B.C. doctor told to stop using hallucinogenic tea to help addicts

[FluffyMcDeath]

I guess it depends when your morals lay. Is it okay to lie to someone in hopes they believe you and get better? If you're a formalized doctor I'd say it's counter to the Hippocratic Oath and immoral.

The placebo effect is real and you don't have to lie to make it work. Some treatments work on some people but not others (very much the case with mental health where hopping from medication to medication is pretty much normal procedure trying to find something that works). Do you suggest that since each individual prescription has such a low success rate, we abandon each of the chemicals in turn since they don't work for everyone?
And how can there be a trial if you are not allowed to use a treatment? It's not a case of "do a trial", but rather, don't do anything with that chemical. Perhaps the problem is that no-one sees hope for patenting it. Or maybe some pharmaceutical company right now is finding the work interesting and wants to do a trial and patent of an artificial version of the plant derivative or other psychedelic treatment which would compete. It wouldn't be the first time that a competing cheaply available alternative had been made illegal or shut down.
But the substance itself is not illegal and many of the people that Matte works with in the Downtown East Side are dying of their addictions. Our current federal government hates helping addicts.

 

[faethor]

1. Tell me when you get there.
2. Tell me when someone you love gets there.

1. - Obviously not yet.
2. - Done. --- Actually, I'm fairly liberal. I believe there is a graph of length of life vs potential of future happiness. For me there's a point of no return, determined by the individual. When someone I love is has a diagnosis that they cannot possibly recover I'm all for giving that person whatever the heck they want. I believe each person should be able to best determine how to go out of this world.

The placebo effect is real and you don't have to lie to make it work. Some treatments work on some people but not others (very much the case with mental health where hopping from medication to medication is pretty much normal procedure trying to find something that works). Do you suggest that since each individual prescription has such a low success rate, we abandon each of the chemicals in turn since they don't work for everyone?

Significantly higher healing rates from a placebo effect is done through lying. Yes there are a few that get better. Don't forget there are times the body heals or the diagnosis was wrong. We'd have to seperate the wheat from the chaff here to determine which was non-placebo healing.

And how can there be a trial if you are not allowed to use a treatment? It's not a case of "do a trial", but rather, don't do anything with that chemical.

They're using a medical treatment as there is none approved. They're using a home remedy which may/may not be effective. We just don't know. How to get a drug that might be good off the do not use list so a better experiment can be designed and conducted is a good question. I assume one would start in Countries that don't block it, Brazil in this case. I wonder if the history of Cannibais testing would give us some clues.

Perhaps the problem is that no-one sees hope for patenting it. Or maybe some pharmaceutical company right now is finding the work interesting and wants to do a trial and patent of an artificial version of the plant derivative or other psychedelic treatment which would compete. It wouldn't be the first time that a competing cheaply available alternative had been made illegal or shut down.

True but again the Doctor didn't bother to build an experiment nor properly track existing cases so he could report on the outcome. For a trained doctor he's doing too much throw shit at the wall and hope it sticks in my book.

But the substance itself is not illegal and many of the people that Matte works with in the Downtown East Side are dying of their addictions. Our current federal government hates helping addicts.

Again does this work?

 

[FluffyMcDeath]

Significantly higher healing rates from a placebo effect is done through lying. Yes there are a few that get better.

A few, and lying, as in doing a double blind study in which some people are given a test drug and others are given a placebo and the placebo effect is as significant as the drug under test - which confounds many double blind anti-depressant trials? There are conditions for which the placebo effect is incredibly strong. There are other conditions where it has almost no or little effect. It makes some clinical trials really difficult to do properly, on the other hand it also makes some drugs which are ineffective seem effective as sometimes there are pronounced side-effects and subjects make the presumption that if they are getting side-effects then they must be getting the "real-McCoy" .

Anyway, here is a talk by Gabor, but not on this exact subject, just thought it might be interesting.

Have a walk around the part of town he works in.

--edit
And, while googling "Downtown East Side" I came across several blog entries by a photographer I know through a mutual friend.
Downtown Eastside 1
Downtown Eastside 2
Downtown Eastside 3

 

[faethor]

A few, and lying, as in doing a double blind study in which some people are given a test drug and others are given a placebo and the placebo effect is as significant as the drug under test - which confounds many double blind anti-depressant trials?

IMO a double blind study isn't lying. All patients and doctors are informed, at least in the US, that they are taking part in a trial and a double blind. All know they may or may not get the working agent.

When I mean lying I mean when a Doctor tells a patient this treatment will help and fails to have the scientific proof that success, failure, side-effects, or dosage is adequate. Gabor appears to be using his opinion and that of group consensus, those in Brazil, that this works. He might be right. But, as a licensed and trained medical doctor he has failed to scientifically prove his guess is anywhere near correct.

There are conditions for which the placebo effect is incredibly strong. There are other conditions where it has almost no or little effect. It makes some clinical trials really difficult to do properly, on the other hand it also makes some drugs which are ineffective seem effective as sometimes there are pronounced side-effects and subjects make the presumption that if they are getting side-effects then they must be getting the "real-McCoy" .

Don't forget not all healing is placebo. As you posted the body can heal naturally and may do so on it's own. And diagnosis themselves may be wrong. For a drug to be seen as effective the rate of improvement for the actual group should be statistically signifcant above the control group. Certainly it's not always this way. These are people and a sysem afterall so there are mistakes. However, conflating a few mistakes to an unworkable system and therefore Doctors should do whatever they believe is best and only follow consensus is a failure within Gabor's medical training and post he holds. Again we have these people in society. We call them homeopaths and herbalists. They use group consensus as the 'proof' of efficacy and rarely move onto a study that something works or know the true side-effects.

Anyway, here is a talk by Gabor, but not on this exact subject, just thought it might be interesting.

Thanks. Didn't have time to watch it all. It's clear here that he does care. Though I argue so do many herbalists, priests, and others. I'd certainly wouldn't call a Christian priest a priest if he were promoting atheism because it might work for a small group of people somewhere else in the world. It's a failure of their school of thought and post.

 

[FluffyMcDeath]

When I mean lying I mean when a Doctor tells a patient this treatment will help and fails to have the scientific proof that success, failure, side-effects, or dosage is adequate.

So if a doctor tells you that this placebo will help you and it does then he is lying and if he says this anti-depressant will help you and it doesn't he is not lying? The science behind anti-depressants isn't understood and what works on whom isn't understood and most treatment is trial and error, going from drug to drug until some improvement is seen. You have some rosy view of this science but clinical practice is notoriously messy and all those "scientifically" demonstrated can have severe side effects - like, for example, death. There is a lot of snake oil out there and some of it is very expensive. Just because something is "science based" doesn't make it scientific, like "contains natural fruit flavours" doesn't mean it has fruit in it.

Gabor appears to be using his opinion and that of group consensus, those in Brazil, that this works. He might be right. But, as a licensed and trained medical doctor he has failed to scientifically prove his guess is anywhere near correct.

Medical doctors don't prove anything in their practices. That's not what practice is about. However, if they find methodologies that appear to work better than other methodologies that they otherwise use it seem prudent to explore them. The people he works with on the DTES are dying. They are "hopeless" addicts that the rest of us have basically given up on - they are hard cases else they wouldn't be where they are. If a person is dying of cancer oncologists feel justified in pumping them full of Chemotherapy drugs and treating them with radiation. These are two things you would never ever do to a healthy person because chemo drugs and radiation are two things KNOWN to cause cancer.

Don't forget not all healing is placebo. As you posted the body can heal naturally and may do so on it's own.

I'm not even sure what you are arguing about here. Placebo IS healing yourself. And as for diagnosis being wrong it's of very little relevance here. How do you misdiagnose an addict?

He is working with a very tough population - we have no idea what his protocol is nor what his results are - hardly anyone else cares about these people anyway and what they put in their bodies every day carries a significant risk of death and damage on an ongoing basis so what is the relative risk of a little hallucinogenic tea? This isn't hypertension or impotence. Ultimately addicts DO have to heal themselves - people that work with them know this but how can you get them to heal themselves?

 

[Glaucus]

I'm not even sure what you are arguing about here. Placebo IS healing yourself.

If you had a head x-ray and they told you that you have a brain tumor and you took a placebo and then the 2nd x-ray says your tumor is gone, there's a good chance you never had a tumor to begin with. You the patient may believe what you like about the pill given, but there was no healing done at all because there was no disease to begin with. First rule for any treatment is proper diagnosis and this is doubly true when conducting a study. Unfortunately diagnosis may be tricky for some conditions which may lead to an inflated placebo effect.

And as for diagnosis being wrong it's of very little relevance here. How do you misdiagnose an addict?

But what the Dr was treating wasn't the addiction. Not directly at least. The Dr was treating what caused the patients to become addicts in the first place. After all, addicts are usually attempting to self medicate. Here the diagnosis becomes critical as not everyone self medicates with the same addictive drugs for the same reasons.

He is working with a very tough population - we have no idea what his protocol is nor what his results are - hardly anyone else cares about these people anyway and what they put in their bodies every day carries a significant risk of death and damage on an ongoing basis so what is the relative risk of a little hallucinogenic tea? This isn't hypertension or impotence. Ultimately addicts DO have to heal themselves - people that work with them know this but how can you get them to heal themselves?

I see where you're coming from. We should definitely explore this as a possible treatment, but it needs to be explorer properly. The current Harper government gets bent out of shape at the slightest hint of illicit drug use and this Dr's past associations will certainly work against him here. It certainly is a catch 22. The thing with modern medicine is that it is designed to work as a system - all Drs prescribe the same drugs for the same symptoms and for good reason (and I know you're gonna say it's because that's what big pharma tells them to do, but that's not the reason). Drs who go rogue and operate outside the system can get themselves into trouble. There certainly are debates within the medical community about this - should Drs work with established guidelines, or just do whatever they see fit? There are some Drs who are truly brilliant and can work independently to great success, but they are the minority. The rest need (and want) guidance. You can argue either way, but in the end the majority will likely favor a tight system where every Dr is kept in line. This Dr is likely to hit a wall even amongst peers.

 

[Glaucus]

The science behind anti-depressants isn't understood and what works on whom isn't understood and most treatment is trial and error, going from drug to drug until some improvement is seen.

Psychiatry is problematic that way. However, scientists have a much better understanding of the effects of these drugs then psychiatrists are at diagnosing. Part of the reason they switch drugs is because it's the wrong drug because it's the wrong diagnosis. People go in with ADHD and get diagnosed as depressed or something else, and are given drugs that otherwise work fine but do nothing for ADHD. When that doesn't work, they change the diagnosis to something else and try again. There are unfortunately no blood tests or screenings that can help diagnose most psychiatric ailments and that's what makes psychiatry seem like a quack profession. But with time that may change, either through better training or better technology.

 

[FluffyMcDeath]

However, scientists have a much better understanding of the effects of these drugs then psychiatrists are at diagnosing.

It turns out that they don't - they only think they do. A theory gets popular, drugs are designed based on the theory, the results are hap-hazard in real life. The brain science is getting better and hopefully more diagnosis will start to be done on a structural/chemical basis but we are also learning (going back?) that the brain is a very plastic organ hugely influenced by experience (internal and external). The nature vs nurture debate is over. The answer is both - now it's just finding out about how much of what is from where.

Diagnosis by prescription is merely symptomatic of not really understanding either.

 

[FluffyMcDeath]

Here the diagnosis becomes critical as not everyone self medicates with the same addictive drugs for the same reasons.

Ta da! And the treatment as described allows the patients to see their reasons.

We should definitely explore this as a possible treatment, but it needs to be explorer properly. The current Harper government gets bent out of shape at the slightest hint of illicit drug use and this Dr's past associations will certainly work against him here.

The Harper government is philosophically opposed to helping addicts because it would be bad for the criminal drug industry. Similarly legalizing drugs would be bad for the the criminal drug industry and, as Portugal has demonstrated, would likely increase the number of people seeking treatment and reduce overall use. Partly this is their "moral" perspective but it isn't at all clear that there isn't also an agenda to maintain the profitability of the illicit trade - I've heard academics voice the suspicion.

all Drs prescribe the same drugs for the same symptoms and for good reason (and I know you're gonna say it's because that's what big pharma tells them to do, but that's not the reason).

Big Pharma DOES tell them what to do because big Pharma puts up big money to influence what Dr.s are taught in Med School, and puts up big money to fund the medical journals that tell Dr.s what the latest greatest thing is and they put up big money to send samples and information packets to Dr.s.I've been handed quite a large number of free samples by Dr.s when I come in and my symptoms match what's on the packet.

--edit
Of course, big pharma are constrained somewhat by the fact that they can't ship stuff that is immediately fatal - it will be noticed, but if a treatment is infrequently fatal then there is an economic disincentive. There are also well intentioned people working in the industry so many have the good of humanity in mind as an ideal and therefore some of that happens, but up at the top where the real money is made they often aren't scientists and tend to be venal and bloody minded. That's why Bayer could sell HIV infected products to people.

 

[faethor]

So if a doctor tells you that this placebo will help you and it does then he is lying

Again you'd still have to prove the placebo had an effect it wasn't the body itself through other means and it wasn't a misdiagonsis. If any placebo works through belief and causes the body to heal itself the innards of that placebo are unimportant. So, again we're back at give them sugar instead of a drug with unknowns.

if he says this anti-depressant will help you and it doesn't he is not lying?

Yes medicine is not an exact science when it comes to an individual If you really want treatment from someone that ignores clinic evidence then I suggest a Shaman. No need for that individual to focus their careers on understanding the science if they aren't going to be bothered to use it. I go back to saying don't tell me the Christian Pastor is doing God's work by making Atheists.

You have some rosy view of this science

Perhaps my rosy view is that when I go to someone who is trained and backing up their knowledge through science that I expect them to be using their knowledge of science to the best of their ability. Not prescribing home remedies they think might work but aren't evidenced except through consensus. I'm not arguing against the treatment as much as the artifical 'it works the doctor said so' in a patient when the Doctor doesn't know and can't be bothered to even gather a bit of his own successes or failures.

Medical doctors don't prove anything in their practices. That's not what practice is about.

No they should be using the best proven science in their practices not unproven solutions. An

However, if they find methodologies that appear to work better than other methodologies that they otherwise use it seem prudent to explore them.

Except for it appears Gabor isn't doing some basic accounting to establish that his methodology does work any better. He's trusting the masses who take this as having an honest and knowledgeable opinion. Opinion isn't scientific. If he's wants to use science he should at least start by charting success and failures so we might judge if this method's success rate is worth building a better experiment to clarify.

I'm not even sure what you are arguing about here. Placebo IS healing yourself.

To a degree you're right. I was making a distinction between self healing and self healing at a slightly higher rate through the use of a lie.

And as for diagnosis being wrong it's of very little relevance here. How do you misdiagnose an addict?

Comments on how this should work is more generality than this specific case. And again if we want to do whatever we want with addicts why bother with a high priced degree? Grab your local Mechanic call him a mind doctor and let him go to work assigning random undocumented treatments he feel might work best.

He is working with a very tough population - we have no idea what his protocol is nor what his results are

Exactly he's failing to track them yet claims wonderful success. First step in hiding the snake oil is to fail to create traceable documentation.

 

[FluffyMcDeath]

Again you'd still have to prove the placebo had an effect it wasn't the body itself through other means and it wasn't a misdiagonsis.

You can NEVER prove that. Because when the placebo has an effect it doesn't actually have any effect and it IS the body through other means. That is precisely what placebo means. There is no active medicine in a placebo so it MUST be the body healing itself through other means.
However, there is also the nocebo effect which can lead to opposite outcomes where you get sick because you believe that it will make you sick. Misdiagnosis and diagnosis both can have a nocebo effect.
But, again, you are talking ... for the sake of talking, I think. There are studies. It's not like no-one has ever looked at these effects before. There is an effect and if the doctor sincerely believes that sugar pills will fix what ailes you then he's not lying.

Perhaps my rosy view is that when I go to someone who is trained and backing up their knowledge through science that I expect them to be using their knowledge of science to the best of their ability.

You believe in them and what they do so you are already receiving the beneficial effects of placebo before you even take a pill. To that extent you are receiving shamanistic treatment - and bedside manner can make a big difference to outcomes despite it being highly subjective - hard to quantify and qualify but a detectable effect.

No they should be using the best proven science in their practices not unproven solutions.

And in areas where there isn't much proven anything - in cases that are resistant to proven whatever? Nothing?

Except for it appears Gabor isn't doing some basic accounting

assertion

I was making a distinction between self healing and self healing at a slightly higher rate through the use of a lie.

Must it be a lie? Didn't I already say near the top that studies say if a physician gives a placebo and explains why he expects a positive outcome then he can still get a positive outcome from a placebo without lying?

Grab your local Mechanic call him a mind doctor and let him go to work assigning random undocumented treatments he feel might work best.

Now you're not even being funny.

Exactly he's failing to track them yet claims wonderful success. First step in hiding the snake oil is to fail to create traceable documentation.

I'm sorry but I completely missed reading that bit. I'm still missing it. Where was the bit about him not tracking anything?

 

[faethor]

You can NEVER prove that. Because when the placebo has an effect it doesn't actually have any effect and it IS the body through other means. That is precisely what placebo means. There is no active medicine in a placebo so it MUST be the body healing itself through other means.

There are people that heal without a placebo. Because placebos heal through a psychological effect of positive thinking they are unpredictable and unreliable. Using them to expect healing is through some degree of lying.

However, there is also the nocebo effect which can lead to opposite outcomes where you get sick because you believe that it will make you sick.

There's some interesting work here. Did you ever see the Third-Arm Experiment? You can fake a person out to the degree they believe they have a 3rd arm. When you stab the 3rd arm that's in no way connected to the body they wince and expect pain.

And in areas where there isn't much proven anything - in cases that are resistant to proven whatever? Nothing?

Opportunity for research and growth in the field. But, yeah think back a mere decade we have medical treatments more successful than before. So now we have new options.

Now you're not even being funny.

Why not? If you are going to rely on a placebo effect might as well have that Doctor's certificate on the wall be a placebo too. Probably even more healing!

I'm sorry but I completely missed reading that bit. I'm still missing it. Where was the bit about him not tracking anything?

"While he doesn’t have numbers, Maté says he has had some significant successes with the tea, as well as some failures....Maté says he will comply with Health Canada’s order, which notes there are strict protocols that must be followed and approvals granted for restricted drugs. He said he will follow those protocols in a bind to gain authorization for the treatment." -- He stated that he wasn't following protocols. He stated that he didn't have a success rate. I'd be more convinced he was halfway using his scientific background to take a scientific approach if he could state he had a XX% rate. I'd at least more convinced he wanted science applied to verify the home remedy.

 

[FluffyMcDeath]

Chemotherapy damages the brain.
A guy I know who underwent chemo about 5 years ago knew about chemo-brain and so did his doctors and yet:

[...] doctors have traditionally dismissed these complaints attributing them to stress caused by cancer diagnosis and treatment.

Two things:
How could so many doctors see so many confirming cases and dismiss them? I guess there was no official study?
(obviously this isn't entirely accurate because my friends oncologist seemed to acknowledge it).
How could a doctor give someone dangerous chemicals with such serious side effects?