What is your opinion of this definition of science based medicine?
First let me say that I'm posting this question here because many alt-med skeptics hang out here and I could use their help in refining this definition. I'm sick of the subtle attacks on science based medicine through the use of words like allopathy, conventional, traditional, etc, and we need a definition of our field that is thorough, correct, and exclusive of quackery. Here is my proposed definition of science based medicine: Medical practices which are: 1.) Directly supported by strong empirical evidence, and a plausible underlying physical theory that is generally accepted by the scientific community or 2.) Are based on physical theories which are supported by strong empirical evidence and a general consensus of the scientific community, and have an underlying physical mechanism that is plausible given current accepted physical theories. This definition would cover both treatment methods that have been directly studied, such as the use of insulin to treat type I diabetes mellitus, and innovative treatments that rest on sound scientific knowledge and can be used in atypical cases. This might include off label drug use that could plausibly work based on the drug's known pharmacodynamic and pharmacokinetic properties as well as the collective knowledge of anatomy, biochemistry, and physiology, or it could include new types of surgery that are plausible because they are based on a sound understanding of modern science. I considered eliminating the word physical, but I mean it in the broad sense of physical sciences. This is therefore inclusive of physics and all sciences based on its accepted theories, including the chemical and biological sciences. Dr. T: The inclusion a general consensus of part 1 was for established methods of intervention. I fully understand that medicine is in many ways a scientific frontier; this is why I included the second part of the definition which I feel allows for experimental techniques that are firmly grounded accepted physical theories to be included in my definition of science based medicine. This means that proposed methods cannot be based on underlying theories that are not generally accepted. An example of this is homeopathy, which has as its underlying foundation the concept of water having a 'memory'. This concept is not supported by current physical theories, thus the implementation of homeopathic remedies cannot be considered science based medicine. Alt, nothing what you have said contributed to this discussion in the slightest manner. Lightning: Many facets of Osteopathic medicine fit into this definition, but many don't. One example is craniosacral therapy. There is no accepted theoretical foundation, nor is there any supporting evidence for craniosacral therapy. Seeing as no portion of my definition states that only doctors can test new plausible theories, I don't see why you even asked this question. My definition has the sole restriction of using the scientific method, and restricting new therapies to those grounded in generally accepted physical theories. Thus any therapy that has its foundation in the existence of invisible energy fields that violate known laws of physics and have never been detected by instrumentation far more sensitive than human senses cannot be considered science based medicine. Lightning: You've made many claims that will require much time to address that I simply do not have right now. I invite others to do so. I will, however, address what I can quickly. You have illogically applied known facts in an effort to refute my statement about undetctable energy fields. In every case you cited regarding humans with seemingly superhuman sensory perception, there exists equipment capable of detecting the same anomaly more than just equally well; it can do it far better. You say an engineer can detect imperfections on the order of 10^-3 inches with his fingers (likely hyperbole, but I'll bite). The existence of imperfectly flat surfaces can be explained using accepted physical theory (atomic theory and its derivatives) and they can be detected on scales far below 10^-3 inches with modern equipment. Atomic force microscopes can view the surface of a steel plate and see imperfections on the order of angstroms (10^-10 meters). While modern technology can detect rythm... s in the head, these rythms are not those that proponents of craniosacral manipulation claim exis and can be detected by only those trained to detect them. As I said, modern technology is far more capable than human perception at detecting energy fields. Similar arguments can cover the rest of your post. Modena instruments can detect palpable changes far better than a human, although they are not feasible in a clinic. In addition, what a clinician is palpating for can easily be shown to exist. The cranial rythm you speak of cannot. As far as the wine taster is concerened, I inIvte you to compare his ability to those of an analytical chemist with an HPLC-MS. Forgive my atrocious grammar. I posted my last responses from my phone Lightning: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564028/ http://ptjournalonline.net/cgi/content/full/82/11/1146 Lightning: The opinions in those papers are what's generally accepted in the scientific community. They cite numerous relevant papers that reflect the general knowledge of anatomists, physiologists, and related researchers. The fact that you would choose to dismiss that evidence for apparently no reason other than it challenges your opinion shows your contempt for actual evidence and demonstrates that you do not practice science based medicine. SkepDoc: Thank you for the friendly advice. My reason for responding to lightning was to prevent readers from assuming that his posts have merit. His blatant disregard for legitimate evidence, his pension for semantic wordplay and fact distortion, and his contempt for science based medicine are now clearly obvious too all those who have yet to sip the quack-aid.
Alternative Medicine - 6 Answers
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1 :
Not bad; I would eliminate the word "physical" though: I think it's too restricting, the way I understand it. Chemical, bio-chemical, bio-social, biological, etc... - rather than enumerating all, just say "theories", "underlying mechanism"
2 :
If you are a regular visitor to the Science Based Medicine blog, you will know they talk about this a lot. The whole point of SBM, was that the Evidence Based Medicine movement that started in the 1980's, while very worthy, ignored the prior plausibility of treatments. This wasn't a huge problem when things that made sense, or fit in with scientific knowledge were being studied. They had often been adopted because they were plausible, though evidence was lacking. The big problem is when EBM protocols are applied to implausible things....just the fact we use a p value of 0.05, means that 1/20 times...something under study may show a positive result just from random chance, and that is where so many of the "positive" altmed studies emerged. What SBM states, is that implausible things...things that go against common scientific concepts or knowledge (eg homeopathy, "energy" medicine etc) need to be held to a higher standard of evidence than things that already fit within a solid scientific framework. So, my definition would be any practice that is scientifically plausible, and supported by rigorous scientific testing. ======================= You've made the mistake of engaging Lightning in a debate...it is a waste of time. He never acknowledges when he's been bested and always has to get the last word. ===================== Dr T.....one of the few Alties on this board who gives reasonable answers. Unfortunately...while YOU may practice EBM ( I note you didn't say SBM...and note the difference) the majority of naturopaths whom I have dealt with do practice an awful lot of woo...and deserve the title of quack. Altie, is just a term of endearment, and I never mean it in a pejorative way. You talk about the line in the sand, and what separates us is evidence. If there is no reason to beleive something should work (ie is implausibile based on known scientific facts and principles) and there is no evidence it does work...then that is "alternative"
3 :
so-called science that seeks to sweep the manifestations of illness under the rug by doping the patient, by consensus or not, is quackery.
4 :
I'd agree with this definition, but for the phrase "and a general consensus of the scientific community." The general consensus takes a lot longer to form - unfortunately, often a LOT longer than it takes for the weight of the evidence to accumulate. This is partially because the "scientific community" at large has neither the time nor (often) the inclination to earnestly investigate the ongoing, ever-evolving frontiers of medical interventions. Especially the frontiers on the fringes of generally accepted norms. But then, I practice evidence based medicine, so it's no surprise that I should agree with the definition! ;) What's interesting to me is that, despite my science background and the fact that I practice science-based medicine, by most accounts I still fall within the "ALTERNATIVE" paradigm. This suggests that science is not really how we define "alternative" vs. "conventional." And therein lies the crux. Science and skepticism, by their very nature and definition, are supposed to be about curiosity and the pursuit of understanding the very boundaries of what is "known" or accepted and that which remains still a mystery. Unfortunately, disparaging terminology is hardly reserved for conventional medicine! (Eg: "altie" and "quack") I think we get too hung up on labeling. We use terminology to draw imaginary lines in the sand between "us" and "them"... and then use those lines to create blanket statements that support our own peculiar dogma. Silliness. Please don't misinterpret this as an accusation. Heck, my ire creeps up now and then too! But I am consciously choosing not to enter into "us vs. them" debates, these days. That kind of discussion seems mostly to serve ego and derision... And that's in nobody's best interest. -------------------- Skep - thanks for the compliment (I think. *wink*) As I'm sure we're both aware, EBM and SBM are generally accepted as synonymous in the context of medical sciences. I'm aware of the semantic difference, but I wasnt being sneaky with my response.; this alt med practitioner is a science geek from way back! :) I know a lot of MDs who practice woo, too! That some NDs' treatment protocols venture into the woo category does not preclude science-based training. And anecdotal observation such as who does or does not practice what you subjectively determine to be "woo" is as relevant as the anecdotal evidence that woo practitioners give that their treatments work. I say again, that which is "alternative" is not NECESSARILY defined by scientific probability/evidence. Furthermore, science sometimes lags behind explaining efficacy! Consider anti-psychotics, for which there's still no defined MOA. Consider also that science is just beginning to elucidate possible MOAs for acupuncture. (Here's a link to a news story on a paper recently published in Nature Neuroscience: http://www.canada.com/health/point+about+pain+study+sheds+light+acupuncture/3090690/story.html)
5 :
Science Based Medicine ? Let us count the ways! Medicine that is practiced by licensed practitioners using as its knowledge base that comes from clinical studies, trials, retrospective analysis', laboratory studies of growing organisms in a dish and more. Most of the data from the sources mentioned are fraudulent and biased prepared by "scientists" and "researchers" and by the very companies that need to have results that can make them money. Data is favorably manipulated by these scientists and researchers so that they get more research grant money and lots of spending cash and perks. Everyone needs continuous employment, right? The doctors use this phony research as a basis to prescribe medication that they know almost nothing about and if it weren't for "detail men" who lie about their drugs, doctors would not know what medicines are for what conditions.
6 :
Sure. Osteopathic practice should fit this definition as its based in our understanding of moden physiology. Does your definition have condiotions that only doctors can test new plausible theories or modlities? If so why? Edit: Well not every Osteopath practices Involuntary motion techniques. If you are happy to allow the non cranial part of Osteopathy in thats a start. As for cranial if your source of reference is Steven Barrat you might think that. On the contrary research has been done and movement in the sutures has been established and detected by machinary. People who studied medicine from books in the 1950's might beleive that the sutures fuse or the Sacro-illiac joints fuse because thats what they tell you. Even though the SI has been established as mobile and not fused this is still taught in SOME med schools. A skull of someone who has lived into ripe old age can still be disarticulated and the individual bones seperated. THESE NEVER FUSE. 2 bones that fuse become 1 entity they are not 2 joints held together by tight fibrous tissue and they do not disarticulate. look at the innominate bone of an adult. Also actually look at the cranial bones of an adult compared to an infant or a child. The bones that fuse during developement do not disarticulate. Moving on people like Dr. Frank Willard and Dr. Upledger have dome lots of research into Anatomy and involuntary motion. Upledger has come up with a theoretical model based on the number of mechano- receptors in the sutures and baroreceptors in the Ventricular system after doing histological analysis from Cadavaric disections. He has theorised that the pumping system of the fluid is controled by a feed back mechanism between these structures which keep the fluid turning over. Upledger and Willard are ahead of the game and pioneers in their fields. You may not know about this research, you may refute it because you disagree with it but it is there. As for whether or not we can feel it, an engineer working fine limits can run his fingers over a flat object and feel a difference of 1000th of an inch and tell you if its flat or not. For someone to tell me they can't accept its possible to feel the cranial rhytum because they haven't trained to is the same as my saying "I can't beleive people can run a mile in around 4 minutes or even less because I can't do it." Palpation is part of your sense of touch. You can develop this sense to a very high level if you train yourself to do so. Still not convinced? OK the most skilled somaliers can drink a sip of wine and tell you what grape made it, where it was grown and even what year the wine was made. Is there any magic involved or have they just developed their sense of taste to an incredibly high level? Edit: Not everyone who practices Cranial Osteopathy does so with the view of "energy medicine". What i am talking about is the movement between the sutures and the flow of CSF within the Dural sack and in the ventricular system. I am not talking about treating the body with an energy system. That isn't how I and many other osteopaths do it. The movement between the sutures has been measured and established with machinary. What is contentious is whether or not we can feel it. Just about anyone could but it does take a lot of practice. It isn't taught as a technique until the 4th year in most undergrad osteopathic courses because the level of palpation required is not good enough for most people up until then. I've met manual therapist who can't even palpate segmental levels of the spine (non of them were osteopaths). They can't even differentiate between L4 and 5 or C2 and 3. One of them was stupid enough to stand up at a conference and Say "Do you seriously expect me to believe you can palpate at a segmental level". The gasps and Jaw dropping of disbelief made him sit down very quickly!!! Edit: thanks for those links. I need to point out they are not papers with evidence they are an opinion with references. You can find references to support anything you have an opinion on. That does not make your opinion the truth by default. His knowledge of anatomy is just plane wrong. The spenoid does not fuse and nor do the other cranial bones although they do indeed become less cartilaginous and ossify. That doesn't mean they can't move. I have seriously questioned whether or not I'm imagining all this but if I was why does what i feel surprise me so often? Wouldn't it feel the same on everyone if it was just my imagination? Or wouldn't my palpation be an externalisation of a predetermined idea that i had therefore being predictable and not surprising? How do you explain why someone who's had a headache for a month post trauma has it stop the next day and their sinuses clear when they don't even know what you are doing and have no expectation of either of these things? Why would that someone come and see me today and say "my husband wants to give you a hug because he now has his wife back". If its placebo its an incredibly powerful one don't you think? Also wouldn't placebo only work on only 30 - 50% of the people you treat? EDit: Lightning: "The opinions in those papers are what's generally accepted in the scientific community." Generally accepted is not FACT. It is still just opinion. If you don't beleive the skull bones move of course you are going to have this opinion. "They cite numerous relevant papers that reflect the general knowledge of anatomists, physiologists, and related researchers." This knowledge is still incomplete and it could be wrong. Why does Greys Anatomy continue to update its version and continue with Cadavaric disections? If we knew it all there would be no point in doing this. "The fact that you would choose to dismiss that evidence for apparently no reason other than it challenges your opinion shows your contempt for actual evidence and demonstrates that you do not practice science based medicine." Take your blinkers off mate!! I have QUESTIONED THIS EVIDENCE". I have made it very clear why. WHY HAVE YOU DISMISSED THE EVIDENCE FROM WILLARD AND UPLEDGER? IS IT BECAUSE YOU DISAGREE WITH IT OR IT BECAUSE IF IT IS CORRECT IT MEANS WE HAVE TO LOOK AT THINGS AGAIN? Science has got many things wrong in the past. Also science is about discovery not exclusion. Remember that. Edit: ##Thank you for the friendly advice. My reason for responding to lightning was to prevent readers from assuming that his posts have merit. His blatant disregard for legitimate evidence, his pension for semantic wordplay and fact distortion, and his contempt for science based medicine are now clearly obvious too all those who have yet to sip the quack-aid.### Ok then Mr. if Upledger has got his theory of the fluid pumping mechanism so wrong, why are there so many proprio-ceptors in the sutures and baro-receptors in the ventricles? Can ESTABLISHED SCIENCE answer that? You love to quote papers but as soon as someone comes along with something that challenges your model you ignore it. Skep doc doesn't debate with me because he is sick of me exposing his ignorance and arrogance.
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