Another part is that the SSRIs (and the tricyclics before them) just aren’t that effective to begin with. In clinical trials, they do beat placebo…but not by much.
There is also good reason to suspect that publication bias and other research-distorting factors have been strongly at play in the antidepressant field, reducing the credibility of that research.
Especially when the results being measured are small, subjective and highly variable (as is the case with depression meds), it is possible to distort a null result into something that appears substantial just by fucking with research funding and publication. Bury the negative results, publicise and promote the positive results, fund studies designed to favour the promoted therapy by comparing to the weakest possible alternatives. Etc.
None of the individual researchers involved need to be corrupted for this to work; it’s kind of like the scientific version of gerrymandering. It is quite plausible that the assumption of significant SSRI efficacy is based entirely upon a marketing illusion.
No. That is certainly not what I am saying. When I say “acupuncture is a conversation mediated by needles” I am not saying “acupuncture is just a therapeutic conversation”. I am saying, “like a therapeutic conversation, the acupuncture treatment process requires the skillful shifting of felt meaning in the body of the recipient through variation of point-selection, needling style, and countless difficult-to-describe shifts in the relationship between therapist and patient”. I do not believe you can reduce the efficacy to a single mechanism without significantly reducing the efficacy.
Keep in mind that the original definition of ‘atom’ was ‘the thing which cannot be subdivided’. Our understanding of atom has changed, but we’ve kept the useful name, despite the inaccuracy.
The pre-modern Chinese were not very interested in the mechanisms, they were interested in the patterns. All of the language of chi and meridians should be understood as a pattern-language, not a reductive explanation. As a pattern language, I believe it makes the “nonverbal conversation conducted through needles” much more therapeutically effective.
We can test my belief by comparing the clinical impact of practitioners trained in that pattern-language against practitioners who are trained in needle hygiene and “where not to poke”. We could also test the idea that simply charging more would be a cost-effective intervention, as you suggest!
But if clinical effectiveness is increased through the use of a language of patterns, then even if we find the metaphors to be metaphorical rather than explicitly and literally predictive we cannot dismiss the body of practice as charlatanry. And in that case, there is no fraud, and the only question of ethics is “why do you stand in the way of effective treatment for conditions such as chronic pain which torment so many?”
We need more large scale clinical research to know for sure, as a society, which question of ethics we should address.
If you craft a discipline of medical theater that is as cost-effective or more cost-effective than the standard biomedical treatment for a particular ailment (or which maintains health better), I would endorse the therapy, even if the underlying metaphors seemed like nonsense to me (e.g. @Footface’s unicorn rock).
But remember a lot of people are absolutists, believing all things are either quintessentially true or utterly false, and some of those people will equate true and false with good and evil. They can’t handle the idea of a useful but false metaphor.
This “quack” medical practice is 3000 years old. Our acupuncturist was trained in China during the cultural revolution and puts 40 to 60 needles from head to toe unlike western trained MD/acupuncturists. Acupuncture is a means of manipulating the chi or qi. Qi Gong is the practice of manipulating the qi using mental imaging and movement. It is the basis for all eastern marshal arts. What they are doing in the army may be placebo or may actually have a real non-placebo and desired effect on the subject, Just because Corry says something is not real does not mean he can’t be mistaken. What my wife and I have done to us with acupuncture is not placebo. Our acupuncturist has been sued by a gastroenterologist when she cured one of his patients of Crohn’s disease. He lost when a few other MDs testified that she (Ying Jia, Bloomington IN) had 95% success with patients that they could not help. This is another post like the GMO video that depends on knowledge that is over the head of the poster and most readers. Believe what you want. If you want to stop shingles in it’s tracks, go see someone like Ying.
Our acupuncturist was trained in China during the cultural revolution
I am sure she acquired useful skills in how to kill intellectuals using needles.
Update: “I trained in acupuncture practice during the Cultural Revolution” is like “I learned genetics from Lysenko”, or “My knowledge of climatology comes straight from the Republican Party”. It is really not something to boast of.
No. My wife and I are patients. Not sure even when this happened. Maybe 30 years ago and before we met her. Friends in Bloomington saw her in her apartment when she first came to the US from China and was not licenced. When my wife was diagnosed with Crohn’s they (Friends in Bloomington) suggested she see the acupuncturist that “cured Larry’s bursitis”. She also cured another friend of these same people of Crohn’s and got sued. By the time we saw her she was legal with two offices. One in Bloomington and one in Indianapolis. I could recount the things I have seen her do but I feel it would be a waste of time The proof isn’t in legal documents about some chinese doctor practicing medicine without a licence for sure. I am not trying to explain to a skeptic how Qi Gong works and why they should try it as a remedy or tonic or yoga. I have some idea how acupuncture works and it is kinda like having someone do qi gong to you. Of course what does that mean? Over the years she has become more sought out the office is more crowded and she has less time to chat. My fear is that if she retires my wife will be at the mercy of Humara and prednisone pushers. . .
I wasn’t asking you that. I’m curious about the legal situation, that is, the basis with which a physician sues a CAM practitioner and the basis on which such a case is settled. I’ve done statistical consulting for medical cases in the past, and my experience is that what is reported by the principles 5 minutes after the case is over is usually not an accurate refection of what happened in the courtroom, that’s why I was trying to track down the case in court records.
Notice the bit where he says that the side effects you get tend to be the side effects you expect to get?
That’s not just a sugar pill thing; it holds true for real drugs as well. So, the more effort you put into making your patients aware of possible drug or surgical complications, the more likely those negative outcomes are to occur.
It’s a real problem. Patient health and patient autonomy are in direct conflict.
