Friday, November 14, 2008

Taking It to the People.....

The following is a rough draft recreation of the extemporaneous introductory statement I gave prior to a wonderful hour of taking questions from the crowd at a recent meeting of a local skeptic society:

I had my first real experience with alternative medicine in residency. Sure I had heard of it before, and was even a little skeptical of the completely outlandish stuff like psychic healing and homeopathy, but I accepted a lot of it at face value. When a commercial for chiropractic came on I didn’t think twice about it. These are licensed doctors of the spine after all. And everyone knows that acupuncture has been proven for things like pain and nausea right? But just as I was discovering the skeptical community thanks to an interview by Penn and Teller of someone named James Randi, I met a little girl one night in the pediatric emergency center who couldn’t breathe.

This little girl, the daughter of a singer who I happened to be a huge fan of, was in something called status asthmaticus, which is when an acute asthma attack isn’t responding well to the standard treatments like albuterol inhalers and intranasal steroids. Her asthma had been flaring up for about a week prior to the acute worsening and the call for an ambulance to bring her in. During this week she had been receiving care by a chiropractor who did not believe that inhalers and steroids were necessary. Now I can’t say that if she had used standard medical treatment at home, her respiratory failure would have been prevented, but I can say with certainty that chiropractic care did nothing to prevent it. Later in the same week I encountered another young girl with difficulty breathing, this time because of an abscess in her throat that had been growing larger and had begun to block her airway. She had been brought to both a chiropractor and an acupuncturist for complaints of fever, cough and sore throat. Any intern, if not most medical students, would have been able to make the diagnosis based on classic findings but it was missed. The ironic thing is that she might have actually benefited somewhat from having a needle shoved into her if it had been shoved into the pocket of infection so that it might drain and decrease in size. The girl with asthma narrowly avoided being placed on a ventilator, the second girl recovered well after emergency surgery, and I became inspired to seek out as much knowledgeable as possible about quackery in all its forms.

These situations are thankfully not that common, but even one child that suffers because of delayed medical care while a parent is seeking out so-called alternative medicine is too many, especially when you consider that in all of these cases there is no chance of a cure. But, like I said, these kind of catastrophic events are not common with kids. Adults are much more likely to make use of alternative therapies and diagnostic modalities when faced with serious medical conditions. And a large number of people of all ages make use of alternative medicine for non-life threatening concerns, especially common signs and symptoms of just getting older like aches and pains, fatigue, decreased memory, etc, etc. So if alternative medicine is so popular, shouldn’t we at least have a decent grasp of what exactly it is?

The truth is that there is no such thing as alternative medicine. There is no such thing as western medicine or eastern medicine either, and claims of the existence of such entities as complementary or integrative medicine are grossly exaggerated regardless of what you may see on Oprah. The simple fact of the matter is that there is only medicine. There is medicine that works, medicine that doesn’t, and medicine that hasn’t yet been evaluated for efficacy. Of course, it goes even deeper than this. There is the question of safety as well as efficacy. Some treatments, thalidomide comes to mind, are very effective for one concern but still not safe for use. Thalidomide treated the nausea associated with early pregnancy very well but was found to cause birth defects.

The foundation of science-based medicine, the scientific method and subsequent development of such tools as the double-blinded placebo-controlled clinical study, although not perfect, are extremely powerful means of rooting out what works, what doesn’t, what is safe, and what isn’t. The bogus category we know as alternative medicine, or any of the other fictional categories I mentioned before, are marketing terms or terms employed with political intent and came about as a means of helping proponents of quackery to circumvent the process that has led to things like vaccines, antibiotics, or any of a vast array of medical treatments that have significantly increased our life spans and added unprecedented quality to our lives.

Within the confines of an all-inclusive category such as alternative medicine are hundreds, if not thousands, of different, often contradictory therapies. Many chiropractors makes claims that the root of poor health is the obstruction of an innate healing force, which travels from the heavens through the spine. Believers in traditional Chinese medicine accept the existence of a mystical healing energy that flows, not through the spine, but along a number of energy pathways throughout the body known as meridians. Homeopaths propose that water remembers the healing essence of substances no longer present in their pills and drops, and naturopaths, who also accept homeopathy, prescribe herbs and supplements with measurable quantities of ingredients in them. Reflexologists look at the bottom of your feet to diagnose and treat medical maladies while iridologists believe that the pathway to discovering what was, is, or will be ailing you is in the flecks of pigment in your iris. All of these systems, and considerably more, fall under the all-inclusive term alternative medicine.


rlbates said...

I like the turn your blogging has taken. Good post

Perky Skeptic said...

This is a great post! Glad you got to speak at a skeptic society meeting!

(Come to Dragoncon! /subliminal message) :D

The Laundress said...

Hmm, those Skeptics did get an earful, especially if supporting chiropractors.

But what about all those other insufferable asthmatics with purple lips and no response to albuterol, etc.?

Clark Bartram said...

They need to be in a hospital. There are other treatments, even IV medications for those situations. It doesn't always work though.

Clark Bartram said...

They certainly don't need their neck or back adjusted.

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Anonymous said...

The post is great and all but the poster left out his own profession medicine it isn't without it's mistakes. If a doctor can't find it then it must be psychological. I must say for it being called the practice of medicine it sure doesn't seem that way. Be it as it may it isn't the practice of medicine but what ever the doctor thinks is wrong at the time whether the diagnosis is wrong or not. Sorry for the sad fact but that is the sorry truth as it is.

Anonymous said...

Medicine isn't perfect but that has no bearing on the safety and efficacy of so-called CAM modalities. I have plenty of opinions on what goes on in the practice of medicine, but that wasn't what my discussion was about.

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