DeadCactus

SDN Lifetime Donor
Lifetime Donor
10+ Year Member
Oct 28, 2006
2,569
654
281
Status
Resident [Any Field]
Things like the Chinese herbal stuff and acupuncture? More curious in learning about the medical beliefs of other cultures than looking to supplement my practice with magic. Anyone know of somewhere that offers some formal education on this topic?
 

Mr hawkings

Senior Member
10+ Year Member
Jul 20, 2004
1,320
6
251
Status
Resident [Any Field]
Things like the Chinese herbal stuff and acupuncture? More curious in learning about the medical beliefs of other cultures than looking to supplement my practice with magic. Anyone know of somewhere that offers some formal education on this topic?
I've heard of some schools doing it as part of a "medicine and society" type course
 

turkeyjerky

10+ Year Member
Sep 27, 2008
1,777
162
281
Status
Resident [Any Field]
our school offers a rotation in cam. it's billed as an 'educational' experience, but the people involved (who also give a few lectures on it during our first year med and society class) seem pretty bat$hit crazy in pushing this stuff
 

thechad

10+ Year Member
5+ Year Member
May 22, 2008
297
9
0
Status
If alternative medicine worked, it would just be regular medicine. I think I once heard a girl at my school talking about some sort of combined IM/alternative residency a while ago, but I never looked into it.
 

p30doc

Ever true and unwavering
10+ Year Member
Aug 22, 2007
2,366
36
261
Status
Attending Physician
We had some lectures on supplements and CAM in our medicine health and society course. Also apparently we have like 1-2hr quick and dirty acupuncture session as part of our OMM lab.

Here is the NIH site on it with some of the more legit stuff. http://nccam.nih.gov/
 

futIDdoc

Fighter of the Nightman
10+ Year Member
Feb 16, 2009
202
2
0
Status
Medical Student
We had some lectures on supplements and CAM in our medicine health and society course. Also apparently we have like 1-2hr quick and dirty acupuncture session as part of our OMM lab.

Here is the NIH site on it with some of the more legit stuff. http://nccam.nih.gov/
Yeah right, 'legit' therapies like reiki (if you don't know what this is, look it up for a good laugh) which is mentioned on the homepage for N-SCAM. They are actually funding studies which look at reiki as a treatment for type II diabetes. "So Mr Jones, I see that your A1c is pretty high, so I am going to wave my hands around you and try and channel your energy better." Any school that offers a rotation in alternative therapy which would take valuable training time away from things you actually need to know (oh say surgery or medicine) should be discredited by the LCME. Thank god it looks like NCCAM will soon be on the funding chopping block.
 

Forthegood

ProcrastinationAficionado
10+ Year Member
5+ Year Member
Sep 6, 2008
844
7
0
Lexington, KY
Status
Medical Student
As a medical student, you should not use the words "legit" and "alternative medicine" anywhere near each other.

Evidence Based Medicine-- the future.
 

Disinence2

Emergency Medicine
10+ Year Member
7+ Year Member
Aug 11, 2006
1,576
23
151
Status
Attending Physician
The DO program at Michigan State offers acupuncture as an elective.

MD students are technically able to take the course, however I am not aware of anyone doing so.
 

TDX

Jan 2, 2010
156
5
0
Status
Medical Student
Informed consent and CAM do not mix well.

After all, thoroughly informing the patient would include making it clear that there is not a single shred of evidence that CAM does anything more than placebos, that there is a metric assload of evidence that it doesn't, and that the only proven effect of CAM is to relieve patients of their hard-earned money.
 

unsung

10+ Year Member
Mar 12, 2007
1,356
13
251
Status
Resident [Any Field]
Informed consent and CAM do not mix well.

After all, thoroughly informing the patient would include making it clear that there is not a single shred of evidence that CAM does anything more than placebos, that there is a metric assload of evidence that it doesn't, and that the only proven effect of CAM is to relieve patients of their hard-earned money.
Oh please. Are you under the illusion that "traditional/Western medicine" is completely evidence-based and justified?

How does electroconvulsive therapy (ECT) work? Answer: No one knows. How well does it really work? *whistles*

Do you realize how much of medicine is actually in this state?

Even with smaller/simpler things like the physical exam, docs are still doing a lot of things with VERY little justification. For example, the McMurray's test has very low sensitivity AND specificity. Is it still being taught? Yes. Why?

Probably because they don't want to send students out into the wards to be chastised by older physicians for not knowing how to do it... despite the fact that studies/evidence has shown that it is worthless. That has to be the lamest reason ever justifying teaching something. But a lot of medicine is like this.

Conversely, while no one is claiming TCM/alternative medicine should be accepted wholesale, it offers many effective treatments. Do you realize where Ephedra comes from? It comes from a Chinese herb "ma huang" which had been used for 5,000 years to treat asthma.

Gee, if an herb has been used effectively to treat a condition for 5,000 years, do you think there might be a good chance that it is somewhat effective? It would behoove Western science to look for value in these so-called alternative treatments, instead of dismissing them off-hand.
 
Last edited:

masterofmonkeys

Angy Old Man
10+ Year Member
7+ Year Member
Sep 9, 2008
1,582
255
181
Status
Attending Physician
As a medical student, you should not use the words "legit" and "alternative medicine" anywhere near each other.

Evidence Based Medicine-- the future.
CAM is unfortunately has a dearth of money and experienced/educated researchers. It's a deadly combo. Because there are some very promising therapies out there that are either poorly researched or poorly understood.

Take acupuncture, which we love to piss all over. While there is little evidence for qi, blah blah blah, there is plenty of evidence for how sticking needles into people might induce pain relief through a number of well-understood mechanisms. And indeed the acupuncture trials that fail to show superiority generally use a 'sham' procedure in which needles are actually stuck into the skin. Not at qi points, but still.

And then there's omega 3s, which have some of the most poorly run clinical trials out there. If you understand the basic biology, you'll understand that the dosages need to be at least 4-5g, and ideally closer to 10g to get a biologically meaningful effect. You'll also understand that ALA is not an appropriate supplement as humans, like many other omnivores, cannot elongate ALA at clinically meaningful rates to the functional fatty acids EPA and DHA. And yet most studies use dosages under a gram. And many use ALA.

These are just a couple of examples, but you get the point.
 

coldweatherblue

10+ Year Member
Nov 24, 2007
1,085
8
251
Status
Medical Student
It's important to remember the time constraints of basic science years in medical school when considering adding courses.

For example, at my school we had two full lectures on acupuncture, including the neurophys of twisting needles stimulating fibroblast production and PAG-mediated pain relief ETC.. we also did a half-day at a chiro clinic. These exercises were meant to "sensitize us to the diverse health-care concerns of our future patients".

On the other hand, we had one lecture on leukemia, one lecture on HIV, and one lecture on cholesterol lowering drugs. These are conditions we'll see frequently in practice that we MUST understand and use in order to make decisions that will absolutely affect the physical quality of patient's lives. I accept the argument that CAM offers patients comfort and that there is great value in emotional well-being, etc etc, that's why I took classes on it; to know how to anticipate patient's feelings and guide them to the best care possible. That's the reason my med school gave to learn about this stuff, nothing at all about proven scientific benefit. However if more time is spent towards learning about something with little proven benefit it means time must be taken away from subjects with much better scientific support. Statins, HIV, leukemia and etc have mountains of research supporting the long-term benefit of tailored treatment regimes to each condition, yet we got less lecture time on these subjects than acupuncture during the basic science years.

When time is limited, why should a school make a genuine effort to teach CAM? What other subjects will be left out by including CAM and is it worth it?
 

dilated

Fought Law; Law Won
10+ Year Member
Nov 4, 2004
1,023
11
251
NC
Status
we also did a half-day at a chiro clinic. These exercises were meant to "sensitize us to the diverse health-care concerns of our future patients".
:bang:

Medical schools are, as an overgeneralization, full of hippie liberals who have an agenda to promote which includes CAM, the holy altar of diversity, the idea that everyone should go into primary care, and other things you probably don't care in the slightest about.

Fortunately, they can't FORCE you to care, and in fact their attempts at indoctrination generally backfired in my class and made people resist those things. The rest of non-academic medicine is equally politically slanted towards conservatives, but at least they don't generally expect you to buy into their particular nonsense.
 

DeadCactus

SDN Lifetime Donor
Lifetime Donor
10+ Year Member
Oct 28, 2006
2,569
654
281
Status
Resident [Any Field]
It's ridiculous to pretend that patients aren't going to be interested in (and pursue) CAM treatments. The patient doesn't give a damn about your double-blind, randomized trial. They care that suddenly they feel better.

But no, you're right. Patients and physicians are much better off with physicians laughing at the idea of CAM and patients going to people without medical training for medical advice and treatment.

I mean what kind of terrible world would we be in if physicians offered CAM in reasonable instances with the admission that evidence supporting it is limited to anecdotal evidence of feeling better. It's much better that patients go give money to people who tell them CAM will cure cancer, AIDs, and the common cold.

I know I sleep better at night knowing that a patient's health and money are going to a person with questionable (at best) medical education rather than a board certified physician.

No, I'm proud that my peers simply scoff at the notion and felate themselves over a recent and incomplete shift to actually evaluating the effectiveness of a treatment...
 

dilated

Fought Law; Law Won
10+ Year Member
Nov 4, 2004
1,023
11
251
NC
Status
It's ridiculous to pretend that patients aren't going to be interested in (and pursue) CAM treatments. The patient doesn't give a damn about your double-blind, randomized trial. They care that suddenly they feel better.
If something has reasonable evidence that it will actually improve the patient's health then I don't consider it CAM. I consider it "medicine". Fortunately, we are not talking about such things. We're talking about such plausible and well supported ideas as the concept of "treating patients with heavily diluted preparations which are claimed to cause effects similar to the symptoms presented" based on the idea that "water is capable of retaining a "memory" of substances once dissolved in it to arbitrary dilution". I feel huge amounts of class time should be spent on these subjects because we have to be diverse multiculturalists who respect all beliefs equally.
 

Forthegood

ProcrastinationAficionado
10+ Year Member
5+ Year Member
Sep 6, 2008
844
7
0
Lexington, KY
Status
Medical Student
CAM is unfortunately has a dearth of money and experienced/educated researchers. It's a deadly combo. Because there are some very promising therapies out there that are either poorly researched or poorly understood.

...

These are just a couple of examples, but you get the point.

I completely agree.

From what I have seen, the majority of the studies are poor at best, and the few decently run studies have shown no improvement over placebo. I refer to the book Snake Oil Science for a short but interesting look at the many ways a study can go wrong.

The truth of the matter is not enough placebo controlled-RCTs are done in this field. We as professionals can not tout them as more or less effective that placebos until we have evidence to do so, right now we don't. It is not to say none of them have any impact, it is just that we don't know the impact because the studies suck.
 

Perrotfish

Has an MD in Horribleness
10+ Year Member
May 26, 2007
7,983
3,861
281
Status
Attending Physician
It's ridiculous to pretend that patients aren't going to be interested in (and pursue) CAM treatments. The patient doesn't give a damn about your double-blind, randomized trial. They care that suddenly they feel better.

But no, you're right. Patients and physicians are much better off with physicians laughing at the idea of CAM and patients going to people without medical training for medical advice and treatment.

We're not laughing at our patients. When we have the time to think about CAM we are quite seriously annoyed at the con artists who take advantage of our patients' trust, low scientific literacy, and very often their desperation to scam them out of their savings. In addition to preying on the anxieties of the healthy these people are stealing from people in chronic pain, people with mental health issues, and even the dying. No one is laughing.

To be fair I'm aware that many of these CAM practicioners aren't consciously scamming their patients and sincerely believe in what they're doing. However the fact that they're sincerely trying to help does not change our obligation to protect our patients.

I mean what kind of terrible world would we be in if physicians offered CAM in reasonable instances with the admission that evidence supporting it is limited to anecdotal evidence of feeling better. It's much better that patients go give money to people who tell them CAM will cure cancer, AIDs, and the common cold.
There is no 'reasonable' instance of CAM use. Chiropractic doesn't cure spinal prblems any more than it can cure AIDS, and acupuncture doesn't promote general health any more than it can cure toxic shock syndrome. I'd love to know what you think a reasonable use of healing crystals, homeopathy, or Reiki is. Our job, with respect to CAM, is to represent science by educating our patients and helping them wade through the flood of mass marketed ignorance they are exposed to. You do not fight fire by lighting another more 'reasonable' fire, you fight a fire by putting it out.

No, I'm proud that my peers simply scoff at the notion and felate themselves over a recent and incomplete shift to actually evaluating the effectiveness of a treatment
Again, it is not our responsibility to 'evaluate' every claim that someone someone has cancer curing pixie dust. Our tests and treatmets work under a governmet mandated guilty until proven innocent philosophy and I, at least, expect CAM to confrom to the same standards.

Which is not to say that this hasn't been studies. There have been private studies, government studies, and meta studies of the studies. There's even a government deparment whose sole purpose is to evaluate CAM. Their conclusions? Just about nothing works. Chiro doesn't even work for back pain, let alone anything else. Exactly how much evaluation do we owe them?
 
Last edited:

Momentum70

10+ Year Member
7+ Year Member
Jul 8, 2007
119
6
141
Status
Attending Physician
Our school has a 4 week rotation that is called Preventative and Complimentary medicine where we learn about nutrition, prevmed, chinese med, accupuncture, chiropracter, etc. We dont really learn how to do the stuff but they do teach us about it and how its done. I think the rotation is great and I think most of it is trash. Why do I think its great? Because a lot of our patients are gonna be trying this stuff and I think its important for us as doctors to learn about it. We need to know the kind of stuff they are using so we can better assist them, and point out all the trash from the better evidence based stuff.
 

Super Mario

10+ Year Member
Dec 13, 2008
20
0
0
Status
Resident [Any Field]
Duke has an integrative medicine center that I believe does offer training in evidence based alternative medicine strategies. The center is staffed by physicians who also practice in their respective specialties (e.g. - internal medicine). I can't comment on the specifics since I haven't elected to receive this training - I will say they have a beautiful facility.
 

murfettie

10+ Year Member
Sep 27, 2008
564
7
251
Status
Medical Student
Last edited: