Not enough controversy

[Freya]

A doctor friend told me that once upon a time doctors could prescribe "Placebin" (or whatever it was called) for their patients who toddled along to the chemists to be given a very fancy looking pack of tablets - of corn-starch. He told me it had been withdrawn though - probably too expensive!

This was withdrawn because it is considered unethical to prescribe a placebo without consent! In trials the patients consent that they might get a placebo in this case the dr is giving them that has no possible benefit when they belive they are getting "Real" medicine!

[El Salsero Gringo]

This was withdrawn because it is considered unethical to prescribe a placebo without consent!

That's ironic, because people *are* allowed to be given homeopathic pills with all sorts of unproven and unprovable quack promises attached. And if that isn't unethical, then what is?

[Freya]

That's ironic, because people *are* allowed to be given homeopathic pills with all sorts of unproven and unprovable quack promises attached. And if that isn't unethical, then what is?

But It wasn't the pills that were Considered unethical it was the giving of them with out the patients kknowledge and the "this'll make you better!" When the Dr knows full well it won't! With Homeopathic pills no Doctor should promise that it'll make them better they should only recomend them as a possible alternative that "MAy" help!!!! If they attach promises to them then yes this is unethical!

[El Salsero Gringo]

But It wasn't the pills that were Considered unethical it was the giving of them with out the patients kknowledge and the "this'll make you better!" When the Dr knows full well it won't! With Homeopathic pills no Doctor should promise that it'll make them better they should only recomend them as a possible alternative that "MAy" help!!!! If they attach promises to them then yes this is unethical!

Find me a homoeopath who's sufficiently honest to tell her patients that the sugar pills have no molecules of any active substance in them at all and that there's no reliable evidence that they're doing anything but wasting their money - then talk to me about the ethics of prescribing placebos.

If your patient leaves with the distinct impression that the pill in their hand is going to help cure their ailment then it's pure pedantry to distinguish between whether you as the therapist promised them it would help, or whether you encouraged them to take it because it might help.

Besides, the doctor prescribing the placebo knows full well that it *is* likely to help because of the psychological benefit. So where's the problem in prescribing it?

[pmjd]

Find me a homoeopath who's sufficiently honest to tell her patients that the sugar pills have no molecules of any active substance in them at all and that there's no reliable evidence that they're doing anything but wasting their money - then talk to me about the ethics of prescribing placebos.

If your patient leaves with the distinct impression that the pill in their hand is going to help cure their ailment then it's pure pedantry to distinguish between whether you as the therapist promised them it would help, or whether you encouraged them to take it because it might help.

Besides, the doctor prescribing the placebo knows full well that it *is* likely to help because of the psychological benefit. So where's the problem in prescribing it?

How do you know there aren't any active molecules, did you count them

Anyway, surely it's all a matter of approach and what you expect.

If you go to see a Doctor and are prescribed a bottle of pills then you have a certain expectation of the these pills had been made by folk in white coats and thoroughly tested. So you come away with the expectation that the pills would work and treat your illness, ergo that is why it would be unethical for Doctors to prescribe a placebo on a regular basis, they know it doesn't work and would be lying if they said it did.

Simlarly, if you choose to see a homeopath you would go with some knowledge of how they work. It's not like you would be suddenly surprised to find out afterwards that all their treatments are diluted down.

In the end of the day whatever works for you...

[El Salsero Gringo]

How do you know there aren't any active molecules, did you count them

The magic of statistics tells me I don't need to count them to know that they aren't there.

Anyway, surely it's all a matter of approach and what you expect.

If you go to see a Doctor and are prescribed a bottle of pills then you have a certain expectation of the these pills had been made by folk in white coats and thoroughly tested. So you come away with the expectation that the pills would work and treat your illness, ergo that is why it would be unethical for Doctors to prescribe a placebo on a regular basis, they know it doesn't work and would be lying if they said it did.

Simlarly, if you choose to see a homeopath you would go with some knowledge of how they work. It's not like you would be suddenly surprised to find out afterwards that all their treatments are diluted down.

I don't see the distinction that you're trying to draw - unless you're telling me that people go to homoeopaths knowing that they're being sold quack remedies and snake oil.

In both cases the patient has an expectation of some active substance (or "active lack of subtance", perhaps) in the pill. In both cases that's untrue - so why is it ethical in one case, and not in the other?

[pmjd]

The magic of statistics, you can do a lot with that

Freya already posted good reasons of why it would be unethical for a Doctor to knowingly prescribe a placebo. The distinction I was trying to draw was the difference between what you already know/expect of a Doctor or Homeopath when being treated by them.

When prescribed a drug from a Doctor you know that the drug has gone through clinical trials and has to have been proven to work otherwise it could not be sold and prescribed, you therefore expect the drug to treat your illness.

On the other hand you would already know that a Homeopath dilutes their remedies down to increase the effects but you expect this treatment to work for your illness.

So the form of medicine may be different but you have the same expectation, to be prescribed a remedy that treats your illness. Prescribing a placebo whilst knowing it would not treat the illness is what would be seen as unethical.

[David Franklin]

On the other hand you would already know that a Homeopath dilutes their remedies down to increase the effects but you expect this treatment to work for your illness.

I'm having visions of a patient who gets 100% distilled water and dies from an overdose...

[pmjd]

I'm having visions of a patient who gets 100% distilled water and dies from an overdose...

That aside, I have wondered how far the diluting thing goes?

[LMC]

Try reading this with a straight face

Hearsay: I've heard that homeopathic dilutions can run into parts per billion.

Next time I have a headache, I'll only take about a quarter of an ibuprofen tablet and jump up and down a few times...

[David Franklin]

Hearsay: I've heard that homeopathic dilutions can run into parts per billion.

Apparently much diluter than that. How does 1:10^400 sound?

[ducasi]

Try reading this with a straight face

I managed that without a problem... OK, it may have raised an eyebrow a few times...

If you're prepared to suspend disbelief for a moment, and work on the theory that it is the interaction of the "remedy's" molecules with the "diluent's" that gives homeopathic medicine its "power", then vigourous shaking is going to cause more of this interaction.

At which point, it's not how much of the remedy that's there as how much interaction there has been between the molecules. Therefore, the more dilute, the more shaken, the stronger it is.

Does that not make some sense?

At which point the argument becomes about what happens when molecules interact, and not how much of the remedy is in the pill...

I'd guess that homeopathic believers will readily admit to how diluted a remedy is, and would agree about the effectively zero chance that any of the remedy is in the medicine after the millions of dilutions. They'll instead point to the power of the "succussions", and what that has done to the molecules of the solvent.

[Barry Shnikov]

However, I disagree with withdrawal of NHS funding from the provision of tried and tested herbal/natural medicines (as opposed to homeopathic) and acupuncture. I don't know if these two are included in the proposal and don't care enough to check.

If a therapy is 'tried and tested' it's no longer 'alternative', whether it's herbal or not. On the other hand, many a herbal therapy is only 'tried and tested' in the sense that it's been recommended for yonks by people who really have not the slightest proof that it works.

Acupuncture may have elements that are useful. But in the sense that the underlying theory of acupuncture is that application of needles to 'meridians' will channel or unblock the flow of 'chi' it is, of course, nonsense. If it works, it works for reasons that are not explained by the theories on which it is avowedly based.

[Barry Shnikov]

OK I will bite

Thanks!

My life partner is a registered Homeopath so although my knowledge and understanding of the subject is not vast I do know a great many of her clients get real benefit from her treatment.

How do you know that? Because they 'self-report'? Because your life partner thinks so? Have you ever seen any double-blind tests?

Whether it is in the mind or in the tablet who knows, but given the choice of taking a chemical contrived by a drug company to boost their profits with the risk of some unpleasant side affect (hope chef is reading this ) or an alternative that results in making me feel better I will go for the second option.

Ri-i-i-ght. Gives treatment for free, does your life partner? Thought not. Gets given homeopathic 'medicines' for free to pass on to customers for free? Not likely. Your snitty side-swipe at 'drug companies' works double against peddlars of 'alternative therapies'. Try, for example, this or this.

Alternative medicine DOES work, not in all cases, but the same applies to modern medicine.

Where is the proof? Mere assertions that something works don't cut it. Astrologers assert that astrology works, Mugabe asserts that he is governing Zimbabwe properly, Bush asserted that Iraq was involved in the WTC attacks, Andrew Wakefield asserted MMR was associated with autism. Any thinking person must be sceptical.

Should the NHS provide it onprescription - probably not, should the NHS support it, and work alongside it giving patients informed information on the many alternative types of treatment available - yes but not in a beaurocratic way.

What? all of them? How many £billions is that going to cost? It's up to the proponents of an 'alternative' therapy to demonstrate its usefulness; once that has happened doctors everywhere will prescribe it.

The care of our health is not (or should not be) an exclusive club where only the people who follow the current thinking or approach to medicine can join.
It should (and does) encompass traditional and alternative forms of medicine.

If the 'current thinking' that is required is the scientific method - propound a thesis, test the thesis, abandon or modify it if wrong and hone it if correct - then you bet it should. 'Alternative' therapists who don't understand the basis of the scientific method or who disdain and criticise it must be kept away from the purses and wallets of vulnerable sufferers.

Oh and the comment on burning witches & homeopathy being 300 years old
In 450bc Hippocrates was advocating the principles of Homeopathic remedies (treating like with like) and Reflexology goes back even further, both the ancient Chinese & Egyptians are thought to have practiced reflexology and evidence can be seen depicted in ancient cave paintings

Well. Greek doctors! They also said that the world was made up of earth, air, fire and water, and that sickness was caused by imbalance of the four humours - blood, phlegm, coler and melancholy - how right were they!
In any event, while no doubt homeopaths would love to claim 'ancient authority' for their ministrations, the main criticism is not the assertion that 'like treats like', but that if you dilute something 1/99 twenty or thirty times, there's no active ingredient left. Quite why rotting duck heart and liver should have any effect on colds is a mystery to me anyway.

(I found the following in one of my partners books)
Homeopathy for use in modern medicine is primarily due to two German Doctors.
Paracelsus (1494-1541) often referred to as the 'father of Chemistry' for he updated alchemy by moving it away from the search for the elixir of life towards treating illness and pharmaceutical studies
and modern homeopathy came about when..........
Samuel Hahnemann (1755-1843) (the founder of modern Homeopathy
who proved that natural medicines mainly derived from plants & minerals provide a safe effective medication for treating majority of ailments on a like for like basis.

Paracelsus had nothing to do with homeopathy, as propounded by Hahnemann and currently practised. Hahnemann plucked it out of thin air. He did attempt to use the scientific method, but his techniques and methodology were insufficiently detailed (the effectiveness of treatments were based entirely on self reporting) and he did not understand the importance of controls.
On the other hand, if homeopaths want to claim that the roots of their proposals are to found in alchemy then...

[Barry Shnikov]

The magic of statistics tells me I don't need to count them to know that they aren't there.

Omigod! There goes the foundation of my world. Statistics is a branch of magic!! Woe is me.

[Barry Shnikov]

On the other hand you would already know that a Homeopath dilutes their remedies down to increase the effects but you expect this treatment to work for your illness.

I'm not at all sure that it is the case that all or even most customers of homeopaths have the faintest idea that there can be no active ingredient in the medicines they are prescribed.

[Barry Shnikov]

At which point, it's not how much of the remedy that's there as how much interaction there has been between the molecules. Therefore, the more dilute, the more shaken, the stronger it is.
Does that not make some sense?

How?

At which point the argument becomes about what happens when molecules interact, and not how much of the remedy is in the pill...
I'd guess that homeopathic believers will readily admit to how diluted a remedy is, and would agree about the effectively zero chance that any of the remedy is in the medicine after the millions of dilutions. They'll instead point to the power of the "succussions", and what that has done to the molecules of the solvent.

That's correct. The leading 'thinkers' among homeopaths say that the molecules of water retain a 'memory' of being in contact with the active ingredient. Currently they are working on how to explain how the water molecules know that they are supposed to 'remember' contact with the active ingredient and not with the billions of other (non-water) molecules they have touched. Rocks, fishes' gills and gut, beer bottles, ship's bottoms, pipes, bladders - the mind boggles.

[El Salsero Gringo]

If you're prepared to suspend disbelief for a moment, and work on the theory that it is the interaction of the "remedy's" molecules with the "diluent's" that gives homeopathic medicine its "power", then vigourous shaking is going to cause more of this interaction.

Let's look at this "shaken together therefore maintaining some 'memory' theory": the random thermal motion of the molecules should bang them together quite hard enough for any 'memory effect' to be apparent. The thermal motions even at room temperature are much stronger than you can generate by shaking; this is clear because you only get a tiny (but measurable) temperature rise when you shake a bottle of water.

[CJ]

this is clear because you only get a tiny (but measurable) temperature rise when you shake a bottle of water.

Will a regular (3-a-day) Tommy Tanker be able to raise the temperature of the water more because of stamina/shaking technique??
If so, does this affect the quality of accupuncturist?

[El Salsero Gringo]

Will a regular (3-a-day) Tommy Tanker be able to raise the temperature of the water more because of stamina/shaking technique??
If so, does this affect the quality of accupuncturist?

TPBM's last orgasm was a "Thomas The Tank".

CJ, I'm beginning to spot a trend. Do you think perhaps you should get out more?