From: dyer@spdcc.com (Steve Dyer)
Subject: Re: On pre-scientific traditions of medicine (was: Use of term
Organization: S.P. Dyer Computer Consulting, Cambridge MA
Distribution: sci
Date: Fri, 21 Aug 1992 14:26:00 GMT

In article <1992Aug21.104014.3239@news.Hawaii.Edu> lady@uhunix.uhcc.Hawaii.Edu (Lee Lady) writes:
>And as far as "big deal":  It sounds to me like the new
>FDA regulations or the proposed legislation now in Congress might make my
>zinc lozenges illegal.  That would really piss me off.  

I don't believe that is correct.

>Besides which, Gordon said that it was crazy to put things in your body
>that don't have official approval.  I wanted to make the point that as
>far as I'm concerned his assertion, taken in the generality in which he
>made it, is totally crazy.  

I don't recall Gordon saying anything like that.

>Those are questions of safety.  But when if comes to *effectiveness* let
>me decide my own level of risk and waste my own money if I want to.  

I don't see what the problem is wrt nutritional supplements, which by their
very nature, cannot makes any claims to efficacy.  In the case of prescription
drugs, the FDA rule requiring proof of efficacy (this was relatively recent--
early 1960's) ultimately had a far reaching effect on the drugs which were
sold by pharmaceutical houses, and this effects was all for the good.  You
couldn't begin to imagine the crap which was sold before that point.  Since
doctor's have to trust what's claimed by the manufacturer, and act on the
patient's behalf, a lot of firms were getting rich, and patient's health
threatened, by the prescribing of drugs which were ultimately ineffective
or harmful.

>>>Getting rolfed didn't offer me all the benefits I'd hoped for but I have
>>>no regrets about having given it a try.
>>So?  I don't understand what you are attempting to address here.
>Rolfing is an alternative therapy which has not been approved by medical
>authority and whose effectiveness has not been shown by published controlled
>double-blind studies.  As I understand it, you and Gordon claim such
>therapies should not be allowed.  Certainly Gordon has said that using
>any such therapy is crazy.  

Argument by reductio ad absurdam won't get anywhere with me, nor, I
suspect, with Gordon.  No one here has made any claim about
"disallowing" such therapy.  On the other hand, if a practitioner of
Rolfing claimed to cure cancer by his/her manipulations, I would not
lose a wink of sleep if the authorities stopped such a cynical,
profiteering practice.

>Aren't these two citations from you a little inconsistent?  I take it
>that "withholding approval" means that I legally couldn't obtain these
>therapies (not that I'd want to!)  For practical purposes, that pretty
>effectively seems to disallow me from making my own decision on the issue.  

My own comment wasn't addressing any statutory agency, but the scientific
establishment in general.

>Excuse me, you seem to have me confused with someone else.  What I want
>is a hands-off policy on the part of the FDA on things whose safety does
>not seem questionable, especially nutritional supplements which have been
>widely used and have a much better safety record than many prescription
>drugs.  

I think this recent FDA scare is second only to the recurring "modem tax"
in disinformation.   I think that the FDA is proposing only to regulate
the sale of nutritional supplements which are found to be toxic (e.g., high
doses of vitamin A, D.)

In any case, the role of the FDA is embodied in statutory law.  There are
some things it is able to do, some things it can't NOT do, and many things
it can't do.  It cannot decide to allow the sale of drugs (note, not nutri-
tional supplements) which have not demonstrated safety and efficacy in the
conditions for which they have been approved for sale.  Congress has said
otherwise.

>Secondly, I would like to have real knowledge available from the
>scientific establishment on alternative approaches, so that when
>somebody tells me, for instance, that taking 5000 units per day of
>vitamin E will double my sexual potency I can find out from a qualified
>authority whether a) this would be dangerous; b) nobody knows whether
>it is safe or not; c) the rationale for this just doesn't make any
>sense; d) there is some informal evidence supporting this claim but
>nobody has done a careful study; e) people did some careful studies and
>there was no evidence of the claimed effect.

If wishes were horses, beggars would ride...  This is not something
you can obtain by statute, because the "scientific community" isn't
a monolithic entity.  You can get a very slight approximation to this
by reading sci.med and asking a question, or you can do a MEDLINE
search and read the original published studies on the subject you're
interested in, remembering that a MEDLINE search is not a trip to the
oracle, but just a collection of references whose quality and veracity
is unstated.  And, of course, any joker can do a MEDLINE search.
If you don't understand what you're reading, you might well come up
with an improper conclusion.  But it doesn't get much better than
this.  If you don't want to trust sci.med, your own doctors and (of course)
Consumer Reports, there isn't anywhere else to turn.  Guess what: that's
life.

>Thirdly, I would like recognition from the scientific community that in
>the empirical world proof is not a binary quality, that there are
>degrees of certainty.

Really?  Like I said, you don't seem at all familiar with the scientific
method or scientists, if you'd make a comment like this.

>And that when a therapy has strong informal
>evidence in its favor -- whether anecdotal or statistical but based on
>imperfect studies -- that therapy is deserving of serious scientific
>investigation.

This is just pushing the problem down a level, because we're going to
start disputing what constitues "strong informal evidence".  There are
lots of conditions which are self-limited and/or which respond to placebos
readily.  Plus, a lot depend on the therapy (see below).

>I would be quite satisfied to see research conclusively proving that
>therapies such as homeopathy and chiropracty don't work.

That's the null hypothesis.  Research provides evidence (or not)
that a therapy DOES work.  When a therapy is not grounded in scientific
paradigms, there is even less of an reason for a reputable doctor/scientist
to take it seriously.  Tell me, Lee, if I proposed to cure your cancer
today by agreeing to pray for you 10 years in the future, do you think
that it would be worthwhile for the "scientific establishment" to waste
its limited time, money and other resources in studying this?  Fine, I
thought so.   So when a practitioner presumes to cure people by administering
dilutions of substances which are so dilute that they aren't present
anymore, I think a degree of skepticism is in order.  Similarly, if
chiropractic presumes to claim that illnesses of all sorts can be cured by
spinal manipulation, and their theory of illness is grounded in a pre-
scientific understanding of the function of nerves, it is only proper to
consider it with skepticism.  As it is, the kind of spinal manipulation
chiropractors perform seems to be useful in certain cases of lower back
pain, despite their theories.  It does not cure stomach problems.

>I would be
>delighted to have solid scientific research to base my own personal
>decisions on.  I would love to know that I could get real information
>about alternative therapies from my doctor.  

What does your doctor say now?

>What I don't like is the attitude that the absence of acceptable
>research is proof that a particular approach has no merit.

But this is a cartoon of how such a conclusion is based.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer