Hard News: No Red Wedding
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the idea that it should be shutting down all rivals to big pharma
Hardly - health stores are still out there in large numbers. People have lots of choice. My beef is that ACC for example will pay for acupuncture for someone like me who carelessly carries around huge pots on her deck and injures her back. Then they quibble about other people's far worse injuries and won't fund the surgeries they need. I mean, don't spend scarce govt money on treatments that are less likely to work ...
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David Hood, in reply to
One is whether is whether acupuncture is better than a placebo; the other is whether acupuncture causes pain relief as effectively as a placebo
Whenever I see discussions of acupuncture and placebos, I flash back to a segment the show Brainic did, where (not constrained by the ethical guidelines of research) they set someone with no knowledge of acupuncture up treating people. The only place it seems to be online is here
http://www.tviscool.com/play.php?vid=111
I am adding that I actually found this quite uncomfortable to watch. I have to say the idea of having someone off the street stick needles into me feels oddly worse than a "trained acupuncturist" (though it seems to have much the same effect). -
Rich of Observationz, in reply to
is all medical care to be prescribed by big pharma?
You do know that most if not all of the alternative pill makers are owned by large pharma companies?
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Bart Janssen, in reply to
“science has all the answers”
Fair point. My apologies, it is hard to try and write some of this stuff and make sure my tone is that same as the tone you read it. It is not my intent to sound patronising.
I would say though, is that idea is not that "science has all the answers" but that "science is the best way we know to find out the answers". All scientists know that there is a huge amount we don't know but good science is about trusting the methods to get to the answers.
That's why I am concerned about the Labour caucus dropping science out of the main picture. It is the same thing they did during the Clark era and as has been reinforced during this National government - a dismissal of the value of science to the country. Replacing Science with Innovation doesn't work.
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Bart Janssen, in reply to
At worst, the alternative medicine is not effective.
No
At worst alternative (ineffective) medicine takes money away from therapies that are effective. This isn't a bottomless pool of money, every dollar you spend on a therapy that fails is a dollar that can't be spent elsewhere.
That isn't to say alternative medicines can't have value, at the very least they have placebo value and for some (eg acupuntcure) there are suggestions that more research may show some value. But again it's an either/or situation, if there is only money for one treatment I want the government spending money on the treatment with the best chance of success.
And even worse, ineffective alternative treatments can cause people to choose to avoid or defer effective mainstream treatments. At that point they do actual harm.
So no, for a government in power with the responsibility to do what is best, it is not simply a matter of OK sure we'll give this treatment a bit of cash for the hell of it.
The worst part of medicine is that there are real hideous choices that have to be made by people like those in Pharmac. They deserve the respect of every New Zealander for making those choices. They also deserve to have the government respect those choices by ensuring funding decisions match up to the rigour of the choices the physicians have to make. Not to say those decisions can't be questioned either.
That's why I'd balk at the idea of seeing the Health portfolio in the hands of The Greens at present. But that is just a speculation anyway.
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The best controlled studies show a clear pattern – with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are what define "acupuncture" the only sensible conclusion is that acupuncture does not work. Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research. The most parsimonious conclusion is that with acupuncture there is no signal, only noise.
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Ok this is a complete side track.
Despite my fairly obvious dislike of alternative medicines there are some that have interesting science associated. While I personally got no value from acupuncture there is interesting science coming to bear of how acupuncture might work.
http://www.the-scientist.com/?articles.view/articleNo/35301/title/The-Science-of-Stretch/
Essentially, what we are starting to see is that stretching connective tissue under the skin may have beneficial effects. If done properly (big big if there) acupuncture can stretch connective tissue and stimulate cell repair and pain relief.
So while I am dubious about most of the practitioners of sticking needles into people it is plausible that acupuncture could have value.
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alternative medicines
There is no such thing as “alternative” medicines. There is medicine that works, and medicine that doesn’t. if it works (“works” being defined as producing measurable and repeatable improvements in proper clinical trials), it will be quickly taken up by medicine and used as another useful treatment tool. If it doesn’t, it is consigned to quackery. By that definition,, natureopaths, iridologists, acupuncturists, osteopaths, chiropractors, and crystal waving new age hippies are all the same – purveyors of quack medicine.
As long as the Green party continues to dispute the centrality of science in medicine in favour of a general ambient enthusiasm for various manifestations of shamanistic quackery, they should and will be kept well away from any involvement in the spending of public money in the health sector.
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Russell Brown, in reply to
Ok this is a complete side track.
Totally.
Despite my fairly obvious dislike of alternative medicines there are some that have interesting science associated. While I personally got no value from acupuncture there is interesting science coming to bear of how acupuncture might work.
We've been through all this here at some length before, but I tend to place acupuncture in the same category as osteopathy -- the founding theory is pure woo, but the developed clinical practice may be helpful.
Three members of my family have experienced significant relief from osteopathic treatment over the years, and evidence reviews like this one tend to recommend it for back pain, alongside conventional treatment:
Sub-acute spinal pain or low-back pain are appropriate conditions to refer to an osteopath (because the evidence suggests patients may derive significant physical and psychological benefit from the therapy, it is cost-effective and may result in fewer prescriptions for NSAIDs).
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I've emailed Kevin Hague and asked him what "selected" means in their policy on complementary health practices.
I hope he answers and I hope their policy is just a leftover from an earlier period.
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Russell Brown, in reply to
By that definition,, natureopaths, iridologists, acupuncturists, osteopaths, chiropractors, and crystal waving new age hippies are all the same – purveyors of quack medicine.
Which is not actually what the respective reviews say, if you take the trouble to read them.
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Idiot Savant, in reply to
Well, we ought to find out before then whether King is planning to stand down, no?
Though this also might be a way of sending a signal that its time for her to do so.
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Bart Janssen, in reply to
Totally.
Sorry, I try to stay on track but I can't help myself getting distracted with other discussions :(. Focus Bart Focus!
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The "worst case":
Baking powder doesn't cure cancer
Natural therapies don't cure cancer
Iridology doesn't cure cancer Iridologist tells patient not to seek conventional treatment even after hole in head develops to the point of patient's brain being visible.Unproven and/or ineffective therapies, trusting patients, and overenthusiastic, non-medical, practitioners are a bad mix.
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Time to channel Tim Minchen
"You know what they call alternative medicine. That's been proved to work? Medicine"
All the rest doesn't work and is bunk
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I think we need to be careful about getting bogged down in what has already been "proven" in the Western medical tradition and not be so eager to dismiss "alternative" medicines. Western medicine is not all scientifically proven but is still developing and science is constantly developing new therapies and casting doubt on the efficacy of old therapies. Many alternative medicines are traditions developed over hundreds or thousands of years. To simply dismiss them as bunk because the underlying theories are weird and unscientific and the therapies don't look like what would happen in any GP clinic or state hospital in NZ strikes me as being highly irrational.
Take Traditional Chinese Medicine as an example, but let me first get something clear:
1: Deer penis wine, powdered rhino horn, and all that nonsense is not real TCM, it's just a stupid mix of vanity, insecurity and superstition.
2: Chinese folk medicine is just like any other folk medicine, a set of customs passed down through families over the millenia. It does involve a lot of superstition, ignorance and old wives' tales, but there are good reasons why folk medicines persist. Even if it's only comfort or placebo, it helps, but there are almost certainly aspects of it that do actually have some medical use beyond comfort.
3: TCM proper is taught in universities by actual doctors who have studied the TCM system. These days TCM students also learn a lot of science, and modern scientific diagnostic tools are used by TCM doctors. There's also been more and more science done investigating TCM - sure, an awful lot of bad science, but that's a start, at least, and I'm sure there's some good, or at least adequate science being done. Some have already mentioned that with acupuncture. Also, don't forget that an awful lot of Western medicine is of herbal origin. Surely TCM doctors must be on to something when they prescribe certain combinations of herbs for certain conditions... After all they're working in a tradition that thousands of years of trial and error behind it. There's a story about the Yellow Emperor touring around China trying every herb and noting its effects before taking some tea to stop those effects turning fatal.... until he got to the last herb he tried, which killed him before he could get his tea.There's a TCM hospital just down the road from me. It has both Western (well, Chinese, but trained in the Western tradition) doctors and TCM doctors. When you go in a nurse asks your symptoms and makes a recommendation of which doctor to see, but you're free to disagree with her. The TCM doctors use stethoscopes and those blood pressure measuring machines whose name I forgot and will send you off for x-rays, scans, ECGs, blood tests and whathaveyou as well as take your pulse TCM-style and inspect your tongue and ask about a bunch of things that have no obvious connection to your symptoms to a Western mind, and good TCM doctors* will tell you when Western medicine would be more appropriate.
This approach of scientifically investigating other medical traditions and blending them with the Western tradition seems to me to be the smart way to go.
And if a Chinese person, TCM doctor or not, tells you that you have shànghuǒ (how to translate? "fire has risen"?), don't dismiss it as superstitious nonsense, understand it as potentially a very useful metaphor for the effect your psychological state is having on your physical health. Rinse and repeat for other strange-sounding diagnoses from "alternative" medical traditions.
Also what Bart said about science being the best way we have to figure out how things work, but we certainly don't know everything yet.
*hint: go for the older ones, they were trained at a time when making vast amounts of money wasn't the national obssession and any sons they have are probably married off already, meaning they face a lot less financial pressure.
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I am not particularly fond of woo either - yay doctors, yay medicine, yay science - but it is worth noting that medical practice is not actually "pure science" and doctors' attitudes towards certain things can change radically within the space of a generation, often based on social movements. I only really know about the women's health movement, so these are my examples: in the early-to-mid-twentieth century "twilight sleep" was considered a terrific way to deliver babies, and many western women formula-fed their babies from birth on medical advice. It wasn't solely the *science* that changed how people approached birthing and baby care. I'm therefore a little leery of assuming that science has every single answer to every medical question.
Homeopathy is some fucking bullshit, though. :)
ETA I had two caesareans and was re-admitted to hospital with life-threatening complications after both my children were born, so I am not exactly a hippy ambassador. Still, thought it was worth mentioning.
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Rob Stowell, in reply to
if it works (“works” being defined as producing measurable and repeatable improvements in proper clinical trials), it will be quickly taken up by medicine
In an ideal world....
Science is a fine thing. Publicly funded science is often a very fine thing.
But getting a medical treatment 'to market' is slow and extraordinarily expensive. It's also far from certain that even decades of clinical tests won't get things approved that turn out to be not so effective, or not-so-harmless.
That's not a problem with scientific method itself. But the 'science' we have is done by people who operate in a social, political and economic world. It's not perfect or all-encompassing.
And human health can be incredibly complex. Incredible advances in understanding genetics, for example, keep revealing how big an influence subtle things can have- and how much we don't yet understand. -
Man this thread moved fast. Anyway, back on the first page...
Jacinda Ardern just has not been getting much traction
I mostly agree, but also think Welfare has become the wedge issue for Labour. Contrast the very direct and successful approach by Jan Logie.
I think he's done pretty much what he said he was going to do - appointed people based on merit and skill rather than who they eat their playlunch with.
I agree Deborah although I don't understand David Clark's position, he struck me as very able. I'm also unsure about the capability of the Whips but appreciate why they particularly are there.
One last thing, David Parker's clearly really bright, my only concern is that in Parliament - I don't know about in other forums - he prefers technical issues over substantive ones and his 'hits' don't appear to translate.
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Bart Janssen, in reply to
But getting a medical treatment ‘to market’ is slow and extraordinarily expensive.
The number that used to get quoted is that each new drug costs US$20 billion to get to market. While I don't profess to love "big pharma" it is very easy to forget that with that cost it really isn't possible for anyone "little" to get a drug to market.
Much of that cost is a consequence of regulatory approval and complex clinical trials to determine that a drug does no harm AND provides a significant benefit given that even with all the testing each new drug carries a risk so without a significant benefit it is considered unwise to take a risk.
BUT
That might be starting to change. One of the biggest problems with testing drugs is that each person reacts differently, both in positive response and in adverse reactions. Some of that difference can be connected to their genome.
Most drug testing now is being done in association with genome testing, so if a new drug has an adverse reaction with a specific gene variant - but is of benefit to everyone else - then you could approve the drug providing a test was carried to exclude those at risk.
Previously such a drug would fail clinical trials and get tossed on the scrapheap adding to the cost of the next drug. There is quiet hope that we may see a new era of conditional approvals, where drugs get approved only for use with those patients who will* actually benefit and who will not* have adverse reaction.
* You can add probably to almost every one of those "will" or will not" statements and the probability will be set at a level that is decided by society. That may sound scary but for example if you have terminal cancer you might accept a "probability of adverse reaction" in a new drug that is higher than if you have pimples.
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Keir Leslie, in reply to
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Deborah, in reply to
Famously, plate tectonics only became widely accepted as the best available explanation of continental drift, oddly matched geology on opposing side of oceans, distribution of species, etc, when certain older geologists died (off). When I’m feeling outrageously technical, I go all Popper and falsificationism, but in my more reasonable moments, I think that Lakatos and Feyerabend make a lot of sense.
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Shit Oh Dear! where did you people go? The labour caucus looks good to me. And if they dont rise/( treat it with the disdain it deserves) the baiting Key&Co will throw at them. I think we might have a govt that could right some of the wrongs a lot of people have suffered under for too long.
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Stephen Judd, in reply to
You realise that was something I tweeted just the other day? Or is that some sort of ironic zing? In any case, what gets funded when there isn't enough money to go around matters, so for me this isn't a matter of striking a more-rational-than-thou pose so much as trying to have a consistent and reasonable basis for funding. I have a problem funding things that extensive review has failed to find evidence for, eg acupuncture, when we could be spending it on things where there is evidence, and I don't think that's unreasonable.
* I may be in favour of funding some kinds of pilot programmes for which there is currently no evidence, in the hope that we might then get some, but that's a different issue.
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Keir Leslie, in reply to
Not an ironic zing: merely a moderately teasing rejoinder.
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