Comment by bluerobotcat | Hacker News Reader

Comment by bluerobotcat | Hacker News Reader

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> Singapore is known to have a great medical system, even for those not well off.

You're spot on with respect to diet. I believe Singapore has the highest rate of diabetes in the developed world.

With respect to supposed excellent medical care, some problems in Singapore that I noticed:

- There is little access to preventative medical care. If you do get preventative medical care it tends to be very expensive (scan all the things!). In my home country, I would get a yearly test for glaucoma as my grandmother was affected and it's genetic, but in Singapore this is quite unheard of (I tried once and was subjected to a battery of tests that cost hundreds of dollars). In my home country most people get yearly dental care, but there's no such thing in Singapore.

- People change doctors a lot, which I think is problematic. However, you're kind of forced to change doctors every time you change companies or if your company switches to a different health insurance provider.

- Strong drugs are available over the counter, no questions asked. GPs also happily give out way too many drugs for minor issues.

- People in Singapore can end up losing all their money if they get a serious illness.

- Strong promotion of pseudo-medicine, such as TCM. It is legitimized even by otherwise respect universities, which may have TCM research centers. After a GP visit, it's also common that you get some pseudo-scientific medicine from the secretary handling your payment (e.g. 'don't eat chicken').

I'm not so much arguing against your hypothesis. However, I worry that optimizing for life span might not mean that people are healthier.

In fact, in some countries, death is sometimes chosen over necessarily prolonging life:

- Euthanasia

- Getting very expensive, painful/dulling medical procedures that end up prolonging your life is discouraged by doctors in some countries

> I'm not so much arguing against your hypothesis. However, I worry that optimizing for life span might not mean that people are healthier.

I think that is quite a bold criticism that is 10 years ahead of its time.

The examples of euthanasia and expensive procedures being discouraged are statistically insignificant at this point in time.

Brushing off TCM as pseudoscience is quite ignorant. There are plenty of legitimate TCM research and verified treatments that have improved the lives of many in the world.

Traditional medicine that is shown to be effective is no longer traditional. It’s modern medicine.

That not what "traditional" means. Traditional dance or traditional costumes don't become modern no matter how "effective" they are.

"Traditional" simply means TCM hasn't changed much over the years.

The point is, the parts of traditional medicine that work are adopted by modern medicine. Meaning, although they're still part of traditional medicine, they're no longer distinctive of traditional medicine. Traditional medicine is distinct from modern medicine only by virtue of the parts that don't work.

This is what is meant by the "traditional medicine that works is called medicine" soundbite. The soundbite on its own condenses the argument very imperfectly, and people should be wary of using it.

Please educate yourself with the term TCM (traditional Chinese medicine, 中药) before making such condescending comments. It's a very specific branch of medicine, not related to the generic English term "traditional medicine".

Your argument, to a Chinese person, is equivalent to "JavaScript is old because Java is old." It makes no sense at all.

https://en.wikipedia.org/wiki/Traditional_Chinese_medicine

Edit: It's also worth noting that in Chinese, TCM is simply 中医, which literally means Chinese medicine. I'm not sure who decided to add the "traditional" in front, but it's not actually how it's called in China.

> Traditional medicine is distinct from modern medicine only by virtue of the parts that don't work.

If you say it this way, then maybe we should stop using the term TCM and just call it its original name "Chinese medicine" so we can both be happy.

Dunno - stuff like acupuncture works for pain relief but is still part of TCM. If you have a bad back it probably has a lot less side effects than being put on opioids as is common in the US.

I was reading a few years back that they didn't have anything like double-blind studies on chiropractic medicine, in part 'cause double blind studies are much more difficult for procedures than for pills.

I mean, I'm not claiming to be an expert here or anything, it's just that last time I read up on that sort of thing it sounded like there was no evidence that chiropractic medicine or acupuncture was more than just placebo. Do you have citations?

The hard thing about all of this is that, as you pointed out, studies are hard to do. Even if they were funded to the same level as pharmaceuticals, it would be much harder to make conclusive findings. But in the absence of huge companies with profit motives or government bodies with political motives, there's not much funding around for thorough studies.

But some examples of where practices from TCM and CAM are achieving recognition are:

- The Nobel Prize awarded to Tu Youyou for finding artemisinin effective for treating malaria [1]

- A recent NIH review finding acupuncture, yoga and other non-drug therapies effective for common pain conditions [2]

- A study of a chiropractic technique to reduce the physiological effects of emotional stress/trauma [3]

But aside from these studies, surely the market is at least somewhat of an indicator of some level of benefit. Economists generally regard consumers of being capable of making rational decisions about how to spend their money in ways that most benefit them.

Of course it's not a water-tight rule, but nor is it completely false. Yet many people dismiss the entire CAM industry as being fuelled by nothing but stupidity, and dismiss the possibility that at least some of the industry's customers are capable of making rational spending decisions when it comes to their health.

[1] https://en.wikipedia.org/wiki/Tu_Youyou

[2] https://www.nih.gov/news-events/news-releases/nih-review-fin...

[3] https://www.ncbi.nlm.nih.gov/pubmed/28181091

Keeping in mind that some antibiotics were found originally in soil. So there's a good chance many random collections of stuff have produced useful medicine. The claim should be stronger than "it's not entirely valueless". How about: on average is it better or worse than modern medicine? Modern medicine is probably better then soil, on average. That's testable. And I'd wager it's better than any alternative effort. Even all of them put together.

All the meridians and whatnot don't lend more credibility over...soil, say. Until they're tested properly. After which Nobel prizes can be won.

> "on average is it better or worse than modern medicine?"

The vast majority of people using/practicing "CAM" are not claiming "CAM" to be "better" than modern medicine; they take a horses-for-courses approach.

Modern medicine is fine for acute illness where you need a medication or surgery to address an infection, break, blockage, etc.

"CAM" seems to be valuable for chronic non-life-threatening conditions like fatigue, pain, mild hormonal issues, mild auto-immunity, etc. It's also chosen by people who are quite healthy and want to keep it that way by optimising their nutrition, emotions, muscular-skeletal strength/alignment, etc.

So it's not a matter of what is better or worse than the other, it's a question of finding the right tool for the job. Every conventional doctor I've consulted in the past few years has endorsed that approach.

To be honest my info was shaky but I just googled and it seems it's kind of like a placebo effect but a good one. There was one study where

>After eight weeks 60 per cent of patients receiving acupuncture, including with toothpicks, reported feeling better. Clinical improvements were reported by just 39 per cent of those who had conventional treatments.

but it didn't make much difference if they stuck in needles or just prodded them with toothpicks. (quote from https://www.mirror.co.uk/news/uk-news/toothpick-acupuncture-... dicussed by NHS here https://www.nhs.uk/news/medical-practice/acupuncture-relieve...)

And even if it's kind of placebo, if the patient feels better that's something, without the risk of an opioid epidemic.

Are you really claiming that TCM and other such pseudosciences have been a net positive for the world? Unproven treatments that may make problems worse, while also encouraging patients to stay away from tested treatments, should play no part in a modern society. If you're in any doubt about this, perhaps you should read 'Bad Science' by Ben Goldacre, which takes a whistle stop tour of such quackery, as well as the various unethical practices undertaken by pharmaceutical companies.

The fact that nobody in the West bothered doing in-depth research into TCM does not mean it's ineffective or bad.

Chinese people have been practicing it for thousands years and we are doing just fine in terms of life expectancy, actually better than US.

Do you have anything better than an appeal to tradition to justify your viewpoint, perhaps a book or study that comprehensively justifies TCM without falling into the basic traps of failed statistical reasoning?

Perhaps the missing point is that the TCM approach to illness or health is dramatically different from Western medicine.

Surgery or modern medicine (injection, pills) focuses on one particular manifestation of illness and targets a particular illness.

On the other hand, TCM is not targeting a particular illness, but rather, it sees illness as the symptom of something deeper going off track in the body. Hence it tries to regulate and balance the body so that it can correct itself, without too much intervention.

It's not something that you can quantitatively study easily and get concrete results, as it is more long-term and therapeutic rather than short-term result driven.

So Goldacre's finding is that unethical practices and unproven treatments exist both in mainstream pharma and "CAM" [1].

So why is your contempt reserved for "CAM"?

> Unproven treatments that may make problems worse, while also encouraging patients to stay away from tested treatments

I keep hearing this but I've only witnessed the opposite.

I've utilised "CAM" for conditions that mainstream medicine couldn't help with (after years of trying to get help from different mainstream practitioners).

Only a combination of treatments from "CAM" modalities (naturopathy, osteopathy, myotherapy, yoga/pilates, limited chiropractic & TCM) has enabled me to get properly well.

Every "CAM" practitioner I saw encouraged me to keep checking in with mainstream doctors, which I did and have continued to do.

My mainstream doctors now look at my test results and just say "whatever you've been doing, keep doing it".

I get that there are horror stories, as there are in many facets of life. But like much of what makes up mainstream news reporting, the very thing that makes them noteworthy is that they are exceptions to the norm.

As someone who has gone about as deep into researching health/medicine as one can without actually undertaking a medical degree, I'm comfortable that the hysterical reactions over "CAM" are overblown.

So, it would seem, are government regulators around the world who are actually looking at the data, otherwise there would be even more stringent controls imposed on practitioners than are already in place.

[1] "Complementary and Alternative Medicine"

Because CAM doesn’t even attempt to be correct.

I know it’s hard to believe and to generalise beyond your own experience but you are one data point. You might have gotten better without any of the things that you mentioned. Most likely it was a placebo effect, strengthened by your own research and belief in the practices.

I’m not sure the lack of government regulation is a valid point. In my experience, and as you’d see if you read Goldacre’s book, government administrators don’t understand statistics. Even if they did, they don’t neccesarily legislate to maximise welfare.

I'm sure you're sincere in wanting to advocate positions that are good for the world. So you'll want to know how your arguments in this comment are flawed.

> Because CAM doesn’t even attempt to be correct.

Practitioners don't stay in business if they don't provide benefits. So unless you're asserting that most "CAM" clients like spending money for zero benefit, this claim doesn't hold up.

> I know it’s hard to believe and to generalise beyond your own experience

If you were committed to intellectually honest discussion, you'd have at least made further enquiries of me before making this assertion.

I have many acquaintances pursuing similar paths through their own health challenges, and have done for many years. I've examined many case reports and research studies, in order to understand the medical basis for what I've observed and experienced. So, yes, I'm one data point, but I've observed and researched many others.

> You might have gotten better without any of the things that you mentioned.

There's no basis for this. My health consistently declined for many years - for reasons that are now easily explained. And it started to turn around only after I started undertaking particular healing practices from the "CAM" sphere - but for reasons that are easily explained using scientifically sound medical knowledge.

> Most likely it was a placebo effect, strengthened by your own research and belief in the practices.

Serious question: do you suggest that my healing was imaginary, or that it was real but caused by beliefs/emotions rather than material factors?

People who invoke the placebo effect in this context often aren't conscious of importance of the distinction, but it matters a lot.

If it's the former, then I guess there's no more to discuss without knowing the details of my case - which you're welcome to enquire about.

If it's the latter, well then I agree with you that my healing has been influenced - indeed mostly driven - by changes in beliefs/emotions, as is the case with the version of the placebo effect that I subscribe to.

I've extensively researched the placebo effect and what is known about it, and how it may be relevant in my case, and I'm happy to discuss it further if it's a topic you're genuinely curious about.

> I’m not sure the lack of government regulation is a valid point. In my experience, and as you’d see if you read Goldacre’s book, government administrators don’t understand statistics. Even if they did, they don’t necessarily legislate to maximise welfare.

My point is not that there is a lack of regulation. There's a lot of regulation in most jurisdictions; professional bodies, health authorities, consumer protection authorities, criminal justice systems.

Governments may not legislate to maximise welfare but they are highly motivated to avoid horror stories on the front pages of newspapers, and the infrequency of such occurrences indicates that the level of harm caused by "CAM" is low.

Sure it would be great if it were lower, as is the case with all aspects of society where any harm occurs.

But striving for a world that only allows the practice of therapies that have been approved in advance by the mainstream medical establishment is not going to lead us to a better world than what we already have.

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