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I agree completely.

Part of the problem remains however that so many treatments have been studied and proven wrong, however proponents of treatment by 'Insert CAM modality here' remain willfully blind to the evidence against their treatment, and still tell everyone that will listen that not only does it work, but modern medicine won't test it and the studies aren't done.

as evidence I proffer the more than $1 Bn spent by the NCCAM for research into CAM that has largely come up bunk on the big issues.

The research should be done, it is important to approach it with an open mind, but CAM proponents must live up to their end of the bargain and stop moving the goalposts whenever a study that debunks a modality is released.

ps. I'm not too sure what your link has to do with the discussion exactly - I mean, artemisinin is not exactly part of the CAM stable anymore, it's a well accepted part of 'medicine proper' these days - joining a long list of other traditional therapies, asprin first and foremost amongst them, that have followed that route

I would be interested to know what you think of Western Medicine in the light of what Ben Goldacre says about how clinical trials are conducted. There are many flaws even in the so-called "Evidence-based" system in Western drug development, which is what you guys are going to rely on when providing treatments.

"better than placebo" being enough to register a drug, cherry-picking patients in the results, targetting very niche patient groups, not publishing any of the failed studies but being able to register on a SINGLE successful trial (which could be pure luck, statistically speaking)... and the fact that nobody ever repeats the trials for confirmation.

Traditional Chinese Medicine may be bullshit, but I think we have a heavy luggage of bullshit in modern Western Medicine as well and we ought to recognize it.

Disclaimer: I have a long track record in pharma industries.

I think the way some trials are conducted is worrying.

Of course there is the points you bring up; I had also heard (but can't find any link from a bit of a cursory look around the net) that all subsequent trials of antidepressants show decreased treatment effect until you end up with meta-analyses that seem to show that they are no better than placebo, leading (jokingly) to Doctors, on the release of a new anti-depressant, saying 'Quick, let's use it before it stops working'

Part of the problem I think is the model of the pharma industry (I have no suggestions on where to start to change this!), part is that students/researchers don't want to give up on publication and years of work with null results and so change the aims or methodology, or rig their study... Which is morally indefensible but understandable at the same time..

I think a lot of people involved with medicine are under no illusions as to the limitations of our current methods. However one of the beautiful things about the scientific method is that we are continually testing our preconceived ideas, and trying to tease out if the effects are real or some artefact of bias, statistics, population dynamics, etc.

When I started Med School they tell us that 'Within 4 years, 50% of what you have learnt will be wrong and replaced. The difficulty is which 50%'.

THAT is how quickly our knowledge is growing, and goes a long way to show that the people involved in the delivery of healthcare don't take this all for granted.

And that 50% is entirely preferable to loyally sticking with long-disproved falsehoods and pretending that they are preferable to updating any knowledgebase.

"I would be interested to know what you think of Western Medicine in the light of what Ben Goldacre says about how clinical trials are conducted."

The benefit of Western Medicine is that we know these terrible things and can work around them. They are not the system working as should be practiced. Using a fictional modality to treat patients is not a preferable alternative. Reform, not revolution.

I agree with you, but the current system shows no incentive to improve and to work around these issues. Regulators (because of the increased complexity) and Companies alike (because of the potential market losses) are unwilling to commit to do real science and to do the right thing. I do not think it is going to change anytime soon, even if we are all aware of the shortcomings.

I agree with all of these problems. I believe that the solution is to root out these inefficiencies and corruptions, not to replace them with a new set of inefficiencies and corruption and a wholly pseudoscientific core.

I wouldn't be so quick to dismiss foundational principles of TCM as 'generally bullshit'. http://en.wikipedia.org/wiki/Acupuncture#Effectiveness_resea...

It's more like - the foundations of TCM hold but over time knowledge passed down has accrued a lot of junk.

I wouldn't use TCM to treat cancer.

If you look at http://en.wikipedia.org/wiki/Chinese_food_therapy a lot of it doesn't make sense.

I still believe the principle is sound however; Eat lots of fried foods and drink not enough water and you can expect to get mouth ulcers.

One must keep in mind that while acupunture works (for some things), it is not for the reasons stated by traditional practitioners, which are not scientific. Humans don't have "qi" or energy blockages or chakras or any of the (frankly) bullshit inventions of Chinese and Asian medicine.

A lot of traditional medicine works (and a lot made-up, superstitious nonsense does not), but it's invariably something that works with no underlying understanding.

To paraphrase Tim Minchin (I believe), alternative medicine that works is called "medicine".

You have this picture of chinese medicine as doing voodoo activities such as the belief of taking certain herbs will cure diseases.

While that may be part of chinese medicine it is not all of it.

For example, when you break your arm, there are traditional chinese medicine techniques that work on the same principles of putting a cast on your arm.

Of course, now that we're in the 21st century, 2000 year old techniques for healing a broken arm may not be as effective, but it is wrong to simply declare all of chinese medicine to be "something that works with no underlying understanding".

Chinese medicine doesn't even have a concept of microorganisms, or cells -- things which we now know are pretty fundamental to knowing how a human body works.

When you say it is wrong to simply declare all of Chinese medicine to be "something that works with no underlying understanding", you are correct -- that statement implies that Chinese medicine works.

You just gave a great explanation how Chinese medicine has no underlying understanding: It has techniques for mending a broken arm, but not the scientific underpinnings to explain why it works. Traditional Chinese medicine does not have an understanding of bone knitting, nor does it identify what infection really is. Without a scientific framework, it's all cargo-cult medicine, doing things that sort of work (sometimes) without really knowing why.

"Humans don't have 'qi' or energy blockages or chakras or any of the (frankly) bullshit inventions of Chinese and Asian medicine."

These things more or less exist, you just don't feel them unless you actively develop the ability. It's relatively easy though, you can get a pretty good taste just during a 10 day vipassana retreat. That's not to say anything about the validity of the various metaphysical explanations of energy phenomena, but I don't think there's any question that the phenomena themselves are real at least on some level.

Why do you think there no question? Do you have evidence? There is not a single scientific study confirming their existence, nor are there testable hypotheses with which we could confirm them. In other words, it is superstition. Worse, it's blatant quackery.

"Why do you think there no question? Do you have evidence?"

Firsthand experience. Saying it's quackery is like saying that colors are superstition and quackery because you can't prove their existence. Anyone (or certainly the vast majority of people) can experience these phenomena, if you haven't yet then it shows lack of intellectual curiosity and initiative.

As it stands though scientists are currently working on cataloging the various states from traditional buddhist literature and then cross referencing those with various other traditions and teachers. This should be done in another couple years, and once that's done this will enable more and better quality research into what people actually experience while meditating or doing yoga.

Everyone I talked to at the meditation retreat I did had the same sorts of experiences though, so I don't think there is really much doubt about what further research will find.

Science knows what color is, how we perceive color, and it is trivial to show that someone can or cannot see color.

Firsthand experience from meditation is only evidence that using your attention in certain ways has various effects on the brain, it says nothing about the existence of chakras, qi, energy fields, auras, or the existence of deities or supernatural entities you were concentrating on.

"Science knows what color is, how we perceive color"

As long as you're willing to accept that step 2 is "and then a miracle occurs."

"Firsthand experience from meditation is only evidence that using your attention in certain ways has various effects on the brain, it says nothing about the existence of chakras, qi, energy fields, auras, or the existence of deities or supernatural entities you were concentrating on."

Chakras, qi, energy, etc. are just names for phenomena you can experience. These phenomena may or may not be supernatural, but there is not necessarily anything supernatural needed for them to exist.

"Chakras, qi, energy, etc. are just names for phenomena you can experience. These phenomena may or may not be supernatural, but there is not necessarily anything supernatural needed for them to exist."

The experiential is a real thing, but it does not necessarily have any greater meaning or value. "Energy" is felt, but that does not mean that it is any more valuable to healing than the hallucinations of a drug, or ecstatic religious experience.

You are describing subjective experiences. We can all agree that subjective experiences exist and they may have psychological value, and even health benefits (stress reduction, psychosomatic reactions, placebo response). To extend this to a method of explicitly physiologically-targeted treatment underpinned by a nonsensical, non-scientific biological framework, however, is where the quackery enters the picture.

To give an example: Treating stress by teaching a person meditation is a rational course of action because we know that meditation affects neurological processes in the brain. Teaching meditation by saying (I'm making this up) it unclogs ghosts in your energy field is quackery because it offers a nonsensical explanation as well as hinges on metaphysical phenomena that cannot be tested nor disproven because the terms (ghosts, energy field) involved are not physical.

"To extend this to a method of explicitly physiologically-targeted treatment underpinned by a nonsensical, non-scientific biological framework, however, is where the quackery enters the picture."

No argument there.

> Humans don't have "qi" or energy blockages or chakras

I do. How do you know you don't?

There is no reason for me to believe that I, or you, do, much as there is no reason for me to believe that ghosts exists, or that crystals can heal.

There is no evidence that the things I listed exist, and there are much simpler, scientific explanations why acupuncture relieves pain and discomfort than reasons offered by Chinese medicine. (Acupuncture has not proven consistently effective for much else.) With simple explanations, Occam's razor implies we can rule out the more convoluted explanations.

Equally importantly, the phenomena I listed have no rational, scientific basis. They are superstitions, or at best philoshopical abstractions irrelevant except as historical curiosities. If you could formulate a testable hypothesis I would be happy to discuss their validity, but unfortunately their existence are predicated entirely upon faith.

Ah, well if wikipedia says acupuncture isn't bullshit then fuck what science has to say.

"The foundational principles of traditional medicine (Chinese, Ayurvedic, whatever) are generally bullshit. But that doesn't mean that everything that emerges from them should be ignored"

Those items are medicine, not alt-med or holistic medicine or TCM or naturopathy.

The problem is that this wheat will nearly never be separated from the chaff. It's possible for that to happen, as Osteopathy came from similar origins as Chiropractic, but not very common these days. There is little business and ethical interest in rejoining "alt-med" into science-based medicine.