Quacks & Pseudoscience

[milo]

I had a bad back and hip problem for years. Went to local doc, SFA doctor and as a last resort a chiro. All said the same thing, can see somethings wrong but don't know what.
Went to a TOP golf pro for lessons and spotted straight away something was wrong but again didn't know why or cause, was there for lessons, nothing to do with back.
Gave up and just accepted that was how it was going to be. Then one day I hurt my little toe and had to go to a podiatrist and she noticed the toe was turning under. She recommended a bio mechanic she knew so went there. He put me through all kinds of tests and said he knew what it was but it wasn't his field. He went next door and got his colleague who was a physio. He asked me some questions then said go to your dentist and get a gum shield, your grinding your teeth in your sleep and the tension from that is giving you the back pain.
Got gum shield and never looked back, if pardon the pun.
Point if the rather long story? Don't discount anything when it comes to your health. Human body is s complex and varied thing

Who's discounting anything? I do not think that it is too much to ask for people who claim that something cures or alleviates the symptoms of an illness or ailment to present evidence to support this and to be sceptical about their claims if they can't or won't.

 

[scaramanga]

I had a bad back and hip problem for years. Went to local doc, SFA doctor and as a last resort a chiro. All said the same thing, can see somethings wrong but don't know what.
Went to a TOP golf pro for lessons and spotted straight away something was wrong but again didn't know why or cause, was there for lessons, nothing to do with back.
Gave up and just accepted that was how it was going to be. Then one day I hurt my little toe and had to go to a podiatrist and she noticed the toe was turning under. She recommended a bio mechanic she knew so went there. He put me through all kinds of tests and said he knew what it was but it wasn't his field. He went next door and got his colleague who was a physio. He asked me some questions then said go to your dentist and get a gum shield, your grinding your teeth in your sleep and the tension from that is giving you the back pain.
Got gum shield and never looked back, if pardon the pun.
Point if the rather long story? Don't discount anything when it comes to your health. Human body is s complex and varied thing

You see, this is the issue with how people absorb and process incomplete medical information.

I'm not sure whether this is a cultural thing or if it's a by-product of how our brains have evolved in a heuristic process manner, but we put way too much faith in anecdotal evidence.

What your story tells us is that in your precise situation, at that particular time, there was a loose correlation between the actions taken and some (fairly impossible to measure) benefit. Even though it tells us nothing about any other situation or combination of circumstances, or even if there was a causal relationship between action and results. Yet people will still read what you've written and assume that there's a link between gum shields and back pain.

 

[glasgowspur]

Milo
how do you present evidence on pain? Especially with muscle pain. You either believe some one is in pain or you don't.
Short of brain activity scan you can't tell.

Scara, teeth grinding, or bruxism, is a recognised medical complaint. Your ignorance doesn't make something imaginary.

 

[scaramanga]

Scara, teeth grinding, or bruxism, is a recognised medical complaint. Your ignorance doesn't make something imaginary.

I didn't say it was imaginary (although I've yet to see a reliable source link it to back pain). What I said is that when you have a sample size of 1, coincidence is indistinguishable from cure.

 

[milo]

how do you present evidence on pain? Especially with muscle pain. You either believe some one is in pain or you don't.
Short of brain activity scan you can't tell.

A double blind trial. One group receives the genuine "treatment", the other a placebo. Ask both groups whether their symptoms have improved. If there is a marked improvement in the group receiving the treatment over the one that did not, then it is reasonable to conclude that the treatment had some affect, assuming that the trial was conducted rigorously.

 

[scaramanga]

A double blind trial. One group receives the genuine "treatment", the other a placebo. Ask both groups whether their symptoms have improved. If there is a marked improvement in the group receiving the treatment over the one that did not, then it is reasonable to conclude that the treatment had some affect, assuming that the trial was conducted rigorously.

Then you can follow up to see if there's a dosing effect.

Get different groups to wear a mouth guard for a different number of nights per week or hours per night. Is there a scale of decreasing pain that follows the dosing? Or is there a fairly standard, measurable cut-off point where there's an effect boundary?

 

[milo]

I should have said "ideally" a double blind trial. The problem with a lot of alternative therapies is that it is only possible to do a blind trial, in that the people administering the treatment know whether the groups are in the control or not.

 

[glasgowspur]

So you're saying I'm not reliable? Cheeky beggar.
Pain isnt a measurable quantity or quality. an injury or symptom in one patient can be excruciating but a niggle to another. Medicine isn't that simple.

 

[milo]

So you're saying I'm not reliable? Cheeky beggar.

No one person is reliable. As Scara said, people are very bad at correctly assessing cause and effect. We like to think that what we does has an impact and frequently falsely attribute our actions with an outcome. One example would be feeling better after taking a treatment. We may well have got better if we had done nothing but the likelihood is that we will attribute the recovery to us taking the treatment. Another example would be superstitious gambler who wins after doing something and then repeats that action every time they gamble. They will continue to attribute future wins to the superstitious action but forget about all of the times that they do the action and do not win.

 

[scaramanga]

I should have said "ideally" a double blind trial. The problem with a lot of alternative therapies is that it is only possible to do a blind trial, in that the people administering the treatment know whether the groups are in the control or not.

A blind trial sufficed in the case of acupuncture.

The group that had needles randomly stuck in them by completely untrained amateurs had the same effect as those 'treated' by acupuncturists.

 

[glasgowspur]

That was a tongue in cheek, pardon the puns, comment to lighten the mood as I thought my ignorance comment may be didn't come across as it was intended, lighthearted.
It's difficult to put humour across on forums sometimes.

 

[glasgowspur]

Anyway, am off to bed to grind my teeth, with all the stress you two have given me tonight I won't be able to walk tomorrow

 

[milo]

A blind trial sufficed in the case of acupuncture.

The group that had needles randomly stuck in them by completely untrained amateurs had the same effect as those 'treated' by acupuncturists.

It is certainly strong evidence but it would be more convincing if neither the practitioner or the patient new whether they were giving/receiving the true or sham treatment. That way we could rule out the practitioner's behaviour influencing the result.

I had always assumed that acupuncture was nothing more than a very powerful placebo and the study you sight certainly suggests that.

It runs contrary to most other studies that I have read about and I have not read anything other than this blog post on this one but I found this interesting

http://edzardernst.com/2015/02/acup...ysis-suggests-it-is-effective-beyond-placebo/

Certainly worthy of further research.

 

[Millsy_Yiddo]

It surprised me that acupuncture was too. When I have some more time I'll take a look at how that ever got accepted and why it hasn't been reversed.

Do you have any links for the myofascial release stuff? I like to keep on top of this stuff because if this is proven to work, it will be the next thing the woo merchants attach themselves to in an attempt to garner credibility (see the word "quantum" in the hands of Deepak Chopra).

http://cre.sagepub.com/content/25/9/800.short

http://www.hindawi.com/journals/ecam/2011/561753/abs/

http://www.sciencedirect.com/science/article/pii/S0161475408000328

Most of that is based round Fibromyalgia. I've not looked at the studies in detail (just the conclusions) so it's entirely possible that the studies themselves are flawed. Also, I've only picked out 3 or 4 from a quick Google search that have some positive conclusions, there could be as many that report no difference.

Foam rolling is already a pretty common recommendation from most credible weight lifting coaches (note: not 'Personal Trainer' these are often equivalent to the 'woo' merchants you talk about as is the 'fitness industry' but that's a whole different conversation). Based on that and my own personal experience I think it's useful from a recovery from athletic endeavours perspective.

 

[Millsy_Yiddo]

It is certainly strong evidence but it would be more convincing if neither the practitioner or the patient new whether they were giving/receiving the true or sham treatment. That way we could rule out the practitioner's behaviour influencing the result.

I had always assumed that acupuncture was nothing more than a very powerful placebo and the study you sight certainly suggests that.

It runs contrary to most other studies that I have read about and I have not read anything other than this blog post on this one but I found this interesting

http://edzardernst.com/2015/02/acup...ysis-suggests-it-is-effective-beyond-placebo/

Certainly worthy of further research.

I've wondered if, aside from all the ching/chang energy flow flimflam, the act of sticking needles into the muscle actually prompts some kind of biological change in the muscle. There's some evidence that says acupuncture slows muscular atrophy which I would assume is because repeated minor damage results in a healing response in the muscle (similar to lifting weights on a training program).

That being said, the systemic response from sticking such a fine needle into a muscle cannot be that great. So yeh, my conclusion is also that it's more likely placebo effect than anything else.

 

[scaramanga]

It is certainly strong evidence but it would be more convincing if neither the practitioner or the patient new whether they were giving/receiving the true or sham treatment. That way we could rule out the practitioner's behaviour influencing the result.

I had always assumed that acupuncture was nothing more than a very powerful placebo and the study you sight certainly suggests that.

It runs contrary to most other studies that I have read about and I have not read anything other than this blog post on this one but I found this interesting

http://edzardernst.com/2015/02/acup...ysis-suggests-it-is-effective-beyond-placebo/

Certainly worthy of further research.

That looks interesting. When I have a little time I'll do some more digging, but there are a few bits that get my spidey sense tingling:

• Use of laser instead of needles
  • Is this even the same theory of application?
  • The acupuncture community has a habit of bait and switch - it wasn't all that long ago that they claimed evidence which was in fact the use of TENS (actual, measurable science)

• Acupuncture might be more than a placebo after all. This notion might be unacceptable to sceptics

  • Despite his credentials and the good work he's done in the past with debunking, this statement couldn't be less accurate
  • He clearly lacks understanding of what scientific scepticism is - we will accept anything if there is good, verifiable evidence to prove it

• Negative or inconclusive studies mostly failed to demonstrate these features

  • None of the poor quality trials showed any positive effect? Really? That doesn't sit right with me for some reason

• the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment

  • Isn't that a risk that only people susceptible to the placebo effect will get filtered in?
  • I assume (without further checking) that those not getting a placebo benefit will just stop getting treatment - that must skew the results somewhat
• The magazine in which it was published
  • It's not one I've heard of, and it's certainly not one I've heard of in terms of having sound peer review

 

[LutonSpurs]

@scaramanga - the employee can self certify for 5 days and after that needs a medical note from a real doctor. Once they have a medical note you cannot do much if anything.

With regards to treatment, if they go to the GP with a bad back they will initially get given some sort of anti inflamotarry drug and then on a second trip they get referred to a chiropractor initially and then it goes to a consultant after that. That process up to seeing a doctor who can put you in for a scan can take up to 4 weeks at least. During that time they are pretty much undiagnosed and the medical note covers them.

Not sure an Accupuncture person should be diagnosing someone at all unless they are a doctor.

Anyway this is why this left winger loves his platinum level private health care, no waiting and good doctors and living the life of a hypocirte!

 

[scaramanga]

http://cre.sagepub.com/content/25/9/800.short

Sample size of 62 in the "Journal of Manipulative and Physiological Therapeutics" - that's that one out

http://www.hindawi.com/journals/ecam/2011/561753/abs/

The experimental group underwent a protocol of massage-myofascial release therapy during a weekly 90-minute session for 20 weeks.

The placebo group underwent a weekly 30-minute session of disconnected magnetotherapy for 20 weeks. With the patient in prone position, magnotherapy was applied on the cervical area (15 min) and lumbar area (15 min)

That's a very, very loose definition of placebo.

A placebo needs to be indistinguishable from a "treatment"

http://www.sciencedirect.com/science/article/pii/S0161475408000328

Same quacks, same problems as above

Most of that is based round Fibromyalgia. I've not looked at the studies in detail (just the conclusions) so it's entirely possible that the studies themselves are flawed. Also, I've only picked out 3 or 4 from a quick Google search that have some positive conclusions, there could be as many that report no difference.

You're right, they are all terrible studies. I'm by no means an expert at analysing trials but even I can spot some glaring errors at a quick glance

Foam rolling is already a pretty common recommendation from most credible weight lifting coaches (note: not 'Personal Trainer' these are often equivalent to the 'woo' merchants you talk about as is the 'fitness industry' but that's a whole different conversation). Based on that and my own personal experience I think it's useful from a recovery from athletic endeavours perspective.

Lots of things are recommended by lots of people. That neither makes them more nor less likely to be quackery, it just makes them popular.

It's an unfortunate state, but very, very few people are any good at finding errors in studies and coming to accurate conclusions. In fact (somewhat worringly), the number is fewer than those who hold proper medical qualifications.

 

[scaramanga]

@scaramanga - the employee can self certify for 5 days and after that needs a medical note from a real doctor. Once they have a medical note you cannot do much if anything.

With regards to treatment, if they go to the GP with a bad back they will initially get given some sort of anti inflamotarry drug and then on a second trip they get referred to a chiropractor initially and then it goes to a consultant after that. That process up to seeing a doctor who can put you in for a scan can take up to 4 weeks at least. During that time they are pretty much undiagnosed and the medical note covers them.

I can't believe that in the 21st Century that is the state of modern back pain treatment. They might as well be sticking leeches on her or calling her a witch.

Remind me why the government needs half of my income again?

Not sure an Accupuncture person should be diagnosing someone at all unless they are a doctor.

They all think they're real doctors, that's the problem.

I don't know if she saw a real doctor first or not, her email would lead me to believe otherwise. I don't even know if I'm allowed to ask!

Anyway this is why this left winger loves his platinum level private health care, no waiting and good doctors and living the life of a hypocirte!

Absolutely. My wife used to be quite lefty - hasn't stopped her enjoying private healthcare and schooling for our son.

 

[Millsy_Yiddo]

Sample size of 62 in the "Journal of Manipulative and Physiological Therapeutics" - that's that one out

Fair point, as I said I just looked at the conclusions. If I have more time I'll see if I can find anything more reputable and of better quality study wise.

On the lots of things are recommended by lots of people point. I agree that this doesn't necessarily make them right. This is why I mentioned credible coaches. Where there is a lack of clinical data and something is being recommended I normally look to the most experienced people in their field who have shown sound scientific understanding of the elements within that field for their advice.

If you take the top 5 most experienced strength coaches in the world who have consistently shown results, none of them will recommend TRX, Muscle Confusion or any of the other popular 'woo - woo' (to steal your expression) stuff.

All of them will recommend foam rolling as part of recovery. I should clarify that I am only talking about using it as a recovery aid here, nothing else.