Your Neighborhood Witch Doctor
Dr. Kay: You have provided me with an extensive bibliography and mention that each of the herbal preparations "has some scientific 'cred' to support" its use, but you do not elaborate on the quality of such evidence. Many of the publications that you cite are either abstracts from meetings or articles in relatively obscure journals with low impact factors. As you well know, it is important to differentiate well-designed and carefully executed studies from those that are of lesser quality. I would appreciate your specific comments regarding the articles, among those that you list, which you find to be most interesting and of the best quality.
Dr. Wei: Do I detect a bit of sarcasm here? Granted, the journals cited don't have the cachet of more "scientific" journals. However, I'm amused and sometimes frustrated by smug academics. It reminds of the New Yorker cover depicting how New Yorkers view New York compared with the rest of the country. The attitude that comes across is, "If it wasn't published in the New England Journal of Medicine, it's not worth reading." It goes without saying, in some instances, that breakthroughs have been reported initially in obscure journals.
I grant that the data on herbal remedies have not been subjected to the same scrutiny as those drugs that have been approved by the FDA. Could it because there are no big dollars available for research into these potential remedies? Yes, some of the citations that I've provided come from obscure journals and report observations and individual case reports -- obviously not the rigorous fodder found in "scientific" journals. Nonetheless, empirical evidence, which often is based on an individual's perspicacity, can be instructive.
I disagree with your assertion that a treatment should be considered legitimate only after it has been scientifically scrutinized and proven to work in rigorous scientific studies. We're only as good as our science is right now. In a thousand years, I bet doctors will look back and say, "How could those doctors in 2013 have been so ignorant?"
With advances in quantum physics and other disciplines, what once appeared impossible is now considered doable. What is now considered hocus-pocus may someday be considered the norm. Even Einstein said, "Imagination is more important than knowledge" -- and he had a lot of knowledge!
Barry Marshall, an obscure internist from Western Australia, was ridiculed for his theory that peptic ulcer disease was caused by an infectious agent. I can remember a grand rounds lecture that I attended at which he was literally booed off the stage. This episode, of course, occurred before his winning the Nobel Prize in Medicine.
Dr. Kay: We can only evaluate existing therapies according to current knowledge. Certainly, information gained in the future may change the assessment of treatments that presently are considered to be state of the art. However, it is impossible to judge current practice according to a future paradigm.
Dr. Wei: The reason that clinical trials are double-blind as well as placebo-controlled is because of the subtle signals that a practitioner can send out regarding the presumed efficacy of an administered treatment. In days of yore, that subtle signal often helped patients to improve. Why is it that witch doctors and medicine men can heal? Could it be because their remedies actually work, or because they prescribe placebo and that their patients have faith in their healing powers? Now, we have treatments that are more effective than those of your neighborhood witch doctor. But before these treatments came along, that was all there was -- and it often worked. How is that unethical?