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Scottish whiskey manufacturer Thomas Dewar once said: “the Mind is like a parachute. Functions only when open.” And the newspaper publisher New York Times Arthur Hays Sulzberger said, “Well, when the mind is open, but not so much that the brains fell out”.
of Course, the Dewar, and Sulzberger were both right. The great American physicist Carl Sagan joined their point of view in his lecture in Pasadena in 1987, explaining how science should treat new ideas:
it seems to Me that you want to find a delicate balance between two contradictory needs: extremely skeptical examination of all hypotheses that we presented, and at the same time, a maximum of openness to new ideas. If you are just skeptic, new ideas you do not get up. You will never learn anything new and turn into a grumpy old man, convinced that the world is ruled by stupidity (of course, there's plenty of data to support this point of view). If you're open to such an extent that they become gullible, and you lack scepticism, you are not able to distinguish great ideas from the worthless. If all the ideas for you have the same value, you lose, because then, as far as I can tell, the ideas do not have any value.
On the pages of this book, we also tried to find a middle ground: to be open-minded to all methods of alternative medicine and their claims and at the same time to expose each of them a severe test. In General, the primary served as a test of clinical research. Getting them to put about two hundred and fifty years ago, James Lind, and in the next century, their technique honed Alexander Hamilton, Pierre Louis and many other medical scientists. Clinical trials and still remain remarkably simple and powerful tool for uncovering the truth. Indeed, the description of the clinical trials, once given by Pierre Louis, is true today:
Suppose that during a certain epidemic, five hundred of the sick, taken indiscriminately, are treated by one method, and another five hundred are also taken randomly. If the mortality rate among the first five hundred higher than among the latter, shouldn't we conclude that the method of treatment of the first group fits smaller or not as effective as the second method of treatment?
Because we tried to be both impartial and skeptical, and rely on the best available data, our overall conclusion is quite simple. The effectiveness of most methods of alternative medicine in the treatment of most diseases is either not verified, or refuted by scientific evidence, and some methods can even harm patients.
will Always be new research that adds new knowledge to the existing one, so perhaps unconventional methods of treatment, which now seem ineffective, will be bringing substantial benefits. However, in 2007, when we worked on the book, there were several major new studies that further discredited alternative medicine. The results of one of the most significant published the British Medical Journal entitled “Acupuncture as an adjuvant in addition to therapeutic exercise for osteoarthritis of the knee: a randomized controlled trial” (Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial). The researchers gave advice and prescribed exercise to 352 patients, and then a third did not receive any more treatment, one third was treated with real acupuncture, and the remaining third were held the sessions of fake acupuncture with telescopic needle.
the Conclusion was: “Our tests failed to prove that acupuncture is a useful complementary method in addition to the individualized course of physical therapy for elderly people with osteoarthritis of the knee”. This conclusion is confirmed and conducted by Eric Manheimer analysis of all recent data, the results of which were published also in 2007. They became a serious blow for acupuncturists, who claimed that acupuncture for osteoarthritis of the knee joint – they are the most effective procedure. This achievement acupuncture even won a special mention by the Prince of Wales in an address to the who in 2006. And now it turned out that the pearl of the collection of acupuncture is bogus.
We wrote this book because I wanted to acquaint readers with the results of the most important studies on alternative medicine, hoping that then it will be easier to make informed decisions concerning their own health. But what about those who have not read this book? What about the millions of patients who only see that sensation in the Newspapers, big promises on the Internet and deceptive advertising in shop Windows? Is it fair that they may spend their money and risk their health, turning to alternative medicine?
One of the biggest problems is that patients entering into the world of alternative medicine, is practically not protected. Homeopathic medicines, for example, you can buy over the Internet, and the pharmacy, and everyone who declares themselves a homeopath, in any case, the sellers are lying, promising that the drugs will help patients, because of the proven homeopathic remedies do not cure, because the process of cooking illogical. Similarly, couples who want to have children, beating infertility, often spend a lot of money on herbalism, although there is no reason to assume that herbal remedies help, as no reliable data is showing. Chiropractors are putting their patients large doses of x-rays, manipulation is performed on the fragile bones of infants and with great force affect the neck in adults, despite the fact that in many cases, these methods do not bring any benefit. And so on, because the acupuncturists, spiritual healers, specialists in Reiki, shiatsu and other non-traditional methods of treatment make totally unjustified, but a very attractive statement.
it is Noteworthy that if a regular doctor will give such ridiculous promises and offer such an untested and risky methods and tools would be suspended from the practice of, and possibly will give in court.
Conventional and alternative medicine both set themselves the same task, namely to cure the patient, but the first is strictly regulated areas, and the second – a sort of Wild West of medicine, where there is complete lawlessness. This means that patients who have decided to turn to alternative medicine is subject to be deceived, lose their money and to harm their health.
the Good way out would be to create a level playing field where alternative medicine would have to meet the same high standards as conventional. The same for all legislative regulation would provide protection to all patients, whatever treatment they may have used.
In particular, this would mean that all alternative treatment must undergo a thorough inspection, and practice will be allowed only those who prove their benefits exceed the possible harm. The majority of patients are not even aware what a tremendous number of tests are conventional treatments, so it might be worth to briefly describe how to assess and examine, say, pharmaceuticals. Then it will become clear what kind of checks we offer to expose the alternatives, that is, in this case herbal remedies.
the law and the relevant procedures for verification in different countries vary, but the birthplace of the world's largest pharmaceutical industry, the United States, therefore, adopted rules more or less typical of many developed countries. The path from initial research to drugs available to patients, can be divided into six stages.
1. Pre-clinical studies. Scientists test different chemicals to figure out whether they can play a role in medicine. This step may include preliminary tests on animals – scientists have found that there is enough substance effectively and safely. In addition, at this stage, they think, is it possible to organize industrial production of this substance, if it turns out that it is useful. It takes at least five years.
2. Clinical study, phase I. a Potential cure give a small group (from ten to a hundred people) of healthy volunteers to investigate its safety for people. The main goal of this phase is to identify a safe dose range. Phase I takes one to two years and approximately $ 10 million.
3. Clinical research, phase II. Give the medication group (from fifty to five hundred people) of patients with the respective disease. The main objective is to assess the efficacy of medication for people.
At the same time, it is important to establish the optimal dosage and duration of treatment for the next stage of testing. Phase II takes two years and costs approximately $ 20 million.
4. Clinical studies, phase III. Medicine give hundreds or thousands of patients to determine its effectiveness and to identify any side effects. This usually requires randomized clinical trials, in which the group receiving the test drug compared with the control group, which is granted either a placebo or the best existing drug. Sometimes in the course of phase III for better care conducted two independent studies: additional required when it appears that the drug works in only some subgroup of patients, say, patients in the early stages of the disease. Phase III lasts for three to four years and is worth up to $ 45 million.
5. Consideration of the Management of quality control food and drug administration. If phase III is successful, probably the news about the new drug will reach the General public. However, before the medicine becomes available to patients, research must be reviewed by the Office for quality control of food and drugs in the United States and in other countries, similar organizations, such as the European medicines Agency. It takes another year or two.
6. Post-marketing surveillance. Even when the medication has been tested and is sold by prescription or without a doctors will continue to record any adverse reactions, notify the Office for quality control of food and medicines. This ongoing monitoring is very important because there is always the possibility that phase III was missed some side effect.
These huge sums quoted in the magazine Scientific American back in 2000, so in recent years, they are likely to be substantially increased. Moreover, only one-third of all drugs that enter into phase one clinical trials reach the stage of application of patients when the drug is allowed to market.
Thus, conventional medicines must overcome significant obstacles that require a lot of money and a lot of time, but only this level of checking ensures the protection of society from harmful or ineffective drugs. Such rigorous testing should strengthen the patients confidence in the effectiveness of drugs, and it would be very reasonable to demand the passage of such research and the same legal regulation and methods of nonconventional medicine.
However, in the case of alternative medicine, apparently, will have to do the tests in reverse order, because the methods are already widespread, while the above-described pharmacological procedure developed for the completely new drugs. If millions of people already treated, say, herbal remedies or acupuncture, it is more logical to assess the safety of these methods, based on the experience of patients. For example, specialists in alternative medicine may be obliged to describe in detail any adverse reactions and register them in a Central database. Next, you will expose non-traditional methods of treatment clinical trials to determine under what conditions (if any) they are effective. Finally, if some unconventional method of treatment passes this test, scientists will investigate what is the mechanism of action, and will be able to conduct preclinical studies.
Reverse the order of the stages in the first place puts the safety of patients as they are already dealing with alternative medicine, but in the end it still requires the same rigorous scientific testing. Such thorough testing is very expensive, but remember that alternative medicine is a multibillion-dollar global industry, so it's only fair that she spend part of their huge profits to the inspection of the goods and services that it sells to people. Moreover, medical research in the budget of all States necessarily pre-allocated a certain amount of money, so they could act in concert and to allocate some of that money on high-quality clinical trials dedicated to the validation tools that are most in demand, and the most popular methods of treatment.
the Procedures performed in the reverse order, as usual, will take several years. In the meantime, waiting for their results, States could require that non-traditional medicines put only such labels, and experts on traditional medicine did only those statements that accurately reflect the available evidence. It proposes Dylan Evans in his book, “placebo” (Placebo). For homeopathic medicines it offers to stick such labels:
Attention! The remedy is a placebo. It works only if you believe in homeopathy, and only when certain conditions, e.g. when the pain or depression. But even then, its therapeutic effect is likely to be weaker than conventional drugs. Maybe this means there will be less side effects than conventional medications, however, use less.
We believe that the idea of Evans deserves attention because it is such an open, honest and accurate warnings will surely help the patients. If the effectiveness of a nontraditional remedy is proven on the label should be written in tips, similar to what we see in conventional pharmaceutical preparations. All other non-traditional drug labels should look more like the warnings of the health risks involved, like labels on cigarette packs. Warnings in this style might appear on packages of tablets and on the web sites, and brochures that are spread in hospitals. And in each case they would have to inform patients about whether the scientific data confirm the effectiveness of a particular treatment.
Attention! Evidence of the effectiveness of this method is confirmed by only a very limited ability to help with certain types of pain and nausea. Even if acupuncture and therapeutic for these conditions, it is short-term and insignificant. Acupuncture more expensive conventional methods of treatment and in most cases less effective. Probably its effects for pain and nausea mainly caused by the placebo effect. Under any other conditions acupuncture has no therapeutic effect beyond the placebo effect. Sessions lead by an experienced acupuncturist, is usually safe.
Attention! This method of treatment can lead to stroke and death, if manipulations are carried out on the cervical spine. Manipulations on other parts of the spine are relatively safe. It is proved that in the treatment of back pain, this method brings some benefits, but conventional treatments are usually equally effective and much cheaper. Under any other conditions chiropractic has no therapeutic effect beyond the placebo effect.
the Herbs: oil of Oenothera biennis
Attention! The remedy is a placebo. It works only if you believe in it and only under certain conditions, treatable placebo-drugs. However, in this case, the placebo effect cannot be predicted, and its therapeutic effect likely to be weaker than conventional drugs. Maybe this means there will be less side effects than conventional medications, however, use less.
Herbal medicine: St. John's wort
Attention! This tool can interact with other medications, so before taking consult with your doctor. There is evidence that it is effective in the treatment of depression mild and moderate, but no more than the existing pharmaceuticals.
These brief descriptions reflect the whole range of complementary therapies, among which are unproven or unfounded, and refuted, and unsafe, and “dummy”, and brings only a small benefit, and almost certainly effective. Of all the methods for which we gave warning signs, the positive feedback received treatment with St. John's wort. In fact, clinical trials of St. John's wort produced such good outcomes that scientists and General practitioners endorse its use. Conventional medicine refers impartially to any unconventional methods that can prove its value from the point of view of safety and effectiveness.
Another fine example of the unconventional medicines that conventional medicine readily incorporated into your Arsenal, is fish oil. It is sold in capsules and falls under the category of biologically active food additives, which are discussed in the Appendix.
The impetus for close examination of possible use of fish oil was the observation that Eskimos eating mostly fish, there are virtually no cardiovascular disease. Therefore, scientists have turned to epidemiological studies of other populations, and in the end conducted clinical trials, which gave very positive results. In the end, everyone was convinced that fish oil is safe and effective as a means for long-term prevention of coronary heart disease. A detailed study also revealed that daily consumption of capsules of fish oil prolongs life by an average of one year. Those who rarely eat fatty fish, take fish oil capsules are definitely beneficial. Fish oil also reduces inflammation, helping with arthritis and people with different skin problems.
Fish oil and St. John's wort – a wonderful examples of drugs that have been used since ancient times, then moved as a means of alternative medicine, now accepted in official medicine. Fish oil is so widely used that most doctors no longer consider his unconventional means, and St. John's wort appears to be moving in the same direction. The Annex describes several areas of alternative medicine, which I approve and conventional doctors, especially those methods that improve overall health through relaxation and stress relief, that is, such as meditation and massage.
Develops a curious pattern: if it is proved that any non-traditional method of treatment is effective and safe, it ceases to be alternative medicine and becomes generally accepted. Therefore, alternative medicine is, by definition, consists of treatment methods that fall under one of the following categories: untested, unfounded, disproved, unsafe, “dummy” and brings only a small benefit.
However, experts on alternative medicine continue to bear his name, like the order, giving with it undue weight low quality methods. They use the term “unconventional” to emphasize, though, involve some alleged alternative aspects of science. However, the truth is that there is no alternative science, as there is no alternative biology, alternative anatomy, alternative research and alternative evidence.
the Scientific method is a universal approach to the assessment of any medical intervention. Results that gives the scientific method, never complete and perfect, but they step by step bring us closer to the truth. The term “unconventional” is just an attempt to evade the truth, replacing the knowledge obtained by the scientific method, conjectures gleaned from other sources. We are talking about could be the best choice, the inventions and traditions, that is, alternative medicine is based on the personal opinion of the person, other people's opinion and the opinion of our ancestors. However, in the introduction we gave a saying: “For the essence, two things: science and opinion; the first begets knowledge, the second – ignorance.”
Though Hippocrates wrote these words more than two thousand years ago, it took us a phenomenally long time to take them seriously. But when we finally, about a hundred and sixty years ago, medicine began to emerge from the medieval state, and the doctors refused methods like bloodletting, are more dangerous than the diseases themselves of which they were treated. Since then, progress was rapidly and steadily. Vaccination has eradicated deadly infection. The diseases afflicting millions of people, and hitherto considered incurable, appendicitis, diabetes and many others – are now treatable. The infant mortality rate has dropped significantly. The pain in most cases can be kept under control. And in General we are living longer and enjoying better quality of life. And all this thanks to the application of the scientific method in health and medicine.
alternative medicine, on the contrary, by its very nature – a relic of the middle ages. Too many practitioners of unconventional treatments, it is interesting to find out how those safe and effective. They also do not want to recognize the importance of strict clinical tests, allowing to produce evidence in favor of a check of the method or against it. And even if you have already obtained strong evidence that these or other methods are ineffective or unsafe, experts in alternative medicine continue to use them as if nothing had happened, tightly closed ears.
Despite this alarming situation, the market and services of alternative medicine is thriving, and the General public again and again deceived, often misled by the professionals who themselves sincerely believe in these methods, and sometimes cunning charlatans.
, We declare that it is time to end this deception and give way to those methods that really help patients. In the name of honesty, progress and good health, we encourage you to enter scientific standards, evaluation procedures and their legal regulation for all kinds of medicine so that patients could be assured that their cure methods, just bringing more good than harm.
If you do not apply these standards to the industries of alternative medicine, homeopaths, acupuncturists, chiropractors, herbalists and similar specialists will continue the hunt for the most desperate and vulnerable members of our society, peeling their pockets, risking their health and giving them false hope.
the Passage from the book of Simon Singh and Ernst Edzard "no wallet, No life. Alternative medicine under investigation"
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