I guess part of the issue here is what “alternative medicine” really means. Is it any kind of care that doesn’t involve drugs or surgery? That’s what alt med folks would like you to think. They claim nutrition, exercise, and pretty much any non-pharmacological or surgical therapy as “alternative.” But, as usual, reality is more complex than that.

Alternative medicine is a label attached to a diverse, and often mutually incompatible, collection of practices, but there are some common philosophical foundations shared by many of them. Most are vitalistic. Most accept a post-modernist view that all epistemology is ultimately culturally relative and any claim to one model being more true than another is not only unjustified but probably motivated by a desire to preserve a certain kind of social and economic order. Personal experience and tradition are counted more important than scientific research in evaluating the worth of practices, though positive studies are still welcomed as a marketing tool. The appeal to nature fallacy is widely accepted, and there is deep suspicion about the safety and effectiveness of conventional or technological interventions. (there are other such themes)

So is sucking on a clove to relieve dental pain “alternative medicine?” I guess it depends on how one views and justifies it. If one chooses the remedy because it is “natural” and thus must be safe; if one presumes that it can be claimed to “work” because one’s pain went away after trying it and lots of other people hink it works; if one is convinced pharmaceutical companies and the “disease industry” are actively suppressing the truth about it; and if one is willing to ignore any scientific evidence against the safety and efficacy of the practice, then it is alternative medicine.

If, however, one considers it plausible that part of a plant might contain chemical with analgesic properties and one is interested in whether there is any experimental evidence to suggest this idea is actually true*, and if one is willing to consider that despite being a plant instead of a drug the practice might have risks as well as benefits#, then using clove for dental pain isn’t alternative medicine at all, it’s just another potential way to approach a clinical problem.

The “alternativeness” of alt med has more to do with philosophy, epistemology, politics, and other ideological factors than with the actual practices themselves.

 

 

*J Dent. 2006 Nov;34(10):747-50. Epub 2006 Mar 13.

The effect of clove and benzocaine versus placebo as topical anesthetics.

Alqareer A, Alyahya A, Andersson L.

Source

Faculty of Dentistry, Kuwait University, Kuwait. .(JavaScript must be enabled to view this email address)

Abstract

OBJECTIVES:

The purpose of this study was to examine whether the natural herb clove can replace benzocaine as a topical anesthetic.

METHODS:

Topical agents were applied to the maxillary canine buccal mucosa of 73 adult volunteers. Four substances were tested in the study: (1) homemade clove gel, (2) benzocaine 20% gel, (3) placebo that resembles clove and (4) a placebo that resembled benzocaine. After 5 min of material application in a randomized, subject-blinded manner, each participant received two needle sticks. Pain response was registered using a 100 mm visual analogue pain scale.

RESULTS:

Both clove and benzocaine gels had significantly lower mean pain scores than placebos (p=0.005). No significant difference was observed between clove and benzocaine regarding pain scores.

CONCLUSION:

Clove gel might possess a potential to replace benzocaine as a topical agent before needle insertion.

#Contact allergy to essential oils: current patch test results (2000-2008) from the Information Network of Departments of Dermatology (IVDK).

Uter W, Schmidt E, Geier J, Lessmann H, Schnuch A, Frosch P.

Source

Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany. .(JavaScript must be enabled to view this email address)

Abstract

BACKGROUND:

Essential oils are used in perfumery and in products for aromatherapy or balneotherapy. Previous studies have shown some to be important contact sensitizers. A practical diagnostic approach, based on the results of a large, central European network and other evidence, is needed.

METHODS:

Data of the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) on all patients patch tested between January 2000 and December 2008 with essential oils were retrospectively analysed.

RESULTS:

15 682 patients of 84 716 consulting in the period had been tested with at least one essential oil, and 637 reacted positively to at least one of the essential oils, most commonly to ylang-ylang oil (I and II) (3.1% as weighted mean of positive tests in special series and consecutive testing), lemongrass oil (1.8%), jasmine absolute (1.6%), sandalwood oil and clove oil (1.5% each). Cross-reactivity between distillate and main allergen, if available, was marked.

CONCLUSIONS:

Patch testing the important essential oils should be considered in patients with a suggestive history. Additionally, culprit products brought in by the patient should be tested, closing a diagnostic gap by (i) including those other essential oils not included in the commercial test series and (ii) providing a means of testing with the oxidized substances to which the patient had actually been exposed.

When I was much younger, I knew a witch’s chant that made a toothache go away for awhile.  But going to the dentist regularly has proven to be a better long term approach.  I can’t remember my last toothache.

Cloves is an old wives’ tale remedy.  It’s been around for a long time, but it doesn’t actually work.  Not sure how old timers got the idea that it works. That ad whiskey on babies’ gums for teething, which science has shown can have an adverse affect on a baby’s developing brain.

Mriana - 02 March 2012 09:56 PM

Cloves is an old wives’ tale remedy.  It’s been around for a long time, but it doesn’t actually work.  Not sure how old timers got the idea that it works.

??? I thought we established that it does work.

??? I thought we established that it does work.

Yes, we did, but is it placeabo or is there a pharmacological cause????

Equal Opportunity Curmudgeon - 03 March 2012 09:49 AM

??? I thought we established that it does work.

Yes, we did, but is it placeabo or is there a pharmacological cause????

Posts 6, 7, 8 showed pharmacological.

traveler - 03 March 2012 08:25 AM

Mriana - 02 March 2012 09:56 PM

Cloves is an old wives’ tale remedy.  It’s been around for a long time, but it doesn’t actually work.  Not sure how old timers got the idea that it works.

??? I thought we established that it does work.

It’s effect is temporary at best.

That is the intention of anesthetic, Mriana: a temporary relief of pain. Nobody is saying it will get rid of the cavity.

George - 03 March 2012 11:58 AM

That is the intention of anesthetic, Mriana: a temporary relief of pain. Nobody is saying it will get rid of the cavity.

Exactly. It is medicine that works as intended. Perhaps not everyone’s first choice, but a viable choice nonetheless.

Mriana - 02 March 2012 09:56 PM

Cloves is an old wives’ tale remedy.  It’s been around for a long time, but it doesn’t actually work. 

I posted because my toothache was severe and it’s very effective indeed.

Which is worth knowing.

Stephen

Although we should be careful of confusing correlation with causation I don’t think we always need science to tell us if something works.

Isn’t it correct to say that we can see for ourselves, at times? I mean do I need to be sceptical of my flicking a light switch turning a light on and off, without further evidence?

That’s what cloves and this particular toothache were like, regular relief from pretty severe pain within a minute or two.

I believe I’m right in saying that I knew it worked, just from my trials.

Stephen

StephenLawrence - 04 March 2012 02:50 AM

Although we should be careful of confusing correlation with causation I don’t think we always need science to tell us if something works.

Isn’t it correct to say that we can see for ourselves, at times? I mean do I need to be sceptical of my flicking a light switch turning a light on and off, without further evidence?

That’s what cloves and this particular toothache were like, regular relief from pretty severe pain within a minute or two.

I believe I’m right in saying that I knew it worked, just from my trials.

This is a good question, but there’s no easy way to distinguish which causal claims require better evidence than testimonial. That said, historically, claims of pain relief have been some of the least credible, probably because pain is most amenable to suggestion (placebo). Pain is exacerbated as well by tension and worry, so doing anything that relieves tension and worry, even taking an ingredient of uncertain effect, can relieve pain even without any additional pharmacologic effects.

That said, of course I have had novocaine and other local anesthetics and the pain relief is so immediate and clearly effective of even (what would be) severe pain that there is no way they could be placebo, at least in my understanding of placebo. Even in that case, though, there is going to be a legitimate distinction between something which I would have reason to believe as versus what people in general (who had not had this procedure) would have reason to believe. Without correctly designed, independently verifiable tests, I don’t think virtually any medical procedure has reason for public acceptance.

The problem with the reasoning that a clear and obvious change with an intervention is adequate evidence for the effectiveness of that intervention is that it has not proven reliable in the past. People have felt instant and unmistakable relief from faith healing, bloodletting, and many other worthless or even harmful therapies. It is true that much of the time flicking a light switch and seeing the light go on leads us to infer a causal relationship that actually exists. Obviously, we aren’t always wrong! In fact, we are probably right most of the time, otherwise we wouldn’t have gotten very fr in evolutionary terms by using such reasoning strategies.

The problem is that cases in which the perceived relationship actually doesn’t exist occur often enough that overall this is an untrustworthy method of establihsing causation, at least with respect to medical therapies. Unfortunately, the sense of certainty we obtain when such events happen is more powerful than the statistical or historical evidence showing that such reasoning leads us astray more often than we might think.

There are many, many people who claim the same kind of clear and dramatic relief Doug and Stephen describe, but they claim it from homeopathy or other remedies that consistently fail objective tests of effectiveness. So either the scientific method doesn’t work very well, or we have to be very skeptical of even such seemingly obvious inferred causal relationships. I think the balance of the evidence is on the side of science. When the science doesn’t exiist with respect to a specific practice, it is reasonable to use the lesser levels of evidence such as testimonials and persnoal experience. But we ought to recognize that these levels are weak, and that even though they are psychologically compelling, we should give preference to objective data. If, for example, large and well-designed studies of cloves showed no efficacy beyond placebo for dental pain, Stephen would be faced with the choice of believing that he was a rare exception to a general rule or that his perception was erroneous. In reality, most people would have a tough time giving up on their perception, which is part of why so many useless therapies persist despte the evidence against them

mckenzievmd - 04 March 2012 03:36 PM

There are many, many people who claim the same kind of clear and dramatic relief Doug and Stephen describe, but they claim it from homeopathy or other remedies that consistently fail objective tests of effectiveness.

Yes and no. With the normal pains of daily life, you’re right. (Including such things as toothache, which can run the gamut from mild to severe). In the case of extreme, operative pain, there is no evidence I’m aware of that placebo makes any difference. This is crucial because in the early reports of acupuncture, it was believed that the NYTimes reporter had claimed people were undergoing surgery only using acupuncture needles. This turns out to have been incorrect. (I can find the sources for this if you want).

Of course, that wouldn’t stop someone from misdescribing an event, either deliberately or in error.

I’m familiar with the question of so-called “acupuncture anesthesia,” but I’m not sure it really challenges the point I was trying to make, which is that people are frequently wrong about seemingly clear and obvious causal connections between medical interventions and the relief of their symptoms. If you mean to say that there might be cases of effects which are so dramatic and unmistakable that we ought to accept them as valid alone for establishing efficacy, I’m not convinced. I mean, I could imagine a situation which would be very convincing, such as acupucnture-only anesthesia or the well-documented complete disappearance of extensive etastatic cancer. But as you point out, further investigation found that the apparently miraculous anesthetic powers of acupuncture were not valid, and spontaneous remissions of cancer do happen, rarely. So I still think controlled research has to be a sine qua non for confident claims about efficacy (though not, of course, for the sort of weak, provisional claims necessarily made when the evidence doesn’t yet exist but the urgency of the situation demands interventions based on lower levels of evidence).

As for the effects of placebo on pain, they are generally mild to moderate at best and consistently inferior to the effects of active analgesic agents. However, placebo effects encompass not only the subjective effects of belief and expectancy, but also other kinds of non-specific effects seen in control groups in research trials; the Hawthorne Effect, regression to the mean, natural history of disease, enhanced compliance with concurrent therapies, classical conditioning, and so on. I think you’re correct that surgical pain would probably be too severe for most people to be effectively managed by something which operated only through expectancy and belief. However, placebo interventions such as sham knee surgery, sham internal mammary artery ligation, and so on have been associated with dramatic improvements in reported pain even for pretty serious conditions. Likely these effects included the influence of not only belief and expectancy but other non-specific effects of therapy. And something like acupuncture likely has not only effects based on belief but non-specific physiologic effects (such as inducing release of endorphins and such). This doesn’t mean acupuncture “works” as an analgesic (unless one wishes to argue that hitting oneself on the thumb with a hammer “works” as a specific therapy for pain from osteoarthritis of the knee), but that it has effects on pain other than those induced by expectancy and belief. So again, while some kinds of pain aren’t likely to respond to pure placebos, and thus an apparent response can be argued to show some kind of real effect from an intervention, I still think that the ways in which we can be fooled are legion and such causal reasoning is still deeply unreliable in general.