About a week ago, I was having lunch with some friends (most of them in med school with me). I can't recall how, but we arrived on the topic of "conventional" vs "alternative" medicine.
We had all read at least some excerpt of Anne Fadiman's book, The Spirit Catches You And You Fall Down. It's a biography of a Hmong girl who develops seizures and about the divide between Hmong culture and and Western medicine culture. Interestingly, my friend and I took away very different messages from the book.
He cited a quote from a surgeon towards the end of the book saying to the effect, "Western medicine works" and claims Fadiman ignores that fact and moves on. He believed that all of the alternative medicine and cultural beliefs of the Hmong in the book were essentially crap and that Western medicine was the one true solution to the girl's seizures, and that everything else got in the way. Western medicine is the only thing that works. I disagreed on two points: 1.) it doesn't really matter if Western medicine is superior or not if the patient doesn't want to take it, 2.) not all alternative medicine is necessarily crap - a lot is just unproven medicine.
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1. The truth of the matter is, patients don't always think highly of doctors. It's our fault, really. Doctors can be so dismissive and so readily "reduce" patients to numbers, diseases, and organs. We can appear cold and disengaged. It doesn't matter if Western medicine is the only thing that works - if patients don't take the medicine we give them, the effect of our medicine is zero. We must negotiate without patients, we must compromise with our patients, we must work with our patients to get them the best medical care possible.
There's a great article written on KevinMD.com (a great medicine/health blog) titled, Stop the Us versus Them mentality in medicine, that speaks very well to this point.
2. The truth of the matter is, not all alternative medicine is crap. A little over decade ago, acupuncture was scoffed at as a sham and now it's routinely used as an adjunct to treat pain and some other conditions. Though the research on acupuncture can be argued as not being the most rigorous and powerful out there, it did demonstrate real potential. Garlic has some medicinal properties and so does St. John's wort.
Herbal medicines and teas can augment or interfere with the effects of our conventional drugs. It behooves us to know what these herbals may do, so we may advise patients accordingly. More research needs to be done. There a lot more alternative medicine out there than research is able to elucidate its true effects. There's a lot of untapped potential that needs to be refined into a product that can reliably and safely work - to disregard it all as "for hippies" or "essentially placebo" is a disservice to patients and the spirit of science and medicine.
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Another friend at lunch remarked, "Do you know what alternative medicine that's proven to work is called? Medicine." I disagree somewhat. There's a difference between the word "alternative" and "integrative and complementary." Not too long ago research showed that a tablespoon of honey in a cup of hot water helped temporarily relieve symptoms of sore throat and cough. But these things alone usually can't suffice, and hence are integrative and complementary. Alternative implies a divergence from conventional medicine.
This article, The Believers, that my friend sent me yesterday unsettles me a little. It may seem hypocritical of me to say that, given what I've argued above. But I am by training a scientist. I acknowledge that there is a world outside what research has touched (because if research has touched it all, there would be no further research). I believe that many alternative therapies warrant further scientific research to see if it truly works or not.
Anyway, the truth of the matter is, we shouldn't dismiss alternative medicine so readily because we don't always have proof it doesn't work. Also, if we dismiss it so readily, patients may take offense and refuse to take the medicines we prescribe. And if they don't take our medicines, that have research backing that they work, then what's the end effect? Oh yeah, nothing.
We had all read at least some excerpt of Anne Fadiman's book, The Spirit Catches You And You Fall Down. It's a biography of a Hmong girl who develops seizures and about the divide between Hmong culture and and Western medicine culture. Interestingly, my friend and I took away very different messages from the book.
He cited a quote from a surgeon towards the end of the book saying to the effect, "Western medicine works" and claims Fadiman ignores that fact and moves on. He believed that all of the alternative medicine and cultural beliefs of the Hmong in the book were essentially crap and that Western medicine was the one true solution to the girl's seizures, and that everything else got in the way. Western medicine is the only thing that works. I disagreed on two points: 1.) it doesn't really matter if Western medicine is superior or not if the patient doesn't want to take it, 2.) not all alternative medicine is necessarily crap - a lot is just unproven medicine.
-----
1. The truth of the matter is, patients don't always think highly of doctors. It's our fault, really. Doctors can be so dismissive and so readily "reduce" patients to numbers, diseases, and organs. We can appear cold and disengaged. It doesn't matter if Western medicine is the only thing that works - if patients don't take the medicine we give them, the effect of our medicine is zero. We must negotiate without patients, we must compromise with our patients, we must work with our patients to get them the best medical care possible.
There's a great article written on KevinMD.com (a great medicine/health blog) titled, Stop the Us versus Them mentality in medicine, that speaks very well to this point.
2. The truth of the matter is, not all alternative medicine is crap. A little over decade ago, acupuncture was scoffed at as a sham and now it's routinely used as an adjunct to treat pain and some other conditions. Though the research on acupuncture can be argued as not being the most rigorous and powerful out there, it did demonstrate real potential. Garlic has some medicinal properties and so does St. John's wort.
Herbal medicines and teas can augment or interfere with the effects of our conventional drugs. It behooves us to know what these herbals may do, so we may advise patients accordingly. More research needs to be done. There a lot more alternative medicine out there than research is able to elucidate its true effects. There's a lot of untapped potential that needs to be refined into a product that can reliably and safely work - to disregard it all as "for hippies" or "essentially placebo" is a disservice to patients and the spirit of science and medicine.
-----
Another friend at lunch remarked, "Do you know what alternative medicine that's proven to work is called? Medicine." I disagree somewhat. There's a difference between the word "alternative" and "integrative and complementary." Not too long ago research showed that a tablespoon of honey in a cup of hot water helped temporarily relieve symptoms of sore throat and cough. But these things alone usually can't suffice, and hence are integrative and complementary. Alternative implies a divergence from conventional medicine.
This article, The Believers, that my friend sent me yesterday unsettles me a little. It may seem hypocritical of me to say that, given what I've argued above. But I am by training a scientist. I acknowledge that there is a world outside what research has touched (because if research has touched it all, there would be no further research). I believe that many alternative therapies warrant further scientific research to see if it truly works or not.
Anyway, the truth of the matter is, we shouldn't dismiss alternative medicine so readily because we don't always have proof it doesn't work. Also, if we dismiss it so readily, patients may take offense and refuse to take the medicines we prescribe. And if they don't take our medicines, that have research backing that they work, then what's the end effect? Oh yeah, nothing.
