Respectful Insolence

Panda Bear MD has posted the second part of his series about the irrationality behind much of “alternative” (a.k.a. non-evidence-based) medicine. He makes an excellent point:

At no time however, will your physicians ever promise a magic cure, a therapy that will definitively fix the problem with no ill effects leaving alone the precarious balance of your fantastically complicated body. At best they will promise good results with minimal and easily tolerated side effects. At worst the therapies they will reluctantly propose are almost as bad as the disease they will ameliorate and the subject of, for example, chemotherapy or a risky aortic repair is broached with dread to a patient who must be made to understand that real medicine is not as it appears in the popular media.

At a philosophical level, leaving aside the utter ridiculousness of Reiki healers shooting sacred energy from their fingers, this is the difference between real medicine and Complementary and Alternative Medicine whose practitioners, as they don’t treat real pathology, have never developed humility in the face of disease. It is easy, for example, for your acupuncturist to promise a perfect cure because they’re not really treating anything, just some nebulous mumbo-jumbo like a dysfunction of your ability to receive pure qi from the heavens.

I’ve often pointed out that it’s the practitioners of alternative medicine who are the real arrogant ones, thinking as they do that they should not be bound by the same standards of evidence as “conventional” doctors because they “know” their woo works. I may have to expand on that and Panda Bear’s point later this week.

Comments

  1. #1 Mike P
    November 7, 2007

    House laid the smack down on an alternative therapy for polio in this week’s episode. Good stuff.

  2. #2 Clare
    November 7, 2007

    .. but House also dished up some Chinese herbal tea to the CIA guy without too much complaint….

  3. #3 gimpy
    November 7, 2007

    I’ve often pointed out that it’s the practitioners of alternative medicine who are the real arrogant ones, thinking as they do that they should not be bound by the same standards of evidence as “conventional” doctors because they “know” their woo works.

    You want to see scary? I reproduced a homeopaths case notes on an alleged cured case of autism the other week (apologies for pimping my blog), here.
    They also export their arrogant idiocy to the developing world as well. Here in the UK, the Society of Homeopaths are celebrating world AIDS day by organising a conference on the value of homeopathy in treating (and even curing AIDS). Worst thing is is that they genuinely believe they make a positive difference.

  4. #4 Rjaye
    November 7, 2007

    Ah, but House was at least using science to try and come up with something that might help, and based his suggestion for the herbal tea on a study that showed the herb helped monkeys (or some other critter-I was on line when House was on). AND he didn’t promise it would work. Just that it was worth a try.

    This is a great post, Orac (and Panda Bear MD). At no time did my physicians claim anything miraculous regarding my ra, and warned me the side effects of the meds could be awful. I am only hoping that I don’t have to be on the steroids, etc., permanently. But I can walk again. For real.

    But one never hears of the side effects of herbals and teas and other treatments. They exist, but they are either played down because somehow the treatment is more natural (it is–eating something we don’t normally ingest is more natural?), or it’s a full blown scam. Oh, and if some herb is of some benefit, the positive effect is always way overstated.

    Or the negative is way, WAY understated. Wasn’t it a diet tea that people were dropping dead from in the nineties? A supposed all natural tea?

    And why are supposed natural remedies so expensive? Oh, wait…that’s part of the scam part…

  5. #5 Schwartz
    November 7, 2007

    Alas, you will find allopathic Doctors with the same attitude. Look hard at any profession and you’ll find quacks, and arrogant fools acting like gods.

    I have met more than my share of foolish and arrogant doctors, and alternative medicine practitioners. Alternative medicine hardly corners the market.

    I think the big difference is that the non-regulated practises can advertise anything without fear of reprisal. In places where acupuncture or chiropractors are regulated by professional organizations, you will find that their advertising (if any) and behaviour is much more similar to regular doctors.

  6. #6 Alan McCrindle
    November 8, 2007

    Let me start by agreeing with you that there is a lot of mumbo-jumbo out there in the name of alternative medicine and a lot of arrogance that has its basis in ignorance.

    Having said that there are practitioners out there who understand their limitations and work within those boundaries and include western medicine while recognising its biases and limitations.

    There is a big difference between having a health focus and a sickness focus. Primary arrogance occurs when we forget that the human is a self regulating complex adaptive system. This system keeps itself healthy without any assistance from any part of the medical professional – main stream or alternative – most of the time.

    Even when someone gets “sick” – and I am generalising – the system will be able to fix itself without any external medical intervention. For example it is estimated that a general practitioner will have to treat 9 people with a drug to get a single benefit that wouldn’t have been achieved by doing nothing. To me that seems wasteful and potentially dangerous.

    A question I put to you is this – do we as practitioners cure patients or does the patient’s system cure itself? Is it possible that we sometimes suppress symptoms with our treatments without removing the causative factors and this leads to further complications down the tract where the symptom expresses itself somewhere else? – take vioxx as an example.

    A lot of alternative medicine fails randomised double blind trails. Why? Could it be that the short term reductive scientific thinking that underpins the logic is at fault? Let me give you an example and you can judge for yourself. Take arthritis as an example (yes I know that there is more than one type but I am trying to keep it simple). Arthritis is a name given to describe the symptoms of an endpoint of a process that started from a position of health. It is a inflammatory disease. My question is what is the process that has driven the inflammation? Is there more than one possible route? My suggestion is there are multiple routes – it could be that it started with an infection. But then again it could be coming from mental or emotional stress or a physical stressor such a pain. Lets not discount obesity and fats cells as a possible trigger or disbiosis (inflammation of the GI tract). What I am trying to say is that we are dealing with processes that have multiple causes rather than single endpoint symptoms that can be reduced to a name that is sacrosanct and forms the basis for treatment evaluation.

    I think I will leave it here. I am not looking for a fight. I am only looking for the best solutions. Dividing the world up into conventional and alternative is based on short term history and is ultimately limiting and unhelpful. I hope I didn’t come across a condescending or dismissive. If you find my analysis deluded or limiting please let me know – it is only an idea – I am not fixated on defending it

  7. #7 Marcus Ranum
    November 8, 2007

    A perfect example, to me, is asprin. It’s as close to a “fix everything” drug as real medicine has found. But if you take too much or if you take it constantly, it’ll do nasty things like dissolve holes in your stomach or thin your blood too much. Homeopathic “cures” – well, you can take as much of them as you like, and as long as you like, and there are never any unpleasant side-effects. Well, that’s because they don’t actually DO anything.

    Was it Randi that began a talk about homeopathy by chugging an entire bottle (300 times the recommended dose, or something like that) of homeopathic sleep aid? I always use that as an example when I’m talking with homeopathic woo-heads: “I’ll drink a whole bottle of homeopathic sleep aid if you’ll eat a whole bottle of ambien. Then we can talk about what ‘works’ means.”