Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?
I mean, there’s always the argument that you should do whatever it is that makes pain go away, but is there a reason to have a chiropractor do this rather than a medical professional?
I don’t want to diss this post which seems quite good, I just wanted to highlight this point.
However, I haven’t done any real research on this subject. The idea that chiropractors are practicing sham medicine is just kind of background knowledge that I’m not really sure where I picked up.
They’re plausibly pretty legit for some joint-related issues. However there’s also a whole set of claims that they can treat totally unrelated issues, for example curing the flu by adjusting the spine. Not all chiropractors make this sort of claim, but enough do to make it background knowledge.
A good chiropractic treatment provides an immediate, if short-term, relief for many joint issues. You can rarely get that from a physio and almost never from a physician without pain meds.
Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?
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However, I haven’t done any real research on this subject. The idea that chiropractors are practicing sham medicine is just kind of background knowledge that I’m not really sure where I picked up.
Same for me. I was a little bit shocked to read that someone on LessWrong goes to a chiropractor. But for me this attitude is also based on something I considered to be common knowledge, such as astrology being pseudoscience. And the Wikipedia article on chiropractic did not change this attitude much.
Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?
Others have discussed the scientific evidence, but I’ll flesh out shminux’s comment with some anecdotal evidence. My father developed some lower back pain from his job as a pilot, and found that a chiropractor was immediately able to solve the problem; he recommends trying it out to people because a single session is low-risk but it should be obvious whether or not it’s working.
In general, statistical analysis of medical treatments runs into the issue that it’s easy to ask the question “did everyone given treatment X get better?” and difficult to ask the question “how can we tell who will get better and who won’t given treatment X?”, and the latter question is the one that tends to be practically useful.
Indeed. They call this “effect modification” in epi. I guess in some sense, this is just another guise for the curse of dimensionality in the context of determining causal effects. Lots of covariates might be relevant for why [X] helps you, but trials aren’t very large, and simple regression models people use probably aren’t right very often. So it’s hard to establish if E[Y | do(x), C] - E[Y | do(placebo), C] is appreciably different from 0 for a sufficiently multidimensional C.
edit: In case it is not clear, p(A | do(B=b), C) is defined to be p(A, C | do(B=b)) / p(C | do(B=b)) (under appropriate assumptions that preclude dividing by zero). This is one of the reasons I don’t like the do(.) notation so much. In counterfactual notation, we can make a distinction about whether C is under the interventional regime or not, that is in general p(A(b) | C(b)) is not equal to p(A(b) | C) (but it is for any pretreatment covariate C, because then p(C | do(B=b)) = p(C(b)) = p(C). That is, the future cannot affect the past.
In general, statistical analysis of medical treatments runs into the issue that it’s easy to ask the question “did everyone given treatment X get better?” and difficult to ask the question “how can we tell who will get better and who won’t given treatment X?”, and the latter question is the one that tends to be practically useful.
Anecdotes don’t answer the latter question any better. Not even if you’re given a statistically effective treatment and happen to improve. I suspect placebo is stronger the more dramatic the treatment.
Anecdotes don’t answer the latter question any better. Not even if you’re given a statistically effective treatment and happen to improve.
Agreed that anecdotes are single points of data with potentially unknown selection effects. Not sure if I agree about the second part; it seems like treatment successes vary in their obviousness and I suspect some component of that measurement will always be anecdotal.
When you can do statistics, of course, you should; Gendlin’s Focusing seems like a good example of the benefit of trying to figure out whether or not therapeutic success could be predicted (it could, and then they could target the success factor directly).
Interesting thing about anecdotal data is I tend to hugely overestimate my effect in making people better. To bring myself back to earth I look at the puny effects many treatments have been demonstrated to have and conclude many patients get better regardless of treatment. I certainly underestimate my faults too, but that’s a tougher nut to crack. I’ve also seen doctors overestimate other doctor’s faults; of course the failure to intervene with a treatment shown to avoid a bad outcome by a few percentage points killed the patient!
A bad doctor that operates you based on a misdiagnosis can also do a lot of damage.
Giving pain killers is a quite standard approach of doctors to deal with people who complain about pain and not very well targeted to solve underlying problems either.
There’s vastly more quality control in medicine than in alternative medicine, which is the context in which I meant my comment to be read.
There are lazy doctors, yes, but I’m a bit tired of you painting all of them with the same brush. Also NSAIDs are the most effective treatment known for many problems which understandably bores patients who are anxious to get all kinds of bells and whistles on their first visit.
the average practice of chiropractic is a lot closer to operating than the average doctoral practice. They do spinal adjustments as a matter of course.
Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?
The latest Cochrane review indicates that chiropractors do as well as conventional treatment for lower back pain.
It’s a bit odd as the first choice of treatment but trying a bunch of different treatments till one solves an issue like this is useful.
Modern opposition to chiropractics is based on the foundation that chiropractors diagnose patients based on what they feel when they touch the patients and not based on X-ray.
It’s quite easy to do objective science based on X-rays. The moment where you diagnose based on subjective perception it becomes harder to do science.
Guesses about what Palmer, the founder of chiropractics thought he was doing turned out to be wrong and it took the chiropractic association till 1996 to update their definition of subluxation.
Big pharma also has a business model where they can outspend chiropractors by a huge margin when it comes to lobbying and PR to establish memes in society.
The fact that some chiropractors claim to be able to treat every disease while they probably can’t also doesn’t help.
The latest Cochrane review indicates that chiropractors do as well as conventional treatment for lower back pain.
It’s not clear from the summary whether the control interventions were conventional best practice or not. The authors also noted most of the trials had high risk of bias.
It’s quite easy to do objective science based on X-rays. The moment where you diagnose based on subjective perception it becomes harder to do science.
Actually it should be quite easy to do science by comparing chiropractors’ diagnostic accuracy to diagnoses done by radiologists. If you can see it on an x-ray in superficial anatomy a chiropractor should definitely feel it. Also if there’s anything wrong with the positions of vertebrae that a chiropractor can feel an MRI would definitely show it. Do such trials exist?
Doctors do diagnostics manually too. The difference is they won’t tell you their subjective methods are out of the reach of science. Same goes for physical therapists, wonder why big pharma isn’t lobbying against them...
Actually it should be quite easy to do science by comparing chiropractors’ diagnostic accuracy to diagnoses done by radiologists.
If it’s about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn’t necessarily show any evidence.
An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.
Same goes for physical therapists, wonder why big pharma isn’t lobbying against them...
I know very little about how how societal attitudes about physical therapists formed and who’s responsible for it but I wouldn’t be very surprised if there isn’t someone on the payroll of big pharma out there who’s job it is to lobby for stronger standards of evidence for studies for interventions of physical therapists.
In practice many physical therapists also do a lot of things that aren’t backed up by studies that show that they work for a specific condition.
If it’s about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn’t necessarily show any evidence.
Point is if they can’t notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn’t avoid science even in this area.
An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.
fMRI is a dynamic modality for imaging the brain which has nothing to do with what we’re talking about. I was suggesting plain MRI, which is actually renowned for its accuracy in imaging soft tissues and not only bones.
In practice many physical therapists also do a lot of things that aren’t backed up by studies that show that they work for a specific condition.
Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.
Point is if they can’t notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn’t avoid science even in this area.
One approach is to say: “Hey, this location feels off. If I do technique X this location doesn’t feel off anymore and the person feels better. They aren’t in pain anymore and their symptoms disappear.”
It’s another problem to figure out the underlying biology and be able to say exactly what’s happening. That takes certain skills that usually don’t go hand in hand with being able to perceive locations that are off.
It’s also next to impossible to get funding for that kind of research. I know someone who does her PHD at using the kinect to do computer modeling of an proven physical intervention used by some physical therapists. There’s little grand money available for that kind of research. Most of the grant money goes to cell biology and biochemistry. Universities have to seek external funding these days and big pharma has money to throw around. Some science that is in principle doable isn’t done because there nobody to fund it.
Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.
I do think that risk of interventions is a concern but I don’t think it’s the driving force for mainstream beliefs about chiropractors. Given the inherent risk, it makes more sense to start with lower risk interventions.
As far as potential harm from interventions from physical therapists the risk is likely less, but I would be surprised if there’s no physical therapists that messed someone up.
Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.
What are your suggestions for how to most reliably evaluate anecdotal data? Would it be possible to do some sort of meta-science on this topic? How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)
I understand many medical treatments aren’t RCT based either but the fact that many are kind of makes me trust the mindset of health care professionals more.
Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.
And indeed it turns out they are: this is a pretty standard part of the alternative medicine anti-rationalist toolkit.
I haven’t made a simply argument against doing science in principle. I made arguments that you shouldn’t assume that everything there is to know is discovered by science_2014.
How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)
Hypnosis is basically about utilizing suggestion in efficient ways. If you do it right then you can switch off any pain with it.
How can argue that this is basically placebo but that doesn’t change anything about the fact that the person isn’t in pain anymore and the person wouldn’t get the same effect if they would go to a person who’s not skilled at using suggestion.
Furthermore any somatic intervention by definition targets someone’s subjective experience. The notion of placebo’s doesn’t make any sense for somatics.
Instead of testing against placebo I would prefer testing against the Gold standard for treatment. A person who’s in ill cares whether he gets healed better by treatment A or by treatment B. He doesn’t care about placebos.
In some cases you can run additional trials with placebos to get additional knowledge, but comparison to Gold standards seems more important to me.
Of course it’s good for big pharma to have placebo blinding as the default standard. That way there less pressure to show that new drugs outperform old ones and treatments that aren’t blinded as easily because they aren’t pills or injections get shun.
I also think that the system that Eliezer proposed in his first april joke post, would work better than what we have.
The doctrine of blindness also shuts down a lot of phenomenological investigation that’s important to understanding treatments.
Would it be possible to do some sort of meta-science on this topic?
Yes. I also care more for that then for chiropractors. I have no personal experience with chiropractic treatment nor know someone personally who has.
I’m not sure to what extend fascia is simply the latest buzzword or whether it a concept that yields a lot of new insight. The International Fascia Research Congress will be hold next year for the fourth time with makes it a pretty new field.
Somatics in general is possible to research by asking people to report their experience. It″s not straightforward. I took 2 1⁄2 years to understand a concept expressible in 21 words to the extend that I internalized it and could really use it.
The little literature there is on somatics feels like it’s making a bunch of trivial points but most of what matters is hidden in plain sight.
Standardizing that knowledge and structuring it in a way that’s well communicated by a book is a hard project.
Last year I had the experience of trying out my newly found perception ability. I noticed a friend strangely interacting with grass and after asking him what he’s doing he talked about it. I couldn’t perceive anything special about the grass. Then he suggested tries because they are easier and it was an interesting experience.
WIth that new found experience I went to my somatics teacher and asked her about perceiving trees to check if my own perception matches with hers and she found what I’m doing a bit strange. If her tree at the balcony needs water than she gets a feeling that it needs water but she never goes out and actively trying to perceive a tree. I felt like a child playing with his new toy while the adults consider that playing and experimenting immature.
It still don’t know whether I understand the full extend of the problem let alone the solution.
Big pharma also has a business model where they can outspend chiropractors by a huge margin when it comes to lobbying and PR to establish memes in society.
Big pharma versus big placebo: one of these is constrained by expectations of evidence, the other to people opposed to joined-up thinking.
Are you seriously claiming the medical opposition to chiropractic is a big pharma conspiracy? If so, do you have actual evidence rather than merely asserting it’s possible?
Are you seriously claiming the medical opposition to chiropractic is a big pharma conspiracy?
I make a claim that’s more complex than that.
Conspiracy assumes not being open.
It has nothing to do with a university rather funding research that produces patents that a pharma company can use than the university doing research that’s beneficial for individuals doing various kind of manual therapy.
As far as real conspiracy goes, there plenty of evidence of pharma companies having to pay huge fines because they bribe doctors in various ways to do what’s good for the pharma company.
If a doctor gives his patients a drug from a big pharma company that company invites him to a fancy all-costs payed luxury vacation conference.
It’s not as bad as it used to be, but it was bad over decades and that made certain memes win memetic competition.
Chiropractors don’t have similar systems for paying doctors who refer clients kickbacks.
In the 20st century big corporations very often won conflicts because the have more power than a bunch of individual practitioners.
It also seems to me more and more silly to believe that the blind man sees more and that blinding in general is the key to knowledge gathering.
It’s one of those things, were a kid in a hundred years will have a hard time understanding history because the idea is just so silly. Just like we today have a hard time understanding what people in the middle ages used to believe.
It’s also interesting that the ideal of blindness is so strong in the medical field and not as strong in any other domain.
A medical professor usually teaches the “evidence-based method” with teaching methods for which he as no evidence that they work. Somehow they succeed to do this without feeling weird. It’s quite remarkable.
I don’t think you can solve the puzzle of why that double standard exists without acknowledging that well-funded parties have an interest in things being that way.
Nobody makes money based on a platform of “evidence-based teaching” so we don’t have it in our society but we do have “evidence-based medicine” because a coalition lead by big pharma payed to establish that meme.
I think it’s a defensible position to argue that everything should be evidence-based but I see no intellectual reason to have it concentrated into one domain. The best way to explain the status quo is through analyzing the interests of those in power for meme generation.
1) You don’t give any figures for how common it is for doctors to get invited to a conference that is an excuse for a vacation. And I suspect you don’t have any.
2) Even if it’s true, there is a limit to how you much you can influence a doctor with such things. You might get a doctor to adopt some new drug which isn’t as good as it should be, but you can’t, for instance, get the doctor to oppose vaccination or convince him that saturated fats are healthy. It would be impossible to get doctors to oppose chiropractic this way unless there was already obvious reason to believe it’s pseudoscience.
Cigarette companies had plenty of money and tried to buy as many experts as they could. The best they could do was get an occasional scientist or doctor on their side; they came nowhere near convincing the whole medical profession that cigarette smoking is safe.
Well as we know now they are healthier than trans-unsaturated fats. Nevertheless, for decades doctors would advise their patients to switch from butter (saturated) to margarine (trans).
It also seems to me more and more silly to believe that the blind man sees more and that blinding in general is the key to knowledge gathering. It’s one of those things, were a kid in a hundred years will have a hard time understanding history because the idea is just so silly. Just like we today have a hard time understanding what people in the middle ages used to believe.
This is a straw man. Blinding is used where it can be used. It’s not necessary for doing medical science, and nonblinded trials are definitely accepted by doctors as a weaker form of evidence in cases where blinding isn’t possible. Many surgical procedures can’t be blinded for example. Blinding doesn’t mean not observing patients, it has a much more specific meaning than that. Because of your background in bioinformatics I think you know this, and are stretching the meaning on purpose.
A medical professor usually teaches the “evidence-based method” with teaching methods for which he as no evidence that they work.
You’re making sweeping generalizations with nothing to back them up.
If a doctor gives his patients a drug from a big pharma company that company invites him to a fancy all-costs payed luxury vacation conference. It’s not as bad as it used to be, but it was bad over decades and that made certain memes win memetic competition.
This is strictly illegal in many (most?) countries.
Blinding doesn’t mean not observing patients, it has a much more specific meaning than that.
Blinding is used where it can be used.
I can cross the street with a blindfold. That doesn’t mean that’s a good idea.
The general idea of blinding in medical science is that on average the human pattern matching ability produces more harm than good.
Good medical treatment in the evidence-based paradigm is supposed to be treatment by the book.
People do things like putting box-plots in their scientific papers instead of providing plots of raw data to hide the messiness of real world data from their eyes. That happens in a culture that values blindness.
That culture of blindness leads to many unknowns unknowns that mess with your process in complex ways.
There are many assumption about how learning and how knowledge work that are just assumed to be true.
One example is measure lung function. I have seen papers on Asthma medication that use FEV1 as metric of success.
I have measured FEV1 daily for over a year and one day before I got the flu I felt restricted breathing. My FEV1 was
still at the normal value.
That’s a reference experience that increases my knowledge about the subject. Involved interaction with the subject matter
leads to knowledge. You don’t get reference experiences by reading journal papers and text books.
You usually also don’t learn new phenomenological primitives that way.
Oscar Wilde wrote: “Nothing that is worth knowing can be taught.”
“Nothing” might be an exaggeration but certain knowledge is just really really hard to transfer.
But you can set up conditions that are conductive to learning.
You’re making sweeping generalizations with nothing to back them up.
Are you arguing that professors are using teaching methods for whom they have published evidence that those teaching methods work?
This is strictly illegal in many (most?) countries.
Today yes. 20 years ago no. Today Big Pharma can’t bribe as much doctors anymore, their business model is in crisis and they have to lay of a lot of workers. Of course it might just be correlation and no causation between the separate observations.
I have seen papers on Asthma medication that use FEV1 as metric of success. I have measured FEV1 daily for over a year and one day before I got the flu I felt restricted breathing. My FEV1 was still at the normal value.
A measure that is wrong in one particular case may still be the best measure available on a statistical level. I highly doubt that doctors would get better ideas of which therapies are good if they discarded this measure and instead used “does the patient claim to feel restricted breathing”.
Furthermore, you haven’t convinced me the measure was wrong even in your case. Measurements are rarely yes or no things; most measurements fall within a range and there is not a sharp cutoff between healthy and unhealthy on the end of the range. You could have been at some point that was far enough within the range to be considered okay, yet still not be 100% okay.
You could have been at some point that was far enough within the range to be considered okay, yet still not be 100% okay.
It’s a measurement I did every day I know how the value fluctuates and it was in the middle of the normal range.
A measure that is wrong in one particular case may still be the best measure available on a statistical level. I highly doubt that doctors would get better ideas of which therapies are good if they discarded this measure and instead used “does the patient claim to feel restricted breathing”.
I don’t claim that doctors should just replace FEV1 with “does the patient claim to feel restricted breathing”.
That’s the kind of thing that doesn’t need any reference experiences and is easily communicable via text.
I claim that the actual experience of interacting with a measurement in a involved way is important to train your intuition to be able to understand a measurement. If you don’t have that understanding you are going to make mistakes.
If someone would give me a million dollars I might also produce a device that measures something better than FEV1 but that’s not the main point of the argument. But that would be me wearing a bioinformatics hat and that’s not the main hat I’m wearing in this discussion.
As far as real conspiracy goes, there plenty of evidence of pharma companies having to pay huge fines because they bribe doctors in various ways to do what’s good for the pharma company.
No, my claim is about the process in which memes succeed. As such it’s not invalid ad hominem to analyse that process.
If you forbid all kinds of ad hominems than you basically say that it’s in general a fallacy to call out someone who’s suffering from bias. To stay in the overall argument, there no reason to blind yourself and ignore features of the process that produces memes.
You’ve made a claim and aren’t supplying evidence for it, formal or even non-negligible Bayesian.
I haven’t made a claim that includes the word “conspiracy”. You used that word. There no reason for my to provide evidence for claims I haven’t made.
Given the kind of claims I’m arguing there no reason to attack straw mans.
The database shows Pfizer has made at least $538,200,000 in side payments to doctors, while Eli Lily comes in a close second having paid out $490,600,000.
That are two companies paying together a billion in bribes and it only counts the bribes of doctors.
Whether or not you want to call a billion in bribes a conspiracy is semantics which doesn’t have much to do with Bayesian reasoning and I specifically didn’t use the word ‘conspiracy’ because I don’t think it’s very helpful in this case.
Do you doubt that big pharma has a bunch of lobbyists that have a lot of influence on the medical system? Is that a claim for which you want proof?
Do you want me to search of the marketing budget of various big pharma companies and for the amount of money that the chiropractor associating can afford to spend on similar activities?
You haven’t advanced a dot of evidence relating to chiropracty, which is the subject of this subthread. You’ve advanced evidence of lobbyists, but not that the lobbyists are destroying a deserved good reputation of chiropracty. Do you have any evidence to this effect? (Both of the lobbying and of the good reputation.)
I claim that certain views are hold by a certain group of people for reason that have to do with the actions of certain organisations.
You claim that’s I’m engaging into a logical fallacy if I look at the way beliefs are formed. As humans don’t form their beliefs through logic, that’s besides the point.
Even if you form your beliefs through logic, it’s still an interesting discussion to discuss why the medical profession believes what it believes.
That fact that you are unable to make that distinction makes you unable to follow the argument I’m making.
I didn’t argue in this thread that chiropractors deserve a good reputation or for that matter recommended to someone that he should go to a chiropractor.
I don’t think in terms of black and white but make statements that are much more nuanced.
A chiropractor?
Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?
I mean, there’s always the argument that you should do whatever it is that makes pain go away, but is there a reason to have a chiropractor do this rather than a medical professional?
I don’t want to diss this post which seems quite good, I just wanted to highlight this point.
My first google result led me to this: http://www.sciencebasedmedicine.org/science-and-chiropractic/
However, I haven’t done any real research on this subject. The idea that chiropractors are practicing sham medicine is just kind of background knowledge that I’m not really sure where I picked up.
They’re plausibly pretty legit for some joint-related issues. However there’s also a whole set of claims that they can treat totally unrelated issues, for example curing the flu by adjusting the spine. Not all chiropractors make this sort of claim, but enough do to make it background knowledge.
A good chiropractic treatment provides an immediate, if short-term, relief for many joint issues. You can rarely get that from a physio and almost never from a physician without pain meds.
Same for me. I was a little bit shocked to read that someone on LessWrong goes to a chiropractor. But for me this attitude is also based on something I considered to be common knowledge, such as astrology being pseudoscience. And the Wikipedia article on chiropractic did not change this attitude much.
Others have discussed the scientific evidence, but I’ll flesh out shminux’s comment with some anecdotal evidence. My father developed some lower back pain from his job as a pilot, and found that a chiropractor was immediately able to solve the problem; he recommends trying it out to people because a single session is low-risk but it should be obvious whether or not it’s working.
In general, statistical analysis of medical treatments runs into the issue that it’s easy to ask the question “did everyone given treatment X get better?” and difficult to ask the question “how can we tell who will get better and who won’t given treatment X?”, and the latter question is the one that tends to be practically useful.
Indeed. They call this “effect modification” in epi. I guess in some sense, this is just another guise for the curse of dimensionality in the context of determining causal effects. Lots of covariates might be relevant for why [X] helps you, but trials aren’t very large, and simple regression models people use probably aren’t right very often. So it’s hard to establish if E[Y | do(x), C] - E[Y | do(placebo), C] is appreciably different from 0 for a sufficiently multidimensional C.
edit: In case it is not clear, p(A | do(B=b), C) is defined to be p(A, C | do(B=b)) / p(C | do(B=b)) (under appropriate assumptions that preclude dividing by zero). This is one of the reasons I don’t like the do(.) notation so much. In counterfactual notation, we can make a distinction about whether C is under the interventional regime or not, that is in general p(A(b) | C(b)) is not equal to p(A(b) | C) (but it is for any pretreatment covariate C, because then p(C | do(B=b)) = p(C(b)) = p(C). That is, the future cannot affect the past.
Anecdotes don’t answer the latter question any better. Not even if you’re given a statistically effective treatment and happen to improve. I suspect placebo is stronger the more dramatic the treatment.
Agreed that anecdotes are single points of data with potentially unknown selection effects. Not sure if I agree about the second part; it seems like treatment successes vary in their obviousness and I suspect some component of that measurement will always be anecdotal.
When you can do statistics, of course, you should; Gendlin’s Focusing seems like a good example of the benefit of trying to figure out whether or not therapeutic success could be predicted (it could, and then they could target the success factor directly).
Interesting thing about anecdotal data is I tend to hugely overestimate my effect in making people better. To bring myself back to earth I look at the puny effects many treatments have been demonstrated to have and conclude many patients get better regardless of treatment. I certainly underestimate my faults too, but that’s a tougher nut to crack. I’ve also seen doctors overestimate other doctor’s faults; of course the failure to intervene with a treatment shown to avoid a bad outcome by a few percentage points killed the patient!
I see two problems with a chiropractor even if they could be of real help which I’m not too sure about.
A bad chiropractor can do a lot of damage.
Temporary relief, real or placebo, will delay diagnosis if there’s an underlying medical problem.
A bad doctor that operates you based on a misdiagnosis can also do a lot of damage.
Giving pain killers is a quite standard approach of doctors to deal with people who complain about pain and not very well targeted to solve underlying problems either.
There’s vastly more quality control in medicine than in alternative medicine, which is the context in which I meant my comment to be read.
There are lazy doctors, yes, but I’m a bit tired of you painting all of them with the same brush. Also NSAIDs are the most effective treatment known for many problems which understandably bores patients who are anxious to get all kinds of bells and whistles on their first visit.
the average practice of chiropractic is a lot closer to operating than the average doctoral practice. They do spinal adjustments as a matter of course.
That depends a lot of how you measure “closeness to operating”. A bad doctor can hit a nerve when he gives you an injection via a syringe.
A lot of drugs can have quite nasty side effects.
The latest Cochrane review indicates that chiropractors do as well as conventional treatment for lower back pain.
It’s a bit odd as the first choice of treatment but trying a bunch of different treatments till one solves an issue like this is useful.
Modern opposition to chiropractics is based on the foundation that chiropractors diagnose patients based on what they feel when they touch the patients and not based on X-ray. It’s quite easy to do objective science based on X-rays. The moment where you diagnose based on subjective perception it becomes harder to do science.
Guesses about what Palmer, the founder of chiropractics thought he was doing turned out to be wrong and it took the chiropractic association till 1996 to update their definition of subluxation.
Big pharma also has a business model where they can outspend chiropractors by a huge margin when it comes to lobbying and PR to establish memes in society.
The fact that some chiropractors claim to be able to treat every disease while they probably can’t also doesn’t help.
It’s not clear from the summary whether the control interventions were conventional best practice or not. The authors also noted most of the trials had high risk of bias.
Actually it should be quite easy to do science by comparing chiropractors’ diagnostic accuracy to diagnoses done by radiologists. If you can see it on an x-ray in superficial anatomy a chiropractor should definitely feel it. Also if there’s anything wrong with the positions of vertebrae that a chiropractor can feel an MRI would definitely show it. Do such trials exist?
Doctors do diagnostics manually too. The difference is they won’t tell you their subjective methods are out of the reach of science. Same goes for physical therapists, wonder why big pharma isn’t lobbying against them...
If it’s about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn’t necessarily show any evidence.
An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.
I know very little about how how societal attitudes about physical therapists formed and who’s responsible for it but I wouldn’t be very surprised if there isn’t someone on the payroll of big pharma out there who’s job it is to lobby for stronger standards of evidence for studies for interventions of physical therapists.
In practice many physical therapists also do a lot of things that aren’t backed up by studies that show that they work for a specific condition.
Point is if they can’t notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn’t avoid science even in this area.
fMRI is a dynamic modality for imaging the brain which has nothing to do with what we’re talking about. I was suggesting plain MRI, which is actually renowned for its accuracy in imaging soft tissues and not only bones.
Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.
One approach is to say: “Hey, this location feels off. If I do technique X this location doesn’t feel off anymore and the person feels better. They aren’t in pain anymore and their symptoms disappear.” It’s another problem to figure out the underlying biology and be able to say exactly what’s happening. That takes certain skills that usually don’t go hand in hand with being able to perceive locations that are off.
It’s also next to impossible to get funding for that kind of research. I know someone who does her PHD at using the kinect to do computer modeling of an proven physical intervention used by some physical therapists. There’s little grand money available for that kind of research. Most of the grant money goes to cell biology and biochemistry. Universities have to seek external funding these days and big pharma has money to throw around. Some science that is in principle doable isn’t done because there nobody to fund it.
I do think that risk of interventions is a concern but I don’t think it’s the driving force for mainstream beliefs about chiropractors. Given the inherent risk, it makes more sense to start with lower risk interventions.
As far as potential harm from interventions from physical therapists the risk is likely less, but I would be surprised if there’s no physical therapists that messed someone up.
Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.
What are your suggestions for how to most reliably evaluate anecdotal data? Would it be possible to do some sort of meta-science on this topic? How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)
I understand many medical treatments aren’t RCT based either but the fact that many are kind of makes me trust the mindset of health care professionals more.
And indeed it turns out they are: this is a pretty standard part of the alternative medicine anti-rationalist toolkit.
I haven’t made a simply argument against doing science in principle. I made arguments that you shouldn’t assume that everything there is to know is discovered by science_2014.
Hypnosis is basically about utilizing suggestion in efficient ways. If you do it right then you can switch off any pain with it. How can argue that this is basically placebo but that doesn’t change anything about the fact that the person isn’t in pain anymore and the person wouldn’t get the same effect if they would go to a person who’s not skilled at using suggestion.
Furthermore any somatic intervention by definition targets someone’s subjective experience. The notion of placebo’s doesn’t make any sense for somatics.
Instead of testing against placebo I would prefer testing against the Gold standard for treatment. A person who’s in ill cares whether he gets healed better by treatment A or by treatment B. He doesn’t care about placebos.
In some cases you can run additional trials with placebos to get additional knowledge, but comparison to Gold standards seems more important to me. Of course it’s good for big pharma to have placebo blinding as the default standard. That way there less pressure to show that new drugs outperform old ones and treatments that aren’t blinded as easily because they aren’t pills or injections get shun.
I also think that the system that Eliezer proposed in his first april joke post, would work better than what we have.
The doctrine of blindness also shuts down a lot of phenomenological investigation that’s important to understanding treatments.
Yes. I also care more for that then for chiropractors. I have no personal experience with chiropractic treatment nor know someone personally who has.
I’m not sure to what extend fascia is simply the latest buzzword or whether it a concept that yields a lot of new insight. The International Fascia Research Congress will be hold next year for the fourth time with makes it a pretty new field.
Somatics in general is possible to research by asking people to report their experience. It″s not straightforward. I took 2 1⁄2 years to understand a concept expressible in 21 words to the extend that I internalized it and could really use it. The little literature there is on somatics feels like it’s making a bunch of trivial points but most of what matters is hidden in plain sight.
Standardizing that knowledge and structuring it in a way that’s well communicated by a book is a hard project.
Last year I had the experience of trying out my newly found perception ability. I noticed a friend strangely interacting with grass and after asking him what he’s doing he talked about it. I couldn’t perceive anything special about the grass. Then he suggested tries because they are easier and it was an interesting experience.
WIth that new found experience I went to my somatics teacher and asked her about perceiving trees to check if my own perception matches with hers and she found what I’m doing a bit strange. If her tree at the balcony needs water than she gets a feeling that it needs water but she never goes out and actively trying to perceive a tree. I felt like a child playing with his new toy while the adults consider that playing and experimenting immature.
It still don’t know whether I understand the full extend of the problem let alone the solution.
Big pharma versus big placebo: one of these is constrained by expectations of evidence, the other to people opposed to joined-up thinking.
Are you seriously claiming the medical opposition to chiropractic is a big pharma conspiracy? If so, do you have actual evidence rather than merely asserting it’s possible?
I make a claim that’s more complex than that.
Conspiracy assumes not being open. It has nothing to do with a university rather funding research that produces patents that a pharma company can use than the university doing research that’s beneficial for individuals doing various kind of manual therapy.
As far as real conspiracy goes, there plenty of evidence of pharma companies having to pay huge fines because they bribe doctors in various ways to do what’s good for the pharma company.
If a doctor gives his patients a drug from a big pharma company that company invites him to a fancy all-costs payed luxury vacation conference. It’s not as bad as it used to be, but it was bad over decades and that made certain memes win memetic competition.
Chiropractors don’t have similar systems for paying doctors who refer clients kickbacks.
In the 20st century big corporations very often won conflicts because the have more power than a bunch of individual practitioners.
It also seems to me more and more silly to believe that the blind man sees more and that blinding in general is the key to knowledge gathering. It’s one of those things, were a kid in a hundred years will have a hard time understanding history because the idea is just so silly. Just like we today have a hard time understanding what people in the middle ages used to believe.
It’s also interesting that the ideal of blindness is so strong in the medical field and not as strong in any other domain.
A medical professor usually teaches the “evidence-based method” with teaching methods for which he as no evidence that they work. Somehow they succeed to do this without feeling weird. It’s quite remarkable. I don’t think you can solve the puzzle of why that double standard exists without acknowledging that well-funded parties have an interest in things being that way.
Nobody makes money based on a platform of “evidence-based teaching” so we don’t have it in our society but we do have “evidence-based medicine” because a coalition lead by big pharma payed to establish that meme.
I think it’s a defensible position to argue that everything should be evidence-based but I see no intellectual reason to have it concentrated into one domain. The best way to explain the status quo is through analyzing the interests of those in power for meme generation.
1) You don’t give any figures for how common it is for doctors to get invited to a conference that is an excuse for a vacation. And I suspect you don’t have any.
2) Even if it’s true, there is a limit to how you much you can influence a doctor with such things. You might get a doctor to adopt some new drug which isn’t as good as it should be, but you can’t, for instance, get the doctor to oppose vaccination or convince him that saturated fats are healthy. It would be impossible to get doctors to oppose chiropractic this way unless there was already obvious reason to believe it’s pseudoscience.
Cigarette companies had plenty of money and tried to buy as many experts as they could. The best they could do was get an occasional scientist or doctor on their side; they came nowhere near convincing the whole medical profession that cigarette smoking is safe.
Well as we know now they are healthier than trans-unsaturated fats. Nevertheless, for decades doctors would advise their patients to switch from butter (saturated) to margarine (trans).
This is a straw man. Blinding is used where it can be used. It’s not necessary for doing medical science, and nonblinded trials are definitely accepted by doctors as a weaker form of evidence in cases where blinding isn’t possible. Many surgical procedures can’t be blinded for example. Blinding doesn’t mean not observing patients, it has a much more specific meaning than that. Because of your background in bioinformatics I think you know this, and are stretching the meaning on purpose.
You’re making sweeping generalizations with nothing to back them up.
This is strictly illegal in many (most?) countries.
I can cross the street with a blindfold. That doesn’t mean that’s a good idea.
The general idea of blinding in medical science is that on average the human pattern matching ability produces more harm than good. Good medical treatment in the evidence-based paradigm is supposed to be treatment by the book.
People do things like putting box-plots in their scientific papers instead of providing plots of raw data to hide the messiness of real world data from their eyes. That happens in a culture that values blindness.
That culture of blindness leads to many unknowns unknowns that mess with your process in complex ways.
There are many assumption about how learning and how knowledge work that are just assumed to be true.
One example is measure lung function. I have seen papers on Asthma medication that use FEV1 as metric of success. I have measured FEV1 daily for over a year and one day before I got the flu I felt restricted breathing. My FEV1 was still at the normal value.
That’s a reference experience that increases my knowledge about the subject. Involved interaction with the subject matter leads to knowledge. You don’t get reference experiences by reading journal papers and text books. You usually also don’t learn new phenomenological primitives that way.
Oscar Wilde wrote: “Nothing that is worth knowing can be taught.” “Nothing” might be an exaggeration but certain knowledge is just really really hard to transfer. But you can set up conditions that are conductive to learning.
Are you arguing that professors are using teaching methods for whom they have published evidence that those teaching methods work?
Today yes. 20 years ago no. Today Big Pharma can’t bribe as much doctors anymore, their business model is in crisis and they have to lay of a lot of workers. Of course it might just be correlation and no causation between the separate observations.
A measure that is wrong in one particular case may still be the best measure available on a statistical level. I highly doubt that doctors would get better ideas of which therapies are good if they discarded this measure and instead used “does the patient claim to feel restricted breathing”.
Furthermore, you haven’t convinced me the measure was wrong even in your case. Measurements are rarely yes or no things; most measurements fall within a range and there is not a sharp cutoff between healthy and unhealthy on the end of the range. You could have been at some point that was far enough within the range to be considered okay, yet still not be 100% okay.
It’s a measurement I did every day I know how the value fluctuates and it was in the middle of the normal range.
I don’t claim that doctors should just replace FEV1 with “does the patient claim to feel restricted breathing”. That’s the kind of thing that doesn’t need any reference experiences and is easily communicable via text.
I claim that the actual experience of interacting with a measurement in a involved way is important to train your intuition to be able to understand a measurement. If you don’t have that understanding you are going to make mistakes.
If someone would give me a million dollars I might also produce a device that measures something better than FEV1 but that’s not the main point of the argument. But that would be me wearing a bioinformatics hat and that’s not the main hat I’m wearing in this discussion.
Your fallacy is: tu quoque.
You’ve made a claim and aren’t supplying evidence for it, formal or even non-negligible Bayesian.
No, my claim is about the process in which memes succeed. As such it’s not invalid ad hominem to analyse that process.
If you forbid all kinds of ad hominems than you basically say that it’s in general a fallacy to call out someone who’s suffering from bias. To stay in the overall argument, there no reason to blind yourself and ignore features of the process that produces memes.
I haven’t made a claim that includes the word “conspiracy”. You used that word. There no reason for my to provide evidence for claims I haven’t made. Given the kind of claims I’m arguing there no reason to attack straw mans.
If you want evidence for big pharma paying kickbacks to promote drugs : http://www.whiteoutpress.com/articles/q22013/feds-sue-novartis-pharma-for-paying-kickbacks/
That are two companies paying together a billion in bribes and it only counts the bribes of doctors. Whether or not you want to call a billion in bribes a conspiracy is semantics which doesn’t have much to do with Bayesian reasoning and I specifically didn’t use the word ‘conspiracy’ because I don’t think it’s very helpful in this case.
Do you doubt that big pharma has a bunch of lobbyists that have a lot of influence on the medical system? Is that a claim for which you want proof?
Do you want me to search of the marketing budget of various big pharma companies and for the amount of money that the chiropractor associating can afford to spend on similar activities?
You haven’t advanced a dot of evidence relating to chiropracty, which is the subject of this subthread. You’ve advanced evidence of lobbyists, but not that the lobbyists are destroying a deserved good reputation of chiropracty. Do you have any evidence to this effect? (Both of the lobbying and of the good reputation.)
I claim that certain views are hold by a certain group of people for reason that have to do with the actions of certain organisations.
You claim that’s I’m engaging into a logical fallacy if I look at the way beliefs are formed. As humans don’t form their beliefs through logic, that’s besides the point. Even if you form your beliefs through logic, it’s still an interesting discussion to discuss why the medical profession believes what it believes.
That fact that you are unable to make that distinction makes you unable to follow the argument I’m making.
I didn’t argue in this thread that chiropractors deserve a good reputation or for that matter recommended to someone that he should go to a chiropractor. I don’t think in terms of black and white but make statements that are much more nuanced.