This Ain’t no Party, This Ain’t no Disco, This Ain’t no Fooling Around
It’s a grim business, medicine I mean. For all the hype it’s nothing more than a futile struggle with death, a battle lost in the early stages by some, a bit later by others, but lost all the same in the end. If you’re lucky you make it to fifty with no Past Medical History until one day your cholesterol is noted to be a little high or you get a little rectal bleeding and things are never the same again. Then you get a little winded and wake up one morning to discover that it’s been ten years since your bypass and all of a sudden your feet seem to be swollen most of the week and you’re urinating all of the time. Your couple of pills a day have become a plastic pill organizer and your Past Medical History, once easily checked as “none” on all of the forms, is now spread through several different computer systems and thick files in various specialist’s offices. You get older and sicker. Your quality of life diminishes with each passing year and you gradually forget what it was like to sprint up a flight of stairs or run to catch a bus. Eventually simple things like getting out of a car or making it to your bedside commode become the major ordeals of a pain-filled day and you are rushed to the hospital every month for fear that you may have at last suffered the Big One, the final event that will put you out of reach of the medical profession’s best efforts to wrest a little more time for you.
In the end, the Reaper who has been waiting in the cool shadows just beyond the incandescent glare on the emaciated ruin of your body gently reaches through the crowd frantically trying to restart your heart and politely claims you as his own.
That’s how it goes. Your physicians are natural pessimists and can see the end for all but the youngest of their patients. We do what we can, of course, and it is our privilege to occasionally snatch you away from death but this is not done without a cost. Our treatments are crude, our understanding of physiology imperfect, and we do not yet have the knowledge or the sophisitication to precisely target your disease leaving the rest of your body unscathed. Every therapy yet devised has a dark parcel of side effects and adverse outcomes. When you start your long march through the medical world the risks of these therapies are relatively benign. We put you on an innocuous little blood pressure pill and warn you that it may cause a persistant but otherwise harmless cough. A few years later you become light-headed from the medications that are absolutely essential to control your potentially lethal cardiac arrythmia and your physicians debate whether to take you off of blood thinners lest you fall and suffer a catastrophic bleed in your brain. Time goes by and to save you from pancreatic cancer the surgeons shell you out like you were some kind of mammalian oyster.
At no time however, will your physicians ever promise a magic cure, a therapy that will definitively fix the problem with no ill effects leaving alone the precarious balance of your fantastically complicated body. At best they will promise good results with minimal and easily tolerated side effects. At worst the therapies they will reluctantly propose are almost as bad as the disease they will ameliorate and the subject of, for example, chemotherapy or a risky aortic repair is broached with dread to a patient who must be made to understand that real medicine is not as it appears in the popular media.
At a philosophical level, leaving aside the utter ridiculousness of Reiki healers shooting sacred energy from their fingers, this is the difference between real medicine and Complementary and Alternative Medicine whose practitioners, as they don’t treat real pathology, have never developed humility in the face of disease. It is easy, for example, for your acupuncturist to promise a perfect cure because they’re not really treating anything, just some nebulous mumbo-jumbo like a dysfunction of your ability to receive pure qi from the heavens. Side effects? None, of course. It’s perfect medicine because, despite being based on a completely imaginary idea of physiology that has no relation whatsoever to the way things actually are, it can magically target your imaginary complaint.
All medicine is a metaphor of course. We speak of proton pumps and “watershed strokes” as a way to explain complex structure and pathology that would be otherwise too cumbersome to describe. Ideally however you would want your metaphors to closely match what they purport to represent. Refining these metaphors is the purpose of medical science and the appropriatness of a therapy depends on the level to which it coincides with the most reasonable description of the underlying dysfunction. Almost all of complementary and alternative medicine is based on metaphors which were either, as is the case with Homeopathy fabricated from whole cloth, or in the case of Acupuncture and Ayurvedic medicine develped at a time when it was impossible to know any better. “Meridians” make sense when your knowledge of the body is based on religious superstition and mysticism. Once you discover the true function of blood vessels and nerves, however, it is time to put away your belief in qi, a spiritual construct that as a metaphor for disease has no basis in real physiology. The metaphors are diverging. Acupuncture stands still with its feet firmly planted in a time when people routinely died in their thirties from diseases that modern medicine has eliminated. It still exists because real medicine provides the practitioner of Complementary and Alternative Medicine a risk-free environment in which to operate as well as a steady stream of customers who cannot accept the truth, namely that we all die, our health fails, and, as there is no evolutionary disadvantage to it, we seem to be genetically programmed to wear out.
So you see, to practice real medicine is to create problems. Fifty years ago the majority of my multiply co-morbid and incredibly sick patients would have died in their fifties from the first of the many conditions which they have today accumulated. No amount of Acupuncture, homeopathy, or Reiki would have got them through their first heart attack just as no amount can now treat the hundreds of petty ailments which have become the bread and butter of the quacks.
Snake oil is something of an American tradition but it is only recently that its purveyors have had the benefit of physicians to do their heavy lifting.
As someone who is much earlier in the MD process than you, yet who also has some experience with the “quack” arts/sciences, I believe there has to be a middle ground somewhere between the two.
Just about every physician I know, either professionally or as their patient, does seem to have that rather fatalistic view to which you appear to subscribe: We all die and let’s just do our best to make you comfortable until you exit the stage.
To paraphrase one of your earlier posts (more crudely), docs are simply mechanics that fix the body once something is broken. They seem to have no interest in the work of prevention.
To continue the car analogy, I think it’s safe to say we’d all love to find that special mechanic that helps us take care of the car to keep it running smoothly as long as it can.
Like docs, most mechanics just fix the current problem. Few will ever treat the patient/car as if it were their own body/car.
We want the mechanic who will tell us, “Look, I replaced the brake pads, but your hoses are going and you should think about getting those rear struts replaced…IF you want to keep the car going.”
In reality, if we’re lucky, we get the mechanic who says, “Look, the brakes are fixed. Come back when you have your next breakdown.”
I believe this is where the alternative treatments come into play. They offer some semblance of prevention in peoples’ minds…real or not.
The way it stands now, give me the alternative stuff for staying healthy. But, when I peel off a rock face and crack my skull, tell the chiropractor to stay the hell away from me and get me to the nearest MD!
hak,
As you get further along, you will find that “prevention” and “wellness” are vague concepts that really mean little in our day to day concepts. Patients are all about “wellness and prevention” until you try to explain to them that what that really means is they will have to get their butts off the sofa and exercise, quit stuffing themselves with saturated fat and simple sugars, stop smoking, and drink alcohol in moderation. But, in my experience, people don’t, and won’t quit doing those things because there is always some new pill or procedure that gets them by long enough to get to the next BigMac. Sorry for the pessimism, I have been in primary care too long. People don’t need this CAM bullsh*t, they need to accept the fact that you cannot continually abuse and neglect your body and not have it break down on you.
Yes, there are people, especially kids, who develop conditions that are not a result of poor diet, lack of exercise, and smoking. But they are not the majority.
Keep up the good work, Panda.
I want to make a big sign with the following commands of health and easy living and tack up in every patient’s home:
1. Don’t smoke, anything, ever.
2. Wash your hands before meals and after using the restroom.
3. Get vaccines on schedule.
4. Don’t drink soft drinks, ever.
5. Rinse and gargle with mouthwash twice each day.
6. Exercise for one hour, three times a week minimum
These principles will easily keep people living for a very long time. With the exception of the vaccines, each step is free—and would work wonders better than any national health plan that the Democrats can come up with. However, if I should ever suggest a treatment plan that involves anything more than being compliant with medications, I’m sure to get groans. What’s worse, even many attendings don’t buy into the idea that the patient has to have a bit of personal responsibility in disease treatment. So long as money gets pushed in Pfizer’s direction, I guess everyone comes out happy.
Nice post. What is especially cool is that you make your very sensible points without resorting to too much mean-spirited sarcasm. You can do it, Panda!
Hak,
Few patients treat themselves as if they were their own body/car. They don’t bother to check the water and go to “mechanics” when they blow a gasket. They expect to be “fixed”. And then “fixed” again.
I’m not a doctor, but if I was I’m pretty sure I would be pulling my hair out because I think you’ve got it wrong Hak, when you say doctors aren’t concerned with prevention and people are.
If people were, they would take care of themselves. If doctors weren’t, they wouldn’t persist in repeating over and over again to people who refuse to take responsibility for themselves, that they should think about what they put in their bodies and what they do with their bodies.
Sometimes I treat my body with respect, because I’m mortal. Sometimes I don’t. Because I’m mortal. Whatever gets to me first, my behaviour or my mortality, Panda’s perspective here is more reassuring to me than the slippery language of AM. I don’t want promises that can’t be kept, or my “spirit” healed. Evidence-based medicine, like life, has it’s limitations. And on both counts, that is a good thing.
“In the end, the Reaper who has been waiting in the cool shadows just beyond the incandescent glare on the emaciated ruin of your body gently reaches through the crowd frantically trying to restart your heart and politely claims you as his own.”
Ahh. So satisying. This is why I continue to read this blog. Very well written piece with some moving imagery.
On another note, I rather enjoy your mean-spirited sarcasm.
Dr. J writes, “Ahh. So satisying. This is why I continue to read this blog. Very well written piece with some moving imagery.â€
“Imageryâ€â€¦perfect. Shamans are masters of imagery – the world’s oldest and probably greatest healing resource. Shamanism was also the first mind-body-soul medicine to address the afflictions of daily life and there is quite a lot of research and areas devoted to mind-body medicine, including the fields of psychology, psychosomatic medicine and the newest one, psychoneuroimmunology.
I would also recommend “Imagery and Healing: Shamanism and Modern Medicine†by the Experimental Psychologist Jeanne Achterberg for a great read on imagery. There are lots of references in her book, even though the book is a little dated.
Physicians are also shamans; they just don’t know it. Irving Oyle, D.O., states, “All healing is magic. The Indian healer and the western healer have a common denominator. The trust and confidence of both the patient and healer. They must both believe in the magic or it doesn’t work. Western doctors make secret markings on paper and instruct the patient to give it to the oracle in the drug store, make an offering in return for which they will receive a magic portion. Neither understands exactly how it works, but if they both believe, it often does.â€
There is nothing magical about pharmaceuticals. Medicine works regardless of belief. Trust and the confidence it breeds are certainly important, but if that’s all you have going for you then I don’t want you treating my illnesses.
PBear is a gifted writer, which is what I was commenting on. His ability to weave a story. Telling a patient a story will not heal them of any real pathology, regardless of any amount of protestation. You could protest that the moon is made of yellow cheese to the same effect.
There’s a quote I read somewhere about this – unattributed. “Medicine is tested, experimental, or unverified. Everything else is politics.”
Dr. J writes, “There is nothing magical about pharmaceuticals. Medicine works regardless of belief.”
Negative. There was a study about giving Ipecac to patients with nausea and telling them it would stop their nausea. Guess what happened?
“PBear is a gifted writer, which is what I was commenting on. His ability to weave a story. Telling a patient a story will not heal them of any real pathology, regardless of any amount of protestation. You could protest that the moon is made of yellow cheese to the same effect.”
Yes, he is a gifted writer and I love his shaman-like name. However, Lewis Mehl-Madrona, MD, PhD would probably like you to call him and talk about two of his books, Narrative Medicine: The Use of History and Story in Medicine and Coyote Wisdom: Healing Power in Native American Stories.
Dr J writes, ““Medicine is tested, experimental, or unverified. Everything else is politics.â€
Western medicine or evidence-based medicine (EBM), has as its bible the double-blind, placebo-controlled (if that is possible) research study. Nothing matters or is used in practice unless it has been through such a study and published in the New England Journal of Medicine (NEJM). An anecdotal account is merely looked on with amusement by the readers of the EBM bible.
It would be too lengthy to go into the details of double-blind studies in a blog post and most people visiting this blog probably already know. However, if you want more information visit Steven Bratman, M.D., an expert in both CAM and conventional medicine.
According to Dr. Bratman, “The insights provided by double-blind studies have been particularly disturbing for alternative medicine. Most alternative medicine methods are grounded in tradition, common sense, anecdote, and testimonial. On the surface, these seem like perfectly good sources of information. However, double-blind studies have shown us otherwise. We now know that a host of “confounding factors” can easily create a kind of optical illusion, causing the appearance of efficacy where none in fact exists. The double-blind study is thus much more than a requirement for absolute proof of efficacy (as is commonly supposed) — it is a necessity for knowing almost anything about whether a treatment really works.â€
Dr. Bratman also acknowledges that, “To be fair, for some types of treatment, such as chiropractic, acupuncture, physical therapy and surgery, it isn’t possible to design a true double-blind study: the practitioner will inevitably know whether real or a fake treatment has been applied.â€
Once a study is completed, it is usually sent to a peer-reviewed journal such as the NEJM mentioned earlier. Normally one hopes that a peer-review process works. However, there may be hiccups as in the case of the Journal of the American Medical Association publishing a “scientific study†by a nine year old girl and a group of skeptics. In this case, even the Rocky Mountain Skeptics chided the prestigious medical journal for being “completely irresponsible.â€
In his blog, The Last Psychiatrist covers “Ten Things Wrong with Medical Journals.†Go there; it’s a good read. So even if the scientific approach is followed to the letter, other factors come into play. Science, and medical journal publishers, should be indifferent.
I’m not an altie. In the *least*.
But I’ve come around on acupuncture. Specifically, there’s a device for treating urge incontinence, the Urgent PC device from Uroplasty, Inc. It’s a neuromodulatory treatment, delivered by the tibial nerve.
What I find most amusing about it is that the location they’re stimulating is a meridian that has been used to treat frequent urination in traditional acupuncture. They’ve done clinical trials and gotten an FDA approval for a medical device to sell acupuncture with additional stimulation.
The key being, they did an RCT.
E
dear randall sexton. good luck on your journey. the only thing we agree on is that it ends in death.
panda, i don’t know how you summon the patience and i’m not saying this because i do not believe in the supernatural, or miracles, or the power of the mind, and i’m not saying that western medicine is infallible. western medicine is inherently fallible because it is based on science and the essence of science and the scientific method is knowledge corrected by repeatable and verifiable experiemtnts and results. CAM is not.
if you want to question the validity of science and the scientific method randall then really, why even bother having an argument at all? your logic is no better than mine. what is true for you is not necessarily true for me. it’s just words.
now i’m placing a voodoo curse on you that your small toenail (left foot) falls off within the next three months. let me know how it goes. MOJOKUIMASHA POW ZAP! (and that curse is from a fully trained allopath so watch the fuck out!)
This post was not snarky enough, but still good. Snake oil is snake oil, whether it’s dressed up in nice chiropractic robes or whatever.
Dear 911doc, you mustn’t use your powers to harm. Don’t turn to the dark side, I beg of you. The possibilities are frightening.
911Doc writes, “dear randall sexton. good luck on your journey. the only thing we agree on is that it ends in death.’
That reminds me…shamans “die” as part of their initiation. During my “death” ceremony,a physician couple was part of my five person group and the lady doc was leading it. I didn’t want to come back and she had to go get the head shaman, lol. I’m back…damnit.
“…i do not believe… the power of the mind…’
Never trained in any sports, eh?
“if you want to question the validity of science and the scientific method randall then really, why even bother having an argument at all? ‘
I believe in the scientific method…but I also recognize it’s limitations. That’s all, pure and simple.
“now i’m placing a voodoo curse on you that your small toenail (left foot) falls off within the next three months. let me know how it goes. MOJOKUIMASHA POW ZAP! (and that curse is from a fully trained allopath so watch the fuck out!)’
I have had “bands of protection” rites so you go right ahead and zap. Just remember that it will come back and haunt you.
no way dude! touch black no trade back and no erasies either! i break through your ‘bands of protection’ laughing while sending bolts of dark energy towards your toenail. it is dying…. slowly dying… MOOYAKASHA BOING POW!
alas, it’s only a matter of time randall till the nail dies from the root, but look on the bright side, you’ve already had your death ceremony so parting with the toenail should be a relatively easy matter.
also, shaman sexton, i have no doubt that it WILL come back to haunt me, as, in fact, it already has. some of my patients have read stuff you wrote so i’m just getting even. karma and all that you understand.
sorry scalpel. sometimes it’s hard not to use the dark skilz. the force is strong with me.
Randall Sexton, I visited your “shaman” website. You are one crazy bastard. Couldn’t you make more than 22$ an hour working as an RN? Ahhh… I see. You find a greater concentration of crazy Americans living in Bangladesh than you do in the good ol’ USofA.
Keep it up Panda. Count another vote for mean-spirited sarcasm.
So many comments I have begun and not finished. Mostly because I am too tired learning pathophysiology and therapeutics which I will need to use some day in the treatment of patients. What really gets me about CAM is that that heaven forbid I use unproven “western” medicine to treat my patients – I’d get sued left and right. But no biggie, I’ll just tell them it is a cure imported from the Far East. Same lack of credibility and still a danger to patients, but now, its “alternative medicine.” Woot!
So most hospitals in the west have slogans nowadays. How about we come up with some ideas for CAM slogans? My submissions:
CAM: At least we tried!
CAM: When results don’t matter, only then shall your qi be free!
ryan writes, “Randall Sexton, I visited your “shaman†website. You are one crazy bastard.’
Enough with the compliments or my head will swell
“Couldn’t you make more than 22$ an hour working as an RN? Ahhh… I see. You find a greater concentration of crazy Americans living in Bangladesh than you do in the good ol’ USofA.’
Yes, and have made mucho $$$ in the states. I see people from lot’s of countries here. The good ole USA is boring.
What you need is for an experience to happen to you that just doesn’t happen and that you can’t explain in your world view. Then let’s talk, lol.
Â
(Randall, I have received many emails from proponents of CAM asking me to ban you from my blog because every time you open your mouth you show how silly CAM really is. It’s one thing to prowl on the fringes pretending that homeopathy is real medicine but you are a full-throttle kook (their term, not mine) who makes it hard for them to close ranks and defend you. Deep (or not so deep) down, most sCAM-artists realize that their particular treatments are bogus and they live lives of self-deception. Asking them to swallow “shamanism” is a little much.
In truth, I am a little ashamed for you. You can post here, of course, but your views on medicine are really, really kooky and while this is just the internet, you come across as something of a fool. Either that or you are a particulary adept con man in which case you have my admiration for making a career out of fleecing the ignoratti who can afford to travel to your country for “enlightenment.”-PB)
lol, indeed. When I’m looking for a product to match a preference, instead of a treatment to match a disease, I’ll give you a call.
Just wanted to say that I love your Talking Heads reference!
(Perhaps the greatest band in the history of the World.-PB)
LOL at all the CAM people embarassed of Randall!
Stop being pansy cowards, stand up and realize what your $hit is about. You have to at least give Randall some credit for that.
Thats like some suburbanite soccer mom going to Starbucks, buying a mochalatte, extra sugar and chocalate syrup, easy on the espresso with whip cream on the top, telling someone who just came out of the local nonchain coffee shop with in house roaster, carrying black, french pressed, freshly roasted with the finest beans, delicious and rich coffee: Ewwww thats gross!
Of course, my analogy may give to much credit to CAM, but you get the point.
hey
Two things:
First, if Panda doesn’t want his real name out there, it’s not for anyone else to post it. Jack…stop being a prat.
Second,
Eric: You commented that you’d “come around” on acupuncture and noted a treatment that seemed to mimic sticking a needle into an acupuncture meridian. I was wondering what you made of this study:
http://www.liebertonline.com/doi/abs/10.1089/acm.2005.11.663
This study suggests that while sticking needles into a patient has an analgesic effect (as claimed by acupuncturists), it appears that the effect does not rely on “correct” needle placement. Wouldn’t this suggest that the very specific placement that acupuncturists claim is not actually supported?
cheers.
Jack, you’re a jackass. Automatic moderation control? Scratch that, you’re a paranoid delusional jackass.
“(Randall, I have received many emails from proponents of CAM asking me to ban you from my blog because every time you open your mouth you show how silly CAM really is. It’s one thing to prowl on the fringes pretending that homeopathy is real medicine but you are a full-throttle kook (their term, not mine) who makes it hard for them to close ranks and defend you. Deep (or not so deep) down, most sCAM-artists realize that their particular treatments are bogus and they live lives of self-deception. Asking them to swallow “shamanism†is a little much.”
Most people realize that a little good natured ribbing is beneficial. And I don’t need defending from other CAM practitioners who lurk in the background afraid to
“produce” in front of physicians. Shamamanism has scientific studies to back it up…from more than one disclipine.
“In truth, I am a little ashamed for you. You can post here, of course, but your views on medicine are really, really kooky and while this is just the internet, you come across as something of a fool. Either that or you are a particulary adept con man in which case you have my admiration for making a career out of fleecing the ignoratti who can afford to travel to your country for “enlightenment.â€-PB)”
My views on medicine are based on history and current events and are greatly influenced by your peers. Give me credit for putting shamanism in the back of your mind for the day you might just want or need something different.
Jack, that’s not cool.
Wow…get behind on my blog reading for a couple of days and I miss all of the fun.
The Western vs. Eastern medicine debate seems to be one similar to abortion. You’re either for it or against it. There’s no middle ground. In regard to this particular debate, I think there is room for a little give and take from both sides.
(It is not similar. There is no middle ground between, for example, Homeopathy and medicine because Homeopathy is a pathetic scam while medicine (the real kind), while imperfect and fraught with problems, is not. I undestand the need to be open-minded but being open-minded also requires you to eventually make a decision about the subject you are considering. Abortion is a thorny ethical problem. “Water memory” is not.-PB)
I agree that wellness is a very loosey goosey term and I’m sure I will see my share of patients who are looking for the magic pill. When I worked as a personal trainer, I saw that all of the time. Very few people want to take responsibility for their health.
I admit I’m probably going into this field with a bit more romanticism in my eyes than practical cynicism….yet I know that will come in due time without my help. At the ripe old age of 40, I know enough to know that I’m not going to change the world nor do I have any interest in doing so. I just want leave my little corner of the planet a better place than how I found it.
(The best outlook on life is to be a “cynical optimist.” There is no need to believe in ridiculous things like CAM to an optimist.-PB)
Best thing about Randall’s post: Shamamanism. Randall, I’m pretty sure I’ll give you credit for putting Shamanism in the back of my mind they way I would appreciate a brain tumor.
Last week in y ER some poor bastard had his lung dropped by acupuncture a little too low in the neck. I got to do a chest tube. Man, that was fun.
Hopefully you’ll never get a brain tumor but if you do, let’s get some drums. “Both neuroendocrine and immunologic alterations were found in drumming subjects following this composite intervention compared with controls. These changes appear to be immunoenhancing (increased DHEA-to-cortisol ratios, increased NK cell activity, and increased LAK cell activity).” Barry Bittman, MD
I’ve got rattles also, lol.
(I had a patient the other day with a glioblastoma multiforma who was dying. I bet his family would have loved to hear you explain how drums and rattles were going to save him, lol. -PB)
At least Randall subscribes to the whole enchilada, rather than picking and choosing which parts of CAM he wants…..
“Negative. There was a study about giving Ipecac to patients with nausea and telling them it would stop their nausea. Guess what happened?”
The PI got fired for lying to test subjects, or at least, he should have been. Nausea is something that we have a bit more control over anyways. You can’t take a beta-blocker and convince yourself not to allow it to block your receptors.
What an excellent post.
An interesting tale about Homeopathic preparations:
http://www.mrhunnybun.com/2007/11/naughty-pharmacists.html
“(I had a patient the other day with a glioblastoma multiforma who was dying. I bet his family would have loved to hear you explain how drums and rattles were going to save him, lol. -PB)”
Come on PB, you’re changing the playing field. You say EBM and I produce the studies and now you change the rules.
(Randall, Randall, Randall. Drumming? Are you crazy? -PB)
“At least Randall subscribes to the whole enchilada, rather than picking and choosing which parts of CAM he wants…..”
Prowler, I think “the mind” is a big factor in CAM and allopathic medicine, but I chose shamanism over acupuncture and all the others because it is the Daddy of “the mind.”
Hey, I’m all for mean-spirited sarcasm, as long as it is executed with eloquence. I just discovered this blog via Crack Emcee’s “The Macho Response” blog, and I’ll definitely be back. Good work, Dr. Bear.
“(Randall, Randall, Randall. Drumming? Are you crazy? -PB)’
PB, PB, PB…sound effects the brain. The brain effects the body. How simple can I make it/
From a music therapy center in Colorado (call one near you);
“The area of neurologic rehabilitation our research findings have focused on 3 areas:
1) The application of rhythmic entrainment to facilitate and improve the long-term gait ability of patients with stroke, Parkinson’s disease, cerebral palsy, and traumatic brain injury;
2) First evidence that rhythmic stimulation might also work in the rehabilitation of arm functions;
3) Data and computational models of the mechanisms showing why auditory rhythm stabilizes and optimizes movement kinematics in therapeutic training.”
Ya gotta get out of the ED more often.
Actually, placebos do make nausea worse, and a nausea nocebo (the same pharmacologically inert material said to make nausea worse) actually makes it better. I discuss this and more (and provide citations) in my blog on the physiology of the placebo effect.
http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html
Essentially the placebo effect derives from the normal regulation of physiology, from the normal allocation of ATP and other metabolic resources to either immediate consumption for things like “running from a bear”, or for things like healing and cellular repair. The “optimum” control system allocates ATP efficiently, which means in an ATP crisis, things that are not needed immediately get shut down to free up that ATP for things that are more important. Something like this happens during ischemic preconditioning, where brief periods of ATP depletion somehow modify a cell’s physiology so it can survive longer periods of ATP depletion without damage. The ischemic preconditioned state is not a state that cells can sustain long term (if they could, they would evolve to be in that state continuously because it is a lower ATP consuming state).
In the extreme limit, the state induced while “running from a bear”, anything that can be shut down to provide a few more molecules of ATP to power muscles a little faster, a little longer, or a little stronger is “worth it”, even if shutting down cell repair causes permanent damage because being caught by a bear causes infinite damage (i.e. death). Any damage short of death is better than being caught. It is this allocation of resources that allows one to run yourself to death, and also which causes the long term damage of chronic stress.
The placebo effect is the switching of physiology from the “fight or flight” state where cell repair is shut-down to the “rest and relaxation” state where cell repair is turned back on. Once repair is turned back on, a placebo can’t do anything more.
It needs to be appreciated that this is not a simple effect. There are hundreds of thousands of different ATP consuming pathways, in hundreds of different tissue compartments, with each cell exerting local control. The regulation of these pathways is not simple, but it is also not at all magical. Everything about the placebo effect is fully consistent with everything that is known about physiology. There is no need to invoke any magical woo to explain it.
(This comment not approved and deleted. You’re right. I don’t want this subject to deteriorate into a pro-life, pro-choice debate. CAM has nothing to do with abortion and their is no similarity between debating it and CAM. -PB)
Here’s an example of “EBM” gone wrong, or at least, wayyyy off base. My 60-ish mother (baby boomer generation who thinks MD’s are omniscient) was diagnosed as a child with asthma, compounded with “severe” allergies. She was then treated like a china doll, not allowed outside to play, given tons of meds. Fast forward to today….she relies on steroid nebulizer and albuterol to breathe, has developed high bp which requires it’s own drugs, also now has high cholesterol (takes RX). Most recent diagnosis-stage 4 breast cancer.
Lifestyle consisted of eating prepared crap, sitting around, and popping pills for the various ailments. I TRULY BELIEVE that had lifestyle been different, we’d be talking about a healthy, well woman. In fact, I think that if she made lifestyle changes now and weaned off her 35 pills/day, she may have a much greater quality of life. I’m not saying that what y’all call “CAM” is a cure=all. I’m talking common sense.
And, MD’s seem to treat specific symptoms rather than the “whole” person. I don’t refer to whole person in the same way others did earlier regarding mind and spirit. I mean, find the cause of the symptom! Don’t refer someone to 3 different specialists so they can all prescribe their own fix that willl, in turn, require more meds for the side effects.
BTW, I am in rural Louisiana. Even here in the Deep South, we have some self-educated people who realize how to achieve overal wellness.
Re: rules to live by posted earlier…you ought to re-think those immunizations. Last time I checked, the mortality rate for the immunization was higher than for the treatable diseases that they “prevent”. Also, might want to include eating food that comes out of the ground instead of a box every once in awhile. And, don’t use the word “exercise”=it has negative connotation. People just need to get off their fat asses.
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(Pure kookery. Who was the last person who you knew who died of smallpox, polio, rubella, chickenpox, diptheria, or a host of other diseases that used to kill millions but have now been eliminated in the United States and the Western World because of vaccines? I tolerate a lot on this blog but you are simply an ignorant fool and know nothing at all about the history of medicine if you really believe this. If there’s one area where Western Medicine is absolutely spot-on it’s in preventative medicine and epidemiology, both areas in which great successes have been achieved even in my lifetime with virtually no drawbacks or side effects.
As for the rest of your comments, while I agree completely that lifestyle modification, for most people, would limit many of their health problems, why this this needs to involve CAM is beyond me. Yoga, for example, is an excellent form of exercise without the loopy Indian mysticism. -PB)
PB, somewhere on here I read that you allow one link. Please allow these for each individual to make their own choice about reading them. From memory and paraphrased, overall the immunizations have higher mortality rate and severe side effects. Some of the older shots have questionable preservatives (please don’t spout about how these are no longer being used, as that is crap!) and some of the newer ones (chickenpox) don’t work and actually make the adult onset of the virus far worse. Additionally, the ingredients (human fetal tissue and cloned cells) are not ever discussed and many MD don’t even realize they’re there.
I pride myself on not being a “sheep” who is taught from day one to follow orders and stay safely inside the box. I also realize that I am unusual in my approach to life, not just health. I know many people who are much more extreme than I am. My family physician (internist, ped) does indeed appreciate how involved I am in my family’s wellness. On the rare occasions we use her services (well visits to catch up 😉 she spends a good amount of time sounding her opinion of us compared to her “typical” patient.
I don’t knock “EBM” as it has saved my husband. He has required several cervical spine surgeries and still has severe symptoms. His treatments are a combination of “EBM’ and CAM including meds, biofeedback, meditation, PT, reflexology, and even accupuncture. I believe that if you were to ask him, he’d say the meds worked but with side effects and increased dosage to very high limits. The CAM works, but only if done religiously. So, for him, a combination really works well.
Those of you in med school, congratulations! (no sarcasm) It is my sincere hope that upon graduation, you don’t forget what drove you to this point. I also hope that you become wise enought to recognize that there isn’t only one right way. If a patient believes something works, sometimes that’s enough.
(I only allow one link, maybe two, because this is not a clearing house for other people’s pet causes. Repost with one link or two and I’ll let it by but I don’t want a laundry list. In other words, pick the most convincing anti-vaccination site and have at it. I’m sure every site on the list you submitted regurgitates the same thing anyways and, as repetition only equals propaganda, not truth, it’s not necessary.
I get, by the way, 500 spam emails a day most of which are filtered precisely because they contain many, many links to all kinds of odd and puzzling things.
I am still waiting for you to tell me how many children die of polio, mumps, rubella, measles, and many other deseases today that, pre-vaccination, used to kill in the millions.-PB)
Yoga, for example, is an excellent form of exercise without the loopy Indian mysticism. -PB)
I suppose you’re speaking of the watered down “americanized” yoga. True yogis would definitely argue!
I am still waiting for you to tell me how many children die of polio, mumps, rubella, measles, and many other deseases today that, pre-vaccination, used to kill in the millions.-PB)
i’ll get those links back out tomorrow.
FYI, I don’t know of any children dying of thos diseases today. However, there are many hundreds dying each year from the vaccinations. Kinda my point.
(Wait just a minute.  70 years ago tens of thousands of children died every year from diptheria alone, a disease that has been wiped out in the developed world. Polio killed and crippled thousands upon thousands of children just fifty years ago until it was wiped out by vaccines. Suppose in our nation of 300,000,000 a hundred children die from vaccines ( a ridiculously high number) every year against which we prevent 100,000 deaths. What, pray tell, is your problem with that? Are you even in the medical profession? -PB)
here ya go…always happy to help educate.
http://www.nap.edu/openbook.php?isbn=0309048958 is kinda long at 464 pages, but I figured it would appeal to you educated types 😉
http://www.thinktwice.com has info in laymen’s terms
Are you even in the medical profession? -PB)
Why? Is it a prerequisite for posting? Or for disagreeing? For the record, I am not in the “medical profession” per se, but would be considered an expert in my niche of said profession.
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(Because I don’t know a single doctor who is against vaccination of children against the once-common childhood diseases that were once common killers. When’s the last smallpox patient you saw, for example? -PB)
Old post is old, but I wanted to respond to Eric on acupuncture.
An anecdote is not evidence, but my own experience when I tried it completely shut me of acupuncture.
The practitioner was extremely reputable; a Chinese immigrant whose name other acupuncturists consider worth mentioning if they studied under him. A friend also reported good results from him in treatment of asthma attacks.
I had heard all kinds of stories, of course, about how these practitioners are supposed to take a more “holistic” approach and the totality of your condition into account before approaching a treatment. So I expected that after I told him the symptoms that were my chief complaint — shortness of breath, despite otherwise excellent health and negative results on examinations for asthma and relevant allergies — he’s ask about other, possibly complicating factors according to his point of view.
None of that happened. The first visit I saw an assistant. He poked me with some needles after a few cursor questions and we were done. I saw the practitioner himself on the second visit. He didn’t ask about anything more than my complaint either, but diagnosed the condition of my meridians using a skin galvanometer, probing each fingertip in turn.
Then we proceeded to the sticking. After turning me into a pincushion, he left me to take a nap for a half hour while the needles… um… Well, I guess they have to be in there a while for some reason.
There were no noticeable results from that visit. That by itself wasn’t a strike against, since scientific medicine often takes time to work too. On my next, I mentioned this to him and he told me that first we need to get me “in balance”, a phrase that was not explained. (Although he did ask about the breathing problem. Why he did, if we shouldn’t expect results, I don’t know.) On that visit, it turned out he stuck me right in one of the extensor tendons on the back of my hand — which I didn’t notice until the finger it was attached to twitched involuntarily while I was laying there. Ouch.
I might have put up with it if it was doing me any good, but it clearly wasn’t. The perspicacious reader will be able to devise a reasonable theory for why it seemed to help my friend’s asthma.
And Eric? The meridian that Urgent PC device “uses”? Do you have any idea how long these meridians are, and how many different ones (at specific points) might be poked to treat a condition that might be described as “frequent urination”? It would be surprising if a needle wasn’t near a large nerve.
This comment not approved and deleted. You’re right. I don’t want this subject to deteriorate into a pro-life, pro-choice debate. CAM has nothing to do with abortion and their is no similarity between debating it and CAM
weep… couldn’t you have edited out the abortion part? The discussion was simply about finding middle ground. I’ll stick to CAM.
What does CAM offer that attracts so many people, even in the face of proven medical treatments? I would suggest that if CAM practitioners treated patients like some western doctors do, the placebo effect would evaporate immediately.
I’m not trying to knock doctors, or say they are crappy people or any such thing like that. All I am trying to say is that doctors have a different set of priorities to treat patients than CAM folks do. Doctors deal with treating patients in an atmosphere of litigation, in a system that requires as much efficiency as possible.
CAM folks do best when patients feel better without regard to actually being better. Well people feel better when they talk about stuff, when they are relaxed, when the environment is not frenetic, when the practitioner is paying attention to them in a slow and calm manner.
Yeah, CAM is total nonsense. But I don’t think the administration of CAM, the way it is delivered to patients, is nonsense.
I just took my wife to an otherpaedist for her back. This is after she insisted on a reputable chiropracter. I told her nothing would come of it, her bakc would get better naturally and would fail again later. As it did.
the ortho talk ed to his recorder, refered to her in the third person while explaining the result of the examination to her. All while sitting in a flourescent lit room, with junky Muzak playing. Does this allow her to understand what he is saying, does this allow her to feel compassion?
I think CAM would go away if doctors could pull off the same sort of way to administer treatment as CAM folks. I’m not saying its possible, with time constraints, paperwork, the way insurance works etc etc, I’m just saying that we could do much better at eliminating CAM if we learned more about what attracts people to it.
“FYI, I don’t know of any children dying of thos diseases today. However, there are many hundreds dying each year from the vaccinations. Kinda my point.” – hippiemama
Arrrgh, are you serious? Have you even been reading PB’s responses? Vaccines have probably been the single greatest advance in modern medicine. My body can take on diphtheria toxin, tetanus toxin, the polio virus, and Hepatitis B with aplomb. Any one of those has the capacity to cause great harm, but I don’t even have to worry about them, because I’ve been vaccinated. I certainly believe that science should continue to seek out methods of vaccination that cause even less harm than any side effects currently caused by what’s in use now, but to even suggest that vaccines are causing more harm than the actual diseases is quite honestly, completely stupid. Anyone who has been harmed by vaccines in this modern era probably had some sort of underlying pathology that predisposed them to their adverse reaction, and that susceptibility would probably have revealed itself in another way sooner or later anyways.
Vaccinations don’t always work. Personally getting the measles and flu vaccines guaranteed that I would come down with them when the season started. Would have the measles twice as long and same with the flu. Going back to the black plague, did you know that almost all the victims had type B blood? There are some diseases that hit some blood types harder than other blood types. So are vaccines more effective with blood types that can fight the disease or with ones that can’t fight the disease? As for polio, a better question might be what caused the immune system not to fight it? as it is a relatively harmless before that epidemic? Sugar can cause the immune system to now work properly but don’t think that was the problem back then .
sugar suppresses immune response for up to 4 hours after ingestion. And re: vaccinations=whatever happened to a natural immunity rather than artificial? I was vaccinated during childhood, and IF the vaccines worked, I should have antibodies that have since been transferred via breastmilk to my children. So, why should I vaccinate them? UNLESS, the vaccines didn’t actually work for me.
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(You see, this is what I mean about a little knowledge being a dangerous thing. You do not have circulating antibodies against the antigens to which you have been vaccinated. You have “memory cells” in your immune system, pre-programmed by the initial infection (the vaccination), that are essentially dormant waiting to trigger the antibody-mediated immune response should this antigen (a components of a bacterial cell wall, for instance) be encountered in the future. These cells live in lymphatic tissue and are not passed via breast milk or transplacentally.  They function to give the immune system a head start against pathogens as the de novo response can take days to ramp up antibody production.
I am simplifying this considerably so all of you immunologists don’t jump on me. Hippiemama, if your beliefs are based on faulty knowledge, shouldn’t you educate yourself and then re-examine your beliefs? -PB)
Slosuzy: “As for polio, a better question might be what caused the immune system not to fight it?”
Ironically, it was better sanitation. Polio is usually spread by the fecal-oral route, so contaminated drinking water and other consequences of poor or nonexistent public sanitation is one of the main vectors in areas of the Third World where it’s still endemic.
Polio infections in infants can be serious, but it paralyzes less often than it does older children and adults and is mostly asymptomatic or causes only minor illness. (Paralysis occurs in 1 in 1,000 cases in infants; 1 in 75 cases in adults.) So the most likely long-term outcome from polio contracted in infancy, which is what happens where it’s endemic, is immunity to the disease thereafter. (Occasionally it is more serious, though. Just growing up in a polio-endemic area doesn’t guarantee you’ll escape being crippled by it. Quite the opposite.)
In the developed world we no longer have the “advantage” of fecally contaminated drinking water and other issues of poor sanitation, so if the disease strikes it tends to strike later when paralysis is a more likely outcome. The action of the vaccine is precisely to simulate the effects of contracting a mild case of the disease at a dramatically lowered risk of actually coming down with it, even with the oral vaccine, in order to confer that lifetime immunity.
The alternative to vaccination is to go back to wallowing in our own waste, and I don’t think that on balance this would be a wise public health policy.