This is a topic I’ve been meaning to write about for some time, and I finally just got a little free time away from school to do so. Thanks for bearing with me, readers!

SCAM-mers (SCAM = Supplements, Complementary and Alternative Medicine) are funny folks. Their grievances with the institution of Medicine are fought utilizing tired, easily debunked tirades appealing to mass hysteria to swing well-meaning patients to their cause. Instead of utilizing science and research to prove their points, they rely on slander, fear, and anecdotal evidence (It worked this way for ME!!) to justify their position. Today, I’ll look at one of the most common arguments they make.

“Doctors don’t treat the cause. They only treat the symptoms!”

How many times have you heard that from friends, family, neighbors, or just the good old quacks on the internet? It’s a common phrase, tossed around quite frequently. But is there any truth to it? Let’s try to shed some light on it.

Contrary to what most peddlers of nonsense wish for you to believe, I’ll go so far as to show my bias and proclaim that the academic training of physicians is rather rigorous. Despite the way some people may wish to paint us, we don’t sit in class and learn how to “toss drugs at a memorized list of diseases”, nor are we “glorified mechanics”. Our training begins at the molecular level, and we are taught how, why and when the human body works. We spend agonizing hours in the lab and the classroom learning how the body controls itself, as well as how it can be damaged. The very nature of medicine as a profession is to understand how human nutrition, environment, genetics and physical activity affect us as a species. And what’s more, the claim is slung around that we have “little to no understanding of these topics.”

Every physician’s first line of treatment is prevention. That’s what we are taught, and that’s the philosophy of medicine. We WANT our patients to exercise, eat healthy and live enriched lives. We encourage our patients to do these things. Preventative Medicine paves the way for lower healthcare costs, less morbidity and mortality, and an over-all healthy populace. However, we need to view this issue from both sides, not just one.

Take the average American. Studies show us he’s middle aged, overweight, probably Diabetic, sedentary, and lives on a diet of fast food. What’s worse, he may even smoke or drink (too much). When this patient visits us in the clinic, we will advise lifestyle changes. The average patient might take this to heart, and begin these changes. But statistics show this trend won’t last, and the patient more often than not “falls off the wagon”. And this is a best case scenario with patients who WANT to live the “preventative” lifestyle! What of those who are non-compliant? Those who don’t care to change? When these patients return to the clinic with uncontrolled hypertension or blood sugar, I need to do something. I cannot hold a gun to their head and force them to change. My only option now is the counsel them further and then prescribe a drug.  It is in this action that the quacks shout the loudest “You’re only applying a band aid! I TREAT THE WHOLE PERSON!”

We must also remember that there are also conditions that we cannot treat the root cause of. Diabetes is a good example. Yes, there are experimental drugs and treatments, but at the time of this writing the only thing we can do chemically IS treat the symptoms. That is the best that ANYONE can do. Prevention can help in the beginning, but eventually with most disease, pharmaceuticals are required. And these are administered as a last resort, and follow careful monitoring of the patient’s blood and other physical changes.

If there existed a magic, natural cure for diabetes, we’d already be using it. Countless websites claim to have the answer. “Use this supplement! It’s ALL NATURAL”. Forgiving the fact that “natural” products have just as many side-effects and complications as pharmaceuticals, and even forgiving the fact that most pharmaceuticals are simply the purified form of those aforementioned “natural” products, the fact that something is “natural” doesn’t automatically make it safer or better. If you’d like to eat Willow Bark for your headaches, be my guest. I however, will take Aspirin, the same “natural” cure purified of all the impurities and possibly toxic substances nature left in it. And I will know the exact dose I’m getting, along with a statistical knowledge of the likely side-effects. And I get the assurance that my medicine is clean and safer than what Mother Nature first started it as.

It’s hard to do, but we have to fight the fear mongering. I’m not saying that there aren’t problems in medicine. There are tons. But it’s the best we have, and quite simply, we aren’t using “alternatives” because they are either unproven, dangerous, or ineffective. As writer Tim Minchin says: “Do you know what they call Alternative Medicine that’s been proven to work? Medicine.”

And right he is. There truly is no such thing as “Eastern” or “Western”, or “Allopathic” medicine. We have what science has shown to work, and the rest is left to the realm of speculation or abandonment when it was shown to be ineffective or dangerous.

So in closing, don’t let people sway you from seeking medical care because your MD “Only treats the symptoms!” Honestly, I don’t profit from your misery in any way, nor do I make more money if I prescribe you drugs. If I can find an easy way to alleviate your pain or fix your underlying problem, I will use it. Otherwise, my only options are to help you feel and live the best possible way you can. And barring a few hucksters, that’s the motto of most doctors. We’re here to serve YOU, the patient. Not the other way around.

So take steps to make your life better. Exercise, eat healthy, stop smoking and drinking, and don’t use illicit drugs. But if there comes a time when that fails, don’t be scared to seek out medicine. We’ll give you the best shot that humanity has, and you’ll walk away from that knowing you can get information about any drawbacks, side effects, or complications. Every treatment is a doubled-edged sword, “natural” or otherwise. The benefit you get with us VS the “natural” is that we give you that information. Mother Nature doesn’t.

As always, stay healthy and stay skeptical folks.

Components of Informed Consent

1. Before patients can give consent to be treated by a physician, they must be informed of and understand the health implications of their diagnoses.

2. Patients must also be informed of the health risks and benefits of treatment and the alternatives to treatment.

3. Patients must know the likely outcome if they do not consent to the treatment.

4. They must also be informed that they can withdraw consent for treatment at any time before the procedure.

5. Physicians must also obtain informed consent prior to entering a patient in a research study. However, if a patient’s condition worsens during the study as a result of lack of treatment, placebo treatment, or exposure to experimental treatment, the patient must be taken out of the study and given the standard treatment for his or her condition

 -Behavioral Science, 5th Edition
 Barbara Fadem, Ph.D.

The last time you went to the Doctor and were prescribed a medication, sent on a treatment plan, or given counsel about your lifestyle, you were likely informed of the benefits. Were you informed of the risks?  Likely not. See, that’s the issue. Many Doctors today are in a hurry, and neglect to fulfill these important aspects of informed consent simply because time doesn’t permit. But is that really a decent excuse?

As clinicians, our duty is to our patients. Over all, their health is our top priority. However, the patient has full right as to what happens with their body, and rightly so. Our duty is to provide them with the knowledge they need to make an informed decision about their health, our recommendations pertaining to it, and any other choices that may have cropped up in their daily lives. In order for a patient to be truly informed, and thusly able to make that important decision, they need the unbiased factual knowledge that is currently known about the choice at hand. This is where personal biases and lack of knowledge (and sometimes sadly, laziness!) come to play. These forces, acting in concert, undermine the purpose of informed consent, and turn it into little more than a blurb to be tested on in relevant ethics sections of exams.

Pills, Thrills, and Shills

Obviously, one of the biggest parts of the Doctor/Patient encounter is the prescription of drugs for any wide variety of conditions. It’s no doubt exciting to the new doctor (speaking as a medical student) and probably hum-drum and dull to the experienced Physician. But, whether you are a green-horn intern raring to go, or a battle-hardened Attending who waxes poetic about the “good old days”, the same policies and principles apply.

When prescribing a patient a drug, you NEED to talk to them about it. Outline  WHY you are prescribing it, what the drug does, and what they can reasonably expect from it. This data should be gleaned from not only your knowledge of Pharmacology, but from the research you have done into the drugs you are desiring to prescribe. This entails reading *gasp*, Medical Journals! Keeping up on the literature is key, and serves to better inform you. Because let’s face it, institutions are slow and resistant to change. The drug du jour for a specific condition may not be the drug you are told to utilize by your institution, or your peers. When facing these discrepancies, you need to be informed so that you can take these concerns to the proper committee.

The patient also needs to know side effects. What are they, which ones are common, and again, what can the patient reasonably expect. This information is not difficult to obtain. It’s available via the classic Physician’s Desk Reference, or for the Tech-Age people among us, on programs like Epocrates on a smart phone.

A lot of people say “That takes too much time!” and yes, it does take time. However, that’s your DUTY to your patient. You make the time. You entered this career for a reason. Don’t forget that reason because you are tired, annoyed, overburdened with work from your Resident, or feeling lazy.

Supplements/Complementary and Alternative Medicine (SCAM) or: How I learned to stop worrying and trust the Science

As many of you know me well, you know I’m a staunch advocate of science-based medicine. This means only recommending or endorsing treatment options based on positive evidence from randomized, double-blinded, placebo-controlled studies. Medicine is a lucrative field for both Pharmaceutical Companies and “Alternative” Peddlers alike, and both will resort to trickery to try and take your money. However, while the marketing teams and corporate lawyers of Pharmaceutical Companies are crooked, their science is not. They have the benefit of reproducible, peer reviewed studies to back their claims. The drugs might cost too much, but they work.

“Alters” on the other hand, don’t have this luxury. They have to resort to testimonials from patients or celebrities, which are not valid evidence of anything. Along with this comes our duty to the patient, and informed consent. If a patient wishes to undergo an alternative therapy, I believe it’s our duty to inform ourselves about that therapy, study the claims of efficacy, and inform the patient of the side effects and likely outcome. Just as we would for any “conventional” drug or therapy.

If you want to try acupuncture, fine. But I’m duty bound to inform you that it’s been extensively studied and shown to have zilch on the way of effects greater than placebo treatment with sham acupuncture. I also should be informing you of the risks of infection (This IS an invasive procedure utilizing needles penetrating the skin!) as well as the reports of collapsed lungs and death. These are all very real side effects that have been documented extensively, yet most alt-medders tend to gloss over them without much thought, while yammering on about how terrible our pharmaceuticals are. However, with that information in mind, if the patient still wants to try, then that is their right, period. You’ve informed them of the necessary information, and they made an informed decision. Your job is done.

Conclusion

Above all, work with your patient. Develop a rapport with them, be understanding, and address their concerns. The above example may seem draconian to some, but delivered with tact and compassion, it’s very likely to work. You’ve done your job, the patient is informed, and is free to exercise their right to choice. Everyone wins, and everyone benefits.

It is in this way, Physicians don’t have to support quackery and health fraud, but can avoid alienating their patients.

Well dear readers, in my scant amounts of free time I have finally finished Part 1 of my Infidus Rememdium project! The first section is a brief introduction to the concept of Critical Thinking, as well as how to spot a few of the most common logical fallacies. Feel free to check it out from the Infidus Rememdium link at the top of the page. As always, questions/comments/concerns/hate mail is always welcome.