Integrative Medicine
The term “integrative medicine,” like the words “holistic” and “natural,” is a mealy-mouthed euphemism for such a broad range of ideas, most of them utter tripe, that it means nothing. Although it once must have meant something to somebody, now it is just another marketing phrase to make people feel good about buying swill. Pleasantly scented swill, no doubt, but swill just the same. This is not to say that medicine shouldn’t be integrative. In fact, many would argue that medicine has become so specialized and sub-specialized that it is a little too integrative. A hospitalized patient, for example, is usually escorted through his Big Hospital Adventure by a small platoon of doctors and other health care professionals. There’s the hospitalist who admitted him, the cardiologist who was consulted because of chest pain, the nephrologist fretting over his decreasing renal function, and the usual gaggle of physical therapists, nutritionists, and pharmacists all integrating their talents for his benefit. Under the aegis of this team however are now added homeopaths, bio-feedback experts, Chinese herbalists, and other purveyors of Complementary and Alternative Medicine. Add an Ayurvedic healer, an acupuncturist, and a couple of circus freaks and now we’re talking integrative, baby!
Originally devised as a marketing ploy to lure desperate cancer patients into for-profit hospitals, integrative medicine has now found its way into primary care where the wealthy and bored can experience the ultimate in egocentric boutique medicine. Take a therapy like Reiki, proudly offered at such notable medical centers like Sloan-Kettering and Duke. Oh my learned colleagues, physicians and inheritors of a profession that has but recently lifted itself from superstition and snake oil, do you really want to be associated with practioners who purport to heal by shooting mystical Japanese spiritual energy out of their fingers? I ask because when you strip away all of the glitz and the pretense, that is exactly and in totality the therapeutic modality of Reiki. Sounds ridiculous because…well…it is ridiculous.
Or suppose I invited an Astrologer to join the faculty and offer medical advice to your patients? Or a faith healer? You’d no doubt protest and mutter darkly about primitive superstition not having a place in medicine and you’d be right. But what, pray tell, is the difference between something like Ayurvedic medicine, one of the usual suspects in integrative medicine, and astrology or faith healing? Nothing, really, except that you’d be embarassed to consult an astrologer and Christian faith healing, as you reject religion in medicine, is prima facie unacceptable while Hindu faith healing gets a free pass. The fact that we even have to have a debate on the validity of Ayurveduc medicine, homeopathy, and other obviously ridiculous treatment modalities is, in itself, ridiculous and I can only shake my head and wonder at the powerful hold of quackery on my learned colleagues in the Ivy League where this kind of thing flourishes. When you are incapable of asking for proof of the existence of chakra, qi, or mystical fire flowing from the appendages of charlatans, maybe you have become a tad too open-minded. So open minded that you no longer have the conceptual tools to distinguish the right from the wrong, the good from the bad, or the reasonable from the ridiculous.
It’s not difficult. Generally, if someone claims to shoot mystical fire or diagnose Hindu humors he should have an uphill struggle convincing the educated. Skepticism should be your first position but that would require a little too much common sense, not to mention being a little judgemental which is the only remaining sin among the over-educated elites. It is in this manner that that prestigious medical centers succumb to a form of blackmail. If they Reject Eastern mysticism and other completely laughable medical therapies they risk losing their street cred’ among their lesser-educated but more institutionally powerful peers.
I had the chance to practice Reiki as a healing art after a 2 weekend intensive course. I considered doing it because I figured that this would be a good way to earn money during med school – despite the fact that a 2 week course would not make me a certified health-care provider of any type.
I agree that chakras and qi is just a multicultural version of exorcism, but there can be good stuff in Eastern medicine. Turmeric, for instance, is a favorite in Ayurveda (and Indian cuisine). Turns out the active ingredient, curcumin, has a ton of antioxidant and antitumor properties, which explain the health benefits of turmeric. Not so obviously ridiculous any more.
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(Tumeric….right….that’s why for centuries them wiley Indians never died of cancer. Come on now. -PB)
Yet the very existence of these (so called) integrative centres speakes to a market condition that not only accepts but demands their pressence. Why, because sick people have become consumers instead of patients, and like all consumers they prefer the best product, not the best health care.
To a health care consumer there is no difference between a doctor who says ‘You need to fix your life style to fix your back pain.’ (or ‘ you have any condition that cannot be cured with a pill’) and a pair of jeans from the GAP that make your ass look fat. Both are lousy products because they don’t live up to the consumers expectations, and so the consumer looks for something else.
Why do people buy Joan Rivers jewlery from the shopping channel? It’s crap, BUT it has the promise of not being crap. It’s the right product at the right moment. Unfortunately that’s what it’s come down to, the people demand their crazy therapies and quack cures, because they are packaged well and they offer what good (honest) medical care often cannot.
Truth is irrelevant, what the people want is a product. (much to my dismay)
Dr. J.
Amen.
Like I’ve said before, CAM is meeting a need that conventional medicine isn’t.
It always strikes me strange to hear a religious person reject alternative healing methods. Applying the same tests you demand of Reiki to any other groundless article of faith will result in their rejection in turn. Why award your own faith special status?
(I render to Caesar what is Caesar’s and to God what is God’s. Religion, except that it can guide our ethical decisions, has no place in medicine as a treatment modality. I might as well turn your statement around and highlight the contradiction inherent in rejecting (Christian) religion out of hand as superstitious and backwards but at the same time embracing some goofy version of Hinduism, a religion about which Mark Twain pointed out that every day was Halloween. -PB)
Amen Panda. I might pray for (silently) or with (if asked) a patient, but only an idiot thinks you can completely substitute chemotherapy and radiation with supplication to a higher power. God gave humanity brains with the intent that we might actually use them, on occasion.
PB wrote to Rameses II:
Yes you might, and you should. Then you could **both** be right.
As nice as it is of you to offer to render unto Caeser, it is not possible to neatly compartmentalize Christianity as having no analog to Reiki. Many, probably most, Christians believe in the healing power of intercessory prayer. Many christian faiths believe in Faith Healing. And many creationist believing Christians are trying to dilute science by claiming the Bible trumps scientific evidence. Science is neither Caeser nor God in this analogy. Either you embrace science and go where the body of scientific evidence goes or you go where your dogma tells you to. Science are Christianity are not Nonoverlapping Magisteria as much as Gould would have liked to pretend they are.
I agree with #1 Dino and Dr. J – CAM is popular because the experience of medicine is unpleasant – people often feel like cattle being herded through doctors offices in 5-10 minute intervals. They are looking for a pleasant, caring experience – and if they can get it from a snake oil-toting fruit loop, then they’ll opt in. It is hard for us to do a better job of providing emotional support for our patients (which is part of good medicine) when we are driven to see 30+ people/day just to pay the rent. With Medicare cuts on the horizon, patients (at least in urban settings) can move to a concierge practice – or be prepared for further disappointment and CAM band aids.
While I agree with your statement that traditional therapies should not be hailed as treatment modalities (which I suspect are at Duke not for their efficacy, but for the message it sends to its customers) I am appalled that you quote such an ignorant Mark Twain statement about Hinduism being Halloween everyday.
(Why are you appalled? You say “assault on the senses,” Mark Twain says “Halloween.” Tomato, Tomatoh.”-PB)
As someone who has travelled extensively in India, and as someone who was once baffled by the assault on the senses that is the Hindu symbolism, I learned that Hinduism is indeed just that: symbolism that represents the deeper ethical and philosophical canons that are found in all religions.
Regardless, do you believe in placebos? Maybe those “ridiculous” therapies actually help people, in that they make them feel like they are being pro-active with their health, unlike the homeless and insurance-less drug-seekers you so despise.
(The placebo effect is over-rated. Placebo control studies need a third arm for people who received no treatment at all but who got better just the same which when you think about it is what the placebo arm of a study is actually detecting. People go into raptures over the placebo effect but it is probably just a result of the slim margin of efficacy of many drugs. If Zoloft, for example, is slightly better than the placebo it only means that zoloft is not very effective, not that the placebo has any power. On the other hand, try a placbo antibiotic the next time your patient has a serious pneumonia and tell me how well it worked. Real disease has no respect for wishful thinking.
And whether patients feel proactive of not has no effect on the outcome. As for despising any class of patients, you have it exactly backwards. I see everybody who walks in the door without regard to their ability to pay and they all get the same level of care. I don’t see too many Reiki healers, chiropractors, homeopaths, or naturopaths treating patients for free. In fact, for all of their supposed spirituality and bonhomie, CAM is a modality almost exclusively for the bored rich. If the typical CAM charlatan had to treat as many patients as we do, many of them for free, he would quickly lose the major selling point of CAM, mainly that the quack, whatever his shortcomings or however ridiculous his treatments, does spend a lot of time with his patients stroking their egos. Like I always say, CAM wants it both ways, they want to be accepted as legitimate medicine but they don’t want to deal with the unwashed, the really sick, or anybody who hasn’t been culturally hypnotized for credulity.-PB)
Right on. I also can’t stand the whole “wellbeing” marketing. Doctors can be a powerful force for good, but I think it borders on arrogance that enough medication is going to fix all your problems. Doctors/alternative health care workers as life coaches. Bleh.
Ah…ah…oh hell, nevermind…
“I see everybody who walks in the door without regard to their ability to pay and they all get the same level of care. I don’t see too many Reiki healers, chiropractors, homeopaths, or naturopaths treating patients for free.”
And you’re on salary aren’t you? So it doesn’t matter whether you see 2 or 25 patients a day nor whether they pay or not. If you were in private practice struggling to survive would it be a different story for you?
(I’m a resident so I get a salary of about $12.50 an hour. In private practice however, most Emergency Departments are staffed by private groups which pay their salaried physicians a certain hourly rate which also depends on their “production.” In other words, while you might slime along seeing two patients per shift for a while, in a couple of weeks you will be fired because the going pace is four patients per hour of any type, from simple to complex, paying or non-paying. I see close to two patients per hour as a resident.
Kirstens assertion was that I despise certain types of patients which is incorrect. I merely point out that many of them are stupid, lazy, ignorant, helpless, and engage in self-destructive behavior. This is the truth, nothing more, nothing less and I suppose I could sugar-coat it with the mealy-mouthed platitude de jour (“conditioned helplessness”) but why bother? Anyone who thinks otherwise is either blind or doesn’t see the kind of patients we see in Emergency Medicine…which is sort of my point. Why I have to call a spade anything other than a spade just to make Kirsten feel good about herself is beyond me.
C’mon down to the Emergency Department and offer your acupuncture services, payed or otherwise, and see how you will struggle to make money. Your drug seekers will claim allergies to bronze needles and swear that only dilaudid works, your COPD exacerbations will still need BiPAP even with needles stickin’ in ’em, and you will rush around trying to see enough paying patients to make it all work.  The fact is that CAM exists to service the paying customer, the bored elites with money to burn.-PB)
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The fact is that CAM exists to service the paying customer, the bored elites with money to burn.
Okay, I have to comment on this because you’ve mentioned this several times. Do you mean to say that you know, for a fact, proof positive, dead balls-on, that CAM exists solely to service the bored elites. You have proof verifying this. I gotta tell you, I had no idea residency afforded docs with special powers that can reach into the minds of the entire populace.
Given the number of docs that I’ve worked with over the years and their varying degrees of belief on this issue, I see you as one of the black and white, speak in absolute terms types that affords no middle ground. It’s a limiting view, and I’d be curious about your treatment of the patient who practices CAM and ends up on your table. Would you tell them that they are one of the bored elites? Would you laugh at them for attributing their lower blood pressure to meditation? I’ve read your blog for a long time now, and I don’t get the impression that you’re not without tact and sensitivity.
Hating all things CAM is your right, but I can’t help but harken back to the words of a very prestigious surgeon who accompanied our medical team to the Amazon; “I’ve seen too much weird shit not to believe there’s more to life than a f*cking microscope.”
Not trying to change your mind here (God forbid), but merely to suggest that speaking with such absolute authority is arrogant. Besides, you should know that the bored elites hire other people to get sick for them.
(Res Ipsa Loquitur, or “The thing speaks for itself.” In other words, the idea that someone can shoot mystical fire from their appendages to effect a cure on a sick patient is so ridiculous that, at least among people who purport to be educated, it should need no further debate. Anyone wth a modicum of knowledge of the biological and physical sciences…hell….anybody with a little common sense should laugh out loud at such an idea; even if he is a prestigious Arkansas surgeon. The thing speaks for itself, despite your appeal to the authority of a prestigious surgeon.Â
I also don’t recall ever saying that there was nothing more to life but what can be seen through a microscope. In the realm of medicine, however, you need to be able to show something, anything, in the microscope. That’s the way it really is.-PB)
I see another Dr. J. I am a different commentor, just want to make that clear.
Lynn wrote “Not trying to change your mind here (God forbid), but merely to suggest that speaking with such absolute authority is arrogant. ”
It is his blog. These servers are the only area he has absolute authority over. Besides, he does make a good point about CAM being for the bored rich. Unless you’re doing it because your grandma taught you to ‘coin’ bad spirits out, you’re nouveau, coming into the quackery game because you’re dissatisfied with the processing plant mentality of modern medicine. If you can afford quackery in the USA you’re rich by global standards.
“I’ve seen too much weird shit not to believe there’s more to life than a f*cking microscope.â€
You’ll forgive me for saying so but just because someone is a surgeon, even a prestigious one, does not guarantee intelligence. I’m reminded of one neurosurgeon Michael Egnor who is quoted as saying “Darwinism is a trivial idea…”
Again, I see comments by you and I think of the book you have written. You are trolling for sales. I’ve found that when someone is pushing an idea that sounds like an easy way out but in reality doesn’t work, if you scratch a little you’ll find a financial incentive to deceive.
In short, Lynn, just posting about how quackery is supposed to work is feeding the misconception that feeds your bank account. You have said it should only be used when the patient isn’t suffering from a serious medical condition that requires real medical attention. Why on earth should it be used when there isn’t something seriously wrong? Because those patients usually get better by themselves and quackery can take the credit. Feh.
I have a bad taste in my mouth from discoursing with you. I can practically smell the greed.
One last thing here. Randall Sexton brought up salary –“And you’re on salary aren’t you?”. I took a look at his site. Interesting findings.
Randall, a fine pusher of alternative therapy, charges 1500 taka per hour for his services which include “Illumination”, “Extraction”, “Soul Retrieval”, and “Death Rites”. Converting to US dollars, that is $22.05/hour. Doesn’t sound like a lot until you consider he lives and practices in Bangladesh, an incredibly impoverished nation with a mean employed income of approximately $1900 US annually. Randall pulls in a little over 23 times what his neighbors do, and his qualifications for doing so are a Masters in Nursing and some training in ‘Zen Shiatsu’ (he also mentions his black belt in HapKiDo for the sake of completeness). ONE HOUR of his services costs 2 WEEKS of minimum wage for someone working in the garment district down the road from him.
Well done, Randy. You’ve trained for a shorter time and are doing objectively better (financially) than American neurosurgeons, who make a mean salary of $430,000 annually, compared with US mean employed income of $37,500, earning merely 11.5 times the salary of a normal working man. Oh, yeah, you’re pushing CAM to “assist people in helping their bodies, mind and spirit heal”… The money is just a nice perk…
I say follow the money and you will find the motivation.
I know it is your blog but it seems a tad rude to append your responses to other people’s posts like an instructor grading papers. You should respond in a separate post, IMO.
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(Why is it rude? I bold and italicize and sign my initials so people know it is my comment. It’s just a convention of my blog.-PB)
Dr. J is a man to have on your side in a fight.
And I do like the idea of Drs. PB&J. No beating that.
Again, I see comments by you and I think of the book you have written. You are trolling for sales.
You’re joking, right? This is LAST place I’d come to “troll” for sales. Docs aren’t exactly my demographics. Sorry to disappoint, Dr. J, but my only reason for coming here is because I am interested in medicine and I like Panda’s writing. Panda has always afforded me respect in our disagreements, as I have him. We’re not new to this debate with one another. Can’t people have a difference of opinion without being attacked? You’ve managed to take this debate to a whole new low. Way to go.
You have said it should only be used when the patient isn’t suffering from a serious medical condition that requires real medical attention. Why on earth should it be used when there isn’t something seriously wrong?
If you cared to actually read what I wrote, you’d see that I’m a proponent of INTEGRATING alternatives alongside allopathic medicine. That means that they’re used side by side. I’ve always been a great supporter of medicine.
I have a bad taste in my mouth from discoursing with you.
Would have been lovely had you refrained from responding if I’m that distasteful. You don’t leave a bed of fragrant roses either, my friend. You know squat about me, yet you’ve decided you know everything about me. Now that’s what I call ignorant.
Panda, I enjoyed your blog and your wit. I enjoyed the discourse we’ve passed around. But I can see I’m no longer welcome. Best of everything to you and your residency.
LOL @ Jared.
PB – Point taken, re: your position on less than swift patients.
While I wrote my last post, I was thinking about palliative care. In this instance it makes sense to allow patients the luxury of having healers of all varieties pay them a visit. Whatever makes them happy, I say. Having said that, I realise how a ‘light and gong’ saiance would be at best impractical in an ER.
Given that you are speaking in the context of microscopes and medicine, how do these alternative therapies interfere with your treatment of patients? Do you fear that you will one day have to coordinate a reiki consult? …Or is it all those acute reiki related injuries you have to deal with?
Re: Kirsten
“Given that you are speaking in the context of microscopes and medicine, how do these alternative therapies interfere with your treatment of patients? Do you fear that you will one day have to coordinate a reiki consult? …Or is it all those acute reiki related injuries you have to deal with?”
How about delaying definitive medical treatment for a condition, say cancer, until it is too late because the patient spent months having their lack of energy and back pain treated by the mystic fire?
Lynn,
Is it taking the low road to point out financial incentives to lie? I don’t think so. Similar disclosure is a prerequisite to publish in any scientific journal. Not to imply this blog is on the level of a peer reviewed journal, but I hold a certain level of distrust for statements made by those who stand to gain. I don’t know everything about you nor do I need to, as the tidbit about your book is enough to make me doubt your thoughts on this topic.
Despite your cries of attack I merely used you as an example of the kind of person who promotes quackery – namely one who stands to gain financially from it. If I insulted your delicate sensibilities may I humbly suggest you grow a thicker skin. It’s the internet and there are people out here who disagree with you and even, dear Lord in heaven forbid it, question your motives.
“I’m a resident so I get a salary of about $12.50 an hour. In private practice however, most Emergency Departments are staffed by private groups which pay their salaried physicians a certain hourly rate which also depends on their “production.†In other words, while you might slime along seeing two patients per shift for a while, in a couple of weeks you will be fired because the going pace is four patients per hour of any type, from simple to complex, paying or non-payingâ€
I started my nursing career in a Level I so know what university hospitals are like as well as contract groups for private hospitals. I didn’t know that a contract physician would have to see a certain number of patients. The last small hospital I was in only had one contract doc per shift. He might be sitting around doing nothing part of the time but snowed under other times. Another hospital I was in had three ER docs per shift. I can see if one of them was lazy, that the others would complain and he might be fired.
(Emergency Medicine has changed radically from that time. It is a rare today to get a salarythat is not dependent at least in part on production. At a Department that is busy enough to hire Board Certifid EM physicians, nobody just sits around getting paid to do nothing. Sorry.-PB)
My main point was that you are getting a salary and if no one shows up in an hour you still get paid. A FP doc in private practice is going to be just as concerned about dollars as the acupuncturist down the street.
“Kirstens assertion was that I despise certain types of patients which is incorrect. I merely point out that many of them are stupid, lazy, ignorant, helpless, and engage in self-destructive behavior.â€
Well, I agree with you there.
“C’mon down to the Emergency Department and offer your acupuncture services, payed or otherwise, and see how you will struggle to make money.-PB)â€
Most people, me included, visit the ER when needed. I think most people turn to CAM for the chronic conditions although I have noticed a few acupuncture book titles with the word “acute†in them.
Netiquette.
Although you probably don’t mean it to be, there is a paternal/pedantic quality to appending the comments in god-like fashion as opposed to using the normal means of posting like regular people. If you check other blogs you’ll note that very few bloggers edit poster’s comments to add editorials. It also allows you to “retroactively” add comments outside of the linear flow of the conversation of the thread which can cause confusion.
Is it a big deal? Probably not, but then neither is SHOUTING but that, too, is still considered bad form.
Very good, Dr. J, but perhaps my website is confusing.
“Randall, a fine pusher of alternative therapy, charges 1500 taka per hour for his services which include “Illuminationâ€, “Extractionâ€, “Soul Retrievalâ€, and “Death Ritesâ€. Converting to US dollars, that is $22.05/hour. Doesn’t sound like a lot until you consider he lives and practices in Bangladesh, an incredibly impoverished nation with a mean employed income of approximately $1900 US annually. Randall pulls in a little over 23 times what his neighbors do, and his qualifications for doing so are a Masters in Nursing and some training in ‘Zen Shiatsu’ (he also mentions his black belt in HapKiDo for the sake of completeness). ONE HOUR of his services costs 2 WEEKS of minimum wage for someone working in the garment district down the road from him.”
Actually I only see expats and not the locals, but that’s not just of my own choice.
My price, while high by local standards, is nothing for the expats and is 1/3 of what I would charge in the states. They have one other choice of semi-quality bodytherapy here (Thai massage) and I charge double what that guy charges. I also receive massage from him weekly and have trained him free of charge in a little Zen Shiatsu. My “high fee” is also designed to provide me with a little rest.
An expat teacher here in an American International school, for example, is pulling down $45k in tax free dollars so I think they can afford me.
My mention of Hapkido is there because I used to treat a lot of martial artists and I was one of them. I could now leave that out I suppose.
As for my shamanic work, I charge nothing as I am doing my “residency.”
However, I’ll bet that the lady I did an extraction on a few weeks ago would have been glad to pay 1,500 taka. This might have shades of “Ghostbusters” to you and be a really funny topic at your dinner table. She had been having nightmares for 20 plus years and I pulled some dark nasty energy out of her and she has not had an unpleasant dream since. I almost lost control of the “bastard” and couldn’t speak clearly for several hours. My wife had given me a small crystal for a present and it fell off my neck and shattered on the floor. I immediately felt better. Double-blind that will ya, lol! However crazy it may sound the lady no longer has the nightmares and she probably doesn’t care a hoot what anyone else thinks.
“Well done, Randy. You’ve trained for a shorter time and are doing objectively better (financially) than American neurosurgeons, who make a mean salary of $430,000 annually, compared with US mean employed income of $37,500, earning merely 11.5 times the salary of a normal working man. Oh, yeah, you’re pushing CAM to “assist people in helping their bodies, mind and spirit healâ€â€¦ The money is just a nice perk…”
I guess you’re clear now on my money status. And yes, I can do things a neurosurgeon can’t do …and he can do things I can’t do.
dear panda,
i reject your logic sir! being a relativist makes this easy because what is true for you is not necessarily true for me. take your western ideas back to europe and leave healing to the artists! harrumphhh! off to the aromatherapist, she is using ganja now and it really makes me feel good. she says it will be just the thing for my tuberculosis too. cough cough. sputter.
toodles.
After being told for 20 years that my chronic diarrhea, fatigue, gut pain, and periodic bouts of anemia had been caused by depression, stress, IBS, and/or not eating well and finding out that I did, in fact, have Celiac disease – well, I can see how some may be tempted to turn to “alternative” medicine.
My eventual diagnosis changed my life. I finally know what healthy feels like. I am still pretty peeved at the medical establishment for blowing me off as a frivolous female for so many years which, consequently, lead to many years of pain and suffering.
I don’t need a pill to change my life, I just need the proper diagnosis so that I can respond appropriately.
My eventual diagnosis changed my life. I finally know what healthy feels like. I am still pretty peeved at the medical establishment for blowing me off as a frivolous female for so many years which, consequently, lead to many years of pain and suffering.
What was the diagnoses and what was the cure?
No one thinks rationally anymore, including the educated which is inexplicable. Pointing out the shortcoming of (Western) Medicine only highlights the fact that a) doctors are not perfect, b) our understanding of disease and physiology is not perfect. It in no way validates CAM. In other words, refuting real medcine at best only refutes real medicine. It in no way vaidates your belief in magic fairies, pixie dust, and spiritual fire flowing from the appendages of faith healers, reductio ad absurdum, I mean.
Manan Shah – she said she had celiac disease, which is an intolerance for gluten. The solution is to have a gluten-free diet. The article on Wikipedia is pretty extensive though, so I won’t say anything else.
@ Ian — Well then they’re just idiots. The topic was how alternative therapies are becoming integrated into allopathic medicine. The imagery there is that reiki master and physician work side by side.
Ridiculous, but why? The physician still has the ultmiate say in his own domain — the hospital!
“Ridiculous, but why? The physician still has the ultmiate say in his own domain — the hospital!”
What hospital do **you** work in that gives you an **entire hospital** as your domain?
BTW, “allopathic” is a perjorative term invented by Mr. Homeopathy, Samuel Hahnemann a few centuries ago. It is not a proper medical term or a substitue for “evidence based.”
Let’s take a vote on who cares if Panda appends to the end of our posts or not. I for one find it BETTER than other sites; if Panda posted an individual comment for each comment he responded to, it would be a hella mess and confusing as all get-out. When Panda has a post unrelated to a comment he DOES post as an independent comment (see those comments signed “Administrator.” I find the convention of posting within comments helpful and not at all “paternal/pedantic.” Heaven knows, it is not like the interweb is a place that defines efficiency and right-brain thought. Why Panda should feel beholden to follow any sort of “Netiquette” that is illogical makes very little sense to me.
PS – did you mean to use “pendantic?” I’m confused by the usage of the word. I’m not trying to be a jerk, I promise, I’m just trying to understand the full text of your position. Pedantic means uninspired, uncreative, boring, etc. It doesn’t seem to fit the context of your post but I wasn’t sure if you were using it in a lateral fashion that I missed the point on. Maybe you meant “patronizing?” Sorry, I had an exam today, my brain is spent.
(I’m “pandantic.” -PB)
I regret taking up the blog space here, but frankly this is fun!
Scartose, whose domain is it then? Who’s at the top of the food chain? I’m sure this sounds elitist but a homeopath can exercise his elitism in his domain, on top of a Walmart perhaps. Put the two together, and I think this is the entire point of Panda’s entry. The only thing with the entry that continues to baffle me is that a small annoyance seems to be blown out of proportion — which is why I ask, again, if homeopaths on the ICU are some kind of threat to someone’s (I don’t know who for the sake of arguement) authority.
I don’t regard “homeopaths in the hospital” as a threat to my authority as much as a threat to my integrity. When I have a patient admitted to the hospital, I am the “team leader” for the patient’s care. All care the patient receives is either explicitly or implicitly requested by me and comes under my responsibility. Homeopaths, Reiki practitioners or whatever would appear to be endorsed by me just as much as medications, IVs, physical therapy and dressing changes. And they most emphatically are not. I swore an oath (yes, really!) ‘to use regimens for the benefit of the ill in accordance with my ability and judgment, and to refrain from all that is unjust or harmful.’ I do not support the hospital participating in fleecing of credulous patients or the cluttering of the patients bedside and charts with useless “therapies,” and I would really hate for anyone to think I endorsed this *stuff.* On the other hand I am happy for patients to have their friends and religious leaders come and visit and do whatever as long as they respect the staff.
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(I could not have said it better myself. I also want to add that at a certain East Coast medical center where I did my intern year and who’s name we will not mention for fear of any criticism serving as chum to attract the voracious empathy-sharks which guard its mysterious lagoons, to state that Complementary and Alternative Medicine was mostly ridiculous and to refuse to send patients to the purveyors of snake oil was to set oneself up for disciplinary actions and criticism from the faculty.-PB)
“I swore an oath (yes, really!) ‘to use regimens for the benefit of the ill in accordance with my ability and judgment, and to refrain from all that is unjust or harmful.”
You say this with a straight face when medicine is what…the third leading cause of death…depending on who’s figures you are looking at.
Sorry, couldn’t resist, lol.
Oh, definitely. Thats why access to health care is such a big deal. People are just begging to be treated by these evil murderers, aka doctors. Thats why I have my acupuncturist treat all my children’s ailments, from foot pain to the flu.
“You say this with a straight face when medicine is what…the third leading cause of death…depending on who’s figures you are looking at.”
That to me makes no sense. Are you cl
“You say this with a straight face when medicine is what…the third leading cause of death…depending on who’s figures you are looking at.”
That to me makes little sense. Medical mistakes can and do happen regularly, but what you are implying is that if patients switched other methods of healing, that the mistakes would cease. Because homeopaths and shamans and the assorted quacks can never make a mistake. Of course, it’s hard to make a mistake when you’re simply putting your hand
over someone’s tumor and relying on the electrical energy to defy the laws of physics and sprout forth from your fingers and cure the tumor, but that’s a different issue.
PB,
While I agree that most CAM is BS therapy that is more suited to making the patient happy rather than healthy, I wanted to point out that there are a good number of therapies that we use regularly in western medicine for which we have NO IDEA how they work. This doesn’t mean the therapies don’t work, and in fact maybe some day we will know the biological mechanism. In the meantime, they remain a mainstay of clinical practice despite our lack of understanding of the mechanism.
To me, this is the difference between western medicine and CAM: there is scientifically collected evidence illustrating that the treatment works (even if we don’t know the mechanism) rather than a series of anecdotes, and a story about grandma’s next door neighbor and her snake oil.
All of this begs a question: If acupuncture was shown to be effective in relieving pain over sham acupuncture and over no treatment at all in an RCT, would you be convinced that it could be an effective treatment for pain?
(Again, let us turn the question around: If various CAM therapies were shown to be ineffective would they be abandoned by their practitioners? Of course not. I can stop perscribing a medication that is proven to be ineffective. And I can modify my practice to incorporate new discoveries that may invalidate what we thought we knew but turned out to be wrong. This sort of process is built into real medicine. But an acupuncturist? No matter what evidence you show him he’s going to find some way to weasel out of facing it because to be a CAM practioner is to want it both ways, on one hand craving scientific legitimacy but on the other discounting it when the truth cuts a little too deeply. -PB)Â
Old MD,
I really don’t give a crap about what you think. I made my point clear in my blog
(Again, not even worth the trouble of deleting. -PB)
Oh please. Panda would SO not respond like that. Get a life people and grow up and stop being twits.
Old MD- Just because we dont know HOW something works, doesnt mean we dont know it works. If CAM therapies had anything better than placebo in double blind trials, by all means, we should use them. Evidence based medicine means we have evidence that it works, not evidence as to the mechanism.
“That to me makes little sense. Medical mistakes can and do happen regularly, but what you are implying is that if patients switched other methods of healing, that the mistakes would cease.”
I’m actually implying nothing. I was commenting on the oath physicians take to “do no harm” when you should know that’s not true. You may cause a lot of harm and even death. But I do understand that’s how the system works. Just wished it were different.
“To me, this is the difference between western medicine and CAM: there is scientifically collected evidence illustrating that the treatment works (even if we don’t know the mechanism) rather than a series of anecdotes, and a story about grandma’s next door neighbor and her snake oil.’
Old MD Girl, correct me if I’m wrong but isn’t “trial and error” a scientific method and one that even today has worked? So, if people over hundreds or thousands of years “collected data” on what worked and abandoned what didn’t work, what was that?
(Whoa, your belief that medical history has been one uninterrupted march of progress is flawed. In fact, the opposite is true. Medicine, until recently, has progressed in fits and starts with long periods of deep conservatism where the received wisdom was accepted without criticism. Aristotle and Galen, for example, were learned authorities and trusted implicitely for a thousand years even though many (if not most) of their observations were flat out wrong…or at least described the natural world with metaphors that while reasonable for the dark ages do not fit well in the 21st century. The same can be said for Chinese and Indian medicine which, as was the case in most of the ancient world, devoted itself to expounding, recasting, and justifying ancient knowledge instead of critically examining it
Take Astrology. For thousands of years it was studied, commented upon, and occupied the sincerest efforts of some of the finest minds in the ancient world. And yet it is so obviously ridiculous that it has gone from a legitimate curriculum to the funny pages.
Claiming that the persistance of an idea is the same as validation is to make a shameless and unfounded appeal to authority.-PB)
“So, if people over hundreds or thousands of years “collected data†on what worked and abandoned what didn’t work, what was that?”
Biased, flawed, and therefore invalid as a basis for treatment when someone’s life is on the line. Using that kind of ‘collected data’, though the innate tendency for us naturally biased homo sapiens sapiens, will kill more people than it will save.
I am amazed you openly admit to pulling ‘dark, nasty energy’ out of someone and still expect us, or anyone else for that matter, to take you seriously.
Mr. Sexton, you said, Old MD Girl, correct me if I’m wrong but isn’t “trial and error†a scientific method and one that even today has worked? So, if people over hundreds or thousands of years “collected data†on what worked and abandoned what didn’t work, what was that?
Yes, that is one way in which people do research — they write case studies and case reports. Very little research worth the paper it is printed on takes this form. This type of research is generally considered fall less valid than Case Control Studies, Cohort Studies, and RCTs. It’s completely impossible to remove bias in the types of studies you’re alluding to.
PB — This phenomenon in which people cling to their beliefs irrationally is not unique to CAM. There are a number of therapies in western medicine that have been shown to be either harmful or ineffective that doctors still cling to because 1) their patients want the hope that it will work, 2) because the doctors believe it will work despite evidence to the contrary.
I’d love to see CAM curing someone that needs anti-biotics.
“I am amazed you openly admit to pulling ‘dark, nasty energy’ out of someone and still expect us, or anyone else for that matter, to take you seriously.”
Most shamans never take themselves seriously, me included. That’s why we can go beyond the double-blind or not be limited by what we think can’t happen. And Old Girl MD, you can never eliminate bias in any study.
But, you notice the patient I alluded to is probably only interested in her results. At least it’s not, “the operation was a success but the patient died.”
Mr. Sexton,
There’s a big difference between trying to reduce bias with your study design and actively incorporating it into your study as part of the design as you would with a case study. Nice try though.
“Most shamans never take themselves seriously, me included. That’s why we can go beyond the double-blind or not be limited by what we think can’t happen. And Old Girl MD, you can never eliminate bias in any study.”
You can never eliminate germs from your hands either, doesn’t mean you should spit in them right before yanking out someone’s gallbladder.
Re: taking an oath to “do no harm.” I quoted the oath directly for a reason. “Do no harm” is a Hippocratic principle which as you pointed out is impossible to apply in its strictest, most literal sense. Pharmacology is toxicology at low doses, as one of my old profs was fond of saying; every treatment is a double-edged sword (except useless ones which may have one edge or none at all)– oncologist deal with this in perhaps the most obvious way. My understanding of the principle is to give the patient the best benefit to risk ratio I possibly can and to recommend and educate against treatments that while attractive are likely to cause harm for little to no benefit. Easy examples of harmful treatments include feeding your infant tea for diarrhea, taking antibiotics for the common cold, and taking cyanide from peach pits for cancer. Harm to the pocketbook from payments to charlatans is a lesser evil but not less real for all that.
If you want to talk about doctors who break their oath, it stands to reason that the oath is only worth something if the person swearing it has integrity in the first place.
Therefore, the purpose of any oath is not to enforce a certain behavior in and of itself (I don’t think we are really expecting deity to curse oathbreakers) but (1) to make a public (and in some cases legally binding) declaration of intent and (2) to inform and focus the conscience of the swearer. It doesn’t have to impress the bystanders. Nonetheless, I do hope you are not so cynical as to imagine entire classes of graduating medical students rolling their eyes or crossing their fingers as they are sworn in.
“Nonetheless, I do hope you are not so cynical as to imagine entire classes of graduating medical students rolling their eyes or crossing their fingers as they are sworn in.”
No, Dr. Bean, not at all.
Whew..my goodness, what lively conversation you are having.
I included a link to the above article in a post of my own this week to illustrate a broad skepticism of CAM.
Come check it out and let me know what you think, especially regarding ‘alternative’ practitioners who have cleverly mastered the bait-and-switch technique. Fortunately for me, I tasted the bait but didn’t bite.
In the Pursuit of Health & Wellness — Is Alternative Medicine Complementary?
I welcome your comments.
If the “good” of CAM is making patients “feel” better (rather than making them well/more well), why aren’t hospitals hiring and training more social workers, rehab, and psych staff? Aren’t they our “traditional” feel good, pain easing folks? How about some hospital food that “complements” treatment (you know, food that is actually nutritious and has taste)
Oh, wait, that’s not trendy….
Sorry to raise the dead here, but I wanted to clarify my comment (5th from the top) above. I didn’t intend to suggest that I believed in or supported Reiki, instead I wanted to illustrate the parallel between Reiki as an article of (religious) faith and all the other articles of faith. My question is simply what method of discrimination puts Lazarus and the Burning Bush ahead of healing energy beams from the fingers?
If you know most of it is hocus pocus, and I very much agree, what’s keeping you from that last step of realizing that it’s all hocus pocus?
Lest I come off as a missionary let me also say that I’m not looking for converts; this is a question that has genuinely puzzled me my entire life. No need to reply, I know I’m dredging old waters. I’ll seek time to comment on something newer.