Talk:Alternative medicine (theories)/Bibliography

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Revision as of 08:53, 3 January 2009 by Pierre-Alain Gouanvic (Talk | contribs) (web of belief)

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A philosophical analysis of the evidence-based medicine debate

"A philosophical analysis of the evidence-based medicine debate[1] attempts to clarify the nature of evidence-based medicine by performing a philosophical analysis of its relationship with alternative medicine." The operative word is attempts. There are sweeping generalizations and simplifications made; I find the analysis useless. If this is philosophy, you can have it.

I scanned through some of the references; everyone seems so busy deconstructing, and fixating on what they think randomized clinical trial means that they seem to ignore:

  1. The low-responder or individualized testing problem is not unique to CAM.
  2. The problem of individualization will get worse, not better, not because of CAM but with mainstream developments such as genomic medicine. I see no references to some of the methodologies that have been seriously proposed for dealing with such.
  3. There's an overemphasis on placebo controls. Placebo controls are, under the current interpretation of the Declaration of Helsinki on human subject research, generally unethical if a treatment with some efficacy exists, and the disease is not self-limiting. For example, in some of the most recent breast cancer trials, aromatase inhibitors were compared with the existing "gold standard", tamoxifen. The safety monitoring board stopped the trial and offered the experimental drug to all subjects, since it had strikingly more efficacy. Ironically, when tamoxifen was in its trials, those were also stopped early because it was so superior to the then-existing standards.

Howard C. Berkowitz 04:52, 3 January 2009 (UTC)

What's interesting here is the Quinean web of belief analysis. What they're telling us is that EBM, which puts basic physiology and biochemistry at the lowest of the hierarchy of medical evidence, still relies heavily on it in specific cases (alternative medicine) like homeopathy.
More importantly yet, if the basic sciences gave us very strong reason to believe that a drug would not be effective, then it is appropriate to be very cautious when interpreting apparently positive clinical results. For example, there have been some RCTs of homeopathic remedies according to which subjects receiving the homeopathic remedy did better than those receiving a placebo, and where the P-values are less than .05 or even less than .001.[30] However, given that homeopathic remedies are typically composed of nothing more than water, accepted basic science should lead us to seriously doubt that these 'drugs' can be effective. In any event, we cannot simply accept that pure water (in the form of a homeopathic medicine) is medically effective unless we are also willing to revise much of our basic scientific conception of chemistry and the body.
This is quite useful, isn't it? Anybody agrees?
--Pierre-Alain Gouanvic 08:53, 3 January 2009 (UTC)