Monday, February 7, 2011

Health Care Reform

I have not found any reasons to believe homeopathy does anything. Certain types -those that involve injection in particular- may actually be somewhat harmful. I find such an utter lack of any discernible basis for any action of homeopathic material that it is difficult to carve out enough interest to even examine homeopathy at all. I would completely ignore it, and suggest that others also ignore it, if not for one nagging problem. The problem is that homeopathic treatments do, in some limited cases, work.

It would be especially easy to claim that any effects of homeopathic treatments are “placebo” effects since homeopathic medications are indistinguishable from placebos. It is also impossible to describe any targeted effect of any measurable physical property of a homeopathic material that is proportional to a measurable effect since there are no constituents of the medications that are not overwhelmingly present in almost everything else. In short, it is almost impossible to scientifically study homeopathic medications because it is essentially impossible to define controls.

Let me engage in a little thought experiment. A homeopathic practitioner begins making up a batch of homeopathic solution “A”. They 1st make up the concentrated solution of compound “A”. Then they begin diluting it. They take the beaker they made the original solution in and wash it. While they are diluting the original solution to the working dilution of ten to the minus sixtieth power the rinsings from the original beaker flow down the sewer pipes of the lab's building, and they then go out into a local stream. The final diluted material is packaged up for sale; and the beaker rinsings flow from stream to river to sea. When the patient receives the homeopathic medication those rinsings, now diluted by all the water on earth, are still more concentrated than the homeopathic medication. When the homeopathic medication maker makes a new batch of “A” he will be diluting the stock with material that is more concentrated than what he wishes to end up with.

One could simply drink a glass of water and imagine that it was whatever homeopathic medication one wanted it to be and actually be more correct than someone reading the label on a vial of homeopathic medication.

If it is impossible to scientifically study homeopathic medications, and they make no sense, then what do I mean by they “work” in certain situations?

Firstly the information that suggests that they “work” is not scientific; it is phenomenological. Patients with certain conditions show a statistically significant greater level of positive medical outcomes when they receive homeopathic treatment than when they do not. The patients are not magically cured, but they do enjoy markedly better outcomes.

I hope at least a couple of my readers are poking their fingers at their computers exclaiming: “Correlation does not equal causation”. I know I am. Of course the result of my poking is the typing of the words you are reading, and so my monitor is less smudgy.

You might think that I picture myself highly elevated to have my finger poking producing a literate output. That is not why I know I am highly elevated. The reason I am so highly elevated is that I am writing this on a plane. There is free facebook connection on this flight, but after a half an hour on fb I begin leaving increasingly inappropriate comments on people's status updates. I am unable to access anything else on the internet (like this blog), so I will type this up without references, and maybe post it later.

This means that those of you who think the problems with the homeopathic treatment studies are in the details will just have to look them up yourselves. I feel your pain.

There are differences between what happens during a homeopathic treatment and a traditional medicine-based treatment. There are more differences than just what substances the patient leaves with. There is a natural inclination, however, to focus on the material the patient can hold in a bottle rather than the whole process of treatment.

Meetings with homeopathic practitioners take much longer than those with traditional doctors; often several times as long. The homeopathic practitioner often asks questions about the patient that are seemingly unrelated to the illness. The homeopathic practitioners often touch their patients. I think the difference can be summed up by saying the the homeopathic treatment is often a more touchy-feely affair.

When one begins to break down the aspects of the homeopathic treatment that are most likely to provide the benefit observed it is the touchy-feely nature of the interaction that stands out as the most likely effector set.

Study-after-study-after-study have shown that kind and caring human interaction improves medical outcomes. This effect is distinct from placebo effect, and is much more effective.

Since it is difficult to buy love (in the compassion sense) it is difficult to quantify the amount of love used as supportive care. This lack of a commodity-type measure for compassion makes it difficult to target addition of compassion to treatment regimes. And forget all about the idea of getting insurance coverage for love.

The homeopathic practitioners have not simply found a new way of being loving either. As often as not these people must know that they are selling snake-oil. Those that are best at it are those that have embraced their inner oily snake; not those who have embraced their inner “Dr. Love”.

The effective nature of homeopathic treatment is the ritualisation of compassion. There are specified methods of touch, and specific lines of questioning. Since homeopathic medicine is nothing there is nothing that is done with any apparent information gathered by the connection rituals that are used in diagnosis. It is these magic diagnostic procedures themselves that cause the benefit.

There is a struggle between alternative and traditional treatments. The losers in this conflict have always been the patients.

One of the most horrifying battlegrounds is in cancer treatments. Many cancers are now fully treatable. As the number of potentially treatable cancer diagnosis increase the impact of patients refusing treatment becomes more significant. Refusal of treatment is a major cause of poor outcomes in cases of treatable cancer (lack of an early diagnosis is THE most significant cause, so learn the early signs of cancer and DON'T ignore them). One all-to-common reason for refusal of effective treatment is reliance on alternative treatments (This is awful, and I will probably talk about it at greater length in another blog post sometime).

It is natural for practitioners of traditional medicine to push back against treatments that harm patients. The alternative treatment folks create cover stories of health-care-industry and government conspiracies. The focus of this back-and-forth becomes the commodity; we focus on the snake oil. We ignore the poorly measured enhancements to treatment that work.

The battle against treatments that do no good, and may dissuade patients from getting effective treatments, must be constantly fought and won. It is important, however, to take everything that appears to be of use in treating patients and apply it, and apply it wherever possible.

We do not necessarily need to dress western doctors in kangaroo skins and carved wooden masks to apply the positive benefit of the witch doctor. We certainly do not need to believe that the witch doctor channels the pre-life force of trans-dimensional beings in order to leverage the healing benefit of ritual. We have studied ritual for hundreds of years, and we should be able to create effective new rituals that far exceed those accidentally derived by previous generations. What a great way of employing previously unemployable archaeologists, anthropologists, and philosophers!

Personally I picture the orderlies and nurses dressed like witch doctors. Visiting relatives will be kindly asked to wear elaborate sequined headdresses. All PA announcements will have the soothing sounds of rattles and pan-flute tastefully added to them by some complex computer signal algorithm.

I have a bunch of great ideas for health-care reform.

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