Thank you for your anecdotal evidence

[Mojo]

http://www.swindonlink.org/uploads/CAMs meeting letter 2nd June.pdf

Thank you all for sharing your personal experiences of various complementary therapies. It was interesting to note the cases of how herbal medicines, nutritional therapies and homeopathy in particular have played in your lives. The case studies of patients who had benefited from complementary therapies presented was also insightful.

...

Specifically, we agreed that NHS Swindon should explore Commissioning Homeopathy services. To the end, I will meet with Mr Andrew Ward, a local provider of homeopathic services to explore how to take this forward.

 

[phelix]

I guess the anecdotes are good to show that it's something people want.
What I don't get is the line at the bottom that "we all agree that not funding any CAM is not sustainable in the long term"

How is that not sustainable... It's not like it would be bad on the budget or result in a swindon "lack of wellness" epidemic...

 

[Aitch]

As a matter of interest, when do anecdotes become evidence?

Is it when someone in a white lab-coat writes them down in the approved format?

 

[fls]

As a matter of interest, when do anecdotes become evidence?

Is it when someone in a white lab-coat writes them down in the approved format?

This would be an example.

http://en.wikipedia.org/wiki/Milwaukee_protocol

Linda

 

[Perpetual Student]

An interesting related question is, "when is one justified in provisionally basing a health care decision on anecdotal evidence?" Similarly, when does it make sense to base a health care decision on incomplete scientific evidence?
We have had several discussions here about the use of substances like vitamin D, vitamin B, etc. and supplements like turmeric where is no conclusive scientific evidence supporting their use.
It seems (to me) that some medical practitioners feel their turf in being invaded when someone might use such supplements where there is little or no down side but here may be a significant benefit, like avoiding or delaying Alzheimer's disease. When one is approaching the age of vulnerability for such a devastating ailment, even if the odds are low of success, it might make sense to indulge in a relatively harmless supplement. Of course, if such a supplement can cause harm, the decision is not so straightforward.

 

[fls]

It seems (to me) that some medical practitioners feel their turf in being invaded when someone might use such supplements where there is little or no down side but here may be a significant benefit, like avoiding or delaying Alzheimer's disease.

I dunno. We let anecdote rule for hundreds of years and came up with gems like blood letting and arsenic poisoning. I think we'd be happy to let someone else take over and make fools of themselves for a while.

Linda

 

[Perpetual Student]

I dunno. We let anecdote rule for hundreds of years and came up with gems like blood letting and arsenic poisoning. I think we'd be happy to let someone else take over and make fools of themselves for a while.

Linda

Perhaps you could clarify the above sentiment. If you had a patient with a serious (life threatening or debilitating) illness, would you actually withhold information about an otherwise harmless treatment that might be beneficial but has only anecdotal and/or suggestive preliminary scientific support?

 

[fls]

Perhaps you could clarify the above sentiment. If you had a patient with a serious (life threatening or debilitating) illness, would you actually withhold information about an otherwise harmless treatment that might be beneficial but has only anecdotal and/or suggestive preliminary scientific support?

Sure. I presume that cancer would count. There are dozens if not hundreds of homeopathic remedies for cancer as well as other alternative remedies, which are supported by anecdote and are probably harmless. I don't tell my patients about any of them when treating their cancer (Note: I enlist the aid of an oncologist to treat their cancer).

Linda

 

[Aitch]

Actually, even though my previous post was couched in my usual smart-arse style, I think there is a small serious question in there.

I also think the answer is that anecdote becomes evidence when someone collects the anecdotes, analyses them and finds a pattern that can be use to devise an experiment to test whether the patten is real.

So, anecdotal evidence is useful, but not in its raw state.

 

[fls]

Actually, even though my previous post was couched in my usual smart-arse style, I think there is a small serious question in there.

I also think the answer is that anecdote becomes evidence when someone collects the anecdotes, analyses them and finds a pattern that can be use to devise an experiment to test whether the patten is real.

So, anecdotal evidence is useful, but not in its raw state.

I realized you were asking tongue-in-cheek...but you happened to hit the nail on the head.

The anecdotes I linked to were an example of the only time when anecdotes are actually evidence (this post describes what is meant by evidence http://www.internationalskeptics.com/forums/showthread.php?postid=7184962#post7184962). All-or-none case series (all the people used to die and now some do not, or some of the people used to die and now none do) are considered evidence on par with good quality placebo controlled randomized trials.

Linda

 

[Mojo]

I also think the answer is that anecdote becomes evidence when someone collects the anecdotes, analyses them and finds a pattern that can be use to devise an experiment to test whether the patten is real.

So, anecdotal evidence is useful, but not in its raw state.

Anecdotal accounts, even if collected together, almost inevitably report only positive experiences, and in the case of a medical treatment are not going to include any sort of control. They can be used to suggest a hypothesis, but they are not going to provide good evidence to support that hypothesis.

If the experiments contradict the anecdotes, I know which one I'll go with.

 

[Aitch]

Anecdotal accounts, even if collected together, almost inevitably report only positive experiences,

Which should still be enough to design an experiment. Isn't this what was done to debunk homeopathy?

and in the case of a medical treatment are not going to include any sort of control.

That comes in the experimental stage.

They can be used to suggest a hypothesis, but they are not going to provide good evidence to support that hypothesis.

Isn't that basically what I said? That you use any pattern/whatever that analysis turns up to design an experiment.

If the experiments contradict the anecdotes, I know which one I'll go with.

That's the whole point of doing the analysis and experiments.

 

[Mojo]

Isn't that basically what I said? That you use any pattern/whatever that analysis turns up to design an experiment.

Not quite: you said that "anecdote becomes evidence when someone collects the anecdotes, analyses them and finds a pattern that can be use to devise an experiment to test whether the patten is real". A collection of anecdotes may be useful in formulating a hypothesis, but it isn't good evidence.

 

[fls]

I'd be disinclined to refer to "anecdotal evidence" to begin with, since it isn't actually evidence (except in those very constrained circumstances I referred to earlier). Otherwise you get people claiming that it is "weak evidence" or "incomplete evidence" as though it tells us something is slightly more likely to be true than false, when it is really still very, very likely to be false.

Linda

 

[Aitch]

Not quite: you said that "anecdote becomes evidence when someone collects the anecdotes, analyses them and finds a pattern that can be use to devise an experiment to test whether the patten is real". A collection of anecdotes may be useful in formulating a hypothesis, but it isn't good evidence.

I see what you mean, but would say that if after analysis you have enough of a pattern (or whatever) to formulate a hypothesis (assuming it's possible that you can spend time doing all the analysis and come up with nothing) then you have evidence; not necessarily good evidence, but enough to take things further.

You may disagree, but look at it this way - it grew your thread a bit.

 

[Perpetual Student]

Sure. I presume that cancer would count. There are dozens if not hundreds of homeopathic remedies for cancer as well as other alternative remedies, which are supported by anecdote and are probably harmless. I don't tell my patients about any of them when treating their cancer (Note: I enlist the aid of an oncologist to treat their cancer).

Linda

Everyone reading this thread knows homeopathy is the antithesis of science and can have no possible efficacy. That was not even a remotely creative way of dodging my question and creating a straw man to thrash! I hope this is not an example of the kind of slight-of-hand responses you give your patients when they have legitimate questions.

I said:

"If you had a patient with a serious (life threatening or debilitating) illness, would you actually withhold information about an otherwise harmless treatment that might be beneficial but has only anecdotal and/or suggestive preliminary scientific support?"

I will give yoiu another chance to formulate an honest answer. I am talking about something that has a plausible mechanism, some anecdotal support and preliminary (but inconclusive) studies that hint toward a possible benefit. The evidence for turmeric and Alzheimer's comes to mind, but perhaps is not a good example because of the slow pace of the progression of that disease. I have a more acute condition in mind.

 

[CaveDave]

I dunno. We let anecdote rule for hundreds of years and came up with gems like blood letting and arsenic poisoning. I think we'd be happy to let someone else take over and make fools of themselves for a while.

Linda

Here's an anecdote:

A few years I had a "scare", which turned out to be "only" that my BP was around 260/140 (that's "head gasket" blowing territory) and I was having atrial fibrillation, PACs, and other nasties.
My attending ordered Coumaden (really PLEASANT belly-fat injections) and wanted me to "donate" (I would have to pay the blood bank, and it would be discarded) a pint or two, because my long,heavy smoking habit had "sludged up" my blood.

The only time I have heard of blood-letting being prescribed in modern times (well, other than Leeches for crush injury / wound care).

Dave

 

[fls]

Everyone reading this thread knows homeopathy is the antithesis of science and can have no possible efficacy. That was not even a remotely creative way of dodging my question and creating a straw man to thrash! I hope this is not an example of the kind of slight-of-hand responses you give your patients when they have legitimate questions.

I said:

I will give yoiu another chance to formulate an honest answer. I am talking about something that has a plausible mechanism, some anecdotal support and preliminary (but inconclusive) studies that hint toward a possible benefit. The evidence for turmeric and Alzheimer's comes to mind, but perhaps is not a good example because of the slow pace of the progression of that disease. I have a more acute condition in mind.

I was serious. I mentioned homeopathy and other alt-med therapies because that was the subject of the letter in the OP. Homeopathy has those things you asked for - plenty of anecdotes, in vivo and in vtro studies, plus clinical trials of various quality. Just because you find it implausible does not mean that others do.

I'm not sure your turmeric is a good substitute because we already have evidence that it is ineffective (pharmacokinetics show that the amount absorbed is trivial, an epidemiological study was negative (it was reported as though it was positive), and a clinical trial was negative) to put up against your non-evidence. Even if we stick with therapies which don't already have evidence against them, googling "alternative cancer therapies" gets you dozens of treatments for which testimonials abound and plausible sounding explanations are given. If I'm meant to be promoting unproven therapies, am I supposed to offer all of them? If not, how do I pick one or a few? To be honest, homeopathy makes the most sense, since at least I can be sure about the "do no harm" part.

Linda

 

[fls]

Here's an anecdote:

A few years I had a "scare", which turned out to be "only" that my BP was around 260/140 (that's "head gasket" blowing territory) and I was having atrial fibrillation, PACs, and other nasties.
My attending ordered Coumaden (really PLEASANT belly-fat injections) and wanted me to "donate" (I would have to pay the blood bank, and it would be discarded) a pint or two, because my long,heavy smoking habit had "sludged up" my blood.

The only time I have heard of blood-letting being prescribed in modern times (well, other than Leeches for crush injury / wound care).

Dave

It's a treatment for Hemochromatosis, and for Polycythemia (primary or secondary (as in your case)). Neither are common conditions.

I suspect your injections were heparin, not coumadin. Coumadin is given orally, but takes a few days to work. Heparin is given IV or subcutaneously and has an immediate effect, so it is used to cover you until the coumadin takes effect.

Linda

 

[CaveDave]

It's a treatment for Hemochromatosis, and for Polycythemia (primary or secondary (as in your case)). Neither are common conditions.

I was not familiar with those names (though I can get close by analysing the word structure), so I looked them up.
Yeah, the secondary form of the latter sounds like it fits, perhaps that explains, several years before the scare, the Doc seemed puzzled by an elevated hematocrit. My Dad, a retired physician, thought it was because of the altitude where I live (3256') and the test was given @ 427'. The Doc was dubious, but let it go.

I suspect your injections were heparin, not coumadin. Coumadin is given orally, but takes a few days to work. Heparin is given IV or subcutaneously and has an immediate effect, so it is used to cover you until the coumadin takes effect.

Linda

OK, I may have misremembered. I knew Heparin was used for hep-locks on IVs, and for sample tubes in lab work (like blood gas analysis), but I must have confused things a bit.

They only gave me 2 or 3 injections while they monitored me overnight.

Dave