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From: B. Harris)
Subject: Re: A Question for the ALT crowd, if they can drop into the real world 
	for a minute
Date: 26 Apr 1999 08:12:14 GMT

In <7g0h4a$o9m$> "Allan&Teresa Widner"
<> writes:

>Is not "folk" medicine at the foundation of modern pharmacology?

   Afraid not.  Folk medicine is at the historical beginning of modern
pharmacology.  But modern pharmacology, while making use of some folk
medicine for suggestions on where to start, is by no means dependent on
folk medicine, and makes less and less use of it year by year, as
knowledge of basic biological mechanisms grows.  For example, some of
the first broad spectrum antibiotics came from natural fungi, but not
the very first-- those were the sulfa drugs that were discovered by
accident, and are completely artificial. As was Erlich's magic bullet,
compound 606, the first antibiotic of the modern kind (effective
against syphilis). It was not discovered by accident, but it was
artificial.  In more modern days, study of bacterial replication has
led to families of antibiotics that do not exist in nature, and have a
mechanism of action which is unknown in nature (fluoroquinolones, which
inhibit bacterial DNA gyrase).  The first good antihypertensive drug
came from a plant (Rawulfia), but near all those developed since have
come from basic physiological reserach, and have no counterpart in the
natural world.

  You speak about the need for rigorous testing of claims, but what do
we do in the meantime?  To interpret a new claim for an herbal remedy,
you need to have some idea of what fraction of such historic claims,
when tested "rigorously" were borne out.  The answer is not a very
large fraction.  But the people who read only the "good news" about
"herbs that work" from the latest hype literature get a false sense of
how rare it is to find this stuff. Most cranks really are cranks.  Most
folklore is junk.  If you spend your time reading about the amazing
exceptions to the rule, you get a very distored view of reality.

>Both sides of this debate must realize that as few as 2 centuries ago,
>patients were bled to restore "metabolic balance".  Some people
>injested mercury and arsenic and killed themselves, firmly believing
>they were curing a disease.  Now, medical science thinks it has
>emerged from these depths -

    Largely, it has.  Much of alternative medicine has not, but relies
on the same kind of evidence which first promoted bleeding, mercury and
arsenic.  Which last two, by the way, really did have some effect on
syphilis, so it's not a completely quack thing.  It's just one that is
almost worse than the disease, rather like chemotherapy. (The old
saying was: "One night with Venus, a year with Mercury.")

>and indeed great strides have been made, which the alternative camp
>seems inclined to erase - but we still find the same intractability
>that almost kept the Jenners and the Listers from contributing to the
>advancement of that science.

   No, you are exactly wrong.  We do NOT find the same intractibility,
for there are now standards, which all agree on, for showing that a
treatment is effective.  Where there were not in the days of Jenner and
Lister.  It is PRECISELY that which makes modern medicine so different
than what came before statistics and blinded, controlled experiments.
An example is Barry Marshall's discovery of H. pylori gastritis, which
is used an example of modern medicine's intractibility toward accepting
new ideas.  In fact, this new idea dates from the end of 1983, at which
time Marshall had not produced the standard of evidence needed, but did
have intriging claims.  It took 5 years for that standard to be
produced in many experiments in many places.  At the end of which the
idea was broardly accepted into orthodoxy.  That's not exactly the
tribunal of Galileo, although some alternative types would have you
think so.  Istead of being threated with torture, Marshall was offered
and accepted a nice professorship in the US.  Sorry, Australia.  We
know you'd like to think of American orthodox medicine as still being
in the dark ages.  But the guy is HERE now.

>The difference, alternative medicine folks, between Jenner and Lister
>and the rest of the fathers of modern medical technique and
>yourselves, is that the doctors and researchers who actually make a
>real contribution are always aware that they may be wrong, and put
>their theories to every possible test.

   Jenner's tests of this theory would be by today's standards grossly
immoral.  Not only did he deliberately infect a boy (not himself!) with
cowpox, but THEN he deliberated tried many times to give the boy real
smallpox.  Ye Gods.

>It is not enough to know that the cure seems to work in a bunch of
>people - one must know for a fact it was the cure and not a
>combination of other factors that worked, and that can only be
>demonstrated in a carefully designed, carefully weighted, and
>carefully repeated experiments.  Rejecting this process, and rejecting
>the medical science based on this process, and relying on your faith
>in a collection of herbs or metals or what have you - many of which
>this very process has proven actually worthless - to heal you, is
>nothing short of base superstition, no different than using talismans
>or sacrificing chickens or dancing naked in the light of the full

    Yep.  Where's your beef with modern medicine?  We still have to
make decisions based on evidence which is less than complete.  Again
the question is what to do with LIMITED evidence.  The answer is that
it depends on a priori knowledge, a lot of inference, and an analysis
of potential costs vs benefits.  Only some of this is science.  One
mistake is thinking that doctors claim that all they do is science.  We
never did.  We also make suggestions based on ethics and practicality
and shared values.

> On the other hand, when I amke an inquiry about an alternative
>treatment that seems like it could be useful, though I doubt it, all I
>get from the scientific crowd is a terse "waste of money", with no
>illumination; this makes me wonder how seriously it was considered, or
>if it was rejected out of hand just because the doctor hadn't heard of

     To find that out you have to ask.

                                  Steve Harris, M.D.

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