Tag Archives: alternative medicine

Does Osteopathy Work? Is it Scientific?

Victorian Skeptics

Osteopathy graphic 800W

By Mal Vickers

I was recently asked, “Does osteopathy work? Is it scientific?” The short answer is: osteopathy is unlikely to be effective for most health conditions. It’s a form of alternative medicine. I wouldn’t put it in the category of a sciencebased medicine. Read on if you’re interested in why I would think such a thing.

It’s difficult to definitively answer questions like this for three reasons.

One – Science is all about probability.

Two – it’s hard to prove a negative.

Three – it’s not a very clear question.

If the idea is to sort the wheat from the chaff in medical treatments, there are better/tougher questions to ask.

Let’s try to explore it.

Whole health disciplines might contain just a handful of useful treatments for some ailments,

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Alternative medicine can be scientific, say besieged academics

The Conversation

Matthew Thompson, The Conversation

RMIT University’s School of Health Sciences has rejected the suggestion that it peddles pseudo-scientific quackery via its courses in complementary and alternative medicine (CAM).

Acting head of the school Dr Ray Myers has defended RMIT’s health science programs as “evidence-based education and practice”, citing collaboration in clinical research of CAM treatments funded by the National Health and Medical Research Council (NHMRC).

Dr Myers was speaking in the face of a campaign by a coalition of prominent medical researchers to expunge higher education of the “undisciplined nonsense” taught in CAM courses at Australia’s “somewhat lesser universities”.

The campaigning group, Friends of Science in Medicine (FSM), has about 400 signatories, including immunologist Sir Gustav Nossal and Professor Jock Findlay, chairman of the NHMRC’s Embryo Research Licensing Committee. It has written to every vice-chancellor in Australia asking for a review of their health science courses to “ensure that primacy is given to scientific principles based on experimental evidence”. The letter laments the spread of chiropractic studies to 19 Australian universities, and complains that ‘energy medicine’, ‘tactile healing’, homeopathy, iridology, kinesiology, acupuncture, and reflexology are taught “as if they were science”.

Group co-founder Emeritus Professor John Dwyer from the University of NSW said that FSM wants “vice-chancellors to ask their deans of science what’s the heck’s going on … It’s just extraordinary that such undisciplined nonsense is being taught in universities around Australia.”

“One of the complaints that we have about so-called alternative medicine is that it doesn’t strive to be tested. … modern medicine is totally devoted to doing everything we can to take this evidence-based approach and do good science and do good research into the things we do to people,” he said. “Alternative medicine doesn’t do that – it’s more than happy to rely on tradition and anecdote and it doesn’t really want to be tested.”

However, Dr Myers said that CAM research at RMIT was conducted in a thoroughly scientific manner, with the NHMRC funding clinical trials of alternative medicines. In a clinical study granted A$560,000 by the NHMRC and A$30,000 by the National Institute of Complementary Medicine, the university was collaborating with two Melbourne hospitals on a clinical study investigating the use of ginseng, a herb used in traditional Chinese medicine, for improving lung function in patients with Chronic Obstructive Pulmonary Disease (COPD), he said.

The NHMRC had also granted A$400,000 for a project in which the university was collaborating with three Melbourne hospitals on a three-year clinical trial of acupuncture for pain management in emergency departments, Dr Myers said. “The project follows the promising results of pilot studies by RMIT researchers, in which more than 1,000 patients received acupuncture treatment for acute pain relief at the emergency department of the Northern Hospital.”

The professions of Chinese medicine, chiropractic and osteopathy are government regulated, Dr Myers said, with RMIT programs in these fields meeting current professional standards and subject to external accreditation. Chiropractic and osteopathy were areas in which clinical research was limited, but RMIT’s education program incorporated the “best available evidence, while promoting further clinical research into these treatments,” Dr Myers said. “RMIT stands by its long record of evidence-based research and the high quality of its health sciences programs.”

But FSM is not buying it. “Those universities involved in teaching pseudoscience give such ideologies undeserved credibility, damage their academic standing and put the public at risk,” the group’s letter states.

The great danger, said Professor Dwyer, was that people who have chronic health problems or who have been persuaded that doctors do not have the answers are delaying the “proper investigation and treatment” of their illness by instead seeking help from therapists offering alternative medicine.

“These are dangerous delusions, and our campaign at the moment is aimed at those somewhat lesser universities, but nonetheless universities, that are offering and teaching pseudoscience as if there was an evidence base to support it, because obviously that gives credibility in the eye of the public,” Professor Dwyer said.

Citing the late CEO of Apple, Professor Dwyer said that “Steve Jobs spent a year with his cancer of the pancreas trusting homeopathic remedies, and by the time he got to the surgeons it was all over.” It is worth noting the veracity of this claim by Professor Edzard Ernst about Mr Jobs treating his cancer with homeopathy has left some struggling to find evidence for it, while others have claimed that for nine months after his diagnosis, Mr Jobs spurned what could have been life-saving surgery in favour of not homeopathy but a vegan diet and herbal remedies.

The “lesser universities” that have aroused the ire of FSM include the Australian Catholic University, Charles Sturt University, Central Queensland University, Edith Cowan University, Macquarie University, Monash University, Murdoch University, RMIT University, Southern Cross University, Swinburne University, the University of Ballarat, the University of New England, the University of Newcastle, the University of Queensland, the University of Technology Sydney, the University of Western Sydney, and the University of Wollongong. To buttress its case, FSM has gathered a list of offending courses, which includes Chinese Medicine, Wellness studies, Applied Eastern Anatomy, Clinical Science with options to study osteopathy and naturopathy, Mind/Body Medicine, and many others.

“It should be a policy that all universities, higher education institutions, should not be involved in in this woolly teaching,” Professor Dwyer said, adding that “I suspect that these are well attended, popular, money-earning courses for cash-strapped universities.”

The claims of FSM, however, ignore the evidence about CAM in higher education, said Dr Wardle, a NHMRC Research Fellow at the University of Queensland’s School of Population Health and co-director of the Network of Researchers in Public Health and Complementary and Alternative Medicine (NORPHCAM), an international group promoting clinical research in CAM.

“They’re actually not that interested in evidence, because the overwhelming evidence is that putting CAM into universities has increased the standards, decreased the fringe element, and improved public safety, so it definitely smacks of dogmatism,” said Dr Wardle, who is a naturopath.

“They love to say that there’s no such thing as complementary medicine and conventional medicine, there’s just evidence-based and non-evidence-based, but, for example, St John’s Wort for over a decade now has been shown to be equally as effective as any pharmaceutical indication for mild to moderate depression, yet there’s still a large group of doctors who refuse to integrate it simply because it’s a herbal medicine,” Dr Wardle said.

The world of CAM is not a “homogenous entity”, said Dr Wardle. “There is a lot of crap, but there’s good stuff, and treating it like it’s all the same thing is very, very fraught. Taking it out of universities runs a real risk of the fringe element getting a stronger voice in the profession.”

“There are studies from Canada, Australia, and Britain that show that CAM practitioners are less anti-vaccination when they’re university trained, and they refer more to conventional [medical] providers when things get serious if they’re university trained.”

“If you look at chiropractic courses [in universities], most of it is human physiology. Chiropractic is certainly not the dominant part of the course. If you look at naturopathy, they do learn herbal medicine and nutrition but they also learn basic health science: they learn the common language of health practice – they learn what a physio or a medical doctor or a nurse would learn. Putting it into the universities diminishes the fringe element,” Dr Wardle said. “If they [FSM] are really worried about public safety they should be not trying to exclude and ostracise them from the university sector.”

He questioned how representative FSM’s roll call of doctors really is, saying that he has just completed a survey of every rural GP in NSW and qualitative interviews with about 30. “About a third wouldn’t have anything to do with complementary medicine providers, another third were very open to it – maybe too open – and the other third if they knew a practitioner who got results they’d send people on.”

About 70 per cent of Australians use CAM and it thus makes sense for research and training to be carried out within the regulation and scientific rigour of the universities, Dr Wardle said.

Comments welcome below.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.


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Still no good evidence that most complementary medicine works

The Conversation

Ian Musgrave

The complementary medicine industry has been quick to respond to an opinion piece by Cassandra Wilkinson in The Australian newspaper on the lack of evidence for many complementary medicines, and particularly complementary medicines for children.

Alan Bensoussan of the National Institute of Complementary Medicine claimed in a follow-up letter to the Australian that complementary medicines included many well-established medicines (scroll down for the letter). He claimed that these well-established complementary medicines include medicines that prevent spina bifida in newborns, osteoporosis in the elderly, macular degeneration, cognitive decline, and childhood bronchitis.

Except, well, they don’t. You can search for clinical trials of complementary medicines for the above complaints that show them to be “well-established” and you will come up empty handed. You will find one or two studies suggesting that there might be a beneficial effect of some complementary medicine (see here for the inconsistent evidence for Ginkgo and macular degeneration), but nothing “well-established”.

Similarly, a search of systematic reviews, which look at the overall evidence from multiple studies, turns up nothing, although one treatment for osteoarthritis (not osteoporosis) glucosamine, might be beneficial in some patients. This is hardly “well-established” though.

If you go to the web site of the National Center for Complementary and Alternative Medicine and look up “bronchitis” you get the following “There is not enough evidence to support the use of any complementary health practices for the relief of asthma”. If you look up cognitive decline, you get a page that shows all current complementary therapies either do not help (and this includes the favoured herb, Gingko) or have not enough evidence.

So where does Alan Benoussan’s claim come from? Some clarification comes from an article in Pharmacy News, where Steve Scarff, regulatory and scientific affairs director of the Australian Self Medication Industry, also claimed that there is a growing evidence base to support the use of complementary medicines. Mr Scarff used as examples of clinically-supported complementary medicines “calcium and vitamin D for osteoporosis, omega-3 fish oil for heart disease, folate for pregnant women in preventing spina bifida, iron supplementation for anaemia, and evidence to support St John’s Wort for depression”.

One problem here, all but one (St. John’s Wort) of these are conventional medicine, not complementary medicine. It was conventional medicine that researched the physiology, did the clinical trials and developed the therapies and approaches, not complementary medicine (calcium and vitamin D for osteoporosis (note that this is not “one size fits all” medication), omega-3 fish oil for heart disease, folate for pregnant women in preventing spina bifida). Just because you sell vitamin pills doesn’t mean you get to appropriate the hard work of medical researchers and clinicians.

“Complementary” use of vitamins is usually use of high dose vitamins, such as high dose vitamin C for colds and flu’s (which doesn’t really work) or high dose antioxidant vitamins (high dose fat soluble antioxidant vitamin are actually associated with slightly worse outcomes and in some cases a slight increase in death). And vitamin supplementation of healthy, non-vitamin deficient people also has no benefit.

St. John’s Wort does have a modest anti-depressant effect (although very variable due to wide differences in composition). It also has significant side effects and very serious interactions with conventional medicines, so is not recommended for therapy. People have died because of it. Information on the side effects of St. John’s Wort from points of sale are generally very poor and most consumers will be unaware of them (see also here)

The claims from the National Institute of Complementary Medicine and the Australian Self Medication Industry does nothing to address the issues brought up in the opinion piece, namely that there is no evidence that complementary medicine works for children and that between 70-90% of complementary medicines surveyed did not meet regulatory requirements (71% had manufacturing or quality problems). As well, complementary medicine sponsors drag their feet when asked to remove non-compliant medicines (see here and here).

This is what the National Institute of Complementary Medicine and the Australian Self Medication Industry should be dealing with, not claiming the work of conventional medicine as complementary medicine.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.


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Dara O’Briain vs homeopathy

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2014, a Bad Year for Homoeopathy

The Conversation
By Ian Musgrave

This has been a bad year for homoeopathy, first there was the Draft Information Paper on Homoeopathy from the NHMRC, which concluded there was no reliable evidence for the use of homoeopathy in the treatment of the 61 health conditions looked at. Then a homoeopathic remedy manufacturer left the North American market due to law suites over the ineffectiveness of their products, then the Federal Court has found that Homeopathy Plus! was engaged in misleading conduct over its homoeopathic “vaccines”

Quoting from the ACCC website “…[Homeopathy Plus!] engaged in misleading and deceptive conduct and made false and misleading representations to the effect that there was an adequate foundation in medical science for the statement that homoeopathic treatments are a safe and effective alternative to the whooping cough vaccine, when in fact no such foundation exists..”

However, this is not a one-way street. Complementary Medicines Australia has claimed, 6 months after the public consultation process had closed, that the NHMRC process was flawed. In the august publication Food Navigator Asia it was claimed to be “fatally flawed”.

What coffee diluted homeopathically looks like. Ian Musgrave

Before we examine these claims, let me remind you that homoeopathy is based on two principles “like cures like” and extreme dilution, in most cases to levels so dilute that there is almost no chance of a single remaining molecule of original compound being present in the remedy. Thus caffeine diluted 1 in a hundred 30 times is used to treat insomnia and Uranium nitrate diluted 1 in a hundred 30 times is used to treat diabetes.

In the latter case it is fortunate at no uranium will actually be present, as uranium nitrate causes kidney failure. In uranium nitrate-induced kidney failure some glucose turns up in the urine, as the kidneys ability to reabsorb it is damaged. This is completely unlike what happens in diabetes, where high blood glucose overwhelms the kidneys capacity to reabsorb it (in uranium nitrate toxicity blood glucose is not elevated so it is not “like” diabetes at all). Thus the rationale for homoeopathic treatment is flawed at many levels.

But back to the draft report of the NHMRC’s review of homoeopathy. This represents the largest and most extensive recent review of homoeopathy research. The review looked at both systematic reviews of the use of homoeopathy in 61 heath conditions and submissions on behalf of interested parties, which contained a mix of systematic reviews and individual randomised controlled trials. All submissions and papers were carefully evaluated against strict criteria recognised internationally for this type of review. The Australasian Cochrane Centre independently reviewed the overview report to ensure that it was valid and high quality.

To remind you, the review found there was no good evidence that homeopathy was effective for any of the 61 medical conditions considered. In some cases, there was clear evidence that homoeopathy was ineffective; in others the evidence base was too weak to give a clear result. These findings are in concert with other large reviews of homoeopathy. Let’s look at the claimed “flaws”.

There was no adequate explanation of why randomised controlled trials (RCTs) were excluded.

They were not excluded. The main review focused on systematic reviews, which included randomised controlled trials (and other types of high level evidence). This is the best way to compare multiple studies. Randomised controlled trials are considered the highest level of evidence, but the results of a single randomised controlled trial may be misleading for many reasons.

Chance is one, if a therapy has no actual effect,by chance alone you will find some studies that appear to show an effect.

Thus it is far better to compare as many high quality trials as possible to get a clearer picture. Randomised trials were not excluded, but an integral part of the evidence through systematic reviews. Randomised controlled trials submitted by stakeholders that were not already part of systematic reviews were considered as well.

While there are limitations to this approach (specifically the most recent research may be excluded), it is widely used in making clinical decisions and in no way invalidates the findings of the report. One of the biggest limitations is that negative findings tend to be under-reported, so that systematic reviews tend to overestimate the effectiveness of a therapy. That homoeopathy cannot pass muster under these conditions is telling.

Three academics invited to comment on the review all broadly agreed there was no high quality evidence recommending homoeopathy for any disorder.

The review excluded too many studies.

Of the 1367 publications considered in the main review, only 60 were finally considered. Not because of anything sinister, but because only those met the review criteria. 374 were duplicate citations, 729 were the wrong study type (not peer-reveiwed, not systematic reviews or metaanalyses, or not looking at controlled trials or high level evidence) or were not looking at the conditions considered in the review or did not report the outcomes (etc. etc.) (see the main review for details).

Of the reports submitted by stakeholders, only a few passed the inclusion criteria or were not already included. Pro tip, if the NHMRC asks you for peer-reviewed systematic reviews and randomised controlled trials in humans, don’t submit books on the life of Hahneman and studies of frogs exposed to thyroxine (yes, I went through the papers).

The review did not consider any publication not in English.

While this excludes some studies, most high quality studies are published in the English language press. As well, the practicalities of translating foreign language papers to ensure there are no complicating errors in translation are avoided. Overall, the impact of this decision on the reliability of the report is marginal at best.

The NHMRC had not appointed a homeopathic expert to the panel.

Assoc Prof Evelin Tiralongo on the NHMRC panel is trained in homeopathic remedies.

The review did not consider animal studies.

These homoeopathic preparations are already in use in humans, so the appropriate studies are ones in humans in the first place. As well, the studies in animals suffer the same flaws as those in humans, too many are of poor quality and many are unable to be interpreted or make claims that cannot be supported. For example, one study submitted to the review that claimed to demonstrate that homoeopathic treatments kill breast cancer cells actually shows that the ethanol diluent is the lethal factor.

Summary

Overall, while there are some limitations to the study, this is a wide ranging, carefully interpreted study. While overall the broad conclusion is that there is no good evidence the homoeopathy being effective in the 61 studied conditions, in at least 13 studies there was good evidence that homoeopathy was ineffective (asthma for example). The results of this study are in broad agreement with previous studies of homoeopathy (see also this, and before you bring up the “Swiss Report” see here and here).

The NHMRC study conclusion that “…the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered” cannot be ignored or dismissed.

This article was originally published on The Conversation. (Reblogged with permission). Read the original article.

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‘Storm’ by Tim Minchin

In the confines of a London dinner party, comedian Tim Minchin argues with a hippy named Storm. While Storm herself may not be converted, audiences from London to LA have been won over by Tim’s wordplay and the timely message of the film in a society where science and reason are portrayed as the enemy of belief.

Written and performed by Tim Minchin @timminchin. Directed by DC Turner @dcturner. Produced by Tracy King @tkingdoll. http://www.stormmovie.net

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Tim Minchin on ‘alternative medicine’

‘By definition, alternative medicine has either not been proved to work or has been proved not to work. You know what they call alternative medicine that has been proved to work? Medicine.’ – Tim Minchin

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Appeal to tradition

by Tim Harding

Appeal to Tradition or argumentum ad antiquitatem (also known as ‘appeal to common practice’) is a common informal fallacy that occurs when it is assumed that something is better or correct simply because it is older, traditional, or ‘has always been done.’  For example, arguments of this type often begin with phrases like ‘It has been a long-standing tradition that…’ on the assumption that such words are persuasive.

The placebo industry (aka ‘alternative medicine’) relies heavily on this fallacy by appealing to the notion that ‘traditional medicine’ or some rare berry or plant root has been used for thousands of years, often in an exotic Eastern country.  Strangely, this argument is regarded by the placebo industry (and gullible consumers) as more persuasive than any evidence that the product actually works.  This fallacy is often comitted in combination with the Appeal to Nature fallacy.

This sort of reasoning has the following form:

Premise: P has always been done.

Conclusion: Therefore P is right or good.

This argument is fallacious because the conclusion does not logically follow from the premise.  There are plenty of counterexamples where something that has always been done or believed in is now regarded as wrong or false such as:

  • Belief in the pseudoscience of astrology is thousands of years old;
  • People believed that Sun revolved around the Earth (rather than vice versa) until only a few hundred years ago;
  • The idea of the Flat Earth is much older than the idea that the Earth is round;
  • Slavery was considered normal until only a couple of hundred years ago;
  • Women have continuously been treated like second class citizens in certain parts of the world.

The opposite of an appeal to tradition is an appeal to novelty – claiming something is good because it is new.  This type of advertising hook is often used to sell new technology, such as software updates, when many of us know of new operating systems that have actually been inferior to their previous versions.

Since false beliefs tend to be rooted out over time, the long-term persistence of a  belief can provide some degree of inductive evidence for its credibility, but not sufficient to qualify as a cogent argument. There are lots of ancient ideas that have persisted to modern times, but they are still false e.g. astrology, quackery, beliefs in the paranormal etc. 

An appeal to common practice can be valid if the cost of abandoning the practice or switching to an alternative outweighs the benefits of doing so. For example, re-defining the direction of the flow of current in electrical circuits to match the direction of the flow of electrons might aid education by reducing confusion, but doing so would come with the significant cost of re-writing text books and translating any scientific material that covered the topic.  Another example is that the cost of changing the calendar to a year zero other than the birth of Jesus would be far greater than the benefits.  Non-Christians would be wiser to stick with the familiar Christian calendar dates.

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Some Origins of Western Quackery

 By Tim Harding

             (An edited version of this essay was published in The Skeptic magazine, September 2013, Vol 33 No 3 p.16. The essay is based on a talk presented to the Mordi Skeptics in April 2013 ).

‘By definition, alternative medicine has either not been proved to work or has been proved not to work. You know what they call alternative medicine that has been proved to work? Medicine.’ – Tim Minchin

A corollary of Tim Minchin’s rhetorical question might be ‘What should we call alternative medicine that has been proved not to work?’  I recently asked this question at my local Skeptics in the Pub meeting, eliciting an immediate and resounding chorus of ‘Quackery!(When you think about it, if the part of ‘alternative medicine’ that works is medicine, and the part that doesn’t work is quackery, there is nothing left in the category of ‘alternative medicine’).

On his Quackwatch web site, Dr. Stephen Barrett defines quackery as ‘the promotion of unsubstantiated methods that lack a scientifically plausible rationale’.  This definition includes questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters.  In line with this definition, Barrett reserves the word ‘fraud’ only for situations in which deliberate deception is involved.

So where did quackery come from?  The word ‘quack’ derives from the archaic word ‘quacksalver’, of Dutch origin, literally meaning ‘hawker of salve’.  The quacksalvers sold their wares on the market by shouting in a loud voice.  In the Middle Ages, the word ‘quack’ meant ‘shouting’.  These days, we tend to associate quackery with dodgy products and practices from the nineteenth century such as snake oil, miracle hair tonics, magnetic bracelets and homeopathic remedies.  But the origins of western quackery actually go back much further – to the cradle of western civilisation in ancient Greece and Rome.

In those ancient times, scientific experimental methods had not yet been developed – let alone clinical trials.  Medical observations were largely confined to patients as individuals rather as a cohort or group.  Ancient physicians were not much better than naturopaths when it came to empirical evidence.  Without scientific data from treatment groups versus control groups, it was difficult to know which treatments worked and which didn’t.  As a result, there was no clear dividing line between medicine and quackery.  Ancient ‘medicine’ consisted of a mish-mash of well-meaning but misguided treatment by physicians and surgeons, faith healers, herbal remedies, aromotherapy, other superstitions – and even sorcery or magic. Sounds familiar? That’s right – many of these weird ancient beliefs have carried through to the quackery of today as a legacy of the vast Roman Empire.

Ancient Greek medicine

The first notable Greek physician may have been the poet Homer in the 7th or 8th centuries BCE.  In his Iliad, Homer describes various medical techniques such as the extraction of arrows, the treatment of wounds, the application of dressings and the dispensing of soothing drugs.  The Homeric poems provide a glimpse of ancient medical ideas and practices long before the formal documentation of medical literature.  It is significant that practical medical treatment appears to have been provided in this early period, probably as a matter of military necessity, so that wounded soldiers could be saved to fight another day.

Homer

Reliance on the gods or faith healing seems to have come later, to some extent in parallel with advances in medical treatment.  The god of healing, Asklepios, had a shrine at Epidaurus in southern Greece, where miraculous recoveries were said to have been made by the sick and lame by sleeping in the temple overnight.  A Greek lyric poet from Thebes named Pindar (c.522– c.443 BCE) wrote:

‘[Asklepios] delivered all of them from their different pains, tending some of them with gentle incantations, others with soothing potions, or by wrapping remedies all around their limbs, and others he set right with surgery.’

The following picture is of a cast showing a physician examining a patient while Asklepios stands nearby holding the symbol of medicine, a snake coiled round a staff.

Asklepios

There were also apothecaries who harvested herbs and prepared drugs, accompanying their ministrations with important rituals and incantations.  Theophrastus (c.371 – c.287 BCE), who was a student of Aristotle, described some of these weird rituals in his History of Plants:

‘They say that the peony, which some call glykyside, should be dug up at night, for, if a man does it in the day-time and is observed by a woodpecker while he is gathering the fruit, he risks the loss of his eyesight; and if he is cutting the root at the time, he gets a prolapsed anus’.

‘One should draw three circles around mandrake with a sword, and cut it with one’s face to the west; and at the cutting of the second piece one should dance around the plant and say as many things as possible about the mysteries of love’.

On the other hand, the medical literature subsequently found in Greece differs markedly from that found elsewhere.  It includes reasoned arguments and debates, reflecting an intellectual openness consistent with Greek philosophy, rather than medicine as some sort of secret mystical art.  The links between medicine and philosophy can be traced back to Parmenides, Empedocles and even Pythagoras, whose ideas on appropriate living included a ban on eating beans!

Athens was one of the first city states to employ a publicly funded physician as a more rational alternative to traditional folk medicine.  Other Greek cities also maintained a public physician as well as several private practitioners.

The Greek historian Herodotus tells the tale of the early Greek physician Democedes of Croton, who started his career in the civil service of Athens and Aegina.  In 522 BCE, Democedes was captured by the Persians and sent to Susa.  The Persian King Darius once sprained his ankle while he was hunting, and his Egyptian doctors seemed to make it worse.  Darius then summoned Democedes, who was able to heal the ankle using Greek remedies.  Democedes was richly rewarded and hired as a physician of the Persian court.  Darius’s wife, Atossa, later had a breast ulcer.  When Democedes cured her ulcer, he was allowed to visit Greece as a reward.

Schools of medicine had existed for some time in various regions of Greece, most notably on the island of Kos, associated with the famous name of Hippokrates, a younger contemporary of Herodotus.  Hippokrates’ contribution to medicine is best remembered today by the ethical oath bearing his name.  Very little is known of Hippokrates himself, or how much of the Hippokrates medical treatises he personally wrote.  Hippokrates is cited in later works by Aristotle and Plato; but the Greek habit of composing imaginary speeches or letters by famous people from the past gradually blurred the distinction between the genuine and the false.  The following references to Hippokrates are actually references to the large body of medical literature bearing his name, the Hippokratic Corpus.

Hippokrates attempted to put medical diagnosis and treatment on a rational basis.  He viewed the human body as an organism whose parts must be understand as a whole.  Hippokrates thought that human physiology was comprised of four fluids or ‘humors’: blood, phlegm, black bile and yellow bile, corresponding to the four inanimate elements of earth, air, fire and water, as shown in the diagram below.

Four humours

Disease was thought to result from an imbalance of these humors, resulting in a disturbance of the natural harmony and order of the world so important to Classical Greek thought.  Hippokrates also placed emphasis on prognosis as well as diagnosis, so that the course of an illness could be predicted.  The more familiarity a physician showed with a disease, the more confidence his patients would have in him.  Prognosis also had practical benefits in planning the medical interventions that would be needed at different times.

In the absence of the modern germ theory of infectious disease, the danger to health from overcrowding within the Long Walls of Athens was not foreseen, resulting in a devastating plague in 430BCE.  Thucydides did not attempt to explain the reasons for the plague, but in the prognostic tradition of Hippokrates, he tried to describe its symptoms and effects so that if it struck again it could be recognised.

Active medical interventions included cauterisation and blood-letting, as well as surgery, the rectification of dislocations and the setting of bone fractures.  Other therapies included cupping, special diets, herbal remedies, potions, purgatives and exercises, consistent with the idea of ‘bringing the body back into balance’.  One rather spectacular treatment often performed in public was succussion, where the patient would be tied upside down to a ladder and then repeatedly dropped from a height of several feet as illustrated below.

succussion

It is unclear what succussion was supposed to achieve, but it is worth noting that succussion is a word still used by homeopaths to describe a shaking step in the preparation of their water doses.  The founder of homeopathy, Samuel Hahnemann falsely believed that succussion activated the ‘vital energy’ of the diluted substance and made it stronger.

The rise of quackery in Rome

Traditional Roman medicine was initially an amateur activity using simple home remedies based on easily available agricultural ingredients such as wool, eggs and the humble but miraculous cabbage.  Cato the Elder wrote in his treatise On Agriculture:

‘For those who are troubled by colic, cabbage should be steeped in water…. ‘

‘Now as to patients for whom urination is painful or dribbling. Take cabbage, put in boiling water, boil briefly till half cooked…. ‘

‘If any sore or cancer develops in the breasts, apply ground cabbage …’

‘In case of dislocation, foment with hot water twice a day and apply ground cabbage: it will soon cure it…’

The Romans were a highly superstitious people.  For instance, the Roman Senate only sat on ‘auspicious days’.  In around 78 CE Pliny the Elder wrote in his Natural History:

‘I find that a bad cold in the head clears up if the sufferer kisses a mule on the nose.’

‘Some people keep a weasel’s heart in a small silver container, for swollen glands.’

The number three was regarded as a ‘lucky number’.  An anonymous Roman inscription reads:

‘To Julian who was spitting up blood and had been despaired of by all men the god revealed that he should go and from the threefold altar take the seeds of a pine cone and eat them with honey for three days. And he was saved and went and publicly offered thanks before the people’

Later Roman culture was greatly influenced by the ancient Greeks in many things, including philosophy, literature, art, science and medicine.

Galen of Pergamon (c. 129-200 CE) was a leading surgeon, physician, and philosopher of Greek origin.  In 162 CE, he established a large and successful practice in Rome, where he attended the Emperor Marcus Aurelias.  Amongst his voluminous works was a short essay entitled That the Best Physician is also a Philosopher, where he urged physicians to emulate Hippokrates and to embrace logic and rationality:

‘What reason, then, remains why the doctor, who practises the Art in a manner worthy of Hippocrates, should not be a philosopher? For since, in order to  discover the nature of the body, and the distinctions between diseases, and the indications for remedies, he must exercise his mind in rational thought, and since, so that he may persevere laboriously in the practice of these things, he must despise riches and exercise temperance,  he must already possess all the parts of philosophy: the logical, the scientific, and the ethical’.

Consistent with this approach, Galen saw the bodies of living things and their various parts as designed and operated by a craftsman-like nature with a purpose in mind; thus an important key to anatomical and physiological knowledge is an understanding of nature’s purposes.  This form of ‘intelligent design’ has been described as a teleological view of biology by modern reviewers of Galen’s writings.  Galen held that nature rules the body from three anatomical centres – the liver, the heart and the brain (in contrast to the Aristotelian view that all faculties are centred in the heart).  He claimed that human physiology can be explained by the principal activities of nature, which are genesis, growth and nutrition.

Like Hippokrates , Galen believed in the need for the ‘four humors’ to be in balance: blood, black bile, yellow bile and phlegm.  He thought that the human body had three physiological spheres: the nutritive, the vital and the logical.  According to Galen, stomach cooks food to what was called ‘chyle’ and sends it to the liver.  The liver adds ‘natural spirit’ and sends it to other organs and the heart.  The heart adds ‘vital spirit’ and sends it to the brain.  The brain adds what was called ‘pneuma’ and sends to the body through nerves.  Such views were the likely origin of the modern naturopathic belief in ‘vitalism’ that persists today.  Naturopathy posits that a special energy called ‘vital energy’ or ‘vital force’ guides bodily processes such as metabolism, reproduction, growth, and adaptation.  Such energies and forces are unknown to modern science.

For religious reasons, there was little or no dissection of human corpses in ancient Rome.  Nevertheless, Galen believed in the supreme importance of anatomy, so he regularly performed dissections on animals.  Although he was conscious of the limitations of extrapolating from animals to humans, he did express some erroneous views about human anatomy, such as the following description by Galen in his work On the Usefulness of Parts of the Body:

‘All the parts, then, that men have, women have too, the difference between them lying in only one thing, which must be kept in mind throughout the discussion, namely, that in women the parts are within [the body],   whereas in men they are outside, in the region called the perineum. Consider first whichever ones you please, turn outward the woman’s, turn inward, so to speak and fold double the man’s, and you will find them the   same in both in every respect’.

Women were treated by male physicians and the gynaecological treatises of the Hippokratic Corpus were almost certainly written by and for men.  Part of the deficiency of observational evidence stems from the failure of male medical writers to speak to women about their illnesses.  Women were traditionally presented as being incapable of knowing what was wrong with them or telling a doctor if they did know.  Galen’s teleological view of biology also appears to have influenced his attitudes towards women:

‘So too the woman is less perfect than the man in respect to the generative parts. For the parts were formed within her when she was still a foetus, but could not because of the defect in the heart emerge and project on  the outside, and this, though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs must be a female. Indeed,  you ought not to think that our creator would purposely make half the whole race imperfect and, as it were, mutilated, unless there was to be some great advantage in such a mutilation’.

These biased attitudes impacted wider Greek and Roman society.  For example, it was believed, on false medical grounds, that a man’s seed was most potent when he was about 30 years of age; and a woman’s body best suited for childbirth when she was still a teenager.

The medical theories of ancient Greece and Rome formed the foundation of Western medicine for centuries, even if they were eventually rejected.  The main reasons for this rejection were the development of empirical scientific methods after the Renaissance; coupled with advances such as the invention of the microscope and the germ theory of infectious disease.  Whilst there were observations of individual patients, there is no evidence of any organised medical experiments being conducted in ancient Greece and Rome, let alone clinical trials.  In some ways, the Greek philosophical traditions of logic and reasoning held back a more empirical scientific approach to medicine.  Instead of conducting practical experiments on illnesses, ancient Greek and Roman physicians became diverted into a search for the underlying purposes of diseases – a relatively fruitless ‘search for meaning’ rather than for empirical evidence.  This mystical and unscientific approach is one of the hallmarks of quackery today.

REFERENCES

 Ancient Sources

Aristotle On the Generation of Animals excerpt translated by A.L. Peck.  Published online http://www.stoa.org/diotima/anthology/wlgr/wlgr-medicine339.shtml

(Accessed 20 September 2012)

Galen That the Best Physician is also a Philosopher translated by Brain, P., 1977, “Galen on the ideal of the physician”, South Africa Medical Journal, 52: 936–938.

Galen On the Usefulness of Parts of the Body excerpt translated by M.T. May.  Published online http://www.stoa.org/diotima/anthology/wlgr/wlgr-medicine351.shtml

(Accessed 20 September 2012)

Herodotus The Histories R.B. Strassler (ed), The Landmark Herodotus, Quercus, London, 2008.

Thucydides A Comprehensive Guide to the Peloponnesian War, R.B. Strassler (ed), The Landmark Thucydides, Free Press, New York, 1996.

Modern Sources

Brain, P., 1986    Galen on Bloodletting: A Study of the Origins, Development and Validity of his Opinions, with a Translation of the Three Works Cambridge University Press, Cambridge.

Flaceliere, R., 2002    Daily Life in Greece at the Time of Pericles. Phoenix Press, London.

King, H., 1995    ‘Medical texts as a source for women’s history ‘  in The Greek World Anton Powell (ed.) Routledge, London and New York.

Martin, T. R., 2000    Ancient Greece – From Prehistoric to Hellenistic Times, Yale University Press, New Haven and London.

Nutton, V., 2004    Ancient Medicine Routledge, London and New York.

Pagel, W., 1970    Book Review of Galen and the Usefulness of Parts of the Body in Medical History/ Volume14 / Issue04 / October 1970, 406-408.  Published online: 16 August 2012

Roberts, J.W., 1998    City of Sokrates: An Introduction to Classical Athens (2nd edition), Routledge, London.

Roebuck, C., 1966    The World of Ancient Times Charles Scribner’s Sons, New York.

Waterfield, R., 2004    Athens – A History, Macmillan, London, Basingstoke and Oxford.

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The David and Goliath Fallacy

by Tim Harding

 The biblical parable of David and the Goliath is taught to many children throughout the Western world and the Middle East.  Goliath was a huge armoured and weapon-carrying champion, who was defeated by a small shepherd boy using only a slingshot and stone.  This parable is often cited to show how an underdog with ‘right on his side’ can defeat much a more powerful opponent.

Andrea_del_Castagno_002

In some cases, this parable is extended into a logical fallacy that attempts to paint large and powerful organisations as bad or wrong because they are large and powerful.  For example, anti-science advocates often disparagingly refer to ‘Big Pharma’, implying that the pharmaceutical industry is bad, at least in part, because it is big.  Never mind that, in terms of retail sales dollars, the placebo industry (or so-called ‘alternative medicine’) is of a similar order of magnitude these days.  Similar disparagements are made against medical science, the medical profession and even government agencies on the grounds of their size and influence.

The David and Goliath Fallacy takes roughly the following form:

   Premise 1: There is a conflict between two organisations A and B.

   Premise 2: A is much larger and more powerful than B.

   Conclusion: Therefore, A is bad or wrong, compared to B which is good or right.

Like all logical fallacies, this argument is invalid because the conclusion does not necessarily follow from the premises.  Small organisations can be bad and/or wrong; and large organisations can be good and/or right. In some ways, the David and Goliath Fallacy can be viewed as a perverse over-correction of the aphorism ‘Might Makes Right’.

One of the consequences of this fallacy is that claiming underdog status against a more powerful ‘Goliath’ can give moral licence to poor behaviour during conflicts, to create a ‘more even contest’.  For example, small organisations like the so-called Australian Vaccination-skeptics Network frequently make false or unsubstantiated claims, with the lame excuse that they do not have the resources to back up their claims with evidence. The David and Goliath Fallacy has been used during ideological debates in attempts to justify intellectual property theft and even terrorism.

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