Well, myself, I practice holistic medicine. Not quite the same thing as naturopathy.

I go with what works and has provable results.

You are right, there is a lot of fakery and superstition in alternative medicine. Most of it is massively under regulated, though to some extent that is better than it being regulated out of existence.

Many natural or alternative healing methods are poorly researched and documented.

On the specific question about herbs. Just as with prescription medicines, many herbs have side effects and interactions that a good professional consultation will examine relative to your condition, diet, lifestyle, etc. Too many so called professionals don't do so.

I do an initial interview that takes about an hour and discuss your allergies, food preferences, other medicines taken, basic physical health issues, any ailments or other issues you have, then I go and do all my related research which takes as much as 6-8 hours, and you have to come back for the results. I believe it is the only way to start a course of alternative medicine.

Too many people are too quick to supply an answer and natural healing is not about a quick fix. It is about doing what the body needs to heal itself *over time*. Anyone in a hurry should go to a hospital.

Many "healers" have forgotten or never practiced according to the oath of making sure that you do no harm when you are supposed to be helping.

Hey Lauren,

Below is an article that helped put double-blind placebo-ness in its place for me.

Generally speaking, as a student of naturopathic medicine, I have come to believe that miracles happen everyday. I am not sure as to which reliable double-blind scientific studies you are referring to when it comes to homeopathy (if you have citaions, I would love to read them), but I have sat in on case studies where very very sick people have recovered from wretched diseases by using homeopathy. In the case of homeopathy, the art is in finding the right treatment for the specific person. But that's not the point here.

Your friends, however wellness-minded they are, do not sound like they are trained naturopathic physicians. They may or may not have an accurate way of knowing which herbs or homeopathic treatment would work best for you. This may be one of the reasons your expereinces with natural medicine have not gone well for you. It could be like someone giving you an antacid for a headache. Naturopaths who have attended accredited university programs take five quarters of herbs, three quarters of homeopathy, five quarters of physical medicine, four quarters of nutrition, and four quarter of counseling: it's meant to be effective and versatile medicine.

The great thing about a naturopath is that they're all different, with respect to what they specialize in and how they view the medicine. If you don't believe in homeopathy, don't go see someone who fancies it. There's plenty of folks to choose from: you can find a local at www.naturopathic.org

Anyway, just some thoughts. Feel free to write me with anymore questions or further discussion you wish to have. I hope you find this dialogue useful in some way.

Peace

Cecily

Oh yeah, and that journal article:

BMJ 2003;327:1459-1461 (20 December), doi:10.1136/bmj.327.7429.1459

Hazardous journey
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
Gordon C S Smith, professor1, Jill P Pell, consultant2

1 Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU

Correspondence to: G C S Smith gcss2@cam.ac.uk


Abstract
Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.

Design Systematic review of randomised controlled trials.

Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall.

Main outcome measure Death or major trauma, defined as an injury severity score > 15.

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.



Introduction
The parachute is used in recreational, voluntary sector, and military settings to reduce the risk of orthopaedic, head, and soft tissue injury after gravitational challenge, typically in the context of jumping from an aircraft. The perception that parachutes are a successful intervention is based largely on anecdotal evidence. Observational data have shown that their use is associated with morbidity and mortality, due to both failure of the intervention1 2 and iatrogenic complications.3 In addition, "natural history" studies of free fall indicate that failure to take or deploy a parachute does not inevitably result in an adverse outcome.4 We therefore undertook a systematic review of randomised controlled trials of parachutes.


Methods
Literature search
We conducted the review in accordance with the QUOROM (quality of reporting of meta-analyses) guidelines.5 We searched for randomised controlled trials of parachute use on Medline, Web of Science, Embase, the Cochrane Library, appropriate internet sites, and citation lists. Search words employed were "parachute" and "trial." We imposed no language restriction and included any studies that entailed jumping from a height greater than 100 metres. The accepted intervention was a fabric device, secured by strings to a harness worn by the participant and released (either automatically or manually) during free fall with the purpose of limiting the rate of descent. We excluded studies that had no control group.

Definition of outcomes
The major outcomes studied were death or major trauma, defined as an injury severity score greater than 15.6

Meta-analysis
Our statistical apprach was to assess outcomes in parachute and control groups by odds ratios and quantified the precision of estimates by 95% confidence intervals. We chose the Mantel-Haenszel test to assess heterogeneity, and sensitivity and subgroup analyses and fixed effects weighted regression techniques to explore causes of heterogeneity. We selected a funnel plot to assess publication bias visually and Egger's and Begg's tests to test it quantitatively. Stata software, version 7.0, was the tool for all statistical analyses.


Results
Our search strategy did not find any randomised controlled trials of the parachute.



Parachutes reduce the risk of injury after gravitational challenge, but their effectiveness has not been proved with randomised controlled trials
Credit: HULTON/GETTY



Discussion
Evidence based pride and observational prejudice
It is a truth universally acknowledged that a medical intervention justified by observational data must be in want of verification through a randomised controlled trial. Observational studies have been tainted by accusations of data dredging, confounding, and bias.7 For example, observational studies showed lower rates of ischaemic heart disease among women using hormone replacement therapy, and these data were interpreted as advocating hormone replacement for healthy women, women with established ischaemic heart disease, and women with risk factors for ischaemic heart disease.8 However, randomised controlled trials showed that hormone replacement therapy actually increased the risk of ischaemic heart disease,9 indicating that the apparent protective effects seen in observational studies were due to bias. Cases such as this one show that medical interventions based solely on observational data should be carefully scrutinised, and the parachute is no exception.

Natural history of gravitational challenge
The effectiveness of an intervention has to be judged relative to non-intervention. Understanding the natural history of free fall is therefore imperative. If failure to use a parachute were associated with 100% mortality then any survival associated with its use might be considered evidence of effectiveness. However, an adverse outcome after free fall is by no means inevitable. Survival has been reported after gravitation challenges of more than 10 000 metres (33 000 feet).4 In addition, the use of parachutes is itself associated with morbidity and mortality.1-3 10 This is in part due to failure of the intervention. However, as with all interventions, parachutes are also associated with iatrogenic complications.3 Therefore, studies are required to calculate the balance of risks and benefits of parachute use.

The parachute and the healthy cohort effect
One of the major weaknesses of observational data is the possibility of bias, including selection bias and reporting bias, which can be obviated largely by using randomised controlled trials. The relevance to parachute use is that individuals jumping from aircraft without the help of a parachute are likely to have a high prevalence of pre-existing psychiatric morbidity. Individuals who use parachutes are likely to have less psychiatric morbidity and may also differ in key demographic factors, such as income and cigarette use. It follows, therefore, that the apparent protective effect of parachutes may be merely an example of the "healthy cohort" effect. Observational studies typically use multivariate analytical approaches, using maximum likelihood based modelling methods to try to adjust estimates of relative risk for these biases. Distasteful as these statistical adjustments are for the cognoscenti of evidence based medicine, no such analyses exist for assessing the presumed effects of the parachute.

The medicalisation of free fall
It is often said that doctors are interfering monsters obsessed with disease and power, who will not be satisfied until they control every aspect of our lives (Journal of Social Science, pick a volume). It might be argued that the pressure exerted on individuals to use parachutes is yet another example of a natural, life enhancing experience being turned into a situation of fear and dependency. The widespread use of the parachute may just be another example of doctors' obsession with disease prevention and their misplaced belief in unproved technology to provide effective protection against occasional adverse events.




What is already known about this topic
Parachutes are widely used to prevent death and major injury after gravitational challenge

Parachute use is associated with adverse effects due to failure of the intervention and iatrogenic injury

Studies of free fall do not show 100% mortality

What this study adds

No randomised controlled trials of parachute use have been undertaken

The basis for parachute use is purely observational, and its apparent efficacy could potentially be explained by a "healthy cohort" effect

Individuals who insist that all interventions need to be validated by a randomised controlled trial need to come down to earth with a bump






Parachutes and the military industrial complex
However sinister doctors may be, there are powers at large that are even more evil. The parachute industry has earned billions of dollars for vast multinational corporations whose profits depend on belief in the efficacy of their product. One would hardly expect these vast commercial concerns to have the bravery to test their product in the setting of a randomised controlled trial. Moreover, industry sponsored trials are more likely to conclude in favour of their commercial product,11 and it is unclear whether the results of such industry sponsored trials are reliable.

A call to (broken) arms
Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.




--------------------------------------------------------------------------------
Contributors: GCSS had the original idea. JPP tried to talk him out of it. JPP did the first literature search but GCSS lost it. GCSS drafted the manuscript but JPP deleted all the best jokes. GCSS is the guarantor, and JPP says it serves him right.
Funding: None.

Competing interests: None declared.

Ethical approval: Not required.


References

Belmont PJ Jr, Taylor KF, Mason KT, Shawen SB, Polly DW Jr, Klemme WR. Incidence, epidemiology, and occupational outcomes of thoracolumbar fractures among US Army aviators. J Trauma 2001;50: 855-61.[ISI][Medline]
Bricknell MC, Craig SC. Military parachuting injuries: a literature review. Occup Med (Lond) 1999;49: 17-26.
Lasczkowski G, Hasenfuss S, Verhoff M, Weiler G. An unusual airplane crash—deadly life saver. Unintentional activation of an automated reserve opening device causing airplane accident. Forensic Sci Int 2002;125: 250-3.[CrossRef][ISI][Medline]
Highest fall survived without a parachute. In: Cunningham A. Guinness world records 2002. London: Guinness World Records, 2002.
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF, for the QUOROM Group. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 1999;354: 1896-1900.[CrossRef][ISI][Medline]
Lossius HM, Langhelle A, Reide E, Pillgram-Larsen J, Lossius TA, Laake P, et al. Reporting data following major trauma and analysing factors associated with outcome using the new Utstein style recommendations. Resuscitation 2001;50: 263-72.[CrossRef][ISI][Medline]
Davey Smith G, Ebrahim S. Data dredging, bias, or confounding. BMJ 2002;325: 1437-8.[Free Full Text]
Pines A, Mijatovic V, van der Mooren MJ, Kenemans P. Hormone replacement therapy and cardioprotection: basic concepts and clinical considerations. Eur J Obstet Gynecol Reprod Biol 1997;71: 193-7.[CrossRef][ISI][Medline]
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288: 321-33.[Abstract/Free Full Text]
Lee CT, Williams P, Hadden WA. Parachuting for charity: is it worth the money? A 5-year audit of parachute injuries in Tayside and the cost to the NHS. Injury 1999;30: 283-7.[CrossRef][ISI][Medline]
Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326: 1167-70.[Abstract/Free Full Text]
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Rapid Responses:
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Uh huh
Joseph E Morales
bmj.com, 19 Dec 2003 [Full text]
Parachutes, padded pants and beneficence
Peter Griffiths
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inherently dangerous behaviors
Emily Jane Woo, MD, MPH
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Excellent Article for Citation and Debate
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Zachary T Bloomgarden
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