The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, March 04, 2007

A Quick Note on Alternative Medicine

I have to admit that my recent forays into the world of alternative medicine have made me far more bitter towards the movement. Being repeatedly attacked will do that to you. But I'm not quite so bitter as, for example, Orac, who publishes a yearly compilation entitled "You Might Be an Altie" (Altie being slang for person who has a strong belief in alternative medicine). This year's edition is up to over 100 points, and is available for your amusement and/or aggravation here.

Those of you who know me know that I'm the last person to jump on any alternative-medicine-bashing bandwagon but more than a few of these hit home just based on my most recent experiences alone.

#3. If you accept without questioning vague and/or poorly documented anecdotes and testimonials as sufficient evidence for you that an "alternative" therapy can produce remarkable results "curing" cancer, heart disease, autism, Alzheimers, heart disease, etc., but routinely brutally nitpick and then dismiss well-designed randomized, double-blinded Phase III clinical studies for conventional medicine, you just might be an altie.

#7. If you make claims for a product or therapy like, "strengthens the immune system," "restores balance," "detoxifies the liver," "cleanses the colon," or "cleanses the blood," you may be an altie.

#14. If you are utterly convinced that autism is a "misdiagnosis" for mercury poisoning, despite the fact that epidemiological and basic scientific studies do not support this hypothesis, that the number of new autism cases in the U.S. has not shown a sign of falling since thimerosal was removed from vaccines three years ago (ditto Denmark, where thimerosal was removed in the early 1990's), and that autism does not share the symptomotology of mercury poisoning, you just might be an altie.

#20. If you believe that vaccines "don't work," that they "hurt the immune system," or that they are a major cause autism or other chronic diseases, you just might be an altie.

#21. If you routinely use Whale.to or Cure Zone as sources for medical information, you just might be an altie.

#24. If you underwent conventional therapy for cancer and then underwent alternative medicine treatment but attribute your survival and present cancer-free condition to the alternative medicine and not the conventional therapy, you just might be an altie.

#38. If you say your healer "is too busy people making people healthy" to conduct evidence-based trials but have never met a single person helped by them, you might be an altie.

#43. If you believe that chelation is a valid treatment for autism, Alzheimer's disease, coronary artery disease, or any medical condition other than heavy metal poisoning properly documented with appropriate symptoms and laboratory tests, you are well on the way to being an altie; that is, if you're not one already.

#51. If you talk about the pH of the "body," you're either an altie or have access to a very large blender.

#68. If you think natural is synonymous with good then you're probably an altie.

#69. If you tell me not to touch my apple because it's covered in pesticide while you're eating a Big Mac, you may be an altie.

#86. If you believe the plural of anecdote is data you are probably an altie

#87. If you believe alternative and complementary therapies cannot adequately be studied using randomized, double-blind, placebo controlled trials because they miss the essence of the therapy, as was recently suggested in an article in the BMJ, you are almost certainly an altie.

#110. If you believe polio was not wiped out by vaccination, and that FDR in fact had EPV .. you're an altie ( and probably posting on whale.to)

Now clearly I don't agree with everything on the list (Orac clearly has no faith in the training or practice of naturopaths and chiropractors) it still was good for a giggle. I think that the majority of the disagreement between my way of thinking and his, however, is based in geography. I am above the Canada-U.S. border, he is below it. In Canada, there is one English-language school of chiropractic medicine and it is fairly conservative in it's teachings. The people who graduate from it are well-educated and will work wonders with low back pain and headaches and don't necessarily believe that they can cure your gallstones through spinal manipulation. In the US, a general rule of thumb seems to be the further west the school, the more radical the school of thought. There is much more variability in the quality of US-trained chiropractors.


It's the same deal with naturopaths. In Canada, the only nationally accredited school of naturopathic medicine is the Canadian College of Naturopathic Medicine in Toronto. It's graduates aren't all anti-medicine (although some are), and are incredible when it comes to complementary care. I think quite highly of them and admire their work. Again, according to Orac "you are considered a 'doctor' with a diploma-mill ND". Not true here, where to call yourself a naturopathic doctor you'd better be a CCNM grad.

Guess we do things differently up here.

20 Comments:

Anonymous Kemette said...

As an "altie" and as a CCNM trained ND, I found the list to be amusing, but also slightly disturbing if those are the stereotypes that well-trained practitioners of CAM need to stand up against. And thanks for the nod, it's nice when someone recognizes the differences in ND training.

By the same token, it should add fuel to our argument that the government needs to step up its effort to regulate legitimate vs. mail-order ND's.

But FTR, you can "strengthen the immune system". :)

7:34 PM

 
Blogger Dr. J. said...

I like #40: "If you believe that there really are herbal cures for diabetes ..."
As a family doctor I have tried to offer many patients the herbal cure for type II diabetes(ie. strictly controlled healthy diet and exercise). There are few takers...even among the 'altie' crowd.
Like so much else in western culture, people want their medicine FAST, EASY and FREE.
Just my 2 cents...

8:52 PM

 
Blogger Dr Dork said...

"Orac clearly has no faith in the training or practice of naturopaths and chiropractors"

Why should he ?

Adhering to scientific evidence and magical thinking are mutually exclusive.

9:44 PM

 
Blogger doctor T said...

The most disturbing trend I've seen among those resistant to "Western" medicine is lack of information about the dangers of herbs, vitamins and other supplements. Natural doesn't equal safe. My Dr., who is a Canadian-trained MD with a PhD in genetics, practices complementary medicine and acupuncture, and was an ER doc for years, keeps a careful eye on my supplements and my normal meds. St. John's Wort isn't a depression cure-all, and it certainly isn't without it's own side effects, and yet people are more likely to start taking it on their own rather than consult with a doctor about it.

Of course, not all doctors are educated about complementary medicine or open to alternative therapies, and in today's world maybe they should be, or at least be willing to consult with a doctor who is. I went to 3 doctors over a twelve month period for help with chronic yeast infections and in the end it was a compounding pharmacist who advised boric acid suppositories and I've been yeasty-free for over a year now. Go figure.

10:04 PM

 
Anonymous Anonymous said...

Enjoying this blog as a reader and now breaking the ice with a comment.

The list presented tends to put those who might question traditional medicine in a bit of a bind. I have no option, apparently, in my hesitancy to vaccinate than to be placed in a box with a bunch of loonies. This weakens the proponent's argument. Try another angle? If the present stance is arrogance it may spring from too much self-assurance, perhaps?

I happen to take Vitamin D3 (around 5000 iu per day) during the cold and dark winters here in New England. It's that or a sun lamp. I've suffered one head cold this season and oddly it was during a period I slacked off the supplement over calcium uptake concerns (which ended up being unfounded). Does this make me a loonie, too?

As readers might guess, the list was not amusing to me in the least.

11:28 PM

 
Anonymous Anonymous said...

"chronic yeast infections"

Ewww.

1:48 AM

 
Blogger Couz said...

Anon 1:48:

Grow the fuck up. It's actually a really common affliction in women.

9:13 AM

 
Anonymous Anonymous said...

Wait a minute, doctor t - boric acid suppositories are an older, but well-known treatment that appear in standard gynecological texts - not CAM at all. UptoDate, frex, says that for chronic C glabrata there's a Clin Infect Dis paper about this. Okay, not a great study - retrospective and all, but still with nice cure rate vs azoles. Admittedly you have to find a compounding pharmacist and pay for it - quite pricey where I am - and the fluconazole regiments now have better data for chronic albicans. However, the nit that I'm picking is that this isn't a good example of CAM. Might rather be a good example of an orphan drug.
Of course, this gets into the whole philosophical problem that, as soon as a method has some data behind it to support it, it's not CAM anymore... it's Western, allopathic, and evidence based. Hmmm...

4:00 PM

 
Blogger Liana said...

Re: strengthening the immune system

Isn't that essentially what we're doing when we give Hep C positive patients interferon gamma?

5:36 PM

 
Blogger doctor T said...

Interesting. I just wish one of the doctors I'd visited had told me about it. The fluconazole didn't work for me, none of the drugstore stuff worked for me and my Dr. basically said I had no other options. That's when I started to look for other solutions, and I happened to find it at a compounding pharmacy. The pills are 50 cents each so actually pretty cheap.

5:44 PM

 
Blogger Corny-yah said...

As a soon-to-be MD I am already facing the questions about alternative therapy. I would say my classmates are 50/50 on the issue. I would say my position is in neither extreme, that Complementary Medicine has its place as does so-called "western medicine".

What irritates me most was best summed by #3. The unquestioning faith in certain unproven methods, while at the same time flat out telling your MD "I don't take pills" (referring to western medicine).

1:07 PM

 
Anonymous Anonymous said...

I have little patience for people who have blind faith in alternative remedies, but what really irritates me are are the docs that believe that all alternative medicine and training are "magical thinking".

(I'm not talking about you Couz)

11:25 PM

 
Blogger Patient Anonymous said...

Some of those made me laugh too. I think there can be a place for what I would say "complementary" medicine as I think you have to be quite careful with a lot of alternative treatment, most especially if you are not under the guidance of a good, and qualified ND. And that's why it needs to be complementary--with your "Western" MD. Even if they don't necessarily have a grip on Naturopathic Science, they need to know what you're doing with your body--especially if you're taking other meds etc...

Naturopathic treatment can indeed have side effects! Goodness! They are still chemical formulations. And since they aren't regulated, you don't always know what you're getting.

Unless you go to a ND who has branded all of their own things and gone to the trouble to have a company/lab oversee what they are making and ensure proper quality control.

But still, no ND that I've ever heard of has actually held controlled studies of their product among populations to test them for efficacy!

Don't get me wrong; I'm not Anti-Alt. Therapy or Anti-ND or anything like that. I think it can serve a purpose among *certain* individuals but it needs to be handled with care.

And really, for some things there isn't a cure all. No panacea. My fear is that as people grow disillusioned with lack of result from Western Medicine they seek out Alternative Therapies with desperate abandon only to have their souls and pockets bled and still be sick.

Okay, that was long. It's kind of a triggery subject for me anyway but I won't litter the Couz' comment section with all of that!

5:04 PM

 
Blogger Leah said...

There are actually two naturopathic colleges in Canada, the other is Boucher Institute of Naturopathic Medicine in BC. CCNM is an accredited college, while BINM is a candidate.

Repeating the kudos for the nod, from a 4th year ND student in the U.S. with a special interest in Emergency Medicine.

1:20 PM

 
Blogger Couz said...

Ever cool! I didn't even know that naturopathic medicine had a role in the emergency room.

I'd love to hear more. If you feel like educating an 'allopath', please contact me at drcouz at gmail dot com.

8:40 PM

 
Blogger Couz said...

Oh, and there is also another naturopathic college in Quebec. But to be picky, CCNM is the only english-language accredited naturopathic college in Canada at the moment. ;-)

8:45 PM

 
Blogger Dr Dork said...

Anon said.

"I have little patience for people who have blind faith in alternative remedies, but what really irritates me are are the docs that believe that all alternative medicine and training are "magical thinking".

(I'm not talking about you Couz)"

Feel free to insult me directly, I can take it !

I don't have a problem with ANY form of medicine, I have a problem with mendacity. All "forms" of medicine deserve rigorous scientific scrutiny. Any distinctions between "allopaths", "naturopaths" or whatever is a bit false, in my opinion.

All health practitioners should be subject to the same requirements, such as 'primum non nocere', registration and credentialling, accountability for any health interventions - especially if unorthodox/unproven, informed consent, and reliance on an evidence base where available.

Some surgeons and physicians are guilty of poor practice in this regard as well. Magical thinking is magical thinking, whomsoever practices it.

There is much potential for good in , for example, the unknown number of unknown flora in our rainforests. We need more research. It also needs to be remembered that belladonna occurs 'naturally', as well.

Dork

11:06 AM

 
Blogger Randall Sexton said...

#69. If you tell me not to touch my apple because it's covered in pesticide while you're eating a Big Mac, you may be an altie.

I worked with a nurse once who ate an apple during her break and a few minutes later was in the crash unit...highly allergic to the pesticide on it. Same nurse later put a boiled egg in the microwave to heat it up and when she bit into it, it exploded. Be careful of those airpockets in boiled eggs!! Lucky nurse!

3:10 AM

 
Anonymous Anonymous said...

#43. If you believe that chelation is a valid treatment for autism, Alzheimer's disease, coronary artery disease, or any medical condition other than heavy metal poisoning properly documented with appropriate symptoms and laboratory tests, you are well on the way to being an altie; that is, if you're not one already.

What about those of us with children who lost their autism diagnosis after being chelated? I'm sick and tired of arrogant people who have NEVER met my child insisting that he must not have been autistic, if he lost his diagnosis without receiving standard therapy like ABA. Yes, my son who didn't speak, spun circles and refused to make eye contact with anyone was not autistic, his chelation in the absence of mainstream treatment had nothing to do with his progression to a normal childhood and his doctor was an idiot for ever thinking he was autistic to begin with or for thinking he isn't autistic at this point (I can never quite tell which of those last two people think it is). Orac is right. My child wasn't cured by alternative therapies. He magically lost his autism diagnosis and all its attendant symptoms on his own - it was a coincidence. If that's the case, then medical science needs to be studying my child to find out what's so special about him, that allowed him to recover from his autism, while other kids need years of intensive therapy.

Couz, until you've met someone whose child has recovered from autism following a DAN protocol, I don't think you should form any sort of opinion on it. If you don't even know whether or not it works, how can you make fun of people who have seen it in their own children?

11:48 AM

 
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4:00 AM

 

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