Real medicine of which we know that it works but not how?

[k0pernikus]

I recently had a discussion about homeopathy with one of its proponents and hit the brick wall of "I know that it works but not how. Some things are unexplainable".

I tried to argue that even if something was yet unexplained of how it would work, we would at least be able to measure if it was working at all. Even if we did not know how antibiotics worked, they would beat the placebo effect nonetheless in a double blind study.

This got me thinking: Is there a current example of real medicine of which we know that it works but not yet how?

 

[Prolescum]

Re: Real medicine of which we know that it works but not how

Welcome to the forum.

I cannot think of one, but I haven't been to a hospital (as a patient) since around 1983 so I'm of practically no use.

Sorry...

Inferno has two or three blog posts on the subject, so he might have something constructive to add, although as you say, we'd still be able to measure effectiveness and similar.

 

[borrofburi]

Re: Real medicine of which we know that it works but not how

This got me thinking: Is there a current example of real medicine of which we know that it works but not yet how?

Anything prescribed for mental illness (brains are difficult). Even SSRIs for depression are still a bit uncertain. Also we thought stimulants for ADHD were about dopamine, but there are also classes of drugs that seem to pretty much only increase dopamine but don't seem to help ADHD. Ketamine seems to be inexplicably helping depression in some (double blind) trials (though I suspect those are currently small). Seriously, brains are hard.

 

[Inferno]

Re: Real medicine of which we know that it works but not how

Welcome Kopernikus.

What you have to understand first is that we don't know the pathways of basically any medicine for 100% certain. Would that count toward your question? Hardly.

Basically any new drug on the market is always uncertain, both in the "that" and "how" department. If we knew how it worked, we'd be fairly certain that it'd work. Instead, we do trials to see that it works and leave the "how" for later.
I'm currently too tired to find the exact reference, so I'll give you the gist of an example: (from Bad Pharma by Ben Goldacre)
Six people were given a new drug, to study the effects. If we had known what it would do to the body (the "how") we wouldn't have done that. A few days after being given the drug, the six people were dead. It had a completely unforeseen effect on the body which shut down the kidneys and killed them.

Would that count toward your question? In some ways I think it would, even though this is a negative example.

What will really count toward your question is the following:
In this article in the Guardian the presenter of "Drugs live" (a program investigating the effect of drugs) comes right out and says: "Incredibly, no one knows how it [MDMA; clinical-grade ecstasy] works in the brain, nor how harmful it is."

Additionally, there's this PDF:
"No one knows how prednisone works; we just know that it does."

You'll find that sentence a lot in medicine. We know very often that something works, but we may only have a hunch how it works.
That being said, homeopathy is suggested even though we know that it doesn't work and that the pathway suggested (the "how") can't work either.

 

[malicious_bloke]

Re: Real medicine of which we know that it works but not how

You'll find that sentence a lot in medicine. We know very often that something works, but we may only have a hunch how it works.
That being said, homeopathy is suggested even though we know that it doesn't work and that the pathway suggested (the "how") can't work either.

This is kind of what I was going to say

There are basically two stages to showing that homeopathy is bunk. Firstly every single mechanism they've ever described for how it works is childishly simple to demolish. Things like water memory and clathrates forming around nonexistent molecules, it's all nonsense. And that's when you can get any actual science out of them at all.

Secondly, if someone is claiming that homeopathy works, ask them to provide evidence of properly randomised and blinded clinical trials showing a clear trend of homeopathic remedies being more effective than a placebo.

This also goes for any other proposed treatment, you don't initially need to know how it works to demonstrate its effectiveness in a clinical trial. But homeopathy and pretty much all altmed wankery has never reached this stage.

Not strictly relevant, but totally fantastic so i'm going to link it anyway:

 

[Prolescum]

Re: Real medicine of which we know that it works but not how

Also not entirely relevant...

[centre][tweet]https://twitter.com/Tylzen/status/64980464762503168[/tweet][/centre]

 

[devilsadvocate]

Re: Real medicine of which we know that it works but not how

"You know what they call alternative medicine that has been proven to work? Medicine."

- Tim Minchin in the song "Storm".

 

[Inferno]

Re: Real medicine of which we know that it works but not how

- Tim Minchin in the song beatpoem "Storm".

Minor quibble.

 

[devilsadvocate]

Re: Real medicine of which we know that it works but not how

- Tim Minchin in the song beatpoem "Storm".

Minor quibble.

It might be a beat poem, as I have no idea what constitutes a beat poem other than taking Tim Minchin's word for it, but it's definitely a song.

 

[Inferno]

Re: Real medicine of which we know that it works but not how

It might be a beat poem, as I have no idea what constitutes a beat poem other than taking Tim Minchin's word for it, but it's definitely a song.

In a song, you sing. In a beatpoem, you talk. Both are acompanied by music.
This is not a song, it's a beatpoem.

 

[Aelyn]

Re: Real medicine of which we know that it works but not how

To further illustrate borrofburi and Inferno's replies, I was looking up paracetamol earlier for completely unrelated reasons, and what do you know according to Wikipedia "the mechanism of action of paracetamol is not completely understood" either. Paracetamol.

 

[Inferno]

Re: Real medicine of which we know that it works but not how

To further illustrate borrofburi and Inferno's replies, I was looking up paracetamol earlier for completely unrelated reasons, and what do you know according to Wikipedia "the mechanism of action of paracetamol is not completely understood" either. Paracetamol.

Here's the thing: Not a single pain-relieving medicine is, as far as I know, understood. We know they do something, like blocking pain receptors and so on, but not how nor why.
Take Morphine, formerly known as Morphium. It's been around since 1804, but we don't know jack about it.
If you want to make a name in medicine, find out how and why pain medication works.

 

[Aelyn]

Re: Real medicine of which we know that it works but not how

To further illustrate borrofburi and Inferno's replies, I was looking up paracetamol earlier for completely unrelated reasons, and what do you know according to Wikipedia "the mechanism of action of paracetamol is not completely understood" either. Paracetamol.

Here's the thing: Not a single pain-relieving medicine is, as far as I know, understood. We know they do something, like blocking pain receptors and so on, but not how nor why.
Take Morphine, formerly known as Morphium. It's been around since 1804, but we don't know jack about it.
If you want to make a name in medicine, find out how and why pain medication works.

To turn the OP's question on its head, is there any medication (or class of medication) the mechanism of which we do completely understand ?

Obviously the wiggle factor is "completely"; I assume we don't understand the body so well that we know how any drug works to an infinite level of precision... But I'm hoping that's not the standard people are using when they say "the mechanism is not completely understood".

 

[Inferno]

Re: Real medicine of which we know that it works but not how

To turn the OP's question on its head, is there any medication (or class of medication) the mechanism of which we do completely understand ?

To be fair, I think there are a few. Aspirin for example. My nearly-doctor flatmate gave me a pretty good summary of the mechanisms. I'm sure there are more.

 

[Homunclus]

Re: Real medicine of which we know that it works but not how

Also not entirely relevant...

[centre][tweet]https://twitter.com/Tylzen/status/64980464762503168[/tweet][/centre]

It is probably worth mentioning that this is not entirely accurate. When you consider the dilution ratios of "proper" homeophatic medicine, if you dissolved Bin Laden on the ocean the resulting solution would be way to concentrated! :lol:

 

[devilsadvocate]

Re: Real medicine of which we know that it works but not how

It might be a beat poem, as I have no idea what constitutes a beat poem other than taking Tim Minchin's word for it, but it's definitely a song.

In a song, you sing. In a beatpoem, you talk. Both are acompanied by music.
This is not a song, it's a beatpoem.

Not to escalate this futile argument further, but knowing something about music, the distinction you are putting forth is frankly asinine. Stuff that starts and stops with music in it is called a "song", whether it involves singing, talking, humming, whistling or no oral expression at all.

 

[Inferno]

Re: Real medicine of which we know that it works but not how

Not to escalate this futile argument further, but knowing something about music, the distinction you are putting forth is frankly asinine. Stuff that starts and stops with music in it is called a "song", whether it involves singing, talking, humming, whistling or no oral expression at all.

And I know nothing about music?

Anyway, this isn't my definition. It's called "beat poem" twice on wikipedia, but the definition refers to the "Beat Generation", which refers to the "rejection of received standards, innovations in style, experimentation with drugs, alternative sexualities, an interest in Eastern religion, a rejection of materialism, and explicit portrayals of the human condition."

That, evidently, does not refer to Tim Minchin's beat poem. So I looked up other definitions and they only have two things in common: A beat, usually underlined with music. (Though it can also be a rhythm, pure and simple.) And poetry, however loosely defined.

The boundaries to rap and hip hop are blurred, so it really remains with the artist to claim it as one or the other. That, as I understand it, has been done.

As such, your argument is not with me.