Leeches and the legitimizing of folk-medicine | Hacker News Reader

Leeches and the legitimizing of folk-medicine

press.asimov.com

30 pointsmailyk52 comments

I remember reading a memoir of a manual therapist who described his work with Ida Rolf. Rolf discovered a specific approach to massage, "rolfing". It appeared very effective, she had a number of apprentices and followers and she was interested in clinical testing and such. Turned out that it would be very expensive. With all her money she could maybe afford a couple small-scale trials. She decided money could be better spent elsewhere.

Rolf isn't a form of massage, it's more like simple exercises that are just things designed to help bring awareness to your posture, where you hold your weight etc.

I think you might be confusing Rolfing with Feldenkrais. They're both great!

I have an interesting story with non-scientific medicine. Normally, I'm a very science-oriented person—"read the paper or it didn't happen." I will even avoid reading a news article about the paper; I'll just go and read the paper itself. The way I treat my illnesses and injuries is the same. That being said, I suffer a lot from sore throats—I will get some flu, get better in 3–4 days, and then my throat will hurt for weeks. In a particularly bad bout, I tried waiting for 2 weeks with no improvement. I almost couldn't swallow. I went to the doctor and was prescribed antibiotics. That resolved it in about 24 hours, and I completed the full course. Three weeks later, the same thing happened. I waited 2 weeks to see if it would resolve on its own, and when it didn’t—antibiotics again. Of course, the problem came back only weeks later.

So I thought—I'm going to try homeopathy. What's the worst that can happen? I'm in pain anyway. I decided to try a scientific approach (not very, given N=1), so again I waited 2 weeks to see if it was going to resolve itself. It didn’t. I went to a homeopathic doctor and got a bottle with some "magic." It took 3–4 days for the symptoms to improve, but they didn’t come back for months. When they did, I jumped straight to the homeopathic medicine, and it helped in the same way it did the first time around. I haven’t used antibiotics for my throat since.

I have no explanation for this. There have been hundreds or thousands of studies on homeopathy, and my reading is that the consensus is that it's "quack medicine." Yet it clearly worked for me, and it worked better than antibiotics for that particular issue. What gives?

No one ever said homeophaty has no effect. But there is no evidence it works beyond being a placebo.. which is what I suspect happened also in your case, whether your consciouss mind believes in homeopathy or not. You gave it a chance, so some parts of your mind decided it will magically work, so it did.

Oh and unlike homeopathy, leeches have a real effect besides placebo.

placebo is not that effective

Do you assume that, or did you read about it in studies?

I read about it in studies!

see, for example:

Hohenschurz-Schmidt D, Phalip J, Chan J, et al. 2024 Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials.

“The average short-term placebo effect was small,”

Strijkers RHW, Schreijenberg M, Gerger H, Koes BW, Chiarotto A. 2021 Effectiveness of placebo interventions for patients with nonspecific low back pain: a systematic review and meta-analysis

“probably not clinically relevant.”

Placebo is by definition highly subjective, and not even in the sense of one's opinion, but rather that it works or not at a subject level.

Yes, it is. People have gotten better after having been told by someone in a labcoat that what they're taking is a placebo.

if you referring to Kaptchuk TJ, Friedlander E, Kelley JM, et al. 2010, that study still involved some deception[1]. See also Locher C, Frey Nascimento A, Kirsch I, et al. 2017

[1]: https://sciencebasedmedicine.org/placebo-effects-without-dec...

That wouldn't explain the difference in effect between the antibiotics and the homeopathy

Why not?

Assuming the placebo makes the mind activate the immune system in a proper way, eliminating the root cause of the inflammation, while the antibiotics only kill the bacteria while it is active, so no lasting effect. Bacterias that makes a sour throat are very common and will just come back if not kept in place by body defense mechanisms.

Key is a healthy and active immune system. The way placebos work, is apparently they support that.

Because the antibiotics would also elicit the placebo response

Not necessarily, as placebo is working on the mind. And it works differently depending on the context, what the person knows, experience and expects. It is apparently quite complicated. So in this case it is even possible, that the original cause was not bacteria, but a virus, so the antibiotics only helping as placebo, while actually disturbing the body, preventing the immune system from developing immunity.

Or it was a specific bacteria, where the body finally developed immunity from and it was just coincidence that he took homeopathy before. Impossible to tell with the given information.

Yes, that's what I mean: you need a further explanation beyond the placebo effect for why there's a different effect of the antibiotics and homeopathy, e.g. the antibiotics having their own negative effects, as you suggest, or some other confounding variable.

I'm just saying that the placebo effect, by itself, doesn't explain why homeopathy would be more effective than antibiotics

Oh and I am saying placebo effect is a psychological effect. Really, really hard to quantify by definition. So placebo and a placebo ain't the same thing. It depends what the person connects with it deep down in their minds. So for whatever complicated reasons the homeopathic placebo alone might have been more effective than the placebo effect of the antibiotics plus the antibiotic effect. (Maybe because their mother recommended it, and mother is connected to deep sense of trust and care)

Still, all speculation of course. I also don't rule out the possibility that (some) homeopathics do have a real efffct because of undiscovered quantum fields (whatever) and hard to quantify. But current studies do imply strongly otherwise. And I consider them sugar. But I do occasionally take some if people I like give them to me with a genuine feeling of care. That effects my mind.

Yes, I see, fair enough. It's an interesting thought about different placebos being more or less effective. I've often wondered whether traditional faith healing methods might have evolved to be more effective at eliciting a placebo response, at least within that cultural context, but never looked into it

It could be that you didn't get real homeopathic medicine. There's been quite a few cases of babies dying after being given "homeopathic" medicine. Because real homeopathic medicine is indeed quack science, literally diluting a substance to the degree of one molecule per a sphere of water the size of the entire solar system, but homeopathic producers are grossly immoral and stupid/bad and unregulated, so can contain high, in some cases deadly, doses of various substances.

TLDR:

Homeopathic medicine is, in theory, 100% safe, since it's literally nothing.

Homeopathic medicine is, in theory, 100% ineffective, since it's literally nothing.

Homeopathic medicine is, in practice, rolling the dice with unregulated producers that have been known to ship poisons.

I think this is the most probable explanation.

Homeopathic medicine is based on the same principles as sympathetic magic. You might as well ask someone to cast a spell.

https://pietersz.co.uk/2013/07/homeopathy-magic

There have been similar problems with dilution of herbal medicines, but of course herbs do often have medicinal properties.

Interesting, you're describing exactly what I went through a few years ago.

In my case, however, I turned to pure ginger infusions, following the advice of a herbalist. Haven't gone through it again so far, plus it also works great for colds and flu.

So, gingerol is anti inflammatory. Fun fact, so is allicin, which is produced by garlic. You get a lot of medicine that looks quite a bit like quack medicine - for instance people making garlic extract: https://www.allicin-c.com/?AFFID=549212

But then you end up with peer reviewed studies which indicate some anti-viral properties of garlic: https://pmc.ncbi.nlm.nih.gov/articles/PMC7434784/

> You get a lot of medicine that looks quite a bit like quack medicine

It depends what you understand by "quack medicine".

To me, in the beginning, all the stuff about drinking weird plants and doing homemade remedies did sound a bit quacky. But that was because of my absolute ignorance.

People have been using these remedies for thousands of years based on a deeper knowledge of nature than your random dude has, but we've fallen into a scam where we are made to feel that anything not made in a lab and costing a certain amount of money is nonsense.

Garlic, onion, ginger, turmeric, honey, echinacea, raspberry... those are natural wonders for basic natural medicine.

I have asthma, a few times I got an attack when I left my drugs at different home. Usually in such situation I have to go to a nightly doctor office (it always happens in the middle of the night on weekends).

But several times this happened I've been at my home and I have some old empty inhalers with 0 doses left and like 5 years past expiry date. I'm talking the disk inhaler, with discreet capsules of the drug that get used on every application - so if there were any traces of the drug substance - it would have been very small amounts that stuck to the inhaler walls or whatever.

I still used it and it stopped the asthma attack just as well as the real thing.

Placebo is one hell of a drug.

Similarly - even just preparing to go to the doctor in the middle of the night lessens the asthma attack for me. Just before I go to the doctor waiting in the queue the symptoms are often very minor.

> I have no explanation for this.

One possibility that RCTs are designed to eliminate is "regression to the mean." If the natural course of disease is to wax and wane and you intervene whenever the disease is waxing it can seem like your intervention is effective even when it has no specific effect.

In addition, placebos produce a small effect even when you know you are taking a placebo.

I’ve been on meds that wreck my immune system and so I get sick a lot. Every time I start feeling the smallest tickle of an upper respiratory virus I start doing the following: 1. Gargle with salt water 3x a day 2. Use saline nasal rinses 2x a day

I still get sick a lot, but haven’t needed antibiotics in all the years I’ve kept to this routine.

For your nasal rinses I hope you're using a "rhino horn" and not an expensive solution sold in pharmacies. Since I discovered it I rinse my nose much more often and more abundantly, and it's great (and waaaay cheaper than alternatives).

There is a null hypothesis which isn't ruled out: it would take two weeks plus 3-4 days for your sore throat to resolve itself, but you were waiting only two weeks each time, taking your timings at face value.

Still, that doesn't explain why the symptoms return sooner after antibiotics than with homeopathy. The body is complicated and there are many variables.

Do you drink alcohol? I'm wondering whether you consciously or subconsciously adjust how much you drink more during or after an antibiotics course than the homeopathy, or whether there's some similar confounding variable. Strong alcohol of course has some anti-bacterial properties (as well as some well-known side-effects which aren't so beneficial), but I don't really know what I'm talking about, just a thought that occurred

With letting the infection persist there might also be an added effect of having trained the immune system. If this is a case where it takes long to build antibodies. This may result in a longer period without an infection due to the improved immunity.

I don't drink, smoke, take drugs. My main vice is drinking a ton (about a liter a day) of Coke Zero.

To me the obvious "cure" for your sore-throat in this story was doing nothing. This has surprising efficacy. Antibiotics are serious drugs. They are inordinately useful, but they also have side-effects. Antibiotics can wheel your body completely out of equilibrium - your sore throat could have been due to yeast or been some kind of fungal thing which the antibiotics inturn made worse (or caused some kind of fungal -> bacterial cycle). In this case homeopathy gave you some utility; it gave you psychological permission to do nothing while feeling like you were doing something.

My guess is placebo, done "right" homeopathy is maybe the purest form of placebo, as extreme dilution make sure that there is nothing active in there. In your case, antibiotics may have been placebo too.

For me, the most probable explanation is that your body just healed by itself and taking nothing would have had the same result. It is not uncommon for symptoms to appear, repeat a few times, and disappear completely. It happened to me countless times, like, for example a cough persisting after a cold episode, coming and going for a few weeks after I realize it is completely gone, some minor injury occasionally manifesting itself before finally disappearing completely.

Your symptoms are a bit more serious, enough for you to justify doing something, but it is probably the same idea. That your interventions worked may be a coincidence, in addition to some placebo effect which is known to be somewhat effective for pain.

I think we should really just stop asking if "the old ways" actually work or not as it seems entirely irrelevant to the people that seek them out most of the time. They are acts of pure ritual.

Well that's a bit too much of a generalisation maybe?

Yes, there are old ways that have been proven wrong, which were based on ignorance at the time, but there are also old ways which are totally legit and are little known or accepted nowadays based on today's ignorance.

Take turmeric for example. It contains curcumin, a chemical that has quite good evidence for anti-inflammatory properties. However curcumin is not present in turmeric in clinically relevant quantities. People taking turmeric medicinally are not actually interested in the curcumin, if they were they would be taking a concentrated extract. They are interested in the ritual and cultural associations of turmeric.

In most cases when we do find evidence for something clinically relevant in traditional medicine we either discover that the effect is something other than it is traditionally associated with and/or that you need to take it at extreme doses for it to do anything at all.

Fair enough. Two points here, then:

- From a strictly scientific standpoint, wouldn't it be interesting to properly understand why and how it works?

- From a purely practical standpoint, who cares about any of that if not only it works, but is also better and healthier than what you might get prescribed at the doctor's?*

* yes, in some cases, not all.

> From a strictly scientific standpoint, wouldn't it be interesting to properly understand why and how it works?

Personally I think it would be, but I think people who actually engage in using traditional medicine couldn't care less how it works beyond making it sound even more magical and spooky.

> From a purely practical standpoint, who cares about any of that if not only it works, but is also better and healthier than what you might get prescribed at the doctor's?*

I don't think most people engaged in traditional medicine care about it actually being healthier, again because they are first and foremost interested in the ritual and cultural aspects rather than the effectiveness of the active ingredients.

My reason for believing this is that people consistently ignore evidence that their favourite magical plant does nothing. And that even when there is evidence to support it, they frequently ignore all findings about effective doses and treatment plans in favour of doing the "natural" thing like making into tea or putting it in orifices you aren't meant to put plants in.

> I don't think most people engaged in traditional medicine care about it actually being healthier, again because they are first and foremost interested in the ritual and cultural aspects rather than the effectiveness of the active ingredients.

I think you're repeatedly resorting to all manner of generalisations. Maybe that's your experience, and all that you've seen. While I've seen a bit of that too, I've also seen quite the contrary, very smart and learned people scientifically exploring fringe approaches in order to obtain results.

I could give you some personal and near examples of that if it were to mean something.

There's also quite a lot in natural medicine (including papers and proper scientific studies, if that's the only thing that matters to you) if you look into it.

The very fact that "natural medicine" practitioners form their own group that doesn't interact much with evidence based medicine is just more evidence for my view. The whole community is more interested in forming some sort of secret club than it is in actually doing medicine. If it worked, it would just be conventional medicine.

There is a third path where the traditional thing can't be commercialized so modern medicine doesn't pursue it. A (sincere) traditional practitioner might be less concerned with gaining and exploiting a patent, so the commercial potential isn't as important.

Telling that person apart from the sea of charlatans complicates things a bit. They're not the people who launch their careers with Oprah's help and spawn a million others riding in their wake.

That’s a thought terminating cliche. Academia doesn’t care about commercialization, they care about grants and they don’t much care which organization it comes from. You can argue why they don’t make it to market as FDA regulated medicines but not why there’s no positive evidence for their efficacy.

> Telling that person apart from the sea of charlatans complicates things a bit.

Peer review (for all its faults) and clinical trials that inform evidence based medicine. That’s how you tell them apart.

> If it worked, it would just be conventional medicine.

There are many reasons why this is not true. One of them is profits, another one (at least where I live) is the mass oriented, streamlined healthcare, in which there are not enough resources to treat you as an individual, but rather as a number, a small part of an average.

For these reasons, as an example among others, when a woman goes to the doctor because her period is painful, they'll prescribe her birth control pills rather than raspberry leaf tea.

Some old ways do work and it is worth asking whether they work. Aspirin was infamously drawn from Willow bark as a treatment. Artemisinin which treats chloroquine resistant malaria was derived from wormwood after looking for inspiration in ancient Chinese medicine. There are probably more examples out there where ancient medicine has informed modern medicine.

I am not arguing that plants do not contain interesting chemicals. I am arguing that they are typically used in a ways that are ineffective and the users don't care because they fulfilled their main priority, taking part in a ritual.

The ritual is the entire evolutionary societal mechanism that allowed us to use plants as medicine, or safely prepare toxic foodstuff.

This is the very nature of evolution; not all rituals will make sense. The ones that do, prevail.

Science is itself a form of ritual for sure. I didn't say we shouldn't have rituals and I support your right to chew on a tree if that's what you want to do.

Folk medicine that succeeded in rigorous clinical trials is called 'medicine'?

Maybe in next century we discover that "horse medicine" is very good against viral infections!

Reply on news.ycombinator.com