Thank you for your interest in migraine and your contributions to this forum. I appreciate your sincerity and desire to assist migraine sufferers. I just have a few comments.
I have just taken the time to review this thread in some detail and I am reminded of what concerned me from the beginning. Obviously this is mostly a conversation between Scott and myself which is fine. I think I am a little frustrated at your ability to be so dismissive of the philosophical basis from which i am arguing. So let me address some of my earlier points.
I think philosophy and science are two quite different disciplines, with different methodolgies. Not that there isn’t room for a philosophical approach, just that it is not science.
The Second Gold Standard of Research. The observational skills of scientist, researchers and doctors cannot be so easily dismissed. Your comment:
“This is where people really get tripped up. It’s very important to realise that no one can completely rely on their own subjective experience as evidence that a treatment or experiment actually works without appropriate controls being put in place. It can be and is very deceiving and we simply cannot rely upon it. All of us, no matter how well educated, are prone to misperception, biased memory, confirmation bias, the need to justify our beliefs, influenced by the fact that we’ve invested in a treatment, and influenced in our hoping that the treatment will work.”
While i can agree that placebo controlled studies are best able to determine what a specific treatment may or may not accomplish, i was speaking more from a philosophical basis. Darwin, Einstein, Newton, Edison, and many others who are credited with adding tremendous amounts to our scientific knowledge did not rely on double blind placebo controlled studies. Rather it was their careful observations that led to their theories that over time have been accepted as scientific fact.
These theories have been accepted after numerous other studies confirmed their plausibility. I’m not sure all their theories have actually been accepted as “fact”, eg evolution, but as plausible.
Along these lines how can we look at the various manifestations of migraine and conclude that it is the same disease in all that suffer. How is it possible to look a women who gets migraines every month at her cycle and a man who gets a migraine every time the barometric pressure drops and conclude they have the same disease? The only way it is possible is to conclude that the symptoms = the disease and if you can design a drug or nutritional supplement that relieves their pain than you have treated their disease. But come on, how can you look at those two people and say they have the same problem? This is in essence the problem with the medical paradigm as it exists today. The migraine sufferer has a clearer understanding of what i am saying than the doctors treating them, no disrespect to any doctors intended.
Many diseases are experienced differently by the sufferer but remain the same disease. Similarly, there are many varying triggers for the same disease. This doesn’t mean the disease is a unique disease or even a unique strain. The evidence does seem to stack up that migraine is a disease of the brain, albeit one which manifests in many areas of the body (which we would expect for a brain disease). It is also well known that migraineurs all experience a range of weird symptoms, including in the gut (abdominal migraine) and that there is a relationship between migraine and a range of other conditions. Further, we also know that each migraineur responds differently to various treatments (not just drugs) so there may well be a place for a gut treatment.
How can we observe that certain foods trigger a migraine and dismiss the possibility that the digestive system is playing a role in migraine disease? To me it is an obvious indication that gut function is playing a role. But because the pain is in the head the focus of research relative to cause must be in the head.
I don’t get headaches with migraine but I do sometimes have abdominal symptoms. It is well documented that migraine manifests in an astonishingly varied way. Such is the reach of the brain.
Another comment you made I found somewhat unfair and misleading so i would like to comment on it. You were responding to my comment: “I felt compelled to ask the question “what if the ancient understanding of disease is correct?” What if it is an imbalance in the organism and the only path to cure is to remove the obstacles standing in the body’s way of its ongoing attempt to reach homeostasis.”
And you said:
“To me that all sounds fantastic and I can see how anyone might think it makes sense about vitality being off, some imbalance being present, the body wanting to reach homeostasis, old traditions etc. However, ancient Egyptians believed the heart was the centre of thought and the brain cooled the body; the Romans figured a bad uterus caused hysteria; and you might have heard about blood-letting days in London around 1800. People were drinking radioactive tonics as recently as the early 1940s saying they actually felt better yet they were killing themselves. The US had to ban them in the end. Myths about the body and health linger on even in 2009, some astoundingly ludicrous but pervasive nonetheless. We can philosophise about this, come up with lots of great sounding ideologies and theories, and even write tons about it I’m sure … it’s all emotionally satisfying.”
Please understand that my comments were philosophical and in no way an attempt to say that any and all treatments that were used at some time in the past were reflective of the traditional philosophies and their belief as to what causes disease. The fact that health care practitioners and philosophers had more limited knowledge than we do today is not an indictment of what their observations told them about how disease occurs.
Agreed. Nor should we consider that what we know now is all we will ever know. Discoveries are constantly being made through ongoing research. These days however, we require more stringent evidence as confirmation. This is a good thing.
Relative to “myths about the body and health linger on even in 2009” why don’t we each list a few and why we believe they are myths.
- Biochemical toxins (drugs) are the best way to cure disease. What is the principal behind this belief? The only one i have been able to find is the success of penicillin (discovered by observation incidentally) in the conquering of infectious disease. This set us on the path of belief that modern medical research would find the “magic bullets” to cure other diseases as well. Can anyone tell you of someone who was cured of their chronic disease by a drug? To the contrary most of the migraine sufferers who I have met who no longer suffer from the disease will credit a life style change, changed my job, got a divorce, changed my diet,etc. rather than claiming they found the right drug.
I agree drugs are not necessarily the only answer, however I have never met a doctor who suggested this. I have only ever heard a holistic approach regarding the need for general health and wellbeing (diet, exercise, lifestyle) to support drug therapy. They all work together to produce a healthy(ier) individual.
- If someone suffers from both IBS and migraine both the neurologist and the gastroenterologist will assure the patient that the conditions are not related. Interestingly, many of these patients will intuitively know there is a connection. This myth that every condition is largely independent of every other condition is the result of the evolution of medical specialization. You go to this doc for your heart and this doc for your gut and this doc for your head and they each study their particular “piece of the human pie” and they are not trained to look at you holistically. Consequently you end up taking different drugs designed to treat the symptoms of each disease and the doctor has done his/her job but the patient is not better. Furthermore Dr. Gershon’s work showing the existence of the gut brain is still being largely ignored by both the gasto docs and the neuro docs…why? Maybe because it will force them to collaborate and that is not they way they were trained.
This has not been my experience, quite the opposite in fact. I recognise however that this is anecdotal and others may have had different experiences.
- The “next” drug is not a problem if it treats the symptom it is designed to treat. Said another way it is okay if you are taking 4,6, or 8 drugs at a time. I spoke recently with a doctor of pharmacy who teaches at a pharmacy school and he told me that when a patient is put on a single class of drugs the doctors are pretty clear on what reaction the body will have to that drug. When they put that patient on a second class of drugs the interaction of two classes is pretty much understood. However once they put a patient on the third class of drug they really dont understand how the combination affects the organism. Now combine that with a conversation I had with the head nurse at a local nursing home. We got into a conversation about health and wellness and she asked me to guess the number of drugs the average person in the nursing home was on. I guessed 5 and she said 12. I was astounded and she commented “oh, that is not the most amazing thing”. “Really?” I said, “what is the most amazing thing?” Her comment was that when a family decides to extend no further effort to keep their loved one alive and the stop all of their medications typically one of two things happens…either nothing or they get better.
While I accept this may well be the case these are anecdotal accounts. Again, in my experience most doctors and health professionals are only too willing to acknowledge the limits of medical knowledge in its current form.
Can anyone show me research that shows taking six or eight medications is beneficial to the human organism? Or can you just show that each one has been shown to be effective to some degree at treating the symptoms they were designed to treat.
Well, this is only anecdotal, but my father takes a cocktail of drugs every day. Before he started he was in a great deal of pain and at risk of a heart attack. I don’t think he’s willing to risk experimenting with suspending his meds. He’s quite fond of life.
Listen, I know that many advocates of natural medicine are out to slay the dragon (pharmaceutical medicine) and they see a great conspiracy to keep people sick and that it is all money driven. I am not one of them. Rather my focus is to acknowledge the limitations of all paradigms and philosophies and try to see if maybe there is a better way to look at the problems (diseases) that so many suffer from.
Again, I think this is admirable but again in my experience doctors themselves are only too happy to acknowledge the limitations. In my experience, where a patient wishes to try a CAM therapy this is generally supported by a doctor (or not ruled out) where there is no evidence of risk in doing so and when taken in conjuction with a drug whose efficacy is supported by evidence (which doesn’t have contraindications with the CAM therapy).
I realize that most of what i am sharing is not based in double blind placebo controlled studies and I do understand their value. I do not think that you are willing to acknowledge their limitations. Where has the gold standard of medical research taken us? Do we have a medical paradigm that effectively treats those who suffer from chronic illness? Is the paradigm effective at returning patients to good health? Is the failure of pharmaceutical medicine in the curing of chronic illness a result of poor product design or is the underlying philosophy faulty?
I don’t think the medical paradigm claims to be perfect. Quite the opposite in fact. That is why research is ongoing - in universities, hospitals and pharmaceutical companies. Perhaps it is not the underlying philosophy which is at fault but human beings themselves? Evolution has produced a lot of imperfect humans, that is for sure
With respect and anticipation of your response,