White Coat Underground

Alternative medicine is very profitable. Herbs and supplements are a multi-billion dollar industry. The practice of primary care medicine is not terribly lucrative, and adding on some “integrative medicine” can turn that around. A primary care doc can significantly increase their income by selling supplements and offering unproven tests and treatments. These are not covered by insurance, so patients must pay cash—and who doesn’t love cash? But how can you get your pigeons to fly in the door?

The folks out there selling miracle cures and spreading the ideology to support them have some serious reach. Regardless of whether one is a “true believer” or simply a cynical leech out to make a buck, it’s easy to spread the word and bring in the suckers. Supplement companies fund tons of advertising, the government allows all sorts of unproven claims to be made, and certain media outlets (such as the Huffington Post) vigorously spread the good word.

There are many myths that help spread the gospel of alternative medicine. Most of them are negative statements about real medicine rather than affirmative evidence for an alternative. It sometimes seems the fight against quackery is never-ending. It’s been a while since we’ve reviewed some of the tactics of the opposition, so let’s go over a few.

The Turf Battle Fallacy

A common accusation is that real doctors are simply protecting their best interests. If we don’t criticize alternative medicine, we’ll lose business to those enlightened enough to embrace the future.

There are several reasons that this argument is a bucket of guano. First, primary care physicians aren’t hurting for business. We might not always get paid as much as we think we should, but we can only see so many patients in a day, and with the current shortage of PCPs, many offices have waiting lists.

Second, this argument assumes that most doctors are primarily motivated by profit. We all need to make a living, but most doctors who choose to practice primary care are aware of the fact that our incomes are more limited than our specialist colleagues and people in some other professions. And while the barrel may contain a couple of bad apples, most doctors prefer to practice ethically and altruistically. One study from the Journal of the American Medical Association found that:

Rather than declining income, threats to physicians’ autonomy, to their ability to manage their day-to-day patient interactions and their time, and to their ability to provide high-quality care are most strongly associated with changes in satisfaction.

Most doctors are in this profession for the right reasons, and when we rail against quacks, we do it to protect our patients, not ourselves.

The Pharma Shill Gambit

Orac coined this term several years ago, and it’s probably the silliest idea that quacks have come up with—and one of the most effective. This lie works because it contains some truth. There have always been unscrupulous doctors shilling for industry, but most of us think we are uninfluenced by, say, a free lunch. Our own literature has shown repeatedly that doctors’ prescribing habits are influenced by seemingly innocent interactions with drug company representatives, even when we think we are not being influenced. This insidious level of influence is very different from the accusations thrown around by many altmed advocates who accuse us of purposefully mistreating our patients to benefit industry.

Still, we must strive to eliminate even unconscious influence, and that’s exactly what we’re doing. Two years ago, the Association of American Medical Colleges called for the elimination of pharmaceutical gifts at medical schools and teaching hospitals, including free lunches and support for continuing medical education (CME). CME is particularly problematic because it is a requirement for all physicians who wish to maintain their licenses, but it isn’t cheap. The data show that the pharmaceutical industry understands how to influence us. And we increasingly understand how we are affected and are working to limit this. In addition to the AAMCs efforts to protect trainees, our own organizations and publications are calling for stricter and stricter limitations on our interactions with PhARMA.

Industry influence on doctors is rarely a quid pro quo phenomenon. It is a subtle influence which we are working hard to purge. To argue that doctors, for example, prescribe vaccines because we are in the thrall of Big PhARMA and need the money is simply false. We have been influenced by, but have rarely profited in a direct, monetary way from industry influence, and this is changing for the better.

Medicine, and the world in general, is a bit more complicated than the quasi-religious altmed crowd would have us believe, and doctors much less sinister.

Comments

#1 David N. Brown
May 6, 2010

I’ve been saying for a long time that even scientists who commit fraud don’t seem to have monetary gain as their sole or primary motive. “Piltdown Man”, for example, could easily have cost Charles Dawson more in materials and labor than he ever gained from it.
#2 Nathan Myers
May 6, 2010

You seem to be saying that the accusations are all partly true, only not quite as true as they say they are. It is commendably scrupulous to admit this. However, it means that the difference between their position and yours is a matter of opinion.

It’s hazardous to your position to bring up the question of money. Yes, plenty is spent on quackery, but orders of magnitude more is spent on mainstream medicine. Much of that seems to be swallowed up by pharmaceuticalists and various insurance scams, but physicians of all stripes — even family practitioners — seem way better off than your typical strip-mall quack.

Yes, the quacks are inordinately proud of their apparent successes and dismissive of their failures, but let us not neglect to note tens of thousands of mainstream iatrogenic deaths every year, nor the failed diagnoses and spurious treatments that were not quite fatal. (I can reel off examples of the latter just from within my family for longer than you would care to listen.)

My impression is that physicians’ pique at quacks is as much a matter of guild solidarity as of care for patients. This, too, is a matter of opinion, but it’s supported by the circumstantial evidence of your attitudes toward diet and other influences on health that do not require a visit and a prescription to act upon, and bolstered by physicians’ overwhelming reluctance to act, or even speak up, against murderously incompetent guild members.

Do more unnecessary deaths result from licensed or unlicensed quackery? On even days I think the one, on odd days the other. But it seems clear which one gets more attention, and which deserves more than it gets.
#3 Chance Gearheart, NREMT-P/EMD
May 6, 2010

PalMD: How does CME translate into CEU, expecially with the different catagories you have, and how much of it do you have to have to renew your medical license?
#4 Ryan
May 6, 2010

Since you brought up PhARMA’s influence on physicians, are you aware that the AMA collects a large percentage of its annual operating budget by selling a list linking physician’s names to their DEA license ID number? This is how drug reps can get weekly feedback on how their tactics influence doc’s drug prescribing patterns. As far as I know, this is something that the AMA doesn’t like to have attention drawn towards. Perhaps this is something you would look into for a post?
#5 PalMD
May 6, 2010

It is very simple to get off of that list, as i did several years ago.
#6 MS3
May 6, 2010

“bolstered by physicians’ overwhelming reluctance to act, or even speak up, against murderously incompetent guild members.”

I am not sure where you are getting your information, but currently in medical school we getting confrontation and conflict resolution all the time. I went through a solid forty hour week of nothing but this at the beginning of third year and it was deficient in the earlier two. Yeah it is tough to have a sea change from the old “one doc to rule them all” model to the new “we are a team” system where janitors are trained to get a physician if a patient looks bad or even the monitors seem wrong. This is happening within the field big time, maybe not as fast as you would like, but you can’t deny current trends.

There is also a world of a difference between trying something evidence based then making a mistake which results in a poor outcome when compared to trying something not even scientifically plausible then making a mistake that results in a bad outcome. You’re right a wrong diagnosis may lead to effectively scamming a patient on treatments that are unnecessary however that is always the starting point that alt-med practitioners begin at.
#7 MS3
May 7, 2010

Wow that was awful. For the record I meant “we get confrontation” and also that “it wasn’t deficient”. Sorry about that, obviously time for bed…
#8 Dianne
May 7, 2010

If I’m in it for the money how come I’m (in some cases literally) more than a year behind in my billing?

And this is a lazy question but how do you get off the AMA’s list?
#9 Ryan
May 7, 2010

I was told that you must register to get off that list each year, and that it takes several months to process each time you try, is this not correct?
#10 James Sweet
May 7, 2010

I have a physician several years ago whom I expect was influenced to prescribe a certain drug because the company gave her office magnets and pens. Seriously.

I’m not criticizing her, just agreeing with you about how subtle this influence can be.
#11 James Sweet
May 7, 2010

You seem to be saying that the accusations are all partly true, only not quite as true as they say they are. It is commendably scrupulous to admit this. However, it means that the difference between their position and yours is a matter of opinion.

Um…. really? So all matters of degrees are automatically matters of opinion?
#12 rob
May 7, 2010

@James Sweet: my thoughts exactly. it is not a matter of opinion. it is a matter of degree.
#13 The Gregarious Misanthrope
May 7, 2010

@Nathan Myers

Here’s some simple logic for you. Alternative medicine succeeds at the level of placebo effect plus spontaneous remission for ALL conditions. Real medicine succeeds at that level at a minimum and in most cases, much, much higher. If you’re sick, which odds do you choose?

Yes, there are preventable deaths in medical care and steps are taken to reduce them. There are also preventable deaths in air travel (pilot error is still a big contributor to crashes), do you still fly? When you are treating real disease with real medicine, mistakes can be deadly (just like in airplanes). The reason few deaths are associated with alt med is that if you get the wrong dosage of homeopathy, you end up damp, not dead. Crystals only hurt if hurled at your head. Short of getting poked in the eye, acupuncture probably won’t hurt you either (unless it deflates your shakra, or something).

People in the “alt med can’t hurt” crowd discount that sometimes such bunkum is turned to after conventional treatments have failed. It may not hurt the patient physically, but it can drain additional resources (and conventional medical bills can eat you up even with insurance), eat up precious time (which is pretty limited with a terminal illness), and provide false hope rather than allow a person to come to terms with their mortality and make the most of what time is left. It picks your pockets of what little you have left in life.
#14 Dangerous Bacon
May 8, 2010

Nathan Myers: “My impression is that physicians’ pique at quacks is as much a matter of guild solidarity as of care for patients. This, too, is a matter of opinion, but it’s supported by the circumstantial evidence of your attitudes toward diet and other influences on health that do not require a visit and a prescription to act upon”

This is a classic fallacy promulgated by alt med promoters, who’d like you to believe that they invented concerns about diet and “other influences on health”, while nasty old physicians just want to prescribe drugs.

The fact is that M.D.s constantly emphasize the importance of diet, exercise and avoiding hazards like smoking, excess alcohol etc. The dietary advice provided by alt med is frequently dead wrong and requires people to chug down lots of supplements (i.e. drugs) that have no proven health value and are harmful in excess, which users may not know they’re getting given poor regulation of supplements (example – alt med guru Gary Null’s severe illness caused by a whopping overdose of vitamin D in his own supplement product).

It’s true that M.D.s often have to manage chronic illnesses with drugs because their patients have such a tough time following advice on diet, exercise and bad habits. The difference between them and quacks is that the drugs used by M.D.s overwhelmingly are effective.
#15 Dianne
May 8, 2010

It’s true that M.D.s often have to manage chronic illnesses with drugs because their patients have such a tough time following advice on diet, exercise and bad habits.

And because some things can’t be managed optimally by diet, exercise and avoidance of bad habits alone. Consider hyperlipidemia (high cholesterol/fat.) Sounds like the ideal diet/exercise manageable condition. Except that it’s not: put people on a low fat diet and some will have decreases in their cholesterol, others won’t. A few unfortunate people will see their cholesterol increase. Furthermore, people using statin drugs have a greater decrease in their cardiac risk than people controlling their cholesterol with diet alone even when each reaches the same goal cholesterol.

The human body is a big ugly evolutionary kluge that doesn’t work all that well. Optimal life habits can prevent some problems. Medical or surgical treatment can help prevent or treat others. Some are beyond the reach of anything but luck at the current level of technology. MDs use drugs because they acknowledge that they help. And acknowledge the limits of drugs-and diet, exercise, and other health habits.
#16 hansragnar
May 9, 2010

Try looking from a patient’s viewpoint. When s/he seeks a doctor the first gatekeeper in front of the doctor asks for money and if the patient can’t cough up, that’s as far as they can get no matter how sick they are. So why wouldn’t the patient think it’s all about the money ?
#17 Molly, NYC
May 10, 2010

This, too, is a matter of opinion, but it’s supported by the circumstantial evidence of your attitudes toward diet and other influences on health that do not require a visit and a prescription to act upon . . .

Huh? I’m sorry to pile on, but I can’t remember the last time I saw a PCP who didn’t make rather pointed inquiries along these lines. The doc I see now–as establishment a clinician as you’d ever hope to see–sends patients home with hand-outs on diet, on exercise, on smoking cessation (the last accompanied by a lecture) etc.

Not only that, but if you went to a public place, blindfolded yourself, took out a peashooter and asked the first person you beaned for health advice, that person would also probably tell you (before having you arrested) to watch your diet, get some exercise and lay off the smokes. So it’s a bit rich that “natural practitioners” are so self-congratulatory about these mysterious little pearls of their practice.

And how do we know this diet/exercise/stop smoking/eat your vegetables stuff works? Because these things have all been verified by freaking tons of research done by MDs and their allopathic minions, and published in JAMA and Lancet and Circulation and like that.

Did naturopaths do any research about these things?

Ha!

And if you want a further laugh, browse through an Elsevier journal, Homeopathy. It’s the apex of intellectual rigor in alt-med; you’ll find research as carefully planned executed and interpreted in other CAM journals, but none to surpass it.

Needless to say, studies of this quality would barely rate a form-letter rejection if they were submitted anywhere else.
#18 Nathan Myers
May 10, 2010

Gregarious: It is extraordinarily deleterious to your position to mention air travel in this context, considering the abyss between aviation’s and medicine’s responses to unnecessary mortality. Atul Gawande writes eloquently about that abyss, most lately in “The Checklist Manifesto”.

In fact alternative medicine often does way better than placebo, and sometimes way better than conventional medicine. The places where it does that are overwhelmingly in places where the only effective treatment is neither patentable nor schedulable. Where there’s enough money to be made, a patentable variation may arise eventually that might (but need not) be more effective, but is reliably more expensive. Where there isn’t, usually no treatment becomes recognized. That’s just economics.

MS3: It is good news that efforts at improvement are going on in medical schools. I hope you will forgive me for taking this as further evidence that (a) there is a problem, and (b) people who recognize it have not yet succeeded in addressing it effectively outside medical school grounds. Yes, the first derivative is positive, but small. The second derivative is probably also positive, but that’s no reason for complacency.

Dangerous, Molly: In mentioning diet, I was referring to Pal’s own admission that he does not normally bring up diet with his diabetes patients. Whatever your opinion about how other physicians behave, in this we’re talking about Pal.

Molly: Homeopaths adhere better than any other health care practitioner to primum non nocere. Their failing is that they cannot get to secundus, succurere. If they had scruples they would not charge for their inaction. That physicians inclined naturopathically cannot find funding for research that could lead to Lancet publications is, as noted above, a matter of economics and politics, not of science. Patentability is a miserably poor proxy for effectiveness, but that’s how our society is organized.

It should be possible to note economic and structural impediments to improvements in medical care without being labeled a quack or a commie.
#19 PalMD
May 10, 2010

Dangerous, Molly: In mentioning diet, I was referring to Pal’s own admission that he does not normally bring up diet with his diabetes patients. Whatever your opinion about how other physicians behave, in this we’re talking about Pal.

You gotta be fucking kidding me. Right?
#20 Nathan Myers
May 10, 2010

Pal: I may have inferred wrongly from what you wrote earlier.

Dietary adjustments that effectively treat illnesses are rarely mentioned by physicians, in my experience, and are routinely downplayed. If your experience differs, I’m interested to hear about it. Do you ask H. simplex patients about their diet?
#21 LadyDay
May 10, 2010

So, I agree with you that some “alternative” medicine supplements are bogus.

But.

Should I mention that aspirin is essentially a derivative of the active ingredient in willow bark extract, and this “alternative medicine” was in use for thousands of years prior to the invention of aspirin?

Another example of an “alternative” medicine could be fish oil, which is now pretty well characterized to have potent anti-inflammatory effects in diet studies in obese mouse models, culminating in decreased insulin resistance.

Or perhaps I should mention that pharmaceutical companies are currently patenting traditional medicines of indigenous peoples the world over, so that they can start assaying for active ingredients, which they will then purify, make in large scale, and then sell to consumers in wealthier countries?

Traditional “alternative” medicine is what was practiced for thousands of years before drug companies came along. Some of these “medicines” really had potent effects on people, and that is why so much effort has gone into the discovery of the active ingredients in them.
#22 PalMD
May 10, 2010

As long as you’re moving those goalposts, Nathan, would you care to cite some data as to how diet is relevant to the diagnosis, treatment, or prevention of HSV?
#23 Nathan Myers
May 11, 2010

Should I take that as a “no”?
#24 PalMD
May 11, 2010

I also don’t ask people with eczema what their favorite color is.
#25 LadyDay
May 11, 2010

Just a clarification of an earlier comment. It’s been a while since I reviewed the literature on fish oil effects. Perhaps that phrase should read “… culminating in decreased risk of metabolic syndrome risk factors.”

While I was writing the above, three other examples of effective “alternative” medicines/treatments came to my mind (though they may not all be “traditional” medicines for a particular culture):
1.) quinine: a drug that was a traditional medicine in South America well before it was used in the West; originally extracted from cinchona bark.

2.) resveratrol: one of the biologically active components of red wine that is currently under investigation for possible positive effects on health.

3.) probiotics: currently being investigated for IBD therapy, among other things.

In fact, looked at another way, perhaps the original method of small pox inoculation could be considered a “traditional” medicine that was effective.
#26 PalMD
May 11, 2010

This is an issue of definitions. In general, once a treatment is validated scientifically, it is no longer considered “alternative”. A huge number of our pharmaceuticals have their origins in natural products (See http://scienceblogs.com/terrasig).

They are only alternative when they either have no supporting evidence, or are promoted despite that lack of evidence.
#27 LadyDay
May 11, 2010

Oh, wait! While I’m at it, let’s take a moment to reflect on “medicine” as practiced by physicians in the past. Was blood letting really effective for everything for which it was prescribed? But, it was a standard therapy back in the day. Lobotomy, anyone? Oh, and there’s always ye goode olde standard(e) mercury therapy!

And, these days, we read studies on adverse effects of marketed drugs on patients – so there’s a modern equivalent of failed medical treatments, too.

Anyway, I’m sorry if I’m repeating points made elsewhere on this blog (I haven’t had time to read all of the critiques of alternative medicine yet), but sometimes alternative medicine turns out to be at the root of profound advances in science.

Just sayin’.
#28 LadyDay
May 11, 2010

Sorry – just saw your response. Yes, you’re right about definitions, I suppose. I see most alternative medicine as being anything that doesn’t get prescribed to me or come from a drug company.

Anyway, I hope you don’t mind the sarcasm. It’s one of my modus operandi, and it’s such a habit now that I can’t do much about it.
#29 PalMD
May 11, 2010

That is a bit of a cognitive error. The argument that “medicine was wrong before” is not an affirmative argument that “alternative medicine is right”.

Science as a basis for medicine is a (relatively) new concept, and our understanding of physiology, biology, and biochemistry is very different than it was 200 years ago.
#30 LadyDay
May 11, 2010

The argument that “medicine was wrong before” is not an affirmative argument that “alternative medicine is right”.

I agree. However, I was merely aiming to show that some practices in institutionalized medicine were not effective.
#31 PalMD
May 11, 2010

That is pretty much a given. The scientific approach to medicine pretty much assumes something is useless until proven otherwise.

I guess i’m trying to parse out what your actual point is. As stated, it sounds like simple concern-trolling. Is there an actual point about medicine or altmed?
#32 rob
May 11, 2010

i would like to see some data on what fraction of “alternative” medicines that were used for thousands of years before drug companies came along actually make it succesfully to science based medicine.

i suspect in addition to willow bark extract, there was oak bark extract, pine bark extract, the larch bark extract, eye of newt extract etc etc etc. just wild ass guessing i would say there is a ratio of a thousand to 1 of unsuccessful alternative medicines to sucessful ones–not very impressive.

also like to point out that you no longer go to the pharmacy to purchase willow bark extract. science based medicine noted that there seemed to be some active ingredient in willow bark, then meticulously synthesized it and create aspirin. now you go buy aspirin and not bark. science has improved on the folk remedy–so even if “alternative” medicine was right, science based medicine still went and improved on it.
#33 Vicki
May 11, 2010

LadyDay:

There’s also the question of what counts as “prescribed.” If your doctor says “take 81 milligrams of aspirin once a day,” and you get that off the shelf without needing to show a prescription or talk to the pharmacist, does that count? What if your brother says “after my heart attack, I started doing this, and genetics is a risk factor, why don’t you try it?” and you do the same thing. How about the physical therapy that was recommended by an orthopedist, and signed off on by my GP (insurance rules being like that)? Do the continuing stretches and exercise count, given that I haven’t been into the PT’s office in a few years?
#34 LadyDay
May 11, 2010

@ PalMD: How am I “trolling”? I’m simply responding to these comments you made:

The folks out there selling miracle cures and spreading the ideology to support them have some serious reach. Regardless of whether one is a “true believer” or simply a cynical leech out to make a buck, it’s easy to spread the word and bring in the suckers. Supplement companies fund tons of advertising, the government allows all sorts of unproven claims to be made, and certain media outlets (such as the Huffington Post) vigorously spread the good word.

There are many myths that help spread the gospel of alternative medicine. Most of them are negative statements about real medicine rather than affirmative evidence for an alternative. It sometimes seems the fight against quackery is never-ending.

by saying that “alternative” medicine isn’t always quackery. I know serious MDs at world class medical schools who are involved in studies that test out some of these “alternative” medicines: probiotics, red wine extract (resveratrol), liquorice extract (glycyrrhizin), seaweed extract (fucoidan). In fact, there’s a regular academic journal club I attend in which studies involving these very “alternative” medicines that are being tested on animals, in cell cultures, and in clinical trials are discussed. Moreover, I personally also know world class researchers in metabolic research who are into yoga for the health benefits, eat only organic food, and incorporate lifestyle choices into their days that other people would consider “alternative” therapies. Just because you call it quackery doesn’t mean that that’s the general consensus in the scientific community.

Another point I was making: the evolution of drugs from “traditional” medicines. It happens. Scientists must have believed in some of these therapies, or we wouldn’t be studying them today. There are probably many drugs “out there” that have yet to be “discovered” that would first be considered “alternative” medicine simply because they come from a traditional practice somewhere outside of the mainstream culture.

@ rob: I never said that every “alternative” therapy that ever existed is going to give us a cure for a disease, now did I. You missed the point I was making, completely.

@ Vicki: well, physical therapy is a different issue. Stretches and exercise should be a normal part of everyone’s day, not just a “therapy,” if you ask me. But, I suppose everyone has their own definition of “alternative” medicine.
#35 Vicki
May 11, 2010

Yes, stretches and exercise are generally good. But the specific stretches and exercises that a person chooses, or is encouraged to do, will differ. I’m doing things specifically for my rotator cuff; someone who has never had shoulder problems won’t be doing those, but can do things at the gym that I shouldn’t (such as pull-ups). Saying “exercise should be part of everyone’s day” is like saying “food should be part of everyone’s day.”
#36 Dianne
May 11, 2010

Was blood letting really effective for everything for which it was prescribed?

A more relevant question is is blood letting effective for everything for which it is currently prescribed. The answer is, yes, with some limitations. (Yep, we still use blood letting for two specific diseases: P vera and hemochromatosis. It is helpful, but by no means a cure-all in both conditions.) Blood letting was abandoned for other conditions when it was clear that it wasn’t helping and was often harming people. What CAM treatments have been evaluated and abandoned because of lack of efficacy or excessive risk? How is this change communicated between various practitioners?
#37 Dianne
May 11, 2010

Homeopaths adhere better than any other health care practitioner to primum non nocere.

Not even.

That physicians inclined naturopathically cannot find funding for research that could lead to Lancet publications is, as noted above, a matter of economics and politics, not of science.

Huh? Ever heard of NCAAM? It’s a very well funded and undersubscribed branch of the NIH. Here’s their grants page. The problem is that the trials that come out of NCAAM, especially the large, well designed ones, keep being negative. Must be some sort of conspiracy.
#38 LadyDay
May 11, 2010

@ Vicki: I suppose I should have just said that I’ve never thought of physical therapy as “alternative” medicine at all. Again, a difference in definition? Yes, what you are doing to help out your rotator cuff may not have been recommended by a physician very recently, but at one point it was.

Anyway, I have a pretty loose definition of “medicine,” in general.

And, you’d be surprised at how many people really don’t think that exercise should be a normal part of their daily lives. I call it couch potato syndrome.
#39 Nathan Myers
May 11, 2010

rob: You miss the point. Some fraction of successful medicines were adopted into the pharmacopeia. Those that have not been (“yet”) still work. It’s become increasingly difficult and expensive to adopt any. Those that cannot be patented can’t generate the revenue needed to pay for the research and trials that would need to be done before adopting them, so they aren’t submitted. Sometimes a minor chemical variation works, and can be patented, which may end up approved under a new name, but the original continues to work as well.

A treatment that could save only a hundred lives a year has practically no chance of ever being submitted to the FDA, patentable or not. A treatment that could save ten thousand lives a year but could not be patented would be of little interest to any company. One may be patented but not submitted because it actually cures a condition, and many companies only develop treatments for chronic conditions. Sure, there’s some science involved in “science-based medicine”, but only after the decisions have already been made. Everything that works but hasn’t had $100M invested in running it past the FDA retains the “alternative” label, and Pal’s very evident contempt.
#40 Dianne
May 11, 2010

Those that have not been (“yet”) still work

Do give some examples. What natural remedies that work have not been adopted? How do you know they work? Why haven’t they been adopted?

A treatment that could save ten thousand lives a year but could not be patented would be of little interest to any company.

Even allowing the premise, what makes you think that “natural” remedies can’t be patented? The very fact that a number of drugs derived from plants are included in standard medicine is a good indication that this is not true. Consider the taxanes, vincristine, even arsenic-all derived from natural products and all patented.

One may be patented but not submitted because it actually cures a condition, and many companies only develop treatments for chronic conditions.

Again, got any examples? What medications haven’t been developed because they are cures rather than treatments for chronic conditions? And how do you explain the counter-examples: Curative treatment for bacterial, fungal, and parasitic infections (less often, but occasionally, even for viruses) , some cancers, even a few rare forms of “chronic illnesses” such as secondary hypertension. The bumbling big pharma scientists accidentally came up with a cure when they were supposed to be finding a prolonging treatment?

Everything that works but hasn’t had $100M invested in running it past the FDA retains the “alternative” label, and Pal’s very evident contempt.

Big naturopathy has $100 million and more to invest. But they also have the DHSEA which allows them to produce and market their product without all that tedious safety and efficacy testing. Why should they spend their millions on testing that might only prove their supplement worthless when they can make billions suckering people into buying it on faith?
#41 LadyDay
May 11, 2010

@ Dianne: I don’t know the answers to your questions (earlier). I’m not a CAM expert – but that doesn’t mean I automatically discredit everything about alternative medicine.
#42 Dianne
May 11, 2010

I’m not a CAM expert – but that doesn’t mean I automatically discredit everything about alternative medicine.

Alternative medicine that is proven effective tends to become non-alternative medicine. Take, as an example, arsenic trioxide as a treatment for acute promyelocytic leukemia. It was initially derived from a traditional chinese medicine which was claimed to be effective for all cancers. Testing showed it likely to be effective in APL but not much else. Early clinical trials showed efficacy but also a lot of toxicity. The original TCM was broken down into its components (mercury, arsenic, and, IIRC, a snake venom). It was found that the arsenic provided most of the effect and the mercury most of the toxicity. So the arsenic was isolated as the active ingredient and became the “mainstream” treatment. I see no particular reason to believe that other naturopathic medications wouldn’t also be taken into the mainstream in similar ways.

OTOH, I could easily believe that there are traditional medicines out there with efficacy that haven’t been tested yet and therefore haven’t been included into standard medical care yet. IMHO, that’s what the NCAAM is for: to test alternative medicine claims and bring attention to those that show promise. But just taking an alternative medication because it MIGHT work? No thanks.
#43 Nathan Myers
May 11, 2010

Dianne: You seem to have answered some of your own questions. Complaints about companies only interested in chronic treatment regimes come from the “bumbling big pharma scientists”. Why would a company invest $100M in submitting a treatment that they can calculate won’t make a profit? But does that economic calculation make the treatment any less effective?

I don’t know anything about “big naturopathy”. I’m interested in individual treatments that work. I can’t buy zinc gluconate gel, except under a “homeopathic” label that makes me shiver with revulsion. Why not? It’s not because it hasn’t passed double-blind trials.
#44 Dave Ruddell
May 11, 2010

Those that cannot be patented can’t generate the revenue needed to pay for the research and trials that would need to be done before adopting them, so they aren’t submitted.

That is patent nonsense. The patent on ASA expired many years ago, yet Bayer still sells lots of the stuff. Same thing goes for Tylenol, Advil, etc…
#45 Nathan Myers
May 11, 2010

Dave Ruddell: Aspirin, paracetamol, and ibuprofen are already approved, and require no substantial investment to begin selling. Did you read the text you quoted?

Dianne: One other thing… “But just taking an alternative medication because it MIGHT work? No thanks.”

For reasonable people, it makes a big difference whether the proposed treatment is safe. If it’s safe, and it might work, why not try it? Physicians are expensive and often have nothing appealing, or nothing, to offer anyway. (What would you suggest for bleeding sinuses? What for tiny blisters on the back of the neck and hands?)

Methylphenidate is prescribed for ADD without suggesting dropping caffeine first. Eliminating or reducing caffeine might not work, but so what? It’s safe and easy. If rinsing your mouth with oil might clear up gum inflammation, what’s wrong with trying it to see? If it works, it works; if it doesn’t, try something else. Anything else amounts to fetishism.
#46 Dianne
May 11, 2010

Complaints about companies only interested in chronic treatment regimes come from the “bumbling big pharma scientists”.

Quotes? References? Evidence of any sort?

Why would a company invest $100M in submitting a treatment that they can calculate won’t make a profit? But does that economic calculation make the treatment any less effective?

You have the oddest idea of what makes a profit for a drug company. Suppose company A makes a drug for disease X. This drug manages the disease but doesn’t cure it. But, it turns out that disease X is easily curable if you follow a couple of widely known clues. Company B follows those clues and makes the drug that cures X. Who makes the money? If you say A you’re very, very confused. And, unless it’s one of those evil vaccines and the disease is wiped out like small pox, company B will continue to make money as new people develop X. And it gets an undeserved rep as a miracle working company. Perhaps there are companies that reason as you believe-I have no reason to think drug companies any more sensible than any other company-but they lose money to the companies that do it right.
#47 Nathan Myers
May 11, 2010

Dianne: Suppose your company A has already patented the drug that B would have sold, but has elected not to submit it for approval. Does B have any recourse? Does anybody? What would prevent a company from so electing, as mandated by their charter to place their shareholders’ interests ahead of others’?
#48 Dianne
May 11, 2010

Does B have any recourse?

Yeah. Add an acetyl group and rename it. You can patent a particular drug but not an entire class of drugs.
#49 Nathan Myers
May 11, 2010

Why then would any profitable patented medicine lack an acetylated competitor? How many such competitors have you ever seen?

I’m mystified by your insistence that drug companies act against their own shareholders’ interests by driving drugs through approval that cannot generate as much revenue as it costs to do so. Or are you saying every drug that could be approved can also generate enough revenue to pay for it?
#50 Dave Ruddell
May 12, 2010

Aspirin, paracetamol, and ibuprofen are already approved, and require no substantial investment to begin selling. Did you read the text you quoted?

Why, yes I did. The point is, the generic (that is, unpatentable) drug market is worth billions still. Even if you have to front the money for approvals, there’s still profit to be made.
#51 Dianne
May 12, 2010

Why then would any profitable patented medicine lack an acetylated competitor? How many such competitors have you ever seen?

You’re kidding me, right? You really don’t realize that most drugs are not unique entities but members of classes of similar drugs with similar effects. Let me give you a few examples: The statin drugs, ACE inhibitors, tyrosine kinase inhibitors, proton pump inhibitors…I could go on. Didn’t the fact that a lot of drugs have similar names (ie lovastatin, atorvostatin, pravastatin, etcstatin) tip you off that they were similar?
#52 LadyDay
May 12, 2010

Dianne’s right about slight modifications made to drugs to extend patents (which keep the money coming in) after the original drug patent should expire. There are also examples in which route of administration of a drug is changed, and then marketed to physicians as having greater efficacy, even though that may not be the case. Also, “controlled release” versions of drugs that may not really improve results over previous versions of the drug. The big drug companies are pretty crafty when it comes to making money.
#53 LadyDay
May 12, 2010

Oops – misread Dianne’s original comment. Too tired to function today. Anyway, ignore what I said above.
#54 LadyDay
May 12, 2010

I mean, ignore what I said as having anything to do with what Dianne said. My original comment is factually correct, but not really addressing Dianne’s original assertion.

I going to quit posting now while I’m ahead.
#55 Dianne
May 12, 2010

Indeed, LadyDay, I think you’ve put your finger on the real sleeze moves that drug companies make. No drug company that wants to stay in business will ignore a drug that is effective for a common disease. They will, however, manipulate the release, ie release the (so to speak) beta version of the drug-maybe one that requires it to be taken three times a day-first, then the “improved” version, which may be no more than a simple change, but enough to make it a once a day drug. Then a me-too drug with no obvious benefit but a new and shiny label…The ACE inhibitor drugs followed that pattern. It’s not that drug companies are pure of heart and 100% moral-what company is?-but I doubt that the particular thing that Nathan was postulating-supression of an effective drug-is practical.
#56 Nathan Myers
May 12, 2010

Dianne: You seem to be pointing out that these competitive compounds actually come from the same company. But we’ve drifted way off topic.

The original subject was treatments that for a variety of reasons cannot generate enough revenue to pay for a single approval. Ginger has been demonstrated many times as effective against motion sickness. You won’t see any corporation driving powdered ginger through the FDA.

Somebody might patent a ginger ingredient and drive that through. (That worked with a statin found in red yeast rice; then they banned red yeast extract itself, a clever touch.) Since ginger powder is itself cheap and effective, and cannot be banned, it would be hard to compete with at a price that would recover the cost. We might see an extract approved, but still not ginger itself. As a result, ginger remains “alternative”.

Likewise, cinnamon (really, cassia) for many type II diabetes patients. Probably there are drugs in the works based on some extract, or that work the same way, but cassia itself will not be approved no matter how safe and effective it is. It remains “alternative”.

Do you really insist it’s crazy to try ginger for motion sickness, or to see if cinnamon keeps your blood sugar level in check? Do you really believe that “FDA approved” maps exactly into and on “safe and effective”?
#57 LadyDay
May 12, 2010

@ Nathan: Very cool – I didn’t know that about red yeast rice until you mentioned it, but even Mayo Clinic has something on it: http://www.mayoclinic.com/health/red-yeast-rice/NS_patient-redyeast.

Also, didn’t know that the first statins were isolated from fungi. Check this out:
http://www.nature.com/nm/journal/v14/n10/full/nm1008-1050.html

Anyway, just a general question for people: does niacin (vitamin B-3) supplementation for patients with CVD count as an “alternative” medicine?
#58 Dianne
May 14, 2010

Ginger has been demonstrated many times as effective against motion sickness. You won’t see any corporation driving powdered ginger through the FDA.

So, just to be clear, you’re hypothesis is that ginger won’t be studied in major clinical trials, recommended by mainstream practitioners, or come to the attention of any drug companies? Is that correct?
#59 Nathan Myers
May 14, 2010

That assertion would take indefinitely long to test, so is not a hypothesis at all. But you haven’t answered my question.
#60 Mel
May 17, 2010

I was expecting facts. There’s nothing here above the level of what we find in the high school debate clubs. I wouldn’t be surprised if you are part of the same organized efforts pretending to be “grass roots” that has the sole objective of stopping people’s options. It has been difficult to find credible information for me in my research project to present the other side…b/c frankly your opinions are not valid enough to quote.