Monday, June 6, 2011

The scientific method and our health

There are several ways to define "science", but here is very basic one by Edzard Ernst, the first professor in  Alternative Medicine, in an interview in Science:
"I was also convinced that scientists need to be critical and sceptical, and that if you apply science to any field you don't want to prove that your ideas are correct, you want to test whether they are correct."
While I probably have to check his own summary of his scientific legacy ("I found that homeopathy is pretty useless. ... Acupuncture we have shown is useful to reduce pain for certain conditions, and that is generally accepted now. There are lots of herbal medicines that are backed by very good evidence."), his definition of science becomes a definition of "correct". Because approximately at the same time that the above article crossed my (virtual) desk, I came across these two articles related to the placebo effect.

"The report says placebos, from vitamin pills to homeopathic remedies or even sham surgery, can prove highly effective in various treatments. In Bavaria, it found, 88% of GPs have sent patients home with prescriptions for placebo drugs."


"In this paper, examples will be given where physiological or pathological conditions are altered following the administration of an inert substance or verbal instructions tailored to induce expectation of a change, and explanations will be offered with details on neurotransmitter changes and neural pathways activated."

Another well-written review of the placebo effect from Wired magazine connects these two dots, "test whether they are correct" and "placebo":
"What all of these disorders have in common, however, is that they engage the higher cortical centers that generate beliefs and expectations, interpret social cues, and anticipate rewards. So do chronic pain, sexual dysfunction, Parkinson's, and many other ailments that respond robustly to placebo treatment. To avoid investing in failure, researchers say, pharmaceutical companies will need to adopt new ways of vetting drugs that route around the brain's own centralized network for healing."
So in essence, what turned out to be a very theoretical discussion down the rabbit hole (switching from a definition from science to a definition to an explicit definition of the word "correct"), is of crucial importance to the pharmaceutical industry, and thus influences our every day life. The definition they use for "correct" when testing drugs or procedures is not "curing something", but is more precisely "curing something without your own knowledge". This, on the one hands, seems very reasonable, because you only want to pay for a very expensive medicine if it is effective. On the other hand, we, as potential users of these science results, only care about the "curing something" part ... 



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