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On the Observed Specific and Non-specific Effects of Complex Therapeutic Interventions: Truly Separate or Complementary?

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GeNeDis 2014

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 821))

Abstract

Specific and non-specific effects observed in randomised controlled trials (RCTs) are generally treated implicitly as ontologically separate and purely additive. Building on the notions of Heisenberg uncertainty and complementarity from the discourse of quantum theory, and using a simple arithmetic argument, it is demonstrated how this separation enables results of RCTs (particularly of complex interventions) to be treated in a convenient but ultimately incorrect manner. Conclusions drawn from RCTs (that justify—and are justified by—a reductionist approach to therapeutic efficacy) should therefore be open to question.

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References

  1. McKibbon KA, Wilczynski N, Hayward RS et al. (1995) The medical literature as a resource for evidence based care. Working paper from the Health Information Research Unit, McMaster University, ON, Canada. http://hiru.mcmaster.ca/hiru/medline/asis-pap.htm. Accessed 17 Dec 2013

  2. Sackett DL, Rosenberg WMC, Muir Gray JA et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312(7023):71–72. http://cebm.jr2.ox.ac.uk/ebmisisnt.html. Accessed 17 Dec 2013

    Google Scholar 

  3. Cartwright N (2007) Are RCTs the gold standard? Biosocieties 2(01):11–20

    Article  Google Scholar 

  4. Cartwright N (2010) What are randomised controlled trials good for? Philos Stud 147:59–70

    Article  Google Scholar 

  5. Cartwright N, Munro E (2010) The limitations of randomized controlled trials in predicting effectiveness. J Eval Clin Pract 16(2):260–266

    Article  PubMed  Google Scholar 

  6. Rawlins M (2008) De Testimonio: on the evidence for decisions about the use of therapeutic interventions. The Harveian Oration. Delivered to the Royal College of Physicians, London 16th October 2008. ISBN 978-1-86016-3470; (2008) Clin Med 8(6):579–588; (2008) Lancet 372:2152–2161

    Google Scholar 

  7. Smith GCS, Pell JP (2003) Hazardous journey. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Br Med J 327:1459–1461

    Article  Google Scholar 

  8. Holmes D, Murray SJ, Perron A, Rail G (2006) Deconstructing the evidence-based discourse in health sciences: truth, power, and fascism. Int J Evid Based Healthc 4:180–186

    PubMed  Google Scholar 

  9. Devisch I, Murray SJ (2009) ‘We hold these truths to be self-evident’: deconstructing ‘evidence-based’ medical practice. J Eval Clin Pract 16:950–954

    Article  Google Scholar 

  10. Davies S (2013) http://www.telegraph.co.uk/health/healthnews/9822744/Homeopathy-is-rubbish-says-chief-medical-officer.html. Accessed 27 Jan 2014

  11. Weatherley-Jones E, Thompson EA, Thomas KJ et al (2004) The placebo-controlled trial as a test of complementary and alternative medicine: Observations from research experience of individualised homeopathic treatment. Homeopathy 93:186–189

    Article  CAS  PubMed  Google Scholar 

  12. Milgrom LR (2005) Are randomised controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology from the theoretical standpoint of patient-practitioner-remedy (PPR) entanglement. J Altern Complement Med 11(5):831–838

    Article  PubMed  Google Scholar 

  13. Walach H, Sherr J, Schneider R et al (2004) Homeopathic proving symptoms: result of a local, non-local, or placebo process? A blinded, placebo-controlled pilot study. Homeopathy 93:179–185

    Article  CAS  PubMed  Google Scholar 

  14. LeGouis C (1997) Positivism and imagination: scientism and its limits in Emile Hennequin, Wilhelm Scherer and Dmitril Pisarev. Bucknell University Press, London

    Google Scholar 

  15. Milgrom LR (2008) Homeopathy and the new fundamentalism: a critique of the critics. J Altern Complement Med 14:589–594

    Article  PubMed  Google Scholar 

  16. Collingwood RG (1940) An essay on metaphysics. 1940, revised edn 1998. Clarendon Press, Oxford

    Google Scholar 

  17. Derrida J (1973) Speech and phenomena and other essays on Husserl’s theory of signs. Northwestern University Press, Evanston, IL

    Google Scholar 

  18. Feyerabend P (1975) Against method: outline of an anarchistic theory of knowledge. Humanities Press, Atlantic Highlands, NJ

    Google Scholar 

  19. Feyerabend P (1979) Science in a free society. Routledge, London

    Google Scholar 

  20. Kuhn T (1963) The structure of scientific revolutions. University of Chicago Press, Chicago

    Google Scholar 

  21. Lakatos I (1978) The methodology of scientific research programmes: philosophical papers, vol 1. Cambridge University Press, Cambridge

    Book  Google Scholar 

  22. Okasha S (2002) Philosophy of science: a very short introduction. Oxford University Press, Oxford

    Google Scholar 

  23. Polanyi M (1958) Personal knowledge: towards a post-critical philosophy. University of Chicago Press, Chicago

    Google Scholar 

  24. Popper K (1959) The logic of scientific discovery. Basic books, New York

    Google Scholar 

  25. Leggett JR (1998) Medical scientism: good practice or fatal error. J R Soc Med 90:97–101

    Google Scholar 

  26. Centor RM (2007) To be a great physician, you must understand the whole story. MedGenMed 9(1):59

    PubMed Central  PubMed  Google Scholar 

  27. Huddle TS, Centor RM, Heudebert GR (2003) American internal medicine in the 21st century. Can an Oslerian generalism survive.? J Gen Intern Med 18:764–767

    Article  PubMed Central  PubMed  Google Scholar 

  28. Canguilhem G (1994) A vital rationalist: selected writings. Zone Books, University of Michigan; ISBN 0942299728, 9780942299724

    Google Scholar 

  29. Horton R (1995) Georges Canguilhem: philosopher of disease. J R Soc Med 88:316–319

    CAS  PubMed Central  PubMed  Google Scholar 

  30. British Medical Journal Clinical Evidence web-site (2011) http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp. Can no longer be accessed directly. Go to http://www.united-chiropractic.org/wp-content/uploads/2011/11/BMJ.pdf. Accessed 19 Dec 2013

  31. Nallamothu BK, Hayward RA, Bates ER (2008) Beyond the randomized clinical trial: the role of effectiveness studies in evaluating cardiovascular therapies. Circulation 118:1294–1303

    Article  PubMed  Google Scholar 

  32. Magni LR, Purgato M, Gastaldon C et al. (2013) Fluoxetine versus other types of pharmacotherapy for depression. Cochrane Database Syst Rev Issue 7. Art. No.: CD004185. doi: 10.1002/14651858.CD004185.pub3

  33. NHS Choices website (2012) http://www.nhs.uk/Conditions/SSRIs-(selective-serotonin-reuptake-inhibitors)/Pages/Side-effects.aspx. Accessed 05/01/2014

  34. Harvard Health Publications (2005) http://www.health.harvard.edu/newsweek/What_are_the_real_risks_of_antidepressants.htm. Accessed 05/01/2014

  35. Kirsch I, Deacon BJ, Huendo-Medina T et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med 25(2) e45:0261-0268

    Google Scholar 

  36. Silberman S (2009). Placebos are getting more effective. Drug makers are desperate to know why. Wired Magazine. http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all. Accessed 21 Jan 2014

  37. Kaptchuk TJ, Friedlander E, Kelley JM et al (2010) Placebos without deception: a randomised controlled trial in irritable bowel syndrome. PLoS One 5(12):e15591

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Paterson C, Dieppe P (2005) Characteristic and incidental (placebo) effects in complex interventions such as acupuncture. Br Med J 330:1202–1205

    Article  Google Scholar 

  39. Cox DA (2004) Galois theory. Pure and applied mathematics (New York). Wiley-interscience. Wiley, Hoboken, NJ. ISBN: 0-471-43419-1

    Google Scholar 

  40. Dummit DS, Foote RM (2004) Abstract algebra. 3rd edn, Wiley, New York. ISBN 0-471-43334-9

    Google Scholar 

  41. Petticrew M (2011) When are complex interventions ‘complex’? When are simple interventions ‘simple’? Eur J Public Health 21(4):397–398

    Article  PubMed  Google Scholar 

  42. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new medical research council guidance. Br Med J 337:a1655

    Article  Google Scholar 

  43. Greenberger DM, Horne MA, Shimony A, Zeilinger A (1990) Bell’s theorem without inequalities. Am J Phys 58:1131–1143

    Article  Google Scholar 

  44. Milgrom LR, Chatfield K (2011) “It’s the Consultation, Stupid!”….Isn’t it? J Altern Complement Med 17(7):1–3

    Google Scholar 

  45. Atmanspacher H, Romer H, Walach H (2001) Weak quantum theory: complementarity and entanglement in physics and beyond. Found Phys 32:379–406

    Article  Google Scholar 

  46. Walach H (2003) Entanglement model of homeopathy as an example of generalised entanglement predicted by weak quantum theory. Forsch Komplementmed 10:192–200

    Article  CAS  Google Scholar 

  47. Strocchi F (2008) An introduction to the mathematical structure of quantum mechanics: a short course for mathematicians. Advance series in mathematical physics, vol 8. World Scientific Pte Ltd., Singapore

    Google Scholar 

  48. Rosenfeld L (1963) Niels Bohr’s contribution to epistemology. Phys Today 16:47–54

    Article  Google Scholar 

  49. Greiner W (2001) Quantum mechanics: an introduction. Springer, New York

    Book  Google Scholar 

  50. Planck M (1931) I regard consciousness as fundamental. I regard matter as derivative. We cannot get behind consciousness. Everything that we talk about, everything that we regard as existing, postulates consciousness. The Observer, London. Accessed 25 Jan 1931

    Google Scholar 

  51. Stapp M (2007) Mindful universe: quantum mechanics and the participating observer. The frontiers collection. Springer, Berlin

    Google Scholar 

  52. Auyung SY (1995) How is quantum field theory possible? Oxford University Press, Oxford, UK

    Google Scholar 

  53. Wooters WK (1998) Quantum entanglement as a quantifiable resource. Phil Trans Roy Soc Lond 89:127–140

    Google Scholar 

  54. Zeilinger A (2004) Quantum teleportation and the nature of reality. Online document at: www.btgjapan.org/catalysts/anton.html Accessed 21 Mar 2008

  55. d’Espagnat B (2006) On physics and philosophy. Princeton University Press, Princeton, NJ

    Google Scholar 

  56. Gribbin J (1984) In search of Schrödinger’s cat: quantum physics and reality. Transworld, London, UK

    Google Scholar 

  57. Kant I (1781) Critique of Pure Reason. Translated by Smith NK, Palgrave-Macmillan, Basingstoke, UK, 2003

    Google Scholar 

  58. Milgrom LR (2008) A new geometrical description of entanglement and the curative homeopathic process. J Altern Complement Med 14:329

    Article  PubMed  Google Scholar 

  59. Weingartner O (2009) A formal approach to the problem of reproducing experimental results with homeopathic potencies. J Altern Complement Med 15(3):287–291

    Article  PubMed  Google Scholar 

  60. Smith K (2012) Against homeopathy—a Utilitarian perspective. Bioethics 26(8):398–409

    Article  PubMed  Google Scholar 

  61. Milgrom LR, Chatfield K (2012) Is homeopathy really ‘morally and ethically unacceptable’? A critique of pure scientism. Bioethics 26(9):501–503

    Article  PubMed  Google Scholar 

  62. Milgrom LR (2002) Patient-practitioner-remedy (PPR) entanglement. Part 1: a qualitative, non-local metaphor for homeopathy based on quantum theory. Homeopathy 91:239–248

    Article  CAS  PubMed  Google Scholar 

  63. Walach H, Möllinger H, Sherr J et al (2008) Homeopathic pathogenetic trials produce more specific than non-specific symptoms: results from two double-blind placebo-controlled trials. J Psychopharmacol 22(5):543–552

    Article  CAS  PubMed  Google Scholar 

  64. Dominici G, Bellavite P, di Stanislao C et al (2006) Double-blind placebo-controlled homeopathic pathogenic trials: symptom collection and analysis. Homeopathy 95:123–130

    Article  CAS  PubMed  Google Scholar 

  65. Milgrom LR (2006) Entanglement, knowledge, and their possible effects on the outcomes of blinded trials of homeopathic provings. J Altern Complement Med 12(3):271–279

    Article  PubMed  Google Scholar 

  66. Roberts AH, Kewman DG et al (1993) The power of non-specific effects in healing: implications for psychosocial and biological treatments. Clin Psychol Rev 13:375–391

    Article  Google Scholar 

  67. Wampold BE, Minami T, Tierney SC et al (2005) The placebo is powerful: estimating placebo effects in medicine and psychotherapy from randomised controlled clinical trials. J Clin Psychol 61(7):835–854

    Article  PubMed  Google Scholar 

  68. Rutten L, Mathie RT, Fisher P et al (2012) Plausibility and evidence: the case for homeopathy. Med Health Care Philos 16(3):525–532

    Article  Google Scholar 

  69. Lüdtke R, Willich SN, Ostermann T (2013) Are the effects of homeopathy attributable to a statistical artefact? A reanalysis of an observational study/evidence-based complementary and alternative medicine; Article ID 612890, 7 pages. doi:10.1155/2013/612890

    Google Scholar 

  70. Hahn RG (2013) Homoeopathy: meta-analyses of pooled clinical data. Forsch Komplementmed 20:376–381

    Article  PubMed  Google Scholar 

  71. Brien S, Lachance L, Prescott P et al (2011) Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology 50:1070–1082

    Article  PubMed Central  PubMed  Google Scholar 

  72. Ernst E (2011) Homeopathy, non-specific effects and good medicine: have we lost core medical values? Rheumatology 50:1007–1008

    Article  PubMed  Google Scholar 

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Correspondence to Lionel R. Milgrom Ph.D., C.Chem, FRSC .

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Milgrom, L.R. (2015). On the Observed Specific and Non-specific Effects of Complex Therapeutic Interventions: Truly Separate or Complementary?. In: Vlamos, P., Alexiou, A. (eds) GeNeDis 2014. Advances in Experimental Medicine and Biology, vol 821. Springer, Cham. https://doi.org/10.1007/978-3-319-08939-3_12

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