Comments on: Glass Houses

By: Privileging Drugs, Bashing Herbs « Know Thy Health

Privileging Drugs, Bashing Herbs « Know Thy Health — Mon, 05 Apr 2010 14:08:28 +0000

[...] has been thoroughly, rigorously and scientifically tested. (Even some defenders of Western medicine acknowledge the [...]

By: Jes

Jes — Tue, 30 Mar 2010 22:45:30 +0000

I appreciate this post, as I'm researching the experience of elderly women living with arthritis, their communication with health care providers, and their use of CAM. A common theme is that people use all sorts of CAM and folk remedies when they are desperate for relief, or when friends or media convince them it's worthwhile. It's about empowerment and trial and error, not necessarily logic and discernment. Even when they can't say the treatments “work” for sure, or when they are doing something so ridiculous they hide it from their friends, they just have to do something.

Meanwhile, most admit that they don't disclose their CAM use to their doctors, because it's something that their doctor has no control over, or they feel their doctors will poo poo it. When this is the case, crucial opportunities are missed for healthcare providers to discuss the risks and benefits of CAM and to address lifestyle issues that go beyond just prescribing a pill. Simply asking patients non-judgmentally about what other self-care or alternative strategies they are using shows that you care, and can foster a sense of empowerment and more open communication. It seems to me that many areas of CAM provide these psychological and sometimes spiritual benefits which the medical system no longer has room for, and that will never be captured in any randomized controlled trial.

By: Dr. Rob

Dr. Rob — Fri, 19 Mar 2010 14:44:30 +0000

I agree that personal observation is hard to deny. Yet that's our job as docs – to put our personal observation (that is 1000 times more observations) out there. I am personally not an antibiotic non-prescriber. The point of this post was to say that we all do some non-science, which makes arguing against CAM a little more hypocritical if it is done via a “science vs. non-science” perspective.

By: Dr. Rob

Dr. Rob — Fri, 19 Mar 2010 14:41:14 +0000

A UTI should always be treated per current recommendation. This is because of how quickly a kidney infection can turn into sepsis.

I have a 7 day rule with coughs – that any cough (bad cough) lasting 7+ days probably warrants an course of treatment. Statistically it is way more likely these will be mycoplasma, or even more importantly, pertussis.

By: Dr. Rob

Dr. Rob — Fri, 19 Mar 2010 14:37:52 +0000

Steevo:
You argued with my mom?? Did she give you “that look?”

By: some dude named steevo

some dude named steevo — Fri, 19 Mar 2010 10:58:03 +0000

Thanks for the words of wisdom, this post made me think. However, I think the antibiotic argument is kind of like arguing with your mom…

By: Texas Reader

Texas Reader — Fri, 19 Mar 2010 06:25:10 +0000

I'm glad you brought up the issue of antibiotics being over prescribed for upper respiratory infections. I'm wondering what a good guideline is for putting a patient with a UTI on an antibiotic. If the patient has a cold for 4 or 5 days and is getting worse in terms of congestion and coughing, is that an indicator that a secondarial bacterial infection might be an issue and antibiotics appropriate?

By: Lisa Chippendale

Lisa Chippendale — Wed, 17 Mar 2010 22:20:03 +0000

That is a very good explanation for why some otherwise very intelligent people often prefer CAM to traditional Western medical practice. There's another: for most people, first-hand observation trumps anything scientists say. That's why despite the fact that I'm usually very supportive of listening to the evidence, I remain very suspicious of the current gospel that antibiotics are always useless for the conditions you list above. I see them work. I am prone to sinus infections; they don't clear up until I start taking antibiotics, then they clear up quickly (and I always wait a couple days to see if it'll get better on its own). My kids get pink eye–within a day of getting the antibiotic eyedrops, they are drastically better. Ditto on severe ear infections (although yes, I have seen the mild ones clear up on their own) and bronchitis. I find it hard to believe that the fifteen or more times I have seen this phenomenon can all be ascribed to coincidental improvement.

By: Alex K

Alex K — Wed, 17 Mar 2010 17:43:44 +0000

I definitely agree! However, I think you can go even further analyzing the science behind traditional medicine to find flaws and problems that make the science behind traditional medicine not as neat and tight as some practitioners would have us believe.
For example, there was just a story in the NY times about how medications to lower blood pressure, increasing HDL, or modulating the postprandial glucose spike in diabetics didn't prevent them from having heart attacks. http://www.nytimes.com/2010/03/15/health/resear...

Similarly, there was story in the NY times about how salsalate was very helpful in blood glucose control http://www.nytimes.com/2010/03/16/health/16diab...

As far as I can tell, the science behind these studies are solid. Yet how long will it take before practitioners follow this scientific advice? How long before they stop trying to aggressively treat diabetics' blood pressure and HDL? Clearly, the science behind medicine is constantly changing, but most physicians I know (as a physician-in-training, I've been exposed to quite a few) are years behind the research.

Also, the science behind traditional medicine is often flawed and biased. Here I would refer you to Overdo$ed America, which is a brilliant expose of how drug companies have famously skewed their research to increase profits. For example, when a drug company (I believe Pfizer) tried to get SSRIs approved in the European market, they were required to submit all the research they had done on SSRIs, not just the studies that were published. What the European drug agencies found was an equivocal response to SSRIs when all the research was analyzed, not just the research published with the best results.

So the process behind traditional medicine's science is wrought with flaws and biases. For example, who would pay, now that most research is privately funded by the companies who have something to gain by their success, for a 10 year trial of lifestyle modifications, or of herbs that have generations of anecdotal evidence? Not only is the first statement of the argument flawed, but the second statement, that when CAM gets enough research behind it, it becomes traditional medicine, is flawed as well. There are lots of CAM treatments that simply will not pay enough to merit the research necessary to “prove” their merit.