View Full Version : Misuse of evidence in scientific papers.


Kunga Dorji
11-20-11, 05:00 AM
Ok Everyone- Dizfriz, especially,
here is a challenge for you.

What I present here is a paper that encapsulates all of the criticisms I have of "evidence based medicine" in one small package.

I present here an abstract of a paper on the application of mantra meditation to ADHD.

Who can spot the flaws?

They are big enough to drive a truck through.

Clue: You should pay close attention to the disconnect between the method, the results and the conclusions here.


Inclusion of studies like this put the concept of evidence based medicine in the bin
55
Krisanaprakornkit T, Ngamjarus C, Witoonchart C & Piyavhatkul N. Meditation therapies for attention deficit/ hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews 2010, Issue 6.

Main results
Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga
compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk
of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically
significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -
2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy
group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was
also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test
(MD -8.34, 95% CI -107.05 to 90.37, 17 patients).
Authors’ conclusions
As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any
conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported.
More trials are needed.


At this point I would specify very firmly that I have seen so many insightless conclusions generated by half baked processing of information by the "Cochrane Collaboration" that I no longer regard it as a credible source of information.

Kunga Dorji
11-20-11, 05:05 AM
Any takers?

namazu
11-20-11, 05:18 AM
What, you want thoughtful responses in 5 minutes?! ;)

I'll try to come back to this later, perhaps after looking up the paper.

Also, it might be nice to include the full abstract (http://www.ncbi.nlm.nih.gov/pubmed/20556767), for those playing the home game:
Cochrane Database Syst Rev. (http://www.ncbi.nlm.nih.gov/pubmed/20556767#) 2010 Jun 16;(6):CD006507.
Meditation therapies for attention-deficit/hyperactivity disorder (ADHD).

Krisanaprakornkit T (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Krisanaprakornkit%20T%22%5BAuthor%5 D), Ngamjarus C (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ngamjarus%20C%22%5BAuthor%5D), Witoonchart C (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Witoonchart%20C%22%5BAuthor%5D), Piyavhatkul N (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Piyavhatkul%20N%22%5BAuthor%5D).
Source

Department of Psychiatry, Faculty of Medicine, KhonKaen University, KhonKaen, Thailand, 40002.

Abstract

BACKGROUND:

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood and can persist into adulthood. The disorder has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population.
OBJECTIVES:

To assess the effectiveness of meditation therapies as a treatment for ADHD.
SEARCH STRATEGY:

Our extensive search included: CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts, LILACS, Virtual Health Library (VHL) in BIREME, Complementary and Alternative Medicine specific databases, HSTAT, Informit, JST, Thai Psychiatric databases and ISI Proceedings, plus grey literature and trial registries from inception to January 2010.
SELECTION CRITERIA:

Randomized controlled trials that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD.
DATA COLLECTION AND ANALYSIS:

Two authors extracted data independently using a pre-designed data extraction form. We contacted study authors for additional information required. We analyzed data using mean difference (MD) to calculate the treatment effect. The results are presented in tables, figures and narrative form.
MAIN RESULTS:

Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17 patients).
AUTHORS' CONCLUSIONS:

As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.

<dl class="rprtid"><dt>PMID: 20556767</dt><dt>[PubMed - indexed for MEDLINE] </dt></dl>

And here's their "plain language summary":
Plain language summary

Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)


Attention-deficit/hyperactivity disorder (ADHD) is a disorder that affects a significant number of children and adults in a variety of ways. It is characterized by chronic levels of inattention, impulsiveness and hyperactivity. Meditation therapy could be a beneficial treatment for those diagnosed with ADHD. The objective of this review was to assess the efficacy of this treatment. As a result of the small number of studies that we were able to include in this review and the limitations of those studies, we were unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. No adverse effects of meditation in children have been reported. More trials are needed on meditation therapies for ADHD so that conclusions can be drawn regarding its effectiveness.

Dizfriz
11-20-11, 10:04 AM
Barliman

I am not understanding the problem here. This seems to be a review of the literature in a public/professional information function and not peer reviewed as such. I could not easily tell just what the review process was on Cochrane's site however.

Since you seem to be in a hurry, this is a based on a quick read of the report.

Here is the original article: http://www.update-software.com/bcp/wileypdf/en/cd006507.pdf

From the article: Agreements and disagreements with other studies or reviews

Meditation for ADHD has been reviewed as a psychological treatment along with other psychosocial interventions. At this time there is no specific systematic review of meditation for ADHD only. Arnold 2001 was a narrative review on alternative treatment for adults with ADHD. This review included the two studies of Kratter 1983 and Moretti-Altuna 1987, which were carried out in children with ADHD. The authors concluded that meditation showed some benefit and warrants further study for both children and adults. The recent narrative review by Greydanus 2007 emphasized medication and meditation was only mentioned under the heading of psychological management, which included many types of psychological interventions (psychotherapy, cognitive behavioral therapy, support groups, parent training, educator/ teacher training, biofeedback, meditation and social skills training). The authors stated that empirical evidence regarding these interventions was inconsistent (Greydanus 2007). These narrative reviews commonly failed to assess the methodological quality of the primary studies, therefore the results tend to overestimate the effects.Implications for practice

There is insufficient evidence to draw conclusions about the effectiveness of any types of meditation for attention-deficit/hyperactivity disorder (ADHD). The adverse effects of meditation in children with ADHD are unknown. And finally:

Implications for research

There is a lack of evidence to support the effectiveness of meditation for ADHD. This review has highlighted the need for further research.
They go on from there to describe how the research should be carried out.

This is a review/critique of the research on mediation with ADHD. The authors conclude that the studies were not sufficiently well designed to be able to come to any conclusions.

Google scholar reports 4 cites on the article.

I am not going to go deep enough into the cited research to be able to make a good critique of the article since this is not an area of deep interest to me.

One may or may not agree with how the authors conducted the review and I would like to read your thoughts on what you see as the flaws of the article.


Dizfriz

KronarTheBlack
11-20-11, 04:58 PM
Main results
Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga
compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk
of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically
significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -
2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy
group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was
also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test
(MD -8.34, 95% CI -107.05 to 90.37, 17 patients).
Authors’ conclusions
As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any
conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported.

This is a very useless study. The only thing the study actually proves is that whoeverthe people who designed it and authored it are absolute morons when it comes to scientific studies and statistics and bias. I am sure the results were probably only published because they had a grant to do the study and the condition of the grant was to publish the results. If I had a study done and it gave those results I would just NOT PUBLISH IT! hehe.

Dizfriz
11-20-11, 06:19 PM
Kronar

While this review has not been vetted (peer review) and I will not comment on the quality of the research without going back to check the original data with their conclusions; sometimes a careful meta study or literature review showing nothing adequately supporting a hypothesis is valuable.

Saying nothing about this particular study but to term the authors as "absolute morons" is just at tad over the top.

Disagree with the article to you heart's content but do try to keep criticisms on a scientific basis and at least explain why you feel this way.

I am respectfully interested in the reasons for your statements.

Dizfriz

meadd823
11-27-11, 03:51 AM
Barilman I found the source you quoted to be inconsistent and confusing but I am into context so I deferred to the long version.



Meditation therapies for attention-deficit/hyperactivity
disorder (ADHD) (Review) (http://www.update-software.com/bcp/wileypdf/en/cd006507.pdf)

There is insufficient evidence to draw conclusions about the effectiveness
of any types of meditation for attention-deficit/hyperactivity
disorder (ADHD). The adverse effects of meditation in
children with ADHD are unknown.

There is a lack of evidence to support the effectiveness of meditation for ADHD. This review has highlighted the need for further research. Meditation therapy research protocols need to be rigorous in design and delivery, and use standardized meditation therapy programs which can be replicated by other researchers.


The operational definition of meditation techniques used should be specified and relate to ADHD core symptoms. The trainers should be skilled or be experts in the meditation methods used. The monitoring of meditation practice at home in addition to the therapy sessions is a crucial element of adherence. The involvement of parents in practice should be considered and controlled.


The concomitant use of medication should be distributed evenly between comparison groups. All the outcomes should be validated and described, including adverse effects. We plan to update this review within 24 months to incorporate any new studies and respond to any comments or criticisms.

When they say lack of evidence they are by no means saying it can not possibly work what they are saying is there is not enough quality research to support of discount meditation as a form of ADHD treatment -

The long version of we don't have a flippin clue one way or the other!

If we want to find out studies to be less subjective and repeatable. Okay soo this the nature of science, lack of evidence is just that but it does not discount any ones experience.

I agree to the best of my knowledge the medical community does not know the effects of meditation upon ADHD symptoms. Why should they claim to?

I am unsure where the problem in the long form data exist but I am open to correction if I have indeed missed some thing which is always possible, it has been a long time sense I did any serious scientific debating so I am probably rusty.

cattail
11-28-11, 02:46 AM
This isn't en example of evidence based medicine but a review which concludes there is a lack of evidence based medicine on this particular topic. It's purpose appears to be to show a gap in research and how to address said gap.

It would be very atypical for a review paper to be funded by a grant. Again, this isn't research, but a review.

One of the biggest biases in science is that only studies with positive results are published. Knowing what does not produce an effect can be just as valuable and prevent duplication of effort but it is less likely to be accepted for publication. Researcher don't just publish something, it usually has to be accepted through the peer review process. Even review articles usually require this. Other posters have said this isn't peer renewed, I am not familiar with this group but I assume the posters are. Non-peer reviewed does not represent all scientific research. It very likely represents research not accepted by the scientific community, else it would be published in a peer reviewed journal.

If you want to criticize evidence based science then only post peer reviewed articles as they are the only ones that should be critiqued by such standards. Also don't expect an abstract to give the whole story. It has holes, it is 200 words to summarize 10000.

Dizfriz
11-28-11, 08:43 AM
cattail,

Good post.

I need to address one point.


Researcher don't just publish something, it usually has to be accepted through the peer review process. Even review articles usually require this. Other posters have said this isn't peer renewed, I am not familiar with this group but I assume the posters are. Non-peer reviewed does not represent all scientific research. It very likely represents research not accepted by the scientific community, else it would be published in a peer reviewed journal.



I am the one who indicated that the article may not be peer reviewed. I looked carefully at the publishing site and could not find where they are peer reviewed as in a scientific publication. When I cannot find evidence for this, I cannot assume it is and unless it is in a standard publication, I treat it as not peer reviewed until evidence establishes it as such.

After reading your post, I did a google search based on "Cochrane reports peer reviewed" and finally dug out where they state their articles as being peer reviewed (it is in their manual).

They state their function asCochrane Reviews are systematic reviews (http://www.cochrane.org/about-us/evidence-based-health-care) of primary research in human health care and health policy, I was not aware of them, they seem to be a service providing literature reviews on medical issues.

Their main site is http://www.cochrane.org/

The manual describing their peer reviewed status:
http://srdta.cochrane.org/sites/srdta.cochrane.org/files/uploads/Editorial_Process_for_DTARS_web_document.doc%5B1%5 D.pdf

I was not conditional enough in my posts on the thread and apologize for this and since I was able to verify their status as a peer reviewed source (wasn't easy though), wanted to correct my impression.

I can make mistakes, I voted for Nixon, mind you; not once, but twice.

Dizfriz

ADHDTigger
11-28-11, 10:52 AM
Barliman, my refutation will include no citations so you are welcome to ignore it now.


First thing I will say is that this is an emotional topic for me. Were it purely scientific, there would be no room for emotion as the science would be the foundation of fact. Within the context you have opened, emotion has a broad range- your thesis is that evidence is misused in scientific papers. Your underlying argument is that alternative treatments are not given equal value, if at all.

Ima tell you a story of fact. I lived this story. This is how I know it's fact. No committees, no researchers. Just fact as I lived it.

I personally saw the x-rays and CT scans on hubby 16 hours after he was admitted to hospital on 8/5/09. I saw with my own eyes that the tumor in his lung had pushed his heart and trachea roughly 90 degrees to the right. I saw the tumors on his kidney and adrenal.

I wasn't allowed to say the obvious- it's cancer. I was shushed and reminded that I don't have an MD to my name.



Early in hubby's treatment, I questioned his oncologist about the idea that I had just heard him advance to hubby- that we could just keep doing chemo "forever". Science clearly states that this type of cancer becomes chemo resistant. I wanted to know what forward planning was in place to defeat that known element.

I was told about "Blanche", a theoretical patient who, diagnosed at the same stage as hubby, went on to live ten years.

Didn't answer my question.

Through chemo, hubby and I were constantly exhorted to "think positively". It was during this time that I tried to kill myself. I was positive that the pain I was in would end if I were successful.

Scientific papers don't discuss the collateral damage.



We did everything that was suggested to us until I pointed out that the oncologist was an *ssclown who couldn't even keep current on scientific understanding of this cancer. I was the one who saw evidence of the brain tumors, demanded that an MRI be done to validate them, had to put up with months of scorn and derision because I have ADHD and aren't so smart... you know.

It only took a screaming scene to get an MRI... that SCIENCE suggested would reveal tumors... but the brain-dead peace and light faction told us was not real...

Hubby was offered "Healing Touch" while in chemo. He suggested that they go touch themselves. To quote him, the only healing oil was the 40 weight in the crankcase of his Ford truck.

My husband and I went through a shade of h*ll because his cancer docs were so buried in the "alternative" science that they failed to treat the patient in front of them. I have been permanently harmed because of that insistence.

I can't argue veracity of one paper over another. More accurately, I won't. To the point as I understand it- misuse of scientific evidence- my experience is that the fluffy pink cloud BS resulted in damage beyond anything I could ever put into words... and have to live with. And that pink cloud horsie-poo, while NOT oppositional to the real science, was treated as if it were as VALID as the real science.

Again, no citations. Just what I have lived.

TygerSan
11-28-11, 12:23 PM
Medicine treats people. . . the discipline is geared towards healing individuals, ideally listening to the individual patient and understanding what works for him/her.

Medicine, I believe in my heart of hearts, is an art form that combines scientific knowledge and other knowledge into an applied discipline. Doctors, in my mind are more akin to skilled mechanical engineers than scientific researchers. They know the inner workings of the engine (human body) but are attuned to the particular engine in front of them. They need to keep up with the evidence-based research in order to operate within the current knowledge base, but they aren't researchers.

Scientific research and inquiry is generally built upon the gathering of larger data sets and looking at statistics: i.e. improvements seen in groups of people, and what is a proven treatment for the *majority* of people. Casting aside of any potential political or profit-margin agendas (not saying that those do or do not exist), there still needs to be critical mass before a conclusion about any treatment regimen can be drawn.

In the case of this review, all the reviewers are saying is that there isn't enough data on the use of meditation in ADHD, and that the studies that have been examined aren't rigorous enough to draw unbiased conclusions. . . When it comes to examining treatment efficacy, it's harder to do so rigorously with some of the alternative treatments, but especially with things that don't involve drugs . . . determination of an adequate control group in this case is hard (what do you have people do before they go into the scanner? Do they stare at the wall? Listen to music? There has to be some kind of intervention). . . that doesn't necessarily mean that they are less worthy of study, just that it's harder to draw hard and fast conclusions about efficacy. This goes for most types of psychotherapy as well, so it's not just an issue of so-called alternative treatments.

There are people studying the neuroscience of meditation itself, and that might lead to some insight about attention issues regardless of ADHD status. The tools for studying such states of consciousness have grown leaps and bounds in the last decade, as have the theories and the means by which the data are analyzed. That means that the study quality in general is likely to increase similarly soon.

qinkin
11-28-11, 06:16 PM
I'm interested in seeing Barliman's take on this. I have some ideas about what I think the errors are (perhaps they ignored the studies that had measurable data) , but dunno where he is going w/this.

cattail
11-30-11, 02:08 AM
Hey Diz, no worries and thank you for your thorough follow up. I looked at their website myself and it was not readily apparent that they were peer reviewed. Either way it was a review paper, not the authors own experiment, and discounting evidence based science due to "flaws" found in the last 1/3 of a review paper abstract is just ludicrous.

I just get a little ranty in response to posts that say science is untrustworthy, especially when the poster doesn't actually interpret their sources, peer reviewed or not, properly. So nothing directed at you. More directed at the idea that researchers just publish crap science because their funding requires them to. It doesn't work that way. I mean if that were the case, I could just post my dissertation on a website somewhere and then cite myself on a webpage and call myself published!

It bothers me how little is known about how the scientific process and the peer reviewed process works and how difficult it is to produce rigorous science. I don't know how our education system could do a better job of explaining it and giving people what they need to be able to assess the credibility of sources. I TA a college gen ed science course and this is something I deal with on a weekly basis, so it hits home.

ahh off to bed. I have broken my no internet after 10pm rule again and this is where it gets me! Up past midnight ranting!

Cheers,
Cat

meadd823
11-30-11, 03:43 AM
It bothers me how little is known about how the scientific process and the peer reviewed process works and how difficult it is to produce rigorous science. I don't know how our education system could do a better job of explaining it and giving people what they need to be able to assess the credibility of sources. I TA a college gen ed science course and this is something I deal with on a weekly basis, so it hits home.

I think every one has a "soap box" nothing wrong with that - Mine is the spelling police and grammar gestapo!


Some of us are living life on the opposite side of the same ship - While we may understand the basics of medical science , the technological jargon and even how to evaluate the quality of studies but we don;t know what it is like on the researcher end of things.

The internet comes complete with a crap load of junk science and scientific sounding mumbo jumbo selling us any thing from brain games to toilet water Even those of us who know better may be approaching the same elephant from opposing sides blind to those aspects of the elephant of which we are not actually a part of ourselves.

While medical practitioners may be on the application of treatments and therapies we have no way of knowing the struggles of those who are on the discovery end of the process. Some times assumptions can be made without actual thought to those fellow ADDF members who may indeed be on the receiving end of those assumptions by profession.

I know I don't like it when my professions are misrepresented, apologies for any unintended insult.


perhaps they ignored the studies that had measurable data)

Below explains why the authors thought this review was important.

Meditation therapies for attention-deficit/hyperactivity
disorder (ADHD) (http://www.update-software.com/bcp/wileypdf/en/cd006507.pdf)

Why it is important to do this review
To our knowledge no systematic reviewhas been carried out specifically
considering the effectiveness of meditation for ADHD, although
several clinical trials have been conducted. This review
aims to address that evidence gap.


page 8 "Data extraction and management"

Excluded studies on page 13 explains the studies they excluded and why -

All studies referred to in the report specified on page 22 - Even if you disagree with their conclusions I do not see where they are purposefully hiding any results. If you are going to challenge their genuineness that is where you will need to start.

I agree more rigorous studies are needed however things like meditation are going to be more incline to the subjective nature of ADHD treatment experience than the effects of a medication.

I agree with the member who posted above that the answer will probably come not from specific ADHD treatment research but from researching the effects of meditation on the general population which may or may not show effects upon selective attention, anxiety, or impulse.

meadd823
11-30-11, 05:09 AM
Barliman, my refutation will include no citations so you are welcome to ignore it now.


First thing I will say is that this is an emotional topic for me. Were it purely scientific, there would be no room for emotion as the science would be the foundation of fact. Within the context you have opened, emotion has a broad range- your thesis is that evidence is misused in scientific papers. Your underlying argument is that alternative treatments are not given equal value, if at all.

Ima tell you a story of fact. I lived this story. This is how I know it's fact. No committees, no researchers. Just fact as I lived it.

I personally saw the x-rays and CT scans on hubby 16 hours after he was admitted to hospital on 8/5/09. I saw with my own eyes that the tumor in his lung had pushed his heart and trachea roughly 90 degrees to the right. I saw the tumors on his kidney and adrenal.

I wasn't allowed to say the obvious- it's cancer. I was shushed and reminded that I don't have an MD to my name.



Early in hubby's treatment, I questioned his oncologist about the idea that I had just heard him advance to hubby- that we could just keep doing chemo "forever". Science clearly states that this type of cancer becomes chemo resistant. I wanted to know what forward planning was in place to defeat that known element.

I was told about "Blanche", a theoretical patient who, diagnosed at the same stage as hubby, went on to live ten years.

Didn't answer my question.

Through chemo, hubby and I were constantly exhorted to "think positively". It was during this time that I tried to kill myself. I was positive that the pain I was in would end if I were successful.

Scientific papers don't discuss the collateral damage.



We did everything that was suggested to us until I pointed out that the oncologist was an *ssclown who couldn't even keep current on scientific understanding of this cancer. I was the one who saw evidence of the brain tumors, demanded that an MRI be done to validate them, had to put up with months of scorn and derision because I have ADHD and aren't so smart... you know.

It only took a screaming scene to get an MRI... that SCIENCE suggested would reveal tumors... but the brain-dead peace and light faction told us was not real...

Hubby was offered "Healing Touch" while in chemo. He suggested that they go touch themselves. To quote him, the only healing oil was the 40 weight in the crankcase of his Ford truck.

My husband and I went through a shade of h*ll because his cancer docs were so buried in the "alternative" science that they failed to treat the patient in front of them. I have been permanently harmed because of that insistence.

I can't argue veracity of one paper over another. More accurately, I won't. To the point as I understand it- misuse of scientific evidence- my experience is that the fluffy pink cloud BS resulted in damage beyond anything I could ever put into words... and have to live with. And that pink cloud horsie-poo, while NOT oppositional to the real science, was treated as if it were as VALID as the real science.

Again, no citations. Just what I have lived.

I agree completely. There is a grand canyon gap between scientific research and actual treatment application - The floor or a hospital, the busy family docs office the psychologist session are nothing like the controlled environment of research - Real live application of treatments involved the general population whose diversities can not be touched by research until some time after the fact. Real live application not only deals with physical responses but emotional ones as well. Research involves a select participation group over a preset period of time. Research papers deal with narrow specifics where as medical application deals with the big picture - they are intertwined but by no mean interchangeable.

I am on real shaky ground here but I intend no disagreement or harm of any kind. I do remember when you were going though some of this stuff and I feel now as I did then, some of their behavior toward you was unprofessional. You should not have been dismissed or treated like you were stupid. Your and Mike's emotional response should have been respected. Cancer sucks - no other way of saying it.

I worked oncology and that area of medicine does embrace more alternative therapies than most other areas of medicine but that is because of the type of clientele - A few cancers do respond well to radiation and chemo but many do not. When evidence based treatments are obviously failing then alternative treatments are employed because there is nothing else to offer.

I never did fluff and stuff any thing , I was about a "candid" as a nurse as I am every thing else I do. I got into just about as much trouble for it - Probably did as well as I did because while I tended to be blunt I was accurate, plus I was able to take other people raw emotions. Some people found my approach comforting while other were irritated by it -

Being pink cloud fluff and stuff helps some to feel better while it annoys the crap out of others - Guess I will put you down for "give it to me straight and let me express my raw emotions" list , no worries I am on the same list myself. I just wanted to share the reason why some oncology places embrace alternative approaches so readily as compared to other areas of medicine.

I am sorry you had to go though what you did and still do. :(

ninjapult
12-01-11, 02:08 PM
Thought I would stick up for science here. Remember that medicine and research studies are practiced by human beings. We're all emotional and prone to confirmation bias in the search for an answer to life's problems. Medical practice does not necessarily equate to scientific certainty (http://www.scientificamerican.com/article.cfm?id=demand-better-health-care-book). Research is not always conducted (http://www.weeklystandard.com/articles/chump-effect_610143.html) or interpreted in a scientific manner.

Personally what changed my mind set to medicine and allowed me to be more compassionate towards my own docs was to think of things in terms of degree of certainty. If we're talking the standard procedure to set a broken bone let's say it's 95% effective. That's not scientific, just a guess for the sake of argument. And effective here means "structurally able to support your weight" not "you'll feel exactly the same as before". Yes I know there are lots of types of breaks and I'm generalizing but a broken bone is a decent generalization -- unlike cancer or ADD. Too many variables. The effectiveness of chemotherapy to treat cancer ranges from 5% - 90% depending on said variables. And chemotherapy has lots of side effects. It's really awful but it's the best we've got in terms of effectiveness where effective means "dead cancer cells" and not "you'll feel exactly the same as before". Scientifically it all depends on what we're measuring and it's hard to get an accurate measure of pain and fatigue never mind happiness or quality of life.

Alternative treatments? Not as effective or not researched. And what gets me about this forum is lack of research seems to be argued as logical deductive analysis vs. intellectual hubris. The anti-alternative-treatment side applauds science and the pro-alternative-treatment side casts science down. I think there's a third perspective here. We can't scientifically perform these studies to begin with. Scientists should be held to a higher standard. There are few true Scotsman.

So think of the rats in Feynman's Caltech commencement speech (http://neurotheory.columbia.edu/%7Eken/cargo_cult.html) and then explain to me how to conduct a scientific study measuring the effectiveness of meditation as a treatment for ADD. For awhile we knew smoking caused cancer only through the interpretation of hundreds of studies and thousands of data clusters. And we can actually agree on what smoking is and measure cancer! The meditation cart is way in front of the ADD horse here. There is no medical breakthrough allowing a blood test for ADD and no agreed upon methodology for right practice. What exactly are we measuring and how are we repeating it in a controlled fashion?

cattail
12-02-11, 12:12 AM
Hi mead,

No insult taken. Your post are well thought out and helpful.

Cat