In article nodrog@hardy.u.washington.edu (Gordon Rubenfeld) writes:  >  Marty, you've also changed the terrain of the discussion from empiric >itraconazole for undocumented chronic fungal sinusitis with systemic >hypersensitivity symptoms (Noring syndrome) to the yoghurt and vitamin >therapy of undocumented candida enteritis (Elaine Palmer syndrome) with >systemic symptoms.  There is significant difference between the cost and >risk of these two empiric therapeutic trials.  Are we talking about "real" >candida infections, the whole "yeast connection" hypothesis, the efficacy >of routine bacterial repopulation in humans, or the ability of anecdotally >effective therapies (challenged by a negative randomized trial) to confirm >an etiologic hypothesis (post hoc ergo propter hoc).  We can't seem to >focus in on a disease, a therapy, or a hypothesis under discussion.  >           >                           I'm lost!  Point 1:  I'm beginning to see that *part* of the disagreements about the whole "yeast issue" is on differing perceptions and on differing meanings of words.  Medical doctors have a very specific and specialized "jargon", necessary for precise communication within their field (which I'm fully cognizant of since I, too, speak "jargonese" when with my peers).  For the situation in sci.med, many times the words or phrases used by doctors can have a different and more specific meaning than the same word used in the world at large, causing significant miscommunication.  One example word, and very relevant to the yeast discussion, is the exact meaning of "systemic". It is now obvious to me that the meaning of this word is very specific, much more so than its meaning to a non-doctor.  There is also the observation of this newsgroup that both doctors and non-doctors come together on essentially equal terms, which, when combined with the jargon issue, can further fan the flames.  This is probably the first time that practicing doctors get really "beat up" by non-doctors for their views on medicine, which they otherwise don't see much of in their practice except for the occasional "difficult" patient.  Point 2:  I understand the viewpoint among many practicing doctors that they will not prescribe any treatments/therapies for their patients unless such treatments have been shown to be effective and the risks understood from well-constructed clinical trials (usually double-blind), or that such treatments/therapies are part of an approved and funded clinical trial.  To these doctors, to do any differently would, in this belief system, be unethical practice.  And it follows that any therapy not on the "accepted" list is therefore a non- therapy - it does not even exist, nor does the underlying hypothesis or theory have any validity, even if it sounds very plausible by extrapolation of what is currently known.  Anecdotal evidence has no value, either, from a treatment point-of-view.  And by and large, as a scientist myself, I am glad that medical practice/ science takes such a rigorous approach to medical treatment.  However, as also being a human being (last I checked), and having been one of those people that has been significantly helped by a currently unaccepted treatment, where "standard" medicine was not able to help me, has caused me to sit back and wonder if holding such an extreme and rigid "scientific" viewpoint is in itself unethical from humanitarian considerations.  After all, the underlying intent of the "scientific" approach to medicine is to protect the health of the patient by providing the best possible care for the patient, so the patient should come first when considering treatment.  What we need is a slightly modified approach to treatment that satisfies both the "scientific" and the "humanitarian" viewpoints.  In an earlier post I outlined a crazy idea for doing just that.  The gist of it was to give any physician freedom and encouragement by the medical community to prescribe alternate, not yet proven therapies (maybe supported by anecdotal evidence) for patients who *all* avenues of accepted therapies have been exhausted (and not until then).  The patient would be fully informed that such therapies/treatments are not supported by the proper clinical trials and that there are real potential risks with real possibilities of no benefit derived from them.  This approach satisfies the need for scientific rigor.  It also satisfies the humanitarian needs of the patient.  And the reality is that many patients who have reached a dead-end in the treatment of their symptoms using accepted medicine *will* go outside the orthodox medical community:  either to the doctors who are brave enough to prescribe such treatments at the risk of losing their license, or worse, to non-doctors who have not had the proper medical training.  This approach also recognizes this reality and keeps the control more within orthodox medicine, with the benefits that the information gleaned could help focus limited resources towards future clinical trials in the most productive way.  Everybody wins in this admittedly rose-colored approach - I'm sure there are real problems with this approach as well - it is presented more as a strawman to stimulate discussion.  Hopefully what I write here may give the sci.med doctors a better idea as to why I am "open" to alternative therapies, as well as why I have real difficulty (read "apparent hostility") with the "coldness" of the 99.9% pure "scientific" approach to medicine.  I believe the best approach to medical treatment is one where both the "humanitarian" aspects are balanced with and by the "scientific" aspects.  Anything else is just not good medicine, imho. Just my 'NF' leanings, I guess.  :^)  Comments?  Jon Noring  --   Charter Member --->>>  INFJ Club.