[Trick or Treatment?]

Trick or Treatment?

I will write my comments about the book "Trick or Treatment?" by Simon Singh & Edzard Ernst (Japanese Edition, published in 2010), which verifies the effectiveness of alternative medicines.

After I got certain recovery from my suffering of severe atopic dermatiis, I works as an alternative medicine practitioner, chiropractic and NAET(Nambudripad's Allergy Elimination Techniques), about half of my week, another half as an ordinary dermatologist as well.
As an alternative medicine practitioner, I read this book with a deep interest.

The summery is as follows;
The first chapter explains past examples of pursuing ways for the truth.
The second, third and fourth chapters are for verifications of Chinese acupuncture needling, chiropractic and herbal therapy, respectively.
About other traditional/alternative/complementary medicines, two pages are given for describing each treatment at the end of the book.

They examined reports of those alternative treatments statistically for "evidence based medicine" and resulted that
acupuncture showed meaningful varidity only in a part of nausea and pain, chiropractic is somewhat effective in back pain and St John's wort is good for just mild depression among herbal medicines; all of other indications were not verified to be effective.
While they revealed there are harmful cases like traumatic injuries by acupuncture, cerebral infarctions (possibly lead to death) and toxic effects of some herbs or their contaminating substances and interference of some harbal medicines to other necessary drugs .
Moreover, in any alternative therapies, the authors emphasized the risks to lose a chance receiving a proper standard treatment of conventional western medicine and nevertheless to lose therapeutic fees in vain.
They are quite worrying of patients to be such victims.

The final chapter entitled "Is truth necessary?" argues the core of the alternative medicine issue;
Is it necessary to be truely effective, or even pracebo effect will be OK because patient can be better anyhow?
I felt the argument especially interesting, though it end with an orthodox conclusion that we should not go back to the past ignorant days.

Now, my impressions and arguements.

First, I was knocked by the superb title, "Trick or Treatment?".
Of cource, its a parody of too famous Halloween children's typical phrase.

The well-known rhythmic saying would have attracted lots of readers in British bookstores.
It appeals the exact theme of the book in very short words.
Additionary, by radiating its own playfull mood from this title, they could also play with alternative medicines as if they are shams.
I could not help admiring.

And, the writers' estimaing stance is generally fair, composed, practical, rational, analyzing and logical from beginning to the end.
They are mostly neither arbitrary nor forcible.
(Just about a case of needling anesthesia demonstration I felt dissatisfied because though they decided it was a quackery prearranged by several sedative drugs, but sufficient corroborative informations were not seen there.)

As a whole this is a book one should read through once who has certain interest in alternative medicines.
But it has quite a volume (451 pages in Japanese Edition), not easy to finish.
I will also write this for people who are interested in but do not have a power to read the book by him/herself, picking up interesting contents of it.

Now, although this book is very good, it did not switch me to stop performing the noneffective arts of alternative medicines.

As I read, I felt I was one who would be crassified into alternative medicines therapists described in this book as below;

"The thought [In medical treatments, there are some other kind of thing which is not scientific.] makes us go back to dark ages.
There are too many alternative medicines therapists who are not willing to see security or effectiveness of their own medical interventions.
Such therapists can not understand the importance operating hard clinical trials and getting scientific evidences to assure or deny their treatments.
Then if there already are scientific evidences showing certain ineffectualities or dangers of the treatment, the therapists will close their ears to the informations and continue their treatments still."

"There would be alternative medicines therapists who intentionally sell useless remedies to seriously diseased people and are complacent by making money.
However, we have to emphasize most therapists are with the best of intentions.
Misleaded by wrong ideas, the therapists believe their interventions are truely effective."
(Note: As I don't have the original book written in English, these writings are by my translating back from Japanese sentences. Samely, sentences and phrases afterwards between " and " are all my backing tranlation.)

As they say, everyone hates the idea that he/she is doing a wrong act. So as to me.
However that may be, don't think I am just becoming obstinate to deny my wrongness.

While their wonderfully organized telling taught and warned me much, I could not agree them totally because I felt they described not just perfect objective truths, but added their interpretation or their uncontious intension to fit the facts to their hoping directions.

For example...
First, they talk much about acupuncture though they do not estimate whole oriental medicine or traditional Chinese medicine.
They say "because whole oriental medicine is too complicated to analyze here" in only an unnoticed phrase of those enormous sentences, whereas writing repeatedly side by side "Acupuncture, chiropractic, homeopathy.." as representatives of alternative medicines to be useless and/or dangerous.
I don't think it's fair.
Repeated saying "Acupuncture is proved to be ineffective" should exactly have an effect to put an image as "Whole oriental medicine is proved to be ineffective" in brains of readers who know that acupucture is a main technic of oriental medicine (i.e., all readers).

Second, stages on which they argue are almost always where modern western medicine are good at.
There are only common cold and lumbago that they pick up as weak points of conventional western medicine. (Even in lumbar pain, they highly estimate physiotherapy and advices to daily lives, which are often cut down in busy actual crinical consultations.)
I think they should more discuss about diseases modern medicine can not cure sufficiently where the needs of alternative medicines emerge.

Third, about an alternative medicine technique I actually operate; the craniosacral therapy which assert a combinated small motion between sacrum and occipital bone.
They comment about it as below.
"Generally, both cranial bones and sacral bones are attached and make fixed structures.
Even if there may be a slight motions between the bones, it's hard to think that the motions affect human health.
In short, the craniosacral therapy is based on a theory which is hard to think biologically."
As everybody know, blood can circulate through whole body because heart the pump push it out.
I want to ask them, then, what do they consider is the propelling power to circulate cerebrospinal fluid (CSF) through whole body around brain and spinal cord continuously nourishing them?
It's logical biologically to consider the propelling pump is the harmonious motions of cranium and sacrum.

Fourth, in the last chapter, they braim culprits of spreading ineffective alternative treatments, one of them as to be doctors, saying,
"Patients who feel 'My physician do not take much time for me and show neither consideration nor sympathy to me.' turn to alternative medicine therapists who 'take time for me and show certain understanding and sympathy'."
This analysis is realy true, but their proposal of the countermeasure is to make a budget for doctors to take more time for each patient.
I think it's impossible because a deep care requires its own cost and the standard medical care aim not to a deep care, but to a proper care.
So in this aspect, the authors are champions of justice in a virtual world.

Fifth, in the chapter about homeopathy, they criticize a TV report of an medical reserch published in 2005 to help ordinary people overestimating the alternative therapy.
In the report, "They said that 70% of 6500 patients of chronic diseases who had received homeopathic treatments in Bristol Homeopathic Hospital described that their health conditions had improved."
The first reason they take the research negative is, "Since there was no control group, it remained unknown that the improvement could be gotten if they had no homeopathic treatments."
I grieve for their stance who can find no meaning except the most reliable randomized control study !

Of cource, the randomized control study is the best research design, but it takes tremendous time and labor, has special difficulty preventing drop-out and may cause ethical problems by intentionally refraining from treatments in the control group.
Therefore, I think reserchs of other designs also should be taken into more account, especially a reserch of massive (6500 patients) long-term (for 6 years) follow-up like this.

The authors quate the words of Hippocrates like below as their guide.
"There are two things, namely science and opinion.
The former give rise to knowledge, the latter ignorance."
So they declare their plan to see alternative medicines from a viewpoint not of opinion, but of science.

However, scientific proof got in evidence-based medicine is in short... a statistic.
If 210 persons died from untreated 500 and only 15 died from treated 500, then the treatment is recognized to be effective.
Because there are significant diffence between the two group, too unreasonable to happen by chance.

I feel an quibbling, but primary doubt about it, i.e.,
...should it truely be called as a science?

Because, I think if the method is scientifically effective, it should show its effectiveness to 100% subjects, namely to all 500 pateints from 500 treatd by it.
The existence of even one or two ineffective patients means the same effective responce is not happening in the exceptional person's body.
Unreasonable, isn't it?

Actually, since a real human body is an extra-complicated system, the same drug can not necessarily cause the very same response in different persons' bodies.
Then, even a perfectly designed randomized control study within human intelligence might contains an accidental deviation between the separated two groups.
I mean even performed by randomized control study, the result should be confirmed by repeated tests before the result is decided to be a truth.

On the other hand, we should never make light of a life.
A diseased person always should be treated by considerable treatments as early as possible.
That means randomized control study is originally quite difficult to be done repeatedly and we could not help relying on hardly gotten few results.
I wonder such incomplete verifiable measure is suitable to be regarded as a science?

In Japan there was a lawsuit concerning an inappropriate exertion of a homeopathic treatment through 2009-2010.
A midwife recommended a mother's baby to take an homeopathic remedy instead of regular supplementary vitamin K syrup. The baby died of intracranial bleeding due to natural neonatal luck of vitamin K dependant coagulants.

A new-born infant does not yet have ability to make sufficient vitamin K it needs in its body and the luck of vitamin K leads to the luck of vitamin k dependent coaglants which may result in serious bleeding.
Though there's such obious cause and effect relationship, clear awareness of the fatal affect of the lucking and no adverse effect of vitamin K supplement, she made the baby lose the chance to get vitamin K; I think that's definitely silly !

When we treat 100 babies by vitamin K2 syrup, the treatment work well for all of the 100 babies preventing them from serious bleeding (and no adverse effect by taking vitamin K).
You see, this is a science, and an ideal medical treatment at the same time.

If the visible effects is not seen in 100% of the treated cases, it's inevitable we should add some interpretation to failed cases.
There appears a space the obsever's arbitrariness might steal in.
And an dditional problem also arise whether the small number of failures could be acceptable or not.

Above consideration takes me to an exorbitant idea that it might be a kind of arbitrariness to regard statistical significance as to be the only justice.
Is this a violent assertion?
As a mass, sufficient big number must be the justice.
But for an individual person in the mass group, the only fact is what oneself experienced.

For example, when a child suddenly died soon after a vaccine injection, what would the family feel ?
They can not help holding a deep regret that if they stopped him/her taking the vaccination, he/she would be here now alive.
For them, evidences which prove definitely rare occasion of a fatal advese reaction to the vaccine will be totally no use.

Yeah, of course vaccination is an important medical mesure, I agree.
We should previously know all risks and benefits of a vaccination before we conclude to inoculate it or not.

I want to say that the evidence is neither a scientific fact nor a conclusion.
It's mere a statistical data.
It's just one of a quite useful reference materials to reach to a proper conclusion.

So a useful reference data like this book should be ready to be read for anyone who need such informations.
After knowing these data showing unvalued results with other informations, the decision whether he/she take the alternative treatment or not is in his/her hands.

In the disturbance of homeopathy in 2010 in Japan, the Science Council of Japan judged homeopathy to be ridiculous and warned Japanese medical practitioners against their homeopathic exertion.
A paper quoted by them as a proof of the ineffectiveness of homeopathy is the one written below:
Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy
Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Steme JA, Pewsner D, Egger M.,
The Lancet, Vol.366(9487), Aug 27-Sep 2,2005, Pages 726-32.

This thesis analyzed all collectable past homeopatic reports (110 reports) as well as contrasive conventional medical reports and estimated treatment effects in trials least likely to be affected by bias.
The conclusion was, 'This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.'
But there were smaller trials showed more beneficial treatment effects than larger ones in homeopathy groups as well as conventional medicine groups.
The smaller ones are judged to be less reliable.

However, if you are or your family member is exactly the one benefited by the small reserch, then what will your feeling be?
"Wonderful homeopathy !", isn't it?

Everyone just desire his/her own better health.
To put it in an extreme way, the only concern anyone has is to cure the ongoing disease of himself/herself, even if how other people's prognosis will be.
Therefore, I predict any reliable evidence could never exterminate alternative medicines.

As written in this book, one reason making patients leave usual western medicine doctors and go to alternative medicine therapists instead is in the medical doctors who lack ability to arrange good relationships with their patients due to short consultation time or so however technicians they may be.

But I think there is a more primary problem the authors should have picked up, that is,
1) there are diseases and disease conditions conventional medicine can not properly cure, and
2) moreover, in some cases modern conventional treatments might even come to harm.

Treatments of conventional modern western medicine gererally are in sharp nature and tend to become stronger while evolving.
The tendency leads to those clear-cut effects (like significant decrese of laboratory data counts) in clinical testing.
On the other hand, western medicine pay less attentions to possibilities the sharp medication may cause another adverse effect at any other parts of human bodies.

Just like cases of anti-TNF alpha agents which amazingly deminish clinincal symptoms in chronic rheumatic arthritis or psoriasis, but might trigger fatal infections due to immunosuppressing.
So as to magical effects of steroids or calcineurins in Atopic Dermatitis or other immunorelative diseases and their serious side effects in excess usage.

Certain vaccinations may be another examples.
It's obious vaccination is definitely beneficial as an life-saving masure for us and our society.
But excess vaccination might be harmful for some people.

In Japan, vaccines of Hib, Streptococcus pneumoniae, Rotavirus, Hepatitis B, polio (inactive) and chickenpox have been induced into clinical use one after another in these several years.
It means a healthy baby is recommended to receive 10-20 times injecitions within 1 year after birth.
Indeed, with the benefits to those vaccines, adverse reactions from the injections will accordingly increase as well.
Can we say it is really good for better health ?

If it is a disease sufficiantly curable by conventional western medicine, with little or no anxiety of negative side effects, without too much costs, then it's no doubt everybody will choose to be treated by that.

The main reason why there remains needs to rely on some alternative medicines is, I think, certain areas modern medicine can not cure enough are still exist.
If going to a hospital or clinic brought about no improvement to one's disease, if his/her suffering is not healed after he/she got plenty of conventional treatments, if the doctor says his/her sickness is of unkown origin and there's nothing the doctor can do for him/her...
the rest for him or her is to explore another possible measure.
As far as medical therapies are finite arts performed by mankind who never be almighty, some alternative medicines are always necessary.
I regard the significance of altermative medicine as a possibility or as a challenge.

So, I agree with the opinion of this book that it's vain to bet on treatments which have no beneficial possibility.
The book will be a good reference to distinguish utility of treatments.

I will end this article with a quotation from the book, a saying of Carl Sagan, a famous physicist in America.

"I think we should keep a delicate balance between two following contradictory need;
to examine proposed hypothesis with thorough doubt
and at the same time to open our heart widely to new ideas.
If we are just doubtful, we can never understand a new idea. We can not study any new things...(omitted)...
While if we open our heart so widely that we would be easily cheated without any doubtful thinking, we can't distinguish a useful idea from a useless one."

Above viewpoint would be a good principle when you examine and judge any alternative or complementary treatments you are interested in for your condition to improve.

You see, your body is yours.
You decide freely how to treat it, hopefully without any loss.

As an alternative medicine therapist and a modern conventional medicine practitioner as well who observe both of them daily, I feel sorry the results of the analysis of this book.
While I face the result and admonitions calmly, but taking it as a result and not a whole one, I continue my travel to search alternative possibilities.
For people who cannot live contently with only conventional medical measures, just like I used to be.

At the end I add NAET(Nambudripad's Allergy Elimination Techniques), an alternative medicine now I also am performing has an randomized control study report which revealed validity of nutritional allergy elimination technique in autism (Please see below).
Improving Comminication Skills in Children With Allergy-related Autism Using Nambudripad's Allergy Elimination Techniques: A Pilot Study
Jacob Teitelbaum, Devi S. Nambudripad et al.,
Integrative Medicine, vol.10,No.5,Oct/Nov 2011, Pages 36-43

2012.10 (translated in 2012.11)  


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