MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

We have probably all fallen into the trap of thinking that something which has stood the ‘test of time’, i.e. something that has been used for centuries with apparent success, must be ok. In alternative medicine, this belief is extremely wide-spread, and one could argue that the entire sector is built on it. Influential proponents of ‘traditional’ medicine like Prince Charles do their best to strengthen this assumption. Sadly, however, it is easily disclosed as a classical fallacy: things that have stood the ‘test of time’ might work, of course, but the ‘test of time’ is never a proof of anything.

A recent study brought this message home loud and clear. This trial tested the efficacy of Rhodiola crenulata (R. crenulata), a traditional remedy which has been used widely in the Himalayan areas and in Tibet to prevent acute mountain sickness . As no scientific studies of this traditional treatment existed, the researchers conducted a double-blind, placebo-controlled crossover RCT to test its efficacy in acute mountain sickness prevention.

Healthy adult volunteers were randomized to two treatment sequences, receiving either 800 mg R. crenulata extract or placebo daily for 7 days before ascent and two days during mountaineering. After a three-month wash-out period, they were crossed over to the alternate treatment. On each occasion, the participants ascended rapidly from 250 m to 3421 m. The primary outcome measure was the incidence of acute mountain sickness with headache and at least one of the symptoms of nausea or vomiting, fatigue, dizziness, or difficulty sleeping.

One hundred and two participants completed the trial. No significant differences in the incidence of acute mountain sickness were found between R. crenulata extract and placebo groups. If anything, the incidence of severe acute mountain sickness with Rhodiola extract was slightly higher compared to the one with placebo: 35.3% vs. 29.4%.

R. crenulata extract was not effective in reducing the incidence or severity of acute mountain sickness as compared to placebo.

Similar examples could be found by the dozen. They demonstrate very clearly that the notion of the ‘test of time’ is erroneous: a treatment which has a long history of usage is not necessarily effective (or safe) – not only that, it might be dangerous. The true value of a therapy cannot be judged by experience, to be sure, we need rigorous clinical trials. Acute mountain sickness is a potentially life-threatening condition for which there are reasonably effective treatments. If people relied on the ‘ancient wisdom’ instead of using a therapy that actually works, they might pay for their error with their lives. The sooner alternative medicine proponents realise that, the better.

3 Responses to There is nothing like the ‘test of time’…to mislead us

  • Many traditions are really about the formation of superstition. Especially in cultures where ancestor worship is strong, doing what one’s predecessors did (without doubt or question) can literally be a religious duty. In the Rhodiola example, the fact that someone in the past had taken Rhodiola and survived a dangerous climb may have been all that was needed to spark the tradition. One instance of “post hoc” attribution of causation instead of correlation has created many medical traditions. If others use the technique and survive, it strengthens the notion. If they don’t survive, explanatory excuses such as “too late,” “not enough,” “incorrect preparation,” “conflicted with spicy foods or seafoods, etc.,” or “it was his time to die, you can’t change fate” all can defend the superstitious tradition in the face of conflicting reality. Only a large enough study with good blinding and a credible placebo control can really discover the truth about many of these traditional herbal remedies.
    Not that the many fans of Rhodiola products will stop using them for “mood, energy, and endurance boosting.” I have no doubt that Rhodiola can subjectively boost perception of improved mood, energy, and endurance in those who believe it will do those things.

  • So it focuses their intent.

  • You can say it focuses their intent, but it is important to note that it does so no more than a placebo pill, and that the *perception* of increased mood, energy, and endurance does not translate to actual increased *performance*. This has been shown in nausea/vomiting studies with acupuncture where the patients reported they *felt* less nauseous, but they still vomited the same number of times as the other groups. Often this sort of reporting can be due to unconscious social pressure (not wanting to let one’s therapist down), or as a way of defending one’s own purchases (i.e. “I spent money on it, so I must feel better than I would have if I hadn’t”). When it comes to preventing dangerous diseases (malaria, for example), a fake remedy which makes hopeful users “feel” more protected has significant risk for indirect harm. Same with asthma, where placebo-based interventions (like acupuncture) often lead to subjective reports of improvement, but actual measures of lung volume show no improvement.

    In terms suitable for a SubGenius (as Bob Dobbs is the figurehead of that sarcastic, humorous “religion”), If Bob’s pipe had fake Frop in it, he may report feeling plenty of Slack from smoking it, but when his behavior was measured objectively, would still be doing the same amount of actual useful chores, etc., as someone who hadn’t smoked Frop. If he smoked real Frop, however, he would be truly Slacking Off and not accomplishing anything “useful” in both objective and subjective measurements.

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