Remembering the Barefoot Doctors
Moderator: Available
Getting to Research
Given some time, the Society for Acupuncture Research will provide what I believe to be the kind of substainication necessary to increase the "believeability factor" for what acupuncture offers in the clinical setting....so stay tuned as I throw out this into the fray.
Learn to use the oriental micro-systems & heal.
Acup. Pt.s Researched by German MD's--Homotoxicology
If one were really interested in digging into some of the interesting research done in the early 50's which suggested acupuncture definately had an effect on the biochemistry of the body, read the works of Voll and Hans-Heinrich Reichiweg, both MD's who did the fundamental research on what has been called "Homotoxicology".
The German physician Hans-Heinrich Reckeweg developed homotoxicology as an integrative view of medicine. Homotoxicology is the study of the influence of homotoxins (homo = human being, toxin = poison) on the human organism. Disease is seen as the organism’s purposeful biological reaction to homotoxins and its ongoing attempt to eliminate them. Homotoxicology focuses not on symptoms of illness but on its cause, namely, the homotoxin that is disrupting the organism’s normal functioning. H.-H. Reckeweg
The methodology of homotoxicology differs from that of conventional medicine in that illness is seen as much more than the mere presence of clinical symptoms. Homotoxicological therapy definitely approaches the patient as a whole. It attempts to detoxify the body, to correct derailed immunological processes through immunomodulation, and to support cells and organs.
Go to this url to learn more:International Academy for Homotoxicology http://www.iah-online.com/cms/iwebs/default.aspx
This may offer a wider and more complete understanding of "whole-person medicine".
The German physician Hans-Heinrich Reckeweg developed homotoxicology as an integrative view of medicine. Homotoxicology is the study of the influence of homotoxins (homo = human being, toxin = poison) on the human organism. Disease is seen as the organism’s purposeful biological reaction to homotoxins and its ongoing attempt to eliminate them. Homotoxicology focuses not on symptoms of illness but on its cause, namely, the homotoxin that is disrupting the organism’s normal functioning. H.-H. Reckeweg
The methodology of homotoxicology differs from that of conventional medicine in that illness is seen as much more than the mere presence of clinical symptoms. Homotoxicological therapy definitely approaches the patient as a whole. It attempts to detoxify the body, to correct derailed immunological processes through immunomodulation, and to support cells and organs.
Go to this url to learn more:International Academy for Homotoxicology http://www.iah-online.com/cms/iwebs/default.aspx
This may offer a wider and more complete understanding of "whole-person medicine".
Learn to use the oriental micro-systems & heal.
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Show stopper. What do they have to hide from a published, trained scientist?only medical doctors and licensed health care professionals can register to view the online educational program, which offers instruction in the scientific background of homotoxicology and explains how it can be used in a health care practice.
Secret science is an oxymoron.
- Bill
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Do you really believe this applies to the country of Germany? We sure upon significant science from Germany post WWII and to this day, most of the military paid for educational research done in the fields of physics and chemistry goes to University of Michigan which grabbed more than a few of the folks working for the Reich and Adolph.
Learn to use the oriental micro-systems & heal.
"The German physician Hans-Heinrich Reckeweg developed homotoxicology as an integrative view of medicine. Homotoxicology is the study of the influence of homotoxins (homo = human being, toxin = poison) on the human organism. Disease is seen as the organism’s purposeful biological reaction to homotoxins and its ongoing attempt to eliminate them. Homotoxicology focuses not on symptoms of illness but on its cause, namely, the homotoxin that is disrupting the organism’s normal functioning. H.-H. Reckeweg
The methodology of homotoxicology differs from that of conventional medicine in that illness is seen as much more than the mere presence of clinical symptoms. Homotoxicological therapy definitely approaches the patient as a whole. It attempts to detoxify the body, to correct derailed immunological processes through immunomodulation, and to support cells and organs."
Bill, will research the site a bit tomorrow. Curious what confirmation they require one is a practicing MD. All you need to do to get to the doctor sites on drug webpages is click a button. Honor system.
Anyhoo, I have to call BS on the above. First, there is no need to invent a field of homotoxicology. Doctors treat humans, and the fields of pharmacology and toxicology, and medicine more broadly, have VAST well established rich literatures on toxins and humans.
Second, the probable reason the invention occurs involves a complete misunderstanding of modern medicine. It is always framed as obsessed with the symptoms and unconcerned with the underlying cause, and unable to see a person as a whole. These become annoying catchphrases after a while... the whole point of allopathic medicine is to treat the underlying cause. We don't just willy nilly give pain medicine for pain; if it's inflammatory, I can use an antiinflammatory. If it's cancer pain there is radiation chemotherapy and resection, or antiresorption bone drugs. Antiseizure drugs and antidepressants are better for neuropathic pain. In brief, the WHOLE concept is to understand the cause before you reach for a cure (as best is possible). So we don't need a fresh alternative to what we're already doing.
And doing better: Third, looking at disease as a purposeful response to toxins is not always wise. There are plenty of diseases which are clearly not reactions to toxins--heritable cancers, infectious cancers, the hemodynamic responses to liver, kidney, and heart disease; the effects of dehydration on water and electrolyte balance and osmolality, the symptoms of hormone excess and deficiency, and so on (almost endlessly). Where toxins do play a role, like cigarette poisons and lung cancer, the disease (cancer) is definitely NOT the body's purposeful response.
Fourth, generally, when one hears about detoxifying the body, or supporting the health or function of cells, we've moved beyond science to poetry. A proprietary unstudied extract of x and y, or a colon cleanse (of nothing) does not support cells; however, determining that an anemia is mixed iron deficiency and megaloblastic because of B12 deficiency allows us to replace iron and B12 so marrow cells can make the blood the patient needs, and further may clue us in to malabsorption, prompting testing for antibodies characteristic of sprue, with confirmation of gluten sensitivity by biopsy showing villous atrophy and finally by a response to a gluten free diet.
THAT'S good medicine--following the clues to the underlying problems, the underlying problem's problems, and intervening in a specific way. Notice that the medical paradigm for managing sprue makes a lot more sense than a wholly toxin based theory, in which cleansing lacks meaning and identification of wheat ("the staff of life") as a "toxin" makes sense only to affected individuals--this is allergy, not homotoxicology, or toxicology, because, again, we're in agreement we are all talking about humans.
I eagerly await solid data on any technique or substance that can help us better care for our patients, regardless of the source or initial believability. Medicine consumes verifiable efficacy like the Borg. If it's proven, it ceases to be "alternative" and just becomes routine medicine.
The methodology of homotoxicology differs from that of conventional medicine in that illness is seen as much more than the mere presence of clinical symptoms. Homotoxicological therapy definitely approaches the patient as a whole. It attempts to detoxify the body, to correct derailed immunological processes through immunomodulation, and to support cells and organs."
Bill, will research the site a bit tomorrow. Curious what confirmation they require one is a practicing MD. All you need to do to get to the doctor sites on drug webpages is click a button. Honor system.
Anyhoo, I have to call BS on the above. First, there is no need to invent a field of homotoxicology. Doctors treat humans, and the fields of pharmacology and toxicology, and medicine more broadly, have VAST well established rich literatures on toxins and humans.
Second, the probable reason the invention occurs involves a complete misunderstanding of modern medicine. It is always framed as obsessed with the symptoms and unconcerned with the underlying cause, and unable to see a person as a whole. These become annoying catchphrases after a while... the whole point of allopathic medicine is to treat the underlying cause. We don't just willy nilly give pain medicine for pain; if it's inflammatory, I can use an antiinflammatory. If it's cancer pain there is radiation chemotherapy and resection, or antiresorption bone drugs. Antiseizure drugs and antidepressants are better for neuropathic pain. In brief, the WHOLE concept is to understand the cause before you reach for a cure (as best is possible). So we don't need a fresh alternative to what we're already doing.
And doing better: Third, looking at disease as a purposeful response to toxins is not always wise. There are plenty of diseases which are clearly not reactions to toxins--heritable cancers, infectious cancers, the hemodynamic responses to liver, kidney, and heart disease; the effects of dehydration on water and electrolyte balance and osmolality, the symptoms of hormone excess and deficiency, and so on (almost endlessly). Where toxins do play a role, like cigarette poisons and lung cancer, the disease (cancer) is definitely NOT the body's purposeful response.
Fourth, generally, when one hears about detoxifying the body, or supporting the health or function of cells, we've moved beyond science to poetry. A proprietary unstudied extract of x and y, or a colon cleanse (of nothing) does not support cells; however, determining that an anemia is mixed iron deficiency and megaloblastic because of B12 deficiency allows us to replace iron and B12 so marrow cells can make the blood the patient needs, and further may clue us in to malabsorption, prompting testing for antibodies characteristic of sprue, with confirmation of gluten sensitivity by biopsy showing villous atrophy and finally by a response to a gluten free diet.
THAT'S good medicine--following the clues to the underlying problems, the underlying problem's problems, and intervening in a specific way. Notice that the medical paradigm for managing sprue makes a lot more sense than a wholly toxin based theory, in which cleansing lacks meaning and identification of wheat ("the staff of life") as a "toxin" makes sense only to affected individuals--this is allergy, not homotoxicology, or toxicology, because, again, we're in agreement we are all talking about humans.
I eagerly await solid data on any technique or substance that can help us better care for our patients, regardless of the source or initial believability. Medicine consumes verifiable efficacy like the Borg. If it's proven, it ceases to be "alternative" and just becomes routine medicine.
--Ian
"I eagerly await solid data on any technique or substance that can help us better care for our patients, regardless of the source or initial believability. Medicine consumes verifiable efficacy like the Borg. If it's proven, it ceases to be "alternative" and just becomes routine medicine."
I totally agree with you on this...and maybe this is why conventional medicine has difficulty absorbing the tennants and theories associated with Traditional Chinese Medicine (TCM) because it does not follow the "straight line or flat earth" ideals kept sacred by conventional allopathic medicine and has a far greater history of use...
Can't fit a square peg into a round hole.
I shall similarly conclude with a quote from the Kalama Sutta: Don't just believe it because it sounds good, nor disbelieve it because it conflicts with your philosophy: go out and try it for yourself.
--SaTerra
I totally agree with you on this...and maybe this is why conventional medicine has difficulty absorbing the tennants and theories associated with Traditional Chinese Medicine (TCM) because it does not follow the "straight line or flat earth" ideals kept sacred by conventional allopathic medicine and has a far greater history of use...
Can't fit a square peg into a round hole.
I shall similarly conclude with a quote from the Kalama Sutta: Don't just believe it because it sounds good, nor disbelieve it because it conflicts with your philosophy: go out and try it for yourself.
--SaTerra
Learn to use the oriental micro-systems & heal.
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Why do you believe allopathic medicine has a shorter history of use?saterraji wrote:
I totally agree with you on this...and maybe this is why conventional medicine has difficulty absorbing the tennants and theories associated with Traditional Chinese Medicine (TCM) because it does not follow the "straight line or flat earth" ideals kept sacred by conventional allopathic medicine and has a far greater history of use...
The biggest difference between "TCM" and allopathic medicine is the recent (turn of the century) adoption of the scientific method to validate what works and what doesn't (and why). Had "TCM" done this earlier, it would look very different today. Many practices would have gone the way of blood letting, which was a common practice in allopathic medicine until the evidence showed it not to be useful.
Having indirectly and directly been involved in the creation of several medical classification systems, I can tell you that the allopathic medicine community's greatest strength is its willingness to be self critical and to adapt and improve. "Traditional" is a pejorative in my world. Tradition and folklore implies it's been done because that's what they did in the past, and not because it's been validated via rigorous, peer-reviewed science. And as this continuous quality improvement (CQI) exercise goes on, medicine itself evolves. Some things that work today may not be practiced tomorrow because an even better understanding and/or intervention is discovered. Case in point - treatment of duodenal ulcers. H2 antagonists were the evidence-based standard of care until someone discovered that most such ulcers were the result of an h pylori infection. Wow... give the person a one-time course of 3 medications and they are actually cured. No more lifetime of drugs/herbs - western OR eastern. Just like that, a standard became inferior.
- Bill
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gmattson
- Site Admin
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- Contact:
How laypeople feel about this subject. . .
Most of us lowly laypeople are interested in "what works" for themselves and their family when it comes to healthcare. Most of us find ways to see their family doctor once a year for checkups and timely consultation in the event of health emergencies.
Because of the risks (to the doctors) regarding malpractice lawsuits, many of these visits result in very expensive "specialist" visits where extremely expensive tests are conducted. Should the treatment recommended by one "specialist" scare the #$%# out of the patient, you can visit another specialist in the same field and be almost assured of getting another series of expensive tests and a completely different recommendation for treatment.
Ask any man who, during a routine visit to his MD, discovers his prostrate is enlarged and begins the process of visiting "specialist" in this field.
Reading this thread, I get the feeling that Bill and Ian are saying that laypeople should place their faith in the ruling medical authority and believe that whatever the drug companies are telling the doctors to use for treatments. . . based on the drug companies sponsored testing, should be considered correct and essentially, "state of the art" and. . . laypeople who discover, through their layperson investigation and word of mouth from people with similar problems, end up visiting individuals who follow a different path relating to testing and treatment, should bypass these paths in favor of following one of the approved treatment.
Now the question I have as a layperson: Why is the medical profession so hostile to alternate methods of dealing with health issues?
Is it because the medical profession has been so successful dealing with disease? (In the past two years five close friends have died from lung cancer - all went to MDs and followed the treatment, which involved operations -radiation - chemo and a very painful death! )
Is it because the medical profession is so confident that the drug companies' drugs are safe and do the job? Whereas, the alternative crowd's potions/treatments don't work better or are less safe?
Is it because there are so many charlatans in the alternative medicine field? ("A person who makes elaborate, fraudulent, and often voluble claims to skill or knowledge; a quack or fraud") Perhaps the statisticians can resolve this question by determining which field gets sued the most and loses these suits for malpractice!)
Is it because so many people seek alternative treatments and are helped . . . but the treatment is the result of what the doctors label a "placebo phenomenon" and not because of any statistical relationship to a specific drug/needle puncture or other non-medically approved procedure?
When searching out a family doctor in Florida, I questioned them as to how they felt about alternative medicine and selected one based on his being open minded about my overall philosophy regarding health and doctors:
1. Diet and exercise (my responsibility - turns out I knew more about diet and exercise than most MDs I talked with)
2. MDs responsibilities: To identify any health issues that need attention, that my diet, exercise and alternative health measures missed.
3. In the event of #2, make recommendations for returning me to good health asap.
4. Evaluate and seek alternative ways to deal with any problems while keeping the MD in the communication and testing loop.
Now. . . my last question: Should a person who follows this or a similar health program, discovers that one of the alternative methods result in a return to health (as determined by MD tests and opinion), but the effect from this alternative healing is determined by medical statistician to be from a "placebo phenomenon. . . should the layperson be criticized for deviating from the approved path of USA medicine?
Finally (I promise), is the costs for something like my hypothetical (but based on a number of real situations) health issue:
MD approved costs - - - $20,000+ (includes all tests, procedures and recommended drugs. No actual treatment.
Charges related to Alternative visits/tests/treatment - $400.
Because of the risks (to the doctors) regarding malpractice lawsuits, many of these visits result in very expensive "specialist" visits where extremely expensive tests are conducted. Should the treatment recommended by one "specialist" scare the #$%# out of the patient, you can visit another specialist in the same field and be almost assured of getting another series of expensive tests and a completely different recommendation for treatment.
Ask any man who, during a routine visit to his MD, discovers his prostrate is enlarged and begins the process of visiting "specialist" in this field.
Reading this thread, I get the feeling that Bill and Ian are saying that laypeople should place their faith in the ruling medical authority and believe that whatever the drug companies are telling the doctors to use for treatments. . . based on the drug companies sponsored testing, should be considered correct and essentially, "state of the art" and. . . laypeople who discover, through their layperson investigation and word of mouth from people with similar problems, end up visiting individuals who follow a different path relating to testing and treatment, should bypass these paths in favor of following one of the approved treatment.
Now the question I have as a layperson: Why is the medical profession so hostile to alternate methods of dealing with health issues?
Is it because the medical profession has been so successful dealing with disease? (In the past two years five close friends have died from lung cancer - all went to MDs and followed the treatment, which involved operations -radiation - chemo and a very painful death! )
Is it because the medical profession is so confident that the drug companies' drugs are safe and do the job? Whereas, the alternative crowd's potions/treatments don't work better or are less safe?
Is it because there are so many charlatans in the alternative medicine field? ("A person who makes elaborate, fraudulent, and often voluble claims to skill or knowledge; a quack or fraud") Perhaps the statisticians can resolve this question by determining which field gets sued the most and loses these suits for malpractice!)
Is it because so many people seek alternative treatments and are helped . . . but the treatment is the result of what the doctors label a "placebo phenomenon" and not because of any statistical relationship to a specific drug/needle puncture or other non-medically approved procedure?
When searching out a family doctor in Florida, I questioned them as to how they felt about alternative medicine and selected one based on his being open minded about my overall philosophy regarding health and doctors:
1. Diet and exercise (my responsibility - turns out I knew more about diet and exercise than most MDs I talked with)
2. MDs responsibilities: To identify any health issues that need attention, that my diet, exercise and alternative health measures missed.
3. In the event of #2, make recommendations for returning me to good health asap.
4. Evaluate and seek alternative ways to deal with any problems while keeping the MD in the communication and testing loop.
Now. . . my last question: Should a person who follows this or a similar health program, discovers that one of the alternative methods result in a return to health (as determined by MD tests and opinion), but the effect from this alternative healing is determined by medical statistician to be from a "placebo phenomenon. . . should the layperson be criticized for deviating from the approved path of USA medicine?
Finally (I promise), is the costs for something like my hypothetical (but based on a number of real situations) health issue:
MD approved costs - - - $20,000+ (includes all tests, procedures and recommended drugs. No actual treatment.
Charges related to Alternative visits/tests/treatment - $400.
GEM
"Do or do not. there is no try!"
"Do or do not. there is no try!"
Excellent questions from GEM.
First, let me say without hesitation that I do not spare "standard" medicine from my wrath. I have many problems with it--overtesting, not following the data and guidelines, giving people things we know don't work like antibiotics for colds, not considering the big picture (eg, no chemo if risks outweigh benefits), not considering cost (generic drugs that work as well vs new brand ones the doctors have pens for), too brief histories, influence of drug companies on studies (eg, offlabel promotion of neurontin; tinkering with supposedly prespecified outcomes to improve apparent trial success; ghost writing "research" that doctors then sign their names to for cash) and physician prostitutes (who accept bribes from drug companies or home care agencies, or who self refer for radiology studies when they have a stake in the MRI scanner, etc). Or how about enthusiasts for the kyphoplasties I mentioned? No better than placebo, and expensive! The proceduralists should cease and desist completely--do you think they will? There is also perversion of logic that is NOT our fault, when insurance or litigation issues make us do stupid things.
My true love (in medicine, science, martial arts) is a brutal self and external evaluation, and the willingness to search for truth, admit ignorance and error, and to try to eliminate them, and to go off the data regardless. The medicine I speak highly of is practiced by some, but not all. Buyer beware! Patients far too often have to double check their doctors to find out that prostate testing is reall inaccurate and has limited benefit, to ensure they're on the right BP medicine, that they washed their hands, and so on. Luckily, more and more data is becoming immediately and publicly available. 50 years ago, the gray hairs and their memories would dictate practice. Maybe a dusty book was cracked. Now, if my team wants to know the incidence of Wegener's, I admit I don't know, and in 7 seconds the team has it on their iphone. The excuses are running out!
So specifically:
I am NOT saying to implicitly trust your doctor; rather, double check their work, look it up, seek alternative input, ask WHY they made that recommendation, check their quality indicators on the internet--not perfect, but that's the best one can do. Bill and I will always be happy to try to dig up data here.
I am NOT hostile to "alternative" methods, unless by alternative one means "zero supportive data but it sounds mystically cool." To that, I say sure, if it's cheap and harmless, consider it; don't rush into strong, potentially dangerous care without thinking, but don't over-believe, for example, that acupuncture reduces cocaine dependence; there's no data that it does as of yet. IF it is shown to work then we embrace it and it's not alternative! Sometimes alternative means lifestyle, as in, diabetes can be CURED with weight loss and exercise and diet in some, and that's far better than drug solutions. We doctors sometimes despair of focusing on this because too few americans will do it
But individuals are always wise to. That alternative is always welcome, too.
We have NOT been so successful with many diseases. Lung cancer (and brain, gastric, pancreatic...) are just terrible diseases. We fail to cure and we extend life only a little and quality is poor. But I promise you acupuncture and tea won't help either. If you get one of these, think very carefully about chemo and radiation and insist on knowing exactly what the expected benefits and risks are.
No, I don't trust the drug companies. They are like lawyers, and snakes; not intrinsically evil, but profit motivated. Ideally, research should be nonindustry funded, OR the funding should be free of any strings--independent researchers with no stake in the studied therapy or test should design and run and report the findings.
Yes, alternative therapies are less likely to work--when something works, the FDA considers it a drug and steps in (eg, red yeast extract). They MAY be dangerous, because they are simply less regulated. People might sneak all sorts of drugs and toxins and heavy metals and hormones into some herbal preps. You can't trust the label and I don't recommend them. Plus, some are just dangerous--think about the hypertension, heart problems, and deaths with hydroxycut, or episodes of liver failure. The Annals of Internal Medicine recently reported that very similar products are still available because the FDA bans herbals mixes one by one and not the known ingredients that cause problems--oye! And yeah--lots of quacks in alternative medicine.
Statisticians can't resolve the quakery issue because 1) errors aren't the primary driver of suits and 2) people expect fewer miracles from TCM and no guarantees are usually made and 3) lawsuit success isn't data driven. Ask those OB's who lose millions over babies born with CP when they did nothing wrong!
We don't (generally) mind if someone else's therapy works where ours fails. I think drug therapy of low back pain is terrible. If chiro or acupuncture works and is done safely? Go for it. I promote core training and activity (and my patients routinely ignore me). '
Should we blame a patient for feeling better on a placebo therapy?? Of course not! Placebos are real. And if we argue with someone that their acupuncture didn't account for their cocaine abstinence, we might "break the spell" and risk relapse. I smile and congratulate them and tell them don't discount what YOU accomplished too. Now, many allopathic doctors use placebos, but there are ethical issues. I think it's reasonably in situations, eg I gave some saline to several people and told them I thought it would help their pain and they acted like they'd gotten heroin. But I wouldn't have lied if they asked for the details--and that risks a confrontation. A homeopathist doesn't face that risk--THEY are using pure saline too, with the active ingredient diluted out--but they somehow believe that will work, seriously, and so they can tell the patient that. Great--until the patient develops something that needs a real drug and doesn't seek it.
As for the costs, we should deal with specifics. There are some drugs that cost $800k per QALY. I don't think we should use them. We should think about value, even when the out of pocket cost is unchanged. We all pay when doctors waste $. But our overhead is higher because we have malpractice, expensive hospitals with amazing therapies to keep up, and so on. What's the TCM guy gonna do when you get leukemia and need a $500k bone marrow transplant? Type one diabetes? Heart attack? HIV? Pneumonia? A bleeding ulcer? Appendicitis? We've got those issues covered, as best humans know how. The American system is terribly inefficient, true--but the evidence based therapies are great, if the patients and doctors and payers all do their jobs.
First, let me say without hesitation that I do not spare "standard" medicine from my wrath. I have many problems with it--overtesting, not following the data and guidelines, giving people things we know don't work like antibiotics for colds, not considering the big picture (eg, no chemo if risks outweigh benefits), not considering cost (generic drugs that work as well vs new brand ones the doctors have pens for), too brief histories, influence of drug companies on studies (eg, offlabel promotion of neurontin; tinkering with supposedly prespecified outcomes to improve apparent trial success; ghost writing "research" that doctors then sign their names to for cash) and physician prostitutes (who accept bribes from drug companies or home care agencies, or who self refer for radiology studies when they have a stake in the MRI scanner, etc). Or how about enthusiasts for the kyphoplasties I mentioned? No better than placebo, and expensive! The proceduralists should cease and desist completely--do you think they will? There is also perversion of logic that is NOT our fault, when insurance or litigation issues make us do stupid things.
My true love (in medicine, science, martial arts) is a brutal self and external evaluation, and the willingness to search for truth, admit ignorance and error, and to try to eliminate them, and to go off the data regardless. The medicine I speak highly of is practiced by some, but not all. Buyer beware! Patients far too often have to double check their doctors to find out that prostate testing is reall inaccurate and has limited benefit, to ensure they're on the right BP medicine, that they washed their hands, and so on. Luckily, more and more data is becoming immediately and publicly available. 50 years ago, the gray hairs and their memories would dictate practice. Maybe a dusty book was cracked. Now, if my team wants to know the incidence of Wegener's, I admit I don't know, and in 7 seconds the team has it on their iphone. The excuses are running out!
So specifically:
I am NOT saying to implicitly trust your doctor; rather, double check their work, look it up, seek alternative input, ask WHY they made that recommendation, check their quality indicators on the internet--not perfect, but that's the best one can do. Bill and I will always be happy to try to dig up data here.
I am NOT hostile to "alternative" methods, unless by alternative one means "zero supportive data but it sounds mystically cool." To that, I say sure, if it's cheap and harmless, consider it; don't rush into strong, potentially dangerous care without thinking, but don't over-believe, for example, that acupuncture reduces cocaine dependence; there's no data that it does as of yet. IF it is shown to work then we embrace it and it's not alternative! Sometimes alternative means lifestyle, as in, diabetes can be CURED with weight loss and exercise and diet in some, and that's far better than drug solutions. We doctors sometimes despair of focusing on this because too few americans will do it
But individuals are always wise to. That alternative is always welcome, too.We have NOT been so successful with many diseases. Lung cancer (and brain, gastric, pancreatic...) are just terrible diseases. We fail to cure and we extend life only a little and quality is poor. But I promise you acupuncture and tea won't help either. If you get one of these, think very carefully about chemo and radiation and insist on knowing exactly what the expected benefits and risks are.
No, I don't trust the drug companies. They are like lawyers, and snakes; not intrinsically evil, but profit motivated. Ideally, research should be nonindustry funded, OR the funding should be free of any strings--independent researchers with no stake in the studied therapy or test should design and run and report the findings.
Yes, alternative therapies are less likely to work--when something works, the FDA considers it a drug and steps in (eg, red yeast extract). They MAY be dangerous, because they are simply less regulated. People might sneak all sorts of drugs and toxins and heavy metals and hormones into some herbal preps. You can't trust the label and I don't recommend them. Plus, some are just dangerous--think about the hypertension, heart problems, and deaths with hydroxycut, or episodes of liver failure. The Annals of Internal Medicine recently reported that very similar products are still available because the FDA bans herbals mixes one by one and not the known ingredients that cause problems--oye! And yeah--lots of quacks in alternative medicine.
Statisticians can't resolve the quakery issue because 1) errors aren't the primary driver of suits and 2) people expect fewer miracles from TCM and no guarantees are usually made and 3) lawsuit success isn't data driven. Ask those OB's who lose millions over babies born with CP when they did nothing wrong!
We don't (generally) mind if someone else's therapy works where ours fails. I think drug therapy of low back pain is terrible. If chiro or acupuncture works and is done safely? Go for it. I promote core training and activity (and my patients routinely ignore me). '
Should we blame a patient for feeling better on a placebo therapy?? Of course not! Placebos are real. And if we argue with someone that their acupuncture didn't account for their cocaine abstinence, we might "break the spell" and risk relapse. I smile and congratulate them and tell them don't discount what YOU accomplished too. Now, many allopathic doctors use placebos, but there are ethical issues. I think it's reasonably in situations, eg I gave some saline to several people and told them I thought it would help their pain and they acted like they'd gotten heroin. But I wouldn't have lied if they asked for the details--and that risks a confrontation. A homeopathist doesn't face that risk--THEY are using pure saline too, with the active ingredient diluted out--but they somehow believe that will work, seriously, and so they can tell the patient that. Great--until the patient develops something that needs a real drug and doesn't seek it.
As for the costs, we should deal with specifics. There are some drugs that cost $800k per QALY. I don't think we should use them. We should think about value, even when the out of pocket cost is unchanged. We all pay when doctors waste $. But our overhead is higher because we have malpractice, expensive hospitals with amazing therapies to keep up, and so on. What's the TCM guy gonna do when you get leukemia and need a $500k bone marrow transplant? Type one diabetes? Heart attack? HIV? Pneumonia? A bleeding ulcer? Appendicitis? We've got those issues covered, as best humans know how. The American system is terribly inefficient, true--but the evidence based therapies are great, if the patients and doctors and payers all do their jobs.
--Ian
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Well put, Ian.
When it comes to cost of traditional allopathic medicine vs. "alternative" therapies, consider Sutton's law. Trial attorneys go for where the money is. The acupuncture doctor or herbalist is less likely to be sued because the stakes are usually less high, the expetcations are lower, and the therapy is often benign. So they have little or no malpractice coverage - hence shallow pockets. The office of Dewey, Chetham, and Howe isn't going to get excited about the payday for litigating against an alternative provider without any deep pockets.
Meanwhile... The OB delivers babies. That's serious stuff. Everyone loves a baby, and any jacka$$ trial attorney (John Edwards) can parade a deformed baby in front of an ignorant jury and make a fortune off an innocent OB's malpractice insurance. So the malpractice insurance goes up, which makes the pockets deeper, which makes the litigation all the more common. Pretty soon, you have no OBs in rural areas where it just doesn't pay to make a living. Can't even cover the malpractice premiums with people not able to pay the exorbitant costs.
So... you have your baby at home, or with a midwife who doesn't have a deep pocket. Schit happens, but it doesn't make the front page of the NYT or the WaPo. Who cares about those dumb rednecks anyway, right?
But I rant....
- Bill
When it comes to cost of traditional allopathic medicine vs. "alternative" therapies, consider Sutton's law. Trial attorneys go for where the money is. The acupuncture doctor or herbalist is less likely to be sued because the stakes are usually less high, the expetcations are lower, and the therapy is often benign. So they have little or no malpractice coverage - hence shallow pockets. The office of Dewey, Chetham, and Howe isn't going to get excited about the payday for litigating against an alternative provider without any deep pockets.
Meanwhile... The OB delivers babies. That's serious stuff. Everyone loves a baby, and any jacka$$ trial attorney (John Edwards) can parade a deformed baby in front of an ignorant jury and make a fortune off an innocent OB's malpractice insurance. So the malpractice insurance goes up, which makes the pockets deeper, which makes the litigation all the more common. Pretty soon, you have no OBs in rural areas where it just doesn't pay to make a living. Can't even cover the malpractice premiums with people not able to pay the exorbitant costs.
So... you have your baby at home, or with a midwife who doesn't have a deep pocket. Schit happens, but it doesn't make the front page of the NYT or the WaPo. Who cares about those dumb rednecks anyway, right?
But I rant....
- Bill
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Re: How laypeople feel about this subject. . .
This is a good approach.gmattson wrote:
When searching out a family doctor in Florida, I questioned them as to how they felt about alternative medicine and selected one based on his being open minded about my overall philosophy regarding health and doctors:
1. Diet and exercise (my responsibility - turns out I knew more about diet and exercise than most MDs I talked with)
2. MDs responsibilities: To identify any health issues that need attention, that my diet, exercise and alternative health measures missed.
3. In the event of #2, make recommendations for returning me to good health asap.
4. Evaluate and seek alternative ways to deal with any problems while keeping the MD in the communication and testing loop.
It takes me forever to find a good doctor. My first choice is someone who was once a competitive athlete. Academia type preferred. They "get" me, they know their schit, and they enjoy talking to a patient who is well-informed and won't waste their time. We each do our parts, and both parties are happy.
And they can "claim" my low cholesterol, ideal body weight, low blood pressure, and absence of any chronic disease. I'm one of their outliers on the "good" side. Never mind that they're lucky to have me as a patient. The truth is if they know how to work with me, they get rewarded with a good set of outcomes. Quid pro quo.
- Bill
