[p2p-research] shots in the dark/p2p article

[Paul D. Fernhout]

Tomas Rawlings wrote:
> Paul Fernhout wrote:
>> But, echoing Michel's theme of a diversity of issues, here is another 
>> item recently in the non-mainstream news, so I don't know how true it 
>> is, but this is as an example of what that article suggests is bad in 
>> that case but actually may work in *some* cases:
>> "Successful Use of Homeopathy In Over 2.5 Million People Reported From 
>> Cuba"
>> http://homeopathyresource.wordpress.com/2009/01/01/successful-use-of-homeopathy-in-over-5-million-people-reported-from-cuba/ 
>>
>> """
>>   
> I saw the author of the article speak at the Glastonbury festival this 
> year - next door to the 'healing fields' - so had plenty of oppositional 
> people in the audience - in the ensuing debate he returned to the same 
> point over and over - that beyond the placebo effect there is not a 
> single well designed study that offered proof of homoeopathic remedies.  
> In the debate plenty of studies were citied but upon examination they 
> always lacked a good design; missing a control, tiny sample size, 
> designed to generate a false positive etc.
> 
> Again, homoeopathic stuff is not something I know anything about, but I 
> do think, while the peer review system has it flaws (and again the 
> author is merciless in exposing them and medical science scams too) we 
> have to have a method that allows us to evaluate ideas beyond personal 
> conviction, anecdotal evidence and/or media article.  Anything else 
> edges towards denialism; we see this in global warming denial and 
> creationism where advocates seem to think that citing opinion polls and 
> petitions signed by 'scientists' equates to truth.
> 
> All I am arguing for is rigour of approach and evidence .....
> 

I was not sure which author of which article you were referring to?
This article references only twelve studies, which is not much for a field 
with hundreds or thousands of preparations:
   "The Scientific Evidence on Homeopathy"
   http://www.acsh.org/healthissues/newsID.632/healthissue_detail.asp

Notice even the title. The entire field is being evaluated by looking at 
some tiny sampling of the preparations and activities.

Here is what the NIH has to say:
   http://nccam.nih.gov/health/homeopathy/
"Most analyses of the research on homeopathy have concluded that there is 
little evidence to support homeopathy as an effective treatment for any 
specific condition, and that many of the studies have been flawed. However, 
there are some individual observational studies, randomized 
placebo-controlled trials, and laboratory research that report positive 
effects or unique physical and chemical properties of homeopathic remedies."

That is not the same as what the person you mention was saying, where he 
claimed there was not a single study showing anything positive.

Still, I agree completely with the testing sentiment that both you and Ryan 
raise. I mentioned that in the rest of that email, quoting someone from Cuba.

On homeopathy specifically, as I said in my previous email: "And personally, 
when homeopathic (infinitely diluted) medicines work, I tend to suspect it 
is about the extra things that are added, like in this case, Bach flowers, 
or in other cases, silver as a preservative. "

Consider, for example, this homeopathic remedy for pink eye you can find in 
almost any drug store in the USA and which I have seen MDs recommend:
   http://www.similasanusa.com/products-pink-eye-relief.cfm

Note the "Inactive Ingredients" list:
"Borate buffer, Purified water, Silver sulfate (as preservative), Sodium 
nitrate"

Consider, from research in 1974 on silver for eye problems:
   http://pediatrics.aappublications.org/cgi/content/abstract/56/3/368
"Silver nitrate is effective in vitro against Neisseria gonorrhoeae and 
Staphylococcus aureus in a concentration of 0.1% and against Escherichia 
coil in a concentration of 0.01%."

Plus silver is widely used as an anti-bacterial in other settings, and it 
works, and that is part of the origin of the term "born with a silver spoon 
in his/her mouth".

Google search:
   http://www.google.com/search?hl=en&source=hp&q=silver+antimicrobial
Example:
http://www.nanotechnology.com/blogs/steveedwards/2005/12/silver-once-and-future-antimicrobial.html
"In the last week, the FDA approved an old drug, an antibacterial called 
silver, the same precious metallic stuff that earrings and bracelets are 
made of. The FDA approval consisted of Silver Soaker catheters from I-Flow, 
which use AcryMed’s “silver nanotechnology that can render existing medical 
devices impervious to infection-causing bacteria”. The catheters are coated 
with silver nanoparticles that kill most bacteria, even those that are 
resistant to the most advanced antibiotics."

Anyway, so, sure there is a lot of hokum out there. But the problem is, as 
you say, using experiment to work through it.

But, the way our economic and academic system is set up, you can only 
experiment on that for which you get funding, and almost the only 
experimenters in a position to get *any* funding are those who already have 
proved they uphold the status quo.

 From Noam Chomsky:
   "What Makes Mainstream Media Mainstream"
   http://www.chomsky.info/articles/199710--.htm
"""
The universities, for example, are not independent institutions. There may 
be independent people scattered around in them but that is true of the media 
as well. And it’s generally true of corporations. It’s true of Fascist 
states, for that matter. But the institution itself is parasitic. It’s 
dependent on outside sources of support and those sources of support, such 
as private wealth, big corporations with grants, and the government (which 
is so closely interlinked with corporate power you can barely distinguish 
them), they are essentially what the universities are in the middle of. 
People within them, who don’t adjust to that structure, who don’t accept it 
and internalize it (you can’t really work with it unless you internalize it, 
and believe it); people who don’t do that are likely to be weeded out along 
the way, starting from kindergarten, all the way up. There are all sorts of 
filtering devices to get rid of people who are a pain in the neck and think 
independently. Those of you who have been through college know that the 
educational system is very highly geared to rewarding conformity and 
obedience; if you don’t do that, you are a troublemaker. So, it is kind of a 
filtering device which ends up with people who really honestly (they aren’t 
lying) internalize the framework of belief and attitudes of the surrounding 
power system in the society. The elite institutions like, say, Harvard and 
Princeton and the small upscale colleges, for example, are very much geared 
to socialization. If you go through a place like Harvard, most of what goes 
on there is teaching manners; how to behave like a member of the upper 
classes, how to think the right thoughts, and so on.
"""

So, you guys are ready to condemn *all* homeopathic medicines when some may 
really truly work. I'm not saying which ones. I'm not saying the theory is 
right of infinite dilution (though, if we are living in a simulation, it 
might exploit a flaw in the virtual machine. :-) But, I'm saying, some 
homeopathic remedies might work to some degree for various reasons 
(including "inactive ingredients" and the placebo effect). But, almost no 
one with an MD/PhD is likely to do large scale research on this (at least in 
the USA). We can spend a trillion dollars a year on "defense" in the USA. 
Why can't we spend a few tens of billion on studying stuff like homeopathy 
(or even vaccination) with some rigor and no conflict-of-interest?

By the way, think about this: :-)
"Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why."
http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all 

"""
   As a psychiatrist, Potter knew that some patients really do seem to get 
healthier for reasons that have more to do with a doctor's empathy than with 
the contents of a pill. But it baffled him that drugs he'd been prescribing 
for years seemed to be struggling to prove their effectiveness. Thinking 
that something crucial may have been overlooked, Potter tapped an IT geek 
named David DeBrota to help him comb through the Lilly database of published 
and unpublished trials—including those that the company had kept secret 
because of high placebo response. They aggregated the findings from decades 
of antidepressant trials, looking for patterns and trying to see what was 
changing over time. What they found challenged some of the industry's basic 
assumptions about its drug-vetting process. ...  Part of the problem was 
that response to placebo was considered a psychological trait related to 
neurosis and gullibility rather than a physiological phenomenon that could 
be scrutinized in the lab and manipulated for therapeutic benefit. But then 
Benedetti came across a study, done years earlier, that suggested the 
placebo effect had a neurological foundation. US scientists had found that a 
drug called naloxone blocks the pain-relieving power of placebo treatments. 
The brain produces its own analgesic compounds called opioids, released 
under conditions of stress, and naloxone blocks the action of these natural 
painkillers and their synthetic analogs. The study gave Benedetti the lead 
he needed to pursue his own research while running small clinical trials for 
drug companies.
   Now, after 15 years of experimentation, he has succeeded in mapping many 
of the biochemical reactions responsible for the placebo effect, uncovering 
a broad repertoire of self-healing responses. Placebo-activated opioids, for 
example, not only relieve pain; they also modulate heart rate and 
respiration. The neurotransmitter dopamine, when released by placebo 
treatment, helps improve motor function in Parkinson's patients. Mechanisms 
like these can elevate mood, sharpen cognitive ability, alleviate digestive 
disorders, relieve insomnia, and limit the secretion of stress-related 
hormones like insulin and cortisol. ...
   Ironically, Big Pharma's attempt to dominate the central nervous system 
has ended up revealing how powerful the brain really is. The placebo 
response doesn't care if the catalyst for healing is a triumph of 
pharmacology, a compassionate therapist, or a syringe of salt water. All it 
requires is a reasonable expectation of getting better. That's potent medicine.
"""

Let's say homeopathic medicine was sometimes just a placebo. It may still 
work as well or better than many medicines. :-) And if it does no harm, the 
results may still be better in many cases than visiting an MD, especially if 
a homeopath also gives nutritional advice or counseling or sympathy. And 
apparently, medications based on the placebo effect continues to improve. 
:-) But, part of this is what Ivan Illich said, that medicine has gotten 
away from being a humanistic process and become a purely technical one. If 
homeopathic medicines even only activate the brain's and body's self-healing 
systems, they may be an effective medicine. In fact, they may even work 
where regular medicine fails.

With that said, there may be something more that that going on in Cuba; as I 
said, the extra herbal aspect of those medicines (Bach flowers) may (or may 
not) have an extra effect as well. We'll see as more information about that 
study works its way out of there.

Another thing, if you go into the hospital for a hip replacement, and that 
goes well, but you die of MSRA (antibiotic resistent stap) contracted in the 
hospital afterwards, then the MD surgeon who advised you to have the 
operation and performed it will essentially just say, "Tut, tut, too bad; I 
did my job right; must have been the cleaning lady" and walk away from 
owning the problem. And they'll also ignore decades of Soviet research on 
phage therapy. The fragmentation and specialization of medicine, combined 
with the large number of people who interact in a specialized medical 
setting (and even the supporting ones you don't see who make the 
preparations and so on) create a huge "diffusion of responsibility" in the 
whole system.
   http://en.wikipedia.org/wiki/Diffusion_of_responsibility
And it is a diffusion that extends to things like using antibiotics in 
animal feed and other larger social/technical problems.

When you start really poking at the history of medicine, there is some very 
ugly stuff. For example, midwivivery at home in the USA has been made very 
difficult, but there is a chance of contracting a deadly infection in a 
hospital, plus hospital births are more likely to have complications because 
of stress. Why are there not more home births or midwives in the USA, at 
least for uncomplicated pregnancies? The MDs essentially ran midwives out of 
town and got laws passed against them in various ways. (Plus maybe some got 
burned way back when.) Related:
   http://parenting.ivillage.com/pregnancy/plabor/0,,6rl1-2,00.html
From:
   http://www.gentlebirth.org/ronnie/homejjg.html
"""
Another factor that is important in making the choice about where to give 
birth may surprise you. It makes common sense, but has also been documented 
by several studies. Women who give birth in a hospital are much more likely 
to experience postpartum depression or even post traumatic stress disorder. 
Kitzinger states that the more interventions a woman experiences, the more 
likely she is to be depressed, with C-sections obviously carrying the 
greatest risk of depression (193). She quotes 5 or 6 studies documenting the 
effects of this "institutional violence."
"""

Granted there may be other confounding factors in those results about how 
homebirth is generally safer for low-risk pregnancies. But, the fact is, 
when you start poking at various aspects of medicine, a lot of stuff starts 
becoming iffy, and a lot of profitable medical practices seem to run against 
the statistics or logic (like a high C-section rate).
   http://www.childbirthconnection.org/article.asp?ck=10456
"All of these factors contribute to a current national cesarean section rate 
of over 30%, despite evidence that a rate of 5% to 10% would be optimal."

What a horror of violence against women and babies by MDs a 30%+ C-section 
rate is. But a very profitable horror. Apparently, it is even worse in some 
areas:
http://www.examiner.com/x-9303-Miami-Health-Care-Examiner~y2009m6d9-South-Florida-Csection-rates-too-high
"Too many South Florida babies are being delivered by cesarean section 
(C-section), according to new state figures. While the national average is 
31.8 percent of births done by C-section, in the year ended June 30, 2008, 
43 percent of births in Broward county, 42 percent in Palm Beach county and 
over 50 percent of births in Miami Dade county were C-section deliveries. 
Statewide the number is 39 percent, the second highest rate behind New 
Jersey. Across Florida, C-section rates vary sharply with a few South 
Florida doctors delivering as many as three-fourths of their patients’ 
babies this way and a few doing almost none. According to state figures, 
half the births at Holy Cross Hospital in Fort Lauderdale and Palms West 
Hospital in Loxahatchee were by C-section, while in other facilities 
two-thirds of the births are natural births."

Now, given that is how the baby gets delivered, excess surgery for profit or 
defensive medicine, justified by "safety" that actually makes both mother 
and child less safe when done unnecessarily, then why should one expect the 
medical horrors for profit to stop there? Why should one trust MDs who are 
willing to do that to women and children? Or all the other MDs who look the 
other way?

To be clear, some women and children do benefit from C-sections; this is 
about a rate way beyond what is reasonable. But even the skeptics trying to 
support high C-section rates admit 22% is a good average internationally:
http://skepticalob.blogspot.com/2009/07/whats-safest-c-section-rate-higher-than.html
But, contrast that with:
http://medind.nic.in/jaq/t06/i4/jaqt06i4p298.pdf
"In Sweden, Denmark and Netherlands, the CS rate is still close to 10% with 
some of the world’s lowest maternal and perinatal mortality rates"
Or, from here:
http://homebirthdebate.blogspot.com/2007/08/low-neonatal-mortality-correlates-with.html
"""
Here are the C-section rates (1998-2001) for countries with low perinatal 
and maternal mortality:
...
Netherlands 13.6
Norway 13.6
Sweden 14.4
Denmark 15
Israel 15
Finland 15.7
Belgium 15.9
"""

The point is, well-trained medical personnel can do far better than in the 
USA, by a factor of two or three. With about four million US births a year, 
that would be about a million women each year who did not get major surgery 
if the rate went from 30% to 15%. And about US$5 billion less a year in 
medical costs somebody needs to pay. And a lot less difficult recoveries.

 From the LA Times:
   http://articles.latimes.com/2009/may/17/business/fi-cover-birth17
"""
The cesarean rate in the U.S. is higher than in most other developed 
nations. And in spite of a standing government goal of reducing such 
deliveries, the U.S. has set a new record every year for more than a decade.
   The problem, experts say, is that the cesarean -- delivery via uterine 
incision -- exposes a woman to the risk of infection, blood clots and other 
serious problems. Cesareans also have been shown to increase premature 
births and the need for intensive care for newborns. Even without such 
complications, cesareans result in longer hospital stays. ...
   "Cesarean birth ends up being a profit center in hospitals, so there's 
not a lot of incentive to reduce them," said Dr. Elliot Main, chief of 
obstetrics for Sutter Health, a Northern California hospital chain.
   But there is a lot hospitals can do to reduce them, as illustrated by the 
wide variation in cesarean rates. Among California hospitals, cesareans 
range from 16% to 62% of births.
   Such variation means a lot of women are getting unnecessary cesareans, 
Main said. "There's no justification for that kind of variation."
"""

Cited in:
"The Soaring Cesarean Rate: It’s the Economics, Stupid"
http://www.scienceandsensibility.org/?tag=maternity-care-systems
"""
The L.A. Times article didn’t elaborate on Dr. Main’s statement, but let’s 
take a cold blooded look at the business side of cesarean surgery: From the 
hospital’s point of view, cesareans – especially scheduled cesareans – make 
staffing needs predictable and maximize patient throughput, essential 
elements of reducing costs. They also increase billing opportunities and 
lengthen postpartum stay, which enhance revenues. On the obstetrician’s 
side, she or he may be paid more, although this isn’t always the case, but 
the real savings is in time management—and time is money. Minimizing time 
spent in the hospital allows obstetricians to increase patient load and, 
what’s more, deliver those patients at times that don’t conflict with office 
hours or disrupt nights or weekends. And both hospital administrators and 
obstetricians believe that cesareans prevent malpractice suits. In short, 
cesareans are good for everybody, except, of course, mothers and babies.
   When a system makes it financially disadvantageous to change obstetric 
practice, it is human nature to find reasons to maintain the status quo, 
which explains why we see so many obstetricians, prominent and otherwise, 
downplay or deny cesarean’s harms, tout benefits that are minimal or 
nonexistent and generally frame cesarean surgery versus vaginal birth as 
“chocolate versus vanilla.” According to the American College of 
Obstetricians and Gynecologists, all an ob/gyn has to do is “believe” a 
cesarean is a good idea—never mind the reality—to make it ethical to perform 
one on a healthy woman. Small wonder that one in three U.S. women now has 
her baby via major abdominal surgery, a rate approaching three times what it 
should be, with no end in sight, and no one trying to do anything about it.
"""

I could go on about stents, heart operations, lack of recommending fasting, 
and a variety of other topics where the health care system is obviously 
failing. With that said, sure, if I was in a terrible car accident I'd 
probably want to be taken to a hospital. There are a lot of good doctors who 
can help people in all sorts of ways. But, clearly, there are also a lot of 
medical practices that are obviously incorrect.

So, when people go on about vaccination being justified, or you guys say, 
let's base our medical decisions on evidence and statistics, I think it has 
to be seen in that light of the system it is part of. And, based on the 
reasoning you and Ryan are all to happy to apply with a broad brush to all 
of homeopathy, what should I conclude about MDs based on how they use 
C-sections, or stents, or various other medicines and procedures in 
disagreement with the statistics and logic?

Want some "safe and effective" Vioxx anyone? :-(
   "How did Vioxx debacle happen?"
   http://www.usatoday.com/news/health/2004-10-12-vioxx-cover_x.htm

Consider:
"Offit's Failure to Disclose Jeopardizes Swine Flu Vaccine Program" 
http://www.reuters.com/article/pressRelease/idUS106778+08-Sep-2009+PRN20090908
"As autumn approaches and millions of Americans consider taking an H1N1 
Swine Flu vaccination, the integrity of all vaccine developers has been 
called into question by the financial relationship of a leading vaccine 
advocate and a pharmaceutical manufacturer.  Dr. Paul Offit of Children's 
Hospital of Philadelphia (CHOP), who was interviewed for a Dateline NBC 
television special, failed to tell millions of viewers that while he was 
promoting MMR as safe he had also made tens of millions of dollars from 
selling another vaccine patent to Merck, which is the manufacturer of MMR. 
According to CHOP documents, Offit's share of a royalty sale for the Rotateq 
vaccine to Merck is a minimum of $29 million and may approach $50 million."

What I see here is a tremendous double standard (not specifically you guys, 
but US society in general on this). Everyone knows homeopathy doesn't work 
(even when it does, perhaps surprisingly) but let's check into the hospital 
for a C-section because doctors know best (even when they don't or are 
motivated by profit or defensive medicine). Noam Chomsky's point on 
mainstream media helps explain that. As does this book:
"Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad 
Decisions, and Hurtful Acts"
http://www.amazon.com/Mistakes-Were-Made-But-Not/dp/0151010986

By the way, this is weird; this search result has dropped back down again -- 
must be something about Google:
http://www.google.com/search?hl=en&source=hp&q=vaccine+conflict+of+interest
"Results 1 - 10 of about 265,000 for vaccine conflict of interest. (0.29 
seconds) "
http://www.google.com/search?hl=en&q=vaccine+conflicts+of+interest
"Results 1 - 10 of about 387,000 for vaccine conflicts of interest. (0.15 
seconds)"

--Paul Fernhout
http://www.pdfernhout.net/