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Wednesday, January 25, 2006

Medicine and Alternative Medicine

In my last post I mentioned the No-Milk List. We're having a dust-up now as people argue about their anti-milk beliefs in particular and their larger view of the worlds of medicine and alternative medicine in general.

I just put up there a post so long that I had to split it into two parts. I'm repreating it here to get it all up in one place, and also before I think it's generally applicable to anyone who has an interest in this blog.

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People here are correct when they say that anecdotal information can't be applied generally to a group of people. I'd go even farther: Most of the time it can't properly be applied to the person with the anecdote. The reason is simple. Change.

Any scientific or medical study depends on changing as few variables as possible. The more things that change, the harder it is to separate out what difference any one change is making. When we take dairy out of our diets, we think we're making just one change, but the truth is that we making all sorts of changes simultaneously. We eat different foods, we substitute for dairy in familiar foods, we alter the amount of food and the ratio of nutrients, lots of changes we seldom stop to think about.

Remember, though, I've always advocated that if it works for you and doesn't cause any damage, fine. Go with it. I have no objection to those who want to remove dairy from their diets. I've spent over 20 years supplying people with all the possible information they might need if they make this decision for themselves.

At the same time I've always warned people that getting tested is always a good idea. You never know where your symptoms are coming from: and the symptoms you're likely to get from either lactose intolerance or dairy allergy can have a thousand causes, some of them quite serious. Just assuming that you have a food allergy can mask another unrelated illness. Trying to determine if a particular food is causing your problems can be a nightmare.

That's what makes medical studies on foods so incredibly difficult. People could be brought into a clinical setting where every particle of food is monitored – but that hardly compares with the realities of everyday life. Much more often, people just keep food diaries and try to make as few other changes as possible. Even so, food studies are expensive, hard to run, and harder to evaluate. Worse, you can't do a double blind study for food. You know if you're taking dairy out of your diet or not, and that will affect the results.

This explains why medical studies about food, nutrients, or medications so often come out with big announcements that seem to vanish or be contradicted by the next study. Most of these studies are of tiny groups for short periods of time, often using protocols that just don't have much relationship to the real world. Even so, they're real studies that get printed in real medical journals and reporters look at the conclusions and write articles that make headlines. That's why I always say that you should never get your medical news from a newspaper. Or the internet, these days.

Most reporters – most people – have no idea of how to read a medical or scientific paper. This is one of the greatest failings of our school system. You can't just read the conclusions section and use that as guidance. You have to go through the entire methodology and procedure to see if the experiment as a whole works to give you real and new information. This isn't all that hard, and doesn't usually require any advance medical training. A few basic questions are all that's needed. Is the group studied random and representative? Is the group healthy or do they have medical problems? How large is the group? How many dropped out before the study was over and why? Is the study something that corresponds to real eating patterns or is it totally artificial? Are the results a true difference or just a slight tendency?

If you read closely, you'll soon notice that the studies that change the way medicine is practiced tend to be huge, long-term studies in which data from many papers are put together to make a larger and more comprehensive whole. This averages out or entirely deletes the exceptions, the poorly done studies, the natural variations in human physiology. Doing this takes medicine as far away from anecdotal information as it can safely get.

So if medicine tries to stay away from anecdotal information, who uses it? The answer is everybody else. All of alternative medicine is based on anecdotal information. All those people out there selling herbs and vitamins and enzymes and proteins and nutrients and nostrums. The ones selling raw milk or soy milk or rice milk or seaweed or spelt or sorghum. All the naturopaths and homeopaths and holistic practitioners. Every person whose religion gives them a special road to healing. They're all faith healers really, every last one, no matter whether a formal religion is mentioned or not. All of them absolutely depend on anecdotal information. They have to. Not one of them has ever done an actual study to back up their claims.

Let me repeat that. Not one of them has ever done an actual study to back up their claims.

Why should they? First, studies are difficult and expensive and time-consuming. Nor do they have the expertise to conduct a study. But most importantly, studies have one major obstacle to faith healing: they sometimes show that what you believe in is wrong. And the common element of all these alternative sites is that they're never wrong. They never allow people to come onto their pages and tell them that they cure is quackery, or that the money spent on their product was wasted, or that it had dangerous side effects, or that it prevented someone from getting medical help until it was too late. Instead, they give you anecdotes about how wonderful their product or their religion or their way of life is.

It may sound like I'm condemning all anecdotal information. Not at all. We use it all the time. If I need some work done on my car, I'll ask my friends for recommendations for mechanics. That's anecdotal information. Usually this works out fine. But there are no guarantees. Maybe all the mechanic's work was really done by a helper who just quit. Maybe my problems are completely different from those of my friends, more complicated, or on a foreign rather than a U.S. car.

It would really help if I knew something about how a car worked and it would be even better if there were a source of objective outside information about the procedures.

Most of us know a little something about cars, even if we can't fix them ourselves. If the mechanic were to tell me that the reason my engine won't start was that the gyroscopes in the tire weren't aligned with the phase of the moon, I'd laugh in the person's face. I sure wouldn't listen to anything else said about cars.

But people on this very list have posted information about the way our bodies work that is just as much moonshine. What's totally frightening is that people didn't laugh or stop listening. Why? Because just as nobody is taught how properly to evaluate a study, nobody is taught even basic knowledge about the way our bodies work.

Those of us with medical problems or conditions of any kind have an absolute need to learn as much as possible about human physiology. You don't have to become an anatomist, you don't need advanced medical training. You just need to know enough to understand when people are talking moonshine to you.

Where can you get this knowledge? Well, not from any of the alternative sites. They don't even want to know how you body works. How could they sell you magnetic bracelets or magic crystals if you knew anything about the body?

And you can't get it from pure anti-milk sites. That's like getting your information about the Democrats from the Republican National Committee website. You might think you were getting at least half the truth, but it doesn't work that way. All you get are the negatives. It's not just that the positives are never mentioned, but that the negatives are manipulated. The conclusions are quoted without any evaluation of studies as a whole. Comments are ripped out of context, and put together in creative new ways. Sometimes the remarks have no relationship to anything the original might have said. Instead of gaining information, you actually lose overall knowledge.

Medical studies have many faults. Many of them are just resume padding. Some of them are funded by firms who have a stake in the outcome. (Although who else is going to put up the money? I often wonder.) Most cannot be taken on their own but have to be evaluated as part of a much larger whole, and this is again, difficult and time-consuming.

But the alternative is no alternative. Even the people who most loudly decry the medical establishment are perfectly willing to quote them whenever a result is on their side. Because real medicine doesn't take sides. It publishes the positives and negatives, the cures and the dangers, the successes and the failures. Medicine changes with the times.

This upsets many people, I know. We all want certainty. But that's the basic difference between faith and medicine. The faith healers of all kinds and types and sorts will sell you certainty. They have a product, whether it's in a bottle or in a belief, and this product will help you, no ifs, ands, or buts. And this never changes. That's the guarantee that it's wrong.

Medicine is uncertain. It changes, updates, revises and contradicts itself. It's difficult and expensive and time-consuming. And it's the only thing we have. Accept no alternatives.

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1 comment:

Anonymous said...

This is a neat blog with lots of interesting stuff in it.

Sincerely,

June
Libra Litrou