia

• Uterine Bleeding

• Infertility

From aurorahealthcare.org


Acupuncture– 4000 year old traditional Chinese medicine


Acupuncture history• Idea probably started in ancient Greece

• Some claims of ancient acupuncture in China were actually blood letting.

• Probably about 400 years old.

• Originally 360 acupuncture points, now more than 2000.

• Depending upon who you ask, there are either 9, 10 or 11 meridians.


http://www.skeptic.com/eskeptic/08-10-08/


http://well.blogs.nytimes.com/2012/09/11/acupuncture-provides-true-pain-relief-in-study/

Acupuncture• Is the history of acupuncture relevant?

• How can we determine if it really works?

• Even if it only provides a placebo effect, is that ok?


Vaccines and Autism• Claims:

– vaccines given to children cause autism.

– Rise in autism correspond to a rise in vaccination rates.

– Measles, mumps and rubella (MMR) shot is the main culprit administered at age 2.

– Wakefield study (now discounted and retracted by the Lancet) claimed that MMR caused inflammation of the gut which is correlated with autism.

• Consequences:– Many parents are not getting their children

vaccinated.


Vaccines and Autism• Fall 2015: mumps outbreak• Spring 2015: measles outbreak

– Lack of vaccinations, also weakening of immunity.

• Spring 2014: mumps outbreak– Lack of vaccinations

• Fall 2013: measles outbreak– Lack of vaccinations

• Fall 2012: whooping cough outbreak– Lack of vaccinations– Also the vaccine has a shorter lifetime than expected.

• Fall 2011: measles outbreak– Attributed to lack of vaccinations

• Herd immunity– Vaccinating the herd (>90%) protects the unvaccinated (often the most

vulnerable)– Example: eradication of smallpox– Could theoretically eradicate measles and polio– Can’t eradicate bacterial diseases



Vaccines• In the first-ever study of its kind, U of Toronto

researchers Dr. Kumanan Wilson and Dr. Jennifer Keelan analyzed 153 videos about vaccination and immunization on YouTube, a popular online video-sharing site. Researchers found that more than half of the videos portrayed childhood, HPV, flu and other vaccinations negatively or ambiguously.

• Of those videos, a staggering 45 per cent contained messages that contradict the 2006 Canadian Immunization Guide, which provides national guidelines for immunization practices. The Canadian recommendations are similar to guidelines from the American Centers for Disease Control and Prevention.

http://www.physorg.com/news116082504.html


The Dietary Supplement and Health Education Act of 1994

• In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994 (DSHEA) as a product that is intended to supplement the diet and bears or contains one or more of the following dietary ingredients:

– a vitamin– a mineral– an herb or other botanical (excluding tobacco) – an amino acid– a dietary substance for use by people to supplement the diet by increasing the

total dietary intake, or – a concentrate, metabolite, constituent, extract, or combination of any of the

above • Furthermore, it must be:

– intended for ingestion in pill, capsule, tablet, powder or liquid form – not represented for use as a conventional food or as the sole item of a meal or

diet – labeled as a "dietary supplement"

• These things are regulated as “foods” not “drugs”• Unlike pharmaceutical companies, supplement manufacturers are not

required to prove the safety or effectiveness of their products; the FDA can take action only after a dietary supplement has been proven harmful.

– E.g. ephedra, only banned after many deaths (including Steve Bechler)

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

http://en.wikipedia.org/wiki/Diet_(nutrition)

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

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

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

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

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

Plausibility• Do cell phones cause brain cancer?

• Is there a plausible mechanism that relates cell phone use to brain cancer?

• All known forms of radiation that cause cancer do so by breaking bonds in DNA.– This causes mutations which can lead to birth

defects and cancer.



Can’t break DNA bonds Can break DNA bonds

Types of studies• Controlled trials of (usually) smaller groups.

– One group gets treatment

– One group doesn’t (or gets alternative treatment)

– Blinded if patients don’t know whether they are getting treatment or not.

– Double-blinded if administrators don’t know if they are administering treatment or not.• Question: How do blind administrators of acupuncture??

• Epidemiological studies– Large groups interviewed/followed based upon

behavior. (maybe 10,000 or more)

– No specific treatment.

– Looking for statistical effects.


Cell phones• Started with anecdotal claims.

• Epidemiological studies mostly (but not all) say no correlation between cell phone use and brain cancer.

• This is not to say that cell phones are not dangerous. Talking on a cell phone while driving is much more dangerous than your risk of cancer or other illness.


Homeopathy• Like cures like

• If you have poison ivy, then it can be treated with Rhus tox(poison ivy)

• The trick, it needs to be diluted. Many times. 10X, 100C.

– If it’s diluted 24X, then a 50/50 chance that zero atoms are left!!

• Then how can it work? Advocates claim the water “remembers” the presence of the treatment.

• Questions:– Could it be a placebo effect?

– Homeopaths are typically quite proud of “individual” or “holistic” approach.


Homeopathy• Millions of people around the world swear by the

alternative medicine homeopathy. In Britain, the Royal Family endorses and uses it. But that hasn't deterred the editors of The Lancet, the prestigious British medical journal, which has launched an all-out attack on homeopathy. In its current issue, The Lancet published a massive study that compared the results of 110 trials of homeopathy with the same number of trials of conventional medicine. The conclusion: benefits attributed to homeopathy were, at best, placebo effects.

Read more: http://www.time.com/time/health/article/0,8599,1114166,00.html#ixzz280pE4cBU


http://www.time.com/time/health/article/0,8599,1114166,00.html

Science and Public Health• Flouridation

– Tremendous success reducing tooth decay

– “One of the 10 greatest public health successes of the 20th century.” CDC

– Reasons to stop: cost, claims it decreases IQ

• Chronic lyme disease

– Claim it doesn’t show up in tests for lyme disease

– Romney campaign targeting Virginia voters about lymeepidemic.


What works?• Science based medicine.

• Are all double blind studies correct? No.– Science is self correcting. That doesn’t mean

that science is always correct.

• Be skeptical.

• Recognize proper experts.– But watch out for “argument from authority”

• Recognize motivations.


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