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Evidence Based Medicine

Posted by silversword 9A (My Page) on
Wed, Feb 25, 09 at 14:43

A lot has been said on this forum about Evidence Based Medicine. I am interested in the opinions of those who believe herbalism as a whole is not evidence based and of those who feel it is evidence based.

I am of the opinion that all systems of medicine, however primitive, are evidence-based and that it is what constitutes evidence that is debatable.

In other words, just because it has not been triple-blind studied does not mean it is not evidence based.

How do you balance your treatment of yourself, and what do you rely upon to make sure you are treating yourself with the best healthcare available?


Follow-Up Postings:

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RE: Evidence Based Medicine

Long and tedious tomes could be written about this. For myself, I think that it's almost like religion - so much of what has been called 'evidence' has been, in reality, based on faith.

Take some obscure tribe somewhere which still follows the customs of millenia. Certainly, they will have discovered certain plants which help to treat certain conditions. So they stick to it. And if I learn about it, and if it works for me, then that's incontravertible evidence. Similarly, if that particular plant is scientifically examined, and found to 'work', then that's incontravertible evidence, too.

However, if this same tribe has a custom of dressing up in feathers and dancing around and chanting or singing as a means (alone) of treating a sick person, and they've been doing it for yonks, I don't call that anything but evidence of faith. It's evidence of the Placebo Effect - even if it doesn't work and the patient dies! They do it because they believe in it, and for no other reason. It probably happened several times that the patient fully recovered with no actual medical treatment whatever beyond the ceremonial. Totally spontaneous - and this reinforced the belief.

I am a believer in herbal medicine. There can be no doubt that certain plants help to heal certain ailments, or at least to minimise their severity.

However, I don't believe they are the whole solution, and I don't think they are always to be relied upon, in every situation. There needs to be too much reliance upon guess-work and chance in many cases. For instance, getting the dosage just right for any individual is problematic.

One of the biggest problems with herbal medicines is that of arriving at a correct diagnosis in the first place. So a person might get a lot of headaches - we find a herb which is known (through experience) to alleviate a headache. But Modern Science has found a huge number of ailments for which one of the symptoms is headaches. Unless the root cause of the headaches is established, it's pot luck to find the herb to 'cure' the condition, with so many options available.

For a one-off, occasional headache, it's comparatively easy to treat with herbs. It's the more serious recurring or severe headaches which need conventional medical intervention.

So I think that traditional and modern treatments both have their place, and in some cases they can go hand in hand. I'll happily treat myself with a simple herbal remedy when the symptoms are mild and of a temporary nature. But for more severe or recurring conditions, or for symptoms which cannot easily be explained - it's off to the doctor I go.

We are very fortunate that we have a choice. Centuries ago people HAD to rely on the flimsy evidence of superstition and limited factual knowledge. It was a lottery whether you were treated by being covered in poo, or were given some sort of herb, or danced around, and in all cases you were lucky to survive at all. This 'lottery' is just fine when there are no alternatives - but these days, we've learned a whole lot more through modern science, and there's no doubt that countless lives have been saved because of our greater understanding of the human body and the things that can go wrong with it.


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RE: Evidence Based Medicine

Most of our modern medicines have come out of a history of herbal use-- in fact, until the turn of the 20th century, most of medicines WERE herb-based. Once the main constituents-- or useful consitients-- could be identified and separated, modern pharmacology was born. So, in short, herbalism has been a part of medicine for as long as medicine itself has existed.

Regarding when to use herbs vs. when to "go to the doctor": This is not a tough decision for those of us who live with herbs or practice traditional methods of healing. Herbs are a part of the balancing act of healthy living. They are, essentially, food and should be integrated into the diet as such. Nothing is static. It's always changing as our body's needs change to deal with the lifestyles we choose to live. When someone seeks out a traditional healer because they are ignorant of or have ignored their body long enough to throw it severely out of balance, they MAY have two choices-- take the long road home via rebalancing which almost always will include an herbal therapy-- or take immediate action via medical intervention. Sometimes we're not given a choice & immediate intervention is needed. Thank god we have it. However, medical intervention is NOT rebalancing-- it's just what it's called-- intervention. In almost every instance of medical emergency and very much so in chronic conditions, there is a need for lifestyle change to affect total recovery. Herbal living, which is a lifestyle and requires a great deal of commitment, is again a possible therapy-- but if the person is unwilling to commit to it or has a continuing need for medical intervention until a workable balance can be achieved to "get off the meds", it may not be the best choice for them.

Regarding another point: It is actually NOT hard for an experienced herbalist to correctly diagnose a problem. I've watched doctors trained in China--where they learn non-invasive diagnosis and herbalism before interventive "western" medicine--make the exact same diagnosis from observatory techniques as doctors who have relied on extensive testing. They just go about it in a different way. I've seen shaman work the same way. It isn't bunk-- and it isn't a placebo affect. It's true healing, practiced the way it's been for centuries prior to interventive medicine arriving on the scene, and it takes lots and lots and lots of training. It is truly an art.

That said, those new to the art should practice only what they're comfortable with & trust healers only as far as they are comfortable with them-- whether those healers be wholistic or medical. To make the switch into an wholistic or herbal lifestyle is a gradual thing and even when fully embraced should never negate the respect and/or need for modern medical intervention in certain instances. I am not a surgeon. I would no sooner attempt surgery on someone than I would expect a non-herbalist to design an herbal therapy for me. The two practices can co-exist and be very effectively integrated when the respect for both parties' knowledge and abilities are observed.

Lastly, believe it or not, you do not need to know the root cause of a disease to heal in the traditional sense. Since wholistic practioners/traditional healers treat body, mind and spirit, sometimes the true root cause isn't found until the symptoms have been alleviated enough for the cause to surface. Experienced healers will admit when they're in over their heads or when medical intervention may be the best option for therapy-- healing for us isn't an ego game-- our objective is to help the person who has come to us hoping we can help. And, believe it or not, faith is a HUGE part of the curative affect. Simply put, if you don't believe you can win, you're not going to.

Literature has continually written about things that don't work-- it's easy to be a critic. Healers learn from other healers & from healing. Sure we make mistakes, and hopefully it doesn't cause a loss of life --same can be said for doctors. Evidenced-Based Medicine is one of those phrases like "Pre-Owned"-- an attempt to make something sound bigger or better than it really is. Herbalists have evidence-- thousands and thousands of years of evidence-- supporting our practices. To call it "alternative medicine" kind of makes me laugh, because it implies we've been supplanted by "mainstream" medicine, when we are the roots of that medicine.

A child always outgrows its parents; it's only in maturity that he can look back and see their wisdom.


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RE: Evidence Based Medicine

? Could the mixed success rate of a traditional herbal remedy, being used in the developed world today, sometimes be due to it's non-specific receptor site(s) being occupied by modern man's chemicals ?
If a crucial receptor is indisposed, the herb's active compound can not dock & the cascade of bio-chemical curative reaction(s) does not proceed.
There are chemical compounds from the modern industrial environment found in human tissue. Possibly the increasing use of popular drugs compromises some non-specific receptors.
Ancestral description of herbal cures is not necessarily fully explained by the placebo theory or projection of a temporary remission.


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RE: Evidence Based Medicine

A style debate of talking about herbalism sometimes helps no one. Take mefor instance at this moment. I'm on a fixed income. My body is trying to pass a large kidney stone(for the last 3 days) I had surgery to remove 3 other stoneslast April. SSI only covers 80% of the cost thus i owe a lot from last surgery. I'm running a fever can't keep food down and am dehydrated. And i simply can't afford to go into the hospital again. Yes i've looked into other avenues for finiancial help and none is available. I make $50 to much. The only chance i have of living is to find an herbal remedy if there is one. I hasten to add there are other elderly people in the same boat as me.

Evidence based medicine is for the haves in this country not the poor and elderly. I became a have not when i retired and than lost my health insurance.
I'm not posting this for pity but just maybe you should look to your future and prepare. STUDY HERBALISM. That can't be taken away from you.
To help myself, I'm drinking fluids constantly.drinking a bit of milk and crackers for nourishment. Taking pain pills occasionally. I can't call my doctor as he will send an ambulance to get me. The ambulance is free BTW.
Forgive me for ranting. Such is life.LOL


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RE: Evidence Based Medicine

First off, there's the need to accurately define what we're talking about when using the term "evidence-based medicine". Here's a good definition:

"Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer."

An increasing percentage of herbalism qualifies as evidence-based medicine (EBM) under this definition, though large portions still depend on folklore and testimonials, without either the backing of research or good clinical evaluation. Herbalism is in vastly better shape as far as EBM goes compared to many other forms of alternative medicine, such as homeopathy (EBM value approximately zero) and chiropractic (outside of narrowly defined uses for musculoskeletal pain).

There is an odd antagonism among some herbalism proponents to the idea of EBM, possibly out of fear that it will devalue cherished practices and/or abdicate control of herbalism to white-coated doctors and researchers. In reality, using principles of EBM only strengthens and validates herbalism. And if a plant chemical is refined into an effective drug, people still have the choice of using that drug or growing and harvesting the plant themselves and using a crude extract (which may not work as well as the drug (or at all, or with more side effects), but still leaves them with what they may perceive as a greater degree of control.

Given the level of hostility seen on this board to the idea of complementary medicine (using the best of both "mainstream" and "alternative" treatments and having the two "sides" work together for the best patient outcome, it's refreshing to see daisyduckworth's comments, which deserve repeating:

"So I think that traditional and modern treatments both have their place, and in some cases they can go hand in hand. I'll happily treat myself with a simple herbal remedy when the symptoms are mild and of a temporary nature. But for more severe or recurring conditions, or for symptoms which cannot easily be explained - it's off to the doctor I go.

We are very fortunate that we have a choice. Centuries ago people HAD to rely on the flimsy evidence of superstition and limited factual knowledge. It was a lottery whether you were treated by being covered in poo, or were given some sort of herb, or danced around, and in all cases you were lucky to survive at all. This 'lottery' is just fine when there are no alternatives - but these days, we've learned a whole lot more through modern science, and there's no doubt that countless lives have been saved because of our greater understanding of the human body and the things that can go wrong with it."


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RE: Evidence Based Medicine

While I do not completely disagree with EBM (after all it supported me for many years), I do not believe it to be infallible either.

My personal experience has been that I am much healthier when I do what I have found works for me, many of which have been outside of the EBM system. I feel that the way I use herbals is very safe and that the ones I use have a long history of safe and effective use. I have had many more reactions to pharmaceuticals than I have ever had from herbals.

While I agree with much of what previous posters here have said, there is no way I will run to my medical Doctor for every little symptom as many do. A yearly checkup is all I have planned. I've been called non-compliant because I won't take prescriptions for a non-life threatening condition but IMO the side-effects of those meds are worse than the symptoms. I once had a well qualified specialist recommend a certain drug which she said has no side-effects. It's a drug which can cause irreversible blindness which seems to me to be a side effect. Needless to say I did not take her recommendation nor return to her. I think this type of experience is what often makes people lose faith in EBM.

I absolutely agree that we all need to be very careful how we "prescribe" for ourselves. For that is what we are doing when we self-use herbals for relief of symptoms. There are many herbs I would not use any more than many Rx drugs I won't take.

I believe there are too many who expect to break the rules of health and regain that health via a magical treatment whether it be by drinking an herbal tea or taking a prescribed Rx. There have been pharmaceutical drugs withdrawn because of fatalities which have been found to not have been researched well enough. Look at the rise in kidney disease since acetaminophen use has become so widespread. The use of statin drugs is another interesting subject and I'm sure one we will hear more about. Probably lots more waiting in the wings.

There are also some unsafe herbals but these are usually known and cautioned against and people take them at their own risk if they ignore the warnings. How many people even know the side effects of the Rx their Dr. prescribes?

I see relying on any one system exclusively as a slippery slope I don't want to be on. Every system can have problems and we all need to be sensible, vigilant, and informed about which ever system(s) we buy into and the way in which we "treat" our bodies.


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RE: Evidence Based Medicine

EBM has never been proclaimed to be infallible. It is intended to produce the best possible decisions on patient care based on solid scientific and clinical evidence. This will not ensure perfect outcomes 100% of the time, but will increase the odds of a good outcome, due to the filtering out of bias, outmoded therapies and treatments backed only by conjecture and easily-manipulated personal testimonials.

"I have had many more reactions to pharmaceuticals than I have ever had from herbals"

A powerful and effective drug will commonly be associated with side effects of some sort. Many non-evidence based herbal drugs either have insignificant effects or are inert, and so naturally don't produce much in the way of side effects.
I've never heard a physician claim that any prescription drug is absolutely lacking in side effects.

Regarding side effects: a key factor is how badly the drug (pharmaceutical or herbal) is needed, and how effective it is for the condition for which it's taken. If we're at marked risk for cardiovascular disease, we may feel that the known side effects of statins are worth their proven beneficial effect. On the other hand, the desire to lose 30 pounds is not worth the risk of taking a Chinese herbal mixture which has not been shown to cause weight loss, and which contains an ingredient unknown to users that cause renal failure and cancer (this actually happened a few years back when severe kidney damage requiring transplantation was traced to an herbal mixture's containing aristolochia).

Hostility to the idea of EBM as expressed in this thread goes along with the hostility among some herbalism devotees to the concept of complementary medicine, where the best of "mainstream" and herbal medicine are combined. There should be no reason not to aim for evidence-based standards for all types of medical treatment that we employ.


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RE: Evidence Based Medicine

So Eric, if I don't embrace EBM unequivocally I am hostile to it, but if you criticize herbals you are not? When I say I have not had side effects from herbals that does not mean I have not had positive results from them which you seem to imply. I think your bias is showing and you are more than a little rude to speak to others in this manner on a herbalism forum.

I'm not sure where you get the idea that those of us who use herbs do not also use other complementary medical treatments or EBM as well. I've used many complementary medical systems over decades with variable results. I also have no compunction against using the orthodox system as well for acute conditions. Herbs just happen to be one of my favs as I find this method safe and gentle and I use it after much research and with common sense.

IMO EBM is in more trouble than it should be and there are many reasons for it, not the least of which are some of the serious problems with the pharmaceutical industry. Not necessary to get into that as most of us are well aware as you yourself are.


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RE: Evidence Based Medicine

"So Eric, if I don't embrace EBM unequivocally I am hostile to it, but if you criticize herbals you are not?"

No, I think you still misunderstood what is meant by EBM. You seem to be equating it to mainstream medical practice in general or the "pharmaceutical industry" (??), and viewing herbalism as something apart from it. A certain amount of herbalism falls under evidence-based medicine, and I certainly support that part, as well as using principles of EBM to evaluate the remainder.

As to side effects of drugs, I think the point is clear enough. Effective drugs which have marked effects on human physiologic reactions will by their very nature be more prone to side effects. Antibiotics which are powerful enough to vanquish life-threatening infections may be strong enough to damage healthy human tissue; the benefits have to be weighed against the risks. To cite a herb sometimes used against infection; garlic has a much milder mode of action than, say, vancomycin, and without significant side effects in most cases; on the other hand it will be useless against the serious cases of infection for which vancomycin works well.

I did not imply that you haven't had success using herbs.


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RE: Evidence Based Medicine

Science is the worst method of discovering the truth...........except for all the others


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RE: Evidence Based Medicine

It's really amazing what early physicians would do to their patients prior to EBM becoming a standard of Western medicine, like bloodletting.

Some say that Chinese herbalists were the first to utilize EBM although that wasn't a term coined until the early 1990's.

Florence Nightingale was a big contributor to EBM. She provided the evidence to skeptics that cleaning the filthy hospitals would reduce sickness and that having trained nurses would prevent deaths.

Evidence Based Medicine has been a wonderful advance in the treatment of patients as there is a lot less guesswork involved.

The question remains, what constitutes as evidence? The population on which things are tested, and the results may not be representative of all the studies that are completed on a given topic (published and unpublished) or may be misleading due to conflicts of interest.

That aside, I think herbalism is very evidence based, just not defined by the same standards as modern proponents of the theory.


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RE: Evidence Based Medicine

Florence Nightingale, Ignaz Semmelweis, Louis Pasteur, or any of the well-known pioneers of advances in sanitation and/or infectious disease would have welcomed modern standards of EBM, and in fact used a form of it in their work. After Nightingale began working at a military hospital in the Crimea in the 19th century..."It is directly through her thorough observations that the association linking sanitary conditions and healing became recognized and established. "Within 6 months of her arrival in Scutari, the mortality rate dropped from 42.7 percent to 2.2 percent"."

Note the part about "thorough observations", which sounds comparable to the collection of detailed clinical evidence by practitioners with clinical expertise that is a part of modern EBM. She did not rely on folklore, hearsay and testimonials to acquire her knowledge and save lives.

"The question remains, what constitutes as evidence? The population on which things are tested, and the results may not be representative of all the studies that are completed on a given topic (published and unpublished) or may be misleading due to conflicts of interest."

There are different types of studies that can be published, ranging from simple case reports all the way to large scale, well-conducted double blind clinical trials, which (especially when repeated with the same results by different researchers) form a gold standard for scientific research. Medical researchers are constantly refining our state of knowledge, not content with a static body of beliefs that have for the most part never been rigorously tested (as is the case with herbalism in general). The scientific community (including respected medical publications) as you know has been implementing more stringent policies to identify and publicize potential conflicts of interest. I would hope that the journals that publish reports about botanical drugs are planning to adopt similar standards.

So, will the research arm of EBM always get things right the first time, and always be 100% free of bias? Nope - but science is continually self-correcting and our knowledge improves constantly. Some users of alt med see this debate and constant change as a weakness*. The most astute know that no rigid set of beliefs is immune to challenge and that re-examination of medical practices is key to discarding useless or harmful procedures and developing the best possible ones to assure the best outcomes.

*I've actually heard chiropractors proudly announce that their beliefs are unchanged since the days of Daniel Palmer well over a century ago. ;)


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RE: Evidence Based Medicine

Eric, are you speaking to me when you write "Note the part about "thorough observations", which sounds comparable to the collection of detailed clinical evidence by practitioners with clinical expertise that is a part of modern EBM. She did not rely on folklore, hearsay and testimonials to acquire her knowledge and save lives."?

Because that is what I was saying! Florence Nightingale was one of the first in modern days to use statistics and compile evidence to prove her theory of sanitation and its connection to disease reduction. She has been called a fore fighter to the EBM movement. She did not rely on testimonials? Who is to say? She had to get her theory from somewhere. She may have heard it from her nurse friends. She may have heard it from her mother, aunt, sisters. She's just the first to show evidence on which to base her theory. She also proved that births at home were less dangerous simply because homes were kept cleaner than hospitals at the time.

Had she not provided evidence that trained nurses were more capable than untrained nurses, and that having trained nurses would reduce the death rate, would the rate of death from those nurses go up or down? No. But because of her research more nurses were trained and the death rate went down.

"Medical researchers are constantly refining our state of knowledge, not content with a static body of beliefs that have for the most part never been rigorously tested (as is the case with herbalism in general)."

Herbalism has been rigorously tested!!! Where do you think aspirin came from? Most drugs come from nature, and from self-studies over time that result in the masses knowing if you chew this bark your pain will go away. Not the most effective, as it will also eat your stomach lining and who wants to chew on bark anyway... but refining that knowledge is another step in our evolution.

Being able to prove something is effective is wonderful and necessary for treatment. But the ways in which things are tested, and the population on which its tested and the people who test it can also skew the results. Just look at the last major testing on homeopathy. The lab assistant was biased in favor and once they did blind testing all positive (in favor of homeopathy) results went out the window.


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RE: Evidence Based Medicine

"(Nightingale) did not rely on testimonials? Who is to say? She had to get her theory from somewhere."

A theory is only the first step. As the Wiki link relates, her thorough observations were a key step towards proving her theory. And that's how EBM essentially works - a theory undergoes rigorous research evaluation and trained clinical observation before it becomes accepted.

"Herbalism has been rigorously tested!!! Where do you think aspirin came from?"

It was invented by a German chemist, Felix Hoffman, in 1897. The initial use of salicylate, of course, was in preparations of willow bark, but the highly effective and (relatively) safe preparations we use today for pain, fever, to prevent blood clots etc. are based on research and clinical trials, some of which continue today. For every drug like aspirin though, there are lots of herbal remedies (apple cider vinegar, anyone?) that claim to solve long lists of health problems but have not had any kind of rigorous study to back up the claims. Much research has been done and more is occurring, and I anticipate that some folklore herbalism will be borne out; a much larger percentage will be found to be highly exaggerated, false, or prone to toxicity or other problems.

"But the ways in which things are tested, and the population on which its tested and the people who test it can also skew the results."

See my last post.


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RE: Evidence Based Medicine

Some herbs are sold in right along with regular medicines esp in Germany. According to a friend that lives there they are very common and have regular testing for strength etc. He was surprised that we did not have the same type of system. Perhaps other readers that have been in Germany can confirm. He is from the former East German area and perhaps that area is still following presplit practices.


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RE: Evidence Based Medicine

When we lived in West Germany many years ago I heard that herbs were prescribed and sold just like other Rx drugs. I did not go to German Doctors tho so didn't have first hand knowledge or the advantage of this system.

"The question remains, what constitutes as evidence?"

This is the question isn't it. It seems to me on this forum there are some who believe that double blind scientific studies are the only answer to this.

IMO anecdotal evidence, clinical observation, and personal experience combined can often provide evidence of the usefulness of a treatment. While the placebo effect is very real, I doubt it works 100% so many testimonies of an effect might be evidence of an actual effect.

I think Florence Nightingale was just an intelligent woman who did not fear change and who was not lazy. It should have been apparent to all Doctors in those days that filth was not healthy and washing your hands between patients made sense. However they were too weighed down by tradition.

Many years ago an MD told me that if ASA were to go thru clinical trials it would not pass. However, it has been accepted as a safe drug for so long that it is deemed safe.

There have been studies which show that the attitudes of the scientists involved had an effect on the outcome of the study. Not that they deliberately influenced the results but that in some way the results were affected by their attitudes. Anyone want to get into woo-woo physics? ;-) Scientists have stated that most physics books are out of date as the theories are changing so quickly. I wonder if the same thing happens in medicine, the extent of it, and how it affects EBM studies and treatments.

While science is continually self-correcting I think that once something has been shown to be of value under EBM it is somehow protected from further evaluation and it will be sometime before it is challenged and perhaps corrected. This is why I do not accept everything said at face value. I have seen too often that many ideas/treatments which were said to be valuable were later found to be not only of little value but dangerous.


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For Goshen

Goshen, I looked under wholistic kidney stone treatments in Google...hope you will call your doctor if this doesn't help.

A lot of people do not realize this, but Medical Assistance (for those under 65) or Medicaid are always available to people whose medical expenses go severely over their income.

If you need to be hospitalized again, be clear with the hospital that you are already under water with medical bills, and that they MUST help you to apply for MA.

A lot of agencies and institutions are being a lot more helpful under the new president than formerly...good luck with this.

Here is a link that might be useful: Earthclinic.com


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RE: Evidence Based Medicine

"It seems to me on this forum there are some who believe that double blind scientific studies are the only answer to this."

I've not seen anyone say this. If you look at the definition of EBM listed in a previous post, it refers to both systematic research and knowledgeable clinical observation as being necessary, and not that double blind studies are the only answer. There are cases where it is not ethical or practical to conduct double-blind studies (for example, no one would sanction a study in which people who suffer cardiac arrest are treated two ways - one, do nothing, or two, conduct advanced cardiac life support according to modern protocols, and see which group had better survival).

"While science is continually self-correcting I think that once something has been shown to be of value under EBM it is somehow protected from further evaluation and it will be sometime before it is challenged and perhaps corrected."

No, nothing gets grandfathered into semi-permanent use under principles of EBM. New ideas and studies are constantly shaking up ways of thinking about problems.

"It should have been apparent to all Doctors in those days that filth was not healthy and washing your hands between patients made sense. However they were too weighed down by tradition."

Are some herbalism advocates too weighed down by tradition to accept that many of their treatments are ineffective, superseded by better therapies, or too hazardous to use? Or are they willing to accept evidence-based change?

"There have been studies which show that the attitudes of the scientists involved had an effect on the outcome of the study. Not that they deliberately influenced the results but that in some way the results were affected by their attitudes."

We often see emphasis by alt med advocates on perceived faults and missteps by scientific researchers, as though instances of error or bias somehow negate the whole system.
To look at a somewhat analogous situation, take law enforcement. Along with the many instances of crimes prevented and solved by police, and lives saved through police action, there are well-publicized instances of police using excessive force or taking graft. When these failings come to light, do we say "Get rid of the police, let's take care of crime ourselves"? Well, a few out on the fringes might, but nearly everybody realizes that 1) police malfeasance will occasionally occur, 2) we need to maximize professional training and standards to minimize difficulties, and 3) have proper oversight to combat problems when they occur.
Choosing anarchy is not an option.

Anarchy is when every scientific/medical proposition is considered valid without regard to the facts, and whoever shouts slogans and testimonials the loudest wins the day.

With regard to the scientific method and medicine, it's like Brandon said earlier. It doesn't work perfectly all the time - it's just vastly preferable to every other alternative. And it's constantly improving itself and increasing our store of knowledge.

Here is a link that might be useful: Testimonials, science, and how not to be fooled


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RE: Evidence Based Medicine

Sorry folks, I don't see a single person address the cost of health care. Do all of you have your heads in the sand and don't know how bad our economy is basicaly due to the high cost of health care and not only to the cost of housing. Most of you cannot except that possibly you will be in the same boat within a year.I hope you wont but chances are you will be. Than an asprin might seem like a lifesaver. See you on the way down. Sure hope not.


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RE: Evidence Based Medicine

Cost is one of the many reasons to embrace evidence-based medicine. By emphasizing the use of truly effective therapies, EBM leads to the discarding of wastefully expensive modalities. If certain types of surgeries, drugs, supplements and various treatments don't make the grade, government and/or insurers will not fund them and more money will be left to spend on effective health care.

It'll be challenging to fight all the lobbies for outmoded or substandard treatments, but it needs to be done.


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RE: Evidence Based Medicine

hmm - I was raised to play both ends off the middle in a world where the 'disinfecting' ingredient in Listerine is a herbal extract called Thymol, digitalis is both a heart drug pill...and a favorite garden flower, and the greeks were right about electric eels and certain blue-green molds, and wrong about some other stuff...

but then, I don't 'get' the religon-vs-science arguements either - I see them both as needing the other to provide relevance and context.

I do see a difference between profit-driven health care economics, the world of medicine and surgery, and the whole idea that health care should revolve around promoting and maintaining health... the latter two are sides of the same coin, the first is just another form of greed.

I love that now there are chemical confirmations of active ingredients in many herbs, and the increased dialog on the various subjects...

but honestly? evidence doesn't do any good if you're not looking for it, and willing to compare different sources - whether you're talking about herbs, dermatology, or pizza.


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RE: Evidence Based Medicine

Chinacat:

"...but honestly? evidence doesn't do any good if you're not looking for it, and willing to compare different sources - whether you're talking about herbs, dermatology, or pizza."

LOL. Isn't that the truth!!!


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RE: Evidence Based Medicine

Well it's been awhile but have turned up again. Been a rough couple of months. Passed a couple of kidney stones. Still alive. Amazing how much pain the human body can stand. Decided to see a doctor a couple weeks ago.My mind decided to go ahead and pass the stone before hand. Saw doctor anyway. He's more concened about my heart. Since i've no fear of death. i just giggled at him. As stated above "Evidence does no good if you're not looking for it."

Have to argue a little about FN being the first to push washing hands between patients tho. Nostradamus was the first that i know of during the plague.
eric, i really hope you were'nt really pushing the American police State as a shining example.MSNBC had an article recntly that America has more people in jail or prison than any other country in the world,bar none. Every 1 in 10 people are in jail or prison at any one time and most are considered political prisoners not criminals. Hopefully the President will address that as well as the health care mess and the Economy.
Thanks for the referances however ER treatment can be free but longterm care is not to be had. Even University care from students is not free. I honestly hope none of you will be in such a position.
Hay on the upside it is spring. The flowers are blooming.
I'll be looking into the more non aggressive kidney stone treatments. I am doing great now. It's a beautiful world.


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RE: Evidence Based Medicine

Glad you're feeling better.

I'm a little confused about the "American police State" and what that has to do with evidence-based medicine. Though if we were all in jail there'd be free medical care, of sorts.

I don't think Nostradamus was the first to call for hand-washing between patients, though I hear he had a vague prediction that it would happen some day. "A rushing river flows through the continent under two suns, and a great leader is cured." ;)


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RE: Evidence Based Medicine

Goshen, I am really glad you're doing better.

I don't know who said FN was the first to push washing hands. I was saying that other people have pushed sanitation but she was the first to gather evidence and present it in order to get people to change their behavior. (and she probably had to gather evidence because no one would believe a female and a nurse in those days without it) Hence the "evidence based".

Eric, Goshen mentioned the police state because you mentioned it in relation to EBM and why it works. I agree with Goshen, probably a bad example:)

"To look at a somewhat analogous situation, take law enforcement. Along with the many instances of crimes prevented and solved by police, and lives saved through police action, there are well-publicized instances of police using excessive force or taking graft. When these failings come to light, do we say "Get rid of the police, let's take care of crime ourselves"? Well, a few out on the fringes might, but nearly everybody realizes that 1) police malfeasance will occasionally occur, 2) we need to maximize professional training and standards to minimize difficulties, and 3) have proper oversight to combat problems when they occur.
Choosing anarchy is not an option. "


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RE: Evidence Based Medicine

I suppose one would have to believe we live in a "police state" to make that leap of, um, logic.

" I agree with Goshen, probably a bad example:) "

Pick any field where adherence to scientific principles is considered important. In another thread someone who identified himself as having a degree in engineering was suggesting that testimonials were enough for him. I don't think he responded to a question about whether he'd feel safe going over a bridge whose construction was based on testimonials rather than sound design. There was a tragic bridge collapse in Minnesota because of faulty design. Because of that would you discard the whole idea of designing bridges for proper load and wear, and go by untested recommendations?

Usually weather forecasters are good at predicting hurricane strength and destination. Sometimes the forecasts are less than completely accurate. As a result, would you rely on an almanac or the reading of entrails to tell where and when a hurricane will hit?

As noted, basing medical therapy on sound scientific/clinical evidence doesn't guarantee a perfect result. It just works vastly better than any other system.


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RE: Evidence Based Medicine

Eric, are you saying the police force is based on scientific principles? I still think this is a lousy example, no matter how you twist it and shouldn't be used to compare the effectiveness of EBM. Where are the test studies of alternate means of "controlling" a population?

I'm not sure which thread you're referring to about the bridges, nor do I want to go looking. I agree that clinical evidence is important but will not discard herbalism simply because double blind studies have not been done on every remedy. It's wonderful when they can work together and that we have a choice of which to use for our problems.


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RE: Evidence Based Medicine

I agree that herbalism should be considered complementary to "mainstream medicine", and that physicians who are knowledgeable about what herbs their patients are taking can help optimize their therapy and avoid problems.

Not sure what the posted link has to do with herbalism, though.


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RE: Evidence Based Medicine

The thought of doing away with the "less effective" concerns me a bit.

Some herbs are less effective, but more affordable and available to some people.

Additionally, "less effective" for who? Many studies have only been done for males or certain age groups. Additionally, modern medicine has conveniently ignored, for a long time, the differing effects of medications and treatments on people of different genomes.


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RE: Evidence Based Medicine

Evidence-based medicine doesn't imply that all "less effective" drugs be eliminated, but that we shouldn't rely on useless ones.


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RE: Evidence Based Medicine

Intresting debate. However for a better debate How would it be for eric_oh to take the side for using herbs and everyone else take up for Western Medicine.

Am i wrong? This is an herbalism forum that i've been reading all day. I just joined BTW. spent part of the day on the vegatable forum. They agreeably talk about growing veggies.

Poor Eric seems so defensive about the medical system and jumps at the chance to be contentious about anything herbal. I wonder if he by chance has had a bad experience with something herbal and is out to get all herbalists or herbs in general.

BTW Nostradamos was a doctor and went through the French countryside caring for people with the plague and preaching that people should wash their hands between caring for patients.

Western Medicine is a boon to mankind but it never would have come about without herbalists to show the way.plus the ancient medicine men who experimented with surgeries. Modern doctors simply did not arise one day and say "I'm superior and know it all." They learned slowly on the backs of many men and women, who came before them and learning the hard way.
I can honestly say i've never met anyone who instantly knew all there is to know about medicine.Even any graduate from a medical school.


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RE: Evidence Based Medicine

Eric, Lucy, and myself are not against herbs, we are just against ineffective treatments. Efficacy is important to us.


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RE: Evidence Based Medicine

"This is an herbalism forum that i've been reading all day. I just joined BTW. spent part of the day on the vegatable forum. They agreeably talk about growing veggies."

Do newly registered posters over there start out by criticizing long-time forum participants, or does the agreeable atmosphere come about through civil discussion of forum-related topics?


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RE: Evidence Based Medicine

>> Eric, Lucy, and myself are not against herbs, we are just against ineffective treatments. Efficacy is important to us.

You are not only opposed to ineffective treatments, but also to effective treatments which simply have not been documented in the style you demand, to the degree which will personally convince you.


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RE: Evidence Based Medicine

help! the antagonism is stifling!!!

even on the hot topics forum people disagree cheerfully. i think something is rotten here...


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RE: Evidence Based Medicine

It doesn't even have to be cheerful, just civil (post #2 in this thread is a good example of the type of post it is pleasurable to read, whatever one's viewpoint is).

As indicated previously, EBM is not a creation of individual posters in this forum intended to stymie herbal remedies. It's an accepted and increasingly valuable way to optimize medical treatment of all types for the benefit of patients (see the posted link for details). When a particular therapy does not measure up by evidence-based standards, useful responses include getting the necessary evidence or, if it can't be found, considering whether to switch to proven treatment.

BTW, my limited exposure to the Hot Topics forum suggests that it is not always sunshine and lollipops there either :)


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RE: Evidence Based Medicine

"You are not only opposed to ineffective treatments, but also to effective treatments which simply have not been documented in the style you demand, to the degree which will personally convince you."

So is everyone. Unless you have a personal conduit to higher truth (if you say yes I will suggest you see a shrink) then you are relying on something you would call evidence. The difference is that I do not trust anecdotes. Any form of evidence that can equally well prove two diametrically opposed points of view isn't worth much to me. If I ran around spouting anecdotes or anecdotal traditions about how an herbal remedy was dangerous you would call me out on it and demand that I provide a study, I just ask for the same standard of evidence everywhere.


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RE: Evidence Based Medicine

Sorry guys, Thought i was just talking like everyone else here. May i ask for a scientific viewpoint then?
Lets say i'm a medicine specialist from the island of Java. I have a man come see me with a plant that his brother found and gave some to everyone in his village who had diarrea and vomiting except for 5 people who refused to take it. The next day everyone who took the plant was completely well however the 5 who refused it were much worse and than died. Now a question for Eric and Brandon and everyone else of course. Say you came downwith the same illness on the same day. Would you take the plant or insist on doing double blind research before taking the plant. It's a question to be debated nicely if you want. What if you were really in this situation? What would you do? It is possible one day you could really be in this situation. What would you do? What would be the commen sense thing to do? I know what i'd do. I'd take the plant in a heartbeat.
Now does anyone think this is an ugly unfair situation to ask? Or is this a good situation to debate nicely?

I would take the plant because i saw people who took it get well and people who did'nt die. I have a small spark of comman sense that tells me the odds are overwelmingly in my favor to take the medicine right then and not wait for someone to complete a double blind study. specially since those who did'nt take it died.

If 2 men died who took this plant and 2 got better who did'nt take the plant i'd still figure the odds were on my side.

I considered using a pill for the plant but decided this was an herbal forum and the plant was more suitable.Should anyone want to use a pill. Well dogone it have at it. ;)
Again i hope everyone takes this in the friendly spirit given and accept my apoligies for any insult i may have inadvertantly given previously.


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RE: Evidence- Based Medicine

In an extreme situation with no trained medical help available I might have to take a chance on something unproven. If I was on a remote tropical island and got bitten by a venomous snake known to cause fatality in a very high percentage of cases, and the only help around was from the local witch doctor who had a magic herb and could cast convincing spells, I'd probably go for it. But that is not the type of situation commonly encountered, in life or in this forum.

Usually that sense of urgency and extremely limited options does not exist. Here, typical questions might be "I want to lose weight and will this herbal mixture help me?" Or, "Can I burn off what I think is skin cancer with this herbal salve?"

In such instances there are other, better options and one can (and should) rank proven efficacy and safety highly in making a health care choice.


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RE: Evidence Based Medicine

Oh, and as to enthusiastic testimonials, let's take dral's hypothetical situation in Java and expand on it. Suppose a person did approach the doctor with a story about a wonder healing herb that resulted in a number of very sick people getting better. The doctor investigates and finds the man's brother has a website listing positive testimonials. An epidemiologist looks into the matter further, and finds that of 30 people with similar symptoms, half did not take the herb and all but three of them got better with rest and fluids. Of the half that did take the herb (along with rest and fluids), all but four got better (the herb promoter explains that those four should have gotten better, but had a bad attitude or didn't take the herb properly). The epidemiologist concludes there is no evidence that the herb works for this illness, and that controlled studies may be desirable. The herb seller goes on adding positive testimonials to his website and selling the herb over the Internet.

That's a hypothetical with real-world implications. :)


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RE: Evidence Based Medicine

OK! Lets say the FDA comes along and investigates the epidemiologist and finds out the good doctors brother just happens to own a company that sells a pill that will improve the symptoms though nobetter than the plant and can afford to pay for the forthcoming study and the scientific results. Greed and corruption happen on both sides of the fence in todays society. I'm sorry to say. Should both sides be as heavily regulated as the other and who will regulate the regulaters.

When one gets more complicated than the simple situation first posted. There are too many variables to say "This is ultimate truth" on any side. Thus any one individual can never be sure and may as well just toss a coin unless he personally knows the reliability of the researchers.Be he herbalist or Doctor. A pill never acts exactly the same on any one person in a group neither does an herb.


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RE: Evidence Based Medicine

"We can't trust anybody so let's listen to the people with the most appealing testimonials" is a recipe for disaster.

Yes, there are ethical lapses in all walks of life. But that doesn't mean we can afford to disregard all the advances scientific research has brought us, or to toss out the rigorous methods that made those advances possible.

There apparently are people who are willing to "just toss a coin" when it comes to their health, and that's their prerogative. Lots of us, before we take a pill, supplement or raw herb want good evidence on its safety and efficacy.

And that's where evidence-based medicine comes in.


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RE: Evidence Based Medicine

Disclaimers by any other name = evidence of no absolutes:
(1) see long lists of possible side effects accompanying pharmaceuticals
(2) see FDA dodge on packaging of herbs (ie: "not intended to diagnose, treat ...)


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RE: Evidence Based Medicine

First of all, the correctly described "dodge on packaging of herbs/supplements" is not attributable to the FDA. It's a ploy used by herb/supplement sellers to stay within the boundaries of DSHEA. That's the legislation passed by Congress that lets these companies get away with dodgy health claims without needing to supply evidence for them. The FDA has largely been taken out of the equation.

Listing of possible side effects from prescription drugs (whether common or rare) represent disclosure to clinicians and patients made possible by clinical trials, a form of evidence-based medicine.

The arguments that "there are no absolutes" and "every patient is different" are used by alt med advocates to try to denigrate scientific research (excepting of course research that seems to support their claims). These assertions are at best a gross exaggeration. With proper clinical testing of drugs (herbal or non-herbal), we can know whether the vast majority of people taking them will experience significant benefits or some other outcome. Individual side effects may vary - but we are all Homo sapiens and there are not such marked differences among us that we can never hope to predict how a clinically tested drug will work in the general population (clinical testing can be and has been expanded to include diverse groups that include both sexes, different races and children as well as adults).

It never ceases to amaze me that the proponents of "no two people are alike, what works for one may not on another, you have to try it to know for yourself" apparently expect us to sample all manner of different non-pharmaceutical drugs/supplements on an experimental basis. We're supposed to be guinea pigs for unproven remedies and have lots of money to shell out on things that have no reasonable expectation of working.

Thanks, but I'd rather not take these kinds of chances with my health or my wallet. Let me see that evidence for efficacy and safety before I take any drug or supplement.


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RE: Evidence Based Medicine

Found an interesting blog that discusses EBM from a British perspective.


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RE: Evidence Based Medicine

As evidence that there's increasing interest in evidence-based herbalism among patients and practitioners, here are a couple of recently published books on the subject.


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RE: Evidence Based Medicine

Eric I am new to this forum too. I came here to learn about herbs so I can get back into it and even start growing them in my garden.

I really do not want to offend you. Just looked how long you have been a member and seen that you like perennials and tree's

Can I ask you why you are interrested in herbs? Sorry if it has been answered or written somewhere already. I am just starting to work through the threads and somehow you are in each one of them rofl.

simplemary are you into holistic healing?

Lucy


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RE: Evidence Based Medicine

Here's a recent thread in which I and other posters talked about why we like to post here.

I've actually participated on GardenWeb since 1996 (before membership was required) and began posting on the Herbalism forum shortly after it was added to the site (it's been ten years or so).

Since you like to grow herbs you may also find the separate Herbs forum of interest.


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RE: Evidence Based Medicine

Eric thank you for the link. Gave me a little more insight to this forum and some folks.

Also reminding me that I can also look up at the Herbs forum. But my main intrest is here right now and the day only has so many hours and only so much time to play on the computer instead in the garden.

Thanks Lucy


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RE: Evidence Based Medicine

I actually agree with Eric that that's not a dodge on packaging by the FDA. Since anyone can claim anything on a package it's good to know what has and what has not been tested and found accurate by the FDA (even if they aren't the most stringent agency out there!). Otherwise anyone could say anything on the box "cures cancer" or "makes you beautiful" and consumers would believe it to be true because the box says so.

But... I also have really big issues with the long list of side effects. For me personally I'd rather try (first) for, example, sleep issues:

aromatherapy, massage, yoga, chammomile tea... etc... (ie things that have not perhaps been clinically studied and double blind tested)

than say, Ambien, which may cause me to do things while sleeping that I have no memory of the next day, may cause severe allergic reaction, or a host of other side effects like:

Daytime drowsiness
Dizziness
Diarrhea
Difficulty with coordination
Lightheadedness
Dry mouth
Heart palpitations
Tiredness
Inflammation of the sinuses (sinusitis)
Unexplained rash
Abnormal dreams
# Suicidal thoughts
# Confusion
# More outgoing or aggressive behavior than normal
# Strange behavior
# Depression (see Symptoms of Depression)
# Hallucinations (seeing, hearing, or feeling things that are not really there)
# Agitation or restlessness
# Fainting
# Slurred speech
# Coordination problems
# Vision changes

I would rather go by the low-dose, herbal knowledge that has been passed on and is based on historical evidence rather than clinical evidence because all the clinical evidence tells me is that in this case, if ambien were my only choice I think I'd rather have insomnia.

I appreciate evidence-based medicine principles and think they are good. But I don't think the resulting medicines are necessarily better. Having standardized methods for determining effectiveness of drugs is great, prevents a lot of unnecessary deaths and injuries and enables a more comprehensive idea of what truly does and doesn't work.

But, if chamomile tea does help me sleep, and there is no proof yet from the scientists, does it make the tea work less? Perhaps it is the placebo effect. Personally, if it is placebo, and there is not harm done, no outrageous cost, I'd rather sip my tea than pop a pill. Relying on testimonials for minor health issues is not dangerous if done with prudence (as with any health recommendations followed, including those from a licensed physician). The answer is that no one knows the answer yet.


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RE: Evidence Based Medicine

Going back to the recent thread on the teenager who was having problems with insomnia and whose mother wanted to know what herbal remedy to use, there was a general consensus among those of us responding that personal/school issues and lifestyle questions needed to be looked into before any sleep aid was recommended. And it makes a lot of sense to try non-drug modalities before going for any medication/supplement (which, if it works, is likely to be habit-forming).

It seems to me that this was mentioned before, but providing a comprehensive listing of a drug's possible side effects (which often looks scary, especially if you are unaware of the frequency and severity with which these may present) is a part of evidence-based medicine.

"...if ambien were my only choice I think I'd rather have insomnia."

You'd likely feel differently if you were plagued with insomnia. I've known people with this problem for whom it was a major health/quality of life issue, and after trying various approaches they'd sooner deal with the possibility of side effects and habituation than go through an endless succession of nights with poor quality or no sleep.


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RE: Evidence Based Medicine

"And it makes a lot of sense to try non-drug modalities before going for any medication/supplement (which, if it works, is likely to be habit-forming)."

Exactly. Which is why a lot of us try herbs prior to medications. I don't consider chamomile a drug or a supplement, nor do I consider most herbs drugs or supplements.

I have had insomnia. It's horrible, and anyone who can get relief however they can get relief is ok with me. But for me, personally, I'd rather have insomnia than take Ambien. Personally. Not recommending this to anyone. As you said, looking at lifestyle is the first step.

If one is overweight they should look into diet and exercise prior to taking a pill or whipping up an herbal concoction. But for me, my first step is diet/exercise/stresses/lifestyle. My second step is balance/deficiencies. My last step is Western medicine.

Unless I am about to get a migraine, which happens once or twice a year. Then I pop two pain relievers and am a very happy camper.


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RE: Evidence Based Medicine

Why do you think that Herbs aren't medication?


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RE: Evidence Based Medicine

Well... I don't consider yogurt to be a medicine. I consider it food. Same with chamomile, mints, oregano, stevia, cinnamon, etc. I will take milk thistle (food) if my stomach is hurting prior to busting out the pepto-bismol (medicine). Epsom salts, also not medicine.

I guess I consider medicine to be things that are manufactured and altered. Herbs are not drugs. They are food.

Perhaps it's not scientific or doesn't agree with what others define as foods/medicine... but it's the way I think.


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RE: Evidence Based Medicine

On the other hand, it's useful to consider herbs taken for medicinal use as medicine.

Food is something we ingest casually. Medications/drugs get more thought, including consideration of potential interactions and side effects, not to mention whether we need them in the first place.


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RE: Evidence Based Medicine

I don't ingest anything casually, most of all food. I consider every little thing that goes in my mouth, comparing nutrition and trying to balance. (check out the Diet Club!) Honestly I don't think of medicines more than food. But I am lucky in that I do not have any that I must take, therefore potential for interactions is low. Other than the occasional strep throat outbreak there are no prescriptions on my shelf.


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RE: Evidence Based Medicine

? Anybody see previous USA Surgeon General Dr. Kessler's published book implicating modern diet with addiction like neurochemical alteration ?


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RE: Evidence Based Medicine

I didn't, but I believe it. I know several people who "can't live" without their fast food and soda pop.

I consider my eating to be very "clean". I eat mostly fruits, vegetables, whole grains, fish, cheese (aged, real cheese), and some beef/chicken/pork on occasion. I don't drink soda. I do drink red wine and vodka. My meals are simple and I don't eat processed foods often, although I do love a burger and fries sometimes.


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