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Comment by cactusplant7374 | Hacker News Reader

I thought all medicine is evidence based as long as it’s not homeopathic or chiropractic?

"(effect sizes) Some of our favorite medications, including statins, anticholinergics, and bisphosphonates, don’t reach the 0.50 level. And many more, including triptans, benzodiazepines (!), and Ritalin (!!) don’t reach 0.875."

"There’s no anti-ibuprofen lobby trying to rile people up about NSAIDs, so nobody’s pointed out that this is “clinically insignificant”. But by traditional standards, it is!"

read more: All Medications Are Insignificant In The Eyes Of God And Traditional Effect Size Criteria ( MAY 31, 2023 ) https://astralcodexten.substack.com/p/all-medications-are-in...

https://pubmed.ncbi.nlm.nih.gov/9276585/

  I conclude that attempts to classify medical decisions as justified 
  or unjustified by scientific evidence have no foundation in logic and 
  that the term 'evidence-based medicine' is logically indistinguishable 
  from the term 'medicine'. The use of the term 'evidence-based medicine' 
  calls for a new type of authoritarianism in medical practice.

The ancient medical schools varied quite a bit when it came to questions of evidence. Something to think about perhaps.

>The Empiricists were sceptics in their attitude to causes, thinking that observation and report of evident conditions and their cures was sufficient for medical science, and thus eschewing causal theory. Rationalist doctors attacked the inadequate methodology of the Empiricists, and they try to explain why the antecedent cause should bring on such and such an effect, while emphasizing the need to decide rationally the proper use of induction, and the relevancy of similarities. The Methodists treat as irrelevant antecedent causes or factors, and they recognized just two pathological conditions—relaxation and constriction; the doctor's concern is to determine by direct observation in which state is the body.

Not really, people probably have better examples but doctors quite often don't actually try to figure out what antibiotic is the best, they just pick something for no real reason (they remember the name) and write a prescription. There are studies on what antibiotic to use quite a lot of the time, but that takes effort. You get a Z-Pack, and you get a Z-Pack, etc...

Probably one of the best known examples is the establishment as helicobacter pylori as the ultimate cause of ulcers, rather than stress, spicy food, and low pH. Marshall won the nobel prize for this, and it's often touted as a situation where there was a lot of initial non-scientific resistence "of course we know it's stress..."

It's often based on authority and tradition, evidence based is a fairly new idea.

homeopathic medicine, chiropractic medicine, folk medicine, traditional medicine, osteopathic medicine, crystal healing medicine... you can make an infinite list of nonsense

and if you want to disambiguate and say "evidence based medicine" to refer to actual medicine, they can just make it "evidence based homeopathic medicine" and so on and so on

can't beat these people

when Western doctors visited China under Nixon, the great medical practices of Chinese medicine were on full view .. acupuncture, herbs, other parts.. The Western Doctors uniformly mocked the Chinese upon return.. oddly reminiscent of the Chinese mocking the "stone age" Tibetans at a later date. zero medicine anywhere but in your own guild, it seems

https://slate.com/technology/2013/10/traditional-chinese-med...

"Traditional Chinese Medicine" as we now know it was invented as a propaganda move by the CCP under Mao, who didn't believe in it himself.

For the sake of clarity for those not inclined to read the linked article: Historically over the two millennia prior to Mao traditional medicine in China was a highly individual and idiosyncratic practice. While there were some aspects which were generally held in common the over all practice was incredibly diverse. It wasn't until Mao that these practices were assembled into the more unified and systematic Traditional Chinese Medicine that people are familiar with today.

> they can just make it "evidence based homeopathic medicine" and so on and so on

Only if the homeopaths lie about the evidence.

curious how combative some people seem to get about homeopathics when placebo has been shown to have consistent positive effect, without side effects, for almost every illness

Yes, it's 'curious' how people with a sense of basic decency get 'combative' when the Alternative Medicine Industry lies to them to sell useless treatments for diseases that could actually be improved by real medicine. It really is odd how that works, isn't it?

homeopathic medicine is clearly marked as such, do you disagree on this point?

anyone who complains about it who doesn't have at least as strong a crusade against crap like phenylephrine is a hypocrite

That's a weird claim. Phenylephrine has a number of well documented and researched effects with demonstrable efficiency greater than that of a placebo. Now there are certainly people who have and do take it as a decongestant despite that particular usage having been shown to be ineffective, but that doesn't make it crap and it certainly doesn't place it in the same category as homeopathic remedies.

It’s used as life saving drug for critically ill patients in ICU…

> homeopathic medicine is clearly marked as such, do you disagree on this point?

I disagree that it qualifies as medicine.

they aren't honestly trying to sell placebos (like Zeebo). They are marketing actual 'cures' for serious maladies that could respond to real treatments

If placebos don’t have side effects, why do the control groups in placebo-based trials always report side effects?

And given that “homeopathic” to most casually informed people is the same as “naturopathic”, what those people are taking are not necessarily harmless placebos.

As for your “almost every illness,” that’s just meaningless hyperbole.

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