"When Trust in Doctors Erodes, Other Treatments Fill the Void" NYTimes

[bloom]

February 3, 2006
...This straying from conventional medicine is often rooted in a sense of disappointment, even betrayal, many patients and experts say. When patients see conventional medicine's inadequacies up close — a misdiagnosis, an intolerable drug, failed surgery, even a dismissive doctor — many find the experience profoundly disillusioning, or at least eye-opening.

Haggles with insurance providers, conflicting findings from medical studies and news reports of drug makers' covering up product side effects all feed their disaffection, to the point where many people begin to question not only the health care system but also the science behind it. Soon, intuition and the personal experience of friends and family may seem as trustworthy as advice from a doctor in diagnosing an illness or judging a treatment.

Experts say that people with serious medical problems like diabetes or cancer are least likely to take their chances with natural medicine, unless their illness is terminal. Consumers generally know that quackery is widespread in alternative practices, that there is virtually no government oversight of so-called natural remedies and that some treatments, like enemas, can be dangerous.

Still, 48 percent of American adults used at least one alternative or complementary therapy in 2004, up from 42 percent a decade ago, a figure that includes students and retirees, soccer moms and truckers, New Age seekers and religious conservatives. The numbers continue to grow, experts say, for reasons that have as much to do with increasing distrust of mainstream medicine and the psychological appeal of nontraditional approaches as with the therapeutic properties of herbs or other supplements....

http://www.nytimes.com/2006/02/03/health/03patient.html?_r=1&th=&emc=th&pagewanted=print

[ayeshahaqqiqa]

1. Holistic medicine

is what I believe in, because the stress is on keeping people healthy instead of drugging symptoms. Holistic health practitioners often face a lot of opposition because often their treatments use drugs as a last, rather than a first, resort. The doctors in this country have been brainwashed to think that vitamins, minerals, and a healthy diet cannot control or prevent disease; even when articles on vitamin research are printed in the JAMA, many MDs have been heard telling their patients that "vitamins don't do anything". My doctor reads the latest research and uses a variety of techniques and therapies to get people well and to keep them well. She has had success with autistic children and with helping people with Hepatitus C. I wouldn't go back to an MD who only believes in drugs again.

[shoelace414]

2. Bodies naturally heal from everything but the last thing you have.

[Orrex]

3. Which, if you play it right, can also be the *first* thing you have

[Orrex]

4. I go to a holistic car mechanic

He doesn't actually know anything about automotive maintenance, other than what he's read in "alternative" car journals. Mostly he tells me to make sure that the car's humors are balanced and that I don't let it ingest any synthetic hydrocarbons.

Sure, there's a constant rattling under the hood, it has no acceleration uphill, and it leaves a trail of nuts and bolts wherever I go, but I feel better about it, and that's what's really important, isn't it?

After all, why should I buy into the great Auto Mechanic Conspiracy designed to keep a lid on ancient repair traditions?

[fed-up]

5. Some family history-experience with the American medical system

My grandmother was killed by an incompetent nurse that put air into her veins the day after my mother was born.

My mother was told the numbness in her fingers was due to past (15 years prior) alcohol abuse. Three days later she had a massive stroke.

Every medication they wanted to give her had side effects that were almost worse than what they were trying to fix. We used diet modification and stress reduction to achieve the same results.

Her cancer was not diagnosed until 10 days prior to her death despite my pointing out to 7 different doctors at Kaiser that there were abnormalities to her segmented neutrophils (part of her white cell blood count). Some told me I was being anal for keeping such meticulous records of her bloodwork. I found out later that can signify cancer.

My sister weaned herself off the 10 different medications that she was taking for her MS. Within a year she went from being practically bedridden to going on a 5 mile hike. (yes, I know MS symptoms fluxuate)

I was told I was depressed in a 5 minute office exam and pills were pushed on me which I refused. I later found out I had food sensitivities.

With over half of Americans having taken some form of prescription medication in the last three months, something is definitely wrong with our current medical practices!

[Warpy]

6. Complementary medicine can make you feel like a million bucks

and can be great adjunctive treatment for the very sick and great treatment for healthy people who want to feel better. The people to watch are the ones who tell you to stop all conventional treatment. Please stay away from them if you're being treated for something serious.

Some complementary medicine, like chiropractic, is finally being recognized as the first line treatment for acute back sprain, since it can shorten the duration of disability by several days, at least, and several weeks in severe cases. Acupuncture has been confirmed as shutting off some of the pain centers in the brain (via PET scan).

I'm not suprised people are turning away from allopathic medicine. It's priced itself out of reach of most of us and complementary practitioners generally charge what an insurance copay does in many cases, and with no 2 week wait to be seen. Hospital bean counters have slashed staffing ratios to dangerous levels, completely unacceptable levels, making hospitals much more dangerous than they were even 10 years ago. Then there's the problem of fighting insurance companies for everything. All these things are making the herbalists and acupuncturists look a lot more attractive.

[RedOnce]

7. If I had a very serious disease, conventional medicine

would probably be my first choice, supplemented by alternative.

However, I prefer to focus on health, wellness and prevention with the goal of delaying disease for as long as possible. Conventional medicine's narrow focus on disease (rather than health) and typically treating with pharmaceuticals, surgery or radiation offers little that is useful in the prevention arena.

Yes, conventional medicine now offers cholesterol lowering statin drugs for prevention but why should I risk the side effects when I achieve similar performance from inexpensive Policosanol and plant sterols?

I think that health can be viewed on a continuum with alternative being generally more effective at prevention and conventional being generally more effective at treating and occasionally even curing serious disease.

[Orrex]

8. A few red herrings here

If I had a very serious disease, conventional medicine would probably be my first choice, supplemented by alternative.

Almost invariably, "alternative medicine" is offered and used in a way that can't be verified or disproven, so that its effect, if any can't be ascertained. The overwhelming majority of evidence supporting the use of alternative medicine is personal testimony, either by the supposed patients themselves or by practitioners who claim to have achieved positive results for some large number of clients. Personal testimony is a poor substitute for empirical evidence. Alternative medicine is subject to little oversight, and there is no way to verify any of these claims.

However, I prefer to focus on health, wellness and prevention with the goal of delaying disease for as long as possible. Conventional medicine's narrow focus on disease (rather than health) and typically treating with pharmaceuticals, surgery or radiation offers little that is useful in the prevention arena.

I have never seen, read about, nor heard of a doctor who prescribed a lifestyle of reckless abandon in anticipation of a miracle recovery fostered by surgery and/or radiation. Every doctor I have ever met recommends a healthy lifestyle of sensible diet and exercise, allowing for moderate indulgences such as alcohol or fast food. Heck, many even recommend vitamins, and almost all engage in "preventative" medicine to some degree or another. It's a mistake to think that alternative practitioners hold some privileged knowledge in this regard. It's hardly "alternative," in fact; it's basic health education, recognized for decades by "western" medicine.

Alternative treatments are attractive because they don't often cause direct harm and because they're often inexpensive in comparison to conventional treatments. They also appeal to a sense of "traditional" wisdom and a benevolent simplicity that's often lost in the face of mass-marketed "blockbuster" drugs. However, alternative medicine makes few testable claims, and there is even less empirical evidence to support what few claims there are.

[RedOnce]

9. Responding to your charges of red herrings

Almost invariably, "alternative medicine" is offered and used in a way that can't be verified or disproven, so that its effect, if any can't be ascertained.

Some of today's alternative medicine finds its way into tomorrows conventional medicine. For instance, not long ago CM's conventional wisdom was "vitamins are a waste of money" and "Acupuncture is quackery". Does this mean that vitamins and Acupuncture did not work yesterday but they do today?

Btw, much of the "off label" use of prescription drugs by CM is without proven verification of efficacy but that does not stop Drs. from experimenting with them.

I think the point is, if you or someone you love had a serious illness and CM wasn't working would you be willing to try unproven AM today or would you wait a few more years for verification? How about unproven "off lable" drug use?

I have never seen, read about, nor heard of a doctor who prescribed a lifestyle of reckless abandon in anticipation of a miracle recovery fostered by surgery and/or radiation.

I did not imply this. My point is that CM is primarily focused on diagnosis and treatment of disease rather than prevention and that CM's tools reflect this bias.

My wife is an RN and sells medical imaging equipment. Through her I am exposed to a large number of Drs., Clinics and Hospitals in 7 western states. We do know one Dr. who offers extensive preventive blood testing, has a Registered Dietitian on staff and sells supplements. I'm sure there are a few more, but they are rare exceptions. In our experience, many Dr's. offer mostly lip service to prevention and few have had much in the way of nutritional training.

I agree with your last paragraph.

[Warpy]

10. Since we're discussing red herrings:

"Btw, much of the "off label" use of prescription drugs by CM is without proven verification of efficacy but that does not stop Drs. from experimenting with them."

Wrong! Doctors prescribe off label uses for drugs because those uses have been found safe and effective in clinical trials but have not yet achieved FDA approval."

"My point is that CM is primarily focused on diagnosis and treatment of disease rather than prevention and that CM's tools reflect this bias. "

I can tell you don't know anyone in "CM" in clinical practice or you'd know that the bulk of our teaching is to convince patients to take their health into their own hands in the form of adopting healthy lifestyle habits. The statin drugs are to prevent illness that has not yet occurred, as are the blood pressure medications. We try to prevent orthopedic surgeries by referrals to physical therapy. The list goes on for a very long time.

You did make a valid point about overall nutrition. However, depending on the specialty, many docs and nurses are spending a great deal of time teaching their patients how to prevent conditions from worsening and how to forestall other conditions they are at risk for developing through DIET.

The world looks very different to those of us who have been in the trenches than it does to those of us who have not.

[RedOnce]

11. Responding to...

1) Off label use of prescription drugs:
"Because every drug has side effects - ranging from annoying to deadly - an off-label prescription often means that a patient is assuming the risk of harm with no assurance of benefit", said Dr. Arnold Relman, a former editor of the prestigious New England Journal of Medicine.

"Neurontin is the most glaring example of the risk of off-label prescribing. A 2003 Knight Ridder investigation found that off-label prescribing was increasing rapidly, with 115 million such prescriptions written in a year, nearly double the number of five years ago."
From: Risky RX: A Knight Ridder investigation - posted May. 14, 2004: http://www.realcities.com/mld/krwashington/news/special_packages/riskyrx/12904523.htm

2) I can tell you don't know anyone in "CM" in clinical practice
Actually, I do and my next door neighbor of 10+ years is a Family Practitioner. They would probably agree with you, but they also complain about not being able to make a living if they spend too much time with a patient and about poor patient compliance. They seem to be frustrated by it.

3) The world looks very different to those of us who have been in the trenches:
I'm sure it does. I am not attacking you or anyone else "in the trenches" I am simply pointing out that the system does not facilitate prevention. If it did we would not be seeing things like an epidemic of diabetes type 2 and our Infant Mortality rate (7.0) would not be twice that of Hong Kong (3.1) and Japan (3.4) http://www.hsph.harvard.edu/now/dec10/apha_infant.html

[Warpy]

13. First, Relman is just spouting the FDA party line du jour. I know

of no practitioner who would prescribe off label uses for drugs without having a clinical trial to back him up. Most docs are all too aware of medication side effects and adverse effects to prescribe on a whim, although they may prescribe advertised meds and antibiotics to shut certain types of patients up and make them go away, hoping they'll stop taking those meds when they don't make them feel better.

Second, poor patient compliance is the norm whether you're talking about taking medications on time and at the correct dose or changing one's entire lifestyle to reflect a new diagnosis of heart disease. The teaching is our job. The follow through is theirs, and they have a right not to, as frustrating as that is for us.

Third, the increase in TypeII diabetes has been linked to bad choices by individual people as well as bad choices by the food industry. There is nothing a doctor can do about individual choice, unless medical fascism comes into fashion, something I think we'll all agree would be a bad thing. The increase in infant mortality in the US is due to a decrease in access to prenatal care, thanks to the best healthcare system in the world presided over by the benificent insurance industry.

There is only so much prevention that can be accomplished with people who are unwilling to put advice into practice and there is only so much prevention and care that can be delivered to people who have simply been priced out of the healthcare market. Expect to see all these things worsen as the health care industry becomes restricted more and more as a perk for the rich and corporate.

[RedOnce]

15. It's nice to know that you are working with conscientious docs

since "off label" use seems to be pretty much left up to them to decide.

Here is an interesting quote from American Academy of Family Physicians

"Physicians who treat children often prescribe drugs for off-label uses because little information is available from well-controlled studies on dosage, formulation, effectiveness, and safety in children. Recent federal legislation and programs are addressing these problems."

http://www.aafp.org/afp/20030801/editorials.html

Further, since children often respond differently to drugs (even paradoxically) than adults do it sure sounds like some experimentation must be going on here.


My doc neighbor's frustration with patient compliance seems to be that a lot of time consuming reinforcement is required and she cannot get paid for doing this. The implication is that she simply does what she can within the limited time allotted.


Well, at least we agree that there is a problem with Type II diabetes and infant mortality.

Of course the increase in Type II diabetes has been linked to bad choices by individual people. They are the ones with the fork in their mouth!

There must be something that's workable between accepting TypeII diabetes and imposing medical fascism!!!

From my point of view we should begin here:

"There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes."

"It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk."

"From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake and trans fatty acids may contribute to the risk."

From a study titled Diet, nutrition and the prevention of type 2 diabetes
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14972058&dopt=Citation

[RedOnce]

12. Re: "You did make a valid point about overall nutrition"

Thank you Warpy.

Nutrition is the foundation of most disease prevention:

"The role of nutrition can't be underestimated relative to a child's health, even before life begins outside the womb. So just how early on can nutrition impact on later health? Numerous studies have shown that proper maternal nutrient intake affects the health of infants, and can follow them right into adulthood by carving out a path toward disease prevention."

"While these studies obviously underline the importance of nutrition in pregnancy, their findings also speak to the fact that childhood diet lays the foundation for good health throughout our lives. The earlier that the pattern of good nutrition is established, the more likely that such healthy habits will stick over the years."

"Unfortunately, healthy eating isn't a reality for many US children. “Dole's Fruit and Vegetable Update: What America's Children Are Eating,” a report released during a government hearing on the US dietary guidelines, presents dismal dietary habits...As a result, kids are falling short of their nutritional requirements, as well as many of the benefits associated with various nutrients."

From: Childhood Nutrition: The Road To Lifelong Health - Le Magazine January 2001
http://www.lef.org/magazine/mag2001/jan2001_report_child_1.html


How can a medical system be weak in nutrition and focused on prevention?

[Warpy]

14. You're overstating nutrition

as most people hostile to allopathic medicine seem to. Yes, you can delay the onset of things you are genetically programmed to get (like heart disease) by eating a balanced and healthy diet and you can make them occur more quickly by living out of fast food places 3 meals a day. However, diet is not a cureall and won't eliminate anyone's risk of disease. You'll get what your genetic load has predicted you'll get unless you get hit by a bus first.

I think of medicine as 90% sanitation and 10% medication. Most illness worldwide is a result of poor sanitation of drinking water and of the general environment, allowing bugs ready access to a vulnerable population. The greatest predictor of childhood survival is the access to potable water, not access to a whole foods diet. The greatest predictor of patient survival in hospitals 100 years ago was how seriously they took sanitation and sterilization procedures, not the quality of the cuisine.

Docs aren't given much education at all in nutrition until they get into the various specialties like endocrinology, nepthrology, and cardiology, where diet control is paramount in controlling the progression of disease. Docs do counsel patients on healthy eating before disease develops; it's usually wasted effort until disease actually occurs and probably for a short time after. Like it or not, people still have the right to choose these things for themselves, and for some, a shortened life of living the way they want to is worth more than a longer life living contrary to their own wishes.

And that is why docs aren't given extensive educations in preventive nutrition. First, it doesn't stop disease completely and second, noncompliance is the norm.

[RedOnce]

16. I doubt that I am overstating nutrition...

While I agree with much of your post, it seems we are back to chasing red herrings:

First, please substitute "critical of" for your use of "hostile to allopathic medicine", at least when you are referring to me.

Second, I am aware of genetic programming but, so far we have little direct control over this, so I prefer to focus on something I can actually affect.

Third, generally speaking potable water and sanitation is no longer a problem in the US. So, what would have the US medical community focus on next in regard to prevention of disease?

Fourth, in my original post I referred to "delaying" disease for as long as possible, not necessarily stopping it in the sense eliminating it should you be so genetically programmed. Isn't this a worthy goal? Nutrition appears to have a important function here.

[Orrex]

17. The false hope given by alternative practitioners is inexcusable

I think the point is, if you or someone you love had a serious illness and CM wasn't working would you be willing to try unproven AM today or would you wait a few more years for verification?

If moved to sufficient extremity, I would no doubt undertake any treatment under the sun to help those I love, as I suspect most people would do. That's exactly why a person in emotional extremity should not be allowed to make such decisions without objective and sound medical guidance.

Consider the late Coretta Scott King, for just one example.

In our experience, many Dr's. offer mostly lip service to prevention and few have had much in the way of nutritional training.

Fair enough, but few alternative practitioners have medical training for the fields in which they claim expertise. The huge majority are either dieticians or chiropractors, or some mix/variation of those two. And if an alt. practitioner does have conventional medical training, it's usually in a tangential field, such as "I was an osteopath for twenty years, but now I sell anti-oxidant supplements."

[RedOnce]

20. Responding...

To your first point:
The first sentence of the article you reference states: "Coretta Scott King, widow of civil rights leader Martin Luther King, Jr., spent her last days at a clinic in Rosarito Beach run by Kurt Donsbach, a chiropractor whose "alternative treatments" for incurable diseases are illegal in this country.

Rosarito Beach is in Mexico, just a little south of San Diego. How do you propose restraining people from seeking treatment in a foreign country that is illegal in the U.S.?

To your second point:
My first choice would be a doc who knows his nutrition. The problem is that they are few and far between. So, where do you go for professional nutritional advice and follow up?

[Orrex]

21. A little off the mark

Rosarito Beach is in Mexico, just a little south of San Diego. How do you propose restraining people from seeking treatment in a foreign country that is illegal in the U.S.?

The late Ms. King (and anyone else, for that matter) can go wherever they want to go, as far as I'm concerned. My intent was merely to point out that people who seek actual medical benefit from alternative practitioners stand a good chance of getting nothing for their money. Often, in fact, those with illness choose to forego actual treatment in favor of these alternative therapies, to their considerable detriment.

My first choice would be a doc who knows his nutrition. The problem is that they are few and far between. So, where do you go for professional nutritional advice and follow up?

Let's be honest about this: if you ask five nutritionists for advice, you'll likely get at least six answers of varying compatibility.

If I want formal nutritional advice, I seek someone who was educated in nutrition science at an accredited university. I don't go to a former osteopath (or other specialist) who's decided to sell anti-oxidant literature.

But for the record, I flatly reject the argument that diet is as key a factor in routine health as alternative practitioners claim (just as, for example "detoxifying" is almost 100% bullshit). Simply put, we didn't evolve to be so fragile.

[RedOnce]

23. Responding to your intent...

"...people who seek actual medical benefit from alternative practitioners stand a good chance of getting nothing for their money."

Your statement may or may not be true depending on who or which type of alternative practitioner they seek and the type of problem they are going for. Many people report that they are helped. But fortunately, as you pointed out earlier: "Alternative treatments are attractive because they don't often cause direct harm and because they're often inexpensive in comparison to conventional treatments."

I suppose there is a "false hope" argument but there is also a "hope" argument and as I read elsewhere in this thread even "placebo effect can be a very powerful"

I can see that you do not hold much faith in nutritionists or nutrition.

[Odin2005]

18. "Holistic Medicine" = Snake Oil.

Using the placebo effect in exchange for $$$. Having a healthy lifestyle is good, but I stay from New Age BS.

[Warpy]

19. Most if it is exactly that

but the placebo effect can be a very powerful one.

I'm all for allowing holistic medicine to fluorish as long as it does no harm. Some of it, like chiropractic and acupuncture, may slowly find its way into the mainstream.

It can make healthy people feel great. It's just not for people who are a little too sick, not unless it's used as adjunctive therapy to mainstream care.

[RedOnce]

22. I agree.

[Orrex]

24. Chiropractic and acupuncture

I'm all for allowing holistic medicine to fluorish as long as it does no harm. Some of it, like chiropractic and acupuncture, may slowly find its way into the mainstream.

Elements of these two practices may make their way into the mainstream, but the underlying notions of "channeling chi" or whatever its designation should be excluded from medical literature because it's an element of faith with no empirical support.

Chiropractic is beneficial for the effect that correcting of misaligned bones can bring about, easing the discomfort of pinched nerves and the like, rather than clearing "subluxions," as some practitioners explain it. Acupuncture appears likewise to have an effect upon the function of nerve cells, but this isn't evidence of alterations in the "chi" flow that is sometimes credited to the practice.

I know, from your posts here and elsewhere, that you're absolutely not advocating this hocus-pocus aspect of these therapeutic practices, but it's worth underscoring so that it doesn't appear that western medicine is stamping its approval on supernatural matters of faith.

[Warpy]

25. The empirical support was announced for acupuncture

when PET scans confirmed that areas of the brain within the "pain center" were found to be turned off by acupuncture. So that has been confirmed, at least. The story appeared within the last month, so Google should turn it up for you.

Double blind studies of chiropractic have found that disability from acute back strain can be shortened by several days by chiropractic manipulation.

That's why I mentioned those two. The evidence is starting to crawl in on those.

However, don't ask me about crystal healing. I'm afraid my language would be unladylike and that I'd offend too many believers on this board. However, if it's not being used as a substitute for desperately needed medical treatment, I certainly see no harm in it.

[Orrex]

26. I see that you're suspiciously mum on pendulum-dowsing...

Is that an implied endorsement? :)

[RedOnce]

27. bloom, this has been a remarkable thread. My sense is...

that it has had a huge impact on this forum.
Thank you for posting it.