CNN.com - Med Student: Integrative medicine is 'new way of healing'

[Drogba]

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Hmm... Let's say your a citizen of Gambia with HIV. The president has stated that HIV doesn't cause AIDS, that's a lie propagated by evil western pharmaceutical companies to steal your money and keep you sick. Out of the goodness of his heart, Yahya Jammeh himself has labored long and hard to single-handedly find the cure for aids. He gives you some bananas and herbs and rubs a green paste on your chest and you're cured! (You better be cured, otherwise, he'll kill you). If only the NIH would fund research into that, we wouldn't be in this AIDS crisis right now. But they aren't interested in curing disease. They can't make any money that way. So poor Gambia must deal with the problem itself. Unfortunately, western media reporters are so steeped in western medicine themselves that they ask very inappropriate questions about Jammeh's cure, and understandably must be banned from the country. Jammeh would love to share his cure with the rest of the world, but they just don't understand, because they are wedded to drugs and surgery. So they are stuck with their evil anti-retroviral concoctions.



The problem is that what you are supporting is only a more sophisticated form of magnets and voodoo. The extreme examples are relevant and instructive of what happens when you take the seemingly innocuous stuff to it's ultimate extreme. And further more, they are happening right now on a grand scale, using the same arguments. When you find that your arguments are in complete agreement with people like president Yahya Jammeh and Manto Tshabalala-Msimang (South Africa's health minister), it's time to reevaluate the company you keep.

You've failed to grasp my argument again so this will be my last response to you as I'm growing tired of repeating myself. I'm not supporting any specific therapy, just suggesting disregarding the possible efficacy of treatments not developed by Pharma and biotech companies is rash.

My arguments are hardly in complete agreement with the examples you've mentioned and the fact you could make such a ludicrous claim has proven to me how pointless continuing this conversation is. Having differing opinions is fine, but an attempt to understand what the other person is saying is a bare minimum for productive discussion.

Oh and there is a lot of mistrust towards western medicine in developing countries, unsurprisingly. If you have a background in the history of tropical medicine and colonization you'll realize why. Its unfortunate that this sometimes can be a major obstacle in introducing effective therapies to these areas and particularly disappointing to see people in power exploiting the public distrust or just being plain ignorant.

 

[lawnboy313]

So tell me: What part of homeopathy, for example, do you believe to be a valid medical therapy independent of the placebo effect? In other words, are you so open-minded that you believe anything anybody says, including that water has memory which is the basis of homeopathy?

Additionally, what if I proposed that astrology, an ancient part of Chinese medicine (as well as Western medicine until relatively recently) was a valid CAM treatment modality. Would you ever refer your patient to an astrologist and if not, why not? After all, like acupuncture, the ancient Chinese made detailed and methodical studies of astrology and invested a great deal of scholarship in the idea that the stars controlled our lives. Are you so open-minded that you can't stand up and say, "This is ridiculous."

People may be interested in alternatives to "orthodox" care but that's only because it is human nature to deny unpleasant truths or cling to the last hope in the face of death, rational or otherwise. Interest does not translate into efficacy. In other words, wishing it so doesn't make it so.

Of course one shouldn't be so open-minded as to embrace any medical treatment recommended by anyone under the sun. But one can't also snub *all* CAM treatments with statements like "Almost everything about Complementary and Alternative Medicine (CAM) is bunk and its purveyors are at best deluded and at worst quacks and charlatans who would make the snake oil salesmen of olden days blush from shame." These kind of statements are also ignorant of reality--not to mention unnecessarily vitriolic.

To see what that reality is, you, or anyone else can begin at: nccam.nih.gov.

 

[smq123]

Considering the shadows drug companies chase I don't see why alternative modalities should not be researched.

I agree - what some drug companies do is insane. (Ex: Duac, which is used to treat acne, could be made at home, for about 60% less. Seriously, you can get the active ingredients at a pharmacy, and only one of the ingredients (clindamycin) requires a prescription. And you could easily get that prescription from any dermatologist.)

But some of the alternative modalities don't really need funded research. Flaxseed isn't really harmful or terribly toxic, so if you want to start eating it, fine. Like I said earlier, I don't need a research study to tell me to allow my patients to try that. It does need to be FDA regulated, just so that any possible interactions/toxic side effects are well documented, but aside from that, I don't think that a lot of funded research is truly necessary. A lot of it goes to patient autonomy - if it doesn't hurt, and they want to try it, why not?

[The exception is chiropractors. You can get chiropractic treatments for your lower back if you want. But getting it near your c-spine is not a good idea, and I will fight patients over that. There have been reports of people having strokes from neck treatments, because the chiropractic treatment led to dissection of the vertebral artery. Not good.]

And BOTH orthodox medicine and alternative medicine need more common sense. Like I said - bringing CAM to the underserved is kind of silly. If you've ever truly worked with the underserved, they don't need CAM. They need jobs and better education, and BASIC medical care. In some areas of the inner cities, just getting people to live long enough to get to the point where they have to worry about heart disease and high cholesterol is a huge victory - i.e. they don't get killed earlier by a drug overdose, a knife wound, or a gunshot. Meditation, yoga, and herbal supplements are not enough to help these people.

 

[sawood]

I guess setting inner city examples aside because I don’t have much knowledge about it.

But for the general public that does have all its basic needs met, and in America, not Africa where I’m sure there are abuses to both CAM and conventional medicine. Take aromatherapy: there are two scents that always calm me. One is from bath and body works and it got discontinued (bastards) but the other is nag champa incense. I can’t provide a published research paper as to why it calms me, or prove that it calms me, but it does nonetheless.

And I do meditation in the form of dancing, which helps relieve stress. I’ve noticed I sleep much better and have less stress when I exercise consistently. I sometimes do get back pain (I had back surgery when I was young) and I’ve done Pilates and not only had no back pain, but felt more energized. BUT, I understand that when I originally hurt my back, I needed surgery, conventional medicine, to make it better, and Pilates at that time would have caused further injury. But now, take a pain pill to ease the pain or do Pilates which eliminates the pain and makes me stronger in general? Easy choice for me.

And here’s my plug on Nature: No, I don’t think that being in the mountains will cure AIDS or cancer or make a broken arm heal. And this will probably make a lot of people roll their eyes, but I completely believe there is a healing benefit to being in Nature. I have no proof! None whatsoever. I simply believe it to be true based on my own experiences in Lake Tahoe, the Rocky Mountains, Grand Canyon, and Yellowstone, to name a few.

Human beings are more than the sum of their parts.

Here’s my emoticon:

 

[Drogba]

I agree - what some drug companies do is insane. (Ex: Duac, which is used to treat acne, could be made at home, for about 60% less. Seriously, you can get the active ingredients at a pharmacy, and only one of the ingredients (clindamycin) requires a prescription. And you could easily get that prescription from any dermatologist.)

But some of the alternative modalities don't really need funded research. Flaxseed isn't really harmful or terribly toxic, so if you want to start eating it, fine. Like I said earlier, I don't need a research study to tell me to allow my patients to try that. It does need to be FDA regulated, just so that any possible interactions/toxic side effects are well documented, but aside from that, I don't think that a lot of funded research is truly necessary. A lot of it goes to patient autonomy - if it doesn't hurt, and they want to try it, why not?

I agree partly with the above statement, but don't you think there needs to be some sort of research demonstrating the benefit of something like flaxseed. Its not the type of intervention that will have an immediate or drastic observable benefits. I'm not necessarily suggesting that money be poured into flaxseed or we establish control and experimental groups to follow over the course of 50 years to see if there is less cardio problems associated with flaxseed supplementation since this would be ridiculously expensive. You could, as has already been done, look at differing diets and the health benefits associated with them and try to understand more of whats causing it.

[The exception is chiropractors. You can get chiropractic treatments for your lower back if you want. But getting it near your c-spine is not a good idea, and I will fight patients over that. There have been reports of people having strokes from neck treatments, because the chiropractic treatment led to dissection of the vertebral artery. Not good.]

I've heard of cspine manipulation causing dissections which is terrifying. That needs to be better publicized. I think people should consult with physicians before undergoing this kind of treatment to begin with but that would require doctors who spend time learning about alternative modalities and are open enough to not reject them and give objective information "You know, its possible that manipulation could help your lower back pain though this hasn't been significantly substantiated by research but manipulation of your c-spine could have very severe, even lethal complications and I would strongly argue against it."

And BOTH orthodox medicine and alternative medicine need more common sense. Like I said - bringing CAM to the underserved is kind of silly. If you've ever truly worked with the underserved, they don't need CAM. They need jobs and better education, and BASIC medical care. In some areas of the inner cities, just getting people to live long enough to get to the point where they have to worry about heart disease and high cholesterol is a huge victory - i.e. they don't get killed earlier by a drug overdose, a knife wound, or a gunshot. Meditation, yoga, and herbal supplements are not enough to help these people.

I couldn't agree more. As I stated in my earlier post what these populations need is better access and structural adjustments to their socioeconomic conditions. I've also found that most underserved communities do not have a great deal of interest in alternative medicine but would rather just get the standard of care (my own anecdotal evidence). Obviously this is not always the case when discussing traditional modalities of care with different cultural groups. I believe that given complete access and taking into considerations all barriers to care will result in most people following effective therapeutic courses. People dying of AIDs generally accept ARVs just like people dying of TB generally accept DOTs therapy.

What year are you? What are you interests in medicine at this stage of your education?

 

[8744]

Of course one shouldn't be so open-minded as to embrace any medical treatment recommended by anyone under the sun. But one can't also snub *all* CAM treatments with statements like "Almost everything about Complementary and Alternative Medicine (CAM) is bunk and its purveyors are at best deluded and at worst quacks and charlatans who would make the snake oil salesmen of olden days blush from shame." These kind of statements are also ignorant of reality--not to mention unnecessarily vitriolic.

To see what that reality is, you, or anyone else can begin at: nccam.nih.gov.

"Ignorant" indeed. I'm about as well-educated as anybody on SDN. Probably more so than most. I just happen to be a skeptic of the old school and have a broad enough background in the physical and biological sciences to understand when someone is blowing smoke up my ass.

Your problem is that you're not judgemental enough. In other words, you're open-minded to the extent that you can no longer discriminate between what is rational and what is not. I want you, in clear terms with no hedging and no appeals to placebo medicine, to tell me what is good and worthwhile about homeopathy and why the government should waste money researching it or why you would refer one of your patients to a homeopath.

Remember, homeopaths treat patients by diluting a substance in water to the point where there is nothing in the medicine but water, periodically shaking the mixture to impart "memory" to it. In other words, the tincture contains nothing of the original substance, itself randomly selected under the dubious theory that "like cures like," and it is only the memory of the original substance that remains.

This is obviously absurd. And the very definition of "snake oil" and "bunk" and yet many otherwise intelligent and ostensibly scientifically educated medical students have no problem with it at all or are too afraid to lose their "open-minded" credentials by stating the obvious, namely that the whole basis for this particular CAM modality is ridiculous.

You can say the same about most of the other popular CAM modalities which are based on nothing but flawed metaphors for physiology.

"Snake Oil," by the way, is another way to say "palcebo."

 

[Kthanksbye]

Remember, homeopaths treat patients by diluting a substance in water to the point where there is nothing in the medicine but water, periodically shaking the mixture to impart "memory" to it. In other words, the tincture contains nothing of the original substance, itself randomly selected under the dubious theory that "like cures like," and it is only the memory of the original substance that remains.

Also keep in mind that the ridiculous word "allopath" was created by a homeopath. The current adoption of it (it's use for this forum, for example) as a description of MD medicine is further evidence of how far people will go to establish those "open-minded" credentials.

 

[sawood]

Remember, homeopaths treat patients by diluting a substance in water to the point where there is nothing in the medicine but water, periodically shaking the mixture to impart "memory" to it. In other words, the tincture contains nothing of the original substance, itself randomly selected under the dubious theory that "like cures like," and it is only the memory of the original substance that remains.

So apparently zicam is homeopathic? Does that mean all they do is dilute stuff in water to the point where its undetectable and then tell people that the ingredients lessen the duration of the cold? How can they claim that the active ingredients are the ones listed below if what homeopathy entails is imparting memory to water and the water cures you, shouldn't they say that water is the active ingredient?

Active ingredients: Zincum Aceticum 2x , Zincum Gluconicum 1x
Other ingredients: Benzalkonium Chloride , Glycerin , Peppermint Flavor , Purified Water , Sucralose

http://www.zicam.com/Product.aspx?eid=2&catid=1

I'll laugh if this is what zicam is (water) because my boyfriend swears it makes him feel better.

 

[KeyzerSoze]

I'll laugh if this is what zicam is (water) because my boyfriend swears it makes him feel better.

It probably actually does make him feel better.

 

[sawood]

It probably actually does make him feel better.

But if its homeopathic, is it pretty much water (and scents or flavoring)?

Hey, anything that makes you feel better....it still makes me laugh though 😀

 

[tulane06]

"There's this thing called being so open-minded your brains drop out of your skull."

-Richard Dawkins

 

[KeyzerSoze]

But if its homeopathic, is it pretty much water (and scents or flavoring)?

Hey, anything that makes you feel better....it still makes me laugh though 😀

The placebo effect is real. Unfortunately, some people feel the need to invent pseudoscientific explanations for it, as demonstrated on this thread.

 

[PeepshowJohnny]

You know what happens when you get too into Integrative/CAM?

You turn into this guy:

Source:
http://www.amsa.org/humed/retreat03.cfm

 

[lawnboy313]

"Ignorant" indeed. I'm about as well-educated as anybody on SDN. Probably more so than most. I just happen to be a skeptic of the old school and have a broad enough background in the physical and biological sciences to understand when someone is blowing smoke up my ass.

Your problem is that you're not judgemental enough. In other words, you're open-minded to the extent that you can no longer discriminate between what is rational and what is not. I want you, in clear terms with no hedging and no appeals to placebo medicine, to tell me what is good and worthwhile about homeopathy and why the government should waste money researching it or why you would refer one of your patients to a homeopath.

Remember, homeopaths treat patients by diluting a substance in water to the point where there is nothing in the medicine but water, periodically shaking the mixture to impart "memory" to it. In other words, the tincture contains nothing of the original substance, itself randomly selected under the dubious theory that "like cures like," and it is only the memory of the original substance that remains.

This is obviously absurd. And the very definition of "snake oil" and "bunk" and yet many otherwise intelligent and ostensibly scientifically educated medical students have no problem with it at all or are too afraid to lose their "open-minded" credentials by stating the obvious, namely that the whole basis for this particular CAM modality is ridiculous.

You can say the same about most of the other popular CAM modalities which are based on nothing but flawed metaphors for physiology.

"Snake Oil," by the way, is another way to say "palcebo."

I agree--you, as a doctor, are probably more educated than most of the people in the premedical forum on SDN. As you should be. Congratulations.

I don't understand why you're interested in my defense of homeopathy--none of my statements specifically defend it. In fact, I agree with your criticism of it, and, void of any mechanism to explain why homeopathic treatment has on occasion proved better than placebo (see some of the trials cited at the NCCAM site), it may not be worth continued investigation.

However, I don't think it's appropriate--or intelligent--to lump herbal medicines, mind-body therapies, massage and other CAM treatments that have both an evidence base and possible mechanism of action with homeopathy, urine-drinking, amulet-wearing, and whatever else might be out there. You're throwing the baby out with the bathwater.

 

[Kthanksbye]

However, I don't think it's appropriate--or intelligent--to lump herbal medicines, mind-body therapies, massage and other CAM treatments that have both an evidence base and possible mechanism of action with homeopathy, urine-drinking, amulet-wearing, and whatever else might be out there. You're throwing the baby out with the bathwater.

Funny, I don't have any problem lumping it all together with urine-drinking. Seems like an adequate description to me, with about as much evidence to back it up (otherwise it wouldn't be CAM). Hell, if it's good enough for India's Prime Minister Morarji Desai, don't you think you should give it a try?

Source: http://www.holistic-centre.com/articles/urine.htm

 

[Kthanksbye]

You know what happens when you get too into Integrative/CAM?

You turn into this guy:

Source:
http://www.amsa.org/humed/retreat03.cfm

Whoa, I just realized that's the same group all the pre-meds at my school belong to. The AMSA is the primary reason I did not join the pre-med club! Didn't know they did purple wizard retreats, too. Scary!

 

[Quix]

Funny, I don't have any problem lumping it all together with urine-drinking. Seems like an adequate description to me, with about as much evidence to back it up (otherwise it wouldn't be CAM). Hell, if it's good enough for India's Prime Minister Morarji Desai, don't you think you should give it a try?

Source: http://www.holistic-centre.com/articles/urine.htm

Snarkiness aside, there are actually articles supporting the clinical efficacy of alternative therapies. I'm not a die-hard advocate of CAM, in that I think that there is a lot of crap out there, but just for a lark I checked PubMed and discovered evidence of clinical effectiveness of massage and acupuncture (among other CAM therapies) in such rags as the Archives of Internal Medicine, CHEST, Annals of Thoracic Surgery, British Medical Journal, the American Journal of Medicine, the American Heart Journal, Journal of the American College of Surgeons, Pediatrics, Rheumatology, and the Canadian Journal of Medicine. I'm happy to post the abstracts if anyone is curious.

The point is that there is no reason to be sarcastic or denigrating about CAM. A lot remains to be researched, but as a concept it's not simply bunk.

 

[sawood]

Whoa, I just realized that's the same group all the pre-meds at my school belong to. The AMSA is the primary reason I did not join the pre-med club! Didn't know they did purple wizard retreats, too. Scary!

Humanistic medicine is just one part of AMSA. There's also divisions like global health, health policy, women's health, etc, etc. The AMSA club at my school has doctors come in as guest lecturers and they have Grey's Anatomy nights, it can be really informative and fun.

I've seen weirder costumes at certain mainstream religious ceremonies, star trek conventions, and football games. Let people believe what they believe as long as they're not pushing a man dressed as a wizard on unsuspecting people. Life would be boring if everyone were the same, with the same beliefs, interests, and passions. If a group of people enjoy the retreat, that's awesome. I'd rather go there than Disneyland anyday (Evil empire).

 

[Kthanksbye]

Humanistic medicine is just one part of AMSA. There's also divisions like global health, health policy, women's health, etc, etc. The AMSA club at my school has doctors come in as guest lecturers and they have Grey's Anatomy nights, it can be really informative and fun.

I've seen weirder costumes at certain mainstream religious ceremonies, star trek conventions, and football games. Let people believe what they believe as long as they're not pushing a man dressed as a wizard on unsuspecting people. Life would be boring if everyone were the same, with the same beliefs, interests, and passions. If a group of people enjoy the retreat, that's awesome. I'd rather go there than Disneyland anyday (Evil empire).

Be my guest. I lived in California for 6 years. I've had my fill of junk like that. But some people (myself included) have to experience it before they realize what bull crap it really is. Actually, the primary reason I don't like AMSA is that they are 100% about creating universal socialized health care in america. I didn't join the pre-med club because I don't agree with their politics. I don't think most pre-meds are even aware of the groups politics. Btw, those retreats and conventions and activities are primarily a way for them to steep members in their politics, and by targeting pre-meds, they get them well before they've had a chance to from opinions of their own. Just my humble opinion.

 

[smq123]

I agree partly with the above statement, but don't you think there needs to be some sort of research demonstrating the benefit of something like flaxseed.

No - I think that in the cases of some CAM therapies, anecdotal evidence is enough to for clinical care decisions. If some of my patients tell me that it worked for them, and it isn't an inherently harmful treatment, I might recommend it to other patients with similar problems. But, like I said - I don't need a research study telling me that I can "allow" my patients to try a vegetarian diet or whatever.

For instance - my grandmother used acupuncture after her hysterectomy, because she couldn't cough out any secretions that were building up. Acupuncture helped her get rid of the secretions without needing to cough. If I have a patient who has the same problem after abdominal surgery, I might say "Oh, by the way, acupuncture might work. You might give it a try." But I don't need a research study or an article telling me that I should or shouldn't recommend it. Anecdotal evidence, in this case, is enough for me.

I think people should consult with physicians before undergoing this kind of treatment to begin with but that would require doctors who spend time learning about alternative modalities and are open enough to not reject them and give objective information "You know, its possible that manipulation could help your lower back pain though this hasn't been significantly substantiated by research but manipulation of your c-spine could have very severe, even lethal complications and I would strongly argue against it."

I don't know if you even need to study CAM extensively, even in med school. If you want to, that's fine, but it really comes down to patient autonomy. All you really need to learn is the possible harms and toxicities of various alternative therapies. If it isn't harmful and not toxic, and the patient wants to do it - so what, they can do it.

What year are you? What are you interests in medicine at this stage of your education?

I'm an MS3. I'm still early in rotations, though. I enjoyed OB/gyn (I'll bet that the med students who read this are already raising their eyebrows!), but we'll see.

 

[smq123]

Btw, those retreats and conventions and activities are primarily a way for them to steep members in their politics, and by targeting pre-meds, they get them well before they've had a chance to from opinions of their own. Just my humble opinion.

Don't worry. Two weeks on the wards in the 3rd year of med school, and everyone becomes disillusioned with AMSA. Particularly when they realize that AMSA is doing NOTHING to help out doctors and med students do things that, you know, sort of matter. Like pressuring politicians to reduce malpractice insurance rates. Or like lobbying for better loan repayment options. Trivial stuff like that. 🙄

AMSA is just another thing that med students sign up for during orientation to put on their resume and to get the free Netter's.

(Sorry to sound so bitter. But when you do OB/gyn and realize just how much your attending is paying in malpractice (in some states, it's > $90,000), and when you realize that hospitals in underserved areas can't afford to pay that so they shut down their maternity wards [leaving patients high and dry], and when you realize that AMSA is doing ZERO to adequately educate med students about this, you'll be bitter too.)

 

[Quix]

Peer-reviewed research on flaxseed! OMG! 😉

J Clin Endocrinol Metab. 2002 Apr;87(4):1527-32.

Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women.

Lucas EA, Wild RD, Hammond LJ, Khalil DA, Juma S, Daggy BP, Stoecker BJ, Arjmandi BH.

Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma 74078, USA.

The risk of cardiovascular disease and osteoporosis drastically increases at the onset of menopause. Phytoestrogens have been suggested to inhibit bone loss and protect the cardiovascular system, in part by improving lipid profiles. The purpose of the present study was to examine the effects of flaxseed, a rich source of the phytoestrogens called lignans, on lipid metabolism and biomarkers of bone turnover in postmenopausal women. Postmenopausal women who were not on hormone replacement therapy were assigned to one of two treatment groups in a double-blind randomized study. Women were asked to consume 40 g of either ground flaxseed or wheat-based comparative control regimen daily for 3 months. In addition, all subjects received 1,000 mg calcium and 400 IU vitamin D daily. Flaxseed supplementation lowered (P < 0.05) both serum total cholesterol and non-high-density lipoprotein cholesterol by 6%, whereas the comparative control regimen had no such effect. Flaxseed regimen reduced serum levels of both low-density- and high-density-lipoprotein cholesterol by 4.7% and triglyceride by 12.8%, albeit not statistically significant. Serum apolipoprotein A-1 and apolipoprotein B concentrations were significantly (P < 0.005) reduced by 6 and 7.5%, respectively, by the flaxseed regimen. Markers of bone formation and resorption were not affected by either of the treatments. The findings of this study indicate that flaxseed supplementation improves lipid profiles but has no effect on biomarkers of bone metabolism in postmenopausal women.

 

[DocWalken]

Just look at Kevin Trudeau's Book.."Natural Cures 'They' Don't Want You To Know About"...This is probably the bible for all you alternative medicine nuts anyways....

Serisouly, cancer is really sad and it sucks but wearing white on wednesday and eating some "mystical native american herb" from some wise chief is not going to help you.

 

[DocWalken]

...god what a bunch of crap

 

[Kthanksbye]

Peer-reviewed research on flaxseed! OMG! 😉

Actually, I prefer fish oil. Take them every morning.👍 I think there's quit a bit of evidence to support it, too. Doesn't mean I'm going out to get acupuncture, however. But hey, someone else mentioned Pilates. I do that, too. Funny that it would be considered CAM. I just consider it exercise. I do, however, avoid the Pilates studios that are incorporated with Chiropractors, which is a growing trend among Chiropractors to lure business. That's just silly. Pilates shouldn't sell itself so short. It's a legitimate exercise.

 

[Quix]

...god what a bunch of crap

Er...

I'm not a die-hard advocate of CAM, in that I think that there is a lot of crap out there, but just for a lark I checked PubMed and discovered evidence of clinical effectiveness of massage and acupuncture (among other CAM therapies) in such rags as the Archives of Internal Medicine, CHEST, Annals of Thoracic Surgery, British Medical Journal, the American Journal of Medicine, the American Heart Journal, Journal of the American College of Surgeons, Pediatrics, Rheumatology, and the Canadian Journal of Medicine. I'm happy to post the abstracts if anyone is curious.

The point is that there is no reason to be sarcastic or denigrating about CAM. A lot remains to be researched, but as a concept it's not simply bunk.

 

[Kthanksbye]

The point is that there is no reason to be sarcastic or denigrating about CAM. A lot remains to be researched, but as a concept it's not simply bunk.

This may be true, but that is no reason NOT to criticize those practices which are complete and utter bunk, which a lot of people fail to do in their attempt to be accommodating to alternatives. The vast majority has no medical value, is a waste of money, time and resources, and if not indirectly harmful by keeping people from proven techniques, then it is itself directly harmful. Such practices should not be tolerated in the name of "open-mindedness". In my posts I have mentioned many practices that may sound obscure, but are actually widely practiced. And you can find books by their practitioners in any book store in the country. I don't feel any remorse for calling them abject quacks.

 

[DocWalken]

j

 

[DocWalken]

Richard Dawkins defines alternative medicine as a "...set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply...becomes medicine."[5] He also states that "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."


...Simply becomes medicine when it works...
and exercise and healthy diet is not alternative, it's known to work

 

[Quix]

This may be true, but that is no reason NOT to criticize those practices which are complete and utter bunk, which a lot of people fail to do in their attempt to be accommodating to alternatives. The vast majority has no medical value, is a waste of money, time and resources, and if not indirectly harmful by keeping people from proven techniques, then it is itself directly harmful. Such practices should not be tolerated in the name of "open-mindedness". In my posts I have mentioned many practices that may sound obscure, but are actually widely practiced. And you can find books by their practitioners in any book store in the country. I don't feel any remorse for calling them abject quacks.

I agree with you - as I said above, there is *a lot* of crap out there. Personal favorites are (1) from several years ago when Janet Jackson was supposedly injecting herself with horse urine to lose weight, and (2) taking shark cartilege because "sharks don't get cancer". Bunk. But the problem is that people lump all of them together far too easily, even when there is legitimate, peer-reviewed research showing efficacy. My aunt is an advocate for alternative therapies (well beyond my limited "acceptible" scope), and at the end of the day recognized that in many cases there is a placebo effect occurring, but we were both on the same page: so long as there is no interaction or objective harm incurred, there is nothing wrong with a placebo effect in treatment. If it makes a patient feel better and optimistic about coping with their illness, that's fine, because there is *objective and repeatable data* supporting mood and healing/recovery. 😉

 

[Quix]

Richard Dawkins defines alternative medicine as a "...set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply...becomes medicine."[5] He also states that "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."


...Simply becomes medicine when it works...
and exercise and healthy diet is not alternative, it's known to work

(1) Victory by definition != legitimate or valid argument.
(2) How many studies are necessary to convey legitimacy? CAM has been tested and undergoes further testing by the same standards of evidence and peer review as other potentially beneficial therapies.
(3) Arguments along these lines tend to push towards the horizons - every time a shortcoming of the definition in question is demonstrated, the proposer tends to shift the scope of the definition away from the concept in question in an effort to maintain apparent validity. Simply defining therapies covered by CAM as covered by contemporary medical practice is this kind of horizon pushing.

 

[Kthanksbye]

I agree with you - as I said above, there is *a lot* of crap out there. Personal favorites are (1) from several years ago when Janet Jackson was supposedly injecting herself with horse urine to lose weight, and (2) taking shark cartilege because "sharks don't get cancer". Bunk. But the problem is that people lump all of them together far too easily, even when there is legitimate, peer-reviewed research showing efficacy. My aunt is an advocate for alternative therapies (well beyond my limited "acceptible" scope), and at the end of the day recognized that in many cases there is a placebo effect occurring, but we were both on the same page: so long as there is no interaction or objective harm incurred, there is nothing wrong with a placebo effect in treatment. If it makes a patient feel better and optimistic about coping with their illness, that's fine, because there is *objective and repeatable data* supporting mood and healing/recovery. 😉

As long as it is actually harmless, then I would not fight a patient who is doing something useless and potentially getting a placebo effect from it, so I agree with you on that one. I think it's very important to evaluate what is and is not harmless, however. An interesting example would be the book about the Hmongs, "The spirit catches you and you fall down." Clearly, these people were doing things which they utterly believed were helpful, but they were killing their child. This is not so uncommon. I talked with a pediatrician at my ER (where I volunteer) who said that many latin american families use a common home remedy that contains about 90% lead. They are poising their children with this stuff, and as a physician, you have to find a way to explain this to them or you are not doing your job.

 

[Quix]

As long as it is actually harmless, then I would not fight a patient who is doing something useless and potentially getting a placebo effect from it, so I agree with you on that one. I think it's very important to evaluate what is and is not harmless, however. An interesting example would be the book about the Hmongs, "The spirit catches you and you fall down." Clearly, these people were doing things which they utterly believed were helpful, but they were killing their child. This is not so uncommon. I talked with a pediatrician at my ER (where I volunteer) who said that many latin american families use a common home remedy that contains about 90% lead. They are poising their children with this stuff, and as a physician, you have to find a way to explain this to them are you are not doing your job.

Absolutely; there are also legal/ethical considerations, to boot. In the U.S., there is an established principle of parens patriae in that the state (in both the "federal State" and "individual states" senses of the term) has a legitimate third-party interest in the welfare of its citizenry.

 

[8744]

So apparently zicam is homeopathic? Does that mean all they do is dilute stuff in water to the point where its undetectable and then tell people that the ingredients lessen the duration of the cold? How can they claim that the active ingredients are the ones listed below if what homeopathy entails is imparting memory to water and the water cures you, shouldn't they say that water is the active ingredient?

Active ingredients: Zincum Aceticum 2x , Zincum Gluconicum 1x
Other ingredients: Benzalkonium Chloride , Glycerin , Peppermint Flavor , Purified Water , Sucralose

http://www.zicam.com/Product.aspx?eid=2&catid=1

I'll laugh if this is what zicam is (water) because my boyfriend swears it makes him feel better.

Water is the active ingredient in homeopathy. It's the only ingredient. There is no scent, chemical, or other substance involved. We're talking dilution to the point where having a single molecule of the original substance is statistically unlikely. The point is that water has "memory" although why the memory of the container or of every other thing the water has come in contact with doesn't overpower the desired memory is never explained.

Naturally, anybody with any knowledge of the physical sciences should see how ridiculous homeopathy really is and yet at our local medical school there is a homeopathic interest group (MSU COM). Are these medical students stupid? Must be. Or maybe they just don't know what they are advocating and confuse "homeopathic" with "holistic."

By extension, a lot of other CAM modalities are equally as ridiculous.

On another subject, to advocate for the placebo effect is to say that real doctors should be allowed to dispense sugar pills. I would love to give my really annoying chronic patients a blue m&m as a subsititute for a three thousand dollar workup but this would be highly unethical as some of them, particularly the elderly who were raised to trust doctors, would claim some benefit and go home with possibly serious medical conditions. The use of placebos is unethical, even if the doctor believes in the placebo.

 

[Kthanksbye]

Don't worry. Two weeks on the wards in the 3rd year of med school, and everyone becomes disillusioned with AMSA. Particularly when they realize that AMSA is doing NOTHING to help out doctors and med students do things that, you know, sort of matter. Like pressuring politicians to reduce malpractice insurance rates. Or like lobbying for better loan repayment options. Trivial stuff like that. 🙄

AMSA is just another thing that med students sign up for during orientation to put on their resume and to get the free Netter's.

(Sorry to sound so bitter. But when you do OB/gyn and realize just how much your attending is paying in malpractice (in some states, it's > $90,000), and when you realize that hospitals in underserved areas can't afford to pay that so they shut down their maternity wards [leaving patients high and dry], and when you realize that AMSA is doing ZERO to adequately educate med students about this, you'll be bitter too.)

Well, it actually makes sense to me, given that they are so committed to state run universal health care, that they wouldn't do anything to improve such conditions as malpractice and insurance problems with the current system. The worse such problems get, the better their argument sounds for a state takeover. It would be contrary to their interests for them to try to improve current conditions. Yet another reason to avoid AMSA.

 

[sawood]

Well, it actually makes sense to me, given that they are so committed to state run universal health care, that they wouldn't do anything to improve such conditions as malpractice and insurance problems with the current system. The worse such problems get, the better their argument sounds for a state takeover. It would be contrary to their interests for them to try to improve current conditions. Yet another reason to avoid AMSA.

Or another reason to join. If everyone who believes their approach is wrong never joins and just avoids AMSA, then how is anything supposed to change for the better?

 

[Kthanksbye]

Or another reason to join. If everyone who believes their approach is wrong never joins and just avoids AMSA, then how is anything supposed to change for the better?

So you're saying that by joining I could effect fundamental change in the organization that restructures all current stated goals?

 

[rickthetwinkie]

So your saying that by joining I could effect fundamental change in the organization that restructures all current stated goals?

No, just that if you feel passionate about AMSA not actually representing the core beliefs of medical students, it is your responsibility to be heard. Granted not all of us are the type to slurp our way to the top, but those who are should reconsider not joining and start participating.

I don't feel this is to be expected of everyone because, lets face it, not all of us have the time or mental stamina to do this, but I would guess part of the reason AMSA isn't representative of these beliefs is because most of those who feel this way just step back and grumble.

Anyways, this is conjecture because I don't quite know how AMSA is structured. I would actually like to see a study of medical schools that have AMSA chapters to see if it actually is representative of the majority of students' beliefs.

 

[rickthetwinkie]

While there are some beneficial forms of "CAM" out there, much of it does not have adequate scientific basis behind it (I agree with Panda on this a lot). And even if it were completely harmless, CAM is a waste of money, so while I agree that the buyer should beware, if a patient were to come up to me asking me what I think, I would say what I think: most likely, they will be spending money on something that simply doesn't work.

Now, this may change, but on a surface perusal of the CAM section of the NIH website, there is very little evidence to support many of the CAM modalities. Also, I would argue that the premises involved in some of these modalities can be toxic if they supplant orthodox medical intervention.

I believe we should be educated about CAM for sure, so we know what these treatments are, so we can address the complications that arise, the possible interactions that can occur, and the possible benefits if there is evidence for it. I do NOT believe we should be trained to use the modalities.

 

[Kthanksbye]

No, just that if you feel passionate about AMSA not actually representing the core beliefs of medical students, it is your responsibility to be heard. Granted not all of us are the type to slurp our way to the top, but those who are should reconsider not joining and start participating.

I don't feel this is to be expected of everyone because, lets face it, not all of us have the time or mental stamina to do this, but I would guess part of the reason AMSA isn't representative of these beliefs is because most of those who feel this way just step back and grumble.

Anyways, this is conjecture because I don't quite know how AMSA is structured. I would actually like to see a study of medical schools that have AMSA chapters to see if it actually is representative of the majority of students' beliefs.

From their website:

"AMSA works through state and national coalitions to advocate for a healthcare reform process that involves sequential reform and a single-payer universal healthcare system."👎


Just a quick look at their website would tell you that they are entirely committed to a government takeover of the healthcare system. I don't see how one could ever hope to change this through joining the organization. It would almost be like a black man joining the clan and trying to convince them to not hate blacks. Choose your battles. This is a hopeless cause. I would prefer to let the AMSA to their populist agenda (and have no part in it) and pursue meaningful reform somewhere where it has more potential to actually take root.

 

[rickthetwinkie]

From their website:

"AMSA works through state and national coalitions to advocate for a healthcare reform process that involves sequential reform and a single-payer universal healthcare system."👎


Just a quick look at their website would tell you that they are entirely committed to a government takeover of the healthcare system. I don't see how one could ever hope to change this through joining the organization. It would almost be like a black man joining the clan and trying to convince them to not hate blacks. Choose your battles. This is a hopeless cause. I would prefer to let the AMSA to their populist agenda (and have no part in it) and pursue meaningful reform somewhere where it has more potential to actually take root.

I actually agree with you. Not everyone sees the logic in trying to change the organization, and your reasoning is sound in my opinion. I'm just hoping that some disagree and actually try to make it more representative of the medical student population. Of course, I don't quite know what is representative of the medical student population.

 

[sawood]

From their website:

"AMSA works through state and national coalitions to advocate for a healthcare reform process that involves sequential reform and a single-payer universal healthcare system."👎


Just a quick look at their website would tell you that they are entirely committed to a government takeover of the healthcare system. I don't see how one could ever hope to change this through joining the organization. It would almost be like a black man joining the clan and trying to convince them to not hate blacks. Choose your battles. This is a hopeless cause. I would prefer to let the AMSA to their populist agenda (and have no part in it) and pursue meaningful reform somewhere where it has more potential to actually take root.

They may be in favor of a government take over now, but my hope would be that AMSA's policies can evolve as new students come in. I totally agree with the choose your battles concept. Hopefully a group of people will choose this as a battle, at least to make sure the policies acurately represent the med student population.

I still shamelessly cling to the belief that things can change, within and outside of AMSA 😳

I feel like I should mention something about CAM since that's what this thread is about.......ohmmmmm 😀

 

[Kthanksbye]

They may be in favor of a government take over now, but my hope would be that AMSA's policies can evolve as new students come in. I totally agree with the choose your battles concept. Hopefully a group of people will choose this as a battle, at least to make sure the policies acurately represent the med student population.

I still shamelessly cling to the belief that things can change, within and outside of AMSA 😳

Personally, I think if you looked hard enough, you would find that AMSA is most likely not a bottom up organization, but most likely, the agenda is set from the top, and they try as hard as they can to mold incoming members to that preset agenda. I have not looked at the top levels, myself, but it would be interesting and informative to find out who supports it, monetarily, politically and ideologically. It will most likely turn out that the organization itself is not so much an attempt at the accurate representation of the current student body as it is a means to an ideological and political end which relies on indoctrinating incoming students to ultimately achieve this goal. Like I said, I don't know the details myself, but I suspect that anyone honestly looking into it would probably find that this is the case. The significance of this would be that it would be as impossible to change their ideology from within as it would be to change you skin color blue. But that's just my suspicion.

I feel like I should mention something about CAM since that's what this thread is about.......ohmmmmm 😀

Is this you doing some kind of CAM meditation?👍

 

[BlackSails]

This would be your personal belief/opinion, not something you can state as fact.

Actually, (and I will try to find the reference later, I dont remember the title of the journal/article, so its a bit difficult. It was some psych journal) there was a study in which they divided patients into 4 groups, which were randomized. All patients had similar diseases and severity.

Control.
Group A
Group B
Group C.

Group A was told they would be prayed for, and were prayed for.
Group B was told they would be prayed for, and were not prayed for.
Group C was not told they would be prayed for, and were prayed for.
The control was not prayed for, or told they would be prayed for.

Control and C were not significantly different. However, there was a statisically significant (but small) difference between Control/C and A/B. A/B patients did worse than Control/C. The difference between A and B was not significant.

 

[thoffen]

Let's give an example from my experience with CAM:

A 7-yo male presents with behavioral problems. After lab work, you find that his androgen hormones are highly elevated. You have ruled out precocious puberty, but realize that his agressive behavior is likely related. Now. You could treat this with LHRH analogs which act on the pituitary. Or you could realize that the extra hormones are being produced by the adrenal glands. You could know that licorice root extract has a chemical called glycyrrhizic acid that is an active inhibitor of 11 beta-HSD which breaks down cortisol. Licorice root extract has been used for centuries for glandular support and is readily consumed as licorice, so it has strong evidence of safety. Since the mechanism of action is known, you can easily monitor it to make sure it's safe and effective. Simply order labs to keep track of the cortisol level and ensure it stays within normal range.

This is just one example of treating people with herbs where the mechanism is well established and preferential to the approved drug for many reasons. I would argue that since it acts on the adrenal glands (the cause of the problem), it is a more logical treatment.

What's the difference between glycyrrhizic acid and other medications? Simply the source.

As a doctor, I would find it unethical not to use treatments that have been supported by peer-reviewed research, whose mechanisms are known, and have been safely used as treatments for centuries.

As a doctor, I would find it unethical to use treatments that have not been supported by peer-reviewed research, whose mechanisms are unkown, and have not been safely used as treatments for a sufficient time frame.

The problem with most alternative medicine is not just lack of research, it's the unsubstantiated and potentially dangerous advertising claims of manufacturers trying to make a buck. I see no problem with promising treatments that have undergone comparable scientific rigor to pharmaceuticals, and neither should you. It is a matter of opinion that more research should be done on these therapies.

 

[Quix]

Just be careful, as glycyrrhizin can produce metabolic alkalosis. 😉

 

[smq123]

A 7-yo male presents with behavioral problems. After lab work, you find that his androgen hormones are highly elevated. You have ruled out precocious puberty, but realize that his agressive behavior is likely related. Now. You could treat this with LHRH analogs which act on the pituitary. Or you could realize that the extra hormones are being produced by the adrenal glands. You could know that licorice root extract has a chemical called glycyrrhizic acid that is an active inhibitor of 11 beta-HSD which breaks down cortisol. Licorice root extract has been used for centuries for glandular support and is readily consumed as licorice, so it has strong evidence of safety. Since the mechanism of action is known, you can easily monitor it to make sure it's safe and effective. Simply order labs to keep track of the cortisol level and ensure it stays within normal range.

1. Yes, it's very safe. So safe, in fact, that instances of hypokalemic rhabdomyolysis have been associated with the use of licorice extract. Considering that Gonadorelin (the LHRH analogue) doesn't have hypokalemia as a side effect, which is a better treatment? I'll stick with the gonadorelin, thanks.
2. Just because it's "MOA" is known, doesn't mean that it's easy to monitor. I don't understand what you mean when you say that.
3. Just keeping track of the cortisol level does NOT ensure that the patient is safe - i.e. if he becomes severely hypokalemic, you might not pick up on that until it's too late.

What's the difference between glycyrrhizic acid and other medications? Simply the source.

Other side effects of glycyrrhizia glabra that you've forgotten in your lyrical defense of its use:
* HTN / hypertensive encephalopathy
* lower extremity weakness
* CHF
* erectile dysfunction

Sorry, but I'll stick with the orthodox medication in this case.

 

[thoffen]

1. Yes, it's very safe. So safe, in fact, that instances of hypokalemic rhabdomyolysis have been associated with the use of licorice extract. Considering that Gonadorelin (the LHRH analogue) doesn't have hypokalemia as a side effect, which is a better treatment? I'll stick with the gonadorelin, thanks.
2. Just because it's "MOA" is known, doesn't mean that it's easy to monitor. I don't understand what you mean when you say that.
3. Just keeping track of the cortisol level does NOT ensure that the patient is safe - i.e. if he becomes severely hypokalemic, you might not pick up on that until it's too late.

Other side effects of glycyrrhizia glabra that you've forgotten in your lyrical defense of its use:
* HTN / hypertensive encephalopathy
* lower extremity weakness
* CHF
* erectile dysfunction

Sorry, but I'll stick with the orthodox medication in this case.

Hey guys. My post of that was premature. I am (obviously) pre-med and thus I shouldn't be debating the actual medicine behind it. The medical use of it was by a physician and I was attempting to paint a picture that I wasn't qualified to promote.

Nonetheless, it does illustrate another potential therapy, and I am glad it has been criticized in that fashion rather than a subjective thrashing.

FYI, the dose necessary is very small. I can get more info from the physician if you like. I'm done arguing the science of it because I shouldn't have been doing so to start with.

 

[Instatewaiter]

This thread is starting to make my blood boil. To the people bashing integrative medicine, welcome to the world of big business. Drug companies pump billions of dollars into clinical trials supporting THEIR drugs. There are so many promising alternative treatments that see scarce funding (I.E. measles virus used in treating ovarian cancer at the Mayo clinic).

First, the money for research definitely does not come only from big pharma. I do agree that there is a problem with funding CAM and in addition there is an inherent bias in the reviewers who read the articles meaning most CAM articles probably wont get published in reputable journals. That said, how many CAMs have undergone RCTs with solid methodology?

Not all treatments in conventional medicine are reliable and completely understood, yet they are still used. For example, drugs that are used to treat depression.

A family member of mine has gone through untold amounts of medication switching, struggling with their effects. My question is if CAM is so bad because its &#8216;unproven' why is it acceptable to turn around and put someone on these psych medications that no conventional doctor has been able to explain to me why some work and others don't, and why they have suddenly stopped working and had detrimental effects?

In general I was under the impression that the body's complex biochemical system is not completely and totally understood, if only because each person is different. Otherwise why would there ever be drug recalls for medications that have unforeseen effects on the body if conventional medicine has all the answers already?

All you need to know is that they are effective against X condition. If you know that then it is 'proven.' Conventional medicine has this efficacy data as required by law while CAM often lacks much solid evidence.

Not all drugs work on every population due to random polymorphisms most commonly either in the activation enzymes of the body or metabolic pathways. This is most likely the cause of needing to switch people to different anti-depressants. And if you look at the literature there is a good amt of this already known about different responses to anti-depressants but to test every patient's genetics just wouldnt be fast enough.

Interesting that you would choose a symptom of strychnine poisoning (an extract of Strychnos nux vomica) in a discussion of herbal therapies, etc. The only thing more appropriate would be a reference to cyanide poisoning because of laetrile.

He was more likely talking about tetanus.

I am aware of the death related to viral treatments. However, how many millions of people die while taking chemotherapies that wipe the life out of them... yet no one thinks twice about it because after all these people did already have cancer. I think its sick and sad that we let business kill people and readily turn the other way, when more funding could go into less toxic treatments, yet there is no money to be gained so it goes unused.

Chemotherapies are rarely the cause of a cancer patient's death. The problem with cancer is that the normal population of cells is very similar to the cancerous cells that there are toxic effects, especially with rapidly growing cells (bone marrow, mucosa). The cancers that are easiest to treat are those that have some major difference from the normal population of cells from which they were derived (CML and imatinib).Those have the fewest toxic effects.

You honestly must have no idea how much the NIH, big pharma and every other grant giving institutions pump into cancer research trying to find better drugs with fewer toxicities.

I agree with you 100%. I am not suggesting that CAM will always, or even work in most cases. In fact I'm making no claim as to the frequency or efficacy of CAM; however, the shortcomings in our system are what have caused such an interest in alternative therapies. Some of these therapies may have clinical value, and many may not.

When people are on the brink of death or are faced with a disease that will kill them of course they will look for alternatives if the current therapy is not 100%.

I agree some CAM may be of clinical value but until there is data on efficacy, a doctor just cant promote it in good concience. "In God we trust, all others bring data."

 

[Kthanksbye]

First, the money for research definitely does not come only from big pharma. I do agree that there is a problem with funding CAM and in addition there is an inherent bias in the reviewers who read the articles meaning most CAM articles probably wont get published in reputable journals. That said, how many CAMs have undergone RCTs with solid methodology?



All you need to know is that they are effective against X condition. If you know that then it is 'proven.' Conventional medicine has this efficacy data as required by law while CAM often lacks much solid evidence.


When people are on the brink of death or are faced with a disease that will kill them of course they will look for alternatives if the current therapy is not 100%.

I agree some CAM may be of clinical value but until there is data on efficacy, a doctor just cant promote it in good concience. "In God we trust, all others bring data."

One of the major persistent and most likely false assumptions that keeps being made is that CAM modalities WANT to do the research to collect the necessary data to "prove" their case. Why would they do that? Most likely, the evidence will come back negative, or severely restrict the scope of the claims that they made prior to research. They are making PLENTY of money (contrary to popular opinion), and such research would, for the vast majority of modalities, if accepted, severely limit their marketing and profit capabilities that they currently enjoy as unregulated cure-alls. Take acupuncture, for instance. Without debating the validity of the research that some posted earlier saying that it is effective for low back pain, do you really think that acupuncturists want to restrict their practice to the few treatments that have shown marginal efficacy? Most CAM modalities would face similar issues if throughly researched, no one currently is forcing them to provide such data, what is the up-side to them?