A quest for the truth

First, let me outline my current beliefs, or some might say “misconceptions” about various alternative medicine practices. Despite my cynicism, I am not totally blind to the potential benefits of the “other way”. I willingly refer my patients to chiropractors for lower back pain, I dabble in yoga, and I love a good massage as much as the next fellow. So at first blush, I place practices such as yoga, low calorie diets, stretching, exercise, meditation, and massage in the “I believe it works” category. My “maybe it works” category includes chiropractor care for lower back pain, acupuncture, vitamin C, zinc, and Echinacea. My “you must be kidding” category includes copper bracelets, magnet therapy, homeopathy, phrenology, and others. I readily apologize for all those disciplines which remain uncategorized at this point, but hopefully I will rectify this over the next year.

You might ask why I willingly refer persons to chiropractors for lower back pain. It is because I know that as an internist, I am woefully bad at treating back pain, and there is in fact a study that gives me guidance. In 1995, the New England Journal of Medicine (the holy grail of western medicine) published a study by Carey and colleagues looking at outcomes and cost for the care of acute lower back pain when seen by various specialists, including internists, chiropractors, and orthopedic surgeons. The results? At six months, there was no difference with regard to time to functional recovery, full recovery, and return to work. The highest cost came from orthopedic surgeons and chiropractors. Yet, those seen by a chiropractor were the most satisfied. What do I take away from this study? If my patient prefers to see a chiropractor for his acute lower back pain, it is unlikely he will be harmed, and in all likelihood, he will be happier with his care.

My internal medicine training in Portland, Oregon followed by my several years of practice in rural North Carolina is what really piqued my interest in “alternative medicine”.  Portland has a reputation (and deservedly so) as being full of progressive “granola” types (I mean no slander here, as my wife whom I met in Portland clearly fits this billing). In this environment, I was rarely surprised by the strange concoctions and fringe medical treatments that patients tried. What struck me more profoundly was that once I had re-located to rural North Carolina (I believe the term “Appalachia” says it all), I was inundated with a whole new spectrum of “alternative meds”. Patients brought in strange concoctions that had been passed down for generations, often made in the very “still” that their grandparents had used.            

I am a strong believer in the “placebo” effect. Basically, if someone believes that a cure or intervention will work, this belief in its own right will go a long way toward a “cure”. So again, as long as I am reasonably sure that the risk of harm is low… I say knock your socks off and give it a try. Who am I to interfere with tradition? I likely would have kept my opinions to myself except one night my wife stirred me to action. She was reading a book by Dr. Andrew Weil which emphasized the value of testimonials. One of these testimonials was with regard to an unnamed doctor who could “feel” cerebral impulses between the cranial bones. Needless to say my cerebral impulses sounded an alarm! I of course was worried that my wife would be brainwashed and turn to the dark side (she already has shown some tendencies). In that moment, I decided I would embark on a journey of enlightenment to decide for myself what works and what does not. I would use my scientifically trained brain and form a fully subjective opinion. What follows is my quest for the truth about alternative medicine.

A movement toward "alternative" medicine

The Associated Press reported in July, 2009 that Americans are spending over 34 billion dollars annually on “alternative medicines”. The amount spent on visits to chiropractors, acupuncturists, practitioners of homeopathy, and other “alternative” modalities, and the medicines recommended by these practitioners is beginning to rival the out of pocket costs spent on traditional western (modern)  medicine. Mothers are frequently opting not to have their children vaccinated against lethal childhood diseases due to concerns of mercury toxicity, Guillain-Barre syndrome, and autism. I even have an acquaintance diagnosed with HIV who is considering herbal remedies instead of his doctor prescribed anti-viral medications. As a long time disciple of western medical practices I am forced to ask myself… what is going on?!? Is every one going crazy?

I practiced as an internal medicine doctor in a small town in North Carolina for several years. I had and still have several standard lines that I say to my patients who inquire about the benefits of taking supplemental doses of various vitamins and herbal remedies. Included among these is: “If it really works it likely would be proven.” I will then recite that the NIH now has an institute of alternative medicine which funds research on alternative therapy. Therefore, if a well designed trial had been done proving a therapy’s benefits we would know about it. It appears the makers of these drugs have a vested interest in not doing these studies which are as likely as not to disprove the touted benefits of their remedies.  If the patient is still listening to me I will usually then go on to list examples such as vitamin E which was felt to decrease the risk of heart attack and stroke and was being recommended by almost all cardiologists 8-9 years ago only to find in subsequent studies that it increased the risk of stroke. I will then add, “Unless there is a well proven benefit, why spend your money on something that is as likely to harm you as help you?”

By now, you are likely taking me for a cynic and you would largely be correct. I have devoted my entire career to learning the scientific method and believe in the necessity of well designed randomized controlled studies to guide our practices. But even I recognize the groundswell of enthusiasm for another way. Modern medicine is largely responsible. The pressure to see patients in 15 minute visits, prescribe an expensive medicine for every malady, and the lack of physical contact that permeates current medical practice in undeniable.

In response to this dilemma I have chosen to place my skepticism on the back shelf and undertake a true examination of alternative medicine. Over the next year I plan on posting weekly accounts of my personal quest for the truth as I put “Alternative Medicine under the Microscope”.