From: geb@dsl.pitt.edu (gordon e. banks)
Newsgroups: sci.med
Subject: Re: On pre-scientific traditions of medicine (was: Use of term
Date: 18 Aug 92 15:33:44 GMT
Distribution: sci
Organization: Decision Systems Laboratory, Univ. of Pittsburgh, PA.

In article <1992Aug17.220859.9259@news.Hawaii.Edu> lady@uhunix.uhcc.Hawaii.Edu (Lee Lady) writes:
>of any rational or factual basis for one's argument.  And whether someone
>is raking in cash or not is not a scientifically relevant consideration
>to the effectiveness of a treatment -- fortunately, or most physicians
>would be discredited!  
>
Conflict of interest is quite relevant to one's objectivity in evaluating
treatment.  This is a major problem for scientific evaluations as it
now stands.  Drug companies provide money to physicians for research
on efficacy of their drugs.  Does anyone see a disincentive to find
them worthless?  I think NIH is very cognizant of this problem
(certain we who review research proposals for them are) and 
we have to take such factors into account in evaluating the
research.  Most physicians providing treatment are not doing any
research, science, or formal evaluation of efficacy.  They are
relying on the research of others.  They are forming their own
opinions based on experience, but that isn't scientifically based.

>
>For instance, look in the yellow pages for any reasonably large city
>under the heading chiropractors.  There are an incredible number of
>chiropractors around.  And to me it's absolutely scandalous that after
>all the time chiropracty has been around and all the money people spend
>on it, there's still no serious research (except for the recent studies
>showing that it does have real benefit for some orthopedic problems) and
>that people are still reduced to arguing about it on usenet on a
>non-factual basis.  
>
Yes, and that research was mostly done by MDs.  Unlike medical schools,
chiropractic schools are proprietary and faculty are hired to teach,
not to do research.  The entire orientation of chiropractic is to
train people to do spine manipulation, not investigation.  One could
always cry that the establishment would never believe such research,
but if it was conducted properly, as the low back pain studies in
England with chiropractic were, the results of which were reported
in established medical journals, the research will be accepted as valid.
It is very difficult for someone who isn't a chiropractor to
conduct research on the efficacy of chiropractic.  So I think
the ball has to be considered in their court.

>The attitude expressed by so many on sci.med is "We're justified in just
>ignoring these approaches since the type of research we believe in hasn't
>been done."  This attitude doesn't benefit anyone.  

From a scientific standpoint, it is the only proper attitude.  To
subject one's body to any nostrum that anyone claims would be
of benefit regardless of whether it has been tested or not
is pretty crazy, in my view.  You may miss out on the benefit
of some wild thing, but you will also miss out on the harm of
the vast majority of useless or dangerous ones.

Not only are most of the quack cures untested, but they are also
are backed by quasi-religious theories that make no scientific sense in
themselves and are often contradicted by known facts.  Certainly
some substance might be useful even though the theory it is based
on is false, but the practitioners who would be doing the testing
are usually so hung up on the theory that they have trouble assuming
the objectivity necessary to test the remedy.
-- 
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Gordon Banks  N3JXP      | "Skepticism is the chastity of the intellect, and
geb@cadre.dsl.pitt.edu   |  it is shameful to surrender it too soon." 
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