SkepticblogSkepticblog logo banner

top navigation:

Folk-Wisdom Medicine
versus Science-Based Medicine

by Michael Shermer, Aug 16 2011

This article first appeared as an alternative medicine opinion editorial for the American Medical Associations’s Virtual Mentor Journal, Volume 13, Number 6: 389–393, June 2011.

For many years now there has been considerable debate between so-called complementary and alternative medicine (CAM) and mainstream science-based medicine. In reality there is no debate because there is only science-based medicine and everything else that has yet to be tested. Most of CAM falls into this latter category. This does not automatically mean that all CAM claims are false; only that most of them have yet to be tested through the rigorous methods of science, which begins with the null hypothesis that holds that the hypothesis under investigation is not true (null) until proven otherwise. A null hypothesis states that X does not cause Y. If you think X does cause Y then the burden of proof is on you to provide convincing experimental data to reject the null hypothesis.

The statistical standards of proof needed to reject the null hypothesis are substantial. Ideally, in a controlled experiment, we would like to be at least 95–99 percent confident that the results were not due to chance before we offer our provisional assent that the effect may be real. Everyone is familiar with the process already through news stories about the FDA approving a new drug after extensive clinical trials. The trials to which they refer involve sophisticated methods to test the claim that Drug X (say a statin drug) improves outcomes in Disease Y (say cholesterol-related atherosclerosis). The null hypothesis states that statins do not lower cholesterol and thus have no effect on atherosclerosis. Rejecting the null hypothesis means that there was a statistically significant difference between the experimental group receiving the statins and the control group that did not.

In most cases CAM hypotheses do not pass these simple criteria. They have either failed to reject the null hypothesis, or they haven’t even been rigorously tested to know whether or not they could reject the null hypothesis.

What, then, is the pull of CAM for so many people? According to a 2002 survey of U.S. adults conducted by the National Center for Health Statistics and the National Center for Complementary and Alternative Medicine: 74.6% had used some form of complementary and alternative medicine, 14.8% “sought care from a licensed or certified” practitioner, suggesting that “most individuals who use CAM self-prescribe and/or self- medicate,”1 and that the most common CAM therapies used were prayer (45.2%), herbalism (18.9%), breathing methods (11.6%), meditation (7.6%), chiropractic (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%), and visualization (2.1%).2

A 2004 survey of 1,400 U.S. hospitals found that over 25% offered such alternative and complementary therapies as acupuncture, homeopathy, and massage therapy. According to researchers Sita Ananth of Health Forum, an affiliate of the American Hospital Association, and William Martin, PsyD, of the College of Commerce at DePaul University in Chicago, in a news release: “More and more, patients are requesting care beyond what most consider to be traditional health services. And hospitals are responding to the needs of the communities they serve by offering these therapies.”3

Herein lies one answer to understanding why CAM sells. There is a market demand for it. Why? One possibility is that people are turning to alternative medicine because their needs are not being met by traditional medicine. As the late medical historian Roy Porter was fond of pointing out, before the 20th century this certainly was the case.4 Medical historians, in fact, are in agreement that until well into the 20th century it was safer not to go to a doctor, thus leading to the success of such nonsense as homeopathy—a totally worthless nostrum that did no harm, thus allowing the body to heal itself. Since humans are pattern-seeking animals we credit as the vector of healing whatever it was we did just before getting well. This is also known as superstition, or magical thinking.

Another explanation may be found in examining what CAMers are offering that mainstream physicians are not: TLC. By this I do not just mean a hand squeeze or a hug, but an open and honest relationship with patients and their families that provides a realistic assessment of the medical condition and prospects. People are going alternative because in too many instances physicians have become highly skilled technicians—cogs in the cold machinery and massive bureaucracy of modern HMO medicine.

I witnessed the effect directly over the course of a decade during my mother’s recurring and malignant meningioma brain tumors. She finally succumbed, but in the process I gained a deeper understanding of why people turn to alternative medicine. Don’t get me wrong—my mother’s doctors were brilliant, her care the very best available, and we have no regrets about what might have been. And that’s the point. Even under such ideal conditions I found the whole experience frustrating and unfulfilling: it was nearly impossible to get honest and accurate information about my mom’s condition; neither my father nor I could get doctors to return our calls; misinformation and (usually) no information was the norm; and despite my best efforts, the relationship with her physicians (with one exception—her oncologist whom I befriended), could not have been more detached.

I found it rather telling, for example, that when I identified myself as “Dr. Shermer” I got faster results at the hospital than when I was merely “Mr. Shermer” (a lie of omission, not commission, since I do have a Ph.D.), but I still found it difficult to get calls returned. Even worse, when my mom’s oncologist (one of the country’s best-known and well-respected in his field) called her surgeons, he too heard too many dial tones. If physicians show such a remarkable lack of professional courtesy with their own colleagues, what are the rest of us to expect?

More than anything patients want information. They want to know what is really going on. They don’t want jargon. They don’t want false hope or unnecessary pessimism. Studies show that patients do better when they know in detail all the steps they will have to take in their recovery process—probably because it allows them to anticipate, plan, and pace themselves. Knowledge is power, and physicians are modern-day shamans. Patients want the power that knowledge brings, and that empowerment cannot be given in the 8.5 minutes the average doctor spends per patient per visit. Patients want a relationship with their primary caretaker that allows them to ask the important questions and expect honest answers.

Physicians tend to have monologues when they should be having dialogues. The reasoning process of diagnosis, prognosis, and treatment goes on inside their heads, and what comes out is a glossed telegram of truncated lingo. The physician-patient connection is a one-way street, an authority-flunky relationship top heavy in arrogance and off-putting to anyone with a modicum of self-esteem and social awareness. If I could reduce all this into a single request, it is this: Talk to patients as if they are thoughtful, intelligent people capable of understanding and deeply curious about their condition.

So…we should turn to CAM then, right? Wrong. An even deeper problem is that CAMers lack much medical knowledge and (especially) scientific reasoning, making them dangerous. The 2002 study referenced above found that 54.9% used CAM in conjunction with conventional medicine but did not always tell their primary care physician, thus leading to possibly deadly mixtures of drugs and herbs.1 It is not a matter of everything to gain and nothing to lose by going CAM (even if your doc offers no hope), because quack medicines cost money, cause harm, and, most importantly, take away valuable time that could and should be spent with loved ones in this already too-short of a stay we have with each other.

Besides TLC, the cognitive pull of CAM is anecdotal thinking. Since humans are pattern-seeking animals, we credit whatever we did just before getting well as the vector of healing. If A appears to be connected to B, we assume that it is unless proven otherwise. This is the very antithesis of the science-based system of the null hypothesis. The recent medical controversy over whether vaccinations cause autism reveals the power of anecdotal thinking. On the one side are scientists who have been unable to find any causal link between the symptoms of autism and the vaccine preservative thimerosal, which breaks down into ethylmercury, the culprit du jour for autism’s cause. On the other side are parents who noticed that shortly after having their children vaccinated autistic symptoms began to appear. These anecdotal associations are so powerful that it causes people to ignore contrary evidence: ethylmercury is expelled from the body quickly (unlike its chemical cousin methylmercury) and therefore cannot accumulate in the brain long enough to cause damage, and rates of autism diagnoses did not decline in children born after thimerosal was removed from vaccines.

The anecdotal thinking upon which CAMers rely—even if unconsciously and with the best of intentions—can be particularly dangerous in the hands of those whose intentions are less than ethical. Thus it is that any medical huckster promising that A will cure B has only to advertise a handful of successful anecdotes in the form of testimonials, and the human brain will do the rest. By way of example from the annals of medical quackery, witness the case of John R. Brinkley, one of the greatest medical quacks of the first half of the twentieth century, and his nemesis Morris Fishbein, the quackbusting editor of the Journal of the American Medical Association. Their decades-long struggle that criss-crossed the American heartland throughout the 1920s and 1930s, represents this tension between folk and scientific medicine, well summarized in Pope Brock’s 2008 book Charlatan: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam.5

What Brinkley was selling was what all men want—sexual vitality—and he developed a surgical technique that offered the type of firm results that his male clientele so desperately sought: goat testis sewn right into the patient’s scrotum, which he likened to “embedding a marble in an apple.” Come one, come all. And they did, to the tune of $750 per surgery, advertised widely in newspapers (an AMA study revealed that over half of all newspaper advertising at the time was for patent medicines) and the new fangled technology—radio—which Brinkley took to like an evangelist to television. The ads featured testimonials from happy men who proclaimed their restored manhood, and these anecdotes made Brinkley a rich man as it drove customers to his practice. But as his business grew he got careless, performing operations both before and after happy hour, and fobbing off work to assistants whose medical credentials were even shadier than his own (Brinkley graduated from the unaccredited and improbably named Eclectic Medical University of Kansas City). The result was dozens of dead patients.5

This got the attention of the ambitious Morris Fishbein, whose career coincided with the rise of the AMA’s attempt to rein in flimflammery through accrediting medical colleges and licensing practitioners. Fishbein made his public mark in 1923 when the Chicago Daily News sent him to investigate the “Hot Girl of Escanaba” (Michigan), a woman who suffered from a temperature of 115 degrees for two weeks. Fishbein exposed her as a “hysterical malingerer” when he discovered that a flesh colored hot water bottle was employed to elevate rectal thermometer readings. For the next two decades Fishbein pursued the country’s “most daring and dangerous” swindler, as he called Brinkley, until he finally brought him down in a decisive courtroom confrontation.5

Fishbein’s promotion of science-based medicine was heroic in his day, but medical flapdoodle flourishes today on the Internet so every medical association and journal needs a quackbusting Fishbein on its staff, for without such eternal vigilance folk medicine will trump scientific medicine in the minds of patients. And thus it is that skepticism should be our default rule of thumb when it comes to CAM claims.

References

  1. Barnes PM, Powell-Griner E, McFann K, Nahin RL. “Complementary and alternative medicine use among adults: United States, 2002.” Adv Data. 2004;(343):6. http://nccam.nih.gov/news/camstats/2002/report.pdf. Accessed May 17, 2011.
  2. Barnes, Powell-Griner, McFann, Nahin, 12.
  3. Ananth S. Health Forum 2005 Complementary and Alternative Medicine Survey of Hospitals [news release]. Chicago, IL: American Hospital Association; July 19, 2006. And: www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtml
  4. Porter R. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton; 1999.
  5. Brock P. Charlatan: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam. New York: Crown Books; 2008.
VN:F [1.9.22_1171]
Rating: 4.9/5 (17 votes cast)
Folk-Wisdom Medicine
versus Science-Based Medicine
, 4.9 out of 5 based on 17 ratings

Recommended Reading

39 Responses to “Folk-Wisdom Medicine
versus Science-Based Medicine”

  1. John Myste says:

    I read an article on MMA (not sure how credible it is) that said the merits of bleeding with leeches was underestimated and in some cases it does have medicinal value.

    These things don’t come from nowhere, do they?

    I can offer additional leech evidence. At this moment, I have TMJ disorder, chronic meniscus issues, allergies. I have not been able to treat any of these maladies.

    I don’t know where to find a leech.

  2. John Myste says:

    More than anything patients want information.

    Right. For example, where are leeches?

    • Tamaresque says:

      Come to Tasmania when it’s wet, or head to the rainforest in NSW or Queensland (speaking from experience here).

  3. BradC says:

    “…there is only science-based medicine and everything else that has yet to be tested.”

    What about claims that HAVE been tested but found to not be effective? Are you deliberately excluding these, or are you saying that the result of a study can only be the confirmation of the null hypothesis, or the confirmation of the claim? (And that the confirmation of the null hypothesis isn’t the same as the refutation of the original claim)

    It seems to me that a more serious problem than the lack of studies is poorly executed or poorly interpreted studies, and a deliberate attempt by the purveyors of CAM to distort and misinterpret their results.

  4. oldebabe says:

    Nothing in your article is news, but interesting, none-the-less. I can second your thoughts/experience re: doc relationships w/their patients, tho I must say that my current `internist’ gives me 10 min. of his time per visit ;-).

    The trend now, even at Mayo Clinic, is to consider CAM potential, not refute it. What’s a person to think?

  5. Max says:

    CAM is popular for treating things that conventional medicine is not good at treating, sort of like the god of the gaps.

    The touchy-feely CAM is hard to test against a placebo, and patients don’t have time to wait for clinical trials that might never happen.

    CAM such as homeopathy often has no side effects, and there are testimonials of miraculous cures after conventional medicine failed. Patients perceive it as a low risk of wasting some money, with a potentially high payoff.

    • Linz says:

      Well said Max. Although Michael’s article covered off a common complaint adbout medicine, your comment illustrates the way an economist or game theorist would look at the problem. At the end of the day, most people are most interested in what is most likely to work, with small chance of adverse effects. However, it is in human nature to make inaccurate estimates as to likelihoods of success and failure, leading to bad decisions. I remember having the same problem when I tried to eat healthier years ago, and tried to research what foods and vitamins to eat. After a few days of research, all you end up with is confusion and a bucket of KFC. (at least I did)

  6. Max says:

    “Medical historians, in fact, are in agreement that until well into the 20th century it was safer not to go to a doctor”

    There’s still a risk that going to a doctor will do more harm than good. Observe the number of medical errors, hospital-acquired MRSA infections, and recalled drugs. I wonder how many people catch the flu while getting their flu shot, and then think they got it from the shot.

    • BillG says:

      Agreed. Going to the doctor’s office – or worse the hospital, it’s literally a leper colony. Lethal diseases such as breast and prostate cancer can have false positive exams, causing nothing but physical and financial stress.

      CAM offers nothing but placebo benefits, though equally, established medicine can also be harmful.

      • Tamaresque says:

        Not always so. I use a food supplement which is produced to drug status standards and has been proven in studies to be effective for various conditions. Due to the difference in US and AUS legislation, it’s better that I don’t say what the product is because in the US the relevant FDA legislation states that disease states may not be mentioned when referring to this product, while in AUS the TGA states that the US claims can not be made here, but certain disease states are mentioned that this product has been proven to be effective for.

        As for myself I’ve had 2 renal transplants over the last 30 years, so I’m very careful what I put into my body; it must be non-toxic, have no adverse effects on my blood counts or, even better, improve them, before I will take them on a continuing basis. This one and very few others pass with flying colours.

        On the other hand I’ve had some interactions between over-the-counter remedies and my medications, but I’ve had more severe interactions with prescribed medication interactions. I like to keep an open mind about all claims , both medical and CAM.

    • Mario says:

      Yes but statistically speaking is far safer to go to a physician: MSRA infection rate are at worst near 5%, that means that there is 95% chance that you won’t get it, but almost 100% chance that your condition will get worst if you decide to treat your Cellulitis or Pneumonia by yourself, Physicians make mistakes but at a fewer rate than the rest of the population, and modern medicine is getting more accurate very single day.

      I think that the real point here is physician-patient relation, the better this is the less likely is a person to seek alternatives; when one is a medical intern or a resident one does not have time to explain, merely the time to finish your tasks and when you finally get your degree then you are way too busy between your office and the hospital. So unless we change that pattern people are going to keep recurring to wackos and herbs, and that begins in medical schools.

      • Max says:

        If you have a life-threatening infection like pneumonia, then MRSA isn’t your top concern, but what’s really sad is when people have knee surgery and die from MRSA or other infections like C. diff.
        Often, self-limiting and not life-threatening conditions are treated with drugs that can have permanent side effects including death, like Tylenol causing liver failure.

        You’re right about the doctor-patient relationship. Young doctors have to pay off their huge med school loans, and doctors who accept HMO insurance tend to have way too many patients.

      • Mario says:

        Yeah I was just pointing out that is safer to go to a physician and far more effective than using charlatans, but there is definitely a higher risk of getting something worse at a hospital than your house.

      • tmac57 says:

        Risks need to be put into perspective,and the proper context too. For example,if you were having a heart attack,burst appendix,stroke,or trauma,would you rather be in your home,or in a hospital? Also not all hospitals have the same level of risk for infection.It is a good idea to investigate the hospitals in your area before needing them to see what their infection rate,and standard of care are,if possible.
        Here is a good resource by Consumer Reports called the Safe Patient Project:
        http://www.safepatientproject.org/topic/hospital_acquired_infections/

  7. Gerlinde says:

    One thing I struggle to understand, why is Chiropractic considered a CAM? It’s a scientific method that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system. It requires 7 years of intense medical studies.

    As someone who has had spinal intervention, I would not put my health in the hands of unproven treatments like herbalism, homeopathy, body talk etc.

    I would greatly appreciate why therefore, chiropractics are considered a CAM.

    • SunnyD says:

      Chiropractors are not doctors and don’t “cure” anything. A massage or other hands on manipulations may make you feel better much like scratching an itch makes you feel better but it doesn’t “cure” anything. If a massage or neck manipulation seems to “cure” something then more then likely you didn’t have anything in need of curing. But chiropractic methods have a dark side; that is some chiropractors believe they can cure real disease by manipulating your neck or back. This superstition based belief has gotten the profession in big trouble in the past and there was a movement to discredit chiropractors and ban them. The chiropratic industry wisely choose to deny (or at least agree to not claim) that they could cure illnesses with their magic hands. But that dark side keeps raising it’s ugly head. Most chiropractors are too smart to make those claims and stick to treating auto accident phoney claims where they belong. So if you have a car accident get a good lawyer and he will refer you to a shady chiropractor who will use his magic hands to determine you have soft tissue damage and your sleazy lawyer can extort the insurance companies driving insurance rates up for the rest of us.

    • BradC says:

      Gerlinde – I didn’t understand this at first either, mostly because I was only familiar with Chiropractors as someone who helped treat neck or back pain. There are really two separate avenues to discuss here:

      1. Belief in “Vertibral subluxation” as the cause for all illnesses:

      “Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease. If we had one hundred cases of small-pox, I can prove to you where, in one, you will find a subluxation and you will find the same conditions in the other ninety-nine. I adjust one and return his functions to normal… . There is no contagious disease… . There is no infection… . There is a cause internal to man that makes of his body in a certain spot, more or less a breeding ground [for microbes]. It is a place where they can multiply, propagate, and then because they become so many they are classed as a cause.” — B.J. Palmer, The Philosophy of Chiropractic, V. Davenport, IA: Palmer School of Chiropractic; 1909

      This is the blatant “CAM” aspect of Chiropractic, and is still a huge part of Chiropractic training and practice, even as they have been forced to tone down their “cure-all” advertising by modern objections. It’s pretty obvious how that conflicts with modern medical understanding (the germ theory of disease).

      2. The unproven nature of spinal adjustment as a safe treatment for neck/back pain vs the risks (of stroke or even paralysis).

      Everyone has a friend or relative that swears by their chiropractor, but personal success stories aren’t a good substitute for actual medical research, of which there is a surprising lack.

      For more on both these aspects, take a look at this series of articles at Science Based Medicine by Sam Homola, a former professional Chiropractor:

      http://www.sciencebasedmedicine.org/index.php/author/sam-homola/

  8. Stephen James says:

    Shouldn’t homeopathy be the perfect nostrum for Doctors? Doesn’t the Hippocratic oath contain the phrase “to abstain from doing harm”? What better way than homeopathy. But, I do like the explanation that homeopathy “worked” because the body heals itself over time, for common ailments.

  9. Arthur Flatau says:

    I found this article very interesting. I have a lot more experience with the doctors than is healthy as I was diagnosed and treated for leukemia (AML) in the early ’90s. I also have a Ph.D. and was several times tempted to say I was Dr. Flatau, but never actually did it (call me chicken :-).

    There are two points I want to make, first of all CAM covers a lot of ground. Although I am not aware of scientific studies of prayer, breathing methods, meditation, progressive relaxation, and visualization (to take some from the study listed), I think most people believe that this are extremely unlike to cause harm when used in conjunction with conventional medicine. They are also very cheap (perhaps the cost of a book on meditation or a prayer book) or free. If they make the patient feel better, even if only because they think they are doing something to get better, it is likely worthwhile for that patient.

    Second I do not think the primary reason patient try alternative therapies is because they want “an open and honest relationship with patients and their families that provides a realistic assessment of the medical condition and prospects”. Although I agree that many or even most patients want such a relationship, I do not think they turn to CAM because of that. As you noted, only 14.8% “sought care from a licensed or certified” practitioner, and “most individuals who use CAM self-prescribe and/or self- medicate,”. I believe people turn to CAM when they have a deadly disease (like cancer) because they want to make sure that they have done everything to make sure they are cured. In addition, there are still time (way too many for cancer treatment at least) where the standard conventional medicine has been proven not to work. At least in those situations it make sense not to use standard therapy but instead to use CAM or clinical trials. [It is also true, as pointed out previously, that some kinds of CAM have been proven not to work and people still use it anyway.]

  10. Nice article.

    It makes me wonder if there is a parallel between the Doctor-Patient relationship and the Scientist-Public relationship. Both have problems due to limited individual attention but also both seem to suffer from a culture/language barrier.

    When a Ph.D or a M.D. tells someone that there is a ‘high probability’ of such-and-such they are expression *much* confidence in it while acknowledging that no one can be 100% sure of these things. We all ‘hedge’. But the general public does not like hedging – they see it as a sign of weakness (or ignorance – why can’t you be 100% sure? Go back and keep looking until you *are* 100% sure). The CAMer’s and pseudo-scientists seem to be far more confident in their claims. They *know* that you suffer from a “flummoxing of bodily fluxes” or that Global Warming is due to the planet Nibiru. And was George W Bush said “You may not agree with me but at least you know where I stand.”

    People like that. They like their authority figures to be clear, decisive and … authoritative.

    Therein lies the problem: Doctors and Scientists are not *authorities* – they are *experts*. Experts know what they know and know what they don’t know – and try to communicate that. Other experts understand this and appreciate being given a probability instead of a certainty. Alas, the general public does not understand or appreciate this.

  11. LindaRosaRN says:

    I’m not impressed with the NCCAM surveys of CAM use. They fail to define CAM and pad it with accepted practices (such as massage) to make CAM look more popular than it is. (Note that many nurses now claim “caring” as a CAM modality.)

    Take a look at the 2004 NCCAM survey (http://nccam.nih.gov/news/2004/052704.htm) of 31,000 American adults. I don’t see a big demand for CAM or CAM practitioners.

    The most common practices cited by the survey were prayer: for self (43%), group prayer (10%) and prayer for others (24%). Over the counter herbals were next most popular (19%) with OTC echinacea, ginseng, gingko and garlic the mainstays. Other top ten practices were mainly relaxation methods: meditation, yoga, massage, and deep breathing, plus various diets. Homeopathy and acupuncture don’t register. Chiropractors were the only practitioners who showed up with any significance (8%); all others grouped together were used by 4% of the population (and that would include the masseuses, as well).

    Yet biased surveys like this are routinely used by CAMsters to gain political leverage for gaining licensure, mandatory 3rd party reimbursements, and medical privileges. See if you can find an article promoting CAM without reference to one of these bloated surveys in the first three paragraphs. So we should be careful not to fall into the same trap and accept these surveys as valid.

    As for CAMsters spending more time with patients, that is only partly true. CAMsters, such as chiropractors, may spend a long time with new patients to seal the relationship. But thereafter, they often may spend less time with clients than physicians are able to do.

  12. LindaRosaRN says:

    One thing more…
    In a 2004 NCCAM survey, of those who used “CAM,” “55 percent… said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments…”

    It think it is human nature to use the “it-can’t-hurt/try-anything-to-get-better” approach, in addition to standard care. When I worked at a VA Hospital years ago, nearly all the cancer patients had grapes at the bedside because that was a fad cure for cancer at the time. I don’t think any of them had much faith in it, but their families wanted to help in any way they could, and the grapes were a touching gesture of their concern and hopes. CAM exploits that vulnerability.

  13. Cathy Fiorello says:

    There is actually evidence supporting meditation, relaxation, and massage for some disorders. Including those with homeopathy simply dilutes your argument.

    • tmac57 says:

      It has been my observation,that most skeptics don’t have a problem with meditation or relaxation when used to release stress.That claim seems reasonable,and there does seem to be scientific support for it.
      Claims of it ‘curing’ anything,are another matter though.

  14. Jennifer Cupp says:

    Doctors are not interested in alternative therapy because they have their paradigm, they’re intentionally overbooked, and they just crank through the patients using the knowledge the drug reps provide over free lunches. It’s a job. Like anyone, doctors resent when people show them how to do their job better.

  15. Andrew Koehler says:

    Enjoyed the article

    In full disclosure, I am pediatrician who recently completed my residency. If it is any consolation (and it’s probably not), many doctors struggle with the nature of what the patient/doctor relationship has become. Many of us wish that we could spend the kind of time that CAM practitioners have with their patients particularly the medically complex ones. It’s why we got into this. Medical educations has put an increased emphasis on effective communication and attempting to purge some of the paternalism that afflicts our profession with some success..

    Yet we fold when confronted by the economic realities of our practices in meeting our overhead, our malpractice insurance, and our $150k student loan debt. Like Jennifer says, it’s a job and in the current health model, the only way to make a living at it is volume. You can bill whatever you want, insurance is still going to pay their set rate. So I try my best to give my patient’s families the attention that I would expect if my child was sick but at the end of the day I have to take care of my family also.

  16. John de Rivaz says:

    The indictment expressed here against conventional medicine, lawyer medicine, defensive medicine, or government medicine – call it what you will – is so well known.

    To that one can add hospital appointments when the patient turns up to find there is no bed for him. I know of cases where patients are pre-meded for an operation only to have it cancelled at the last minute. Words fail me to describe the amount of unneccessary stress surrounding the practise of conventional medicine. This can only come from a totally arrogant profession that really ought to know better. However there is no real alternative for customers to go to. But the stress and arrogance is so severe that they do go elsewhere.

    If the government was genuine in wanting people to use conventional (ie science based) medicine, then the way to achieve this is easyily said — remove these stresses. But of course, they do the opposite — try and add stress to CAM by sending in gangs of police and lawyers. It is probably easier, and more fun, really for them to do it the bad way.

    As the Maquis de Sade wrote something to the effect of: power over another man is more fun that sex with a woman.

  17. Kimberly Karn BSN says:

    two things.
    1- The first time I saw my cardiologist my husband came along. After the examination and the review of my history, The doctor turned to my husband and spoke to him about my problems at length. The doc even asked my husband (an engineer who never worked any sort of medical profession) all the questions he should of asked me, the patient. I was so mad I couldn’t even speak. To be totally ignored like that was beyond the pale. I made another appointment just to talk to him after I calmed down. When I talked to him he did apologize and admit that was not his finest hour. I continued under his care only because I liked his nurse practitioner, otherwise I would have switched.

    2- Why is it that people will totally ignore their physician who studied for years in order to become licensed and must continue in order to maintain her licensure, but will take the advice of some stranger they met in the supermarket? It blows me away.

  18. The indictment expressed here against conventional medicine, lawyer medicine, defensive medicine, or government medicine – call it what you will – is so well known.

  19. gewisn says:

    <15% utilized CAM, but probably near 99% of the pop'n used allopathic medicine (the proper term for the method of treating ailments by counteracting symptoms and identifiable causes) in some form (including most OTC medicines) in the last few years. So allopathic medicine must be doing something right. Physicians are overbooked and hospitals are crowded because people want their services. Don't kid yourself. The business of medicine helps regulate the number of doctors graduated every year and the government generally only permits new medical schools where there is already a documented severe shortage. This approach has its advantages, but it certainly maintains the basic shortages. The other huge factor is that the hardest working, most important physicians, Primary Care Providers, generally get the lowest pay. Change that factor and a lot more medical graduates will stay in Primary Care instead of seeking lucrative specialties. "If I'm going to treat patients anyway, why do it for half of what I could be making, and pay off my loans in 10 years instead of 30?"

    But the medical industry really does a poor job of communicating in almost every form. It doesn't take an enormous amount of time. It takes some specific skills, an interest in what the patient has to say, and some basic salesmanship – so that the patient feels an investment in the treatment plan. Medical schools today talk a lot about the relationship, but DON'T teach how to do it. They bring in doctors who have some charisma to talk about the subject, but those doctors don't even know why their charisma works or how to impart it to others. They bring in physiologists to teach us endocrine function, and pharmacologists to teach us how medicines work, and epidemiologists to teach us medical statistics – but they never bring in experts in communication to teach it like any other practicum – learn the principles, demonstrate proficiency in lab settings, perform on patients while strictly supervised. In medical school, I had an administrator (no relevant training, whatsoever) fail me on a medical interviewing exam because I let the patient pick the first topic of conversation instead of sticking to a script.

    "CAM" is a marketing term for non-allopathic approaches. It is equivalent to changing "anti-abortion" to "pro-life." The name change changes nothing. Some probably work. But we know little yet about which are actually "safe and effective."

  20. Finally, the ASA are getting tougher on homeopathy advertisers – http://coffeelovingskeptic.com/?p=762 – we need them to continue. So please continue to forward false claims to them.

  21. Sheila says:

    The cure for cancer has been around since the ’50s called Essiac, an Ojibwa indian recipe. It was tested by Rene Caisse only on terminal cancer patients who eventually died but none died of cancer. After receiving 55,000 signatures the Canadian House of Commons voted against releasing this herbal concoction to regular people who had cancer but were not terminal. Even back then the pharmaceutical industry had huge influence. So put that in your pipe and smoke it.

  22. Sheila says:

    There is also a cure for muscular dystrophy (maybe Jerry Lewis found out about it and refused to participate in the joke which is called the telethon). There is even a cure for diabetes called eleotin. There’s also a cure for bi-polar with has an 80% cure rate – you may want to speak to Dr. Charles Popper from Harvard about that. If you don’t know anything about these, then you haven’t been looking.

  23. Sheila says:

    Isn’t it against the law in your country to pretend to be a doctor when you’re not? How come you haven’t been charged with impersonation?

  24. Dragoness Eclectic says:

    Late to the discussion, but I’ll tell you why some of us turn to herbal medicine or self-medicate:

    If I have the same-old recurring sinus crud, I can make an appointment to visit my doctor. Since none of the doctors around here don’t work evening or weekend hours, I have to take time off from work to do that–that eats into my PTO, so I have less available when I need to take a vacation to relax, spend time with family, de-stress. Fortunately, I have a job that actually gives me PTO, rather than just docking my pay for however many hours going to the doctor takes. I cough up a co-pay of $30 or so–fortunately I have medical insurance, or I’d be paying anywhere from $75 – $150 for an office visit. The doctor will usually prescribe an antibiotic and cough medicine for the usual crud–I go wait at a pharmacy to get the prescription filled for about $10 and say half an hour of waiting if they’re not busy. Again, I have insurance; if I didn’t, I’d be paying quite a bit more, since I am allergic to penicillin and can’t take the cheapest antibiotics. Finally, my sick, miserable self can go home from all the waiting in offices and stores and take my medicine and get some rest.

    Or, I could buy a bulb of garlic from my local supermarket for about $1, and eat about two cloves a day of crushed raw garlic (mixed with cheese or spread on toast because I am not manly enough to eat raw garlic straight). Yes, it’s not quite as effective as prescription antibiotic, and the dose is not consistent (How big is the clove? How much of the cell walls were crushed converting the binary precursor compounds into the final antibiotic chemical?), but it is an actual, known antibiotic that will work, and I don’t have to spend my limited resources of time and money just to get permission to use it, let alone actually get it in my hands to use.

  25. Victor Carulei says:

    - – - Doctors are not interested in alternative therapy because they have their paradigm, they’re intentionally overbooked, and they just crank through the patients using the knowledge the drug reps provide over free lunches. It’s a job. Like anyone, doctors resent when people show them how to do their job better.

    WHAT TRASH.

    All MD have to complete ongoing medical education. I receive 10 journals per month, go to 4 conferences per year and take study credits online to ensure that I retain my license. No dumb ass med rep has given me worthy information for the simple reason that WE as a group refuse to see med reps. They have their silly charts and “one sentence underlined in yellow” for emphasis/ evidence. I feel totally insulted engaging in a conversation with a med rep. In any event the data they produce has to be backed up by clinical trials and I must say in their defence, they will usually present an article published by an expert in the field validating their “punt” for a particular drug.

    By the way no MD in Canada goes to a free lunch with med reps. It has bee banned for over 6 years now. The most one can attend is a meeting discussing whatever drug and the food supplied consists of a few sandwiches NOT scallops and lobster with wine.

    When the reps do stage a meeting to, for example, sell the merits of nexium for acid reflux, they will ask an expert gastro-enterologist to present a discussion on GERD/ARD. This will involve a discussion on the latest diagnostic tools, treatment types and outcomes. The specialist presenting the findings HAS to declare at the beginning of the discussion, that he/she has no conflict of interest with the drug company. In fact when attending a meeting like this even though nexium is regarded as the Rolls Royce drug for resistant ARD, the presenter cannot single it out as the only drug to use for ARD. So what happens is this. All the PPI will be discussed and where there is evidence to support the use of nexium, in exceptional proven circumstances, it will be mentioned as the drug of choice.

    So for GERD/ARD I hardly ever use nexium. Why should I when losec, pantoprazole and lansoprazole do the job 95% of the time for $40 pm as opposed to $80 pm for nexium? So why should I listen to the med rep pushing nexium. It is a waste of time.

    If the drug reps think they are converting MD to use their drugs good luck to them. We remain eternally skeptic of any “wild” claims made by drug reps. Been burned before. So i would say that if a drug company is stupid enough to think that MD will all reach for their script pads after a meeting regarding a drug they must be deluded.

    What is most important at medical meetings is to update ones knowledge on diagnosis and treatment. So one has to be sure that for example in people who have coronary artery disease, they must be on 4 different classes of drugs, all of which decrease risk in a different way.

    ACE – Ramipril – elanopril, lisinopril, coversyl, trandalopril, perindopril etc

    OR if ACE inhibitors are not tolerated

    ARB – irbesartan, losartan, valsartan, olmesartan etc etc
    Statins – Atorvastatin, lovastatin, rusovastatin, pravastatin and simvastatin etc etc
    B Blockers – propranolol, Metoprolol, atenolol, acebutalol, pindolol etc
    ASA – Aspirin

    And those who have had stents use plavix from 3 months to 1 year to prevent occlusion, depending on the type of stent.

    Those in capital letters have best evidence.

    So if I go to a conference where the manufacturer is putting on a discussion on statins for coronary artery disease, we all know that they are “punting” their drug. However the speaker (Usually a top academic from a University) will only specify the company’s drug where it has been shown in clinical trials that this particular drug is superior. In most cases I would think that it is a CLASS EFFECT. In other words just use a statin to get the LDL down even if it is simvastatin despite the fact that the most robust trials were done with atorvastatin. The manufacturer of atovastatin will push the evidence and say “Oh no it is not a class effect, our drug is unique/better/more effective”. In a sense they are right because even if simvastatin works exactly on the same enzyme as atorvastatin (lipitor) does, the fact remains that the hard, most robust research was done with atorvastatin in terms of plaque regression. And the manufacturer of simvastatin will not fund a “head to head” trial to compare their drug i.e. simvastatin with the opposition’s atorvasttain, in case the outcomes show that atorvastatin is indeed a better drug. So the manufacturer of simvastatin will say that simvastatin and atorvastatin are just as good which will annoy the manuctfurerer of atorvastatin because atorvastatin is actually more potent. However to make it even more complex rusovastatin is the most potent of all the statins but again the hard research was done with atorvastatin. It is assumed by many MD’s that the outcomes 10 years later will be the same for patients who had a heart attack, with any of the statins provided the targets for LDL were achieved.

    There is no doctors office on earth that can run on time. Sometimes you just have to spend 45min with a patient to the detriment of all those waiting and yourself, because now you are way behind (every day of your life) for the rest of the day. You have no way of predicting what the next persons problem will be and in some cases a HUGE amount of time is spent on one person i.e attempted suicide. You can’t just say 10 min are up see me next week.

  26. Victor Carulei says:

    - – -To that one can add hospital appointments when the patient turns up to find there is no bed for him. I know of cases where patients are pre-meded for an operation only to have it cancelled at the last minute. Words fail me to describe the amount of unneccessary stress surrounding the practise of conventional medicine. This can only come from a totally arrogant profession that really ought to know better. However there is no real alternative for customers to go to. But the stress and arrogance is so severe that they do go elsewhere.

    Well in Canada this happens ALL THE TIME

    It has nothing to do with the doctors. If a surgical suite is running late sometimes the next person has received pre med at 4pm only to be told that their surgery will be cancelled because its down tools at 5pm. So if your surgery takes 2 hours and is due to start at 3.30pm because of delays, your surgery will be cancelled. Government will not pay 1/2 hour overtime to the nursing staff to work until 5.30pm. The doctors will work, very often until 7-8-9 pm if they have to to get the work done. But they are “private entrepreneurs” if you will and the poor unionized nurses are victims who have to work overtime because some greedy surgeons want to earn more money. Never mind the case that the surgeon is taking the risk. Why can the surgeon work 18 hours a day and the nurses are overworked after only a 8 hour shift

    Blame the government/financier/owners/management and other idiots who run the hospital. Who makes THE money at the hospital, the cardiac surgeon or management? You would maybe say, of course the surgeon does. Not so, management gets profits for performance and that means trimming costs, which in turn are passed down onto the patients in the form of cancelled surgeries. And the doctors get the blame for being greedy/technocratic/unfeeling/arrogant etc etc

  27. Victor Carulei says:

    Or, I could buy a bulb of garlic from my local supermarket for about $1, and eat about two cloves a day of crushed raw garlic (mixed with cheese or spread on toast because I am not manly enough to eat raw garlic straight).

    Better you become more enlightened and read what Prof Edzard Ernst has to say about garlic.

    Maybe the most trivial of bacterial infections would respond to garlic. And most patients don’t want to hear: “Go take a decongestant”. After all they took time off from work and they need “real treatment” not just advice by a MD to get some OTC remedy. Most often no treatment will work just as well. So very often the reality is that if you do nothing the illness lasts 14 days and if you take antibiotics it lasts 2 weeks. So much for garlic and antibiotics. But the consumer wants a strong antibiotic. Even if most cases are just a cold/rhinitis or some other viral upper respiratory tract t infection (80% of all URT are viral). And if you do try and “educate” it is almost always futile in my experience, where usually the customer has decided in advance he/she are going to pick some e.g. ciprofloxin. I often get this response after explaining why they do not need a prescription of antibiotics

    “So doc what dose do I need 500mg bid for 7 or 10 days?”

    SIGH. You start writing out the script because otherwise you will have to re explain all over again and the patient will again ask the same question and they are often not receptive to your explanations. Studies have shown most patients remember 10% of what they were told in a MD office. So I can see where many MD just write out a script. It saves time. Does not make the patient mad. Imagine this scenario. “Doc, you mean to tell me that after battling a traffic jam for over an hour and taking time of from work, all you can say is to take tylenol? Thats all you can do for me? What is this world coming to. I’ll go and find myself another damn doctor who knows something”. THAT is the reality of medical practice. We are not dealing with a practice full of microbiologists holding PH.D’s, but the general public to whom complimentary medicine is just another option. That scientific illiteracy is due to a terrible public education system in the USA where most high school students cant even spell science let alone understand it.

    For those who are interested. Go look up South Africa matriculation pass rate for 2010. 40% of all high school grade 12 students failed their exams. FAILED. Not passed as they are in the USA by having a raw score of 30% and then placed on a percentile chart so that the village idiot now gets a 70% because of being placed on the “percentile curve”. Actually the failure rate was much higher than that because of how the data was selected to make the politicians look good. You can’t have students failing at school in “feel good about yourself North America”, because then you may have to deal with some very unpleasant truths such as not everybody actually can get a grade 12. Or it may point out where the teachers are sub par. So you are forced to dumb down the system so that lowest common denominator can drag his ass over the pass mark even if the fellow can barely read or write. A survey was done, I think in Switzerland regarding high achieving pupils at science olympiads, and the educationist interviewed said this. “The secret is we teach the three R’s thoroughly”

    And they are:

    1) reading
    2) ‘riting
    3) ‘rithmetic

    If these principles have not been hammered into your head early on you are done.