It's nuts how many people still anecdotally believe in chiropracty, acupuncture, naturopathy and other woo woo and spend good money on them. It doesn't help that countries like Canada officially...
It's nuts how many people still anecdotally believe in chiropracty, acupuncture, naturopathy and other woo woo and spend good money on them. It doesn't help that countries like Canada officially license them and give them credibility.
Hold on, naturopathy? That's a doctorate. Most naturopaths practice a combination of traditional allopathic medicine (they can prescribe, run labs, all the things) and science based holistic...
Hold on, naturopathy? That's a doctorate. Most naturopaths practice a combination of traditional allopathic medicine (they can prescribe, run labs, all the things) and science based holistic medicine.
There are also naturopaths who stray pretty far from science based medicine, but that doesn't invalidate the entire profession.
Acupuncture has been extensively studied, especially in China, and it has quantifiable benefits in some areas (such as pain management/inflammation reduction). At Harvard, scientists even discovered the neurons responsible for acupuncture's ability to trigger an anti-inflammatory response.
As with naturopathy, there are people who get lost in the woods and make unreasonable claims, but that doesn't invalidate the field. There are also a lot of dangerously inept MDs out there, that doesn't mean the practice as a whole should be disregarded.
I'm sure you can get a doctorate in whippet-fondling with basket-weaving if you look hard enough. Sure, some "naturopaths" may incorporate some scientific principles in their work, but that...
I'm sure you can get a doctorate in whippet-fondling with basket-weaving if you look hard enough. Sure, some "naturopaths" may incorporate some scientific principles in their work, but that doesn't legitimise the field in my book.
The fact that it's illegal in some US states, includes homeopathy and is "based on vitalism and folk medicine" (whatever they are) plants it firmly in the "woo-woo" basket for me.
The federal government doesn't let basket weavers prescribe pharmaceuticals. ND curriculum includes all the same medical sciences found in an MD program. Possibly the biggest difference is that an...
The federal government doesn't let basket weavers prescribe pharmaceuticals. ND curriculum includes all the same medical sciences found in an MD program. Possibly the biggest difference is that an ND takes up to three times as many hours of nutrition.
At least consider that if your knowledge of the field ends at the wikipedia entry, you may be unqualified to write off an entire profession.
As far as I can tell, the degrees that you describe (which include all the MD curriculum) exist only because a degree containing only the woo wouldn't qualify them to treat real patients - because...
The federal government doesn't let basket weavers prescribe pharmaceuticals. ND curriculum includes all the same medical sciences found in an MD program. Possibly the biggest difference is that an ND takes up to three times as many hours of nutrition.
As far as I can tell, the degrees that you describe (which include all the MD curriculum) exist only because a degree containing only the woo wouldn't qualify them to treat real patients - because it's woo. So such degrees allow the woo-mongers to get at patients, because they can claim "I'm a real doctor too".
At least consider that if your knowledge of the field ends at the wikipedia entry, you may be unqualified to write off an entire profession.
I did wonder if I was going to get the "dO yOuR rEsEarCh" response.
If someone is going to claim that chewing this root (which mainstream medicine rejects as being a placebo at best) is going to cure someone's (potentially serious) illness, and that person is liable to ignore real treatments in favour of it, then this falls squarely under "Extraordinary claims require extraordinary evidence".
So the onus is not on me to read past a wikipedia entry (which is quite scathing), it's on you to demonstrate that root-chewing is going to help more than real medicine.
Without weighing in on the rest of this, I'd like to say that this is not something you're safe from with an MD or DO. My mom has always been on the "crunchy" side and has fallen victim to a lot...
So such degrees allow the woo-mongers to get at patients, because they can claim "I'm a real doctor too".
Without weighing in on the rest of this, I'd like to say that this is not something you're safe from with an MD or DO. My mom has always been on the "crunchy" side and has fallen victim to a lot of scammy "alternative medicine", and it absolutely included at least one MD participating in diagnosing her with phony conditions.
I'm not sure what root you're referring to, or why it's relevant to the conversation. I'm increasingly sure, though, that it's not a good faith conversation.
I'm not sure what root you're referring to, or why it's relevant to the conversation. I'm increasingly sure, though, that it's not a good faith conversation.
That's an impressive re-write of my post. It's the sort of hyperbolic reinterpretation that, in my experience, people make when they're angry. But maybe you're not angry, it's impossible to say...
That's an impressive re-write of my post. It's the sort of hyperbolic reinterpretation that, in my experience, people make when they're angry.
But maybe you're not angry, it's impossible to say via text.
Please remember that Tildes, as a community, is trying for something different. Or so I like to hope.
Granted I'm also no expert, but everything I'm seeing about the profession is that they don't focus on evidence based medicine. That's probably the single most important aspect of any specialist...
Granted I'm also no expert, but everything I'm seeing about the profession is that they don't focus on evidence based medicine.
That's probably the single most important aspect of any specialist for me... That they have done the research to determine the proper way to treat me, not based on gut intuition or anecdotal happenstance
It kind of does though. If there's no licensing group holding them accountable, then you might not know if you've got a bad one until it's too late. There needs to be a minimum standard, and if...
There are also naturopaths who stray pretty far from science based medicine, but that doesn't invalidate the entire profession.
It kind of does though. If there's no licensing group holding them accountable, then you might not know if you've got a bad one until it's too late. There needs to be a minimum standard, and if that minimum standard includes unscientific and potentially harmful advice, then the whole field cannot be trusted.
Imagine if we treated civil engineers with that logic. Some follow engineering principles and physics, and others use the holistic approach of stacking things on top of each other and seeing if it falls down. Yes, some of these engineers are useful, but if the latter group is also allowed to practice, the group as a whole cannot be trusted.
There is licensing? No need to go so far for a comparison. We treat medical doctors with that logic, despite a long history of some doctors prescribing harmful treatments that ignore the current...
There is licensing?
Imagine if we treated civil engineers with that logic
No need to go so far for a comparison. We treat medical doctors with that logic, despite a long history of some doctors prescribing harmful treatments that ignore the current science.
In engineering the science is usually solid. In biology it's constantly evolving, with new information routinely invalidating old.
I'm not as radical as the other guy, I'm not going to compare them to a phd in basket weaving (though I met a woman with a phd in juggling and she's great), but I'm also skeptical because of...
I'm not as radical as the other guy, I'm not going to compare them to a phd in basket weaving (though I met a woman with a phd in juggling and she's great), but I'm also skeptical because of anecdotal evidence in the vein of "I trusted them until they started speaking about something that I actually understand":
I have been studying the gut microbiome, its relation to various illnesses and practical methods of changing it for years now. I don't have a background in medicine or microbiology, but as far as I know, all that I learned about it is scientifically backed or directly inferred from scientific studies with a reasonable degree of certainty, and I regularly consult it with doctors. This is challenging because the knowledge of human microbiome is one of the (if not the) fastest developing fields in medicine right now and basically any source on the topic older than 10 years can be safely discarded, so a lot of practically usable information shared on the internet or in books is wrong and useless at best.
I have been a member of a few large facebook groups on this topic, because while they are usually full of (sometimes harmful) pseudoscience, there are normally a couple people posting actual interesting studies and/or people from commercial labs/research groups.
One of the most persistent topics there are people sharing their experience with naturopaths. Whether they're shared positively or negatively, I don't remember ever seeing one that was reasonable and based on current science. It was always inevitably some person shooting in the dark with significant doses of herbal antibiotics, antifungals or probiotics, making broad stroke recommendations that are demonstrably harmful for some portion of patients, blindly switching to some different "solution" when the patient gets worse without investigating what actually happened.
And that's the better variant, the worse variant is telling a patient who feels worse after a treatment "that's just a die off reaction, keep taking what I recommended, you will get better eventually" - referring to Herxheimer reaction, which is a real thing associated to treating certain bacterial infections, and it can in some cases really happen with regard to the microbiome. But in a large portion of cases this is not what's happening and instead the patient is just getting worse and worse and pushing through it thinking they'll get better in the end.
The reason why normal doctors don't do this is because it's not backed by science and now known with some certainty to be dangerous to the patient, so there are no standard guidelines produced for doctors to use. Naturopaths do not seem to care about this. There is a very understandable demand from patients with difficult illnesses that are hard to treat for a doctor to try to treat them experimentally because they're frustrated and drained from being in a situation with little hope. But blindly treating them based on outdated knowledge without proper testing (good quality microbiome sequencing is not even that expensive nowadays, but interpreting it is the difficult part) in a way that often makes them worse is not the solution, a responsible and self-aware doctor should know not to do this. Unfortunately there seems to be a huge number of naturopaths who have no issue with this.
For all normal doctors get wrong (and I have my own experience with that), they almost always know to stay conservative and rarely do fuck ups like this.
It's a lot muddier than many of these comments would have one believe. I think William Gibson coined the term "winning the medical lottery" aka when what ails you has been cured by science based...
It's a lot muddier than many of these comments would have one believe. I think William Gibson coined the term "winning the medical lottery" aka when what ails you has been cured by science based medicine. If you have the luxury of a lottery winner then by all means stay within the confines of clinically tested and proven cures. But then lobotomies were all the rage as recently as the 60s, and Fen-Fen was widely prescribed for weight loss in the 90s, and ... and and. If we're discussing the entire populace as a whole, then there's a statistically optimal path to take for relief. But, outside of communicable diseases, the sample size of the relief seeker is 1 and statistics can be and often are terrifically misleading with tiny sample sizes. All of the above being said. A very large % of chiropractors are wack-a-doo's and I avoid the entire group as a personal life policy. ND's I'm a bit fuzzier on.
Counterpoint: The reason why I spent years studying the gut microbiome is specifically because I did not win the medical lottery and I have to help myself. I was not able to get into remission,...
I think William Gibson coined the term "winning the medical lottery" aka when what ails you has been cured by science based medicine. If you have the luxury of a lottery winner then by all means stay within the confines of clinically tested and proven cures.
Counterpoint: The reason why I spent years studying the gut microbiome is specifically because I did not win the medical lottery and I have to help myself. I was not able to get into remission, but the only things that helped my symptoms were things backed by science, the problem being that most doctors don't know about them because it's impossible for a normal doctor to keep up with research until it gets to a stage where clear diagnostic and treatment guidelines exist. I realize that most people are not capable of doing what I'm doing and they seek help, but I don't think that abandoning science is the right way, it's still the least bad alternative that exists and there are occasionally doctors who are able to practice it in a way that allows for a more reasonable kind of experimentation, they're just exceptionally rare and often expensive.
I'm hoping that AI helps solve this expertise problem sooner rather than later.
Clinical research takes forever. :( I'm excited about what AI can/may do to help too! Much of the population lacks critical thinking skills and even more of the population abandons critical...
Clinical research takes forever. :( I'm excited about what AI can/may do to help too! Much of the population lacks critical thinking skills and even more of the population abandons critical thinking when stressed over things like medical crises, both of which open the door for wack-a-doo's and grifters. Humans can be just awful.
Ive seen a DO before - she was a medical doctor + and actually did a residency and the like. She prescribed me medicine AND suggested other remedies that were not from the homeopathic aisle. (Its...
Ive seen a DO before - she was a medical doctor + and actually did a residency and the like. She prescribed me medicine AND suggested other remedies that were not from the homeopathic aisle. (Its been a while but mostly I felt like it was holistic without being woo woo)
My coworker sees an ND and I think they changed her diet based on her blood type and she likes the doc but I cannot even imagine seeing someone that far down the woo train. I a kid chiropractors as a whole for the same reason. I'd rather do PT.
I didn't know that. Are they closer to Naturopaths/chiropractors? Mine was truly a regular doctor who happened to have an inclination to treat with the minimally invasive method first, which is...
I didn't know that. Are they closer to Naturopaths/chiropractors?
Mine was truly a regular doctor who happened to have an inclination to treat with the minimally invasive method first, which is something my NP has as well, through she is more inclined to refer to a specialist.
If we know something is placebo, maybe we could do something that is meant to be the best placebo ever instead. Off the top of my head, get me a beautiful young actress to read poetry for me while...
If we know something is placebo, maybe we could do something that is meant to be the best placebo ever instead. Off the top of my head, get me a beautiful young actress to read poetry for me while naked. Or an actor if that's your thing. I can see that making me forget my pain for a while.
Or some other very relaxing things people do while naked.
Deep tissue massage.
Or something like Wicca, or Chaos magic. Or hypnosis, which is very much assumed to be placebo. Or listening to Bach.
As long as we're being honest about what it is. That's where the practitioners of all these alternative medical systems fail in my opinion. It's fine to get acupuncture as an effective placebo,...
As long as we're being honest about what it is. That's where the practitioners of all these alternative medical systems fail in my opinion. It's fine to get acupuncture as an effective placebo, but good luck finding an acupuncturist who doesn't denigrate real medicine and make outrageous claims about the efficacy of what they're doing.
I had a shower thought this morning after reading this comment, we know that placebos work even when patients know they are a placebo. So why not dispense with the mysticism and just open up a...
I had a shower thought this morning after reading this comment, we know that placebos work even when patients know they are a placebo. So why not dispense with the mysticism and just open up a Placebo Bar, where you can go in have been given your placebo of choice.
Would you like a sugar pill? Here you go.
Would you like to have a relaxing aroma therapy? Sure, the scents smell nice, they won't cure you but it's still very relaxing
Would you like a massage? Again not going to cure your chronic disease but temporary relief is still good for you.
Want some needles stuck in you? That stimulation can override pain elsewhere in the body for a bit so here's a clean environment, someone certified in proper usage and a well regulated sterilization procedures.
Want someone to crack your knuckles or other joints? The sound is satisfying and we won't do any dangerous stuff like neck "adjustments" that could potentially leave you paralyzed.
Want some water that's been diluted to the point that no molecule of medicine could remain from the original batch? We gotchu, fresh tap water.
Want to chew on roots? Got plenty of those, these ones taste good too.
Yeah, I'm fine with that. However, people really misunderstand the "placebos work even if you know they don't work" idea. Basically, you need someone you trust sincerely telling you it will help,...
Yeah, I'm fine with that. However, people really misunderstand the "placebos work even if you know they don't work" idea. Basically, you need someone you trust sincerely telling you it will help, even if you know there's no reason for that to be the case. So, yeah, you need the spa rigmarole, or we might as well plop people in front of TV or send them to a supermarket for their dose of distraction.
That's probably why successful practitioners are uncritical, almost cultish, believers. Their sincerity convinces and assures the patient, so the placebo works.
That's probably why successful practitioners are uncritical, almost cultish, believers. Their sincerity convinces and assures the patient, so the placebo works.
I forget where I read it, but I once saw a quote to the effect of "you won't feel the pain in your leg with a butterfly specimen needle in the nape of your neck".
I forget where I read it, but I once saw a quote to the effect of "you won't feel the pain in your leg with a butterfly specimen needle in the nape of your neck".
Also: The placebo effect is getting stronger. This is not new news either, my psychiatrist has been telling me this for 8 years. It's becoming a problem for new drug development because new...
Also: The placebo effect is getting stronger. This is not new news either, my psychiatrist has been telling me this for 8 years.
It's becoming a problem for new drug development because new medicines can't beat placebo even if they have roughly same effectiveness as old medications. Some of our older medicines wouldn't pass certifications now because they couldn't pass placebo trials these days.
It really depends on what you are trying to treat, as well as how you are treating it. Cochrane reviews are very informative. For instance, acupuncture can be effective for preventing migraines:...
I'm not going to be abrasive about it, but that's largely not the case. The UK doesn't regulate the license. In Canada, only British Columbia allows them to prescribe. In the US, only 12 states...
I'm not going to be abrasive about it, but that's largely not the case. The UK doesn't regulate the license. In Canada, only British Columbia allows them to prescribe. In the US, only 12 states allow prescription of medications. The breadth of training may be the same as MDs and DOs, but the depth is not, and the practice hours are neither the same in breadth nor depth. There is probably a higher focus on nutrition, though.
For what it's worth, I'm good friends with a naturopath and do see her for advice on herbs and buy her tinctures. But I do that because I'm curious and open. The same way I'll talk to her about star signs and her medium work. I would never outright recommend it to a patient, but I also wouldn't try to dissuade them except to present evidence that the standard medical care has behind it, and then only if they're open to hearing it.
That's a fair point, I'm only familiar with how it works in the US. There, though, at least in the states that take it seriously, the depth is indeed similar, with the exception of residency...
That's a fair point, I'm only familiar with how it works in the US. There, though, at least in the states that take it seriously, the depth is indeed similar, with the exception of residency usually being optional. Thus the ability to prescribe, refer and be covered by insurance in those places.
As someone in a different field that also requires practical experience to be a good practitioner*, I'm not sure the optional residency (which the Internet seems to frame as definitely none not as...
As someone in a different field that also requires practical experience to be a good practitioner*, I'm not sure the optional residency (which the Internet seems to frame as definitely none not as a maybe) is an aside here. That seems to me to be a huge part of the "depth" of education. It makes sense why they wouldn't because there aren't naturopathic hospitals, but that makes their training significantly different, by a matter of literal years.
*Mental health. My counseling degree gave me the underpinnings but I learned how to do both my clinical and non-clinical jobs from doing the work.
Just because some naturopaths also practice medicine doesn't mean that naturopathy is legit, just as chiropractors can help, but chiropractic is a load of shit. Acupuncture can help with pain, but...
Just because some naturopaths also practice medicine doesn't mean that naturopathy is legit, just as chiropractors can help, but chiropractic is a load of shit. Acupuncture can help with pain, but so can literally just pressing on the area, and sticking a needle in somebody's ear isn't going to relieve their depression any more than cutting their wrists will.
It's the same with legit medicine. Ibuprofen and opiates can relieve pain, but acetaminophen won't do shit for you, even from a doctor.
Actually acetaminophen (APAP) does actually help with pain. Does it help significantly? Maybe not, but we do have clinical evidence that APAP when combined with ibuprofen (IBU) demonstrates lower...
Now mind you I'm not by any means saying APAP is a wonder drug, but it does have potential benefit when used in the right situations/combinations. And since APAP is cleared by your liver, and IBU your kidneys, taking the two drugs in tandem is safe and confers greater analgesic potential than the two agents alone. However with that being said, IBU monotherapy does generally provide greater analgesia than APAP monotherapy
Fully agree. I'm reposting a response I made last time a discussion on acetaminophen came up. There is plenty of evidence to support the analgesic effect of acetaminophen.
Fully agree. I'm reposting a response I made last time a discussion on acetaminophen came up. There is plenty of evidence to support the analgesic effect of acetaminophen.
This recent and very comprehensive review of the various analgesic mechanisms of acetaminophen debunks that claim outright. It isn't a NSAID and has weak anti-inflammatory properties so may not be as effective for certain types of pain management - but even there, the authors cite some interesting work on one of the metabolites of acetaminophen which does act on inflammatory pathways.
The synergistic effect of acetaminophen and NSAIDs is also well established. See for example this review of post-operative dental pain concluded that the analgesic effect from acetaminophen and ibuprofen combined that was higher than each individually, and which rivalled several opioid formulations.
If it has been shown to not work better than placebo on its own, doesn't that imply that the combination of APAP + a drug that has been shown to work is only more effective than ibuprofen alone...
If it has been shown to not work better than placebo on its own, doesn't that imply that the combination of APAP + a drug that has been shown to work is only more effective than ibuprofen alone because it is ibuprofen + placebo instead of just ibuprofen?
Firstly, it is superior to placebo for most things. You are misinformed. Secondly, even if that was right, no. The study cited is literally comparing either APAP or ibuprofen in isolation to the...
Firstly, it is superior to placebo for most things. You are misinformed.
Secondly, even if that was right, no. The study cited is literally comparing either APAP or ibuprofen in isolation to the combination. Even if that weren't true, there could still be a mechanism of action by which APAP synergized with ibuprofen to result in more pain relief. Or it could just block a specific set of neural pathways associated with opioid addiction. The logic you've walked through here is basically that if x + y = z, and we know for sure that y > 0, z > 0, but have no lower bound for x, x must equal 0.
Except that we don't know the value of z in this context, and you are assuming that x = placebo. Which is wrong in principle, especially since you didn't read the goddamn paper. I'm not going to...
Except that we don't know the value of z in this context, and you are assuming that x = placebo. Which is wrong in principle, especially since you didn't read the goddamn paper.
I'm not going to bother beyond this comment if you're going to be such an ass about this. Back pain is remarkably intense and is not properly treated by NSAIDs or opioids either, arthritis is historically difficult to treat and NSAIDs are close to the ideal treatment for it, and headaches are caused and cured by wind as much as ibuprofen.
How about
cutting your finger and not wanting to bleed
blunt force trauma
fever (!)
acutely poor subjective sense of wellbeing due to illness
bone pain unrelated to the spine or osteoarthritis
The spine and arthritis are, seriously, the worst examples you could use to make your case here.
You are spreading medical disinformation based on misunderstanding a few random studies, ignored the bulk of substance of my comment for the sake of attacking a shorthand analogy, blatantly...
You are spreading medical disinformation based on misunderstanding a few random studies, ignored the bulk of substance of my comment for the sake of attacking a shorthand analogy, blatantly interpreted a simple statement about a painkiller's efficacy as some inconceivably misplaced argument, and couldn't even bother to come up with a #2. Yeah, I'm ranting at you for imperfect examples, sure.
Well no, that's not how medical literature works. If I understand your implications correctly, a placebo is essentially nothing at all, so IBU+placebo should be no different than IBU monotherapy....
Well no, that's not how medical literature works. If I understand your implications correctly, a placebo is essentially nothing at all, so IBU+placebo should be no different than IBU monotherapy. Remember that APAP is in fact an active drug, whereas placebos are inert
Also, if you read the study I linked you would see that the analgesic potential of APAP+IBU was potentially greater than IBU alone, as evidenced by the reduction in opioid consumption within the APAP+IBU group. Though the authors recommend IBU monotherapy, that doesn't change the fact that combination therapy demonstrated less opioids being consumed by patients
Tylenol is by no means a wonder drug, but to say it does nothing at all is simply incorrect. In the medical world we are starting to see more and more APAP+NSAID combinations, as synergistically the two classes do confer greater reduction in pain without necessarily jumping to opioids
No, I did not say that placebo is nothing. The placebo effect is real, so ibu+placebo could be stronger than ibu monotherapy, meaning APAP+IBU could be more effective than ibu alone if APAP is...
If I understand your implications correctly, a placebo is essentially nothing at all, so IBU+placebo should be no different than IBU monotherapy.
No, I did not say that placebo is nothing. The placebo effect is real, so ibu+placebo could be stronger than ibu monotherapy, meaning APAP+IBU could be more effective than ibu alone if APAP is ineffective on its own.
I'm not really sure why you're implying that I didn't read the article or understand that APAP+IBU > APAP||IBU when I said that "the combination...is only more effective than ibuprofen alone" when the study also showed that ibuprofen alone is more effective than APAP (26mg vs 36mg respectively).
I suppose then what you meant here then was that the placebo effect might have accounted for the increased efficacy seen in the APAP+IBU group? If so, I do hope you realize that's a very bold...
If it has been shown to not work better than placebo on its own, doesn't that imply that the combination of APAP + a drug that has been shown to work is only more effective than ibuprofen alone because it is ibuprofen + placebo instead of just ibuprofen?
I suppose then what you meant here then was that the placebo effect might have accounted for the increased efficacy seen in the APAP+IBU group? If so, I do hope you realize that's a very bold implication to make, as the differences were statistically significant
Yes, placebo effect is a real thing, but we design clinical trials to be sure (or usually at least 95% sure) that the ultimate outcome is accurate and not due to chance, including placebo effect
The reason why I don't think you read the article btw is because the IBU monotherapy group in the trial was IBU+placebo lmao
I always wonder how this myth started because I only ever saw it from Americans online and it's simply wrong. I tried to google it and the only explanation I found was that many pills containing...
It's the same with legit medicine. Ibuprofen and opiates can relieve pain, but acetaminophen won't do shit for you, even from a doctor.
I always wonder how this myth started because I only ever saw it from Americans online and it's simply wrong. I tried to google it and the only explanation I found was that many pills containing acetaminophen sold in the US contain a strangely small dose (250 - 350 mg). Around here the standard dose for older kids and adults is 500 mg and it is considered safe to double it.
Anecdotally, for headaches, even strong migraine-like ones with nausea and light sensitivity, 500 mg of acetaminophen works much better than 400 mg of ibuprofen, and it's faster too (though rapid acting ibuprofen variants exist). For pain caused by inflammation, NSAIDS are likely generally better, but that doesn't mean that acetaminophen doesn't work or that it cannot be better for some types of pain.
Even for fever as an antipyretic, a pharmacist around here is likely to tell you that if one doesn't work for your current illness, you should try the other because their mechanism is slightly different and it sometimes happens that one works better than the other.
I don't know if the dosing in the US has much to do with this recent myth. Most Americans I know are happy to double or triple up on pills for a headache. But, I do know that, speaking for myself...
I don't know if the dosing in the US has much to do with this recent myth. Most Americans I know are happy to double or triple up on pills for a headache. But, I do know that, speaking for myself and my family, APAP is only ever used as a second line or combination treatment, and it's terribly unlikely to affect a headache. That might just come down to our pain being more often inflammatory in nature than not, and that could be a widespread phenomenon. No clue.
Your interpretation, not mine. The metastudies are not in conflict with what I say. It works for tension headaches (which is my case) and some other cases, doesn't work for others. Regarding the...
Maybe check yourself before assuming Americans are the problem with everything.
Your interpretation, not mine.
The metastudies are not in conflict with what I say. It works for tension headaches (which is my case) and some other cases, doesn't work for others. Regarding the tension headaches, some of the studies are interesting because they show that it works really well for some portion of people (criterion was completely ending a moderate to high intensity pain) and not at all for others, which might explain this weird situation, I am clearly one of the lucky ones. Some of the studies show that that "functional" group is very small (10%), other recent studies with large enough sample size indirectly show this is likely not the case (88% overall success in removing or reducing pain with symptomatic medication, where about 45% of people used paracetamol and about 55% NSAIDS).
The evidence clearly shows that for some issues it does not work at all, but it also clearly shows that in other cases it works well enough to say that "acetaminophen won't do shit for you, even from a doctor." is not a reasonable conclusion.
edit: so, this not a part of an argument, I'm just doing it for fun because it just honestly seems like an incredibly strange thing to me. I have a instagram page with just bellow 1800 followers, all of them Czechs and Slovaks, so I made a poll asking whether they use paracetamol for any kind of pain and if so whether it usually works or usually does not. A day later, about 200 people responded, out of that over 70% said that they use paracetamol and that it usually or always works for some type of pain for them. That only confirms the strangeness of this situation.
So it won't do shit for some people, even from a doctor. Still, that was one of a handful of examples in a whole comment where, frankly, disproving that one example would actually provide greater...
So it won't do shit for some people, even from a doctor. Still, that was one of a handful of examples in a whole comment where, frankly, disproving that one example would actually provide greater evidence to my claims that the chiropractics, naturopaths, etc are only effective with the actual medicine they practice and not the quackery parts.
No disagreement from me here. You just reminded me of a study that I'm too lazy to go find, but it was investigating the placebo effect and concluded that a doctor showing enthusiasm and care...
my claims that the chiropractics, naturopaths, etc are only effective with the actual medicine they practice and not the quackery parts.
No disagreement from me here.
You just reminded me of a study that I'm too lazy to go find, but it was investigating the placebo effect and concluded that a doctor showing enthusiasm and care about the patient's problem creates the same effect as taking a placebo pill. They obviously proposed a possibility that this is the reason why some people who seek out woo doctors are happy with the result, because them having enough time to show care and enthusiasm is one of their main selling points, whereas a normal doctor is often overworked and tired and therefore less capable in this regard.
For whatever it's worth, the only acetaminophen I've ever seen sold in U.S. stores is in 500mg form with the instructions advising you take 1–2. I was able find a handful of 325mg dosages several...
I tried to google it and the only explanation I found was that many pills containing acetaminophen sold in the US contain a strangely small dose (250 - 350 mg).
For whatever it's worth, the only acetaminophen I've ever seen sold in U.S. stores is in 500mg form with the instructions advising you take 1–2. I was able find a handful of 325mg dosages several pages deep on some drug stores, and I imagine those are quite uncommon given how buried they are coupled with not even recognizing the packaging.
Those doses do look small. Standard therapeutic doses of acetaminophen for adults here in Ireland and in the UK (and I believe across much of the EU) is 1000mg 3 to 4x daily.
Those doses do look small. Standard therapeutic doses of acetaminophen for adults here in Ireland and in the UK (and I believe across much of the EU) is 1000mg 3 to 4x daily.
Great overview. Sadly it’s often not (medical) professionals deciding what gets reimbursed or not. Also it is really really hard to argue with laypeople (see TikTok example in the video), when...
Great overview. Sadly it’s often not (medical) professionals deciding what gets reimbursed or not. Also it is really really hard to argue with laypeople (see TikTok example in the video), when they feel some type of ‘treatment’ works for them. Because there’s no hard evidence (like there could be in hard sciences) for so many things in medicine, it’s difficult to really prove what should be reimbursed and what shouldn’t; leaving the door open for chiropractors or homeopaths etc. Even harder: If the patient/consumer pays out of pocket anyway. It’s a free market no?
Post COVID I feel the hostility towards the medical world has grown, which probably gives even more room for quacks to step in.
Its partly policy that it works likes this. Stop letting chiropractors practice could be a solution for example. It’s all fine and dandy when you crack a few joints and waste some money, but there are real dangers associated with chiropractic movements, e.g.: NY Times archive link
To Dr. Grunch, who treats one or two patients with the injury every year, the connection is clear: “Arterial dissection is a known complication of spinal manipulation.” So even though the risk is rare, Dr. Grunch strongly advises against having your neck manipulated by a chiropractor.
In my opinion, complications are a risk of medicine, which we balance out by assessing the chance that a treatment will be effective. However, if the chances of effective treatment are zero, the risk of complications become unacceptable.
Part of the problem is the referral from medical doctors to chiropractors instead of physical therapists, mentioned in The NY Times article. In my locale this would not be accepted guideline practice, - and the chiropractic lobby is probably less strong, but that’s speculation.
I'll just leave this here in relation to the above post. This is something I've been involved with for many years now and why we need is another James Randy in the mainstream to debunk these things.
I'll just leave this here in relation to the above post. This is something I've been involved with for many years now and why we need is another James Randy in the mainstream to debunk these things.
Penn and Teller had a debunking TV show. It was criticized for debunking second hand smoking and it was a bit heavy handed to my taste. They didn't even go to the places, only presented in the...
Penn and Teller had a debunking TV show. It was criticized for debunking second hand smoking and it was a bit heavy handed to my taste. They didn't even go to the places, only presented in the studio and narrated. Felt like low effort.
It's on YouTube.
They seemed to focus on alternative health while Randy was more focused on psychic charlatans.
Is this another show after Bullshit!? I guess for me, it was a whole thing. Generally I watched Bullshit!, read and watched Randy, listened to Does Skeptics Guide to the Universe and on. It was a...
Is this another show after Bullshit!?
I guess for me, it was a whole thing. Generally I watched Bullshit!, read and watched Randy, listened to Does
Skeptics Guide to the Universe and on. It was a large part of my early 20s.
About a decade ago I did tech support for a guy who ran a set of 3 chiropractor clinics in the Phoenix area. Dude was a whack job, full stop. Espoused everything this video talks about. The kicker...
About a decade ago I did tech support for a guy who ran a set of 3 chiropractor clinics in the Phoenix area. Dude was a whack job, full stop. Espoused everything this video talks about.
The kicker is, most of his personal income came not from the practice of chiropractic but from holding seminars and classes and conferences in how to run a successful clinic. I got to see a lot of the literature and listen to presentations while doing VHS->DVD transfers and its all a load of bullshit.
It's basically the same in Europe with osteopathy. What worries me is the high frequency of medical professionals that have an osteopathy diploma on the side, even among university professors who...
It's basically the same in Europe with osteopathy. What worries me is the high frequency of medical professionals that have an osteopathy diploma on the side, even among university professors who actually teach physiotherapy.
Interestingly enough, it's even more confusing because the Doctor of Osteopathy degree in the US is equivalent to the allopathic MD plus a focus on physical independence and rehabilitation. Odd world.
Interestingly enough, it's even more confusing because the Doctor of Osteopathy degree in the US is equivalent to the allopathic MD plus a focus on physical independence and rehabilitation. Odd world.
I'm always torn about labeling all chiropractors as quacks, because there have been specific times in my life when they provided me with actual relief. The worst case had my back so locked up that...
I'm always torn about labeling all chiropractors as quacks, because there have been specific times in my life when they provided me with actual relief. The worst case had my back so locked up that I couldn't turn my body at all without extreme pain; I could only sleep on my back and needed help getting in and out of bed. Now, I'm not saying that chiropractic care is the only way to solve an issue like this. Massage and/or physical therapy may have been just as effective. However, in terms of quick relief, having my spine manipulated and cracked by a chiropractor did a pretty great job in helping me.
A good chiropractor, in my book, is one who adjusts their treatment according to your specific concerns. Furthermore, once you're feeling better, they don't expect you to keep coming back.
That being said, I've also encountered two "bad" types of chiropractors:
The chiropractic is a cure-all person. I went to one particular chiropractor who took some x-rays and just kept asking over and over again about whether I'd had any traumatic injury at any point in my life. He was clearly fishing for a justification for extended treatment and seemed frustrated that I couldn't give him one. He also wanted me to come in several times a month, with no end date in sight. When I asked about stretches or exercises I could do at home, he insisted I wasn't "ready for that yet". On a follow-up visit to that chiropractor I saw that he had convinced some poor woman that her 1-month-old baby needed regular adjustments. We should not be "adjusting" babies! Needless to say, I noped out of there pretty fast. Bonus: pretty sure he was also hawking some MLM dietary supplement out of his practice.
The "drive-thru" chiropractic shops (in my example, The Joint) that have a rotating cast of chiropractors that all do the exact same moves regardless of what your concern is. Tight neck? Let me do these 5 adjustments. Lower back bothering you? Same 5 adjustments. Hip pain? Yep, same 5 adjustments. That'll be $45 dollars for your 5-minute visit.
I think chiropractic care could potentially still be beneficial if it's being used to treat a specific problem in the short-term, but clearly a large percentage of practitioners are trying to turn it into some sort of cure-all, which is about the biggest red flag there is in medicine. If you find a good one that helps you with your issue, gives you tips for how to do some basic physical therapy on your own at home, and offers or refers you to a massage therapist, then great. If they're trying to push more on you than that, probably best to try a different approach.
It's nuts how many people still anecdotally believe in chiropracty, acupuncture, naturopathy and other woo woo and spend good money on them. It doesn't help that countries like Canada officially license them and give them credibility.
Hold on, naturopathy? That's a doctorate. Most naturopaths practice a combination of traditional allopathic medicine (they can prescribe, run labs, all the things) and science based holistic medicine.
There are also naturopaths who stray pretty far from science based medicine, but that doesn't invalidate the entire profession.
Acupuncture has been extensively studied, especially in China, and it has quantifiable benefits in some areas (such as pain management/inflammation reduction). At Harvard, scientists even discovered the neurons responsible for acupuncture's ability to trigger an anti-inflammatory response.
As with naturopathy, there are people who get lost in the woods and make unreasonable claims, but that doesn't invalidate the field. There are also a lot of dangerously inept MDs out there, that doesn't mean the practice as a whole should be disregarded.
I'm sure you can get a doctorate in whippet-fondling with basket-weaving if you look hard enough. Sure, some "naturopaths" may incorporate some scientific principles in their work, but that doesn't legitimise the field in my book.
The fact that it's illegal in some US states, includes homeopathy and is "based on vitalism and folk medicine" (whatever they are) plants it firmly in the "woo-woo" basket for me.
The federal government doesn't let basket weavers prescribe pharmaceuticals. ND curriculum includes all the same medical sciences found in an MD program. Possibly the biggest difference is that an ND takes up to three times as many hours of nutrition.
At least consider that if your knowledge of the field ends at the wikipedia entry, you may be unqualified to write off an entire profession.
As far as I can tell, the degrees that you describe (which include all the MD curriculum) exist only because a degree containing only the woo wouldn't qualify them to treat real patients - because it's woo. So such degrees allow the woo-mongers to get at patients, because they can claim "I'm a real doctor too".
I did wonder if I was going to get the "dO yOuR rEsEarCh" response.
If someone is going to claim that chewing this root (which mainstream medicine rejects as being a placebo at best) is going to cure someone's (potentially serious) illness, and that person is liable to ignore real treatments in favour of it, then this falls squarely under "Extraordinary claims require extraordinary evidence".
So the onus is not on me to read past a wikipedia entry (which is quite scathing), it's on you to demonstrate that root-chewing is going to help more than real medicine.
I'm reminded of this Dara O'Briain clip (at 1m45):
Without weighing in on the rest of this, I'd like to say that this is not something you're safe from with an MD or DO. My mom has always been on the "crunchy" side and has fallen victim to a lot of scammy "alternative medicine", and it absolutely included at least one MD participating in diagnosing her with phony conditions.
I'm not sure what root you're referring to, or why it's relevant to the conversation. I'm increasingly sure, though, that it's not a good faith conversation.
That's an impressive re-write of my post. It's the sort of hyperbolic reinterpretation that, in my experience, people make when they're angry.
But maybe you're not angry, it's impossible to say via text.
Please remember that Tildes, as a community, is trying for something different. Or so I like to hope.
Granted I'm also no expert, but everything I'm seeing about the profession is that they don't focus on evidence based medicine.
That's probably the single most important aspect of any specialist for me... That they have done the research to determine the proper way to treat me, not based on gut intuition or anecdotal happenstance
They don't practice "evidence based medicine" and they sure as hell don't practice "science based medicine".
It kind of does though. If there's no licensing group holding them accountable, then you might not know if you've got a bad one until it's too late. There needs to be a minimum standard, and if that minimum standard includes unscientific and potentially harmful advice, then the whole field cannot be trusted.
Imagine if we treated civil engineers with that logic. Some follow engineering principles and physics, and others use the holistic approach of stacking things on top of each other and seeing if it falls down. Yes, some of these engineers are useful, but if the latter group is also allowed to practice, the group as a whole cannot be trusted.
There is licensing?
No need to go so far for a comparison. We treat medical doctors with that logic, despite a long history of some doctors prescribing harmful treatments that ignore the current science.
In engineering the science is usually solid. In biology it's constantly evolving, with new information routinely invalidating old.
I'm not as radical as the other guy, I'm not going to compare them to a phd in basket weaving (though I met a woman with a phd in juggling and she's great), but I'm also skeptical because of anecdotal evidence in the vein of "I trusted them until they started speaking about something that I actually understand":
I have been studying the gut microbiome, its relation to various illnesses and practical methods of changing it for years now. I don't have a background in medicine or microbiology, but as far as I know, all that I learned about it is scientifically backed or directly inferred from scientific studies with a reasonable degree of certainty, and I regularly consult it with doctors. This is challenging because the knowledge of human microbiome is one of the (if not the) fastest developing fields in medicine right now and basically any source on the topic older than 10 years can be safely discarded, so a lot of practically usable information shared on the internet or in books is wrong and useless at best.
I have been a member of a few large facebook groups on this topic, because while they are usually full of (sometimes harmful) pseudoscience, there are normally a couple people posting actual interesting studies and/or people from commercial labs/research groups.
One of the most persistent topics there are people sharing their experience with naturopaths. Whether they're shared positively or negatively, I don't remember ever seeing one that was reasonable and based on current science. It was always inevitably some person shooting in the dark with significant doses of herbal antibiotics, antifungals or probiotics, making broad stroke recommendations that are demonstrably harmful for some portion of patients, blindly switching to some different "solution" when the patient gets worse without investigating what actually happened.
And that's the better variant, the worse variant is telling a patient who feels worse after a treatment "that's just a die off reaction, keep taking what I recommended, you will get better eventually" - referring to Herxheimer reaction, which is a real thing associated to treating certain bacterial infections, and it can in some cases really happen with regard to the microbiome. But in a large portion of cases this is not what's happening and instead the patient is just getting worse and worse and pushing through it thinking they'll get better in the end.
The reason why normal doctors don't do this is because it's not backed by science and now known with some certainty to be dangerous to the patient, so there are no standard guidelines produced for doctors to use. Naturopaths do not seem to care about this. There is a very understandable demand from patients with difficult illnesses that are hard to treat for a doctor to try to treat them experimentally because they're frustrated and drained from being in a situation with little hope. But blindly treating them based on outdated knowledge without proper testing (good quality microbiome sequencing is not even that expensive nowadays, but interpreting it is the difficult part) in a way that often makes them worse is not the solution, a responsible and self-aware doctor should know not to do this. Unfortunately there seems to be a huge number of naturopaths who have no issue with this.
For all normal doctors get wrong (and I have my own experience with that), they almost always know to stay conservative and rarely do fuck ups like this.
It's a lot muddier than many of these comments would have one believe. I think William Gibson coined the term "winning the medical lottery" aka when what ails you has been cured by science based medicine. If you have the luxury of a lottery winner then by all means stay within the confines of clinically tested and proven cures. But then lobotomies were all the rage as recently as the 60s, and Fen-Fen was widely prescribed for weight loss in the 90s, and ... and and. If we're discussing the entire populace as a whole, then there's a statistically optimal path to take for relief. But, outside of communicable diseases, the sample size of the relief seeker is 1 and statistics can be and often are terrifically misleading with tiny sample sizes. All of the above being said. A very large % of chiropractors are wack-a-doo's and I avoid the entire group as a personal life policy. ND's I'm a bit fuzzier on.
Counterpoint: The reason why I spent years studying the gut microbiome is specifically because I did not win the medical lottery and I have to help myself. I was not able to get into remission, but the only things that helped my symptoms were things backed by science, the problem being that most doctors don't know about them because it's impossible for a normal doctor to keep up with research until it gets to a stage where clear diagnostic and treatment guidelines exist. I realize that most people are not capable of doing what I'm doing and they seek help, but I don't think that abandoning science is the right way, it's still the least bad alternative that exists and there are occasionally doctors who are able to practice it in a way that allows for a more reasonable kind of experimentation, they're just exceptionally rare and often expensive.
I'm hoping that AI helps solve this expertise problem sooner rather than later.
Clinical research takes forever. :( I'm excited about what AI can/may do to help too! Much of the population lacks critical thinking skills and even more of the population abandons critical thinking when stressed over things like medical crises, both of which open the door for wack-a-doo's and grifters. Humans can be just awful.
Ive seen a DO before - she was a medical doctor + and actually did a residency and the like. She prescribed me medicine AND suggested other remedies that were not from the homeopathic aisle. (Its been a while but mostly I felt like it was holistic without being woo woo)
My coworker sees an ND and I think they changed her diet based on her blood type and she likes the doc but I cannot even imagine seeing someone that far down the woo train. I a kid chiropractors as a whole for the same reason. I'd rather do PT.
I'm sure it varies but no thanks.
One thing to keep in mind is that DOs in the U.S. are not the same as DOs in most (all?) of Europe (the latter ones are more woo-ey).
I didn't know that. Are they closer to Naturopaths/chiropractors?
Mine was truly a regular doctor who happened to have an inclination to treat with the minimally invasive method first, which is something my NP has as well, through she is more inclined to refer to a specialist.
Important caveat, placebo works pretty well for some kinds of pain so acupuncture still has a use.
If we know something is placebo, maybe we could do something that is meant to be the best placebo ever instead. Off the top of my head, get me a beautiful young actress to read poetry for me while naked. Or an actor if that's your thing. I can see that making me forget my pain for a while.
Or some other very relaxing things people do while naked.
Deep tissue massage.
Or something like Wicca, or Chaos magic. Or hypnosis, which is very much assumed to be placebo. Or listening to Bach.
As long as we're being honest about what it is. That's where the practitioners of all these alternative medical systems fail in my opinion. It's fine to get acupuncture as an effective placebo, but good luck finding an acupuncturist who doesn't denigrate real medicine and make outrageous claims about the efficacy of what they're doing.
I had a shower thought this morning after reading this comment, we know that placebos work even when patients know they are a placebo. So why not dispense with the mysticism and just open up a Placebo Bar, where you can go in have been given your placebo of choice.
Would you like a sugar pill? Here you go.
Would you like to have a relaxing aroma therapy? Sure, the scents smell nice, they won't cure you but it's still very relaxing
Would you like a massage? Again not going to cure your chronic disease but temporary relief is still good for you.
Want some needles stuck in you? That stimulation can override pain elsewhere in the body for a bit so here's a clean environment, someone certified in proper usage and a well regulated sterilization procedures.
Want someone to crack your knuckles or other joints? The sound is satisfying and we won't do any dangerous stuff like neck "adjustments" that could potentially leave you paralyzed.
Want some water that's been diluted to the point that no molecule of medicine could remain from the original batch? We gotchu, fresh tap water.
Want to chew on roots? Got plenty of those, these ones taste good too.
So either we've reinvented spas or Walmart, depending on the business model.
Just remove the absurd claims and keep the things that feel good.
Yeah, I'm fine with that. However, people really misunderstand the "placebos work even if you know they don't work" idea. Basically, you need someone you trust sincerely telling you it will help, even if you know there's no reason for that to be the case. So, yeah, you need the spa rigmarole, or we might as well plop people in front of TV or send them to a supermarket for their dose of distraction.
That's probably why successful practitioners are uncritical, almost cultish, believers. Their sincerity convinces and assures the patient, so the placebo works.
I forget where I read it, but I once saw a quote to the effect of "you won't feel the pain in your leg with a butterfly specimen needle in the nape of your neck".
Also: The placebo effect is getting stronger. This is not new news either, my psychiatrist has been telling me this for 8 years.
It's becoming a problem for new drug development because new medicines can't beat placebo even if they have roughly same effectiveness as old medications. Some of our older medicines wouldn't pass certifications now because they couldn't pass placebo trials these days.
It really depends on what you are trying to treat, as well as how you are treating it. Cochrane reviews are very informative. For instance, acupuncture can be effective for preventing migraines: https://www.cochrane.org/CD001218/SYMPT_acupuncture-preventing-migraine-attacks
I'm not going to be abrasive about it, but that's largely not the case. The UK doesn't regulate the license. In Canada, only British Columbia allows them to prescribe. In the US, only 12 states allow prescription of medications. The breadth of training may be the same as MDs and DOs, but the depth is not, and the practice hours are neither the same in breadth nor depth. There is probably a higher focus on nutrition, though.
A good overview with sources is here: https://www.medscape.com/viewarticle/465994?form=fpf
For what it's worth, I'm good friends with a naturopath and do see her for advice on herbs and buy her tinctures. But I do that because I'm curious and open. The same way I'll talk to her about star signs and her medium work. I would never outright recommend it to a patient, but I also wouldn't try to dissuade them except to present evidence that the standard medical care has behind it, and then only if they're open to hearing it.
That's a fair point, I'm only familiar with how it works in the US. There, though, at least in the states that take it seriously, the depth is indeed similar, with the exception of residency usually being optional. Thus the ability to prescribe, refer and be covered by insurance in those places.
As someone in a different field that also requires practical experience to be a good practitioner*, I'm not sure the optional residency (which the Internet seems to frame as definitely none not as a maybe) is an aside here. That seems to me to be a huge part of the "depth" of education. It makes sense why they wouldn't because there aren't naturopathic hospitals, but that makes their training significantly different, by a matter of literal years.
*Mental health. My counseling degree gave me the underpinnings but I learned how to do both my clinical and non-clinical jobs from doing the work.
Just because some naturopaths also practice medicine doesn't mean that naturopathy is legit, just as chiropractors can help, but chiropractic is a load of shit. Acupuncture can help with pain, but so can literally just pressing on the area, and sticking a needle in somebody's ear isn't going to relieve their depression any more than cutting their wrists will.
It's the same with legit medicine. Ibuprofen and opiates can relieve pain, but acetaminophen won't do shit for you, even from a doctor.
Actually acetaminophen (APAP) does actually help with pain. Does it help significantly? Maybe not, but we do have clinical evidence that APAP when combined with ibuprofen (IBU) demonstrates lower opioid consumption.
Now mind you I'm not by any means saying APAP is a wonder drug, but it does have potential benefit when used in the right situations/combinations. And since APAP is cleared by your liver, and IBU your kidneys, taking the two drugs in tandem is safe and confers greater analgesic potential than the two agents alone. However with that being said, IBU monotherapy does generally provide greater analgesia than APAP monotherapy
Source: I'm a clinical pharmacist
Fully agree. I'm reposting a response I made last time a discussion on acetaminophen came up. There is plenty of evidence to support the analgesic effect of acetaminophen.
If it has been shown to not work better than placebo on its own, doesn't that imply that the combination of APAP + a drug that has been shown to work is only more effective than ibuprofen alone because it is ibuprofen + placebo instead of just ibuprofen?
Firstly, it is superior to placebo for most things. You are misinformed.
Secondly, even if that was right, no. The study cited is literally comparing either APAP or ibuprofen in isolation to the combination. Even if that weren't true, there could still be a mechanism of action by which APAP synergized with ibuprofen to result in more pain relief. Or it could just block a specific set of neural pathways associated with opioid addiction. The logic you've walked through here is basically that if x + y = z, and we know for sure that y > 0, z > 0, but have no lower bound for x, x must equal 0.
Except that we don't know the value of z in this context, and you are assuming that x = placebo. Which is wrong in principle, especially since you didn't read the goddamn paper.
I'm not going to bother beyond this comment if you're going to be such an ass about this. Back pain is remarkably intense and is not properly treated by NSAIDs or opioids either, arthritis is historically difficult to treat and NSAIDs are close to the ideal treatment for it, and headaches are caused and cured by wind as much as ibuprofen.
How about
The spine and arthritis are, seriously, the worst examples you could use to make your case here.
You are spreading medical disinformation based on misunderstanding a few random studies, ignored the bulk of substance of my comment for the sake of attacking a shorthand analogy, blatantly interpreted a simple statement about a painkiller's efficacy as some inconceivably misplaced argument, and couldn't even bother to come up with a #2. Yeah, I'm ranting at you for imperfect examples, sure.
Well no, that's not how medical literature works. If I understand your implications correctly, a placebo is essentially nothing at all, so IBU+placebo should be no different than IBU monotherapy. Remember that APAP is in fact an active drug, whereas placebos are inert
Also, if you read the study I linked you would see that the analgesic potential of APAP+IBU was potentially greater than IBU alone, as evidenced by the reduction in opioid consumption within the APAP+IBU group. Though the authors recommend IBU monotherapy, that doesn't change the fact that combination therapy demonstrated less opioids being consumed by patients
Tylenol is by no means a wonder drug, but to say it does nothing at all is simply incorrect. In the medical world we are starting to see more and more APAP+NSAID combinations, as synergistically the two classes do confer greater reduction in pain without necessarily jumping to opioids
No, I did not say that placebo is nothing. The placebo effect is real, so ibu+placebo could be stronger than ibu monotherapy, meaning APAP+IBU could be more effective than ibu alone if APAP is ineffective on its own.
I'm not really sure why you're implying that I didn't read the article or understand that APAP+IBU > APAP||IBU when I said that "the combination...is only more effective than ibuprofen alone" when the study also showed that ibuprofen alone is more effective than APAP (26mg vs 36mg respectively).
I suppose then what you meant here then was that the placebo effect might have accounted for the increased efficacy seen in the APAP+IBU group? If so, I do hope you realize that's a very bold implication to make, as the differences were statistically significant
Yes, placebo effect is a real thing, but we design clinical trials to be sure (or usually at least 95% sure) that the ultimate outcome is accurate and not due to chance, including placebo effect
The reason why I don't think you read the article btw is because the IBU monotherapy group in the trial was IBU+placebo lmao
I always wonder how this myth started because I only ever saw it from Americans online and it's simply wrong. I tried to google it and the only explanation I found was that many pills containing acetaminophen sold in the US contain a strangely small dose (250 - 350 mg). Around here the standard dose for older kids and adults is 500 mg and it is considered safe to double it.
Anecdotally, for headaches, even strong migraine-like ones with nausea and light sensitivity, 500 mg of acetaminophen works much better than 400 mg of ibuprofen, and it's faster too (though rapid acting ibuprofen variants exist). For pain caused by inflammation, NSAIDS are likely generally better, but that doesn't mean that acetaminophen doesn't work or that it cannot be better for some types of pain.
Even for fever as an antipyretic, a pharmacist around here is likely to tell you that if one doesn't work for your current illness, you should try the other because their mechanism is slightly different and it sometimes happens that one works better than the other.
I don't know if the dosing in the US has much to do with this recent myth. Most Americans I know are happy to double or triple up on pills for a headache. But, I do know that, speaking for myself and my family, APAP is only ever used as a second line or combination treatment, and it's terribly unlikely to affect a headache. That might just come down to our pain being more often inflammatory in nature than not, and that could be a widespread phenomenon. No clue.
Maybe check yourself before assuming Americans are the problem with everything.
https://pubmed.ncbi.nlm.nih.gov/31453982/
https://www.mja.com.au/journal/2021/214/7/efficacy-and-safety-paracetamol-pain-relief-overview-systematic-reviews
https://www.acsh.org/news/2023/08/22/tylenol-6-more-years-failure-17266
Your interpretation, not mine.
The metastudies are not in conflict with what I say. It works for tension headaches (which is my case) and some other cases, doesn't work for others. Regarding the tension headaches, some of the studies are interesting because they show that it works really well for some portion of people (criterion was completely ending a moderate to high intensity pain) and not at all for others, which might explain this weird situation, I am clearly one of the lucky ones. Some of the studies show that that "functional" group is very small (10%), other recent studies with large enough sample size indirectly show this is likely not the case (88% overall success in removing or reducing pain with symptomatic medication, where about 45% of people used paracetamol and about 55% NSAIDS).
The evidence clearly shows that for some issues it does not work at all, but it also clearly shows that in other cases it works well enough to say that "acetaminophen won't do shit for you, even from a doctor." is not a reasonable conclusion.
edit: so, this not a part of an argument, I'm just doing it for fun because it just honestly seems like an incredibly strange thing to me. I have a instagram page with just bellow 1800 followers, all of them Czechs and Slovaks, so I made a poll asking whether they use paracetamol for any kind of pain and if so whether it usually works or usually does not. A day later, about 200 people responded, out of that over 70% said that they use paracetamol and that it usually or always works for some type of pain for them. That only confirms the strangeness of this situation.
So it won't do shit for some people, even from a doctor. Still, that was one of a handful of examples in a whole comment where, frankly, disproving that one example would actually provide greater evidence to my claims that the chiropractics, naturopaths, etc are only effective with the actual medicine they practice and not the quackery parts.
No disagreement from me here.
You just reminded me of a study that I'm too lazy to go find, but it was investigating the placebo effect and concluded that a doctor showing enthusiasm and care about the patient's problem creates the same effect as taking a placebo pill. They obviously proposed a possibility that this is the reason why some people who seek out woo doctors are happy with the result, because them having enough time to show care and enthusiasm is one of their main selling points, whereas a normal doctor is often overworked and tired and therefore less capable in this regard.
For whatever it's worth, the only acetaminophen I've ever seen sold in U.S. stores is in 500mg form with the instructions advising you take 1–2. I was able find a handful of 325mg dosages several pages deep on some drug stores, and I imagine those are quite uncommon given how buried they are coupled with not even recognizing the packaging.
Thanks! It's always tricky trying to find those things out through the internet over the ocean.
Those doses do look small. Standard therapeutic doses of acetaminophen for adults here in Ireland and in the UK (and I believe across much of the EU) is 1000mg 3 to 4x daily.
The UK does offer acupuncture on the NHS too. My dad had to do it for a few months for his chronic migraines.
Great overview. Sadly it’s often not (medical) professionals deciding what gets reimbursed or not. Also it is really really hard to argue with laypeople (see TikTok example in the video), when they feel some type of ‘treatment’ works for them. Because there’s no hard evidence (like there could be in hard sciences) for so many things in medicine, it’s difficult to really prove what should be reimbursed and what shouldn’t; leaving the door open for chiropractors or homeopaths etc. Even harder: If the patient/consumer pays out of pocket anyway. It’s a free market no?
Post COVID I feel the hostility towards the medical world has grown, which probably gives even more room for quacks to step in.
Its partly policy that it works likes this. Stop letting chiropractors practice could be a solution for example. It’s all fine and dandy when you crack a few joints and waste some money, but there are real dangers associated with chiropractic movements, e.g.: NY Times archive link
In my opinion, complications are a risk of medicine, which we balance out by assessing the chance that a treatment will be effective. However, if the chances of effective treatment are zero, the risk of complications become unacceptable.
Part of the problem is the referral from medical doctors to chiropractors instead of physical therapists, mentioned in The NY Times article. In my locale this would not be accepted guideline practice, - and the chiropractic lobby is probably less strong, but that’s speculation.
I'll just leave this here in relation to the above post. This is something I've been involved with for many years now and why we need is another James Randy in the mainstream to debunk these things.
Penn and Teller had a debunking TV show. It was criticized for debunking second hand smoking and it was a bit heavy handed to my taste. They didn't even go to the places, only presented in the studio and narrated. Felt like low effort.
It's on YouTube.
They seemed to focus on alternative health while Randy was more focused on psychic charlatans.
Is this another show after Bullshit!?
I guess for me, it was a whole thing. Generally I watched Bullshit!, read and watched Randy, listened to Does
Skeptics Guide to the Universe and on. It was a large part of my early 20s.
It is Bulshit!
About a decade ago I did tech support for a guy who ran a set of 3 chiropractor clinics in the Phoenix area. Dude was a whack job, full stop. Espoused everything this video talks about.
The kicker is, most of his personal income came not from the practice of chiropractic but from holding seminars and classes and conferences in how to run a successful clinic. I got to see a lot of the literature and listen to presentations while doing VHS->DVD transfers and its all a load of bullshit.
It's basically the same in Europe with osteopathy. What worries me is the high frequency of medical professionals that have an osteopathy diploma on the side, even among university professors who actually teach physiotherapy.
Nice documentary though.
Interestingly enough, it's even more confusing because the Doctor of Osteopathy degree in the US is equivalent to the allopathic MD plus a focus on physical independence and rehabilitation. Odd world.
I'm always torn about labeling all chiropractors as quacks, because there have been specific times in my life when they provided me with actual relief. The worst case had my back so locked up that I couldn't turn my body at all without extreme pain; I could only sleep on my back and needed help getting in and out of bed. Now, I'm not saying that chiropractic care is the only way to solve an issue like this. Massage and/or physical therapy may have been just as effective. However, in terms of quick relief, having my spine manipulated and cracked by a chiropractor did a pretty great job in helping me.
A good chiropractor, in my book, is one who adjusts their treatment according to your specific concerns. Furthermore, once you're feeling better, they don't expect you to keep coming back.
That being said, I've also encountered two "bad" types of chiropractors:
I think chiropractic care could potentially still be beneficial if it's being used to treat a specific problem in the short-term, but clearly a large percentage of practitioners are trying to turn it into some sort of cure-all, which is about the biggest red flag there is in medicine. If you find a good one that helps you with your issue, gives you tips for how to do some basic physical therapy on your own at home, and offers or refers you to a massage therapist, then great. If they're trying to push more on you than that, probably best to try a different approach.