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Cloves and toothache
Posted: 04 March 2012 07:53 PM   [ Ignore ]   [ # 31 ]
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mckenzievmd - 04 March 2012 04:24 PM

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).

I don’t think we’re disagreeing here, but I was trying to push the envelope a bit. My point is that there is some room here for epistemic certainty as the first-person receiver of a pain medication. (Though not so much in the third person case, which is what after all science cares about). There are certain ways that placebos aren’t known to work. Of course, this assumes that you know you aren’t misremembering, dissembling, etc., and of course sometimes it isn’t possible to know that. People do misremember or dissemble—even to themselves—all the time.

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Posted: 04 March 2012 10:58 PM   [ Ignore ]   [ # 32 ]
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mckenzievmd - 04 March 2012 03:36 PM

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

I think we humans are good at working out cause and effect relationships on our own, it’s to a large extent what we do.

I know we can be tricked but I think it’s pushing things too far to claim that there aren’t many cases in which we know cause and effect relationships without scientific data, pain relief being amongst them.


Stephen

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Posted: 04 March 2012 11:05 PM   [ Ignore ]   [ # 33 ]
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Another thing I knew is that water relieved it. Not as effective but before I got the cloves I would regularly drink water when the pain got intense and it made it more bearable for a little while.

The dentist asked me what relieved the pain, I told him this and from the information he knew what stage the toothache was at.

Stephen

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Posted: 05 March 2012 07:36 AM   [ Ignore ]   [ # 34 ]
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I think we are absolutely horrible at working out cause and effect. The problem with pain is that most of it is merely temporary and will go away on its own. Our body is extremely good at healing itself and without science we can never be sure what the real cause of relieving pain was.

I remember being once at a wedding and having a horrible headache. The wedding started early in the morning, it was a very hot day and I was the best man. I was exhausted. I didn’t want to take any pill for my headache because I was drinking. A family member who is a chiropractor took me inside the house, did his “stuff,” and got rid of my headache. I didn’t know any better back then and I was amazed. What I didn’t realize at that moment was that the headache had to go away sometimes anyway (unless I had a brain tumor) and maybe the time when my family member was doing his tricks was just that time. Or maybe what helped me was the fact that he took me inside an air-conditioned house and allowed me to relax for twenty minutes or so. All I knew was that the headache was gone, and worked out the easiest explanation for the cause and effect. I have absolutely no idea, though, if in fact I was right.

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Posted: 05 March 2012 12:04 PM   [ Ignore ]   [ # 35 ]
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“I know we can be tricked but I think it’s pushing things too far to claim that there aren’t many cases in which we know cause and effect relationships without scientific data, pain relief being amongst them.”

Then how to you explain the unprecedented impact scientific analysis has had on human health and longevity? Tens of thousands of years of no real change in average life expectancy, followed by a doubling in 200 years? How do you explain the fact that a large majority of humans still give supernatural agents credit/blame for most things that happen? How do you explain magic or the enormous research data in psychology illustrating the unreliability of our perceptions and judgments?

I think fundamentally you’re still caught in the grip of a compelling personal experience. In this case, the research evidence supports your impression that cloves ameliorate dental pain. But what would you think if it didn’t? It’s a real challenge to doubt the evidence of our own experience, but it’s also the key to all the progress science has allowed.

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Posted: 05 March 2012 08:59 PM   [ Ignore ]   [ # 36 ]
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A while back somebody posted about pharmacists advising or selling homeopathic medicine.  As a hospital pharmacist, I was going to remark on the fact that the only “alternative med”’ on the formulary was clove oil, and it does work well for teething babies as well as adult tooth pains. 

There are many drugs that come from the plant kingdom. Drug companies manipulate the structure for various reasons(. Less toxicity, more bioavailability , the patent ,etc..) .  For some reason clove oil serves no purpose in the profitable formula to market a drug.

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Posted: 05 March 2012 09:58 PM   [ Ignore ]   [ # 37 ]
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I think one of the problems many have is confusing the term, “alternative” with produced naturally, that is, not synthesized.  Many of our antibiotics were first discovered being produced by fungi or bacteria.  Penecillin, terramycin, and streptomycin being three examples.  Quinine, aspirin, morphine, AND eugenol (from oil of cloves) are more examples. 

On the other hand, most “herbal” remedies sold are alternative medicine. 

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Posted: 06 March 2012 07:34 PM   [ Ignore ]   [ # 38 ]
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StephenLawrence - 04 March 2012 10:58 PM

I think we humans are good at working out cause and effect relationships on our own, it’s to a large extent what we do.

I know we can be tricked but I think it’s pushing things too far to claim that there aren’t many cases in which we know cause and effect relationships without scientific data, pain relief being amongst them.


Stephen

IN fact we are really bad at this. Our personal biases frequently affect our interpretation of cause and effect. I remember an incident when i was a resident. A report came out in the news that low cholesterol levels were associated with higher rates of cancer. My first impression was Duh!  cancer patients suffer from decreased appetite and cachexia both of which will naturally lower your cholesterol level ( cancer was causing low cholesterol levels), but the reporter drew the conclusion that low cholesterol was causing cancer and that cholesterol lowering meds should now be viewed as possible carcinogens.

My personal bias was based on what i was seeing on the wards every day. The reporters personal bias was to a desire to find things that might scare his listeners and improve ratings.

If you ever want to witness a literal buffet of cause and effect misinterpretation listen to John Tesh’s radio show “Intelligence for your life”. He’s a local guy with a national show. He used to be the host of Entertainment tonight. He seems like a nice enough guy but he quotes studies throughout his show and draws cause and effect conclusions from studies that only imply an association. He does this without qualification or reservation and more often than not he seems to get the cause and effect backwards or at the very least has no clue that there could be another interpretation.

Humans see cause and effect the way they want to see it not necessarily the way it is. That’s why the scientific method is so crucial in the pursuit of the truth.

[ Edited: 06 March 2012 07:51 PM by macgyver ]
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Posted: 08 March 2012 12:42 AM   [ Ignore ]   [ # 39 ]
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macgyver - 06 March 2012 07:34 PM
StephenLawrence - 04 March 2012 10:58 PM

I think we humans are good at working out cause and effect relationships on our own, it’s to a large extent what we do.

I know we can be tricked but I think it’s pushing things too far to claim that there aren’t many cases in which we know cause and effect relationships without scientific data, pain relief being amongst them.


Stephen

IN fact we are really bad at this. Our personal biases frequently affect our interpretation of cause and effect. I remember an incident when i was a resident. A report came out in the news that low cholesterol levels were associated with higher rates of cancer. My first impression was Duh!  cancer patients suffer from decreased appetite and cachexia both of which will naturally lower your cholesterol level ( cancer was causing low cholesterol levels), but the reporter drew the conclusion that low cholesterol was causing cancer and that cholesterol lowering meds should now be viewed as possible carcinogens.

My personal bias was based on what i was seeing on the wards every day. The reporters personal bias was to a desire to find things that might scare his listeners and improve ratings.

If you ever want to witness a literal buffet of cause and effect misinterpretation listen to John Tesh’s radio show “Intelligence for your life”. He’s a local guy with a national show. He used to be the host of Entertainment tonight. He seems like a nice enough guy but he quotes studies throughout his show and draws cause and effect conclusions from studies that only imply an association. He does this without qualification or reservation and more often than not he seems to get the cause and effect backwards or at the very least has no clue that there could be another interpretation.

Humans see cause and effect the way they want to see it not necessarily the way it is. That’s why the scientific method is so crucial in the pursuit of the truth.

Basically I’m saying I knew the cloves worked after a few trials and I knew the water worked after a few trials.

I have no argument with anything else.

Stephen

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Posted: 08 March 2012 12:47 AM   [ Ignore ]   [ # 40 ]
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mckenzievmd - 05 March 2012 12:04 PM

In this case, the research evidence supports your impression that cloves ameliorate dental pain. But what would you think if it didn’t?

I would keep using the cloves whilst the apparent effect followed the apparent cause and would believe it probably was working. If the experience changed I would change my mind.

Stephen

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Posted: 08 March 2012 08:54 AM   [ Ignore ]   [ # 41 ]
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wheld - 05 March 2012 08:59 PM

A while back somebody posted about pharmacists advising or selling homeopathic medicine.  As a hospital pharmacist, I was going to remark on the fact that the only “alternative med”’ on the formulary was clove oil, and it does work well for teething babies as well as adult tooth pains. 

There are many drugs that come from the plant kingdom. Drug companies manipulate the structure for various reasons(. Less toxicity, more bioavailability , the patent ,etc..) .  For some reason clove oil serves no purpose in the profitable formula to market a drug.

Right. I was referring mainly to retail pharmacy. Hospital pharmacy is certainly more clinical and science-based. My son is an ER pharmacist.

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Posted: 08 March 2012 09:47 AM   [ Ignore ]   [ # 42 ]
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I would keep using the cloves whilst the apparent effect followed the apparent cause and would believe it probably was working. If the experience changed I would change my mind.

Unfortunately, this is the epistemological approach that keeps homeopathy, faith healing, and ritual sacrifice alive and well as medical therapies. I understand your reasoning, and it is perfectly sound. Unforunately, abundant evidence shows it to be untrustworthy when it comes to separating effective from ineffective therapies. “I tried it and it seemed to work” is the defense offered for every failed medical therapy ever tried. It is psychologically compelling, which makes it very difficult to convince people it is wrong no matter how much evidence there is. If I could produce a hundred studies showing that clove oil was useless for pain control and caused unpredictable sudden death in a small fraction of users, most people in your position would still say, “Yeah, but it works for me and I’ve never had a problem.” Sort of makes science seemed pointless. :-(

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Posted: 08 March 2012 11:04 AM   [ Ignore ]   [ # 43 ]
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mckenzievmd - 08 March 2012 09:47 AM

I would keep using the cloves whilst the apparent effect followed the apparent cause and would believe it probably was working. If the experience changed I would change my mind.

Unfortunately, this is the epistemological approach that keeps homeopathy, faith healing, and ritual sacrifice alive and well as medical therapies. I understand your reasoning, and it is perfectly sound. Unforunately, abundant evidence shows it to be untrustworthy when it comes to separating effective from ineffective therapies. “I tried it and it seemed to work” is the defense offered for every failed medical therapy ever tried. It is psychologically compelling, which makes it very difficult to convince people it is wrong no matter how much evidence there is. If I could produce a hundred studies showing that clove oil was useless for pain control and caused unpredictable sudden death in a small fraction of users, most people in your position would still say, “Yeah, but it works for me and I’ve never had a problem.” Sort of makes science seemed pointless. :-(

I think we can differentiate between cases in which something seeming to work means it probably does work and those in which it doesn’t.

I could switch the pain on by drinking a hot drink and switch it off with a clove. I really do think I knew I was doing that and it’s because some correlations are more definately cause and effect relationships than others.

So I think understanding why that is can be used to seperate this sort of thing from homeopathic remedies, for instance.

Science is for the less definate cases.

Stephen

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Posted: 08 March 2012 11:29 AM   [ Ignore ]   [ # 44 ]
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StephenLawrence - 08 March 2012 11:04 AM

I could switch the pain on by drinking a hot drink and switch it off with a clove.

Or maybe by the time you applied the clove the effect of the hot drink was already disappearing anyway. You can never be sure.

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Posted: 08 March 2012 11:55 AM   [ Ignore ]   [ # 45 ]
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I could switch the pain on by drinking a hot drink and switch it off with a clove. I really do think I knew I was doing that and it’s because some correlations are more definately cause and effect relationships than others.

The problem is that “less definate cases” don’t seem any less definite to those who have experienced them. I am constantly bombarded by anecdotes that illustrate apparent cause/effect reelationships no less clear or immediate than yours but relating to prayer or energy healing or any number of other methods that can only be truly effective if the core principles of established science are wrong. The immediancy and replicability of the experience reinforces your sense of certainty about the meaning of the experience, but it actually does little to improve the accuracy of the conclusion. Confounders, information bias, placebo effects, and lots of other factors make even such obvious cases less reliable than they feel.


The epistemologicaly appropriate response to such an experience is to view it as suggestive of a cause/effect relationship worth investigating in a more rigorous way. In the absence of such rigorous controlled evidence, the kind of replication of exerience you describe is a useful heuristic, and I don’t claim we should never use such experiences to guide our behavior or actions. However, the number of cases in which our conclusiions based on such experiences turn out to be wrong is enormous, and I think that justifies more skepticism and less certainty about their meaning.

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