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circello
Jul 27, 2010, 3:05 PM
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http://www.sciencebasedmedicine.org/?p=6266
I've been a regular reader of this blog since a disagreement with my sister-in-law over vaccinations. Generally they do their due diligence and so I thought it might be worthwhile to pass along this entry on glucosamine.
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welle
Jul 27, 2010, 3:08 PM
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WTF is science-based medicine? what on oxymoron as in medicine is not science based? that's called voodoo.
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circello
Jul 27, 2010, 3:14 PM
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Chiropractic, acupuncture, homeopathy, etc etc. Just to name a few. There's even a federal agency - the NCCAM (National Center for Complementary and Alternative Medicine) It's all woo and wasted money, but people buy into it. The website I linked, attempts to debunk a lot of the noise.
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j_ung
Jul 27, 2010, 3:17 PM
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Aw, crap. My back already feels worse.
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circello
Jul 27, 2010, 3:31 PM
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jt512 wrote: Well, the placebo effect is still an effect. Jay |
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tomtom
Jul 27, 2010, 4:33 PM
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welle wrote: WTF is science-based medicine? what on oxymoron as in medicine is not science based? that's called voodoo.
Even in Western medicine, there is a lot of standard practice which hasn't been proven to be effective through scientific study.
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circello
Jul 27, 2010, 4:54 PM
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Fair enough.
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reno
Jul 28, 2010, 12:41 AM
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welle wrote: WTF is science-based medicine? what on oxymoron as in medicine is not science based? that's called voodoo.
Not all medical decisions are evidence based. There's a reason it's called "The Art and Science of Medicine."
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onceahardman
Jul 28, 2010, 2:22 AM
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reno wrote: welle wrote: WTF is science-based medicine? what on oxymoron as in medicine is not science based? that's called voodoo. Not all medical decisions are evidence based. There's a reason it's called "The Art and Science of Medicine."
Well said. For example, designing, engineering, machining, and installing a joint replacement is pretty much pure science.
Getting someone who has had a joint replaced to have full ROM and strength, and to walk without an assistive device, without gait deviations, varies greatly between patients. It's as much art as science.
Doing studies on medications, and their effectiveness, as complicated as it seems, is really relatively simple, mathematically.
Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively?
(This post was edited by onceahardman on Jul 28, 2010, 2:24 AM)
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reno
Jul 28, 2010, 2:32 AM
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onceahardman wrote: reno wrote: welle wrote: WTF is science-based medicine? what on oxymoron as in medicine is not science based? that's called voodoo. Not all medical decisions are evidence based. There's a reason it's called "The Art and Science of Medicine." Well said. For example, designing, engineering, machining, and installing a joint replacement is pretty much pure science. Getting someone who has had a joint replaced to have full ROM and strength, and to walk without an assistive device, without gait deviations, varies greatly between patients. It's as much art as science.
I was thinking more along the lines of my former profession (Emergency Medicine) but yeah, you're spot on:
Science tells me that both albuterol and sub-cutaneous Epinephrine will help a case of acute asthma exacerbation due to the Beta-adrenergic effects, dilating the bronchii, reducing airway restriction, etc.
It's the "art" of medicine that tells me "This patient needs Epi NOW and can't wait for me to do a Peak End-Expiratory Flow Rate Test to decide if he just needs albuterol or if he's bad enough to warrant Epi."
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welle
Jul 28, 2010, 8:54 PM
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onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively?
Empirical evidence is science, no? The sampling error is minimized with greater sample size.
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onceahardman
Jul 28, 2010, 9:40 PM
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welle wrote: onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively? Empirical evidence is science, no? The sampling error is minimized with greater sample size.
Yes. Empirical evidence is science. The consistently effective treatment of some chronic pain syndromes, however, has thus far proven to be elusive. I was not talking about sampling error. I was talking about whether or not modern medical science is even measuring the correct thing.
Does a researcher measure (invasively) the afferent firing rate at the dorsal horn, so as to get a truly quantifyable measure of the volume of "pain" entering the spinal cord?
When, say, an amputee still complains of pain in the amputated limb (phantom pain), how does one empirically measure that, much less treat it?
I think chronic pain is primarily a brain problem, but I can't prove it.
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jt512
Jul 28, 2010, 9:59 PM
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onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively?
With a pain scale.
Jay
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pfwein
Jul 28, 2010, 10:22 PM
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circello wrote: Chiropractic, acupuncture, homeopathy, etc etc. Just to name a few. There's even a federal agency - the NCCAM (National Center for Complementary and Alternative Medicine) It's all woo and wasted money, but people buy into it. The website I linked, attempts to debunk a lot of the noise.
Out of curiousity, I looked at NCCAMs website.
I think you are really misssing the point of that organization: I think it is to apply scientific methods to "alternative" medicine, which seems to be the opposite of what you're implying.
Or maybe I just didn't understand your point. Regardless, seems like the organization has a good purpose.
From
http://nccam.nih.gov/health/whatiscam/A Note About Safety and Effectiveness
Rigorous, well-designed clinical trials for many CAM therapies are often lacking; therefore, the safety and effectiveness of many CAM therapies are uncertain. NCCAM is sponsoring research designed to fill this knowledge gap by building a scientific evidence base about CAM therapies—whether they are safe; and whether they work for the conditions for which people use them and, if so, how they work.
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onceahardman
Jul 28, 2010, 10:59 PM
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jt512 wrote: onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively? With a pain scale. Jay
Pain is inherently subjective. This was noted by Henry Knowles Beecher (1904 - 1976), an anesthesiologist. Here's an interesting extract from a writeup on his findings:
"Serving as an Army medical consultant on the Anzio beachhead, [Beecher] observed that soldiers with serious wounds complained of pain much less than did his postoperative patients at Massachusetts General Hospital. Beecher hypothesized that the soldier's pain was alleviated by his survival of combat and the knowledge that he could now spend weeks or months in safety and relative comfort while he recovered. The hospital patient, however, had been removed from his home environment and now faced an extended period of illness and the fear of possible complications. Beecher argued that "the reaction component" made pain such a complex and individualized phenomenon that it could only be studied effectively in the clinical setting. Patients with real pain would not exhibit the same physiologic manifestations or the same responses to analgesics as experimental subjects, who knew that they were in no serious danger and that the pain would soon cease."
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reno
Jul 29, 2010, 12:47 AM
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jt512 wrote: onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively? With a pain scale. Jay
You can objectively measure using a subjective tool?
You're better than every single physician in the world, then. Ever consider a career in medicine?
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davidnn5
Jul 29, 2010, 1:22 AM
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jt512 wrote: onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively? With a pain scale. Jay
I think you just debunked the myth that you never say anything stupid.
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bill413
Jul 29, 2010, 1:52 AM
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reno wrote: You can objectively measure using a subjective tool?
For the above question to appear in a rock climbing site, where we almost universally assign objectively agreed upon grades to climbs based on subjective perception is interesting.
Just saying, as I fully agree pain is a subjective phenomena.
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jt512
Jul 29, 2010, 2:35 AM
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reno wrote: jt512 wrote: onceahardman wrote: Effectively treating chronic pain (for example) and proving your treatment effective, is much more difficult. There are various pain scales which claim to measure pain objectively, but it can be well argued that pain is at least partly a subjective experience. How does one measure a subjective experience objectively? With a pain scale. Jay You can objectively measure using a subjective tool?
I'm not sure what you mean by a "subjective tool." A pain scale converts a subjective experience of pain to a concrete number on a rating scale. If your interest is in determining whether a treatment (say, glucosamine) is more effective than a control (say, a placebo), then comparing the mean pre-treament–post-treatment difference of the pain scale rating for the treatment group with the mean pre-post difference for the control group provides an objective measure of the effectiveness of the treatment relative to the control.
In reply to: Ever consider a career in medicine?
Yes, but I decided (in spite of extremely high MCAT scores) that my talents were better suited to designing studies for doctors than becoming one myself. In retrospect, I'd probably have gone the MD/PhD route, with an emphasis in biostatistics.
Jay
(This post was edited by jt512 on Jul 29, 2010, 3:03 AM)
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davidnn5
Jul 29, 2010, 3:02 AM
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I remember when I gave up my dreams of being an astronaut to be a lowly brain surgeon and rock star...
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jt512
Jul 29, 2010, 4:51 PM
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circello wrote: http://www.sciencebasedmedicine.org/?p=6266 I've been a regular reader of this blog since a disagreement with my sister-in-law over vaccinations. Generally they do their due diligence and so I thought it might be worthwhile to pass along this entry on glucosamine.
The author ignores several well-controlled clinical trials that have shown benefits for glucosamine sulfate for osteoarthritis of the knee. See, for example, the GUIDE trial. These studies used pharmaceutical grade crystalline glucosamine sulfate, which is available by mail order in the US under the brand name Dona. It costs about double that of other brands of glucosamine that you find at the local drug store, but it is the only brand and formulation of glucosamine that has been shown to be beneficial in clinical trials, and only for osteoarthritis of the knee, as far as I know.
Jay
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rmsusa
Jul 29, 2010, 5:48 PM
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In reply to: Yes, but I decided (in spite of......
Hope the spray didn't get your shirt wet. :-)
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jt512
Jul 29, 2010, 5:51 PM
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rmsusa wrote: In reply to: Yes, but I decided (in spite of...... Hope the spray didn't get your shirt wet. :-)
Nah, if I had been spraying, I probably would have mentioned things like my perfect "15" on the biological sciences section, etc.
Jay
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circello
Jul 29, 2010, 6:29 PM
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jt512 wrote: circello wrote: http://www.sciencebasedmedicine.org/?p=6266 I've been a regular reader of this blog since a disagreement with my sister-in-law over vaccinations. Generally they do their due diligence and so I thought it might be worthwhile to pass along this entry on glucosamine. The author ignores several well-controlled clinical trials that have shown benefits for glucosamine sulfate for osteoarthritis of the knee. See, for example, the GUIDE trial. These studies used pharmaceutical grade crystalline glucosamine sulfate, which is available by mail order in the US under the brand name Dona. It costs about double that of other brands of glucosamine that you find at the local drug store, but it is the only brand and formulation of glucosamine that has been shown to be beneficial in clinical trials, and only for osteoarthritis of the knee, as far as I know. Jay
I don't normally posit a 'pharma-shill' gambit, but I am curious how often the company producing the product designs not the experiment, but the statistical analysis thereof. Seeing as you have loads more expertise in this field - is there anything abnormal about this practice or the statistics they performed?
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jt512
Jul 29, 2010, 7:02 PM
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circello wrote: jt512 wrote: circello wrote: http://www.sciencebasedmedicine.org/?p=6266 I've been a regular reader of this blog since a disagreement with my sister-in-law over vaccinations. Generally they do their due diligence and so I thought it might be worthwhile to pass along this entry on glucosamine. The author ignores several well-controlled clinical trials that have shown benefits for glucosamine sulfate for osteoarthritis of the knee. See, for example, the GUIDE trial. These studies used pharmaceutical grade crystalline glucosamine sulfate, which is available by mail order in the US under the brand name Dona. It costs about double that of other brands of glucosamine that you find at the local drug store, but it is the only brand and formulation of glucosamine that has been shown to be beneficial in clinical trials, and only for osteoarthritis of the knee, as far as I know. Jay I don't normally posit a 'pharma-shill' gambit, but I am curious how often the company producing the product designs not the experiment, but the statistical analysis thereof. Seeing as you have loads more expertise in this field - is there anything abnormal about this practice or the statistics they performed?
I'm not familiar with the European model, but in US drug trials, usually the drug company designs, conducts, and analyzes the study, in accordance with FDA regulations. What struck me as strange about the GUIDE study is that none of the authors were evidently affiliated with Rotta, yet Rotta performed the statistical analysis. I would be more comfortable if an independent statistician had done the analysis. That said, the analysis they performed seems to be both rigorous and routine.
Jay
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