Acupuncture and Herbal Medicine - Unfortunately Supported by Evidence

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Pythagoras a trois: Feb 19, 2004; I have a lot of points to make and I will make them later.

Who likes an OP full of quotes from another thread?

I don't like either acupuncture or herbal medicine, which is why it annoys me that there's evidence that they're medicinally beneficial that stands up to modern scientific rigor. This was brought up as a derail in another thread, so here we are. My argument is that the Acupuncture and herbal medicine have medicinal benefits that are backed by double blind clinical trials, the gold standard of what's 'real'. Where we left off:

Kiwi Ghost Chips posted:

Cheekio posted:
Sure, here's a couple of studies where accupuncture is tested vs fake needling and appears to have effects against chronic lower back pain, tension headaches

Oh dear. First, acupuncture's publication bias is strong and well-known. These meta-analyses (both of which only find tiny positive results) also pool together studies using different types of sham acupuncture as the controls. Some did needle insertion at the "wrong" points, while others did superficial needle poking. The latter (besides making it impossible to blind the caregiver) also only shows efficacy of sticking needles in, not "meridians." Finally, both meta-analyses had experienced acupuncturists rate how good the technique was of the studies, and they disagreed with each other quite a bit.

You're citing an article that lists eastern countries' publication bias, and reviews papers from the 60's up until 96. For starters, there's a strong agreement between western and eastern medicine that there are medical benefits to acupuncture, the article is primarily arguing about a matter of degrees:

quote:

Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively.

Also, this timeperiod mostly predates the widespread acceptance of evidence based medicine, and while double blind trials are ancient and evidence based medicine was a common topic for research and discussion in the 1980's, it really caught fire in the early 90's when it became standard teaching practice.

The meta analysis I posted here also pulls much more recent articles:

quote:

We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003.

Kiwi Ghost Chips posted:

Cheekio posted:
and here's a study testing echenecea vs cold symptoms. All show statistically significant improvements vs their control groups.

Which disappears in the meta-analysis: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000530.pub3/abstract

Point taken. I withdraw my use of echenecea as an example of herbal medicines being of medicinal value. I'll stick with the cannabis example, having a better clinical track record and, I think, qualifying as herbal medicine.

evilweasel posted:

To explain why the "alternative medicine" can find statistically significant results - statistically significant simply means that, assuming the null hypothesis (that the thing is worthless compared to a placebo) you'd get the result you got by chance only one out of 20-100 times (depending on the confidence interval used). But when you've got something with as much quacks believing in it as this, you're going to have 20-100 studies, and therefore one, by chance, will appear statistically significant. You pick that one, ignore the rest, and it seems proven. You notice the other failed tests, and you can figure out what happened.

That said, this is a better subject for a different thread.

I think we agree that looking at meta-analyses will help avoid cherry-picking the outlying studies that prove our points. See: echenecea being a bad example.

# ? Oct 23, 2014 20:08

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# ? Apr 29, 2024 00:14

Smudgie Buggler: Feb 27, 2005; SET PHASERS TO "GRINDING TEDIUM"

I actually don't think cannabis qualifies as herbal medicine in the sense that it ought to give you shits because it's fundamental bullshit non-medicine that hippies insist unclogs your chakras or whatever with some incidental medicinal benefits. Cannabis is just medicine at this point. There are plenty of medicines that are perfectly legitimate (ie. not alternative medicines, just loving medicines) that are derived from plant matter. That shouldn't be an annoying fact. The plant kingdom produces a lot of various chemicals, some of which we've discovered quite legitimately are good at healing illnesses or alleviated symptoms. That ain't bad.

The real bullshit of 'herbal medicine' is the kind sold by snake-oil salesmen to gullible shitheads who are told their child doesn't need antibiotics for that pneumonia don't you know that's just big pharma trying to steal your money no no here just buy this tiny jar of powdered lavender root for a fuckload more than it's worth and have her huff a steam-bath with this poo poo three times a day. That kind of nonsense is dangerous. Cannabis is just good medicine for a lot of people. Don't hate on poo poo that works.

# ? Oct 23, 2014 23:11

Dancer: May 23, 2011

About the herbal stuff: I'm not sure what statement you're trying to make. If the statement is "plants can be effective therapy", then yes, that is undoubtedly true, and something that doctors and reasonable people cannot disagree with. Aspirin is derived from willow, you can take your cannabis example, etc. My problem would be that you *seem* to be implying (you're at least slightly ambiguous) that this reality of certain herbs actually having a therapeutic effect grants some credence to schools of thought like "alternative medicine" or "traditional medicine". People who ascribe to these schools of thought (which do not have formal definitions, and every user/practitioner/researcher defines differently) tend very much to not rigourously apply the scientific method. If an MD recommends the extract of plant X to me, I assume he was taught that in medical school or some conference he went to, where the information presented was obtained properly, by scientists. Obviously, this assumption is not always correct (there are plenty of actual doctors who also fail to accurately assess information they obtain), but it is much more likely to be wrong for someone who calls themself a naturopath, or herbal medicine practitioner, or alternative medicine practitioner, etc.

(and slight bonus: Just like the extract of the willow was slowly optimized into aspirin, I can basically guarantee you that whatever effect cannabis has, will become better and/or more consistent if we figure out the right dosages and delivery methods. At the very least there will be less side-effects).

# ? Oct 23, 2014 23:14

Dancer: May 23, 2011

BTW, I will highly recommend the blog Science Based Medicine for lots of articles on many aspects of alt-med. At the top of the page you will also find links to reference pages. Here are excerpts from the one on acupuncture (it's a fairly large block of text, I understand if you can't be bothered with it all, but it genuinely includes a lot of good points. Only section 1 is slightly "off-topic", but still valuable IMO):

quote:

1. Acupuncture is a pre-scientific superstition

Acupuncture is based upon the Eastern philosophy of chi (also spelled qi), which is the Chinese term for the supposed life force or vital energy that animates living things. In Traditional Chinese Medicine (TCM) chi flows through pathways in the body known as meridians. Illness results from the flow of chi through the meridians being blocked, or by the two types of chi (yin and yang) being out of balance. Acupuncture is the practice of placing thin needles at acupuncture points, which are said to coincide with points at which meridians cross, to improve the flow and restore the balance of chi.

There is no more reason to believe in the reality of chi than there is in the four humors, or in the effectiveness of acupuncture than the effectiveness of bloodletting.

2. Acupuncture lacks a plausible mechanism

Centuries of advancement in our understanding of biology has made the notion of life energy unnecessary. Further, no one has been able to detect life energy or formulate a scientifically coherent theory as to what life energy is, where it comes from, and how it interacts with matter or other forms of energy. Within science, the vitalists lost the debate over a century ago. Without chi, there is no underlying basis for acupuncture as a medical intervention.

Recent attention given to acupuncture has attempted to bring it into the scientific fold by hypothesizing physical mechanisms for its alleged effects. For example, some proponents argue that the needles may stimulate the release of pain-killing natural chemicals, relax tense muscles, or inhibit the conduction of pain through counter-irritation.

These potential mechanisms, while more plausible than the non-existent chi, remain speculative. Further, they would only explain the very non-specific effect of acupuncture causing a temporary mild reduction in pain (no better than rubbing your elbow after accidentally banging it against something hard). Such mechanisms could not account for any of the medical claims made for acupuncture, or the alleged existence of acupuncture points.

Further, it is misleading to say that such mechanisms could explain �acupuncture.� Acupuncture is the needling of acupuncture points to affect the flow and balance of chi. Using needles to mechanically produce a temporary local counter-irritation effect is not acupuncture � even though it may be an incidental consequence of this practice and may have contributed to its perceived effectiveness.

3. Claims for efficacy are often based upon a bait-and-switch deception

The most common example of the �bait-and-switch� for acupuncture are studies that examined the effects on pain of electrical stimulation through acupuncture needles. This is not acupuncture � it is transcutaneous electrical stimulation (TENS), which is an accepted treatment for chronic pain, masquerading as acupuncture.

Electrical stimulation is no more acupuncture than if morphine were injected through a hollow acupuncture needle and then claimed that any resulting pain relief was due to �acupuncture.�

Further, during a typical acupuncture treatment there are many other incidental effects that may occur. The atmosphere is often relaxing, and practitioners typically will palpate the �acupuncture points� prior to inserting the needles, for example. Practitioners also provide their kind attention, which has a positive psychological therapeutic value. There are therefore many nonspecific subjective effects that could lead to clients feeling better, making the actual insertion of needles an unnecessary component.

Reports of acupuncture anaesthesia are also misleading. Independent investigation shows that patients having surgery under anaesthesia (dramatic reports of which are largely credited with acupuncture�s popularity in the West) reveal that patients were receiving morphine in the IV fluid. Other reports indicate that patient were experiencing great pain, but were simply instructed to remain quiet by the surgeon (a product of Eastern culture). There are no verified reports of acupuncture serving as effective anesthesia during surgery.

4. Clinical trials show that acupuncture does not work

It is important to evaluate the literature as a whole to see what pattern emerges. The pattern that does emerge is most consistent with a null effect � that acupuncture does not work.

Controlled clinical trials of actual acupuncture (uncontrolled trials should only be considered preliminary and are never definitive) typically have three arms: a control group with no intervention or standard treatment, a sham-acupuncture group (needles are placed but in the �wrong� locations or not deep enough), and a real acupuncture group. Most of such trials, for any intervention including pain, nausea, addiction, and others, show no difference between the sham-acupuncture group and the true acupuncture group. They typically do show improved outcome in both acupuncture groups over the no-intervention group, but this is typical of all clinical trials and is clearly due to placebo-type effects. Such comparisons should be considered unblinded because patients knew whether they were getting acupuncture (sham or real).

The lack of any advantage of real- over sham-acupuncture means that it does not matter where the needles are placed. This is completely consistent with the hypothesis that any perceived benefits from acupuncture are non-specific effects from the process of getting the treatment, and not due to any alleged specific effects of acupuncture. In other words, there is no evidence that acupuncture is manipulating chi or anything else, that the meridians have any basis in reality, or that the specific process of acupuncture makes any difference.

More recent trials have attempted to improve the blinded control of such trials by using acupuncture needles that are contained in an opaque sheath. The acupuncturist depresses a plunger, and neither they nor the patient knows if the needle is actually inserted. The pressure from the sheath itself would conceal any sensation from the needle going in. So far, such studies show no difference between those who received needle insertion and those who did not � supporting the conclusion that acupuncture has no detectable specific health effect.

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study the smaller the effect, and the best-controlled trials are negative. This pattern is highly predictive of a null-effect � that there is no actual effect from acupuncture.

# ? Oct 23, 2014 23:24

Chernobyl Prize: Sep 22, 2006

I'm hoping for great things from this thread. I want to hear about acupuncture/pressure, crystals, homeopathy, and chiropractic medicine. I've never heard of marijuana being called alternative medicine, when discussed for health reasons it's always medicinal marijuana as if everyone knows it's not bullshit.

# ? Oct 24, 2014 03:25

Rent-A-Cop: Oct 15, 2004; I posted my food for USPOL Thanksgiving!

Chernobyl Prize posted:

I'm hoping for great things from this thread. I want to hear about acupuncture/pressure, crystals, homeopathy, and chiropractic medicine. I've never heard of marijuana being called alternative medicine, when discussed for health reasons it's always medicinal marijuana as if everyone knows it's not bullshit.

Medical marijuana is sort of an edge case in that it isn't any more effective in a medical sense than synthetic drugs that do the same thing, but it does get you high so people obviously want an excuse to smoke it.

# ? Oct 24, 2014 03:46

Dancer: May 23, 2011

Chernobyl Prize posted:

I'm hoping for great things from this thread. I want to hear about acupuncture/pressure, crystals, homeopathy, and chiropractic medicine. I've never heard of marijuana being called alternative medicine, when discussed for health reasons it's always medicinal marijuana as if everyone knows it's not bullshit.

Marijuana is just... weird. Because, as Rent-A-Cop said, there was a lot of interest in it, cuz it gets you high. All the other things you mentioned are either 99% or 100% bullshit (the 99% number is there because some of those terms can conceivably also refer to some techniques which can have *some* legitimate therapeutic use, though almost universally far less than what an alternative medicine practitioner will claim).

# ? Oct 24, 2014 04:12

Uranium Phoenix: Jun 20, 2007; Boom.

Chernobyl Prize posted:

I'm hoping for great things from this thread. I want to hear about acupuncture/pressure, crystals, homeopathy, and chiropractic medicine. I've never heard of marijuana being called alternative medicine, when discussed for health reasons it's always medicinal marijuana as if everyone knows it's not bullshit.

I loving hate this poo poo. Every time I go into a rock shop to get rocks (because rocks are awesome), every single loving one is labeled with some bogus ~~special power~~ that the rock has. Can I please just get a halite candle holder without getting told about how it releases ~~positive ions~~ (and destroys negative ones!) or how this geode that's about ten times more expensive than it should be promotes ~~concentration and regeneration~~?

# ? Oct 24, 2014 04:12

wheez the roux: Aug 2, 2004; THEY SHOULD'VE GIVEN IT TO LYNCH

Death to the Seahawks. Death to Seahawks posters.

I hate unproven alternative medicine as much (probably a whole lot more) than most people and fervently believe in evidence-based medicine. If you're biased against something scientifically and rigorously proven to be beneficial just because of what it is or where it came from, then by definition you don't actually support evidence-based medicine and need to get the hell over it and whatever weird cultural biases you're holding.

seriously, how can someone be annoyed at something that has strong, well-defined scientific proof of efficacy? :psyduck:

e: I fully support chucking crystal healers, chiropractors, and homeopaths into the ocean, or denied medicine that contradicts their own personal beliefs because poetic justice is hilarious

wheez the roux fucked around with this message at 05:32 on Oct 24, 2014

# ? Oct 24, 2014 05:28

Uranium Phoenix: Jun 20, 2007; Boom.

wheez the roux posted:

e: I fully support chucking crystal healers, chiropractors, and homeopaths into the ocean, or denied medicine that contradicts their own personal beliefs because poetic justice is hilarious

Send them here:
https://www.youtube.com/watch?v=HMGIbOGu8q0

# ? Oct 24, 2014 06:26

hobbesmaster: Jan 28, 2008

Rent-A-Cop posted:

Medical marijuana is sort of an edge case in that it isn't any more effective in a medical sense than synthetic drugs that do the same thing, but it does get you high so people obviously want an excuse to smoke it.

One of those components of marijuana is an approved FDA drug called marinol. The problem is that its only one of many, the DEA is the only thing preventing the isolation of other chemicals that may be helpful. This leads to the question of why marijuana is schedule I when one of the psychoactive components is schedule III; its all dumb politics.

# ? Oct 24, 2014 15:17

A big flaming stink: Apr 26, 2010

So...is acupuncture shown to have evidence-based medical benefits? Or shown not to? Or is it inconclusive either way? it's hard to tell what with the bickering

# ? Oct 24, 2014 21:26

Dancer: May 23, 2011

A big flaming stink posted:

So...is acupuncture shown to have evidence-based medical benefits? Or shown not to? Or is it inconclusive either way? it's hard to tell what with the bickering

SBM posted:

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study the smaller the effect, and the best-controlled trials are negative. This pattern is highly predictive of a null-effect � that there is no actual effect from acupuncture.

Dancer fucked around with this message at 03:22 on Oct 25, 2014

# ? Oct 24, 2014 21:33

Pythagoras a trois: Feb 19, 2004; I have a lot of points to make and I will make them later.

Dancer, you haven't established 'sciencebasedmedicine.org' as a credible source, and as it doesn't cite research in its conclusions, it doesn't seem to establish itself as a credible source either. Here's a meta analysis of multiple double blind clinical trials where acupuncture was tested against control groups to see if it had any medicinal effect:

http://summaries.cochrane.org/CD001351/BACK_acupuncture-and-dry-needling-for-low-back-pain

The conclusion that the Cochrane Collaboration came to was that acupuncture outperformed the control groups by a statistically significant margin across the many studies they examined.

edit: If you don't mind adding '.org' to your quote I'd appreciate it, as quoting 'science based medicine' is an appeal to a school of medicine that exists beyond that one website you're quoting, and looks intellectually dishonest.

Pythagoras a trois fucked around with this message at 22:43 on Oct 24, 2014

# ? Oct 24, 2014 22:26

Pythagoras a trois: Feb 19, 2004; I have a lot of points to make and I will make them later.

Dancer posted:

About the herbal stuff: I'm not sure what statement you're trying to make. If the statement is "plants can be effective therapy", then yes, that is undoubtedly true, and something that doctors and reasonable people cannot disagree with.

I agree with this, and I think the problem with the discussion about Herbal Medicine is I don't know any way to accurately pin down the terminology to be clearly right or wrong. Echenecea apparently isn't more effective than placebos, but willow bark certainly is.

Chernobyl Prize posted:

I'm hoping for great things from this thread. I want to hear about acupuncture/pressure, crystals, homeopathy, and chiropractic medicine. I've never heard of marijuana being called alternative medicine, when discussed for health reasons it's always medicinal marijuana as if everyone knows it's not bullshit.

The majority of homeopathic medicines I've encountered are just herbal medicines with a label that says Homeopathy. That said, I've never seen anything suggesting Homeopathy had any medicinal benefit, so if anyone wants to refute homeopathy or crystals then I'd be all ears.

Pythagoras a trois fucked around with this message at 22:38 on Oct 24, 2014

# ? Oct 24, 2014 22:32

parasyte: Aug 13, 2003; Nobody wants to die except the suicides. They're no fun.

Cheekio posted:

http://summaries.cochrane.org/CD001351/BACK_acupuncture-and-dry-needling-for-low-back-pain

The conclusion that the Cochrane Collaboration came to was that acupuncture outperformed the control groups by a statistically significant margin across the many studies they examined.

No.

quote:

Compared to no treatment, there is evidence for pain relief and functional improvement for acupuncture at shorter-term follow-ups. Compared to sham therapies, there is evidence for pain relief at shorter term follow-up, but these effects were not maintained at the longer-term follow-ups, nor were they observed for functional outcomes.

Acupuncture outperformed no treatment, and placebo also outperformed no treatment. Acupuncture did not outperform placebo. That paper even blasts most of the papers it analyzes for poor methodologies and lovely reporting.

# ? Oct 24, 2014 23:08

pentyne: Nov 7, 2012

Cheekio posted:

I agree with this, and I think the problem with the discussion about Herbal Medicine is I don't know any way to accurately pin down the terminology to be clearly right or wrong. Echenecea apparently isn't more effective than placebos, but willow bark certainly is.

The majority of homeopathic medicines I've encountered are just herbal medicines with a label that says Homeopathy. That said, I've never seen anything suggesting Homeopathy had any medicinal benefit, so if anyone wants to refute homeopathy or crystals then I'd be all ears.

Actual "acupuncture" was proven to be as effective or worse in reported pain relief when compared to just poking people with toothpicks and telling them it was acpunture.

Traditional Medicine, Acupunture, etc. as fields are completely full of poo poo. Saying some plants work as medicine is a factually correct statement, but when that happens, the plant is studied and the active compound is isolated and then reproduced in large quantities by pharmaceutical companies for research and development.

Homeopathy is such a broad term its hard to simply use a blanket statement to disprove it other then "stupid bullshit". If you talk about the dilution method, i.e taking a small amount of something toxic, diluting the poo poo out of it with water, then ingesting the massively diluted material basic math can demonstrate that you are consuming quantities of material in the parts per trillion, orders of magnitude below the established threshold for toxicity.

For crystals, I don't really know what else to say besides a specific geometric configuration of certain elements isn't in any way chemically different then regular rocks. You don't see people going into their garden, grabbing pebbles and rubbing them all over themselves to absorb the "energy" present.

# ? Oct 24, 2014 23:19

moebius2778: May 3, 2013

Cheekio posted:

Dancer, you haven't established 'sciencebasedmedicine.org' as a credible source, and as it doesn't cite research in its conclusions, it doesn't seem to establish itself as a credible source either. Here's a meta analysis of multiple double blind clinical trials where acupuncture was tested against control groups to see if it had any medicinal effect:

http://summaries.cochrane.org/CD001351/BACK_acupuncture-and-dry-needling-for-low-back-pain

The conclusion that the Cochrane Collaboration came to was that acupuncture outperformed the control groups by a statistically significant margin across the many studies they examined.

edit: If you don't mind adding '.org' to your quote I'd appreciate it, as quoting 'science based medicine' is an appeal to a school of medicine that exists beyond that one website you're quoting, and looks intellectually dishonest.

Okay, here's the copy of the paper I'm using.

So, I'm not seeing how this paper addresses points 3 and 4 from the SBM link. Looking through the studies they looked at, exactly one (Edelist 1976) uses a proper sham acupuncture technique:

quote:

Interventions:

1) Acupuncture: Manual insertion of 4 sterile needles into traditional acupuncture points (BL 60 and BL 25 bilaterally) until reaching Teh Chi, then electroacupuncture at 3-10Hz. 30minutes, 3 treatments in maximum 2 weeks. Training & experience of acupuncturists unknown.

2) Sham acupuncture, 4 needles placed in areas devoid of classic acupuncture points, no Teh Chi.

However, for that one, the conclusions are:

quote:

There seemed to be no difference in either the subjective or objective changes between the two effects and suggest that much of the improvement in pain syndromes associated with acupuncture may be on the basis of placebo effect.

The other studies are either:

1) Comparing different acupuncture techniques (Carlsson 2001 (sorta - conclusions don't actually compare the different acupuncture techniques), Ding 1998, Kurosu 1979(b), Takeda 2001)
2) Control acupuncture either involves superficial needle insertion, or no needle insertion (Araki 2001, Ceccherelli 2002, Inoue 2000, etc.)
3) Control did not involve any form of acupuncture (sham or otherwise) (lots)
4) ...and then there was one that was actually testing cupping, but seems to have been included in this analysis because both the experimental and control groups received acupuncture.

# ? Oct 24, 2014 23:33

Cockmaster: Feb 24, 2002

Smudgie Buggler posted:

The real bullshit of 'herbal medicine' is the kind sold by snake-oil salesmen to gullible shitheads who are told their child doesn't need antibiotics for that pneumonia don't you know that's just big pharma trying to steal your money no no here just buy this tiny jar of powdered lavender root for a fuckload more than it's worth and have her huff a steam-bath with this poo poo three times a day. That kind of nonsense is dangerous. Cannabis is just good medicine for a lot of people. Don't hate on poo poo that works.

There's also the fact that the FDA imposes no regulation whatsoever over herbal remedies. Even if a particular herb has been scientifically proven to work, it's not much good if you have no way of knowing how much of its active chemical you're actually getting (if any).

# ? Oct 25, 2014 00:50

Kiwi Ghost Chips: Feb 19, 2011; Start using the best desktop environment now!
Choose KDE!

Cockmaster posted:

There's also the fact that the FDA imposes no regulation whatsoever over herbal remedies.

http://www.fda.gov/Food/GuidanceRegulation/CGMP/ucm079496.htm

# ? Oct 25, 2014 01:14

Idran: Jan 13, 2005; Grimey Drawer

Kiwi Ghost Chips posted:

http://www.fda.gov/Food/GuidanceRegulation/CGMP/ucm079496.htm

Some herbs do fall under that category, but only because dietary supplement restrictions apply to supplements intended to add nutritional value to the diet.

quote:

A dietary supplement is a product intended for ingestion that contains a "dietary ingredient" intended to add further nutritional value to (supplement) the diet. A "dietary ingredient" may be one, or any combination, of the following substances:

a vitamin
a mineral
an herb or other botanical
an amino acid
a dietary substance for use by people to supplement the diet by increasing the total dietary intake
a concentrate, metabolite, constituent, or extract

Herbal supplements intended for medicinal purposes rather than nutritional purposes aren't covered, though they also aren't allowed to make specific medicinal claims, like saying they will cure or treat some specific ailment. General claims only.

# ? Oct 25, 2014 03:37

Kiwi Ghost Chips: Feb 19, 2011; Start using the best desktop environment now!
Choose KDE!

Idran posted:

Some herbs do fall under that category, but only because dietary supplement restrictions apply to supplements intended to add nutritional value to the diet.

Herbal supplements intended for medicinal purposes rather than nutritional purposes aren't covered, though they also aren't allowed to make specific medicinal claims, like saying they will cure or treat some specific ailment. General claims only.

No, because the FD&C definition of drug includes

quote:

articles (other than food) intended to affect the structure or any function of the body of man or other animals ... A food or dietary supplement for which a claim, subject to sections 343 (r)(1)(B) and 343 (r)(3) of this title or sections 343 (r)(1)(B) and 343 (r)(5)(D) of this title, is made in accordance with the requirements of section 343 (r) of this title is not a drug solely because the label or the labeling contains such a claim. A food, dietary ingredient, or dietary supplement for which a truthful and not misleading statement is made in accordance with section 343 (r)(6) of this title is not a drug under clause (C) solely because the label or the labeling contains such a statement.

Any medical claims at all means it's regulated under one class or another.

# ? Oct 25, 2014 03:45

Dancer: May 23, 2011

Cheekio posted:

I agree with this, and I think the problem with the discussion about Herbal Medicine is I don't know any way to accurately pin down the terminology to be clearly right or wrong. Echenecea apparently isn't more effective than placebos, but willow bark certainly is.

Can you then please clarify what is it you'd like to know/debate with regards to herbal medicine? Right now, the way I understand it, you're saying that "there exists at least one therapy derived from a plant that has legitimate medical use". That is a statement no reasonable person will disagree with. Do you want to know about naturopaths and other alt-med practitioners that attempt to treat patients with "natural" (that term is ambiguous and not exactly scientific) means, and why they are almost universally a load of poo poo?

As for SBM, the "Reference" bit is a more recent addition to the site. The original purpose of the site was as a blog, and the blog posts (mostly) contain proper arguments and references. Think of that page as a 1000 word summary of the many many thousands of words on the specific topic on the site. Yeah I get that you won't just buy it from me that "those dudes know what they're saying, done",

# ? Oct 25, 2014 03:49

Idran: Jan 13, 2005; Grimey Drawer

Kiwi Ghost Chips posted:

No, because the FD&C definition of drug includes

Any medical claims at all means it's regulated under one class or another.

Huh, I've been misinformed, then; I was under the impression that so long as you didn't make specific medicinal claims, the FDA had no jurisdiction over you. How does something like Airborne or a homeopathic remedy get away with not needing FDA approval, then?

# ? Oct 25, 2014 03:56

Dancer: May 23, 2011

Kiwi Ghost Chips posted:

No, because the FD&C definition of drug includes

Any medical claims at all means it's regulated under one class or another.

A problem here is that the term "medical claim" is maybe not as inclusive as it should be. If I market a product (say, echinacea), with the statement "helps fight the common cold" big on the front label, and "This product is not intended to diagnose, treat, cure or prevent any disease", I'm fairly confident that that will bypass regulation. My product will basically be treated by the FDA as if it were a food product.

Edit: ^^^^^ what Idran said is also a big part of it. "Helps with the common cold" for instance is, I'm fairly confident, still not specific enough to override the "not intended to treat..." message.

Dancer fucked around with this message at 04:01 on Oct 25, 2014

# ? Oct 25, 2014 03:58

woke wedding drone: Jun 1, 2003; by exmarx; Fun Shoe

Kiwi Ghost Chips posted:

Any medical claims at all means it's regulated under one class or another.

Yeah you can see how careful marketers are about their claims by looking at the language in "natural male enhancement" ads and "HEAD-ON! Apply directly to forehead!" They're counting on yokels to make the inference that "male enhancement" means "boner" and "apply to forehead" means "works on headaches."

In a way this reminds me of the time I went into a gas station and saw the clerk and a customer looking at a pack of Nat Sherman cigarettes. The clerk pointed to the label that said "NO ADDITIVES." "See," the clerk said, "it says "NOT ADDICTIVE."

"Ohhh," said the customer.

# ? Oct 25, 2014 04:03

Kiwi Ghost Chips: Feb 19, 2011; Start using the best desktop environment now!
Choose KDE!

Idran posted:

Huh, I've been misinformed, then; I was under the impression that so long as you didn't make specific medicinal claims, the FDA had no jurisdiction over you. How does something like Airborne or a homeopathic remedy get away with not needing FDA approval, then?

Dietary supplements don't need approval because the fact that they're limited to nutrients and plant-derived substances is supposed to make them safer (lol). Manufacturers still have to follow manufacturing standards and report severe side effects, and the FDA can take action if there's evidence that one is dangerous to more than just your wallet.

Homeopathy has special exemptions just for their "medicine."

# ? Oct 25, 2014 04:10

Dancer: May 23, 2011

Kiwi Ghost Chips posted:

Dietary supplements don't need approval because the fact that they're limited to nutrients and plant-derived substances is supposed to make them safer (lol). Manufacturers still have to follow manufacturing standards and report severe side effects, and the FDA can take action if there's evidence that one is dangerous to more than just your wallet.

Homeopathy has special exemptions just for their "medicine."

Fun story about homeopathy. So usually whatever ingredient is in it is dilluted in water by a factor somewhere between 10^10 and 10^1000 times, so it basically has no non-placebo effect at all. About three years ago a zinc-based homeopathic product had to be taken off the market because, it turns out, the zinc was dilluted in water by factor 3, and the very high concentration of zinc actually made some people go blind.

# ? Oct 25, 2014 04:22

Captain_Maclaine: Sep 30, 2001; Every moment I'm alive, I pray for death!

SedanChair posted:

In a way this reminds me of the time I went into a gas station and saw the clerk and a customer looking at a pack of Nat Sherman cigarettes. The clerk pointed to the label that said "NO ADDITIVES." "See," the clerk said, "it says "NOT ADDICTIVE."

"Ohhh," said the customer.

Ages ago I did a summer job in a gas station and remember wondering why Wilson cigarettes were making such a big deal in their advertising about having "NO ADDITIVES," and that makes at least as much sense as my original idea that they were playing to the organic crowd.

# ? Oct 25, 2014 04:23

Zeitgueist: Aug 8, 2003; by Ralp

Cheekio posted:

Who likes an OP full of quotes from another thread?

I don't like either acupuncture or herbal medicine, which is why it annoys me that there's evidence that they're medicinally beneficial that stands up to modern scientific rigor. This was brought up as a derail in another thread, so here we are. My argument is that the Acupuncture and herbal medicine have medicinal benefits that are backed by double blind clinical trials, the gold standard of what's 'real'. Where we left off:

You shouldn't be surprised that some herbs and some treatments have measurable effects. Sugar pills have measurable benefits in treating diseases, because the placebo effect is a thing.

All modern medicine does is isolate the parts that working and put a measurable dose and result on it.

# ? Oct 25, 2014 05:31

Buskas: Aug 31, 2004; ?

Acupuncture is pure horseshit and there are lots of good writeups on why that is the case if one is willing to do a bit of research.

This article is not perfect but has some good info: http://www.dcscience.net/?p=6060

# ? Oct 25, 2014 05:52

Melthir: Dec 29, 2009; I need to go scrap some money together cause my avatar is just sad.

Does anyone have anything that shows why you think chiropractors are horeshit. Because I tell you what, I feel like a million bucks after I get my back adjusted. If it is poo poo I would like to know why and what about getting my back adjusted is feeling good.

# ? Oct 26, 2014 02:22

UrbanLabyrinth: Jan 28, 2009; When my eyes were stabbed by the flash of a neon light
That split the night
And touched the sound of silence; College Slice

http://www.sciencebasedmedicine.org/reference/chiropractic/ is probably a good place to start.

UrbanLabyrinth fucked around with this message at 02:27 on Oct 26, 2014

# ? Oct 26, 2014 02:24

Dancer: May 23, 2011

Melthir posted:

Does anyone have anything that shows why you think chiropractors are horeshit. Because I tell you what, I feel like a million bucks after I get my back adjusted. If it is poo poo I would like to know why and what about getting my back adjusted is feeling good.

You asked for both evidence, and an explanation. Presenting a collection of evidence that's conclusive would be a lot of effort, and the page UrbanLabyrinth linked seems to do a plenty good job of it. What I will try to do is summarize what's happening, and explain the "why". I will warn you that I'm kinda sleepy and slightly tipsy, so my writing may not be great, but I think I do a decent-ish job of answering your question (eventually)

Just like with many other aspects of alt-med, there are levels of horseshit-ness. The "pure" chiropractors out there (of which there are plenty) make a billion different claims with regards to what they can treat. They claim that manipulating your back will help with allergies, cancer, general feelings of malaise, etc. I'm going to assume you believe me when I say that these claims are ludicrous. Moving around some vertebrae isn't going to make your body better at killing the viruses in it, and it's not going to make cancer cells divide less. They use a bunch of magic words ("subluxation" is one of the more common ones, though I'd be hard pressed to define it, and I'm pretty sure most chiropractors would also fail to give a rigurous definition).

The next level is chiropractors who claim to help with back problems, sore muscles and similar ailments. In a similar fashion to herbal stuff, there might be an actual legitimate benefit there, but any information about the natural world that a chiropractor uses in order to diagnose and treat you is much less likely to be obtained via a correct application of the scientific method than information an actual doctor uses. Basically, if someone ever tells you the spinal manipulations they want to give you are good for you (remember, this is someone pushing your vertebrae around, so they can actually cause damage), try to make sure they got a degree from medical school and not... chiropractic school (This is ignoring the fact that there exist plenty of MDs out there who have also fallen for all sorts of alt-med, including this, but that's besides the point I'm trying to make).

And finally, just like plenty of other alt-med practitioners (stuff like light therapy comes to mind), some chiropractors will claim to make you feel better, and you will genuinely feel better, simply because you're getting personal attention, and a nice back massage, probably a nice cup of tea too, and this is all happening in a friendly environment. It's basically a glorified massage parlour. Alt-med practitioners are also generally seem less rushed than proper doctors. This has a direct effect of making the treatment just feel more relaxed, but also the indirect effect of making the practitioner seem more concerned with you, and making it seem as if he's paying better attention to your ills. If you have a disease that a GP can diagnose after hearing 3 out of the 10 symptoms it has, then the GP may not be as attentive to the other 7 (you can easily imagine him just nodding while he writes down a prescription on his pad for instance). The alt-med practitioner will act very interested in every single problem you have, and will be better at giving you the impression that he's treating exactly those problems that you have.

# ? Oct 26, 2014 03:04

Uranium Phoenix: Jun 20, 2007; Boom.

Cheekio posted:

That said, I've never seen anything suggesting Homeopathy had any medicinal benefit, so if anyone wants to refute homeopathy or crystals then I'd be all ears.

There's no need to refute something that has never provided a single shred of credible evidence in the first place.

# ? Oct 26, 2014 03:05

Buried alive: Jun 8, 2009

Cheekio posted:

...
The majority of homeopathic medicines I've encountered are just herbal medicines with a label that says Homeopathy. That said, I've never seen anything suggesting Homeopathy had any medicinal benefit, so if anyone wants to refute homeopathy or crystals then I'd be all ears.

It's Wikipedia, but you should read that. Start with the part about dilutions. The long and the short of it is that in order for homeopathy as such to work the way that it's adherents say that it does, our current understanding of some really, really basic laws of physics and biology, such as the way that atoms behave in a liquid state and what a dosage is, needs to be wrong. If you start getting into stuff like, "Well, homeopathy is really just herbal medicine," or, "Homeopathy is a holistic style of treatment," then what you're doing is getting fuzzy with the definition of homeopathy. Something like that will naturally be hard to refute, because any one feature that gets refuted can be replaced ad-hoc style with some other feature. At that point responses are going to shift to me asking you to define what the hell you even mean when you say 'homeopathy' and then we can talk about that.

# ? Oct 26, 2014 15:31

woke wedding drone: Jun 1, 2003; by exmarx; Fun Shoe

It sounds more like he's talking about naturopathy. Homeopathy is specifically the theory of dilution and nothing else. And naturopathy is lousy with belief in it, but covers other things as well.

# ? Oct 26, 2014 17:15

Pythagoras a trois: Feb 19, 2004; I have a lot of points to make and I will make them later.

SedanChair posted:

It sounds more like he's talking about naturopathy. Homeopathy is specifically the theory of dilution and nothing else. And naturopathy is lousy with belief in it, but covers other things as well.

I meant to say if anyone wants to support homeopathy they're welcome to, because I assumed no one here would defend homeopathy. I certainly won't, so there's probably not a lot of good debate to be had on the subject here.

I was just looking up more evidence for acidophilus and its effects on the brain, re: The Radiolab epidsode "Guts", and couldn't find anything. Which is sort of disappointing, because I also struck out on convincing evidence that Omega 3 has any effect on brain function, which is something I thought was well accepted.

# ? Oct 26, 2014 17:49

duodenum: Sep 18, 2005

I don't have anything to cite because I heard this in conversation a long time ago, but it was said that the benefits that people report from things like acupuncture and chiropractic back manipulation are only about what one would see from receiving a massage treatment. That's it's more likely about what benefits (psychological and physical) we receive from mutual grooming behaviors than from anything like what quack practitioners claim.

Does that sound right or reasonable as a shorthand to explain whatever benefits people stand by to defend quacks?

# ? Oct 26, 2014 18:16

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# ? Apr 29, 2024 00:14

pentyne: Nov 7, 2012

Cheekio posted:

I meant to say if anyone wants to support homeopathy they're welcome to, because I assumed no one here would defend homeopathy. I certainly won't, so there's probably not a lot of good debate to be had on the subject here.

I was just looking up more evidence for acidophilus and its effects on the brain, re: The Radiolab epidsode "Guts", and couldn't find anything. Which is sort of disappointing, because I also struck out on convincing evidence that Omega 3 has any effect on brain function, which is something I thought was well accepted.

Omega 3 and Omega 6 fatty acids are a type of compound that we still can't make artificially and the only source is a natural byproduct. Also, the study of the mechanisms of both are so closely entwined that they really aren't separately examined.

http://en.wikipedia.org/wiki/Essential_fatty_acid_interactions

That article isn't really clear for the layman, but if you really want to understand the importance of the omega fatty acids the explanation/proof is there.

# ? Oct 26, 2014 19:32

The Something Awful Forums > Discussion > Debate & Discussion > Acupuncture and Herbal Medicine - Unfortunately Supported by Evidence

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