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Rebuttal to Skepchick’s youtube Homeophobia rant
Posted: 28 November 2011 11:31 AM   [ Ignore ]   [ # 196 ]
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Yes, rabies is an interesting exception. The nature of the virus is such that it remains confined to the locale of introduction to the body for long enough that local measures, such as immunoglobulin infiltration and wound care, as well as systemic vaccination are successful at preventing spread to the central nervous system even after the virus has been introduced into the body. Just another great example of how the devil is in the details, and the more carefully and rigorously we study the details the better we are able to make the right decisions.

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Posted: 28 November 2011 11:44 AM   [ Ignore ]   [ # 197 ]
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Ok, since this has gone a bit off-topic, I have a question regarding terminology. Specifically, live, attenuated, and inactivated.

Live - I think I understand this one. It’s obvious.

Attenuated - I think this is a live thing but “damaged” in order to reproduce very slowly so that your immune system can win. Also means less need for booster compared to dead?

Inactivated - I think this is the same as dead, but I’m not sure. If it is, then why the hell don’t they just say dead?

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Posted: 28 November 2011 11:48 AM   [ Ignore ]   [ # 198 ]
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mckenzievmd - 28 November 2011 11:27 AM

Yeah, well I don’t see any problems with taking vitamin supplements.  There is so much controversy on it that I really don’t care anymore.  In a few years, they may reverse the decision again.  The information on it is so flip-flop

Well, as I said the evidence for active harm is small, and confined to certain groups, so there is certainly room for argument about specific supplements and their risks and benefits, unlike homeopathy for example. However, I don’t agree that the evidence or the conclusions of science have flip-floped. That is a common complaint about science-based medicine, and it comes from a misperception generated by the media and how they cover science, and from a small percentage of scientists who publically oversell their results.

Often, I’ll read a news report about a study that claims a groundbreaking, revolutionary discovery, and when I read the actual paper, the conclusions are much more modest and qualified. When susequent research accumulates and it becomes clear the original hypothesis was wrong, the media reports it as a dramatic reversal in the previous groundbreaking discovery, but the scientists view it as the natural process of science leading gradually to greater and greater confidence in ideas which are almost always still sen as provisional at some level. The initial hype about vitamins was mostly based on low-quality pre-clinical evidence and anecdote, like so much alternative medicine. The data now accumulating from higher-level clinical trials is showing the hype to be unfounded, but again that is more about public perception than a true reversal in established scientific conclusions.

Vitamins, like any other substance which influences health status, have to be used when there is a clear and evidence-based indication for them. And if they have enough of an effect to have benefits, they are likely to have side-effects too. The problem is not with the vitamins themselves or the uncertainty in the data, since such uncertainty always exists to some degree. The problem is with the perception that vitamins must be safe, that since a little is good more must be better, and all of the other assumptions that underlie so many unscientific health practices.

I certainly wouldn’t say the data is clear enough or that I personally have the expertise to make specific recommendations about what vitamins a person should or shouldn’t take. I just feel like sometimes there is a bit of a double standard among skeptics, who are quick to dismiss alternative therapies based on unscientific thinking or weak data, but then seem to find the same kind of thinking and data sufficient to justify more traditional supplements like vitamins.

Very true. I hear this complaint from patients quite frequently and unfortunately it gives many of them an excuse to revert to lazy thinking since “even the experts keep changing their mind”.  Somehow the health professions need to get the media to do a better job of explaining this to the public when they report on things.  We can have this discussion with patients every time it comes up but even if we make some headway its only one person we’re educating.

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Posted: 28 November 2011 11:59 AM   [ Ignore ]   [ # 199 ]
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traveler - 28 November 2011 11:44 AM

Ok, since this has gone a bit off-topic, I have a question regarding terminology. Specifically, live, attenuated, and inactivated.

Live - I think I understand this one. It’s obvious.

Attenuated - I think this is a live thing but “damaged” in order to reproduce very slowly so that your immune system can win. Also means less need for booster compared to dead?

Inactivated - I think this is the same as dead, but I’m not sure. If it is, then why the hell don’t they just say dead?

You are correct in your definition except that all live virus vaccines that I can think of are attenuated, so there are no “live” vaccines, just “live attenuated” vaccines. Killed, dead, and attenuated all mean the same thing. They are vaccines made of viruses that have been destroyed. Inactivated may actually be a more accurate definition since there is dispute about whether viruses are truly alive and therefor if they are not they can’t be dead either, just no longer active. There are of course other types of vaccines as well such as toxoid vaccines ( ie. tetanus) where an altered form of a toxin is injected so the body makes an antibody to the toxin rather than the organism itself. There are also protein subunit vaccines where a protein from the surface of the virus/bacteria used. Often the protein is produced in another organism that has been genetically modified like yeast ( the hep B vaccine is produced this way). There are also some new experimental approaches to making vaccines, some of which involve using DNA but they are still in the developmental stages

Correction: Dead , killed and inactivated are the same not attenuated

[ Edited: 28 November 2011 12:55 PM by macgyver ]
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Posted: 28 November 2011 12:25 PM   [ Ignore ]   [ # 200 ]
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Thanks Macgyver, but if dead, killed, and attenuated all mean the same thing, then why do they market nasal flu vaccines as different from the shots? And why are there medical articles like LIVE ATTENUATED VERSUS INACTIVATED…?

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Posted: 28 November 2011 12:42 PM   [ Ignore ]   [ # 201 ]
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traveler - 28 November 2011 12:25 PM

Thanks Macgyver, but if dead, killed, and attenuated all mean the same thing, then why do they market nasal flu vaccines as different from the shots? And why are there medical articles like LIVE ATTENUATED VERSUS INACTIVATED…?

I misspoke. dead , killed and inactivated mean the same thing. The nasal vaccine for the flu is a live attenuated vaccine whereas the injectible flu vaccine is an inactivated vaccine. Live attenuated vaccine have some advantages ni that they can be given by non-injectible routes sometimes.. like the nasal flu vaccine and the live attenuated polio vaccine (sabin vaccine) which was given as a drop on the tongue or a sugar cube laced with vaccine. They also sometimes trigger a better or more long lasting immune response but not always. The disadvantage is that because they are live virus vaccines there is some risk of developing the actual illness in a small percentage of people. For this reason the nasal flu vaccine is not recommended for older individuals or people with cardiovascular or pulmonary diseases or for children under the age of 2.

[ Edited: 28 November 2011 12:54 PM by macgyver ]
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Posted: 28 November 2011 01:47 PM   [ Ignore ]   [ # 202 ]
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Ok, now I understand. I also now appreciate the inactivated as a label for viruses since they may not strictly be alive when they are “functioning.”

Thanks!!

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Posted: 28 November 2011 05:29 PM   [ Ignore ]   [ # 203 ]
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Mckenzie, off topic (a little), I had to rush my dog to the animal hospital when he went into status epilepticus last week (he has a history of GM sz, but has never had extended sz activity). I was happy to see most of the doctors there were board certified specialist, but very disappointed to see a chiropractor posted and given equal footing, as if it were legitamate science. The seizures were treated appropriately, with benzodiazapams and IVF until he could eat and take his phenobaritol again. But all in all, I am very disappointed. I am happy that my own vet doesn’t use chiropractors.

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Posted: 28 November 2011 05:37 PM   [ Ignore ]   [ # 204 ]
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With all respect for full fledged MDs, is there no place in the medical profession for chiropractic technicians in limited situations, similar to radiology technicians, or even naturopathic technicians (not to be confused with homeopaths)?

[ Edited: 28 November 2011 05:44 PM by Write4U ]
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Posted: 28 November 2011 06:00 PM   [ Ignore ]   [ # 205 ]
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Write4U - 28 November 2011 05:37 PM

With all respect for full fledged MDs, is there no place in the medical profession for chiropractic technicians in limited situations, similar to radiology technicians, or even naturopathic technicians (not to be confused with homeopaths)?

There should be no place in medicine for those who reject the use of objective scientific evidence to support their treatments. Physical and rehabilitation medicine in some ways is like chiropractic but with good science behind it so i see no need for chiropractic care. For chiropractic practitioners to gain respect they would have to abandon their crazy theories ( like Chi) and come up with theories that can be tested and verified. They would have to also submit their treatments to controlled studies. None of this will ever happen of course because they are making good money as it is so why should they spend the time and money to do something that might undermine their profession?

Naturopaths are equally guilty of promoting unproven treatments and questionable theories and are therefor no more worthy of our respect than chiropractors. I’m curious though about your lumping radiology technicians into this group. A radiology technician is someone trained in the use of radiology equipment. They are the ones who generally perform the sonogram or CT scan which is later read by a radiologist. Perhaps you had someone else in mind.

[ Edited: 28 November 2011 06:02 PM by macgyver ]
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Posted: 28 November 2011 06:16 PM   [ Ignore ]   [ # 206 ]
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Write4U - 28 November 2011 05:37 PM

With all respect for full fledged MDs, is there no place in the medical profession for chiropractic technicians in limited situations, similar to radiology technicians, or even naturopathic technicians (not to be confused with homeopaths)?

Physical therapy is science based. Some chiropractic is physical therapy, but infused with woo instead of scientific understanding. Other chiroprctic is just plain dangerous, and other treatments are useless. You are also paying for this bunkum.

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Posted: 28 November 2011 06:24 PM   [ Ignore ]   [ # 207 ]
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macgyver - 28 November 2011 06:00 PM
Write4U - 28 November 2011 05:37 PM

With all respect for full fledged MDs, is there no place in the medical profession for chiropractic technicians in limited situations, similar to radiology technicians, or even naturopathic technicians (not to be confused with homeopaths)?

There should be no place in medicine for those who reject the use of objective scientific evidence to support their treatments. Physical and rehabilitation medicine in some ways is like chiropractic but with good science behind it so i see no need for chiropractic care. For chiropractic practitioners to gain respect they would have to abandon their crazy theories ( like Chi) and come up with theories that can be tested and verified. They would have to also submit their treatments to controlled studies. None of this will ever happen of course because they are making good money as it is so why should they spend the time and money to do something that might undermine their profession?

Naturopaths are equally guilty of promoting unproven treatments and questionable theories and are therefor no more worthy of our respect than chiropractors. I’m curious though about your lumping radiology technicians into this group. A radiology technician is someone trained in the use of radiology equipment. They are the ones who generally perform the sonogram or CT scan which is later read by a radiologist. Perhaps you had someone else in mind.

From Wikipedia,

Chiropractic

A Doctor of Chiropractic (DC) performs spinal manipulative therapy
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.[1] It is generally categorized as complementary and alternative medicine (CAM),[2] a term which 69% of chiropractors in a survey rejected, with 27% preferring the term integrative medicine.[3] Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry.[4]
The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling.[5] Traditional chiropractic assumes that a vertebral subluxation interferes with the body’s innate intelligence,[6] a vitalistic notion that brings ridicule from mainstream health care.[7] A large number of chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence.[8]

sorry, radiology tech was a bad comparative choice.

I was trying to make a distinction between those traditional practices which have evolved and integrated with modern medical diagnosis and practices, unlike homeopathy, which clearly has not evolved beyond the “snake oil” stage.

Perhaps, this is why some clinics TODAY allow chiropractics on staff, where certain conditions may be treated with manipulation when medicine alone may not be effective and surgery is not required.

[ Edited: 28 November 2011 06:31 PM by Write4U ]
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Posted: 28 November 2011 06:47 PM   [ Ignore ]   [ # 208 ]
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Asanta,

Sorry to hear about your dog. Unfortunately, there are many chiropractors who work on pets in California, driven by popularity even in the complete absence of any evidence of safety or efficacy. Given the income generated by something many clients clamor for, it is the rare practice able to send their clients somewhere else for chiropractic care, with the risk they will never return, just because it’s pseudoscientific nonsense.

You might be interested to know that there are specific rules written into the veterinary practice act in CA about how chiropractors can be used in veterinary settings. They have very specific requirements which, as far as I can tell, nobody actually follows. But it might be worthwhile pointing out to some of these vets that they are violating the law.

The law requires:
1. Veterinarian evaluate patient and determine chiropractic is appropriate.
2. Chiropractor evaluates pet
3. Chiropractor consults with veterinarian and they agree on a treatment plan
4. Client signs awritten statement that reads chiropractic, “is considered to be an alternative (nonstandard) veterinary therapy.”
5. Complete records shall be kept of all evaluation, diagnosis, and treatment.

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Posted: 28 November 2011 06:59 PM   [ Ignore ]   [ # 209 ]
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is there no place in the medical profession for chiropractic technicians in limited situations

The only problem for which chiropractic has been shown through good-quality scientific research to have any benefit is acute lower back pain, for which it appears comparable to conventional therapy. That’s not much after over 100 years of aggressive marketing and extensive scientific study. But if chiropractors are willing to give up pseudoscientific theories of health and disease (innate intelligence, subluxation, and all the non-manipulative therapies they frequently employ), and stick to treating back pain, they could reasonably be a component of physical therapy for this problem. There is a VERY small segment of chiropractors who believe this is the way for their profession to go, and a somewhat larger group who are at least willing to renounce the mythical subluxation. However, a sizeable majority still base their practice on pseudoscience, claim to be able to treat many diseases unrelated to the muskuloskeletal system, promote anti-vaccine illogic, and so on.

The basic problem is that people believe, based on anecdoe and uncontrolled observation, that chiropractic is far more effective for far more things than it has actually been shown to be through good science. It is, like bloodletting before it, sustained by unreliable kinds of evidence and belief despite the negative results of higher-quality evidence. So its integration into conventional medicine is based on popularity (i.e. patient or client or demand) and profitability, which are the results of belief based in turn on untrustworthy evidence. Chiropractic should be welcomed into conventional medicine the day it passes the same standards of proof that new conventional therapies are expected to meet, and with that one very limited exception, it has consistently failed to do so.

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Posted: 28 November 2011 07:07 PM   [ Ignore ]   [ # 210 ]
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Write4U - 28 November 2011 06:24 PM

sorry, radiology tech was a bad comparative choice.

I was trying to make a distinction between those traditional practices which have evolved and integrated with modern medical diagnosis and practices, unlike homeopathy, which clearly has not evolved beyond the “snake oil” stage.

Perhaps, this is why some clinics TODAY allow chiropractics on staff, where certain conditions may be treated with manipulation when medicine alone may not be effective and surgery is not required.

I have not seen any evidence in my experience of chiropractors who are willing to give up their existing methods for a more science based approach. If such a movement is in progress that might be a good thing but I am naturally suspicious. The term “integrative medicine” is just code for “sneaking alt med into traditional medical practices”. Its a term that many medical institutions are now using in an effort to appear more open minded so as to attract the increasing portion of the population that has fallen for this nonsense. The reasons clinics allow chiropractors and other purveyors of woo inside their walls is not because it is a valid science but because they need to increase revenue. Its incredibly cynical but thats how they approach this. If public opinion towards this stuff becomes more positive and there is money to be made then the hell with science, they will open their doors gladly to chiropractors, and naturopaths, and magic crystals and witch doctors and whatever else they think the public wants.

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