Quacks Like a Duck

Almost everything about Complementary and Alternative Medicine (CAM) is bunk and its purveyors are at best deluded and at worst quacks and charlatans who would make the snake oil salesmen of olden days blush from shame. Maybe a hundred years ago you could make a case for magic potions and mysterious cures from the East but today we should know better and only don’t because of a combination of scientific illiteracy and an ingrained bias against rational Western thought. What little benefit patients can derive from most of the quackery being sold to them is not worth a fraction of the money spent and the same effects could be achieved without the smoke and mirrors if people paid as much attention to diet, exercise, and all around clean living as they do to looking for an easy fix. Additionally, while I am a firm believer in the principle of caveat emptor (let the buyer beware), CAM verges on criminality when it fleeces the desperate and the hopeless with promises of cures for terminal diseases. Many spend their life’s savings, money that should have gone to the support of the spouse or the family, on worthless therapies.

CAM exists in an alternate universe from real medicine. It wants to be legitimate but manages to avoid the responsibilities and liability of real medical practice. As most CAM treats nebulous symptoms with equally nebulous modalities, there is no measurable standard for efficacy of any of the treatments. Acupuncturists, for example, diagnose perturbations of “qi,” a mystical life force which apart from serving as the basis for Star Wars has no physiological equivalent and cannot be measured in any way except through the magical powers of its purveyors and the faith of its believers. I imagine it would be impossible to sue your acupuncturist for a bad outcome. There are no bad outcomes just as there are no good outcomes. It’s all highly subjective. If you’re not really treating a disease, you can get away with this and probably why EMTALA does not apply to CAM.

What sets complementaty and alternative medicine apart from faith healing and snake handling are the credentials of its believers. Those who speak in toungues and exorcise demons are simple uneducated people who lead intellectually isolated lives. They believe and need no proof other than faith. The adherents of CAM are educated enough to realize that their beliefs are ridiculous and try to give them the imprimateur of scientific legitimacy, often with shoddily constructed studies. Every major legitimate study on CAM, however, has found very little to substantiate it even though the researching institutions bend over backwards and contort their data to make the best possible case for it. CAM is currently the darling of the medical elites and to say, with confidence, that it’s bunk would be to lose your politically correct credentials.

The real medical profession while imperfect like all human endeavors is not so conservative that ineffective or ridiculous therapies are not discarded. This is the whole basis of evidence based medicine. There is no evidence based Complementary and Alternative Medicine. It exists in the absence of and often despite the evidence. When challenged, its practioners will retreat like the sweaty televangelists to anecdotes and testimonials. Either that or they will cite the placebo effect, that last hope and refuge of medical scoundrels and upon which rock they will cling as their last handhold in the rational world.

The placebo effect is vastly over-rated. Imagine the typical double-blinded placebo controlled study. If the patients in the placebo arm have a benefit it is tempting to interpret the results as proof that the mind has strange powers to heal. All it really means, however, is that some patients would have had an outcome with no treatment whatsoever. What placebo control studies really need is a third arm for patients who don’t know they’re being studied and are not given any intervention. Real or not, the even the most ferverent believers of the placebo effect concede that it has a very small role to play in the management of even subjective diseases. It’s a mighty shakey foundation on which to build a medical career.

Homeopathy: Water Has Memory?

According to homeopaths, to cure a desease one has only to isolate the offending agent, say a toxin or a chemical compound, dilute it with enough water so as to have none of the original compound left, and then rely on the retained memory of the compound in the water to have the desired effect. There are some variations but that’s basically it. When pressed, it’s proponents will mumble something incoherent about immunology and suggest that their cures work in a similar manner to vaccines, showing clearly that a little knowledge is a dangerous thing. Vaccines are nothing like exposing yourself to a random molecule of something unwholesome diluted in a bottle. No one who thinks they are should be allowed to graduate medical school and yet you still see the odd Homeopathic Medicine interest group at even academic medical powerhouses.

If you add the usual holistic mumbo-jumbo and exhortations to well-being and spiritual balance to a bottle or two of over-priced tinctures, that’s homepathic medicine and the fact that people can make a living at it makes me weep for the shoddy condition of the public schools.

Advantages: Easy money. No liability. Good street cred with your crunchy friends.

Disadvantages: Somewhat of a niche market and few Homeopathic practitioners can make a living just from homeopathy. Most people with money enough to burn are not that stupid anyways so you’re fighting for a small patient base. The money is in combining homeopathy with other quackery.

Naturopathy

There are two kinds of Naturopaths, the highly educated kind with a quasi-legitimate degree granted by one of a handful of Schools of Naturopathy and the free-lancer with no formal training except perhaps an easy to obtain mail-order degree. There’s not really a dime’s worth of difference between the the two and discerning it is a little like trying to differentiate a pickpocket and a burglar. Both are thieves, you understand, but one works harder at it.

At the heart of Naturopthy is a flawed belief in the healing power of nature. That nature, red in tooth and claw, also includes deadly natural pathogens, horrific genetic mutations, and single-minded predators (both human and otherwise) seems to have escaped consideration. It’s a Bambi-centric weltanschung to say the least and chief among it’s tenets is a reliance on medicinal botanicals which, as they are untainted by the rapacious talons of the Devil (man) are thought to be more effective in restoring some kind of natural order to the body.

Because they’re natural, you see. Nature good. Man bad.

While there is no dobt that many plants have medicinal properties, this doesn’t mean that plants make good medicines. This should be obvious to anybody who has studied even a little pharmacology. You can take some random preparation of weeds for a condition but why not take a cheaper preparation of a chemical compound with better effects and get the benefit of quality control? The next obvious question is why otherwise cynical people who discount many of the claims of the pharmaceutical industry (and I’m one of those cynics, by the way) and view Medical Doctors with dark suspicion are totally credulous when it comes to advice from someone who prescribes them misletoe for their hypertension and are completely trusting of Steve, the nice Sociology major working at the local holistic food store, when he gives medicinal advice about organic dietary supplements.

It is also true that the body has “healing powers.” Of course it does. But again, Naturopathic healing operates on the fringes, just staying on the safe side of subjective complaints and never bringing it’s natural goodness to bear on objectively bad diseases which would require some sort of unequivocal treatment.

Advantages: Easy money for a minimal investment of time. Good hippy street cred. Your marketing has been done for you as most people instinctively think that “natural is better.” Some states view Naturopaths as primary care providers which if you are in primary care should be gravely insulting.

Disadvantages: You probably have to combine your quackery to make a dishonest living. Maybe work as a chiropractor and do a little naturopathy as a side line. Having to compete with those mail-order wankers.

Acupuncture

Traditional Chinese Medicine (of which acupuncture is a prominent part) is so good that everybody lived long, healthy lives in ancient China before they had access to Western medicine.

Ha ha. No, not really. The chinese, like their European couterparts, until very recently had lifespans a fraction of what they are today and were cut down routinely by things that it took Western medicine to finally defeat. So that’s the rub. Acupuncture, as it predates the scientific method, is based on a metaphor of the body and health that has no association with reality. As soon as those wiley Chinese started using antibiotics…bam…diseases started being cured.

The organizing principle of acupuncture is “qi” or a life force which flow in the body through pathways called meridians. As these meridians predate a knowledge of anatomy and physiology, they do not correspond with nerves, blood vessels, or any known physiological process. The existence of qi can’t be proven and some have likened it to the soul, another metaphysical construct that defies objective proof. Fair enough, and as a good son of the Orthodox Church I believe in the soul. I’m just not trying to stick needles into it.

Think of it as Feng Shui (geomancy, another ridiculous asian import) for the body. Some acupuncturists attach bundles of burning herbs to the needles (moxibustion). Others use electrical currents or vibration. Still others don’t use needles at all but pressure points. There are also different schools of acupuncture each with a different map of the body’s meridians. You might go to five different acupuncturists and get five different nebulous diagnosis and five different treatments for the same complaint. It doesn’t matter because you’re not being treated for anything that requires a discrete diagnosis and if you feel subjectively better for a nebulous complaint I guess we can put that in the win column.

On the other hand it’s part and parcel with the medicalization of life so forgive me if I don’t clap my hands and squeal for joy when the intelligentsia gain relief from their imaginary complaints. It’s nice, it’s fun, but it’s not medicine.

Advantages: Money, of course. In the right market you can do well. It also has the air of legitmacy as many major academic institutions, despite underwhelming evidence, walk on eggshells when they should be merrily kicking the ass of acupuncture (and all CAM for that matter).

Disadvantages: Sticking needles into people is more dangerous than other quackery so the needle-trade is a little more regulated than most CAM. There are a bewildering array of licensing and ceritfication options with a confusing mish-mash of abbreviations and credentials.

Keep an Open Mind

So they asked me a lot, when I was interviewing for medical school, what I thought about complementary and alternative medicine particularly the use of traditional practices as adjuncts to Western Medicine.

I’m all for it. There are a lot of traditional practices I’d like to see become a part modern medicine. Like snake handling. For my money snake handling has everything you’d ever need in an alternative therapy. You’ve got your snakes representing nature, you’ve got your mystical religious overtones, and you’ve got scads of anecdotal evidence and testimonials in prestigious religious journals attesting to it’s efficacy.

For those of you who don’t know, snake handling has flourished in the folkways of the southern United States for more than a hundred years and is a time-honored method of casting out the demons that cause most sickness, at least those that cannot be ascribed to qi or bad karma. I understand that the NIH offers a fellowship that will equip anyone interested for an expedition to the wilds of Louisiana in which strange and magical land they may sit at the feet of ancient masters of this art and learn the secrets of the serpents.

And don’t forget to try Uncle Skeeter’s Gator-Taffy if your expedition passes through Lafayette.

I also would like to see more faith healing employed in the modern clinic. I’ve personally seen the lame walk, the blind see, and the gaseous find relief all from the “laying on of hands” as the technique is described by the learned shaman who practice it. For those of you who are lacking in cultural competence, the faith healer’s art is practiced in tents or, more lately, air-conditioned football ashrams where a large crowd can direct their good karma (or “prayerful thoughts” as it is often roughly translated) towards the patient. The patient, under the power of both suggestion and an Ayurvedic being named “Jaysus,” has his bad chakra forcefully removed, some would say driven, from his body with a precisely placed blow to the forehead.

The Shaman often yells “Come out!” but this is just showmanship, not unlike the way we yell “stat” in the Emergency Department even though we know that we’ll be lucky to get the labs by next Tuesday.

There is some debate whether faith-healing owes it’s effectiveness to the so-called “placebo effect” rather than any demonstrable physiological process but the debate is ridiculous and anybody who challenges this ancient traditional practice is a close-minded bigot. It’s not like they’re sticking needles into people or something lame like that. We’re talking bona-fide healing here, often before a television audience of millions. It would be highly unlikely that something like this could be faked in front of so many highly intelligent television viewers.

I have also heard of another traditional mind-body therapy for psychiatric problems, this one practiced in the deep hearts of our ancient cities. Basically, the patient dials a talismanic number, usually preceded by the mystical “900” or any other Number of Power and ceremoniously asks to speak with a priestess whose name is usually Yolanda or Mistress Debbie. The priestess then diagnosis all kinds of psychiatric and sexual dysfunctions, often times correctly pointing out that somebody close to you is cheating on somebody else close to you and “he needs to show you love, girlfriend…and you are so not fat…besides, he digs big women.”

Sometimes they throw in the winning lottery numbers.

Anyways, with all of my patients, the “P” in SIG E CAPS is “Psychic Hot-line.” I understand medicaid will reimburse for it. It’s not as if we’re asking them to pay for something ridiculous like a visit to the chiropractor.

Finally, for my money, nothing can compare to the healing powers of a good old-fashioned poultice like the kind my grandma used to make out of chicken droppings and mustard greens. It was the sovereign cure for a variety of ailments from lumbago to dropsy. Through years of experimentation, traditional practitioners have developed a wide spectrum of salves and rubs that are pushing the boundaries of our understanding of medicine. Our so-called “evidence based medicine” has nothing to compare to alternating layers of gumbo clay, sassafras bark, and chicken bile covered with brown paper and tied to the offending limb with common twine. It’s so good it’s almost magical. For fever, pepper is often added as it is a hot spice. For chills, it’s not uncommon to add the musk of a nutria as everybody knows this hardy animal can gnaw it’s way through the ice that forms every fifty years or so on the bayou. Beaver semen will do, I suppose, but there is no good evidence to support its substitution and I wouldn’t have that kind of quackery in my practice.

Besides, there’s no room to stock it as my shelves are crammed with homeopathic remedies.