Do you use/believe in complementary and alternative medicine?

As a rule I don’t believe in the healing power of alternative medicine, but I think many of them have beneficial ‘side-effects’, like relaxation, eating healthier, etc.

Some things like acupuncture I think probably have some validity. However, most of the rest of complementary/alternative medicine is untested, and fraught with major problem. For example, homeopathy has the idea that if you dilute a substance beyond the point that even a single molecule of the original substance is left, that the solvent somehow “remembers” the molecular footprint, and that footprint provides healing powers.

Likewise, a lot of people equate natural with healthy, which is nonsense. Amanita mushrooms are natural, but if you eat them they will cause liver failure and death.

My biggest peeve with the whole genre is the unwillingness to subject the “natural” “complementary” “homeopathic” therapies to rigorous scientific analysis. The few examples of testing of alternative treatments have failed, like the recent study of saw palmetto for benign prostatic hypertrophy published in the New England Journal of Medicine. Thus, all alternative therapies rely on faith(in nature) rather than science.

The placebo effect is powerful and documented phenomenon. In most opinions, those people who benefit from alternative medicine are experiencing a placebo effect rather than true scientifically proven efficacy. As was pointed out above in the case of saw palmetto, once actual double-blind testing is conducted, many claims of medicinal value are discredited. Most herbal remedies have not undergone scientific testing because it is an expensive proposition and there is typically no profit to be had since one can’t patent it. Now that’s not to say that they are all crap, after all, aspirin was derived from willow bark so there may be natural compounds that are legit but until they can withstand scientific scrutiny, beware.

To date, this discussion is a little bid one-sided. Let me take a devil’s advocate position. My experience is that Western medicine has a blinders on, jaundiced view of the possibilities outside its own sphere. It too has built-in biases and practices that are anti-consumer. There are countless examples of this, but here is just one. Prevailing practice in cardiology today is to run patients through evaluation (echo cardiograms, stress, tests, etc.) and then in the face of unclear findings straight to heart catheterization. This procedure allows the cardiologist to collect thousands of dollars for for about fifteen minutes work. This practice continues in the face of the development of cardiac cat scans, which are a much less costly viable alternative in many cases.

It is absolute horse feathers to denounce “herbalism” so globally. What pray tell do you think many drugs used today in modern Western medicine came from? Aspirin came from use of willow bark as an herbal remedy as only one example.

I, for one, welcome controlled scientific study of any type of therapy or substance. Sadly, just as powerful pharmaceutical companies keep drug prices artificially high and promote drugs without evidence they are more effective than current treatments, and sometimes in the face of evidence that they are not or are harmful, there are interests associated with greed in the supplement arena that actively fight the kind of testing, regulation (of active ingredient strength and sourcing for example) and scrutiny that would benefit the consumer.

There are no all-white or all-black hats in this arena. Sadly, like so many areas of public discourse and policy, there has been a polarization of the discussion. This makes unbiased examination and advancement difficult.

For myself, I try to be my own advocate and seek as much information as possible no matter what type of therapy, drug or herb I am considering.

Finally, I would suggest that conventional Western medicine should not blind itself by thinking the growing use of alternative or complementary therapies is a function of ignorance by the consumers, and instead might examine what dissatisfactions (and they are enormous) with their own practices are driving so many people to seek alternatives.

Edit: Sorry, did not see reference to aspirin and willow bark above. Let me substitute foxglove and digitalin.

That some medicines today are derived from more complex herbs, plants, or animals is undisputed. The problem with herbalists is that they (often) maintain that since their combination of herbs in “natural”, that one shouldn’t worry about the complexity of chemicals in there. Furthermore, if “herbs” really worked so well, why are they often combined into some form of mishmash? Is the combination of plant X, Y, and Z somehow better than the active ingredient(s) in plant X? Yes, the active ingredient of foxglove is digitalis (not digitalin), but the rest of the plant is essentially useless.

As far as your cardiology example, you are placing the entire discussion out of context. First, its apples and apples. A 64 slice CT scan may eventually replace the diagnostic angiogram, but as with our discussion of ice/warm compresses, no one has yet to evaluate them yet they have come into routine clinical practice. Also, a 64 slice CT is not that much cheaper than an angiogram, but the added advantage of the angiogram is that if a significant abnormality exists, it can be fixed at the same time.

People seek alternative because there have always been snake oil salesmen, and the herbalists/naturopaths today are just a modern example.

@shilolo: Every time you post I want to start a fan club.

Hmm, this isn’t really a discussion, is it? More of a pep rally.

If I pull my cardiology example off the table (not that I totally concede your point, but it is off topic somewhat and would take more time to respond to than I have at the moment), what about the other issues I raised?

Are you willing to acknowledge that conventional Western medicine has significant problems and issues of its own? What about bias (shown to occur over and over again) in flawed scientific studies?

Noun 1. digitalin – a powerful cardiac stimulant obtained from foxglove

dig·i·tal·in (dj-tln)
n.
1. A white crystalline glycoside, C36H56O14, that is obtained from the seeds of the common foxglove.
2. One of several mixtures of digitalis glycosides that are extracted from the leaves or seeds of the common foxglove.

Finally, I think the comment about snake oil salesmen proves my point about bias and polarization. I think there are definitely issues with alternative and complementary medicine. I think the entire arena should be subject to scientific inquiry and controlled studies. I acknowledge your points.

I find it disheartening that you are not willing to have that inquiry and controlled study done before condemning an entire very broad field.

That scientific studies are sometimes flawed is true. That it can take years to decades to determine the “correct” way of managing complex diseases is also true. Humans are very complex, and clinical studies have to be designed with the correct statistical methods, which often require huge numbers of volunteers.

That said, Western medicine is by far less flawed than Eastern or complementary medicine. As a purveyor of Western medicine, let me take credit for vaccination, antibiotics, public health (and the germ theory), chemotherapy, recombinant proteins like insulin for diabetes, oral contraceptives, antiretrovirals for HIV and so on and so on. Complementary medicine, like massage and acupuncture I can handle. So called “alternative” medicine I cannot.

Pray tell, if you had pneumonia, would you want a strong antibiotic, or the bark of a tree? As the old saying goes, “you get what you pay for.”

@Marina: I really did want to open this up for discussion, but I have erred on the side of full disclosure ever since getting berated for ostensibly failing to do so. So I made my opinion public not hoping for a cheerleading team but trying to be forthcoming.

Do you think that the principle of evidence-based medicine is flawed? Can you elaborate on what you mean by “bias…in flawed scientific studies”?

Don’t deny the advances you mentioned although I think the jury is still out on some of them. Wish the prescribing of antibiotics was held for conditions like pneumonia and not overprescribed and misprescribed (for viral infections) leading to superbugs like MRSA and resistant strains of TB. As for chemotherapy, while it has saved lives, I think it could well in the future be regarded the way bleeding is today. It is a nine pound hammer approach to a problem we don’t have a better solution for yet. As such, it is responsible for deaths and complications too.

I never said, nor do I feel “Western medicine bad; complementary or alternative medicine good.” Is Western medicine better? Maybe. I simply wish that it was more skeptical of its own practices and more willing to think outside the paradigm. I also think it could borrow from other traditions about adopting a wellness model rather than a disease model.

@nikipedia I think human beings are flawed and we operate in medicine as elsewhere with too much hubris on incomplete and sometimes flawed and sometimes flat wrong evidence. As to what I mean by bias in flawed scientific studies, the examples are too numerous to mention. One form of bias could be put into the same aphorism shilolo used: “You get what you pay for.” Here are a few references: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040005&ct=1; http://www.nofluoride.com/science_for_sale_sjmn.htm; http://www.sciencenetlinks.com/lessons.cfm?BenchmarkID=9&DocID=254
and that does not even include outright fraud which has also occurred too many times to point out by individual instance.

Sorry, break for din din. Should also say to both shilolo and nikpedia, thanks for the discussion. I am enjoying it.

@Marina. Yet another opportunity for a point-by-point rebuttal.

Don’t deny the advances you mentioned although I think the jury is still out on some of them.
> I’m not sure which of the therapies I described you think “the jury is still out on” (please don’t say vaccines, or I’ll have an aneurysm). You mention chemotherapy as a sledgehammer below, but it is a very effective one. That example notwithstanding, everything else I listed (and it was a short list) is highly effective. Still, scientists are constantly looking for the magic bullet therapy in cancer, like Rituxan for non-Hodgkin’s lymphoma, Gleevec for chronic myelogenous lymphoma, Herceptin for breast cancer, and so on.

Wish the prescribing of antibiotics was held for conditions like pneumonia and not overprescribed and misprescribed (for viral infections) leading to superbugs like MRSA and resistant strains of TB.

> The overprescribing of antibiotics is definitely a problem that is multifactorial. It owes a lot to the structure of medicine today, but also to the demanding patients (now “consumers”) who want an antibiotic for every little sniffle. As for TB, antibiotic resistance has little to nothing to do with overprescribing of antibiotics and everything to do with the HIV epidemic and a failure of public health in Africa, Southeast Asia and Russia. People who have TB have to take 3–4 drugs every day for 6 months, and many just don’t do it, leading to resistance.

I never said, nor do I feel “Western medicine bad; complementary or alternative medicine good.” Is Western medicine better? Maybe. I simply wish that it was more skeptical of its own practices and more willing to think outside the paradigm. I also think it could borrow from other traditions about adopting a wellness model rather than a disease model.

> First of all, Western medicine is far more skeptical than Eastern or complementary medicine. Are there flaws? Yes. Do people fabricate data? Yes. Are there unethical scientists? Yes. But, in the end, most of the useful therapies do come out, and the things that don’t fail. One thing that can’t be argued is the dramatic increase in life expectancy over the past 150 years, from about 40 years to almost 80 years, owing primarily to improvements in public health AND modern, Western medicine.

As far as the wellness model is concerned, it is unlikely to enter modern medicine any time soon because the wellness model cannot be easily defined, quantified, measured, etc. Since doctors/scientist need quantitative results, asking someone “are you feeling well, on a scale of 1 to 10?” would create real difficulty is studies (although some studies are in fact designed that way.)

@Marina: If you will permit me to use “Western-based medicine” and “empirical-based scientific studies” interchangeably, as it seems the two have been so far, then I would say the solution to all of the problems you present is more Western-based medicine (/science), not less. Fraud and bias are not inherent parts of Western medicine—in fact, the better you do it, the worse of these things you should have. As far as I can tell these problems you mention are symptoms of greed and low accountability—not inherent flaws.

Can you elaborate on what you mean by a “wellness model”?

Thanks for biting—I also appreciate the discussion.

There’s a LOT of stuff in alternative and complementary medicine. I think it’s hard to lump it all into one gook. Acupuncture is very different from homeopathy, which is very different from aromatherapy and meditation. I mean, even herbalism is HUGE.. aren’t we basically talking about all the herbs (plants) in the world that are not currently used by the Western medical establishment? How can you throw out the possibilities that some plants int eh world might be beneficial in one go?

So to say that “none of it works” seems to be a bit of a brash statement. I would have to take them one by one and well, try them out! Isn’t that part of the scientific study? To try by experience? So to say, ”all alternative medicine is bullshit” without examining the evidence would seem to be a rather narrow minded worldview.

We’ll have to differ regarding the jury still being out on chemotherapy. As to antibiotic misuse, I lay the blame solidly at the door of the medical and pharmaceutical professions. C’mon, if demanding patients asked for other inappropriate drugs, would the poor, henpecked medical professionals have to give in? Same with TB regimen and care management. The failure here belongs to medicine and society as a whole. If patients are confused or overwhelmed by a needed treatment regimen, the practitioner bears some responsibility for that and for failing to bring the problem to the attention of public policy officials, and failing to create adequate educational and/or therapeutic support.

I would not dream of arguing that Western medicine has brought about wondrous things in terms of disease reduction and even elimination, infant mortality rate decline, cancer cure rates, death from heart disease, too many to list.

I also agree that it is a factor in the increase in life expectancy. A factor. By no means would I agree that it has been the only factor and the data for its being the primary factor is not clear. It would be difficult to prove I think.

Here is one piece of input on that from a Swiss study of Improved Life Expectancy in Women Over the Last 100 Years (eufic.org):

“With adults, as for infants, there has also been a significant, and undeniable, contribution from better medical treatment but the situation is not as clear. Several studies have been done to evaluate the relative contribution of preventive and therapeutic practices to the reduction of, for example, cardiovascular mortality. Most of them have concluded that prevention and treatment have had almost equal impact. Factors in prevention have included, better food availability, variety and balance, more appropriate nutrition, recognition of the benefits of physical activity and a reduction in smoking habits.

Non-medical factors, such as better living conditions and hygiene, better food availability, variety and balance and improved nutrition, have also played a significant role but direct and clear evidence for their individual importance is difficult to obtain. Indirectly, however, their potential importance can be judged by the fact that declines in mortality from certain diseases have preceded medical advances in the treatment of the particular diseases. An example of this is tuberculosis (McKeown, 1976). Figure 8 shows that the mortality from tuberculosis in England and Wales, which was very high at the beginning of the 19th century, had declined by about 50% by 1880, the year that the causative tubercle bacillus itself was first identified. Mortality had substantially declined even further by the mid 20th century, when the first effective treatment and vaccines were developed.”

Response on the wellness model will have to wait. You guys are tag teaming me and I’m plum wore out for now!

@Marina. Do you practice clinical medicine? Your analysis of the failings of antibiotic use and TB therapy are off base. As far as antibiotics go, there is tremendous demand on the part of patients when they come to the doctor for something. If Doctor A doesn’t provide it, then this newly minted health care consumer will just go to Doctor B for what they want. Eventually, Doctor A figures this out and just caves. Even though he knows its wrong in the big picture, he probably figures nothing bad can happen to one individual. Another (probably more significant) cause of antibiotic resistance is the extremely aggressive care given within intensive care units (ICUs). Many people end up in the ICU at the end of life, either coming from home or a nursing home. They often end up on broad spectrum antibiotics, which breeds superbugs in the ICU that then spread to the community. Also, the heavy use of antibiotics in agriculture contributes significantly. Laying the blame on doctors is just wrong.

As far as TB is concerned, you are partly correct that this is a public health disaster, but its not the doctor’s fault when a patient can’t or won’t take his medicine. I’m an Infectious Diseases doctor who specializes in tuberculosis. We have less than 20,000 cases of TB in the US annually, but worldwide there are over 8 million cases with about 2 million deaths, mainly in Africa, Asia and Russia. Those places have weak to nonexistent public health systems, and so patients are often left to their own devices, and they invariably fail. In fact, the recent outbreak of XDR TB which killed 100% of infected patients occurred in an AIDS ward in South Africa. So, most of the major resistance has developed outside of the US. You can blame nonexistent public health (DOT: directly observed therapy) for that.

That said, your attempts to blame doctors for patients’ failings is falling on deaf ears. I have spent hours trying to cajole HIV+ patients to take their antiretrovirals correctly. We have pharmacists who explain everything to them, fill medisets, and count pills. Those who are able and willing to follow directions do very well, and for them, HIV is just another chronic disease like diabetes or hypertension. But, a large number do not, and their failing lead to drug resistance, which is bad for them personally, but also bad for the community at large. I do not consider that to be my fault. I do my best for my patients, and if they can’t participate enough to take care of themselves, well I can do no more.

Finally, I tried to find the Swiss study you quoted, but all I ended up finding was a nutrition website (I hope you have better sources than that.) Just basing my critique on your quoted material, I already see a major flaw with the analysis. Yes, it is true that Koch described the tubercle bacillus in 1882, but more importantly the “reduction in mortality from tuberculosis” correlates with Laennec’s invention of the stethoscope in the 1820s. Before the stethoscope, pretty much all pulmonary diseases were classified as tuberculosis. As soon as doctors adapted his techniques, they were able to distinguish tuberculosis from pneumonia, emphysema etc. So, there were fewer deaths from tuberculosis because there were fewer diagnoses of tuberculosis and more of pneumonia, emphysema, pneumothorax, etc. Ironically, Laennec himself probably died of tuberculosis. Also, in the mid 1800s, sanitariums were created, which broke the chain of infection by removing contagious individuals. Whether allowing TB patients to live in “cleaner” environments actually helped is unclear.

Truth is, I don’t deny that improvements in sanitation, better living conditions, and improved food intake helped. But, before antibiotics were developed, if you got a serious infection, you died. More people died in WWI from influenza than battle. Blood typing allowed people to get transfusions. Antitoxins allowed people to survive various infectious events. Vaccines allowed kids to live to adulthood. Vitamin A and D fortification of milk reduced blindness and rickets. Colonoscopies and mammograms save countless lives. People live with kidney failure on dialysis. We tranplant whole organs. And on, and on… I await the day when alternative medicine has a list 10% as long as one I could generate in 5 minutes regarding Western medicine.

Hi Doc,

I am sure you are a dedicated and caring professional. As to your question, to paraphrase Leonard McCoy, “Dammit, shilolo, I’m a writer, not a doctor.

And now, once more into the breach although we have wandered pretty far from the original question.

I will start by stipulating your point that Western medicine has saved more lives. I have no data to refute it with even if I wanted to. We cannot go backwards into history to look at or analyze how many people may have been saved by the use of traditional practices, such as Chinese medicine, or herbal craft.

On the other matters:
Quoting you: “As far as antibiotics go, there is tremendous demand on the part of patients when they come to the doctor for something. If Doctor A doesn’t provide it, then this newly minted health care consumer will just go to Doctor B for what they want. Eventually, Doctor A figures this out and just caves. Even though he knows its wrong in the big picture, he probably figures nothing bad can happen to one individual. Another (probably more significant) cause of antibiotic resistance is the extremely aggressive care given within intensive care units (ICUs). Many people end up in the ICU at the end of life, either coming from home or a nursing home.”

Umm, I actually think that quote supports my argument. Who else do we blame in those two cases if not doctors? I will certainly grant you the use of antibiotics in the food supply as a significant factor.

I bow to your professional knowledge on the TB front. I thought your point about the stethoscope was really intriguing.

It was the last bit where I came a cropper. I am sure (having had my share of public interaction positions) that there is a lot of frustration dealing with patients that can’t or don’t follow instructions. I winced at what appeared to be a lack of compassion. Perhaps that is not the case, and you merely have to draw the line at how much responsibility you can take on for each case lest you go mad. You are, after all, dealing with people’s lives, and it would seem to me some level of detachment would be vital.

In this country, though, there are some flaws inherent in the system that contribute to patients’ inability to follow instructions. They include limited time with the doctor, a paternalistic and authoritarian doctor-patient culture that intimidates many people into not asking questions and “not wanting to take up too much of the doctor’s valuable time,” fear regarding their own condition and mortality that blanks their thinking skills. I could go on.

Really, when we began this discussion, I only wanted to point out the logic flaw that lifeflame so eloquently stated in the second paragraph of his/her post. It is hard for me to see how you can on the one hand say that alternative therapies with a few exceptions have not been subject to scientific scrutiny and then condemn them as bs or snake oil as a group—before there is data of the type you prize to prove your contention.

As the exchanges went on though, I was hoping for more concession on the fact that the Western conventional medicine system is flawed. Great, maybe, better than nothing or the alternative definitely, but seriously flawed. I have been saddened not to have that happen.

I think as I alluded in an earlier post that there are multiple reasons people are flocking to alternative medicine other than ignorance or gullibility. I think there is a perceived lack of compassion. I think there is frustration with the bureaucratic bs built into the system.

I obviously haven’t reached you. My failure, the limitations of the medium of exchange, I don’t know. So, I’m going to take one final run at this a different way. If I can at least get you to see where I am coming from, I will be thrilled. If not, no doubt you would have to become a patient in your own system to see some of my issues with it.

How often do you walk into an examining room and call the patient by his or her first name while expecting them to address you as Dr. X?

Is there a fee for missed appointments or late patients? If so, what is the average wait time past appointment time for the patients? If it is routinely 15 minutes or more is there a credit on their bill? if the doctor does not show because of an emergency, is the patient’s make up appointment free?

Does the office staff and medical staff remember the patient on visits past the first one? Is there a practice of prepping for patient visits by reviewing the file before a scheduled appointment? (And grabbing it out of the basket, opening it and scanning for fifteen seconds outside the closed exam room door does not count.)

Do you ask as a matter of course before leaving an exam room: “Do you have any additional questions? Is there anything else you’d like to tell me about your health, your body or your life today?

I don’t ask these questions to make you or anyone defensive. I ask them because they represent differences in practice between Western medicine and alternative practitioners that I think register with patients and contribute to dissatisfaction with Western medicine and cause people to look elsewhere for care.

A bientot. If we’re ever in the same city at the same time, I am sure I owe you a beer. BTW, in Philly ever go to Strolli’s? I’m not even sure it’s still there (Papa Strolli died some time ago), but it was an institution and an experience. Loved the escarole!

@nikipedia Thanks for the stimulating and thought-provoking question.

yes, i do believe in it.

@Marina. It will be hard to answer all of your points and questions, but excuse me if my responses are short, since there were a lot of issues raised. Many, however, are really issues of perspective. You want to blame the doctor (and medicine in general) for a lot of issues. You want a doctor that won’t make you wait, but also one that will spend an hour talking to you when you need the time. What affect your hour has on the next patient’s wait time is beside the point. Medicine has become a business, and doctors both in private practice and in HMOs are forced to see more patients than they want to on any given day, in order for their practice to be profitable. At this point, let me transition to point by point, since it is easier.

Umm, I actually think that quote supports my argument. Who else do we blame in those two cases if not doctors?
> Personally, I “blame” the patients, if blame is the right word. Many come in expecting to be given an antibiotic, and no amount of education, reassurance or persuasion will convince them otherwise. “Doc, I know you say its just viral, but my last doctor gave me antibiotics for this, and I got better in 3 days.” (Of course you did, but you got better in spite of the antibiotics, not because of them, since the virus was going away on its own anyway). Personally, I never cave, but I have the luxury of practicing at a Veteran’s Hospital, and those patients can’t do more doctor shopping like in the community.

It was the last bit where I came a cropper. I am sure (having had my share of public interaction positions) that there is a lot of frustration dealing with patients that can’t or don’t follow instructions. I winced at what appeared to be a lack of compassion. Perhaps that is not the case, and you merely have to draw the line at how much responsibility you can take on for each case lest you go mad. You are, after all, dealing with people’s lives, and it would seem to me some level of detachment would be vital.

>With all due respect, I have a lot of compassion for my patients, or I wouldn’t have specialized in ID/HIV. That said, I can only do so much. I cannot go to patients’ homes and insist they take their meds (wouldn’t that itself be paternalistic, something you criticized doctors for?). I can’t make my drug abusing patients stop their bad habits to take better care of themselves (though I certainly try at every visit to talk to them about their habits). I can’t make my schizophrenic or schizoaffective patients be less paranoid of the system. And on and on.

Really, when we began this discussion, I only wanted to point out the logic flaw that lifeflame so eloquently stated in the second paragraph of his/her post. It is hard for me to see how you can on the one hand say that alternative therapies with a few exceptions have not been subject to scientific scrutiny and then condemn them as bs or snake oil as a group—before there is data of the type you prize to prove your contention.

> My problem with alternative medicine is that a tremendous number of people believe in it, even though there is nothing to support it, while at the same time believing that Western medicine is so flawed (as you have stated). Just walking past the nutrition stores, or the wall of supplements at the pharmacy drives me crazy. I mean seriously, who decided that it was right to sell expensive supplements and random, rare, possibly inert vitamins directly to consumers? Everyone is up in arms about the latest drug snafu, like Vioxx for example, but at least there were clinical studies done on the drug! Conversely, here is just one example of thousands I could find on google relating to “alternative” or “natural” remedies. The home remedies for heart disease include a diet exclusive of grapes, eating apples and apple jam, indian gooseberry, onions, honey, asparagus, alfalfa, safflower, vitamins E and C (these at least have been debunked in true clinical studies). As an aside, the same meta analysis (of Vitamin E) found that beta carotene (another natural product) actually had a “small but statistically significant increase in all-cause mortality and a slight increase in cardiovascular death.” Not all natural products taken in large doses are good for you (shocking, isn’t it?).

As the exchanges went on though, I was hoping for more concession on the fact that the Western conventional medicine system is flawed. Great, maybe, better than nothing or the alternative definitely, but seriously flawed. I have been saddened not to have that happen.

> You will not convince me of this, I think.

How often do you walk into an examining room and call the patient by his or her first name while expecting them to address you as Dr. X?

> Never. If I’ve never met someone, and its their first visit, I will say (as I shake their hand), “Hello Mr. Smith, I am Dr. X. I am going to be your new doctor.” Or, “Hello, I’m Dr. X. I’m working here today.” That said, if you are talking to a police officer, do you call him Jim, or Officer Smith? If you are in court, do you address the judge by her first name? Why not? If you meet a priest or rabbi, do you address him/her by their first name or Rabbi X? Why shouldn’t doctors be accorded some respect? The truth is that respect is deteriorating daily. I’m not a doctor anymore, I’m a health care provider, to be lumped together with a whole bunch of other providers…

Is there a fee for missed appointments or late patients? If so, what is the average wait time past appointment time for the patients? If it is routinely 15 minutes or more is there a credit on their bill? if the doctor does not show because of an emergency, is the patient’s make up appointment free?

> See, here you are wanting your cake and eating it too. You are a consumer of medicine. This isn’t an art, or a relationship, its a business transaction. If you are my patient and come in with an urgent issue that requires more time, and I save your life because that chest pain you were having is a life threatening pulmonary embolus, I’ll be damned if I care one iota if the next patient has to wait, and frankly, I think you wouldn’t care either. One day you wait a few minutes more because a patient 3 appointments before you looked like they were about to die, and some other time (I’m not wishing this on you, but just making a point), that patient will be you.

Does the office staff and medical staff remember the patient on visits past the first one?
>Yes.

Is there a practice of prepping for patient visits by reviewing the file before a scheduled appointment?
>See my points above. I’m not quite sure what you want actually. To have your doctor review your records for 10 minutes before seeing you, spend an hour talking to you, calling you after you leave, etc. If that were the case, a doctor would only be able to see a handful of patients a day. That’s neither good for the doctor’s practice, nor for the other patients who also want to see the doctor.

Do you ask as a matter of course before leaving an exam room: “Do you have any additional questions?
>Yes. Plus, I ask “Do you understand everything we talked about today? Can you summarize for me?”

Is there anything else you’d like to tell me about your health, your body or your life today?

> No. Usually, I come in and say, “I have two issues I want to talk about with you, your X and Y. Do you have anything you want to discuss?” If the patient’s list is a foot long, I will ask them to narrow it to their 2–3 most important points. Most people know their bodies well and will focus on what’s bothering them the most. If issue #10 is that pesky bunion, then it can wait until the next visit.

For me, I think the most telling argument is that most people, while on the one hand espousing their beliefs in alternative medicine, will on the other hand turn to Western medicine when the proverbial shit hits the fan.

@Marina. Since it was late last night, I forgot my two most salient points.
First, my major objection to alternative medicine (beyond what I have already stated) is the general aversion to rigorous scientific testing. Why would this be the case if practitioners of alternative medicine are so eager to heal? To paraphrase Aesop, why kill the goose that lays golden eggs? So many people are naive enough to ardently believe in the therapeutic miracle that is alternative medicine that they are willing to spend billions of dollars on unproven treatments. Thus, scientific analysis is really a lose-lose situation for the makers/practitioners of alternative treatments. If the therapy fails (which is highly likely), then the proponents of treatment X lose out. If the therapy succeeds, then they were right all along, and perhaps make a bit more money, but realistically, the marginal profit gained is not worth the risk.

My second point has to do with the wellness model you alluded to. I believe that this is unlikely to gain much traction, because the history of science and medicine shows that treatments improve when we probe deeper into the biology of disease. For example, the advent of the germ theory forced a transition from thinking infectious diseases where caused by foul humors to microorganisms. We now know what causes most infectious diseases, and modern techniques allow us to identify new agents rapidly at the molecular level, a la the SARS coronavirus. I doubt a wellness model or holistic approach would provide the protection the world would seek in the event of another unusual outbreak. So, while I certainly can see the attraction of a wellness model (“I just want to feel well, irrespective of disease”), I can’t accept that this way is better.

Can you summarize for me?

Yes. Here goes:

Q: Does complementary/alternative medicine work?
A: Western medicine sucks.

So these are really two separate (but related!) issues. I personally don’t have doubts about western medicine working, and I believe that many people are frustrated with The System. What I am still curious about is whether there are any complementary/alternative medicines that have value, even anecdotally, but it seems that is a less interesting discussion point than the extent to which western medicine sucks.

So does western medicine suck? Perhaps we should start a separate thread to address this issue specifically and see if we can get a few more perspectives. I personally am of the belief that western medicine is doing a-okay and problems within The System are an artifact of people sucking at their job or being overwhelmed or [obligatory something about greedy insurance companies].

If by work, you mean “convince some people that there is some sort of positive effect”, then the answer has to be YES. However, if by work you mean “demonstrates a measurable, tangible benefit in a randomized, double blind, placebo controlled trial” then the answer is an emphatic NO.

That said, I do feel that I offered a reasoned critique of alternative medicine, and why we will likely never know if it works or not (see above).

You think? I feel like some of it has been opened up to critique (I searched for meta-analyses for maximum power):

http://www.ncbi.nlm.nih.gov/pubmed/2147032

http://archinte.ama-assn.org/cgi/content/abstract/158/20/2235

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1371348

http://www.ncbi.nlm.nih.gov/pubmed/2693491

http://linkinghub.elsevier.com/retrieve/pii/S0022399903005737

Although unsurprisingly, some techniques seem to have held up better than others…

I stand corrected. You are right that there have been some studies on alternative medicine approaches, but to summarize all of the meta analysis papers you cited, most studies are poorly designed and thus are excluded from analysis. The few that are entered into the studies then generally show no benefit… I’m waiting for data testing all of the herbs and vitamins sold online and at the pharmacy as well as homeopathy, aromatherapy, etc. etc.

Indeed. I think those people border on criminal. A friend of mine did a doctor shadowing thing with an oncologist who was treating a patient who had spent a year going to her herbalist while her cancer metastasized and became untreatable.

Exactly my point.

Just curious, nikipedia (and flutherites in general), what are you expecting when your post a question on fluther in which you already have a clear standpoint and answers (and evidence to support your point of view)?

Are you there to play debate.. or are you actually hoping to be pleasantly surprised (in this case, for someone to come up with a double blind study of some aspect of alternative medicine)?

I genuinely wanted to hear the other side. I am a scientist and have a great background in western medicine and science so I am clearly very biased toward that perspective. I really wanted to know if someone could make a good case for the other side, since I know virtually nothing about it.

I tried to disclose my perspective not to rally those who agree with me but because I have been chastised for failing to do so in the past.

Besides, what’s wrong with debating?

Incidentally, I was the person who eventually posted empirical studies of CAM since no one else bothered to look them up.

No, nothing is wrong with debate.. in fact, there are many lively threads in fluther that are a result of people bringing up something they do want to debate. (Though it is slightly off-putting to see a particular point of view tagged as “BS” and “a lot of other crap” in the question… but from what I have read of your posts I consider you as someone who is open and who comes up with good points.)

I’m not a doctor and I don’t have any medicine background, Western or alternative, so I really don’t feel qualified to add any studies, etc. I do have several friends studying to be doctors and of course, here in Hong Kong the practice of Chinese medicine is almost as prevalent as Western medicine. I believe there is a whole branch in the university devoted to its study.

From the little I do know, I do think Western medicine tends to address the symptoms rather than the problem. So if I have a headache, I go to the doctor and he or she’ll prescribe me some aspirin or something. Now if the doctor has time he or she might actually talk and figure out why I’m having these headaches (overwork?), but by and large if the cause is not physical, it’s really outside their domain and there is a psychotherapist or some other specialist for that.

A lot of Chinese medicine will look at the body as a whole system; a system that is by an large in equilibrium, and when it is upset, that’s when we get sick. So for example, I keep getting mouth ulcers, especially when I am stressed. I actually tried searching on the net for an answer, and all I got was a bunch of creams. Now a Chinese doctor would say that my constitution has a “wet” and “hot” base.. and actually instead of telling me to put something on the ulcer itself, will give me a formula to help balance my constitution. Somehow, based on the collective experience of many centuries, they have identified patterns in people and assigned them constitutions.

More importantly, when I drink the soup it feels right.
Of course, you can say that oh, it is a placebo effect, but in general nowadays I am trying to cultivate a sense in my body as to what it wants to eat and what it needs. Actually I really think we should listen to our bodies more and trust them.. they actually have a pretty good sense of what is needed.

So, in short: I don’t have enough knowledge to make a case for it empirically, and unfortunately, I am as ignorant in the logic of Chinese medicine as to why an aspirin might chemically work.

However, I do think there is value is listening to our bodies, and there is value in thinking about our bodies as a system of balance. If I have a major accident on the road, I’m going to ER. I’m not going to wait for herbs and stuff. With minor colds and flus or even minor headaches I’m staying at home and sleeping, I’m trusting my body to heal myself. And with everything else in between, well, I’d like to keep an open mind on it; and try things out.

The truth is, there are many choices for us in healing – many choices within Western medicine, and many choices offered in alternative medicine. There is so much literature and also many vested interests in the dissemination of information and within the medical establishment that it can be hard to sort it out. So in the end, I try something out and if it works for me, great. In this sense, I really don’t think of the problem as “Western medicine” vs. “Alternative medicine” ... Rather I see health and healing as a personal matter, and the necessity for each person to figure out what is right for them.

.
(I think this is the longest response I’ve ever posted on fluther!)

Bravo lifeflame, well said!

With all due respect to lifeflame, how is this any different from Hippocrates’ four humours? Is the earth flat too? Does the sun revolve around the earth? Was the Black Plague caused by humoral imbalances? C’mon. This is the 21st century!

In any event, his comments proved my point. People may tinker with so-called alternative medicine because it warms the heart to think “I’m really in touch with my body”, but when issues “get serious”, they turn to what they know works, Western medicine.

Good question shilolo!

You know, the Hippocratic four humours, Western and alternative medicine are but models of how we think about healing. There’s nothing sacred or inherently true about Western scientific method, it just happens to be the most effective model we have of explaining the world. .

The four humours was the best the Greeks could come up with at that time for explaining the world, and chemical compounds seem to be the best model we (as in the mainstream) agree on to explain the world. Maybe in years to come our jargon could be as ridiculous as the Hippocratic four humours seem to us today.

So the argument to “C’mon, this is the 21st century!” feels like an appeal to convention… (and Western mainstream convention at that.. there are many other cultures in the world too)

If we are truly open-minded about our search for the truth (or failing that, the closest approximation of what works), we need to keep our minds open.

Is it really so terrible to be in touch with one’s body? (and just for hippies?)
Is it not a serious matter to be disconnected with one’s body?

By the way, the Chinese medicine lingo is as mysterious to me as the Western medicine lingo would to someone who never studied biology. (And it sounds even weirder in English than it would in Chinese). But I feel unless you actually know what they are referring to—which incidentally, I don’t, not really either -, don’t diss it because they “sound funny” ..

By the way, I’m a “she” ...

@Lifeflame. Sorry for the gender misunderstanding.

Its a bit of a stretch to say that Western medicine “is just a model”. Some things will become clearer over time, but we have quite an understanding of the human body, even to the molecular level. For example, we know that a diatomic gas, nitric oxide (NO), mediates blood pressure, neurotransmission and immune defense. Likewise, we have a very broad and deep understanding of a variety of diseases that for centuries eluded Eastern and Western doctors alike. Infectious diseases (germ theory), cancer (cellular mutations, oncogenes, cancer viruses), autoimmune diseases (hyperactive immune system), endocrine diseases (lack of insulin, weak or hyperactive thyroid, etc.) and so on. Can Eastern medicine cure tuberculosis? Cancer? Diabetes? I don’t think so.

Incidentally, anyone who is really interested in this question might find the book Grace and Grit by Ken Wilber interesting. It is an account of the last five years of his wife (Treya), we died of breast cancer.. and they were confronted precisely with the same question we are discussing (with a bit more at stake than we have).

Basically they found that that Western medicine was extremely pessimistic, and the evidence for alternative medicine anecdotal… and their journey in search of the best answer. It’s very interesting, because Ken is a philosopher, which means he is very rigorous in his thinking; but at the same time he is a perennial philosopher, so I think he gives a pretty interesting account of how one might reconcile science and spiritual practices.

@shilolo… Can Western medicine cure cancer either? Can it really cure diabetes?
(I’ll take your word on TB since I don’t have any info on this)

To answer your medical question, most infectious diseases can be cured with antibiotics and quickly at that. Even drug resistant bacteria can be treated with other drugs (although it gets harder as time passes). We have a harder time with viruses, but we are now able to make HIV a treatable chronic disease, and even cure hepatitis C. Of course, I haven’t even mentioned vaccines to prevent a long list of dangerous and life threatening ailments, along with the successful eradication of small pox and the near eradication of polio.

Some, but not all, cancers can be cured. I won’t belabor this issue, but cancers including thyroid cancer, lymphoma, leukemia, sarcoma, basal cell and squamous cell skin cancer, testicular cancer, cervical cancer, prostate cancer and colon cancer can be cured. Likewise, diabetes can be treated very effectively with insulin (I don’t think there is an “alternative medicine” for insulin, correct me if I’m wrong), and researchers are developing a cure in the form of islet cell transplants.

I assume that you are referring to Type I diabetes. Insulin certainly is not the answer of choice for hyperinsulinemia.

I assume you are referring to Type II diabetes in your critique of my response. FYI, Type II diabetes is due to peripheral insulin resistance, NOT hyperinsulinemia! I would add that many patients with Type II diabetes eventually require insulin.

@Lifeflame. I also want to address something you said which is brought up a lot, that “From the little I do know, I do think Western medicine tends to address the symptoms rather than the problem.”

How is this true? If you have pneumonia, and I give you an antibiotic, I’m alleviating your suffering AND curing your bacterial illness. If you are so sick as to require hospitalization, and I provide extra oxygen, I alleviate your symptoms and help you get better sooner. If you are so sick that you need to be placed in the intensive care unit, and I put in a breathing tube to keep you alive, is that addressing the symptoms rather than the problem (i.e. your imminent death from respiratory failure)?

I can make the same case for a long list of curative treatments ranging from antibiotics to blood pressure medicines to thyroid hormones and so on.

Chicken and egg, isn’t it? High levels of insulin cause the insulin resistance. Also, and this will probably come as no surprise, treatment of people with too much insulin with insulin is another one of those things I don’t think medicine has gotten right.

It is not clear whether high levels of insulin found in the early stages of type II diabetes is the cause rather than the effect. Most endocrinologists believe that in the face of hyperglycemia due to peripheral insulin resistance, the pancreas secretes more insulin, initially. That is why in early in Type II diabetes, patients are treated with medicines to increase their peripheral sensitivity to insulin. Eventually, all patients with type II diabetes will secrete very little insulin, which is why they ultimately require insulin replacement. The inability to increase their insulin production in the face of peripheral resistance is one of the major reasons why they develop severe hyperglycemia, the hallmark of diabetes. Frankly, most of the data points to obsesity (and excess adipose tissue) as the major cause of type II diabetes.

As far as your comment that “Also, and this will probably come as no surprise, treatment of people with too much insulin with insulin is another one of those things I don’t medicine has gotten right.” all I can say is that I’m glad you aren’t an endocrinologist or internist. Insulin is considered standard of care for type II diabetics when their hyperglycemia is unresponsive to oral agents. I doubt anyone else is following this thread, but I’m sure you could ask the fluther community who is taking insulin (or knows someone on insulin).

I would be glad to continue debating the merits of alternative medicine with you (I note that you didn’t answer my last two messages directly), but I will not debate medicine. This whole discussion of diabetes is just a sidetrack. Let me pose some simple questions. If you were diagnosed with type I (insulin dependent) diabetes today, would you take insulin injections, or seek out an “alternative” approach? If you were diagnosed with bacterial meningitis, would you accept intravenous antibiotics, or take a holistic approach?

Put it this way: I have pneumonia; you give me an antibiotic. Great. I assume it works.
However, why did I get pneumonia in the first place? Is it because I have a crap immune system because of x or y (I’m smoking, I live in a nasty damp place, etc)

If you are a kind doctor with time, you probably will ask these questions and give me advice to solve the larger problem. But if you don’t have the time and energy, as a Western doctor it really isn’t in your domain of responsibility to cure anything outside the problem in front of you (the pneumonia).

Now I’m not saying that a Chinese doctor would necessarily would.either. But the system of Chinese medicine (from what I know about it) will try to take care of things before it reaches that stage. It’ll try to fix your immune system before you catch the pneumonia. It’ll flag your imbalances and bad habits before you get sick.

So when I say “problem” I guess that I’m talking about underlying causes, rather than merely the effects of the disease. Does that clarify it some?

Yes, that provides some clarification, but I remain highly skeptical that you can be “taken care of” beforehand by alternative medicine. Don’t forget though, that Western medicine does the same thing but with Western science reasons. We vaccinate for pneumococcus (the cause of pneumonia), hemophilus (pneumonia), diptheria (whooping cough), influenza (viral pneumonia, bacterial superinfection) and so on. Plus, in many cases it isn’t possible to know why someone gets sick (whatever the illness). Perhaps Chinese medicine pretends to know why (you aren’t in balance…..) but who knows if that’s true or not? Its self-fulfilling. If a Chinese medicine practitioner gives you a tea to drink for being out of balance and you stay healthy, then props to them (but you might have been fine anyway). Conversely, if you get sick despite the treatment, then what? They’ll say, “but you would have been a lot sicker if not for the tea!”

Its also a mistake to think that Western doctors don’t look for underlying causes. If I diagnose you with hypothyroidism (a weak thyroid), then I will check a number of things to see if I can identify why that happened. Likewise, if you develop inflammation of the pancreas (pancreatitis), I will check for gallstones, alcoholism, high triglycerides, high calcium (and some others as well). You get my drift?

Sure, any good system of healing should look for underlying causes; and any good doctor should do preventive medicine as well as address the issue when it comes up.

As I said, I don’t have enough expertise to say anything about teas (or vaccinations either), but I do know that the top two universities in Hong Kong have their own faculties for Chinese medicine and are busy running all sorts of clinical trials for its use. So obviously the medical establishment over here is sensing some kind of value to Chinese medicine:

http://www.cuhk.edu.hk/icm/en/research/research01.htm#proj02
http://www.hku.hk/facmed/04research_areas_tradable_chi.htm#

I’m glad someone is doing research on the subject. It can only help in the long run. I hope they publish both positive and negative results.

That said, we have homeopathy schools in the US, but that doesn’t make homeopathic treatments effective.

Well, shilolo has largely beaten me to the punch. lifelame, it seems like you and marina have both raised this point about Western doctors being too busy/preoccupied. I guess I’m curious why you think that is a consequence of being a Western doctor rather than a consequence of being busy or preoccupied. Y’know?

And I will also contest that Western doctors aren’t into preventive medicine. Doctors nag their patients to lose weight, quit smoking, use condoms, etc…

Thanks again for taking this on, and apologies for anything offensive in the asking. Was not intentional.

@shilolo I did not respond to those last posts for several reasons:

1. The tenor of the discussion seemed to me to be getting increasingly heated.

2. You pointedly did not respond to any use I made of humor to lighten the atmosphere.

3. You said in one of them that I would not convince you that there are flaws in the Western system of medicine so it seemed pointless to consider trying.

I will respond to some of the posts:
A. My question regarding relative forms of address between doctor and patient. Bravo to you for how you handle it. As to whether doctors should be accorded respect, certainly, but no more and no less than that accorded to anyone else, be they professional, craftsman, artist, whatever.

B. You misconstrued my point about missed appointments. Let’s skip it under the premise referred to in Number 3 above.

C. Review the File Ditto

D. Regarding providing patient opportunities for asking for clarification or reporting other issues, it is excellent that you cover these topics with your patients.

Second Post
“My major objection to alternative . . .”
I completely agree with you that alternative medicine should be subjected to rigorous scientific testing as I said in my very first post in this thread.

What I have always objected to is that you and nikipedia have globally condemned the entire grouping as “bs” and “snakeoil” before any large-scale testing is done.

I also never equated natural automatically with healthy (you ascribed that to “people”). In fact, that is not what I think.

As to the second point in that post, I have a response, but was not sure there was a point in going on.

@nikipedia I’m not clear what you were summarizing. The Q is not the original question you posted and the A is certainly nothing I said, nor does it appear in any other post I have read in this thread.

Despite the limited available data, there are a number of alternative therapies that have shown promise in clinical studies, although I am not aware of many, if any, that have had sufficient study.

My own reluctance to stroll down that path with you stems from the built-in bias and hostility displayed in the posting of your original question (To wit: “I am inclined to call shenanigans on the whole thing” and your topic tagging that included “a lot of crap” and “BS.”

Nothing I’ve read from you since suggests to me that you are sincere when you said that you “really did want to open this up for discussion” or are genuinely “still curious about whether there are any complementary/alternative medicines that have value, even anecdotally.” Not to mention the snotty “since no one else bothered to look them up.” A statement, BTW, for which you have no evidence. You only know that no one posted them.

I suspect that you simply want someone to set up the pins so you can knock them—and the poster—down, thus my own reluctance to go there with you.

But, let’s see. Here are a few references that point to some efficacy. Again, let me stipulate that there has not been sufficient study of any one of these and some methodology may be flawed, but the data are interesting enough to warrant further study.

Gymnema Sylvestre This is a plant used to treat hyperglycemia in the Ayurvedic medicine tradition from India.
http://www.ncbi.nlm.nih.gov/pubmed/2259217
Chattopadhyay RR. Possible mechanism of antihyperglycemic effect of Gymnema sylvestre leaf extract, part I. General Pharmacology. 1998;31(3):495–496.
Ogawa Y, Sekita K, Umemura T, et al. Gymnema sylvestre leaf extract: a 52-week dietary toxicity study in Wistar rats. [Article in Japanese] Shokuhin Eiseigaku Zasshi. 2004;45(1):8–18.
Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozotocin-diabetic rats given Gymnema sylvestre leaf extracts. Journal of Ethnopharmacology. 1990;30(3):265–279.
Shigematsu N, Asano R, Shimosaka M, Okazaki M. Effect of long term-administration with Gymnema sylvestre R. BR on plasma and liver lipid in rats. Biology and Pharmacy Bulletin. 2001;24(6):643–649.
Sugihara Y, Nojima H, Matsuda H, Murakami T, Yoshikawa M, Kimura I. Antihyperglycemic effects of gymnemic acid IV, a compound derived from Gymnema sylvestre leaves in streptozotocin-diabetic mice. Journal of Asian Natural Product Research. 2000;2(4):321–327.

Red Yeast Rice This traditional Chinese herb contains a naturally occurring statin compound, the same statin found in Lipitor
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VS8–445RB5C-CP&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=da40d4ecc41d0886c50b0b248d2a861b
http://www.ncbi.nlm.nih.gov/pubmed/9989685

Hawthorn in traditional herbal practice is a hypotensive and is used also to treat heart failure
I don’t have access to this study itself, but here is the specific journal reference: http://www.medscape.com/viewarticle/537304_6
http://www.cochrane.org/reviews/en/ab005312.html
http://www.ncbi.nlm.nih.gov/pubmed/12798455

I’ll stop there for now.

@Marina: I am pretty offended by your statements about my bias, hostility, snottiness, and insincerity. I don’t think I have anything left to add to this conversation. Thank you for the links.

Sorry, I was basing those conclusions directly from your exact words. I don’t see another meaning to calling something “a lot of crap” and “BS.” Perhaps characterizing your “since no one else bothered to look them up” as snotty was unfair, but how would you characterize it? It wasn’t exactly friendly. It didn’t really add to the discourse. And you had absolutely no way of knowing if it was true.

I think it would be helpful to bring the same rigor to the discussion in terms of accuracy and logic that you demand in your work. As I said, I never, nor did anyone else except you say “Western medicine sucks.”

Again, I am sorry you felt offended.

@Marina. Thank you for your candor. Let me respond to some of your comments.
1. Regarding the issue of respect, I beg to differ. While I agree that all human beings should treat each other with respect, certain positions in our society (typically those which are harder to achieve) are accorded more “job-related” respect than others. Do I respect the mechanic who fixes my car. Certainly. Should he be accorded the same “respect” as a Supreme Court Justice? Not in my opinion. That’s not to equate being a doctor with a Supreme Court Justice, but I am using extremes to make a point.

2. (and 3) I’m not clear on how I misconstrued your points about waiting at the doctor’s office and/or reviewing the chart. To me, they were a veiled swipe at the “arrogance of doctors” to make people wait, and then not take that waiting into account. Apparently I was wrong, but you certainly can feel free to clarify.

Finally, with respect to those studies you listed, in my mind, it doesn’t change anything. Here’s why. (As an aside, I have long been aware of red yeast rice and statins). I don’t deny that many plants, trees, animals, fungi, bacteria, etc. contain chemicals that have medicinal properties. Many of our best medicines represent these compounds, either in their original form or modified somewhat by modern chemists. That said, I don’t understand how someone would think that taking 1200 mg of red yeast rice (twice a day) in order to take about 5 mg of a stain is preferable to just taking 5 mg of the statin in a pill form? Is the complexity of the herbal product actually preferable to the pure, active compound that has been prepared so that it gives predictable pharmacokinetics? Or is it just the thought, “it’s natural”? In any event, what’s so “alternative” in taking a statin in the form of red yeast rice?

To give you another example, artemisinin is now a widely used antimalarial drug that has a long history in Chinese medicine (found in the leaves of the wormwood tree). But, it turns out the the active ingredient is only produced in small quantities and only when the tree is under stress. So, if you wanted to just eat the leaves as a cure for malaria, it might work, but if the leaves don’t contain the medicine, you’re out of luck. So, it is far better to chemically synthesize the pure drug, modify it and mass produce it rather than try to extract it from leaves or give people leaves to eat. And that is from a compound we know works in clinical trials.

Anyway, your comment about my considering alternative products and medicine as “snakeoil” until proven otherwise is an accurate description of my beliefs. I don’t deny it. Then again, I also am extremely skeptical of new, Western medical technologies and medicines until they are proven to work. This gets back to my main concern. Most alternative practitioners and producers of the stuff you see in “naturopathic stores” nd on the pharmacy shelves are not interested in testing the product for the reason I listed. In most cases, there is no reason to kill the golden goose.

The bottom line is this, if following alternative practices makes you feel good, by all means continue doing what you are doing. That said, I would be curious to know what your response would be to a serious illness (for which a Western treatment or cure is readily available)? Would you continue pursuing the “alternative” or seek Western medical care?

1. Respect. Again, we will have to agree to disagree here. I subscribe literally to the “all men are created equal” school when it comes to respect (I use men here in the traditional sense of all people). As to societal and historical norms, I think those are somewhat suspect. After all, not so long ago, women were not even accorded person status in many cultures including ours; they were chattel. Just as I do not accord people respect based on wealth or fame, I do not accord it based on education or professional status. For me, respect beyond the basic courtesies due any fellow floater through the medium of the collective, is something given based on someone’s actions: Are they respectful of others (including the beliefs or opinions of others)? Do they move through the world making efforts to be a positive part of it? Do they perform whatever their work is in a conscientious manner to the best of their ability?
2. OK, I’ll tackle the waiting room thing. No, it was not a swipe at the arrogance of doctors. It was about reciprocal standards and valuing each party’s time equally. Stuff happens. Emergencies. Whatever. I merely intended to suggest that if the office charges the patient for a missed appointment, then if the patient arrives at the office and his or her appointment is cancelled by the doctor, a make-up appointment that requires the patient to arrange their schedule to come back should result in a credit equal to the missed appointment charge for the patients.
3. I am pretty sure that you will dismiss the following examples as anecdotal rather than representational and, strictly speaking, you would be correct. I have, however, throughout the years heard from others and read about so many similar instances that I believe the problem is rampant.
—I have had the experience at least a half dozen times at medical facilities to which I was making a visit other than the first visit of being called by the wrong name by the doctor or another staff member. (Maureen, Marine, etc.)
—On two visits (again, after the first) even though it was noted in my records, I have had to bring to the practitioner’s attention at the ENT specialist’s office that I have a tube in my left year when they have puzzled aloud about anomalous test results for example.
—I have had a doctor who was my family physician the previous two years say to me, “If you ever decide to become sexually active, let me know.” When I replied, extremely puzzled, “Dr. W (name withheld), I am sexually active. I am married.” My marital status was, of course, noted in my records. It’s possible this last example should not be included here, because the doctor’s behavior in subsequent visits escalated to making sexual advances so I may have just been being dense that first time.

Aside to @nikipedia. My experiences with alternative health practitioners have been very different. Again, my sample only spans a relatively small number, but the quality of personal interaction and degree of familiarity with my ongoing medical situation and course of treatment has been uniformly higher. In conversations with others, I have heard similar comments.

Regarding standardized dosing for active ingredients and regulated sourcing for supplements, I wholeheartedly wish it were so and would support legislation that mandated that oversight.

Your concluding questions. I primarily use conventional Western medicine for my care, and it is always my starting point. When I feel that it has failed me or is insufficient, I have looked for other solutions to my pain or to correct my problem. Here is only one example. I suffered significant soft tissue injury in an auto accident in which our car was rear-ended on the freeway, resulting in loss of range of motion and chronic back pain. My doctor prescribed Ibuprofen, ice and rest. As days passed, he had no other suggestions for care when I was unable to sit in a chair in front of my computer and work or perform other normal activities. In desperation, I began to talk to friends to seek other options. I received chiropractic care and therapeutic massage (both covered by the automobile insurer because the industry’s own studies showed those practices sped recovery from soft tissue injury), which were immediately effective in improving my problems.

@Marina. In terms of the respect issue, I think it is very noble and egalitarian of you to think that, but I doubt your views are shared widely. Across all cultures, and throughout the ages, there have always been individuals within groups who are regarded differently, and accorded more respect, whether it is the village chief, priest, healer, shaman, or judge, lawyer and doctor. Focusing strictly on medicine (since that has been the topic), today it takes 10–12 years minimum to enter clinical practice from the beginning of college. One needs to be smart, disciplined, determined and willing to make significant sacrifices to succeed. Furthermore, it is one of the few professions (including policeman, fireman, nurse and professional soldier) where you actually are putting your own life on the line. Caring for sick patients is a real risk, since in cases of contagious illness, a doctor can succumb to the same disease afflicting her patient. Recently, doctors have died from Ebola, tuberculosis and SARS.

With regards to your personal experiences, I cannot comment on (as you said) anecdotal events. Also, I am not in private practice, so I am not familiar with these charges you describe. I will only say that doctor’s offices tend not to be as efficient as the Swiss railroad. With respect to your comments regarding better experiences at alternative practitioners, I wouldn’t be surprised if there were a bit of a “rose colored glasses” effect. You anticipate a negative experience at the doctor’s office, and the slightest thing is offputting. Conversely, you anticipate a glowing experience at the alternative practitioner’s office, and might disregard the same minor things that would trigger unhappiness about your doctor.

I’m glad you had a positive experience with chiropractic care and massage. I could give you a list of chiropractic horror stories that would curdle your milk, but I’ll spare you.

No need on the chiropractic horror stories. Believe me, it took a lot to drive me to a chiropractor. The one I chose was on the state board and did the exams for that state. They can and do kill people. I would never let mine manually adjust my neck. (Sure, snap my neck. I always wanted to live in my head.)

Along the lines of what you said two posts ago, about also being extremely skeptical about new Western etc., I apply the same standards to alternative practitioners that I do to conventional medicine. I do not assume they are better, nicer, more conscientious, rigorous in their thinking, well-trained, whatever.

(Aside: I am also pretty sure insurance companies do not wear rose colored glasses—just green eye shades.)

Whatever form of health care you choose, you have to be your own advocate, you cannot assume you will be taken care of and just turn over the keys and say “Fix me.”

Nikipedia… what hydra did you unleash with this question! ... what is going on here, and how did that question get so polarised ? I feel it’s gotten to the point where it’s jsut hamemr and tongs… not about dialogue any more…

Honestly though, I feel that for that debate to be meaningful we need some expert voices on alternative medicine; frankly, none of us so far haev the qualifications/expertise to talk about alternative medicine properly. We all just have anecdotes on things that either work, or don’t work; or we can cite studies from the web… but I’m sure there are studies for both sides, and without the context it’s hard to know…

As Nikipedia points out, this question was not meant to be a comparison between Western vs. alternative medicine, it was a question as to whether alternative medicine is effective. And until we have actually an expert we can question, our understanding of the subject will remain only on the surface level.

Any practitioners of alternative medicine out there?
Or even people with Western medical training who actually have studied some aspect of it and can give an informed opinion?

@Lifeflame. That depends on what you mean by “studied”. I have way too much Western medical training, and have read a fair amount about alternative medicine. In that sense, I have studied it. I feel I can give an informed opinion. Its just an opinion you probably don’t like.

Whoa! Marina, I respected the quality of your postings before, but this was outstanding. You expressed everything I think and feel on this subject in ways I never could. Reading this has only furthered my belief that the medical system in this country is hoplessly flawed.
What would happen if we could manage many of our minor health issues on our own? Well, for one, we wouldn’t be paying for a doctors visit to be told to pick up some Ibruprofen. Worse yet, to be prescribed something that we many times don’t need and is actually harmful to us in the long run. Long term effects, drug interactions, these are real and common issues. Why? because it is easy and profitable. It has become a business, pure, plain and simple. This is how the doctors visit goes at my clinic. I am made to wait in the waiting room for anywhere from fifteen minutes to an hour and a half. I am then led to an exam room where this is repeated. The doctor comes in, says hello and clocks in on the computer. I am asked a couple of questions. I am asked if I have any questions. I am sent away with a prescription, or tests to take. A few weeks later I get a bill for $190.00 (no insurance, self-employed). A basic office visit would have been only $150.00, but I had the audacity to ask a few questions which made it “an extended visit”. The last time I put myself through this, the doctor never once made eye contact with me. Shililo, I know that the billing aspect of your business is not of your choosing. You cannot tell me that it does not affect the quality of care that individual physicians are able to give. This is a minor example of my experience with mainstream health care. I would not presume to think that homeothapy could cure my cancer or fix my heart. As for practicing alternative and preventative healing methods for minor issues, yeah, I will skip all those warm fuzzies I get down at the clinic. I am off to take some Quercetan http://en.wikipedia.org/wiki/Quercetin for my allergies.

@ SoapChef. I have two things to say. One, as always, let the buyer beware. Two, when the shit hits the fan, we both know people turn to western medicine.

As you said, some aspects are going to be legitimate and most are bunk. You would have to consider each type on a case-by-case basis, there is no blanket coverage for any study of this.

To be honest, I find it mind-boggling that intelligent scientifically-minded people can write-off alternative medicine, especially medicine with centuries-long traditions in experimentation (if not scientific “experimentation”). How is this possible?

It’s no slur on western medicine to say that there may be things that work that western medicine does not currently teach or practice. Isn’t knowledgeable progress into the unknown is the purpose of scientific inquiry and discovery?

I’m appalled that science-minded people can act like western medicine is the be-all and end-all of health care.

If the efficacy of acupuncture, say, has not been proven, well then, my understanding is that it has not been disproven either. Wouldn’t an intelligent, scientific-minded person say “let’s study this!” not “what a load of s***!”?

Over the history of western medicine (and I’m sure eastern too), there have been any number of “treatments” that have fallen out of favor – either because they failed to work as expected, they had unexpected side effects, or a better approach was found. This is good. This is progress. This is why western medicine is able to accomplish such (seemingly) miraculous life-saving feats.

How could we assume that the present state of medicine is all there is?

No, I can’t afford to spend money on $12 bottles of red bean extract. I’ll just eat the 69 cents worth of red beans.

“Complementary” and “alternative” are silly words people place in front of real words to give their pseudo-scientific ideas a semblance of legitimacy. Either it is scientific, (it can be tested and shown clinically to have an effect on the human body) or it is not.

Perhaps some treatments just lack the proper studies to prove their worth. By all means! Let us study so-called “complementary and alternative medicine”, find out which ones work, and add them to the register of medicines that work.

Until that point, the fact that their health claims are unverified and not controlled by the FDA, and their lack of empirical support, added to the failures of homeopathy, acupuncture, chiropractic and others under test conditions, I’m not exactly keen to throw down my money for it.